This interview was one of the original JobShadow.com interviews back in 2008 and was conducted with a radiologist in the Southeast. I conducted and recorded it via Skype and transcribed the interview verbatim. It was done anonymously at the request of the radiologist because of the level of income data revealed.
What do you do for a living?
I’m a radiologist and I also sub-specialize in interventional radiology.
How would you describe what you do?
Radiology is using technology and a variety of imaging techniques to look at the human body and diagnose problems.
How much do radiologists make a year? According to payscale.com and others radiologist salary ranges from $50,000 to $200,000 per year. For more accurate information see how much this doctor actually makes Click Here.
That includes: x-rays, fluoroscopy, which is kind of real time x-rays; CT scanning, which is using x-rays and computer reconstructions to look at the body; MRI scanning, which is using magnetic resonance, which includes radio frequency waves and a high-strength magnetic field to look at the human body; ultrasound, which uses high frequency sound waves to look at the body; Overlay and nuclear medicine, which involves injecting a very small amount of radioactive substance in a person tagged to a substance that will go to different parts of the body and show how they’re functioning.
We’re basically Doctors’ doctors because the patients don’t come to us. The doctors have a patient, and then they have a problem that they can’t solve without our help, and so they come to us whether it’s by ordering a test or consulting us with a problem that they need help figuring out…We’re problem solvers, and a lot of the time, whatever we see and say is going to determine the course of the patient’s therapy.
Then interventional radiology is a sub-specialty. In interventional radiology, we use imaging techniques and minimally invasive techniques to do a lot of things that used to require surgery, including treating arterial disease with balloons and stints, being able to drain different areas of the body including the bowel ducts, the kidneys, and fluid collections or abscesses, any place in the body, and then also using the imaging guidance to do biopsies of almost any place using a skinny needle. So, a lot of imaging allows us to do things more targeted than having to actually open somebody up.
What does your work entail as a radiologist or what is a radiologists’ job description?
We work from 7:30 in the morning till about 5:00 at night, and other radiologists work longer hours in some places, but that’s our normal work day. And then once a week I’ll be on call for general radiology, and I usually get a call about every 15 minutes. We have (T1) lines to our homes and teleradiology so we look at the images while at our homes many times while on call. The emergency rooms just keep us hopping because now they’re conditioned to use imaging for almost everything. And so, about every 15 minutes, we’re looking at another CT scan or some sort of examination. And then at one other time of the week I’m on the interventional call. That’s not as busy, but it can be. Sometimes, I can go for an evening and not get called, but if I do get called, it means that I’ve got to go into the hospital, do a procedure that could last anywhere from an hour to four hours. And then once a month I’m on call for the weekend; Friday, Saturday and Sunday.
How did you get started?
I was in television before. Then at twenty-nine I decided I wanted to go to medical school. I went into medical school thinking that I would do something more standard as far as medicine, like internal medicine, or surgery, or obstetrics and gynecology. But as I went through, I realized, especially at the time I was there, that the technology was booming, and CTs had just come out, and MRIs were just coming out, and that there were all of these different types of interventions that could be performed using the imaging that saved lots of money, lots of time, lots of pain.
The consulting interaction with the physicians is very satisfying because we get to scratch our heads and think through things and talk to them. And they have information that I don’t have from doing their examinations, and knowing the patient, and I have information that they don’t have about what I can do and what I can see, that would help them. And so, it’s a collaborative process with other physicians that’s satisfying.
I could usually do the procedures as out-patients instead of a week-long hospital stay, and it was all fascinating to me. So, that’s what I chose to do as a residency and then wound up in private practice.
What do you like about what you do?
We interact with almost every different aspect of medicine. We work with pediatrics, obstetrics, surgery, internal medicine, all the sub-specialties, and so there’s a huge range of things that we participate in. It’s hard to get bored because it’s hard to keep up with everybody, they expect us to know more about them than their patients. We’re basically Doctors’ doctors because the patients don’t come to us. The doctors have a patient, and then they have a problem that they can’t solve without our help, and so they come to us whether it’s by ordering a test or consulting us with a problem that they need help figuring out an answer to, or help taking care of. We’re problem solvers, and a lot of the time, whatever we see and say is going to determine the course of the patient’s therapy. So, even though, you don’t get quite as much satisfaction from the patient contact and the patients being really grateful to you”a lot of times they don’t even know that you’re the one who figured out what was wrong with them”but you do get a lot of satisfaction in knowing that what you’re doing makes a big difference in the lives of all of these patients every day.
The interventional part of it, I do have patients. I take care of them. I have patient contact and interaction as their physician; doing procedures on them, and a lot of the procedures that I do allow me to help people in ways that if it wasn’t for us they would have had to have major surgeries for. And so that’s satisfying. The consulting interaction with the physicians is very satisfying because we get to scratch our heads and think through things and talk to them, and they have information that I don’t have from doing their examinations, and knowing the patient, and I have information that they don’t have about what I can do and what I can see, that would help them. And so, it’s a collaborative process with other physicians that’s satisfying.
What do you dislike?
Well, I think all physicians, and radiologists probably as much as anybody else, are unhappy about the way the control of medicine has been taken out of doctors’ hands in a lot of ways; by the government, by insurance companies, by hospitals. The amount of bureaucracy, the amount of paperwork, the number of obstacles that are placed in your way in actually just taking care of what we’re supposed to be taking care of, is real frustrating. And in this state, in particular, because of the way that the government has changed reimbursements, we have a much lower medicare reimbursement rate than most every place else in the country. I think Puerto Rico maybe is the same. But we’ve got a real low one, and most of the other reimbursement rates are keyed off of the medicare rate.
I don’t want this to sound like I’m complaining about how much money I make, because I’m very happy with what I do, but in order to continue a practice, you’re going to have to be able to recruit new physicians to the practice. And the problem for us, as well as the problem for other physicians in the state, is that somebody coming out of a training program looks at what the reimbursement rates are here compared to someplace else, and they have to really want to be here to make the sacrifice that they’re making financially to come here and stay here. I think we’re losing a huge number of physicians in this state to other places because of that, and I don’t see that turning around any time in the near future. So that’s disappointing to me, because we’ve always had a really good medical community here and the in the rest of the state”really high-quality physicians”and I fear that in the future, the standard is going to be lowered because the financial incentives are going elsewhere.
How do you make money/or how are you compensated?
We only make money when we’re doing something. We’re paid fee-for-service. We bill for what we do, and the insurance companies, the government, and/or the patients pay us for our services. We don’t own any of the equipment. Something that most people don’t realize is that there are two fees for radiology: one is a technical fee and one is the professional fee. The technical fee is paid to the facility or whoever owns the equipment that the procedures are performed on. The equipment is really expensive, and reimbursement rates for that is pretty high. Our portion of the total cost of an imaging procedure is usually between 5 and 10%, whereas the technical component is between 90 and 95%. We’ve chosen not to own imaging facilities for equipment because that puts a sort of a vested interest for us to do more procedures on that equipment, to earn more money off of it. And we felt like it was and, some people don’t have a problem with that, we just felt like it was a conflict, and it might make us make choices that were altered by financial concerns rather than patient concerns.
How much money do you make as a radiologist?
I’m going to have to guess here, but I would say that probably if you count the amount that we contribute to our pension plan and the amount that we are salaried and our bonus, and don’t count other things like insurance health, malpractice, disability, and that sort of thing I’m going to guess it would be right around $500,000 a year.
Well, obviously, you have to go to medical school. You have to have a college degree to get there. So you need a four year college degree, four years in medical school, an internship, a four-year residency, and a one to two-year fellowship after that. As far as skills, they need to be a problem-solver. Some people are good at memorizing things. Some people are good at problem solving. Some people are good at both, not too many, but it’s not good enough just to know a lot. You have to be able to apply that, and in a lot of ways what we do is like extremely complex video games. I mean, we’re using images and we’re using all sorts of information to figure out the answers. And so two things that are really key are visual and spacial orientation, and analysis skills. If you are able to think three dimensionally based on two-dimensional objects”drawings, pictures”if you can think three dimensionally, you can turn things around in your mind, upside down, sideways, backwards, forwards, with limited amounts of information, then you probably have one of the major skills necessary. If you can’t do that, this may not be the field for you.
What is most challenging about what you do?
There’s really two. One is that if you’re highly trained at what you do, and something that I tell patients is You don’t want your doctor to be excited, or surprised, or thrilled about what he’s doing with you. You want him to be a little bit bored with it. Because you want him to know it so well that he’s seen it, and it’s second nature for him to be able to do it. And so you’re so highly trained at it that ninety-five percent of the time, you know the answers pretty quickly and pretty easily. So one of the challenges is when it’s not challenging, because you’ve done it over and over, and you know it so well is to still do it as intently and with as much perfectionism and professionalism as you would if it was the first time you had done it. And sometimes you’re under a lot of chronic fatigue, so one of the challenges is to do it just as well when you’re exhausted as you do when you are fresh in the morning.
What is most rewarding?
Well, it’s obviously financially rewarding, but I guess the major reward that most of us have is that we know that what we do makes a difference in people’s lives, and that if we weren’t there for them at the time that they needed us, that things wouldn’t go as well. We know we make a difference for doctors who are struggling with trying to help patients, we know we make a difference in the patients’ lives, we know we make a difference in our community. Even when things are hard, you feel good about what you’re doing, all of the frustrations are tolerable, because you feel like what you’re doing is worthwhile.
What advice would you offer someone considering this career?
Well, that would depend on what stage of life they’re in. If they’re in high school then I would say, Find somebody who does this and then ask them if you could come visit and see what it’s really like, and most radiologists are delighted to have people come by and spend a few hours with them and let them see what they’re doing and what it’s really like. Because some people might say, This is something I would go nuts doing, or, Gosh, I’m fascinated with it, and I really would like to do this.
If you’re in college and you want to do it, the big thing that you’re going to have to do is get into medical school, and that’s hard to do. You’ve got to get good grades and you’ve got to score well on the entrance examination. And so, the answer to that is, find out what it requires to get in and then figure out if you can do it, and then go for it. But that takes a lot of self- sacrifice to do that.
If you’ve made it into medical school already, you are not going to be encouraged to go into radiology, nor will you get a lot of exposure to radiology. And so, by the time you’re ready to make your decision about what sort of career you would like to pursue, you almost haven’t had very much information about radiology or enough to make the choice. And so, if you think that you’re interested in it”and when you’re in medical school, you’re going to have to be a little bit of a self starter and just go by the radiology department and meet the professors there, and tell them that you’re interested, and ask them to help you decide whether this is the right career for you”and get some exposure. Because in medical school, you do get exposure to primary care, surgery, obstetrics, pediatrics, and some of the other sub-specialties, but very few people get much exposure to radiology before it’s too late to choose it. I think radiology and orthopedic surgery are the two most difficult residencies to get. So the other side of that coin is that if you want to get into the radiology residency, you’re going to have to do well in medical school. And actually, that’s another sacrifice to suck it up and everybody that goes through medical school gets to be a doctor as long as they pass all the courses, but not everybody gets to do what they want to. You have to finish reasonably high in your class in order to be able to get to do radiology.
Two, count the costs. I was married and had a child, and then had another one when I was in medical school. And most people, when they enter into medical school at that stage of life and are married, do not get out of medical school with their marriages intact. So, count the costs. Understand that it’s going to be difficult. Understand that people who are there who are younger than you are going to have a little more energy than you, but that you’re going to be more disciplined than they are, and so that kind of balances things out. But one of the things that my wife and I did when she was completely on board with this decision, was that if, at any point in the process, our marriage was in trouble because of it, that our marriage took priority, and I would¦I would bail on that and do something else. And so, I think if you have a marriage or a family and you do it, then you have to make some real priority choices in your life in order to survive it and get out on the other side.
Otherwise, doing it later in life gives you somewhat of an advantage because a lot of the people who come straight out of college are a little burned out, and they also may or may not be certain that that’s what they want to do. Whereas when I came, I was absolutely certain that that’s what I wanted to do, and I was excited to be there, and enjoyed strangely enough, most people don’t enjoy that much of medical school but I enjoyed most about it because I wanted to learn the things I was learning and I felt very privileged to be able to even be there. I remember looking up from a microscope one time in one of the classes, and looking around and just saying, I can’t even believe I’m here. I’m grateful for this.
How much time off do you get/take?
Well, this year I might not get any. Typically, radiology practices try to have somewhere between ten and twelve weeks of vacation a year, and it’s a little bit like being an air traffic controller. You concentrate so hard for so many hours, even though it doesn’t look like you’re working that hard because you’re sitting in a chair in a dark room, and it’s comfortable, and you can drink coffee and¦The amount of concentration that you’re having to put forth is way more than other people understand. And so, you need some periodic breaks just to let your mind rest and to be fresh. And that’s what people shoot for. And radiologists can do that because they don’t have files worth of patients who are looking to them as their doctor. And if a specific doctor isn’t there then there isn’t the, I’m disappointed or unhappy, because most of the patients don’t know us personally, so as long as one of us is qualified in doing the job, it’s not too much of a problem for us to take time off. There’s some flexibility involved.
Unfortunately, there’s a nationwide shortage of radiologists and, as I said, it’s hard to recruit them here. So, about every four or five years, we’ll go through a period of time where our vacation drops to almost nothing because of the inability to keep adequate staff on hand to manage the vacation time. Because, basically, in our practice, if we’re fully staffed, we have a ten-man practice, and we’re paying people to be off all the time, working eight people and having two people off at all times. So, right now we’ve got eight people with nobody off. This is actually my last day off, I’ve had four days off and this will be the last time I’ll get to do that for a while until we can get somebody else in.
What is a common misconception people have about what you do?
Well, amongst the general public, I don’t think they have much of a clue what we do. They get a bill from us and they don’t even know who we are or what they’re paying for.
A second one is that the public has not recognized, over the last 30 years, how most of the significant diagnostic effort in medicine has shifted from history and physical exam to imaging, and that imaging is now becoming the new physical examination. In fact, in the emergency rooms, when people come in, often they get a CT scan before they even see a doctor. And they want us to tell them what’s wrong with them before they’ve even seen the patient. So, the actual significance and value of what we do, in terms of the decision-making process in medicine, I don’t think is understood very well by the general public. The doctors, of course do, but the public doesn’t.
And the third one is that 50 years ago, radiologists didn’t work very hard and didn’t have nearly as much business. I mean, they did x-rays and fluoroscopy. They didn’t have ultrasound, they didn’t have CT, MRI, they didn’t have interventional radiology and so they just did a few things. Those things could be done during routine working hours, they didn’t even take call for years. And so, the impression in the medical community, among the physicians, is that radiologists have a cushy job and don’t work very hard, and there’s some jealousy because of that. And we also make good money. But the reality is, though, that now, when we’re on call, we probably work harder than any other physicians because the emergency rooms are completely dependent on us, and the other doctors are dependant on us when they get into a crisis with a patient in the middle of the night.
Often, the surgeons, or neurosurgeons, obstetrics, gynecologists, and other doctors, don’t have to come in to see a patient because they can get them scanned, we can tell them what’s going on, and if everything’s okay, they can wait until the next morning to take care of it. Whereas, they used to have to come in all the time and see them. So, the workload, the call requirements, and the stress of being kind of bottom line for a lot of decisions, is far greater than most physicians have any idea of. They still kind of have the 50 year ago paradigm that we don’t work very hard and¦They’re coming around because they’re starting to see. But when you read a (a lot of) CT scans in a night that’s an awful lot of work, with people who are at times potentially going to be paralyzed or die if you say something wrong. It’s an awful lot of work and a lot of stress that people don’t understand.
What are your goals/dreams for the future?
Well, I want to finish well. I’ve got another 12 years or so that I’m going to practice and I want to stay competent and do a good job and take good care of patients. But I also, as much as anything else, want to try to help my younger partners continue to build their practice in a way that they will have as much benefit from it, and be able to continue to benefit our community as much as I feel like I have.
What else would you like people to know about what you do?
In general, medicine is reaching a crisis. The baby boomers are getting old. There’s a bunch more of them that are going to be needing healthcare. Our healthcare system is going to be drained financially and is being drained financially. And the imaging side of that is growing exponentially, and so, the government is going to be looking for ways to limit the amount of imaging that’s done on patients, and in the meantime, they’ve been cutting our reimbursements 10% a year or so. There’s going to reach a tipping point with that, where radiologists¦all the radiologists will say, That’s enough. I’m just¦I’m done, and they’re going to quit. We don’t have enough radiologists as it is. And so, the government is probably going to have to make a choice as to whether or not to allow imaging to be shipped overseas, to be read by people who may not have the same kind of training or credentials and don’t work at the same level that American radiologists do. That’s not across the board. There are excellent radiologists around the world, but not all of them.
And the other is that they may start to use less trained individuals to interpret the imaging procedures. Sort of like instead of going to see a doctor, you go to see a nurse practitioner. They may start using people and saying, Okay, we’re going to allow these people to read the images. I think the American public doesn’t really understand what we do very well, and doesn’t understand the level of care that they’re getting, and that it may be almost invisible to them if that change is made, but it will be a phenomenal change in the quality of care that they are receiving. It may not happen because the doctors who are ordering the procedures will be so uncomfortable about their medical-legal risks. Somebody besides a fully trained, credentialed radiologist is interpreting the exams¦they might not allow it to happen.
But I just fear that the crunch of the increasing numbers of people, the increasing numbers of imaging procedures, and the decreasing amount of reimbursement is going to force things to occur that would be less than beneficial for the patients in the long run. And then, the legal side of it is that if physicians don’t order imaging done and something is wrong, then they get in trouble. I think probably 40% of what I do is doctors ordering these tests in order to cover their rear ends from malpractice suits. So, changing those tort laws so that they’re not so afraid, that if they don’t order these things that they’re going to be sued, and the other is training more radiologists and starting soon, because it obviously takes a long time to get them out. It’s predicted that there’s going to be an absolute shortage of radiologists for at least the next twelve years, and I can’t imagine that it’s not going to last longer than that unless they do something. So, train more of them, and reform the malpractice laws so we’re not doing so many procedures that are unnecessary.