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The Health Care Finance Administration ( Medicare / Medicaid ) sets reimbursements rates, and most private insurance companies follow suit. So, I don't get to charge whatever I want to read an MRI. And, I don't order the studies that I read, other doctors do that.

The only thing I can control is the number of studies I read. If I work harder and read more, I make more. It just so happens that I am very fast, and I have surrounded myself with fast partners. On average we read two or three times what other radiologists read, so we make two or three times more.

As far as disruption is concerned, for now the law is on my side. Of course a doctor working in India could read studies cheaper than I could. Most doctors complain about malpractice, without understanding the benefits. Trial lawyers hold me liable for my reports, and rightly so. If I miss a small treatable cancer, it can turn into a large untreatable cancer. This liability also confers a monopoly. How can a lawyer sue a doctor in India? Consequently, in order to perform a 'final read' on a radiology study in the USA, you must have trained in USA, be credentialed in the USA, and liable in the USA. This makes it very hard to undercut on price.

So, I'm not sure if I deserve what I make. There aren't a lot of people that can do my job, or withstand the training. Anyway, I'm saving everything I earn, because I don't think it will last forever.

I had a different experience. Medical school was easy, I was single and went out drinking / partying two or three nights a week. Not to be crass, but I did well with the ladies. Luckily I can get by on four hours of sleep or less. So, I don't feel like I missed out on much of the early twenties experience. Most of my non-medical friends had jobs and I didn't, but that was the only real difference.

Things got a little more serious my intern year, but I still managed to go out twice a week, and the nurses were much more responsive to my advances now that I was doctor.

At the start of my residency I got serious with a girl from my medical school. Her training was in Psychiatry and I was in Radiology. We worked a minimum of 80 hours a week, but we always had time for each other. We got married during third year.

Now I'm a partner in a successful practice, and she's taking a few years off to raise the kids. I make over 800k a year, and take 14 weeks of vacation. I don't deal with patients. I have the ultimate job security. And, I am a tremendous resource for my family. I'm sure you know how easy it is to get screwed by the medical system. That won't happen to me or mine.

I'm not a risk taker, so what else could I be doing with the security and benefits of my current job? Lawyer, maybe.