Ben White

A Bias for Unfiltered Input

10.22.24 // Medicine

Henrik Karlsson, from “Scraping training data for your mind,” on the need for the right kind of information to learn new skills:

[You] want the input you observe to be as closely connected to a practice as possible. You want to see the process, not just the results. The results are often misleading. If you are a musician looking at successful bands, you might get the impression that you need to make music videos to succeed, whereas, in fact, a video only makes sense after you have achieved a certain level of success—so imitating that will lead you to misallocate your time.

You will also be led astray if you rely on advice and explanations unconnected to an ongoing process. Experts can rarely articulate the behaviors that allow them to perform at a high level. The knowledge is tacit. The explanations are post-hoc rationalizations; they do not produce the results.

But if you look at the performance, if you get close to it, it is all there.

Looking at the final product to reverse engineer the process can be an impossible task. This is why seeing doctors and surgeons practice medicine and operate is so important. Why it’s so critical to have good readouts when you first start radiology training.

You need to be exposed to the unfiltered expert approach. The “teaching” isn’t just the discrete teaching points and other pearls; it’s seeing the expert practicing natively that helps create the scaffolding to incorporate book learning, real world experience, and ultimately be able to learn the most from the emotional microtraumas of repeated failure that are an unavoidable part of medical training.

The Effectance Motive

10.20.24 // Miscellany

Some passages on what makes a job “good” from The Happiness Hypothesis by Jonathan Haidt:

Psychologists have referred to this basic need as a need for competence, industry, or mastery. [Psychologist Robert] White called it the “effectance motive,” which he defined as the need or drive to develop competence through interacting with and controlling one’s environment. Effectance is almost as basic a need as food and water, yet it is not a deficit need, like hunger, that is satisfied and then disappears for a few hours. Rather, White said, effectance is a constant presence in our lives: Dealing with the environment means carrying on a continuing transaction which gradually changes one’s relation to the environment. Because there is no consummatory climax, satisfaction has to be seen as lying in a considerable series of transactions, in a trend of behavior rather than a goal that is achieved.

This reflects the importance of developing the craftsman mentality.

The effectance motive helps explain the progress principle: We get more pleasure from making progress toward our goals than we do from achieving them because, as Shakespeare said, “Joy’s soul lies in the doing.”

Believing the opposite was coined as “the arrival fallacy” by psychologist Tal Ben-Shahar, who wrote the best-selling Happier. (As in: I’ll finally be happy when I finish that big exam or project. No, when I graduate! Or get that promotion! No, when I retire!)

Contrast the effectance motive with the many narrowly defined clock-in clock-out closely supervised jobs that limit personal choices:

In 1964, the sociologists Melvin Kohn and Carmi Schooler surveyed 3,100 American men about their jobs and found that the key to understanding which jobs were satisfying was what they called “occupational self direction.” Men who were closely supervised in jobs of low complexity and much routine showed the highest degree of alienation (feeling powerless, dissatisfied, and separated from the work). Men who had more latitude in deciding how they approached work that was varied and challenging tended to enjoy their work much more. When workers had occupational self-direction, their work was often satisfying.

My profession of radiology can easily fall into this trap in the wrong environment. You have to carve out ways to take ownership of both the process and product.

It’s an incredible privilege to work at a place and live in a country that is willing to set aside money to answer these existential questions. I heard a phrase the other week, existential humility, and I really liked that. We’re this complex life form that has evolved over billions of years to the point where we can ask these questions — and yet we’re perhaps not the only ones in the universe. And if we could know that for certain, that would be humbling in the most wonderful possible way.

– Astronomer Vanessa Bailey in Dave Eggers’ “The Searchers,” a profile on NASA’s Jet Propulsion Lab.

// 10.18.24

Physician Survey Signup Bonuses

10.11.24 // Medicine

The current welcome bonus landscape:

  • Curizon is entering new physician registrants in a drawing to win $100 (5 winners this month). The odds aren’t bad, several of my readers have won!
  • Sermo is again (finally, after years) offering readers of this site an exclusive $10 welcome bonus.
  • InCrowd is offering $10.
  • M3 Global Research, M-Panels, and All Global Circle are each offering $10 for the following 12 specialties: Hematology / Oncology, Dermatology, Gastroenterology, Pulmonology, Cardiology, Family Medicine or General Practice, Neurology, Urology, Nephrology, Allergy and Immunology, Surgery, Psychiatry, or Rheumatology.

My complete list and more thorough descriptions can be found here.

In addition to being a way to earn extra money (and start a side business that enables you to take some business deductions or start a solo 401k), signing up through these links also helps support my writing. Thank you!

The Irreplaceable Radiologist

10.09.24 // Radiology

The radiologist shortage is definitely here. There are different ways to approach the market, but balancing short-term vs long-term plays is nontrivial. Leverage is great, but using too much can amplify negative downstream second-order consequences too.

What’s happening now varies and what will happen is anyone’s guess, but this anonymous op-ed “Radiologists need to be realistic about the job market” is absolutely worth reading.

…Hospitals quite literally cannot operate beyond a few hours without diagnostic radiology. We are the bottleneck for all inpatient care. All service lines run through us. Any radiologist can easily take one of the hundreds or thousands of teleradiology jobs, which offer less commute, less non-interpretive work, and often higher pay per hour. Hospital systems simply have no leverage against their radiologists except fear of the unknown.

We work in interesting times:

A group of radiologists is severely understaffed, reading far beyond what they normally would. Radiologists are overextended, and high-volume readers are threatening to quit unless something is done. The group is unable to afford hiring radiologists in the current market. Many other unsolvable issues, such as retirements, interpersonal issues, poor work ethic, interventional radiology (IR) vs. diagnostic radiology (DR) squabbles, and [plug in your practice’s problems here] plague the group. Negotiations with the hospital have yielded minimal results. What is a group to do? Take the money, or continue the negotiations?

Again, imagine all of the unsolvable problems this group may face: recruitment, billing issues, MIPS, exploding volumes during nights and weekends, older partners wanting to cut down or retire, cantankerous partners who are indispensable, ad infinitum. More money can’t solve all of these problems, because in this labor market, an exclusive contract is a massive liability. The group decides to turn these liabilities into leverage: They walk away from the contract and tell the hospital they can hire them as employees for base + productivity, or see you later.

The tables have immediately been turned. Suddenly, all of the issues that were unsolvable now become points of leverage. Can’t recruit? More leverage for us. Can’t staff weekends? More leverage for us. A couple of people retired? More leverage for those who stayed. Volume too high? I’m on productivity, or I’ll read slowly and take my base salary. Billing sucks? Not my problem. Overnight services increased their rates? Not my problem. Want to find another group? Good luck, there’s nobody else. We have three months of trailing AR to keep us fed until we get credentialed literally anywhere else.

Guess who wins?

The Low (Possibly No) Tax for Pre-Tax Argument

10.08.24 // Finance

An important pre-tax vs Roth argument that is often missed, from “Why Pre-Tax Retirement Contributions Are Better Than Roth In Peak Earning Years (Even If Tax Rates Increase)“:

The most powerful argument for a pre-tax account as a retirement savings vehicle is that it comes with the option to convert the pre-tax dollars in the account to Roth at any time. That is to say, the account owner can choose when they want to be taxed on the funds in the account (which is what happens when pre-tax funds are converted to Roth), and make those dollars tax-free from that point on. Which makes it very useful to have pre-tax funds available to convert to Roth in years with lower-than-normal income, such as the years between retiring and beginning Social Security and/or RMDs. During this time, the funds can be converted to Roth and taxed at a lower rate than they would have been during high-income working years, or in later years when Social Security and RMDs push the owner into a higher tax bracket.

Notably, Roth accounts do not have this option: There’s no way to move funds from a Roth to a traditional account and take a tax deduction in a higher-than-normal income year (i.e., the opposite of what someone would do with a Roth conversion). The ability to choose when income is recognized only goes in one direction, from traditional to Roth. So from a tax timing perspective, it’s more valuable to have pre-tax funds, with the possibility of converting them to Roth during lower-income years, than to have Roth funds that stay Roth no matter what.

Which is ultimately why, even if tax rates are expected to go up at some point in the future, it can still make sense to contribute to a pre-tax traditional retirement account. Whether or not tax rates increase, the tax timing opportunities to recognize income from pre-tax accounts will still exist. For higher earners, if there’s a reasonable chance of having several low- or zero-income years after retirement, it can make sense to defer the recognition of some of their income from a higher-tax year into a lower-tax year by making pre-tax retirement contributions.

As in, the Roth conversion option gives high-earners the benefits of a Roth contribution without committing to high taxes upfront. Play your cards right and you could even take out some of that pre-tax money tax-free in retirement too. The article’s discussion of historical taxes is worth the read.

The important counterargument is that, in real life, the effective investment between a maxed-out pre-tax and Roth account is already not apples to apples. As in, $10k in a Roth has already been taxed and is therefore reflects a greater than $10k investment. Many people (including presumably most doctors) investing in pretax accounts do not take the extra money they would need to max out a Roth and invest that in a taxable account alongside their pretax contribution. It’s all a set-and-forget it payroll deduction. So, optimized tax considerations aside, many retirees will end up with more money to spend with the Roth contribution just because they saved more money upfront. The option for a Roth conversion is powerful, but it adds complexity and requires timing, two things investors often struggle with.

Both types of accounts have strengths, and all outcomes are a combination of math and behavior in a largely unpredictable tax context.

Another paper suggesting that clinicians prefer some structure (but not too much structure) in radiology reports. There are always edge cases where structured reporting becomes cumbersome–and overly parsed reports are also inefficient/unreadable–but there’s no denying it’s so much easier for me to scan a prior report when it’s not narrative free text.

// 10.06.24

Radiology Jobs

10.01.24 // 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. Here are 10 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.)

//

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

//

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:

  • 18-month associate period leading to full partnership with board of directors membership.
  • Equity within a large expanding outpatient imaging practice (STRIC)
  • Competitive salary with 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
  • Fully remote and onsite options available.

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

//

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

//

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: General, Overnight ER, Swing Shift ER

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

//

Radiology Associates of Ocala

(Ocala, Florida)

A growing Central Florida private practice, rare for the region, with 70+ radiologists looking for an on-site general radiologist.

  • Practice owns multiple imaging centers, generating technical fees and rental income for partners.
  • New business ventures of software development and a separate Telerad company.
  • Optional internal moonlighting available. Nights are covered by dedicated internal nighthawks.
  • Option to rotate/vacation in the US Virgin Islands at a practice-owned timeshare at the St. Thomas Ritz.
  • Equitable non-tiered 3-year partnership track with nominal buy-in and equal call/PTO/scheduling for pre-partner and partners. 14+ weeks vacation (~185 shifts/yr).

Learn more at https://raocala.com.
Contact: Dr. Vivek Kalra at Vivek.Kalra@raocala.com

//

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

//

RAPA

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

40+ radiologists covering 20+ sites with a multi-subspecialty mix of inpatient, outpatient, and ED imaging. Robust reading room assistants and IT presence to promote peak efficiency including a unified reading list/PACS (no switching stations or PACS to read other sites) and RadAI automated impressions to improve efficiency.

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

Partnership track:

  • 2 years to partner for new graduates, 1 year with experience
  • 10 weeks vacation + 1/2 day off per week on average for partners
  • Highly competitive compensation combined with a 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

Employee track:

  • Flexible scheduling (mammography, teleradiology swing shift, other options available)
  • Fully remote, hybrid, or on-site options available
  • Competitive salaries
  • Robust CME allowance, signing and moving bonuses, full benefits

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

//

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
  • 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

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

//

Hudson Valley Radiologists

(Poughkeepsie, New York)

A congenial team of 25 sub-specialized radiologists in New York’s scenic Hudson Valley that understands the importance of work-life balance. Since the 1970s, HVR has been respected in the community and known for its entrepreneurial spirit and excellence in patient care, currently providing services to five local hospitals and multiple outpatient imaging centers.

Fulltime MSK Position: On-site Partnership or Remote Employee
  • Competitive compensation with full benefits package (not RVU-based)
  • Additional earning potential with internal moonlighting
  • Hospital and office-based work
  • On-site & remote weekend call responsibilities
  • Leadership opportunities, if desired
  • Starting salary range: $375 – $400K depending on experience
Fulltime Remote Overnight Position: 7 on 14 off
  • Competitive compensation with full benefits package (not RVU-based)
  • Additional earning potential with internal moonlighting
  • Remote weekend call responsibilities
  • Leadership opportunities, if desired
  • Starting salary range: $400 – $425K depending on experience

Learn more at https://www.hvrads.com/
Contact: Dr. Evan Kurz at esk@hvrads.com

//

Radiology Associates of North Texas

(Dallas, Fort Worth, Texarkana, Sherman/Denison, Longview, Tyler, Lubbock)

The largest 100% radiologist-owned and operated group in the country, serving the greater North Texas area since 1937. 290+ radiologists, 30+ APPs, and robust business staff support. Low turnover, healthy culture, ownership mentality, work-life balance, reasonable call schedules, and unlimited voluntary internal moonlighting (both scheduled shifts and anytime when not scheduled). 24/7 neuro and pedi subspecialty support.

The practice is organized into four distinct areas within DFW and seven distinct regions outside the Metroplex. This allows for practice opportunities ranging from small & intimate to large & subspecialized.

Positions (On-site):

Body
  • Dallas (East and South opportunities)
    • Mix of high-end body and general imaging
    • Desirable work sites within a small radius
  • Fort Worth
    • Mix of high-end body and general radiology with light IR procedures
    • Sites: within 30 minutes of the Ft Worth medical district
  • Tyler
    • Mix of high-end body and general imaging
    • Close-knit team
    • High volume
Mammo
  • Fort Worth
    • 100% mammo and combo mammo/general options available
    • Employed/partnership options
    • High compensation: mammo stipend
  • Dallas
    • Employee/partnership options
    • High compensation: mammo stipend
  • Texarkana
    • Mix of general and mammo
    • $900k+ compensation opportunity
    • Small town charm
  • Longview
    • Mix of general and mammo
    • $900k+ compensation opportunity
    • Small town charm
Pediatrics
  • Dallas
    • Two sites: Medical City Children’s Hospital and Cook Children’s Prosper
    • Full scope of pedi (nearly 100%)
    • $150,000 signing bonus
    • Salary Range: $620k+ during workup, $945k+ for shareholders
  • Fort Worth
    • Single site: Cook Children’s Ft Worth
    • Full scope of ped (100% pedi)
    • Pedi Neuro also available (50-80% pedi neuro depending on daily staffing)
    • $150,000 signing bonus
    • Salary Range: $620k+ during workup, $945k+ for shareholders
Neuro
  • Dallas (South and East Opportunities)
    • 100% neuro and mix of neuro/general opportunities
    • Subspecialty support
    • Desirable work sites within a drivable radius
  • Fort Worth
    • 100% neuro opportunity or mix of general/neuro
    • Hybrid onsite/remote work
    • No mammo expected, neuro-interventional support available
  • Tyler
    • Mix of neuro and general (the inpatient component is mainly neuro)
    • Clinicians specifically seek out/value the neurorads
    • High volume
MSK
  • Fort Worth
    • Subspecialty support
    • 20% MSK/80% Diagnostic (with some days at 100% MSK)
    • High-level body cases available if desired
    • Basic procedures
General
  • Fort Worth
    • Sites within 30 minutes of the Ft Worth Medical District
    • Wide variety of cases
    • Subspecialty support
  • Sherman/Denison
    • Smaller town with big city access (1 hour north of Dallas)
    • Wide variety of cases
    • 2 work sites
  • Texarkana
    • Small town charm
    • $800k+ earning potential

Positions (Remote):

General Overnight
  • 24 hour IT support
  • Team support – 7 rads on the list at a time
  • Subspecialty support
  • Base pay plus productivity bonus
Longview General Daytime
  • Employed position
  • $900k+ earning potential
  • Team support
Part-time Contractor – flexible hours
  • Work when you can
  • Paid at $32/RVU
  • Team support
Swing (Tyler)
  • Monday–Friday, no weekends required
  • 20 weeks of 10a – 7p CST,  20 weeks of 4p – 12a CST
  • Base comp: $400k plus productivity bonus – high earning potential
Remote Daytime Pediatrics
  • Part-Time or Contractor
  • Full scope of pedi, 100% pedi
  • Read from anywhere in the US
  • Schedule: flexible hours, 12pm-5pm
Remote Nightime Pediatrics
  • Full-time or Part-Time
  • Up to 80% pedi
  • Read from anywhere in the US

Learn more at https://radntx.com/radjobs

Contact: Todd Howard @ radjobs@radntx.com

//

If you’re a group looking to advertise, get in touch. The monthly post here is limited to just 10 groups at a time, but in August I launched Independent Radiology as a resource for the broader community, a dedicated private practice radiology job board with 75+ groups so far. If you’re in the market, please check it out for your job-hunting needs.

A reader asked if anyone had successfully started a new radiology private practice recently, particularly one that involved financing, opening up new imaging centers, and fresh payor contracts. There is a vacuum in some areas, especially with the PE-exacerbated instability, and therefore a clear opportunity to those who can muster the manpower (no easy feat).

As a follow-up, I thought I’d ask (on their behalf): is anyone who has willing to mentor other upstarts?

// 09.30.24