Here’s a breakdown of factors to consider when looking, some which you can gleam from the job posting, while others you may not figure out until you start working. These topics are focused on diagnostic, non-mammo, non-IR positions.

Location

This is pretty straightforward; you probably already know what cities you want to live in. However, try to think far into the future when looking at urban vs. suburban locations. Where you want to be as a new grad might look very different ten years down the line.

Practice Type

There are a few main models you will encounter:

• Hospital Based: These are the vast majority of groups. They hold contracts at a single or multiple hospitals and require varying degrees of on-site staffing. This involves ER and inpatient coverage with after-hours and possibly overnight requirements. The nights may be covered by dedicated “night rads” or nighthawk services, but you need to know exactly where you fit in that puzzle.
• Academic: Associated with a residency program. These range from heavy research-based roles with significant teaching to roles that are essentially private practice with minimal resident interaction.
• VA: A unique setup with lower volume and lower pay. This isn’t for most radiologists. It used to be more appealing due to a large pension, but those benefits have been cut down significantly.
• Outpatient: Providing read services only for outpatient imaging centers. The benefits are no ER or inpatient hours, reduced weekend responsibilities, and more scheduling flexibility. While not very common and compensation varies, some outpatient gigs actually pay more for the same amount of work compared to hospital-based practices.

The “Vacation” Trap vs. Days Worked

You’ve probably heard some crazy vacation numbers through the grapevine, but it’s important not to take these at face value. It is much better to evaluate jobs by “days worked.”

There are 260 weekdays in a year (52 weeks x 5). If you get a ‘standard’ 10 weeks of vacation without working weekends, you work 210 days a year—that is a great number to target.

But watch the weekends: If a job offers 15 weeks of vacation but requires Q2 (every other) weekend call, your working days actually increase to 211 days a year. Even though they get to advertise “15 weeks of vacation,” this is a worse deal. Working a weekend call is not a 1:1 trade for a weekday off; the burnout factor is much higher.

Support Staff

There are a lot of time consuming tasks that can take up a radiologists day, and its important to have the support structure to let you accomplish what you do best – read studies. This can range from having an extensive assistant team to filter all phone calls, reach out to clinicians for all emergent findings, manage the schedule, as well as having competent technologists that can protocol vast majority of studies. This kind of support staffing requires $$ and is more common with larger groups.

Workload and Distribution

How is your daily workload determined? The ‘classic’ set up is everyone logs on and reads from the same list- this is extremely outdated with a variety of issues, including cherry picking and wide discrepancy in workload, which can punish more efficient readers. The next basic step is tracking RVUs with thresholds, which again has serious issues- wRVUs are not a reliable indicator of ‘work’ done, and a mammographer shouldn’t be able to log off at noon when a Body rad would take until 4pm to hit the same RVUs.

There’s a variety of solutions from automated workflow distributors to manual distribution teams, using ‘credit units’ which are essentially an analog to RVUs, but titrated to how much work/how long each study takes to read. These systems are more common in larger groups and are essential for long term sustainability. You want to know the rad next to you is working as hard as you, especially if he’s getting paid the same.

Another important factor is, how busy is the usual day? Extrapolating 50th percentile wRVUs (~10-12k) and using 210 days, you land at around 50-60 wrvus a day. This is on the lower end for practices I’m aware of, but 60 is a good target for a moderate amount of work (this also varies widely based on subspecialty).

Call Responsibilities

“Call” can mean a lot of things, and you need to ask for the specifics on frequency and distribution.

• Does it mean being the solo rad on the ER list from Friday night through Sunday, reading 300+ studies a day while stuck at the hospital?
• Or does it mean reading a set amount of routine studies at your own pace, at home, anytime during the weekend?The difference in your quality of life between these two scenarios is massive.

Associate Treatment

It’s hard to figure this out from the outside, but how a group treats new rads vs. senior rads tells you everything. It is common for new rads to have higher call, but if they also have less vacation and less pay, be careful.

The most fair model is reduced compensation with the same call and vacation responsibilities as the seniors. This is the most sustainable and prevents burnout.

Example: Imagine a busy group where the daily volume is so high that the partners need 20 weeks of vacation (working only 160 days) just to recover. If they bring you on at reduced pay, the same daily workload, but only 10 weeks of vacation—that is asking for burnout. They’ve created a “work hard, play hard” model but expect you to just suck it up until seniority. This also incentivizes senior rads not to promote you; the newcomers are essentially subsidizing the seniors’ salaries and vacations.

Compensation, Rates, and the “Three Levers”

Think of every group as having three levers: Days Off, Salary, and Daily Workload.

1. To have a lot of days off and a high salary, the daily workload has to be high (“The Work Hard, Play Hard” group).

2. To have a sustainable daily workload and a moderate salary, the days off must also be moderate.

3. If you want an easy day and a lot of time off, you can say goodbye to your salary.

The most important distinguisher is: How much do they get paid for the work they do? This is the dollars earned per wRVU. In employed models, this is a set amount. If the group does its own billing, you can extrapolate this based on what they collect. Groups with higher on-site and after-hour responsibilities can command a higher $/RVU, while some outpatient groups may have a higher proportion of “high RVU” work like MRI or Mammography.

Compensation can be tied to individual productivity, so pooled and split by the number of days/shifts worked. The latter is more fair, assuming there’s a distribution system that prevents cherry picking. Individual productivity pits rads against each other and can cause some issues.