If you haven’t yet read an explainer on “AI”, I consider Jeremiah Lowin’s “An Intuitive Guide to How LLMs Work” to be a good one.
The current welcome bonus landscape:
- Curizon is entering new physician registrants in a drawing to win $100 (5 winners this month). The odds aren’t bad, several of my readers have won!
- Sermo is again (finally, after years) offering readers of this site an exclusive $10 welcome bonus.
- InCrowd is offering $10.
- M3 Global Research, M-Panels, and All Global Circle are each offering $10 for the following 12 specialties: Hematology / Oncology, Dermatology, Gastroenterology, Pulmonology, Cardiology, Family Medicine or General Practice, Neurology, Urology, Nephrology, Allergy and Immunology, Surgery, Psychiatry, or Rheumatology.
My complete list and more thorough descriptions can be found here.
In addition to being a way to earn extra money (and start a side business that enables you to take some business deductions or start a solo 401k), signing up through these links also helps support my writing. Thank you!
The radiologist shortage is definitely here. There are different ways to approach the market, but balancing short-term vs long-term plays is nontrivial. Leverage is great, but using too much can amplify negative downstream second-order consequences too.
What’s happening now varies and what will happen is anyone’s guess, but this anonymous op-ed “Radiologists need to be realistic about the job market” is absolutely worth reading.
…Hospitals quite literally cannot operate beyond a few hours without diagnostic radiology. We are the bottleneck for all inpatient care. All service lines run through us. Any radiologist can easily take one of the hundreds or thousands of teleradiology jobs, which offer less commute, less non-interpretive work, and often higher pay per hour. Hospital systems simply have no leverage against their radiologists except fear of the unknown.
We work in interesting times:
A group of radiologists is severely understaffed, reading far beyond what they normally would. Radiologists are overextended, and high-volume readers are threatening to quit unless something is done. The group is unable to afford hiring radiologists in the current market. Many other unsolvable issues, such as retirements, interpersonal issues, poor work ethic, interventional radiology (IR) vs. diagnostic radiology (DR) squabbles, and [plug in your practice’s problems here] plague the group. Negotiations with the hospital have yielded minimal results. What is a group to do? Take the money, or continue the negotiations?
Again, imagine all of the unsolvable problems this group may face: recruitment, billing issues, MIPS, exploding volumes during nights and weekends, older partners wanting to cut down or retire, cantankerous partners who are indispensable, ad infinitum. More money can’t solve all of these problems, because in this labor market, an exclusive contract is a massive liability. The group decides to turn these liabilities into leverage: They walk away from the contract and tell the hospital they can hire them as employees for base + productivity, or see you later.
The tables have immediately been turned. Suddenly, all of the issues that were unsolvable now become points of leverage. Can’t recruit? More leverage for us. Can’t staff weekends? More leverage for us. A couple of people retired? More leverage for those who stayed. Volume too high? I’m on productivity, or I’ll read slowly and take my base salary. Billing sucks? Not my problem. Overnight services increased their rates? Not my problem. Want to find another group? Good luck, there’s nobody else. We have three months of trailing AR to keep us fed until we get credentialed literally anywhere else.
Guess who wins?
An important pre-tax vs Roth argument that is often missed, from “Why Pre-Tax Retirement Contributions Are Better Than Roth In Peak Earning Years (Even If Tax Rates Increase)“:
The most powerful argument for a pre-tax account as a retirement savings vehicle is that it comes with the option to convert the pre-tax dollars in the account to Roth at any time. That is to say, the account owner can choose when they want to be taxed on the funds in the account (which is what happens when pre-tax funds are converted to Roth), and make those dollars tax-free from that point on. Which makes it very useful to have pre-tax funds available to convert to Roth in years with lower-than-normal income, such as the years between retiring and beginning Social Security and/or RMDs. During this time, the funds can be converted to Roth and taxed at a lower rate than they would have been during high-income working years, or in later years when Social Security and RMDs push the owner into a higher tax bracket.
Notably, Roth accounts do not have this option: There’s no way to move funds from a Roth to a traditional account and take a tax deduction in a higher-than-normal income year (i.e., the opposite of what someone would do with a Roth conversion). The ability to choose when income is recognized only goes in one direction, from traditional to Roth. So from a tax timing perspective, it’s more valuable to have pre-tax funds, with the possibility of converting them to Roth during lower-income years, than to have Roth funds that stay Roth no matter what.
Which is ultimately why, even if tax rates are expected to go up at some point in the future, it can still make sense to contribute to a pre-tax traditional retirement account. Whether or not tax rates increase, the tax timing opportunities to recognize income from pre-tax accounts will still exist. For higher earners, if there’s a reasonable chance of having several low- or zero-income years after retirement, it can make sense to defer the recognition of some of their income from a higher-tax year into a lower-tax year by making pre-tax retirement contributions.
As in, the Roth conversion option gives high-earners the benefits of a Roth contribution without committing to high taxes upfront. Play your cards right and you could even take out some of that pre-tax money tax-free in retirement too. The article’s discussion of historical taxes is worth the read.
The important counterargument is that, in real life, the effective investment between a maxed-out pre-tax and Roth account is already not apples to apples. As in, $10k in a Roth has already been taxed and is therefore reflects a greater than $10k investment. Many people (including presumably most doctors) investing in pretax accounts do not take the extra money they would need to max out a Roth and invest that in a taxable account alongside their pretax contribution. It’s all a set-and-forget it payroll deduction. So, optimized tax considerations aside, many retirees will end up with more money to spend with the Roth contribution just because they saved more money upfront. The option for a Roth conversion is powerful, but it adds complexity and requires timing, two things investors often struggle with.
Both types of accounts have strengths, and all outcomes are a combination of math and behavior in a largely unpredictable tax context.
Another paper suggesting that clinicians prefer some structure (but not too much structure) in radiology reports. There are always edge cases where structured reporting becomes cumbersome–and overly parsed reports are also inefficient/unreadable–but there’s no denying it’s so much easier for me to scan a prior report when it’s not narrative free text.
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 10 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
- 10 weeks of vacation
- Sign-on bonus
- 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
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:
- 18-month associate period leading to full partnership with board of directors membership.
- Equity within a large expanding outpatient imaging practice (STRIC)
- Competitive salary with 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
- Fully remote and onsite options available.
Learn more at https://stric.com/.
Contact: Waynea Finley at wfinley@strg-pa.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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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: General, Overnight ER, Swing Shift ER
Learn more at www.meckrad.com/recruitment.
Contact: Charlene Eichinger at ceichinger@meckrad.com
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Radiology Associates of Ocala
(Ocala, Florida)
A growing Central Florida private practice, rare for the region, with 70+ radiologists looking for an on-site general radiologist.
- Practice owns multiple imaging centers, generating technical fees and rental income for partners.
- New business ventures of software development and a separate Telerad company.
- Optional internal moonlighting available. Nights are covered by dedicated internal nighthawks.
- Option to rotate/vacation in the US Virgin Islands at a practice-owned timeshare at the St. Thomas Ritz.
- Equitable non-tiered 3-year partnership track with nominal buy-in and equal call/PTO/scheduling for pre-partner and partners. 14+ weeks vacation (~185 shifts/yr).
Learn more at https://raocala.com.
Contact: Dr. Vivek Kalra at Vivek.Kalra@raocala.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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RAPA
(Central Arkansas [Little Rock, Conway, Searcy, and Pine Bluff] & Northwest Arkansas)
40+ radiologists covering 20+ sites with a multi-subspecialty mix of inpatient, outpatient, and ED imaging. Robust reading room assistants and IT presence to promote peak efficiency including a unified reading list/PACS (no switching stations or PACS to read other sites) and RadAI automated impressions to improve efficiency.
Greatest needs are IR, mammography, body imaging, MSK, and nuclear medicine, but all subspecialties and general radiologists are welcome.
Partnership track:
-
2 years to partner for new graduates, 1 year with experience
- 10 weeks vacation + 1/2 day off per week on average for partners
-
Highly competitive compensation combined with a 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
Employee track:
- Flexible scheduling (mammography, teleradiology swing shift, other options available)
-
Fully remote, hybrid, or on-site options available
-
Competitive salaries
- Robust CME allowance, signing and moving bonuses, full benefits
Learn more at http://rapaxray.com/
Contact: recruitment@rapaxray.com and Dr. Brandon Kelly at bkelly@rapaxray.com
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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
- 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
Learn more at http://www.iowaradiology.com
Contact: recruit@iowarad.com
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Hudson Valley Radiologists
(Poughkeepsie, New York)
A congenial team of 25 sub-specialized radiologists in New York’s scenic Hudson Valley that understands the importance of work-life balance. Since the 1970s, HVR has been respected in the community and known for its entrepreneurial spirit and excellence in patient care, currently providing services to five local hospitals and multiple outpatient imaging centers.
Fulltime MSK Position: On-site Partnership or Remote Employee
- Competitive compensation with full benefits package (not RVU-based)
- Additional earning potential with internal moonlighting
- Hospital and office-based work
- On-site & remote weekend call responsibilities
- Leadership opportunities, if desired
- Starting salary range: $375 – $400K depending on experience
Fulltime Remote Overnight Position: 7 on 14 off
- Competitive compensation with full benefits package (not RVU-based)
- Additional earning potential with internal moonlighting
- Remote weekend call responsibilities
- Leadership opportunities, if desired
- Starting salary range: $400 – $425K depending on experience
Learn more at https://www.hvrads.com/
Contact: Dr. Evan Kurz at esk@hvrads.com
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Radiology Associates of North Texas
(Dallas, Fort Worth, Texarkana, Sherman/Denison, Longview, Tyler, Lubbock)
The largest 100% radiologist-owned and operated group in the country, serving the greater North Texas area since 1937. 290+ radiologists, 30+ APPs, and robust business staff support. Low turnover, healthy culture, ownership mentality, work-life balance, reasonable call schedules, and unlimited voluntary internal moonlighting (both scheduled shifts and anytime when not scheduled). 24/7 neuro and pedi subspecialty support.
The practice is organized into four distinct areas within DFW and seven distinct regions outside the Metroplex. This allows for practice opportunities ranging from small & intimate to large & subspecialized.
Positions (On-site):
Body
- Dallas (East and South opportunities)
- Mix of high-end body and general imaging
- Desirable work sites within a small radius
- Fort Worth
- Mix of high-end body and general radiology with light IR procedures
- Sites: within 30 minutes of the Ft Worth medical district
- Tyler
- Mix of high-end body and general imaging
- Close-knit team
- High volume
Mammo
- Fort Worth
- 100% mammo and combo mammo/general options available
- Employed/partnership options
- High compensation: mammo stipend
- Dallas
- Employee/partnership options
- High compensation: mammo stipend
- Texarkana
- Mix of general and mammo
- $900k+ compensation opportunity
- Small town charm
- Longview
- Mix of general and mammo
- $900k+ compensation opportunity
- Small town charm
Pediatrics
- Dallas
- Two sites: Medical City Children’s Hospital and Cook Children’s Prosper
- Full scope of pedi (nearly 100%)
- $150,000 signing bonus
- Salary Range: $620k+ during workup, $945k+ for shareholders
- Fort Worth
- Single site: Cook Children’s Ft Worth
- Full scope of ped (100% pedi)
- Pedi Neuro also available (50-80% pedi neuro depending on daily staffing)
- $150,000 signing bonus
- Salary Range: $620k+ during workup, $945k+ for shareholders
Neuro
- Dallas (South and East Opportunities)
- 100% neuro and mix of neuro/general opportunities
- Subspecialty support
- Desirable work sites within a drivable radius
- Fort Worth
- 100% neuro opportunity or mix of general/neuro
- Hybrid onsite/remote work
- No mammo expected, neuro-interventional support available
- Tyler
- Mix of neuro and general (the inpatient component is mainly neuro)
- Clinicians specifically seek out/value the neurorads
- High volume
MSK
- Fort Worth
- Subspecialty support
- 20% MSK/80% Diagnostic (with some days at 100% MSK)
- High-level body cases available if desired
- Basic procedures
General
- Fort Worth
- Sites within 30 minutes of the Ft Worth Medical District
- Wide variety of cases
- Subspecialty support
- Sherman/Denison
- Smaller town with big city access (1 hour north of Dallas)
- Wide variety of cases
- 2 work sites
- Texarkana
- Small town charm
- $800k+ earning potential
Positions (Remote):
General Overnight
- 24 hour IT support
- Team support – 7 rads on the list at a time
- Subspecialty support
- Base pay plus productivity bonus
Longview General Daytime
- Employed position
- $900k+ earning potential
- Team support
Part-time Contractor – flexible hours
- Work when you can
- Paid at $32/RVU
- Team support
Swing (Tyler)
- Monday–Friday, no weekends required
- 20 weeks of 10a – 7p CST, 20 weeks of 4p – 12a CST
- Base comp: $400k plus productivity bonus – high earning potential
Remote Daytime Pediatrics
- Part-Time or Contractor
- Full scope of pedi, 100% pedi
- Read from anywhere in the US
- Schedule: flexible hours, 12pm-5pm
Remote Nightime Pediatrics
- Full-time or Part-Time
- Up to 80% pedi
- Read from anywhere in the US
Learn more at https://radntx.com/radjobs
Contact: Todd Howard @ radjobs@radntx.com
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If you’re a group looking to advertise, get in touch. The monthly post here is limited to just 10 groups at a time, but in August I launched Independent Radiology as a resource for the broader community, a dedicated private practice radiology job board with 75+ groups so far. If you’re in the market, please check it out for your job-hunting needs.
A reader asked if anyone had successfully started a new radiology private practice recently, particularly one that involved financing, opening up new imaging centers, and fresh payor contracts. There is a vacuum in some areas, especially with the PE-exacerbated instability, and therefore a clear opportunity to those who can muster the manpower (no easy feat).
As a follow-up, I thought I’d ask (on their behalf): is anyone who has willing to mentor other upstarts?
In The Happiness Hypothesis, Jonathan Haidt describes work by William Damon at Stanford that sought “to see why some professions seemed healthy while others were growing sick”:
Picking the fields of genetics and journalism as case studies, they conducted dozens of interviews with people in each field. Their conclusion is as profound as it is simple: It’s a matter of alignment. When doing good (doing high-quality work that produces something of use to others) matches up with doing well (achieving wealth and professional advancement), a field is healthy.
In their study, modern journalists were suffering in the era of market consolidation and the growing attention economy:
Many journalists who worked for these empires confessed to having a sense of being forced to sell out and violate their own moral standards. Their world was unaligned, and they could not become vitally engaged in the larger but ignoble mission of gaining market share at any cost.
Contrast that with genetics, where doing good and doing well are usually the same thing.
Decide if you think being a healthcare worker in the now-typical corporatized environment reflects a coherent or incoherent profession. This is essentially the premise behind the “moral injury” reframing of physician burnout.
Unfortunately, recognition doesn’t really help because reclaiming coherence is hard:
A coherent profession, such as genetics, can get on with the business of genetics, while an incoherent profession, like journalism, spends a lot of time on self-analysis and self-criticism. Most people know there’s a problem, but they can’t agree on what to do about it.
The battle between Radiology Partners and UnitedHealthcare has ended with United as the victor.
The summary:
- RP claimed United owed them lots of money for underpayment because United was using a 2020 contract to determine some of its payments instead of a more lucrative 1998 contract originally held by one of its purchased groups, Singleton.
- United then sued Radiology Partners alleging an illegal pass-through billing scheme. It’s a good read.
- The arbitration panel awarded RP an interim award of $153 million. This was very much interim, not just because the independent panel had awkward bias conflicts, but also because the panel decided to separate the question of whether Singleton’s lucrative contract was in effect (it was) and if RP was abusing it (which it was) into separate steps.
The $153 million award would really have only been an extra $94 million since United had already paid for the work at a lower rate. (Author’s note: That’s quite the contract.)
Phase III–that awkward fraud question–just finished. The ultimate findings of the panel (free login required):
In the Phase I Decision entered on April 2, 2023, the Panel made the following finding: “The Panel finds the 1998 contract to be the operative agreement between the parties.” The Panel confirms this finding.
In Phase II the Panel entered the Interim Award On Singleton’s Arbitration Demand on September 26, 2023. The Panel now vacates that Interim Award.
The difference between the amount United paid on claims pursuant to the rates specified in the 2020 Agreement and the amount it would have paid pursuant to the rates specified in the 1998 Agreement is $94,275,324.00. United’s underpayment of Singleton’s claims at the rate specified in the 2020 Agreement was a breach of the 1998 Agreement.
Because of its breaches of the 1998 Agreement and its other acts and omissions, Singleton is not entitled to recover this difference and underpayment or any other relief against United. Because of its breaches of the 1998 Agreement and its other acts and omissions, United is not entitled to any other relief against Singleton. The Panel determines that the evidence fully supports these decisions at law and in equity.
Translation: you are both jerks, you are both wrong in your typical unique and despicable ways, please go away forever:
United was wrong to unilaterally use the incorrect contract to determine payments. RP was wrong to hide its ownership and then essentially pretend that every group in the region it owns was Singleton when they clearly weren’t.
(For more description/backstory, see the previous two posts: United against Radiology Partners & United is Still Fighting Radiology Partners.)
For those keeping score at home, United’s lawyer was correct when they said, “We do not agree that Singleton will recover an award from UnitedHealthcare.”
In other news, whether or not they were right, United is still a terrible company.
Or, “Why Independent Radiology is different from most job boards (but also still boring)”
So recently I created a simple, small website called Independent Radiology. It’s a boring job board, but it’s also different from most job boards.
Jason Fried from 37signals (makers of Basecamp, HEY, and other stuff) argued years ago that software should be opinionated. A random WordPress website isn’t software per se, but I feel as a random dude on the internet with a full-time job, family, writing avocation, etc that anything extra worth doing in this sphere is only worth doing if it’s going to help someone and is unabashedly done the way I would do it. It’s a project that reflects my biases, preferences, and mission. It’s idiosyncratic. It’s opinionated.
The Context
When I first thought seriously about the issues with the ACR job board earlier this year that inspired this project (now significantly improved, you’re welcome), I was partly irritated by disingenuous job listings from Radiology Partners that were masquerading as independent private practices. But I was also struck by several things:
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