Tag: private practice

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Not Sure What You Want? Private Practice, Hospital Based, Or Academic Residency: Find A Radiology Program With All Three!

not sure

Usually, I’m not particularly eager to toot my own horn. But, with the new merger of our three residency programs, we have established a unique situation that very few programs throughout the country can boast. Residents can now experience what it is like to work as a trainee in private practice, a practice with radiologists directly hired by a hospital, and an academic hospital, all under the roof of one residency program. Why is this situation so helpful for residents who have graduated from a program like this? Well, if you are not sure now, later, it can minimize the chances that, as a new hire, you will pick the wrong career path. And that decision can be challenging. Let me explain why.

Not Sure? Pick Among All The Experiences!

Private Practice Experience 

Welcome to our world. When you attend a residency with a private practice-based mentality, the program becomes very different than a standard residency program. Private practice’s priority is getting through a significant number of cases daily. Every study you read is extra cash in the group’s pocket (and yours too if you are a partner) So, we need to complete all the work as soon as possible. So, the main goal is to maximize efficiency. If you have a residency program associated with a private practice, you will see how this way of thinking affects your faculty. Around ninety percent of radiologists eventually go into some form of private practice. So, you must discover what you are in for when you get out of training! (Most residents have no idea!)

Hospital Based Experience

This experience is the most common for radiology residency programs. The typical structure is that the hospital hires individual radiologists. Perhaps, they have some form of incentives for efficiency, teaching, and participation in hospital committees. But, radiologists don’t get a specific piece of the professional or technical fee action. So, these hospital-based groups are more aligned with the needs of the hospital than the needs of the other partners. Therefore, in most of these sorts of practices, there is only a monetary incentive for getting the work done, no more than what the individual hospital contract asks. If there are no riders for reading other films, most likely, these employees will not read them without additional incentive. This structure causes a different mentality than the typical ownership mentality of private practice. Yet, it does have some alignment with the standard private practice in terms of primary efficiency goals.

Government/Academic Experience

Here is the typical large university center structure. In this structure, your salary is more based on academic achievement than efficiency for reading films. You get your raises and your bonuses based on academic grant production, teaching residents, and giving lectures at conferences throughout the country. Attendings in the situation will align with some private entities they are researching. And they will get some form of a stipend for studying their equipment, drugs, procedures, etc. Academic practices often do not incentivize efficiency as much as the other models. This mentality is not the real world for most radiologists, but those intellectual sorts will live like this. Some love the academic experience; others do not so much!

Not Sure? With A Wealth Of Different Residency Experiences, The World Is Your Oyster

Finding a residency program that encompasses all three experiences, private practice, hospital-based, and academic, allows the resident participant to get a feel for the world post-residency in most potential career paths. If I had such an opportunity, I probably would have stuck to one job post-residency because I would have known the practice scenario I would have wanted. So, if you have the rare opportunity to get a residency spot that allows you to experience all three ways of working, seriously consider it over others. It’s a great way to avoid the wandering situation where you work at multiple practices until you find the right one!

 

 

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External Moonlighting In Private Practice: Tread Carefully!

external moonlighting

It’s exciting to collect that first paycheck which can be an order of magnitude higher than your residency salary when you first start as a fully trained radiologist. But, many of you may want to make even more at the beginning. It’s not uncommon to have debt loads that would make regular folks cringe. Nevertheless, some private practices discourage external moonlighting to make that extra money when starting. Why do some businesses work this way? And, what do you do if you want to continue working at your first practice but are not happy about this policy? Let us muddle through some of the issues that you may face when you want to make some extra dough when starting.

Why Do Some Practices Discourage External Moonlighting?

External Allegiances

Moonlighting outside the realm of your main job could create loyalties external to the practice. Let’s say you sign a contract to work during a vacation at an external site, but the primary imaging business also could use your help. This dichotomy of purpose can create a conflict of interest since you will support another practice instead of your primary allegiance. Furthermore, perhaps that other job can be more enticing than the one that does not allow moonlighting. Radiology practices fear having employees change jobs. It is very costly and causes the other practice members to have to take up the slack.

Practices Want To Encourage Their Own Internal Moonlighting

Sometimes the work can get busy. Maybe, it’s a new MRI that opened up. Or, perhaps a senior partner recently retired. In either case, there are many times that practices need all hands on deck to cover the rotations with the extra work. Why would a business allow external moonlighting when it may have many opportunities of its own? The practice needs to cover this extra work!

Exhaustion/Burnout/Vacation

Some practices are more lifestyle-oriented and encourage their radiologists to take their vacations. Burnout is an actual entity. And, we all need a break once in a while. Working all the time on your vacation time can be a recipe for burnout. The exhaustion of the partners and employees is a very costly situation. Why not go to the extra lengths to discourage burnout by forbidding doing external work outside the practice?

I Like The Practice But How Can I Deal With Strong Policies Discouraging External Moonlighting?

Ask For Internal Moonlighting Gigs

Some practices don’t advertise moonlighting opportunities that they have available. So, instead of assuming that your primary radiology practice has nothing available, just ask around. Sometimes senior partners would rather have time off rather than the extra money. Other times, work needs to get done that is making the days longer and more stressful. Both situations often occur. And although not advertised many times, they are potential extra ways to earn some extra dough. Sometimes all you need to do is ask!

Have Them Make An Exception

Sometimes rules are made to be broken. Practice by-laws are in place for the average situation for the average employee or partner. But, who is to say that you are average? If you provide a compelling reason for the business to make an exception to the external moonlighting policy, sometimes they will. Some practices may be more liberal for non-partners or partners. If need be, check with the chair and find out if it is possible.

Work Only During Vacations Or Out Of State

Suppose the practice is concerned that you won’t be dedicating your full attention to your primary job as an external moonlighter. Or, your main radiology job is worried that you will be competing locally with your primary radiology practice. Then let the radiology practice know that your external work will not interfere with either. Guaranteeing that you will only work out-of-state or on vacations may convince the partnership to allow a bit of extra work to make some more cash.

External Moonlighting: The Unwritten Rules

When you look at external moonlighting policies from a birds-eye view, it can make a lot of sense for a practice. It can protect the business from losing their employees and partners, ensuring that work does not go uncovered, and preventing burnout and exhaustion. But there are ways to deal with these issues and get the extra work that you want. So, instead of folding your hand, ask around and make sure to let your practice know that you are interested in moonlighting from the get-go. You may get the extra work you want without destroying your primary job!

 

 

 

 

 

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New Radiologist? Don’t Go Over the Head of Your Boss!

your boss

For many of you, working as a radiologist will be your first full-time job. You are finally going to enter the real world. And, if you have not worked outside the world of training and education, you may be in for a few surprises. First of all, most practices’ mission is very different from your residencies, medical schools, and universities. Your boss will no longer be a teaching physician. Instead of educating students, your first position’s goal is most likely good patient care and earning a living.

Additionally, some of the rules and regulations you will need to follow along the way are also not the same. And many of these rules are unwritten. One of the biggest faux pas of new radiologists is going straight to the top without consulting your boss in the chain of command. Of course, sometimes, there are extenuating circumstances. But, for the most part, it does not serve your needs. Let’s go through some of the reasons why!

Hard Feelings

First and foremost, most bosses don’t like it when a senior manager tells them what to do when they could have managed the situation by themselves. Say, for instance, you decided to go directly to your chairman instead of the chief of nuclear medicine to tell her about an unruly technologist that yells at patients. And then the chairman decides to deal with the issue. Well, you are leaving the chief of nuclear medicine out of the equation. How do you think your boss would feel if the chairperson decides on the matter without consulting your boss. Or if she consults with your boss without you involved. Either way, you may cause a bit of bad blood in the department. That is poor communication!

People At The Top Often Don’t Have Time For All The Details

As y0u go higher up the chain of command, many leaders have much less time to deal with the day-to-day clinical work. Many chairpersons deal more with hiring and firing, salaries and negotiations, and budgetary issues rather than taking care of the daily needs in your ultrasound section. And, they have meetings and work that takes them away from your world. Why would you ask someone with less time to help you? The best person to ask if you are having an issue with an ultrasound machine is more likely to get an answer with the chief of ultrasound instead of a radiology chairman! Moreover, your direct boss usually has more time to deal with the situation.

Your Boss Knows More About Your Position

Your direct boss knows much more about what you do than the hospital president or the CEO of your private practice. Going directly to that person in charge will much more likely give you the answers you need than someone dealing with the business’s general issues. It’s always best to go to the source that knows what you do.

Builds A Better Relationship With Your Boss

Finally, you want to get to know your boss better? Well, the best way to do so is to communicate with him. Asking your senior questions when issues arise shows that you trust their opinions and feel like they are a valuable part of the team. What is a better way to build good relationships in your department?

Don’t Go Straight To The Top Unless Necessary!

There is a chain of command for a reason. Breaking it can cause undo hard feelings, give you the wrong answers, and prevent you from building better relationships within your department. So, think twice if you need a problem that you need to solve by going too far above the chain of command unless necessary. The outcomes may not be what you desire!

 

 

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What Makes The Ultimate Radiology Job?

Recently, I received a question from one of my readers about the ultimate radiology job. What kind of job would it be? I was about to spit out the dull answer: there is no perfect job for everyone, which is true. However, I thought about this question more deeply. I figured I could get a little more down and dirty because there might be a perfect job for a specific person. So, I will do just that. 

Let’s talk about the ideal job for three different particular kinds of radiology personalities. The first would be the perfect job for the lifestyle radiologist. The second would be for the academic radiologist. Finally, the third would be the money-loving radiologist who wants to pay off all their debts as quickly as possible. At the end of each description, I will give you what I think would be a reasonable but high-end salary for the job I describe. You can’t have all the lifestyle features with all the money. And, you can’t be hardcore academic and always have the best lifestyle. But you can find a radiology job with at least one of these features!

Lifestyle Radiologist’s Ultimate Radiology Job

Optimal Working Time

Picture this. You get up late at 10 am without a furrow in your brow after taking a stroll with your dog down the street. Afterward, you return home and start working at 11 am at your own pace. You encounter nary an interruption. After a few hours of work, you have had enough for today. So, you take a shower and plan your next vacation to Thailand. Of course, you have 16 weeks of vacation per year, so finding time for this next adventure is not too difficult. You spend a leisurely dinner with the family, and the day ends smoothly.

The next day, you get up a bit earlier because you had gotten more than enough sleep the day before. Today is your day to come to work. Out of every three days of work per week, you stay at home one day, the other one you come in for, and the third is a miscellaneous day to catch up on the practice’s studies in no particular place and without hurry.

Friendly Practice Situation

As you arrive, all the techs and nurses greet you excitedly and are happy to see you. You are well-liked in the imaging center. Because of the complexity, you start reading through interesting films in your subspecialty that no one else can read. Of course, there is a smattering of normal cases every once in a while in between. Lunchtime finally arrives around noon. You meet with your colleagues for about an hour and go to a fancy restaurant to chat and enjoy the lunch break like you do when you go to work. You return to work unrushed and unfettered, in no rush to complete the rest of the day because you could always finish the rest some other time. 

The following day, the last one of the week, you help the practice catch up on occasional studies. You log on from home and leisurely read your cases. You make a few phone calls and complete your day’s work in a few hours. Of course, you may not get paid like other radiologists who do more. But the time off is worth it!

Radiologist Pay:350,000 dollars

Academic Radiologist’s Ultimate Radiology Job

Out of every five days of work, you have three full days to work on your academic research. Of course, that does not include the eight weeks out of every year that you receive paid speaking engagements or have time for continuing medical education (CME). Moreover, you have the support staff that most others can only dream about. These include two statisticians, a research coordinator, and your secretary. And you have the software and backup to quickly garner the resources to create well-sourced papers at the drop of a hat. Additionally, you have the administration’s help to obtain grants from private and public sources. This help includes multiple connections that overcome many hurdles other academics may encounter. 

Then, you have several days every week to resume clinical work. But, you have the help of your resident, fellow, and junior attending. They do most of the dictation; you get to edit and sign off on their reports. Your residents, fellows, and observers also do much of the work to help you create your following research paper. 

Also, you have easy access and collaboration with multiple specialties throughout the institution. No one is at each other throats. Everyone is willing and able to help each other to come up with great ideas for projects. It’s an environment that fosters learning and research.

Finally, you have already accumulated tenure at your institution. There is almost no way that you can be “canned.” You have put in the time, and the work has paid you back. 

Radiologist Pay: 550,000 dollars

Money Loving Radiologist Ultimate Radiology Job

This radiologist is willing to work as hard as it takes to repay all their student loans as quickly as possible and accumulate enough income to retire as soon as possible. That is the prime goal of this radiologist. And they have found the job they need to meet this goal. 

First, they found a job where the practice pays them precisely what she is worth for each case, plus a stipend from the hospital because she is in a somewhat underserved location. Her days are busy, but they go by fast. They read 200 cases daily, and the caseload is light on findings but large in number. Fortunately, she also works in an area where the case complexity is relatively low and the payer mix is quite high. Of course, they don’t take much of a break during the day, but they work hard all day and reap the rewards.

They also have the backup they need to increase speed regarding radiologist support. These include radiology assistants, a fabulous computer IT department, and an excellent dictation system. They work five days a week, and she gets paid a lot of extra money when they work on the weekends. But most critically, they can do that when they want. Finally, they get lots of vacation, but only take a few weeks out of the year to go away because they don’t want to do this job for the rest of their lives. She would rather have the cash instead. 

Radiologist Pay: 800,000 dollars

The Ultimate Radiology Job- What Do You Think?

You may or may not think that any of these jobs sound great. And that is OK. However, these scenarios are perfectly reasonable for these individuals and can present an ideal situation for these individualized career paths. Let me know if you have an idea for the perfect job, and I can devise another scenario for you!

 

 

 

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How Do I Find Hybrid Model Radiology Practices?

hybrid model radiology practices

Question About Hybrid Model Radiology Practices

 

Hi,

I just read the “Radiology Private Practice Versus Other Career Pathways- Is It Worth “The Extra Money“?“. I am interested in the hybrid model for the same reason you mentioned and I love money :-). Also, I love teaching the residents. But I am not big on research, publishing, etc.

But I do not have any idea, and I do not seem to find any information about the hybrid model. Is it a rare breed? I am a PGY4 resident and working in one of the hybrid model radiology group led residency training on the East coast.

Any ideas about some of the hybrid radiology groups along the east coast or anywhere in the US?

Answer

 

Great question!

 

There are probably more hybrid model radiology type jobs than you might think at first glance. However, not enough such that it can potentially limit you when it comes to living circumstances/location. You may need to be flexible on where you eventually want to settle down if this is the type of practice you want. It worked out well for me at Saint Barnabas in New Jersey (Imaging Consultants of Essex), and it happened to be in a place that I wanted to live.

If I were to start looking for places with a hybrid business model, I would start by looking at community residencies throughout the country. Or, you can look at “minor” affiliate hospitals that have residents rotating through the department. These sorts of programs are more likely to house hybrid model radiology practices as well. Not all of these are private practices; however, Some will be hospital run practices, and others will be purely academic.

You can certainly give these folks a call and find out what kind of business model they follow. I believe that this sorting method will provide you with the most excellent chance of finding hybrid type practices. Like your residency, my old stomping grounds at Brown University/Rhode Island Hospital used to be a hybrid model practice. But, I think it has changed to more of a hospital-based imaging practice if I am not mistaken. Unfortunately, some of these hybrid practices have become hospital-owned for a myriad of reasons.

 Regardless, try this method out. I think it will help you find some of these sorts of practices.

 

Regards,

Barry Julius, MD

 

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Are You Getting the Outpatient Experience You Need In Your Residency Program?

outpatient experience

Some radiology residency programs throughout the country often claim a great outpatient experience. And others, if you ask, they won’t mention it at all. As an interviewee, you may not think about this segment of radiology. But, as a practicing radiologist, this is where you will spend a good chunk of your time.

So, what are the different sorts of outpatient experiences? And, is this outpatient experience even critical to your training? Or, is it something that you can forego because the hospital covers it? The bottom line, are you getting the outpatient time that you need?

Let’s investigate the world of outpatient radiology and what it all means for the typical radiology resident. To do so, I am going to discuss why it is critical to your training. Then, I will split the categories out outpatient imaging into those that you might encounter. And finally, I will talk about what you genuinely need in radiology residency to make your outpatient experience complete.

Why Is Outpatient Imaging So Important?

They say that about 90 percent of radiologists go into private practice (me included!), and the other 10 percent become hospital academics. And, a large swath of those 90 percent practices some form of outpatient imaging. Moreover, the imaging mix differs in outpatient imaging compared to the standard hospital menu of cases. So, if you want to simulate the real practice of radiology, you need some form of outpatient experience.

Three Different Types Of Outpatient Environments

Hospital Outpatient

Almost all hospitals have nonemergent patients that will show up to receive their imaging. The extent can vary from hospital to hospital depending on the location, patient mix, etc. However, the sort of patient that shows up for nonemergent imaging at a hospital tends to differ from the standard clinic patient that wants imaging. These studies often are more complex. And, they show up to the hospital either because they have some complicating issue that prevents them from getting outpatient center imaging (asthma, contrast reaction, etc.) Or, they may have an appointment at the hospital and may as well get their studies. Finally, less likely, a patient will show up here because he wants to go to a hospital rather than an imaging center.

Regardless, these outpatients will less likely have complaints like osteoarthritis or a superficial lump on the back. Instead, the patients will overall have more complex and involved issues. So, your mix of patients will not be the same.

Hospital Owned Outpatient Center

This experience is a hybrid between private practice imaging and the outpatient hospital experience. Here, you will get complex referrals from a hospital center. But, you will also receive the more typical outpatient type of studies. When you sit down and read, you will find a mix of patients with widely varying difficulty levels of cases.

Private Practice Outpatient

And most likely, private practice is what you think of as the “pure” outpatient experience. Here you get referrals almost exclusively from local doctors. Or, you will get patients who come in independently to receive screening tests like mammograms. Cases tend to be more one complaint sort of issues with more “normals.”

How You Might Experience Outpatient Radiology

Sampling

Depending on how the residency arranges your outpatient experience, you may be an occasional observer. Perhaps, the attendings dictate the outpatient cases because they get paid for them. And, you get to watch them interpret the studies. Or, it may be a random sampling as you are reading hospital outpatients. In either case, this is not the immersive type of outpatient experience.

Immersive

Here, you will be primarily interpreting outpatient cases and having your attendings sign off on them. It is much more similar to the daily workflow you might encounter in any given private practice. You will have a more similar experience as an outpatient private practice radiologist.

What Is The Best Outpatient Experience?

Well, as usual, the answer depends. Though, the key to becoming an excellent radiologist, in general, is to have varied experiences across the board. It is possible to have too much outpatient radiology at the expense of inpatient imaging, especially if you want to become a hardcore academic. So, you need to ask yourself, am I getting a broad enough experience concerning all the other segments of radiology training for my interests?

Nevertheless, I would recommend searching for a program that gives you the capability of reading and interpreting all sorts of “simple” and complex outpatient cases. And, I also believe that immersive experience is better. Why? Well, it allows you to get a feel for private outpatient practice. And, it will enable you to make a more informed choice of practice situations when you ultimately decide to settle on a final path.

Are You Getting What You Need To Become An Excellent Radiologist?

Having all the ingredients available for you to get the training you need to become a radiologist, well, that is the main point of residency. So, if you are in a situation that does not give you the right mix outpatients, look into ways that you can get the appropriate outpatient experience. Take some time and effort on your part to create a custom rotation. Or, push your faculty to allow you to get the proper exposure. In any case, make sure not to skip out on this subsegment of radiology. Without this experience, you will not be the consummate well-trained radiologist you want to be!

 

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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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Do Average RVUs Matter For Private Practice And Academic Radiologists?

average RVUs

Question About Average RVUs:

 

Do you know the average RVUs per shift for radiologists and the differential between private practice and academic radiologists?

 

Thank you,

Wondering About RVUs

 

_____________________________________________________-

Answer:

I have not found a specific breakdown of work RVUs per radiologist regarding academic versus private practice. I can shout out to my audience and see if anyone has this information. Has anyone found any valuable data about this? If so, please write something in the comments section!) However, to figure out the average RVU per shift, you can take the average RVU of 10020 in 2023 (from Lifetrack Medical Systems) and divide that by approximately 200 days per year. (around the average number of days worked per radiologist) That would give you around 50 RVUs per day shift.

However, the question may not matter concerning practicality and potential job search. I know of private practices where they have a “lifestyle” practice and complete very low RVUs. Likewise, I know of academic centers where the radiologists work like dogs and meet ungodly RVUs. So, using this information to determine whether to go into private practice versus academia would be a mistake. You need to approach this issue individually, not on a global academic versus private practice basis. On the other hand, if you are using the information for research purposes, it may have an alternative use.

Assuming that you are using RVU data to look for jobs using this criterion, I would look at the specific RVUs of a group and, even more importantly, remember to also look at your particular role in the academic or private practice. Some “academic” centers do very little research and expect some radiologists to do almost entirely clinical work. Likewise, other private groups have a partial academic bent and are less heavily RVU-oriented.

Good luck with your search!

Director1

 

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Which Radiology Practices Are Ripe For A Buyout?

buyout

When they start in practice, most new radiologists fear one thing more than most. Will a private equity firm buy out my practice even before I make partner? For one, this lousy timing can lead to the abandonment of the promise of partnership. Or even worse, it can cause the loss of a job. We discussed a bit about private equity buyouts in a previous blog. But, this week, one of my residents asked a great question. Is it possible to tell which practices are headed for a private equity buyout? So, I thought that would be an excellent topic for today. (Residents come up with the best ideas!) More importantly, I think this will be helpful for many of you in deciding on which practice to join.

How Old Are The Partners?

You might think that age has no boundaries. But that aphorism does not strike true in the world of ownership. If you are looking into a practice where most or all partners are over 50, you may want to think twice.

Think of it this way. Why would someone over 50 not want to receive a premium buyout when their work life may only last another 5 to 15 years? If you, as a partner, had the option of taking a payout of a few million dollars, you would undoubtedly want to consider it, especially since you can continue to work in the same practice, perhaps at a slightly lower income level. But that does not matter. You have received a flush payment that you can add to your investments for your retirement. You would probably come out way ahead of the game.

On the other hand, if most of the partners are under 50, a private equity buyout would not benefit them as much. Why? These folks would be losing out on a higher annual income than owning one’s practice brings. And these radiologists have many more years of work ahead of them.

Location

Depending on the location, a practice may or may not be enticing to a private equity firm. So, what kind of sites would stimulate these companies’ appetites? If I were a private equity firm, I would want to ensure that the practice has a good payor mix. Therefore, the more affluent the community, the more likely a private equity firm would swoop in and buy an imaging business.

Also, if I were a private equity firm, I would want to ensure that I could rapidly recruit radiologists for my practice if the former employees were to leave. So, I do not wish to choose a very rural location where it may be hard to attract on-site radiologists. Or, I do not want to pick a place that may seem undesirable to radiologists.

Age Of The Practice

This factor is likely one that you probably have not thought much about. However, the age of the practice itself can affect how quickly a private equity firm can buy it out. Suppose a radiology business has had long-standing contracts with a hospital or imaging center. In that case, it is much harder for a private equity firm to swoop in and make a hostile takeover. You may have heard of something called goodwill. If a practice has had a contract for, say, fifty years, the price of that goodwill becomes very high. And guess what? The private equity firm would likely have to pay that price to buy out the practice. Private equity firms don’t like to shell out more money than they need.

What Is The Market For The Other Practices In The Area?

So, if you are looking at a practice and you notice that private equity firms have already bought out most of the other imaging centers in the area, well then, likely, the business you are interviewing at will be next. Generally, it is not a good sign when you are talking to the last independent practice in a neighborhood. Likely, that independence won’t last too long!

Partner Dissatisfaction

Finally, you should get a sense of the “esprit de corps” of the partners in a practice. Who wants to let go of a good thing if everyone is happy? Probably no one. So, if the partners seem satisfied, that goes a long way in preventing the business from getting bought out. So, be careful to interview the partners and talk to colleagues to find out how the partners feel about where they work. Smiles can make all the difference in the world.

What Is The Moral Of All This Talk About A Buyout?

Well, it naturally comes back to due diligence. Joining a practice is a significant decision you should not take, especially when you plan to work there for the next 10, 20, or 30 years. Therefore, the possibility of a private equity buyout should be another factor to consider when you are targeting where to interview. You certainly do not want to be left in the dust as an employee when you find out the partners have taken a deal!

 

 

 

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The Sharp Breast Ultrasound Technologist: The Key To A Well Run Practice!

technologist

In a thriving radiology practice, all technologists contribute to the functioning of the whole. However, one sort of technologist, in particular, can tip the balance between a smoothly run practice and disaster. Which one would that be? Well, if you read the title, you would know immediately!

Why does a breast ultrasound technologist wield so much power over a successful radiology practice? Unlike other technologists, I came up with three reasons why we rely on them so much. First, these technologists are the most “independent” of all other technologists. Second, they require a good eye, more so than other technologists. And finally, they must have excellent hand-eye coordination. We will examine all three characteristics and what happens when your practice uses a suboptimal technologist.

Independence

Sure, most technologists have some autonomy. I mean, CT techs must set the parameters for the scans independently. And mammography techs must ensure they perform all the QI before beginning a study. But breast ultrasound technologists are unique in this regard. When breast sonographers leave the room to create their images, you cannot check the quality of their work directly. What do I mean by that? Sure, there are required images. However, the ultrasonographer can choose to show you whatever they deem crucial. Alternatively, this same tech can leave out what they think is “unnecessary.”

I can’t think of any other technologists with such independence of action. You can almost always check the work of a CT, mammography, MRI, or fluoro technologist. The body part is complete, or it isn’t. The breast tissue is all on the film, or it’s not. On the other hand, with ultrasound techs, you can never know if they have completed what they were supposed to. You must rely on their word and their word alone.

What happens when the ultrasound technologist does not act independently? These technologists come reeling in and out of the reading room incessantly, asking questions and interrupting the day’s workflow. Furthermore, the radiologist’s stomach churns when unsure if the technologist knows the morphology and location of what they are searching for. That means they must check and recheck everything the breast ultrasound technologist completes. It wastes so much time that the radiologist cannot attend to his other duties.

The “Good Eye”

Radiologists rely on the ability of breast ultrasound technologists to pinpoint a specific lesion on mammography. Or, they need to find the proverbial needle in a haystack on screening ultrasound. In other words, they must keep constant awareness of their search. In addition, they need to identify the shapes and abnormalities they see on the mammogram. This task becomes challenging when you have a 350-pound patient with a large amount of breast tissue! A “good eye” varies widely among technologists, similar to radiologists. But, good technologists will reliably find what is needed and discard the impertinent findings in the breast.

I can’t tell you how often a technologist without a “good eye” will search and search for something, only to have you, the radiologist, come in and find the lesion first. Imagine the hours over a lifetime that a radiologist must waste to compensate for the ultrasound technologist without a “good eye”!

Hand-eye Coordination

Finally, an ultrasound technologist’s ability to scan patients relies upon a baseline level of coordination. This baseline becomes vital for two main reasons. First, the ultrasound technologist needs to find and rediscover a lesion. For instance, some lesions are tiny or roll off the transducer very easily. Good ultrasound technologists need a steady hand to create images of these abnormalities.

Furthermore, breast ultrasound technologists, in particular, play an essential role in performing procedures to assist radiologists with cyst aspirations and biopsies. They need to be able to keep the transducer on a specific plane at the time of a biopsy.

Frustrating is the singular word for performing procedures with a breast ultrasound technologist with two left hands! Imaging studies and techniques can take triple the amount of time with a technologist with poor coordination. That does not include contamination of the sterile field!

The Sharp Breast Ultrasound Technologist- The Key To A Well-Run Practice

As you can see, a breast ultrasound technologist is much more than just another member of the imaging center team. Without a quality breast ultrasound technologist, the center becomes much less efficient and can fall apart at the seams. If you find a great one, this team member becomes the glue holding the imaging center together. Keep the tech even if at a higher-than-average cost. Why? Because the costs to a practice pale compared to the damage if they leave!