It’s job-hunting season, and I’ve received a variation of the following question several times this week alone: “How do I figure out if a practice I interview at might sell to private equity?”

I appreciate the fear of joining a private practice only to have the rug pulled during the workup in a sale to private equity. It’s what I was worried about when looking for jobs in 2017, what I was scared of when I entered practice in 2018, and what happened to some of my friends in 2018-2019.

My group was and is fiercely independent, and I was fortunate that the Dallas area was not ripe pickings for Radiology Partners, unlike Houston and Austin markets. But I had many of my friends end up on the wrong end of a sale and eventually change practices.

I have also certainly spilled enough digital ink on this topic over the years myself, so I am probably not entirely free from blame for increasing the collective anxiety about this issue.

But I do think that at this juncture, it’s relatively low risk.

The era of PE expansion in radiology through debt-fueled acquisitions of individual practices is essentially over, as far as I can tell. This is a model almost entirely dependent on the zero interest rate environment of the twenty-teens. The costs of borrowing money now are too high to enable these shenanigans, and the degree of leverage these companies have is already so high that there really isn’t any excess capital to deploy in acquiring individual practices when they also need to service their debt, pay for operations, and invest in AI and other magic.

Furthermore, the PR is not great at this point, and I doubt most practices that are actually healthy would want to sell. No one is buying the initial magic & sparkles pitches, so I don’t think either party wins in 2025, and everyone knows it. A struggling practice wanting to hitch their ride to a larger organization and/or extract some value before implosion would be a different story—but those would be less desirable for a purchase. RP, USRS, and LucidHealth may not be that good at actually running a radiology business, but they are very good at their real business, which is a primarily finance game that happens to involve healthcare.

So, investing tens of millions of dollars (even if you had them to burn) in an individual practice acquisition is very risky in 2025. Since these companies have reached scale, there are better ways for them to grow.

Private equity is more likely to grow their workforce through hiring individual radiologists than they are through group purchases, and they’re more likely to grow their imaging volume through organic growth or contract sniping than they are through the outright purchase of a practice. They can also grow by picking up the pieces when someone else fails, like RP did when Envision “transitioned” the corpse of its radiology business.

The “hostile takeover” is still somewhat possible, in the sense that an RP or similar could swoop in and try to steal a contract from a local group, have that local group dissolve because that contract represented a large fraction of their business, and then hope to hire up some of those radiologists for free on the back end to essentially keep the jobs they already had but have since lost (as in, keep staffing the hospitals they were already staffing before the contract change).

This has happened before, but even this, I think, is relatively unlikely to happen now or happen at scale, because these PE companies are not immune from the challenges in the market and have a hard time staffing as well (and also because many hospitals aren’t particularly happy with their level of service).

The reality is that private equity hasn’t gone away and won’t go away, but the greater fear for an individual practice is to implode under the weight of unsustainable image volume growth or be unable to provide the right lifestyle and compensation balance that are required to hire and retain radiologists in this increasingly nationwide market in the era of teleradiology.

A group failing because they can’t be competitive in the job market because their hospital won’t pay for the stipends to make their job competitive, for example, is a real concern. Could a PE-entity swoop in and hoover up some work there? Absolutely, but that’s not the same thing as your new practice screwing you over.

This is to say: If the job sounds good enough that you want to do it, then I personally wouldn’t worry much about it at this point. A healthy group probably doesn’t have much to fear from private equity in the short term given the radiologist shortage. The market itself is enough of a challenge.

When I was a fellow, my key metric when choosing my job was variety, not so much in terms of pathology or the pictures themselves but in the day-to-day. Variety helps me do one overarching critical thing for my professional satisfaction: optimize for enthusiasm.

There are a lot of things I like about radiology and some that I don’t, but one thing that makes everything go down smoother is a nice balance to the week—with different kinds of work on different kinds of days that demand different kinds of things from you.

Academia

I always thought I would be in typical academic practice because I generally like being “involved,” and I like the community. I enjoy teaching and mentorship, and I always have. I’ve been a peer mentor of one variety or another since high school. It’s just something that I find meaningful. I don’t didn’t even mind committee work and other kinds of bureaucracy, even if how the sausage gets made is off-putting. (If we’re being honest, I also probably felt I’d stay in academia because of comfort with the only system I’d ever known, willingness to buy into the lie that the best work gets done there, and a general failure of imagination.)

One thing I didn’t like was the rigid hierarchy, the prevailing pay-your-dues to get a better job attitude, the unfair treatment and distribution of different kinds of work among different kinds of people, especially when such treatment is a preference for seniority or clout that is sometimes unearned and often counterproductive for actual department functioning.

Another was that I don’t particularly enjoy the research game, which is the only meaningful academic currency in many departments, even when most research we do as a field—and certainly all the research I’ve done—has been trash. Someone should do it, but it doesn’t need to be me.

A bit of research here and there is fine, but a job with a “clinician educator” focus (and where that is valued) is what spoke to me.

Academia providing less vacation and money, while often true, wasn’t actually that much of a consideration at the time.

Physician-Ownership & Governance

As those who have read the relevant posts on this site, I wanted nothing to do with private equity when I found my first job. Thankfully, that wasn’t an issue in Dallas. I don’t regret that outlook, and my peers who joined PE or joined practices that sold to PE have all left without exception.

With regards to university or hospital employment, it doesn’t take much exposure to the layers of management or dubiously useful hierarchy to find a representative democracy with physicians in control to be refreshing. Obviously, the hospital is still the hospital and is dysfunctional in all the ways large organizations so often are, but a true private practice is one-step insulated and removed, able to advocate for ourselves and control our own workflows.

Speaking to hierarchy, I liked that new associates could be involved in everything and do anything in the group except serve on the board of directors. I was an associate program director for the residency before I was a partner.

A Truly Hybrid Schedule

My schedule is a combination of teaching at the hospital, working from home, and sometimes working solo at an imaging center in a strip mall somewhere.

Ultimately, I’m a better teacher when teaching is part of my job that I get to look forward to and not something I do every single day. Trust me, even I sometimes get tired of hearing myself speak and saying the same things over and over again.

I also like the fact that I get to spend some of my days working with residents and students, and some of my days working by myself—reading my own cases at my own pace, sometimes doing my own procedures and talking (briefly) to my own patients.

(I did just take over the program director role this month, and that also means regular admin time as well.)

Having a hybrid schedule was especially important for me, because while I have no interest in being a teleradiologist, I very much have an interest in working from home on at least a weekly basis (I’m about 50% remote).

My wife has her own solo psychiatry practice and makes her own schedule. So as the parents of two young children, the ability to have lunch together or take a walk around the neighborhood during the week is an incredible boon to our marriage. We’ve had more mini dates and spent more quality time together during the day than we could ever hope to carve out from our busy evenings with the family or over-scheduled weekends.

Some flexibility is seriously valuable.

A Four-Day Workweek

I also really appreciated my group’s goal of a four-day workweek. I didn’t really need an academic day—which can get filled by meetings and duties and other administrative tasks—what I really wanted was a day off to pursue my hobbies/interests, to be a good partner and parent, take my kids to school, pick them up, make sure the house is in order, and yes, recharge my battery at least just a little.

Some groups have lots of week-long vacation blocks because it is by far the easiest way to do scheduling, but the reality is that I don’t need week-long blocks in huge numbers. In my current life, I’m not going on lots of trips when my kids are in school. I also don’t need large blocks of time off because I’m not diligent enough in my time management to take advantage of them for creative pursuits—I need regular time off.

So a four-day workweek combined with healthy vacation is a great mix. When you combine my eight weeks of PTO and my four-day workweek, you end up with the equivalent of like 17 weeks off, which is, of course, phenomenal.

From a partnership perspective, this is also a strong way to handle staffing in that the fifth day off is not a guarantee depending on who’s on vacation and how the lists are, but it allows for our division to be flexible accomodating shifting workloads, scheduling PTO even one day at a time, and staffing/recruiting.

This is to say, I don’t always get that fifth day off—but I do most of the time. And when I don’t, I just get paid extra for working.

But when people ask how I have time to write, that’s certainly part of the answer. 1I wrote this last Thursday while sipping my Cometeer iced coffee (p.s. help me, I’m running out).

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My situation is, of course, mine. My wife became an attending when I was a senior resident, and we’d already returned to be near our families for residency. We weren’t going anywhere. I wasn’t canvassing the country looking for the most magical of all possible jobs. I was looking for the best job for me in the Dallas area, and I was trying to achieve that combination of work variety, location variety, and schedule flexibility.

There’s nothing wrong with different kinds of radiology practice. Different strokes and all that. But I will admit that when I was a trainee deciding between staying in academics at my home institution and joining a traditional, typical private practice, I couldn’t shake the feeling that I wasn’t excited about either choice/extreme. I feel very fortunate that the chance to do something in the middle was available where I was looking.

(And yes, we’re hiring.)

In his 2023 book Decisions about Decisions, Harvard Law School professor Cass Sunstein offers this advice: Rather than concentrating on the probability of being right or wrong in a decision—which is often impossible to determine due to the intrinsic uncertainty and the unpredictability of the future—focus instead on comparing the cost of being wrong with the benefit of being right. These factors, according to Sunstein, are easier to estimate without the need for forecasting outcomes.

Applying this very logical argument to using high-quality AI tools for diagnostic medicine, we come to a straightforward problem as fleshy, fallible humans: the logical course of action is to agree with any plausible AI answer and only contradict the machine in cases of undebatable error. This is true for potential liability, but it’s also true just for saving face generally.

If the goal is to maximize accuracy or quality, one can imagine a world where a human radiologist interprets a scan independently and an algorithm interprets a scan independently. If both agree, then we’re done. If those two evaluations are in disagreement, then a third party—either another human or a different algorithm with different parameters—steps in to adjudicate the disagreement. (We could, of course, have that initial AI product itself be the result of a debate between multiple algorithms, but you get the idea.)

There is no guarantee that such a combination would be an improvement, but it’s a plausible outcome that will, of course, be studied. However, the effectiveness of such an approach remains uncertain. How much would such a system genuinely enhance diagnostic accuracy? Surely, it would be a moving target, but would such human-AI collaboration genuinely enhance accuracy or would it be awkward source of complexity and hamstring the needed efficiency gains. It certainly wouldn’t look very good if the third party nearly always sided with one source.

Potential Outcomes of AI-Human Collaboration

There are several possible outcomes:

1. The human is usually right, and the addition of the AI does not create a significant change.
2. The AI is usually right, and the addition of a human does not create a significant change.
3. The human is usually right, but the AI results helps catch what would be unequivocal bone-headed mistakes.
4. Both the human and the AI are usually right, but in cases where they disagree, a third-party adjudicator adds additional value by catching edge cases with higher frequency than either individual alone. If nothing else, the third party creates the system that is needed to handle discordance.
5. Alternatively, the combination could result in overall reduced accuracy. For example, the AI is almost always right, but the uncertainty of human disagreement actually reduces the overall accuracy.

That will be studied. Yet, reality could be complex—we may find that AI’s strengths and weaknesses differ across imaging modalities, patient populations, or specific pathologies. AI may be great at breast screening but terrible at most MRI. Or the opposite. The optimal balance between AI independence and human oversight may depend on more or different variables than we’d suspect. Or not. Why pretend to know?

The Likely Commercial Model for AI in Radiology

The commercial reality is that the sort of AI utilization I just described is unlikely to be the primary solution for handling the radiologist shortage or maximizing profitability for stakeholders unless it’s a rule. The more likely scenario is that AIs will churn out preliminary reports of increasingly high quality, which a human radiologist will review, make changes to, and ultimately be liable for.

This shifts the radiologist’s role from a thoughtful creator and analyst to more of a quality inspector—checking for plausibility rather than deeply analyzing every case. When the AI is reasonable, the human will likely agree. When the AI makes an obvious mistake, correcting it won’t require much effort from the human. Obvious contrast mixing in a pulmonary artery is not a thrombus. Calcified lymph nodes are often chronic findings, etc. A clearly benign breast lesion misclassified as a potentially malignant tumor may be easy for an experienced mammographer to catch, especially if that mammographer has access to priors and context that the AI does not.

It’s easy for many observers with a vested interest to believe that their magical subset of skills will be particularly thorny to emulate, and some may even be right.

Even the quality inspector assumption presumes a relatively stable and predictable level of AI performance. How confident should a human be in their assessment when there is disagreement if the AI is improving while the human is mostly stagnant? What if AI-generated reports vary significantly in quality for different use cases? Scrutiny may be hard to employ judiciously in a piecemeal fashion.

Regulatory agencies could impose strict requirements for human oversight that make the process more labor-intensive than expected, and those requirements could be either reasonable or stupid over the short, intermediate, and long term. AI adoption will depend not only on technical feasibility but also on evolving legal, ethical, and financial pressures.

The Risk of Automation Bias

But what will radiologists do when the AI calls a focal asymmetry that the radiologist would not have called? We’re getting there already. If the AI is usually right, the human being will almost certainly just agree with whatever it says as long as it’s plausible—because the risks of agreeing are negligible, but the risks of incorrectly disagreeing are high.

How foolish will you feel calling a mammogram normal when the AI suspects a mass—with its black-box, pixel-based approach that detects patterns beyond and different from your human understanding? No one wants to get in the way, so no one will disagree and take on the liability of calling a case negative when the AI has flagged it as positive in an otherwise usually accurate system.

That’s the reality we need to live in. That’s what we’re going to see unless we specifically craft one to prevent it.

That’s going to be a big problem—because all the commercial and workforce pressure will push us toward utilizing AI tools in ways that practically ensure automation bias becomes the single biggest challenge facing radiologists in the near future.

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 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).

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

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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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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: 3^rd 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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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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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):

Positions (Remote):

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

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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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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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.

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

Learn more at https://www.vrads.com/
Contact: recruiting@vrads.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 August I launched Independent Radiology as a resource for the broader community, a dedicated private practice radiology job board with 150 groups so far. If you’re in the market, please also check it out for your job-hunting needs.

In Give and Take, Adam Grant divides people into three types: givers, takers, and matchers.

• Takers try to get more than they give.
• Matchers aim for even trades.
• Givers help without expectation.

Grant argues that givers are both the most and the least successful (because people like givers, but they are also the easiest to take advantage of):

“Givers are overrepresented at the bottom and the top of the success ladder.”

Radiology practice is no exception. The culture is the people, and it arises organically from the people in the organization working within the constraints of the clinical work.

Picker of Cherries

Consider cherry-picking in radiology:

• Takers cherry-pick to get more RVUs, easier cases, or both.
• Matchers behave appropriately, unless they are working with known takers or see taking behavior, since people generally don’t like being taken advantage of.
• Givers read down the list and jump on the grenades left over by the others. This can result in looking less efficient by various metrics.

Conditional Behavior

The reality is that people’s behavior is both variable and domain-specific. Someone may run amok on the list but be willing to do tedious extra administrative work that no one wants to do. Someone may be a huge team player at the hospital when they’re part of a small group where they feel seen, but a bad actor when part of a massive shared list.

We need to acknowledge that 1) hiring matters, 2) culture matters, and 3) we should try to build better systems that make it easier for people to behave nicely and win.

It’s impossible, even in easy times, to hire right all the time. The solution, in the old days, was to make partnership contingent on good behavior (and, sometimes, high productivity). The problem of course is that, like tenure, that doesn’t fix sloth or selfishness among partners. And certainly in the current market, dropping people when staffing is tenuous isn’t trivial when the work has to get done. Rug pulling too often would seriously harm a group’s reputation, and warm bodies don’t grow on trees.

Workflow-wise, too many metrics and too much surveillance are extremely toxic. No one wants to have their movements tracked like an Amazon warehouse worker to make sure their bathroom breaks are industry-conforming. But the reality is that an open list where you select your next case is a big temptation for takers, and it only takes a tiny sliver of takers in an organization to spur the suboptimal behavior of matchers. That leaves everyone feeling like a distrusting victim.

Giving, More Broadly

Not all giving is equal. And not all of it scales.

“Being a giver doesn’t require extraordinary acts of sacrifice. It just involves a focus on acting in the interests of others.”

Matching is about dividing the work pie fairly, but giving often involves other gifts of time, energy, knowledge, skill, and emotional support. Teaching is a gift. Administrative duties like committee work, medical directorship, and practice leadership often disproportionately fall on givers. The “reward” for doing these tasks well (or even just being willing to do them) is often being given more responsibilities.

We can’t let giving be a suckers game:

“If you don’t protect yourself, giving can be dangerous.”

Give to matchers, and you build reciprocity.
Give to givers, and you build culture.
Give to takers, and you burn out.

Takers exploit. Matchers track. Givers build.

We need systems with guardrails to ensure that opportunities for exploitation are rare and that bad behavior can be policed effectively. If your group is using independent contractors for list support, that might mean giving them access to only a specific list or specific cases instead of letting them graze freely.

The problem is that if takers dominate, everyone becomes a matcher. Generosity becomes naïve. Trust becomes weakness. And the whole system corrodes.

“The more often people give without strings attached, the more others start to match their generosity.”

Practices thrive when givers can lead with open eyes and no remorse.

Here’s a little compilation of posts from the last few years about getting started as a new radiology resident.

Transitioning

Scan by Scan is an essay about starting in radiology.

Doing

Approaching the Radiology R1 Year and its short companion post: How to be a First-Year Radiology Resident.

Want something a little more controversial? You Should be Correlating Clinically.

Learning

Book Recommendations for First-Year Radiology Residents (and some further recommendations for when there’s extra book fund to burn).

You can round that out with some more general thoughts on studying during residency. Then try my deeper dive: ultralearning radiology.

Iterating

Some important considerations for getting better every day.

Getting and making the most of feedback. Also, a few more words about your self-worth as an early trainee.

Lastly, radiology call tips (which are also helpful every day).

Efficiency & Ergonomics

There’s a lot you can and should do other than just using whatever is plugged into your workstation, but this post for trainees is a start.

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Also, residents from across the country in the ACR Resident and Fellow Section came together and assembled a nice collection of free radiology learning resources from across the interwebs including lots of videos.

Headset vs. Handheld vs. Fixed Microphones

There are three main form factors for microphones in the context of a radiology setup.

You can hold a dictaphone, as radiologists have done since time immemorial. You can wear a microphone like a headset. Or you can have a microphone that is not in any way on your person.

There are pros and cons to each solution.

The pro of the old standby handheld microphone is that it contains dictation controls, allowing you to manipulate dictation software with your nondominant hand. As I’ve discussed elsewhere, this is the wrong solution for efficiency and for ergonomics. The limitations of the built-in dictaphone tools are too numerous for it to be the right answer—even though it is the default solution.

I believe every radiologist should drop the dictaphone and use something else with their off hand. An off-hand device like the one I use can more effectively manipulate both dictation software and PACS and is less likely to cause repetitive strain or ulnar neuropathy.

An off-body solution has the benefit of freeing up your hands while also remaining plug-and-play. The microphone stays where you put it and just works when you log in. No effort needed and—with the right microphone—can be very effective.

There are infinite options. The Rode VideoMic NTG, a shotgun microphone I attach to my monitor and point at my face, has been my home dictation solution for several years now. It is efficient, effective, and works every time. I find it effortless and surprisingly resilient to slouching. The main downside to that solution is that you are still somewhat more susceptible to ambient room noise and posture.

For some radiologists, the preferred solution is a headset microphone, which has the added benefit of moving with you so that it always accounts for position regardless of where you are relative to your desk and is less susceptible to ambient noise.

While you could also use a lav mic clipped to your clothing, but a headset also allows you to use headphones with your computer, meaning you can handle meeting requests like Zoom/Teams and listen to music without needing a second device.

For many years, headsets for dictation functionally required a wired USB connection, as Bluetooth and wireless dongles were simply too unstable, slow, and choppy for dictation accuracy. But if you don’t mind a little lag, that is no longer the case.

Headsets, like headphones more generally are very much a personal preference thing. I included several fan favorites in the equipment post, but my preferred headset solution is these Shokz bone-conduction headphones, specifically the Shokz OpenComm2 UC for several reasons. This style has become very popular with runners because you can’t lose them as easily as earbuds and you can still hear the ambient world around you for safety (I still like the AirPods Pro 2 with transparency mode).

One perk is that the Shokz are incredibly light and comfortable for long periods of time. Over-ear headphones can feel hot and are often heavier, resulting in fatigue over a long shift. There was a time as an early attending that I often used a cheap wired Plantronics headset, but I actually usually wore them around my neck with the mic arm angled toward my mouth for comfort. I think the over-the-ear behind-the-head form factor is overall more comfortable for long-term use. The Shokz are light enough that it’s basically possible to forget you’re wearing them, which I would say is ideal.

The bone-conduction pads on your tragus are non-intrusive and do not block ambient noise. This can be both a pro and a con—in the sense that if you are working in a loud place (such as next to the magnet or at home while doing laundry), you are not going to block out the room noise.

But it also helps if you want to deploy a headset while working with other human beings and wanting to be able to hear the noise around you. It means people can talk to you, and you can hear them—and that you can answer the phone and still use a receiver without needing to remove your headset.

So, for some work situations, this is ideal.

The battery lasts for a long time (reported 16 hours of dictation, 8 hours if playing music), though one downside is that the charging cable is proprietary—so you’ll have to keep the cord handy for charging (it fits in the included carrying case). A 5-minute quick charge provides 2 hours of talk time. I haven’t had battery issues yet, but since the tiny battery inside is like literally every other lithium battery in the world, I expect this to degrade eventually.

You can connect via Bluetooth, but it also plugs in easily with a USB-C (or USB-A) dongle that is safely secured in the carrying case. My understanding is that the quality with the dongle is slightly better.

If you are looking for a portable solution that reliably works, allows you to use them as functional headphones and attend Zoom/Teams calls—but also doesn’t isolate you from the rest of the world—the Shokz is, I think, a good solution for radiology.

A couple of very important limitations:

1. There is a slight lag when activating dictation, where you might notice degraded accuracy at the beginning of a phrase. You really need to use toggle on/off controls and not the deadman switch, and your accuracy will be way better if you just keep dictation turned on while reporting. Once dictation kicks on, transcription speed is fast and accurate. I think you will need to break the habit or toggling dictation on/off repeatedly for every discrete phrase or you will hate them.
2. Audio quality is lower when you’re actively using the microphone dictating, so if you are toggling back and forth all the time it’ll keep switching between higher and lower fidelity modes. It’s annoying. Bone conduction headphones aren’t audiophile quality anyway, but you’ve been warned. Because your ears are uncovered, if you don’t mind looking like a psychopath, you can keep AirPods in your ears while wearing the headset, which means you can have incredibly flexible audio input/output between your computer and cellphone. I wouldn’t listen to music via them while working.

I’ve been using the Shokz as an alternative to my cheap desk-clamp-to-hold-the-dictaphone method when at imaging centers, which allows for some more position flexibility (and the chance to channel your inner telemarketer.)

If you don’t need the headphones part of the headset but want something portable, you might instead try a lavalier format like the wireless Hollyland M2S.

It’s easy to measure radiologist productivity in terms of RVUs per hour.

What’s harder to assess is how efficiently a radiologist reaches that production number—both cognitively and psychologically.

I’ve written a lot about the biomechanical side of reducing friction in the radiology workflow: better input devices like programmable mice, off-hand keypads, and simple AutoHotkey scripts. But there’s another important piece—minimizing distractions and maintaining momentum from case to case.

On the macro shift level, you can have so-called bunker shifts free of technologist and clinician phone calls and other external distractions. Literature has shown, big surprise, that on the whole, people read more if you don’t interrupt them. But there are two issues with that:

1. Talking to people is part of the job, at least some of the time.
2. You can still distract yourself.

Auto Advance

One simple but powerful tool is AutoNext or equivalent automatic case-loading function in your worklist manager. When you sign a case, the next one opens automatically.

This reduces the liminal space between cases—those tiny gaps where your monkey mind looks for distraction, dopamine, or the occasional excuse to manipulate a shared worklist to avoid difficult or low-RVU studies.

(We can however acknowledge that automatic case selection/loading can increase the feeling of being on an endless hamster wheel, but overall I still believe it’s ultimately effective in removing some useless clicks and unnecessary decisions.)

Enough with the Email

Another low-effort win: don’t keep your email open in a browser tab. Just closing the tab dramatically reduces the urge to check email every five seconds between cases, especially when you can see the unread message counter climbing.

We are always looking for an excuse to disengage when a task gets hard. Your phone may be in your pocket, and you may need to be reachable, but it’s still better to batch-check email sporadically than to leave it constantly accessible.

Phone Just Out of Arm’s Reach

I need to be able to answer the phone. Anyone who needs me generally is going to call my cell or text, and I also forward the hospital phones to my cell phone when covering from home. This is one reason why I often keep an AirPod or two in my ears most of the time when I’m working alone: I can hear and answer the demand without needing to have my phone on my person. Just a little friction can go a long way.

Creating vs Editing

One feature I’ve come to really appreciate in my practice is access to a team of human editors (the imaging center pays)—someone who helps input clinical histories, contrast details, catch template mismatches, and fix obvious transcription errors. They’re not perfect, and they certainly don’t always make big changes, but the value isn’t just in the edits themselves.

What the editor allows me to do (only when I’m on an outpatient list) is separate the diagnostic report creation task from the editing task. I can read multiple cases in a row, focusing on interpretation and moving efficiently down the list—then switch into editor mode to proofread and finalize my reports. I catch more of my own mistakes with those few minutes of temporal distance.

This separation is key. Constantly switching back and forth between different cognitive modes creates attention residue (not to mention editing fresh words is always a challenge as your mind often sees what you meant to say and not what’s actually there).

While avoiding distractions like email, phones, and messages is intuitive but challenging, task batching is an overlooked opportunity (obviously only when working on non-time-sensitive cases). Diagnostic, then editorial. Not both at once. It’s a subtle shift, but I’ve found that when practical it makes a real difference in my focus, efficiency, and effectiveness.

I’ve been fielding job questions via email over the past months and after my talks at RSNA, ACR, and ASNR, so it seemed like the easy solution was to collect some responses here for dissemination (instead of trying to turn them into a bunch of separate posts).

As always, no one has to agree with me.

Private Practice

Is private practice still viable?

and

If private practice is so great, then why are so many groups struggling and failing?

See my answer here.

Teleradiology & Locums

So many people seem to want to do teleradiology, is the stigma/taboo gone?

The taboo is absolutely gone in the sense that you won’t be shunned, but I think many groups still find tele to be a necessary evil brought on by market demands. Off-hours swing/overnight work aside—where I think there is absolutely a growing realization that there is a very important and meaningful unique value in providing that service just like there is for driving around and doing fluoro—I think people generally find it frustrating and would be happier if they didn’t have to resort to hiring for it.

To be clear, everyone loves a hybrid work schedule, and almost everyone wants to work from home sometimes. But hiring 100% remote rads to absorb remote work often means a greater fraction of on-site work for local rads and an altogether different kind of easily comparable job.

This often results in functional dual-class structures in order to create fairness between on-site and remote rads etc. That might be no remote partners. That might be higher RVU requirements. That might be less pay. It varies.

I suspect that, over the long term, cultural dilution may be a real problem, and I’m not sure it isn’t intrinsically destabilizing for the field. I suspect we will see multiple larger tele practices opening up and grabbing business. Things are so hot that they can get great rates from desperate hospitals. I don’t know how sustainable any of this is.

Is the teleradiology trend temporary?

Overall, I think the teleradiology trend is real and not going anywhere. And at least for those willing to do off-hours work, like evening swing shifts and overnight, the demand for those services will probably never go away so long as humans are involved in interpreting diagnostic imaging. I think for the foreseeable future, there is really no reason why anybody needs to be on-site for most of those jobs.

For better or worse, there is a growing contingent of people, including fresh graduates, who want to have that same lifestyle experience during the daytime. Part of that cohort are those who are unhappy in their current positions—fairly or unfairly—and looking for greener pastures but don’t want to uproot their families and move. I do think some of that trend may go away if we do see significant efficiency gains with the coming radiology products over the next few years. Some of the AI stuff is hype or won’t change productivity, but some of it is absolutely real. You don’t need to replace a radiologist to completely change supply and demand in the workforce.

If an organization becomes fully staffed or—hard to imagine—overstaffed, the first person to go is the remote, employed or (especially) contractor, daytime-only-no-weekend teleradiologist.

I think one question becomes, if that happens, how much of a chilling factor does that lead to for the tele market and does it create an opportunity to create meaningful on-the-ground jobs again in radiology? Right now, nobody wants to do the work of practice building, procedures, and other personal touches. I think the COVID era broke a lot of residents’ brains and has made many completely discount how important meaning and connection are to long-term satisfaction. I think those residents have taken the physical component of the job for granted and don’t realize how isolated they will be working from home all the time.

Yes, work-life balance etc is better as a remote worker. The lack of a commute is a huge deal. I absolutely do like working from home for a fraction of my job. And I absolutely think that in 2025, even many happy local rads are essentially demanding a hybrid schedule. But there is a difference between regularly or frequently working from home and always working at home.

I think at least some young radiologists are chasing a good job but perhaps not building a meaningful career. I’m not sure that is a great long-term plan for life satisfaction for a 30+ year career for everyone making that choice, even if it does unquestionably make your life easier day-to-day. At the same time, we shouldn’t paint with too broad a brush either; there are obviously individuals who are much, much happier working 100% remote for a wide variety of personal reasons, and certainly not all 100% remote jobs are the same. If nothing else, simplified school logistics alone are huge.

Anyway: different strokes, and all that.

It seems like locums folks are making great money, is that what I should be doing?

Many hospitals are fine paying high rates temporarily out of need but are terrified of agreeing to a healthy long-term. Part of this is organizational dysfunction in the sense that ultimately the managers’ skin in the game is limited: overpaying out of necessity isn’t their fault, but signing a costly contract makes them look bad (and they worry about ripples across the org). This is compounded by, I think, a willful ignorance of the state of the market (which more are coming around to now). Needless to say, I think this particular strain of management is shortsighted.

No doubt, you can make good money as a mercenary right now and for the foreseeable short-term future. The question is, when things shift, can you find yourself good employment or are you left out to dry with slimmer, less-desirable pickings? Nailing the landing could be hard or it could be a total non-issue. But the nature of locums is that you can usually make more money—especially if you’re geographically or temporally flexible—because you’re trading safety and stability in order to fill those urgent, well-paying coverage gaps. Nothing wrong with that as long as you acknowledge the tradeoff.

Training & Mobility

Do I Need to Do a Fellowship?

To get a job? Absolutely not. There are jobs right now for fresh trainees without a fellowship.

To get a specific job? In many cases, yes.

There are plenty of places—both groups and hospitals—that still want fellowship training for radiologists, whether that’s because the paper has actual value, because the marketing of said paper has value, or because they want specific skills that are hard to get on the job without some pain or investment and are easier to build on with that additional foundation.

It’s not unreasonable for residents to ask themselves the fellowship question—especially since, while many radiologists don’t necessarily do a lot of deliberate learning on the job outside of gradual improvement with experience, we do know that we can learn new things if we want to, even outside of the confines of a residency training program.

If you want to forgo a fellowship and there’s a place you want to live—especially if you’re willing to be in smaller or more rural areas—it makes sense to ask those groups.

It makes sense to go look at job listings (on Independent Radiology, for example) and see if there are options in the right spot.

If it’s not clear from the internet, then start the real job search early, put feelers out, and find out if people are willing to give you a job that you actually want without additional training.

The follow-up question is always: “But what happens if I don’t like that first job?”

And to that, I have no idea.

There are certain situations where fellowship is permanently important. For example, there are some hospitals and places that truly do want to have CAQ-holding neuroradiologists on staff, and that is something that is challenging to achieve without playing the game.

But in many other situations, multiple years of experience should matter more than how you spent a single year a decade in the past.

So the reality is: if you stay in your first job for five years and then move to another one, is anyone going to care that you didn’t do a body fellowship?

I would think not—but I couldn’t say for sure. Probably depends on how subspecialized you’ve been in practice and what your skillset actually is. Fellowship is certainly a terrible proxy for skill, but it is still widely used.

I think if you do take a job and you hate it and you want to quit within a year—that might be more awkward. But as long as the radiology shortage persists, I think you’ll have some flexibility on that front.

What’s the downside if I hate my job and leave it?

Well, for one, it’s sad—and it means that you probably didn’t enjoy yourself while you were working there.

Logistically, it means you’ll probably have to deal with a non-compete, which could mean either working in a different geographical area—possibly needing to move—or entering the remote teleradiology workforce.

Now, you may not mind working 100% remotely, but for those who were hoping to have support, connection, and community (particularly in their early career), that may be less fun.

If you’re interested in becoming a partner in a private practice, it means you’re going to have to restart that path when you get your next job—which again may not even be possible if you’re working as a teleradiologist. Given the relatively short workups these days, this is less of an issue today than even just a few years ago.

There may be some mostly minor benefits issues: delayed 401(k) access, potentially lost 401(k) matching, giving back signing bonuses, paying for tail insurance, and other such things.

In reality, all of the financial considerations can be handled, mitigated, and dealt with—and none are the end of the world.

If you are a remote employee leaving your current gig to be a remote employee somewhere else, the downside obviously is mostly just that breed of transient hassle, maybe learning a new system, etc. There’s no reason for us to pretend that in our increasingly mobile workforce that swapping tele gigs necessarily carries a huge cost. The musical chairs that teleradiology enables is one of the reasons the market is so crazy right now.

Mammo

What on earth is going on in breast imaging??

High demand and low supply, coupled with typically high reimbursement and productivity of breast imaging.

An increasing share of trainees have been drawn to breast by the market. Of course, many are intrinsically passionate or want a patient-facing job without the IR lifestyle and stress, but we should also just acknowledge that some are chasing the perceived chill of well-paying jobs with no evenings, weekends, or call. For this latter group, I am somewhat more concerned, if only because picking anything based on the current state of idiosyncratic and unpredictable market forces seems like a pretty poor decision metric.

(But, as long as they won’t be disappointed when things change, obviously it can be a very fulfilling career even if it wasn’t some deep-seated passion. I think passion is highly overrated. Breast imaging isn’t going anywhere, and the personalized patient counseling component and procedures remain critical healthcare tasks that are obviously deeply meaningful to both doctors and patients and not as prone to outsourcing or AI disruption.)

We currently live in a world where “telemammo” is definitely a thing, of course in part to remote diagnostic coverage at far flung centers but also capitalizing on screener volume and specifically tomo to allow for things like really well-paying 4-day 100% remote breast jobs without call. Some of that is often remote diagnostics with actually talking to patients variable/optional and all procedures driven to either centralized on-site staffed locations or to specific days when coverage is present. (I haven’t done any breast imaging since training, but I will admit I honestly don’t get the idea of breast imaging with essentially zero direct patient contact.)

As a semi-outside observer of women’s imaging, I think the opportunity for disruption there is extremely high, and the odds of those jobs staying the way they are–often “higher” pay and “better” lifestyle than other rads–is perhaps the least likely status quo to remain completely unchanged. For one, we aren’t done seeing screening reimbursement cuts, especially for tomosynthesis, which I’m told is currently the biggest financial driver for enabling all these shenanigans.

To top it off, the corporate footprint in breast imaging is large (Solis, SimonMed, RP, etc) and the economic case for AI for these companies is huge. If you ask around about AI in radiology, it’s AI for breast screening that really gets these folks salivating. And that’s because AI-enabled improvements to productivity and efficiency for screening mammograms could be more easily economically profitable compared to essentially any other part of diagnostic radiology.

Give me an AI tool that provides a frequently signable report like an upper-level resident, and that will make me more efficient, yes, especially for certain things such as radiographs, but the reality is that me reading twice as many radiographs doesn’t yield massive RVU gains or windfall profits. Thanks to the BIRADs reporting structure, breast imaging is already the most standardized written report of anything in all of radiology. If AI-generated reports were ready to click and go for the majority of screeners with a well-calibrated callback rate—and there are no breast-specific legislative rules preventing their use as an autopilot, which of course there could be—then I think that would move the needle. I don’t do any breast imaging and only vaguely know the volumes in play with the current shortage, but I would suspect that it wouldn’t take a massive efficiency gain (20%?) to fundamentally change the supply and demand that has led to these lifestyle positions that have essentially derailed recruitment and retention throughout radiology, especially when it comes to young rads.

I am not exactly sure why no one is talking about this, but I’ll admit I was hesitant to include this part in the Q&A. Because to be clear, I’m not saying breast is “easy” or that breast imagers are going to be replaced first or any nonsense like that. Obviously nothing on the market right now is anything other than an improved CAD, so nothing is happening currently. I certainly don’t put stock in my predictive capabilities, but I do think this recent post-tomo status quo with breast over the past few years is the least sustainable part of the radiology workflow, if only because with the money at stake and the narrow task, the opportunity for disruption is too high (but yes, on an unknowably multiyear timescale). Either a change to reimbursement or productivity or both could easily substantially adjust the sweetheart offers of these employed and private-equity positions that are driving the market.

I don’t know when, and I don’t know if breast will actually be affected more than other subspecialties with AI, because it’s possible that radiology capabilities of the coming vision-language models will be satisfactorily broad across the whole field. I do know companies are looking at mammo as the exciting thing they’re willing to actually pay money for in AI. Anyone can see that the current tools are overhyped and brittle, but it’s also a mistake to assume that everything is and will remain vaporware, especially for narrow diagnostic tasks.

Of course, how things get deployed and what guardrails are put in place are total unknowns, and the timeline and scale of reimbursement changes are a constant battle.

But to answer the question: in addition to body/general radiology skills, breast is the most in-demand subspeciality. For now.