Robbing Dr. Peter to Pay Dr. Paul

January 31, 2014

Think it’s fair to play Robin Hood between the primary care and specialist physicians? Good luck finding someone who deserves to be looted some more.

A couple of mainstream media pieces have run recently, trotting out the old dog-and-pony show about how unfair it is that specialists like radiologists tend to earn more than primary care folks. This time around, CNN and The New York Times were the bigger carriers of this “news.”

Such pieces play well with the lay public, always hungry for the prospect of ill-gotten gains being torn away from undeserving hands. “Greedy 1%ers” and “Wall Street bankers” have been popular targets in recent years. One doesn’t need much in the way of details or facts to back up the story; just put it out there and there’s a good chance the item will get a swarm of excited commentary. That’s enough of an incentive for most media types - let alone those with a personal axe to grind, like the NYT author who, I’m told, is herself an internal med (primary care) doc.

I don’t know whether to be cheered or discouraged that physicians respond to these things just as reliably as blue collar folks do to the anti-Wall Street pieces. On the one hand, it’s kind of reassuring to know that human behavior is reliable, even predictable. On the other, it’s disappointing that even otherwise educated professionals are so easily goaded into turning on one another, fighting over scraps of an ever-diminishing financial pie.

One might be tempted to take the high moral ground and not participate in this repeated scrum. The problem is that this who-gets-what game is decided by a handful of referees sitting in DC, swamped with information and entreaties from all sides. If your team is not there along with all the others, squawking just as loudly to cut the other guys’ funding instead of your own, you stand out as the easiest target. “The only winning move is not to play” might have made sense in the old chestnut WarGames - but doesn’t pan out so well, here.

As radiology still tends to be one of the heavier financial hitters amongst the specialties, we remain a particularly prominent target. It doesn’t matter to other specialties how disproportionately rads have been financially used and abused in recent memory; as long as they can point at some salary survey which says our numbers are better than theirs, they’re eager to volunteer us for more of the same.

Like other “income inequality” debates (I use the term loosely, as it implies anybody is liable to change their mind), it doesn’t matter to detractors what specialists like ourselves say. We can point out that we put in more years of training for our areas of expertise, and overcame tougher competition for our in-demand residency spots. Heck, it’s fair to say that at least some of us identified radiology at the outset as a more desirable, financially viable specialty to pursue, and that our colleagues in primary care had the opportunity to make the same choice. We can cite the higher cost of doing business in radiology, and the greater medicolegal liability we face.

We might also reference our frequently-central position in the healthcare machine: On a typical night in a hospital, a doc in the ER might see 1/3 of the patients who come in the door, a surgeon might round on some SICU patients and consults, do a couple of emergent procedures, etc. But for every single one of those patients (not to mention all others in the facility) who gets imaging to determine whether admission, intervention, or discharge is warranted-and I daresay that means the vast majority of them-the covering radiologist is shouldering the burden.

So, to any believing they have the wisdom and fairness to play Robin Hood between the primary care and specialist physicians who, combined, currently receive less than 10 percent of the USA healthcare dollar: Good luck finding someone who deserves to be looted some more. We’ve already given.