- AI
- Molecular Imaging
- CT
- X-Ray
- Ultrasound
- MRI
- Facility Management
- Mammography
Sawtooth or Smooth: A Closer Look at Radiology Compensation Options
What are the keys for ensuring optimal pay during the course of your career?
At some point, my closet’s stockpile of “party games” kind of exploded. It snuck up on me. I have no idea when all these things crept into the house. We haven’t played most of them.
They haven’t just grown in number. There is also a lot more creativity and just plain fun involved. Some of the stuff I played a couple of decades ago seems downright dull by comparison.
Still, some moments stick in the memory. I recall a philosophy probing question from a game of that era, regarding the general pattern one would like life to follow: High highs and low lows, a sort of roller coaster of extremely positive and severely negative events, or a more uniform, gently fluctuating affair. There would be fewer if any deep tragedies and disasters, but also not much in the way of soaring triumphs.
It wasn’t a tough question to me at all. I knew folks who lived the extreme high/low fluctuation, and sometimes found it exhausting just to keep track of them. It seemed like that lifestyle was plagued by randomness. Even if you managed to keep your wits about you and pursue your long-term goals, circumstances would constantly shove you off course.
My attitude probably isn’t all that surprising for a MD. Making it into this kind of a career depends on one’s ability to make a plan and see it through, including sufficient performance through nearly a decade of post-high school education and several years of post-grad training. Most docs I know would also prefer their subsequent careers to be non-tumultuous affairs. I would rather, for instance, have my call shift in the ICU be a boring snooze fest than an onslaught of new admissions, patients coding, etc.
Yet it is a little incongruous that the type of radiology job I have come to embrace has about the most widely fluctuating model of compensation in the field. Further, rather than wishing that one little aspect could be changed, I enjoy it.
I have held a few jobs in the past couple of decades, and they have almost run the gamut of approaches to comp. They ranged from flat salary with no chance of a bonus whatsoever and a salary with theoretical chances at productivity bonuses that never amounted to much to hourly rates with slightly realer productivity incentives, and of course “per click” comp. The latter is where I have (happily) wound up, but also experienced for seven years in a previous gig.
Salaried comp is the steadiest, least fluctuating situation. You know what your paycheck will be every month. Maybe, if there is a bonus system, you get a bump here or there, but otherwise there are no surprises except for times of upheaval in your institution or the field at large. Renegotiations happen, but that’s rare. If you drew a graph of your income versus time, it would be a pretty smooth curve (mostly a straight line).
The biggest contrast to that is the per-click model, in which your comp varies every month, and you rarely see the same number twice. The calendar itself is partially to blame: Some months have more days of work for you than others. Take a week’s vacation in February and, at best, your productivity that month will be around 75 percent of any of the other 11 months.
Your personal capabilities and efforts factor in of course. Fresh off a full night’s sleep and in a good, go get them kind of mood, you will probably have a better day than if you stayed up late watching your favorite sports team lose and then woke up with a headache and sore throat. Then there is the matter of your daily case mix, how many interruptions you get, technical issues, etc. All of these things average out in the long run but in the moment, they can seem, well, momentous.
Unlike the salaried situation with its smooth comp versus time graph, a model based heavily or entirely on productivity will look a lot more jagged, with those highs and lows that the party game question referenced. It might be described as a sawtooth affair. Some might not care much for that. As I mentioned earlier, I rather like it.
One of the reasons for that is I live below my means. That is, even a month where my RVU tally runs low isn’t going to dip to anywhere near making me worry about how I am going to pay my bills. Heck, I could have a few bad months back-to-back, and it wouldn’t have me panicking (although I would certainly notice the trend, examine what caused it and whether it was likely to accelerate, and take appropriate action).
I also like it because I am constantly reevaluating my situation, a habit I think everyone should cultivate. Both with my current per-click job and my previous one, I had a learning curve as I got familiar with things like software, workflow, etc. It was gratifying to see my productivity increase with each passing month, and not just because that meant a bigger deposit to my bank account. One likes the sense of becoming more capable.
Part of that learning curve is seeing what works and what doesn’t. If I have a particularly good month (or especially a day, when I am in a situation that lets me track my RVUs in a smaller timeframe), I can zero in on what was different that made me do better. If I have a downturn, I can identify reasons for that too and adapt.
I’m sure that not everyone is going to share that sentiment, and there is plenty to like about a smooth curve as opposed to a sawtooth. Some might simply avoid per-click gigs for this reason.
There are nevertheless ways to smooth the per-click sawtooth, and there are rad groups out there that have done this. One approach is a hybrid system: part salary, part productivity. The more you increase the former, the smoother the curve gets. You might even shift the productivity to a bonus that only happens once or twice per year, so it is a rare blip in the curve.
Another method I have imagined but not specifically heard of in rads is a “moving average.” You might have heard the term from financial fields. Instead of having each month’s comp generated purely from RVUs of the preceding 30 days, suppose you have your software track what a rad’s RVU tally was for the past, say, 90 days, and pay a third of that.
One would effectively smooth the saw teeth in this curve. It’s like drawing a “line of best fit” between data points. The rad still sees fluctuations that provide him or her feedback for self-improvement and incentives for harder work, but the rad has got more of a “safety net.” A lot of folks appreciate that sense of stability.
The Reading Room Podcast: Emerging Trends in the Radiology Workforce
February 11th 2022Richard Duszak, MD, and Mina Makary, MD, discuss a number of issues, ranging from demographic trends and NPRPs to physician burnout and medical student recruitment, that figure to impact the radiology workforce now and in the near future.
