Field Notes from the Rad Race (Conclusions on Choosing the Right Practice Type)

Field Notes from the Rad Race (Conclusions on Choosing the Right Practice Type)

I’ve come to the conclusion of this series on choosing the right practice type. This blog post covers a few last noteworthy trends in the radiology employment market, and sums up some key points to keep in mind as you assess the different practice types and make decisions about your radiology career path.  Finally, I’ll round it up with 100ccs of common sense and a pinch of your elders’ wisdom. 

Nighthawk positions

Although nighthawk radiology is not an ACR-defined practice type, it has increasingly become an attractive alternative model of practice.  Hospitals and radiology groups have increased the number of nighthawk radiology opportunities in the last five years so that all their radiologists wouldn’t have to work nights and weekends.  Nighthawk has become another radiology subspecialty within academic, private practice, and other types of practices. The hours are commonly 7 PM to 7 AM Monday through Sunday, with one week on and one or two weeks off.  In some cases, radiologists may split the night shift, working 4 PM to 12 AM or 12 AM to 8 AM, one week on and one week off [1]. Salaries are often similar to or higher than those of non-nighthawk radiologists. If the early bird gets the worm, the nighthawk gets the bacon (plus some decent time-off).

Radiologists who fill nighthawk positions are drawn to the opportunity to have large blocks of time away from work to pursue other professional or personal activities.  The nighthawk radiologist has been likened to a hospitalist. Hospitalists cover the hospital so that other physicians can perform only outpatient work. Nighthawk radiologists cover nighttime hours so that other radiologists can work only during the day.  Nighthawks may be stationed at one hospital but provide night and weekend reads for other hospitals. The volume can be challenging, averaging 120-150 reads during a 12-hour shift [1], resulting in a high rate of burnout. That’s roughly a read every 5 minutes for 12 hours! 

Practice consolidation

Practice consolidation is a subject that has come up frequently over the course of the previous blog posts across all practice types—as it is a trend that impacts the entire radiologist workforce. To put it simply, there are fewer, but increasingly bigger radiology group practices. 

Show me the numbers, you say? In 2014, 30,492 radiologists were affiliated with 4,908 group practices.  In 2018, 32,096 radiologists were affiliated with only 4,193 practices, representing a 14.6% decline in number of groups over 4 years [2].  This reveals a significant, and growing shift of radiologists from smaller- to larger-sized group practices and an associated decrease in the number of unique practices with which radiologists are affiliated.

While this trend is impactful, it doesn’t necessarily spell bad news for young radiologists or that the corporate-sponsored-mega-healthcare-system-apocalypse is upon us (yet). Indeed, the consolidation of smaller groups to larger groups actually offers many benefits.  

Larger radiology groups benefit operationally and financially from economies of scale, are likely to have greater access to capital and technology, and are better positioned to participate in population-based care, alternative practice models, and federal and private payer value-based payment programs.  Consolidation may facilitate large-scale quality improvement initiatives and standardization of care pathways. A larger number of radiologists are better able to subspecialize. Larger groups have greater market power and leverage when negotiating payer contracts.  

Of course, it’s not all skittles and beer. As large groups become attractive to radiologists, especially those more recently finishing their training who value flexibility, stable salary, and other lifestyle considerations over practice ownership, the remaining smaller practices in rural or other underserved areas may have difficulty in recruiting new members [3].  And many radiologists are concerned with how the trend of corporatization may affect the future of radiology practice.

Bigger picture view

It should be noted, the trend towards consolidation isn’t just occurring in radiology.  The American Medical Association (AMA) Division of Economic and Health Policy Research has conducted a Physician Practice Benchmark Survey in every even year between 2012 and 2018.  

Data reported included whether physicians were owners, employees or independent contractors with their main practice; the practice type in which they worked (e.g., single or multi-specialty group); how many physicians were in their main practice; and the ownership structure of their main practice.  

2018 marked the first year in which there were fewer physician owners (45.9%) than employees (47.4%). The report also showed that while the distribution of physicians had been shifting toward large practices and practices that were hospital-owned, in 2018 40% of physicians still worked in practices that were both small (10 or fewer physicians) and physician-owned. [4].

Key considerations when choosing a practice type

There are important differences among the various practice options [5].  Trade-offs among job security, autonomy, requirements for efficiency and productivity, compensation, and opportunity for subspecialty practice should be considered when evaluating different practice options.

A person’s professional and personal needs change with time and the variety in practice types offers an opportunity to shift from one type of work environment that worked early in one’s career to a different type more suitable to the middle and end of one’s career.  

Bear in mind, considerable overlap exists among the different practice types and the once clear distinctions that defined one type over another are becoming increasingly blurred. Trainees should take this last point into consideration as they evaluate any job opportunity. 

Choosing a practice type is a major decision, but it’s not an all-determining, irrevocable one. In reality, any practice type you choose is going to have pros and cons, involve aspects of the job you love and certain aspects you dislike. Down the road, you may find a different practice type is a better fit for where you are at in life or you may just plain change your mind—and that’s okay.  

A person’s professional and personal needs change with time. The variety in practice types offers an opportunity to shift from one type of work environment that may have worked early in one’s career to a different type more suitable to the middle and end of one’s career. Radiologists often change jobs during their career and switching between one type of practice to another is not only feasible but common.  

Keep sight of what’s true and what really matters. Life is messy and imperfect; your career path may take unexpected turns, have ups and downs you could never have envisioned, but the future is always still yours to create.  

Go forth, do good work, be a good human—and of course, stay rad. (Note: someone else suggested that last line – I’m not that cool.)


  1. Kaplan DA.  Job market looks good for radiologists.  Diagnostic Imaging.  August 24, 2017.  Available at:  Accessed July 2, 2019
  2. Rosenkrantz AB, Fleishon HB, Silva E, Bender CE, Duszak R.  Radiology practice consolidation: fewer but bigger groups over time.  J Am Coll Radiol 2019; in press and available online at:
  3. Kirchhoff, S. M. (2013). Physician practices: Background, organization, and market consolidation. Washington, DC: Congressional Research Service.  Available at:  Accessed July 2, 2019
  4. Kane CK.  Policy Research Perspectives Updated Data on Physician Practice Arrangements: For the First Time, Fewer Physicians are Owners Than Employees.  American Medical Association. 2019. Available at:  Accessed July 5, 2019
  5. Dutton SC, Sze GK, Lund PL, Bluth EI.  Radiology practice environment: options, variations, and differences – a report of the ACR Commission on Human Resources.  J Am Coll Radiol 2014; 11:352-358


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