Last updated: 12/2008

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. . . Issues for the 21st Century . . .
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Business and Medicine

For several years, the radiologist is in training, learning the Medicine part. Years of grueling stress and pressure, striving, reaching. Days and days, even weeks and weeks, working straight through, up all night, etc. And often with no interim day off. It?s been all about Medicine. Years and years spent learning clinical medicine.

Now it?s time for Business, serious business. It?s time to look at the business side of the medical profession. It?s time to the learn how to venture out into the practice of medicine, how to implement all those clinical skills into a successful clinical practice, a practice which can sustain you and your family for the length of your career.

For the young radiologist, the job search may be the first introduction to the business side of the medical profession, after several years spent on learning the clinical side of the medical profession. Years are spent on the clinical aspects of the profession and virtually no time spent on the business side.

Initially, job hunting may seem like a lark, a delightful relief, like selecting candy in Fowler?s Confectionery. We assume there is no wrong choice. But the assumption does not dissuade us from due diligence, does it? We analyze the candy selection, taking much delight while gazing at the marvelous candies on display. Great fun.

Au contraire, job searching is not a visit to the candy store. Bad choices are easily made when job searching. Due diligence is the mantra. Look under every rock, or at least understand there is rock under which you should look, and have not looked. Slice and dice the prospective jobs into several parameters and compare them objectively, absent the rose colored glasses. Done properly, the analysis can make the selection oh so sweet, with the radiologist being nicely matched to the new employer. Absent a thorough investigation, disaster may be the outcome of the job search. To wit, job searching the second time is much less fun than the first time.

Pushing the metaphor, it?s very possible to be unhappy walking out of Fowler?s Confectionery. Spend some thoughtful time at the candy counter before you select. Spend more time, more thoughtfully, in the job search.

Let us help you help yourself.

Forward

At the end of my residency in 1975, CT scan and ultrasound were coming on line, to the great excitement of most of us. For sure, we didn't fully understand their value, but we were excited by the new technology. All kinds of predictions were made about the future of these modalities.

Some submitted that pneumoencephalography would be supplanted. Imagine that. No more pneumoencephalograms!

Regardless of the imaging modalities themselves, what we failed to understand at the time was the potential value of the fundamental piece of equipment at the heart of these modalities. We did not realize the great potential of the computer. We did not see the value of data management and analysis, the basic applications of the computer. We only saw the outcome of the computer's analysis - we saw the subdural hematoma, the CVA, and the SAH. We saw the gall stones, and the in utero fetus.

To be honest, these new modalities and the computer were not tops on the list of daily chatter at the time. Rather, we spent more time fretting about the job market. Everyone wanted to know where everyone else was going after the residency, and why they are going there. By and large, the answer was location, location, location. While there were minor differences in the jobs themselves, the variations were considered minimal or insignificant. It was basically about location. Jobs in those days were hospital based, and not particularly complicated. Do the work, do it well, do it efficiently and on time. The job was straight forward, predictable, even boringly so.

So there we sat, with the ACR's job posting, waiting for the next monthly updated listings. Our interest was focused on the job market. The fancy new CT and ultrasound modalities were pleasantly interesting, but of secondary interest compared to the necessity of finding a job.

Unbeknownst to us at the end of our residency, we were witnessing the ignition of an explosive growth of the computer in medical imaging. Multi-slice helical CT, digital subtraction, MRI and PACS may have been a research scientist's dream, but they were not on our radar screen at the time. For us, looking for a job was the big deal, and the looking was location, location, location. Move back home, move to the mountains, move to NYC, etc. Don't worry about new imaging modalities; they will catch up to us, wherever we move.

In the ensuing decades, computer technology and applications have expanded geometrically. Computers no longer merely make images. Now, they are basic to image storage and retrieval (PACS), demographics, reports and billing (RIS), and even dictation of reports (digital dictation, voice recognition). Everywhere we turn in the imaging dept., a computer is involved.

The growth of the computer in imaging has resulted in a huge expansion in the business of imaging. The monetary requirements to develop an imaging service have risen dramatically over the years, such that medical imaging is no longer a mom and pop business. The landscape of medical imaging is no longer a simple medical office in the local medical arts building. Rather, it has become a sophisticated business with marketing, management, cash flow projections, and hard work. Personal loan guarantees (ugh!) are not uncommon. Millions of dollars can be invested in a medical imaging office, and cash flow demands can be huge with the employment of a full cadre of supporting staff to keep the business afloat, and the cash flowing. Mom and pop are seen less frequently these days, being replaced by more sophisticated business types.

Since the business of medical imaging has changed so dramatically, job hunting is no longer a question of getting the ACR's job posting and doing the location thing. Nowadays, it may be about looking for a job with a corporation, much as your friend may have done when he looked at Kodak or Dupont, General Electric or Boeing. Nowadays, it's about looking at the corporate structure of the prospective employer while, at the same time, looking at the professional aspects of the job. Does this new job have a strong corporate structure and a valid business plan? Is this entity going to hold together long enough to meet your professional and non-professional needs? Would you be willing to invest your hard earned cash in the company at the time of partnership buy in? Or would the NASDAQ be a safer bet? How about the mattress or the cookie jar?

For the class of 1975, life was simpler. We needed to know income and location. Most other issues were only distractions. What, we would have asked, is corporate structure, and who cares anyway? We were not going into business. We were going out to practice medicine. In those days, the two did not coexist.