Ben White

Structured Procrastination

10.09.25 // Miscellany, Writing

From “Structured Procrastination” by John Perry, philosopher and author of The Art of Procrastination (delightfully subtitled: A Guide to Effective Dawdling, Lollygagging and Postponing):

The key idea is that procrastinating does not mean doing absolutely nothing. Procrastinators seldom do absolutely nothing; they do marginally useful things, like gardening or sharpening pencils or making a diagram of how they will reorganize their files when they get around to it. Why does the procrastinator do these things? Because they are a way of not doing something more important. If all the procrastinator had left to do was to sharpen some pencils, no force on earth could get him do it. However, the procrastinator can be motivated to do difficult, timely and important tasks, as long as these tasks are a way of not doing something more important.

Structured procrastination means shaping the structure of the tasks one has to do in a way that exploits this fact. The list of tasks one has in mind will be ordered by importance. Tasks that seem most urgent and important are on top. But there are also worthwhile tasks to perform lower down on the list. Doing these tasks becomes a way of not doing the things higher up on the list. With this sort of appropriate task structure, the procrastinator becomes a useful citizen. Indeed, the procrastinator can even acquire, as I have, a reputation for getting a lot done.

This is the story of my life. Everything I’ve written stems from this reality. This blog started in 2009 to escape studying as a medical student. I even started writing and publishing Twitter fiction (of all things!) to further fit something creative in the cracks of my day.

For most of my life, the easiest way to get anything done was to have an overly full plate and just juggle interesting distractions with the sheer terror of missing deadlines.

The Hard Work Muscle

10.06.25 // Reading

From Don’t Believe Everything You Think by Joseph Nguyen:

While a job may be demanding, does that mean it must lead to suffering? Or put another way: Is it absolutely true that every person who has the same intense job feels the exact same way about that job?

The ability to work hard is trainable like a muscle.

It is also common—whether in medical school struggling to land a residency or in residency waiting for attendinghood or being an attending already searching the horizon for retirement—to look forward to milestones:

There are two sources of goals: goals created out of inspiration and goals created out of desperation.

When we dig a little deeper into these types of desperation goals, we see they are all typically “means goals” and not “end goals.” In other words, we want to accomplish the goal in order to get something else, which is why these goals make us feel that we never have enough.

The effectance motive is the only antidote for the arrival fallacy. Being miserable while waiting is a choice. Working hard isn’t always worse: it depends so much on what you’re doing, where you’re doing it, who you’re doing it with, and why you’re doing it. Not all of those facets are necessarily going to be the good ones on any given day or task, but you get to choose your labels and perspectives.

When it’s time to best fill the time you do have, perhaps this thought experiment would help:

If I had infinite money, had no fear, and didn’t feel the need to receive any recognition, what would I do or create?

In real life, you can—to an exent—choose your community and who you hang out with. Online with social media, that’s much, much harder. This is a good video (“Something Strange Happens When You Trace How Connected We Are”) from Veritasium, and if you’re busy, that link takes you to the section on how the classic Prisoner’s Dilemma works when you add in network effects. Game theory tells us not to feed the trolls.

// 10.03.25

From her remarkable memoirs, the German-Jewish Gluckel of Hameln, writing about her childhood village of Altona sometime in the 17th century:

But great love and a close community spirit reigned among them, and in general they all enjoyed a better life than the richest man today. If a man were worth only 500 Reichsthalers, he could well be satisfied; and everyone was happier with whatever he had than nowadays when even the rich can never get enough.

The notion of the “good old days” surely comes for us all.

// 10.02.25

Radiology Jobs

10.01.25 // Radiology

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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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
  • Flexible fully remote options (11a-8p, 8p-3a, or 3a-11a PST)

Independent Contractor (remote or onsite):

  • Flexible shift options (as above), high compensation

Learn more at http://www.renorad.com/
Contact: CEO Anthony Dispenziere at adispenziere@renorad.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

100% Remote Neuro/General:

  • Daytime tele neuro/general radiology approximately 50/50 split.
  • 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
  • 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 with the following training:

  • Pediatric Imaging
  • Breast Imaging
  • Neuroradiology
  • Body Imaging
  • Nighthawk/Overnight
  • General Diagnostic Radiology
  • Vascular/Interventional

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.
  • 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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Mecklenburg Radiology Associates

(Charlotte, North Carolina)

Established in 1917 and fiercely independent, MRA is a well-respected subspecialized practice of 60 radiologists and growing. They especially take pride in their group culture (seriously, there are some really nice people in that group including one of my old senior residents).

Partnership track:

  • 3-year partnership track with 8 weeks of vacation per year
    $400K starting salary and an additional $75K sign-on bonus ($125K with 2+ years of experience)
  • On-site daytime hospital and imaging center coverage. Hybrid evening and weekend call coverage, including the option to read from home.
  • Available positions: Breast, Body, Cardiovascular, Neuro, Light IR, MSK, Nuclear Medicine, and General

Employee track:

  • Fully remote, hybrid, or on-site options
  • Competitive salary
  • Available positions: MSK, General, Overnight ER, Swing Shift ER, Neuro, Body, and Cardiovascular

Learn more at www.meckrad.com/recruitment.
Contact: Charlene Eichinger at ceichinger@meckrad.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 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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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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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).

Remote Overnight Shareholder/Partner and Limited Shareholder Offers
  • Shareholder/Partner Offer (remote):
    • 1 week on followed by 2 weeks off + 36 additional 2nd shifts annually for full Shareholder status.
    • Average Shareholder compensation of $1MM.
    • Additional internal “moonlighting” paid per RVU. Legitimate seven-figure position with immediate economic parity with existing Shareholders.
  • Alternative Coverage / Compensation Options: (remote)
    • 1 week on / 1 week off for $1.1MM total compensation
    • 1 week on followed by 2 weeks off for $700,000 total compensation
  • Shift Details:
    • 10PM – 7AM Central Time
    • 2 radiologist overnight team with additional triple coverage until midnight and after 6AM
    • RVU Benchmark expectation of 115 wRVUs
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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Iowa Radiology

(Des Moines, Iowa)

34-radiologist subspecialized collegial private practice with long-term stability providing coverage to 30 locations across Central and North Central Iowa. Ownership of several outpatient imaging locations yields distributions from technical fees, and Des Moines is one of the fastest-growing areas in the country with a low cost of living, excellent schools, and low taxes.

Partnership track:

  • 2-year partnership track with 12 weeks vacation
  • On-site daytime coverage; hybrid night and weekend call coverage
  • Greatest needs: Breast, Neuro, General. All subspecialties considered for the right candidate.

Employee track:

  • Fully remote, hybrid, or on-site options
  • Excellent salary and benefits package, including up to 10 weeks of vacation depending on role/shift
  • Immediate Need: 3rd Shift Radiologist
    • Nine-hour shift, 7 on/14 off, 100% teleradiology
    • 90-120 cases/shift; ~40 of those CT
    • Base compensation $450,000 w/ additional compensation opportunities
      • Additional comp consideration based on subspecialty (for example, can final read neuro cases)
      • Moonlighting available
      • RVU productivity incentives
    • Full benefits package including 401k, health/dental/vision, pension, life insurance, etc. ($83k benefit value annually)
    • Malpractice and tail paid
  • Other Available positions: General, Breast, Flex Shift, Overnight
    • Overnight shift is 10p-8a CST, 7 on/14 off, 100% teleradiology with average 90-120 total cases per shift
    • Evening shift is 4p-12a CST, alternating weeks M-F only (26 weeks and no holidays/weekends)

Learn more at http://www.iowaradiology.com
Contact: recruit@iowarad.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:

Breast:
  • Approximately 75% breast imaging and 25% general radiology.
  • 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
MSK:
  • Full-time or 3/4-time partnership-track hybrid position
  • Caseload consists of multimodality imaging (CT, MR, and limited ultrasound) of joints and spine as well as CT and fluoroscopic-guided diagnostic and therapeutic procedures. Typical general ER/inpatient evening and weekend call shifts from home.
  • No breast or IR requirements

Learn more at https://www.vrads.com/
Contact: recruiting@vrads.com

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Radiology Consultants of Little Rock

(Little Rock, Arkansas)

Founded in 1961, RCLR is a 25+ radiologist, subspecialized, independent private practice serving the largest healthcare system in Arkansas as well as the largest urology group in the state.

7 on / 14 off Early Evening/Swing Position:
  • Fully Remote
  • Employee or independent contractor
    • Pay based off competitive rate per RVU
    • Malpractice coverage provided
  • 8 hour shifts, 12 – 8 PM central time
    • Ideal for radiologists in Pacific time zone
  • General and emergency radiology
  • All modalities excluding breast and PET, NM is minimal
    <~75 RVUs/shift average before internal moonlighting
  • Internal moonlighting optional
    • Available during shifts and weekends
    • Additional daytime weeks available
  • Single IT stack
  • Employee Benefits: 401(k), health/dental/vision, life and disability insurance
7 on / 7 off Early Swing Shift (Partnership eligible):
  • Fully remote
  • Starting salary of $575K
  • 1 year track to full partnership
  • Competitive partner salary
  • 7 on/7 off but with the perk of being excused from 6 weekends per year
    • Excused from holidays that may fall on your scheduled week but share in overall holiday coverage evenly with the rest of the partnership
  • 8 hour shifts, 12 – 8 PM central time
    • Ideal for radiologists in Pacific time zone
  • General and emergency radiology
  • All modalities excluding breast and PET, NM is minimal
    <~75 RVUs/shift average before internal moonlighting
  • Internal moonlighting optional
    • Available during shifts and weekends
    • Additional daytime weeks available
  • Single IT stack
  • Benefits: 401(k), health/dental/vision, life and disability insurance

Learn more at https://www.radconlr.com
Contact: Terrie Threlkeld at terrie.threlkeld@radconlr.com

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Grand Traverse Radiologists

(Traverse City, Michigan)

Established in 1938, GTR is a 100% physician-owned and operated private practice in a four-season resort town on the bays of Lake Michigan.

  • High compensation and 12 weeks vacation
  • Post-call weekend days off
  • Internal moonlighting available
  • Positions/partnerships are on-site, but multiple shifts can be done from home.
  • Collegial and youthful group with an average age under 40. All partners are equal.
  • Hiring for growth. Lists are caught up!

Needs: Body, Breast, ER/General, and IR

Learn more at https://www.grandtraverseradiologists.com
Contact: Dr. Anthony Livorine at alivorine@gtradiologists.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 with the ability to decrease or increase total time off.
  • Average after-hours obligations = 9 weekends per year and 22 evening/swing Shifts.
  • Salary Range – $450,000 – $600,000
  • Full Benefit Package including health, life, vision, dental, disability, and life.
  • 401k match, profit-sharing contribution, and cash balance plan.
  • Hybrid Work Options

Current Openings:

  • Remote overnight ER
  • Neuroradiology (choice of Spokane, Seattle, Walla Walla, Tri-Cities, or Missoula)
  • Washington
    • Tri-Cities (with $75k signing bonus)
      • Breast
      • Neuro
      • MSK
    • Spokane – Pediatrics
    • Moses Lake – General/Breast (with $90k signing bonus, $20k relocation benefit, and annual retention bonus)
    • Colville – General/Breast
  • Montana
    • Missoula – IR
  • Oregon
    • Pendleton – General/Breast

More information about these positions can be found on our Independent Radiology listing.

Learn more at https://inlandimaging.com/careers
Contact: Sarah Russell, CEO at srussell@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 140+ groups. If you’re in the market, please also check it out for your job-hunting needs.

30-year Timelines

09.29.25 // Medicine, Radiology

The average radiology trainee will finish residency in their early 30s and hopefully enjoy a 30-plus year career if they like it (and otherwise make enough money fast enough to retire early if desired).

30 years is a long time

Do we really think that we have any idea what the world will look like in 30 years in a meaningful, actionable way? We don’t need to look at old-timey science fiction predictions of us flying cars and cities on the moon to know that we simply do not have this capacity as a species.

We can just look back 30 years to see how different the world is now compared with when I was growing up.

Thirty years ago, I was 9 years old playing Super Nintendo, which had 16-bit graphics with chiptune music and games with file sizes of a couple megabytes stored in plastic cartridges that you blew into when they didn’t work properly. The original Playstation was just coming out and featured a CD-ROM drive so slow that changing scenes often required waiting several minutes. We were yet on the cusp of the Nintendo 64 and the first time seeing Mario in 3D.

The internet existed, but many people used it by logging into AOL and getting curated content from its narrow gateway. Chat rooms and email were novel, but not the default form of communication for most people, and the broader decentralized World Wide Web hadn’t really taken off. Geocities had just launched, but most of its strangeness was just around the corner.

We had just moved from computers with text-based interfaces to the world’s first truly popular universal graphical user interface: Windows 95. We saved our work and transferred it from place to place in rigid, brittle plastic “floppy” disks that were 3.5 inches wide and had a magnetic tape with a capacity of 1.44 megabytes (an improvement[!] from 5.25″ ones that were actually floppy that I used on my first computer, which used MS-DOS and actually had a green and black screen a la the Matrix).

I logged onto the internet with a 28.8k modem, where images of any size took minutes to load, and you paid by the hour. We were still years away from Napster, high-speed internet, cell phones, or any number of other things that completely changed the landscape of what it means to be a citizen in America. Our lives may rhyme with our past but seem so comically different.

Things like CD & DVD collections and other relics of that era and the following decade now seem laughably quaint in the era of streaming media—and radiology is no exception.

Years ago, radiologists read films on viewboxes and dictated reports into dictaphones, which were then transcribed by hand by flesh-and-blood transcriptionists. Quick prelim reports jotted on paper were the rule of the day. MRIs and CTs took forever and were printed in multislice grids on film. Scrolling, that destroyer of wrists, did not exist as an interaction model. The job now is essentially unrecognizable compared to the job before. No one is hand-scanning every ultrasound or shooting invasive angiograms as a routine diagnostic test.

This is all to say: a lot can change in 30 years, and a lot will change over the next 30 years. And if enough people put their predictions on paper, some of them will undoubtedly be right, and in hindsight, those folks will look very prescient.

Actionable Predictions

So we should all get ready to look back from that future vantage point and celebrate some “thought leaders”—and then acknowledge that most of it will be bullshit survivorship bias.

The reality is that there is too much unknown to make meaningful, actionable predictions about the specifics of what things will look like in a way that should drive individual behavior. Instead of trying to know where things will land with AI, or the second- and third- and fourth-order effects of improved computer tools on radiology, medicine, or society more broadly, and the downstream consequences of all of these changes in the workforce and the world—the real question is: How inflexible is your comfort and success in a largely unknowable future?

When you change one thing, other things will change. We live in a nominally free market economy, and even though healthcare is essentially an exception due to a variety of regulatory and industry shenanigans, the reality is that things will change because things always change.

As Taleb argues in The Black Swan, you can know that a black swan (a highly improbable event) will eventually occur. That’s the easy part. Knowing exactly when and how is the impossible part.

So the goal can’t be to predict the future and land perfectly. The goal has to be to make yourself resilient to the unexpected.

The real answer for anybody in any profession, if you’re truly concerned about your skill set and its value in the future or the future of any tiny brick in the big house of medicine or the future of any specific profession if the future isn’t a magical post-capitalist techo-utopia, is twofold:

1. Live like your career is short.

Earn well, live modestly, save reasonably.

Make your life affordable. An intuitive example would be a 15-year instead of a 30-year mortgage. Don’t consign yourself to needing to strictly maintain your level of income for the next 30 years in order to pay for the decisions of today.

Modern first-world society has helped humans trade physical existential danger for ill-defined, constant low-grade anxiety. Don’t add extra to your plate.

2. Increase the surface area of your skills and the flexibility of your identity

The more narrowly you define what you do and how you do it, the more pivoting becomes unthinkable. This doesn’t mean you need to sacrifice your deep, narrow skills to be a generalist. The reality is that it’s possible those deep skills will be the ones that matter (predictions are hard, remember?). It’s largely a matter of mindset/attitude.

You and your big wrinkly brain have a variety of skills by the nature of who you are, how you’ve trained, and what you do. There’s a strong argument that amassing broad experiences is a great way to stay agile, whether that’s getting involved in practice management, teaching others, working with other humans face to face sometimes, etc.

What will likely serve you well overall is being less precious with what you do and who you think you are. You get to choose your identity and how crystallized you are.

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If your current position doesn’t pan out forever—whether because of AI, healthcare consolidation, or any number of other factors—you need to either be able to adapt or not need to care in the first place.

Draft No. 4

09.25.25 // Writing

Four of my favorite passages from Draft No. 4: On the Writing Process by John McPhee:

The approach to structure in factual writing is like returning from a grocery store with materials you intend to cook for dinner. You set them out on the kitchen counter, and what’s there is what you deal with, and all you deal with. If something is red and globular, you don’t call it a tomato if it’s a bell pepper.

Another mantra, which I still write in chalk on the blackboard, is “A Thousand Details Add Up to One Impression.” It’s actually a quote from Cary Grant. Its implication is that few (if any) details are individually essential, while the details collectively are absolutely essential.

So much good writing is rooted in real, personally-filtered human experience.

“How can you afford to use so much time and go into so many things in such detail with just one writer when this whole enterprise is yours to keep together?” He said, “It takes as long as it takes.” As a writing teacher, I have repeated that statement to two generations of students. If they are writers, they will never forget it.

That part is hard.

No one will ever write in just the way that you do, or in just the way that anyone else does. Because of this fact, there is no real competition between writers. What appears to be competition is actually nothing more than jealousy and gossip. Writing is a matter strictly of developing oneself. You compete only with yourself. You develop yourself by writing. An editor’s goal is to help writers make the most of the patterns that are unique about them.

You develop yourself by writing.

My son asked me last night about writing in the era of ChatGPT. In short, I told him yes, I think it really still matters.

 

Medical Selection

09.22.25 // Medicine

As is the case with so many things in medicine, our selection process—for medical school, residency, and nearly every stage until a person has the requisite skills to practice—is riddled with suboptimal, if not entirely meaningless or counterproductive, proxy measures.

When we select college students for medical school, or medical students for certain residencies, the presumed goal is to select people who will become good doctors. On the first pass, we want to find those who will make good doctors generally, and on the second, those who will excel in specific fields. But if we’re honest, we’re terrible at this. We are absolutely abysmal at identifying the right people for the job.

Magical Metrics

The metrics required for field competitiveness are a reflection of supply/demand (i.e. the relative scarcity of training spots) more than the cognitive firepower, personality/disposition, or physical skills required for competency.

Our testing systems are, at best, inefficient measures of general intelligence and hard work. While those traits are important, the process we use to assess them requires students to spend countless hours learning material of dubious utility, often at the expense of other potentially valuable endeavors.

Economics teaches us that when resources are limited, the question isn’t whether something has value—most things do— but whether it’s the best use of those resources. There is no empirical evidence that our current testing paradigm or medical school curriculum broadly is the best use of applicants’ time, or that it effectively selects for the traits we actually care about.

On top of flawed testing—and accelerated by pass/fail Step 1—we have an obsession with CV-padding. Whether due to laziness, limited resources, or a lack of better alternatives, we’ve created a system that rewards applicants for amassing measurable activities that give the illusion of merit, even when those activities are empty gestures.

This leads to students wasting their free time on meaningless research, instead of pursuing hobbies, passions, or other fulfilling endeavors. To this, we’ve added a layer of well-intentioned but often questionable community service and outreach activities—nice in theory, but of dubious impact for both the person doing them and the community receiving them. None of these activities are inherently bad. Research isn’t bad. Helping people certainly isn’t bad. But when these tasks are reduced to tokenized, measurable units, we have to ask ourselves: are they being done in service of actual good, and is this the best way to accomplish that good? Is it possible for the outsider observer to distinguish the real deal from the slop?

Time & Money

Another valid criticism is that these demands favor students of means. Those with time, money, and connections are better positioned to engage in these resume-building activities, take gap years, or pursue additional schooling to improve their applications. This creates barriers for students without these resources. As if four years of undergraduate education weren’t enough preparation for a medical career, we’ve created a system where applicants need even more time, money, and effort just to qualify for medical school.

The irony is that other countries, and even parts of our own, have occasionally managed to streamline this process. Medicine faces a “good problem”: more people want to enter the field than there are spots. But we also face a deeper issue: many who do get those spots end up unhappy in practice or with no intention to practice in the first place. Some of this is due to the inherent difficulties of working in our broken healthcare system, but part of it likely reflects poor selection among applicants. Our laziness comes at a cost: we rob students of the full breadth of life when we force them into a narrow mold and make them compete in proxy contests trying to accumulate  “experience.”

What makes a good doctor?

What actually makes a good doctor? Hard work, kindness, and resilience are likely more important than test scores or resume padding. Yet, as Peter Drucker famously said, “What’s measured gets managed.” When we measure test scores and activities, we optimize students to achieve those outputs. But those outputs come at a cost. And too often, that cost includes losing good, happy, and fulfilled students, trainees, and practicing physicians.

Things Become Other Things

09.18.25 // Reading

From the titular passage of Craig Mod’s Things Become Other Things, a memoir partially about walking through the ancient pilgrimage trails of Japan’s depopulating Kii peninsula:

As the husband drives me down off the mountain, back to the Ise-ji path, he breaks our silence by saying, She aint… our daughter.

I am entranced by something out the window: Beyond the fields, past a dirt road, in the forest something burns.

Before I can register what he said, he continues with more fuency: She just appeared seven years back. Wanderin’ the country, needin’ a job, somehow… found us. Not a daughter but like a daughter. Time passes, life moves, and that’s what happens: Things become… other things.

I’ve been reading Mod’s writing (newsletters, etc) for quite a while (I just checked: 2015!). Other than being people who do some writing on the internet (him: more and better), we have essentially nothing in common. Yet through the bizarre, inevitable parasocial relationships you develop with people who share of themselves, I can’t help but feel like I sorta know the guy? Which, to be clear, I don’t. But it’s a good memoir! Japan is a crazily popular tourist destination right now, but there’s no way I or most people could hope to travel Japan like Mod has captured here.