Radiology has hottest job market in medicine?

[Taurus]

This chart suggests that. Who knows. Radiology job market is the hottest I’ve ever seen. Enjoy it while you can. Things happen in cycles. When I was in residency, the job market was at its bottom.

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[vm26]

Thanks for posting...Do you have a link for this data? I would like to share with my group (currently in contract negotiation) but some would downplay this data (they apparently don't want to be too aggressive with Hospital administration)

 

[SeisK]

The physician recruiting firm formerly known as Merritt-Hawkins publishes the number of listings through their service every year. For the past three years, radiology has occupied the number 3 most searched-for specialty through their service behind #1 Nurse practitioner / APRN and #2 Family Medicine. This is confounded by the different size of varying specialties, and radiology is one of the larger ones. You could normalize the data by the number of residents graduating annually. Regardless, the job market is currently exceptional. A pleasant, reasonably hard working radiologist with a straight head on shoulders stands a very good chance of getting a job at a particular desired practice in a desirable area, across the country, with no connections by cold calling, and the gig would probably be pretty good.

I hesitate to say this and I don’t know how long I’ll keep this up but: All in all, this job market is good enough that certain practices are seeing their rads pay go from very high to insane due to new negotiations for hospital subsidies to incentivize recruitment lest services go uncovered. I’ve heard of cases of $55/RVU per rad jump to $70/RVU per rad after hospital subsidies. A high productive practice with good IT support could net a mean salary for their partner near or even above 7 figures at those rates. Of course, I expect medicare contractions to follow precipitously in short order in response.

We have got to find a way to head off the list delays though. I don’t know any good solutions other than heavy handed discussions with providers to do better triaging, but even routine studies like cancer staging are already being delayed weeks by the imaging site to the point they’re harmful adding much more time to the report delay. I don’t know how we’re going to do this. Very interesting time to be a radiologist. Fast changes.

https://www.amnhealthcare.com/siteassets/amn-insights/blog/physician/2023physicianincentivereview.pdf

 

[Cognovi]

We have got to find a way to head off the list delays though. I don’t know any good solutions other than heavy handed discussions with providers to do better triaging, but even routine studies like cancer staging are already being delayed weeks by the imaging site to the point they’re harmful adding much more time to the report delay. I don’t know how we’re going to do this. Very interesting time to be a radiologist. Fast changes.

A good solution would be the insurance company pays radiologists to spend time triaging and approve/block imaging requests.

 

[SeisK]

A good solution would be the insurance company pays radiologists to spend time triaging and approve/block imaging requests.

My experience has been that >95% of radiologists are not clinically astute enough to be absolutely sure a scan is pointless / superfluous given other laboratory, exam, and ROS data.

 

[sloh]

You rads are killing it. How many of you or those you know are making 7 figures?

 

[Radology]

7 figures is pretty rare without a LOT of moonlighting

 

[vm26]

You rads are killing it. How many of you or those you know are making 7 figures?

Not many. Thats probably >95th%

 

[Taurus]

No single radiology job is going to pay out 7 figures. If you want to make 7 figures, you have to hustle, meaning putting in hours more than just for that job and getting paid for those hours. Because radiology is a 365/24/7 field, I would argue that radiology is one of a very few fields where it is realistic for any rad to earn 7 figures if they want to and most of the extra income is working from the comfort of your home and working fewer hours than most surgeons. If a derm, urologist, plastics, etc wanted make 7 figures, what would they have to do to make it possible? Run clinic 16 hours every day including weekends? Do surgery til midnight every night? Unlike most other fields, there is no overhead for my side hustles. I don’t need to pay a nurse or front desk person to help me make extra income. It’s just me and my workstation while my kids are playing just a few feet in front of me. I get paid hundreds per hour and keep every dollar I make (minus taxes). Can anyone name me a better side hustle that is realistically obtainable than this?

 

[GadRads]

No single radiology job is going to pay out 7 figures. If you want to make 7 figures, you have to hustle, meaning putting in hours more than just for that job and getting paid for those hours. Because radiology is a 365/24/7 field, I would argue that radiology is one of a very few fields where it is realistic for any rad to earn 7 figures if they want to and most of the extra income is working from the comfort of your home and working fewer hours than most surgeons. If a derm, urologist, plastics, etc wanted make 7 figures, what would they have to do to make it possible? Run clinic 16 hours every day including weekends? Do surgery til midnight every night? Unlike most other fields, there is no overhead for my side hustles. I don’t need to pay a nurse or front desk person to help me make extra income. It’s just me and my workstation while my kids are playing just a few feet in front of me. I get paid hundreds per hour and keep every dollar I make (minus taxes). Can anyone name me a better side hustle that is realistically obtainable than this?

But at what cost? I am an employed radiologist and making $1 million will require a lot of call, weekends and late shifts. Not worth it.

 

[SeisK]

Just to be clear, these contract changes I discussed above were VERY recent, and the financial result has yet to clearly delineate themselves.

My expectation is that previously poorly reimbursed service lines subsidized by the DR group will now increasingly be subsidized by the hospital, which results in the higher pay per RVU per rad. a $70/RVU per rad practice can net 7 figures at 14.5k wRVU annually, which is a lot, but doable in a high volume practice with full vacation. What I’m saying is that the net average $/RVU we’re seeing is going to increase in the next few years as hospitals will increasingly have to subsidize their contracted radiology groups to maintain coverage. This is kind of inevitable, just a matter of time.

 

[Taurus]

But at what cost? I am an employed radiologist and making $1 million will require a lot of call, weekends and late shifts. Not worth it.

It’s not for everyone I agree. That’s why no matter what specialty most physicians do not make 7 figures. Most people in any field won’t make 7 figures, ie, lawyers, bankers, etc. For those who have the drive, then radiology is one of a very few fields with the potential to make 7 figures. It takes lots of hustling and keep looking for the right opportunities. Not every hustle is a good one. You keep the good ones and drop the bad ones. I am fortunate that I am in situation where I am earning a very high hourly rate consistently. I personally hate per click model so I usually avoid those hustles. I like to get a guaranteed rate for every hour I work. On my best days, I’m clearing 10k. Today, I took it easy and only worked 1.5 hours and made 1k. There’s so much work that I can’t do it all and have to leave money on the table. Yet, I still work fewer hours than most surgeons. My income this year is on track to be double what would be considered good PP income.

At this point though, I’m not trying to earn more income. It’s disheartening to have to pay Uncle Sam 400k in taxes. So right now, I’m more focused on ways to reduce my taxes. After all, what you keep is as important as what you make.

 

[Cognovi]

My experience has been that >95% of radiologists are not clinically astute enough to be absolutely sure a scan is pointless / superfluous given other laboratory, exam, and ROS data.

In questionable cases, there should be a discussion with the referring provider, which cannot stop at "because my attending wants it" or "per neurosurgery request".

The bean counter could incentivize the rads to check off a box in the protocolling software to indicate a back-and-forth communication occurred and document the outcome of the discussion, garnering a bonus if it's checked for at least 5% of advanced imaging orders.

Pipe dream?

 

[Womb Raider]

In questionable cases, there should be a discussion with the referring provider, which cannot stop at "because my attending wants it" or "per neurosurgery request".

The bean counter could incentivize the rads to check off a box in the protocolling software to indicate a back-and-forth communication occurred and document the outcome of the discussion, garnering a bonus if it's checked for at least 5% of advanced imaging orders.

Pipe dream?

And who is going to pay the rad for digging through the entire chart and making sure the exam isn't warranted? Completely untenable. What person is going to work for free in order to deny themselves future business?

 

[GadRads]

In questionable cases, there should be a discussion with the referring provider, which cannot stop at "because my attending wants it" or "per neurosurgery request".

The bean counter could incentivize the rads to check off a box in the protocolling software to indicate a back-and-forth communication occurred and document the outcome of the discussion, garnering a bonus if it's checked for at least 5% of advanced imaging orders.

Pipe dream?

Imaging is certainly over-utilized. When I was a senior resident and fellow, I would routinely deny unnecessary and ridiculous imaging requests. I would give an excellent tutorial explaining why the requested study was redundant or would not answer the clinical question, and most commonly they would resist. I am not sure whether they were just clueless, stubborn or egotistical. It was so laughable that a PGY2 or 3 internal medicine resident would try to lecture me (as a fellow) on cross-sectional imaging. It seems PACS makes everyone think they can do our job, until EPIC goes down for 1 hr and they begin to call the reading room frantically for verbal reads.

At times the residents, fellows and attendings would escalate denials to the section chiefs or, on rare occasions, the chair of radiology. In the unusual situation that the section chief agreed to perform the study, I would routinely call the result in so they knew that they just wasted everyone's time and money (in a nice way). It is one thing if the doc is overworked and does not have time to think, but if I have taken the time to explain why a study should not be performed and you still insist, then I begin to question your intelligence or intellectual humility.

 

[GadRads]

And who is going to pay the rad for digging through the entire chart and making sure the exam isn't warranted? Completely untenable. What person is going to work for free in order to deny themselves future business?

We just need to incentivize it. I would wager that easily 10-20% (probably higher) of studies are unnecessary. In my health system, that 10-20% would be worth approximately $50-$100 million. The radiology department in my health system brings in $500+ million annually.

 

[Womb Raider]

Imaging is certainly over-utilized. When I was a senior resident and fellow, I would routinely deny unnecessary and ridiculous imaging requests. I would give an excellent tutorial explaining why the requested study was redundant or would not answer the clinical question, and most commonly they would resist. I am not sure whether they were just clueless, stubborn or egotistical. It was so laughable that a PGY2 or 3 internal medicine resident would try to lecture me (as a fellow) on cross-sectional imaging. It seems PACS makes everyone think they can do our job, until EPIC goes down for 1 hr and they begin to call the reading room frantically for verbal reads.

At times the residents, fellows and attendings would escalate denials to the section chiefs or, on rare occasions, the chair of radiology. In the unusual situation that the section chief agreed to perform the study, I would routinely call the result in so they knew that they just wasted everyone's time and money (in a nice way). It is one thing if the doc is overworked and does not have time to think, but if I have taken the time to explain why a study should not be performed and you still insist, then I begin to question your intelligence or intellectual humility.

Must be nice having attendings with backbones. Our attendings, and especially chair, say "yes" to everything related to radiology. Unnecessary overreads, ordering more scans, you name it. The entire philosophy is about pleasing our clinicians rather than doing the right thing. Can't wait to leave.

 

[SeisK]

Must be nice having attendings with backbones. Our attendings, and especially chair, say "yes" to everything related to radiology. Unnecessary overreads, ordering more scans, you name it. The entire philosophy is about pleasing our clinicians rather than doing the right thing. Can't wait to leave.

Not so bad in private practice where every head c spine not meeting criteria is negative, fast read, AND your practice is bringing in extra money for it.

 

[Womb Raider]

Not so bad in private practice where every head c spine not meeting criteria is negative, fast read, AND your practice is bringing in extra money for it.

Exactly. If I were getting paid per study I would embrace this approach haha.

 

[Neopolymath]

Not so bad in private practice where every head c spine not meeting criteria is negative, fast read, AND your practice is bringing in extra money for it.

Sad for the patient but it takes longer to tell someone all the reasons they are objectively wrong than to just do the wrong study/non-indicated study and collect RVUs. Garbage in, garbage out. Order a non-con CT soft tissue neck and get the report you deserve lol.

Our attendings that don't block studies aren't doing it because they are spineless (mostly). They are too busy.

 

[GadRads]

Must be nice having attendings with backbones. Our attendings, and especially chair, say "yes" to everything related to radiology. Unnecessary overreads, ordering more scans, you name it. The entire philosophy is about pleasing our clinicians rather than doing the right thing. Can't wait to leave.

As a group, radiologists are spineless. I have no idea why. It is as if some of them forget how hard they trained to acquire their imaging skillset, and somehow they allow themselves to get pushed around. There is a somewhat popular case of a neurosurgeon who insisted his patient get the MRI despite a contraindicated hardware. The spineless radiologist decided to stop pushing back, and the kid died on the MRI scanner. That forced the health system to remind radiologists that they (not the surgeons) were in charge of imaging decisions. The poor radiologist got sued. When surgeons insist on getting a risky study done, I tell them to put a note in the chart assuming liability and stating the radiologist is not in support. They are usually more meek and ask me for alternatives.

I was fortunate to train at a place with attendings who had strong back bones. We did not get pushed around by referrers. My fellowship institution however was a different case. Referrers seemed to get surprised when I denied a useless study. The techs loved me as I decreased their workload. Despite the denials, we were still very busy.

One example in residency. No hydronephrosis on ultrasound 3 months prior. Very textbook normal CT urogram 3 weeks prior with an excellent excretory phase. Now the urology team wanted a MAG3 study to rule out obstruction. Normal BMP/renal function. This was at a top 10 institution. We performed the study only after our chair got involved. I read the MAG3 study in 2 mins. This was a waste of the technetium radiotracer, tech effort, camera time, and unnecessary radiation to the patient. Medicine is addicted to imaging. Lots of waste and it pisses me off.

 

[Cognovi]

As a group, radiologists are spineless. I have no idea why. It is as if some of them forget how hard they trained to acquire their imaging skillset, and somehow they allow themselves to get pushed around. There is a somewhat popular case of a neurosurgeon who insisted his patient get the MRI despite a contraindicated hardware. The spineless radiologist decided to stop pushing back, and the kid died on the MRI scanner. That forced the health system to remind radiologists that they (not the surgeons) were in charge of imaging decisions. The poor radiologist got sued. When surgeons insist on getting a risky study done, I tell them to put a note in the chart assuming liability and stating the radiologist is not in support. They are usually more meek and ask me for alternatives.

I was fortunate to train at a place with attendings who had strong back bones. We did not get pushed around by referrers. My fellowship institution however was a different case. Referrers seemed to get surprised when I denied a useless study. The techs loved me as I decreased their workload. Despite the denials, we were still very busy.

One example in residency. No hydronephrosis on ultrasound 3 months prior. Very textbook normal CT urogram 3 weeks prior with an excellent excretory phase. Now the urology team wanted a MAG3 study to rule out obstruction. Normal BMP/renal function. This was at a top 10 institution. We performed the study only after our chair got involved. I read the MAG3 study in 2 mins. This was a waste of the technetium radiotracer, tech effort, camera time, and unnecessary radiation to the patient. Medicine is addicted to imaging. Lots of waste and it pisses me off.

Link to that case please

 

[vm26]

Just to be clear, these contract changes I discussed above were VERY recent, and the financial result has yet to clearly delineate themselves.

My expectation is that previously poorly reimbursed service lines subsidized by the DR group will now increasingly be subsidized by the hospital, which results in the higher pay per RVU per rad. a $70/RVU per rad practice can net 7 figures at 14.5k wRVU annually, which is a lot, but doable in a high volume practice with full vacation. What I’m saying is that the net average $/RVU we’re seeing is going to increase in the next few years as hospitals will increasingly have to subsidize their contracted radiology groups to maintain coverage. This is kind of inevitable, just a matter of time.

Definitely an unique situation as these contract changes may come too late with too little. Groups that are borderline/short-staffed are vulnerable to implosion due to lack of recruitment/retainment-all based on a contract negotiated 3 years ago.

 

[GadRads]

Link to that case please

No official link. But told to me by a trusted source and confirmed by many others familiar with the institution.

 

[collegestud2013]

And who is going to pay the rad for digging through the entire chart and making sure the exam isn't warranted? Completely untenable. What person is going to work for free in order to deny themselves future business?

Those who are strictly salaried or paid by the hour (eg many academic jobs and the VA) and do not get paid by RVUs will definitely have the incentive to do the least amount of work possible and see the least volume, regardless of specialty.

A lot of the reason for the good radiology job market right now is due to the sheer volume of imaging that everyone orders nowadays for every little complaint. We're at the point where people often won't trust a documented physical exam anymore. It's well known that imaging is overutilized and CMS is already going after it to cut down the volume of imaging order, especially in the ED in the inpatient settings where there's not insurance pre-auth (for example, hospital EMRs are already being required by CMS prompt the ordering provider if it detects that an imaging study being order is not appropriate for the indication, and require providers to at least override it).

As others have said things come in waves. There have been endless posts discussing how AI is on the verge of being effective enough that it will soon lead to less radiologists being needed across the board. It will likely come with at least another CMS cut in imaging reimbursement which would require reading even higher volumes to maintain the same pay.

 

[SeisK]

There have been endless posts discussing how AI is on the verge of being effective enough that it will soon lead to less radiologists being needed across the board.

Not happening. AI increasing read rates has gone from an academic curiosity to controversial. Many radiologists, including myself, are convinced it slows them down, and it is nowhere near close enough to supplant radiologist reads of certain systems.

 

[Radology]

AI ironically made things worse

We used some AI software package to dramatically decrease our scan times on MRI. So now we are doing 20% more volume year over year with the same number of radiologists to read the studies

 

[SeisK]

AI ironically made things worse

We used some AI software package to dramatically decrease our scan times on MRI. So now we are doing 20% more volume year over year with the same number of radiologists to read the studies

Those algorithms scare me because they haven’t been validated at all and are becoming increasingly common. I have no idea what pathology could be interpolated over by reducing acquisition matrix size or interpolation to denoise. I don’t trust that ****.

 

[ProReduction]

No official link. But told to me by a trusted source and confirmed by many others familiar with the institution.

Did the Radiologist legitimately get named via the malpractice case being filed in court? Or did the health system quickly and quietly settle with the family before any malpractice case was filed? If a case like this was filed in court and there was an actual paper trail then this would be front page clickbait on every popular news outlet in the world. All of us would have read about it. That O2 tank being brought into an MRI scanner room and killing that kid in 2001 was less egregious and was a big headline.

 

[GadRads]

Did the Radiologist legitimately get named via the malpractice case being filed in court? Or did the health system quickly and quietly settle with the family before any malpractice case was filed? If a case like this was filed in court and there was an actual paper trail then this would be front page clickbait on every popular news outlet in the world. All of us would have read about it. That O2 tank being brought into an MRI scanner room and killing that kid in 2001 was less egregious and was a big headline.

They probably settled. I personally know some bad cases that never made it to the press post-settlement.

 

[meister]

Definitely a unique situation as these contract changes may come too late with too little. Groups that are borderline/short-staffed are vulnerable to implosion due to lack of recruitment/retainment-all based on a contract negotiated 3 years ago.

If you really want to see your salary skyrocket, stick around after an implosion.

Salary figures above are true. And do not necessarily require tons of weekends or nights. If anyone who reads this is stuck with a bad contract, non renew and make your demands. Does take some sweat and tears.

Know your worth. And realize the hospitals had no problem for the last 10+ years turning the screws to the max. And wouldn’t hesitate to do it again. It’s just business.