Is a Pay-Per-Click Safety Net an Option for New Rad Jobs?

I have written a couple of columns in the past about my lack of thrills over pure per-click employment models in radiology. Even the term “pay per click” rankles me a bit. It’s not the type of job I’d want for myself, all other things being equal.

I know this from personal experience. I spent a little over seven years of my career working for what was then the biggest corporate per-click player in the radiology world. That was partially due to the lousy job market in 2011, which gave me few options. It was also my reaction to previous jobs with salaried systems that failed to reward productivity.

Living by the per-click sword showed me ways I could be cut by it. Even that big telerad entity wasn’t always able to supply me with a full work list. Sometimes there just wasn’t enough imaging to keep all the radiologists busy. Sometimes technical problems or even scheduled maintenance would interfere. Whatever the mechanism, there were more than a few instances when I had no options for clicking.

It didn’t seem right. There I was, a professional manning my station and because my employer wasn’t giving me any work, it was not paying me a penny for my time. The employer was the one having issues, but I was suffering the consequences.

Such circumstances recurred often enough over a course of years. I was far from the only rad pointing this issue out to the group’s leadership but there was never corrective action. It didn’t take much cynicism to note that those leaders, unlike us, were salaried so they weren’t sharing our pain.

They didn’t say anything memorable in defense of the status quo. They claimed that, in the grand scheme of things, there really wasn’t much down time so this was not a big deal.

Maybe it wasn’t a big deal to them but when you are the rad whose livelihood depends on churning out RVUs, any moment you’re prevented from doing so feels like an injustice of the first order. This is especially the case when the company’s whole model is based on the notion of maximum efficiency, which they point to when trying to justify the bargain-basement values they assign to their imaging studies. “You’ll make it up on volume” rings hollow whenever you don’t have access to said volume.

Furthermore, most rads seeking to optimize their productivity will tell you they get into a certain rhythm, a “zone,” when they’re reading one study after another. That gets disrupted if the work list is suddenly empty or unavailable, even if just for a fraction of a minute.

Fast forward to the present day. Regular readers of this blog know that I’ve been on the hunt for a new job, after spending three years with a non-per-click gig that followed the one I mentioned above. For job seekers, the market is currently rife with juicy targets. Is it akin to shooting fish in a barrel? Maybe but one doesn’t want to be job hunting again in a few years. This is even more reason to thoroughly investigate all opportunities. Be as certain as possible that one’s next destination is the absolute best.

That said, I have looked at some per-click gigs. For the most part, they don’t stand much of a chance in my considerations. Every now and then, a potential gig turns up with features that turn my head. Some of these benefits include particularly good values for cases, nice schedules, and future upside potential (partnership, etc.).

But there is another change from when I moved to per-click in 2011: I’m older and somewhat wiser. Approaching a per-click gig, I now ask whether the prospective employer has what I’ve come to refer to as a “safety net.” This would be some logistical mechanism for circumstances in which, as result of issues at my employer’s end, I cannot read cases.

It doesn’t have to be huge. Would I like my downtime to be paid pro rata, equal to my average productivity for the preceding 12 months? Sure, but I recognize that an employer can’t afford to just turn on a faucet of money for rads who aren’t generating RVUs. On the other hand, getting zip for my time is a nonstarter for me.

In these conversations, I bend over backwards emphasizing that I do not expect anything if problems are at my end. If I have a power or internet outage, why should my remote employer bear any responsibility? (It would be another matter if I worked on site.)

A funny thing happens in these exchanges. Unless the group already has some sort of safety net in place, the prospective employer invariably tries to convince me that one is unnecessary. For instance, I tell the rad group about times that my biggest-in-the-industry telerad company sometimes had an empty list … and the prospective employer, a fraction of that telerad’s size, proudly tells me about its annual case volume, saying it “never” has an empty list.

I don’t know about you, but when I tell a prospective employer about a concern of mine and it is dismissed with a wave of the hand, I don’t marvel at the rad group’s Jedi mind-trick skills. I get annoyed that the prospective employer is not taking me seriously.

I try being patient with the rad group. I express understanding that it chose a per-click model for a reason. The rad group may have a certain amount of revenue coming in and it has planned how much of that revenue can be paid out for each case.

Still, there’s always some slack in the system. Nobody pays per-click rads 100 percent of their RVU worth. There is excess to cover operating costs, unforeseen expenses and, of course, profit. Certainly, there is enough for there to be a financial “floor” for the rad’s time in consideration and respect for he or she being part of the team and forsaking other opportunities to be at the post.

I also try to go with the flow. Hey, it’s great that you never have downtime. Most rad groups do. We’ve established that you want me to join your team. Why not reassure me by putting a safety net in place, knowing that your flawless system will never require the net to be activated?

Most groups balk at this. Maybe it’s because their negotiators know darned well that downtime happens or could…and they’d rather try to snow me about it than agree that my time as a professional is worth something for which they should pay, however little in terms of compensation. Alternately, they may realize that setting up a safety net would be more work for them than just hiring someone other than me, someone who doesn’t ask these troublesome questions.

That is just fine with me. I prefer an upfront “No” to a drawn-out “maybe” that has no chance of turning into a “yes.” The less said about a “yes” that gets walked back into a “not really,” the better. I recently wasted several weeks of my time playing out such a drama with a per-click employer.