Roads Less Traveled: Don’t Overlook These 3 Practice Types

Here’s a quick refresher: this post is one of a series of blog posts that delves into some key distinguishing aspects of the 6 different radiology practice types, as defined by the ACR. In previous posts, I took an in depth look at the 2 most common types of practice—private practice and academic practice. 

In this post, I’ll venture into less populated territory and explore 3 more radiology practice types for you to consider.  While fewer radiologists may go into the following practice types, they are not without their own distinct benefits. Challenge your preconceptions—it’s good for you. 

It’s okay to take the road less traveled. It’s also okay just to read the bullet points of key takeaways listed at the end of each section (but keep it to yourself). 

Hospital-based practice

ACR definition: radiologists or ancillary personnel are employed by a hospital, an entity affiliated with a hospital (e.g., a foundation), or an entity developed by a hospital to work with or employ a physician.

The percentage of radiologists employed by a hospital in 2018 was 12% but has been as high as 22% in 2015.  A radiologist can be employed directly by a hospital or by a hospital medical foundation. A prominent example is Kaiser Permanente, which is an integrated managed care consortium providing care to its member patients through hospital-based employed physicians.  As of 2017 it operated in 8 states and the District of Columbia and was the largest managed care organization in the United States.  Its radiologists and other doctors are salaried rather than paid on a fee-for-service basis.  Radiologists are employees and have very little autonomy. Salary, benefits, and hiring are determined centrally.  However, the radiologist’s job is relatively secure as the patient population is guaranteed and competition is eliminated.  

Key takeaways

  • Salaried
  • Greater degree of job security 
  • Little autonomy 

Multi-specialty or academic clinic

ACR definition: radiologists or ancillary personnel are employed by an academic clinic such as the Ochsner Clinic, Mayo Clinic, or Cleveland Clinic.

A multispecialty practice is somewhat of a hybrid between an academic and private practice setting.  Radiologists are members of a large group, not just the radiology department, and are generally employees of a large foundation.  As with hospital-based practices, decisions regarding salary, benefits, and hiring are centralized. Radiologists become senior employees of a large group of multispecialty doctors.  They may have input regarding expansion and equipment purchases, but only so far as they have a seat on the committee that makes decisions on capital expenditures for the whole group.  This is very similar to how capital expenditures are determined in an academic setting.  

Also similar to an academic setting, there can be considerable emphasis on scholarly activity, depending on the institution. However, radiologists are not offered tenure, and promotions and salary are most commonly based on clinical productivity.  In addition, some multispecialty groups may be associated with a medical school and/or have residency programs, allowing radiologists the opportunity to teach and assume leadership roles in education.

Key takeaways

  • Salary usually based on clinical productivity 
  • Opportunity to teach, leadership roles
  • Emphasis on scholarly activity 
  • May have some decision making input 

Government (VA or military)

ACR definition: radiologists or ancillary personnel are employed by the government, including the VA and military institutions.

Government radiology practices range from active military service and civilian employment within the Veterans Affairs (VA) to county, state, and other federal agencies.  Radiologists are generally salaried with compensation based on rank, seniority, specialty, and reenlistment. Like hospital-based employment, the position is relatively stable as the patient cohort is guaranteed and there is little competition.  

VA radiologists have opportunities for teaching and research activities at large medical centers, similar to academic radiology.  Advanced leadership opportunities are available earlier in one’s career compared with civilian practice environments.

VA jobs have emerged as being more desirable than previously considered, with reasonably high pay, lower academic responsibilities, and preservation of lifestyle.  The clinical volume is generally not as high as it is in private practice and often there are no call or after-hours responsibilities. The generous benefits associated with a VA position can partially compensate for lower salary, particularly for the radiologist who practices long enough to earn a pension.

Key takeaways

  • Lower salaries, but generous benefits
  • Greater degree of job stability 
  • Research and teaching opportunities
  • Offers more lifestyle flexibility 


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