Thursday, March 30, 2017

Radiology Job Search: Practice Models

I'm currently an abdominal radiology fellow in Los Angeles, Ca and interviewing (mostly in Southern California)) for my first job out of radiology training; I interviewed at handful of academic and private practices. I had no idea what to expect and was super surprised by what I learned. I wanted to share what I learned from my interviews about different radiology practice models in Southern California:
  • Setting: Just like other practices, the main division is between outpatient and hospital based (inpatient/ER) practice (although, keep in the mind that some academic and private hospitals are expanding the outpatient business).
    • Hospital based practice: 

      • Private practice: I interviewed at three hospital based private practices (PP) and all three groups were small (10-12 radiologists).

        • Salary and other perks: base of 300-370k for the first 1-2 years before partnership. After partnership, income exceeded 450k depending on how much extra shifts you wanted to take. The base salary is low 200k plus the bonuses quarterly can add up to over 400-550k/yera. One PP gave 24k (pre-tax) per month for mileage, computer purchase, CME, conferences, etc etc. Another PP had 1099 for all partners so everyone deducted their own business expenses.
          • Large corporations like RadNet, vRad, StatRad mostly cover outpatient, but many small PP will contract out the overnight (nighthawk) services to them. 
        • Volume/type: 90-110 per shift. 40-50% cross sectional (mostly CT) and the rest are radiographs.   Everyone reads everything and it's usually read from one list.
        • Pathology: Usually bread and butter community pathology.
        • Call and schedule: Two of the three groups I interviewed shared called equally among the group. So it was q10-12 weeks. 
        • Partnership: When you make partner, you get bonuses and other perks depending on the practice. It  usually takes 2 years. One of the group paid 75% the first year, 85% 2nd year and 100% the third year of partnership. 
        • Vacation:  5-12 weeks. Two groups gave 12 wk vacation; one group gave 5 week vacation plus additional weeks as needed (these were RVU based practices). Another gave 8 wks. The vacations included CME, sick time, medical leave etc.
        • Benefits: Malpractice and professional fees are usually covered from year 1. One of the group did not allow group contribution to 401k till you made partnership. 
        • Home workstations: Two of the groups had home work station; one group did not. 
        • Extra shifts: there are extra back up and shifts to cover, and usually paid about $2000 per shift. 
        • Procedures: One practice had all procedures done by IR; one practice was open and willing to let you do procedure depending on how comfortable you were.  The cases were straight forward lines, perma-caths, biopsies, drainage.  Embolization and other vascular procedures were left to IR. None of the practice did TIPS, TACE, ablations, etc etc.
        • Mammogram: willing to do breast imaging is a bonus. Body/Mammo was a very popular and common job posting that I came across during the job hunt.
        • Non-payer rate: <5% (it's amazing so you reimbursement is good). Also, over the last 1-2 yrs, volume across PP have gone up 10% and reimbursements have gone up due to Omabacare (more people have insurance).
        • Employment type: three was W2; on PP was 1099

      • Academic and academic affiliate practices hospital based practice:

  • Income for recent graduate: I interviewed at five academic institutions; one practice said 75% tile of whatever academicians made. The academic salary was about 330-380k (very competitive). Two academic practice had a base salary of 300k (or 5000 RVU)  plus RVU based bonuses (one group gave $50/RVU you read after your base; an RVU is worth about $55 in the market apparently). In this practice, faculty made over 100k in bonuses depending on how much more they read. Three of the academic practices had non-RVU based bonuses (bonuses were based on conferences, academic activities, etc etc).

  • Modalities/ volume: 40-70 cross sectionals per day. Usually, it's in your area of specialty; most did not have to do overnight. It was either left to ER radiologists or residents/fellows covering overnight. In half of the institutions, more senior faculty had dips and covered most of the highly desired rotations or had sub specialized emphasis more frequently than the junior faculty. 
          • Call and schedule: q6-16 wks depending on how many faculty members.
          • Vacation:  5-12 weeks. Two groups gave 12 wk vacation; one group gave 5 week vacation. 
          • Benefits: all academic practices had standard benefit 401k, 4 wks of vacation, 2 wks of CME/meeting, 1 wk of sick day; and usual pension/retirement benefits. One group had a spectacular benefit (contributed additional 45-55k to 401k in addition to the salary which could be realized by 5 years (if you left after one year, you get 20%; after 5 years, you got 100%). 
          • Home workstations: none of the academic practices had workstations 
          • Extra shifts: one group offered 6k to cover other attendings on medical leave, etc. One group allowed internal moonlighting in ED ($1400/shift).
          • Employment type: W2

      • Outpatient practice

        • I interviewed at several outpatient practices.   One was a large company (valued at $40 million; they owned 22 outpatient centers and staffed each center with 1-2 radiologists; the company was owned by non-radiologists who built the billing, and technical infrastructure) and the others were much larger (>200 outpatient centers).
          • Salary and other perks: the salary is based on a fee schedule; each modality is worth so many dollars. You read everything scanned at your outpatient center. The income is >350k but it's contractor (1099) so you covered your own malpractice, health insurance, etc etc)
          • Volume/type: 90-110 per shift. 40-50% cross sectional (mostly CT) and the rest are radiographs.   
          • Pathology: Usually bread and butter community pathology.
          • Call and schedule: 8-5pm; all outpatient studies; no call; no weekends
          • Partnership: none. You are a contractor so you get no bonuses, no benefits. But everything else (staff, tech, scanner, schedule) done for you it. 70% of the studies are HMO so the model depends on VOLUME (at low cost). The company absorbs the non-payer rate. 
          • Vacation:  depends on you; each month is vacation is about 30k in value.
          • Benefits: none. you have to buy health, malpractice, etc on your own
          • Home workstations: no
          • Extra shifts: if other outpatient centers need coverage, you can cover it 
          • Procedures: biopsy, breast bx
          • Mammogram: willing to do breast imaging is preferred. 
          • Employment type: 1099 
          • Note: these are usually the big RadNet, UMI groups.

    Beyond these details, there are several important observations/considerations:

    • Degree of control and transparency:
      • Academic practices are similar to corporation (it's a managerial bases system); you have the section chief, then the division chief and then the vice chair, and chair.  There is a lot of administrative personal which are managed by different people in the department. There is tremendous overhead cost and you have minimal insight into the inner workings of the department.
      • Private practice groups: you had equal say once you made partner; one practice gave more weight to more senior members but three had a equal voting privileges. The group usually only had 1-2 employees hired by the medical group so there is minimal overhead cost and the cost/expenses are transparent
      • Company based practice: you had minimal control. You do your job as a radiologist and the company took care of the rest. 
    • Academic activities/administrative time: 
      • Academic practice: four of the academic institutions gave 1 day of academic time (either two half days and one full day).  One pseduo-academic practice gave 20% but in reality, the faculty had none because the volume was so high, they couldn't afford people taking academic time.  
      • Private practice: none, but there is little administrative responsibilities/meetings outside of work.
    • Time and flexibility
      • Academic practice: had more flexibility because residents and fellows were available so you don't have to sit at the workstation 70% of the time; but if there was no trainee, then it was just you
      • Private practice: you work and kept working. 
    • Financial freedom:
      • RUV-based bonuses: the outpatient private practice and two academic practices had RVU based models, so your bonus was based on your volume (after your base). 
      • non-RUV based bonuses: get the work done and everyone gets equal distribution of the bonus. 
    • Diversity
      • academic practice: there is no question you see more tertiary pathology and diseases; work with multidisciplinary team. In addition, there is constant fresh blood from new residents and fellows that keep things fun, interesting and engaging. People don't really get old because they're always around young people, which serves as the fountain of youth.
      • Private practice: definitely less exciting and depending on where you work, you could have interactions with referral providers or not; none of the PP had residents/fellows; in fact, there was a fear of residents because trainees would slow down the radiologists.  But, there is more efficiency in the staff and process.
    • Upward mobility/growth:
      • Academic practice has more upward mobility and growth in the long run because you keep updated on recent findings and technologies, etc. It keeps you sharp. You teach and are taught by colleagues; you're surrounded by trainees which keeps you active in various academic activities (education exhibits, research, etc).
      • Private practice: learning and growing peaks at fellowship and then plateaus once you start practice. I'm sure there are exceptions to this model but this is how it is.
    My Timeline for Job Search:

    I had my first three interviews in November (two were out of state and one was in Northern California). All three were academic practices.  I had wanted to stay in Los Angeles, so started searching locally. My first private practice interview was in January, followed by a hospital based academic affiliate hospital. Both were outstanding and I couldn't decide. Then I was invited to two full-on academic practice jobs, but I didn't interview until March! One of the job was a back up position (in case the four radiologists that was previously hired decided to bail) and second position was not entirely available (funding was not secured yet). Four of my five colleagues had already signed contracts by January. I still hadn't heard confirmation back from the full academic institution and I was super stressed.  So, I took a vacation this past week and started searching for job online ( and ACR job search). I had three private practice interviews and am scheduled for my fourth. I got offers from all three and feel much better now and have a better idea of what I want. I learned so much (see above). Honestly, I didn't know what I was looking for and didn't know what I wanted. Now, I have a more informed understanding of different practice models.

    I hope the above blog helps you with your search for jobs in Southern California. Good luck! Let me know if you have any questions.

    Additional fun readings:

    Aunt Minnie: AMGA: Median radiologist salary nears $500K 

    Job search websites:
    American College of Radiology Job Search Website
    RadWorking Radiology Job Search Website

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