Ben White

Radiology Attention Residue

02.16.26 // Radiology

The radiology job of “reading scans” is actually two different jobs in rapid alternation: pattern recognition (pixels, asymmetry, gestalt) and translation (turning that visual certainty—or uncertainty—into clean prose with a defensible impression).

The vast majority of my work is diagnostic these days, but there have been times in my life when I wore lead, did a lot of procedures, and planned for a career as such. Interventions were much more physically demanding and certainly had moments of emotional intensity that I haven’t felt in years at this point in my career. But I always found diagnostic radiology more mentally exhausting, especially earlier in my career, when a greater fraction of cases required a greater amount of Type 1 thinking.

A lot of that end-of-day exhaustion isn’t from volume alone; it’s from the accumulated switching cost (attention residue) of bouncing between visual cognition and written language, case after case. If you want real efficiency (and fewer mistakes), you don’t just read faster—you reduce forced context switches so your brain can stay in one mode longer.

We all need to work on our own personal version of the iterative loop and efficiency/ergonomics.

This is one of the missing joys of working without a better process—whether that’s macros, pick lists, templates, or even better physical integration with your computer. A streamlined, efficient process minimizes interruptions, and that seamlessness allows you to move through the cases instead of fighting to get each one done.

I 3D-printed an MRI for my daughter’s somewhat excessive Calico Critter collection.

My wife overheard her playing with it, as one critter was telling another it was time for her scan.

“It’s your turn to take a nap in the MRI machine,” one says.

“What’s an MRI machine?” asks the patient.

“Oh, it’s just a machine that gives you extra critter magic.”

// 02.04.26

Task Spreading

02.03.26 // Medicine, Radiology

In many practices and especially in academia, important but burdensome tasks are either treated like hot potatoes or flow downhill to the most junior faculty. There are several strategies for distributing important but non-measurable or non-promotable tasks:

  • random assignment
  • rotating schedules
  • clear benefits like compensatory time off
  • automatic cycling/off periods (e.g., do a task for one year, then off for four years)

Avoid asking for volunteers in some situations, particularly for tasks that have little upward mobility, little chance to shine, and where performance is perhaps less important or easy to measure. Otherwise, you get the same people-pleasers doing everything and burning out. Even if they’re not burning out, their time is taken up (perhaps by doing the wrong activities as acts of service).

Alternatively, if a task is important enough to get done, consider ways in which it can be part of someone’s job description. This may be more practical when something undesirable is paired with something desirable, like remote schedules with a more challenging case mix.

Another possibility is putting your money where your mouth is. My practice has a small component of bonus compensation tied to accumulating enough brownie points for doing various tasks like tumor boards, recruiting activities, etc. The reality in our group is that we are large enough and the tasks varied enough that the minimum threshold to qualify is laughably small, and there aren’t measurable benefits to accumulating more than you need. It ensures a floor, probably relying more on the principle loss aversion than the actual money at stake.

You can give people effort RVUs for doing those tasks, but in this market, anything that gives you credit towards a full day’s work that detracts from reading cases can also contribute to overall staffing problems. In other clinical fields, it just pushes more work into the evening/weekends (and eats up precious academic/admin time if in the mix). In small groups where such activities may be distributed evenly, nothing may need to happen. In larger practices where most members will do nothing except interpret scans, stipends are an option, particularly for larger tasks like division directorship.

Bean counting is fine to an extent, and some activities like multidisciplinary conferences are easy to count. But many important tasks are challenging to quantify and may even backfire when attempted. The classic daycare fine experiment added a financial penalty when parents arrived late to pick up their infants, which replaced a powerful social norm with a market norm (swapping guilt for a few dollars). Sometimes, something people would do for free is devalued when a sticker price is put on it that is laughably small.

Consider preventing excess accumulation/consolidation: if someone is going to do something more, the default should be for that person to do something less as well. It’s not just for their benefit. Our institutions are fragile when they rely on individuals too much for any reason.

(On a related note, documentation is key for onboarding and transferring. Truly useful internal documents that are up to date are exceedingly rare.)

Distinguish between areas where someone is specifically important—where the specific representation matters—versus when someone is a warm body. Not all extra work is the same, and not all additional roles are interchangeable or easy to replace. The ones that leave a real hole need to be valued more, even if that comes mostly in the form of consistent gratitude.

If you think someone special knows just how much they are respected and appreciated, they don’t. I promise.

Radiology Jobs

02.01.26 // 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 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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Kettering Network Radiologists

(Dayton, Ohio)

Kettering Network Radiologists, Inc. (KNRI) is a physician-owned, independent private practice serving Kettering Health’s extensive network. Our team consists of 56 radiologists, 8 physician assistants, and 8 radiology residents, providing high-quality imaging services across  8 hospitals (115-500 beds), 20 outpatient centers, 11 emergency departments, and 2 trauma centers (one Level II, one Level III).

Overnight:
  • 1 week on / 2 weeks off rotation (3 night radiologists are working every night shift)
  • Scheduled shifts (EST):
    • 9 PM – 6 AM, 6 PM – 3 AM, and 7 PM – 4 AM
  • Productivity bonus for those working overnight shifts. Additional individual shifts are available for extra pay but are not required.
Swing Shift:
  • Monday – Friday schedule, contracted for 5 days per week with the radiologist choosing between 10-17 weeks of vacation.
  • Includes 5-weekend shifts per year, with the radiologist selecting their preferred weekends.
  • Scheduled shifts (EST):
    • 12 PM – 9 PM, 2 PM – 11 PM, 3 PM – 12 AM
  • Weekend shifts include:
    • 6 AM – 3 PM, 9 AM – 6 PM, 11 AM – 8 PM, 12 PM – 9 PM, 2 PM – 11 PM, 3 PM – 12 AM
Daytime Neuro:
  • Partnership Track on-site/hybrid role
  • Standard 4- or 5-day workweek with 5 weekends per year.
5-on/9-off Neuro:
  • 5 days on (Thursday – Monday) followed by 9 days off (Tuesday – following Wednesday).
  • This schedule amounts to ~130 shifts per year with each work cycle being 5 consecutive days.

When working ER or night shifts, you are never alone—always part of a team. We are a stable, well-compensated group, enjoying flexible scheduling with very comprehensive benefits.

Contact: Dr. Natalia Gaulke at ngaulke@gmail.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

Daytime Teleradiology:

  • 100% remote.
  • Subspecialty work available with up to 50/50 split with general radiology
  • 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 including daytime teleradiology, 7 on/14 off. General radiology, but any subspecialty is a plus.
  • 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 in all subspecialties.

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.
  • Most specialties can work nearly 100% in their desired field of interest.
  • 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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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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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:Tara Nalley at tnalley@meckrad.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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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 for diagnostic radiologists, 2-year track for interventional radiologists
  • 10 weeks of vacation
  • Sign-on bonus for diagnostic radiologists
  • Call compensation for interventional radiologists
  • 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 models (including benefits if employed/full-time)

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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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 (<30 min), 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
  • Onsite preferred, fully remote night available (8p-3a PST)

Independent Contractor:

  • Flexible shift options, high compensation

Learn more at http://www.renorad.com/
Contact: CEO Anthony Dispenziere at adispenziere@renorad.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 or 100% breast (full-time or 3/4 time).
  • 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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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 – $499,454-$624,318
  • 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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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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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 140+ groups. If you’re in the market, please also check it out for your job-hunting needs.

Our family had some nice, quiet snow days over the weekend here in Dallas, so I finally finished this historically interesting if morbid Lego mosaic of the first CT scan from 1971 (right frontal GBM):

The Stoics thought everyone should have a memento mori, but the typical skull is so staid.

// 01.26.26

The Unhelpfulness of AI Predictions

01.26.26 // Medicine, Radiology

Most Content is Boring

Most current articles about AI and radiology work don’t help us much with regard to the questions people are constantly asking about predicting the future. Publish or perish is fine, but I’ll admit I also don’t really care how many ways we can say these early tools are sorta maybe helpful sometimes for some people but are also super brittle and unreliable and also the most important thing is that they don’t make things worse, particularly due to bad integration with a legacy workflows. How to incorporate something only borderline useful into a workflow you probably don’t control just isn’t very interesting, and people keep dropping predictions about what things will look like years (or even decades!) in the future based on what we’ve seen so far.

Extrapolating linear growth when we have exponential compute isn’t helpful. But imagining a post-work techno-utopia vs dystopia is also not actionable for anyone. We can skip the hand-wringing and just agree that everything currently available isn’t good enough to change the world but that maybe one day it will be.

We live in a complicated world where many of what we perceive as challenging problems are computationally straightforward (e.g. cumbersome long calculations, playing chess) and other things that can become automatic to most humans are computationally intense (as it turns out, driving a car, though it’s getting better!). Corner cases and uncertainty are, in some sense, the whole game when it comes to automation. Medicine—with its treatment algorithms designed for squishy humans with limited narrative skills and inherently incomplete information—is a combination of both.

Lots of medicine is straightforward and subject to guild protectionism, but some of it is genuinely hard. And sometimes the difference between those two situations is only knowable after the fact. If nothing else, ambiguity is hard, and how much uncertainty and risk to accept has never been codified. For example, many current AI tools are designed for a high negative predictive value and are therefore overly sensitive. That’s fine for a tool to help a human not make a mistake, but that still can lead to cry-wolf problems and certainly wouldn’t work for an autonomous machine.

Balancing uncertainty and service expectations is no joke for humans or machines or the combination.

Even Good Predictions about Important Things Are Challenging to Act On

As I’ve said before, I don’t think the reality of impending change means that we can meaningfully predict the contours of that change or should even try to plan for its eventuality in ways that would be destabilizing in the intervening time. What Hinton got wrong is that predictions about replacement are dangerous because, until replacement actually occurs and/or demand shifts, we need to maintain the status quo. There’s no way to know if any field (whether primary care or even surgery) will be augmented or replaced over an effectively infinite timeline, or if the contours of the work will change and if so to what extent and how fast, and therefore what the correct number of people we need long-term such that we could preemptively adjust the pipeline of training to help us land at the optimal amount of people for every kind of job. It’s not going to happen.

For long training pathways like most physician careers, trying to pretend we can is insanity. Central planning in that fashion almost never works because there are far too many unknowns. What we need to do is continue training people for the world we live in with a plan, desire, and ability to adjust our workforce over time as the world changes. We need less planning and more flexibility. Less preciousness about how we work and more orientation on the desired outcomes.

Until the exact day a computer replaces a human, you need that human. Trying to predict a societal need years in the future is a fool’s errand. We haven’t been able to fill the halls of medicine  “correctly” over the past century; why would we be better at doing it now?

The Breast Scenario

Let’s just posit a very narrow scenario to see how futile the situation is. Let’s magically say AI for screening mammography becomes incorporated into major vendors at some point in the next X years, allowing for automated reports, even for callbacks. A computer report and a human report would be indistinguishable, especially since BI-RADS facilitates complete automation of reporting language and organization. (I’m also picking breast imaging for this thought experiment because it’s currently very much in demand, tends to be narrowly subspecialized, and has relatively unique current job offerings.)

Let’s also say that the algorithm performance and regulations are such that, for now, those exams are still read by a human being as well—at least in the short term. Guess what the incremental efficiency gain will be? How many screeners can someone read in that setting? The answer, of course, is that it varies.

Automation bias is going to hit fast, so it’s not clear if someone will be able to read 10-20% more, twice as many, three times as many, or some other multiple. Whatever the number is, the first question becomes: how does that affect breast imaging staffing? Does it change the premium that breast imagers can currently command because of the high volume of high-paying screening exams, particularly those with 3D tomosynthesis? How many nefarious rubber-stampers do we need to change the competitive landscape? Think of how fast turnaround times can be! This of course will happen on the backdrop of continually increasing imaging volumes and technological development.

Okay, then what happens to mammography reimbursement? The RVUs will inevitably change if the effort to do the work changes. How fast will that happen, and how drastic will the change be? The RVU system is a zero-sum game, and undoubtedly, there will be a lot of fighting about any changes to radiology reimbursement that occur thanks to AI tools—but they will occur. Tomosythesis is well-paid and already in crosshairs.

How would the subspecialty handle a shifting balance of non-procedural and procedural work, or remote vs on-site work?

Then, how would the job market respond? Would we see similar jobs with less pay? Or would we see a chilling of the growing lifestyle niche of 4-day workweeks with no evenings or weekends? Would we just be able to better staff growing volumes? When I finished training less than a decade ago, it was common for breast imagers to take general call. It would seem that’s pretty rare now. Medicine, like politics, is local. Of course, breast imaging isn’t operating in a vacuum; this is all taking place within an even larger lifestyle teleradiology trend. But variables don’t play nice and isolate themselves: everything is always changing all the time.

What is the timescale for those changes, and how piecemeal would they be? What are the second and third-order downstream consequences of even a single shift in radiology productivity? What about fully automated DEXA? What about prepopulated ultrasound measurements? Natural language draft reports for other modalities. We don’t even know. But the answer isn’t simply that we need fewer breast imagers when there are currently not enough, just because one day we might.

Medico-legally, how will we as a society handle mistakes made by machines? Or, with a human checker, how will we weigh a change made by a human versus a mistake made by a human coupled with a machine?

How will we feel about a mistake where the AI misses something and the human doesn’t catch it–or doesn’t fix it–versus a situation where the AI calls something and the human pulls it back, even when the AI is right? How will we handle type 1 versus type 2 errors? Will companies self-insure for autonomous work as the dominant strategy, or will we see protectionist legislation about a variety of key human tasks?

We don’t know, long-term, whether there are edge cases where humans are more or less important. But we also don’t know, even short-term, where the contours of those skills will reside. Maybe we’re entering a world where the ED would be a better place if a computer did most of the interviewing and initial workup for stable patients.

We are amidst a jagged frontier where AI is good at some things and bad at others, and we know there is a lag between capacity, implementation, legislation, and regulation. Planning is always a challenge; useful prediction is basically impossible.

So, instead of predicting exactly what will happen, we need to acknowledge the broad potential possibilities that could occur and plan a system to deal with them when/if they do occur, as opposed to trying to nail the blind landing.

We All Just Do Stuff Anyway

I don’t want to call out any behavior as irrational, but we should acknowledge upfront the human tendency to just do whatever we want to do and then create post hoc rationales + explanations + narratives to justify and explain our behavior after the fact. Much of this is unconscious and may be a clever trick of our mushy brain psychology, but that doesn’t make it any less real. Try to be honest with yourself and see why you feel the way you do about just about anything and if the reasons you give yourself actually mesh with reality. Write it down, or you’ll cheat (it’s our nature).

It’s like a medical student saying they like “technology” and “problem solving” and “people coming to the reading room for answers” for why they picked radiology when it was really that it seemed relaxing and quiet with good vibes and plenty of coffee and that people at least respected the radiologists’ intelligence and oh yeah they heard they were paid well.

Over the past decade or so, psychiatry has gone from very uncompetitive to pretty competitive. Is it because mental health is important and less stigmatized? Surely that’s part of it. But maybe also because cash-based private practice in a high-demand field (potentially even done via telehealth) sounds like a nice quality of life and a rare way to practice medicine on your own terms. We always seek single explanations thanks to our bias for narrative, but that doesn’t mean that the compelling storytelling is any more reflective of reality.

The examples of failed central planning and the reliance on narrative are legion.

To reiterate my point: No single person or entity has the answer.

So—

Yes, we need all varieties of doctor now, and we need to keep training all of them until we don’t—if that ever occurs.

Will a job like radiology or even primary care pay the same 10 years from now as it does today, or 20 years from now? That will depend on how much value the human provides within the system, how much work they do, how hard or complex that work is, and the supply/demand balance of the available workforce. Volatility and all kinds of non-AI factors already lead to lots of unpredictability.

There may be golden years of excess income for scalable jobs like radiology as these changes first take place. If senior engineers can use AI to do more projects without hiring as many junior coders, it results in rising incomes for those on top and a rug-pull for those entering the workforce.

Both medicine and society need ongoing, never-ending conversations in order to work on creating adaptable systems. Instead of placing bets, the acronym organizations need to set stakeholders up for success across the full spectrum from an AI-nothingburger to AI-work-is-optional.

I’m in the new episode 7 of AJR’s Radiology Trailblazers podcast with Dr. Lindsey Negrete and Dr. Amy Maduram. Please do not think for a second that I accept my inclusion in any “trailblazing” premise(!), but we had a nice discussion about the writing process in and out of radiology. Whenever I do a podcast, I am always able to create at least one new verbal tic. This time it was “in reality”—please forgive me.

// 01.21.26

Why are Body Imagers in Such High Demand?

01.12.26 // Radiology

A paraphrased reader question:

I want to be a daytime tele neurorad. Why do so many of the listings seem to be for body? Are there too many neurorads?

I don’t think it’s really that there are too many neuroradiologists per se. It’s that the true need across the widest variety of practice types is general radiology.

If body imagers only read specialized body MRI, they wouldn’t be filling the holes that we have as a field. The greatest need is for plain films, ultrasound, and generic CT.

That is generally part of the job for body imagers, but many neurorads (and other subspecialties as well) really want to read more within their subspecialty, leaving a pile of general radiology for which groups are desperate enough to bring on remote readers.

In reality, there is nothing about a thyroid ultrasound that should make it a “body” examination and not a neuro one, given that the thyroid gland is in the neck. But this is the way everyone practices.

As a result, if a group hires more neurorads to support general needs without needing a full neuro FTE, that dilutes the available neuro work and requires the neurorads to start reading more general radiology. They, generally, don’t want to do that. And in practices where neurorads are 100% or nearly fully subspecialized, they don’t have the ability to overflow into another subspecialty easily.

Staffing in body typically doesn’t really work that way: smaller changes to their casemix aren’t going to result in a super different job or fundamentally change the spectrum of cases they interpret. No new skills needed.

And therefore, body is the greatest need. Not because there are an infinite number of liver MRIs to read (though there are a lot), but rather because we need people who are willing to do basic radiology work. And many body radiologists are expected to do that.

At least that’s my impression of the current state.

There is daytime tele neuro work out there, but I agree it’s mostly if you’re also willing to also read general too.

The Iterative Loop of Radiology

01.05.26 // Radiology

The first few months of radiology residency can be pretty bewildering. It’s rare in adult life to start from scratch quite as much as you do the summer you transition from internship. Even if you did some studying during internship or you were fortunate enough to have electives in radiology during your intern year, there is a steep learning curve in July, and no one’s foundation in radiology is typically all that strong in terms of actual working ability.

Even though you’ve been looking at things and talking your whole life, it isn’t the same thing as looking at medical imaging and dictating reports. And so the first few months are dedicated to learning the core skills of a radiology foundation: getting comfortable, learning the hospital and the EMR, understanding the radiologist’s roles in the clinical workflow, and putting up some serious imaging reps.

Junior residents will typically take some variety of call after a year, and—even if you don’t have independent call—I know that’s a big step. As your spirit attending, I do want you to continue seeing as many cases as you can and studying outside of work to make sure that you are rounding out your radiology knowledge to build on the things you’ve seen in real life and fill in the gaps for the things that you haven’t. The List Gods do not provide you with everything you need, and the Venn diagram circles of radiology experience and radiology testable knowledge from books/questions/videos/etc do not have perfect overlap.

The spring semester of the R1 year is a great chance to work on the deliberate practice of radiology. There is an iterative loop of interpreting radiology cases that we perform over and over again, and I find that most trainees struggle with certain parts more than others.

The Radiology Loop

I view the five-point interpretative loop as follows:

1. Attend
Bring your complete focus to every new case, because every case is a new patient who deserves your full attention and your best work.

2. Observe
Review the images to make the observations/findings. This involves scrutinizing everything, of course, but also involves practicing avoiding certain pitfalls, like missing findings at the top and bottom images or at the edge of the field of view, falling prey to satisfaction of search, and forgetting to do a targeted review of specific imaging areas to exclude relevant pathologies, second order findings, and seek pertinent negatives (the true search pattern).

3. Decide
Make the decision/diagnosis. This includes deciding if an observation is real or artifactual as well as settling on the differential or significance of a finding. Practice deciding to the best of your ability without perseverating on findings by endlessly scrolling back and forth or agonizing. Practice making a targeted review on the internet to help categorize a finding without getting too deep down the rabbit hole, and be willing to phone a friend or an attending to get an outsider’s more experienced perspective when you need it. Cultivating independence is critical, yes, but we can also get more reps and do more work if we don’t get too bogged down. Try to do it alone when you can, but don’t get trapped in your own head.

4. Describe
Dictate the report with the goal of an organized and concise but thorough findings section as well as a clear, actionable impression. I personally subscribe to the “the more you write, the less they read” perspective, but everything is truly a balance, and the goal is not for you to emulate any specific style but rather to figure out how you want to practice and how to do your best work.

5. Polish
Proofread and hone that report until it is as good as you can make it. I argue that sloppiness never stops at transcription errors or other seemingly less important things; it percolates and permeates. It’s important to practice doing your best work, and that may mean adjusting how you work so that you make great reports routinely.

More on Attention

Within the spectrum of giving each case your full attention, you need to set yourself up for success, and that means not cutting corners. That includes reviewing the history and utilizing relevant priors. Yes, it takes some more time upfront, but it also guides your search pattern and informs your decision-making. It is critical to the practice of radiology. And you will make so many fewer mistakes if you get into the practice of doing this consistently.

You would probably severely underestimate how many times I have seen people be wrong in their conclusion or agonize over a decision that didn’t even have to be made because they failed to look in the chart for relevant history, to look at prior scans and prior reports in your system, or even to see if there were prior radiology reports hiding in Epic available in Care Everywhere. There are countless age-indeterminate or nonspecific findings—including those that generate useless follow-up imaging and unnecessary admissions—that, with some scrutiny, are chronic or stable for years. You’re never going to bat a thousand on this kind of stuff, but you might as well try.

Additionally, those prior reports are often your greatest teacher. So please do not waste these opportunities.

Maximum Learning

Additionally, I strongly recommend that when reading follow-up scans, you take a moment to look at the presentation scan. In many cases, that initial scan when that stroke is less obvious or the pre-operative scan before a lesion is resected gives you the most valuable visual exposure instead of just monitoring a mostly stable ball of blood or resection cavity. Don’t rob yourself of the opportunity to see the full spectrum of radiology/pathology, and try to find things and see how they look and really evolve over time. These are an important part of your learning, so don’t waste them.

It is very reasonable to review your case first before looking at the priors and their reports so as to give yourself the opportunity to approach each case de novo. This is admirable if time-consuming, but don’t take the desire to bring fresh eyes to each experience as an excuse to cut corners and not review the priors.

Your Job

It’s your job, with the help of your attendings, to figure out:

  1. Where you are strong
  2. Where you are weak
  3. Which things you don’t like doing

It’s worth pointing out that the things you don’t like doing are often the things that you struggle with. There is a saying that practice makes permanent, so it’s important not to just try to get through the day but to really focus on these steps to build your skills and work on your tired moves:

If you don’t do things the thoughtful way on a regular day with no pressure, then you’re never going to do them well when you’re tired and under pressure. So we need to work on doing things the “right” (read: consistently improving) way every time, over and over again during the regular workday, to build up the muscles of doing radiology a better way.

And, those things we don’t enjoy aren’t as fixed as you might think if you’re able to cultivate a craftsman’s mentality.

There may be no universal right way to practice radiology, but there are definitely some wrong ones.

Treadmill Desks Are So Worth It

12.26.25 // Miscellany, Radiology

I finally got a standing desk, which means I was finally able to try a foldable treadmill under it. I love it.

In early 2024, I started using an under-desk elliptical, and it worked surprisingly well. One downside is that since it is only self-paced, it’s easy to stop.

This fall, I got the WALKINGPAD P1, which is a foldable treadmill I stow behind my door when not in use. It’s reasonably quiet and has served me well for a couple of months so far. If I were to buy one right now, I actually really meant to get the R2, which has a handle that allows for higher speeds and, more importantly to me, also means it’s easier to move and can be stably stored upright. If folding and stowage weren’t important to me, I’ve also heard good things about the Pacerocker, which has a 9-level incline feature to make things harder without increasing your walking speed (though I have no idea if having an incline would make it too hard to concentrate?). I may still upgrade to the R2 at some point.

Prior to purchasing, I had wondered if I’d be able to work while walking. I figured if I couldn’t, I could at least use it for meetings and maybe lighter/passive tasks like email.

The answer is I can definitely work while walking, at least at modest speeds, and I can easily clock 15-20k steps walking intermittently during a workday.

Admittedly, super fine motor control with the mouse is a bit harder, especially at higher walking speeds. It can, for example, be hard to measure lesions if you’re bouncing, so I find myself walking at a slower pace than my natural cadence. But while mouse control is a little harder, typing on the keyboard is surprisingly natural. It also definitely remains much easier to scroll effortlessly with my Contour Shuttle, which uses a finger, than power scrolling with the mouse.

Additionally, while the treadmills are definitely movable, it doesn’t mean they’re the kind of thing that you really want to have to wheel all the way to and from their corner multiple times per day. I find that when I would like to sit, I tend to just fold the treadmill back under the desk into the leg nook and use it as a bit of a footrest or put my feet along its sides. Having a standing desk means that you can adjust the height a bit as needed to keep things comfortable to accommodate those few extra inches. The main downside of sitting in front of the folded treadmill is that the wheels on your chair can easily bump up against it. It’s best to sit slightly back, so having a pull-out keyboard tray (which I do) really helps with positioning. This is the main reason I wish I’d bought the model with the handle, which would make it easier to move around and probably obviate the need to ever do this. If you try it and don’t like sitting at it folded, the answer is probably just to use it in one session per day and move it away when you’re done.

I think standing desks on their own are somewhat overrated. I like standing at work sometimes for variety, but it’s also sorta meh? Unless you like to do a little dancing in place, the data suggest that standing isn’t really magically better than sitting, and there is some data that they’re not great for your lower extremity veins if you clock too many hours. Being sedentary has more to do with not moving than the actual position you’re staying still in.

The opportunity to try work-walking was my main motivation for wanting a standing desk at home in the first place. I’m not a teleradiologist, so I’m not cranking in my pajamas during the workweek as a full-time job, but as a component of my hybrid workweek, the treadmill desk has been awesome.

A helpful note from a reader:

  • I recently purchased the WalkingPad R2, which has been working well so far. What I’ve found especially useful is the KS Fit app that syncs with the treadmill. It unlocks a few features that significantly improve the experience:
  • 1. Disable auto-stop – This is a big one. By default, the treadmill stops if you step off even briefly. When I’m reading out studies, there are moments where I need to stand on the rails for 5–10 seconds to make precise measurements, then hop back on. Disabling auto-stop lets me keep the speed constant without restarting the treadmill each time. Much smoother workflow—and no more awkward Fred Flintstone tricks to keep it running.
  • 2. Accurate step tracking with Apple Health integration – You can enter your height and weight, and the app tracks steps and syncs with Apple Health. This turned out to be huge for me. A lot of my walking simply wasn’t being counted by my phone or Apple Watch (not surprising, given how still your upper body is while working). With the app, those steps finally count—and importantly, it doesn’t count steps when I step off the treadmill to measure something. It seems to track based on pressure rather than just belt rotation. [Ed: if you don’t have a watch but keep your phone in a pocket, it will track your steps. Obviously, this doesn’t work for everyone based on their phone-use and clothing.
  • 3. Finer speed control – The default 0.5 mph increments always felt too coarse. Through the app, you can adjust speed in 0.1 mph increments and even preset three favorite speeds that you can switch between with a single tap.

It seems the R2’s more robust build quality would be better allow you to stand on the rails intermittently as suggested. I’ve tried this as a way to take a brief measurement/stretch break here and there to stretch my back or do some fine mouse control, but I will admit that it’s a little bit hard on my P1 with its plastic rounded edges. It’s another reason why I’m thinking about upgrading, being able to hop on and off without needing to restart the treadmill would be awesome.