Making an Opinionated Project

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:

• The ACR board was huge and had around two thousand listings presumably from at least many hundreds of employers.
• Filtering was difficult to use. The feature had so many options and the UI element to control them was buried in a small box in the corner.
• It was ugly (personal opinion)
• The job listing text was lots of HR job-board BS-speak. Long posts with no oversight.
• The proliferation of remote and on-site jobs has added a lot of hard-to-parse volume (no one’s fault there per se, it’s just the reality).
• A small group with simple needs is easy to lose in the noise.

The ACR is full of listings from RP, LucidHealth, etc, and it’s hard for the true private groups to stand out. Part of it is just the size and usability of the ACR’s platform.

Ultimately, these private equity companies are primarily money-moving enterprises that dabble in healthcare, and it was creating a space for true private practices that was the primary motivation for doing the new site.

(For what it’s worth, I do also believe in the academic mission, and there’s nothing inherently wrong with being an employee. However, these university and hospital jobs can choose to dip into technical fees to supplement and improve their job offerings if they want to remain competitive. They don’t need my help.)

Every radiologist should hope for the success of independent physician-owned radiology private practices. A thriving independent practice where doctors get paid for the full amount of their professional work and have the autonomy to choose how to do it provides the anchor for all radiology jobs. When the market is hot and the pay at corporate jobs is strong, that is a direct result of the need to compete with true private practice. A hospital job should pay more.

The Broader Problem

When I first wrote about the radiologist shortage, I discussed the pressure on small groups. I was recently quoted about it again in Radiology Business:

“We are in the midst of a true radiology labor shortage. Many groups have more work than they can comfortably handle and a real challenge recruiting new rads,” White said by email. “Couple that with the growing teleradiology trend and it can be especially hard to recruit for on-site positions, especially in smaller or less desirable metro areas. Lots of unsatisfied rads are quitting their jobs but then joining the remote workforce in order to stay where they are (and plenty of fresh graduates are tired from training and choosing to jump straight into teleradiology lifestyle as well). The result is a domino effect: The more people are only willing to work remotely, the more remote positions groups need to create to get manpower, even when it’s suboptimal. The downstream consequences are a premium for on-site work and a real squeeze for practices that need on-site coverage.”

It would seem the vast majority of groups feel at least relatively understaffed and would like to hire. Some are critically understaffed and on the threshold.

Some of that is assuredly deserved.

But some of that is demographic changes and geographic preferences compounded with an exceptional growth in teleradiology that has fundamentally changed the market. Consolidation can be necessary to deal with ever-growing health networks and regulation, but I worry about small groups. I’d rather them thrive enough to stay independent or merge with other like-minded groups than implode.

The typical job board method is individual job postings, which allows large groups (and especially corpos with money to burn) to buy multiple listings. It creates a lot of noise and drowns out smaller practices. Their trees get lost in the forest.

The Approach

So when I set out to create a new job board, my primary focus was one listing per group. I wanted to put the focus on joining a practice and not just finding a job. That’s opinionated, especially in a world where many radiologists have seemed increasingly interested in employment and not partnership models. And I don’t blame them: private practices selling to PE over the last decade burned through a lot of goodwill, and the future is, as always, uncertain. The market is hot such that the delta between employment and partnership is in many cases quite small, for now.

So each group has one listing, whether they’re looking for one general radiologist or an infinite number of every subspecialty.

I wanted the design clean and minimal, not unlike this site. I wanted only the most important filters that tell the user which groups are remotely plausible:

1. Location
2. Subspecialty
3. Type: Partnership, Employee (non-partner track, full-time, part-time, etc), and Contractor (1099, locums, etc).
4. Arrangement: On-site/hybrid vs Remote

Not every little thing is worth filtering for. Sign-on bonuses are great, but that should be the listing itself and not a filter factor.

I originally planned to separate on-site, hybrid, and remote working arrangements, but the reality is that the majority of jobs now have some home shifts such that the overlap was near 100% even if the degree is highly variable. My goal here is just to distinguish: do I need to move there or not?

There are some downsides to this approach. For one, job board software (even when I’ve customized it) is still really designed for specific job listings. In a traditional job board, a group hiring for Neuro on-site and Body Remote would have two different listings. Clicking Neuro + Remote would filter that group out. Here, that group will show up. If the group is hiring for your desired subspecialty and arrangement, it’ll show in your results, even if they may not be the precise combination you’re looking for. As another example, you can’t click Remote+Parternship and only find jobs that offer partnerships to their remote workers (incidentally, not many). The board is small enough, and the job search process important enough, that I believe this is the right approach to do the right thing for applicants and groups.

Another issue I didn’t solve is the reality that most groups are not 100% subspecialized. Being a general radiologist and being a subspecialist is really a continuum more than a binary in most situations. How do you handle a group that wants a generalist who has done a fellowship? Technically, they’re hiring for basically everything. That may not be what some applicants think of when they begin their search, but I believe that is nearly impossible to capture at the filtering level.

One thing I also can’t help is how many radiologists want flexible per-click work. I am confident that groups will get applications from mercenaries just looking for someone to let them cherry-pick their lists. This is the world we live in now.

I also created this in the stupidest, least efficient, hands-on process possible. I am posting every listing myself, vetted, and hand-edited. I proofread. I remove the stupidest BS language. I ask for clarification when I think the language is misleading or unclear. I’m not sure of the right balance to strike there; it’s a work in progress to be sure.

I have, however, not been overly prescriptive. I’ve provided some feedback about listing content to some groups, but I am not forcing radical transparency. Over time, as we see listing performance, I may be able to help groups do a better job. But, for now, I don’t want to pretend that I know the best way.

I do totally understand the desire for radical transparency as a job seeker. Information is power, and it’s easier to make decisions like this with a comprehensive picture. I also understand why groups don’t want to disclose every detail of their practice on the internet for everyone to see including their payers, hospitals, local competition, etc. I don’t agree with groups being cagey with serious applicants. It’s not unreasonable to want to know what partners made last year and how much time they had off. You can’t evaluate the sweat equity investment if you don’t know what you’re buying.

(On that note, that should come with a job offer at the latest if not before. If you need to wait for the in-person interview for every detail so be it, but it’s a waste of everyone’s time if there’s a serious expectation mismatch, so as much as practical should probably happen at the phone level.)

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There is no algorithm. There is no corporate backing or big network platform. This is a small venture created by hand to share real radiology practices practicing independent radiology with real radiologists who are looking for that very thing.

In the era of transient social media and a more crowded less searchable internet increasingly filled with derivative AI spam and advertising disguised as content, here is one more tiny thing that just is what it says it is.

I think it’s a great place to start a job search.