Making No Apologies for Being a Lifestyle Radiologist

I don’t know when I first heard the phrase “lifestyle radiology.” I originally thought I heard the term sometime after I began doing telerad in 2011. The rad job market had previously ranged from crummy to lousy during my post-fellowship years. If there were “lifestyle” jobs, I certainly didn’t hear about them.

A little digging tells me the term might be a bit older. Folks reference Samuel Shem’s The House of God, in which a savvy resident tells the interns about several specialties which offer a cushier professional experience. Radiology was one of them but best as I can recall without paging through my copy of the book, the author didn’t specifically use the word “lifestyle.”

My digging session also investigated whether there is any consensus as to what makes a “lifestyle” specialty. The term is pretty darned subjective with common themes including desirable hours (in terms of quantity and quality), comp, stress level, etc. In other words, the ideal lifestyle gig impinges little or not at all on your non-professional life.

Therein lies the subjectivity. A lot of non-rads, shades of the House of God reference, regard all of radiology as a lifestyle specialty. Some of that is a “grass is always greener” phenomenon, but there are a couple of online writeups that compare branches of medicine based on measurable things like salary and vacation time. Radiology stacks up decently.

However, let us say you’re an interventionalist in a demanding institution. You cover a lot of odd hours, take a lot of calls, and shape much of your life around your job. You might take exception to anyone implying that you have an easy gig. On the other hand, you might eagerly agree that a lot of other rads do have a “lifestyle” situation, such as folks who only work daytimes, Monday-Friday, enjoy 12 weeks of vacay per year, etc.

Outside of the job recruitment venue, “lifestyle” often gets used as a borderline pejorative term. Implications include the lifestyle rad being greedy, lazy, selfish, etc. After all, other rads are slogging away during all of the unfavorable hours that the lifestyle rad is not. Don’t you know that patient care is 24-7-365? How dare the lifestyle rad turn his or her back on all those folks who don’t get their imaging done during hours convenient to the rad!

As a result, I’ve noticed that some rads who have gotten themselves a lifestyle gig (or hope to) can be a little defensive, even secretive, about their preferences, lest they be called out. To each his or her own, but I think this is an unnecessary self-contortion in a futile effort to appease everyone.

Let’s drill down on some reasons why other folks might look down their noses at a lifestyle rad and see whether that rad should give a darn about any of them.

• Envy. This is probably the most prevalent, although few of the lifestyle disparagers will have the intellectual honesty to admit it. This strikes me as kind of funny as most of us would admit that envy is a universal human frailty. We know we should strive against it, but it is very seductive. Maybe we made it one of the seven deadly sins. It can sneakily cloak itself in the guise of nobler motives. You’ll pretty much never hear someone say “I don’t like that lifestyle rad because he or she enjoys a situation I can’t seem to find for myself.” The sentiment nevertheless often rings loud and clear.

• Value judgment of motives. This one usually takes a holier-than-thou form. Stuff like “You went into medicine for the wrong reasons.” This is also a tack used by non-physicians poking at docs for supposedly earning too much. I am 100 percent supportive of folks who think that being a doc—radiological or otherwise—should be some sort of monastic, self-sacrificial, noble thing. But if that’s your true feeling (and not envy as mentioned above), let it apply to you, and go admire other people who live up to your high standards. A lot of us went into this field because we had the talents and determination, knowing that we would make a good living while helping some patients. If that’s not enough for you, that’s your problem.

• Fear of public opinion. This one comes up a lot whenever rads are discussing work-related rewards online, especially compensation. The idea seems to be that, if you make things sound too good for yourself, any non-rads overhearing will somehow use that to take things away, not just from you, but from rads as a whole. In these conversations, it sometimes seems like anything qualifies as “too good.” If you’re earning, say, more than a public schoolteacher, some politician might see it and cut you down to size. My first response is that it does you no good to live in fear. Second, if you really think your comments on social media about having a decent lifestyle will enable the government or hospital admins to do anything they aren’t likely to do to you anyway, trust me, they need no such excuses.

• What about the other rads? What about the patients? This is the only semi-legit line of reasoning I have heard. True, any work not done by lifestyle rads will fall to others, and there is a shortage. However, supply/demand is a real dynamic. When there is a need for radwork on nights or weekends, the market will find a way to supply it. Alternatively, maybe the system will move to diminish unnecessary imaging, especially the many routine studies that get done in ERs and during off-hours with gratuitous “STAT” treatment.

Meanwhile, plenty of rads do choose to work nights and weekends to cover those needs. Unless they opt otherwise, many of them work fewer hours than I do, and earn a higher rate. I did that myself earlier in my career and still cover weekends to this day (I’m actually typing this column a week in advance because I’m working both days next weekend when I would normally be writing). Technically speaking, I’m not a full-on lifestyle rad yet, but I have moved steadily in that direction.

It wasn’t my original intention. Sure, I like working normal weekday hours. But for nearly 20 years after my training, I put in a good share of nights and weekends, paying my dues to work toward something resembling partnership or executive status. Such things never materialized. Maybe I had them coming to me. Maybe not. But without that incentive, I am inclined to work the hours I want for the best available rate. If some folks disapprove, they are welcome to their opinion, just not my endorsement of it.