As most markets are, the job market for physicians is fluid and is subject to shifts that can be either gradual or abrupt. At Merritt, Hawkins & Associates, Irving, Texas, we track these shifts in our annual Review of Physician Recruiting Incentives, which we have been compiling for 15 years. The review includes a breakdown of the recruiting incentives that our clients offer to physicians in a variety of different specialties, including radiology. National in scope, the review suggests which physician specialties are in particular demand and whether the salaries and perks that employers are offering are rising, falling, or merely treading water. Merritt, Hawkins’ 2008 review, which covers the 12-month period from April 2007 through March 2008, reflects a trend that is gradual, yet significant. Over the past several years, the demand for radiologists, as indicated by the number of search assignments that Merritt, Hawkins receives, has declined. For 2005–2006, 237 assignments were received; for 2006–2007, 187; and for 2007–2008, 109. The average annual salary or income guarantee offered to radiologists by our clients has increased over the same time frame. This figure was $351,000 for 2005–2006, $380,000 for 2006–2007, and $401,000 for 2007–2008. One explanation for these two trends is that the types of radiology recruiting assignments that Merritt, Hawkins carries out have changed. Several years ago, we commonly received assignments to recruit multiple general radiologists on behalf of a group or hospital. Today, we are more likely to be retained to recruit a single radiologist in a subspecialty area, such as neurointerventional radiology or mammography. While overall demand in radiology has diminished, demand for specialized radiology services remains robust, and employers are willing to pay more for these services. Partnership and Time Off In a more abrupt shift, recruiting incentive packages in radiology have become cleaner. Radiology groups and hospitals are simplifying their offers, with typical packages including a salary of $400,000 and a one-year partnership track. Signing bonuses and production bonuses are notably absent from these contracts. Recruits know exactly what they will make, and there is no ambiguity about the timeframe or terms for partnership. There are exceptions, and candidates still can be offered production bonuses or immediate partner income (though usually without voting rights). Today, however, candidates may find that their income prospects are better when they remain employees and do not have to support costs as partners in a group. Some candidates even prefer longer partnership tracks of two years in order to avoid the responsibilities and risks of partnership. Over the past year, we have seen paid time off in radiology remain steady at 8 to 12 weeks per year. Having 16 to 18 weeks off, which was not unusual several years ago, is a rarity today. Paid relocation (average allowance: $9,800), paid CME (average annual allowance: $3,900), malpractice insurance, and retirement/401k remain standard components of most contracts. To date, the Deficit Reduction Act (DRA) has not created a significant impact on the permanent physician-recruiting market, though that may change in coming months as more groups feel the pinch of declining collections. The Market in Locum Tenens The DRA has had a more pronounced effect in the locum-tenens job market. Prior to the DRA, Staff Care (a locum-tenens staffing company allied with Merritt, Hawkins) offered radiologists a daily rate of about $2,000 (radiologists and other physicians working as locum tenens are independent contractors who can negotiate the daily rates that they are paid.) Today, Staff Care offers a daily rate to radiologists in temporary positions of about $1,500, with paid transportation, lodging, and malpractice insurance offered in addition to per-diem pay. Due, in part, to the effects of the DRA, some radiology groups can no longer afford the extended vacations of 16 to 18 weeks that they previously covered with locum tenens, and this has led to lower rates. Groups, however, still find using locum tenens to be a practical way to provide specialty services such as mammography and interventional radiology, as well as a cost-effective way to maintain services while recruiting permanent candidates. Despite the dampening effect of the DRA, imaging volumes continue to increase. Technological innovations in imaging, an aging patient population, and defensive medicine should ensure that utilization remains high. While incentives will undoubtedly fluctuate, the underlying market for radiologists should remain strong for the foreseeable future.