Choosing a Career after Radiology Training: Academic, Private Practice, or Industry?
Introduction
A frequent question facing graduating residents and fellows is “academic radiology or private practice?” Trainees today have plenty of job opportunities in light of the radiologist shortage and increasing demand for imaging 1. Moreover, radiologists are at the forefront of technological innovation in health care, and their skill set is highly sought after in industry. The Paradox of Choice , a psychological phenomenon suggesting that more options can lead to greater mental effort and anxiety 2, may be relatable to many trainees. In this article, we summarize our interviews with four radiologists to help trainees make a more informed career choice.
Academic Radiology
Most trainees are familiar with academic practice. Academic institutions provide education, research, and leadership opportunities, allowing radiologists to identify a niche and become highly skilled in their field. Its mission has broad appeal because education and research advance the field and are “effort multipliers.” The nature of academic practice also fosters more avenues for scholarly pursuit. Cases referred to academic centers tend to have higher complexity with fewer time constraints during interpretation. Together with the high volume of subspecialty examinations, they allow staff to build greater domain expertise. Moreover, many radiology departments provide dedicated research resources with opportunities to collaborate closely with colleagues and clinicians. The scholarly experience and professional network, in turn, lead to greater representation on scientific committees and journal editorial boards, allowing academic radiologists to establish themselves as authoritative voices in the field.
Many departments offer up to 1 day per week of unfunded academic time. Researchers can fund more time through grants, which can be broadly divided into intramural (eg, department, hospital, or university level), governmental (eg, National Institutes of Health, Department of Defense, Agency for Healthcare Research and Quality, Patient-centered Outcomes Research Institute), societal (eg, Radiological Society of North America [RSNA], American Roentgen Ray Society, and various subspecialty societies), philanthropic, and industry. Institutions provide varying levels of support for academic endeavors, and prospective employees should clarify departmental practices with existing staff before accepting the position.
Owing to its broad scope, achieving excellence in all aspects of academic radiology may be challenging. Moreover, residency and fellowship programs prepare trainees for clinical practice. Trainees who decide to pursue academic radiology early in their education can apply to programs that provide opportunities for structured research training, such as the American Board of Radiology Holman Research Pathway, RSNA Resident and Fellow Research Grants, or residencies and fellowships with built-in research tracks. Trainees can also consider exploring the various research and teaching opportunities—if offered by their programs—to develop a niche. Conferences and networking events can also help trainees connect with mentors who can guide them toward their professional goals. Because research projects can be time-intensive, trainees should ensure that such endeavors do not supersede their clinical training.
Academic radiology is not without drawbacks. Producing high-quality educational and research material may require more than the dedicated time afforded by departments and grants. Together with the increasing volume of examinations, this may lead to burnout as radiologists attempt to juggle scholarly activities alongside greater clinical responsibilities, with little personal time to spare. Despite this, academic radiology remains a popular option for graduating trainees, even among those who intend to join private practice, because the first few years of independent practice are often perceived as an extended training period, when junior attendings continue to accumulate experience and build confidence in collaboration with mentors and colleagues.
Private Practice
Approximately 53% of radiologists in the United States work in private practice 3. Group sizes vary widely, from solo practice to numbering more than 100 staff, with groups smaller than 50 staff being the majority 4. The most significant appeal of private practice is probably the combination of competitive salaries and longer vacation time 5. Private practice groups are also perceived as more efficient because members have greater autonomy to implement initiatives that improve patient care, clinical workflow, and the business model. The workload is generally characterized by a higher volume of cases with lower complexity, and subspecialty-trained radiologists can still interpret general radiology studies, with the broad range of cases appealing to many. Speed and accuracy are especially valued, and most groups have compensation models that associate productivity with income.
Private practice jobs can be divided into employee and partnership (shareholder) tracks. Partnership-track associates invest in building the practice. They may work on a reduced vacation schedule and receive lower compensation than employees. Associates also take on additional responsibilities similar to those of partners, including handling hospital contract negotiations, regulatory and compliance matters, collections, informatics, quality assurance, and accounting duties. Such ancillary skills are often acquired on the job. Therefore, adaptability and taking the initiative to fulfill nonclinical roles are essential. Some practices may also expect associates to contribute financially through equity buy-in. In most cases, the effort and monetary contributions translate into ownership of the practice, and partners eventually make significantly more than employees.
Because private practice groups are fundamentally businesses, graduates must consider that a portion of the group’s resources will be devoted to ensuring its profitability, resulting in a culture that may not always align with their career objectives. In particular, the trend of private equity (PE) ownership in U.S. health care has reshaped the landscape of private practice. PE-backed acquisitions have increased significantly over the past decade, resulting in mixed to negative effects, including reduced physician job satisfaction, lower quality of care, and increased cost 6,7. However, the decision between joining a radiologist-owned practice versus a PE-backed corporation is not always straightforward, as radiologist ownership does not always lead to a healthy work culture, and partnership-track associates may risk time and financial loss in case of a future PE buyout. In some cases, graduates who prefer certain geographic areas may find that PE firms have already penetrated a significant portion of the market 7, leaving few alternatives.
In recent years, several trends in the United States have narrowed the distinction between academic radiology and private practice, including PE corporatization, Medicare pay cuts, and the global radiologist shortage. Private practices are experiencing a loss of autonomy and more subspecialization opportunities from consolidation and PE buyouts. At the same time, academic centers are seeing greater volume and a need to increase revenue and productivity. Both have experienced a decline in inflation-adjusted reimbursement 8. Overall, these trends have resulted in fewer radiologists choosing private practice 9.
Industry
Motivations for radiologists to seek industry opportunities include a desire to discover another niche or acquire interdisciplinary skills, a serendipitous opportunity, current job dissatisfaction and burnout, or a significant life event. The extensive training required to be a radiologist is best applied in clinical practice, where these skills are essential and put to their fullest potential. However, this should not be a limiting factor if switching to an industry career aligns with one’s interests and ambitions. Moreover, many physicians possess excellent communication skills, adaptability, and grit—traits that enable them to flourish in any profession. One should also not be hindered by the lack of additional qualifications, as many skills can be learned in school or on the job.
The possibilities for an industry career are vast 10. In recent years, the adoption of artificial intelligence (AI) has also bolstered its appeal and created new opportunities for radiologists. Aside from traditional careers in health care administration, consulting, insurance, and pharmaceutical companies, the radiologist’s skill set is also valuable in domain-specific fields such as AI, picture archiving and communication system (PACS) development, clinical trial imaging support, and health informatics.
Despite the many opportunities, there is also a high level of competition, and success entails innovative thinking, management skills, and industry-specific knowledge. Before making the switch, one should reflect on their personal and career objectives. Once a purpose has been defined, there are many books, coaches, and online resources to help guide one toward their destination. New graduates may wish to consider accumulating a few years of academic experience, as the clinical, research, and publishing skills can be advantageous for certain roles in imaging or pharmaceutical companies and technology start-ups. One may also consider negotiating with their new employer to engage in part-time clinical work—if feasible—to maintain professional connections and skills.
Embarking on an industry career may be unconventional, but it offers unique opportunities for skill development and personal growth. There is no one-size-fits-all trajectory, and a decision that reflects personal values and interests will significantly enhance job satisfaction and overall happiness.
Final Thoughts
Although the myriad of possibilities after graduation may invoke anxiety, few life decisions are permanent, and trainees should embrace their learner role to build a solid knowledge foundation, with which a rewarding career will follow. Even though income is a significant consideration in the job search, trainees should also reflect on other equally important factors, such as cultural fit, scope of work, geographic location, and personal goals. Finally, there is no standard approach to establishing a successful career. As trainees enter the job market, leveraging their unique skills, embracing the diversity of opportunities, and staying true to their values will pave the way to a fulfilling professional journey.
Acknowledgments
We would like to acknowledge our interviewees: Laura Oleaga, MD, PhD, neuroradiologist at Hospital Clinic Barcelona and Scientific Director of the European Diploma in Radiology; Adrian Gonzalez-Aguirre, MD, interventional radiologist at Memorial Sloan Kettering Cancer Center and Associate Director of the Interventional Radiology Fellowship; Timothy Klostermeier, MD, musculoskeletal radiologist at the University of Cincinnati Medical Center; and Matthew Lungren, MD, MPH, Chief Data Science Officer at Microsoft Health and Life Sciences.
