Because the multiplicity of practice options for radiologists makes understanding each practice environment difficult, radiology residents should consider trade-offs among job security, individual physician autonomy, compensation, productivity, and opportunity for subspecialty practice, according to an article published in the April issue of the Journal of the American College of Radiology. 

Changes in practice environment have abounded for radiologists in the last decade, leading to a confusing decision making process when it comes time to select a place of occupation. As environments diversify, it is crucial that radiologists consider issues such as autonomy, productivity, efficiency, and subspecialty expertise, according to the article’s lead author, Sharon C. Dutton, MD, MPH, of Radiological Associates of Sacramento, Calif., and colleagues.

Dutton et al delineated the following practice options for radiologists:

• Private practice-This is the prevailing practice for most radiologists. Physicians in this situation are granted the most amount of autonomy to decide elements like work schedules, benefit and compensation structures, and group governance. It is important to note, however, that this may be changing as small private practice groups are beginning to consolidate to larger megagroups. Greater financial risk, administrative burden, and less financial stability are also noted elements of private practices.
• Hospital-based practice­-Only a small percentage of radiologists work in this environment, but this is expected to change with an upward trend. As radiologists become increasingly linked to hospitals, their job security improves as their sense of autonomy declines.
• Academic or medical school-Radiologists in this situation tend to be highly subspecialized and organized by organ system or technology. A hierarchy within departments determines levels of power and responsibilities. These radiologists are usually promoted for gains in clinical activities or research.
• Multispecialty or academic clinic-Radiologists are members of the entire group rather than one specific department. Decisions regarding salary and other important factors are usually centralized. Opportunities for global leadership are present here. Promotions and salaries are most often based on clinical productivity.
• Corporate employees-Corporations call the shots in this environment and radiologists have a salaried relationship with them. This situation could provide greater opportunities for radiologists to work in their areas of interest. The relationship between radiology corporations and hospital systems is still in its infancy because of the new health care reimbursement environment.
• Government-Salaried relationships often protect radiologists from competition and practice management in the government. These radiologists work in diverse environments with less autonomy but more possibilities for leadership advancements. They are well positioned to maintain job security during the health care reform.

Changes in the health care system are also creating different demands and responsibilities for radiologists in terms of autonomy, productivity, and efficiency. The defined split between general and subspecialty practice also poses challenges for radiologists. Ultimately, “Physicians should seek the work environment that has the balance of attributes that best meets their needs,” wrote Dutton and colleagues.