ACR Bulletin

Covering topics relevant to the practice of radiology

Making the Right Choice

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Spending focused, front-end time with job candidates is a long-term investment.

Radiology leadership needs to make a thorough hiring process a priority, even when it’s the least convenient time to be thorough.

—Darcy J. Wolfman, MD
March 12, 2020

“The job market right now is heavily in favor of candidates, not radiology groups,” says Jay R. Parikh, MD, FACR, medical director of the MD Anderson Cancer Center Breast Care Network and a member of the ACR Commission on Human Resources. When looking for new talent, he says, it behooves radiology leaders to assemble a multifaceted group of staff who focus on hiring and retention — to flesh out more than technical skills in candidates — to find the best fit for a practice’s current culture with the most potential to meet its future goals.

Financial compensation will always be a part of enticing new radiologists, Parikh says, “but there are many other factors you need to look at over and beyond that.” This is true for private practices of all sizes and large hospitals and academic models, he adds. When it comes to these non-salary factors, Parikh says, “there’s a lot of overlap in what candidates are looking for, and all radiology leaders will be considering many of the same things when bringing someone on board.” Picking the wrong candidate can have disastrous downstream consequences. The team you task with evaluating new recruits should be equipped and empowered to pick a winner.

Hiring Players

Ideally, your recruitment and retention team will be supported by leadership — allocating enough money and time — and populated with staff from different generations, experience levels, cultural backgrounds, and workplace responsibilities, says Claire E. Bender, MD, MPH, FACR, professor of radiology at Mayo Clinic in Rochester, Minn. “Your team should have a committed radiology leader,” she says, “but also a representative from administration or the human resources department if you have one — someone who has been with the practice or in the hospital department for a while who can explain the culture of the place.”

Someone from the business side of the group can explain why and how the practice is successful. An HR representative can explain benefits, FMLA, and parttime policies. They may also be useful in interpreting the candidates’ applications. “These employees are well-suited to spot red flags when talking to applicants and reviewing the material they present,” says Bender.

Your organization may have a diversity committee. If so, you should definitely seek their help during the hiring process, Bender suggests. “If an applicant comes in to an all-white group of interviewers, for instance, that might not be sending the right message," Bender adds. A person who lives in the area in which the candidate will live and work can illustrate what they may like about it. A community member might also know of potential volunteer or outreach opportunities of interest to the candidate.

“The people in your hiring group should be people with soft skills who are relatable and natural communicators,” Bender says. A first impression is important, and the commitment and goals of the practice’s leadership must be clear. Interviewers should be as transparent as possible when explaining future plans, including possible changes to the size, scope, or location of the radiology group,
Bender says.

Meeting Needs

Whether in private practice or an academic setting, candidates typically have most of the same questions, Parikh says. Employers will hear: What are my hours? Will I be on call? When and how often? What is the leave policy? Are there education, research, or community service opportunities? Employers should be prepared with a hard sell.

Selling them on your culture is key. “High turnover raises red flags for candidates,” Parikh says. “That is going to weaken your position when trying to hire the best people — if they sense something is wrong with the culture of your organization.”

Radiology leaders — and those in the know on the hiring team — should be forthcoming about what has worked well and where there have been challenges. It is critical to assure the candidate that disruptive issues are promptly addressed and that you are committed to moving forward to create the best possible culture for future members of the group.

Candidates may ask how a radiology group addresses burnout and whether wellness programs are in place. Studies suggest that burnout in radiology has escalated enough in recent years to compel leaders in the field to put mechanisms in place to address the issue.

Family leave and work-life balance are also top of mind for more junior candidates, regardless of gender. “We have a lot of male imagers come in and ask about parental leave,” says Parikh. “These are the kinds of things that make your radiology group more or less appealing.”

Diversity is increasingly important to many job-seeking radiologists. It can be difficult for a small practice just starting out to make diversity a priority, Parikh acknowledges. “They may simply want to hire whoever appears to be the best candidate on paper,” he says. “But as you grow, it is essential to pay attention to your organization’s culture to include diversity.”

If you are not adding more diverse hires as your business expands, Parikh says, you might want to revamp your hiring team to avoid detractors such as unconscious bias. The more diverse you are, the more it helps your organization — and not just in hiring. You become more available to patients who may feel more comfortable seeing diversity in your staff.

The more time and effort you put into recruiting the right people on the front end, the more benefits you will reap longitudinally.

—Jay R. Parikh, MD, FACR

Looking Inward

Just as the hiring team should be prepared to evaluate the needs and concerns of candidates, leadership must value the process as a long-term investment — giving its team the time and resources needed to make the best match. “Radiology leadership needs to make a thorough hiring process a priority, even when it’s the least convenient time to be thorough,” says Darcy J. Wolfman, MD, clinical associate at Johns Hopkins University and a member of the ACR Commission on Human Resources.

“Sometimes you just need a body — anybody — because you’re feeling overwhelmed with work,” she says. “In the long-run, it makes sense to take a step back, take a deep breath, and figure out what you actually need.” Radiology groups and new hires will benefit from a deeper dig.

Mention things you would like to see from the person filling the position — things that may not be in the official job description. “Sometimes groups are too focused on what they need in the moment,” Wolfman says. “If they have an immediate need for someone to split their time between reading general and MSK, for example, but could also use someone who really understands MRI protocol, why not tell the candidate? That person might be really into that.”

As important as finding out what the candidate might be interested in down the road is your truthfulness about the future direction of the practice. “You don’t want to go through the whole hiring process again in a year when the new hire decides it isn’t working out,” Wolfman says.

She recalls an interview scenario in which the candidate accepted a position based on the understanding that she would be covering two community-based hospitals and two outpatient clinics. By the time she started the position, the employer was wrapping up a deal to cover a level-one trauma center — a move that was already in play during the candidate’s interview.

“That meant there would be all sorts of things she didn’t sign on for, like overnight and weekend shifts,” Wolfman remembers. “When she learned that the deal was being negotiated during the hiring process, she felt betrayed and didn’t stay long.”

Losing Futures

“The more time and effort you put into recruiting the right people on the front end, the more benefits you will reap longitudinally,” Parikh says. “Not only are you bolstering the practice’s reputation in terms of future hires, but there is huge cost in continuously recruiting. The costs of replacing a physician are estimated to be two to three times the physician’s annual salary. That’s a heavy hit for groups to take.”1

The cost to a radiology group when someone leaves is more than dollars lost. “It disrupts workflow when someone leaves,” Parikh says. “There’s some acclimation that has to happen when new hires join a team. New radiologists must build trust and continuity with referring physicians and administrators. There’s a lot of non-clinical, almost political, capital that develops the longer a radiologist stays on.”

This comes back to how much time you are willing to invest on the front end when meeting candidates, Bender says. The process is long and expensive, but upfront costs for a new hire — staff time, multiple visits, travel expenses, and so on — will probably reduce turnover.

To save your radiology group time and money, look for candidates who have done their homework, Wolfman says. “Regardless of whether the candidate is younger ormid-career, they need to be prepared with a checklist of what they are looking for — and that list needs to be prioritized,” she says.

Bender agrees, and stresses that the items on the checklist will likely be similar among candidates from different generations and with different levels of experience. Their priorities are the best indicator when determining who may work well with the radiology team, she says.

Wolfman also cautions about candidates who are adamant about never working for a certain type of radiology group. Someone who wants a guarantee that the way things are now is the way they will always be is not the flexible team player you want.

Mentoring Growth

“A bad hire can erode the culture of the group,” says Juan J. Jimenez, MD, associate medical director of radiology at Carle Health System and clinical associate professor at Carle Illinois College of Medicine, who presented on the topic of recruitment with Bender at the 2020 ACR-RBMA Practice Leaders Forum in San Diego in January. “It amazes me how one vocal malcontent can impair an otherwise cohesive and collaborative group,” he says.

Although it is incumbent on the leadership of a radiology group to make the best picks through a thoughtful hiring process, the practice’s work doesn’t end there, Jimenez suggests. New hires need to continue to feel engaged once they are on the job.

“If your group is large enough, get new hires out into the organization to serve on committees and to represent their department,” Jimenez says. “A private group with a hospital contract may have more difficulty establishing these kinds of connections, but making an effort is vital to the group’s continued success.”

Let your newer hires know about educational and other academic activities, Bender says. “Money in medicine is not the great motivator. They want to know about things like research time and mentorship programs,” she says. Younger generations are often interested in learning from more experienced radiologists, and they look for a fair path to leadership positions.

“Some of the younger hires are very service-oriented. They want to get involved with community outreach efforts an institution sponsors,” Bender says. They want to work with a purpose and have time for career development and training — including outside events and seminars, she adds. Retaining new hires hinges on getting them excited, making their job feel meaningful, and putting future goals in reach.

The hiring process can take up to a year or more for some organizations. Making the wrong recruiting decisions means lost time, wasted money, and added pressure on radiology teams to fill gaps. “When you have people who are overworked or burned out, they leave,” Bender says. “Or maybe worse, they stay and the quality of their work suffers.”

Patients deserve access to the best radiologists. “Hiring the right person will cost,” Bender says. “But it will cost less later if it’s done right now.”


1. Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc. 2017; 92(1):129–146.

Author Chad Hudnall, senior writer, ACR Press