Super Careers: Radiology from Start to Finish

Go to school. Work. Retire. It’s the standard cycle of a career. For radiologists, technologists and radiology administrators, however, while the beats may be familiar, the melody is ever-changing. A new focus on value is altering practice for some mid-career, while those just starting out are facing a different job landscape than previous generations. Increasingly, those nearing retirement are having to push back the finish line. Whether you’re finishing school or already have many years on the job, here’s what the experts are saying about having a successful career in imaging.

The Starting Line

The radiology job market has had its ups and downs over the past two decades. In the late 1990s, there was talk of a surplus of workers, though a combination of economic factors quickly reversed that trend, resulting in a shortage by the early 2000s.

Now, the script has flipped again. About 1,000 radiologists enter the job market each year, but fewer radiologists are retiring.

“When you have more coming in and less going out, that’s going to be like a balloon filling up,” says Sanjay Jain, MD, MBA, founder of RadXperts in Washington, D.C., and a regular speaker on issues in healthcare. Due to the recession and a series of sharp reimbursement cuts, older radiologists are delaying retirement, making the job market tighter for those starting out now as opposed to periods when the number of new radiologists more evenly matched retirees.

Jain says things are getting better, but it definitely doesn’t hurt to take steps to position yourself for success as early as possible. Last year, the American College of Radiology (ACR) Task Force on Medical Student Education in Radiology teamed with the Alliance of Medical Student Educators in Radiology (AMSER) to offer recommendations to improve medical student radiology education. Their suggestions were based on surveys sent to medical school deans and radiology department chairs and were published in the Journal of the American College of Radiology.

Ultimately, the ACR-AMSER made six recommendations:

• Radiologists should acknowledge the expansion of expectations surrounding medical imaging education. Exposure to medical imaging education taught by radiologists should be implemented and increased at every chance.
• Medical school leaders must identify radiologists as the “go to” faculty members for medical imaging teaching. This can be achieved by lobbying for fundamental medical imaging concepts to be taught by radiologists, identifying educational opportunities for medical students to directly observe radiologists’ role in patient care and considering utilization of social media and points of student access beyond the realm of formal medical school curricula.
• Shift medical imaging education earlier in medical school curriculum. Students exposed to radiology in their preclinical curricula are less likely to hold negative stereotypes about the profession, so radiologists should be aggressively promoted as integral to every anatomy course. Additional preclinical courses in which imaging is used or could be integrated should also be identified. The creation of a radiology interest group for junior students may be helpful, as well as offering increased availability of digital imaging resources.
• Radiologists should offer a uniform message and experience at all institutions. Integrated medical imaging training across all four years of curriculum and a nationally recognized core imaging curriculum—with didactic and digital interactive materials and easy access—should be adopted. A required radiology-led medical imaging clerkship should be instituted in the third year of schooling. Direct patient contact should be emphasized.
• Adopt standardized measures of student competency in medical imaging. ACR-AMSER’s survey revealed a need for standardized assessment tools, which may be acquired by supporting the testing of students on basic principles and concepts using nationally available resources.
• Medical student education should be a top priority for radiology chairs. Lack of clinical faculty time and department cost affects implementation of more comprehensive radiology education programming. To avoid this, department chairs should be encouraged to develop and support an education track for faculty promotion within their programs. Faculty membership in professional organizations that promote educational material development and collaboration should also be supported.

Another factor for educational institutions and their students to consider is the growing need to communicate with patients. As the face of healthcare changes and the mantra of patient-centeredness takes hold, many will expect radiologists to directly communicate with patients.

This will be a challenge for those accustomed to the old-school practice of radiology, where meeting patients was not an expectation. Navigating proper implementation of patient portals—where patients will have easy and quick access to results—and discussing difficult diagnoses will understandably bring a new kind of stress for those who are unprepared.

Students and those early in their career should seek out workshops that involve simulations or role play to build up their comfort level with patient communication, whether they are discussing a normal finding, a more serious diagnosis or other difficult topics such as radiologic errors and radiation risk.

Positioning for Potential

Those with more years under their belt also should seek continuous improvement, especially in light of the challenges facing radiology. Jain notes the constant scrutiny of imaging and reimbursement reductions of recent years as an example. Much of this was brought on by a boom in the early 2000s where non-radiologists increasingly got involved with imaging. Family practices, orthopedics, oral surgeons and many others invested in imaging equipment, which likely led to some degree of self-referral.

“Everybody bought imaging to supplement their practice,” says Jain.

While that trend has started to reverse, commoditization of radiology still looms. When patients—and also administrators—fail to understand the full value of a radiologists as physicians, imaging services risk being seen as an interchangeable commodity. Instead of respecting the consultative role of radiology, people may perceive it in a more mechanical sense—in goes a scan, out comes an interpretation. Most consumers won’t care what’s going on behind the scenes.

That is, unless radiology does a better job at making them care. Jain says radiology must think differently and be more aggressive in identifying and, perhaps more importantly, publicizing the value it brings to the table. This means more robust social media campaigns, email marketing and updating of websites to be mobile-compatible. Instead of thinking about marketing in a business-to-business sense by focusing on relationships with referrers, radiology needs to adopt a business-to-consumer model by reaching out directly to patients.

“We’ve been really slow to adapt to the rest of the world,” says Jain. “There are so many marketing avenues, we haven’t even hit the tip of the iceberg yet.”

Instead of being seen as the physician who sits in a dark room all day, radiologists need to re-brand. Jain says imaging should be seen as the “roadmap to disease” and radiologists themselves might be akin to the Grand Central Station of the care team, given that so many specialties rely on imaging.

“Who doesn’t go to a radiologist?” asks Jain. “That should be considered a strength. Interacting with so many other specialties creates opportunities for medical administration.”

On a more individual level, those working in imaging need to position themselves for potential and prepare for the unexpected, says Bruce W. Hammond, CRA, FAHRA, of TheCailcoGroup in Fort Worth, Texas.

“You need to be responsible for you and where you’re going. Think outside the box,” he says.

Hammond stresses that technology is moving at such a fast rate and can be so disruptive that we’re in a state of continual technological revolution. For example, only one company used to market portable ultrasound, now it’s a standard. In only about seven years, smartphones and mobile devices have completely changed the way people communicate, including physicians.

The rapid rise of the smart phone and other devices is why radiologists shouldn’t scoff at futurists who discuss topics like 3D printing or nanotechnology, says Hammond. Devices can go from seemingly distant science fiction to reality quickly, and imaging professionals need to be prepared for whatever technology comes along.

This is why Hammond recommends diversifying your education, whether you are a technologist, a radiologist or an administrator. Most people in radiology, he says, could probably tell you everything about CT—specs of the latest models, common indications for use, protocol considerations. The problem is they ignore everything else. Their education is solely focused on the medical or scientific side of the equation.

Hammond suggests studying business or economics to gain a better understanding of the financial aspects of medicine. The ACR also now offers a fellowship in scholarly publishing, for those wishing to move in the direction of getting more involved in medical journalism. Jain is author of the book “Optimal Living 360: Smart Decision Making for a Balanced Life,” a New York Times bestseller. There are many paths to choose from.

If you are in department administration, get your Certified Radiology Administrator certificate. Pay attention to industry publications like Health Imaging and stay connected to the pulse of the field through social media.

“Position yourself to be promotable,” says Hammond. “Don’t position yourself as indispensable, because if you’re indispensable, you’re unpromotable. You can be the best radiology director in the world, but that doesn’t mean you’ll ever be in the C-suite.”

Radiology department heads need to be able to talk competently with a CFO, while also working with the people below them to train them.

“You aren’t the director of radiology,” says Hammond. “You are the CEO of medical imaging at your facility. Go act like it.”

When to Call it a Career

Eventually, every career comes to an end. The question is, when?

For some practicing radiologists, that time has been delayed. A recent survey from Moriarity et al, published in the August 2014 issue of Academic Radiology, found that while the most desired age for Baby Boomer generation radiologists to retire was 60-65, less than 30 percent expect to retire at that age.

While the economy has slowly improved since the Great Recession, the economic damage done during that period put a serious damper on many retirement plans. Housing values fell 33 percent and pensions suffered losses of 30 to 50 percent in some cases. The response was to keep working; in 2010, only 1.5 percent of healthcare workers retired, compared with about 4 percent per year the decade prior. Radiologists fell in line with this trend. According to a report from the ACR Commission on Human Resources’ Subcommittee on Retirement, 7 percent of practicing radiologists are over 65 and some 7,000 radiologists aged 56 to 65, a period when some choose to scale back practice in lieu of other pursuits, are still practicing full-time.

Despite the preference—or necessity—of some radiologists to work beyond age 65, about 10 percent of groups have mandatory retirement ages and nearly one quarter of those that do set that age at 65, according to the ACR.

While there are some trends, there is no “normal” retirement age for radiologists, according to Donald Bachman, MD, radiologist at MetroWest Medical Center, Framingham, Mass., who spoke on retirement issues at the 2014 annual meeting of the Radiological Society of North America (RSNA).

“You can’t make generalizations,” he said. “We age at different rates, our emotional construct is different, our personal lives are different.”

Financial concerns might keep people on the job, but so does a sense of value and contribution to society. Bachman said a happy retirement means finding something to fill the 50+ hours per week a radiologist was working, and that pursuit of other interests and a gradual transition makes sliding into retirement easier.

But can a radiologist lose his or her edge? Bachman noted that state boards discipline older physicians at a higher rate; more than 6 percent of those working 40 years after medical school are disciplined compared with just 1 percent for those under 10 years out from school.

“The practice of radiology has physical, cognitive and personal challenges for all of us, and age-related changes really provide further domain-specific challenges,” said Stephen Chan, MD, an academic radiologist at Columbia University in New York City and member of the RSNA’s professionalism committee, who spoke along with Bachman at the meeting.

Vision declines for everyone, said Chan. A 60-year-old’s retina receives about one third as much light as a 20-year-old due to increasing lens opacity. Cataracts, which cause cloudy vision, fading color and glare, are common. Half of 65-74 year olds and two thirds of those over 75 develop a cataract, which Chan described as insidious because often people don’t notice the changes right away.

Cognitively, radiologists are better off than most. Because radiologists typically possess higher intelligence, they have more cognitive reserve and exhibit little cognitive slowing as they age, according to Chan.

A study of mammography interpretation performance conducted by Miglioretti et al and published in the December 2009 issue of Radiology found that performance steadily increased until a radiologist had about 20 years of experience. Between 20 and 24 years, there was an increase in false positive rate (odds ratio 1.43) but also an increase in sensitivity (odds ratio 1.84). Chan noted, though, that as radiologists get older, sensitivity dips again while false positive rates remain elevated.

To stay as sharp as possible, as long as possible, Chan recommended a balanced diet with regular exercise and stimulating mental activities such as games or puzzles.

As Bachman noted, a gradual transition into retirement may make things easier for senior radiologists, and it also has the benefit of allowing practices to bring in newly trained radiologists, who can learn from those with more experience. The ACR Commission on Human Resources suggests phased retirement and part-time work as possibilities, as well as job sharing, which is similar but involves two radiologists sharing a single full-time equivalent position by splitting the hours (and the compensation). Senior radiologists could also help fill in gaps in night call and off-site branches.

The key at all phases of a career is to have a plan and execute it. Plans may change, as they did for those nearing retirement whose assets evaporated when the economy tanked, and technology or healthcare policy may impact those already on the job, but by taking reasonable steps to prep for the unexpected and position for potential, a fulfilling career in imaging awaits. HI