It’s a challenging market for group practices trying to get and keep radiologists. Here are some of the tricks the pros use.

There are many challenges that private practices, imaging centers, and academic institutions encounter in today’s market with respect to recruiting and retaining general and subspecialty radiologists. It’s not just the shortage of radiologists but also the cost/standard of living of communities and regions, the limitations placed by the hospitals and practices themselves such as certifications and subspecialty training preferred for marketability, length of time to partnership, call schedules, and, of course, compensation. Unfortunately, all of these factor in with each other, and create a huge recruitment and retention nightmare.

The shortage of radiologists has been an ongoing battle for years, and is one with no easy solution. There are roughly 1,000 residents graduating in 2009, but there has been no major change in that number in the last several years even though the population keeps rising. Approximately half of the residents will go on to complete at least a 1-year fellowship. Additionally, as residency and fellowship slots go unfilled, programs reduce the number of available slots. Statistically, it therefore looks as though more graduates are completing programs, which is not the case. But the shortage and reduction of available slots are only part of the issue.

Another part of the issue is regional differences. In years past, there were definitive regions that people sought out. Nowadays, regions are becoming more “blurred” as groups across the regions become more creative to attract high-caliber radiologists. Common “themes” have emerged: The Pacific Northwest is lifestyle oriented, the Midwest is where you go to earn big dollars, etc. With practice groups becoming more creative and offering bigger starting packages, shorter tracks to partnership, and more vacation time, physicians often are willing to explore areas they previously would not have, regardless of family ties. This is also true from a subspecialty perspective as well, as subspecialists typically want to put to use as much of their subspecialty training as possible. Groups have caught on to this, and are creating positions with more subspecialty work than ever before. Another regional issue is the economic factor. This comes from the cost of living in an area, as well as one’s standard of living, and includes the housing market. Numerous physicians I have spoken to purchased a house just 2 to 2 years ago, and are unable to sell it today. This has a drastic impact on the ability to relocate to another area.

Additionally, reimbursements have gone down, yet costs and standards of living have gone up.

Breaking apart the regions and looking at them state-by-state, we are noticing some states are seeing an increase in physicians desiring to relocate to them. They include Indiana, Wisconsin, Louisiana, Texas, New Mexico, Colorado, Idaho, and California, all of which were listed by the AMA as “stable” in 2007. The increase in interest stems from different factors.

One is the better climate in which to practice medicine. The rates of malpractice insurance are often lower in those states, allowing physicians to keep more of their earnings as opposed to spending on higher premiums.

The second is a lower cost of living as compared to the United States as a whole. Although California is often thought to have a very high cost of living, that is not always the case. The higher costs of living there are usually found in the major cities and along the coast, but there are plenty of other areas within the state that are beautiful without the high cost of living.

Third, most of those states have strong reimbursement rates, in turn allowing physicians to earn higher compensation.

Fourth is the partnership track, as most of the practices in those states are offering no more than 2 years to partnership, and in some cases as little as 1 year. Last, due to the higher reimbursements, practices are able to offer significantly more vacation time.

Supply and Demand

Going back to basic economics, low supply and high demand create high prices. As the demand for radiologists increases, so do their starting salaries. In conjunction with increasing the initial offer is the addition or increase of bonuses. The highest increase in bonuses seems to be for breast imagers, who now routinely receive a base salary with a bonus structure that raises their total compensation close to partner earnings.

Streamlining the partnership track is one more means of addressing recruiting and retention. This is done as a competitive move among groups in the same area. Additionally, radiologists are increasingly skeptical about groups nowadays with news of groups losing their contracts and only partners remaining, while the newly hired radiologists are the first to leave. The shorter partnership track provides a sense of security they would not have as group employees.

As hybrids, some groups have shortened the track to be a partner but have set up a scale of percentage of partnership so the partner earnings are paid out slightly longer.

Once income and partnership track are solidified, radiologists look at the lifestyle offered: how much vacation they will receive and what is the frequency of calls. These two categories can be split in three areas: interventionalists, breast imagers, and all other radiologists.

Interventionalists seem to be in the highest demand, and they often have the most frequent call schedule in the practice. To offset this and create a more equitable feeling among the interventionalists compared to the other group members, we have seen an increase in practices offering a call stipend or additional time off.

Breast imagers are also in high demand. According to the Society of Breast Imaging’s listing of fellowships by state, there are only 43 programs offering at least one fellowship slot. In contacting them, some said they have more than one fellow while a few did not have any. Because of this, groups have been more inclined to create a dedicated breast imaging position with no nights, call, or weekends.

Other factors such as number of days worked per week, hours worked per day, and desired full weeks off play a role in whether the group is willing to offer partnership and/or a bonus structure. On the flip side, we have seen a plethora of neuroradiologists seeking a new position.

There has been no shortage of residents going into neuroradiology fellowships. This has diluted the private practice ability to offer high percentages of neuroradiology, and we are seeing more neuroradiologists with an interest in academic programs as they typically offer dedicated subspecialty positions.

Looking Outside

One final solution to groups trying to recruit radiologists is using a recruitment firm. Matt Johnson, MD, head of interventional radiology with Indiana Radiology Partners at Indiana University, has seen an increase in IRs to his practice. He cites several factors contributing to their recruitment success: location and community amenities, the stable malpractice climate, the financial and benefits package, and the professional reward of practicing high-caliber dedicated interventional radiology.

Joseph Kleinman, MD, of Boca Radiology Group, a state-of-the-art private practice in Boca Raton, Fla, also outsourced the group’s recruitment efforts. He cites the following options as the reasons the group was able to secure breast imagers:

  1. the flexibility the group offers the section with respect to the number of days per week a breast imager may want to work;
  2. the compensation and bonus structure;
  3. the no call/nights/or weekends scenario; and
  4. the option to read up to and including 100% breast imaging.

The demand for outsourcing the recruitment of radiologists is on such a rise that we have seen an increase of nearly 100% in new job orders outsourced to our firm alone from just 2 years ago.

But practices beware: Just as you check references and do your due diligence on the physician you hire, you must do your homework when selecting a firm to use. Some key questions to ask the firm: Are they a member of the National Association of Physician Recruiters (NAPR)? Do they solely recruit in radiology? What conferences do they attend? How long have they been in business? And what differentiates them from the other recruiters trying to earn your business?

Christopher D. Swab is director of Radiology Physician and Administrator Recruitment for American Medical Recruiters. For more information, visit www.americanrecruiters.com or email: .