Why would you ever go into Radiology?

[xxxxxxxxxxxxxxx]

Recently someone tried convincing me not to go into DR for the following reasons:

1. Workload is exponentially increasing and reimbursement is going down
2. You'll have to do a useless (?) Intern year that won't have much of a bearing on how you practice in the future.
3. A fellowship is essentially required at this point, extending length of training to 6 years before you start making a decent salary.
4. Burnout and job dissatisfaction is near the top of the list now according to the 2018 report.


Now I'm not so sure I buy the usual doom and gloom...If you love something you just have to do that thing. What is your opinion of these arguments?

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[cyberchicken001]

1. Yes but this true in most of not all fields of medicine
2. One year is an insignificant amount of time relative to the rest of your career. Yes it can be terrible depending on the program, but it would be foolish to not choose radiology because of an intern year. I say this as someone currently suffering through said intern year - I don’t regret choosing radiology because of it.
3. It’s a total of six years post medical school, which is the same as cardiology, GI, pulm/CC, most surgical fields, etc. And I think the salary is in line with the length of training.
4. I can’t really speak to this as I have not started working in radiology yet, but I can tell you that I would be miserable doing medicine/surgery/er/whatever clinical field of medicine, so it’s really a personal decision. If you think you’d be happier doing something else then go for that.

 

[Mo991]

Its funny, some may advice not to go into DR because of AI and try to convince that you won't find work, others advice against it because of the increasing workload.

 

[Cognovi]

4. Burnout and job dissatisfaction is near the top of the list now according to the 2018 report.

Citation needed

 

[odyssey2]

My guess is Medscape: Medscape Access

But I'm not sure I trust a poll where PMR docs are more burnt out than gen surg

 

[redoitall]

I don't where the OP found the burnout statement.
No one can answer the question for you unfortunately. I have done 1 year of IM and I am now in Radiology. I can tell you that I will pick rad 10 times over. I truly enjoy it, even more than I though I would. Now granted I am just a resident and haven't had brutal night calls yet. But really, I wished my days were longer so that I would do more rad.
There are a few things I didn't know about rads before starting. First a day in rad is hard work and draining. Down time is often minimal so the pace is quite frantic at times. But time flies and it is only at the end of the day that you feel "tired". Another thing that can be an issue for some is the amount of knowledge to have. We must know a lot about all pathologies, and all modalities while most other specialties have a deep knowledge within 1 field. So that makes the amount of studying quite important and certainly more important than IM (that is the only field I can compare it to).
Other than that, I really like everything about radiology (the efficiency, not having to deal with orders, patient/nurse request and other notes and social issues).
Again, it is for you to find what you like most. What others say, or predict about the future and so on is honestly not relevant. All of medicine has always been changing.

 

[meister]

Its funny, some may advice not to go into DR because of AI and try to convince that you won't find work, others advice against it because of the increasing workload.

What is funny?

 

[Cognovi]

What is funny?

Nihilism. Either (A) your workload is going to go down because of AI until you're out of a job, or (B) your workload is going to continue to go up until you're burned out.

 

[meister]

Ah, misunderstood.

 

[xxxxxxxxxxxxxxx]

My guess is Medscape: Medscape Access

But I'm not sure I trust a poll where PMR docs are more burnt out than gen surg

It was this one.

So, why is radiology one of the most competitive specialties? I mean, we all know that it is up there with Derm, Orthopedics, ENT, etc. What are the reasons that push this field towards the top? Why are all the best medical students applying DR?

 

[Kuratz]

So, why is radiology one of the most competitive specialties? I mean, we all know that it is up there with Derm, Orthopedics, ENT, etc. What are the reasons that push this field towards the top? Why are all the best medical students applying DR?

To address your original points:
1. This is not unique to radiology and is happening in just about every other field
2. Some attendings felt like it was a useful year, others not. Regardless I wouldn't let one potentially "useless" year influence your decision much. Ophtho, Derm same thing
3. Yep. Again wouldn't let an additional year influence you much. Also required in many other fields so not unique to rads.
4. Hard to trust any survey with such a low response rate. But burnout is a real thing. I think the most burned out rads are those who are trying to maintain/maximize compensation and so feel like there is never-ending volume. Can mitigate by getting the right job.

So why go into rads?
In short: intellectually engaging, broad knowledge but still get to be a consultant, higher percentage of day spent using medical knowledge vs. social work etc, decent number of procedures, the paperwork is minimal/tolerable, pay is good, no pager, call sucks but otherwise 8-5. Some PP gigs get plenty of vacation. Lots of negativity on forums, go out and talk to rads in a variety of settings. I cannot stress the importance of being in the right work situation. A high volume skim job where you don't feel valued would be miserable.

 

[Piebaldi]

Recently someone tried convincing me not to go into DR for the following reasons:

1. Workload is exponentially increasing and reimbursement is going down
2. You'll have to do a useless (?) Intern year that won't have much of a bearing on how you practice in the future.
3. A fellowship is essentially required at this point, extending length of training to 6 years before you start making a decent salary.
4. Burnout and job dissatisfaction is near the top of the list now according to the 2018 report.


Now I'm not so sure I buy the usual doom and gloom...If you love something you just have to do that thing. What is your opinion of these arguments?

I would say it all depends. There is no magical medical job, or any magical job where all will be bliss in any field. I say this as someone who switched out of Radiology and went into PM&R.
I really disliked Radiology but then again I was not a good fit for it. I did not like the never ending reading of studies, and I felt anxious all the time about missing something and getting sued. It just wasn't right. I am in PM&R - I guess the most burn out specialty as Medscape or whoever says. As I have posted elsewhere my job certainly is not ideal, but I do get compensated fairly for the very saturated desirable city I am in. I work very reasonable hours in a low stress job. I will be doing a Pain fellowship that will increase my pay much more. So for me Radiology was not a good choice but a lot of that had to do with personal fit. I think Radiology is a necessary field that is definitely intellectually challenging and I doubt that AI will ever really be a threat.
Reimbursement goes down to some extent for one reason or another in most fields. Orthopods complain that surgery reimbursement has gone down. One of the people I will be training with for pain explained how SCS trials have gone down significantly in terms of compensation. EMGs got hit a while ago. Mohs got hit. It' s just the nature of the field.
Intern year is pretty much for everything you do - just about every specialist has to do an intern year. Surgical fields don't per se but their residencies are longer - ie gen surg is 5 years.
A fellowship is required in many fields, or the specialty requires specializd training - ie - you can be an internist in 3 years but as someone pointed out to be a GI, Cards, Pulm/cc doc you have to do extra training so its all about the same.
Burnout I am not sure since I don't have stats directly.

But again it's a personal choice. I would imagine that all specialites have pros and cons. There is no magical specialty. No magical field anywhere. Everything is a job at the end of the day, it simply depends on what you can toelrate more. I can tolerate PM&R more than I could ever tolerate Rads.

 

[Radology]

Burnout is definitely a thing in radiology. I never thought it was possible but I’m feeling it for the first time. But it was definitely self inflicted by working extra shifts so I have nobody to blame but myself.

Luckily, I’ll have 10 weeks of vacation the rest of the year to think about what I’ve done.

 

[Piebaldi]

Burnout is definitely a thing in radiology. I never thought it was possible but I’m feeling it for the first time. But it was definitely self inflicted by working extra shifts so I have nobody to blame but myself.

Luckily, I’ll have 10 weeks of vacation the rest of the year to think about what I’ve done.

Burnout is a thing with every specialty

 

[xxxxxxxxxxxxxxx]

Burnout is definitely a thing in radiology. I never thought it was possible but I’m feeling it for the first time. But it was definitely self inflicted by working extra shifts so I have nobody to blame but myself.

Luckily, I’ll have 10 weeks of vacation the rest of the year to think about what I’ve done.

How many hours per week do you normally work?

 

[TCOM12]

Surveys have a lot bias.

Radiology is getting busier and busier, but vacation time makes it doable. Vacation time for those in my class ranged from 9-18 weeks, jobs in the midwest and southeast. If you are willing to work nights, you can do a 7 on and 14 off schedule. Once you've built a nest egg, you can ease up and do teleradiology and work from home (telerads usually pays less). My work days are 7-8 hours a day. I worked 3 days last week, weekend off, worked today, three days off, work 4 days (Friday-Monday), work 3 days, 3 day weekend, 4 days the next week, then the next 9 days off...

Every practice is different, though. Some of the burnout comes from the fact that there are virtually no self employed radiologists, so there is always someone to answer to. But the burnout in other fields has to do with seeing a full load of patients and put coherent notes together, all while getting good patient satisfaction scores. A family practice doc may have a standard follow up for refills that still takes 15-20 minutes just because the necessity converse with the patient. If I come across a normal brain MRI without and with contrast, I can get through that study in a couple minutes without having to answer the "what if" questions. My production is largely based on my competence and speed.

Also, if I ever hear myself complaining, all I have to do is ask some colleagues in other fields. We still have it good.

 

[Piebaldi]

Surveys have a lot bias.

Radiology is getting busier and busier, but vacation time makes it doable. Vacation time for those in my class ranged from 9-18 weeks, jobs in the midwest and southeast. If you are willing to work nights, you can do a 7 on and 14 off schedule. Once you've built a nest egg, you can ease up and do teleradiology and work from home (telerads usually pays less). My work days are 7-8 hours a day. I worked 3 days last week, weekend off, worked today, three days off, work 4 days (Friday-Monday), work 3 days, 3 day weekend, 4 days the next week, then the next 9 days off...

Every practice is different, though. Some of the burnout comes from the fact that there are virtually no self employed radiologists, so there is always someone to answer to. But the burnout in other fields has to do with seeing a full load of patients and put coherent notes together, all while getting good patient satisfaction scores. A family practice doc may have a standard follow up for refills that still takes 15-20 minutes just because the necessity converse with the patient. If I come across a normal brain MRI without and with contrast, I can get through that study in a couple minutes without having to answer the "what if" questions. My production is largely based on my competence and speed.

Also, if I ever hear myself complaining, all I have to do is ask some colleagues in other fields. We still have it good.

18 weeks off? Wow. Where is that?

 

[deleted674723]

Surveys have a lot bias.

Radiology is getting busier and busier, but vacation time makes it doable. Vacation time for those in my class ranged from 9-18 weeks, jobs in the midwest and southeast. If you are willing to work nights, you can do a 7 on and 14 off schedule. Once you've built a nest egg, you can ease up and do teleradiology and work from home (telerads usually pays less). My work days are 7-8 hours a day. I worked 3 days last week, weekend off, worked today, three days off, work 4 days (Friday-Monday), work 3 days, 3 day weekend, 4 days the next week, then the next 9 days off...

Every practice is different, though. Some of the burnout comes from the fact that there are virtually no self employed radiologists, so there is always someone to answer to. But the burnout in other fields has to do with seeing a full load of patients and put coherent notes together, all while getting good patient satisfaction scores. A family practice doc may have a standard follow up for refills that still takes 15-20 minutes just because the necessity converse with the patient. If I come across a normal brain MRI without and with contrast, I can get through that study in a couple minutes without having to answer the "what if" questions. My production is largely based on my competence and speed.

Also, if I ever hear myself complaining, all I have to do is ask some colleagues in other fields. We still have it good.

I'm trying to get an understanding of the negativity of "the ever-growing list" and the pressures of speed. It was a large point of discussion in one of the most viewed posts on this board "advice from an attending radiologist" from 2014 (Advice from an attending radiologist). This thread is immensely negative about radiology in general, but one of the main complaints was some people working until 9-10pm to finish their list. I have only seen academic radiology and don't understand the workflow of PP. My understanding was radiology is shift work and when the clock hits 5, you finish up the reads that came in before 5 and head out. Can these really pile up that high? Do you ever get burned out from racing through reads? I know radiology isn't a lifestyle field. I don't want a lifestyle field. I am totally ok working nights and weekends. It IS important to me to have predictable hours though. Having an 8-5 weekday when I am not on call is important to me. Can you elaborate a bit on what the private practice workday is like?

 

[Radology]

Highly practice dependent. In my group, 80% of people are out the minute 5 pm hits. 15% are out at 530. The other 5% are just incredibly slow people or ones with neuroses that prevents them from committing to anything in a report.

I’ve heard of other practices where everyone reads until 8 pm; they are a minority But those do tend to be the ones with the highest compensation.

 

[deleted674723]

Highly practice dependent. In my group, 80% of people are out the minute 5 pm hits. 15% are out at 530. The other 5% are just incredibly slow people or ones with neuroses that prevents them from committing to anything in a report.

I’ve heard of other practices where everyone reads until 8 pm; they are a minority But those do tend to be the ones with the highest compensation.

Thanks for the reply. Really appreciate ya. A similar follow up as I only see how things work in a giant academic center... do you feel that what you do matters? My main concern with radiology is that I would feel as though my work is unimportant. That would be instant burn out.

I have zero problem being in the background. I don’t need anyone to know my name or thank me. I don’t derive my self worth from what patients or the lay public think of me. I DO need to believe that what I’m doing matters though.

So far at my institution, I’ve seen a surgeon look at a radiology report one time and the medicine team a handful more. I’ve heard people refer to radiologists as simply liability coverage for the hospital. Their only job is to document incidental findings because the rest of the hospital takes action long before reports even come out more than half the time. Plus 75-80% of the reads are stone cold normal. Is any of this true in community practice? If I end up serving my community by keeping my hospital from getting sued... I’m going to regret my decision.

 

[colbgw02]

So far at my institution, I’ve seen a surgeon look at a radiology report one time and the medicine team a handful more. I’ve heard people refer to radiologists as simply liability coverage for the hospital. Their only job is to document incidental findings because the rest of the hospital takes action long before reports even come out more than half the time. Plus 75-80% of the reads are stone cold normal. Is any of this true in community practice? If I end up serving my community by keeping my hospital from getting sued... I’m going to regret my decision.

These people are deluding themselves and/or lying to you. How do I know? Because I used to be on faculty at an academic center and I know that we add value, even to highly specialized surgeons. That isn't to say that non-radiologists can't get very good at looking at scans in their specialty, just that we're better at it and add real value.

Let's also remember that workflow in tertiary centers is distorted because a relatively high percentage of people are already known to have a diagnosis. For example, what trainees often don't see is that the patient saw a midlevel in an ED of an OSH, who (over)ordered medical imaging on which a radiologist made a diagnosis, prompting transfer to the tertiary center.

The idea that people are interpreting studies before reports are available has largely gone the way of the dodo. TATs in private practice are often in single digit minutes, and even in academia, where it might take a couple of hours for the attending to sign off, the residents' preliminary report is often available for review very quickly. Also, can I tell you how many times I get a phone call for a "stat" read on something that's been finalized with the completed report in the EMR from hours before?

The fact that so many of the studies we read are normal speaks more to how indispensable we are than the opposite. If people were so good at figuring out what was going on without radiology, then they could save everybody a whole lot of time and money by not ordering so much. But they're not, so they can't.

I've said this before, but if you ever want to shut down a hospital in a hurry, shut down radiology. That's especially true of the ED. And this is true in academia as well. An ED physician at my old job put the hospital on divert because she couldn't get a plain film read for a couple of hours (you know, while the radiologists were busy reading trauma scans and other assorted cross-sectional studies). Diversion. Because an attending academic EP couldn't trust her own read of a CXR for a couple of hours. That is the degree to which radiology is integrated into modern medicine.

 

[lagbydesign]

From all the reading I've done about rads, the feeling I get is that you are like a commodity with no real power and can be easily replaced, unlike a surgeon, for example. It appears that you are more at the mercy of the healthcare system. Are my feelings wrong?

 

[Wantnosmoke24]

From all the reading I've done about rads, the feeling I get is that you are like a commodity with no real power and can be easily replaced, unlike a surgeon, for example. It appears that you are more at the mercy of the healthcare system. Are my feelings wrong?

Maybe....but why would anyone willingly become a surgeon??

 

[TCOM12]

Most subspecialties think they're the most important thing, and how could anyone miss the obvious symptom, finding, lab value, etc. The advantage that the surgeon/clinician has over a radiologist is having a talking patient sitting in front of them. I can say that 85% of histories given are non-contributory. Some of that is a result of EMR, some of it is laziness, some of it is having a medical assistant or secretary enter information they don't totally understand. Some of it is the willingness of radiology department to simply scan a patient because there is a billable indication and not a relevant history. It's not uncommon that I receive a non-contrast CT of the abdomen and pelvis without contrast (IV or oral) and the indication states "pain." The clinician has poked on the patient and can localize the pain, then they can look at the targeted area and make the finding. The radiologist just goes through a search pattern and will usually make the finding. If you have that scenario 85 out of 100 times, then you're bound to miss something on one of those scans.

Most clinicians would have difficulty coming to a conclusion without the information necessary to make the diagnosis. Additionally, with the rise of mid-level providers who have absolutely no imaging taught in school, then that definitely makes us necessary. There are also a lot of medical schools that teach radiology at a sub-par level given how ubiquitous it is. You are taught much more histology in med school then you will ever use in a career.

In terms of commodity and no power-- all specialties are susceptible to this. I suppose surgeons may have more "security." Go to finance/wealth management boards (not this site, try WCI or bogleheads) and type "negotiation" into the search. You'll learn about the real world of medicine when you see the numbers and the things that are offered to physicians or other providers.

Oh and the clinician who thinks that we exist to protect a hospital... maybe they're dissatisfied with their life and they wish they were a radiologist and just projecting? I don't know. As a 3rd year student who was rotating on medicine and meandering into the pathology suite (because waiting on labs and twiddling my thumbs on wards was boring), I was offered some good advice from an attending pathologist... look around at the interns, residents and attendings and look how happy they really are. That will tell you how burned out they really are, not a feigned smile with the room ablaze while they state "everything is fine."

 

[colbgw02]

From all the reading I've done about rads, the feeling I get is that you are like a commodity with no real power and can be easily replaced, unlike a surgeon, for example. It appears that you are more at the mercy of the healthcare system. Are my feelings wrong?

This is a concern in any specialty that doesn't control the patients, e.g. radiology, EM, anesthesiology, but I think it's overemphasized by non-radiologists. So much of what we do isn't about image interpretation, and so many people undervalue the importance of having a local, known radiologist with which to interact. It takes awhile for people to figure that out once they're gone.

Fifteen years ago, teleradiology was going to complete the commoditization of radiology, until it didn't, and the newest threat is VC/corporate radiology. It, too, will take awhile to work itself out, usually because the admin/business people have a poor understanding of how this whole thing works. Keeping radiology in a mild supply shortage would help as well.

 

[TCOM12]

I was going to mention telerads, as well.

There are also a number of image guided procedures that many physicians are unwilling to perform. It was common for bedside paras and thoras to be performed by internists without the need for image guidance. Now they ask for therapeutic taps because of the lack of confidence, as well as the time (it takes a while for 10L of ascites to get drained).

An echo to colbgw, there is a trust that specialists have in a radiologist they know. The clinicians know who is good at reading what. For example, where I trained, the clinicians would ask for a specific radiologist they trusted. If that person wasn't there, they would just call back later, even if there were other subspecialty trained radiologists who were more the competent enough to provide an interpretation. We have to over-read overnight teleradiology preliminary reads (read by board certified radiologists). If they miss something that we have to call about, the clinicians complain because they don't know who read the scan (even if said radiologist is held to the same miss standard everyone else is).

One of the harder things about missing something as a radiologist is that the scan never changes. It can always be looked at later by someone else and the data hasn't changed. A clinician can always have the leeway of memory and perspective from others in the room, which can change over time (which is why documentation is so important).

 

[deleted674723]

This is a concern in any specialty that doesn't control the patients, e.g. radiology, EM, anesthesiology, but I think it's overemphasized by non-radiologists. So much of what we do isn't about image interpretation, and so many people undervalue the importance of having a local, known radiologist with which to interact. It takes awhile for people to figure that out once they're gone.

Fifteen years ago, teleradiology was going to complete the commoditization of radiology, until it didn't, and the newest threat is VC/corporate radiology. It, too, will take awhile to work itself out, usually because the admin/business people have a poor understanding of how this whole thing works. Keeping radiology in a mild supply shortage would help as well.

Any idea what the outlook for radiology residencies is as far as creating a supply shortage? It seems like we’re cranking out new radiologists at a large clip.

Edit: another question I’ve come across is about these 7 on 7 off shifts. As is the theme with my questions, just trying to understand the private practice job setting. When a job lists these 7 on 7 off jobs, the assumption is you work 26 weeks a year but then there is often vacation time of 8 weeks. Does that mean that you really only work 18 weeks a year? Am I missing something here?

 

[Rad2013]

I am not aware of 7 on 7 off jobs that have vacation (but I don't know for a fact that they don't exist... just haven't seen a listing myself). 7 on 7 off without vacation is probably not sustainable. What's becoming quite common is 7 on 14 off without vacation (34 weeks off is assumed to be plenty of vacation). I have seen one listing for 7 on 21 off (presumably without vacation).

 

[colbgw02]

Any idea what the outlook for radiology residencies is as far as creating a supply shortage? It seems like we’re cranking out new radiologists at a large clip.

I'm not really well enough informed to speak to whether we're training too many or too few radiologists. I know that a few years ago, when the job market was bad, there were a lot of people up in arms about the number of residents being trained as well as the alternate pathway to ABR certification. Not surprisingly, at least not to me, the job market turned around without a significant reduction in the number of trainees.

Edit: another question I’ve come across is about these 7 on 7 off shifts. As is the theme with my questions, just trying to understand the private practice job setting. When a job lists these 7 on 7 off jobs, the assumption is you work 26 weeks a year but then there is often vacation time of 8 weeks. Does that mean that you really only work 18 weeks a year? Am I missing something here?

I encourage you to think about time off not as number of vacation weeks, but rather number of shifts worked per year. A 7 on/7 off job is exactly that, which sounds like a lot of time off (26 weeks!). However, that's 182 shifts/year, which is only a handful fewer than what I work as a full-time private practice radiologist who gets to work when the sun is out (most of those jobs are evening/overnight). Considering that most humans aren't nocturnal and you're working half of all holidays/weekends, it's a bad deal for most people. 7 on/14 off is more sustainable, but even then it's still not the right fit for a lot of people.

 

[Piebaldi]

I am not aware of 7 on 7 off jobs that have vacation (but I don't know for a fact that they don't exist... just haven't seen a listing myself). 7 on 7 off without vacation is probably not sustainable. What's becoming quite common is 7 on 14 off without vacation (34 weeks off is assumed to be plenty of vacation). I have seen one listing for 7 on 21 off (presumably without vacation).

How is that sustainable though? I mean 7 on/14 off is essentially working 2 weeks every month, I assume 12 hour shifts? but the other - 7 on 21 off seems silly.

 

[colbgw02]

Check your math. 7 on/14 off isn't 2 weeks every month. The first is around 120 shifts per year; the latter is 168 shifts per year.

The shifts for these jobs average around 10 hours, but I've seen as short as 8 hours. Twelve hours is too long to maintain, unless maybe it's a telerad gig from home.

And what are you asking about sustainability? Are you asking from the group's or the individual's perspective?

 

[Piebaldi]

Check your math. 7 on/14 off isn't 2 weeks every month. The first is around 120 shifts per year; the latter is 168 shifts per year.

The shifts for these jobs average around 10 hours, but I've seen as short as 8 hours. Twelve hours is too long to maintain, unless maybe it's a telerad gig from home.

And what are you asking about sustainability? Are you asking from the group's or the individual's perspective?

Why would most groups offer someone to only work so little out of the month? 7 on/14 off and then another 7 on is 28 days. So 14 days on and 14 days off essentially. Point is - working only 7 days and then being off for 3 weeks seems financially unsustainable for any group

 

[Rad2013]

With 7 on/14 off, there are some months where you work 2 full weeks. Then there are months where you only end up working 1 full week. Then there are months where you work something in between (i.e. one full week within the month and then another week bridging two months).

 

[colbgw02]

Why would most groups offer someone to only work so little out of the month? 7 on/14 off and then another 7 on is 28 days. So 14 days on and 14 days off essentially. Point is - working only 7 days and then being off for 3 weeks seems financially unsustainable for any group

Because overnight work sucks, so groups are willing to take the financial hit by paying someone a premium to work it exclusively. The rise of 7 on/14 off jobs reflects an improving market and groups' realization that 7 on/7 off isn't sustainable for most people. They want to be able to attract and keep high quality in these positions.

I've personally never seen a 7 on/21 off job, but I would guess that the remuneration is substantially less than an FTE. These other 7/7 or 7/14 jobs are either equal to partner pay or close, respectively, at least the good ones are.

 

[deleted674723]

Because overnight work sucks, so groups are willing to take the financial hit by paying someone a premium to work it exclusively. The rise of 7 on/14 off jobs reflects an improving market and groups' realization that 7 on/7 off isn't sustainable for most people. They want to be able to attract and keep high quality in these positions.

I've personally never seen a 7 on/21 off job, but I would guess that the remuneration is substantially less than an FTE. These other 7/7 or 7/14 jobs are either equal to partner pay or close, respectively, at least the good ones are.

Is it still the case that most jobs are the regular 8-5 with call? That is most certainly what I would prefer. I can understand the motivation for some working 7/14, but are the people working 7/7 new grads without many options or in saturated cities or something? Is this considered a second tier position or just an option for people who want that lifestyle? Also, it sounds like you're saying these nontraditional schedule jobs aren't usually partnered positions. Why is that if they are still putting in what is considered full time?

 

[Radology]

I’ve heard of 7 on 7 off alternating swing shifts (Ie 2-12) and night shifts. 7 on 7 off overnight work is really only viable if it’s a true partnership position. overnight shifts at corporate outfits like vrad are really just designed for the bottom of the barrel radiologists.

That said...cowlb may say that overnight work sucks. After spending a couple years in private practice, I’m not so sure anymore. The tumor boards, the phone calls from needy referrers, the fluoro cases. And don’t even get me started on the incessant whining from the partners who have utterly lost every bit of perspective of the world they live in. “Oh you had to stay 15 minutes past 5 saying words into a microphone to generate your 700k salary? Oh, you only 9 of the 10 vacation weeks you wanted? That sounds so hard.”

At least at night, ER work tends to be rather straight forward and more interesting. No pulmonary nodule follow ups. No oncology cases with 20 comparisons. No degenerative spine mri. No boluses of spinal fusion follow ups. Just you and the cases of acutely Ill patients. I know grass is always greener, but damn does that grass look green in a 7/14 model. As someone who tends to be a night owl, the money difference is really the only thing that makes me avoid a job change.

 

[colbgw02]

Is it still the case that most jobs are the regular 8-5 with call? That is most certainly what I would prefer.

As an average, that's probably about right.

I can understand the motivation for some working 7/14, but are the people working 7/7 new grads without many options or in saturated cities or something? Is this considered a second tier position or just an option for people who want that lifestyle?

Yeah, I would say wanting to stay in a desirable city is the biggest reason. The idea being that they can pay the bills for a couple of years until something else opens up. Most people probably underestimate the physical toll that switching your sleep cycle so frequently takes, and obviously there is a subset of people who just like that type of work/schedule. The 7/7 jobs are still out there, but I would not consider one, especially because good 7/14 jobs are probably equally abundant nowadays.

Also, it sounds like you're saying these nontraditional schedule jobs aren't usually partnered positions. Why is that if they are still putting in what is considered full time?

Many of these groups offer some sort of partnership, sometimes even full partnership, but it's important to realize that there's more to being a partner than just working full time. Partners are expected to engage in various practice building activities, like sitting on hospital committees, attending meetings, or even just hanging out with other docs in the lounge. It's hard to do that when you're gone 2/3rds of the time and no one else is around when you are working. It's easy to feel isolated in these jobs, which is why good groups go out of there way to make sure their overnight teams feel included.

Also, for 7/14 jobs, it's pretty common for people to commute, even from great distances, for their weeks on. Groups may be wary of giving a partner's vote to someone who doesn't have strong ties to the area. And in an era with so many groups selling out, it's hard to blame them.

 

[deleted674723]

I’ve heard of 7 on 7 off alternating swing shifts (Ie 2-12) and night shifts. 7 on 7 off overnight work is really only viable if it’s a true partnership position. overnight shifts at corporate outfits like vrad are really just designed for the bottom of the barrel radiologists.

That said...cowlb may say that overnight work sucks. After spending a couple years in private practice, I’m not so sure anymore. The tumor boards, the phone calls from needy referrers, the fluoro cases. And don’t even get me started on the incessant whining from the partners who have utterly lost every bit of perspective of the world they live in. “Oh you had to stay 15 minutes past 5 saying words into a microphone to generate your 700k salary? Oh, you only 9 of the 10 vacation weeks you wanted? That sounds so hard.”

At least at night, ER work tends to be rather straight forward and more interesting. No pulmonary nodule follow ups. No oncology cases with 20 comparisons. No degenerative spine mri. No boluses of spinal fusion follow ups. Just you and the cases of acutely Ill patients. I know grass is always greener, but damn does that grass look green in a 7/14 model. As someone who tends to be a night owl, the money difference is really the only thing that makes me avoid a job change.

How much of a hit would you take on taking that night shift instead? Also, these old radiologists still making 700k... are they making that because they generate that much revenue or just because they are the oldest guys in the practice? Is that a reasonable expectation for you and other young radiologists to be in a similar position (I'm making an assumption that you are younger based on what you said) as they age out of the practice and you become more senior?

 

[deleted674723]

As an average, that's probably about right.



Yeah, I would say wanting to stay in a desirable city is the biggest reason. The idea being that they can pay the bills for a couple of years until something else opens up. Most people probably underestimate the physical toll that switching your sleep cycle so frequently takes, and obviously there is a subset of people who just like that type of work/schedule. The 7/7 jobs are still out there, but I would not consider one, especially because good 7/14 jobs are probably equally abundant nowadays.



Many of these groups offer some sort of partnership, sometimes even full partnership, but it's important to realize that there's more to being a partner than just working full time. Partners are expected to engage in various practice building activities, like sitting on hospital committees, attending meetings, or even just hanging out with other docs in the lounge. It's hard to do that when you're gone 2/3rds of the time and no one else is around when you are working. It's easy to feel isolated in these jobs, which is why good groups go out of there way to make sure their overnight teams feel included.

Also, for 7/14 jobs, it's pretty common for people to commute, even from great distances, for their weeks on. Groups may be wary of giving a partner's vote to someone who doesn't have strong ties to the area. And in an era with so many groups selling out, it's hard to blame them.

That all makes a lot of sense. How big of an issue does "groups selling out" pose for those starting a career in the next 5-10 years?

 

[colbgw02]

That said...cowlb may say that overnight work sucks. After spending a couple years in private practice, I’m not so sure anymore. The tumor boards, the phone calls from needy referrers, the fluoro cases. And don’t even get me started on the incessant whining from the partners who have utterly lost every bit of perspective of the world they live in. “Oh you had to stay 15 minutes past 5 saying words into a microphone to generate your 700k salary? Oh, you only 9 of the 10 vacation weeks you wanted? That sounds so hard.”

At least at night, ER work tends to be rather straight forward and more interesting. No pulmonary nodule follow ups. No oncology cases with 20 comparisons. No degenerative spine mri. No boluses of spinal fusion follow ups. Just you and the cases of acutely Ill patients. I know grass is always greener, but damn does that grass look green in a 7/14 model. As someone who tends to be a night owl, the money difference is really the only thing that makes me avoid a job change.

There's a lot of truth to this. I did week long overnight shifts 6-8 times a year for 5+ years, and while I wouldn't say that the work is more interesting, it's definitely more straightforward and streamlined. In a field where distractions are the norm, it's so refreshing simply to be able to sit down and read studies. Also, I've found hospitals have a totally different, much lower stress vibe at night. I strongly considered overnight positions, but it's really difficult with family and kids. I was also really worried about doing the day/night switches as I got older.

 

[Radology]

1 on 2 off tends to be 350ish if onsite. 275-300 if remote.

At my group, 700 is total package if you include profit sharing/bonuses etc. salary itself is probably 500ish. Partners make the same, partner track employees like me make lower rates than vrad

So yes. Huge long term financial hit. But huge lifestyle gains. realistically, I’ll probably make the change in 10-15 years to part time or nighthawk (Or whenever my group sells out). YOLO

 

[colbgw02]

How much of a hit would you take on taking that night shift instead? Also, these old radiologists still making 700k... are they making that because they generate that much revenue or just because they are the oldest guys in the practice? Is that a reasonable expectation for you and other young radiologists to be in a similar position (I'm making an assumption that you are younger based on what you said) as they age out of the practice and you become more senior?

Once reaching full partnership, everyone typically makes the same amount. No system is perfect, and this approach allows slower and/or lazier radiologists to profit from harder working ones. That said, eat-what-you-kill compensation models come with a whole slew of different and, in my opinion, bigger problems.

 

[deleted674723]

1 on 2 off tends to be 350ish if onsite. 275-300 if remote.

At my group, 700 is total package if you include profit sharing/bonuses etc. salary itself is probably 500ish. Partners make the same, partner track employees like me make lower rates than vrad

So yes. Huge long term financial hit. But huge lifestyle gains. YOLO

I imagine much of the partner income is from ownership of imaging machines or centers or something, correct? Or is 500k achievable just on the RVUs from interpreting studies? This is where I would imagine the problem of private practices selling out presents itself. Radiologists would lose income as a result of anything except reading studies for their employer... which seems like a big knock. Am I off base?

 

[colbgw02]

That all makes a lot of sense. How big of an issue does "groups selling out" pose for those starting a career in the next 5-10 years?

If I had that kind of insight, I would have directed it toward the stock market and be retired already.

From what I can glean from people that know more than I, the locomotive corporate/VC radiology is going to derail eventually. They're already having difficulty hiring people, because most people know that these are not good jobs. They're staying afloat right now because they are in a honeymoon period during which the "partners" are obligated to stay with the practice after receiving the buyout for so many years. When that period is over, the radiologists are going to bolt or retire, and then the suits will lose the hospital contract when the work can't get done. There's a lot more to it, obviously, but I'm not really business savvy to speak to it in more depth.

Selling out seems to be a regional thing, so the likelihood you'll run into it is probably a function of where you end up practicing.

 

[colbgw02]

I imagine much of the partner income is from ownership of imaging machines or centers or something, correct?

Not anymore. The vast majority of a radiologist's income is from professional fees.

Or is 500k achievable just on the RVUs from interpreting studies?

Yes.

This is where I would imagine the problem of private practices selling out presents itself. Radiologists would lose income as a result of anything except reading studies for their employer... which seems like a big knock. Am I off base?

Right. When a VC group buys a practice, they're really just buying the accounts receivable and temporary use of the radiologists. It's a fundamental flaw in the business model, but again, I'm not savvy enough to discuss in detail.

The way radiologists get paid is also a reason to avoid eat-what-you-kill models. There are lots of ways people add value to a practice beyond just reading studies, so overemphasizing RVUs - an already flawed metric - leads to beaucoup problems.

 

[Radology]

400-500k is achievable from reading studies alone. Imaging centers bump those up another 100-200.

Correct on your assessment of the selling out. What was 600k is now 400k. Except that the corporation has also found other ways to make your group more “efficient”. Couple less days off here or there. Rvu minimums. Cut a couple of FTEs. Except the fun part is if your group had done that themselves, you would have turned that 600k into 700k.

We’re seen the first wave of corporate buyouts. It led to the complete dissolution of a local private practice. Partners sold, worked for 5 years, got their buyouts, and everyone left. The group couldn’t hire, and lost their contracts to an academic center nearby

That’s why you should avoid envision, radpartners jobs like the plague. They’ll lure you in with a decent offer, much higher than private practices and academics start at. But There will be a very good chance you’ll be starting over again looking for a new job after 5 years

 

[deleted674723]

Not anymore. The vast majority of a radiologist's income is from professional fees.



Yes.



Right. When a VC group buys a practice, they're really just buying the accounts receivable and temporary use of the radiologists. It's a fundamental flaw in the business model, but again, I'm not savvy enough to discuss in detail.

The way radiologists get paid is also a reason to avoid eat-what-you-kill models. There are lots of ways people add value to a practice beyond just reading studies, so overemphasizing RVUs - an already flawed metric - leads to beaucoup problems.

Alright what the hell is a professional fee? (Really appreciate you taking the time to teach me by the way)

 

[deleted674723]

Selling out seems to be a regional thing, so the likelihood you'll run into it is probably a function of where you end up practicing.

Common in the Southeast?

 

[colbgw02]

Alright what the hell is a professional fee? (Really appreciate you taking the time to teach me by the way)

In general terms, a radiology CPT code will have professional and technical RVU components attached to it. The former is designed to compensate the professional for providing his/her expertise. The latter is designed to maintain the equipment, pay the technologists, keep the lights on, etc.

 

[deleted674723]

400-500k is achievable from reading studies alone. Imaging centers bump those up another 100-200.

Correct on your assessment of the selling out. What was 600k is now 400k. Except that the corporation has also found other ways to make your group more “efficient”. Couple less days off here or there. Rvu minimums. Cut a couple of FTEs. Except the fun part is if your group had done that themselves, you would have turned that 600k into 700k.

We’re seen the first wave of corporate buyouts. It led to the complete dissolution of a local private practice. Partners sold, worked for 5 years, got their buyouts, and everyone left. The group couldn’t hire, and lost their contracts to an academic center nearby

That’s why you should avoid envision, radpartners jobs like the plague. They’ll lure you in with a decent offer, much higher than private practices and academics start at. But There will be a very good chance you’ll be starting over again looking for a new job after 5 years

Very enlightening. Thanks for explaining.