Salary Data Reveal Medicine’s Golden Cage

Are you a glass-half-full or a glass-half-empty kind of person? Either way, there’s lots to unpack in the latest data on physician salaries, this time from Medscape

Medscape’s survey of over 10k US physicians across over 29 medical specialties found that overall physician salaries have grown 18% over the last five years, to $352k, while specialists made an average of $382k. 

As with last year, radiologists landed in the top 10 of highest-compensated specialists, a finding that’s in line with previous salary surveys, such as from Doximity. Medscape found that radiologists had an average annual salary of $483k in 2023, compared to $437k in 2022. Radiologists had an average annual salary of $504k in the Doximity data. 

Other nuggets from the Medscape survey:

  • “Stagnant” reimbursement relative to rising practice costs has cut into physician income. 
  • The gender gap is narrowing. Male primary care doctors in 2023 earn 19% more than females, compared to about 25% previously.
  • Male specialist physicians earn 27% more than females, down from 31% last year and 33% the year before that.
  • Only 19% of radiologists are women – one of the lowest rates of female participation among medical specialties. 
  • 58% of radiologists feel they are fairly paid.
  • Radiologists report working an average of 49.6 hours a week.
  • 90% of radiologists say they would choose their specialty again, ranking #10.

The Takeaway

On the positive side, physician salaries continue to rise, and medicine is making encouraging progress in narrowing the gender gap. Radiologists seem to be well-compensated and relatively happy, but the specialty has more to do to attract women.

Underlying the raw data is a disturbing undercurrent of physician dissatisfaction, with many feeling as though medicine is a golden cage. In the free-response portion of the survey, doctors described themselves as caught between falling reimbursement and rising costs, with overwork also leading to burnout

The Medscape survey shows that addressing physician burnout must become a priority for the US healthcare system, and it can’t be solved merely by boosting salaries. Increasing the number of residency slots is a good first step (see below).

Radiology Bucks Doctor Salary Decline

The latest news on physician salaries is out, and it’s not pretty. A new Doximity survey found that average physician pay declined 2.4% last year, compared to an increase of 3.8% in 2021. The drop was exacerbated by high inflation rates that took a bite out of physician salaries. 

The Doximity report paints a picture of physicians beset by rising burnout, shortages, and a persistent gender pay gap. Doctors across multiple specialties report feeling more stressed even as wage growth has stalled.

To compile the 2022 data, Doximity got responses from 31,000 US physicians. There was a wide range of average annual compensation across medical specialties, with radiology landing at number 10 on the top 20 list, while nuclear medicine occupied the 20th spot:

  • Radiation oncology: $547k vs. $544k in 2021
  • Radiology: $504k vs. $495k 
  • Nuclear medicine: $392k vs. $399k

In other findings of the report:

  • Male physicians made $110,000 more than women doctors. At a gap of 26%, this is actually an improvement compared to 28% in 2021.
  • Men physicians over their career make over $2 million more than women.
  • Nuclear medicine had the smallest pay gap ($394k vs. $382k)
  • The pay gap could contribute to higher burnout rates, with 92% of women reporting overwork compared to 83% of men. 
  • Two-thirds of physicians are considering an employment change due to overwork. 

Ironically, Doximity cited results of a recent survey in which 71% of physicians said they would accept lower compensation for better work-life balance. 

The Takeaway

The news about salaries could be a gut punch to many physicians, who are already dealing with epidemic levels of burnout. Radiology salaries bucked the trend by rising 1.6%, which could explain its popularity among medical students over the last three years. 

The question remains, is the money worth it? Rising imaging volumes have been tied to burnout in radiology, and the Doximity report indicates that some physicians are willing to forgo money for better quality of life.

Moral Distress in Radiology

The rising volume of medical imaging studies isn’t just a data point. It’s causing moral distress among radiologists and is a major systemic cause of the specialty’s burnout epidemic. 

Radiology’s problem with burnout is no secret, with a recent analysis disclosing that 54% of all radiologists identify as burned out. Studies have found that a cause of burnout can be moral distress, defined within healthcare as when a clinician knows the right course of action for a patient, but is prevented from taking it due to systemic factors.

In a March 22 study in American Journal of Roentgenology, researchers describe findings from a survey of 93 radiologists on their feelings of moral distress in different clinical scenarios and the impact it had on their careers. In short:

  • 98% reported some degree of moral distress
  • 48% thought the COVID-19 pandemic influenced their moral distress
  • 28% considered leaving their jobs
  • 18% actually did leave a job

Several factors contribute to moral distress in radiology: 

  • Case volumes that are higher than can be read safely
  • Higher case volumes that prevent resident teaching
  • A lack of action and support among administration

These latter issues lead to burnout in specific ways, the authors wrote. Institutional constraints to providing high-quality care can prompt physicians to spend more time at work. Error rates can also grow during shifts with high study volumes or that last longer than 10 hours. And orders for unnecessary imaging exams can be seen as disregard for professional expertise. 

The Takeaway

This study rips the Band-Aid off the burnout problem in radiology, pointing out that inexorably rising imaging volumes rather than bad bosses or lazy colleagues are a root cause, one that’s been exacerbated by the COVID-19 pandemic.  

A further implication is that no amount of “self-care” – often prescribed as a solution for burnout – will cure the problem in the long run as long as radiologists will have ever-growing worklists to return to after their sabbaticals and motivational staff meetings. The researchers recommended “urgent action” to address the issue.

The Radiologist Skill Gap

A new Stanford study revealed that diagnostic variations are largely due to differences in radiologist skill levels (not work styles/preferences, etc.), suggesting that physician skill gaps might represent a major source of healthcare waste, and warning that efforts to standardize care could lead to even worse results. 

The researchers analyzed 4.67M CXR interpretations from patients with suspected pneumonia, finding that radiologist skill level accounted for 39% of variations in positive diagnoses (both true & false) and 78% of variations in missed diagnoses. Those variations had a major impact on patient care:

  • Reassigning a patient from a radiologist in the 10th to 90th percentile for positive diagnostic rates would increase their probability of receiving a positive diagnosis from 8.9% to 12.3%.
  • Reassigning a patient from a radiologist in the 10th to 90th percentile for missed diagnosis rates would increase their probability of receiving a false negative from 0.2% to 1.8%.

Perhaps counterintuitively, they found that the radiologists who were more likely to diagnose patients with pneumonia were also more likely to submit false negative diagnoses, suggesting that less skilled radiologists are responsible for an outsized share of unnecessary, delayed, and inconsistent care.

Skill can be hard to define, but the researchers found that the “most skilled radiologists” were generally older and more experienced, wrote shorter reports, and spent more time on each report.

The researchers weren’t specifically trying to understand radiologist skill variations with this study, and their main takeaway is that we might have to change our assumptions about how to fix the U.S. healthcare system:

  • Healthcare inefficiency might have more to do with physician performance, and less to do with other commonly cited issues (e.g. misaligned payor/provider incentives) 
  • Relying on standardized approaches to equalize patient care and address cost variations might actually lead to worse care and higher costs

The Takeaway

Most readers probably aren’t surprised to hear that some radiologists are way more accurate than others, and that diagnostic skill increases with age/experience. However, this study gives new evidence supporting the value of quality improvement efforts, and could make it easier to demonstrate how radiology products/processes that reduce variability but don’t generate revenue (like AI…) might deliver clearer ROI than some might think.

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-- The Imaging Wire team