In his 2023 book Decisions about Decisions, Harvard Law School professor Cass Sunstein offers this advice: Rather than concentrating on the probability of being right or wrong in a decision—which is often impossible to determine due to the intrinsic uncertainty and the unpredictability of the future—focus instead on comparing the cost of being wrong with the benefit of being right. These factors, according to Sunstein, are easier to estimate without the need for forecasting outcomes.

Applying this very logical argument to using high-quality AI tools for diagnostic medicine, we come to a straightforward problem as fleshy, fallible humans: the logical course of action is to agree with any plausible AI answer and only contradict the machine in cases of undebatable error.

If the goal is to maximize accuracy or quality, one can imagine a world where a human radiologist interprets a scan independently, and an algorithm interprets a scan independently. If both agree, then we’re done. If those two evaluations are in disagreement, then a third party—either another human or a different algorithm with different parameters—steps in to adjudicate the disagreement. (We could, of course, have that initial AI product itself be the result of a debate between multiple algorithms, but you get the idea.)

There is no guarantee that such a combination would be an improvement, but it’s a plausible outcome that will, of course, be studied. However, the effectiveness of such an approach remains uncertain. How much would such a system genuinely enhance diagnostic accuracy? Surely, it would be a moving target, but would such human-AI collaboration genuinely enhance accuracy or would it be awkward source of complexity and hamstring the needed efficiency gains. It certainly wouldn’t look very good if the third party nearly always sided with one source.

Potential Outcomes of AI-Human Collaboration

There are several possible outcomes:

1. The human is usually right, and the addition of the AI does not create a significant change.
2. The AI is usually right, and the addition of a human does not create a significant change.
3. The human is usually right, but the AI results helps catch what would be unequivocal bone-headed mistakes.
4. Both the human and the AI are usually right, but in cases where they disagree, a third-party adjudicator adds additional value by catching edge cases with higher frequency than either individual alone. If nothing else, the third party creates the system that is needed to handle discordance.
5. Alternatively, the combination could result in overall reduced accuracy. For example, the AI is almost always right, but the uncertainty of human disagreement actually reduces the overall accuracy.

That will be studied. Yet, reality could be complex—we may find that AI’s strengths and weaknesses differ across imaging modalities, patient populations, or specific pathologies. AI may be great at breast screening but terrible at most MRI. Or the opposite. The optimal balance between AI independence and human oversight may depend on more or different variables than we’d suspect. Or not. Why pretend to know?

The Likely Commercial Model for AI in Radiology

The commercial reality is that this sort of AI utilization is unlikely to be the primary solution for handling the radiologist shortage or maximizing profitability for stakeholders unless it’s a rule. The more likely scenario is that AIs will churn out preliminary reports of increasingly high quality, which a human radiologist will review, make changes to, and ultimately be liable for.

This shifts the radiologist’s role from a thoughtful creator and analyst to more of a quality inspector—checking for plausibility rather than deeply analyzing every case. When the AI is reasonable, the human will likely agree. When the AI makes an obvious mistake, correcting it won’t require much effort from the human. Obvious contrast mixing in a pulmonary artery is not a thrombus. Calcified lymph nodes are often chronic findings, etc. A clearly benign breast lesion misclassified as a potentially malignant tumor may be easy for an experienced mammographer to catch, especially if that mammographer has access to priors and context than the AI does not

It’s easy for many observers with a vested interest to believe that their magical subset of skills will be particularly thorny to emulate, and some may even be right.

Even the quality inspector assumption presumes are relatively stable and predictable level of AI performance. How confident should a human be in their assessment when there is disagreement if the AI is improving while the human is mostly stagnant? What if AI-generated reports vary significantly in quality for different use cases? Scrutiny may be hard to employ judiciously in a piecemeal fashion.

Regulatory agencies could impose strict requirements for human oversight that make the process more labor-intensive than expected, and those requirements could be either reasonable or stupid over the short, intermediate, and long term? AI adoption will depend not only on technical feasibility but also on evolving legal, ethical, and financial pressures.

The Risk of Automation Bias

But what will radiologists do when the AI calls a focal asymmetry that the radiologist would not have called? If the AI is usually right, the human being will almost certainly just agree with whatever it says as long as it’s plausible—because the risks of agreeing are negligible, but the risks of incorrectly disagreeing are high.

How foolish will you feel calling a mammogram normal when the AI suspects a mass—with its black-box, pixel-based approach that detects patterns beyond and different from your human understanding? No one wants to get in the way, so no one will disagree and take on the liability of calling a case negative when the AI has flagged it as positive in an otherwise usually accurate system.

That’s the reality we need to live in. That’s what we’re going to see unless we specifically craft one to prevent it.

That’s going to be a big problem—because all the commercial and workforce pressure will push us toward utilizing AI tools in ways that practically ensure automation bias becomes the single biggest challenge facing radiologists in the near future.

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 (including remote openings with a partnership-eligible remote swing position). 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 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).

Learn more at www.radiologyofhuntsville.com.
Contact: Brandy McCown at bmccown@radhunt.com or call 256.713.0621.

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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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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: 3^rd 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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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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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):

Positions (Remote):

Learn more at www.midwestradiology.com.
Contact: Barry.Lindo@MidwestRadiology.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

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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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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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.

Learn more at https://www.hvrads.com/
Contact: Dr. Evan Kurz at esk@hvrads.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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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, 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 (3a-11a PST, 11a-8p PST, or night)

Independent Contractor (remote or onsite):

• 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:

Learn more at https://www.vrads.com/
Contact: recruiting@vrads.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 August I launched Independent Radiology as a resource for the broader community, a dedicated private practice radiology job board with 150 groups so far. If you’re in the market, please also check it out for your job-hunting needs.

In Give and Take, Adam Grant divides people into three types: givers, takers, and matchers.

• Takers try to get more than they give.
• Matchers aim for even trades.
• Givers help without expectation.

Grant argues that givers are both the most and the least successful (because people like givers, but they are also the easiest to take advantage of):

“Givers are overrepresented at the bottom and the top of the success ladder.”

Radiology practice is no exception. The culture is the people, and it arises organically from the people in the organization working within the constraints of the clinical work.

Picker of Cherries

Consider cherry-picking in radiology:

• Takers cherry-pick to get more RVUs, easier cases, or both.
• Matchers behave appropriately, unless they are working with known takers or see taking behavior, since people generally don’t like being taken advantage of.
• Givers read down the list and jump on the grenades left over by the others. This can result in looking less efficient by various metrics.

Conditional Behavior

The reality is that people’s behavior is both variable and domain-specific. Someone may run amok on the list but be willing to do tedious extra administrative work that no one wants to do. Someone may be a huge team player at the hospital when they’re part of a small group where they feel seen, but a bad actor when part of a massive shared list.

We need to acknowledge that 1) hiring matters, 2) culture matters, and 3) we should try to build better systems that make it easier for people to behave nicely and win.

It’s impossible, even in easy times, to hire right all the time. The solution, in the old days, was to make partnership contingent on good behavior (and, sometimes, high productivity). The problem of course is that, like tenure, that doesn’t fix sloth or selfishness among partners. And certainly in the current market, dropping people when staffing is tenuous isn’t trivial when the work has to get done. Rug pulling too often would seriously harm a group’s reputation, and warm bodies don’t grow on trees.

Workflow-wise, too many metrics and too much surveillance are extremely toxic. No one wants to have their movements tracked like an Amazon warehouse worker to make sure their bathroom breaks are industry-conforming. But the reality is that an open list where you select your next case is a big temptation for takers, and it only takes a tiny sliver of takers in an organization to spur the suboptimal behavior of matchers. That leaves everyone feeling like a distrusting victim.

Giving, More Broadly

Not all giving is equal. And not all of it scales.

“Being a giver doesn’t require extraordinary acts of sacrifice. It just involves a focus on acting in the interests of others.”

Matching is about dividing the work pie fairly, but giving often involves other gifts of time, energy, knowledge, skill, and emotional support. Teaching is a gift. Administrative duties like committee work, medical directorship, and practice leadership often disproportionately fall on givers. The “reward” for doing these tasks well (or even just being willing to do them) is often being given more responsibilities.

We can’t let giving be a suckers game:

“If you don’t protect yourself, giving can be dangerous.”

Give to matchers, and you build reciprocity.
Give to givers, and you build culture.
Give to takers, and you burn out.

Takers exploit. Matchers track. Givers build.

We need systems with guardrails to ensure that opportunities for exploitation are rare and that bad behavior can be policed effectively. If your group is using independent contractors for list support, that might mean giving them access to only a specific list or specific cases instead of letting them graze freely.

The problem is that if takers dominate, everyone becomes a matcher. Generosity becomes naïve. Trust becomes weakness. And the whole system corrodes.

“The more often people give without strings attached, the more others start to match their generosity.”

Practices thrive when givers can lead with open eyes and no remorse.

Here’s a little compilation of posts from the last few years about getting started as a new radiology resident.

Transitioning

Scan by Scan is an essay about starting in radiology.

Doing

Approaching the Radiology R1 Year and its short companion post: How to be a First-Year Radiology Resident.

Want something a little more controversial? You Should be Correlating Clinically.

Learning

Book Recommendations for First-Year Radiology Residents (and some further recommendations for when there’s extra book fund to burn).

You can round that out with some more general thoughts on studying during residency. Then try my deeper dive: ultralearning radiology.

Iterating

Some important considerations for getting better every day.

Getting and making the most of feedback. Also, a few more words about your self-worth as an early trainee.

Lastly, radiology call tips (which are also helpful every day).

Efficiency & Ergonomics

There’s a lot you can and should do other than just using whatever is plugged into your workstation, but this post for trainees is a start.

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Also, residents from across the country in the ACR Resident and Fellow Section came together and assembled a nice collection of free radiology learning resources from across the interwebs including lots of videos.