July 14, 2008
By Dan Harvey
Vol. 9 No. 14 P. 36
Physician recruiters discuss how ever-growing demand, subspecialization, and technology are affecting what organizations must do to hire radiologists.
If you assess today’s market for radiologists, specifically as it relates to physician recruitment, you may find it easy to draw a parallel with the current global peak oil situation: In both sectors, diminishing supply can’t keep up with increasing demand. You don’t need to be a world-class economist to determine what’s amiss with the world’s energy resources, but what circumstances have created the imbalance in the medical arena?
One is that procedural needs have outdistanced the number of available radiologists. “Essentially, radiologic procedures are growing three times faster than the radiologist pool,” says Mark Euckert, a managing partner with the Colonial Health Group, a physician recruiting and staffing firm headquartered in Fort Worth, Tex. “With the way things have been trending, I’m not sure how it’s possible to catch up.”
Observers attribute the imbalance to the aging population and the diminishing number of radiologists emerging from residencies. “Today’s market is comprised of about 34,000 radiologists, and many of them are 55 years and older,” says Jim Fuller, director of recruiting for Dallas-based Delta Physician Placement, adding that the numbers not only include general radiologists but radiation oncologists, physicists, nuclear medicine professionals, and interventional radiologists. “Right now, there are more physicians retiring than coming out of residencies and fellowships.”
Christopher Swab, director of physician and administrator recruitment for Fort Lauderdale, Fla.-based American Medical Recruiters, concurs: “That decrease is one of the biggest developments we’ve witnessed in our business in recent years.”
“From last year’s residents, only 888 are entering the professional ranks this year, so the supply has dwindled,” adds Sam Karam, vice president of Merritt Hawkins & Associates, a national permanent placement physician recruiting firm based near Dallas.
The fact that more opportunities exist than physicians makes radiology an excellent career choice. Starting and average salaries are as attractive as the offered incentives, which are all quite significant. Moreover, radiologists often can stamp their own ticket. “With the current supply-and-demand situation, they can be as selective as they want, which continues to drive up the costs for radiologists,” says Fuller.
But that only leads back to the fundamental question: With all of the apparent advantages, why should the field suffer shortages at all? The aforementioned issues aside, no one appears to have a definitive answer. “You’d think that more and more people would be rushing to enter the field,” comments Euckert.
Not only is the field financially rewarding, it’s also technologically exciting and professionally gratifying. “Imaging is the fastest growing area within the healthcare field, and technology is only going to advance, so it provides many interesting opportunities,” says Euckert. “So it’s hard to explain why more people aren’t jumping on this bandwagon.”
Nevertheless, the shortage exists, and it’s expected to last for at least several more years. “That puts radiologists in the driver’s seat,” says Swab.
Sometimes location is the most decisive factor, overriding even salary. Deciding where to live involves personal ties related to geography, schooling, or, most importantly, family. “Some candidates feel that strong pull towards home,” Swab says. “Often this pull increases as they begin to get a bit older. Obviously, their parents and grandparents are getting older, too, and they want to get back to a place where they can be close to them.”
Spousal input looms large in location-based decisions. Physician spouses often make huge sacrifices and for a long time. Typically, they follow their partners through an early career path determined by medical school acceptances, available residencies, and fellowships, despite the fact that it takes them far from their families.
After training, the relationship often reaches a point of fair reciprocation. “In our experience, we’ve found that when radiologists complete their education and residencies or fellowships, they realize it’s time to accommodate the spouse and choose a position that is close to home,” says Euckert.
But other geographic considerations come into play, such as regional climates. “Older radiologists looking to change jobs often seek the warmer areas such as the Southwest or Florida,” says Swab.
Cost-of-living considerations may attract other job seekers to even more specific locations. For them, a state such as Kansas may be more appealing than California because it costs considerably less to live there. “Pick just about any state in the Midwest, and you can buy a larger house that sits on a larger parcel of land at a significantly lower price,” says Swab. “Further, goods are less expensive, which is especially relevant today with the rising food and gas prices.”
Conversely, some radiologists may simply prefer to work in a metropolitan area close to a major city. Indeed, popular job locations include New York City, Los Angeles, Chicago, and San Francisco. “But such preferences have contributed to the uneven distribution of physicians by geography,” says Fuller.
Competition for jobs in such locations is so strong that local employers are insulated from the kinds of shortage problems in other parts of the country. At the same time, this compels employers in more remote regions to design a more attractive employment package to attract high-quality radiologists. This, in turn, drives up market prices. A West Coast employer at one time could attract a radiologist for $200,000, but Midwestern employers were compelled to respond with higher starting salaries and more attractive benefit packages.
In the current market, the average salary has risen to $450,000, a figure that places radiologists in the same financial echelon as cardiologists, neurosurgeons, orthopedic surgeons, and urologists. “We’ve seen a huge trend in groups increasing their salary proposals, especially the initial compensation, which has increased dramatically,” says Swab. “Five years ago, some of the groups we’ve been working with offered a $300,000 starting salary. Today, they’re offering $400,000. Now, some Midwestern groups that offered starting salaries in the high $300s are now having to offer starting salaries in the $450,000 to $500,000 range.”
But radiologists aren’t just looking at salary. They’re assessing the entire package, including benefits and vacation time. “Radiologists work hard, so they like to play hard,” says Euckert. “Thus, they consider an equitable vacation arrangement to include eight to 12 weeks on average. But that’s only a practice-based range. Teleradiologists who work intense shifts—for instance, 7 am to 7 pm—want 26 weeks of vacation time.”
“It’s a quality-of-life issue,” says Swab, “and that’s becoming as important as location, compensation, and work quality.”
The Right Setting
As far as work quality and environment, radiologists are increasingly attracted to settings equipped with state-of-the-art technology. “Take PACS, for instance,” says Euckert. “Several years ago, it was still rather novel, but it’s now becoming the norm. If a facility hasn’t transitioned to PACS, many job candidates will decide to look elsewhere.”
Further, many new residents and fellows are coming out of medical schools where they worked with the latest and greatest technology. Therefore, they may opt for employment within a group or health system that utilizes comparable equipment, according to Euckert.
Such technology considerations can make it hard for some facilities located in remote areas to compete. Because they can’t afford the best technology, they may not be able to attract the best radiologists. “That’s something that rural facilities have been forced to deal with,” says Fuller.
Radiologists are also attracted to positions at places that offer greatly reduced partnership tracks. Several years ago, partnership tracks lasted about four years. Today, partnerships are offered after only a year and sometimes even less. “Tracks have been reduced dramatically, as groups are trying to make their job offers as attractive as possible,” says Swab.
Also, candidates are becoming more specific about employment structure. “That is, some radiologists seek single-specialty groups, which can provide more autonomy and greater income potential, not only from what they can generate from professional billing, but what they can generate from ancillary income, which comes from the imaging equipment they own,” Fuller explains.
Radiologic Hot Spots
When it comes to specialties—or, more specifically, subspecialties—some radiologic areas are “hotter” than others. As radiology divides into specialization areas (eg, interventional radiology, musculoskeletal, neuroradiology, cardiac imaging), some specialists are more in demand than others. “Cardiac imaging is a new ‘hot’ area and so is women’s imaging,” says Swab.
Other high-demand areas include pediatric and musculoskeletal imaging. “Subspecialization represents a market shift that has significantly impacted demand, making requests much more focused and specific,” says Karam. “For instance, neurointerventional radiologists can pretty much choose the location and practice, and employers will do whatever is necessary to gain their services.”
At the same time, Swab sees other areas cooling off, often because of “turf” issues. “For the past several years, interventional radiologists have become embroiled in turf battles with areas such as cardiology and vascular surgery,” he explains. “The quantity and caliber of work they’ve done at hospitals has been reduced because of the competing specialties. So interventional radiologists are looking to move to smaller facilities where they don’t face as much competition from other specialties.”
As previously suggested, the many complexities involved with today’s imaging marketplace make it hard for some facilities and health systems to compete for top-grade radiologists. This calls for flexibility when assessing options, and one increasingly attractive solution is teleradiology, especially for practices located in the hinterlands.
“For smaller community hospitals in rural settings, teleradiology provides an enormous benefit,” says Karam. “It allows facilities to cover service lines without having to overcompensate a full-time radiologist. Only a few years ago, they didn’t have that option.”
Further, the option is garnering greater interest from both radiologists and recruiting firms, and it should ultimately contribute to the available radiologist pool. “For radiologists, it’s a very appealing career path, and it should attract many more people in the future, as it contributes to their quality of life,” says Fuller. “Because radiology is such a technology-reliant specialty and because it’s becoming more digitized, radiologists are literally able to work anywhere they want if they have the right equipment.”
“More and more, physicians are looking at this as a way to supplement their income or to move into it full time,” says Euckert. “We’ve been receiving an increasing number of inquiries from radiologists looking for that kind of recruitment piece. They’ve been working in hospitals for many years. They’ve grown tired of the long hours. They’re ready for a change. Now, recruiters are fielding more questions about the teleradiology direction.”
— Dan Harvey is a freelance writer based in Wilmington, Del., and a frequent contributor to Radiology Today.