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Radiology negotiating power
Been reading a lot of recent threads regarding corporate consolidation, job market, and contract negotiations. One thing I still don’t understand is why more radiology practices don’t use negotiating power against hospitals like surgical/medical subspecialists do. I recently saw an article where a group of neurosurgeons felt that they weren’t getting a good deal and just bailed. Hospital lost its level I trauma status and its clinical services just collapsed. They were forced to renegotiate a more favorable deal for the doctors. Is this uncommon in our field?
[link=https://www.beckersspine.com/orthopedic-spine-practices-improving-profits/item/49929-it-is-just-a-gut-punch-expired-contract-disrupts-neurosurgical-care-at-california-hospital-23-apps-terminated.html]https://www.beckersspine.com/orthopedic-spine-practices-improving-profits/item/49929-it-is-just-a-gut-punch-expired-contract-disrupts-neurosurgical-care-at-california-hospital-23-apps-terminated.html[/link] -
117 Replies
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Where is that for rads? When there are so many tele service?
Maybe you should treat your IRs and mamms better. They are how you can do this to hospitals.
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Neurosurgeons are not easily replaceable. In any decent market there are plenty of radiologists waiting in the wings.
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Is that still the case though? From 2014-2018 that was undoubtedly true. However, looking at the most recent numbers, the demand for DR relative to supply is quite high. Merritt Hawkins released the 2020 data and they have radiology as the #2 most requested specialty per capita: [link=https://www.merritthawkins.com/uploadedFiles/Merritt_Hawkins_Incentive_Review_2020.pdf]https://www.merritthawkins.com/uploadedFiles/Merritt_Hawkins_Incentive_Review_2020.pdf[/link]
From my anecdotal experience of co-residents looking for jobs, people are getting multiple great offers all over the country (admittedly pre-COVID, but still).-
Demand Supply Curve
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It depends on the situation. Negotiating power to accomplish what?
Do you want a particular location, salary, flexibility, vacation, workload?
There are risks and pitfalls to any negotiation as well. You have to understand not only your situation but that of your negotiating partner and the situation in the surrounding community as well as within your own group.
For instance, a newly minted fellow may be able to go to the mat and try to wring every concession out of a new deal if they have a couple other acceptable offers to fall back on.
Whereas a group that has members with deep ties to the community, members who just bought a new house, have large families and so on will likely rebel against group leadership if they are perceived as putting their livelihoods at risk via an unnecessarily disruptive negotiation.
There are people who are Maximizers and Sufficers. Maximizers try to get every possible inch, and are often unsatisfied/unhappy upon completion of deals; one rarely finds out the other partys absolute limit and the Maximizers feel like they might have left money on the table, even if they didnt.
Sufficers are willing to accept a variety of deals so long as they are within a certain zone of acceptable terms. They usually end up happier over time.
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Neurosurgeons are gold mines for a hospital for various reasons. No one has their negotiating power. Apples to oranges.
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Merrit Hawkins data is skewed to places that need to use a recruiter in the first place (e.g. the middle of nowhere).
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Radiology has always been a bottom feeder, that’s its Achilles heel. Always poached, always insourced into large ortho/multi practices. Been that way for a while, but incomes still go up…so something must be going right.
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^^ Incomes going up and avg. rvus up each year as well. Nothing going right, just working harder.
Radiology has less bargaining power than the local cleaning crew since they need to be on site to do their job. There are plenty of bottom feeder radiologists who will read scans for peanuts.
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If you never attempt negotiating how do you know you have no strength.
I have seen many radiologists and groups complain passively and then accept a “no” passively, with the C-Suite calling the requests silly or requests for “more toys.” Radiology and imaging makes a ton of $ for hospitals.
Radiology might not have the leverage of neurosurgeons but if you do nothing you get nothing. You can’t start by admitting failure before you even start.
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^^ Radiology and imaging make lots of money.
I would say the referrers who order those scans make lots of money for the hospital.
Radiology is a vendor who reads those scans like the cleaning company cleans or the food service company services the cafeteria. We are a necessary service. A liability sponge.
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It still comes down to, if you don’t try….
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BB and Frumi,
Its very often good to negotiate. A recipe for success includes a clear idea of what you would like to accomplish, a BATNA, an idea of your zone of possible agreement, an ability to be allocentric (put yourself in the other parties shoes), and a mindset that is resilient to ups and downs during the process.
BB, to address your last post: what would happen is that the hospital admin may or may not be sympathetic to your plight. However, the hospital will say that the personnel, staffing, RVU meter decisions are under the control of whatever group youre a part of; RadPartners uses the meter from what I hear.
The hospital merely contracts with the radiology group to provide radiology services. The hospital has no control over the administrative decisions you mentioned, unless you are in a setting where you are directly employed by the hospital.
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Quote from radgrinder
BB and Frumi,
Its very often good to negotiate. A recipe for success includes a clear idea of what you would like to accomplish,
One would take that for granted if you are the one opening negotiations in reaction to the C-Suite decisions. After all, you do negotiate your own contracts & don’t exactly walk in not knowing what you want in the contract.
How would this be different? -
Quote from radgrinder
BB and Frumi,
Its very often good to negotiate. A recipe for success includes a clear idea of what you would like to accomplish, a BATNA, an idea of your zone of possible agreement, an ability to be allocentric (put yourself in the other parties shoes), and a mindset that is resilient to ups and downs during the process.
BB, to address your last post: what would happen is that the hospital admin may or may not be sympathetic to your plight. However, the hospital will say that the personnel, staffing, RVU meter decisions are under the control of whatever group youre a part of; RadPartners uses the meter from what I hear.
The hospital merely contracts with the radiology group to provide radiology services. The hospital has no control over the administrative decisions you mentioned, unless you are in a setting where you are directly employed by the hospital.
“The hospital merely contracts with the radiology group to provide radiology services. The hospital has no control over the administrative decisions you mentioned, unless you are in a setting where you are directly employed by the hospital. ”
The hospital ALWAYS has control. Don’t be a rube. -
I see no reason to show you a path out of a viewpoint that is clearly very important to you.
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Young rads, take a step back here and really evaluate this place. Should you really be taking advice from people arguing about sex in your 50s vs 20s? This place is a toxic echo chamber of people trying to be relevant in the world of radiology, but stuck at home.
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Ive always thought that a lot of the problem has to do with how quickly another group of rads is willing to cannibalize another groups contract. Most cities and large towns have a handful of practices and if group A tells hospital system X they want more pay better coverage/staffing, and no RVU meter invariably group B comes in and says we will do it and give you a 10% discount because we have these other contracts too. No if all the rads in town said to the hospital systems we arent doing this unless these conditions are met we would have more negotiating power.
But I also believe that if you dont ask or try to make your situation better it wont get better. C suite people care very little for you or the patient just the dollar so they arent going to give you anything just because. IMO rads are often to scared to even ask for better hence some of the reason we are treated like bottom feeder despite historically attracting some of the brightest and best medical school candidates.
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Vanilla corn,
No, that characterization of radiologists is incorrect.
As an analogy, imagine you have a group of first-time cooks. You put them in a kitchen, set some spinach, eggs and pastries in front of them and tell them to make spinach puffs for dinner. But how, they ask. They arent given a recipe, or even an understanding of what the final spinach puff should look like.
Some of your rookie cooks wont even try and will just eat the raw spinach for dinner. Others will give it a try and make an unholy mess of things, creating a product that make them jealous of the raw spinach eaters. Maybe a couple will miraculously create an edible spinach puff, pretty much at random. And then you come in afterwards and criticize all the failed puff cooks, tell them theyre scared or idiots.
Its the same thing with radiologists and negotiating. Negotiating is a skill like cooking: it requires some methodology and practice to acquire. Its not something that you can expect people to do with no training, no practice, minimal instruction, unclear goals, and so on. Even a smart person like a radiologist will fail spectacularly under such conditions. -
I agree whole heartily with your comment just because you graduated medical school does not make you a good business person or negotiator. A huge failing of medical education in my opinion ( discussion of money in med school is forbidden or frown upon for some reason). This is part of the PEs and hospital corps are ravaging medicine. But if you are unwilling to try and negotiate than itll never get better and often will continue to get worse.
As for radiologist willing to destroy Another radiologist across town to get access to more RVUs. I personally have seen this happen a couple times and I am no old timer. So yeah I do think rads are this way and many would think twice about screwing the other guys over for another buck even if they dont know how they are gonna cover it. But maybe I am just jaded.
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Neurosurgery is a true outlier in the entire field of medicine. In many places they get up to 3K call money. No other service even gets close to them.
So compare radiology to an average specialty field and not neurosurgery. Most other fields can not compare themselves to neurosurgery, FYI.
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Agreed on the failing of medical education aspect. Disagree on the false dichotomy presented between trying and not trying to negotiate.
Try taking some negotiation classes first. There are some excellent ones out there, including inexpensive ones online. The major commitment is the time involved in educating oneself in a new skill. It pays off a hundredfold, but most people dont commit. -
I never said people shouldnt learn and pick up skills. If you are going to negotiate for yourself or a group. You should learn the best ways to be effective but all the online classes in the world cant replace the real world situations but at least give you the tools. But if no one wants to try to negotiate with the hospital or Corp than youll get nothing is my point. With the previous present metaphor pretty soon the hospital will only be offer spinach and no eggs for the puffs cause the rads dont want or care to keep them.
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LOL – Radiologist having negotiating power? What kinda of fantasy world is that – we depend on the hospital completely.
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Going in circles at this point. Yes you should negotiate. Yes you should have a structured approach to performance and improvement as you would acquiring any new technique or skill. This is how you succeed.
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Yes going in circles. The point I was making above is one cannot compare ourselves to NS. We typically have exclusive contracts and if we walk away the hospital will go find a replacement right away.
Does that mean we shouldnt use the leverage we hopefully have gained by providing great service and state of the art imaging? Of course not. This leverage comes with a price though. One must be working to make oneself indispensable all along. Plus the group must participate in administrative roles to be respected. If this happens smart administrators will see how much easier it is to stick with their current contract.
Notice I say smart administrators. If you dont have that there is not much you can do.
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LOL – are you guys noobs or have you actually been in real world PP for a significant amount of time? You can provide all the “great service” and “state of the art” nonsense you want and Admin will still show you the door without hesitation if they have a different “vision”. You can go to all the meetings you want and they will not hesitate to show you the door and give the contract to their Corp radiology country club buddy. You will never be indispensable and the medical staff won’t say a word to defend you.
The sooner you embrace the reality of you situation the sooner you can stop wasting time on things that really don’t make any difference. You must accept the nature of radiology and that we are viewed as a service line by admin and very little else. There is a reason most Rads have passive aggressive tendencies. -
Im sorry your experience has you feeling this way WD.
Lets put it this way. A NS can play hard ball just by the virtue of their certificate. A radiologist can prove their added value but it takes a lot of hard work.
Its easy to see in this place who is up for the task.
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Quote from Waduh Dong
LOL – Radiologist having negotiating power? What kinda of fantasy world is that – we depend on the hospital completely.
It’s not as if everyone walks around with their pants around their ankles. You do have power just that local circumstances differ. No, you can’t pretend to have strength where you have none & yes there are practices that will be happy to promise more than you for less cost.
I assume your practice negotiated something or just accepted what was offered without complaint?
Medicine in free markets is subject to market forces which includes competition from other practices, especially corporate. And hospitals are likely better organized as they actually know what they want. So yes, the sky is not the limit for negotiations but you can negotiate and get things you want. -
WD,
Not a rookie. Someone who has practiced in a variety of settings, and learned to improve outcomes via trial, error, study and practice.
Once you acquire the skill, like most skills, a new world of opportunities opens.
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Except you are not negotiating for yourself, you are negotiating for a group. A big difference.
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Yes. As I mentioned above.
The message has been provided for those who are ready to hear it. Folks can feel free to PM me for specific resources.
Good luck.
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In the real world, there are only two things that give a Radiologist leverage:
1. An significant labor shortage – give Rads easy opportunities to bail and makes a Rad more difficult to replace.
2. BFE location – difficult to recruit to Trump country or other BFE locations for obvious reasons.
If you do not have either of these forms of leverage, I would be really careful before you try to throw around your imaginary power with Admins.
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[Deleted by Admin]
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Quote from Waduh Dong
In the real world, there are only two things that give a Radiologist leverage:
1. An significant labor shortage – give Rads easy opportunities to bail and makes a Rad more difficult to replace.
2. BFE location – difficult to recruit to Trump country or other BFE locations for obvious reasons.
If you do not have either of these forms of leverage, I would be really careful before you try to throw around your imaginary power with Admins.
This would be the case in the setting of a typical adversarial negotiation setting. Im not talking about that. Im thinking in a more collaborative way. It takes time and effort but a good group can develop a relationship that allows both sides to benefit by bringing in new technologies etc.. Its not about power. -
Quote from Waduh Dong
In the real world, there are only two things that give a Radiologist leverage:
1. An significant labor shortage – give Rads easy opportunities to bail and makes a Rad more difficult to replace.
2. BFE location – difficult to recruit to Trump country or other BFE locations for obvious reasons.
If you do not have either of these forms of leverage, I would be really careful before you try to throw around your imaginary power with Admins.
Sounds like someone has some real world experience and a thread of honesty.
These are the ONLY things that limit the power of hospital admins -
Quote from drad123
Quote from Waduh Dong
In the real world, there are only two things that give a Radiologist leverage:
1. An significant labor shortage – give Rads easy opportunities to bail and makes a Rad more difficult to replace.
2. BFE location – difficult to recruit to Trump country or other BFE locations for obvious reasons.
If you do not have either of these forms of leverage, I would be really careful before you try to throw around your imaginary power with Admins.
Sounds like someone has some real world experience and a thread of honesty.
These are the ONLY things that limit the power of hospital admins
May I ask why this negative real world experience is the only one you seem to want to believe?
Like I said, if it becomes a “power” struggle then any physician group will probably lose in the end. Even neurosurgeons.
It’s strange to me that experienced radiologists choose to share positive experiences for encouragement and they are met with incredible resistance from some. One does not win anything by trying to prove them wrong… -
Wah Dung, give others a chance to make their opinion known. The constant negativity is irritating
Many different outcomes can result from negotiations. I agree with most of what is said on here with respect to negotiations and lack of significant leverage. If the group has it’s own billing, the negotiations should center around better support — get better PACS equipment/support, decreased onsite staffing on weekends of after hours — working from home has a significant QOL component, improving VPN, getting better RN support for IR and having techs who are competent….training techs in more unusual applications (cardiac MR, etc) Paying for an RN to call results on breast biopsies, improve through put in mamms, etc.
all of this is very geographic and hospital system specific. Some practices are able to intertwine themselves into administration, however, this requires a stable hospital leadership and vision. having CEOs and mergers every 2-3 years makes this impossible.
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I think (I heard, not sure, its possible) there’s a guy by name of A. D (Andruey Dauyutcchh) something like that in the lower californian desert rejion. It is possible that He has these massive foundations that donate a ton of money to hospitals. It’s been reported and heard, that In return for his OR her generosity, hospitals give him contracts. It’s worked out very well for him, so it has been said, because he doesn’t practice radiology and squeezes their salaries for nothing, and just rotates them…like a labor boss.
If LE would just catch wind of this, run the paper trails, and see where the money comes from and goes, would be helpful in order to determine the veracity of these claims, because at this time we don’t know if it’s true but it would be nice to determine.
there is widespread corruption in the field of radiology -
Quote from R@diology1011
I think (I heard, not sure, its possible) there’s a guy by name of A. D (Andruey Dauyutcchh) something like that in the lower californian desert rejion. It is possible that He has these massive foundations that donate a ton of money to hospitals. It’s been reported and heard, that In return for his OR her generosity, hospitals give him contracts. It’s worked out very well for him, so it has been said, because he doesn’t practice radiology and squeezes their salaries for nothing, and just rotates them…like a labor boss.
If LE would just catch wind of this, run the paper trails, and see where the money comes from and goes, would be helpful in order to determine the veracity of these claims, because at this time we don’t know if it’s true but it would be nice to determine.
there is widespread corruption in the field of radiology
The Ellis Norsoph of the west!
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Quote from R@diology1011
there is widespread corruption in the field of radiology
I find it comical when an anecdote is posted and then the conclusion is as broad as this. Looking at your total of 3 posts including the two in the student section it is clear you have an agenda. You will have to do a much better job than this. -
Quote from R@diology1011
I think (I heard, not sure, its possible) there’s a guy by name of A. D (Andruey Dauyutcchh) something like that in the lower californian desert rejion. It is possible that He has these massive foundations that donate a ton of money to hospitals. It’s been reported and heard, that In return for his OR her generosity, hospitals give him contracts. It’s worked out very well for him, so it has been said, because he doesn’t practice radiology and squeezes their salaries for nothing, and just rotates them…like a labor boss.
If LE would just catch wind of this, run the paper trails, and see where the money comes from and goes, would be helpful in order to determine the veracity of these claims, because at this time we don’t know if it’s true but it would be nice to determine.
there is widespread corruption in the field of radiology
Andrew Deutsch, MD, CEO of RIMA, sold to RP in 2018. He is around retirement age.
[link=https://www.itnonline.com/videos/video-managing-multi-site-radiology-practice-ai-based-workflow]https://www.itnonline.com…tice-ai-based-workflow[/link]
86% subspecialty reads? Wow. Why not just skip the residency? -
Private practice radiology was really ripe for PE-backed Corp takeover with all of these top heavy Chiefdoms scattered throughout the country and boomer Rads looking to cash out. Seems like it was the perfect target.
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what is BFE ??
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Rads that have the work ethic, dedication and balz do very well financially with an amazing work life balance. Those that expect a gravy train hang out on AM and bitch.
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drad,
Wherever I go, its radgrinder country :).
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Quote from ntesla
what is BFE ??
Beyond F-ing Egypt. In other words, the deep dark cesspools of Trump country
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Cool story bro, I’d rather die than live in a coastal city. Thanks for your opinion and now you have mine to cancel it out.
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Quote from Cubsfan10
Cool story bro, I’d rather die than live in a coastal city. Thanks for your opinion and now you have mine to cancel it out.
What is wrong with coastal cities?
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drad,
The secret of success is figuring out what the price of success is, and then paying it.
If all the stands between me/my group and the accomplishment of our objectives is eating a poopoo sandwich, then sure, Ill eat that sandwich and Ill do it with a smile. Might ask for some ketchup.
Its just your ego. Its not important. Let it go.
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Quote from radgrinder
drad,
The secret of success is figuring out what the price of success is, and then paying it.
If all the stands between me/my group and the accomplishment of our objectives is eating a poopoo sandwich, then sure, Ill eat that sandwich and Ill do it with a smile. Might ask for some ketchup.
Its just your ego. Its not important. Let it go.
Radiology killed my ego years ago. A modest silence is a radiologist’s crown.
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Poop sandwiches? Radiology crowns? I got lost in the thread
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Quote from radgrinder
Yes. As I mentioned above.
The message has been provided for those who are ready to hear it. Folks can feel free to PM me for specific resources.
Good luck.
What have you negotiated radgrinder?
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BTW the hospital in the original story brought on locums at the last minute and retained level 1 status. So maybe even neurosurgery doesnt have as much clout as we thought.
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Medical free market.
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Quote from Frumious
Medical free market.
How dare you- LOL
medical and free market do not belong in the same phrase, sentence or even paragraph -
Quote from drad123
Quote from Frumious
Medical free market.
How dare you- LOL
medical and free market do not belong in the same phrase, sentence or even paragraph
Medicine will always be highly regulated. esp. in the USA.
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Even more reason to take a collaborative approach. A person or group can act as though they have power and it works until it doesn’t.
Much better to have relationships and an ability to add value. There is more opportunity for this in radiology than many on this site believe. -
Quote from Thread Enhancer
Even more reason to take a collaborative approach. A person or group can act as though they have power and it works until it doesn’t.
Much better to have relationships and an ability to add value. There is more opportunity for this in radiology than many on this site believe.
What have you and your group gotten through collaboration?
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Quote from drad123
Quote from Thread Enhancer
Even more reason to take a collaborative approach. A person or group can act as though they have power and it works until it doesn’t.
Much better to have relationships and an ability to add value. There is more opportunity for this in radiology than many on this site believe.
What have you and your group gotten through collaboration?
Directors fees. Money to help cover call. Better rates per wRVU from the contracts that are based on that… -
Quote from Thread Enhancer
Quote from drad123
Quote from Thread Enhancer
Even more reason to take a collaborative approach. A person or group can act as though they have power and it works until it doesn’t.
Much better to have relationships and an ability to add value. There is more opportunity for this in radiology than many on this site believe.
What have you and your group gotten through collaboration?
Directors fees. Money to help cover call. Better rates per wRVU from the contracts that are based on that…
Directors fees and call pay? I tip my hat to you on that. Hard to get those nowadays.
what kind of wRVU comp have you been able to negotiate? what was offered to begin with?
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I have never gotten a higher comp rate than what was initially offered. I have turned down many deals that were low paying though.
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Quote from drad123
I have never gotten a higher comp rate than what was initially offered. I have tuned down many deals that were low paying though.
Turning down a bad contract is the most power you have. It’s the only time you really have any true power. Nobody should expect to negotiate themselves out of a bad contract into a good one. -
Quote from drad123
Quote from Thread Enhancer
Quote from drad123
Quote from Thread Enhancer
Even more reason to take a collaborative approach. A person or group can act as though they have power and it works until it doesn’t.
Much better to have relationships and an ability to add value. There is more opportunity for this in radiology than many on this site believe.
What have you and your group gotten through collaboration?
Directors fees. Money to help cover call. Better rates per wRVU from the contracts that are based on that…
Directors fees and call pay? I tip my hat to you on that. Hard to get those nowadays.
what kind of wRVU comp have you been able to negotiate? what was offered to begin with?
I honestly didnt care. I went private practice with the intent of becoming partner, and after that its about managing the practice effectively, maximizing value, and being directly rewarded for your efforts instead of coming to an employer, hat in hand, hoping for an extra helping of gruel.
The employee years functioned as an apprenticeship. Aside from learning how to be a good practicing radiologist, it was important to seek out responsibility wherever possible. Medical directorships, committee roles, administrative stuff. Become the expert, become the person people ask about problems, become visible to the hospital and medical staff as a doer and a fixer. There are many paths to success, this was mine.
I would suggest that one not worry about the last few bucks in the first couple of years out. Actively seek out opportunities for responsibility, and constantly, constantly ask how things can be done and how you can be better. -
You didn’t care what kind of wrvu comp you got? Really?
becoming a partner is a means to an end, not an end in itself. -
Quote from drad123
You didn’t care what kind of wrvu comp you got? Really?
becoming a partner is a means to an end, not an end in itself.
Of course. I didnt care about scratching and clawing for a buck an RVU here or there as an employee. Always a ceiling with that, no matter what you do. -
I dunno. Seems hard to believe that the hospital offered them everything they wanted and the neurosurgeons said no thanks.
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Quote from radgrinder
Quote from drad123
You didn’t care what kind of wrvu comp you got? Really?
becoming a partner is a means to an end, not an end in itself.
Of course. I didnt care about scratching and clawing for a buck an RVU here or there as an employee. Always a ceiling with that, no matter what you do.
Do you care to fight for a dollar per wrvu here or there as a partner?
The point is not about partner vs employee but rad negotiating power in general- or more accurately the lack thereof. -
Only specialty surgeons will have any real negotiating power going forward.
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Quote from drad123
Only specialty surgeons will have any real negotiating power going forward.
And that will go up in a puff of smoke the day the insurers catch on to the scam that is spine surgery and the corruption that involves implants. There will be no shortage of NS willing to do locums for $500/day to carry the trauma pager. -
Ha thats an existing business model. Come work with me and Ill show you.
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Quote from radgrinder
Ha thats an existing business model. Come work with me and Ill show you.
Are you in Trump country? LOL -
This is pure fantasy. I’m not a spine surgeon but I do study the business side of healthcare. Jealous observers have been predicting the death of spine surgery since the mid-1980s, and yet here they are continuing to make bank over 30 years later. The vast majority of things that have traditionally been thought of as scams, like surgery for black disc disease, back pain, etc. are ALREADY denied by insurers. Payers aren’t stupid, they wouldn’t be giving away tens of millions of dollars if they had the option not to. Moreover, the literature showing a benefit to a lot of their surgery continues to grow, most recently with the NEJM RCT showing the superiority of microdiscectomy vs. medical management for persistent sciatica in disc herniations. They also graduate <200 residents/year with an aging workforce and huge aging population with spine deformity, brain tumors, DBS candidates etc. No neurosurgeon is ever going to work for $500/day. Urology procedures keep getting cut every year while their incomes continue to rise because they have a similar workforce shortage.
If anything, spine surgeons are going to make more money as Medicare continues to approve more and more of their procedures for ambulatory surgery centers. This gives them (as well as the rest of ortho) huge leverage against hospitals. Could single payer pass with across the board cuts that ends everything? Sure, but then everyone would be screwed. At least they have the option of doing private hospital work for cash/supplemental insurance. As it currently stands, it looks like there’s a much greater chance of us working for $500/day reading 300 CTs for Radiology Partners. -
Of course, Rads is a joke field compared to Neurosurgery. We are in a race to the bottom of the barrel and is wishful thinking that Neurosurgery will be joining us. Having said that even though most Rads probably had the grades to go into a surgical sub specialty most dont have the work ethic, dedication or ballz to do it.
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Quote from Waduh Dong
Of course, Rads is a joke field compared to Neurosurgery. We are in a race to the bottom of the barrel and is wishful thinking that Neurosurgery will be joining us. Having said that even though most Rads probably had the grades to go into a surgical sub specialty most dont have the work ethic, dedication or ballz to do it.
Or they chose a “normal work-life balance” to “the special and very unusual lifestyle” of a neurosurgeon.
It is not like that people hang around OR a few hours a day and make a bank in surgery. The surgeons that make crazy high money (and not Radiology money) don’t have a normal life or at least haven’t had it for 15-20 years ( 7-8 years of training plus a decade of establishing themselves).
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Quote from Waduh Dong
Of course, Rads is a joke field compared to Neurosurgery. We are in a race to the bottom of the barrel and is wishful thinking that Neurosurgery will be joining us. Having said that even though most Rads probably had the grades to go into a surgical sub specialty most dont have the work ethic, dedication or ballz to do it.
Or they chose a “normal work-life balance” to “the special and very unusual lifestyle” of a neurosurgeon.
It is not like that people hang around OR a few hours a day and make a bank in surgery. The surgeons that make crazy high money (and not Radiology money) don’t have a normal life or at least haven’t had it for 15-20 years ( 7-8 years of training plus a decade of establishing themselves).
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Quote from Hospital-Rad
Quote from Waduh Dong
Of course, Rads is a joke field compared to Neurosurgery. We are in a race to the bottom of the barrel and is wishful thinking that Neurosurgery will be joining us. Having said that even though most Rads probably had the grades to go into a surgical sub specialty most dont have the work ethic, dedication or ballz to do it.
Or they chose a “normal work-life balance” to “the special and very unusual lifestyle” of a neurosurgeon.
It is not like that people hang around OR a few hours a day and make a bank in surgery. The surgeons that make crazy high money (and not Radiology money) don’t have a normal life or at least haven’t had it for 15-20 years ( 7-8 years of training plus a decade of establishing themselves).
The problem with this argument is that Rads is no longer a lifestyle friendly field and hasn’t been for a decade or more. Rads is a tough job in PP and the mental stress is high. Volumes keep going up and reimbursements down. I know a solid rad that killed himself 5 years ago – this is not an easy life any longer.
Most Rads I know went into because they didn’t really like patients and wanted to make good money while not working that hard – a completely different type of individual compared to those that matched NS. Radiology self-selects for a certain type of person and ultimately this is one of its biggest weaknesses. -
Quote from Waduh Dong
Quote from Hospital-Rad
Quote from Waduh Dong
Of course, Rads is a joke field compared to Neurosurgery. We are in a race to the bottom of the barrel and is wishful thinking that Neurosurgery will be joining us. Having said that even though most Rads probably had the grades to go into a surgical sub specialty most dont have the work ethic, dedication or ballz to do it.
Or they chose a “normal work-life balance” to “the special and very unusual lifestyle” of a neurosurgeon.
It is not like that people hang around OR a few hours a day and make a bank in surgery. The surgeons that make crazy high money (and not Radiology money) don’t have a normal life or at least haven’t had it for 15-20 years ( 7-8 years of training plus a decade of establishing themselves).
The problem with this argument is that Rads is no longer a lifestyle friendly field and hasn’t been for a decade or more. Rads is a tough job in PP and the mental stress is high. Volumes keep going up and reimbursements down. I know a solid rad that killed himself 5 years ago – this is not an easy life any longer.
Most Rads I know went into because they didn’t really like patients and wanted to make good money while not working that hard – a completely different type of individual compared to those that matched NS. Radiology self-selects for a certain type of person and ultimately this is one of its biggest weaknesses.
Wow. I suggest you take a good long look at both yourself and your social circle. What you’re describing above sounds like an unhealthily negative group of people and life’s too short to be surrounded by whiny losers. Go find some people who actually enjoy their jobs and are happy, and try to be one of those people yourself. -
Quote from Waduh Dong
The problem with this argument is that Rads is no longer a lifestyle friendly field and hasn’t been for a decade or more. Rads is a tough job in PP and the mental stress is high. Volumes keep going up and reimbursements down. I know a solid rad that killed himself 5 years ago – this is not an easy life any longer.
Most Rads I know went into because they didn’t really like patients and wanted to make good money while not working that hard – a completely different type of individual compared to those that matched NS. Radiology self-selects for a certain type of person and ultimately this is one of its biggest weaknesses.
Agreed. New grads shouldn’t go into radiology. And college students shouldn’t go into medicine.
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“Agreed. New grads shouldn’t go into radiology. And college students shouldn’t go into medicine.”
I hear this a lot from physicians and you’re entitled to your own opinion but it’s just silly. Yes, medicine has problems but so does everything. Yes, radiology has problems, but so do all specialties.
To suggest to college students that they shouldn’t go into a respected, fulfilling career that guarantees a great salary for life (even if there is single payer, etc.), is just wrong. Even resident and fellow salaries are higher than anyone in my family ever made – and more than most Americans make.
If you want to then respond by saying yeah but finance! business! Those are FAR from guarantees. Only a small percentage of well-connected people and/or lucky people can make more than a physician in those fields and it’s not like they were sitting on their butt or only working 30 hours a week either. -
If you compare Radiology lifestyle to surgery, you either don’t know what surgeons do or you are not a Radiologist.
Regarding medicine as a career, I tend to agree more with people who question it as a good career choice. I believe the money and the success still exists in medicine but the price that you pay is huge. The price is “the best years of your life”.
To youngers: 50 is 50. You are not young anymore. The wine doesn’t taste the same. The steak isn’t as great as before. The sex is not even comparable. So before choosing medicine just think twice. You are giving up the joy of life in your 20s and 30s with the hope that you can make a few mil by your 60s.
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HR,
I believe you need to visit better wineries and steakhouses.
Also, have you considered having your testosterone checked? Not kidding. Testosterone deficiency happens frequently as men get older and this sounds a lot like that.
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Also, find better women.
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I am 45 y/o and wake up with a raging boner half the time… so my T can’t be too low, right?
I also share some concern about medicine as a career for my kids, who seem to be interested in it due to growing up with a physician Dad, but if you are not obsessed with coin I think it can be a fulfilling career. Unfortunately, I think a lot of docs are too focused on coin rather than an interesting and solid career. -
Possibly.
Seriously, a lot of these descriptions about pleasures no longer being enjoyable, a sense of hopelessness and so on in these threads may actually be signs of a serious depression or other mental and/or physical illness.
I make a lot of quips; this is not one of them. Its been a rough year, and physicians are prone to internalizing stress.
Please take these signs seriously and have them evaluated.
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If you think sex at the age of 50 with a 40+ year woman is similar to sex at the age of 22 with a 22 year old girl, you probably don’t have a good memory of good old days. Make sure you don’t have early dementia.
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Hospital-Rad makes some valid point. You sacrifice many of the best years of your life to become a physician. At some point it may no longer be worth the costs to go to medical school.
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Quote from CoronaRad
Hospital-Rad makes some valid point. You sacrifice many of the best years of your life to become a physician. At some point it may no longer be worth the costs to go to medical school.
There are two opposing forces here. Giving up the best years of your life for a quality gig with earning potential was great when you had traditional society with women who cared about such things like man/woman/virtue/family. Now the only reason to do it is because there isn’t sh*t else to do, to be frank — that’s why you do it.
Indebted, tattooed, dyed hair fatties … or promiscuous sluts don’t make things that attractive for men anymore, especially when the culture is girl power and anti male, and the laws are also anti male. I find it funny that women can’t even be honest about what men value, just what they value (= not 30+ year olds, never have, never will – unless you already gave him your high value days).
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Not this garbage again.
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Hey Casino Royale; what do you think about real estate investing?
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Looks like Boomer figured it out. I can name that poster in four posts!
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To address the idea of giving up the best years of your life…
You are choosing to spend these years on learning medicine, yes, but its not as though you can just hold your age 26-30 years in a bank somewhere.
Those years vanish whether you do something worthy with them or not. Now one can debate whether medicine is the best choice, but its certainly a worthy one.
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I love the have you considered 50 yo sex with a 22 year old? Possible if younget out of the USA. Hahahaha what a creep. Stay tuned for To catch a predator, Bangkok edition.
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Quote from touchingcotton
I love the have you considered 50 yo sex with a 22 year old? Possible if younget out of the USA. Hahahaha what a creep. Stay tuned for To catch a predator, Bangkok edition.
If you are in good shape what’s the issue? I’ve never been to Bangkok, wouldn’t know. But if women can’t make their own decisions as adults you should be for either raising the voting age, or repealing the 19th. Apparently you don’t believe they have agency or can make sound decisions. -
Quote from boomer
Hey Casino Royale; what do you think about real estate investing?
Is this an inside joke? I’m laughing regardless. It’s ok
Like with comedians, the truth is often funny, indeed. -
Quote from CoronaRad
Hospital-Rad makes some valid point. You sacrifice many of the best years of your life to become a physician. At some point it may no longer be worth the costs to go to medical school.
This really applies to any field or any business, not just medicine. Success requires sacrifice. Some people overdo it though.
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Daniel son, balance not just lesson for karate, lesson for whole life.
If you “gave up the best years of your life” for medicine, that’s on you. I had a great life during my training – I was only middle of the pack in terms of grades and scores. If I wanted to have no life, I’m sure I could have been in the top 10%. The amount of extra energy required to reach top 10% is not worth it, this applies to basically everything from career, to fitness, to health.
The same burnt out radiologist grinding out in private practice, is very happy working half time. You work nights and weekends for extra cash, and then you get taxed more on top of it and have no life…You retire early because you can, only to find that the best years of life have passed you by…because you chose to put in incremental extra time chasing a higher salary or more than likely you simply got trapped in the golden handcuffs of partnership. -
Quote from striker79
Daniel son, balance not just lesson for karate, lesson for whole life.
If you “gave up the best years of your life” for medicine, that’s on you. I had a great life during my training – I was only middle of the pack in terms of grades and scores. If I wanted to have no life, I’m sure I could have been in the top 10%. The amount of extra energy required to reach top 10% is not worth it, this applies to basically everything from career, to fitness, to health.
The same burnt out radiologist grinding out in private practice, is very happy working half time. You work nights and weekends for extra cash, and then you get taxed more on top of it and have no life…You retire early because you can, only to find that the best years of life have passed you by…because you chose to put in incremental extra time chasing a higher salary or more than likely you simply got trapped in the golden handcuffs of partnership.
If balance was that easy I don’t think so many rads and people in general would have a problem with it. -Deep psychological and existential issues at play.
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Quote from striker79
Daniel son, balance not just lesson for karate, lesson for whole life.
If you “gave up the best years of your life” for medicine, that’s on you. I had a great life during my training – I was only middle of the pack in terms of grades and scores. If I wanted to have no life, I’m sure I could have been in the top 10%. The amount of extra energy required to reach top 10% is not worth it, this applies to basically everything from career, to fitness, to health.
The same burnt out radiologist grinding out in private practice, is very happy working half time. You work nights and weekends for extra cash, and then you get taxed more on top of it and have no life…You retire early because you can, only to find that the best years of life have passed you by…because you chose to put in incremental extra time chasing a higher salary or more than likely you simply got trapped in the golden handcuffs of partnership.
Overall, a great post. Totally agree. It reminds me a bit of understanding the big picture, and I excelled in a lot of things (10% is better if you are talented and smart about what you do) … but I recall it being real obvious to me that medicine was in general P=MD and also that training was so long, you couldn’t help but eventually be really good if you were intelligent or savvy at all. For example, 7 years of radiology training and at least a fellowship? How are you not going to be good? And I’m gonna “go read 4 hours every night” during residencies, like some silly attending would suggest? Give me a break, juice not worth squeeze. Come to the think of it, that’s generally a modern day rule, especially in the US (and with women in the US): juice ain’t worth the squeeze. Live wisely and do what you gotta do, but don’t get consumed by this crap, just as striker79 states. -
@corona bs. Nothing is ripe for anything.
PE in medicine is a snake that needs to be chocked off. -
Wait a minute when did Rebirth change his name?
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Must have been when he was reborn
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Cant get women in the us? Compare them to sour lemons. Then head to Thailand. Sour grapes more like it
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Quote from Casino Royale
Quote from striker79
Daniel son, balance not just lesson for karate, lesson for whole life.
If you “gave up the best years of your life” for medicine, that’s on you. I had a great life during my training – I was only middle of the pack in terms of grades and scores. If I wanted to have no life, I’m sure I could have been in the top 10%. The amount of extra energy required to reach top 10% is not worth it, this applies to basically everything from career, to fitness, to health.
The same burnt out radiologist grinding out in private practice, is very happy working half time. You work nights and weekends for extra cash, and then you get taxed more on top of it and have no life…You retire early because you can, only to find that the best years of life have passed you by…because you chose to put in incremental extra time chasing a higher salary or more than likely you simply got trapped in the golden handcuffs of partnership.
Overall, a great post. Totally agree. It reminds me a bit of understanding the big picture, and I excelled in a lot of things (10% is better if you are talented and smart about what you do) … but I recall it being real obvious to me that medicine was in general P=MD and also that training was so long, you couldn’t help but eventually be really good if you were intelligent or savvy at all. For example, 7 years of radiology training and at least a fellowship? How are you not going to be good? And I’m gonna “go read 4 hours every night” during residencies, like some silly attending would suggest? Give me a break, juice not worth squeeze. Come to the think of it, that’s generally a modern day rule, especially in the US (and with women in the US): juice ain’t worth the squeeze. Live wisely and do what you gotta do, but don’t get consumed by this crap, just as striker79 states.
I don’t think you and Striker are saying the same thing.
Somehow you are putting sleaze into common sense advice.
I personally feel that real estate is the answer; the best way to get out of the rat race…what do you think? Good idea? -
RE is the answer but its tricky now. Very. Houses are ATH.
Commercial is very uncertain. Residential with prices at peak and unemployment uncertain.I have a feeling Im just not in the right market.
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HR,
Pilates.
Youre welcome.
(End of tangent)
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radgrinder,
Definitely will look into it.
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Quote from Hospital-Rad
If you think sex at the age of 50 with a 40+ year woman is similar to sex at the age of 22 with a 22 year old girl, you probably don’t have a good memory of good old days. Make sure you don’t have early dementia.
I like how Hospital-Rad is challenging some people here, it is amusing, but what about sex at age 50 with a 22, Hospy? If you are in shape and know the world (get out of the US) it is possible. -
Quote from drad123
Quote from radgrinder
Quote from drad123
You didn’t care what kind of wrvu comp you got? Really?
becoming a partner is a means to an end, not an end in itself.
Of course. I didnt care about scratching and clawing for a buck an RVU here or there as an employee. Always a ceiling with that, no matter what you do.
Do you care to fight for a dollar per wrvu here or there as a partner?
The point is not about partner vs employee but rad negotiating power in general- or more accurately the lack thereof.
Yes and no. Focus on finding ways to expand the pie, reduce bills going to collections (collections charges 30%+ contingency fee on whatever they collect), negotiating lower malpractice premiums, make sure everyone’s computer is top of the line in computing power, etc., etc., etc. Most of these interventions end up worth more than $1/RVU. Focus on what creates value. -
Quote from radgrinder
Quote from drad123
Quote from radgrinder
Quote from drad123
You didn’t care what kind of wrvu comp you got? Really?
becoming a partner is a means to an end, not an end in itself.
Of course. I didnt care about scratching and clawing for a buck an RVU here or there as an employee. Always a ceiling with that, no matter what you do.
Do you care to fight for a dollar per wrvu here or there as a partner?
The point is not about partner vs employee but rad negotiating power in general- or more accurately the lack thereof.
Yes and no. Focus on finding ways to expand the pie, reduce bills going to collections (collections charges 30%+ contingency fee on whatever they collect), negotiating lower malpractice premiums, make sure everyone’s computer is top of the line in computing power, etc., etc., etc. Most of these interventions end up worth more than $1/RVU. Focus on what creates value.
How do you reduce bills going to collections?
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Quote from radgrinder
Quote from drad123
Quote from Thread Enhancer
Quote from drad123
Quote from Thread Enhancer
Even more reason to take a collaborative approach. A person or group can act as though they have power and it works until it doesn’t.
Much better to have relationships and an ability to add value. There is more opportunity for this in radiology than many on this site believe.
What have you and your group gotten through collaboration?
Directors fees. Money to help cover call. Better rates per wRVU from the contracts that are based on that…
Directors fees and call pay? I tip my hat to you on that. Hard to get those nowadays.
what kind of wRVU comp have you been able to negotiate? what was offered to begin with?
I honestly didnt care. I went private practice with the intent of becoming partner, and after that its about managing the practice effectively, maximizing value, and being directly rewarded for your efforts instead of coming to an employer, hat in hand, hoping for an extra helping of gruel.
The employee years functioned as an apprenticeship. Aside from learning how to be a good practicing radiologist, it was important to seek out responsibility wherever possible. Medical directorships, committee roles, administrative stuff. Become the expert, become the person people ask about problems, become visible to the hospital and medical staff as a doer and a fixer. There are many paths to success, this was mine.
I would suggest that one not worry about the last few bucks in the first couple of years out. Actively seek out opportunities for responsibility, and constantly, constantly ask how things can be done and how you can be better.
A recipe for success includes a clear idea of what you would like to accomplish- I honestly dont care about compensation rates. Lol
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I don’t think the neurosurgeons here lost at all. A recent article described: “Castro, however, said CRMC offered multiple proposals during weekend negotiations, including one (on Sunday) around 6:30 p.m. that we believe meets all CCFMGs demands.
Getting locums isn’t a win. Locums is by definition temporary. They were forced to do it because level I status has implications beyond neurosurgery. Locums for neurosurg also costs you at least $3,000-4,000/day. You’re overpaying for services because you’re forced to use a locums company and it causes more inconvenience for the provider. You’re also losing all of the elective volume and lucrative service lines you had with your original group (MIS spine, endovascular, etc.) Neurosurgeons/ortho who do locums are predominantly low-volume generalists who are on the way out (someone with a successful, busy clinical practice isn’t going to sign up for locums). A lot of these trauma patients are also uninsured, and the hemicranis you’re doing in the middle of the night are losing you money. The hospital will be forced to give in to the group’s demands because paying random out of the area surgeons locums rates for trauma call just isn’t sustainable financially. -
Quote from drad123
Quote from radgrinder
Yes. As I mentioned above.
The message has been provided for those who are ready to hear it. Folks can feel free to PM me for specific resources.
Good luck.
What have you negotiated radgrinder?
Multiple hospital contracts and renewals, multiple radiologist employee, partner-track, locums contracts, vendor contracts, referral and outpatient imaging agreements. Always with respect, courtesy and professionalism. At this stage we’ve done multiple renewals and all parties involved have grown wealthier, so the process has been satisfactory.
Also home and car loans of course, and the usual improved subscription deals on Hulu, WSJ, etc. -
Quote from radgrinder
Quote from drad123
Quote from radgrinder
Yes. As I mentioned above.
The message has been provided for those who are ready to hear it. Folks can feel free to PM me for specific resources.
Good luck.
What have you negotiated radgrinder?
Multiple hospital contracts and renewals, multiple radiologist employee, partner-track, locums contracts, vendor contracts, referral and outpatient imaging agreements. Always with respect, courtesy and professionalism. At this stage we’ve done multiple renewals and all parties involved have grown wealthier, so the process has been satisfactory.
Also home and car loans of course, and the usual improved subscription deals on Hulu, WSJ, etc.
What is your idea of professionalism? Bending over and saying yes sir may I have another?
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Quote from Frumious
Except you are not negotiating for yourself, you are negotiating for a group. A big difference.
Does a group have more negotiating power? Before the internet and corporate physician service organizations, yes. Now? I don’t think so.
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Quote from Frumious
It still comes down to, if you don’t try….
How does one try? Pretty please don’t let RP take our contract?
Rads are small fish in big ponds.
Now in small towns….
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Quote from radgrinder
It depends on the situation. Negotiating power to accomplish what?
Do you want a particular location, salary, flexibility, vacation, workload?
There are risks and pitfalls to any negotiation as well. You have to understand not only your situation but that of your negotiating partner and the situation in the surrounding community as well as within your own group.
For instance, a newly minted fellow may be able to go to the mat and try to wring every concession out of a new deal if they have a couple other acceptable offers to fall back on.
Whereas a group that has members with deep ties to the community, members who just bought a new house, have large families and so on will likely rebel against group leadership if they are perceived as putting their livelihoods at risk via an unnecessarily disruptive negotiation.
There are people who are Maximizers and Sufficers. Maximizers try to get every possible inch, and are often unsatisfied/unhappy upon completion of deals; one rarely finds out the other partys absolute limit and the Maximizers feel like they might have left money on the table, even if they didnt.
Sufficers are willing to accept a variety of deals so long as they are within a certain zone of acceptable terms. They usually end up happier over time.
I agree with you that negotiation for the sake of getting every last drop is poor form and generally a losing proposition. However, you hear about cases all the time where people are miserable, working harder and harder (essentially reading unsafe volumes nonstop all day), getting slapped with more weekends/holidays for the same pay, and then get an RVU meter tacked onto their computer that flashes different colors and tells them when they can go home like they’re some dog.
Under these circumstances, I think it could be possible (especially if the local stakeholders share the same mindset like you said) to go to the hospital and say that you won’t be continuing to read for them until they offer some combination of improved staffing, more pay for weekends/holidays, and removal of the RVU meter. Teleradiology obviously exists, but it’s stretched thin at baseline and it’s quite disruptive for a hospital with high imaging volumes to find adequate coverage quickly.
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