Units of work per hour

You are certainly correct about the increasing volume of mandated uncompensated work. But it is also what occurs during those hours of work that has changed dramatically.

Most physicians are paid on some variation of an RVU formula, and in some cases a base fixed salary or hourly fee. There has been little change in the reimbursement for those RVUs over the past 30+ years in dollar amounts, so inflation has significantly eroded the pay docs receive for a unit of service. In organized radiology we consider it a significant win when we can hold annual Medicare decreases to estimated overall reimbursement to 1-2%, not accounting for inflation. And of course, those decreases along with inflation are compounded year after year.

But the biggest change I’ve seen since I started practice in 1983 is the sheer volume and pace of work. That increase has allowed some specialties to maintain, or even increase, their annual income. But others specialties have not been able to sufficiently increase the volume and have seen an effective decline in compensation. The idea of having a break for lunch, even 20-30 minutes, is a thing of the past. Having time to sit and chat with colleagues or discuss a case in depth with a referring physician is long gone. Every physician I know feels that they are on a fast spinning hamster wheel and are behind the moment they walk in the door in the morning.

As just a rough guess, I think the number of cases that I interpreted each year doubled from when I started until I retired. And the volume of images and complexity of interpretation increased vastly more. What was a flat and upright abdomen with a PA chest x-ray with 3 images has become a CT scan of the chest-abdomen-pelvis with 200 to 1000 images. The reimbursement is probably 3 times what I got for the plain films. There is no comparison in the degree of difficulty involved.

The intensity of the work, the pace, and the overall volume reached a point that I know I could not do anything more. Were I to work another 10 years I know my effective income would decrease as I simply could not generate any more RVUs and the effective reimbursement per RVU will continue to diminish.