Pay and Partnership in Radiology Practices

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In the past, many radiology private practices used a fairly traditional (and extended) track leading to full partnership in the practice. Now, however, many practices are exploring emerging compensation models—including accelerated partnership tracks and enhanced flexibility in balancing earnings and hours—to accommodate the needs and preferences of a new generation of radiologists. Making these changes without antagonizing established partners is particularly difficult in some practices, so considerable finesse, patience, and communication skills will often be required.

For practices seeking physicians, it really is a buyer’s market right now. Many physicians are coming out of training now and finding that there are fewer jobs to be had, partly because physicians have become more productive. In addition, advances in health IT (such as PACS) have made it possible for fewer physicians to cover a given geographic area.

A recent look at the ACR® Career Center ( www.jobs.acr.org) gave me an indication of the subspecialties that are now in highest demand. The top four fields, based on the number of job openings, are breast imaging, neuroradiology, musculoskeletal radiology, and teleradiology. The only surprise here is teleradiology; its position as the fourth most requested subspecialty tells us not only about the growth of teleradiology itself, but about the ability of teleradiology companies to get radiologists to work for less compensation than they might once have expected.

Some of us will remember that in the early 1990s, practices were discussing how they were going to raise the starting salary for radiologists from $120,000 per year to $144,000; there was a lot of heated debate. Today’s radiologists are typically seen starting at $250,000 to $300,000 per year and ramping up from there.

Under the traditional model of the partnership track, radiologists could expect fixed compensation and benefits for their first and second years of working with a practice. Partnership was usually offered after the second or third year, depending on the supply of available radiologists and the demand for their services.

The third year offered fixed base compensation plus a bonus that was based on a percentage of the practice’s earnings (but was not equal to the full partners’ bonus). During the fourth year, the radiologist earned base compensation plus the full bonus distributed to partners.

Today’s partnership track in radiology looks quite different in its early phases, although it reaches the same point—base compensation plus the full partners’ bonus—during the fourth year. In effect, the first and second (bonus-free) years of the old model are being skipped, and the third year, under the traditional system, is being extended to last for the first three years of work.

The radiologist begins working with the practice in exchange for base compensation plus a percentage of the partners’ bonus. Based on the results of quarterly performance evaluations, partnership is often offered at the end of the first year. During the second and third years, the bonus percentage is increased annually, reaching the full amount in the fourth year.

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Table . Example of an evaluation form used for quarterly assessment of newly hired radiologists.

This is a way of spreading risk, since the fixed compensation is a smaller amount and the bonus percentage depends on the financial health of the practice. If there are revenue problems, the practice will be responsible for paying a lower amount than it would have paid under the traditional partnership model (which had larger fixed compensation and had smaller—and later—bonuses). The risk borne by the senior shareholders is spread, in this way, to the newcomers as well.

In addition, the practice’s efficiency and income can benefit when making an earlier offer of partnership becomes the norm. If the practice knows, by the end of the first year, that it likes a new radiologist, offering that person partnership status can inspire greater effort on that physician’s part—by making him or her a stakeholder (as well as a shareholder). The new partners in a practice are more willing to bring forward new ideas, and they are more likely to participate in the committees and governance activities of the group.

Evaluating New Radiologists

The earlier a partnership in the practice is offered, however, the more certain the practice must be of the new radiologist’s abilities, qualifications, and general