20 year attending Diagnostic Radiologist: Ask me anything.

[HILLSRAD]

Hello. I am an attending Radiologist who belongs to a larger single specialist group in the Midwest. Been doing general radiology for 20 years. Also was in academics for a few years at the start of my career. Found reading threads on SDN interesting and would like to offer my perspective on anything related to radiology career at all. Lots of confusion and misunderstanding seems to swirl about in general about radiology. I also am a DO so I can field questions related to being a DO in this specially as well. Regards.

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[M&L]

hi! just the post i was hoping for hahaha. BTW - i understand that all the answers to the questions is just your personal opinions, but i do appreciate your insight.

I am a current M3 in mid-range state school on east coast (have local radiology with optional IR thing as an option, will get letter from local PD). . Right now my choices are : radiology is top choice, pathology second choice (no local residency).

1. could you comment on your opinion about job market and salary range for one vs the other (or just radiology if you are not comfortable talking about path). Is it hard to find radiology jobs in big cities?
2. If i have no idea what radiology specialty i want to do, do you think applying to integrated diagnostic rad/IR programs worth it? or applying to just diagnostic, wait, and look at all the specialties till you decide is a smarter choice?
3. what are the hours right out of the residency? what about later on in the career? how do they differ in academic vs private practice?
4. fellowship "required"? ( to find a good job in a big city)
5. What were your other choices when you were applying for residency, and why did you choose radiology?

 

[hal9000]

What made you leave academics?

 

[Dave1980]

How much better was the field 20 years ago in terms of $$$ and work-life balance?

 

[HILLSRAD]

What made you leave academics?

In the academic institution I was at you received points toward tenure. One point for teaching one point for clinical service and two points for research. I felt that teaching obviously was undervalued and didn’t get enough credit. And I liked to teach So that was one reason to leave.

I also did research and published one paper and submitted another but it was very tedious and applying for grant money is not fun. I also felt that my general radiology skills were atrophying since I did not see the volume of cases that I would see in private practice. Salary was about half what I make in private practice.

Academics can be great. It’s collegial it is fun teaching it’s a slower pace and you feel more of a community but for me at a young age it wasn’t the right fit. It felt more like a job you would do right before retirement.

 

[HILLSRAD]

How much better was the field 20 years ago in terms of $$$ and work-life balance?

Yes good question. My work day seems to get busier and busier. I come home most days mentally fried and just want to sit on the couch next to my wife and watch something mindless on tv 😀.

I started hanging out with radiologists in college way back in the 80s. It was quite different then. It was much slower paced you read fewer cases. The radiologist seemed to get more face time with techs and fellow clinicians. Today it is less so that way. The ability of distributed/teleradiology allows us to read from multiple hospitals 24/7. And it is expected as well. Days now are much more cranking through films and answering phone calls in isolation than they used to be. I think that is the same most everywhere now. It certainly was busy 20 years ago but the volume and number of images has exploded almost exponentially in the field. The ED cranks out studies like ther is no tomorrow and it never stop! It can be a grind. There is also a shortage of radiologists now. My group can’t hire fast enough. So we are always doing extra work.

I think most of my colleagues would agree that work is much more difficult than 25 years ago and that makes balance more difficult. Fortunately in radiology in just about any sized group you can get lots of vacation. Some groups depending on how hard you want to work you can have anywhere from 6 weeks to 12 weeks or more. One year I had 18 weeks off. Many groups also let you have more time off if you work third shift like every other week.

As far as $$$ goes. I make more than I ever thought I would! The money is just as good or better accounting for inflation but you work harder. Efficiency has also gone up tremendously with canned reports and filters and the way PACS can be set up. That helps. I have been hearing “the sky is falling” for 25 years now about radiology salaries. And it has never happened. It may in the future. 🤷🏼‍♂️

Regards hope that helps Good luck.

 

[HILLSRAD]

hi! just the post i was hoping for hahaha. BTW - i understand that all the answers to the questions is just your personal opinions, but i do appreciate your insight.

I am a current M3 in mid-range state school on east coast (have local radiology with optional IR thing as an option, will get letter from local PD). . Right now my choices are : radiology is top choice, pathology second choice (no local residency).

1. could you comment on your opinion about job market and salary range for one vs the other (or just radiology if you are not comfortable talking about path). Is it hard to find radiology jobs in big cities?
2. If i have no idea what radiology specialty i want to do, do you think applying to integrated diagnostic rad/IR programs worth it? or applying to just diagnostic, wait, and look at all the specialties till you decide is a smarter choice?
3. what are the hours right out of the residency? what about later on in the career? how do they differ in academic vs private practice?
4. fellowship "required"? ( to find a good job in a big city)
5. What were your other choices when you were applying for residency, and why did you choose

Hi there. Congratulations on becoming a doctor. It’s still a noble profession and you can have a good life while helping society more than just about anybody else! I will try to answer your questions. I don’t have that much experience with pathology.
1. In general the salary range for radiology is greater than that for pathology. Radiology always seems to be in the top 10 for salary range. The Job market is very cyclical. The market right today for radiology is hot. Every day I get emails and texts from head hunters telling me about jobs. That will probably change it always does. But then it swings back again! I’ve seen this happen over and over. I have heard in meetings that there is some pathology outsourcing going on. Yes this happens in radiology too but maybe not to the degree that it detriments salary and lifestyle. Finding a radiology job in a “big city” will always be more difficult. It depends on your definition of a big city! There is a lot of consolidation going on and I thin opportunities abound in medium cities from 100-200 thousand people. If you need to live in Chicago or New York or something then yes traditionally it’s more difficult.

2. I think applying to an integrated program is an excellent idea. Remember that IR rads often have more difficult schedules and call is more difficult and many times they don’t get rewarded but I think you will be more marketable going forward IMO.

3. Hours right out of residency will vary widely depending on what group you get hired into. Some groups limit vacation for new hires for 2-3 years until you become partner. You will also often be slower out of residency and if your group has quotas then you may have to work longer to meet them. As an older rad you can go 3/4 time often or even buy vacation from your partners. Sorry to not get so specific but it varies widely. Most of the time the older partners will go part time in their 50s or later. Academics gives you more time during the day typically but less overall vacation time. You will almost always get out on time because the residents are there.

4. Yes. Fellowship is pretty much required these days to get a good job in a nice city. Few groups ey are desperate or they really know you will hire you without a fellowship. My group never would.

5. My other choices in specialty were cardiology and emergency medicine. I found both interesting and enjoyable especially cardiology. I chose radiology because at that time every radiologist I met seemed to like their job and their work life balance. I liked the consulting aspect and technology and the fact you didn’t have to follow patients long term.

Hope those answers help some. Good luck as you progress!

 

[HILLSRAD]

Thanks for sharing!

1. Where do you work (hospital or private practice, and which state)?
2. How quickly do you have to read scans? Are you pressured to read faster or is it relatively at your own pace?
3. What are your hours, what is call like for you and do you work weekends?
4. How many weeks of vacation do you get per year?
5. What do you think, given that you are in the field, will be the future of radiology? Will demand increase? Will reimbursements drop?
6. What is your salary?
7. Are you happy?

These questions are from this thread.

Also, has being a DO had any effect on your career as a radiologist?

Hello. Good questions!

1. I work in private practice. We contract with local hospitals and also have our own office. I live in the Midwest (rather not say the state so I can be more free with my answers)

2. It depends on the modality how quickly you can or have to read. If you are on an ED shift then yes you need to read as quickly as you can safely and accurately. Typically a simple normal plain film can be read in one minute. More complex plain film in several minutes. It goes up from there. A complex CT may take 20 minutes. Complex ultrasound may take 10-15 minutes. A trauma case of head through pelvis may take 30 minutes or more. And yes unfortunately most of us feel pressure to read faster. You can combat that by being alert and efficient and taking appropriate breaks. During the day you can often read at your own pace. But you may have to stay several hours longer to get the work done. I do this sometimes.

3. My hours are typically 8-5 but usually I find myself staying until 5:30. If there is extra work or conference I have days that may go from 7am to 6 or 7 pm. Overall I work about 50-60 hours a week when weekends are averaged in. Our group has coverage 24/7 so I never work nights. I do work some second shifts in the afternoon til 11 pm or so. I work about 1.5 weekends a month.

4. True vacation weeks will vary. Typically I get about 10-14 weeks a year. Less if I want to work more. Some groups work harder and have less vacation. This may seem like a lot but you have to factor in weekends and holidays.

5. A book could be written on this topic! I think there will for at least the next 30 years be a need for smart hardworking radiologists. Artificial intelligence has promised things my entire lifetime and has never really delivered. Still the amount of work taken from me from AI today is zero. Actually I think AI would make my job more efficient and more accurate and maybe more fun. AI will not in the foreseeable future be able to do what I do every day. Just not gonna happen. Trust me I’m a radiologist. 😀. As far as demand goes it is hard to say. I personally think demand will increase as older radiologists retire and the population ages. Salaries may drop especially if we go to a single payer model. But when maybe radiologists will be in such a demand that hospitals will pay extra. I think you will always make above salary. I wouldn’t plan on making giant money though it’s just too difficult to predict. Just live below your means and invest from day one. You will be fine.

6. My total compensation including retirement contributions malpractice insurance base salary and bonus will vary from year to year. I think in the last 10 years the low has been 475 and the high 675k. Usually in the middle somewhere.

7. Am I happy? Yes great question. I think for most part yes. Medicine has been difficult and traumatic at times but it has given me a wonderful job to serve humanity and given me great respect and financial resources to do cool things and take care of others who are less fortunate than I am. Happiness is in general something you can cultivate and learn despite variations in circumstances

8. Has being a DO had an effect on my career? None really. I did do a great fellowship at a higher end MD academic university. But I work with both MDs and DOs and really none of us care. I work with Ivy League rads and I feel I am just as good or better in many modalities. Work hard and study hard during your early ears as an attending and nobody will care if they even did in the first place. I know of DOs in high academic positions and in great jobs every where. So for me it hasn’t mattered. It may if you are a lower tier DO student but then that will happen with MDs as well. I like being a DO radiologist. It’s a more tight knit group and we have our own meetings and I have lots of great friends.

good luck on your career choice!

 

[GadRads]

I have been hearing “the sky is falling” for 25 years now about radiology salaries. And it has never happened. It may in the future. 🤷🏼‍♂️

I think what people mean to say is that you work much harder for the same level of compensation. Per unit of work, the pay has dropped.

Also, many academic centers have raised their pay, but they are still 30-40% lower than partner pay at many groups.

 

[giguerex35]

Hello. I am an attending Radiologist who belongs to a larger single specialist group in the Midwest. Been doing general radiology for 20 years. Also was in academics for a few years at the start of my career. Found reading threads on SDN interesting and would like to offer my perspective on anything related to radiology career at all. Lots of confusion and misunderstanding seems to swirl about in general about radiology. I also am a DO so I can field questions related to being a DO in this specially as well. Regards.

hey appreciate the post. How is radiology compensation done, are you paid a certain amount per image, a base requiring you to meet a certain minimum of studies/images + bonus for any over that amount or something different. I am someone who needs incentive to wake up and would find it hard to go to work if there was no opportunity to make more if I bust my ass. So i guess ultimately, what is the payment model for most radiologists and is there anyway to make more than what your contract states. Also if you happen to know too, how does the payment model differ for IR and DR. appreciate the help

 

[HILLSRAD]

hey appreciate the post. How is radiology compensation done, are you paid a certain amount per image, a base requiring you to meet a certain minimum of studies/images + bonus for any over that amount or something different. I am someone who needs incentive to wake up and would find it hard to go to work if there was no opportunity to make more if I bust my ass. So i guess ultimately, what is the payment model for most radiologists and is there anyway to make more than what your contract states. Also if you happen to know too, how does the payment model differ for IR and DR. appreciate the help

Believe me you will be busting your ass for whatever you make in most every field of medicine. In our group the partners get a base salary plus quarterly bonuses which are shared equally depending on how well the group does. The group bills and gets paid per study and that goes into one giant pot. Many groups have a quota you must meet every day in order to receive maximal bonus. Don’t meet quota less bonus. You can make more by picking up extra shifts from people who are wanting to get rid of them or by volunteering for more work or less vacation time. The bigger the group gets the more opportunities there are to make more or to have more vacation. If I wanted to make a million dollars a year I probably could I suppose but that would entail long days and weekends and little vacation and probably suicidal ideation and burnout after one year or less. Money is great but once you pass 3-400 k and don’t spend like a drunken sailor much more money won’t make your lifestyle any better. It certainly won’t make you happier. I know a few miserable neurosurgeons.

Many IR docs will also do some or even mostly of DR depending on how big your group is. The IR docs bill per procedure like surgeons do. That may go away though where you get a certain amount of the pie per covered life or per hospital visit. Payment models will most likely change in the future I suspect.

 

[HILLSRAD]

I think what people mean to say is that you work much harder for the same level of compensation. Per unit of work, the pay has dropped.

Also, many academic centers have raised their pay, but they are still 30-40% lower than partner pay at many groups.

I think that is true across most medicine that the pay per unit of work has dropped. But we are also more efficient. I think the previous payments were a statistical aberration for 15-20 years or so.
Many academic centers have different pay models with normal professor salary and then a bonus at the end of the year or quarter. If the hospital doesn’t do well you don’t get the bonus or as much or you may even get chargeback. I haven’t looked at academic salaries In a while so I don’t know how they are trending.

 

[Dave1980]

hey appreciate the post. How is radiology compensation done, are you paid a certain amount per image, a base requiring you to meet a certain minimum of studies/images + bonus for any over that amount or something different. I am someone who needs incentive to wake up and would find it hard to go to work if there was no opportunity to make more if I bust my ass. So i guess ultimately, what is the payment model for most radiologists and is there anyway to make more than what your contract states. Also if you happen to know too, how does the payment model differ for IR and DR. appreciate the help

in radiology you get paid per study you read. you get paid the same whether you read it right or wrong and whether it takes you 1 minute or 30 minutes.

unless you go to the VA you will be busting your ass in radiology whether or not you are employed, a partner in a PP, or an associate in a PP.

 

[HILLSRAD]

in radiology you get paid per study you read. you get paid the same whether you read it right or wrong and whether it takes you 1 minute or 30 minutes.

unless you go to the VA you will be busting your ass in radiology whether or not you are employed, a partner in a PP, or an associate in a PP.

Here are more details on that: In Radiology you get paid per study on an RVU basis. Each study is assigned a “value”. For example an average RVU payment may be 65 dollars. A chest X-ray is worth .3 RVU and a CT scan of the abdomen and pelvis is worth 1.5RVU approximately so the insurance company would pay you 20 dollars for reading the cheaper X-ray and 90 dollars for reading the CT scan. Obviously payment per RVU varies widely from government health insurance to private insurance to private pay. But those above are approximate other studies can be much more RVUs such as intensive MRI studies pay much more.
Many hospital contracts pay extra as well for time spent reviewing technical work or consulting with other physicians when you claim that time from day to day. Depends on the contact and the hospital.

Also many insurance will not pay you for a never ever event such as calling a brain tumor on a wrong patient and then they get operated on. You won’t get paid for that. Studies that are read in error often will get written off by the hospital so you won’t get paid. Also radiology groups now have intensive peer review and many will penalize you for poor reads or you will get remediation.

 

[medstudent1718]

Hello. I am an attending Radiologist who belongs to a larger single specialist group in the Midwest. Been doing general radiology for 20 years. Also was in academics for a few years at the start of my career. Found reading threads on SDN interesting and would like to offer my perspective on anything related to radiology career at all. Lots of confusion and misunderstanding seems to swirl about in general about radiology. I also am a DO so I can field questions related to being a DO in this specially as well. Regards.

Are there any DR or IR jobs with no call whatsoever? I've seen a few posted online before but not sure if those are spammy or not

 

[HILLSRAD]

Are there any DR or IR jobs with no call whatsoever? I've seen a few posted online before but not sure if those are spammy or not

IR by its very nature involves call. It’s like being a surgeon in many respects. So I doubt you would find any.
There really is no “call” anymore in radiology. It is a 24/7 business done in shifts by multiple radiologists. In the rare circumstances where it is really busy some groups have people on call for those circumstances but the typical call you are thinking of does not exist. I think that answers your question. I suppose if it is a tiny hospital in the middle of nowhere and it is only covered by a couple radiologists yes then I suppose you would have to get called in when there is a procedure or something but most of the DR work is sent out at night to bigger groups or to nightcall services.

 

[guytakingboards]

Are there any DR or IR jobs with no call whatsoever? I've seen a few posted online before but not sure if those are spammy or not

Both no-call DR and IR jobs exist but are not common. On the DR side, there are groups like RadSource which just read outpatient MSK/neuro MRIs. They generally hire mid-career/experienced rads, not people fresh out of training. On the IR side, office-based lab (OBL) groups like Modern Vascular are becoming more common. They're usually staffed by a combo of IR, vascular surgery, and interventional cards and are doing lower acuity work. Office-Based Labs: Trends & Best Practices - PV Podium Again these OBL groups typically hire experienced mid-career interventionalists who would like be able to handle certain complications without need for a hospital backup.

Either way, no-call jobs are not something someone fresh out of training can expect to get.

 

[matthew87922]

Hello. I am an attending Radiologist who belongs to a larger single specialist group in the Midwest. Been doing general radiology for 20 years. Also was in academics for a few years at the start of my career. Found reading threads on SDN interesting and would like to offer my perspective on anything related to radiology career at all. Lots of confusion and misunderstanding seems to swirl about in general about radiology. I also am a DO so I can field questions related to being a DO in this specially as well. Regards.

Hey
I’m a 4th year from low-tier MD school. I’m planning to apply for DR this year. I’m concerning my odds of getting into some competitive DR programs. Can you give me some advices? Thank you so much. My brief summary of app as follows:

I’m a US army veteran. Did bunch of volunteers during med school. 4H and 2HP during Clerkships. Published couple case reports and submitted two radiology paper to RSNA that still under review (I’m the 1st and 2nd authors). Four strong letters from gen surgery, IM, two from radiologists. I got 247 on step1 but got 241 on step2.

I want to do DR residency at New York, preferably New York City where my family lives. Can you guys let me know if I have any chances match into a competitive DR residency at NY? Or anywhere? (I’m really concern of my drop in step2 score)

I know it’s a little bit late but is there anything I can do to boost my application a lit bit more? Or increases my chances?

I know it’s a little bit late but is there anything I can do to boost my application a lit bit more? Or increases my chances?
I’m thinking to apply 80-100 programs

What’s my odds of getting into TY programs?

Any guidance/advices are appreciated, thank you so much.

 

[hal9000]

In the academic institution I was at you received points toward tenure. One point for teaching one point for clinical service and two points for research. I felt that teaching obviously was undervalued and didn’t get enough credit. And I liked to teach So that was one reason to leave.

I also did research and published one paper and submitted another but it was very tedious and applying for grant money is not fun. I also felt that my general radiology skills were atrophying since I did not see the volume of cases that I would see in private practice. Salary was about half what I make in private practice.

Academics can be great. It’s collegial it is fun teaching it’s a slower pace and you feel more of a community but for me at a young age it wasn’t the right fit. It felt more like a job you would do right before retirement.

Thanks. I'm early career few years in academics and a few things you said echo with me. The corrollary fear for me going pp is atrophying my subspecialist skills and becoming more of a cog, but that's probably group dependent. Interesting to ponder.

 

[HILLSRAD]

Thanks. I'm early career few years in academics and a few things you said echo with me. The corrollary fear for me going pp is atrophying my subspecialist skills and becoming more of a cog, but that's probably group dependent. Interesting to ponder.

Depends on the group you hire into. Sometimes it feels like I am just a cog in a big machine. One of my colleagues calls it the “radiology mines”. Academics may be more sheltered for the changes in medicine that many people are predicting.

 

[HILLSRAD]

Hey
I’m a 4th year from low-tier MD school. I’m planning to apply for DR this year. I’m concerning my odds of getting into some competitive DR programs. Can you give me some advices? Thank you so much. My brief summary of app as follows:

I’m a US army veteran. Did bunch of volunteers during med school. 4H and 2HP during Clerkships. Published couple case reports and submitted two radiology paper to RSNA that still under review (I’m the 1st and 2nd authors). Four strong letters from gen surgery, IM, two from radiologists. I got 247 on step1 but got 241 on step2.

I want to do DR residency at New York, preferably New York City where my family lives. Can you guys let me know if I have any chances match into a competitive DR residency at NY? Or anywhere? (I’m really concern of my drop in step2 score)

I know it’s a little bit late but is there anything I can do to boost my application a lit bit more? Or increases my chances?

I know it’s a little bit late but is there anything I can do to boost my application a lit bit more? Or increases my chances?
I’m thinking to apply 80-100 programs

What’s my odds of getting into TY programs?

Any guidance/advices are appreciated, thank you so much.

I am not a program director but do work in a residency program and have done some interviewing so you may want to also ask the Ustinov of program directors out there.
Right now DR is considered a “second choice” residency program because of perceived lowering of reimbursement and theoretical encouragement of AI among other factors. So I think if you interview well and given your research and other experiences you have a good chance to match somewhere. A big competitive program like those in NYC may be less likely. It may be good for you to broaden your horizons however and go live in another part of the country for 5 years. You would see a different perspective and learn some new things that you may not learn in NYC. You would probably grow more as a person and be ready to come back to NYC when you are finished with residency and fellowship.

as far as doing anything more now. I’m not sure much more can be done other than applying to lesser programs in other parts of the country and really be a great interview. Read up on the programs and the interviewers. Ask lots of questions. Be confident without being arrogant.

best of luck.

 

[matthew87922]

I am not a program director but do work in a residency program and have done some interviewing so you may want to also ask the Ustinov of program directors out there.
Right now DR is considered a “second choice” residency program because of perceived lowering of reimbursement and theoretical encouragement of AI among other factors. So I think if you interview well and given your research and other experiences you have a good chance to match somewhere. A big competitive program like those in NYC may be less likely. It may be good for you to broaden your horizons however and go live in another part of the country for 5 years. You would see a different perspective and learn some new things that you may not learn in NYC. You would probably grow more as a person and be ready to come back to NYC when you are finished with residency and fellowship.

as far as doing anything more now. I’m not sure much more can be done other than applying to lesser programs in other parts of the country and really be a great interview. Read up on the programs and the interviewers. Ask lots of questions. Be confident without being arrogant.

best of luck.

Awesome, I appreciate your perspective.

 

[fun8stuff]

Thanks. I'm early career few years in academics and a few things you said echo with me. The corrollary fear for me going pp is atrophying my subspecialist skills and becoming more of a cog, but that's probably group dependent. Interesting to ponder.

You have it backwards. Staying in academics atrophies your radiology skills. You lose the skills needed to work in a normal radiology practice. After 5 years in academics you’ll only really be competent in your 1 small area of work. It’s far easier to keep your expertise in your subspecialty in private practice where you may read 25-50% of your subspecialty, while still maintaining your general radiology skills. Otherwise, you’re pigeoned holed into staying in academics… less job options, lower pay, and way less vacation.

 

[SeisK]

You have it backwards. Staying in academics atrophies your radiology skills. You lose the skills needed to work in a normal radiology practice. After 5 years in academics you’ll only really be competent in your 1 small area of work. It’s far easier to keep your expertise in your subspecialty in private practice where you may read 25-50% of your subspecialty, while still maintaining your general radiology skills. Otherwise, you’re pigeoned holed into staying in academics… less job options, lower pay, and way less vacation.

Or you can just negotiate ED shifts once a week to keep your generalist skills up.

lots of academic programs are going the way of PP anyway.

 

[jambro]

Do you think covid has made teleradiology more common in the field? Say if youre a partner in private practice some number of shifts that can be done at home?

Do you think a person who's good with technology may be able to leverage that better in radiology than other fields? I'm thinking about heavy use of macros and computer shortcuts, etc

 

[Clean7795]

Do you think covid has made teleradiology more common in the field? Say if youre a partner in private practice some number of shifts that can be done at home?

Reporting from home a few time per week is common now. Moving forward it will be interesting to see how far we move in that direction.

My general feeling is that the current balance of having most rads will working in-person with some remote reporting sprinkled in will be continue to be the norm. It's too nice of a feeling to be able to work from home some days. On the otherhand, group cohesion would fall apart if 90% of rads reported purely from home.

Do you think a person who's good with technology may be able to leverage that better in radiology than other fields? I'm thinking about heavy use of macros and computer shortcuts, etc

Short answer is yes, somewhat.

Slightly longer answer is there's a limit to how much efficiency you can squeeze doing that. Most of the time spend working will still be image interpretation, reporting, and interruptions from phone calls & people dropping by. Sure you can have a custom mouse w/shortcuts, a good mic, templates, and possibly KVM switch. A lot of fancy macros won't work because things are often hidden behind a VM.

 

[Gadofosveset]

You have it backwards. Staying in academics atrophies your radiology skills. You lose the skills needed to work in a normal radiology practice. After 5 years in academics you’ll only really be competent in your 1 small area of work. It’s far easier to keep your expertise in your subspecialty in private practice where you may read 25-50% of your subspecialty, while still maintaining your general radiology skills. Otherwise, you’re pigeoned holed into staying in academics… less job options, lower pay, and way less vacation.

Ha - sort of, but academics have the mistaken idea that reading everything means you have to be an expert in every field you read. This is not true. I could go to PP next year — I’m certainly still *capable* of reading just about every area at an average level — I would just have to choose to accept a higher miss rate and get used to low (no) detail reports that come out of many “normal radiology groups”, esp high volume groups.

It’s really just like sports. You get at what you train at and you get really good at what you focus on and practice a lot. No mystery. Maybe you weaken in some other areas. No real surprise there - that’s not the game you’re training for. My referring tertiary care oncologists will not tolerate anything but high level reports with a minimal miss rate, so that’s the game I get good at. It’s also not really a bad situation if you’re a patient.

I do like mixing in a few other kinds of studies into my day, though. Change of pace. Enjoy flexing those muscles every now and then.

 

[HILLSRAD]

You have it backwards. Staying in academics atrophies your radiology skills. You lose the skills needed to work in a normal radiology practice. After 5 years in academics you’ll only really be competent in your 1 small area of work. It’s far easier to keep your expertise in your subspecialty in private practice where you may read 25-50% of your subspecialty, while still maintaining your general radiology skills. Otherwise, you’re pigeoned holed into staying in academics… less job options, lower pay, and way less vacation.

This is not completely true. I’ve seen and been in several academic settings where it is a private practice academic hybrid. I had lots of vacation when I was a assistant professor for several years. I also read many modalities. Some other university settings also have a hybrid model. Also some private practices have you do just one or two areas. There is no blanket statement. You can find just about every situation.

 

[DOFOSHO]

Hello. I am an attending Radiologist who belongs to a larger single specialist group in the Midwest. Been doing general radiology for 20 years. Also was in academics for a few years at the start of my career. Found reading threads on SDN interesting and would like to offer my perspective on anything related to radiology career at all. Lots of confusion and misunderstanding seems to swirl about in general about radiology. I also am a DO so I can field questions related to being a DO in this specially as well. Regards.

What do you know about the longevity of groups once they sell out or bought out by a venture capital group? Does VC generally run the group into the ground once the partners who got their buy-out bonuses retire? Is there any benefit in joining a VC group that has shown stability over several years post buy-out? If you were faced with joing 1 of 3 of the following options which would you chose: Group bought by VC, group employed by hospital, or very small private group (likely to get swallowed by large hospital system vs encorporated into existing nearby VC group)? Thanks.

 

[maxxor]

What do you know about the longevity of groups once they sell out or bought out by a venture capital group? Does VC generally run the group into the ground once the partners who got their buy-out bonuses retire? Is there any benefit in joining a VC group that has shown stability over several years post buy-out? If you were faced with joing 1 of 3 of the following options which would you chose: Group bought by VC, group employed by hospital, or very small private group (likely to get swallowed by large hospital system vs encorporated into existing nearby VC group)? Thanks.

Having lived through the last option, the stress and uncertainty is not worth it while on a partnership track. Only do #3 if it’s a short track.

 

[Womb Raider]

Hello. I am an attending Radiologist who belongs to a larger single specialist group in the Midwest. Been doing general radiology for 20 years. Also was in academics for a few years at the start of my career. Found reading threads on SDN interesting and would like to offer my perspective on anything related to radiology career at all. Lots of confusion and misunderstanding seems to swirl about in general about radiology. I also am a DO so I can field questions related to being a DO in this specially as well. Regards.

Current radiology resident interested in private practice with a few questions:

1. With a trend toward PP groups selling out, is there anything you’re aware of that could help protect a new guy like me interested in the partnership track in those gap years before I reach partner? I wonder if there’s anything I can include in the contract.

2. I’ve been told one of the most important things to know going into a job and negotiating contracts is to know your worth. Unlike most other specialties, radiology seems relatively straightforward since we can connect RVUs read to average RVU payout with the payor mix. Is this oversimplified? What other aspects of a radiologist’s worth do I need to consider? (Particularly in regards to PP - I will not be going academic.) Willingness to take night/weekend call? Experience?

3. Last, now that you’ve done this for a while, do you have any words of wisdom to offer to a fresh radiology grad searching for a new group to join? Anything to look out for or consider beyond the obvious?

Appreciate your time.

 

[HILLSRAD]

Current radiology resident interested in private practice with a few questions:

1. With a trend toward PP groups selling out, is there anything you’re aware of that could help protect a new guy like me interested in the partnership track in those gap years before I reach partner? I wonder if there’s anything I can include in the contract.

2. I’ve been told one of the most important things to know going into a job and negotiating contracts is to know your worth. Unlike most other specialties, radiology seems relatively straightforward since we can connect RVUs read to average RVU payout with the payor mix. Is this oversimplified? What other aspects of a radiologist’s worth do I need to consider? (Particularly in regards to PP - I will not be going academic.) Willingness to take night/weekend call? Experience?

3. Last, now that you’ve done this for a while, do you have any words of wisdom to offer to a fresh radiology grad searching for a new group to join? Anything to look out for or consider beyond the obvious?

Appreciate your time.

Hello. Good questions. Sorry for the delay in responding. Been on a well deserved vacation.

1. I seriously doubt that you would be able to get a group to modify your contract but you could ask a contract lawyer. The best at to protect yourself it to be difficult to replace. Be able to do multiple modalities or be able to do a high in demand modality such as neuro or woman’s imaging or pediatrics. Also make yourself visible. Sign up for committees sign up for tumor board. Start imaging techniques that are ne to the group you are working for that you are the best at. We are all expendable really. But those things will make them think before they don’t offer you partnership. In reality if you do those things they would almost certainly recognize your worth.

2. I think some of this question I answered in #1. Be flexible is what I can tell you. When I first started out I was willing and able to do just about anything any modality including light interventions. This makes you valuable on the schedule. Also be collegial and respectful to others. Overwhelm yourself with CME and learn to do different things. People get fired because of three things mainly. 1. Because they are not good at what they do and are not Illini to advance their knowledge. 2. Because they are slow radiologists who do few modalities. 3. Because they are jerks. In my experience #3 will get you fired far far quicker than the other two. Simple. Don’t be a jerk. Your worth is a combination of all of the above.

3. I would see if I could find people who quit the group and ask them why they quit. I would also look for a group that has long term stability and is more of a lifestyle group as opposed to a group that is looking to make as much money as possible. Realize that on average a radiologist switches jobs 3 times in his career. So it’s OK to move on once or twice if it is not working out. Also look at TOTAL COMPENSATION. It’s easy to get enamored but big salaries but maybe they are big because you have to pay out of pocket for everything. Total compensation should include money from salary and bonus, malpractice insurance paid by the group, medical insurance paid by the group, CME paid by the group, extra medical bills reimbursed by the group that otherwise you would pay out of pocket like eyeglasses, braces, or your deductible, retirement contributions by the group like 401k, health savings account, cash balance plans etc. Also don’t join a top heavy group. Meaning look for a group where the average age is less than or around mid 40s. Older radiologists have different priorities typically and if you are the only young guy in the group you may find your vote will never count.

Good luck in your search.

 

[HILLSRAD]

What do you know about the longevity of groups once they sell out or bought out by a venture capital group? Does VC generally run the group into the ground once the partners who got their buy-out bonuses retire? Is there any benefit in joining a VC group that has shown stability over several years post buy-out? If you were faced with joing 1 of 3 of the following options which would you chose: Group bought by VC, group employed by hospital, or very small private group (likely to get swallowed by large hospital system vs encorporated into existing nearby VC group)? Thanks.

I don’t have any experience in VC groups at all. But I would far prefer to be a part of a stable hospital group rather than the other two.

 

[Dave1980]

I don’t have any experience in VC groups at all. But I would far prefer to be a part of a stable hospital group rather than the other two.

are you a neurorad?

 

[Rad Res]

Fellowship applicant interested in private practice.

What are the pros and cons of doing a general MRI fellowship for private practice versus a sub-specialized fellowship (Body, Neuro, MSK, etc).

People have different opinions about this.

 

[guytakingboards]

Fellowship applicant interested in private practice.

What are the pros and cons of doing a general MRI fellowship for private practice versus a sub-specialized fellowship (Body, Neuro, MSK, etc).

People have different opinions about this.

The general MRI fellowship is largely becoming obsolete in my opinion. It was a bigger thing 20 years ago before MRI became predominant in neuro/MSK and even lately in body. There's just too much specialty specific nuance to learn in 4 mo per specialty. Jack of all trades, master of none.

I think a good resident aggressively going after MR training in 4th year could be just as good as the bread and butter stuff in each specialty (e.g. stroke in neuro, large joints in MSK, and MRCPs/livers in body) as a MRI fellow. The MRI fellow will never come close to being as good specialty level as a sub-spec fellow.

There's only a few circumstances that I could see it being useful and way more circumstances where a full-year specialty fellowship would be better.

Pro's:
-if you joined a smaller group where everyone is a generalist, you may do better reads than older guys who might not have had much MRI training. You'll be valuable because you're able to read more study types semi-comfortably than other people.

Con's:
-Unless you're the only warm-body available, you'll never be "the guy" for body/neuro/msk questions if there is a competent, specialty-trained person around. It may not seem like a big deal but i derive a good bit of job satisfaction from being good at my job (as a PP neurorad who reads >95% neuro) and being a go-to for clinicians and other non-neurorads. It also makes feedback and growth easier when you get locked into specialty specific conferences.

-You're not going to be good at the high-level, lower volume specialty studies (e.g. H&N cancer/peds in neuro, small joints in MSK, rectal cancer/pelvic/GU in body). Plenty of people do a full year fellowship in those specialties and still aren't good at those things. --- Depending on the job, that might not be a big deal. Especially if you're looking at an after-hours/overnight gig.

-Just an assumption, but even doing a MRI fellowship you may not be decent at all three specialties. My group has an overnight guy who's MRI trained. He's pretty good at neuro (surprisingly better than his neuro-trained overnight colleagues) but he's pretty bad at MSK and meh at body.

-Future job prospects, kind of the same conversation as current job prospects. *if you ever wanted to back into academics they're almost certainly going to want a full-year fellowship. If a decent sized PP groups wants an MSK or Body MR guy, they're going to want a full-year guy.

 

[guytakingboards]

Current radiology resident interested in private practice with a few questions:

1. With a trend toward PP groups selling out, is there anything you’re aware of that could help protect a new guy like me interested in the partnership track in those gap years before I reach partner? I wonder if there’s anything I can include in the contract.

Unlikely. Your best bet is to do your homework on the groups you're applying to and get a sense of vibe re: a private equity buyout. Some groups have gauged the market and realized that a buyout would screw themselves long-term (though others still go ahead with it). Some groups are (crazy thought) likely too big to be bought out. Some of those 120-150 rad groups might cost well over $500m to buyout.

Also, **** happens. If you join a group and they get bought out before you become partner that's just tough **** in most cases. It happened to a ton of people over the last decade.

2. I’ve been told one of the most important things to know going into a job and negotiating contracts is to know your worth. Unlike most other specialties, radiology seems relatively straightforward since we can connect RVUs read to average RVU payout with the payor mix. Is this oversimplified? What other aspects of a radiologist’s worth do I need to consider? (Particularly in regards to PP - I will not be going academic.) Willingness to take night/weekend call? Experience?

RVU's to compensation is way over simplification of the considerations. There's a ton of things to consider in RVU's to compensation

Production:
- RVU's per year and per day are good surrogates to look at. "knowing your worth" means it may not be worth it go generate 90%ile RVUs for a 50% compensation job. I think that's what you're referring to.
- That being said, not all RVU's are created equally. What's your job's case mix going to be like? are you slinging a lot of barium and reading a ton of plain films and DEXAs? Are you doing a bunch of low RVU procedures? Or are you reading a lot of high-RVU MRI and low-effort CT calcium scores? Are you joining a productivity leaning group where the older guys cherry pick and expect their newbs to clean up all the time-suck, garbage studies?
- What hours are you working to generate said RVUs? How many evenings, nights and weekends are you expected to cover? How long are the day shifts? a 10hr work day (excluding commutes) is considerably more work over time than an 8 hr day

Compensation:
-Total compensation has to be the comparative factor, not just salary. What are the benefits like? What tax-advantaged retirement options does the job offer? How much does the job contribute towards your yearly retirement account (if at all).
-How many weeks of paid time off (PTO) are you getting? 4-6 is standard in academics, 8 weeks is the minimum in PP and some PP groups go significantly higher in PTO. Does getting more salary and PTO justify working 10-11hr days vs 8 hr days?


Basically:

Production: How much are you working, how hard you are working and when you are working vs

Compensation: How much are you making and how often are you off

3. Last, now that you’ve done this for a while, do you have any words of wisdom to offer to a fresh radiology grad searching for a new group to join? Anything to look out for or consider beyond the obvious?

Appreciate your time.

-Try as much as possible to clarify what the expectations of your job are. Then gauge from the more recent hires how good the group is on delivering on those expectations. Are you going for a more sub-specialty job or general job? Mammo and light IR or not? I was personally sold on my group as all neuro with some occasional plain film shifts. Then in my first year I did a fair amount of body at times. Lol, then later on in a neuro section meeting people asked what body studies new hires should be comfortable reading and I had to speak up and say "hey you guys recruited me with the promise of all neuro, this is a bait and switch". I was eventually weaned off body shifts as I got more senior but it was unpleasant as a junior to be tossed into body whenever the need arose. Thank goodness mammo was never on the table.

-Commutes matter. The 8hr work day can easily turn into 9.5hr days with bad commutes. (and the 10hr work day can creep towards 12hr).

-Larger groups can sometimes operate as section fiefdoms. My section is large and for the most part decently well run. Some of the other groups are dumpster fires. A junior associate told me our section runs competently while other sections are terrible and that's mostly been true.

 

[DOFOSHO]

how many RVUs per ~8-9 hour shift would be expected of a private practice radiologist at a steady pace in a reasonably busy setting. Again, average, somewhere between slow grab a snack VA and @ss on fire cant take a piss burn out practice.

 

[Cognovi]

how many RVUs per ~8-9 hour shift would be expected of a private practice radiologist at a steady pace in a reasonably busy setting. Again, average, somewhere between slow grab a snack VA and @ss on fire cant take a piss burn out practice.

60?

 

[maxxor]

average across all settings is 10k rvu according to some RBMA article.


Divide by number of work days and there you go.

 

[HILLSRAD]

are you a neurorad?

I am not. I am a body rad. Although I have done everything from light interventional to pads neuro.

 

[HILLSRAD]

how many RVUs per ~8-9 hour shift would be expected of a private practice radiologist at a steady pace in a reasonably busy setting. Again, average, somewhere between slow grab a snack VA and @ss on fire cant take a piss burn out practice.

You should be able to produce 55-85 RVU per that time frame depending on the case mix and what modality and how many questions etc you answer during the day. Some of our ED readers do about 100 in a 9 hour shift. I can do about 8-9 an hour when things are going well. Anything over 11 an hour is kind of unstable unless you get lucky with a bunch of normal neuro or high value normal ultrasound

 

[whatamievendoing]

Can you explain what an RVU is? Does that mean you read 55-85 studies in an 8-9 hour shift?

You should be able to produce 55-85 RVU per that time frame depending on the case mix and what modality and how many questions etc you answer during the day. Some of our ED readers do about 100 in a 9 hour shift. I can do about 8-9 an hour when things are going well. Anything over 11 an hour is kind of unstable unless you get lucky with a bunch of normal neuro or high value normal ultrasound

 

[Cognovi]

Can you explain what an RVU is? Does that mean you read 55-85 studies in an 8-9 hour shift?

The American Medical Association's relative value update committee (RUC) determines the relative value of medical procedures and visits based on factors such as average time to perform, complexity, training required, malpractice risk, geographical practice cost differences, practice expenses, and technical (non-MD) costs.

When we are talking about RVUs, we are usually referring to work RVUs, which is the component of the RVU that excludes the technical component, the practice expense, the malpractice risk, and the geographical adjustment. This is a metric of physician work.

You can find the wRVUs for radiology procedures on the Medicare physician reimbursement schedule by entering the CPT/HCPCS code into this website License for Use of Current Procedural Terminology, Fourth Edition ("CPT") | CMS

For example, a noncontrast head CT (70450) is 0.85 wRVU.

 

[2brads]

I am a med student but faculty are saying I have a poor bedside manner (due to chronic irritability). Should I become a radiologist or should I altogether quit the profession? I am especially worried that patients might file complaints about my bedside manner in the future. I know most people go into radiology because they are passionate about imaging? But is it okay to go into radiology because I might not be able succeed in specialities requiring patient interaction? Did you have a passion for imaging right from the beginning or is it something that grew with time? Thanks!

You've recognized the problem, which is half the battle. Bedside manner is a skill like anything else, why do you not want to work on this? When I was a med student, I was never great at pt interactions, but I've worked on it and now my patients love me (mainly biopsies, joint injections, paras, thoras - the abscess drain pts never seem very appreciative.) Every few weeks, there will be a pt who will only see me for their procedure, either because they had a friend who had a good experience or I've worked on them before. Just develop it like any other skill.

 

[Dr_feelsbadman]

A bit of a niche question, but in your perspective - how much of a leg up does going to an academic residency provide for getting hired? In previous job market downturns how challenging was it for rads to get hired from "average" residencies

I'm considering ranking a "community" program over several widely recognized academic programs because of my partner's job prospects. My radiology mentor is telling me to always rank the strong academic programs first, even if my partner takes a lesser job, in case there is a downturn in the job market. Any insight?

 

[Clean7795]

A bit of a niche question, but in your perspective - how much of a leg up does going to an academic residency provide for getting hired? In previous job market downturns how challenging was it for rads to get hired from "average" residencies

I'm considering ranking a "community" program over several widely recognized academic programs because of my partner's job prospects. My radiology mentor is telling me to always rank the strong academic programs first, even if my partner takes a lesser job, in case there is a downturn in the job market. Any insight?

If you are working in the community/PP, then they just care that to have the skills to get the work done (usually meaning reading all or most modalities efficiently and being able to do basic procedures/fluoro) .

If you are working in academics pedigree can matter.

Mostly it comes down to networking and if you want to work in that area, generally you want to do residency or fellowship there (unless there is for some reason a known issue with that residency program of course).

 

[2brads]

If it comes down to you and another applicant, and you are exactly the same except one of you has a pedigree then it will matter. Fellowship pedigree matters much less than residency.

 

[Redpancreas]

Interested in learning to read abdominal/pelvic CT scans in a comprehensive, systematic manner. My background is not in Radiology, but Internal Medicine residency. Are there good resources for this? Obviously there's no substitute for a radiology residency and I assume you'd give different advice to a medicine resident vs. a radiology one, but I have access to a lot of CT scans to continue to practice.

 

[Clean7795]

Interested in learning to read abdominal/pelvic CT scans in a comprehensive, systematic manner. My background is not in Radiology, but Internal Medicine residency. Are there good resources for this? Obviously there's no substitute for a radiology residency and I assume you'd give different advice to a medicine resident vs. a radiology one, but I have access to a lot of CT scans to continue to practice.

Look at any of your cases, correlate with the report, then correlate with the clinical presentation/findings. Look up findings you don't understand on Radiopedia or StatDx (equivalents of UpToDate in a way). Rinse and repeat to increase proficiency.

You could cap off with a 1 month elective in a radiology rotation (assuming your institution has staff rads interested in teaching). We had a IM-trained ICU fellow rotate with us to gain more proficiency in CTA chests and CT abdomen/pelvises. They told us it was helpful for feeling more comfortable catching large PEs and understanding the basics.