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8 questions to ask yourself before deciding which radiology practice to join

High demand for imaging combined with a finite supply of board-certified physicians means radiologists can be selective about where and how they practice. Before you choose, examine your own goals and motivations—both personal and professional. Then, find a radiology practice whose culture and processes align with your career expectations and work/life balance needs.

Following are eight questions to ask yourself, along with a few considerations for each.

1. Where is home, or where might I like it to be?

Your ideal home may be near snowy mountaintops, or by sandy beaches. In the heart of the city, or away from the crowds. Or simply close to friends and family, regardless of geography.

Wherever you place your dot on the map, there will be hospitals, clinics and practices within a certain radius of home. If you’re interested in working on site, your comfort with daily commutes will affect how wide you are willing to extend that radius. Keep in mind, you will likely divide time between a few locations, so your commute will include travel between facilities in addition to getting to and from home. Also, the farther away your home is from the city, the more limited your options may be regarding hospitals and clinics with full-time radiologists on staff, and you will probably be looking at longer commutes.

If you are interested in working remotely, teleradiology opens the possibility of practicing from any location. One of my vRad colleagues, Jonathon Lee, MD, has a reading room at his home in Dublin, Ohio, and a second in Key West. This arrangement allows him to continue his regular work schedule while enjoying more family time, including extended stays in the Florida Keys.

2. When it comes to reading pace, what is my “zone”?

Some radiologists prefer reading cases at a rapid rate, while others favor a slower tempo. For each person, the length of time per case may vary based on study type, modality, or the need for subspecialty expertise.

Think about your zone. When are you operating at your peak? How long can you sustain that level? What type of cases do you most enjoy? What signals you to step away from your screens, to refresh and to return? At what point do you go home energized and not exhausted?

Carefully consider how a practice’s expectations align with yours regarding study volumes, study types, RVU goals, case allocation and schedule flexibility. A practice’s culture comes into play here, too. Some colleagues have told me that they’ve worked places where the stress of meeting high productivity minimums led to exhaustion and professional burnout.

You probably won’t get an unbiased view of company culture in a typical interview with their senior staff. So, tap into your personal network. Fellow radiologists may be able to provide perspective based on their experiences.

3. What is my ideal case mix?

Are you a generalist who enjoys a mix of emergent and routine cases? Or do you have a skillset which you feel is best applied to specific pathologies or modalities? Perhaps you’re driven by a personal connection to a practical area, such as women’s health or oncology.

Caseload mixes vary widely based on practice location, declared specialties, access to technologies, culture, radiologists on staff, market demands, and other factors. It’s also important to understand the processes in place for distributing cases. If you bring subspecialty expertise to a new practice, will you see your share of cases in that area, or might you be placed in queue behind a senior partner (or partners) with similar training?

Find a practice whose case mix and distribution policies match your skills and preferences.

4. Am I most comfortable communicating in person, remotely, or somewhere in-between?

COVID-19 has prompted a huge shift in how we communicate, both physician-to-physician and physician-to-patient. Pandemic protocols had the medical industry minimizing close contact while relying more heavily on online tools to stay connected.

Many radiologists made the move to remote reading for the first time during the pandemic. Some of them discovered they prefer working remotely. Some are anxious to return to physical spaces to interact face-to-face with colleagues and patients. Others are looking for a balance between the two.

When working on site at a hospital or clinic, it may be generally accepted that you answer your desk phone when it rings, or that people might pop into your office with a question. Some radiologists feel more connected in an environment where personal interactions are more frequent and spontaneous.

Personally, one of the reasons I like working remotely is that I can avoid interruptions common to working on site. If someone reaches out to me electronically with a non-emergent issue, I can finish the case I am working on, and return their call when I’m ready to give them my full attention.

If you are considering a practice that’s offering the opportunity to work remotely, find out how frequently it is allowed, and if the remote position is permanent or will you be expected to return to the hospital full time post-COVID. Ask other radiologists at the practice about their experiences reading remotely, and make sure the technology and support won’t be a source of frustration.

5. How much will I be happy earning?

Theoretically, high imaging demand means you should be able to open the spigot any time you want and find cases to read. Of course, no one can (or should) leave the faucet running 24/7. But to fill the hours you intend to dedicate in the reading room, you’ll want to be confident that the systems and processes in place will ensure the practice can provide a steady volume of cases for you and everyone on staff.

Of course, total case volume isn’t the only contributing factor. Ask any prospective practice how cases are distributed among the radiologists on staff. Equitable case distribution is key. Avoid practices that allow—or worse promote— “cherry-picking” of high RVU studies. (This is another area where your personal network might provide a more unbiased perspective.)

Look closely at performance-based incentives. Are there minimum performance requirements? Are there maximum incentive ceilings? Ensure that any incentive benchmarks align realistically with your work style and expectations.

Finally, if on occasion you feel the need or desire to pick up an extra shift or two, some practices offer greater availability and flexibility in this area than others.

Ultimately, find a practice that is transparent with their compensation plan and can clearly demonstrate your realistic individual earning potential.

6. What’s most important to me when I’m not in the reading room?

Half of all radiologists report they are burned out, many citing professional demands that overwhelm personal priorities. Stress compounds when you feel work is distracting you from personal and family priorities.

Knowing that you have control over how your time is spent is a huge factor in helping reduce the stress of potential schedule conflicts. A stable practice should empower you to make responsible choices between priorities at work and home with:

  • Predictable scheduling. A routine work calendar makes it easier to manage personal and family time.
  • Equitable holiday schedules. Everyone does their share. No favoritism.
  • Reasonable vacation policy. People can take time when needed, and not have to plan around the preferences of a chosen few.
  • Flexibility when the unforeseen arises. The ability to step away—for a few hours or even days—if a family emergency or opportunity arises, with a process in place to fill the gap at work.

Whatever practice you choose will demand a lot from you while you’re on the clock, as well they should. But make sure they also understand that you will be a better radiologist when professional and personal priorities are in balance.

7. What does career success look like for me?

Most rads will find ample reward in spending the balance of their careers focused on delivering diagnostic insights one study at a time. However, you may be compelled to uncover alternative methods and processes through research. Or perhaps you are drawn to education, helping to prepare the next generation of radiologists. Or maybe you see yourself in a leadership or administrative role.

If ownership motivates you, you might be looking for a partnership track. Be aware that the definition of “partnership” can vary from practice to practice. Clarify what may be required to reach partnership levels at a given practice, and what that means in terms of recognition, compensation and voting status.

A note to women radiologists: Women are underrepresented in our profession, accounting for only 21% of practicing radiologists and 13% of radiology leaders. However, there are practices that defy these numbers. I’m very proud to be part of vRad, where women make up 30% of our radiologists and 36% of our clinical leaders. If you want to find practices that actively engage and promote women, look at their rosters. (For more on this, check out the recent blog post from my colleague, Nina Geatrakas, MD, Remote reading helping female radiologists battle burnout.)

For every radiologist, make sure the practice you choose allows you to keep both near-term and long-term aspirations in your sights.

8. What support do I need to help me be my best?

If you’re like me, the answer is, “As much as I can get!” The way I see it, anything that distracts my eyes from images threatens my ability to be at my best.

Technology can be a huge advantage—or your biggest obstacle. The best radiology platforms seamlessly integrate worklist management, PACS and case reporting, while helping physicians make faster, more accurate diagnoses with the assistance of artificial intelligence. However, if the interface is non-intuitive or the system is prone to crashes, you might spend more time chasing down IT support than reading images.

If you are unfamiliar with the platform a particular practice uses, ask to sit down at a computer for a demonstration. Talk with other radiologists to try to get a sense of what the system is like to work with on a daily basis.

A good quality assurance process is also critical. There are times we can all benefit from timely, constructive feedback and guidance. However, a QA program that comes off as overbearing and punitive can impede growth and development. Seek out a practice with a positive, supportive approach to QA.

Whether you’re fresh out of residency or fellowship and looking for that first placement, or you’re a tenured physician considering your options, choosing the right practice to sign on with is a personal decision. The ideal practice for one person may not be the best fit for another.

Author Donald Bitto, MD

Associate Medical Director and Nuclear Medicine Clinical Chief, vRad. Nuclear Radiology Fellowship, University of Pennsylvania. Dr. Bitto joined vRad in 2011 and has also practiced in both private and academic practices. As a teleradiologist, he enjoys the breadth of cases he sees, and the professional growth gained by working with providers across the country. He especially appreciates that while providing additional opportunities to broaden his career vRad allows him greater control and flexibility in managing his work/life balance.


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