Mother, May I Make a Living? Simon Says: Maybe, Radiologist, Maybe
From adjusting to the rules of early childhood games to understanding the nuances of tax law and the ‘One Big Beautiful Bill,’ adaptability plays a key role in navigating change.
I don’t have anything resembling demographics as to who reads this blog. It seems likely that most are radiologists or those related to the field. Medical school graduates are usually at least 26 years of age, and then there are years of post-grad training.
In this age group, childhood wasn’t spent staring at cellphone or computer tablet screens. Playtime meant actually doing things, often with other people. Not to look down my nose too much at the current day, but a walk down memory lane suggests that screen-less leisure time provided greater ancillary benefits.
Educational/adaptive value varied with activity, of course. Playing “tag” might have been good for making exercise fun, but other stuff was a little more cerebral. Games like “Mother, May I” and “Simon Says” come to mind. Good performance meant learning how to attend to detail, including heeding verbal instruction.
I wouldn’t be surprised to hear that kids who went on to thrive in the legal field played those games well. The law is a massive “Simon Says” for societal behavior and includes plenty of “Mother May I” elements (you need to apply for licenses and permits to do certain things, for instance). If you are in a heavily regulated field like health care, you don’t even need to be a lawyer to know the consequences of doing what Simon didn’t say, or Mother didn’t pre-allow you.
Just like in those games, rules and laws are subject to change, and it can be hard to keep up. They’re innumerable and complicatedly interwoven at differing levels of jurisdiction. It has been observed that anybody, if scrutinized enough, can be found in violation of something or other. A cynic might point out that such a system, designed by a bunch of lawyers, pretty much forces everyone to depend on lawyers to stay out of trouble.
Tax law is an example of which many of us are particularly aware. It might not be on your radar all that much if you are a W-2 individual and just throw all your documentation at an accountant every year, or if your affairs are so blessedly simple that you just take a standard deduction on a one-page tax return you can do yourself.
It doesn’t take much for a rad to leave that situation behind. Go 1099, do some side gigs, or launch your own venture, and you are going to get educated one way or another. Next thing you know, you are reading news items about how various political candidates’ proposals might impact you, and tracking how the winning politicians’ policies thrive, mutate, or die once they are in office.
I resisted playing that game as long as I could. When I left my last on-site job in 2011 and started my life as an independent contractor rad (at the time, tele didn’t offer a choice), I soon saw that even if I decided not to play the game, it would still play with me. It wasn’t too many years before I had my own S-corp and LLC.
From my perspective, most people who created such business entities did so as ambitious, enterprising moves. I have been an employee doing, let’s say, HVAC, and now I start my own HVAC business. I set sail on my metaphorical S-corp ship, maybe after a few successful years as a sole proprietor without a formal entity for my business. If I continue to succeed, I might grow and flesh out the S-corp with employees, even other shareholders. Someday, I might sell my stake in it.
In my case as a rad, I only paid lawyers and accountants to make and manage my entities because the legal/regulatory infrastructure told me “Simon says do this and you will pay less in taxes.” Put another way, this was how one asked the IRS “Mother, may I keep more of what I earn?” I wasn’t doing anything differently in my professional work. I protocoled and read cases just like I always had. The business was me and would never be anything more.
Years went by, and the details of my work shifted. I became an employee for one gig, got paid by the hour instead of by the RVU for another. The “SALT” deduction got capped, and other rules/regs changed with different administrations.
I found myself doing nothing in particular with my S-corp and LLC, other than having to file tax returns for them which included paying “franchise tax” for their mere existence. I couldn’t use them to ask Mother for anything, nor did Simon issue any relevant directives. Accordingly, I nixed the biz entities, since my state allows such things to be revived if I ever want to.
Like magic, a single year after I did that, the “One Big Beautiful Bill” came along. Now in the habit of reading up on such things, I saw a couple of wrinkles that might be relevant to me. My accountant confirmed that, yes, I could be looking at substantial tax savings, but I would have to use a business entity again. For reasons not worth going into here, it would be best to create a new entity, rather than reviving one or both of the old ones.
In other words, Simon has said that I will be allowed to keep more of what I earn if I jump through hoops like creating the business entity, keeping books, and filing quarterly returns. This will impact nobody but me, my accountant, and the tax collectors. I don’t think anybody would say it makes me a better radiologist, but then again, neither Simon nor Mother ever had to justify their directives either.
Newsletter
Stay at the forefront of radiology with the Diagnostic Imaging newsletter, delivering the latest news, clinical insights, and imaging advancements for today’s radiologists.
The Reading Room Podcast: Emerging Trends in the Radiology Workforce
February 11th 2022Richard Duszak, MD, and Mina Makary, MD, discuss a number of issues, ranging from demographic trends and NPRPs to physician burnout and medical student recruitment, that figure to impact the radiology workforce now and in the near future.
Where Things Stand with the Radiologist Shortage
June 18th 2025A new report conveys the cumulative impact of ongoing challenges with radiologist residency positions, reimbursement, post-COVID-19 attrition rates and the aging of the population upon the persistent shortage of radiologists in the United States.
