Tag: career

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What’s In The Cards For The New Radiologist Job Market After Covid?

radiology job market

In such a short time, a matter of weeks, the tenor of the radiologist job market has changed dramatically. Jobs in radiology were bountiful up until the beginning of March. Then, suddenly, elective procedures trickled down to almost nothing. And, practices began to fire their locum’s workers and furlough many part-time and full-time employees. But, this status will eventually end. And, the radiology job market will change and then establish a new baseline. But, what will that new baseline be? Can new graduates look forward to a booming job market once again? Well, let me give you a summary of what I think will happen as Covid-19 begins to wind down.

From Now To Three Months From Now

As we see a slight ramp up in elective studies, we will not yet see a brisk demand for radiologists. We will still have significantly fewer procedures, as many folks do not want to go to an imaging center for fear of contagion. However, many “elective” interventions, such as colon surgery for previously detected masses on colonoscopy, will need to begin again. But, don’t count on seeing many practices hiring just yet. Most practices will be more than adequately staffed during this time for the number of studies. Hiring freezes will remain.

Remember. You will continue to see advertisements for radiologists, but practices paid for these previous to the pandemic. These advertisements do not represent the current state of the job market!

Up To A Year From Now

Here, I will have to make a few more assumptions. But, I will postulate that a widely available vaccine is not yet available. And, I will conjecture that we have more widespread antibody testing (unlike now). Based on these premises, we will see more folks willing to come out to get their studies, especially those that tested positive for the antibody. However, fear will still prevent a lot of patients from getting the elective imaging that they want as not everyone will feel comfortable returning to hospitals and imaging centers. So, the patient load will not be back to the baseline. And, many practices will still be overstaffed based on the pre-Covid demand.  Therefore, new hires will have fewer job choices with lower salaries. Prospective new hires will face a tight job market.

The New Baseline Post- Covid Era Radiologist Job Market

The further you go out, of course, my predictions will become less accurate. And, we will assume that Covid infections go away from vaccinations and herd immunity. But, having seen other cycles, I believe that we will see several changes from the pre-Covid world. First of all, many patients will likely still be reluctant to return to imaging. Why? Unemployment will be much higher than what it once was before the pandemic.

Additionally, we will see a cultural shift of less imaging than before the crisis. Patients will more likely demand higher standards for cleanliness and sterilization. And, therefore, we may see fewer radiology procedures than in the pre-Covid world.

Also, many practices will have augmented their home teleradiology capabilities. So, reading efficiency will have increased dramatically.

Then, to add insult to injury, private equity firms and corporate radiology have become more significant players in the radiology space. These firms, formerly offering enticing salaries to new graduates, will now significantly lower the wages of new hires. Furthermore, we will see a decline in the salary of the contracts of the old hires since these firms renew these contracts on an annual basis. Why will this happen? Because profits rule their bottom line, and corporate radiology can cut with impunity. Corporate radiology will work radiologists to maximal efficiency, skimming any gains that they can from their radiologists. They will have no incentive to hire.

Finally, if we assume that the stock market remains lower than it was before March 2020, many prospective retirees will not retire. Why pack it in when your portfolio remains much less than what you planned at the time of retirement?

Between all these significant factors, the radiologist job market will not return to the pre-Covid era baseline. Instead, the market will most likely be more similar to the world five to ten years ago when good jobs were harder to come by.

What Are The Chances That I Am Wrong?

Of course, I can be wrong. However, I see the winds of change ahead based on what has happened in previous cycles. So, for those folks that are graduating soon, don’t expect the same radiology job market as the recent past. You will most likely have to work much harder to get the same position at a lower wage.

So my recommendations for you, as for years prior, take your training and residency seriously.  Be competitive. Step out of your comfort zone. Aggressively take charge of your education to become well versed in all areas of radiology. And, finally, expect to practice in locations and subspecialties that are not your primary area of interest. Although not for forever, we will see a return to a world more similar to the previous down cycle of the radiology job market. For those of you soon to find jobs, prepare accordingly!

 

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So, You Want To Become A Radiology Chair?

radiology chair

Maybe, you are ambitious and want to head a department. Or perhaps, your parents have high hopes for you and want you to become the boss. Although you think you may know, you probably have no idea about what goes into the radiology chair role. I know I didn’t until I started to practice. And, it can be challenging to find the truth about the job description (because they have too much bias!). So, what better venue than this blog to give you an accurate depiction of the position?

Of course, how much work you want to put into becoming a Radiology Chair is up to you. But, what does it entail to play the role of the Chair and do it well? And, is it worth the extra effort? First, I will discuss some of the personality traits that may be beneficial for the job. Then, let’s talk about the work, struggles, and benefits that you will need to think about before you start the process of working toward this goal. If you dare, go into this job pathway with your eyes wide open!

Personality Requirements For The Radiology Chair

Politically Savvy

Why is it critical to have a knack for politics? Well, invariably, there will be political factions that will push you towards different ends. And, you need to be strong enough to move the ship in a direction that is just and right for the practice. Therefore, you will need to deal with all sorts of personalities and points of view well.

Not Take All Criticisms To Heart

As a Chair, you will hear and field mostly complaints from colleagues, staff, and hospital administration. Very rarely, do folks get a compliment on a job well done. (Even if you are doing so!) So, you will need to let the upsetting criticisms slide off your back. Do not take it to heart. Or else, you will become a depressed and bitter radiologist!

Good Communicator

You need to let all parties know what you are doing with an open hand. One ingredient that gets employees more upset than anything else: finding out changes after the Chair has implemented them. Or, not letting anyone know about your intentions. Poor communication is a recipe for disaster in practice.

Strong Decision Maker

And, finally, this position entails making some hard choices that you will have to live with for the rest of your life. You will need to hire, fire, budget, and strategize. I would recommend that you have a strong stomach to make these decisions. Rarely, can you make everyone happy with all the decisions you make.

Job Requirements

Hiring and Firing

First of all, you will have the honor and privilege of hiring new employees. Not so bad, huh? But, that also comes with the painful task of firing ones that are not working out. If you have never experienced such a job, let me tell you, from my experience as a partner, that is certainly not fun. And, the Chair tends to be the leading player in this activity.

Fielding All Complaints- Radiologists And Other

Any practice of substantial size will receive complaints. And, if you are not getting them, you are probably not reading enough films to sustain a business. But with the territory of Radiology Chair comes fielding those complaints. And these can be from your practice, staff, hospital administration, or other clinicians. You will soon discover that many folks are not happy. And you have to deal with it all!

Attending Tons Of Meetings

If you like meetings, the chairman position is the job for you. Between partnership meetings, hospital staff meetings, galas, and more, you will soon become all too familiar with gatherings. You better have some tolerance for this activity!

Paperwork and Budgetary

As the head of a department, your signature needs to go onto lots of documents. It’s not official unless your name is on it. Moreover, you need to read those papers. Indeed, you don’t want your name going out on something you or your practice does not want.

Future Planning/Strategic Management- Mergers, Acquisitions, Contracts, Etc.

OK. I think that this part of the job is not so bad. Who doesn’t like planning the direction of your business? I believe it is the responsibility of all partners. But, the Chair should take a particular interest in these activities. They need to lead the business to better places!

Political Representation For Department- Parties, Etc.

The Radiology Chair is the figurehead of the practice. Think of the position as the President of the United States. If you don’t go to the hospital gala, who else will? And if you don’t show up on time for your work, everyone else will arrive late as well. Whatever you do makes a statement for better or worse.

Negotiations- Insurance and Other

Every hospital and private practice has times when you need to arbitrate to accomplish the goals of your department. Perhaps, you need to negotiate a salary or an insurance rate. Or, you need to get that great new CT scanner for the department. Regardless, you will be in charge of this process. Learn how to bargain with your peers!

Legal

Finally, your name will appear on lawsuits that strike the partners and employees. Since you are representative of the practice, there is a better chance that you will have to show up in court to defend the group’s position. Be prepared for this eventuality.

Advantages To The Role Of Radiology Chair

More Admin Time

Well, now you finally have what you want. You’ve got some more administrative time. Unfortunately, you will dedicate that time for all of those new responsibilities listed above (and probably a few more!). But, you may have a little bit more flexibility with your schedule. (If you are lucky!)

? Increased Pay

In some departments, the Chair makes a substantial amount more than her colleagues (especially in academics or massive private practices). For others, it does not move the needle that much. Regardless, there is usually some monetary bonus to being a chairman

? Respect

If you do an excellent job as a Radiology Chair, your colleagues and work alliances will respect you more. You will become a highly trusted member of the hospital and physician community. On the other hand, beware of becoming a poorly performing chair. You will have the active hostility of all!

Disadvantages

Time Away From Family

All these additional roles do not come without a price. You will most likely need to spend more time with your colleagues than with your family. It’s just the nature of the job.

Meeting After Meeting

The chairman’s role necessitates numerous meetings. To maintain communication with all parts of the practice, it becomes a necessary evil. The worst of the meetings are about when to decide the next meeting!

Less Clinical Time

The more you spend on administration, the less you spend on clinical work, That is just the nature of the beast. For some folks, this may seem enticing. And for others, not so much. In either case, know what you are getting into before you take this path!

Radiology Chair- Is It A Job Or A Lifestyle?

So there you have it. As you can see, becoming a chairman is not a road to a passive job with passive income. Instead, you most likely will work harder than you ever did before (unless you don’t care and want to do a bad job!) But, at the same time, it can come with a few rewards and prestige if approached in the right way. Just think about all the possibilities if you take this path. And, as I said at the beginning, go into this role with your eyes wide open!

 

 

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Radiology Sign On Bonuses: A Marker Of An Imploding Practice Or A Booming Market?

sign on bonuses

Nowadays, checking out any of the job websites or even the ACR career center, it’s like window shopping at a candy store. So many great opportunities. High salaries, suitable locations, and even sign-on bonuses. But, are these jobs with sign-on bonuses all that they are cracked up to be? I mean, how bad can it be, begin with an extra twenty grand before you have even started to work! Well, of course, there is more to the sign-on bonus than what you would realize at first glance. So, let’s go through some of the conditions and circumstances for that first sign-on bonus. And, let me even disappoint you some more when you find out the strings that may be attached!

The Clawback

First and foremost, when you sign on to that job with the bonus, take a look at the fine print. Often, the money will come with the assumption that you will be working there for a certain amount of time. It could be one, two, three years, or more. And, the firm will have the right to take a portion or all of it back if you have not met all the specified conditions.

Look At The Specifics

Sometimes, this signing bonus can be not exactly what you think you are signing up for. Take a look at all the stipulations. It could depend on the number of films that you have read. Or, the practice may only release the money on the condition that you have read mammograms or another specialty that does not interest you. Again, the devil is in the details!

Issues With The Practice Itself

Then, you need to ask yourself, why is the practice offering this extra money? Can’t this imaging center find great people because they are a known entity in town where all the radiologists want to work? Take a second look if they are offering you a bonus. Sometimes these entities provide these excellent bonuses because they can’t retain their employees currently. Is this “gift” just an act of desperation to find a warm body to read the films? Well, maybe yes or maybe no!

Market-Related Factors

And then finally, the most likely reason for sign-on bonuses, the market itself. Is the demand for radiologists at the moment so competitive that it forces them to compete with additional incentives? Is the location not that desirable? Is there truly a severe shortage of radiologists that they would have to make such an offer? Any or all these reasons may be at play. A practice can be an excellent place to work. But, market forces can sometimes create a situation for you to gain from their loss. And, for the end of 2019, these situations are all too common.

My Final Two Cents (A Bit Less Than Some Sign-On Bonuses!)

Really, the case for a sign-on bonus depends on many circumstances, some practice-related and others that rely wholly on the market. In any case, make sure to look at the fine print before you “sign-on” to a job with a sign-on bonus. It may not be what you had initially thought!

 

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Can Trauma Radiology Help You In Your Career?

trauma radiology

I have to admit. When I was a radiology resident, I used to dread the “traumaramas” that would arrive at our level one trauma center in Rhode Island. Because of our unique location, we would receive tons of vehicle accidents. And motorcycle accidents were the worst. Limbs would hang on by a thread. Road burns, covering more than half the body, shearing off half of the patient’s skin. And, horrible head injuries would be part of the norm (especially in those riders without a helmet!). Subsequently, we would image almost every body part imaginable! Squadrons of surgeons and surgical residents would stop by to check the films. Trauma radiology was an enormous time drain.

In the past, I did talk about trauma radiology a bit (check out How Important Is Level One Trauma To My Radiology Training?).  But, recently, with our residency merger marching onward and new potential opportunities for our residents to rotate through trauma at other sites, I began thinking again about the highlights and pitfalls of a trauma rotation again from a new perspective. Did all this extreme level I trauma help me to become a better radiologist? What about it do I still utilize today? And, most importantly, the question that you would be afraid to ask… what about the experience may not add anything at all to your radiology training experiences? These are some of the issues that I will tackle (like a 400-pound linebacker!)

The Good

Organizational Skills

First and foremost, since you have these trauma patients that come in with a gazillion injuries and bazillion imaging studies, you have to keep your wits about you. You cannot afford to forget about any of the search patterns you have learned and miss any of the studies that the ED performs. Of course, if you do, Murphy’s law says that it will be the one with the critical findings!

Having a trauma rotation forces you to keep your priorities straight and organize your work. And, it’s critical for getting through the night. But, these same skills will aid you immensely when you start your first radiology job.

Working Under Pressure

Pressure creates diamonds. Sometimes we all new need a bit of pressure to be at our best. Unfortunately, our work is not all beds of roses and teddy bears. We need to think on our feet and give appropriate advice. And, that also applies to the real world. Doctors expect their reports on time without mistakes. And patients want excellent patient care. Working in an active trauma rotation allows you to build these critical skills that will find you in good stead later on.

Trauma Findings

And then, of course, you will not look at studies the same way after completing a trauma rotation. Instead, you will read every image with an eye toward trauma. Liver lacerations, bowel injury, renal pedicle avulsions, and more will become part of your search pattern for all-time. In the real world, sometimes, but not often, we still see the same trauma that you will learn about during your residency.

Just as critically, it can help to prepare you for the boards. If you have seen a bit of trauma, it that much less you need to study. You have lived it!

The Not So Good

Trauma- Can Be Overly Repetitive

I’ve mentioned it before in my other blog on the topic, but I will re-emphasize again. Trauma radiology is a bit more repetitive than other areas in radiology. The patterns remain the same with a more limited repertoire of findings. There is only so much that we need to enhance our skills.

Learning Checklist Radiology- Not So Great!

I hate cookbook medicine. And, unfortunately, trauma radiology can be the epitome of the proverbial cookbook. Emergency doctors and surgeons expect particular views and types of studies for every given trauma patient and situation. And, we need to oblige as their radiologist. They will assume that we do things their way, whether required or not. It is just part of the trauma formula. I like a bit more flexibility!

The Hours

For multiple reasons, traumas tend to roll in late at night when you are at your peak of exhaustion. Additionally, they tend to occur all at once. It’s just a fact. So, you will have to power through the tough nights when you will not get an ounce of shuteye (Not that you were getting any on other call rotations anyway!)

Trauma Radiology- The Final Verdict

Learning trauma radiology is critical for the boards. And though it may or may not be central to your practice of radiology, and can drain you at times, it can reinforce some good habits that you need to become an excellent radiologist. Whether it is organizational skills, working in tough situations, or knowing the critical elements of trauma, these are some of the skills that you will need later on in your career. So, take it all in stride!

 

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Do Recommendations Come With An Expiration Date?

recommendations

Do letters of recommendation last forever? Obviously not! But, if someone provided you with a kind word once, shouldn’t it last? It all depends on the type of recommendation and what purpose it serves.  So, let me provide you with a basic outline of the staying power of different sorts of recommendations for radiology residents and radiologists (kind of like the shelf life for foods!)

To organize this into something useful that you can use as a resource that you can come back to many times, I will divide the recommendation categories into both timing and purpose. And, I will begin in the order of training and subdivide the recommendations into subtypes. Let’s start at the beginning, medical school, and end with recommendations for attending radiologists.

Medical Students Applying To Radiology Residency

General Recommendations

Of course, before you even start talking about expiration dates, we need to mention the sorts of recommendations that medical students should obtain. It is not fixed (and dilated!). Instead, it can be fluid. From my experience, I like to see one radiology related reference and a couple of non-radiology recommendations for our program. But, I’ve seen some impressive applications with credentials coming from all radiologists and also all non-radiologists. So, in general, it is essential that the referrer knows you, the applicant well.

Unexceptional Recommendations

Now that we got this general caveat out of the way, how old can the average recommendation be before it begins to get stale? For the average, unexceptional reference, I would say no more than two to three years. Usually, it is best to get these recommendations from physicians with whom you work in your medical school. These recommendations are a general evaluation of your work ethics during this time. So, it shouldn’t be much older than that.

Exceptional Recommendations

Instead, let’s talk about extraordinary recommendations. What do I mean by that? Let’s say you are a former olympian, and your coach gave you an incredible reference and testament to your grit and personality. Or, maybe the President of the United States knew you and wanted to put in a word (for some that may not be so great!). But, I think you get the idea. These sorts of residency recommendations can be used as an adjunct and have a longer shelf life, perhaps indefinite. You can probably afford to put one of these in your application to differentiate your application from the others. And, this recommendation has some staying power. More importantly, it can help the program director to remember your credentials at the time of interview selection and ranking.

Known Entities

And, then, finally, what about the recommendation from a known entity/physician within the radiology residency or someone that the program director knows directly? These recommendations also come with a longer shelf life. These sorts of recommendations last until the referrer is no longer known to the program/program director.  If you are talking about someone that a resident knows within the program, that shelf life only lasts until the resident leaves and no longer has much influence anymore.

Residents Applying To Fellowship

General/Unexceptional Recommendations

For your “Average Joe” recommendation for fellowship, generally, you should ask an attending from your institution to write you a reference. At the bare minimum, it shows that you can interact with your team and garner the appropriate support to apply for fellowships. These recommendations should be no older than the time you have already been within your residency. I would not request references from your former ERAS application for residency. That would show a bit of laziness as well.

Exceptional Recommendations

For Fellowships, the unique/unusual recommendation now has much less meaning. Most importantly, at this stage in your career, you want to show that you are capable of performing the work. Although it would be interesting to get a recommendation from the President, that will not help your program director to figure out if you can perform liver biopsies. Recommendations at this stage should be much more laser-focused on your future specialty. The role of this sort of reference wears off as you advance in your career.

Known Entities

These recommendations become more important than ever. Why? Well, that would be because the fellowship director wants to feel comfortable that he will be working with someone capable. And, for residency, there is no better way to accomplish that than to receive a recommendation from someone that you know. Therefore, the shelf life of one of these recommendations will last much longer. It may last as long as the person recommending you is actively involved with radiology!

Fellows Applying For Radiology Attending Jobs

General/Unexceptional Recommendations

These recommendations are a bare minimum requirement before beginning to look for your first job. Typically, most of these references are no longer actual letters. Instead, they come through direct phone conversations with the referrer. Practices will often place random phone calls to the referrers that you list on your application. So, these recommendations will only last as long as the person that recommends you is at your current institution. If that person leaves, the reference is no longer “kosher.”

Exceptional Recommendations

These sorts of recommendations no longer should play any role in your application for a job. Your future employer is only interested in two things, mostly. Can you function as an attending in your new job? And, can you get along with others. A recommendation from a President or other interesting source cannot tell you the answer to either of those questions.

Known Entities

At this point, these recommendations are the most critical. If the applicant receives a reference from someone that the practice knows, it is like proverbial “gold.” It is most likely a checkmark for you to get the job. Most partnerships take these recommendations the most seriously. Why? Because most other measures do not provide valuable information about the candidate. These recommendations will last as long as the referrer is in practice.

Bottom Line About Recommendations: Different Strokes For Different Folks

Depending on the stage of your training, recommendations do have different shelf lives and impact. Known entities usually have the most significant influence on chances of admission or getting a job, and they tend to have the most extended shelf life. On the other hand, “exceptional” recommendations play a smaller role as you go further in your career training. Additionally, in general, make sure that an average reference should not be older than your medical school or residency training time. Or, if you are trying to get your next job, these recommendations will last as long as your faculty are present and continue to remember you.

Laziness can prevent you from getting into the residency, fellowship, or faculty position of your choice, especially when it comes to references.  Don’t rely on ancient endorsements. Instead, remember these guidelines the next time you ask for your recommendation. Don’t just leave the process on autopilot!

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New Radiologist Wanting Locum Work? Think Twice!

locum

Have you ever thought about living in different places for a little a bit at a time? Maybe you have always wanted to do some traveling before starting to work? Of course, it sounds exciting to go from Honolulu for six months and then onto Dayton for the next six. Indeed, I thought about the locum lifestyle when I first started.

But, are you missing out on by taking this route instead of the established full-time job career path? Potentially. As much as the ability to travel for your job may entice you, think twice before embarking down this infrequently traveled road as a new radiologist. Let me give you some good reasons for turning this opportunity down.

Pigeon Holed/Loss of Skills

Do you want your new practice to call you that temporary plain film reader gal? Unfortunately, this sort of attitude prevails among many groups. And, imaging groups tend to place you in a particular role based on the desperate needs of the practice. So, if you sign up for XYZ, the group may utilize you in Y capacity. Over the years, this is a surefire way to lose your skills in other areas that you trained for in residency.

Will The Good Times Last?

What do you think happens when the bottom drops out of the radiology job market? Perhaps, imaging reimbursements drop precipitously. Or, suddenly, the stock market crashes and older radiologists stay in the field. And, yes, unfavorable radiology job markets like this have happened in two separate cycles since I started medical school.

In these situations, what happens first? Well, the excess fat gets cut. And, what exactly is the excess fat? It tends to be the locums’ jobs! When you start, you certainly don’t want to be in that first wave of job cuts. It becomes challenging to recover.

Locums Looked Upon Unfavorably

At many practices, the question that arises when they consider a new locum radiologist is: WHY ARE YOU A LOCUM RADIOLOGIST? From my experience, many radiologists believe (rightfully or wrongfully so) that locums radiologists have a defect. Perhaps, they read to slow and cannot hold a job. Or, maybe, the individual cannot get along with others and drifts from job to job. So, if you have a track record of only holding locum work, you have painted a particular picture of yourself that may not be attractive if you ever want to find a longer-term career!

Never Quite Maximize Efficiency

When you drift from place to place, you never get to learn all the systems in place to maximize your output. PACs machines, paperwork, clinician demands, and technology continually change. And, they differ from one practice to another. By definition, you remain less efficient and slower just because you do not have the long-term knowledge you need to keep up with your colleagues at a job using the same technology for the past ten odd years!

Difficult To Establish Long Term Relationships

What do I value most from my current job? I treasure the relationships that I have made with my colleagues, residents, and fellow clinicians. How do you create and maintain these relationships as a locum? Well, it can become very challenging at the very least. You are new the kid on the block and will remain that way until your short term tenure as a locum radiologist ends.

Locum Work: A Dangerous Road To Travel

Now, locums can be an excellent opportunity for specific individuals. If you have a family and want to fill in some time with some extra hours, it can make some sense. Or, maybe you want to retire soon and desire some additional inconsistent or occasional work. Finally, perhaps, you are independently wealthy, and a full-time career does not matter for you. But, for the typical fresh graduate with a lot of debt and wanting to begin a new locum path, you will encounter many obstacles that can affect your future career and growth. So, think twice if you choose to become a locum radiologist when you start. It may become one of your biggest regrets!

 

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Radiology Game of Thrones: University Vs. Corporate Vs. Private Practice- Who Will Win?

radiology game of thrones

Each of the three most prevalent practice models is vying for complete domination of the realm of radiology.  And, each of them wants to leave no survivors. They want to capture all the money, glory, and radiologists for themselves! Well, in honor of the up and coming last episode of the Game of Thrones, I figured I would narrate an all-out battle within the radiology Game of Thrones, which is happening right now as we speak.

So, first, who are the players and what are their armaments and defenses against the  “battle-hardened troops” of each group? And then, who will be the winners and losers in the battle to obtain the “Radiology Iron Throne”? We will discuss the conflict in detail!

University Radiology

Armaments

Out all of the weapons that the Universities can use to maintain control over radiology, they can manipulate the credentialing boards and legislative bodies such as the American Board Of Radiology (ABR), American College Of Radiology (ACR), and the Accreditation Council For Graduate Education (ACGME). In other words, they can stack these organizations with their members to get the radiologists they want. Want to make it harder to become a mammographer? Just make a new exam! Decide you need to work at a university hospital to provide services for a specific need. Well, let’s make the rules for that. They hold the majority of the political cards and are willing to use it pronto!

Also, who trains the radiologists? The academics, of course! These organizations can manipulate the minds and careers of new radiologists coming out to meet their own needs! Want to lengthen the time to credentialing? (Which they’ve done already by creating the credentialing exam!) Go ahead and have fellows for a few additional years to meet the requirements of these practices!

Defenses

These organizations tend to be large and have lots of money and politics backing them. It is challenging to uproot the Massachusetts Generals and the Columbia Presbyterians of the world. Plus, they have reputations that precede them. If you are planning to root them from the face of the earth, good luck!

Corporate Radiology

Armaments

These large entities can slice and dice the cash flow coming in so that they can create efficiencies that did not exist before. How do they do it? Of course, economies of scale. And they find willing radiologists to join their ranks. How? By offering younger radiologists higher salaries but never giving them a complete slice of the pie when they become more senior.

Plus, they have the backing of large private equity companies who have large amounts of money to throw at the situation to make their cause more viable. Need more equipment or bodies? They can raise more funds and gather up their needs. They have economies of scale in their favor.

Defenses

Many radiologists want to have a quality lifestyle and are willing to pay for it in any way they can. So, they can always recruit teleradiologists, part-timers, and early retirees to fill their ranks. What better defense than having the ability to maintain a constant supply of low paid troops to protect the organizations!

Private Practice Radiology

Armaments

Which organizations tend to be the most efficient and provide the highest long term cost effectiveness for imaging centers and hospitals alike? The private practices, of course. When you have incentives to work, you create these opportunities to save money for the system with good quality healthcare. So, this is their strong point and mantra.

Defenses

Although they do not have large swaths of capital at their back like the other entities, they can recruit new radiologists who want to form long-lasting relationships and are committed to entrepreneurship while taking control of a slice of the pie for themselves. Also, it is very challenging to find new general radiologists to replace the old guard since training programs emphasize subspecialization over private practice. Good luck finding academic subspecialists to read general work in rural areas to replace the current radiologists, especially when the job market now is so tight!

The Battle For The Radiology Game of Thrones: Who Will Win?

The Current State Of Affairs

Well, the fight for the radiology Game Of Thrones is raging on right now. And, the swords are swinging. So, what’s happening in the current market wars?

Private practices have been losing some ground. Why? New radiologists that come out are no longer as committed to the lifestyle of an individual practitioner. Many do not want to perform the sacrifices that need to be made to work for these organizations. Working on weekends and call, indeed, do not entice these new radiologists. Also, programs no longer emphasize training of general radiologists over subspecialization, causing some private practices to wither and die. So, private practice overall has been at the losing end.

On the other hand, the large corporate entities have been enticing new applicants with the promise of a quality lifestyle. They have been the big winners of late. And, these numbers bear out at each of the AUR meetings that I attend. Teleradiology and corporate radiology have been increasing their numbers.

And then, of course, academics have continued along their merry way. They are a steady presence since they control the politics, research, and numbers of residents they produce.

The Future: My Predictions

But, what about the next several years? I mean there are fewer radiologists per job. So, where will they go? Well, corporate radiology can always jack up the salaries of its members when times are good. Therefore, they will continue to recruit well. And, when the cycle reverses, they will continue to squeeze radiologists for every penny they have! But, lifestyle alternatives in corporate structures will continue to trump private practice organizations for most new radiologists.

And, what about the academic radiology world? Well, as long as they continue to maintain control of the politics and entry into radiology, they will be around for a long, long time. They can also promise a better lifestyle for new radiologists as they enter the field as well as have the financial backing to do so. And, for those residents I interested in research and teaching, they will always be an option.

Where will the private practice radiologists fit into the equation? Well, I see continued mergers and acquisitions until the smallest groups can finally compete with the other entities. Only by protecting themselves with increasing size can these private practices compete in the real world. Until then, the overall numbers of private practice radiologists will continue to shrink a bit.

So, there you have it, folks. As we wait for the last episode of the Game of Thrones, we will finally learn who the clear winners and losers are. Similarly, for us, only time will tell if my predictions for the radiology Game of Thrones will come true. For those of us that are fans of the show, enjoy tomorrow’s episode. You will never think of radiology and its different career pathways the same!

tomatoes

 

 

 

 

 

 

 

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The Radiology Job Market Cycle: Don’t Enter At The Bottom!

market cycle

Last month, one of my favorite fellow radiology bloggers, Eric Postal at Diagnostic Imaging, wrote a piece entitled Where Did You Enter The Job Market? In it, he described some of the issues of entering the job market at different points of the radiology job market cycle. And, he painted a relatively even-handed picture of the situation.

Now, I don’t want to be Negative Nancy or David Downer, but, unfortunately, I have to give a less rosy assessment of the situation. Sometimes, you have to describe it like it is: The residency graduate at the bottom of the job cycle sometimes may never completely recover.

Fortunately, for anyone who is entering the job market at this current “high point” of the cycle, you will not have to experience any of these issues if you find the right job at the outset. But, for those of you who entered the job market cycle at less desirable times, you will understand precisely what I am saying. So, let me tell give you a summary of the reasons why job applicants in the nadir of the cycle may permanently feel the pain.

It Takes Years To Recover From The Personal Financial Losses

Once again, the magic of compound interest only works when you can maximize the earnings of your earliest working years. Unfortunately, working at 20 vs. 25 years at maximal salary makes an enormous difference. And, if you find a barely adequate job when you first start, you will have lost out on that opportunity. You may have delayed partnership by three, four, five, or more years. Or maybe, you chose a second fellowship instead of going out into the job market. Either way, those lost years can become more significant than you might initially think. In the end, a loss of this amount of time can lead to millions of dollars of decreased savings as a radiologist!

You May Have To Root Up Your Family From A Locale

So, you don’t like the circumstances of your first job due to its location or circumstances. Well, it may not work out so well for you and your family. Perhaps, you have children in elementary or middle school. In this situation, you may have to pack up your bags and take your whole family with you to another town. Imagine the trauma of moving for your children to a new school in a different city. It is happening right now to many of you that entered the job market toward the negative end of the cycle!

Forced To Practice In A Specialty Area That You Don’t Like

OK. You did that fellowship in mammography because you thought that it would help with obtaining a job in a medium sized city, even though you did not enjoy it that much. Now, your skills have atrophied in other areas in radiology. What do you do, now that you want to switch jobs? Another fellowship? Well, at your stage in your life, it’s not so easy to pick up and start another training subspecialty again, once you’ve been out and working for several years, is it? Your decision may stick with you, forever!

More Likely To Have Multiple Jobs

Anyone that starts a so-so job during a downturn will become more likely to leave their job when the market improves. Perhaps, you need to go because the practice has become so oppressive. But, who wants to pick up and start anew again? Moving can be such a drag. And, all those connections that you have made in the community, utterly lost!

Academic Career Rewards Delayed

Maybe, you have set your sights on an academic career, possibly becoming a chairman. But, wait. Since you entered at the bottom of the cycle, your department may not promote you as rapidly. Why? Because you have nowhere else to go. They can get away with it, of course!

Entering The Job Market At The Bottom Of The Cycle

No matter what other authors may say, there is no way around it. Nor, can I sugarcoat it. Entering the job market at the bottom of a cycle can become a permanent disadvantage to your career, finances, and future. But, I am glad to say these issues no longer apply for those starting after completing residency and fellowship now. Let’s continue to hope that for all of the future job applicants; the good times continue to roll!

 

 

 

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Why Does No One Want To Go Into Mammography?

mammography

Question:

Why Does No One Want To Go Into Mammography?

Hey! Why are so few residents interested in pursuing a breast fellowship? The job market for breast has always been ‘hot’ and the hours and salaries are generally higher than other subspecialty specific jobs. I was an IR resident who dropped to DR because of the discrepancy in lifestyle vs. salary vs. free time. Let me know… thanks!

Answer:

My Four Reasons For Fewer Mammographers Than Expected

Well, I have a few insights for you about the world of breast imaging. Back in the day, eons ago before when I even started practicing, mammography was a no brainer. If you talk to some of the older radiologists, you will be surprised to learn that most will say that they initially felt comfortable reading the films. But, the field slowly became more litigious. And, eventually, the area grew into the most sued specialty in the field of radiology.
However, that is not all. Many radiologists went into the field to “get away” from the day-to-day emotions of the patient encounter. And, what do you do when you work in this field? You work with one of the most touchy subjects known to women, breast cancer. You will serve some crying emotionally charged patients. That is not why many radiologists signed up for radiology.
Additionally, mammography differs from other fields in daily practice themes. Unlike other radiologists, breast imagers mainly work with management issues. Instead, most general radiology practitioners want to solve diagnostic dilemmas rather than management matters. Hence, the name of our field “diagnostic” radiology. That’s very different from the expectations of most radiologists.
Finally, this last thought may be a bit more controversial, but I will stick my head out a bit. Many mammographers tend to work intensely at one time or another just reading one type of study, screening mammograms. You may drown in hundreds of the same sorts of studies all day long. Now, this does not necessarily apply to the radiologists that are consummate all-around breast imagers who do biopsies, read MRIs, and work directly with surgeons. But, some of the older breast imagers do only the straight screening and diagnostic mammography portion of breast imaging. And, for many, this work can become redundant and tiring.

My Final Take On Mammography

Now, taken together, these unique practice issues make a particular sort of person to want to go into mammography. And for that reason, regardless of salary, lifestyle, free time, you will not find as many breast imagers as some of the other specialties in radiology. To each his or her own!
Regards,
Barry Julius, MD
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Does Artificial Intelligence Spell The End For Radiology?

artificial intelligence

Question About Artificial Intelligence:

Greetings, could you elaborate on these words ”(Artificial intelligence) will profoundly affect all of our careers, for better or FOR WORSE” and ”have more to gain and MORE TO LOSE”.

I am asking because, in the above text, you’ve written only about the good things about AI, while with these words, you’re also implying bad things about it, but I, as a reader, don’t know about them as you haven’t listed them.

I am a doctor from Europe whose first specialty choice is radiology, but this artificial intelligence surge is making me think twice about it. Everything I read, including your piece, is a 2-way street ala. ”AI is great, but you must adapt to it.”. The end. Could somebody please tell me HOW I will have to adapt and what the BAD things about AI in the radiology field are? It’s freaking me out! Radiology, as it is now, is a fantastic specialty, but I don’t want to be jobless and incompetent 10,15,20 years from now. It’s a life’s decision, and I have exactly ten days to decide!!

Thanks,

Worried Applicant

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Answer:

You are not alone in worrying about the future of radiology and AI. However, after attending the RSNA meeting and talking to colleagues, AI will not take over a radiologist’s job entirely for a long time (if ever). That aside, AI technology may allow fewer radiologists to do the same amount of work that we do right now. Improving triage, artifacts, and integration will make the radiologist’s job easier.

AI Will Not Take Over The World!

Why do I say this and not worry about AI taking over the world? First, the ability of an algorithm to detect something is only as good as the programmer, the number of data points, and the quality of the data. However, programmers have not optimized the algorithms. The data points are too few. And the quality of the data is not uniform. So, I don’t believe that will happen for many, many years from now.

Moreover, deep learning algorithms still have difficulty distinguishing simple solitary findings on a plain film, such as pneumothorax (often mistaken for chest tubes), let alone all the findings on a chest film. Therefore, I don’t believe the interpreting programs can independently function.

More importantly, companies will not want to accept the consequences of the liability of missing findings on films that go unchecked by a radiologist. So, I see AI as more of a team effort instead of a radical upheaval of all radiologist’s jobs. Let’s spread the liability risk!

What Is The Real Downside Of AI?

With the advent of any new technology, we will see our fair share of crashes, bugs, and technical problems. So, I believe that these would be the main downside. But I think the downside is reasonably limited overall. My advice- if you like radiology, you should go for it. If I were deciding on a profession today, I would not let my fears of AI dissuade me from choosing the radiological field.

My two cents,

Barry Julius, MD