Income Inequality

January 28, 2014

Radiology incomes will inevitably continue to decline. But like they say, you get what you pay for, and time will tell what that says about the future of medicine.

With all the debate over income inequality, I refuse to apologize for my earnings as a radiologist. Over the years I have had to defend my income to members of the public as well as other physicians. In the case of the former, the public at large believes that all physicians are overpaid. In the latter, our non-radiology colleagues frequently believe that radiologists are grossly overpaid for what we do.

When an acquaintance complained about his medical bills, I explained that reimbursements have been declining for the past 20+ years. He smirked and told me that was only fair and doctors should be able to live off the huge amounts of money they made during all the years they overcharged the public. Many years ago I was confronted by an orthopedic surgeon who probably made three times what I made, who joked about my exorbitant income as a radiologist. Frankly, I didn’t know what to say.

Personally, I don’t care what other people earn. What actors, athletes, hedge fund managers and other medical specialties are paid is none of my business. I believe in capitalism and the free market. I believe that capitalism has been the single most important human invention for improving the standard of living throughout the world. Granted, it does create a disparity of wealth across society but so does every other economic system, usually more cruelly and rigidly. Capitalism isn’t a perfect system, but it is the best one we have come up with so far.

Having said that, as we are all too well aware, medicine is not a free market. As the largest single insurer, the United States government exerts irresistible, downward pressure on the payment curve. The Medicare Sustainable Growth Rate enacted in 1997 was supposed to control the unsustainable growth of healthcare costs by reducing physician payments. The full impact of the SGR has not been felt so far because Congress has passed annual resolutions delaying its implementation.

The Affordable Care Act addresses this legislative shortcoming by creating the Independent Payment Advisory Board. This board will determine Medicare payments, freeing Congress from having to take unpopular votes on reducing physician reimbursement and its decisions can only be overturned by a supermajority vote of the Congress.

All this talk about incomes is bound to cause the inevitable backlash about all the greedy physicians and their fraudulent schemes to inflate their incomes. There are a few bad apples in our profession. A doctor in my town was recently convicted of Medicare fraud. He was found guilty of charging for injecting an expensive drug while actually injecting a cheaper one. I know this happens but believe that it is the exception, not the rule.

Perhaps I am naïve, or more likely, I just lack the criminal gene necessary for such fraudulent behavior. If a patient is charged for a 3-view study but only had 2-views, I insist that the charges be corrected. I could no more knowingly cheat a patient than plan an armored car heist.

Still, I believe I am worth what I am paid because of the years of training, the long hours in a sedentary profession that is likely shortening my life, and the stressful nights and weekends for the last 30 years. It seems inevitable that radiology incomes will continue to decline for the foreseeable future.

I know most don’t enter our profession only for the money, but the laws of economics and market forces cannot be ignored. Like they say, you get what you pay for. What does that say about the future of medicine? Time will tell.