David Epstein, author of Range, writing about Herbert Simon’s notion of “satisficing” in the NYT as part of his promotional blog tour for his new book, Inside the Box:

Maximizers tend to be less satisfied with their decisions and their lives. They are typically less happy, more prone to regret and more likely to compare themselves endlessly with others. Satisficers don’t necessarily have low standards. Their standard is “good enough for me” rather than “the best out there,” and that makes it possible to feel satisfied with their choices, instead of haunted by the ones they didn’t make.

The psychologist Mihaly Csikszentmihalyi, who first used the term “flow” to describe states of complete absorption in an activity, put it well. By making up one’s mind to invest in a choice, regardless of more attractive options that may come along later, “a great deal of energy gets freed up for living, instead of being spent on wondering about how to live.”

Delightful. Both feet fully in as opposed to one foot out. Assuredly hard to always employ in a world where social media functions as “an infinite comparison engine,” but delightful.

// 07.23.26

Three quotes about science from the delightful Reality Is Not What it Seems by theoretical physicist Carlo Rovelli:

Science is born from this act of humility: not trusting blindly in our past knowledge and our intuition. Not believing what everyone says. Not having faith in the accumulated knowledge of our fathers and grandfathers.

Science is not reliable because it provides certainty. It is reliable because it provides us with the best answers we have at present.

It is precisely its openness, the fact that it constantly calls current knowledge into question, which guarantees that the answers it offers are the best so far available: if you find better answers, these new answers become science.

Rovelli’s book on “The Journey to Quantum Gravity” includes a thoroughly enjoyable tour of physics from Democritus (pre-Socratic originator of the atomic theory of the universe) through today. As one might imagine, the implications of quantum loop gravity aren’t easy to grok. Nonetheless, he tackles the challenge admirably: eminently readable, highly recommended.

// 07.20.26

From Mattering, by Jennifer Breheny Wallace:

We lose our footing and our sense of where we fit. The world feels colder, unwelcoming. The human brain wasn’t built for this kind of world. We often describe what’s happening around us as a mental health crisis, but this language only provides a partial picture. In truth, we are living through a social health crisis, a profound breakdown of the relationships that once protected us. We’ve lost track of our most basic human needs for connection and contribution. Now we often feel tempted to fill that void with counterfeit forms of mattering—chasing attention over connection, prestige over purpose, and money over meaning. The rise in loneliness, burnout, and anxiety is the predictable consequence of a society that has forgotten how to make people feel valued.

And later:

There’s a growing tendency in our culture to treat responsibility to others as an inconvenience, an obligation to dodge or delegate. In trying to guard against burnout or preserve autonomy, we can begin to see every task as a threat, like one more thing to manage rather than a sign that we matter.

It’s hard to feel weightless but simultaneously anchored.

// 07.14.26

From Wisdom Takes Work by Ryan Holiday:

The purpose of knowledge is action.

Too much study and not enough doing creates a paucity of knowledge, a shelter of naïveté, no matter how smart you are.

There are things that make sense on the page but do not survive contact with events.

We are living in a world where information is getting ever cheaper and ever more abundant. It still takes work to use it.

// 07.09.26

Racing Toward Commodization

07.06.26 // Medicine

On the effects of using AI to replace knowledge workers, from lawyer and typographer Matthew Butterick:

How might this work? The economy is increasingly driven by intangible assets. Knowledge workers provide those assets. If a company lays off its knowledge workers in favor of adopting some vendor’s AI, at first it gets the same productivity at much lower cost. So much win.

But in doing so, the company commoditizes its own output. If your company can automate its output via AI, others can too. Your existing competitors, certainly. But also upstarts who don’t have your cost footprint. Whatever intangible assets AI can generate will be produced in excess, leading to a deflationary market for that asset. A company’s knowledge workers may be its greatest expense. But they also contribute to its competitive moat.

Feel free to take his argument about legal services and see how hard you feel you have to stretch to apply it to healthcare:

Consider large law firms, aka Big Law. Currently certain legal-AI startups license LLMs from Big AI and repackage them for Big Law at high prices. These startups claim to add other special sauce. OK, sure. Where’s the economic equilibrium? If legal-AI startups prove that money can be made selling AI to Big Law—won’t Big AI just sell to Big Law directly, and cut out the startups? Or if legal-AI startups prove that AI can effectively provide legal services—won’t legal-AI startups just sell to clients directly, and cut out Big Law? Won’t members of Big Law that adopt AI have to lay off a lot of equity partners, because adoption of AI will shrink profit margins? Won’t the members of Big Law refusing AI have to consolidate to preserve their margins? Or just cave to AI? (The tendency of competitors to adopt similar practices is called institutional isomorphism.) So it goes. Most states prevent nonlawyers from sharing in legal fees, so law firms will probably remain a distinct set of entities. But one plausible equilibrium is that legal-AI startups disappear (quickly), and members of Big Law consolidate (relatively quickly) until there are only a handful left, all contracting directly with Big AI.

Along these lines, I expect that to succeed financially, Big AI will likely need to demolish a significant number of existing tech companies and grab their revenue for itself. By the process described above: Big AI essentially uses its tech customers as an R&D facility. Big AI licenses models to these companies. Tech companies compete to adapt their businesses to AI. Once a concept is proven, Big AI directly takes over that market. The labor-replacement story will grow into a company-replacement story. Many of those tech companies—and their shareholders in the public markets—may also find that AI is a poisoned chalice.

The possible deflationary component to AI deserves much more attention. When companies raise and spend oodles of money to address a specific market, the assumption is that those big companies and the AI companies will reap the economic profits. But even if that were to happen, those profits may disappear quickly if the once scarce cognitive good is repriced accordingly.

Perhaps that will lead the entire planet to enjoy a widespread post-scarcity techno-utopia thanks to Jevon’s Paradox once we can deploy at scale the cognitive resources that used to be the exclusive domain of the human brain, but I’d argue the law of supply/demand is, broadly, real.

Radiology Jobs

07.01.26 // 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.)

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

Kettering Network Radiologists

(Dayton, Ohio)

Kettering Network Radiologists, Inc. (KNRI) is a physician-owned, independent private practice serving Kettering Health’s extensive network. Our team consists of 56 radiologists, 8 physician assistants, and 8 radiology residents, providing high-quality imaging services across 8 hospitals (115-500 beds), 20 outpatient centers, 11 emergency departments, and 2 trauma centers (one Level II, one Level III).

Overnight:

1 week on / 2 weeks off rotation (3 night radiologists are working every night shift)
Scheduled shifts (EST):
- 9 PM – 6 AM, 6 PM – 3 AM, and 7 PM – 4 AM
Productivity bonus for those working overnight shifts. Additional individual shifts are available for extra pay but are not required.

Swing Shift:

Monday – Friday schedule, contracted for 5 days per week with the radiologist choosing between 10-17 weeks of vacation.
Includes 5-weekend shifts per year, with the radiologist selecting their preferred weekends.
Scheduled shifts (EST):
- 12 PM – 9 PM, 2 PM – 11 PM, 3 PM – 12 AM
Weekend shifts include:
- 6 AM – 3 PM, 9 AM – 6 PM, 11 AM – 8 PM, 12 PM – 9 PM, 2 PM – 11 PM, 3 PM – 12 AM

Daytime Neuro:

Partnership Track on-site/hybrid role
Standard 4- or 5-day workweek with 5 weekends per year.

5-on/9-off Neuro:

5 days on (Thursday – Monday) followed by 9 days off (Tuesday – following Wednesday).
This schedule amounts to ~130 shifts per year with each work cycle being 5 consecutive days.

When working ER or night shifts, you are never alone—always part of a team. We are a stable, well-compensated group, enjoying flexible scheduling with very comprehensive benefits.

Contact: Dr. Rachel Shikhman at rachel.shikhman@gmail.com

RAPA

(Central Arkansas [Little Rock, Conway, Searcy, and Pine Bluff] & Northwest Arkansas)

40+ radiologists covering 20+ sites (hospitals + clinics) with a multi-subspecialty mix of inpatient, outpatient, and ED imaging.

Robust reading room assistants and IT presence to promote peak efficiency. Unified Clario reading list, Inteleviewer PACS, Powerscribe dictation (no switching stations or PACS to read other sites). RadAI automated impressions to improve efficiency.

Partnership track – Central Arkansas (Little Rock, Conway, Searcy, and Pine Bluff) and Northwest Arkansas:

1 year to partnership
10 weeks vacation + 1/2 day off per week on average for partners
Highly competitive compensation combined with low cost of living
Internal moonlighting options to boost income
Robust CME allowance, signing and moving bonuses, full benefits
Many work-from-home shift options
Minimal after-hours requirements – overnight shifts are fully staffed with telerads

100% Remote Nighthawk, partnership track:

7 on/14 off, 10 pm-7:45 am CST
1 year to partnership
Competitive compensation, robust CME allowance, signing bonus, full benefits

Daytime Teleradiology:

100% remote.
Subspecialty work available with up to 50/50 split with general radiology
Option for employed or partner track. Partner track includes call weekend shifts, approximately 1 in 5 weekends.

Employee track:

General radiology, mammography, and other options available
Fully remote, hybrid, or on-site options available
Flexible scheduling including daytime teleradiology, 7 on/14 off. General radiology, but any subspecialty is a plus.
Competitive salaries
Robust CME allowance, signing and moving bonuses, full benefits

Greatest needs are IR, mammography, body imaging, MSK, and nuclear medicine, but all subspecialties and general radiologists are welcome.

Learn more at http://rapaxray.com/
Contact: recruitment@rapaxray.com and Dr. Brandon Kelly at bkelly@rapaxray.com

Eastern Radiologists

(Greenville & Coastal North Carolina)

Eastern Radiologists is a private practice in Eastern North Carolina that is physician-owned and operated and seeking to hire multiple radiologists due to growth and retirement. The well-established private practice serves a large geographic region through 14 area hospitals and several state-of-the-art imaging centers. Support is provided by nearly 70 subspecialty radiologists.

Currently seeking candidates in all subspecialties.

Details:

Positions are available in Greenville and other coastal communities in Eastern North Carolina.
Most are partnership track positions which include evening and weekend call responsibilities, but other employment options can be considered. Employment positions can be customized to fit desired schedule/income. Internal moonlighting is available for extra income.
Most specialties can work nearly 100% in their desired field of interest.
Great benefits, competitive salary including profit sharing and bonus, generous vacation and paid family leave, and business/educational discretionary account.
Sign-on bonus

Learn more at https://www.easternrad.com.
Contact: Erica Askew at easkew@easternrad.com

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

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

Radiology of Huntsville

(Huntsville, Alabama)

ROH is 60+ physician, high-volume, private practice with a 2-year partnership track and nominal buy-in. Hiring for a remote partnership-eligible overnight position as well as onsite/remote openings in most subspecialites. Huntsville is a tremendously livable, high-tech, and growing mid-sized city (a #1 Best Place to Live in the U.S. by U.S. News and World Report).

Pediatric Radiologist – Shareholder Track

Consistent annual shareholder compensation exceeding $1MM++
Shareholder (Partnership) opportunity after two years with nominal buy-in
Average 205 clinical shifts annually
Shared 1:6 general radiology weekend call
Dedicated overnight radiology team — no routine overnight call responsibilities
Flexible scheduling options, including daytime-focused practice
Join our collegial team of FOUR pediatric radiologists with a dedicated Women’s and Children’s Hospital, comprehensive pediatric imaging including high-volume pediatric MRI, CT, ultrasound, fluoroscopy, neonatal, emergency, and outpatient imaging, as well as light image-guided procedures.
Additional voluntary internal locum opportunities compensated per RVU

Onsite and Remote, Daytime and Second Shift opportunities

Abdominal / Body
Emergency
General Radiology
MSK
Neuroradiology
Nuclear Medicine
Pediatric
Light Interventional

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

Vantage Radiology & Diagnostic Services

(Near Seattle, Washington)

~35 subspecialized radiologists practicing near Seattle and enjoying a quality lifestyle focused on work-life balance, located minutes from urban amenities, and with easy access to abundant outdoor activities in the natural beauty of the Pacific Northwest. We’ve provided professional services for two hospitals since 1970 and are co-owners of their affiliated imaging centers.

Competitive salary ($370-570k) with a signing bonus for a 4-day work week and 8 weeks of vacation.
Benefits include a CME allowance, memberships to professional societies, profit-sharing, malpractice and disability insurance, 401K contributions, and a commitment to associate mentorship.
All partners and partner-track associates share in general call responsibilities (many from a practice-provided remote home workstation). Overnight call is covered by our internal nighthawk team.

Openings:

Swing:

4PM – 1AM PST from Monday to Friday.
2PM – Midnight on Saturdays and Sundays.
Practice is open to flexible staffing solutions or a combination of above shifts
Additional compensation as desired via internal moonlighting or reading OP cases as swing shift case volumes permit
Concurrent staffing with at least one other radiologist.
Caseload volume is approximately 60-65 wRVU per weekday and 70 wRVU for the weekend.
Salary for 7 days is approximately $25,000.
May be 1099 or W2.
Benefits are available at cost as desired.

Breast:

Approximately 75% breast imaging and 25% general radiology or 100% breast (full-time or 3/4 time).
Qualified candidates must be skilled in all breast imaging studies and procedures including screening and diagnostic mammography, ultrasound, MRI, and needle/Savi Scout localization and biopsy.
Participation in weekly breast tumor conference.
No IR requirements

Neuroradiology:

Full-time or 3/4-time partnership-track hybrid position
Neuroradiology daytime shifts. Typical general ER/inpatient evening and weekend call shifts from home.
No breast or IR requirements

Body:

Full-time or 3/4-time partnership-track hybrid position
Abdominal daytime shifts with body MRI, multiphase CT, and general radiology. Typical general ER/inpatient evening and weekend call shifts from home.
No breast or IR requirements

IR:

Full-time partnership track position for fellowship-trained IR
Caseload consists of venous access, biopsies, dialysis access, interventional oncology, TIPS/BRTO, central and peripheral venous therapies, pelvic congestion and UFE, and emergent angiography interventions, as well as general radiology (no breast required).
In the past several years, we have developed new service lines and are looking for future growth leaders. Daily work is supported by 2 IR PAs and clinic staff.
Competitive salary + signing bonus, with additional incentive-based pay opportunities

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

Reno Radiological Associates

(Reno, Nevada)

Serving Northern Nevada since 1947, RRA is a strong, highly subspecialized, democratic, extremely collegial, high-earning group of 25 radiologists working in perhaps the best city in the country for raising a family and enjoying unparalleled access to natural beauty, endless outdoor activities (perhaps the best ski-city in the US), and incredible weather (jokingly referred to as “the cheapest city in California” for its proximity to Lake Tahoe (<30 min), Napa Valley, national parks, and more without the super high cost of living and no state income tax).

Shareholder Track (onsite):

1 year to 75% partner, 2 years to 100%
Top 90+% comp nationally, maximally generous benefits
8/9/10+ weeks of vacation
Remote shifts + opportunities for extra income, $100 buy-in

Employee Track (remote or onsite):

High comp, Maximally generous benefits, opportunities for extra income
Onsite preferred, fully remote night (8p-3a PST) or early morning (6a-2p EST) available

Independent Contractor:

Flexible shift options, high compensation

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

Radiology Imaging Associates

(Denver, Colorado)

RIA is the largest private radiology practice in Colorado with over 120+ radiologists. Our group is dedicated to providing high-quality subspecialty imaging and interventional services as well as excellence in patient care. We currently have over 125 radiologists and cover over 35 hospitals and 15 imaging centers in multiple healthcare systems in Colorado, Kansas, and Hawaii.

Our practice:

12 weeks of vacation for associates and 14 weeks for partners.
2 year partnership track.
Compensation ranges from $ 500 to $ 1,000,000 with unlimited internal moonlighting opportunities.
Generous benefits package including health and dental insurance with premiums covered by the group. Benefits also include an ample CME/business expense account, 401k plan, credentialing assistance, and relocation allowance.

On-site/hybrid (partnership track):

IR
Abdominal/Thoracic imaging
Breast imaging (traditional as well as 100%-breast options)
Neuroradiology
MSK imaging
Nuclear Medicine/PET
Pediatrics

Remote (partnership track):

Nighthawk – General/Body
7 on / 7 off General/Body Swing

Contract positions are also available for those needing flexible work requirements.

Learn more at https://www.riaco.com/
Contact: radrecruiting@riaco.com

Inland Imaging

(Washington, Oregon, Montana)

Inland Imaging is a 120+ radiologist-owned private practice proudly serving multiple outpatient, clinic, and hospital sites throughout the Inland Northwest region. We own and operate one of the first outpatient interventional labs in the West in addition to 7 outpatient imaging centers.

Our practice:

Sub-specialty interpretations available across all locations.
All studies are accessible on a common PACS system, one common voice recognition system, and one common worklist
Internal Nighthawk System providing final interpretations on all ER, STAT, and Inpatient Exams. 24/7 Neuroradiology Coverage and IR Call Coverage.
2-year Partnership Track.
Full-Time Radiologist Average Time Off = 15 weeks
Average after-hours obligations = 9 weekends per year and 22 evening/swing Shifts.
Associate: $503,415–$566,342+ | Shareholder: $629,269+
Compensation ranges above reflect base; additional earning potential available through extra shifts and increased productivity
Full Benefit Package including health, vision, dental, disability, and life; 401k match, profit-sharing contribution, and cash balance plan.
Flexible scheduling arrangements accommodated across all positions, with a rich case mix across multiple outpatient, clinic, and hospital settings
Hybrid Work Options

Current Openings:

Remote overnight ER
Neuroradiology (Spokane, Seattle, Walla Walla, Tri-Cities, Missoula, or remote)
Body Imaging (Spokane, Seattle, Walla Walla, Tri-Cities, Missoula, or remote)
Washington
- Tri-Cities ($75K signing bonus) — Breast, Neuro, MSK, Body
- Spokane — Pediatrics, Breast, MSK
- Moses Lake — General/Breast ($90K signing bonus, $20K relocation, annual retention bonus)
- Colville — General/Breast
Montana
- Missoula – IR
Oregon
- Pendleton – General/Breast

Learn more at physicians.inlandimaging.com
Contact: Spencer Piper at spiper@inlandimaging.com

If you’re a group looking to advertise, get in touch. The monthly post here is limited to just a handful of groups at a time, but last year, I launched Independent Radiology as a resource for the broader community, a dedicated private practice radiology job board featuring ~160 groups. If you’re in the market, please also check it out for your job-hunting needs.

Isaac Asimov (from a 1988 interview), providing a different perspective on trust, incentives, and guardrails:

It’s insulting to imply that only a system of rewards and punishments can keep you a decent human being. Isn’t it conceivable a person wants to be a decent human being because that way he feels better?

// 06.29.26

Getting Started in Radiology

06.24.26 // Radiology

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.

More on deliberately improving what I call the “iterative loop of radiology.”

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

The umbrella post that contains the other posts about efficiency, ergonomics, workstation equipment, AutoHotkey, etc is here. People have described the series as (no joke) life-changing.

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.

AI-wRVU

06.22.26 // Radiology

Speaking of work units, Dr. Avery J. Knapp Jr. dreams of a different multi-parametric AI work unit for radiology, arguing that wRVUs (and even time-based units) just don’t cut it:

There are at least 30 factors that affect how hard a study is to read. wRVU captures approximately one of them, poorly.

The RUC won’t fix this. It’s the RUC’s job to maintain the current system, not replace it.

PE won’t fix this. PE profits from the information asymmetry between what a study is worth and what a radiologist gets paid.

I wrote about e(ffort)RVUs last year as well. Whether you agree with his first draft of a proposal, it makes useful points for discussion.

He argues that private practices are the best suited to develop an ideal system:

So who builds it?

Radiologists. Independent groups. People who actually sit in front of a PACS and know that an 80-year-old’s postop MRI and a 30-year-old’s screening study are not the same job.

Just turning the dials in a raw time-based fashion for a CPT code creates winners and losers in an ultimately unsatisfying way. Improvement on RVUs or not, it certainly doesn’t capture the whole picture. Those who were/are frustrated to see their favorite exams changed in a system like TBWU might be happier if the hard exams paid better and were counted fairly, and the easy exams were too, and they practiced in a system where those reading complicated cases weren’t punished for doing yeoman’s work.

We all know that there are hard and easy versions of everything (not to mention people can typically still cherry-pick with the tried and true method of previewing a case and then skipping it if it looks bad). So, no, it doesn’t always balance out in an average. And even if the time to interpret a scan across 52 million exams was a neat bell curve, it doesn’t mean every radiologist’s workload will be right in the middle. RP for example says they removed “outliers” from the calculation, which is arguably important to not inadvertently capture the impact of dietary fiber when a case is paused mid-read, but not all outliers are spurious either. None of this is actually easy. The need to add “incremental seconds” in their system tells us that open/sign times in voice recognition software don’t tell a complete story.

If a new system feels unfair to people—not just because of sour grapes, but because it truly doesn’t reflect the effort it takes to read exams—then it would follow that a simple time-based work unit is insufficient to capture effort and that an ideal system would likely be more complicated. Now, RP certainly doesn’t need to attempt an ideal system, and we could surmise that an AI-derived work unit would be even more of a black box, potentially more contentious, and certainly more expensive to create, and that may all be true. But, it might also work.

From Pilgrim at Tinker Creek, by Annie Dillard:

Thomas Merton wrote, “There is always a temptation to diddle around in the contemplative life, making itsy-bitsy statues.” There is always an enormous temptation in all of life to diddle around making itsy-bitsy friends and meals and journeys for itsy-bitsy years on end. It is so self-conscious, so apparently moral, simply to step aside from the gaps where the creeks and winds pour down, saying, I never merited this grace, quite rightly, and then to sulk along the rest of your days on the edge of rage. I won’t have it. The world is wilder than that in all directions, more dangerous and bitter, more extravagant and bright. We are making hay when we should be making whoopee; we are raising tomatoes when we should be raising Cain, or Lazarus.

Ezekiel excoriates false prophets as those who have “not gone up into the gaps.” The gaps are the thing. The gaps are the spirit’s one home, the altitudes and latitudes so dazzlingly spare and clean that the spirit can discover itself for the first time like a once-blind man unbound. The gaps are the cliffs in the rock where you cower to see the back parts of God; they are the fissures between mountains and cells the wind lances through, the icy narrowing fiords splitting the cliffs of mystery. Go up into the gaps. If you can find them; they shift and vanish too. Stalk the gaps. Squeak into a gap in the soil, turn, and unlock-more than a maple—a universe. This is how you spend this afternoon, and tomorrow morning, and tomorrow afternoon. Spend the afternoon. You can’t take it with you.

Lush prose, serious advice for living. Dillard won the Pulitzer Prize for this in 1975. It feels and reads very human.

// 06.19.26