ORIGINAL ARTICLE

Career Alternatives for Radiologists

Beyond Clinical Practice
Jay R. Parikh, MD a, Edward I. Bluth, MD b

Abstract
Radiologists may choose or need to leave radiology as a career. The purpose of this article is to discuss options available to radiologists
beyond their clinical careers.
Key Words: Transition, career, unemployment, radiologist, disruptive change
J Am Coll Radiol 2016;-:---.
2016 Published by Elsevier on behalf of American College of Radiology

INTRODUCTION been fired [7] and may no longer be able to find a

During the past four years, the annual survey by the ACR position as a clinical radiologist.
Commission on Human Resources has publicized the Whatever the reason, radiologists are leaving the
changing job market for radiologists in the United States. profession, and the ACR Commission on Human Re-
In 2014, job opportunities were limited [1]. In 2015, sources is sensitive to this difficult time in radiologists’
opportunities appeared to be improving but were still careers. This article provides information to help prepare
limited [2]. As a result of decreasing job availability, our radiologist membership for careers beyond radiology.
some radiologists are choosing to leave the profession.
Additional factors are having an impact on the radi-
PLAN AHEAD
ology workforce. Some radiologists decide that they
Radiologists planning to leave radiology should consider the
would simply like a change after 20 or 30 years in practice.
financial impact of a career change [8]. Reviewing current
Others experience job dissatisfaction [3] or burnout [4] or
finances with a spouse, significant other and/or and financial
simply may not like their jobs [5]. Radiologists sometimes
planner can be beneficial. Leveraging projected income and
need to leave radiology as a career. Because of an injury,
current savings against estimated future expenses can
a radiologist may not be able to perform expected
determine if a career change is fiscally responsible.
clinical duties. Episodes of impairment [6] may result in
Several of the sequential steps previously recom-
clinical privileges being temporarily or permanently
mended by the Commission on Human Resources [9] for
suspended. A radiologist may have been cited in
career transitions within radiology apply to radiologists
multiple lawsuits and therefore have difficulty finding
seeking careers beyond radiology. These include
a new position or obtaining privileges and malpractice
updating your curriculum vitae or résumé [10],
insurance. Alternatively, a radiologist may have
leveraging your network [11], establishing a professional
interpersonal conflicts with multiple groups or may have
online profile [12], establishing a presence in radiology
and nonradiology societies, conducting job searches, and
a
Department of Radiology, University of Texas M.D. Anderson Cancer undergoing job interview training [11,13].
Center, Houston, Texas.
b
Ochsner Clinic Foundation and The University of Queensland, Depart-
One of the most fundamental considerations is
ment of Radiology, School of Medicine, Ochsner Clinical School, New whether a radiologist wants to pursue a career that is
Orleans, Louisiana. based on or independent of medicine.
Corresponding author and reprints: Edward I. Bluth, MD, Ochsner Clinic
Foundation, and The University of Queensland, Department of Radiology,
School of Medicine, Ochsner Clinical School, 1514 Jefferson Hwy, New CAREERS BASED ON MEDICINE
Orleans, LA 70121; e-mail: ebluth@ochsner.org.
The authors have no conflicts of interest related to the material discussed in Nonclinical career opportunities based on medicine
this article. include positions related to health care administration,

ª 2016 Published by Elsevier on behalf of American College of Radiology

1546-1440/16/$36.00 n http://dx.doi.org/10.1016/j.jacr.2016.02.014 1
medicolegal consulting, resource utilization management,
research, medical writing and editing, and operational
consulting.
Administrative and Management Positions
An increasing number of physicians are pursuing leader-
ship roles in health care [14]. Radiologists aspiring to
leadership roles in hospitals or health care systems can
gain experience by serving on hospital and radiology
department committees [15] such as workflow
standardization, quality, radiation safety, and utilization
management. Interdisciplinary committees such as
cancer committees and continuing medical education
program committees also provide opportunities for
experience. Over time, radiologists can serve on
hospital-wide committees such as credentialing, peer re-
view, medical discipline, physician behavior, medical
mortality, and resource utilization. Serving on a medical
executive committee in some capacity is a possible segue
into full-time administrative roles such as chief medical
officer, chief quality officer, chief operational officer, and
chief executive officer.
Often, radiologists will better qualify for administrative
positions after formal management training. The Radi-
ology Leadership Institute of the ACR offers leadership
training specifically tailored for radiologists [16]. The
American Association for Physician Leadership also
provides leadership training for physicians, independent
of specialty [14]. More formal educational degrees, such
as a master’s in business administration, health
administration, or medical management, may also
assist radiologists in becoming more marketable for
administrative careers.
Advantages of this career are the reasonably high in-
come and leadership roles. Disadvantages of this role
include the time and expense required for additional
education and distrust of former colleagues of your new
role [15].
Medicolegal Consultant
Some radiologists choose to become involved in expert
medicolegal work. Typically, these types of cases focus on
determining if a radiologist stayed within or fell below
the standard of care during the management of a patient
who had an adverse outcome. Often there is a gray area,
and experts for both the plaintiff and defense are con-
tracted to help define standards of care [17]. Depending
on the complexity of the case and the abilities of the
consultation radiologist, involvement ranges from brief
image and report review to complete review of the
2 Journal of the American College of Radiology
medical record and providing depositions and trial
testimony.
Radiologists interested in pursuing this career should
both educate and market themselves. Attending law
classes to learn the fundamentals of tort law and physician
negligence helps establish credibility. Attending legal
continuing education seminars and interfacing with
plaintiff and defense attorneys are opportunities to build
your network. Informing your radiology colleagues at
local, regional, and national radiology society meetings
of your interest may be helpful. A radiologist who is
established in this line of work and willing to serve as a
mentor can be an invaluable resource for a beginning
radiologist expert witness.
Advantages of this career choice are potentially high
income [18] with little risk to the consultation radiologist
[19]. This type of career choice, however, may make a
radiologist unpopular with his or her peers.
Resource Utilization Management
Radiologists can be effective medical directors for in-
surance payers. Since passage of the Patient Protection
and Affordable Care Act and the introduction of
accountable care organizations, value-based imaging
inherently has the goal of the right patient undergoing
the right examination at the right time. Avoiding
unnecessary imaging tests and reducing radiation
exposure are consistent with themes of the ACR’s
Imaging 3.0. The need for such expertise will likely
increase in the next few years. Radiologists can use
their experience to guide ordering physicians to the
appropriate imaging study for a clinical indication
using ACR Practice Parameters and ACR Appropri-
ateness Criteria.
Radiologists interested in this career path would
benefit from serving on radiology utilization or hospital
resource utilization committees to gain experience and
being familiar with the ACR Practice Parameters and
ACR Appropriateness Criteria. Formal continuing med-
ical education courses in resource utilization and serving
in hospital roles such as chief utilization officer can be
valuable training for this career.
Advantages of this career path include the professional
satisfaction of being able to promote patient quality and
safety, a reasonable steady income, and a predictable
lifestyle. Disadvantages include dealing with some
contentious referring physicians [15] and participating in
a process many physicians view as unpopular and hold in
low regard.
Volume - n Number - n Month 2016
Research
Dedicated research positions in academic settings are
typically rare because radiologists often are required to
solicit enough grant funding to justify their salaries.
However, in rare circumstances, a clinical researcher may
be able to convert to a full-time researcher with no
clinical obligations or call.
Radiologists can also find opportunities in industry
research. Specialized radiologists can become involved in
the pharmaceutical industry in the design and develop-
ment of contrast agents and can offer clinical expertise
and collaborate in the design and development of imaging
equipment.
Radiologists interested in pursuing this career should
plan to develop a research portfolio, a task that typically
takes years. High visibility through publications and
presentations of papers at respected meetings is essential.
Becoming involved in grant writing with successful
funding of research projects may also be helpful. Serving
on editorial boards for journals; reviewing grants for
private, institutional, and government agencies; and
obtaining prestigious research awards all add credibility.
Interfacing with industry by consulting on scientific
panels, serving on advisory panels, and participating in
reader studies helps develop a radiologist’s network.
Advantages of this career path are a flexible lifestyle
(no call) with income. Challenges with this career path
are funding, relative job insecurity, and lack of patient
contact.
Writing and Editing
Radiologists who have an interest in the field can consider
a writing or an editorial career. Publishing editorials and
review articles in peer-reviewed journals can help develop
and maintain your reputation in the radiology commu-
nity and prepare you for this career. Voluntarily
contributing content to blogs and websites can increase
your visibility, expand your writing portfolio [20], and
prepare you for writing freelance articles.
Publishers, medical websites, and other medical
communications companies may be looking for physi-
cians to provide scientific oversight and review content
[20]. Professional writing of freelance articles for
radiology magazines and Internet blogs is a career
opportunity that can be quite lucrative. A survey of
freelance writers in 2011 by the American Medical
Writers Association [21] revealed a mean gross income
of $116,000 for full-time freelance writers, with a me-
dian of $99,000. One way to get started is to look at
websites such as www.elance.com, www.freelancer.com,
Journal of the American College of Radiology
Parikh, Bluth n Career Alternatives Beyond Clinical Practice
www.freelance.com, and www.guru.com. Jobs are posted
for freelance medical writers to provide contributions
for a fee.
Benefits of this career choice include schedule flexi-
bility and the opportunity to work from home. Concerns
are stresses related to deadlines and lack of job stability
and security.
Operational Consultant
During a radiology career, a radiologist may develop
expertise in an operational arena that could be financially
beneficial to other practices. These areas include regis-
tration, patient workflow, quality assurance, reporting,
billing and coding, practice efficiency, and management
including governance [15].
Anybody entering the operational consulting field
must balance personal motivation against investment of
resources and the time needed to build business and
referrals.
CAREERS INDEPENDENT OF MEDICINE
Examples of nonclinical careers that are not based on
radiologists’ experience in clinical medicine include
becoming a physician entrepreneur, being a physician
coach, teaching, and pursuing hobbies.
Physician Entrepreneur
Physicians can be excellent, successful entrepreneurs [22].
The Society of Physician Entrepreneurs (www.sopenet.
org) was launched in 2011 and currently has more than
4,700 members. Radiologists’ entrepreneurial roles can
range from consulting for intellectual property
knowledge [20] to investing in medical and nonmedical
businesses to becoming a venture capitalist to field-
testing products. Radiologists involved in industry
consulting should be knowledgeable about antikickback
and Stark laws [23].
Physicians may also be involved in startups. These
physicians typically have a deep-seated passion for
explosive, tangible, real-world impact and the optimism
and conviction to believe they can achieve this [24].
These types of physicians are often innovative,
focused, technology driven, and knowledgeable [25].
Key obstacles for physicians to overcome include
professional peer pressure to not discard their training,
institutional pressure to surrender intellectual property
to the university or hospital where they practice,
concern from collaborators that physician investors may
be more a part of the problem rather than the solution,
3
and managing the difficult jump from an established
practice into the unknown [24].
Physician Coach
With the turbulence in health care, the demand for
coaches of physicians has increased over the past decade
[15]. Physicians can be extremely effective coaches for
other physicians because they understand from
experience the current demands and challenges of
practicing medicine. They are inherently respected and
trusted by physician colleagues.
Physicians interested in a coaching career often have
had significant leadership and mentorship experience in
health care organizations, are willing to pursue further
formal training, and will need to market themselves.
Serving on peer review, physician behavior, and physician
discipline committees enables radiologists to gain experi-
ence in dealing with disruptive physicians. The Physician
Coaching Institute is an organization led by a physician at
which radiologists can attend formal education for 6
months to obtain certification as physician coaches [26].
Strengths of this position include income with a
lifestyle typically without call. Challenges of this position
include dealing with potentially toxic personalities and
low job security.
Teaching
Many physicians who are thinking of leaving medicine
cite teaching as one of the careers they would like to
pursue [15]. The pressures of clinical practice sometimes
preclude physicians from finding the resources and time
needed to be effective at teaching. However, teaching
positions in medical schools without coupled clinical
responsibilities are rare. Other teaching opportunities
are available, however, such as in community colleges,
in high schools, or as tutors to individuals [20].
Hobby or Encore Careers
The term encore career denotes work in midlife that
combines income, meaning, and frequently social impact.
The goal of an encore career is to work less hard at
something you enjoy doing [8], but encore careers usually
mean reduced income. However, physicians who can
handle a reduction in remuneration may find an encore
career a satisfying choice.
After their clinical careers, radiologists can spend
more time on their hobbies of choice whether that be art,
photography, or cooking. Although these pursuits may
generate limited if any income, these activities can be a
4 Journal of the American College of Radiology
source of positive energy and provide purpose to radiol-
ogists. Sometimes one can blend clinical expertise with a
hobby. For example, some physicians have blended their
passion for travel and clinical knowledge to create medical
tourism businesses [20].
BRIDGE WHEN YOU CAN
Bridging employment is common among radiologists and
may be an appropriate strategy when radiologists are
considering career changes. Possible mechanisms include
working part-time for a group, engaging in phased
retirement from a group, working per diem for a previous
employer, or having an offshore or distance setup from a
practice [27]. Benefits of bridged employment include
enabling a gradual transition to a new and different life
of socialization, relevance to the individual, and purpose
to society [28].
Bridging enables a radiologist to test the waters [8]. A
radiologist also could potentially have more time to look
for another position if necessary. This way, there is also no
gap in the curriculum vitae, thus enabling the radiologist
to be more marketable for an alternative future position.
MANAGE THE FINALITY AND THE
OPPORTUNITY
It is difficult but important to manage expectations and
the finality of the transition. Once a radiologist leaves his
or her current position, it is often difficult to go back to a
former employer and get an old job back. After departure,
the security and the environment of the previous position
will typically be gone. If a radiologist does go back, the
radiologist’s integrity and loyalty to the old position may
be questioned by peers.
Physician reentry can also be a challenge for physi-
cians who have left clinical practice. The AMA defines
reentry as “a return to clinical practice in the discipline in
which one has been trained or certified following an
extended period of clinical inactivity not resulting from
discipline or impairment” [29]. Some states have
complicated reentry requirements and processes [8,29]
that can cause delays. It is generally recommended that
physicians maintain their state licensure [8].
The ACR Commission on Human Resources wishes
to emphasize to radiologists that there can be a compo-
nent of finality to a radiologist’s decision to leave clinical
practice. At the same time, this is a tremendous oppor-
tunity to reinvigorate yourself and discover a career
transition that may be a blessing in disguise [30]. Even if
the first transition is not a complete success, the next one
could be. Without risk, there will be no reward.
Volume - n Number - n Month 2016

TAKE-HOME POINTS
- Radiologists may either choose or need to leave
radiology as a profession.
- Irrespective of the reason for changing careers, life
can exist beyond radiology for a radiologist.
- There are career options related to medicine that
radiologists can pursue after exiting radiology.
- Encore careers refer to careers outside of medicine
that radiologists may want to pursue because of
their personal passions.
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