I…love this song (and the others). I helped my daughter write a book, but this dad wins the next level by immortalizing the songwriter of a generation.
I believe in the importance of thriving independent private practices for the field of radiology. True private practice—where doctors control the organization, are responsible to their peers and patients, and earn the full fruits of their labor—is the benchmark that sets the market and provides the anchor against exploitation from unscrupulous employers.
My group, like most groups in this market, is hiring. Here are several more 100%-independent radiologist-owned private practices across the US that are recruiting. If you’re in the market for a new position, consider reaching out with your CV. (Click the triangles for more information.)
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Radiology and Imaging Specialists
(Central Florida: Lakeland/Winter Haven, SW Orlando, Bradenton)
Independent and long-standing group covering a diverse mix of financially sound hospital partners, outpatient imaging centers, an ASC/OBL, clinics, and a multi-specialty group. 50+ radiologists and 10+ midlevel providers. In-house and experienced IT, Credentialing, HR, and Admin team including dedicated Radiology Liaison support 24/7/365.
Recruiting for Body, Breast, Cardiac, Neuro, IR, and General.
Partnership Track:
- 1-year track for diagnostic radiologists, 2-year track for interventional radiologists
- 10 weeks of vacation
- Sign-on bonus for diagnostic radiologists
- Call compensation for interventional radiologists
- Internal moonlighting available but not required
- Full benefits including CME allocation
Employee or Contractor:
- Flexible scheduling: Hospital (ED/IP) or outpatient coverage options available
- Fully remote, hybrid, or on-site depending on location(s) and coverage schedule desired
- Competitive compensation models (including benefits if employed/full-time)
Learn more at http://risimaging.com.
Contact: Alice Varnadore, Executive Assistant at avarnadore@risimaging.com
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Reno Radiological Associates
(Reno, Nevada)
Serving Northern Nevada since 1947, RRA is a strong, highly subspecialized, democratic, extremely collegial, high-earning group of 25 radiologists working in perhaps the best city in the country for raising a family and enjoying unparalleled access to natural beauty, endless outdoor activities (perhaps the best ski-city in the US), and incredible weather (jokingly referred to as “the cheapest city in California” for its proximity to Lake Tahoe (<30 min), Napa Valley, national parks, and more without the super high cost of living and no state income tax).
Shareholder Track (onsite):
- 1 year to 75% partner, 2 years to 100%
- Top 90+% comp nationally, maximally generous benefits
- 8/9/10+ weeks of vacation
- Remote shifts + opportunities for extra income, $100 buy-in
Employee Track (remote or onsite):
- High comp, Maximally generous benefits, opportunities for extra income
- Onsite preferred, fully remote night (8p-3a PST) or early morning (6a-2p EST) available
Independent Contractor:
- Flexible shift options, high compensation
Learn more at http://www.renorad.com/
Contact: CEO Anthony Dispenziere at adispenziere@renorad.com
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Vantage Radiology & Diagnostic Services
(Near Seattle, Washington)
~35 subspecialized radiologists practicing near Seattle and enjoying a quality lifestyle focused on work-life balance, located minutes from urban amenities, and with easy access to abundant outdoor activities in the natural beauty of the Pacific Northwest. We’ve provided professional services for two hospitals since 1970 and are co-owners of their affiliated imaging centers.
- Competitive salary ($370-570k) with a signing bonus for a 4-day work week and 8 weeks of vacation.
- Benefits include a CME allowance, memberships to professional societies, profit-sharing, malpractice and disability insurance, 401K contributions, and a commitment to associate mentorship.
- All partners and partner-track associates share in general call responsibilities (many from a practice-provided remote home workstation). Overnight call is covered by our internal nighthawk team.
Openings:
Swing:
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4PM – 1AM PST from Monday to Friday.
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2PM – Midnight on Saturdays and Sundays.
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Practice is open to flexible staffing solutions or a combination of above shifts
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Additional compensation as desired via internal moonlighting or reading OP cases as swing shift case volumes permit
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Concurrent staffing with at least one other radiologist.
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Caseload volume is approximately 60-65 wRVU per weekday and 70 wRVU for the weekend.
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Salary for 7 days is approximately $25,000.
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May be 1099 or W2.
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Benefits are available at cost as desired.
Breast:
- Approximately 75% breast imaging and 25% general radiology or 100% breast (full-time or 3/4 time).
- Qualified candidates must be skilled in all breast imaging studies and procedures including screening and diagnostic mammography, ultrasound, MRI, and needle/Savi Scout localization and biopsy.
- Participation in weekly breast tumor conference.
- No IR requirements
Neuroradiology:
- Full-time or 3/4-time partnership-track hybrid position
- Neuroradiology daytime shifts. Typical general ER/inpatient evening and weekend call shifts from home.
- No breast or IR requirements
Body:
- Full-time or 3/4-time partnership-track hybrid position
- Abdominal daytime shifts with body MRI, multiphase CT, and general radiology. Typical general ER/inpatient evening and weekend call shifts from home.
- No breast or IR requirements
IR:
- Full-time partnership track position for fellowship-trained IR
- Caseload consists of venous access, biopsies, dialysis access, interventional oncology, TIPS/BRTO, central and peripheral venous therapies, pelvic congestion and UFE, and emergent angiography interventions, as well as general radiology (no breast required).
- In the past several years, we have developed new service lines and are looking for future growth leaders. Daily work is supported by 2 IR PAs and clinic staff.
- Competitive salary + signing bonus, with additional incentive-based pay opportunities
Learn more at https://www.vrads.com/
Contact: recruiting@vrads.com
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South Texas Radiology Group
(San Antonio, Texas)
STRG is a well-established, expanding, independent subspecialty practice of 70+ radiologists serving 15 hospitals, multiple freestanding ED facilities, and a large outpatient imaging practice (STRIC). Both onsite and remote positions are available.
STRG is a forward-thinking practice with a strong and cohesive culture. Multiple AI projects are in place and in progress to improve efficiency and quality. Internal moonlighting opportunities are available.
Shareholder Track:
- Flexible associate period as short as 18-months.
- Leads to full partnership with board of directors membership.
- Equity ownership within a large expanding outpatient imaging practice (STRIC)
- Competitive salary with up to $800K starting salary for experienced applicants. Up to $600K starting salary for inexperienced applicants.
- Excellent benefits package
- Onsite and work-from-home options for daily work and call
- Hiring across all specialties, with a current emphasis on Body Imaging and Cardiothoracic/Body
Emergency Radiology Track:
- 1 week on/1 week off (7/7) and 1 week on/2 weeks off (7/14) positions available
- Competitive salary with excellent benefits package available.
- Fully remote and onsite options available.
Employee Mammography Position (Onsite):
- Competitive base salary with excellent benefits package
- No call. No nights or weekends.
- Remote opportunities available for general radiology or body imaging work if interested.
Employee Position – All Subspecialties (Onsite, Hybrid, or Remote ):
- Competitive base salary with excellent benefits package
- 5.5 weekends (day shift) per year. No evening or overnight call.
Learn more at https://stric.com/.
Contact: Waynea Finley at wfinley@strg-pa.com
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Kettering Network Radiologists
(Dayton, Ohio)
Kettering Network Radiologists, Inc. (KNRI) is a physician-owned, independent private practice serving Kettering Health’s extensive network. Our team consists of 56 radiologists, 8 physician assistants, and 8 radiology residents, providing high-quality imaging services across 8 hospitals (115-500 beds), 20 outpatient centers, 11 emergency departments, and 2 trauma centers (one Level II, one Level III).
Overnight:
- 1 week on / 2 weeks off rotation (3 night radiologists are working every night shift)
- Scheduled shifts (EST):
- 5 PM – 2 AM, 6 PM – 3 AM
- Productivity bonus for those working overnight shifts. Additional individual shifts are available for extra pay but are not required.
Swing Shift:
- Monday – Friday schedule, contracted for 5 days per week with the radiologist choosing between 10-17 weeks of vacation.
- Includes 5-weekend shifts per year, with the radiologist selecting their preferred weekends.
- Scheduled shifts (EST):
- 2 PM – 11 PM, 3 PM – 12 AM
- Weekend shifts include:
- 6 AM – 3 PM, 9 AM – 6 PM, 11 AM – 8 PM, 12 PM – 9 PM, 2 PM – 11 PM, 3 PM – 12 AM
Daytime body, VIR, breast, and general:
- Partnership Track on-site/hybrid role
- Standard 4- or 5-day workweek with 5 weekends per year.
- IR also available as 1 on/2 off
5 on/9 off ER
- 5 days on (Thursday – Monday) followed by 9 days off (Tuesday – following Wednesday).
- This schedule amounts to ~130 shifts per year with each work cycle being 5 consecutive days.
- Scheduled shifts (EST):
- 6 AM – 3 PM, 8 AM – 5 PM, 9 AM – 6 PM, 11 AM – 8 PM, 12 PM – 9 PM, 2 PM – 11 PM, 3 PM – 12 AM
When working ER or night shifts, you are never alone—always part of a team. We are a stable, well-compensated group, enjoying flexible scheduling with very comprehensive benefits.
Contact: Dr. Rachel Shikhman at rachel.shikhman@gmail.com
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RAPA
(Central Arkansas [Little Rock, Conway, Searcy, and Pine Bluff] & Northwest Arkansas)
40+ radiologists covering 20+ sites (hospitals + clinics) with a multi-subspecialty mix of inpatient, outpatient, and ED imaging.
Robust reading room assistants and IT presence to promote peak efficiency. Unified Clario reading list, Inteleviewer PACS, Powerscribe dictation (no switching stations or PACS to read other sites). RadAI automated impressions to improve efficiency.
Partnership track – Central Arkansas (Little Rock, Conway, Searcy, and Pine Bluff) and Northwest Arkansas:
- 1 year to partnership
- 10 weeks vacation + 1/2 day off per week on average for partners
- Highly competitive compensation combined with low cost of living
- Internal moonlighting options to boost income
- Robust CME allowance, signing and moving bonuses, full benefits
- Many work-from-home shift options
- Minimal after-hours requirements – overnight shifts are fully staffed with telerads
100% Remote Nighthawk, partnership track:
- 7 on/14 off, 10 pm-7:45 am CST
- 1 year to partnership
- Competitive compensation, robust CME allowance, signing bonus, full benefits
Daytime Teleradiology:
- 100% remote.
- Subspecialty work available with up to 50/50 split with general radiology
- Option for employed or partner track. Partner track includes call weekend shifts, approximately 1 in 5 weekends.
Employee track:
- General radiology, mammography, and other options available
- Fully remote, hybrid, or on-site options available
- Flexible scheduling including daytime teleradiology, 7 on/14 off. General radiology, but any subspecialty is a plus.
- Competitive salaries
- Robust CME allowance, signing and moving bonuses, full benefits
Greatest needs are IR, mammography, body imaging, MSK, and nuclear medicine, but all subspecialties and general radiologists are welcome.
Learn more at http://rapaxray.com/
Contact: recruitment@rapaxray.com and Dr. Brandon Kelly at bkelly@rapaxray.com
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Eastern Radiologists
(Greenville & Coastal North Carolina)
Eastern Radiologists is a private practice in Eastern North Carolina that is physician-owned and operated and seeking to hire multiple radiologists due to growth and retirement. The well-established private practice serves a large geographic region through 14 area hospitals and several state-of-the-art imaging centers. Support is provided by nearly 70 subspecialty radiologists.
Currently seeking candidates in all subspecialties.
Details:
- Positions are available in Greenville and other coastal communities in Eastern North Carolina.
- Most are partnership track positions which include evening and weekend call responsibilities, but other employment options can be considered. Employment positions can be customized to fit desired schedule/income. Internal moonlighting is available for extra income.
- Most specialties can work nearly 100% in their desired field of interest.
- Great benefits, competitive salary including profit sharing and bonus, generous vacation and paid family leave, and business/educational discretionary account.
- Sign-on bonus
Learn more at https://www.easternrad.com.
Contact: Erica Askew at easkew@easternrad.com
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Midwest Radiology
(Minneapolis – St. Paul, Minnesota)
Large 175+ subspecialized practice with 17 weeks of vacation. Two-year shareholder track for new graduates and a one-year track with experience.
Positions (On-site):
Body (100% Body) – Regions Hospital
- Mix of shifts worked on-site
- Mixture of hospital, outpatient, and remote
- Interpret MRI, CT, U/S, and radiographs
- After-hours coverage provided internally by the emergency radiology section
- No neuro or MSK
Body/Mammo – Western Wisconsin
- 45-minute drive from the Twin Cities.
- No overnights, evenings, or weekends required.
- Interpreting CT, US, body MRI, plain film and mammography studies.
- Onsite procedures include general fluoroscopy, minor ultrasound, paracentesis, and thoracentesis.
- No neuro or MSK.
General Body/Mammo
- Regional hospital sites north and west of the Minneapolis/St. Paul area.
- Interpreting CT, US, body MRI, plain film and mammography studies.
- Onsite procedures include general fluoroscopy, minor ultrasound, paracentesis and thoracentesis.
- No neuro or MSK.
Pediatric Radiologist (100% Peds if desired)
- General pediatric imaging including fluoroscopy, CT and ultrasound.
- Experience in MR is optional.
- Hospital-based.
- 100% pediatrics if desired (may split time between pediatrics and an additional section).
Neuroradiologist (100% Neuro)
- Daytime, on-site neuroradiologist.
- All evenings and 95% of weekend call shifts are off-site.
- Hybrid weekday (2-3 remote daytime shifts/week).
- Onsite procedures include lumbar punctures, myelograms, and swallow studies.
- Functional MRI a plus but not required.
- Subspecialty CAQ required.
- No body or MSK.
Positions (Remote):
Daytime Body
- Fellowship-trained 100% body position
- Fully remote, daytime, Monday through Friday position with no evenings, weekends, or nights required.
Overnight Body/MSK (Partnership)
- 1 year to shareholder for experienced radiologists, shareholders work 121 shifts per year (17.3 weeks)
- Shifts are 10pm to 7am
- At least two years post-fellowship experience required
- Multiple other overnight radiologists (Body, MSK, and Neuro) will be working the same shifts allowing for collaboration.
- 24/7 IT, transcription/editing, and clerical/QA staff assistance.
Learn more at www.midwestradiology.com.
Contact: Barry.Lindo@MidwestRadiology.com
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Radiology of Huntsville
(Huntsville, Alabama)
ROH is 60+ physician, high-volume, private practice with a 2-year partnership track and nominal buy-in. Hiring for a remote partnership-eligible overnight position as well as onsite/remote openings in most subspecialites. Huntsville is a tremendously livable, high-tech, and growing mid-sized city (a #1 Best Place to Live in the U.S. by U.S. News and World Report).
Pediatric Radiologist – Shareholder Track
- Consistent annual shareholder compensation exceeding $1MM++
- Shareholder (Partnership) opportunity after two years with nominal buy-in
- Average 205 clinical shifts annually
- Shared 1:6 general radiology weekend call
- Dedicated overnight radiology team — no routine overnight call responsibilities
- Flexible scheduling options, including daytime-focused practice
- Join our collegial team of FOUR pediatric radiologists with a dedicated Women’s and Children’s Hospital, comprehensive pediatric imaging including high-volume pediatric MRI, CT, ultrasound, fluoroscopy, neonatal, emergency, and outpatient imaging, as well as light image-guided procedures.
- Additional voluntary internal locum opportunities compensated per RVU
Onsite and Remote, Daytime and Second Shift opportunities
- Abdominal / Body
- Emergency
- General Radiology
- MSK
- Neuroradiology
- Nuclear Medicine
- Pediatric
- Light Interventional
Learn more at www.radiologyofhuntsville.com.
Contact: Brandy McCown at bmccown@radhunt.com or call 256.713.0621.
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Radiology Imaging Associates
(Denver, Colorado)
RIA is the largest private radiology practice in Colorado with over 120+ radiologists. Our group is dedicated to providing high-quality subspecialty imaging and interventional services as well as excellence in patient care. We currently have over 125 radiologists and cover over 35 hospitals and 15 imaging centers in multiple healthcare systems in Colorado, Kansas, and Hawaii.
Our practice:
- 12 weeks of vacation for associates and 14 weeks for partners.
- 2 year partnership track.
- Compensation ranges from $ 500 to $ 1,000,000 with unlimited internal moonlighting opportunities.
- Generous benefits package including health and dental insurance with premiums covered by the group. Benefits also include an ample CME/business expense account, 401k plan, credentialing assistance, and relocation allowance.
On-site/hybrid (partnership track):
- IR
- Abdominal/Thoracic imaging
- Breast imaging (traditional as well as 100%-breast options)
- Neuroradiology
- MSK imaging
- Nuclear Medicine/PET
- Pediatrics
Remote (partnership track):
- Nighthawk – General/Body
- 7 on / 7 off General/Body Swing
Contract positions are also available for those needing flexible work requirements.
Learn more at https://www.riaco.com/
Contact: radrecruiting@riaco.com
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Inland Imaging
(Washington, Oregon, Montana)
Inland Imaging is a 120+ radiologist-owned private practice proudly serving multiple outpatient, clinic, and hospital sites throughout the Inland Northwest region. We own and operate one of the first outpatient interventional labs in the West in addition to 7 outpatient imaging centers.
Our practice:
- Sub-specialty interpretations available across all locations.
- All studies are accessible on a common PACS system, one common voice recognition system, and one common worklist
- Internal Nighthawk System providing final interpretations on all ER, STAT, and Inpatient Exams. 24/7 Neuroradiology Coverage and IR Call Coverage.
- 2-year Partnership Track.
- Full-Time Radiologist Average Time Off = 15 weeks
- Average after-hours obligations = 9 weekends per year and 22 evening/swing Shifts.
- Associate: $503,415–$566,342+ | Shareholder: $629,269+
- Compensation ranges above reflect base; additional earning potential available through extra shifts and increased productivity
- Full Benefit Package including health, vision, dental, disability, and life; 401k match, profit-sharing contribution, and cash balance plan.
- Flexible scheduling arrangements accommodated across all positions, with a rich case mix across multiple outpatient, clinic, and hospital settings
- Hybrid Work Options
Current Openings:
- Remote overnight ER
- Neuroradiology (Spokane, Seattle, Walla Walla, Tri-Cities, Missoula, or remote)
- Body Imaging (Spokane, Seattle, Walla Walla, Tri-Cities, Missoula, or remote)
- Washington
- Tri-Cities ($75K signing bonus) — Breast, Neuro, MSK, Body
- Spokane — Pediatrics, Breast, MSK
- Moses Lake — General/Breast ($90K signing bonus, $20K relocation, annual retention bonus)
- Colville — General/Breast
- Montana
- Missoula – IR
- Oregon
- Pendleton – General/Breast
Learn more at physicians.inlandimaging.com
Contact: Spencer Piper at spiper@inlandimaging.com
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If you’re a group looking to advertise, get in touch. The monthly post here is limited to just a handful of groups at a time, but last year, I launched Independent Radiology as a resource for the broader community, a dedicated private practice radiology job board featuring ~160 groups. If you’re in the market, please also check it out for your job-hunting needs.
Regarding a study of remote work looking at 500,000 Americans with “remotable jobs,” Prof Emma Harrington, one of the ‘Home Alone’ study’s authors:
When one person is out of the office, it impacts people who remain in the office, so even an on-site worker in a remotable job may now be lonelier because their colleagues choose to work from home.
They conclude that remote work “substantially increases isolation and worsens mental health.” The reality is assuredly varied and more complicated, but the impact of remote work on onsite work is, as suggested, pretty clear.
I have literally no association with the ABR, but since they’ve been gradually publishing more info about the new Oral Boards (coming to a computer near you in 2028) and not everyone reads The Beam newsletter as religiously as I do, I thought I’d share the goods in one spot here as well. Here’s what’s available so far:
1. Written Sample Case content, which walks you through a couple cases in each subspecialty: what you’re supposed to get from the presentation images, differentials, further imaging requests, and key features. Despite being written, this is very helpful.
2. 46 min “simulation” video (where an experienced radiologist playacts being an examinee). Contains 3 cases/attempts (a strong pass, a clear fail, and a marginal fail). To be clear, you can fail individual cases and still pass the exam. Overconfidence is a cardinal sin, and the clear fail is a parade of whiffs. One example contains a partial scrollable CT with some PACS tools. After the three cases, they re-perform them with the opposite performance/outcome.
3. A logistics guide PDF (no, you won’t be able to have a stand-in take the exam for you).
4. An FAQ, of course. One interesting tidbit: all MRI sequences will be labelled. They say:
The ABR Image Quality Committee and the Board of Trustees think that having candidates spend exam time identifying sequences would not add value to the exam experience. The rare exception might be a case where recognizing the specific sequence is the concept being tested (e.g., in-phase vs out-of-phase imaging in the abdomen, or “silicone-only” image on a breast implant study).
Something tells me there will be “rare” exceptions? (They also happened to include unlabeled MRI sequences in the video above.) I would also be totally unsurprised if nucs studies are still often presented as unknowns, even though that would also never happen in real life, but we’ll see.
5. The usual, generally unhelpful “study guide” (which lists the exam content including such profound hints as “pancreas” and “normal variants”).
6. A Scoring explanation:
Performance on an individual case is scored as 68, 69, 70, 71, or 72. Although a candidate does not need to pass every case to pass the category, the average of the case scores must equal or exceed 70 to pass the category. Hence, a candidate who is shown five cases and receives scores of 69, 70, 70, 70, and 71 would pass because the average of those scores is 70.
Those numbers (68-72) correspond to absolutely unsatisfactory, marginally unsatisfactory, satisfactory, good, and outstanding, respectively. In response to the scoring guide, I did reach out to the ABR to ask why the oral exam would be graded so…distinctively, instead of, say, 1-5 or some other more typical scale.
The answer:
First, “70” is often (but not universally) used as a passing threshold for high school and college exams, so it has an intuitive feel for a pass-fail test that is intended to measure competency rather than relative performance such as “excellence” or “perfection.”
Second, a 3 is “200%” better than a 1 (i.e. proportionally “large”). On the other end of the scale, a score of 5 on a case could be incorrectly understood to be “a lot better” than a 3. This is less an issue for a 70 vs a 72 although, as you imply, it’s mathematically the same result.
In re-introducing the DR Oral Exam, we’re sticking with the past model to avoid making too many changes as once, and to parallel the RO, MP, and IR scoring that has been in continuous use. All that said, I think we will consider going with the simpler version of 1-5 at some point in the future.
In other news, what’s old is new again.
From Stefan Zweig’s short book on the famous sixteenth-century Frenchman, a passage where Montaigne rales against schooling as the mere transmission of knowledge:
“They never cease whining into our ears,” he gripes, “as if it were being poured into a funnel, and our task is merely to parrot back everything we have been told.” Instead of allowing his own thoughts to ripen in his mind, the masters fill it with a petrified knowledge and leave it “bereft of insight and consciousness”. And he angrily contests: “What use is it to have a bellyful of meat, if one cannot digest it, if it cannot transform us, if it cannot improve us and fortify us?”
…
“As when plants suffocate for too much moisture, and lamps from too much oil, so the action of the spirit is suffocated by an overload of study and matter.” Such knowledge is a burden on the mind, not an action of the soul: “To know by heart is not to know, it is to keep what they have given you and store it in your memory.”
…
Therefore, later, the mature man will hand out a bad mark and a good lesson to those masters who only seek to inculcate rules mechanically: “our masters”, he says in his last years, should judge the aptitude of a child not by his memory but by the testimony of his life… Let the young man read and sift and verify, not just accept the authority in good faith. A rich variety of opinions must be presented to him. He will make his choice, and if he cannot, then he will remain in doubt. He who sheep-like follows another follows nothing. He discovers nothing, because he seeks nothing.
As Montaigne may have hoped, modern pedagogy has moved more toward flipped classrooms and discussion sections. After all, there is a difference between information and education. Interesting, though, is how the cheapening of readily accessible knowledge seems to have stunted educational growth. Perhaps a driven, precocious polymath may not have needed those strict guardrails of a rigid system, but inadequate groundwork and the lack of constraint also don’t seem to, well, work.
Undeniably:
Books are, I find, the best provisions a man can take with him on life’s journey.
Zweig happily points out that Montaigne, like Marcus Aurelius, was learning in public, not issuing decrees from a self-help pulpit:
It is true: Montaigne achieved little else in his life aside from posing the question: “How should I live?” But what is so magnificent, so philanthropic in his case, is that when he posed this question: “How should I live?” he did not insist on following it up with: “This is how you should live!”
…
He had never sought to counsel others on anything he did not know intimately himself. “This is not my doctrine; it is my study, and no one else’s lesson but my own.”
Possible false humility aside, admirable restraint.
Ordinary Abundance is a lovely little visual essay. Go ahead, feel good about human progress today.
From independent interventional radiologist Dr. Kavi Devulapalli’s recent article, “Coming to Terms With Reality“:
I can build a program that did not exist before I got there, develop the referral relationships, create the clinic, generate the patients, perform the procedures and produce millions of dollars of new facility economics. The hospital can measure that value, present it to a board, use it to justify investment and congratulate itself on the growth of the service line. When it comes time to figure out what I should be paid, however, we are suddenly talking about how many wRVUs I produced, what fair market value is for call coverage, how many hours I spent doing administrative work, what other employed IRs make and what percentile my compensation falls into.
This is why I increasingly describe the game as rigged. I don’t mean there is some guy at CMS sitting around trying to figure out how to personally ruin my life. What I mean is that once you understand how the pieces fit together, the result becomes pretty obvious. CMS separates the physician economics from the facility economics. The hospital owns the facility and employs the physician. The physician can then create tremendous additional enterprise value for the hospital, while Stark and AKS make it difficult to simply reconnect physician compensation to the downstream economics that physician helped create. Compensation gets pushed back toward the defensible value of physician labor, which is then informed in part by surveys of what other physicians operating inside the same system are being paid. If that doesn’t strike you as at least somewhat circular, I don’t know what to tell you.
Value has always been hard to define, but even if RVUs were a perfect measure of physician work in direct patient care, they would never, ever tell the complete story. The hospitals know this, even if they pretend not to during negotiations or their usual budgetary gerrymandering.
Back in 2018, fresh out of training, I was asked, along with some physician finance bloggers, to contribute an answer to an article about early-career financial mistakes (my post about that post is here). That site is now defunct, but my answer (referring to my work as a student and pre-moonlighting resident) at the time:
“The ‘correct’ answer is usually to spend less on a car, not buy a house, put more away for retirement, and get disability insurance. But looking back, my biggest real regret is not being more purposeful with my discretionary time. Time outside of work obligations has both a monetary and nonmonetary value, and I was very free with spending too much of it to ‘maximize’ my income at rates that are trivial to me now. I was worth more on a per-hour basis back then, even if I didn’t realize it.”
On the same note, a fantastic short visual essay on writing: Do It 14,000 Times Slower With This One Trick
“Please use AI” is a poem by Shawn Smucker.