Radiologists who responded to this year's Medscape compensation survey described their compensation, number of hours worked, practice changes resulting from healthcare reform, and how they have adapted to the new healthcare environment.

When asked about their compensation for patient care, radiologists came in sixth from the top ($351,000). The lowest earners, starting from last place, are pediatricians ($189,000), family physicians ($195,000), and endocrinologists and internists (both at $196,000). The top earners this year are orthopedists ($421,000), cardiologists ($376,000), and gastroenterologists ($370,000). The top earners have changed from the 2011 Medscape Compensation Report. Although orthopedists led that year as well, the next top earners were radiologists and anesthesiologists. The bottom earners then were still pediatricians, PCPs, and endocrinologists. Note: Values in the charts have been rounded. Caption sums may not agree with chart value sums due to rounding.

When 2014 compensation is compared with the prior year's, radiologists reported an increase of 3%. Only rheumatologists experienced any large decrease in income (4%). Urologists were the only other specialists to see a decline, but by only 1%. The rest of the physicians reported an increase. The greatest increases appeared among infectious disease physicians (22%), followed by physicians who mostly work in hospitals: pulmonologists (15%) and emergency medicine physicians and pathologists (both at 12%).

Orthopedists, who make the most from patient-care work, are also at the top of the list for compensation from non–patient care activities ($29,000). Non–patient care activities include expert witness duties, product sales, and speaking engagements. At $6000, radiologists are at the bottom of the list of specialists in non–patient care compensation. Physicians (and notably PCPs) who are at the lower end of patient-work compensation also tend to trail in non–patient care compensation.

This year, in contrast with most other physician groups,^[1] self-employed female radiologists are earning more than their male counterparts, and although employed male radiologists earn more than their female counterparts, the difference is only 3%.^[1]

Fifty-five percent of female radiologists are satisfied with their income, which is slightly higher than the rate reported by their male counterparts (52%). Percentages of satisfied radiologists of both genders this year are identical to those reported last year.

In setting Medicare fees, the challenge for CMS is to address the higher cost of living in certain areas against the need to attract physicians to underserved places with lower costs of living.^[2] Additionally, competition and physician density play a role in physician salaries. This year, the highest earnings for radiologists were reported in the Northwest ($404,000) and North Central ($378,000) regions, whereas the lowest were in the South Central ($322,000) and the Mid-Atlantic ($327,000) regions. The 2011 Medscape Radiologist Compensation Report indicates little change in these regional differences; the highest radiologist earners then were in the Northwest ($367,000), and the lowest were in the Mid-Atlantic region ($322,000).

Employed radiologists make $309,000, which is less than their self-employed counterparts ($411,000). A number of factors in 2015 might negatively affect compensation for employed or self-employed radiologists, including the end of ACO shared-savings programs, meaningful use penalties, payment-reporting websites, and changes in CPT codes.^[3]

Given that employed radiologists make less than those who are self-employed, it is of some interest that 57% of employed radiologists believe that they are fairly compensated, a greater percentage than those who are self-employed (51%). Both employed and self-employed radiologists reported a reduction in satisfaction from the 2011 Medscape survey, when nearly 70% of both groups felt they were fairly compensated.

Radiologists in healthcare organizations make the most ($399,000), followed by those in single-specialty groups ($389,000). Those who earn the least money are in solo practices ($237,000) and academic and government centers ($285,000). As is the case this year, in 2014, radiologists who earned the most last year were in healthcare organizations ($427,000). Those in academic and government centers earned the least ($243,000).

In the 2011 Medscape report, 66% of radiologists said they would choose medicine again and 82% would select their own specialty. This year, only 49% would still choose medicine, and 52% would select their own specialty. Furthermore, in 2011, 56% said they would choose their own practice setting, but this year only 32% would go that same route.

To determine the level of general career satisfaction, Medscape averaged the percentage of radiologists who again would choose medicine, those who would choose their own specialty, and those who thought they were fairly compensated. At 51%, radiologists came in slightly below the middle in overall satisfaction—which is the same as last year's percentage (51%), with a similar ranking. According to the calculation, the most satisfied physicians this year are dermatologists (63%), followed by psychiatrists and pathologists (both at 57%) and emergency medicine physicians and pediatricians (both at 56%). The least satisfied, from the bottom up, are internists (47%), nephrologists (48%), and general surgeons (49%).

Despite considerable publicity, cash-only and concierge practices are still not significant payment models for radiologists.^[4] Participation in accountable care organizations, however, continues to rise steadily, from 26% last year to 29% currently, with 12% more expecting to be part of an ACO this year.

The American Medical Association has warned that the "'regulatory tsunami' facing US physicians could cut Medicare payments by more than 13% by the end of the decade."^[5] Nevertheless, 76% of employed and 78% of self-employed radiologists said they will continue taking new and current Medicare or Medicaid patients, which is up from their responses last year, when 66% of employed and 76% of self-employed radiologists said they would take these patients. There was a slight decline in those not taking Medicaid or Medicare. There was a decline among undecided employed radiologists between last year and now, from 30% to 19%, and no change among those who were self-employed. This overall decline, coupled with the increase in those taking Medicaid/Medicare patients, suggests that more undecided radiologists opted to take these patients.

In a Medscape report on insurers conducted in 2014, well over one half (58%) of all physicians received less than $100 from private insurers for a new-patient office visit. In the current report, when asked whether they would drop insurers who pay poorly, 17% of radiologists said they would and 40% would not. (The question was not applicable to the remaining survey respondents.)

According to Medscape survey findings, 19% of employed and 21% of self-employed radiologists say they have offered new ancillary services within the past 3 years. Of particular concern to radiologists is the proliferation of ancillary in-house imaging services provided by nonradiologist physicians to boost their practice revenues.

Only 44% of radiologists say they discuss the cost of treatment with patients, and a mere 6% do this regularly. Sixteen percent are unaware of the cost of treatment. A 2013 editorial in the New England Journal of Medicine stressed the benefits of such discussions, including finding lower-cost alternatives and making trade-offs, and noted that it is "well within physicians' traditional duties to discuss such matters with our patients."^[6]

Twenty-six percent of radiologists spend 30-45 hours per week seeing patients. Less than one third (30%) spend more than that. A JAMA study of all physicians found that between 1997 and 2007, there was a decrease among all physicians of nearly 4 hours per week in seeing patients, which may be in part related to the declining fees over that same period.^[7] Another reason for the decline is the increasing proportion of women physicians and older physicians, who tend to work shorter hours and fewer weeks.^[1]

In a 2012 survey, physicians reported spending 22% of their time on nonclinical paperwork.^[8] Paperwork load is nearly equal among self-employed radiologists compared with those who are employed: 33% of those who work for themselves spend 10 or more hours per week on these tasks, compared with 47% of those who work for others.

Less than one half (41%) of radiologists spend 16 minutes or less per patient. Only 11% spend more time than that.

Nearly one third of female radiologists (31%) and only 13% of male radiologists work part-time. These percentages reflect those among the general physician population, where nearly one quarter (24%) of female and 13% of male physicians work part-time.

The oldest radiologists (65 and older) make up the largest part-time age group, at 35%. Three percent of those under 35 and a slightly higher number (between 7% and 14%) of those in middle age work part-time.

Female and male radiologists reported only slight differences in what they found most rewarding about their jobs. Fifty-six percent of women and 59% of men believed that being very good at their job is a major source of satisfaction. More women (20%) than men (16%) cited making good money as a reward, and an equal percentage (9%) of male and female radiologists named relationships with patients. Being proud of being a doctor was last on the list as a reward for both genders.

Only 20% of radiologists are planning on participating in health insurance exchanges, which is down from 29% last year. This year, 22% of radiologists said they were not participating, up from 13% in the 2014 Medscape report.

Radiologists were asked what impact health insurance exchanges would have on their income. Many physicians may have already felt their effect, and radiologists expect to have a harder time than PCPs. Only 4% of radiologists believe that their income is likely to increase with health insurance exchanges, whereas 10% of PCPs think it will rise. Over one half (51%) of radiologists believe that their income will decrease, compared with 27% of PCPs.