The Orkan, Bizarro-world Bottomless Well of Radiology

October 10, 2014

Unlike other careers, radiologists receive the best rewards as their career begins, and then gradually lose them.

Summer is now solidly behind us, but the holidays are not quite imminent enough to claim every last bit of advertising time/space. Like clockwork, along with football and post-season baseball, this means it’s once again time for us physicians to be put in our collective place with another hack to our bottom line.

Perhaps some readers have habitually received their financial smackdown at other times of the year, usually peppered with trite commentary of costs being up and reimbursements down. I have to admit, I think I would be in a better frame of mind to get such news when the days are longer and warmer. Sitting on a beach and fuming about my complete lack of control over my profession would have to be better than similar brooding while huddling indoors and resisting the urge to turn up the thermostat.

Friends and family in non-medical careers never quite get it. In their world, you complete whatever schooling and training you are going to pursue, start a job at entry-level wages, and move up in rank and compensation as you gain experience and prove yourself. Barring bad performance or rare misfortune, your circumstances gradually improve. If raises are infrequent or meager, everyone hears about it, and commiserates.

In radiology, at least for the past decade, things work in reverse, a la DC Comics’ “Bizarro world” (also referenced in the Seinfeld series, if that helps). Also reminiscent of the Orkan aliens from “Mork and Mindy,” born physically elderly and becoming more apparently youthful as they age. A good year is one in which you are not informed you will be earning less, working more, or a combination of the two. Actually, make that a great year - most radiologists I know have been psychologically bludgeoned to the point that they are actually borderline-grateful when they will “only” be losing another 2% of their bottom line, working yet another weekend-day per month, etc.

Maybe it’s a good thing to receive the best rewards of your career as it begins, and gradually lose them as you go on. It’s sort of like an interest-free loan on your future, enjoyable while you’re still relatively young and healthy. It also encourages you to retire when your “love of the game” has run out, since by that time your other incentives will have dwindled, unlike in other fields where you might be tempted to hang in there for another year or three to reap the benefits of whatever lofty position you have managed to attain with your decades of tenure.[[{"type":"media","view_mode":"media_crop","fid":"28399","attributes":{"alt":"well of gold","class":"media-image media-image-right","id":"media_crop_5558780682927","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2880","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 117px; width: 165px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":" ","typeof":"foaf:Image"}}]]

On the other hand, it does make planning for your future tricky. Trying to figure out whether you can afford a particular house, car, additional child, etc.? The answer this year or next might seem a no-brainer…but what’s comfortably attainable now might be a squeeze for you by 2020, and a financial impossibility a few “just another 2% cut” years after that. And if forecasting personal finances is dicey, is there any real hope of making long-term plans for a business you are trying to run?

I think, maybe, our approach of annually begging for reprieves from thousand-cuts-death-by-bleeding needs to be retired. The powers that be have decided that those of us actually providing healthcare, though we actually receive less than 10% of medical costs, are a bottomless well, especially in radiology. They’ll keep coming back for more as long as there’s anything left to take from us, and we’re fooling ourselves if we consider it a victory when we get hurt slightly less in one particular year than the next.

Instead, perhaps we could try establishing a firm bottom to our well. Next time the metaphorical bucket is lowered to siphon from us, let’s offer not to resist-but, instead, maybe even to sweeten the pot with another percentage-point or two. On the condition, however, that this buys us a concrete floor, rendering us immune from consideration for future reductions in reimbursement. Let subsequent budgetary crunches be resolved at someone else’s expense for a change.

Yes, of course the politicians and other assorted bureaucrats would take our concession and go back on their end of the deal anyway…but it would probably take a few years before they figured out a pretext for welching. That’s a longer interval of stability than we’ve seen in this field for awhile.