Category: Resident Career

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Radiology Attending Day One: How To Get Started On The Right Foot

day one

Imagine: Your whole adult life consisted of schooling, including four years of college, four years of medical school, one year of internship, four years of residency, and perhaps one or two years of fellowship. And you will finish it all in a few days. This situation will be yours at some point. (If not at this moment!) Now, it’s day one, and you embark upon your new life as an attending.

For most, this transition is like moving from the confines of jail to the free world. No longer do you have someone to monitor you all the time. Now you become the arbiter of last resort. The buck stops with you. (All those hackneyed phrases are true!)

The transition to becoming an attending is enormous. And you want to make sure that you do it right. So, what are the most important tasks to accomplish on day one of your new job? What do you want to avoid? Assuming you have completed your administrative tasks before starting, we will go through some boxes you should check off on your first fateful work day.

Introduce Yourself To All The Staff

After the hospital orientations, ALS courses, and all that jazz has died down; you need to make a good impression on day one. The people you meet on that first may work with you for the next 30 years! So, make your introductions to all staff. That includes fellow attendings, technologists, nurses, secretaries, and janitors. By introducing yourself to everyone, you make yourself seem like a team player that is not “standoffish.” Who wants to work with someone who can’t talk to anyone in the department?

Dress The Part Of An Attending

You don’t want to stand out too much on that fateful day. So, make sure that your attire is appropriate to the department. I remember a few attendings at my prior residency that arrived at the department without a tie for the first time. The department chairman made these attendings return home and get a tie from their closet! You don’t want to start on the wrong foot in a department where you expect to work for many years.

Make Sure To Listen Carefully To Your New Colleagues

You will hear much on the first day of your new life. Sometimes, however, you will receive invaluable advice from your colleagues that you may never get again. So, pay attention. And, take notes if you don’t have a photographic memory. You are better off having the information you will need now than having to find someone to get the same information later on when you become really busy!

Stake Out The Joint

The first days are the time to explore your surroundings (Don’t break into the chairman’s office, though!) Discover the locations of the best bathrooms, cafeteria locations, local restaurants (if at an imaging center), physician and secretarial offices, reading rooms, interventional suites, and more. Become as familiar with the surroundings as you can. This is your new home!

Ask Lots Of Questions

OK. You don’t want to ask too many indiscriminate questions (It may seem like you don’t know anything!) But you do want to ask lots of important and relevant questions. Get to the practice’s expectations, pitfalls, and more. After the first day, your colleagues may become less attuned to answering these questions, as you will no longer be the new kid on the block. Get those questions in before it is too late!

Discover Your Boundaries

Especially on that first day, you do not want to step on anyone’s toes. Ask first if you want to help with a study that may not be in your daily expected routine. The last thing you want to do: is dictating a case only to find out that the clinical attending wanted a read from someone else. It does not look good for you or the practice. So, get to know and ask what you can and cannot do.

Get Dictation Standards

Different practices have specific requirements for all radiologists’ dictations. Some want structured reports, and others need the impression at the beginning. Make sure to ask your colleagues what exactly they expect before beginning your work. You certainly don’t want to rock the boat too much!

Learn The PACS and EHR

The PACS and Electronic Health Records systems have become crucial for relevant and quality reports. In addition, knowing these systems will significantly help your efficiency (You want to get out of work on time, don’t you?) Therefore, you need to spend your first day working to make sure that you get to know the PACS and EHR well. A little time now will save tons of time in the future. Think of it as an investment.

Work Slowly And Deliberately

As a fresh radiologist right out of fellowship, you don’t want to be known as the gal who does careless dictations. So, especially on that first day, slow down. Make sure everything you dictate is correct. You have years and years to pick up speed with your work. Now is not the time to rush, and newbies make more mistakes. Don’t add to the reputation!

Radiology Attending Day One- Final Thoughts

The first day as an attending is tough. You are transitioning to a new world, just like the many worlds you had transitioned to before. So, go forward and welcome the changes with open arms. Believe it or not, you will find your comfort zone one day. It just takes a bit of time!

 

 

 

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What Really Goes On At A Radiology Practice Partners’ Meeting?

partners' meeting

I can remember back during my radiology residency many years ago. Every so often, the radiologists at my hospital would meet secretly outside the hospital for their partners’ meetings. As the radiology attendings rapidly left to abandon their shifts to get to this meeting, I thought perhaps the partnership was just like the secret societies such as the Freemasons or the Illuminati. Maybe, they had a secret handshake? Or could they be plotting the overthrow of the hospital or government? What was going on at the partners’ meeting?

Most likely, you also wonder what happens during the partners’ meeting since you have never experienced anything like it. Moreover, you are an outsider, not privy to private practice business. Yet, one day many of you will also become a partner in a radiology practice. So, today I will reveal the secrets behind what partners discuss at their business meetings. Therefore, pull up a chair, read this post, sit back, drink, relax, and enjoy. Now, you will learn the truth behind what the partners discuss at a partners’ meeting!

Finances

As you might expect, at most meetings, a business manager often discusses the current state of a practice’s finances. Are reimbursements declining? Do new potential sources of revenue exist? What imaging modalities are trending higher? Should the business renegotiate insurance contracts? For some of you, your eyes may glaze over when you hear about a practice’s finances. However, these discussions are essential for continuing business as usual. And, yes, radiology is not just about health care. It also needs to run positive income to pay the employees, the fixed costs, the partners’ salaries, that end-of-the-year Christmas party, and more. Most meetings involve financial discussions.

Long-Term Strategies- Mergers, Acquisitions, And Partnerships

Nowadays, practice size has trended upward. Many practices must evolve to create larger entities so that they can use economies of scale to reduce costs and maximize profits. What do I mean by that? Essentially, practices can distribute fixed costs among a larger group of employees, thus saving money for the business. Therefore, you probably hear a lot about practices merging or private equity firms buying out imaging companies to save on costs. Well, partner meetings are common private forums for discussing these issues. In addition, you can expect practices to talk about ways to maintain good relationships with the hospitals and clinical colleagues as a long-term strategy. This long-term strategizing all happens at some partners’ meetings.

Manpower Issues/ Human Resources

Almost every practice has its fair share of issues with employees. Perhaps, some physicians do not meet the requirements of the hospital. Or maybe, clinicians have been complaining about certain practice members. Partners meetings are the appropriate forums to discuss these practice problems. In addition, partners discuss hiring new employees to meet the demands of the practice. Partners will discuss these problems and attempt to devise solutions to match the workforce to the practice’s needs.

Scheduling

One thing that is constant in any practice is change! Whether it be new imaging modalities, increasing requirements of films to be read, or losing business to other clinicians, the scheduling demands must meet the appropriate workloads. Partnerships will broach better ways to schedule partners and employees to maintain maximal efficiency. In this same vein, practices will also debate vacation policy schedules and the appropriate workloads for daily and weekly rotations whose needs may differ over time. These items commonly enter into the typical partners’ meeting.

Beauracracy and Compliance Issues

Every year, governments develop new rules and regulations for practices to follow. A few years ago, it was ICD-10 codes. Now we have new quality improvement mandates set by Medicare. Whether for certification maintenance or hospital credentialing bylaws, these items constantly change and can be crucial for maintaining the practice and complying with the law. All partners need to keep aware of the newest compliance issues to run an imaging business successfully. What better forum than a partner’s meeting to discuss this?

Insurance And Benefits

In this category, I will include malpractice, health, life, and disability insurance, pension plans, and yearly bonuses. Partners must approve the renewal and disbandment of these annual benefits. These changes depend on the costs and overall contribution to the practice and partners. You wonder how they come up with these policies. Well, usually, this occurs at the partnership meeting!

Residency Issues

Lastly, although residency issues crop up, that can affect the practice. If you have an imaging company with a residency, the partners may or may not discuss it in a partnership meeting. But, they occasionally make it to the partners’ meeting agenda. The discussion could be about new residency requirements, a site visit from the ACGME that all partners need to plan for, a specific resident issue, a problem resident, and more.

The Secret Partners’ Meeting- Final Thoughts

A partners’ meeting is a necessary evil to maintain a practice. And, as you can see, a partners’ meeting agenda can fill up quickly. Depending on the time of year and the number of issues, meetings can take hours and hours. Yet, the partners’ meeting is an essential aspect of a quality partnership and business. So, the next time you see the partners disappearing to attend the partners’ meeting, you now have some faint idea of what happens. Although you may never learn the secret handshake (or the nitty-gritty financial details), you now know what to expect from that occult partners’ meeting. And no, it’s most likely not just about discussing you!

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A Ridiculous Error In The Radiology Report: Can I Recover My Dignity?

error

At some point in our careers, we all make ridiculous report errors. In fact, I know several radiologists that collect and sort several of these “oopsies” in the hopes that one day they will create the book of their dreams. However, some of these mistakes can feel embarrassing if you are the radiologist writing the report. Worse than that, sometimes your referring clinician or patient will call you on it. It could be a simple error like an obscene typo. (the substitution of the word “fecal” for “fetus”!) Or, it could be a detail you would have never thought to mention but your clinician wanted to know. (He asked to rule out sphenoid sinus disease, and you forgot to mention the sphenoid!) Ultimately, these mistakes go on record for all the patients and clinicians. So, how do you deal with these unfortunate miscalculations? And what do you tell the clinician? As you can tell, we will answer these questions as we dedicate this post to the delicate unforeseen “oopsie” and subsequent attempt to recover your dignity!

The Three-Step Process When You Make An Error

Make A Quick Addendum

First off, luckily, you have discovered the error in the report. Perhaps, you read the old dictation or received a phone call from the secretary. Unfortunately, however, you often make the discovery a long time after signing it off. So, what do you do? Issue an addendum as soon as possible! In most clinical practices, addendums from voice recognition technology software typically get faxed to the clinician, just like the initial report. In this situation, the clinician will receive the addendum with the rest of the dictations for the day.

Guide The Doctor To The Correct Report And Follow-Up

However, issuing an addendum is not enough. Often, the clinician will not expect the fax you give as an addendum. Bottom line: it might not get read. And sometimes, the undiscovered “oopsie” may lead to inadequate follow-up, insurance problems, patient anger, or other subsequent clinical issues. Therefore, the rules of mutual respect obligate you to contact your referring physician directly by phone or in person, if possible. It’s a horrible phone call, but you must close the loop.

Profusely Apologize For The Error

Although a touchy subject, I would recommend apologizing to the clinician (or patient if necessary) for the error. More importantly, let the receiver of the error know that you have made amends by changing the report and following up with the report recommendations. Most clinicians will appreciate your effort to correct the issue with the dictation.

Can You Recover Your Dignity From An Error?

Unfortunately, I can’t give you a better answer than it depends. For ages, some may refer to you as the clinician who added a ridiculous mistake to their patient’s report, potentially giving you an unwarranted reputation. On the other hand, others will realize that you made the error as a “one-off” and will quickly forget. Regardless, we need to negotiate these pitfalls as the hazards of our profession. And most importantly, we are more likely to garner respect from our colleagues by dealing with the consequences of the “oopsie” head-on rather than lurking in the shadows, hoping the error will go away one day. So, don’t just ignore the error, so you don’t draw its attention. Instead, own your mistakes before they own you!

 

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Work Expectations For New Attendings: How To Know If You Meet Them

work expectations

Every career stage has its difficulties. And you thought figuring out the ropes as a resident was difficult? Working as a new board-certified radiologist in your career of interest is no different. Just like you have in the past, you will worry about both the quality and quantity of your work. So, how do you know what you do is enough to make a good impression on your future partners and colleagues? Some would say that if you have to ask this question, you are probably not reading enough. But I think that answer is way too simplistic. Instead of relying on aphorisms, let’s go through some work expectations for completing enough studies at each early stage during the first few months and years before starting as a partner in a practice.

First Few Months Of Work Expectations

At the beginning of your first employment opportunity, most practices tend to give new employees a bit more leeway (although not all!). Rather than focusing on quantity, most practices would want you to concentrate your efforts on maintaining the quality of your work. That said, if you garner a reputation of working slowly as a slug, that is not likely to do wonders for your likelihood of becoming a partner or a long-term employee within a practice. Most practices have unstated minimum work expectations. And as a new employee, you should expect to try to take as much work as you can reasonably muster so long as you are not overdoing it and you are not sacrificing the quality of your work.

You should always try to help by taking extra cases, performing as many procedures as possible, and becoming the “invaluable go-to guy or gal.” Don’t let yourself get stuck in the mind frame of “that is not my responsibility.” Of course, if the folks that run the practice are assigning you duties that you have not trained for and cannot complete, you need to say something. But for the most part, you should welcome the additional responsibilities and expectations the owners have given you.

So, what are some signs that you are not reading enough to maintain weight and meet practice work expectations? If you notice the partners are frustrated that they have to take over much of your work because you are not working fast enough, then maybe you need to consider taking it up a notch. Fortunately, most practices, however, will give you a little bit of leeway at this point in your career.

First Few Years

After the initial probation period, you really have to consider whether you are keeping up with the appropriate amount of RVUs and meeting work expectations. No longer can you rest on your laurels because you are the new gal in town. It’s not just about quality anymore!

At this point, your colleagues expect you to pull your weight by completing your assigned lists, which is why they hired you. In addition, you should be helping out with others; if the day ends at 5 pm and you can help others complete their work after this time, by all means, go ahead. Especially when you have your sights on the partnership, you should put your best efforts forward. At most practices, your performance still counts toward your group’s chances of adding you to their fold.

Which candidates will your practice cut during the first few years? Essentially, any partnership track employees who did not fulfill the expectations of their initial reasons for hiring. If you feel that this includes you in this category, beware!

In addition, those folks on the chopping block include employees that cannot adapt to workload changes and work expectations. Practices are not stagnant. Instead, you can’t expect to read the same amount of studies in any given year. Working conditions can become busier, or your practice may add new modalities and procedures. So, always ask if you are keeping up with their expectations even after your first few months. You are not quite at the end of the tunnel until the group has officially voted you in!

Final Thoughts On Work Expectations

Working at a job where you intend to stay for years is more of a marathon than a sprint. Therefore, your mentality needs to be one of “what can I add to the practice?” rather than “why should I do extra work?” or “it’s not my job!” If you maintain this attitude toward your work, you will not only form good employment habits, but you will also think of your role as part of a team effort, not just pulling for oneself. And in the end, that is what most partnerships expect. So, go forth and put your best foot forward. Then, you, too, will find success!

 

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How To Add A New Modality To Your First Practice Fresh Out Of Fellowship

modality

The most significant controversies in private practice often stem from workload/relative value unit (RVU) or differences in “earnings” among physicians. Anytime one physician “works more” or earns less on a daily rotation, partners and employees interpret that difference as unfair. Even more so, radiologists heighten this perception when one physician performs this rotation more than others. So, imagine starting and attempting to introduce a new procedure or imaging modality to a radiology practice right after graduating from a fellowship. Often, this will tip the workflow balance for an entire radiology business. So, how do you incorporate this new work into a practice’s current workflow? And what might you need to do to sway your partners to change the workflow for this new procedure in your practice? Today, we will delve into what you need to know as a new radiologist fresh out of fellowship who wants to start a new program or modality.

Show That The New Modality Increases Practice Value

To begin the process, you need to demonstrate that the new procedure adds value to the practice. What do I mean by that? Well, your job (if you choose to do so) becomes to convince your partners that your procedure or modality will eventually increase or at least maintain business.

How do you go about this process? One of the easiest ways to accomplish this goal is to give a practice-wide presentation. To do so, you need to show that your new modality will provide revenue above and beyond what the practice brings in. If this is not the case, you should demonstrate how the new procedure may act as a loss leader or at least increase ties with the hospital for all to benefit.

Another option to increase the buy-in of the partners would be to perform the art of “politicking.” Talk to your partners individually to get them to understand what the new procedure/modality will bring to the practice. So, when it comes time to discuss adding your new procedure to the daily rotations, each radiologist will be on board.

And finally, you need to consider what the practice will need to add and the costs to start the new procedure or modality. Is this procedure going to take away from other businesses in the practice? Or, in the case of new high-tech equipment, are the costs prohibitively expensive? These items are crucial to think about before beginning the new procedure.

Make A New Schedule That Is Fair For Everyone

Next, you need to think about not just the procedure value but also you should develop ways to incorporate the new procedure into the schedule reasonably. The less onus on the partners to establish a new schedule, the more likely you will be able to add the new modality to the practice. So, come up with ideas about how to add the new procedure. Perhaps you want to first tack it on to a current rotation. Or maybe, it is worthwhile to go full-steam into a new daily or weekly rotation. You must consider working out these factors before “going live.” If you cannot accomplish this, the chances of creating a new addition to practice dramatically decrease.

Be Aware Of The Politics

Sometimes beginning a new venture can wreak havoc on a practice or hospital system. For instance, adding a new SPECT/CT to one site may take away business from another within the system. This new equipment and procedure may decrease the employment opportunities for technologists within the site that does not have the latest technology. And, you may get a lot of pushback when you try to add it to the site. Therefore, taking the politics of the practice and hospital before beginning the new procedure is crucial.

Don’t Overwhelm The Decision Makers

These steps listed above are instrumental to creating something new in your practice. However, you have to tread very carefully. Frequently, your partners may be busy with lots of other practice requirements. So, try not to overwhelm them. What do I mean by that? Ensure the new procedure will not burden the partners and employees significantly. In the beginning, consider taking on much of the excess work yourself to get the new modality started within the schedule. Remember, you are the champion of this new procedure. So, it would help if you put in additional work to begin up front. If not you, then who else will do it?

Bottom Line For Starting A New Procedure Or Modality

Whenever you want to start something new within a practice, it is not enough to jump right in and begin. You need to put in much forethought and work before beginning. Starting something new not only affects the person initially responsible for developing the initiative. Instead, incorporating new procedures into the schedule affects the entire practice due to its effect on workflow. So, show that the modality increases practice value, demonstrate how to incorporate it into the schedule reasonably, be aware of the politics, and take on much of the initial grunt work yourself at the beginning. If you can accomplish these steps, you markedly increase the chances of starting a new procedure or modality within your practice for the benefit of all!

 

 

 

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The Real Reasons Partnership Track Salary Offers Are Lower (And The Risks You Take!)

salary offers

Now that you are beginning to search for employment opportunities or have plans to start in a few years, you may hear a bit about the employee and partnership track salary for radiologists. Also, you probably have learned that new radiologists on the partnership track earn significantly less. Since you were hoping to become a partner in a practice, are you getting sticker shock about the lower partnership track salary offers? And, why do stark salary differences exist between a partnership track position and an employee anyway? Moreover, what are the pros and cons of taking on this lower starting salary? To answer these questions, we will examine the most critical reasons why starting salary offers differ dramatically. Then we will discuss the risks you take when starting with this lower partnership track salary.

Why The Differences In Salary Offers?

Increased Partnership Income

After all these years, you’ve probably heard the adage: you never get something for nothing. In this case, this aphorism holds. Those who take on a lower starting salary get more significant rewards in the end. When you start on a partnership track, you sacrifice your current income for future increased income. So, that makes a bit of sense.

Buy-ins And Buy-outs

When you start as a partner in private practice, it’s only fair to put some of your money toward buying a share of the practice’s assets. These assets may be accounts receivable, buildings, equipment, and more. No one is going to give that away. So, here is where the buy-in comes to play. Usually, practices will deduct some of this amount from your initial salary during your partnership track to pay for it. We know this amount as “sweat equity,” or the work/money you must put into the imaging business to share in ownership.

Bigger Benefits

Hey buddy, it’s not just about the salary. The fringe benefits of partnership often make a more considerable difference in your lifestyle. In the case of many partnerships, partners get larger pensions, increased malpractice insurance, more extensive life and disability insurance policies, tax-free car write-offs, cell phone and internet usage deductions, and more. These perks can add up over time. So, practices tend to compensate for these more considerable benefits by issuing a lower salary on a partnership track.

Increased Control

Nowadays, it is next to impossible to control almost anything fully in healthcare. However, entering into a partnership allows you to manage your destiny more than working as an employee for a practice. No doubt, the increased control you will eventually obtain from completing a partnership track factors into those first few years of partnership.

What Are You Risking For All Of This?

The Chance You Will Never Make Partner

You take a leap of faith when you begin on a partnership track. Rightfully so, you assume that you will be able to meet the requirements of the practice and eventually become an equal shareholder. But what happens if this is not the case? Well, that can be undoubtedly devastating. You will lose out on years of potentially higher income that you would have made elsewhere. So, you are looking at potentially significant risk when starting a partnership track.

Company Buyout

More commonly than ever, large corporate conglomerates and massive practices buy out smaller “Mom and Pop” firms or even mid-size practices. Let’s say you happen to be on a partnership track at the time of one of these buyouts. In this case, you will have no guarantee that the new owners will add you to the partnership track, issue you any significant benefits, or even compensate you appropriately when the buyout ensues. All your hard work and lower initial starting salary proverbially can be down the drain.

Partnership Will Not Be The Same

You go onto different forums (check out Aunt Minnie!), and you will find many threads on this topic. Let’s say everything goes great, and you eventually become a partner in a practice. Who is to say that the results will pan out? Sometimes, but not often, private partnership salaries can be lower than the salaries that their employees enjoy. Especially for practices that are not well run. Or, maybe, reimbursements for procedures will take a nosedive when you are working on a partnership track. Who knows if the benefits will remain 5 or 10 years down the road?

My Bottom Line

You probably understand why practices issue lower salary offers to employees on the partnership track than their employed colleagues at this point. You are receiving the potential for real future benefits. 

At the same time, however, working on a partnership track involves taking significant risks. What you choose in the end will probably pan out. But, it certainly does not always work out. Therefore, before starting any job, you must do your due diligence and determine if a partnership track or employed position works well for you. Good luck with your search!

 

 

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Contract Negotiations: What Do You Ask From Your Future Employer?

contract negotiations

When you are in the process of completing a residency or fellowship, looking for a radiology job becomes a daunting task. Not only are you trying to find a career that will last for years, but you are also left alone swimming through the complexities of contract negotiations, an area you probably have not experienced before. It’s a brave new world.

 So, what do you do? As a typical resident, you find general information on the internet about the basics of contracts. And if you contact an attorney, he will probably give you generalities about how to approach contract negotiations. But, this post is different as it outlines what negotiation points a practice is more likely to give to the applicant.

To that end, today, you will get an insider’s view of what you are most likely to be able to negotiate and which benefits you may find difficult to change. You will also receive the perspective of someone who works as a private practice partner and advocates for his residents. Remember, I am not an attorney, so I am not providing legal advice. Instead, I am telling you what I think practices are more likely to leave on the table for negotiation and what items practices do not want to touch.

Depending on the desirability and location of the practice, however, you may be able to get a lot more, or you may have no wiggle room at all. That is something you will have to judge for yourself based on what you know about the practice. So, let’s go through some of the basics.

Benefits You Can Negotiate More Easily

Moving Expenses

Moving can cost a lot. Generally, you are talking about multiple thousands of dollars, especially if you move a substantial distance. However, many practices will usually be willing to include this benefit into the contract. Why? First, it is a tax-deductible expense for the business so that the practice will pay for it in pretax dollars. And then, it pays to create as many connections for you to the area as possible. What better way to accomplish this than to provide for moving expenses?

401k Plan Perks

Typically, practices tend to be more flexible with indirect expenses such as matching contributions to a 401k plan. Why? Again, it is a pretax benefit that the business can write off. Yet, it does not appear as an increase in income. Partners would prefer to negotiate a 401k plan than a salary because increasing a wage could lead to adding on additional income to other employees. It is much harder to calculate indirect perks!

Time Spent In Particular Departments

Maybe you hate mammography or can’t stand interventional procedures. In the beginning, discussing your expectations for where you want to work in the practice is entirely reasonable. For some applicants, this can make or break the quality of a job. And, for the imaging business, this can be a minor concession compared to other benefits!

Malpractice Tail Insurance

Malpractice tail insurance can cost an employee thousands of dollars when they leave a practice. So, this can potentially be a significant cost saving. And the practice can pay for coverage with pretax dollars. Like the 401k plan, it differs from the subheading of salary/income. For these reasons, the imaging business may be more willing to budge a little on a negotiated contract.

Restrictive Covenants

Nowadays, many practices place restrictive covenants within the contract to prevent the applicant from leaving and working for a local competitor. Each state enforces these covenants differently, and the time and distance restraints can vary widely. But, this can potentially lead to a problem if you want to continue living in the area and decide to quit your job. However, it is very unusual for a practice to enact the clause on a former employee legally. (although possible!) So, if you need to stay in the area, no matter how the job goes, this may be an item that you should consider entering into contract negotiations.

More Difficult Items For Contract Negotiations

Annual Income

Salaries are usually the most challenging item to negotiate. Why? Although typically not allowed, employees will often compare salaries, and tempers can flare if the employees perceive their salary as unfair. In addition, the partners usually compare the salaries of all their employees and themselves. It becomes hard to create a fair deal that does not impact others in practice. Some employees may have had more experience, and others bring particular skills to the practice. So, it can seem unfair among the partners as well. Unless you are in an enviable position of working at an undesirable location or you have a particular skill that the practice cannot find elsewhere, annual income is not as easily changed.

Years To Partnership

Years to partnership can also be a very touchy subject. Partners may have invested themselves in the business for years. And, you want to change the system to give you fewer years to partner? That typically does not fly as well as negotiating other benefits. In addition, large sums of money are at stake for each year removed from the track. So again, you will be hard-pressed to negotiate fewer years to partnership.

Buy-ins

Typically, a buy-in or sweat equity is an amount you pay to the practice for the privilege of becoming a partner. This number can vary from a nominal amount to millions of dollars. Again, emotions can flare when you decide to change the amount it costs to enter a partnership, as you may have to pay less than the other partners. In addition, some practices own equipment or real estate. It would be unfair for the practice to give away these assets. Depending on the business, this can be a challenging item to negotiate as well.

Loan Repayment

Unfortunately, residents bemoan student loans more than anything else. And the high debt burdens residents must face paying for the privilege of going to college and medical school can be overwhelming. To make things even worse, however, most practices will not make this an employee perk because the practice cannot deduct the money pretax. Perhaps even more important than that, the business has to trust that the employee will not skip town and leave the practice prematurely. As you can see, imaging businesses take a lot of risk by adding this benefit to sweeten the deal for the applicant. Therefore, a new employee getting loan repayment as a benefit is unusual unless the practice is in desperate need of the applicant.

Contract Negotiations: A Battle Or The Beginning Of A Great Friendship?

Finally, I have not mentioned the most critical point of contract negotiations. A contract is only as good as both of the parties’ word. A contract can be ironclad for the employer or employee. Regardless, the specifics outlined by a contract are rarely used if the employee likes the job, and the employer likes the employee’s work. Only when things don’t go as planned the contract becomes truly important. So, here’s the bottom line and the irony of it all. As crucial as contract negotiations can be, invest more time and effort in figuring out whether the job is right for you rather than worrying about the nitty-gritty details of the contract. Good luck!

Comments

Have any strong opinions about other items that should be negotiated in a contract? We would love to hear your thoughts by commenting below!

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Partnership Track Behavior: A Primer

partnership track

Congratulations! You’ve nabbed the job you have always wanted. And your employer has placed you on a partnership track. But, you know that not all who started on the partnership track made it to the Promised Land. To prevent yourself from becoming the next casualty, you’ll do almost anything to ensure that one day you will become a partner with all its benefits. So, how can you entice your employers over the next two, three, or four or more years to take you into their fold? Having experienced the process and worked for many years as a partner in private practice, let me give you some basic tenets you need to follow.

Make Small Pleasant Waves, Not Large Ones

Let me tell you a little obvious secret. As much as the practice owners say they will treat you the same as other partners, please don’t believe a word they say. Until the day that you become a partner, any current partner can use any irritation or error against you. Worst case scenario, the upset partner can delay your partnership indefinitely!

So, my advice to you is: don’t rock the boat. Do what you must, but don’t push your views on others. Sure, consider changing a knee MRI protocol with the blessing of all the other MR readers in the department. But, don’t overhaul all the protocols on the magnet without their consent. Talk to the CT scan representative but don’t volunteer to become the promoter of the CT scan manufacturer without notifying the chairman. And so on. I think you get the picture.

Complete All Your Assigned Work And Some

Want to impress your fellow practice partners? Of course, you need to complete all of your work. But even more importantly, when you finish everything, help out your fellow radiologists. Over time your extra effort will get noticed. It certainly can’t hurt to have rave reviews from your cohorts when the time comes for them to vote you in as an equal shareholder. Who doesn’t want a fellow partner that always wants to take on additional responsibilities?

Pace Yourself

Many former employees never made it to partner: What do they have in common? Either they made too many mistakes because they read films too fast. Or, they become so worried that they will miss essential findings that they take forever to read and dictate the studies. Especially at the beginning, you don’t want the partners to categorize you as either of those sorts of radiologists. So, take your time. But remember, you don’t have all the time in the world!

Avoid Saying Anything Bad About A Partner

This advice seems obvious but is a common reason for ending a partnership track or, even worse, your employment! Never. Never utter a bad word about your superiors to anyone else. Trust me. Trash talking about your colleagues is a cardinal error that will bite you when you least expect it. Indeed, that partner you were talking about will not want to hear that he is lazy when the time arrives to decide on your future!

Don’t Complain Unless It’s Unavoidable

OK. Maybe, that PACS system keeps malfunctioning. Or that technologist always to forgets to put the measurement of the spleen on the worksheet. Try to deal with these minor situations yourself before running them by the partners. No one likes a constant complainer. And, who wants to make that person your fellow partner? Indeed, not your employers!

Volunteer For Practice Building

You are taking on a partnership track for a reason. Of course, you expect to play a role in not just the daily reading of films and performing procedures. Instead, you desire to involve yourself in the other facets of the business. In that vein, nothing looks better than taking on Grand Rounds talk that no one else can or wants to do. Or volunteer for the hospital credentialing committee. Perhaps, you should become the point man for the CT lung screenings in your community.

Practices usually do notice these additional activities. But most importantly, the partners appreciate the extra effort when the time comes to vote on your final disposition.

The Psychology Of The Partnership Track

Like any other path that you have undertaken in your career, you have to first start at the bottom. Beginning a partnership track is no different. So, put your tools to the grindstone and prepare to work hard for the time you are on a partnership track (and hopefully beyond!). Only then can you increase your chances of reaching your final goal of reaping a partner’s added rewards, prestige, and respect!

 

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Should I Be An Independent Gun For Hire?

independent gun

Nowadays, new radiologists may face a new choice, not as prevalent years ago. As such, you may work for one or more than one firm that allows the option of independent contracts or employed work. Most commonly, this decision exists for those who choose teleradiology. But other arrangements are also possible. So, what do you do? Do you operate as an independent contractor getting yearly 1099 forms? Or do you take employment wages and receive a W-2 at the end of the year? Although this decision may seem innocuous, significant consequences await those who don’t think about how to proceed. So, today we will discuss the advantages and disadvantages of contracted work. In addition, we will talk about a significant pitfall you must avoid when you begin your first independent contractor job. Let’s start!

Reasons To Become A Gun For Hire

Independence allows radiologists to contract out with multiple groups. Many employed positions muzzle the worker by outlining in the contract that they may not work with other groups or outside work. On the other hand, theoretically, as an independent contractor, you can work with five or more different groups and facilities. Similarly, the more the independent contractor works, the more you can get paid. This workflow differs dramatically from an employed worker that often has a fixed salary with, perhaps, a small production bonus.

In addition to the ability to work with multiple facilities, the independent contractor can also deduct expenses from their income taxes. As a typically employed radiologist, you cannot write off items like fax machines, paper, health insurance, 401k plans, and more. When you work for yourself, all these deductions can significantly reduce your taxable income. Therefore, making more take-home income with the same salary is possible.

Then, of course, depending on how you structure your business, you may be able to take advantage of the new tax laws that favor corporations. For instance, you may depreciate capital equipment more rapidly over time. And, if your income dives below a lower threshold, you can deduct additional earnings as a pass-through corporation. Additionally, you may be able to put more retirement account funds away in a SEP-IRA versus an employed 401k plan. Whatever the case, I highly recommend discussing the consequences of different corporate structures and tax ramifications with your accountant.

Becoming A Gun Is Not All Peaches And Cream!

What issues do independent contractors need to contend with? Maintaining contracts with different entities becomes your responsibility if you independently contract with multiple facilities. And the loss of one or more contracts can devastate your finances if you rely on this income to sustain your household. No longer can you rely on your employer for your paycheck.

Working for yourself as an independent contractor can also become a lonely business. Instead of working in an extensive practice with many other radiologists, some independent work can isolate you from your colleagues. For some, this can be a potential deal breaker.

Other issues arise, such as traveling from facility to facility to work. (if you work at multiple locales) If you have a more capital-intensive business and, for instance, you run remote computer software, you may need to fix the equipment if it goes down. Or, if you work from home and have a power outage, how do you run your business? These questions do not have to cross the mind of the employed radiologist.

Finally, if you employ other workers/services, you also rely on their work. If they don’t show up, you don’t get paid!

A Major Independent Contractor Pitfall

For those of you who go down the road of an independent contractor, you must remember what you take home; you do not entirely keep. Naturally, you always have to save additional money for the taxman. More than that, you will also likely need to pay quarterly estimated taxes to prevent IRS penalties. Again, I would talk to your accountant about the details of your situation.

To Be Or Not To Be An Independent Contractor

Becoming an independent contractor as a radiologist certainly can have significant benefits. But, no job comes without its pitfalls as well. Suppose you like the independence of working for multiple groups, getting paid as much as you work and being able to deduct certain work expenses. In that case, independent contracting has a certain allure. At the same time, it also involves different risks you must take. Additional rewards never come without some sacrifice!

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Nighthawk: A Viable Career Option For Radiologists?

nighthawk

When you think about the field of radiology, do you picture yourself working from dusk to dawn for years at a time? I suspect that most of you have not. More likely, you’ve probably dreamed of a 9-5 job with an occasional call on weekends and evenings. So, what do you lose out on by beginning a career as a nighthawk? And, are there any permanent advantages to working as a Nighthawk for years? Let’s delve into the main issues of working as a radiology Nighthawk.

Why Nighthawk Can Be So Difficult

Imagine yourself on the computer at night beginning at 10 pm and working until the wee hours of the morning at 7 am, reading films night after night. For most people, social and business activities occur during the daylight hours. So, when you create a schedule for yourself such as this, you essentially live the life of a loner. Sure, you may receive phone calls from attendings and medical professionals who need your assistance from time to time. But are those interactions you looked for when you decided to go into radiology? Probably not.

Furthermore, say you need to take care of some business at a bank or make returns to a store. These mundane activities turn into a real hassle. Instead of conveniently stopping by these places to take care of business, now you must reverse your entire schedule to get there. It can be hard enough sometimes to get out of work, even for me during the daytime! I can only imagine the difficulties for a nighthawk.

And then, of course, there are the health issues. Study after study has espoused the dangers of reversing one’s sleep schedule to counter normal nighttime sleep. Take a look at this article from the sleep foundation (1). They list many physical, mental, performance, and safety issues the night worker encounters. Believe it or not, it includes increased cancer risks, depression, and more. Do you want to take on these increased risks?

The Allure Of Nighthawk

Yet, wouldn’t it be nice to set up shop any place you want? Do you want to live on the west side of Manhattan? Or, maybe rent a home in Malibu on the beach? Well, it doesn’t matter if local jobs are unavailable when you are a Nighthawk. You can work from anywhere. But is it worth the sacrifice?

For some folks, Nighthawk positions allow radiologists to get their proverbial foot in the door. In some locations, getting into a practice can be exceedingly tricky. (although not as much in the current job market!) And sometimes, Nighthawk can be a solution. Because the hours are less desirable, radiologists are less likely to compete for these entry jobs. Now, you have a way in. But don’t think you can quickly work your way into a daytime position. Other radiologists in practice certainly will not chomp at the bit to take your place!

Then, working at an office or hospital with others may not sit well. Some people would instead go it alone, literally. Of course, Nighthawk from home can be a very solitary assignment. Maybe, this is what you want from life.

And finally, practices will often jack up the income stream to entice the new radiologist to take a Nighthawk position. The savings can be enormous for those of you with extreme debt (I mean greater than 500,000 dollars). Of course, it is not without sacrifice, however.

To Make The Ultimate Sacrifice- A Nighthawk Position

In the end, it is your decision. A Nighthawk position does have significant advantages, but not without substantial sacrifices. If you are willing to forego convenience, tempt fate, and live a loner’s life but live where you want and pay your debts off sooner, then maybe, just maybe, a Nighthawk position is for you!

 

(1) https://sleepfoundation.org/shift-work/content/living-coping-shift-work-disorder