The Radiology Review Guide to Finding Your Ideal Job
For all current and future radiologists, finding your ideal job in radiology is a high-priority pursuit. Joining a radiology practice is an important life decision that can impact your life for decades. Unfortunately, many radiology trainees are not optimally prepared to find their ideal job. This article provides useful information that can help future radiologists secure an ideal radiology position.
First, know thyself.
For a career in radiology, as for life in general, if you don’t know what you are looking for you are less likely to find it. The first step to find your perfect job in radiology is to define and envision your ideal radiology position.
Every future radiologist must understand what brings the most satisfaction in radiology and in life and then make those factors the foundation of a job search. Key questions to consider include:
Is living in a specific geographic location a top priority?
Would you trade the ideal location for the ideal work-life balance?
Is an academic, hybrid, or private practice setting the top priority?
Is maximizing your income the top priority?
Will teleradiology provide your ideal lifestyle?
Is a subspecialty radiology practice a high priority or do you enjoy being more of a generalist?
Does partnership track—with typical requirements of buy-in, relative value unit (RVU) thresholds, and call—fit with your life goals?
Are you looking for a full-time or part-time position or do you want the option to go part time in the future?
Some radiologists know precisely what they want in their future job before completing training. For others, experiencing their first radiology position shows them what they value most. Although it is stressful to switch away from one’s initial practice, I know many radiologists who are extremely happy with their second radiology position because they selected their new position based on better-informed priorities.
Understand different practice models. Professional satisfaction is not all about salary.
You cannot expect a radiology training program to teach you everything you should know regarding different career options in academic and private practice radiology. Understanding the true breadth of radiology employment options requires independent effort.
Radiology residents and fellows are sometimes too unaware—in my opinion—of the challenges and opportunities that various radiology careers offer. Residents and fellows also tend to assume that the practice of radiology they experienced in training will be the same everywhere. After all, radiology is radiology. The truth is that the scope, practice, and culture of radiology is broad. You cannot assume that the way it feels to practice radiology and the way radiology is practiced at your training institutions will translate into your future career in varied practice settings.
Enter your future radiology career with your eyes wide open. Don’t be surprised when join a high salary practice that the volumes you are expected to read may feel overwhelming at the start. Understand that there are tradeoffs that must be navigated and it is your job to make your best decision—based on the maximal information you can obtain—before you start on day one.
It is important to understand that volumes of cases to be read, availability of support of various kinds to maximize efficiency such as administrative support and IT support, and interactions with other staff including other radiologists can vary widely depending on the practice setting. The ability of a practice to recruit and retain excellent radiologists can also have a big impact on your future career. Sometimes the practices that recruit the most are also those that also have the hardest time retaining radiologists.
At a minimum, understand basic differences between academic departments and requirements for advancement that can vary between institutions. Understand basic differences between private practice models including those that prioritize revenue versus those that prioritize lifestyle and understand where your priorities lie along this spectrum. Understand what a hybrid model may look like—for example a predominantly private practice hospital system that also teaches trainees or otherwise is affiliated with an academic health system. Understand what teleradiology options exist and the opportunities and challenges that may come with this often very flexible practice model.
Do not necessarily chase the highest starting salary. True earning potential can be difficult to estimate from starting salary alone. You can find high and low salary careers and high and low volume practices both in academics and private practice. Your true earning potential in any given radiology career is multifactorial and not exclusively determined by your starting salary or eventual partnership salary. For example, the future partner level salary you desire may ultimately not materialize if the practice is acquired. A comparatively lower starting academic salary at the right institution or practice may lead to lucrative leadership positions, royalties, and consulting revenue later in your career. Differences in retirement plans between practices may have a big impact on your net worth at retirement. The cost of living in your particular geographic location may have a big impact on your net worth at retirement. Being unhappy at work may have a big impact on your net worth at retirement. Ultimately, there are many paths forward towards financial independence and success. The personal finance decisions you make with your money can ultimately have more of an impact on your net worth than your actual salary.
The default for most trainees is to enter a partnership track, private practice position following training. However, do not assume that academic radiology or teleradiology is not a good fit until you have performed proper due diligence. Academic radiology may provide career satisfaction that may be a worthwhile tradeoff for what can be a slightly lower salary. Too many trainees do not consider academic radiology because they “don’t like research”. Not all academic radiology jobs are tied to high expectations for research—there are many pathways to success in academic radiology. Teleradiology may also provide excellent career opportunities for many radiologists. Hybrid academic and private practice positions also exist that can be a great fit for the right individual.
Do your homework. Consider all options. Remember also that choosing the road less traveled may bring unexpected happiness.
utilize your professional connections to find additional radiology openings.
Selecting the right radiology residency and fellowship can propel you towards your ideal radiology job. The connections and geographic location of your fellowship often greatly influence the professional doors that will open or close for you. For trainees, leverage the connections of your faculty and recent program graduates to find out about jobs that may not be posted on a job board. It is often said that “the best jobs in radiology are not posted on a job board”. While not absolute truth, the principle is that you should leverage your connections because your ideal job may not be posted on a job board.
Do not underestimate the influence of connections that can be made external to a residency or fellowship program. For example, being involved and contributing to your local ACR state chapter can absolutely help you find jobs that are not formally posted.
Job boards are also important. Know if your radiology subspecialty society has a job board and, if so, use it. Beyond listing professional current job openings, the number of postings may stand as a surrogate of the strength of the job market. Other quality job boards include those from the ACR and RSNA. Finally, don’t forget to check the websites of specific academic institutions, or contact a specific radiology practice directly, to introduce yourself and inquire about current or future positions.
Understand the Job Market
The state of the job market changes. Sometimes this change is rapid. As of this posting in mid 2021, the radiology job market is favorable towards the job applicant and radiology jobs are plentiful. However, this could change in unpredictable ways.
When I was a medical student the Radiology job market was very good—likely better than what we are currently experiencing. When I entered radiology residency, the radiology job market was extremely challenged and this change occurred swiftly. When I was a fellow the radiology job market was better but not nearly as strong as it is today. Since I have been in practice, the radiology job market has become excellent. Here is my point: I am an early career radiologist and I have already witnessed a complete cycle in the radiology job market. Therefore, I suggest that future job applicants stay apprised of the current and anticipated future state of the radiology job market and prepare now to become maximally employable as a hedge against volatility in the radiology job market.
Understanding the job market is key to understand the success and degree of negotiation that is possible during a job search. If the job market is good, your ability to negotiate beyond what is offered is increased. More on negotiation later.
Understand your leverage
When applying for medical school or residency, the program selects the applicant perhaps more than the applicant selects the program. The entire application process is designed for the applicant to prove themselves to the program. Although training programs compete for medical students and residents, there is probably at least a slight power differential at play that is in favor of the training program. For example, who pays the cost of flying to visit said program to interview (in the recent past years, prior to current virtual interviews, these costs are paid by cash-strapped trainees).
When applying for fellowship, the playing field starts to even. Programs must start to compete more for the best applicants. Expenses like hotel costs may start to be covered. The program is on their absolute best behavior with smiling faces when fellows come through. From my experience, when the large group of residency applicants walk through a radiology department you will see many smiles and hand waves from seated radiologists. When fellow applicants walk through, however, those same radiologists will stop what they are doing, stand up, and talk to the applicants in person.
When applying for a job, the potential employer should pay expenses for the flight, hotel, car rental, and even for your significant other (if applicable) to visit the to visit the area (at a first or second interview). You may even be surprised to find that said practice booked a luxury hotel room and reserved the luxury vehicle or a private car to drive you during your stay. This treatment is likely to be a welcomed improvement compared to you bootstrapping these expenses during medical school, residency, and fellowship applications. However, the message you should realize is that this now shows that you possess leverage due to the highly valued, and long-borne radiology skillset you have acquired.
Don’t go overboard and assume that this leverage will provide you every ask on your list of ideal job characteristics. However, do realize that this means you can ask for certain things that are not initially offered to you that match your personal priorities.
What applicants may underappreciate is that a job needs to be a good fit for both the practice and the radiologist. It does not serve the practice well, for example, if you say during an interview that you are willing to read **insert subspecialty** area of radiology if that is actually not true. The goal of both parties is to find a long-term, win-win situation and this is most likely to occur if both parties are transparent from the onset, discuss disparate expectations in advance, and establish what the win-win position looks like prior to the contract being signed.
It is very important to realize that your leverage diminishes substantially once a contract is signed. For example, if you trained with a specific new technology and would like to see that technology implemented at your future practice—the time to ask for that implementation (or a similar request) is prior to signing on the dotted line. Making such a request after you have signed the contract is very different. Your leverage—and the ability to ask for changes to your contract or practice setting—is no longer the same once you have signed on the dotted line.
Interview the right way
The purpose of a hiring interview has more to do with understanding whether you are compatible with the practice, and if the practice is compatible with you. During your interview be authentic and be personable. The most successful job interviews occur when neither the applicant nor the radiology practice are putting up a front. The interview is an opportunity for all parties to really examine if the fit is right.
Practices customarily pay for all interview expenses including airport transportation and parking, flight, hotel, and food. It is normal for the practice to also fly any partner or significant other to the location (if distant from where you live) to see the area for themselves, which may occur during the initial interview or during a second-look visit.
If you are interviewing in a location that is unfamiliar to you, spend at least a few hours with a realtor. That can give you invaluable information that will allow you to envision not only what it could be like to practice in that city, but also what it may be like to live in that city.
Interviews often start with a phone call as a pre-interview screening process. Again, be polite, personable, and authentic on your phone call and expect the same in return.
Be prepared to specifically answer why you are interested in the practice you are interviewing at and why you would consider moving to the location the practice is located in. Before and after the interview perform due diligence to vet the practice. More on that later.
Negotiate well and set yourself up for maximal success.
Negotiation is important and typically takes place once you receive an initial offer letter. Some things are more likely to be negotiable than others. It can be helpful to have some understanding up front regarding what can often be negotiated, and what cannot. It is also important to understand the offer letter in entirety so you can know what issues may need to be addressed. It is advisable to have somebody who has a professional knowledge of physician contracts—such as a lawyer—review your offer letter/contract to help you understand the nuances of the language and the implications of the terms. Because the maximal offer available to you is not necessarily presented to you up front, you probably should address any negotiable terms that fall short of your expectations.
A higher salary is one component of a radiology position that may not negotiable—potentially for good reason. The metrics upon which salary are based should be transparent and equitable among all radiologists in the practice. If you somehow negotiate for a salary that is substantially different than other radiologists in the practice this inequality can cause discord.
Remember that large inequalities within a practice decrease the stability of a practice. Allowing a new radiologist to negotiate a higher salary than others in the practice (or subspecialty section depending on the practice setting) may not be in the practice’s long-term best interest. Similarly, don’t let a practice pay you less than the other radiologists that are also starting out in the practice or are at your same career stage. My advice is to ensure equal opportunity for compensation based on transparent performance metrics and equal opportunities for advancement to higher salary and partnership, if applicable. It may be best for the practice that no individual radiologist is an exception to that rule.
What items may be more negotiable than salary? Moving stipends, signing bonuses, extra house-hunting trips, student loan payoffs, and other one-time expenditures are typically more easy to negotiate. Given that these are one-time expenses that practices institute to secure quality-hires, these expenses are less likely to cause discord within the practice if unequal. It is also typically understood that the values of these incentives vary depending on the strength of the job market.
Other proposals that are fair and equitable to the practice can be negotiated. For example, if you value income over vacation, you could ask for the option to trade some of your vacation days for additional clinical shifts to thereby boost your overall income. If you are signing a contract during residency, you could perhaps negotiate for an advanced stipend during your fellowship year to help offset cost-of living during your fellowship. For those concerned about a practice being acquired, a potential ask that may or may not be granted and enforceable (please check with a lawyer) is a stipulation in your contract that you will become an immediate partner if a practice is acquired during your non-partnership period. This potential hedge against a practice buy-out could work greatly in your favor if this is granted and contractually enforceable.
A final point of attention regarding signing bonuses: Make sure you understand clearly the terms of repayment of signing bonus if you leave the practice early. Many signing bonuses may need to be repaid if you leave the practice prior to a prespecified number of years. Be aware that even though you paid taxes on the signing bonus up front, if you leave the practice early and need to repay the signing bonus you will repay the pre-tax value of the signing bonus that is owed, according to the terms of the contract. Therefore, a repayment of a signing bonus can potentially be costly, and even lead to an overall loss as a result of paying taxes up front and then repaying the pre-tax value of the signing bonus, depending on the contractual terms you agree to.
Perform due diligence to vet your future practice
You must find reliable sources with little to no bias to confirm that the practice you are considering joining is what they say they are. A non-inclusive list of things to independently confirm through a neutral third-party person, if possible include:
Is the reputation of the practice strong?
Is the quality of practice of radiology up to referring providers expectations?
Is the practice stable? Is there a lot of radiologist turnover in the practice?
Are there other radiology practices in town? If so, how does the practice you are considering joining compare with other competing practices in the region?
Whenever possible, find a neutral third party. For example, a friend at the same hospital in a related but separate field (such as a neurosurgeon who has worked with a given neuroradiology practice), a radiology friend who previously worked at that practice, or a friend who trained at an academic institution you are interested to work at can provide extremely valuable information about a practice to help you decide whether you should join the practice or whether additional questions need to be addressed with the practice before you sign a contract.
Once you sign the job offer do everything you can to make this position your dream job
It is no secret that beginning a radiology career is both exciting and stressful. Realize that you may need to grow into your new job, at least a little bit if not a lot. As long as the fundamentals of the job match your own top priorities, you should be on track for career satisfaction. The whole point of upfront due diligence is to make sure that the fundamentals of the practice you are joining are correct, and as good for you and your life goals as possible. Realize that your job is unlikely to be exactly what you expected in every way, and surprises will come your way regarding your new position, yet do everything you can to thrive in your new career. If you sufficiently prepare for your future radiology job, you will succeed.
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