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Radiology Jobs

09.01.25 // Radiology

I believe in the importance of thriving independent private practices for the field of radiology. True private practice—where doctors control the organization, are responsible to their peers and patients, and earn the full fruits of their labor—is the benchmark that sets the market and provides the anchor against exploitation from unscrupulous employers.

My group, like most groups in this market, is hiring (including remote openings with a partnership-eligible remote swing position). Here are several more 100%-independent radiologist-owned private practices across the US that are recruiting. If you’re in the market for a new position, consider reaching out with your CV. (Click the triangles for more information.)

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Radiology and Imaging Specialists

(Central Florida: Lakeland/Winter Haven, SW Orlando, Bradenton)

Independent and long-standing group covering a diverse mix of financially sound hospital partners, outpatient imaging centers, an ASC/OBL, clinics, and a multi-specialty group. 50+ radiologists and 10+ midlevel providers. In-house and experienced IT, Credentialing, HR, and Admin team including dedicated Radiology Liaison support 24/7/365.

Recruiting for Body, Breast, Cardiac, Neuro, IR, and General.

Partnership Track:

  • 1-year track
  • 10 weeks of vacation
  • Sign-on bonus
  • Internal moonlighting available but not required
  • Full benefits including CME allocation

Employee or Contractor:

  • Flexible scheduling: Hospital (ED/IP) or outpatient coverage options available
  • Fully remote, hybrid, or on-site depending on location(s) and coverage schedule desired
  • Competitive compensation

Learn more at http://risimaging.com.
Contact: Alice Varnadore, Executive Assistant at avarnadore@risimaging.com

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South Texas Radiology Group

(San Antonio, Texas)

STRG is a well-established, expanding, independent subspecialty practice of 70+ radiologists serving 15 hospitals, multiple freestanding ED facilities, and a large outpatient imaging practice (STRIC). Both onsite and remote positions are available.

STRG is a forward-thinking practice with a strong and cohesive culture. Multiple AI projects are in place and in progress to improve efficiency and quality. Internal moonlighting opportunities are available.

Shareholder Track:

  • Flexible associate period as short as 18-months.
  • Leads to full partnership with board of directors membership.
  • Equity ownership within a large expanding outpatient imaging practice (STRIC)
  • Competitive salary with up to $800K starting salary for experienced applicants. Up to $600K starting salary for inexperienced applicants.
  • Excellent benefits package
  • Onsite and work-from-home options for daily work and call
  • Hiring across all specialties, with a current emphasis on Body Imaging and Cardiothoracic/Body

Emergency Radiology Track:

  • 1 week on/1 week off (7/7) and 1 week on/2 weeks off (7/14) positions available
  • Competitive salary with excellent benefits package available.
  • Fully remote and onsite options available.

Employee Mammography Position (Onsite):

  • Competitive base salary with excellent benefits package
  • No call. No nights or weekends.
  • Remote opportunities available for general radiology or body imaging work if interested.

Employee Position – All Subspecialties (Onsite, Hybrid, or Remote ):

  • Competitive base salary with excellent benefits package
  • 5.5 weekends (day shift) per year. No evening or overnight call.

Learn more at https://stric.com/.
Contact: Waynea Finley at wfinley@strg-pa.com

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Radiology of Huntsville

(Huntsville, Alabama)

ROH is 60+ physician, high volume, private practice with a 2-year partnership track and nominal buy-in. Hiring for a remote partnership-eligible overnight position as well as onsite/remote openings in most subspecialites. Huntsville is a tremendously livable, high-tech, and growing mid-sized city (a #1 Best Place to Live in the U.S. by U.S. News and World Report).

Remote Overnight Shareholder/Partner and Limited Shareholder Offers
  • Shareholder/Partner Offer (remote):
    • 1 week on followed by 2 weeks off + 36 additional 2nd shifts annually for full Shareholder status.
    • Average Shareholder compensation of $1MM.
    • Additional internal “moonlighting” paid per RVU. Legitimate seven-figure position with immediate economic parity with existing Shareholders.
  • Alternative Coverage / Compensation Options: (remote)
    • 1 week on / 1 week off for $1.1MM total compensation
    • 1 week on followed by 2 weeks off for $700,000 total compensation
  • Shift Details:
    • 10PM – 7AM Central Time
    • 2 radiologist overnight team with additional triple coverage until midnight and after 6AM
    • RVU Benchmark expectation of 115 wRVUs
Onsite and Remote, Daytime and Second Shift opportunities
  • Abdominal / Body
  • Emergency
  • General Radiology
  • MSK
  • Neuroradiology
  • Nuclear Medicine
  • Pediatric
  • Light Interventional

Learn more at www.radiologyofhuntsville.com.
Contact: Brandy McCown at bmccown@radhunt.com or call 256.713.0621.

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Iowa Radiology

(Des Moines, Iowa)

34-radiologist subspecialized collegial private practice with long-term stability providing coverage to 30 locations across Central and North Central Iowa. Ownership of several outpatient imaging locations yields distributions from technical fees, and Des Moines is one of the fastest-growing areas in the country with a low cost of living, excellent schools, and low taxes.

Partnership track:

  • 2-year partnership track with 12 weeks vacation
  • On-site daytime coverage; hybrid night and weekend call coverage
  • Greatest needs: Breast, Neuro, General. All subspecialties considered for the right candidate.

Employee track:

  • Fully remote, hybrid, or on-site options
  • Excellent salary and benefits package, including up to 10 weeks of vacation depending on role/shift
  • Immediate Need: 3rd Shift Radiologist
    • Nine-hour shift, 7 on/14 off, 100% teleradiology
    • 90-120 cases/shift; ~40 of those CT
    • Base compensation $450,000 w/ additional compensation opportunities
      • Additional comp consideration based on subspecialty (for example, can final read neuro cases)
      • Moonlighting available
      • RVU productivity incentives
    • Full benefits package including 401k, health/dental/vision, pension, life insurance, etc. ($83k benefit value annually)
    • Malpractice and tail paid
  • Other Available positions: General, Breast, Flex Shift, Overnight
    • Overnight shift is 10p-8a CST, 7 on/14 off, 100% teleradiology with average 90-120 total cases per shift
    • Evening shift is 4p-12a CST, alternating weeks M-F only (26 weeks and no holidays/weekends)

Learn more at http://www.iowaradiology.com
Contact: recruit@iowarad.com

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Mecklenburg Radiology Associates

(Charlotte, North Carolina)

Established in 1917 and fiercely independent, MRA is a well-respected subspecialized practice of 60 radiologists and growing. They especially take pride in their group culture (seriously, there are some really nice people in that group including one of my old senior residents).

Partnership track:

  • 3-year partnership track with 8 weeks of vacation per year
    $400K starting salary and an additional $75K sign-on bonus ($125K with 2+ years of experience)
  • On-site daytime hospital and imaging center coverage. Hybrid evening and weekend call coverage, including the option to read from home.
  • Available positions: Breast, Body, Cardiovascular, Neuro, Light IR, MSK, Nuclear Medicine, and General

Employee track:

  • Fully remote, hybrid, or on-site options
  • Competitive salary
  • Available positions: MSK, General, Overnight ER, Swing Shift ER, Neuro, Body, and Cardiovascular

Learn more at www.meckrad.com/recruitment.
Contact: Charlene Eichinger at ceichinger@meckrad.com

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Midwest Radiology

(Minneapolis – St. Paul, Minnesota)

Large 175+ subspecialized practice with 17 weeks of vacation. Two-year shareholder track for new graduates and a one-year track with experience.

Positions (On-site):

Body (100% Body) – Regions Hospital
  • Mix of shifts worked on-site
  • Mixture of hospital, outpatient, and remote
  • Interpret MRI, CT, U/S, and radiographs
  • After-hours coverage provided internally by the emergency radiology section
  • No neuro or MSK
Body/Mammo – Western Wisconsin
  • 45-minute drive from the Twin Cities.
  • No overnights, evenings, or weekends required.
  • Interpreting CT, US, body MRI, plain film and mammography studies.
  • Onsite procedures include general fluoroscopy, minor ultrasound, paracentesis, and thoracentesis.
  • No neuro or MSK.
General Body/Mammo
  • Regional hospital sites north and west of the Minneapolis/St. Paul area.
  • Interpreting CT, US, body MRI, plain film and mammography studies.
  • Onsite procedures include general fluoroscopy, minor ultrasound, paracentesis and thoracentesis.
  • No neuro or MSK.
Pediatric Radiologist (100% Peds if desired)
  • General pediatric imaging including fluoroscopy, CT and ultrasound.
  • Experience in MR is optional.
  • Hospital-based.
  • 100% pediatrics if desired (may split time between pediatrics and an additional section).
Neuroradiologist (100% Neuro)
  • Daytime, on-site neuroradiologist.
  • All evenings and 95% of weekend call shifts are off-site.
  • Hybrid weekday (2-3 remote daytime shifts/week).
  • Onsite procedures include lumbar punctures, myelograms, and swallow studies.
  • Functional MRI a plus but not required.
  • Subspecialty CAQ required.
  • No body or MSK.

Positions (Remote):

Daytime Body
  • Fellowship-trained 100% body position
  • Fully remote, daytime, Monday through Friday position with no evenings, weekends, or nights required.
Overnight Body/MSK (Partnership)
  • 1 year to shareholder for experienced radiologists, shareholders work 121 shifts per year (17.3 weeks)
  • Shifts are 10pm to 7am
  • At least two years post-fellowship experience required
  • Multiple other overnight radiologists (Body, MSK, and Neuro) will be working the same shifts allowing for collaboration.
  • 24/7 IT, transcription/editing, and clerical/QA staff assistance.

Learn more at www.midwestradiology.com.
Contact: Barry.Lindo@MidwestRadiology.com

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RAPA

(Central Arkansas [Little Rock, Conway, Searcy, and Pine Bluff] & Northwest Arkansas)

40+ radiologists covering 20+ sites (hospitals + clinics) with a multi-subspecialty mix of inpatient, outpatient, and ED imaging.

  • Robust reading room assistants and IT presence to promote peak efficiency
  • Unified Clario reading list, Inteleviewer PACS, Powerscribe dictation (no switching stations or PACS to read other sites)
  • RadAI automated impressions to improve efficiency.

Partnership track – Central Arkansas (Little Rock, Conway, Searcy, and Pine Bluff) and Northwest Arkansas:

  • 1 year to partnership
  • 10 weeks vacation + 1/2 day off per week on average for partners
  • Highly competitive compensation combined with low cost of living
  • Internal moonlighting options to boost income
  • Robust CME allowance, signing and moving bonuses, full benefits
  • Many work-from-home shift options
  • Minimal after-hours requirements – overnight shifts are fully staffed with telerads

100% Remote Nighthawk, partnership track:

  • 7 on/14 off, 10 pm-7:45 am CST
  • 1 year to partnership
  • Competitive compensation, robust CME allowance, signing bonus, full benefits

100% Remote Neuro/General:

  • Daytime tele neuro/general radiology approximately 50/50 split.
  • Option for employed or partner track. Partner track includes call weekend shifts, approximately 1 in 5 weekends.

Employee track:

  • General radiology, mammography, and other options available
  • Fully remote, hybrid, or on-site options available
  • Flexible scheduling
  • Competitive salaries
  • Robust CME allowance, signing and moving bonuses, full benefits

Greatest needs are IR, mammography, body imaging, MSK, and nuclear medicine, but all subspecialties and general radiologists are welcome.

Learn more at http://rapaxray.com/
Contact: recruitment@rapaxray.com and Dr. Brandon Kelly at bkelly@rapaxray.com

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Eastern Radiologists

(Greenville & Coastal North Carolina)

Eastern Radiologists is a private practice in Eastern North Carolina that is physician-owned and operated and seeking to hire multiple radiologists due to growth and retirement. The well-established private practice serves a large geographic region through 14 area hospitals and several state-of-the-art imaging centers. Support is provided by nearly 70 subspecialty radiologists.

Currently seeking candidates with the following training:

  • Pediatric Imaging
  • Breast Imaging
  • Neuroradiology
  • Body Imaging
  • Nighthawk/Overnight
  • General Diagnostic Radiology
  • Vascular/Interventional

Details:

  • Positions are available in Greenville and other coastal communities in Eastern North Carolina.
  • Most are partnership track positions which include evening and weekend call responsibilities, but other employment options can be considered. Employment positions can be customized to fit desired schedule/income. Internal moonlighting is available for extra income.
  • Great benefits, competitive salary including profit sharing and bonus, generous vacation and paid family leave, and business/educational discretionary account.
  • Sign-on bonus

Learn more at https://www.easternrad.com.
Contact: Erica Askew at easkew@easternrad.com

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Radiology Consultants of Little Rock

(Little Rock, Arkansas)

Founded in 1961, RCLR is a 25+ radiologist, subspecialized, independent private practice serving the largest healthcare system in Arkansas as well as the largest urology group in the state.

Early Evening/Swing Position:

  • Fully remote
  • 7 on/7 off but with the perk of being excused from 6 weekends per year
    • Excused from holidays that may fall on your scheduled week but share in overall holiday coverage evenly with the rest of the partnership
  • 8-hour shifts, 12 – 8 PM central time
    • Ideal for radiologists in the Pacific time zone
  • ~80 RVUs/shift average
  • All modalities excluding breast and PET, NM is minimal
  • Starting salary of $575K for experienced candidates
  • 1-year track to full partnership
  • Competitive partner salary
  • Internal moonlighting optional
  • Benefits: 401(k), health/dental/vision, life and disability insurance
  • Single IT stack

Learn more at https://www.radconlr.com
Contact: Terrie Threlkeld at terrie.threlkeld@radconlr.com

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Grand Traverse Radiologists

(Traverse City, Michigan)

Established in 1938, GTR is a 100% physician-owned and operated private practice in a four-season resort town on the bays of Lake Michigan.

  • High compensation and 12 weeks vacation
  • Post-call weekend days off
  • Internal moonlighting available
  • Positions/partnerships are on-site, but multiple shifts can be done from home.
  • Collegial and youthful group with an average age under 40. All partners are equal.
  • Hiring for growth. Lists are caught up!

Needs: Body, Breast, ER/General, and IR

Learn more at https://www.grandtraverseradiologists.com
Contact: Dr. Anthony Livorine at alivorine@gtradiologists.com

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Inland Imaging

(Washington, Oregon, Montana)

Inland Imaging is a 120+ radiologist-owned private practice proudly serving multiple outpatient, clinic, and hospital sites throughout the Inland Northwest region. We own and operate one of the first outpatient interventional labs in the West in addition to 7 outpatient imaging centers.

Our practice:

  • Sub-specialty interpretations available across all locations.
  • All studies are accessible on a common PACS system, one common voice recognition system, and one common worklist
  • Internal Nighthawk System providing final interpretations on all ER, STAT, and Inpatient Exams. 24/7 Neuroradiology Coverage and IR Call Coverage.
  • 2-year Partnership Track.
  • Full-Time Radiologist Average Time Off = 15 weeks with the ability to decrease or increase total time off.
  • Average after-hours obligations = 9 weekends per year and 22 evening/swing Shifts.
  • Salary Range – $450,000 – $600,000
  • Full Benefit Package including health, life, vision, dental, disability, and life.
  • 401k match, profit-sharing contribution, and cash balance plan.
  • Hybrid Work Options

Current Openings:

  • Remote overnight ER
  • Neuroradiology (choice of Spokane, Seattle, Walla Walla, Tri-Cities, or Missoula)
  • Washington
    • Tri-Cities (with $75k signing bonus)
      • Breast
      • Neuro
      • MSK
    • Spokane – Pediatrics
    • Moses Lake – General/Breast (with $90k signing bonus, $20k relocation benefit, and annual retention bonus)
    • Colville – General/Breast
  • Montana
    • Missoula – IR
  • Oregon
    • Pendleton – General/Breast

More information about these positions can be found on our Independent Radiology listing.

Learn more at https://inlandimaging.com/careers
Contact: Sarah Russell, CEO at srussell@inlandimaging.com

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Vantage Radiology & Diagnostic Services

(Near Seattle, Washington)

~35 subspecialized radiologists practicing near Seattle and enjoying a quality lifestyle focused on work-life balance, located minutes from urban amenities, and with easy access to abundant outdoor activities in the natural beauty of the Pacific Northwest. We’ve provided professional services for two hospitals since 1970 and are co-owners of their affiliated imaging centers.

  • Competitive salary ($370-570k) with a signing bonus for a 4-day work week and 8 weeks of vacation.
  • Benefits include a CME allowance, memberships to professional societies, profit-sharing, malpractice and disability insurance, 401K contributions, and a commitment to associate mentorship.
  • All partners and partner-track associates share in general call responsibilities (many from a practice-provided remote home workstation). Overnight call is covered by our internal nighthawk team.

Openings:

Breast:
  • Approximately 75% breast imaging and 25% general radiology.
  • Qualified candidates must be skilled in all breast imaging studies and procedures including screening and diagnostic mammography, ultrasound, MRI, and needle/Savi Scout localization and biopsy.
  • Participation in weekly breast tumor conference.
  • No IR requirements
Neuroradiology:
  • Full-time or 3/4-time partnership-track hybrid position
  • Neuroradiology daytime shifts. Typical general ER/inpatient evening and weekend call shifts from home.
  • No breast or IR requirements

Learn more at https://www.vrads.com/
Contact: recruiting@vrads.com

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Reno Radiological Associates

(Reno, Nevada)

Serving Northern Nevada since 1947, RRA is a strong, highly subspecialized, democratic, extremely collegial, high-earning group of 25 radiologists working in perhaps the best city in the country for raising a family and enjoying unparalleled access to natural beauty, endless outdoor activities (perhaps the best ski-city in the US), and incredible weather (jokingly referred to as “the cheapest city in California” for its proximity to Lake Tahoe, Napa Valley, national parks, and more without the super high cost of living and no state income tax).

Shareholder Track (onsite):

  • 1 year to 75% partner, 2 years to 100%
  • Top 90+% comp nationally, maximally generous benefits
  • 8/9/10+ weeks of vacation
  • Remote shifts + opportunities for extra income, $100 buy-in

Employee Track (remote or onsite):

  • High comp, Maximally generous benefits, opportunities for extra income
  • Flexible fully remote options (3a-11a PST, 11a-8p PST, or night)

Independent Contractor (remote or onsite):

  • Flexible shift options, high compensation

Learn more at http://www.renorad.com/
Contact: CEO Anthony Dispenziere at adispenziere@renorad.com

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If you’re a group looking to advertise, get in touch. The monthly post here is limited to just a handful of groups at a time, but last year, I launched Independent Radiology as a resource for the broader community, a dedicated private practice radiology job board featuring 150+ groups. If you’re in the market, please also check it out for your job-hunting needs.

I’m running low on my stash of Cometeer coffee. If you’re interested, you can get $30 off your first order ($15 off the first two boxes) + free shipping and help subsidize my terrible caffeine addiction. (Full review here. Not an ad, but I’ve been ordering for the past three years and I really do like cheaper coffee.)

// 08.31.25

Another lawsuit against Radiology Partners due to its billing practices, this time from UnitedHealthcare (again) in Arizona. Like the Aetna lawsuit in Florida, this one focuses on abuse of the No Surprises Act’s Independent Dispute Resolution process by routing in-network claims through an out-of-network subsidiary in order to make more money. Perhaps it shouldn’t be a surprise that RP is the #1 initiator of IDR claims across the whole country.

// 08.30.25

Associate vs Partner Pay

08.25.25 // Radiology

A previous reader question:

What do you think is a fair compensation ratio for pre-partner to partner pay? It seems like a lot of jobs offer a 50 to 100 percent pay bump. Is there a threshold that should be a red flag?

I don’t think there is a red flag number.

These numbers mostly reflect supply and demand (and in some cases the impact of technical fees from center ownership after a buy-in).

Part of what will feel acceptable will depend on how long the track is. So if a group has a one-year track, you can tolerate a pretty big differential, but if they have a 5-year one, that might be unconscionable. If someone has a seven-year track, I probably wouldn’t want a big differential—that’s a long time to be paid less. (Given the number of unknowns over almost a decade, I  also think it would be very hard to know if you’re working toward a healthy return on that sweaty equity over such a long period).

Part of it will also depend on how high partner pay is. If a group has truly incredible contracts or an amazing real estate portfolio, it may make sense to accept a large temporary differential to enjoy potential massive returns on that time over the long term.

So I don’t think there’s a set number for it. I think it’s more a matter, unfortunately, of the holistic view.

The reality is that if you look at private practices over the past five years, everyone has shortened their track and bumped associate pay. I think most practices, especially in competitive areas, are largely doing what they can to balance recruiting desirability and providing perks to partnership.

Especially when hiring fresh graduates, it’s also not uncommon for a practice to lose money on its new hires for a while until they get up to speed. The reality is: the practice is often investing in you upfront. Partners also take risks that associates don’t, so there have to be some benefits to being a partner.

So again to summarize: it’s all supply and demand. These are businesses, and fairness is in the eye of the beholder. Years ago, when the job market was tight, we had long tracks and big differences. We are in a different era. Tracks and pay are what they have to be to recruit, and the better the offer relative to a partner, the more desperate the need to recruit or the more challenging the competition for recruitment is. The increasingly nationwide market for teleradiologists isn’t finished having its ripple effects.

So I am entirely unwilling to say there’s a rule of thumb here. Everything is local, but even then, sometimes things are good on paper because they have to be to be competitive in the market, which might mean they’re not competitive in some other way that’s harder to measure.

There are few shortcuts to evaluating jobs, few true red flags, and no ways to entirely de-risk the big decision of where to work.

Justified Leisure

08.21.25 // Reading

On the spurious need to justify leisure for leisure’s sake, via Four Thousand Weeks:

John Maynard Keynes saw the truth at the bottom of all this, which is that our fixation on what he called “purposiveness”—on using time well for future purposes, or on “personal productivity,” he might have said, had he been writing today—is ultimately motivated by the desire not to die. “The ‘purposive’ man,” Keynes wrote, “is always trying to secure a spurious and delusive immortality for his actions by pushing his interests in them forward into time. He does not love his cat, but his cat’s kittens; nor in truth the kittens, but only the kittens’ kittens, and so on forward forever to the end of cat-dom. For him, jam is not jam unless it is a case of jam tomorrow and never jam today. Thus by pushing his jam always forward into the future, he strives to secure for his act of boiling it an immortality.

This is, in part, an invocation to stop making everything count for something and just, you know, be. But, that’s hard:

It’s like trying too hard to fall asleep, and therefore failing. You resolve to stay completely present while, say, washing the dishes—perhaps because you saw that quotation from the bestselling Buddhist teacher Thich Nhat Hanh about finding absorption in the most mundane of activities—only to discover that you can’t, because you’re too busy self-consciously wondering whether you’re being present enough or not.

Soon, leisure isn’t very leisurely. It’s just a different kind of job:

The regrettable consequence of justifying leisure only in terms of its usefulness for other things is that it begins to feel vaguely like a chore—in other words, like work in the worst sense of that word. This was a pitfall the critic Walter Kerr noticed back in 1962, in his book The Decline of Pleasure: “We are all of us compelled,” Kerr wrote, “to read for profit, party for contacts … gamble for charity, go out in the evening for the greater glory of the municipality, and stay home for the weekend to rebuild the house.”

When was the last time you really did something without an eye toward some other goal?

In his book Sabbath as Resistance, the Christian theologian Walter Brueggemann describes the sabbath as an invitation to spend one day per week “in the awareness and practice of the claim that we are situated on the receiving end of the gifts of God.” One need not be a religious believer to feel some of the deep relief in that idea of being “on the receiving end”—in the possibility that today, at least, there might be nothing more you need to do in order to justify your existence.

and

“Nothing is more alien to the present age than idleness,” writes the philosopher John Gray. He adds: “How can there be play in a time when nothing has meaning unless it leads to something else?”

and

Taking a walk in the countryside, like listening to a favorite song or meeting friends for an evening of conversation, is thus a good example of what the philosopher Kieran Setiya calls an “atelic activity,” meaning that its value isn’t derived from its telos, or ultimate aim.

You can stop doing these things, and you eventually will, but you cannot complete them.

You cannot complete them.

Cosmic insignificance therapy is an invitation to face the truth about your irrelevance in the grand scheme of things. To embrace it, to whatever extent you can. (Isn’t it hilarious, in hindsight, that you ever imagined things might be otherwise?) Truly doing justice to the astonishing gift of a few thousand weeks isn’t a matter of resolving to “do something remarkable” with them. In fact, it entails precisely the opposite: refusing to hold them to an abstract and overdemanding standard of remarkableness, against which they can only ever be found wanting, and taking them instead on their own terms, dropping back down from godlike fantasies of cosmic significance into the experience of life as it concretely, finitely—and often enough, marvelously—really is.

Read some more thoughts and quotes from Burkeman’s excellent book in Productivity is a Trap, Inescapable Finitude, and Choosing Rocks.

First Job Support

08.18.25 // Radiology

A reader question:

A lot of my attendings recommend my first job should be somewhere like academics or a hospital system where I have support if there’s a complicated case or someone to help me. Do you feel like you have that in private practice?

So I personally had/have that. Does everybody? No, it depends on the practice. I originally thought most people do, but the number of people I hear from on their second job search has informed me that this is certainly not universal.

But, overall, yes. I think the idea that academia has a monopoly on support is totally inaccurate. People can make you feel inept or give you a hard time for your inevitable mistakes in any environment (I often noticed more attending-on-attending cattiness when I was a trainee).

One key support-related question: Is there a way for you to ask people for help when you have a tough case?

There are plenty of practices now that have built-in instant messaging/case sharing features in their PACS. In this setting, even teleradiologists can share cases with their colleagues back and forth all the time so long as people are generally responsive and sufficiently pleasant.

(Call is always a bit of a different story when there are fewer people working, but this varies too. It’s often a lonelier one-person job. Texting or phoning a friend is always an option, but it’s certainly easier if people are on the outpatient list moonlighting etc and able to provide some support as needed when you’re stuck on a tough case. Being comfortable asking a colleague is, of course, a really helpful place to be psychologically.)

Yes, being in a big, vibrant, distracting reading room is probably going to feel more supportive and lively for most people. One question to answer for yourself when considering an academic job is whether that environment still actually exists. With demands for remote work and expansion of academic medical centers, even large institutions sometimes have their rads increasingly scattered to the winds. (Then, you have to ask yourself if you’ll actually feel more comfortable asking in person, potentially in front of additional attendings and trainees.)

Related and important: Do people share your mistakes with you in a way that’s not going to make you feel too bad, but still let you learn from it? Or do people roll their eyes when you have a miss but don’t tell you, potentially mocking you in front of others but robbing you of the chance to learn from it? Again, that can happen anywhere (including academics).

Ultimately, I think support has more to do with the specific job and less with the model. Every practice is  “collegial” in its job postings, regardless of the reality, and plenty of radiologists in all environments take pride in their work and want new hires to learn and achieve high performance.

I think there’s a certain bubble doctors get into due to the nature of medical education, where we think academia is where the good work happens, and the outside hospital is where the bad work happens. My perception between my experience in academia, my current privademic model, and seeing the work of other practices working in our health system, is that there is no consistent relationship between overall model and quality. Subspecialization to extent, but there are good and bad radiologists and good and bad versions of every model, including in the academy.

I do think being 100 percent teleradiology is probably overall harder to feel supported. Certainly not impossible, but just those interactions won’t all feel the same if no one knows who you are and you don’t really know anybody. Asking a name on a chat list you’ve never met before doesn’t feel the same as asking a friend or a colleague in the same room or one you’ve had dinner with.

How “supported” you feel in that setting may have just as much to do with you and your needs as what the practice provides, but I’ve seen enough young radiologists on the market to know that many people discount how isolating even local radiology can be.

 

The Lucrative Business of Narrative Fallacy Trafficking

08.14.25 // Reading

From How Not to Invest by Barry Ritholtz:

There is a forecasting-industrial complex, and it is a blight on all that is good and true. The symbiotic relationship between the media and Wall Street drives a relentless parade of money-losing tomfoolery: Television and radio have 24 hours a day they must fill, and they do so mostly with empty nonsense. Print has column inches to put out. Online media may be the worst of all, with an infinite maw that needs to be constantly filled with new and often meaningless content.

The broader internet—with its incredible volume of content, endless noise, spam, grift, and now AI slop, ruthless competition for attention, and the need to placate the algorithm gods—has gotten really bad. This is one of the reasons why I never transitioned my writing to a niche like student loans or other financial pseudoadvice, even when that was potentially a lucrative option. The need to continue writing the same things over and over in my free time was unfathomable. Once I said what I wanted to say (for example), I had no interest in saying it again. To wit:

Award-winning Wall Street Journal columnist Jason Zweig brilliantly defined what he actually did: “My job is to write the exact same thing between 50 and 100 times a year in such a way that neither my editors nor my readers will ever think I am repeating myself.”

I’m not sure that’s possible for most people? Not to most readers, and probably for only a select few writers. The problem with all this thirst for raw material is that most of it isn’t very good, and much of it is derived from our worst storytelling tendencies:

The idea of narrative fallacy—the term was actually coined by Nassim Taleb in The Black Swan—applies to pretty much everything. Danny Kahneman explains it in Thinking, Fast and Slow: Flawed stories of the past shape our views of the world and our expectations for the future. Narrative fallacies arise inevitably from our continuous attempt to make sense of the world. The explanatory stories that people find compelling are simple; are concrete rather than abstract; assign a larger role to talent, stupidity, and intentions than to luck; and focus on a few striking events that happened rather than on the countless events that failed to happen. Any recent salient event is a candidate to become the kernel of a causal narrative.

The ability to tell a convincing story is very different from the ability to be right.

All of us, by our very nature, are telling “wrong” stories most of the time (even when we’re right).

The Generalist vs Subspecialist Continuum

08.11.25 // Radiology

When I was in training in the 2010s, there was a big push for sub-specialization. It was felt to be the future of radiology (and of course, everyone absolutely needed to do a fellowship). Observers opined that the days of the general radiologist were numbered because people needed fancier skills to deal with the increasingly complex and increasingly high-volume of complex imaging.

When the ABR ditched the original oral boards in favor of exclusively multiple-choice examinations, they pushed the final “Certifying Exam” until after fellowship and gave examinees the ability to select a portion of their testing content precisely because the idea was that everybody would be increasingly specialized, and therefore the test should accommodate that increasing specialization. (Never mind that the test was duplicative and useless—that tailoring was at least part of the attempt.)

The Flaw

One flaw in that logic is that increasing imaging volumes have increased imaging across the board. Yes, MRI and CT have disproportionately increased, but there are still plenty of plain films and ultrasounds and DEXA scans, and plenty of CTs are bread-and-butter work well within the skillset of the majority of radiologists. If everybody is so specialized and reads only in their fellowship—doing magical high-end imaging—then no one is left except the aging, near-retirement boomers to read a huge swath of high-volume, often low-RVU work. That is obviously not sustainable. The approach was inherently flawed for our times and has certainly contributed to the current shortage.

The Spectrum

Many discussions of generalist vs specialist are a false dichotomy in the sense that being generalized or specialized is more of a continuum than a binary. There are varying degrees of everything, and the shifting nature of radiology and the expectations of any given job mean that basic foundational skills can end up being important—even if they seem superfluous based on a very narrowly defined position that some radiologists, particularly in academia, find themselves in.

All points on the subspecialization continuum are available. 100% cross-sectional neuro-only? Yes. 100% subspecialized during regular weekday shifts with general radiology only on call (like evenings and weekends)? You bet. Mostly subspecialized with a daily shared pool of things like plain films? Totally. Mostly generalized with carve-outs for things like specific surgeon requests, small joint MRI, certain kinds of procedures, or breast imaging? That too. “General” may include breast imaging, or it may not.

Whatever way you think things are always done, you’re wrong. We have multiple ways to work in part because we have many different employers across 50 states, all trying to solve the question of how to best provide radiological care for patients. The fewer/larger employers we have, the fewer models we’ll continue to enjoy. (That’s one reason I like to support independent practices.)

Back to That Push for Subspecialization

There are several good reasons for increasing specialization. One is that proposed by the ivory tower: complex imaging demands greater skill, and people with more training and focus can theoretically (at least on average) provide higher-value and higher-quality care in those cases. It’s easier, on average, to be better at doing a small subset of the same things over and over again than trying to maintain a broad skillset as a jack of all trades. That narrow skillset can be brittle (all those body parts are squeezed into some tight real estate after all), but there are plenty of surgeons out there who essentially operate on one joint for the same reason.

Obviously, not every case requires marshaling our greatest diagnostic powers, but the reality is that you never know prospectively which cases do—or how to get them to the right person (please, please don’t invoke AI case assignment right now). And in many cases, retrospectively, we don’t know either. Plenty of subtle findings are missed for this reason. Radiology is the easiest field to Monday morning quarterback because the pictures are always there.

So we trade breadth for depth. This approach was once common only in academia but is now increasingly available in the broader market for several reasons—but in large part because people want it.

  1. In a tight job market, many practices have had to offer more subspecialization in order to land candidates. For one simple example, an academic neuroradiologist who hasn’t read a chest x-ray in 20 years may not be willing to fill your practice’s neuro needs if you make them start reading the other stuff. So the easiest way to recruit people who are already subspecialized is to offer subspecialization.
  2. Even many young people like the idea of specializing. When you spend a year of fellowship doing one thing over and over again, it’s easier to envision spending the rest of your career in a similar fashion. This can feel natural, especially since many people train in an academic environment where most attendings are similarly siloed.
  3. Certainly, to an extent, a job can be “easier” in many ways because you develop and evolve your crystallized skillset faster when you’re doing the same thing in higher volume. There’s comfort there—especially when we live in a world with productivity incentives and productivity metrics, where it’s easier to hit production numbers or deal with high call volumes if you’re able to work efficiently.
  4. Increasingly common productivity compensation models (e.g. flat $/RVU) encourage subspecialization because it’s easier to be fast and reasonably accurate doing a smaller number of things. This is especially true when your niche involves reading things that are higher-value, like mammograms, and you can make yourself immune to routine plain films and ultrasound. Yes, internal RVUs can mitigate some of the workload “benefits” of subspecialization, but that doesn’t change the true reimbursement value or the general nationwide trend.

Bigger Pie, Easier to Slice

Another nuance is that—thanks to regulatory demands, payor shenanigans, increasing workloads, quality bureaucracy, and recruiting/retention challenges—the increasing consolidation in the radiology space has itself enabled greater subspecialization.

A small group sharing a call burden means that everyone working alone on the weekend has to read whatever the hospital throws at them. But if multiple hospitals are consolidated into a shared worklist, then there’s enough volume and enough people working to divide out the work by subspecialty in ways that would previously have only been possible within academia.

Whereas previously fellowship training meant that the complicated cases (or the postoperative cases, or the MRIs, etc) went to the person who had done fellowship training and everything else was just shared equally, now it might mean that most if not all cases can be spread similarly.

People operating at the peak of their efficiency—which is, in many cases, more likely to occur when people have a narrow work focus—means that these large corporations, larger companies, and larger groups can also probably get more bang for their buck working with that strategy. Given the workforce shortage, any edge to getting the work done can be a big deal (also, it’s easier to squeeze a juicier fruit). For those rads in the gig economy, it’s also easier to earn a higher hourly rate when you’re reading what you can crank on.

All of this is why “body” imaging and general radiology are in such incredibly high demand—because we need people to do general radiology, especially when many radiologists have opted out.

Making General Work Pay

Long-term, this has some problems, not just because people want to practice at the “height” of their license and training, but because it’s easier to do a “full day’s work” (as measured in RVUs) reading MRIs than it is reading plain films. Adjusting the internal work values to account for the desirability of cases that nobody wants to do—the low-reimbursement, high-frustration, often tedious work of plain films and DEXA and ultrasounds—is one solution. But any change, even internally, means winners and losers. And everyone hates to lose.

The economic and spiritual degradation of general radiology has also meant that with fewer and fewer people really focusing on certain exam types, the quality of those interpretations has gone down, leaving the door open for mid-level encroachment or AI replacement of many tasks.

What Next?

The status quo isn’t going to last.

But the reality is, long-term, it’s impossible to know exactly where things will go, in part because we are at the jagged frontier of AI in radiology. It may be that the need for general radiology will continue to grow as people increasingly subspecialize and opt out of maintaining broad skills from training, older radiologists retire, and imaging volumes continue to explode.

Or, perhaps the hot job market (and fear of being inflexible in the coming AI world) will encourage some people to forgo fellowship and enough others to maintain broad skills to alleviate this pressing issue.

Or, it may be that those tasks—like ultrasounds and plain films—will be the easiest to satisfactorially offload and/or preliminary pre-draft reports from AI tools, such that we can better account for relatively low reimbursement while meeting the already acceptably low quality of those interpretations.

That being said, there’s no way to know how these tools and techniques will percolate through the broad swath of radiology tasks and radiology practices, and what radiologists’ responses to those changes will be, and what the payors responses to that utilization will be, and what the regulators will do when bad outcomes make the news, and so on and so on and so on—and therefore it’s impossible to know the ripple effects in the day to day or the broader workforce (and even later on, the radiology training pipeline).

Predictions are hard.

I would argue that, regardless of individual desires or quality differences, there are several regulatory and market forces that have pushed us toward consolidation that will be difficult to undo. And in a world of increasing consolidation, it is relatively easy to silo people into discrete boxes in ways that are not possible for small groups, especially when those people want to be siloed.

If small groups continue to thrive despite market pressures, then the model of general radiology will continue to survive.

Lastly, Fighting Automation Bias

One related question: as AI tools become more helpful, do we end up in a world where human beings must be extremely skilled in order to add value and countermand automation bias? If so, that may be the strongest and potentially most durable argument for sub-specialization.

A person who reads mostly normal brain MRIs here and there may not be able to function as an effective “liability operator” (or “sin eater“) for AI tools the same way that a subspecialized neuroradiologist could be. We’ve already seen in early trials that susceptibility to AI mistakes is experience-mediated.

So it does depend on how that dance plays out and how regulation plays a role in the implementation of AI tools going forward. There are several plausible outcomes (not to mention midlevel involvement if we can’t get our act together).

But, in the meantime, the willingness to do full-spectrum radiology is and will remain a desirable and valuable skill.

Wild Problems

08.07.25 // Reading

From Wild Problems: A Guide to the Decisions That Define Us by Russ Roberts:

Instead of spending more time trying to make the right decision, I show you that often there is no right decision in the way we usually think of the term.

Sometimes there are no right or wrong choices, just choices. And, of course, the status quo bias of not making a choice is itself also a choice.

The ability to boil complexity down to a single number so you can make comparisons is very powerful. The mathematical name for a number that describes physical concepts like area is scalar.

A matrix is messy. Its lessons are opaque. A scalar is clean and precise. The precision makes scalars seductive. But the usefulness and accuracy of a scalar depends on how many corners have to be cut to turn a complex set of information into a single number.

It’s easy to want to summarize nebulous concepts like quality with metrics, but the more we try to reduce important multimodal things (good care, a good career, a happy marriage) into measurements, the more often our models of the world become a poor proxy for the things we really care about.

Summarizing the “Vampire Problem” as crafted and popularized by LA Paul:

In her book Transformative Experience, L. A. Paul uses the choice to become a vampire as a metaphor for the big decisions that are the focus of this book. Before you become a vampire, you can’t really imagine what it will be like. Your current experience doesn’t include what it’s like to subsist on blood and sleep in a coffin when the sun is shining. Sound dreary? But most, maybe all, of the vampires you meet speak quite highly of the experience. Surveys of vampires reveal a high degree of happiness.

But will it be good for you—the actual you and not some average experienced by others—a flesh-and-blood human being who will live the experience in real time? Ah, different question. You have no data on that one. And the only way to get that data is to take the leap of faith (or in this case, anti-faith, maybe) into Vampire World. Once you’ve made the leap and find you don’t care for an all-liquid, heavy-on-the-hemoglobin diet, you can’t go back. One of the weirdest parts of the decision, as Paul points out, is that once you become a vampire, what you like and what you dislike change. As a human, you might find narcissism repugnant. But vampires find narcissism refreshing and look back on their humbler non-vampire selves with disdain for their humility. Which “you” should you consider when deciding what’s best for you? The current you or the you you will become?

Paul uses this example as a metaphor for becoming a parent. It’s a powerful thought experiment for approaching what Roberts calls “Wild Problems,” the big decisions without prospectively correct answers that are hard to change, the ones that define us.

To summarize:

Many decisions involve burning bridges, crossing into a new experience that will change you in ways you can’t imagine, including what you care about and what brings you joy or sorrow, sweetness or sadness, sunshine or shade.

Becoming a parent is perhaps the biggest one-way street. But broad choices about marriage, where to live, and what kind of career to pursue also have massive impacts, especially over time.

One of the unavoidable tradeoffs is the pursuit/balance of Hedonia vs Eudaimonia:

Human beings care about more than the day-to-day pleasures and pains of daily existence. We want purpose. We want meaning. We want to belong to something larger than ourselves. We aspire. We want to matter. These overarching sensations—the texture of our lives above and beyond what we call happiness or everyday pleasure—define who we are and how we see ourselves. These longings are at the heart of a life well lived.

To flourish as a human being is to live life fully. That means more than simply accumulating pleasures and avoiding pain. Flourishing includes living and acting with integrity, virtue, purpose, meaning, dignity, and autonomy—aspects of life that are not just difficult to quantify but that you might put front and center, regardless of the cost. You don’t get married or have children because it’s fun or worth it. Having a child is about more than just the accumulated pleasure and pain that comes your way because there is a child in your life. You have a child because it makes your entire life richer even if it makes your bank account poorer.

Of course we do want both. One caution about the pursuit of eudaimonia (flourishing, more or less) is that perhaps we shouldn’t become too self-serious and dry. As Oliver Burkeman argues, most of what we do doesn’t really matter—we are cosmically insignificant.

Even so, we can all acknowledge the long-term satisfaction of Type 2 Fun:

A Type 1 experience is nice the whole time—nothing too stressful, mostly positive. You enjoy it while you’re in the middle of it and you enjoy it after. A day at the beach. A walk in the park. A Type 2 experience is hard. There are moments of pain that have to be endured—difficult days with a lot of altitude gained over a fairly short distance, streams to be crossed without your shoes where the water runs so cold your feet go numb while you’re crossing, heavy gear to be carried on the trek that hurts your back or feet. But a Type 2 experience is one that you never forget, one that makes you stronger, and when you overcome the obstacles in the way, you feel like you’ve accomplished something. A Type 2 experience can teach you something about yourself. A Type 2 experience has a chance to be more than pleasant. It can be exhilarating. You might not enjoy it (much) while you’re in the middle of it. But you enjoy it after it’s over and in a different way than a Type 1 experience.

And sometimes we choose a Type 2 experience that isn’t just a test, but a chance to experience something profound and meaningful, a chance to share something with another person that brings out the best in us and allows us to grow. Marriage and parenting are much more Type 2 than Type 1.

It can be impossible to know prospectively when type 2 fun is worth it. The problem with “wild problems” is that they are problems of inherent, unavoidable uncertainty. When they turn out poorly, we often think of them as mistakes:

Often in such situations, we’ll say, I took the job, but it was a mistake. I got engaged, but it was a mistake. I went to law school, but it was a mistake. But none of those things are mistakes. A mistake is when you know you don’t like anchovies but you keep ordering them on your pizza. A mistake is trusting someone you know is a person without honor.

A lot of what makes wild problems so painful is the specter of regret. You decide not to marry someone and you end up regretting it. Or the opposite—you marry someone and it doesn’t turn out well. You go to law school and you hate it. The potential for these decisions to turn out badly tends to cause fear of making any decision at all. We say to ourselves that we need more time to gather information, ignoring that more information isn’t going to help—it’s just a form of procrastination.

Outcomes matter, but at least the process is controllable. At the end of the day, sometimes we just have to decide and live.

Baumol’s Cost Disease and the Undercutting of Physician Pay

08.04.25 // Medicine

In the 1960s, economist William Baumol attempted to explain why services like healthcare and education keep getting more expensive: they’re labor-intensive, and there’s a ceiling on how much productivity can improve without sacrificing quality.

This idea—known as Baumol’s cost disease—goes like this:

  • In sectors like manufacturing or tech, productivity is routinely increasing. You can automate, outsource, and scale (often all three).
  • In labor-intensive fields like medicine or education, that’s a lot harder. You can’t operate on two people at once or scale up human empathy. A physician visit in 2025 takes the same amount of time as one in 1995 (okay, a maybe half as long because healthcare is terrible now).

The “disease,” according to Baumol? Wages still rise across the board, even in those low-productivity-growth fields.

Why?

Because the cardiologist isn’t just competing against other doctors—she’s also competing against the broader economy. If productivity increases in other sectors boost wages, medicine has to keep up just to retain talent.

This means that costs rise even if productivity doesn’t.

So why hasn’t physician pay risen?

If you follow Baumol’s logic, we should expect physician pay to have risen steadily just to track broader wage inflation. But that’s not what Medicare has done.

  • The Medicare Physician Fee Schedule uses a conversion factor to translate RVUs into actual payment.
  • That conversion factor has fallen from $36.78 in 1998 to $32.74 in 2024—and that’s before inflation.
  • Adjusted for inflation, that’s a real pay cut of over 40% per RVU.

The government that sets the rules is also the dominant customer setting the prices.

Physicians are providing the same service (and often more of it), with higher expectations, greater documentation, and more liability—and getting paid less to do it.

This is the exact opposite of what Baumol’s model would predict.

Rising costs, falling pay

The paradox: overall healthcare cost increases are outpacing inflation even though clinician pay is falling in real terms. If Baumol’s cost disease is supposed to explain rising prices due to rising wages in stagnant-labor sectors, then how can healthcare spending keep growing when labor (e.g. doctors and nurses) is squeezed?

Because labor isn’t the main thing driving healthcare costs.

The three dominant forces:

1. Regulation & administrative bloat

Healthcare hasn’t just added labor—it’s added layers. In the U.S., we have more administrators per capita than any other country, and the fastest growth in healthcare employment has been in non-clinical roles.

We’ve created a complex system that requires armies of coders, billers, compliance officers, prior auth specialists, and case managers just to keep the machine moving. These people may be necessary to varying degrees, and some may unlock revenue through their work, but none generate revenue through patient care: they are, on the whole, a drag that adds cost to the system.

Baumol predicted rising costs due to labor intensity, not bureaucratic overgrowth. The U.S. did both.

2. Technology that adds cost more than efficiency

In theory, technology should help reduce costs by boosting productivity. But in healthcare, it often adds capabilities rather than replaces old ones.

  • MRI didn’t replace the physical exam. It just got added to the diagnostic workflow. (Okay maybe that one is a bad example.)

  • Robotic surgery didn’t make operations faster or cheaper. It made them more expensive—and arguably more marketable.

  • EMRs don’t actually make charting more efficient, because they allow for more elaborate and demanding documentation rules.

On the whole, new certainly doesn’t mean cheaper.

3. The disconnect & moral hazard of third-party payment

Unlike most sectors, patients don’t directly pay for services. That disconnect between consumption and payment drives demand beyond what you’d see in other labor-intensive industries. As in, when you think a physician visit actually costs a $35 copay with infinite free mychart messages after, you have no idea what you’re really asking for.

Insurers buffer the cost, employers shift premiums, and the government subsidizes the system. We’ve uncoupled the market forces of supply and demand.

So of course we want the newest, shiniest things, and when insurance “pays” for it, there’s little incentive to say no. Combine that with medicolegal defensive medicine and the customer-service/patient-satisfaction mindset, and it’s only worse.

Structural forces vs. policy levers

Baumol’s cost disease explains why costs in healthcare should rise: it’s structurally labor-bound. But instead of acknowledging that, Medicare has tried to hold the line on overall costs by cutting per-unit reimbursement. This creates a massive disconnect between how much it costs to provide care and how much physicians are paid to do it. Meanwhile, we have sabotaged ourselves with processes and guardrails without really figuring out long-term when they’re actually helping and removing the ones that don’t. We are awash in open-loop errors.

This is why independent practice is vanishing. It’s why private equity has a foothold. It’s why primary care is on life support and many doctors are shifting toward concierge and other DPC models to opt out of the system. Practices get squeezed, so they look for scale and efficiency—not for better care, but for survival.

Private insurance, everyone’s favorite bogeyman, picks up some slack by paying more than the government (and profiting handsomely as a middleman processing claims), but even that’s tied to underlying government payments. So we see further consolidation, burnout, cost-shifting, and administrative creep.

Bigger doesn’t mean better, but it does mean more negotiating clout.

The deeper tension

This is the heart of the issue:

Natural economic forces push healthcare costs up.

Political mechanisms try to push them down.

Even well-intentioned regulations are converted to pure bloat or subverted by administrative capture, resulting in painful and expensive inefficiencies as compliance becomes the dominant force in healthcare.

And in between is the physician workforce, stuck trying to deliver high-quality care under increasingly unsustainable conditions.

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