“Ramblings On Radiology And The Job Market”

Image courtesy HoustonMethodist.com

Dalai’s note: Daniel Corbett is a Radiology business consultant who has posted incredibly useful information on Aunt Minnie as long as I’ve been there. This opinion piece should be mandatory reading for all in the field.

There has been much posted lately about the robust job market for radiologists.  There has been wide ranging discussion about the quality of the jobs available with regards to corporate practices and teleradiology.  The potential to join a group without knowing about “discussions” the group may be having with other entities is very real.  As for private practice jobs I think most would agree many if not all practices are facing the same difficulties with short staffing due to increasing volume, retirements and partners leaving for greener pastures.  All this adds up to an increasingly risky job market with potential for “jumping from the frying pan into the fire” for experienced radiologists or just plain getting screwed by a fellow looking for their first job. For you 2020 fellows this can be disconcerting as there are many jobs to choose from and recruiting tactics have become aggressive. Loan repayment, signing bonuses, super short partnership tracks all tell of the desperation of groups down one or more FTE’s and desperately need the help. 
In my 30 years in radiology I have been through several swings in the job market.  The radiologist shortage of the early 2000’s was deep but technology leaps and radiology increased efficiency lessening the impact of short staffing.  It was bad and many groups fell apart but as a specialty we got through it.  This new shortage seems more intense and desperate as efficiency through technology has maxed out.  We all felt safe  for the last 10 years and even complained that there were too many radiologists turning radiology into a commodity.   I never believed that for a second.  Radiology is THE anchor specialty and cornerstone on which all healthcare relies on.  There was never a question in my mind that volumes would continue to grow along with the demands on radiologists. 
In my mind the whole corporate radiology model is nothing more than a Wall Street attempted takeover of the most lucrative healthcare specialty.  It changes nothing in the dynamic of traditional relationship between the radiologist, the medical staff referrer and the patient.  Corporate radiology is an invasion of suits and greedy radiologists selling out their specialty for a cut of the pie which has been steadily declining.  These corporate entities have invaded our specialty by taking advantage of the market forces which are beyond anyone’s control.  With a large percentage of radiologists at or near retirement age, many of which were in controlling position within their groups, it was easy for them to lure “exit strategy” radiologists with large amounts of PE money.  Over the past ten years the delayed retirement of many senior radiologists created the short term surplus of radiologists which helped these entities take hold due to a ready supply of radiologists looking for work.  Another aspect is the marketing power they wield with large amounts of money. The corporate groups have unlimited funds in which to hire people to call your hospitals to get an audience.  They bring high powered radiologists and business people to pitch their product of efficiency, quality, technology and 24/7 sub-specialty reads to dreamy eyed administrators who are tired of hearing complaints about their private practice radiologists.  The corporate groups have moved from purchasing the fat cat groups to hostile takeovers.  The gloves are off and they will steal your contract from under your nose and the next thing you know you will be offered to become an employee or leave.  I know this is true because I am seeing it happen in real time with several groups.  It is a train wreck in slow motion. 
I believe no group is safe as the stated goal of these entities is total market domination.  The total corporatization of radiology would be a disaster for radiologists, hospitals and patients.  These corporations must be fought at every level to keep radiologists as autonomous clinical and business entities.  Radiologists should refuse to work for them even if it is for excellent pay in the perfect location.  As an employee you have no control and never will.  Do not trust their “partnership” sales pitch.  Only in a corporate practice as an employee are you truly a commodity to be used and replaced.  Only in a private practice do you truly have a say in your business and your future. 
The deepening shortage of radiologists is our best weapon in the fight against corporate radiology.  As long as there are good private practice options the the corporate groups will struggle for staffing.  Being unable to fulfill their lofty promises will be their demise. Their whole business model is dependent on properly staffing their contracts while taking a cut for investors.  They throw a lot of money up front but the ROI depends on maintaining the status quo over time.  I believe once the time limits for the buyouts expire those radiologists will leave causing the house of cards to collapse.  Private practices must also do their part in the fight.  Dishonest and dysfunctional practices must strive to be better.  To remain relevant and secure private practices must do away with unfairly long partnership tracks, tiered partnerships and shady outpatient and billing schemes.  Strive to be democratic and provide good professional management at all levels.  Work had to promote fair practices so partners and soon to be partners feel they are treated properly and are invested in their practices.  If you don’t lose people you never have to recruit new people.  Only by being the best option for new radiologists will private practice win over corporate radiology.  Strive to improve and maintain the best relationship with your contracted hospitals.  Meet regularly, immediately address issues, constantly promote your practice within the medical staff.  If there are no cracks in the armor the enemy can’t get in! 
Finally I want to advise the 2020 fellows on a few things.  So far I have encountered an astonishing number of 2020 fellows who have already committed to a practice, before even starting their fellowship.  I know this is because of the huge number of opportunities out there.  If you get an offer with the top group in the community of your choice and you know in your heart this is THE job for you then by all means sign.  But know over the next 15 months there will be plenty of other opportunities open to you.  Don’t be tempted to continue to interview after making a commitment.  This past year I know of several fellows who reneged on groups they signed contracts with to take another job they found later.  This is not how you want to start your career.  When you interview you must expect the practice to put pressure on you to sign.  This is normal and expected but trust me you will rarely lose an opportunity by delaying.  If you interview early tell practices up front you will not make a decision until you have completed your interview process no matter how long that takes.  If they chose to not interview you then you know what they are about.  Do not succumb to the pressure to get a job while the market is hot.  You have all the time you need.  Traditional timing of interviewing after starting your fellowship and committing before the end of year or later will work out well for you.  I foresee groups hiring 2020 fellows very early then continuing to recruit for an experienced candidate.  If they find one they may renege on you! 
Radiology is experiencing rapid change again.  There are some bad things to be wary of but there is also great opportunity. Knowledge is your best tool so do your homework before making changes.  Seek advice from trusted sources whether your a radiologist looking to make a job change or a group looking to improve your operations and processes.  Hopefully private practice will win the day and we will see a new radiology paradigm evolve over the next decade. 

via Blogger https://ift.tt/2WqENkq March 27, 2019 at 08:44AM

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