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What Every Radiologist Should Know Before Signing a Contract

For a radiologist exploring new opportunities, here’s a familiar scenario: You’ve had the interview, you've been offered a position and now you're reviewing the contract. But do you know what to look for? Do you know what important points may not be explicitly included in writing? Many factors come into play when a radiologist considers signing a contract for employment. It often comes down to two things: Time and money. Here are some particular points you should consider before you sign.



Hours and Days

Start with the amount of time you’re given to review and sign the contract. This might seem like a minor point, but if the time period is short — and feels rushed — it could be a red flag. As a radiologist, you’re trained to interpret studies, not contracts. So make sure there is adequate time for you and your advisors to review the terms of the offer.

With regard to your time after you’ve been hired, you’ll want to ensure that the hours you’ll be required to work are clearly spelled out: days on, days off, start and end times for work days. You’ll also want to review provisions for time off, including sick days and vacation. Plus, check to see your contract clearly defines how call is handled.  If it is not, be sure to find out how this shift is covered. Are specific radiologists assigned to cover call? Will you be required to do a week rotation per year? Or, do new hires get the later shifts? 



First, let’s take a look at how compensation is defined in a contract. Whether your contract has a set straight salary, a base salary with incentive payment for productivity, or an earn-what-you-read model, keep in mind that your actual earnings may be hindered by a practice’s architecture and process. After a little digging, you might find that a compensation offer that looked good on paper may not translate to actual money in your paycheck.


Impact of Productivity on Compensation

No matter how your compensation is defined, if it includes any kind of performance-based compensation make sure you understand how your performance will be measured, when the measurement begins, and what is required for you to achieve productivity or incentive goals. If there is a minimum level of productivity required to fulfill your obligation (the "floor") make sure it is clearly spelled out. Ask yourself if you’re comfortable with the minimum requirements based on an honest self-evaluation of your abilities and experience. 

Productivity in the radiology market is often measured by the RVUs. (At vRad, we use the term “structured work unit” as a more accurate measurement.)  No matter the measurement metric, you’ll want to pay particular attention to how volume is tracked and measured and how it will impact your compensation. Keep in mind that regardless of how the practice calculates or measures productivity, many variables can impact your ability to meet your performance goals, including the platform that you’ll be working with. You’ll want to confirm that the architecture supports your ability to work to your potential.

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How a Practice's Platform Can Impact What You Earn

Platform and process can present frustrating limitations on your compensation. For example, if a platform can’t accommodate viewing more than one image at a time, or forces you to go off platform to make a phone call or get critical information or a consult, then you’re losing time, productivity and the opportunity to work (and earn) at your potential. We often see this with private practices and small to mid-sized groups who use off-the-shelf platforms from outside software development companies.  

I feel compelled here to point out that vRad’s platform was designed by radiologists, from the bottom up specifically for the teleradiology environment. This allows our radiologists to focus more on their practice, patients and their potential. Ultimately, giving them more control over their compensation.


Bonus & Debt Forgiveness

If your contract includes a sign-on bonus or debt forgiveness, make sure you understand any payback requirements should you leave the practice before the stated length of time. Penalties here can be significant so make sure you understand them before you sign.


Future Employment Restrictions

Some contracts contain language on restrictions and non-competes regarding where you can work if you leave the practice. These terms are enforceable in some states and unenforceable in others, so you should consult with your advisor. They should be specific as far as duration and location. They’re usually considered enforceable if they are reasonable and not overly broad.


Path to Partnership

If the offer includes a path to partnership, the details should be clearly defined, realistic and not ambiguous.  You’ll want to look for specific milestones, performance goals, measurement metrics and the time-frame for achieving any benchmarks included.  As an example, language like “meets groups expectations” is vague and arbitrary. What are the group’s expectations? Any income distribution and compensation formulas should be clear and straightforward. This is critical. If you don't understand it, you won’t know if you're being fairly compensated.



As important as it is for you to carefully review the “nuts and bolts” of an offer with regard to your time and how you will be compensated, it’s just as important to realize that what is not spelled out in the contract can have just as much impact on your job satisfaction and what you actually earn. While an offer might be attractive on the surface, in the end it will pay to read between the lines.


Study Distribution And Case Mix

One potential obstacle to your earning ability is the process for assigning studies, specifically the case mix that ultimately ends up on your worklist. If certain radiologists are allowed to cherry pick higher value cases, it makes it harder for others to hit their goals. A radiologist that has a steady stream of CTs, ultrasounds, and MRIs will end their shift with more RVUs than someone given a list full of x-rays. Compounding matters is the fact that RVU systems are variable and x-rays are often underpaid for a variety of reasons. A radiologist considering an offer that is based in part on RVUs would do well to ascertain how cases are distributed.


Radiologist Staffing And Queue Pressure

Depending on how the practice is structured and how many radiologists are credentialed, the queue of studies for individual radiologists can build up and you may be required to finish them before your workday is done. If you’re concerned about having to work beyond the hours specified in your contract, you’ll want to clarify how many radiologists will be covering the same facilities as you.


Practice Culture and Approach to Patient Care

Lastly, one of the things you’ll probably never see in a contract is a description of the practices' philosophy of providing patient care as well as the well-being of their radiologists. While this is certainly less tangible and abstract compared to the more transactional elements I elaborated on above, this doesn’t mean it won’t bear directly on your compensation, your practice and ultimately, your happiness. In reality, what’s not in the contract can be just as important as what is.



When reviewing a contract, begin by checking the following questions off your list:

  • How many RVUs per day/shift do I need to produce?
  • What happens if I don't meet the minimum for RVU’s?
  • What will my case list look like? 
  • Will it utilize my skills and subspecialty adequately?


Your bottom line will often come down these two questions:

  • How is this practice going to deliver on their promises?
  • Do they have the infrastructure and support to enable me to reach my potential?


When reviewing your contract, it pays to read between the lines to discern what it promises, what it doesn’t, and what you will ultimately derive from it. 

Author Raymond Montecalvo, MD

Originally from New Jersey, Ray Montecalvo earned his bachelor’s degree from Franklin & Marshall College in 1981. Dr. Montecalvo received his medical degree from The University of Medicine and Dentistry of New Jersey in Newark and completed his fellowship in US/CT/MRI at Thomas Jefferson University Hospital in Philadelphia. He was an assistant professor of radiology at Thomas Jefferson University Hospital from 1991-1992. In 1992, Dr. Montecalvo joined Naples Radiologists in Naples, Florida and was chairman of the radiology department at Naples Community Hospital from 1997-2004. In 2005, Dr. Montecalvo joined vRad. He is a practicing member of the vRad radiology staff with the expertise in US/CT/MRI radiology. In addition to reading, as medical advisor for vRad radiologists, Dr. Montecalvo uses his expertise to implement workflow and practice efficiencies.



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