The Trappings of Success

July 21, 2017
Eric Postal, MD

It’s no secret: radiologists make good money.

Regular readers of this column, seeing last week’s title was part of a famous quotation, might have expected this edition to utilize the other portion. In truth, the remaining phrase could have been relevant to today’s subject matter…but I’d have to put quite a different spin on it to make that work.

The subject being: We radiologists make a pretty good living.

That makes some folks kinda uncomfortable…to the point that they’d rather it not be discussed. To them, I’d suggest skipping this particular blog entry. If they can’t bring themselves to do so…well, sorry.

Taking myself as an example, I live in a pretty nice house, on a fine chunk of land in a good area. I drive what’s considered a luxury vehicle, go on vacations, and dine out regularly. (Granted, I saved up for that house by living in a humble hovel till my 40s, the vehicle in question is from 2005, and my vacation travel is when work permits, rather than on my personal whim.)

In modern society, folks have gotten quite comfortable sizing up others’ possessions and/or income, forming opinions (sometimes quite vocally) as to whether those others deserve their lot. These opinions rarely offer more specificity than “more” or “less.”

Disparaging talk about “those rich doctors” thus rarely gets down to the nuts and bolts of just how much our services in diagnosing or treating somebody’s cancer, stroke, trauma, etc. should be worth. Typically, it’s in vague terms, such as whether we should be doing all that much better than, say, a public school teacher.

Determining someone’s professional worth is a far more complex affair than I’m inclined to get into, especially when it’s intertwined with sociopolitical stuff like whether or how much the government should be involved. I’m focused more on the basic issue of whether we truly earn our keep…and, more importantly, how to convey that to others whose minds aren’t entirely closed on the matter.

One factor that a lot of our would-be appraisers don’t seem to know, or at least keep in mind, is that a physician doesn’t jump right out of school and start raking in dough. Assume graduation from college at the age of 22 is immediately followed by med school (4 years). Then there’s internship (1 year) and residency (this is a radiology blog, so 4 years), perhaps followed by fellowship (another 1-2 years), so by the time a rad is ready to earn something beyond housestaff wages, he or she is in their early 30s.

That’s 10 years during which their non-doc friends have been earning a living, and presumably working their ways up various hierarchies in their lines of work (and commensurate increases in pay, benefits, etc.). That decade also means plenty of time for the doc’s student loans to have accrued interest, whereas the non-docs have been paying theirs off…and let us not forget the extra (not uncommonly double!) principal incurred by med school itself.

In other words, while physicians might run faster, eventually pulling ahead, in the net-worth race, their non-doc friends and family have had a pretty decent headstart…and when the docs do get moving, they tend to be carrying a heftier financial burden. Sort of like running that race while laden with extra weight.

Not enough of an equalizer, some might say. How about one more dollars and cents factor: Courtesy of our medicolegal system, at any moment well-to-do docs can find themselves judged liable for malpractice. The price tag being pretty much unlimited, since laws setting ceilings on same can often be appealed and overruled in specific cases. That’s right, an X-ray for which I received $5 a couple years ago can wind up costing me everything I own. A rather unlikely turn of events to occur, say, to my friend who designs book jackets for a living.

Still not enough? It’s not just about the dollars and cents. While the doc was spending his extra decade in school and low-comp postgrad training (12+ hour days, covering call overnight and on holidays and weekends), the non-docs were typically enjoying comparatively light schedules, classically Mon-Fri, 9-to-5 with all weekends and holidays off, and plenty of room for personal lives.

Let’s not forget this is during their 20s…a big slice out of the prime of life. Perhaps a doc willing to sacrifice that should earn some sort of reward, later on.

There are other points I could bring up-for instance, how else might we motivate young folks with the capability to be good physicians in the future to enter the field, as opposed to something else, far less demanding and stressful-but I’ve gone on at length as it is.

Upshot: Yes, I think most of us earn every bit that we have, and many probably deserve even more. No, that doesn’t mean it’d be a good idea to needlessly flaunt it like an obnoxious reality TV star…but we shouldn’t feel guilty and/or pressured to keep it a big secret, either.