Category: Resident Career

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Good Radiologists Are Like Car Salespeople- Make Them An Offer They Can’t Refuse!

car salespeople

As I was on the phone with a colleague trying to convince the referrer of why I think a patient has Paget’s disease instead of metastases, I described the cortical thickening of the iliopectineal line and the lack of activity on the bone scan at the site and elsewhere throughout the body. And I mentioned the MRI was nonspecific, with some expansion of the ilium that went along with the case. The retort was that the alkaline phosphatase level was not high. And to that, I added that Paget’s disease in the chronic phase often does not demonstrate elevation of this enzyme. All this back and forth was to get my colleague to buy into my conclusion that the case was Paget’s disease, not metastases. At this point, I realized my job at that moment was just like all the other car salespeople I know! And allow me to tell you why.

After looking at and synthesizing all the images and analyzing other less definitive dictations and reports, I incorporated all the information. Then, my goal was to package all the data into one convincing deal- an offer the physician could not refuse, just like the car salesperson trying to get us to buy a car. So, how can we, as radiologists, convince colleagues of what we see, just like car salespeople persuade us to buy cars?

Give All The Evidence For Your Convictions

Like in the case above, I gave this referrer all the reasons why I thought the osseous lesions were not metastases and instead Pagetoid. This tactic is no different than that of used-car salespeople. They will try to persuade you to buy a car by explaining why it satisfies your needs. It’s safe for kids, has Apple Play, reliable ratings, etc. Does this technique sound familiar? Did you ever think radiologists and car salespeople are so similar?

Definitively Lead The Referring Doctor Toward The Correct Treatment Goal

Using more absolute terms can lead our referrers toward the correct diagnosis and, ultimately, the proper treatment for the patient. Avoid using equal probabilities and weights in our speech and our written descriptions. We can almost always come up with a likelihood for one or another diagnosis. Make sure to relay that information to our referrers. Also, try to eliminate words like “appears,” “maybe,” and “cannot exclude” from our communications. Rarely are these terms practical. And these words connote insecurity, not the message your clinician wants to hear when trying to determine what to do next. Likewise, if car salespeople told you the car might be safe, you probably would not be too interested in it. But if they told you it is the safest car on the market, that’s another story!

Be Convincing In A Nice Way, Just Like Car Salespeople

We may sometimes feel like the referrers are dullards (and it might be true!). Nevertheless, it is critical to relay our issues in a way that is not aggressive or toxic. Talking down to our colleagues or yelling at them will not get the point across as well as a friendly conversation or chat. Likewise, it never pays to put provocative subjective terms in our dictations as these are legal records for the patient. You certainly don’t want negative phrases like these to be present when you are involved in a lawsuit; it doesn’t make you look too professional! Car salespeople need to do the same. They may secretly hate you, but they must be nice to make the sale!

Radiologist As Car Salespeople- Make Them An Offer They Can’t Refuse!

We, as radiologists, rarely realize all the roles that we play in our organizations. And excellent radiologists need not only to make the correct diagnoses but also to play the role of salespeople. We need to give all the evidence, lead definitely, and be nice to our colleagues to persuade them about the final disposition and diagnosis. In a way, we are no different than car salespeople that need to make the next sale. We must convince our colleagues just as they would need to persuade their customers to buy a car. But, I would like to think that we also use extensive training and depth of knowledge (more so than a car salesman) to get to the point of excellent patient care!

 

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Radiology Practices Feeling The National Radiologist Shortage Crunch!

shortage crunch

I can’t speak for everyone. But, nowadays, most practices throughout the country feel the pinch of an acute radiologist shortage crunch. For those on the job seeker’s side, the news right now is a mixed blessing. It is excellent for those of you searching for a job. But, once you set your career path, you may notice longer-term issues until the crisis resolves. Here are some of the problems you may encounter once you start working.

New Radiologists Making More At The Expense Of Future Earnings

Most of you probably see some of the advertisements for new radiologists on the web. Starting salaries of 400,000, 500,000, or more are not uncommon. But all this money needs to come from somewhere. Well, it is coming out of the pockets are practices, hospitals, or corporate radiology, to meet the coverage needs of the radiology work that needs completion. It just means that new radiologists are less likely to see the more significant raises they typically get when they achieve parity with the partners or own shares in the practices. Every dollar comes from somewhere!

Larger Stipends From Hospitals Means Increased Dependency

The lack of radiologists also means that hospitals are committed to ensuring that radiologists stay in the fold. Commonly, hospitals are issuing increasing stipends to practices throughout the country. Unfortunately, this process increases the dependency of radiologists on the hospital and not their work. So, when conditions change (and they certainly will at some point!), it can make it all the more painful when hospitals pull the rug out from the radiologist and stop issuing stipends upon leaner times. Eventually, hospitals are more likely to be able to take over lesser well-run practices. Too much dependency on other institutions is not ideal for the solvency of radiologists in the long run!

Unending Work And Shift Coverage

Sure, extra work is great when you are starting and are hungry for more business and money. But as you get along over time, the extra work is not so desirable. Many of you will likely have families and other obligations to which you will attend. Nevertheless, the streams of work keep on flowing to no end. And who will be covering all this work? Most likely you, whether you like it or not!

Shortage Crunch Increasing Long-Term Competition And Midlevels

I’m all for physician assistants, nurse practitioners, and other mid-levels to help the radiologist. However, suppose radiologists cannot meet the demands of the radiology world. In that case, different professionals will likely replace our roles due to a lack of ability to meet the needs of today’s imaging. These include increasing independent procedures and reads performed by these helpers. In addition, it also makes us more likely to lose work to other physicians. Cardiologists, urologists, and neurologists are just some physicians who would be happy to take over some of our business. Over the long run, this situation does not bode well for radiology practices.

More Films Going Unread And Increasing Liability

With the inability to command more staffing, more films will go unread. Patients will have more complications from a lack of appropriate imaging workups. And this can all lead to increased liability for radiology practices that are obligated to read all the films promptly. An incomplete workforce of radiologists hampers medical care and increases the potential for lawsuits!

The Shortage Crunch Continues! 

Although I do not have a crystal ball, I don’t see an abrupt end to this acute radiologist shortage crunch; The imaging loads increase every year with new technologies and the increasing age of our population. The numbers of new radiologists are not significantly increasing to meet the demands. And it takes ten years to create new radiologists starting from the beginning of medical school, so creating more radiologists is like turning a large aircraft carrier- it takes forever. Moreover, based on recent experiences with artificial intelligence, it has not replaced us or made us significantly more efficient. If these trends continue, we will continue to dive into the abyss of a shortage crunch. Good news, we’ll all be in high demand. Bad news, these pressures will probably continue for years to come!

 

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The Art Of The Last Minute Radiology Deal

last minute

Ever notice how most big financial deals are settled, not years or months before the deadline, but only a few days, hours, or minutes until the final click of the clock? Whether it’s the federal government’s budget, car purchases, or buying a house/investment property, the definitive signature and finalized contract only takes place at the 59th second of the last minute, right before the deal has to be done. Settling for a new radiology position or a contract with the hospital as a radiologist is no different. Many radiologists expect they will not have to play this game because they are physicians and not subject to the vicissitudes of the business world. Nothing is further from the truth. This dance is merely how businesses, including imaging practices, complete large financial packages. And, as we are part of the business world in the imaging world’s eyes, you should expect the same.

So, what are some last-minute items you should negotiate when you sit down at the table to create your final package? When and how should you walk away from the table to whet the appetite of the other party and enhance your party’s circumstances? We will divide the conversation about negotiating into two separate parts, the individual and the hospital. Let’s talk about the art of the last-minute radiology deal!

Nailing The Best Last Minute Radiology Package

Generally, the contract is partially negotiable when you finally go through the interview process and receive your offer in the radiology world. At this point, there is a bit of give-and-take with your future employers. Typically, the first parts to settle are the salary structure, years to partner, vacation time, and some of the oversized line items within the contract. Some of these items may be immutable, but what can you leave to the end so that you can harness the best deal possible?

Moving Expenses

Most practices will flip the bill for this service for two reasons:

  1. It is a tax-deductible expense for the business.
  2. It ties the applicant to the imaging company because they will need a residence close to the job. In all my positions after fellowship, moving expenses were available as an option paid for by the practice.
  3. You can request it at the last moment.

Malpractice Tail Coverage

Typically, most malpractice insurance companies do claims-made coverage. And, if a plaintiff sues after you leave the practice, you will still need malpractice coverage. This detail is where malpractice tail coverage comes into play. If an imaging business wants you as an employee, they may very well tack this bonus onto your contract at the last moment.

Percent Working At Specific Roles

Nowadays, there are fewer and fewer generalist radiologists. So, you may not want to practice mammography if you had little experience of comfort in the modality during residency. So, practices will often accept additional clauses securing the percentage of time that you want to work in a specific modality, especially if they need this service anyway. You can often easily tack this stipulation onto the contract at the final moments.

Getting The Most Out Of Your Hospital Deal Last Minute

Similar to negotiating as an individual for a position, often, you may play the role of negotiating a contract with a hospital. The extensive line items usually come first, like contracts, the functions that the practice will need to fulfill, etc. But what are some other critical parameters you can negotiate at the end?

Separation Clauses

Sometimes the deal does not work out the way that both parties expect. Therefore, you may want to find a way for the hospital and practice to part without too much hardship. This separation clause is a stipulation that may not seem important at the time of the deal signing. But, it is critical to have an out when things go south. So, it may not be the priority, but it is something that you can negotiate later on.

Support For Other Services (Chairman, etc.)

Some radiology services can be very costly but not considered at first glance. Here is where you can negotiate for extra support. Line items such as residency management, chairmanship, or other ancillary roles are some examples of fees that the institution should pay because they don’t come for free. These are great add-ons at the end of the deal.

The Art Of The Last Minute Radiology Deal!

Consider these line items to add to the contracts you might negotiate. Of course, they may not be the first items you would consider when starting a negotiation. But, they can be critical add-ons once at the end of the talks that can make a significant difference in your final contract. Every little bit counts when you are about to strike a deal in your favor!

 

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Should You Join A Practice With Skeleton Coverage?

skeleton coverage

We are in a brave new world. A great job market for starting radiologists is associated with a tough time with radiologist recruitment. And it’s a nationwide problem—tons of work but few radiologists to complete it. So, like many new radiologists, what do you do if you consider joining a practice with skeleton coverage? Should you join these practices or move on to the next “fully staffed” large conglomerate? What are the main risks that you will encounter when starting? Is it at all worth thinking about these practices with skeleton coverage? Let’s figure out if you are the type of person who should consider such a practice!

Advantages Of Skeleton Coverage

Lots Of Opportunities For Moonlighting

When I started, I was hungry for additional shifts to help pay down my student loans. And those spots were not always available. But, in an environment like this, with thinly covered practices, you will have many opportunities. Nights, weekends, and teleradiology coverage will all most likely be available to you, ripe for the picking. You can pay down your debts and save a bit for a new house in no time!

Opportunities For Leadership Positions

A thin bench will create many opportunities for you to become part of almost any organization role right from the bat. If you are interested in hospital administration, you can begin on this path to fulfill your ambitions from the beginning. Are you interested in teaching? Start on your merry way toward becoming a program director, no competition! Or want to become the practice’s CEO eventually? Take on financial roles immediately. You will have very little competition to get started at these positions!

Potentially A Quicker Path To Partnership/Owner

The more needed you are, the more leverage you have. And, if you have enough radiologists barely to fill the rosters, guess what? You may be able to use that leverage to up your time until you can become an owner. Think about it. You have the potential to increase your earnings significantly, more than you may have thought when you first started looking.

Disadvantages/Risks Of Skeleton Coverage

Ripe For Buyout

A thin bench can mean that radiologists can no longer take on the extra workload. It’s just not sustainable. And the casualty can be the sale of the practice to a private equity firm. Caveat emptor- may the buyer beware!

Unhappy Radiologists

More than any other factor, working with fellow radiologists with low morale can be a real downer. And, no factors more than a thin shell of coverage can cause your fellow radiologists to be stressed and miserable. Especially when you are raring to start at your first new practice, this is not the toxic environment you had signed up for when you first applied for the job.

Forced Coverage

Sure, you have all these extra opportunities. But, at what cost? Now that you are missing out on a nucs guy, you have to cover the PET-CTs. Or, maybe you have to cover all these extra available shifts you were not planning to work. If you’ve recently had a baby or have lots of other hobbies that you want to pursue, additional opportunities can be a curse instead of a blessing.

Should You Join A Practice With Skeleton Coverage?

It can be a tough call. But, it depends on your needs and wants. For the new radiologist with lots of ambition, it can be the right decision with lots of opportunities and time to make extra money. But be careful. It can be at the expense of a sell-out by your fellow radiologists or just a plain old miserable environment. So, consider all these factors when joining a practice with a thin bench!

 

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What Milestones Will You Achieve At The Age Of 50?

milestones

Now that I am on the cusp of hitting the big 50 and I have been practicing radiology for nearly twenty years post-residency let me give you some thoughts about where I have gone in my radiology career after residency and fellowship. Life does not end after residency. By showing you my career path and milestones, I hope to give you a bit of perspective on the twists and turns you can expect in your career. Also, you might find it enlightening to see the critical junctures I had and apply them to what you may want to do as you go along in your practice. I will start when I just finished my fellowship in 2004, summarize what happened in approximately five-year intervals from 2009 to 2019, and finish with the present. 

2004- My First Job

As I had just started my first practice, my first goal was to get as much experience as possible to become the best radiologist I could be. Also, paying off my student debts and saving for the eventual purchase of a house was first and foremost on my mind. At this point, I would work extra shifts and read as many cases as possible; it was a considerable adjustment after six years of postgraduate training and medical school. I made sure to attend loads of courses to keep up with radiology. And I was excited to start on a path to a partnership tract. (Turns out that happened during my second job!)

2009 – Partnership Begins

After this point, we had paid down our student loans (one of the significant milestones) and lived in our house for a bit. After years of medical school, residency, fellowship, and partnership track, I felt what it was like to settle down in a stable career; I became ensconced in the radiology residency and began to take on new roles once I started as a partner in a partnership. And, I began to learn a bit more about the intricacies of the business of radiology, not just the day-to-day practice. Work and routines became more familiar and seemed like a family.

2015-2016- Expansion And New Roles- Many New Milestones

Our practice began to grow incrementally with the acquisition of new hospital contracts and outpatient sites. Learning about how mergers and acquisitions work was fascinating as part of this expansion. And I became the medical director of one of our outpatient sites. To this day, I continue to run this private office. During this period, I learned about all the organizations and issues with new sites, ensured appropriate staffing, and began covering all the different areas at this site. The outpatient office has become a second home within the practice for me.

Then, in 2016, I decided to start up radsresident.com on a whim due to my interest in teaching and the internet. Still, it has been an incredible experience that merges all the aspects of radiology, technology, and writing that I enjoy. And it’s been going strong ever since!

2022- The Fun Continues

To this day, I still enjoy the complex cases and people that I have met in radiology since I started. Although I am no longer gung-ho about working extra shifts like at the beginning of 2004, the residency program, this website, and my day-to-day work continue to challenge me. And I look forward to going in to work every week. Moreover, extra-curricular activities play a more significant role in my life. Yes, they have changed over the past twenty years, but they are critical for having a fulfilling life and career.

What Are The Milestones You Expect Over Your Career?

Indeed, I could not have exactly predicted what would happen to my radiology career since my fellowship ended. If you had told me after finishing my training in 2004 that I would be running a blog, a residency program, and an outpatient office while being a partner in practice at 50 years old, I am not sure if I would have believed you. Changes along my career path have made the past twenty years enjoyable. So, I advise you to embrace the milestones you will experience in your career. It will make for a much more rich and exciting path. For me, I expect the next twenty years to be no different!

 

 

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Know Your Marketplace Value!

value

As you meander through your training, it is rare to hear from your hospital or training program about your actual value. Sure, you can look on the internet and figure out what the average radiologist in a particular place and situation makes. Of course, you will find salary surveys like Doximity and Medscape. But, they are often off base for your specific situation. These surveys are an odd mixture/overall average of all sorts of practitioners- part-timers, owners, full-time employees, and other employment situations.

So, why is the most accurate information so difficult to find? First of all, hospitals, corporate practices, partnerships, and teleradiology firms (and even your residency program!) are vested in either obfuscating or undercutting the value of radiologists and their practices. It is in their vested interest to hire you at the lowest possible rate to save the most money. Furthermore, you are less likely to change jobs if you don’t know your worth. And, you know what that means. Whether you are a new graduate from residency or an owner/partner of a practice, every radiology trainee and radiologist needs to know their value in the workplace. So, today I will talk about how you can figure out a closer approximation of your value in the marketplace. Knowing your worth is essential for negotiating your next offer to get your best and most comparable value in the market.

Look On Job Sites- Can Give You A Ballpark Value!

Nowadays, many job sites (comp health, radworking, etc.) can give you a vague idea about what radiologists are getting in your market. Sometimes these numbers are inflated for bad situations such as too many RVUs or inappropriate working environments. Nevertheless, it can give a general gestalt of the numbers in that particular radiologist market.

Read ACR Magazine And JACR

The ACR tends to have some good information about the state of the marketplace. It tends to tell you which trends are taking place right now. These trends can give you an idea about the hiring environment. For instance, every once in a while, they will have surveys on working environments or market demand. I find it an interesting ancillary source to figure out the general trends about how radiologists are valued.

Check Out The Big Surveys, But With A Grain Of Salt!

I mentioned some more prominent surveys before, like Medscape, Doximity, and the Aunt Minnie Salary Survey. However, you can’t entirely rely on these for your specifics. Some even include the average with residents who mistakenly add their numbers to the mix. But, if you are looking into the practice of radiology in general, they are not horrible. Then, there is the paid-for evaluation of physician salaries, which has biases. Some have a hospital bent. Others lean toward a private practice or even partnership. You need to be very careful when interpreting this information. It may not apply to your particular situation!

What Are The Needs At Your Hospital And Network?

Sometimes a microcosm of the radiologists at your local residency can be applied to other practices in radiology. For example, is your practice having a tough time findings mammographers. Most of you will hear murmurs of these issues during your residency. This gossip can help determine the value of particular specialties and know how valuable you may become to your future radiology practice when the time comes.

What Is The Mood Of The Forums?

Here is another criterion that is not entirely objective. But, it does give you a flavor of the needs of radiologists in the general community. I like the Aunt Minnie Forum because it has a general radiology bent. And, you see here all sorts of opinions on there. Of course, you will find a few trolls. But, it does give the overall mood of the specialty at a given time when it comes to radiologists and radiology practice valuation. It works as a starting point.

Knowing Your Marketplace Value Is Essential!

When the time comes to look for a job, knowing your worth is essential. Some offers will not be close to the actual value of the work that you will do. And others will be more realistic. To negotiate appropriately, knowing this number is essential. So, consider surveys, but remember they are not entirely correct. Also, consider using other ancillary methods such as the ACR magazine, online job sites, your own hospital needs, and even the overall gestalt when you scroll through the forums. All these are tools that can help to give you a better idea of your magic number. If you don’t learn this information, there is a good chance you will not receive what you are worth!

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Losing A Radiology Partnership Track Midstream

radiology partnership track

Imagine this. You have been working hard coming in day after day at the crack of dawn before anyone else starts dictating for years while on the radiology partnership track. And, you leave last. The techs and nurses love you. You answer all their questions with enthusiasm. You are nice to all your colleagues, partners, and non-partners alike. And, you have a family that relies on you to bring home a salary to pay for the house and the kid’s school. Then, one day, suddenly, one of the senior partners enters the workroom and says they need to speak to you. OK. No problem

The senior partner tells you that you are off the radiology partnership track. Unbeknownst to you, a quirky primary referrer is angry about some of the reads you have made over the past year. He threatens to send patients elsewhere if you stay on as a partner. And, the senior partner says as much as the rest of the practice likes your work, your employer has no choice but to discontinue your partnership track. You protest that your work ethic and your dictations are second to none. It doesn’t even move the needle.

This situation or something like it plays out every year at some practice in the country. The reasons for the termination of a partnership can vary widely. Anything from insubordination to malpractice, personality conflicts, or financial reasons can all cause the end. Once you lose partnership tract, you lose several years of your life to a place you have dedicated your time to a job that does not love you back. No matter how you slice it, it is a heart-wrenching situation for the employee. So, if this situation happens to you, what are your options? Which ones can work, and which ones can you avoid? Here are some of my thoughts.

Continue Working At The Practice As A Non-Partner

Usually, this is a short-term solution if at all possible. But, sometimes, you have to continue to work at the site for a bit. You may have a family where you cannot just take up and leave. And, many practices have non-compete clauses that can make it very difficult to pick up and move to another local employer. So, as painful as it may be, it can still be reasonable to work at the site for a while until you are ready to move on and start another job.

Quitting And Moving To Another Place

You will most likely still have loads of opportunities available in this market (as it stands today!). But, you will have to explain what happened at the previous practice to throw you off the partnership track. Many places will continue to allow you to work if you have a reasonable explanation. Most employers know that getting thrown off a partnership track can happen for many reasons, some nonsensical. In many cases, they may be willing to give you another chance.

However, starting another partnership track may not be feasible in certain situations. For instance, if you have one of many red flags, such as losing a partnership track for the fourth time. Or if you have a horrible reputation with poor recommendations from another site. You may need to opt for a nonpartnership job, work in teleradiology, or some corporate gigs in these situations.

Suing The Practice For Damages For Loss Of Radiology Partnership Track

Sometimes, your anger can get the best of you. And, you may not understand why the employer had to let you off the partnership track. Furthermore, all the time and money you put into the partnership track can seem wasted. However, unless egregious, this path does not usually work very well. For one, the contract laws favor the practice. A business can typically hire and fire an employee for multiple reasons. And, it will be tough to prove that not making you a partner has been illegal. Also, the practice will have deeper pockets to protect itself than you will have as a solitary employee. And finally, this pathway can establish you as a non-hirable radiologist because all this can go on the public record. Most practices will think twice about hiring someone who will sue them if they don’t get what they want.

It’s Tough To Lose A Radiology Partnership Track Midstream

Hands down, it is one of the most challenging experiences for radiologists when a practice throws them off of a partnership track. Losing out on time and the energy you put into a job can drain you professionally, emotionally, and physically. 

A partnership is subject to the whim and fancy of multiple factors. So, make sure not to establish roots before you make a partner. And, choose the best option for you and your family when and if the time arises that you don’t make the final cut. A partnership is rarely guaranteed. But, making the right choices afterward can help you move on in the best way possible.

 

 

 

 

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Rural Versus Urban Radiology- Who Wins?

urban radiology

Go to any radiology forum, and you will see an ongoing battle. Everyone wants to prove their point that where they work is the best. Some vouch for working in an urban radiology setting, and others espouse the benefits of working out in the middle of “nothing and nowhere.” Either way, I’m sure there are merits to both. But, let’s pick this topic apart and check out the overall best place to work for the average radiologist resident that is thinking about looking for their first attending job? To do so, we will enumerate and describe the main advantages and disadvantages of each of these choices. In the end, let’s look at the evidence and conclude as to which one is the most desirable outcome!

Rural Radiology

Advantages

More Benefits/Money

Indeed, this perk is the one everyone hears about the most. The farther away from civilization, the more money that most physicians make. And, why is that? Usually, hospitals need to supplement your salary to get you to work there! Nevertheless, it is a fact, and you can use it to your advantage in the outback!

Slower Pace

Everything work-related crawls at a slower pace in rural radiology. You are simply not going to see those crazy enthesioblastomas as often as you might like. On the other hand, because you are not a tertiary referral center, you can scroll the cases at twice the speed since they are much less fraught with complications.

Less Competition

Typically, you don’t need to vie for every patient and every dollar. The subsequent radiologist may be as far as 500 miles from you. So, you just don’t need to worry. You’ve just gained a few anti-stress points and lost a few pounds right there!

Nicer More Open Facilities

In the rural world, land and buildings are generally cheaper. So, you may notice larger and more modern reading rooms, better IR suites, and more well-designed hospitals in general. Lower costs for facilities usually mean more space for you.

Fresh Air

You probably know that smell when you walk outside into the natural world. Simply put, there is much less soot and grime in the air. So, all the flowers and pollen are hitting your sensory receptors as soon as you walk out the door. But, it is true. Your nose will know the difference when you work in a rural environment. And, you will gain a few extra years of life too!

Appreciative Patients

When medical resources are more scarce, patients tend to be more appreciative. You have a better shot at receiving a box of chocolates every year for your services. What you do is hypercritical in a place where fewer physicians work.

Mixed Results/Depends

You Do More Of Everything

Plus or minus. You may get to do more. Now, this may float your boat. Or it may be a cause for your concern. Either way, you will more likely be doing the arthrograms even though you are not an MSK-trained radiologist. Or you will read the mammo, even though you are not breast imaging trained. It’s part of the rural expectations!

Disadvantages

Less Collaboration

Fewer physicians mean less collaboration. That’s just how the math works. Also, it may be a little bit harder to get other expert opinions from your colleagues and your fellow specialists because they just don’t exist. Something to consider before you start a rural radiology career.

Loneliness,

For some folks, family is everything. And, when you live rurally, you have to consider that you may not have your usual family support structure. If you expect the in-laws to come by to help out with the baby, it is unlikely that will happen too often. Just something to think about when you decide to work rurally.

Different/Lack of Cultural Activities

You will not find as much theater and opera out in El Ranchero. But, you may have an excellent Strawberry festival! You just have to have expectations that you will have to travel to get some of the cultural activities you might expect in a large city.

 

Urban Radiology

Advantages of Urban Radiology

Culture

Some rads love the option to go out and watch the newest incarnation of West Side Story with the most famous actors and actresses. Others not as much. In any case, you will have more cultural options for all these activities.

Restaurants

If you like to eat out, the city is just a better environment. You have much more to choose from. And, you can have your Ethiopian fix (I like that cuisine!) and your Afghan meal for the next. It is just more readily available.

More Physicians/Collaboration

More people means more collaboration. You will have more subspecialists at your fingertips to contact and bounce ideas. It often helps when the cases are more complicated. Second opinions sometimes can be a lifesaver.

More Prestige

Larger cities and larger hospitals offer more powerful titles and sometimes more national/international respect. Working at Mass General does mean something to many other physicians and patients. Your name may carry more weight in the big city if you are into prestige.

Better High End/Tertiary Care

If you need treatment for rare diseases, most patients need to go to the big city. These places tend to be hotbeds of research and new therapies and diagnostic tools. The city is the place to be for this work.

Disadvantages Of Urban Radiology

Decreased Pay And Benefits

With all of these perks come the decreased pay because of the desirability of the location. This factor is more pronounced if you decide on a partnership track somewhere. These imaging businesses can afford to pay their radiologists less because they will come anyway!

Increased Competition In Urban Radiology

More physicians mean more competition for every dollar earned. You can’t just build a new imaging center and expect patients to come. Why can’t they get imaged at the business down the street instead?

Higher Living Expenses

Along with lower pay comes higher living expenses. Costs in cities like New York and San Francisco are out of control. And, even as a physician, the economy may force you to rent. Those Benjamins just don’t go anywhere near as far with those high housing and food costs.

Less “Outdoor” Activities

Cities are more conducive to the museums and theaters but less so to hiking up a beautiful green mountain somewhere. For you, that fact may be a game-changer.

So, Who Wins The War- Rural Or Urban Radiology?

Sorry. But, not every location will float everyone’s boats. However, I can say the following. Consider the rural job if you have significant debt because the cost of living can outweigh almost any other advantages of living in the city. The expenses alone will cause you to delay any such hope of financial freedom. Otherwise, find a place that will suit your needs for a long-term relationship. And that can be either rural or urban depending on your family and personality. Just remember. Weigh the pros and cons!

 

 

 

 

 

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Making A Radiology Schedule Can Be Tough!

radiology schedule

In any stage of radiology, we all want the best schedule possible. Most of us hope for rotations where you can enjoy what you are doing, perhaps within your specialty. We desire vacation time that is fair and equal to others in a similar specialty/situation. And, you want a call that is equitable and reasonable compared to everyone else. Not all rotations fit that bill, though. Nor is it possible to accommodate everyone all the time. If you tweak one person’s schedule, you can make someone else life miserable. The balance is delicate. It’s kind of like when you give medication, and it comes with untoward side effects! So, if you are helping out with the schedule at your institution, how can you make the radiology schedule as palatable as possible for everyone? Here are some of the guidelines that work at our site.

Get The Appropriate Tools For The Radiology Schedule

Our main job is practicing as a radiologist, not as a scheduler. So, make sure that you get all the necessary tools to make your job as easy as possible. Whether it is radiology scheduling software, a business manager, or a secretary for the practice, you should have some assistance to help you along the way. Don’t try to make the schedule without these tools. It is below your pay grade!

Be Redundant

We all are human, and calamities befall all of us at one time or another. Whether it is sickness or taking care of loved ones, we have to expect that not all of us will be available on any given day. So, every practice needs a little bit of redundancy in the schedule. That way, your practice will have adequate coverage when these events happen. It is not feasible to allow just a skeleton crew to steer the ship. It can become a potential recipe for disaster if some calls out sick!

Communicate All Schedule Changes Well

In practice, this statement sounds entirely logical. But, often, lack of communication can represent the downfall of a radiology department. If you decide to change a location or rotation, you need an excellent system to communicate the change. And, preferably, you should make the change well in advance of the new schedule. Radiologists have plans too!

Make Sure There Is A Balance

If you want to stoke the anger of your colleagues, the best way to do that is to make sure that one radiologist gets the most cush rotation at the expense of everyone else. Therefore, it is critical to monitor the different calls and rotations and ensure that the numbers are as equitable as possible for each practice member. This step can be time-consuming. But, recording where each radiologist is working and how many calls they work should become a critical mission to improve the schedule.

Be Nice But Firm

You can’t always get what you want. (Just like the Rolling Stones song!) Sometimes, we need to cover rotations and calls that no one wants. And, everyone at some point will have to take one of these shifts regardless of how they feel about it. So, if you are in charge of the schedule, there are times you have to hold your ground for fairness’ sake, of course, in a friendly way. Scheduling can be a tough job!

Take Suggestions For The Radiology Schedule

Making a schedule for a practice can be complicated. And, you might not have the experience to know what makes sense in all of the subspecialty departments. Therefore, a scheduler must be willing to listen to the suggestions of those folks that may know the rotations and schedule in their area the best. Without the input of others, it is unlikely that you will be able to create a reasonable plan for everyone!

Making A Fair Radiology Schedule

Scheduling is a critical part of any radiology practice. And it is not easy. Moreover, it may be impossible to satisfy everyone. But, if you have the tools you need and take into account the input of others while listening to some of my suggestions, you can make a schedule that will maximize equitability for everyone. It is possible to make a reasonable schedule for your residency or practice!

 

 

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Working From Home: A Difficult Dilemma For Radiology Practices

from home

Since Covid began, almost all practices have established a teleradiology presence from home. But, it is a work in progress. Some radiologists still need to man the forts, especially in hospital and imaging center-based practices. Contrast issues, treatments, complex studies such as cardiac CTAs, and on-site ultrasounds still involve a radiologist on-site. And many practices have been struggling to figure out the right mix. This dilemma leads to problems with structuring rotations, compensation, and making the staff happy. Therefore, I will discuss the most significant issues practices face and potential solutions to the most critical problems. I will divide these into rotations, compensation, and personal staff issues,

Rotation Problems Caused By Working From Home

Setting rotations to staff the practice from home versus in-house adequately can be daunting. Some radiologists typically have expertise in areas more conducive to work at home. Others need to be in the department more often. These lead to inherent problems of inequity and jealousy. So, setting up appropriate rotations to equalize home rotations can be very difficult. In addition, technologists and nurses need to be in contact for occasional events like contrast reactions and when to do so. If you create new rules, you must ensure the staff understands who to get and when.

To create equity, you have to recognize the following facts. First, only some people can work from home all the time in a non-teleradiology practice. And then, some specialties allow radiologists more freedom to work at home. Once we recognize these inherent problems with total equity and fairness, we can create rotations to equalize some of these issues. For instance, the practice can make some of the in-house rotations “easier” to compensate for inequities within the practice partially. Or, you can make some rotations on-call rotations. These are just simple ways to relieve some of the problems of unfairness among the staff.

Compensation 

Should employees and partners receive the same compensation if they can do more at home? Is there an upcharge or premium for having to come in more often? These potential inequities in the fairness of compensation also lead to other problems. Some procedures you can read at home pay more per unit worked (MRI) than others involving in-house work (IR). How do you account for that when you compensate your radiologists for their work?

Well, there are a few simple models. First, you can make all work equal with the philosophy that all work is valuable to the practice regardless of the reimbursement. It would help if you had the low RVU fluoroscopers as much as the high revenue MRI readers because they all provide a helpful service. This philosophy works much better in a partnership. In addition, you can provide more revenue and moonlighting opportunities to increase income for radiologists who are more interested in making some extra money. These opportunities help out a bit.

You can also decrease pay for radiologists who only work by teleradiology since they do not provide the same on-site services, such as management of contrast reactions, consults, and procedures. A practice can adjust the rate depending on the time worked outside the office compared to an “average” practice radiologist.

Either way, these models provide some equity for the practice.

Personal Staff Issues

Finally, you have issues such as radiologists who have extenuating circumstances. You may have new mothers or radiologists who temporarily need to move far from the practice, and so on. Sometimes, you need to make accommodations for individual radiologists so they can continue to work. Again, compensation needs to reflect the amount of time that these radiologists work outside the office and the need for the radiologist once they return. 

Working From Home: Not All A Bed Of Roses

On an individual basis, working from home can be a godsend. What’s better than being present at home with kids, dogs, spouses, contractors, and more? On the other hand, from a practice perspective, working from home introduces many additional problems. Fairness/equity of rotations, compensation issues, and individual staff issues are just some of the problems that group leaders need to contend with. Practices can work out most of these kinks. But getting the right mix takes a bit of effort and creativity. Having all radiologists working from home is more complex than it seems!