A recent survey of early-career radiologists in March’s Journal of the American College of Radiology found that younger docs are overwhelmingly turned off by corporatization in the specialty. The findings may fly in the face of common conceptions that millennial doctors prefer the comfort of employment at a large national entity, said one author of the study.
Radiology Business recently spent a few minutes with the lead writer behind the analysis—Daniel Ortiz, MD, who conducted the poll as a fellow at UC San Diego, and is now a first-year radiologist in private practice in Cartersville, Georgia.
Ortiz discussed what interested him in this topic, why he believes its “unethical” to keep a practice’s ownership plans secret from interviewees, and his belief that late-career radiologists should avoid taking the "golden parachute” at the detriment of others. What follows is an edited transcript of our discussion.
Radiology Business: What motivated you to want to look at this trend? Talk about the spark for the survey?
Ortiz: Personally, my motivation stemmed from my role at the time two years ago as the vice chair of the resident and fellow section at the American College of Radiology. I heard a presentation from a private equity investment expert talking about how 'millennial' physicians preferred to be employees and did not want to deal with the business of medicine. My personal feeling and the feelings of those around me differed substantially from that characterization. The literature cited was for all physicians, including many specialties that are predominantly already employed. I didn't feel like this was an accurate reflection of radiology trainees. [Study coauthor and radiologist] Arvind Vijayasarathi, MD, MBA, personally faced the negative impact of a private equity-backed buyout of the practice in which he was a partnership-track associate. His time invested in the group was not accounted for in the buyout and he was left with minimal options. [Study coauthor] Lawrence Muroff, MD, is a long-term private practice radiologist who has made a substantial part of his career helping private practices engage in sustainable business practices to support independent practice as a consultant.
Radiology Business: Are you surprised at all by the results?
Ortiz: As I transitioned to chair of the RFS and looked more into this topic, I heard of more and more stories of junior radiologists making life decisions based off of false premises provided to them in an interview, only to realize that their 'sweat equity' would not yield the long-term benefit that they were willing to sacrifice upfront for.
Radiology Business: What is the one takeaway that you hope radiology business leaders will get from this survey?
Ortiz: I want radiology business leaders to not discount junior radiologists in the business and leadership of the practice. Junior radiologists are eager to continue the robust culture of radiology independent practice. We are willing to adjust and innovate, but this does not have to entail giving up our autonomy. We are constantly bombarded with the idea that all of medicine is consolidating and we have to consolidate to compete. Truth is there are many opportunities to achieve comparable outcomes of scale that the national private equity-backed practices claim to include locoregional collaboratives or [management services organizations].
Radiology Business: How would you describe the practice by some of hiring early-career radiologists, but not informing them of the potential acquisition of the practice by a national entity? It sounds like the team thought that this is not a good way of doing business.
Ortiz: I think this is absolutely unethical. If these private equity-backed practices are as good of a deal as they claim to be, then they should be willing to be open with applicants to the practice. Interviewers and practices should not present the practice as is, but rather present the practice as anticipated after any anticipated acquisition.
Radiology Business: A JACR editorialist described radiology’s corporatization as a “burning platform.” Would you agree with that sentiment?
Ortiz: I don't believe the 'ship has sailed' on independent private practice. I believe the 'doomsday prophets' paint the picture of the environment to best support their practice model. I think groups, instead of selling their autonomy, should look to vendors to support the pain points of their practices. There are plenty of business and IT solution companies out there. If your practice is not happy with their services, you can always switch companies. You lose that option when you sell to a private equity- or venture capital-backed national organization.
Radiology Business: Any avenues for further investigation following this survey?
Ortiz: At this point, I'd like to see how the next couple of years pan out. History and data suggest that investor-backed companies will hold on to medical practices for about seven to nine years. Given the age of several of the major players in the market, the next few years should provide some interesting developments. I'd like to see how these future developments impact junior radiologists, especially as the stock options begin to mature for the senior partners who sold their practices.
Radiology Business: Anything else you’d like to add that we haven’t discussed?
Ortiz: I want trainees to go into interviews with eyes wide open. Ask the hard questions. Press the group members about their perspective on this consolidation trend, and how the group plans to adapt. You should not be viewed as a lesser applicant for asking these questions; rather, I believe you should be viewed as engaged and mindful. If a group has a problem with you asking these questions, then you probably don't want to be in that group. For the junior radiologists finding yourself in a practice that's selling, be cautious with the stock options as a carrot to keep you in the practice. These are risky investments. For practice leaders, think long and hard about the legacy you want to leave for your practice. If you spent years building it, let that legacy shine on with proper succession planning and give the next generation the same opportunities you were afforded, rather than taking the 'golden parachute' on your way out at the expense of everyone who follows.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.