Get ‘Em and Hold ‘Em: Radiology Staffing and Retention

Radiologists are in more demand than ever, yet supply still remains short. While imaging utilization continues to grow, the number of radiology slots at residency programs remains unchanged and veterans are beginning to retire or enter the freelance market. The result: outpatient centers, hospitals, and teleradiology services are all competing for the same small pool of interventionalists and imaging subspecialists.

With that kind of competition, it takes more than just a top salary to complete your radiology staff. These days, it is flexibility, lifestyle, and the overall package that pull in the best candidates—and keep them.

Coming Up Short

There is little doubt that Medicare-funded imaging services will steadily increase thanks to retiring Baby Boomers. At the same time, radiology slots in fellowship and residency programs remain stagnant, while new medical school graduates aim for disciplines that are less threatened by declining reimbursements.

One small snapshot of the demand comes from an informal survey of the American College of Radiology’s job board, which in mid February listed 686 radiology vacancies throughout the United States.

Rural markets are typically strapped and usually find it difficult to compete with more affluent urban markets. One Topeka, Kan, practice alone sought to fill 30 positions, according to its posting on the job board, www.acr.org/MainMenuCategories/JobsCareerDevelopment/Jobs.aspx. But even in metropolises such as Houston and Denver, group practices are trying to fill vacancies.

Christopher Govea, MD, is vice president and director of outpatient imaging at Houston Progressive Radiology Associates, a boutique practice with 10 radiologists. After being notified of a future expansion in the medical system that his group covers, Govea filled two positions using a headhunter at a cost of $30,000. While his group is somewhat overstaffed until the expansion is complete, he knows that is not the case in other Houston-area practices.

“I think it’s easy to get a job in Houston right now,” Govea said. “There’s definitely a shortage in Houston. I know of several groups that are looking for people.”

Kip McMillan is the CEO of Diversified Radiology of Colorado, Denver, a large practice that would like to have 60 radiologists on staff—but is currently two shy.

McMillan believes that today’s radiologist shortage has been ameliorated by more equitable partnership packages for new hires. But he also feels that a recent pay package trend of shorter partnership tracks with low buy-ins and nearly equal pay for nonpartners has ironically made retention more difficult.

“Previously, if you were a partner and weren’t 100% happy for any variety of reasons, you could go somewhere else, but you’d be starting over and staring down 4 years to partnership,” he said, “You’d also have a huge amount of buy-in invested in your current organization. Today, if you’re struggling with the same feelings, it’s only a year [to partnership], and then you’re going to be making as much as you do here, so why not [move]? So, we’ve created a much higher mobility of doctors in the industry than we’ve ever experienced before.”

However, it takes more than a competitive pay package to find and keep your future partner.

Let Subspecialists Be Subspecialists

Subspecialists have spent time and money on their residencies and fellowships because they love what they do. Large groups or boutique practices that have redundancies in their covered subspecialties can be more attractive to subspecialty candidates.

“Many of the subspecialists appreciate that if we hire a musculoskeletal radiologist or women’s imager, it’s not that they’re going to do [their subspecialties] in addition to reading plain films,” McMillan said. “Literally, that is all they do. So, the musculoskeletal person will come to the practice and sit at a workstation and pretty much read MRIs all day long and musculoskeletal-related cases.”

Govea also believes that allowing subspecialists to focus on their area helped attract his new hires. However, with his small practice, radiologists also have to cover other areas. “Our philosophy is to provide subspecialty coverage, but we all read within the subspecialties, and we always have a go-to person if there’s a need,” he said.

Of course, some candidates, though trained in a particular subspecialty, do not want to be cornered into those reads all of the time.

“We have some in our practice who say that they want to do their subspecialty 80% or 90% of the time, but still want to keep up their skills in this other area,” McMillan said, “As long they’re capable and good at it, we’ll provide that opportunity also.”

Allow for Flexibility

Some veteran radiologists have succeeded to the point where they want to give back and teach. Others want to spend more time with their family or travel. Being flexible while still being able to meet the group’s responsibilities can be a huge draw for the experienced and in-demand subspecialists.

McMillan has one physician who wanted to work 1 day a week at the university because he liked training residents. “After talking with the university, they were thrilled, so we worked out a way to make that financially neutral for our group to allow him to do that.”

McMillan’s practice also allows physicians to be part-time shareholders, working as little as 70% of what a full-time shareholder is expected to work. At the same time, there are those who do not need as much vacation and would rather make more money.

“As long as the group can cover the practice and we have significant advance notice of [physicians’ desires], the group will work to balance those who want to work more and those who want to work less,” he said.

Govea’s boutique practice cannot afford the same kind of part-time flexibility, but they are flexible with vacation time. “We give, starting off, 8 weeks, and I’ve seen as low as 5 or 6 weeks. But we won’t make them take a week at a time. We’ll grant them a day or two if they put in for it.” The group also allows physicians to work from home for overnight coverage.

Connect with Residents

Another benefit to allowing radiologists in the group to teach is that they are directly working with the next generation of new radiology fellows and residents. Having that relationship with teaching institutions allows practices to get ahead of local competition.

In addition to his regular radiology duties, Govea is also clinical assistant professor of radiology at Houston’s Baylor College of Medicine.

“The reason I do it is that I like doing it, but I also keep in touch with the residency program, and I can identify good talent and try to get them early in the process and bring them on.”

McMillan’s Diversified Radiology practice went a step further. “We, as a practice, had some musculoskeletal physicians, who were very interested in the fellowship training and teaching environment, so the group started a musculoskeletal fellowship just to provide that opportunity for those physicians.

Forget Headhunters

“We don’t hire headhunters,” McMillan said. “Certainly, we get plenty of offers for replacement services, but we opt not to invest our dollars that way. We’ve found that our most successful method of recruiting is simply letting the industry know that we’re hiring. That can be the RSNA [Radiological Society of North America] or our doctors letting fellow doctors, both in state and out of state, know that we’re looking.”

Aside from advertising locally, both McMillan and Govea believe that the ACR’s job board is one of the most effective ways to publicize an available position.

Though Govea did use a headhunter to fill his two positions, he admitted that he is not sure he would use a headhunter service again. The candidates he hired had seen his advertisements on the ACR’s job board and said they probably would have applied anyway.

Use Technology to Attract

Having the best equipment for patients is attractive for referring physicians, and it is also a way to attract young fellows and residents.

New graduates from university medical centers and fellowships are used to working with the latest and greatest 3T MRIs, PET/CTs, and 64-slice—or better—CTs. Having learned the cutting edge techniques on advanced imaging equipment, these graduates will often go to the group that uses similar or even better equipment.

Of course, having an up-to-date RIS/PACS system allows candidates to be mobile and work from home if they are used to that lifestyle.

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Tor Valenza is a staff writer for Axis Imaging News. For more information, contact .