My third workforce column for the AJR is out: “Who Will Do the Regular Radiology?”
The problem with the current vision [of subspecialization] is that no one does a fellowship in, say, thyroid ultrasound. There is a large volume of work that can best be considered general radiology and needs to get done. Yet, by working in a system of reimbursement and respect among peers that prioritizes liver MRI above liver ultrasound, we inadvertently devalue and disincentive a large swath of important work.
It’s tempting to try to view a complicated, dysfunctional, or otherwise broken system by the intentions of those who designed it previously or promote it currently. But that generosity doesn’t fix it.
The counterargument is a systems-thinking heuristic: The purpose of a system is what it does (POSIWID), coined by the British management consultant Stafford Beer. It doesn’t matter if the side effects are worse than envisioned or if the unintended but inevitable consequences are more dire. The descriptive view removes some of the baggage of good intentions. As the saying goes, “every system is perfectly designed to get the results it gets.”
I’ve been using some version of this cheap corded mouse for radiology since 2022. It goes by many names (TRELC, TKMARS, ZLOT, Zelotes C18, others). I like a “vertical” mouse and need on-board memory for the hospital, and while the build quality in the hand isn’t up to the quality of the Logitech MX Vertical, it works well, it’s lasted for a long time tossed into my backpack, and its thumb joystick is absolutely perfect for triggering window/level presets.
It turns out there is now a wireless version (via Bluetooth and built-in USB dongle) called the F18. The current brands on the Amazon listing for this form factor are the Attoe and the Zelotes F18 (which I’m sure will change), a price in the $30-40 range, and an enticing description like “Gaming Mouse with 5 D Rocker, Wireless Vertical Mouse with [24000 DPI] [12 Programmable Buttons], Computer Mouse for Gamer/PC/E-Sports/Laptop (Black).”
I’ve been using it for a few weeks, and it works. The buttons may be a bit clickier in a slightly less pleasing way than the wired version, but if you were curious about a cheap tool like this but your PC tower was too far away for a wired mouse (or you just hate cords that much), this also gets the job done.
For further reading on leveling up, I recommend reading my series on Radiology Ergonomics and Productivity.
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 many groups in this market, is hiring for everything (including overnight & swing). 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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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:
Learn more at https://www.easternrad.com.
Contact: Erica Askew at easkew@easternrad.com
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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:
On-site/hybrid (partnership track):
Remote (partnership track):
Contract positions are also available for those needing flexible work requirements.
Learn more at https://www.riaco.com/
Contact: radrecruiting@riaco.com
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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.
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
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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:
Employee or Contractor:
Learn more at http://risimaging.com.
Contact: Alice Varnadore, Executive Assistant at avarnadore@risimaging.com
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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):
Employee Track (remote or onsite):
Independent Contractor:
Learn more at http://www.renorad.com/
Contact: CEO Anthony Dispenziere at adispenziere@renorad.com
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~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.
Openings:
Learn more at https://www.vrads.com/
Contact: recruiting@vrads.com
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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.
Learn more at https://stric.com/.
Contact: Waynea Finley at wfinley@strg-pa.com
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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).
When working ER or night shifts, you are never alone—always part of a team. We are a stable, well-compensated group, enjoying flexible scheduling with very comprehensive benefits.
Contact: Dr. Rachel Shikhman at rachel.shikhman@gmail.com
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Large 200+ 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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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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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:
Current Openings:
Learn more at physicians.inlandimaging.com
Contact: Spencer Piper at spiper@inlandimaging.com
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Minneapolis Radiology Associates (MRA) is a highly diversified practice of 35 physicians and 8 APPs celebrating its 56th year in business.
MRA is seeking a diagnostic radiologist for an evening 7 on / 7 off second-shift position. The role is centered on high-volume, bread-and-butter ED and inpatient cases across all modalities, enabling efficient RVU generation and exceptional income potential. We operate within a Level I trauma system, maintaining a steady and manageable evening workflow. A reliable PACS and strong IT support help ensure uninterrupted coverage, with swing overlap during the bulk of the shift. On-site radiologists are also available for backup in the rare event of connectivity issues.
Position Summary:
MRA is seeking a diagnostic radiologist for a full-time shareholder track position. The role includes a mix of on-site and remote shifts with a standard four-day work week. We operate within a Level I trauma system, maintaining a steady and manageable workflow. A reliable PACS and strong IT support help ensure uninterrupted coverage, with constant overlap during the entirety of the shift.
Position Summary:
MRA is seeking an interventional radiologist for a full-time shareholder track position. Well-rounded interventional practice including peripheral vascular and stroke. Some diagnostic work but 85%+ is interventional. Stroke is required, but willing to train. Last four hires have been trained in stroke so the internal training program is well-developed. We operate within a Level I trauma system.
Position Summary:
Learn more at http://www.mplsrad.com/
Contact: HR@mplsrad.com
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If you’re a group looking to advertise, get in touch. The monthly post here is limited to just a handful of groups at a time, but last year, I launched Independent Radiology as a resource for the broader community, a dedicated private practice radiology job board featuring ~160 groups. If you’re in the market, please also check it out for your job-hunting needs.
One of the markers of quality, such as it’s commonly understood in medicine, is reducing variability. This is why we have best practices that are often not really the “best” in truth but are, essentially, a reasonable consensus approach. The primary intention is of course to raise the floor (and not to reduce the ceiling), but the reality is that variability and noise in general are a real problem in all human endeavors, and medicine is no exception.
Over the years since I began working in radiology, one of the ways that’s manifested has been in the promotion of structured reporting: making radiology reports look the same, organized in the same way, and, in many cases, using the same language. The drive there is obvious and intuitive. Even as a radiologist, I find it easier to find what I’m looking for in a prior report if all prior reports look the same. When I grade resident work from overnight, I generally find it simpler to take it in a structured report at a glance than to read a long narrative.
Now, I’ll be the first to admit that the benefit requires a reasonable degree of structure (and not dozens of entry fields), and even then, part of the benefit is because long unstructured narratives tend to be, well, long, and if somebody did a great job dictating concisely, the delta would be not quite so high. The right person can make terrible reports in any format.
I generally agree with the goal of tamping down outliers: some reports are so terse they look lazy and incomplete; others are so long as to be functionally unreadable. Balance in all things, as they say.
The great irony is that our push for standardization, in essence, also functions to remove personality from the radiology report. This isn’t a bad thing per se. I don’t necessarily need to see that a report was written by Todd or Kevin instead of Sharon based on how long it is, how many words they use, or the weird quirks of language that we all accumulate, refine, and cling to as we dictate our thousands upon thousands of cases.
But a standard report with concise language also sands down the edges that make human work distinctly human. It makes it easier for us to become interchangeable cogs in a reporting machine, where a CT head report is a CT head report is a CT head report. And in the nascent age of AI drafting, it also means that, in many cases, it will likely not be possible to know at a glance if the work was really done by a human or done by a machine on the human’s behalf. And to be clear, many will almost certainly prefer the generic machined product (because, if we’re being honest, some idiosyncrasies are just annoying).
That will be a very weird thing indeed. Already, I find myself irritated by so much of the writing I see online, so much of the inbound I receive, because it’s clearly generated by AI. We’ve divorced the written word from the effort it takes to generate it, and that’s a brave new world, even in these early days. I wonder how that will feel as the wave continues to climb and ripple through all of medicine.
A reader question:
What sort of mindset do you think helped you shift from “needing to spend as much time as possible being productive” to actually enjoying leisure time?
I think it’s hard to make that change straight out of training in your early career without the constant thought in the back of your mind that you could be earning $X while watching a movie or going for a walk, as examples. With the widespread use of home workstations and increasing volumes nationwide, it’s an ever increasing pressure as it’s so easy to log on and almost instantaneously be able to turn on that money faucet.
The reader was responding to a quote from a blog post I contributed to back in 2018 about “early career finance mistakes” as a student/resident:
“The ‘correct’ answer is usually to spend less on a car, not buy a house, put more away for retirement, and get disability insurance. But looking back, my biggest real regret is not being more purposeful with my discretionary time. Time outside of work obligations has both a monetary and nonmonetary value, and I was very free with spending too much of it to ‘maximize’ my income at rates that are trivial to me now. I was worth more on a per-hour basis back then, even if I didn’t realize it.”
Radiology suffers from a curse of easily accessible extra work. Many doctors may work too hard, but radiologists are uncommon in the current era of frequently being able to do extra remote work on an hourly or even “pay-per-click” basis, often on an ad hoc basis without notice and without a minimum. Work easily bleeds into the rest of the day, and we start to take a billable time approach to everything. A little bit of that time-is-money mindset is helpful (like knowing when to outsource tasks you don’t like), but too much is essentially just sad. If you could only work full extra shifts or extra weekends, you’d be less able to make reading a book to your kids “cost” $75.
Now, I don’t think I’m necessarily a good example of having it all figured out. I definitely did a fair bit of moonlighting during my early career as well as related endeavors (consulting, expert witness work, etc). I think one cheat code is having a generative hobby. I think for many people who are inclined to overwork, having “productive” leisure time can be a bit of an enjoyable loophole. It’s one thing to trade passively scrolling short-form video for extra money; it’s another thing to skip something you find truly meaningful and that aligns with your priorities.
For me, writing is part of that hobby. Writing, in some cases, also has outputs that have economic value, but I am not a professional writer, and the vast majority of my time spent writing does not lead to any direct income like reading scans does. But it does hit differently than, say, watching TV (to be clear: watching TV is fine). I think parenting also falls into that category in terms of being something that is “worth” the time that work can take away.
A second argument for leisure is a variation on the work-smarter-not-harder mode of productivity, which is that grinding gears for incremental gains at the margin can actually be counterproductive in the long term. Leisure time, meaningful relationships, physical fitness, etc., are all important ingredients to a long-term career. Maximizing long-term income is a marathon, not a sprint. I will say that I found this argument difficult to internalize when I was younger. Everyone always talks about diet and exercise and sleep as being important, but it wasn’t until I hit my personal rock bottom of fitness after doing COVID with two young children that I really doubled down and revitalized myself physically (though even now, I have a truly horrendous/embarassing caffeine habit).
Lastly, and most directly to the reader’s point, wealth accumulation is the difference between income and spending. “Number goes up” has some real novelty, and I don’t think it’s inherently bad to do extra work to get your financial house in check. I would say that living below your means is extremely helpful in taking the pressure off. Having student loans paid off, for me, was a great relief. Becoming debt-free except for a mortgage that we could easily afford was probably the next biggest threshold. I found the cash flow more reassuring (bank account still goes up every month despite saving appropriately) than the number in my 401k (which is prone to fluctuations and set aside for future-me). The money is for the purpose of living your best life. The money isn’t the goal.
There’s a good quote from Amos Tversky, the late Israeli psychologist, that we “waste years by not being able to waste hours.” He was talking about doing high-quality research, but I think it applies to high-quality living as well.
Life is what’s called an Infinite Game. You can’t win it. There is no “end” that we are trying to achieve and no conditions for victory. Living it well is the whole purpose.
From “The Radiologist Faces Automation,” Dr. Laurence L. Robbins’ Holmes Lecture, presented at the annual meeting of the New England Roentgen Ray Society in Boston on May 18, 1956 (a great find shared by Dr. Joseph D. Janizek).
A lot has changed over 70(!) years, and yet portions of this talk are prescient and surprisingly germane to our current times:
In selecting today’s subject, not an easy task, I reached the conclusion that although the recently coined word “automation” is not yet recognized by Webster, it is expressive and to a certain extent self-explanatory. In future dictionaries the word will no doubt be described as deriving from “automaton,” which is now variously defined, one meaning being “A person acting mechanically, especially one unintelligently following routine. Cf. Robot.” This, of course, is the last goal at which a radiologist would aim. To me the word “automation” means a speeding-up process, but it is more commonly used to indicate mechanical replacement of one or more persons at the sacrifice of such factors as individual thought, logic and reason. Increased rapidity of work is highly commendable if efficiency of method does not replace quality of product. As mechanization becomes more widespread we must awaken from our smug, self-satisfied dreams and ask ourselves, “Are we making any real effort to advance in our chosen field?”
And when it comes to training:
The primary objective in the entire course of education should be to help the student to think for himself.
Which I think remains exactly true today in the age of AI.
Our modern desire for medicine to be as convenient and quick (“on demand”) isn’t new either:
All the scientific advances experienced by the man in the street today have led him to expect as a matter of course a continuous flow of miracles, along every line of life. Medicine, he thinks, has not kept abreast of the times. The average American is not content with having the best medical facilities in the world; he wants them served to him as these other marvels are served, “on demand.” Since we physicians are being “weighed in the balance,” let us too throw our weight on the scales and try to regain the balance by broadening and bettering our public relations.
Dr. Robbins also points out the negative trend of radiologists ceding control of the radiology department. Again, in 1956:
…in certain hospitals there is a tendency for the supervision of the department of radiology to be taken away from the radiologist and placed in the hands of the hospital administration, with emphasis on income to the hospital rather than on the professional quality of the work.
And predicts the move to professional (not technical) fee reimbursement:
As radiologists we are bound to submit ourselves to a certain amount of investigation of attitudes toward and relations with our colleagues, many of whom are incensed over the radiologist’s insistence on contracts that are believed to serve simply as a means of placing him in a position that the inquiring colleague regards as invulnerable. If we consider ourselves consultants aiding in the care of the patient, we should be willing to put ourselves on a status exactly comparable to that of our fellow practitioners of medicine. Possibly the best method of accomplishing this would be to have an “open staff” in the field of radiology and to put our fees entirely on a professional basis. It cannot be overemphasized that the technical aspects of the examination, however, must remain under the control of the radiologist.
I wonder how he would view the consolidated macrosystems of today.
At the end, we get his overarching point and conclusion about automation, efficiency, and radiology practice that feels timeless:
Because our colleagues desire more rapid work from us and since we are living in an age in which equipment available in many fields is lavish and luxurious far beyond the dream of our grandfathers or fathers, it is well that we put the best of the potential improvements to use.
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Each new advance offered by mechanization — processes, procedures or equipment — must be reviewed and appraised critically, its advantages being tested against its disadvantages. If the advantages prove worth while for the patient, they should be adopted routinely; disadvantages should not be forced by “popular demand” upon the patient, the physician or the public. If speeding-up processes in radiology merely mean examining more patients a day with an eye to more profit, if they mean going through the motions of an examination without intent or effort at the best possible study of the patient, if they mean division of a department into misdirected, isolated, totalitarian parts that have lost relation with the whole, or if they mean turning the radiologist from a physician into a technical charlatan seeking primarily fees for himself or the hospital, automation will harm the patient and ultimately ruin a department of radiology as well as a hospital.
The wisdom with which we face mechanization, the inevitable and often valuable accompaniment of scientific discovery, will do much toward determining our future.
How will we as radiologists face automation? The strongest and best answer is, “by continuing to be physicians.” Perhaps, as I believe Dr. Holmes would agree, this discussion should have been entitled “The Real Radiologist Rejects the Role of Robot.”
1956. Incredible.
My second workforce column for the AJR is up. Predictions are hard, especially about the future.
I’ve been happily using AutoHotkey as a radiologist for years. My scripts are basically simple, mostly human-made artifacts for getting a limited number of specific things done, like using keyboard shortcuts in PowerScribe to replicate the PowerMic buttons with my Contour Shuttle.
For some users on some workstations, the toggling keyboard shortcut method I described in my 2023 AutoHotkey post is laggy and occasionally unreliable (when compared to the buttons on the PowerMic).
The following script, shared with me by radiologist Jon Brandon is a great example of what is possible with AI. He stated he was able to vibe-code an AHK script that (after about 60 tries from ChatGPT) replicates the actual PowerMic buttons themselves as opposed to toggling the active program and entering the keyboard shortcuts.
I tried it, and it worked for me. I’ve never personally really had big issues with script lag, but I know it’s been a big frustration for others.
If it doesn’t work for you (or you use PSOne, for example), upload it to your AI tool of choice and start iterating. The bottom line is that if there is software you want in order to make your life better, it’s now often possible to make it.
CorePrep is a new, completely free, community-supported radiology qbank with over a thousand questions so far.
I trained in the era before Radiopaedia. Back then, most institutions paid for a subscription to STATdx, which one typically opened at the beginning of every shift knowing it would eventually be used. That feels pretty superfluous these days thanks to the community effort that has made such a helpful resource available for free to internet users everywhere.
A robust, community-created and vetted question bank for radiology board review is long overdue, and this most recent attempt seems like one worth supporting. There are 1,200+ questions so far. The process for submitting new cases/questions is easy, as is the method for flagging issues.
A project like this is only as good as people working together to make it, but given the pricey nature of test prep materials, a free community-created, high-quality qbank would be a very welcome development. After this matures, I would love to see a future iteration that includes oral board-style, multi-step questions.
In the meantime, I hope folks will support the endeavor by adding their hard-fought cases, particularly attendings or residents after doing a lot of question-based learning or taking the Core Exam yourself, when you have a good idea of what a good question looks like. It would be great to try to share your knowledge—without recalls, of course!—for the benefit of your peers.