It's no surprise that radiologists again finish near the top of the annual American Medical Group Association (AMGA) Medical Compensation and Financial Survey. A diagnostic radiologist's median income is over $438K! It's a fool's errand to try to defend or attack our salaries, what with myriad examples of underpaid and overpaid radiologists, physicians and non-medical people. Rare is the individual who believes he or she is paid too much. However, in the midst of healthcare reform, I wonder how long this situation will last.

Howard P. Forman,
M.D., M.B.A.

Neither the healthcare "market," because it is not truly competitive, nor providence has bestowed upon us our financial good fortune—it's simply an outcome of a system that rewards almost everyone for doing more, even fixing our own complications. When a clinician pays no incremental cost in self-referral, or even garners a profit, the obvious ensues. The incentive realignment promised by reform must wait another decade or more while other experiments with payment incentives occur. From a purely pecuniary short-term point of view, radiologists benefit from every day of delay.

How do we maintain our economic status quo? In most re-formulated reimbursement models, an accountable care organization or similar proxy assumes financial responsibility for patient care, with real economic incentives to provide higher efficiency and quality. Radiologists adeptly manage processes and choose proper imaging algorithms. Clinicians practicing defensive medicine rely on imaging; radiologists cannot do more than recommend appropriate use. "Preventing" an inappropriate study is never compensated, while interpreting even the most loosely indicated study is. The results are all too predictable. Before we can redefine our role and deliver only high-quality imaging, malpractice and tort reform are needed, as is a revamped healthcare delivery model.

Short-term prospects for radiologists are excellent but the future is a serious question, especially if our training programs don't teach the skills necessary for us to remain integral parts of the healthcare system of the future. I have confidence that our leadership knows this and efforts by major societies to promote and expand maintenance of certification give me great hope. More than just leadership, however, is necessary to continue coming out on top.

Howard P. Forman, M.D., M.B.A., is a professor of diagnostic radiology, economics and public health at Yale University and Director of the Yale MBA for Executives: Leadership in Healthcare. He is also director of the MD/MBA Program at Yale. He is also a manuscript reviewer for Radiology and formerly served as chair of the Health Services Policy & Research subcommittee of the RSNA Scientific Program Committee.