Job Search Advice

[MouseChair]

I am current senior rads resident, going to fellowship (IR) in a different state. Hoping to move to wife's hometown after training. It is a big city (Top ~8 or so by population) in the USA. There are tons of practices around, ranging from academic to private equity with a few privately owned practices in between.

My ideal job would be at a true physician owned PP. I want to do mostly IR but want to also have a good mix of DR to maintain skills and maybe step back into that if needed in the future. that being said... i'm open to an academic or PE if it makes sense.

Going from med school to residency and fellowship, the path seemed fairly straightforward. Now I kind of feel like I have no idea how to pick a job, especially with variability in types of IR procedures and DR requirements.

What is the appropriate time line for looking for a job? I will be done with training in around 18 months. Too early to talk to them now? Or is it better to talk before I leave for fellowship?

How to tactfully talk to multiple practices at the same time? This may be silly, but dont want to be a guy who is asking all the girls out to prom if that makes sense

Many jobs in this location are not on ACR/SIR job boards. Is it ok to cold call/email these practices?

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[guytakingboards]

What is the appropriate time line for looking for a job? I will be done with training in around 18 months. Too early to talk to them now? Or is it better to talk before I leave for fellowship?

At your level, It's absolutely not too early in the current market. Any time from now onward is fine.

How to tactfully talk to multiple practices at the same time? This may be silly, but dont want to be a guy who is asking all the girls out to prom if that makes sense

Groups have better things to do than compare notes on who's applying to them. They also understand it's a buyer's market and people will explore a lot of options. I wouldn't worry about this.

Many jobs in this location are not on ACR/SIR job boards. Is it ok to cold call/email these practices?

Absolutely. I think most groups would be thrilled if a qualified, interested candidate just dropped in their laps. Worst possible outcome is they don't get back to you.

 

[CherryRedDracul]

Not my website, but check out Independent Radiology for jobs.

 

[vm26]

I am current senior rads resident, going to fellowship (IR) in a different state. Hoping to move to wife's hometown after training. It is a big city (Top ~8 or so by population) in the USA. There are tons of practices around, ranging from academic to private equity with a few privately owned practices in between.

My ideal job would be at a true physician owned PP. I want to do mostly IR but want to also have a good mix of DR to maintain skills and maybe step back into that if needed in the future. that being said... i'm open to an academic or PE if it makes sense.

Going from med school to residency and fellowship, the path seemed fairly straightforward. Now I kind of feel like I have no idea how to pick a job, especially with variability in types of IR procedures and DR requirements.

What is the appropriate time line for looking for a job? I will be done with training in around 18 months. Too early to talk to them now? Or is it better to talk before I leave for fellowship?

How to tactfully talk to multiple practices at the same time? This may be silly, but dont want to be a guy who is asking all the girls out to prom if that makes sense

Many jobs in this location are not on ACR/SIR job boards. Is it ok to cold call/email these practices?

I graduated from fellowship as a DR in 2013 and did not sign a contract around Memorial Day my fellowship year. By this time, the job that I had interviewed for 5 months earlier-which was a 2 year partnership track into a traditional private practice, was now an employee only job with productivity bonus's after you hit >17KwRVU (around >90th% MGMA) 🙄...Point being you are graduating into a vastly improved market (aside from the PE factor), so essentially you have nothing to lose with whatever approach you chose to take.

Off the top of my head, here are a few things to keep in mind:
1. Regardless of net income, time off, case/procedural mix, location, buy-in, benefits, etc, the bottom line to the "quality" of your job is what are you earning per wRVU. Are you making $3/latte or $6/latte?
2. I have a hard time seeing working for PE as making sense unless your significant other is the bread winner and you just need a job due to location. Inherent to the PE model, you will be working at a discounted $/wRVU rate (from what I have heard this is likely in the 40% range), which is needed so they can may show some type of profit that sees its way back to their investors.

 

[MouseChair]

How does the $/RVU calculation change for an IR?

 

[vm26]

How does the $/RVU calculation change for an IR?

In general its much harder on IR particularly for inpatient stuff (however this service is invaluable to hospitals and helps maintain a PP's contract)...The real money for IR would be a OBL (assuming that the radiology group owned or at least took a cut) given the astronomic technical fees-typically like 3-4x the pro-fee. "Pro-fee" is wRVU+ practice fee+ malpractice fee, this is complex and many rads do not understand this, I only partially understand it, so for now we can stick with just the wRVU but be aware that groups at times use "pro-fee" and "wRVU"synonymously but they are not the same (Pro-fee will always be higher than just wRVU).

For any exam/procedure, all you have to do is search for the CPT code for a specific procedure and then this into a wRVU calculator (see far below). Here is a random example I found for 36837which is pretty solid as it equates to 9.3wRVU. PCN is around 4.0wRVU, not great. CT a/p with IV is around 1.8, brain MR with/without is around 2.29. Screening tomo is around 1.3 (goldmine).

In PP, mammo-donna's b*tch that they are subsidizing the whole group. DR rads b*tch that they are subsidizing the IR's. IR rads b*tch that they are the ones keeping the contract doing thankless (eg.low paying work) on in-pts 24/7.

CPT® 36837, Under Hemodialysis Access, Intervascular Cannulation for Extracorporeal Circulation, or Shunt Insertion Procedures on Arteries and Veins​

Work RVU Calculator - AAPC

www.aapc.com

 

[irwarrior]

Great point above. The Inpatient interventionalist is often delegated to doing minor procedures (paracentesis/lp/thoracentesis/abscess drains/ biopsies/ central lines etc) and emergent procedures (GI bleeders/ hemoptysis/epistaxis/ acute limb ischemia/DVT/PE/stroke etc). The bulk of minor procedures generate low professional fees. The hospital does require these services but take it for granted in most places as it is given for "free" with the radiology contract. Stroke is an exception to this as the hospitals will often fund the rads group $$$ per year to provide services. The rads group "subsidizes" the IR physicians to provide these low level services to the hospitals.

Some VIR physicians are offering independent coverage separate from DR with a "stipend" that the hospital gives to cover call and provide inpatient coverage. The VIR physicians will generate x amount of revenue by performing a consult and rounding and that sometimes generates more revenue than the procedure. They also provide high level DVT/PE thrombectomy which is a large DRG for the hospital that provides these services. The independent VIR physicians will often have an outpatient clinic and can bring their patient's to the hospital lab of their choice and thus the hospital can get the technical fees for that. Once, the hospital sees the benefit of patients brought into their hospital by VIR they start to cater to those physicians.

The higher reimbursing embolization/angioplasty/thrombectomy codes generate reasonable professional fees but pale in comparison to DR counterparts reading neuro or mammography. The technical fees are pocketed by the hospital. If you own an OBL/ASC the group now pockets the globals (professional and technical fees).

Most OBL/ASC are driven by PAD interventions and dialysis interventions with an increase in embolization (prostate/fibroids/hemmorrhoids/genicular etc). These require marketing budgets and some even have joint ventures with other specialists (podiatry/wound care centers/ GI/Urology/ortho etc). The marketing to patients and primary and running a clinic and E and M coding are not taught in most VIR training programs but are critical to success in the private sector.

 

[guytakingboards]

How does the $/RVU calculation change for an IR?

Mostly it doesn't. It's mostly a group-level metric meant to normalize pay per productivity. E.g. is a $500k pay for $11k RVUs better or worse than $750k for $20k RVU's? The latter offer is 50% more by gross but you're doing well more than 50% more RVUs. The $/RVU for job 1 is $45/RVU but the $/RVU for job 2 is only $37.5/RVU.

For IR, the denominator is clearly going to be different given that IR's produce less RVU's on the whole. But the math for job comparisons sake is going to be similar.

It's not meant to get into the weeds of the ease of individual RVU generation: (e.g MRI brain WOW contrast vs Rheum clinic hand xrays) or on the IR side PE thrombectomy vs paracentesis.

 

[Olddogdoc]

This lecture might provide some answers. It's about a year old and is slightly out-of-date but mostly on target.

https://michigan-rad.org/wp-content/uploads/2023/12/How-To-Find-A-Radiology-Job-And-Evaluate-A-Job-Offer-12-23.pdf