Tag: career

Posted on by

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!

 

Posted on by

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 

 

Posted on by

Radiology Recruiters: The Good, The Bad, And The Ugly

radiology recruiters

Every once in a while, radiology residents and former radiology residents will ask if they should use radiology recruiters to search for jobs. And, if you glance at some forums (which will remain nameless!), radiology recruiters are labeled the epitome of evil. But, what is the real story behind radiology recruiters? Does it ever make sense to utilize their services? Or should you believe the hype online? Based on my own experience and the perceived experience of current and former radiology job seekers, I will give you the lowdown on the lowly radiology recruiter. By the time I finish, you will understand the good, the bad, and the ugly! (the Amazon affiliate link to the actual movie!)

The Good

Let’s start with the merits of a recruiter. For some with less job experience, recruiters can help improve the applicant’s overall package. What do I mean by that? They can provide services like interview practice, resume scrutinization, and general mentorship. For some, these services can be invaluable.

And then sometimes, these recruiters can provide insights to the applicant, such as contract negotiation tactics, legal help with contracts, and tips for the uninitiated. The recruiter can serve these individuals well if you don’t have the appropriate background to know some of the finer details of these job negotiation skills.

In some markets where the job seekers are scarce and applicants have lots of opportunities, some practices will utilize a recruiter to gain an edge. Rumor has it that those practices that use a recruiter are second-class. But, I don’t believe that is necessarily so. Sometimes, these practices may be smaller or do not have the connections with the local residency program as a feeder for positions. In these situations, recruiters can provide a valuable service to these lesser-known smaller practices, matching the appropriate applicant for the right job opportunity.

Finally, if the applicant is unfamiliar with an area or market, good recruiters can provide a good reference for the lay of the land. A good radiology recruiter will know a lot about the location and the market opportunities. Sometimes, searching for this information can be challenging to find on one’s own during the throes of residency or fellowship.

The Bad

The interests of the radiology recruiter and the applicant do not always align. What do I mean by that? A radiology recruiter can heavily advocate for an applicant to take a job that does not match his needs. If you think about who typically pays the recruiter (the practice), it almost always makes sense for the recruiter to push the job. Now, this can happen whether the job fits or not. To that end, an “honest” radiology recruiter may avoid this conflict of interest. But this is the real world, folks. And, not all recruiters follow the rules of nobility!

The Ugly

So, think about it. How are recruiters paid? Typically, most recruiters receive payment from a practice (a retainer) when they have placed a candidate successfully. And now, who do you think would be the preferred candidate, all things being equal, if you have two folks with precisely the same credentials, one using a recruiter and the other going it alone? Well, it’s pretty simple. The applicant without the recruiter will get the job. Why? It’s free for the practice to acquire the resident without the recruiter! This problem leads to the ultimate paradox of recruiting!

The Real Truth Behind Radiology Recruiters

Radiology recruiters can be a godsend for those applying to noncompetitive locations who are unaware of job opportunities or do not have honed business skills. On the other hand, recruiters can put you at a distinct disadvantage for those interested in more competitive locales with a bit more experience and those who know the opportunities and most of the practices in the neighborhood. So in these cases, I recommend you try to network or cold-call first.

As you can see, based on your situation, a recruiter may or may not be suitable for the applicant. Here’s the bottom line. Do your homework before looking for a recruiter. Radiology recruiters can be the reason for obtaining or losing your next job!

Posted on by

How Much Work Is Too Much For A Radiologist? (Think RVUs!)

RVUs

You are excited to start your career as a radiologist. And, you are interviewing, hoping to find a job where you can make the most money and pay off your student debt. There is much more to find the correct position than just assessing the income. Of course, you should consider the location and job profile. Just as importantly, however, you also need to figure into your calculations the workload and relative value units (RVUs) you need to complete to reach that income.

Avoid the following situation: an insurmountable daily imaging workload with a queue of patient studies that never ends. A job like this is bound to end badly. But, what is an unsafe workload for you, the radiologist? Or, more accurately, when looking for a job, how many studies are too much to read daily? Let’s investigate these issues together by examining some of the markers of workload and then get to some more specifics about the appropriate RVUs for an individual radiologist.

The Lowly RVU

Before we conclude how much work is too much, we first have to define a unit of work. The essential measurement of work is the RVU or relative value unit. According to an excellent presentation on the history of insurance, the first “RVU” came out in 1992 (1). It defined a relative value unit as three different components- physician work, practice expense, and malpractice. Most of the cost/workload of the RVU relates to physician work and practice expenses.

So, who decides the cost of an RVU? The American Medical Association defined a committee called the AMA Specialty Society Relative Value Update Committee (the RUC). It consists of an expert panel of an individual from the 21 major national specialty societies, two IM specialists, one primary care practitioner, one specialist, and six additional committee members. They assign explicitly what the Medicare costs are for each procedure. (1)

Why Is The Average RVUs Per Radiologist Is Important? (And Why It’s Not!)

OK. So, we have defined what makes an RVU and who creates an RVU for any given procedure. The following important question: What is the median number of RVUs per radiologist throughout the country. Well, I found a relatively recent article in The Reading Room that reports just that. (2) To summarize, it says that the average radiologist performed 10,020 RVUs in a 2020 survey. Now that we know the average RVUs per radiologist, it’s a relatively simple step to ask the average number of RVUs per radiologist per year in any given practice. Usually, the business or practice manager can obtain the number if you ask. If you find that the number deviates significantly from the mean, perhaps, you are looking at too few or too many studies.

But wait… There’s more to the equation! Let’s say you are a neuroradiologist that reads almost exclusively high-value RVU MRIs. Perhaps, you may read them significantly quicker than a general radiologist. Then, you can probably handle more RVUs than the average radiologist. Or, let’s say you just started and have not yet picked up speed with dictating. In that case, you will likely read lower amounts of RVUs. Therefore, you have to put in your weighted factor to determine how much work is reasonable.

Why Are Daily RVUs Even More Important?

Finally, we have developed your individual optimal yearly RVU number where you should lie within a reasonable spectrum. But, it is impossible to conform to that number precisely every day in any given practice. Some days you will have more studies and others less.

To add even more variation, in some practices, the radiologists may take 16 weeks of vacation, leaving only 36 weeks to complete all the work. To make the appropriate calculation of RVUs in this sort of practice, you would need to take the individual practice’s annual RVU number and divide it by the number of days per year worked. In actuality, that yearly average total RVU number does not measure the amount of daily work. A more appropriate calculation would be the daily RVU number. Therefore, a practice with a seemingly ordinary yearly RVU number can have an exceedingly high daily RVU number.

The RVU Tipping Point

What happens when a radiologist reaches the daily RVU tipping point beyond which they are comfortable? Well, most practicing radiologists have had bad days like this at some point. (Hopefully not every day!) You cut corners; your mind drifts elsewhere; burnout ensues; eye strain develops. Not only is it a wrong place for you, but it is also terrible for patient care. Let’s try to avoid that situation as much as possible.

How Much Is Too Much?

Back to the original question again. Too much work can vary widely for any individual. But at least, you now have a feel for calculating how much is too much. So, go forth and ask about the RVU number when you interview for a job, calculate the daily RVU value and compare it with your comfortable RVU numbers. That way, you are much more likely to find appropriate work for you!

(1) http://www.rsna.org

(2) https://thereadingroom.mrionline.com/2020/11/radiologist-alary-update-2020-show-me-the-money/

 

Posted on by

Radiology Swap- University Radiologist Goes To Private Practice (Part 2)

radiology swap

Today we return to Part 2 of our Radiology Swap blog. Click on Radiology Swap- Radiology Private Practitioner Goes To University (Part 1) to catch up if you missed the first part of Radiology Swap!

University Radiologist Goes To Private Practice

Day 1 Radiology Swap:

Unaccustomed to working in a private office, the University radiologist is surprised by the relatively small size of the office. The parking lot is not too full, and he can walk rapidly from his car to the office, very different from usually having to walk from the back of the parking lot—a nice perk.

Finally, entering the building, he locates his workstation and seat. As soon as he sits down at the desk with the PACS monitor, a technologist dumps a stack of papers with today’s work next to the monitors. It must be about 150 cases. Where are my resident and fellow? I need them to help me with the dictations! Oh, my God!!!! I just realized that I forgot how to use a dictaphone.

After struggling with dictations and having read maybe 10 of them, 11 AM rolls by as he teaches the technologists about the ultrasounds they show him. But, the technologists roll their eyes as they just want to get through the cases so they can go home. They sense him droning on and on! He looks at the stack of papers given in the morning. It still looks the same!

Noon: He begins to receive phone calls, not happy ones. Clinicians are asking him about the results of chest x-rays, ultrasounds, and MRIs. Unsuccessfully, he tries to soothe them and let them know he has not looked at them yet, but he will get to them! No lunch for me.

Eyes reddened, head bleary, and voice cracking, the University radiologist now realizes it is almost 5 PM. He has only finished maybe half of the stack of orders. Lots more to go. No one to talk to. I can’t leave yet to get to the family.

10 PM arrives, and he is finally finishing his last dictation of the “day.” How does the private practice radiologist do it?

Day 15 Radiology Swap:

He arrives wearily into the office, looking haggard and worn with a 15 lbs weight loss since he started the job (1 pound per day!). His temper flares every once in a while, taking out his frustrations on the constant bombardment by the technologists by making snide remarks and yelling at the staff’s mistakes. For the past 15 days, he has left the office in the dark, no earlier than 8 PM. No direct contact with interested learners or other clinical physicians. All interactions on the phone. So, this is physician burnout!

Day 30 Radiology Swap:

Assessment day for Radiology Swap!!!

Practice President: So, you have worked in our practice for the past 30 days? Let’s start with the good part: I’m glad to see that you have made it through the encounter.

Academic Radiologist: Yeah, barely. How do you guys do it?

President: We do it efficiently to make money. The more we read, the more we earn. It keeps us going. In any case, let’s continue with your review. We received many complaints from our staff that you were curt and inappropriate at times. It was like pulling teeth to get you to do fluoro cases on our patients. You kept on grumbling- “Where’s my resident?”

Academic Radiologist: I thought you would at least provide me with a physician assistant to help with daily work. I don’t usually touch patients. My residents do it for me.

President: We also received numerous complaints from our referrers that they did not receive their reports in a timely fashion. We lost some serious business this week.

Academic Radiologist: When you get 150 new studies per day, everyone has to wait!!!

President: I don’t think we would be able to keep you here because we need radiologists to keep up with the work. We don’t get paid if we don’t read the minimum volumes!

Academic Radiologist: The best part of this job was the 15 lbs weight loss! I can finally get some sleep again. His eyes begin to close, dreaming about returning to his academic position.

 

The Radiology Swap Meetup

So, the academic and private practice radiologists now seat themselves in the same room to share their experiences after having returned to their respective jobs.

Private Radiologist: How do you do your job on a daily basis without getting totally bored?

Academic Radiologist: How do you do your job without getting totally burnt out?

Private Radiologist: Let’s agree that we are not right for each other’s jobs. It would never work out for us.

Academic Radiologist: At least I can understand what you go through on a daily basis. We used to make fun of private practice radiologists. Don’t think that I will do that anymore.

Private Radiologist: Doesn’t mean that we can’t be friends. Let’s go out for drinks! I think we both earned it…

Academic: True. We both earned some stiff ones.

The radiologists leave the room and head down the street, never to look back on their former residency swap experiences again and happy to go out for some drinks…

THE END

(until next time!)

 

 

Posted on by

Expectations vs Reality Upon Graduating Radiology Residency (I Hate To Burst Your Bubble!)

expectations

During residency, most physician trainees are studying and working so hard that they vaguely realize what is in store for them when they finish their training and begin their first job. What they often expect differs dramatically from reality. So, I thought this would be the post to give you the lowdown on some expectations versus reality when you start as an attending. We will cover six employment topics: money, job performance expectations, the importance of the bottom line, teamwork, case sign-off, and feedback.

Money Issues

Scenario

You begin residency and see these large salaries that come across in your email from recruiters. And, you hear stories of friends doing well at their first job, making tons of money that they don’t even know what to do with.

The Reality:

Many residents consume themselves thinking about the relatively “large salaries” they will earn once they finish their residency. You may think, well, if I can do that for ten years, I will be out of debt and rich. However, every large salary comes with a price. Either you will be working like the proverbial “dog,” or you may be located in a place very far from your friends and family.

Other new attendings also do not realize the costs that accrue from debts, buying a house, and maintaining a luxury lifestyle. Often, these folks go into further debt, funding a lifestyle that they cannot afford. Don’t let that be you!

Job Performance Expectations

Scenario:

You have just graduated as a neuroradiologist, and you are ready to take your first job. The job post said you would be performing 50 percent neuroradiology and no mammography while on a partnership track. You are excited as can be not to have to read any mammography!!!

The Reality

As soon as you start, one of the partners asks you to help out reading mammography by taking a course and over reading one of the other radiologists’ mammograms. Since one of their mammographers left, they need the help until they can hire another.

This situation is commonplace in the world of private practice. Sometimes, undue circumstances arrive beyond the practice’s control, and your expectations for your work will not precisely align with reality. If you cannot be somewhat flexible, you may not become a partner in the practice!

Importance of the Bottom Line

Scenario:

Your academic nuclear medicine position at a high-powered center of excellence is about to begin in a few days. Since it is a large academic center, you figure you will have lots of administrative time to pursue your research interests. I can’t wait!

The Reality:

After a few days of working in your position, the institution issues rules regulating administrative time. If you cannot obtain a grant to support the institution, you will have very little administrative time.

Don’t assume that a large academic institution does not care about how much money it earns. It needs radiologists to financially support the institution by reading films just as a private practice needs to perform procedures and interpret enough films to stay solvent. An academic institution does not mean lots of free time!!!

Teamwork Expectations

Scenario

You are about to begin your first private practice job, and they told you that they treat all employees and partners equally. So, you are very excited to start a career with an equal footing to everyone else.

The Reality:

In your first week of work, a partner asks if you could help him out with reading some extra films because he and his wife want to go to a concert. You tell him that you had early dinner plans with your wife, but he continues to insist. You feel you have to stay to complete the work because he is an influential partner in the practice. Bottom line… Everyone is equal, but partners are often more equal than others!!!!

Case Sign-off

Scenario:

You are sick of waiting for your attending radiologist to sign off the reports you dictated a few hours ago. When you finish residency, now you will be able to complete your dictations whenever you are ready!

The Reality:

Now that you are the final reader and the buck stops with you, you become unsure of the findings and want to ask your colleagues before completing some of your more complex reports during your first days of work. Well, now you don’t have to wait for someone else to sign off your reports. Instead, you may need someone else to look at the cases for a second opinion before completing the study!!!

Feedback

Scenario:

The practice partners state that you will get immediate feedback about your progress after six months. Furthermore, they say that they can even tell who will be partnership material by the first year.

The Reality:

Six months roll around, and no one lets you know about your progress. You think you are doing well, but you are not sure. The patients and the clinicians seem to like you. After one year, no one lets you know if you will make a partnership after the three years they promised you. Unlike residency, feedback can be much more challenging to obtain since it is not designated. There is no guarantee!!!

Expectations For The New Attending!

Becoming a radiology attending is not like entering Shangri-La. There will be new challenges that you do not expect. Along with the added respect, you will have many additional responsibilities. So remember, as a radiology resident, try to prepare yourself for the reality of becoming a radiology attending. So, you will not be surprised about what to expect when you begin!!!

 

Posted on by — 2 Comments

Radiology Private Practice Versus Other Career Pathways- Is It Worth “The Extra Money”?

private practice

The herculean question up for debate: is a private practice career path worth the extra money? To answer this question, you have to know your career options. Suppose you are talking about standard career options for the radiologist (not the alternative career paths discussed in a prior post). In that case, you can divide it into three main choices: private practice, academic/government, and the hybrid model.

Lucky for you, if you are reading this article and you are now making this decision, you have come to the right place. I have worked in the world of academics as a fellow and dabbled in private practice at my first job out of training at Princeton Radiology. Now, I work at Saint Barnabas Medical Center, where we operate with a hybrid model (I was also formerly a resident at a program with a hybrid model-Brown University). Since I’ve been through it all, I am uniquely qualified to talk about how to decide between each option. So, I am going to do just that!!! (Don’t let other posers fool you!)

Are There Income Differences?

What is the difference in income for an academic practice radiologist versus a private practice radiologist? If you look at the Medscape Radiologist Compensation Report from 2016 (later surveys did not have this information!), the academic radiologist made around 262,000 dollars (in this category also is included the military and government physician). On the other hand, some of the other private practice type radiologists made significantly higher amounts: the office-based solo practitioner- 434,000 dollars; the office-based single-specialty group practitioner – 386,000 dollars; and the typical hospital compensated radiologist- 381,000 dollars. So, suppose you take these debatably inaccurate academic and private practice numbers into account. In that case, a pretty substantial difference exists between the income of private practice and academic radiologists (almost 100-150 thousand dollars per year).

It’s Not Just About The Income Though!

But not so fast! In terms of numbers alone, the actual compensation may not account for other benefits like pension and health care. Employees that work for the government or large institution academic hospitals can sometimes receive substantial fringe benefits such as a pension of 70-80 percent of the final salary. Or, they can get incredible health care insurance that you cannot earn elsewhere. Finally, some have other perks, such as free tuition for children in college.

Moreover, the typical smaller radiology private practice will not give these perks. If you take the pension alone, that could amount to a guaranteed (0.8)(262000 dollars per year) or about 210,000 dollars for the rest of your life based on 2016 salary numbers. You would need to have 5.24 million dollars in the bank to have that kind of money guaranteed annually, assuming a 4 percent relatively risk-free return. So, the difference may not be as substantial as initially thought at first glance.

So, now that I have debunked some of the income-based differences (there are always exceptions to every rule!), let’s talk about the different models and decide which option is the right one for you. Let’s start!

The Academic/Government Model

In the purely academic or government model, the primary goal is not reading films and making money. Instead, you will need to publish, teach, or exist (if you are talking about a place like the VA hospital!). Prestige and promotion results from these activities. For comparison, the typical private practitioner couldn’t give a lick about these job requirements. The philosophy is often: publish or perish!

The typical academic sort writes a lot, obtains grants, and is responsible for his/her residents’ teaching and welfare. He/she typically reads fewer studies and sees fewer patients than a typical private practice radiologist. But, that may vary depending upon the institution for which you work. He/she gives many conferences, travels all over the country/world to give lectures, mingles with other academic sorts on all different types of committees, and plays a significant role in directing the future of radiology. Many of these radiologists have outside ventures and partnerships with various companies and academics centers since they do not only occupy themselves with the standard day-to-day role of reading films. Some of the associations may be based on their research or area of expertise.

The higher-up academic radiologists manage their staff as chairmen. These individuals may be responsible for budgeting, hiring, and firing depending upon the institution. Again, your mileage may vary depending upon the role that you have in the institution. The almighty dollar has less control over your day-to-day work. (Although many would say it still plays a nice-sized role!)

The Pure Private Practice Model

What about private practice? In general, private practice wants to maximize income and the number of patients that go through your system. Of course, excellent radiology businesses have an element of quality. But quality exists to increase profitability, and the almighty dollar tends to rule the day. And, of course, all roads lead back to the almighty dollar. Employees and owners grind out films daily, day in day out. The philosophy: if you do not work, you do not make money.

Now, of course, the private practitioner also accomplishes other activities in trying to make money. These folks may perform some or all of the following practice needs: advertising, buying and selling equipment, strategic partnerships, and mergers, maintaining relationships with hospitals, hiring and firing an army of numerous employees (possibly radiologists, technologists, janitors, nurses, physicists, and so on), maintaining and purchasing real estate, payroll, billing, legal issues, parking, and utilities. On the other hand, academic hospitals/ institutional facilities typically take care of most of these issues. Therefore, you need to enjoy playing many different hats and roles and being a self-motivated entrepreneur.

The Hybrid Private Practice/Academic Model

I currently work in this role. I like to think that I get the best of both the private practice and academic world. (Although some would like to say that is the worst!) The hybrid practitioner’s philosophy: A dabbler who enjoys elements of both private practice and academia, but not in such depth.

So, how does the hybrid model work? First of all, you have a few variations on a theme. In my situation, I am involved in a hospital-based private practice with a residency program and multiple covered hospitals and imaging centers. For another type of system, the hospital may employ you, but the hospital may tie you to the private practice world via output bonuses. In essence, the practice expects you to teach, do a little bit of research, and maximize your work output. Thereby, you create income by grinding through studies. Most of these practices are not involved in purely academic activities such as obtaining grants. And, you will probably not involve yourself in typical pure private practice issues. For instance, you will probably not need to maintain the building utilities.

The hybrid practitioner/dabbler likes to do a little bit of everything without delving into some hardcore academic and pure private practice issues. I was never interested in writing grants, but I certainly wanted to teach. I was not interested in dealing with some of the fundamental problems of private practice, such as hiring/firing technologists. Yet, I was interested in the mechanics of business and private practice. For the sort of person that likes to be a bit more generalist, the hybrid model can be a great career path.

How To Make The Final Choice?

I think the final choice becomes a personality-based thought process, not one based on the different income constructions of each career model. If you hate business in all forms, work for the government or academia. If you hate writing and teaching, a private practice may be for you. On the other hand, if you love doing a little bit of everything, think about the hybrid model. Bottom line: You need to be true to your self. Do what you like, not what others will think you will enjoy. If you follow these precepts, you will make a great choice and have a fantastic career!

Comments are welcome!!!

Posted on by

How To Combat A Difficult Radiology Job Market!

job market

Once again, like in many other economic cycles, the radiology job market has hit a bit of a pause. This time, it is due to Covid-19. Although the job market is not as bad as it was back around 2010, it certainly is not the same as it was at the beginning of this year. And, in many locales, the job market froze up entirely. Competition remains fierce in desirable practices on the east and west coasts. Even with some folks abandoning the cities for the more suburban and rural areas, you will likely find it very difficult to obtain a partnership position in San Fransisco or Manhattan!!!

How do you, as a graduating radiology resident or fellow, begin to approach finding a job in this competitive landscape? We are going to cover the essentials for finding a quality job in these problematic radiology markets. I will divide the essentials into the following sections: networking, diversification of skills, location, recommendations, and research/national organization involvement.

Networking, Networking, Networking!!!

Maintain Relationships At Home

Networking does not only begin when you start looking for a job. The search for the ideal job commences at home. What do I mean by that? The first and most important part of networking is maintaining good relationships with your colleagues and attendings.

Many attendings have their proverbial “ear to the ground.” More often than not, therefore, many can tell you about opportunities in the area. Moreover, they can guide you to those jobs. So, to get access to these high-quality jobs, you need to perform and be a good team player. The resident that has not been “playing nicely in the sandbox” during training will not receive those inside tips. More likely, the poorly behaved resident will need to fend for himself. On the other hand, residents who continuously strive for excellence and relate well to their colleagues will have first dibs on those desirable jobs with connections to your radiology attendings.

Keep In Touch

It also becomes more critical than ever to stay in contact with your colleagues and coworkers. When you are ready to leave your residency to go to your fellowship, keep in touch with your former colleagues, residents, and attendings. You never know when that next job lead is going to pop up. And, most former colleagues will happily give you a tip for a new contact. These connections will be the most likely to help with finding that next great job.

What about social media? Nowadays, professional-based social media groups such as LinkedIn can play a role in getting that next job. Besides, social media can keep you in contact with your former colleagues. And, social media allows you to let others stay aware of your current training and expertise. Therefore, residents should maintain at least one account. But be careful to keep the account relevant and correct. View it as a resume. If it is not updated and contains false information, it can be detrimental to finding that next great job. Otherwise, it can be a great way to contact your former colleagues as well as a way to obtain new leads.

Always Be Nice

Finally, even when you have started on that first job, whether it be a dream job or merely a stepping stone, make sure to be cordial and appropriate to your interviewees. I remember when I was interviewing, I met with a private practice attending who was touting the merits of his work to me. I subsequently found a job with a different practice. However, six months later, that same attending who interviewed me became an interviewee at my current practice. You never know what is going to happen!!!

Diversification of Skills

As a resident and fellow, try to do things in your field slightly out of your comfort zone. What do I mean by that? You never know what practices are going to want. Things change. Sometimes an imaging business may need a cardiothoracic radiologist but also require a radiologist that can also read mammograms. Other times, a practice may need an interventionist that feels comfortable with reading musculoskeletal MRI. To become the most competitive candidate in your class, you need to make sure that you feel comfortable in as many modalities as reasonable. Therefore, you should not just concentrate on your fellowship skills or areas of comfort, but also your weaker procedures/imaging areas.

As a fellow, it also becomes crucial to moonlight to maintain your skills in other general radiology areas, outside of fellowship. It can build your speed and accuracy. So, when you start your first job, you will be able to read studies at a reasonable pace. Moonlighting will allow you to have a higher likelihood of remaining at your first job after training!

Should Location Be The Sacrificial Lamb?

Sometimes the job market in some locations becomes so ultra-competitive that good jobs may not exist in your desired area. In that case, there are times when it makes sense to alter one’s expectations and apply to other locales outside of one’s original intentions. By switching locations, the applicant may significantly increase the job market choices that will allow her to practice her subspecialty or earn more income. However, an applicant should not take this decision lightly because personal or family issues sometimes can trump job selection. But, an applicant should consider all the alternatives before selecting a job.

Recommendations

As a radiology resident or fellow, obtaining a radiology job recommendation differs significantly from asking for one as a medical student. Instead of a formal letter, a radiology resident or fellow should let the attending know to expect a phone call from a radiologist at the practice where he had interviewed. Although informal, this practice gives more information to the radiology practice than a simple letter of recommendation. A radiologist can relay the real personality and information about a candidate on the phone more easily without legal repercussions. In this situation, no paper trail exists.

In the conversation, the caller may informally ask your supervising attending about your work ethic, whether you played well with your team, and more. Other times, a member of the practice may speak with a friend of theirs within your residency program to confirm that you would make a reasonable job candidate. Bottom line: it is good manners to let your attending and program know to expect a phone call!

Research/National Organizations

For those interested in academics, completing research projects can help to snag that first academic job. Although not as crucial for the private practitioner, it also can’t hurt to have completed research projects. As I’ve mentioned in a prior post on research, if practices have a choice between two equal candidates, they may sometimes choose the resident with more research experience. You never know…

Also, getting involved in national organizations, whether it be the ACR, RSNA, or AUR, can be a great way to learn about the politics of radiology as well to meet colleagues and practitioners. Residents should consider participation in these organizations.  It could be a stepping stone to find a great job or to become the next President!

Final Thoughts About The Job Market

If the job market is tight, all is not lost. Even in the most challenging markets, some practices will usually have a few jobs available. To increase your chances of getting one of these popular slots, you may need to work a bit more intelligently and focused so that you can become a desirable candidate. Networking, diversifying your skills, making sure to get great recommendations, finding the correct location, and participating in research and national organizations can help your cause. Ultimately, these practices will choose someone that fits the expected identity of an ideal candidate. If you follow these essentials, you have a much better chance that that person will be you. Good luck!!!

Posted on by — 1 Comment

Physician Burn Out- Is An Inadequate Medical Education System The Fundamental Cause?

We read article after article about the complete dissatisfaction of physicians throughout the United States and how it affects patient care.  Since it makes a good story to cover the woes of physicians, the general press seems to covers this topic as dogma. But it is not just the general news. Even Medscape, one of my favorite radiology news/blog sites, has multiple articles and surveys on this topic.

Many different reasons are espoused for the cause of physician burnout. But, I believe there is one major factor that is not addressed. It all has to do with our medical school system and how the system is not made for the student/trainee but rather to support the folks running the schools.

Continue reading Physician Burn Out- Is An Inadequate Medical Education System The Fundamental Cause?

Posted on by — 3 Comments

My First Real Radiology Job- Do I Want Partnership?

partnership

Every once in a while, a resident or fellow will ask me, “Should I take a partnership track versus an employed position?” Or, “What questions should I ask about partnership when I interview for a job?”. These can be somewhat tricky questions to answer since there are so many variables involved. I will tackle some of these issues here. I will also answer some common questions and clarify some misconceptions.

To make this post somewhat structured, I will first talk about the features of employed positions and ownership/partnership track positions. Then, I will determine whether it makes sense to be a permanent employee or on a partnership track. Finally, I will elaborate on the questions you should ask if you are fortunate (or unfortunate) to be placed on a partnership track. So, let’s begin…

To Be Or Not To Be– A Partner!!!

What are the initial differences between jobs that are permanent employee versus partnership tack positions? First of all, no hard and fast rules exist. Some employed roles have features of partnerships, and others have characteristics of employed positions. For the sake of simplicity, I will ignore these nuances and instead talk about the general features of each type of employment situation. You can further determine how the different components of your particular job offer apply to you.

Employed Positions

Basic Issues

Most practices pay employees a fixed salary that makes up the majority of their income. Some employees also may receive a production bonus of some sort, but it tends to be a small percentage of the salary. Starting salaries of employed positions tend to be higher than partnership track positions at the beginning. But, they remain more stable or gradually drift higher for many years to come. If the partnership or practice has a “banner” year, you will likely still get the same negotiated salary regardless of its profitability.

They also tend to be at the mercy of the employing body, whether a hospital system, partnership, or corporate entity. In general, employees have less control over their situation. Employers make the business decisions. If you don’t like the technologist, nurse, or administrator in your practice, you will still have to live with that person. You may not be able to change your PACS system or to set your protocols. Bottom line. You are at the whim of your employers.

Defined Written Responsibilities

Also, in general, employed positions usually have particular sets of responsibilities written in the contract. If you perform a duty that lies outside the realm of your negotiated deal, the practice does not require you to accomplish that task unless your employer pays for it. Being an employee allows you to concentrate on radiology without dealing with the day to day issues of running a practice.

For instance, you don’t have to worry about hiring, firing, buying magnets, billing, capitalizing on radiology trends, attending hospital events, and more. A lot goes into the management of a practice that is not related to day to day radiology. And as an employee, you will likely be a lot less responsible for these activities. But everything comes with a price. You are selling your ability to control the entity for which you are working.

Risks of A Private Equity Buyout

And most importantly, for some, practices treat employees very differently when there are significant changes. In today’s rapidly changing practice environment, groups are merging; hospitals are buying out imaging centers; large corporations are taking over smaller entities. When a significant event such as this occurs, the employee usually does not benefit as the practice’s employer will. Typically, when a radiology practice is “bought out,” the partners or employers will get a large sum of money to pay for the accounts receivable, equipment, real estate, goodwill, and so on/so forth. On the other hand, the employee will typically get nothing. Or even worse, the employee will be the first to be fired if there is a business restructuring.

Partnership Track Positions

Partnership track positions usually pay a lower amount at the beginning than an employed position until you make a “partner.” A partnership track employee can make a substantially different income than a permanent employee. Many starting radiologists do not understand this concept, but it makes a lot of sense. You are paying for the equity/ownership of the partnership in two ways.

Sweat equity

First, there is a concept called “sweat equity.” “Sweat equity’ is essentially a time commitment. This process can last almost any time interval. Most practices have a partnership track period that can last anywhere from almost immediately (in the early 2000s, I knew one fellow offered immediate partnership before finishing fellowship!) to 10 years.

Time to partnership varies depending on multiple factors. First and foremost, these include location. The more desirable the area, the more competitive the partnership spots. And, the more years to partner the practice will charge the partnership track radiologist. Additionally, the time to partnership can be longer if you own equipment, real estate, and other assets. That makes sense because to pay for that share in the partnership, you need to put in more “sweat equity.” Finally, market conditions also affect time until a partnership. Suppose numerous radiologists are looking for partnership positions. In that case, the practice will charge a more extended period of “sweat equity” because of the high demand for a job and willingness of the partnership track position “to pay” for it.

Buy-ins

Second, many practices expect the partnership track employees to buy-in monetarily to the radiology business at the end of the partnership track term. This buy-in may be related to the accounts receivable and the owned assets of the practice. Furthermore, buy-ins can range from a nominal amount to over a million dollars, depending on the assets owned. It can be paid for directly, by a loan, or by increased “sweat equity.” The amount of buy-in can be a critical factor in selecting a partnership track position.

Practice building

Practices also expect partnership track employees to be involved in practice building. You will not just perform your daily duties as a radiologist, but you will be assisting and learning to accomplish other tasks outside of the normal radiologist purview. You may involve yourself with hospital committees, giving grand rounds, attending events outside regular business hours, and other important “non-radiologist” functions. These events are essential training for the partnership track radiologist to learn the business roles of the partner.

Partnership- Not An Obligation

The applicant needs to remember: Practice partners usually do not want to create a partnership position!!! Why? It’s pretty simple. It dilutes the preexisting partners’ equity (meaning that each partner will get a smaller share of the profits). There has to be a significant need to create a partner. These issues include lack of coverage in a particular subspecialty, need for more practice managers, etc. There is no such thing as an entitlement to a new partnership track position. Also, be prepared to work hard to gain a share of the partnership for that period.

What about the Partners?

Usually, practices pay partners a fixed salary. However, they earn a substantial portion of their income from the practice’s excess profits, usually a bonus. Usually, you expect the compensation of the partner to be higher than that of the employee. Why? Partners assume the risk of the practice and also manage practice issues. If reimbursement decreases, partners are affected first. If there is a loss of an employee, the partner needs to cover that position. Or, if there is a lawsuit against the practice, partners need to manage the subsequent issues.

However, the difference in salary between a partner and a non-partner can vary widely depending on the profitability of the practice. Therefore, it behooves the applicant radiologist to determine what the partners are making before joining the practice. You need to “check the books” or talk to the business manager. You certainly do not want to go through the process of “sweat equity” only to find out that your final income is not much different from your partnership track salary.

Does It Make Sense To Be On A Partnership Track?

Believe it or not, there is no quick answer to this question. It all depends on the individual situation and the job. There are also inherent risks to taking a partnership track position versus a permanently employed position. So, let’s evaluate each piece of this equation individually with different questions.

Are you the sort of person that likes running the show, or do you just want to do your work and go home?

A partnership track individual needs to be interested in business and practice building. There is no room for a partner who does not have any interest in building the practice outside regular business hours or is unwilling to perform different roles during the workday outside the normal radiology purview.

Is the job something temporary for you, or do you want this job to be permanent?

It would be best if you did not put “sweat equity” into a job where you think you will be leaving in several years to be closer to family or other needs. Generally, imaging centers will pay less for a partnership position. So, it’s just not worth it. Or maybe, you just need a position, but the practice job description is not exactly optimal, but it is the only thing available in your desired location. In this case, you may also decide a partnership track is not the correct decision. For example, you don’t want to be practicing women’s radiology when your only desire is to be an interventionist!

What is the current business environment in your location?

In some practice locations, hospitals are converting private practice jobs to employed positions due to mergers and acquisitions. You do not want to be stuck in a partnership track, only to find out that there is no partnership position at the end of the road. You may never make the “partnership” salary, or even worse, you may be out of a job. Remember, in a situation like this: employees are the first to go.

Have multiple recent retirees received buyouts?

First of all, what is a buyout? It is essentially the opposite of the buy-in. A partner that steps down expects to get the equity back that he put into the practice. Every once in a while, a practice may have many former partners retiring with enormous buyouts. Large buyouts can affect the partners’ salaries dramatically depending on the circumstances. It would help if you looked into all the specifics for yourself.

Is there a tiered partnership?

Some partnerships have separate buy-ins for the professional portion of the practice and the practice’s technical ownership. Others may give you only a small percentage of ownership compared to a “full partner.” You may become a partner one day. But, the partnership may not be what you thought it would be. Some practices are more equal than others!!! It is imperative to get all the facts correct before starting that partnership track.

Should Student Loans Affect The Decision To Be On A Partnership Track? 

I will try to tackle this question separately from all the others because it is becoming an important issue for residents/fellows before the partnership decision, given their enormous loan burdens. The difference between an employed position and a partnership track position can also seem substantial at the beginning. It may or may not be more financially savvy to take the initially lower-paying partnership track job. Here’s where it is vital to try to glean the specifics of your future career. And, this decision can be complicated. You have to plug in the numbers for yourself and make the calculations. To show you, we will take a specific circumstance under consideration. I will give you the example below.

Here are the inputs:
  1. You owe 500000 dollars on student loans.
  2. Student loan interest and long-term investment returns are both 6%
  3. The partnership track lasts three years.
  4. The difference between the salary of a partner and an employee is 150000 dollars.
  5. A permanent employee makes 100000 dollars more per year on average than the partnership track position during the partnership track term.
The calculation:

Theoretically, the salary difference can go to student loan payments if you are in a permanently employed position at the beginning. So, after taxes, you will have 66,000 dollars (100,000 dollars *0.66) per year or about 200,000 dollars (66,000 dollars x 3 years) more principal paid toward the student loans at the end of three years. Given that the loan’s interest rate and that the money you will make after you pay the loan is 6 percent, for a 30-year career, that same amount is equivalent to saving 200000 *1.06^30 or approximately 1.15 million dollars.

On the other hand, if you decide to take the partnership track, you lost out on the 1.15 million dollars you would have made if you were an employee. But, how much more, in the end, will you make to compensate for those years of “sweat equity”? So, let’s subtract the salary difference between a partner and a non-partner and take the taxes out every year. That number would be (150,000 dollars* 66 percent) or 100,000 dollars. Let’s take that 100000 dollars and multiply it by the number of years worked. That number would be 100,000 dollars *27 years (30 years of working minus three years of making less than an employee) or 2.7 million dollars. This number does not even include interest!! In this case, it would certainly make financial sense for the applicant to take a partnership track position.

The bottom line: you need to perform the calculations for yourself. It may make financial sense to take the partnership track position even though the initial salary is less than the permanent employee.

Bottom Line

The decision to become a partner vs. a permanent employee may not be simple due to the applicant’s personality, job-related factors, and monetary considerations. If you are thinking about the partnership route, make sure to know your role and get as much information/specifics as possible so you can leap. A partnership is a long-term decision, just like a marriage. Know what you are getting into!!!!

Please leave in comments below. I would love to hear from you!!!