What is it like to live the life of a radiologist? This is a broad question and the answer, like most things in life, comes as a spectrum. In this post, I’ll cover the more ubiquitous features that tend to exist across jobs. I’ll also highlight some of the more common radiology job setups out there as well as some more unique positions that exist. Take-home point: with all of this variability, there’s something for everyone!
What is a Radiologist?
Radiologists are medical doctors/physicians that specialize in diagnosing and/or treating a wide range of medical conditions ranging from traumatic injuries to various cancers. Regardless of their subspecialty, all radiologists are trained to interpret (commonly referred to as “read”) basic radiology examinations including radiography (x-rays), fluoroscopy (video x-ray), ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine including positron emission tomography (PET), and mammography.
All radiologists were once medical students who have obtained an undergraduate degree completing specific medicine prerequisites, completed medical school, and completed either a diagnostic radiology residency program or interventional radiology residency program. The vast majority of diagnostic radiologists subspecialize and complete a 1- or 2-year fellowship. All radiologists gain experience within all subspecialties throughout their radiology training including diagnostic imaging procedures and clinical training via their interventional radiology rotations.
All radiologists spend a great deal of their time in “reading rooms” where we interpret imaging studies. And smart clinicians always know where to find us – in our reading rooms. In diagnostic radiology, this is our happy place! đŸ™‚
(For more information, check out my post: What is a Radiologist? Everything You Need to Know!)
Becoming a Radiologist
Radiologists typically complete four years of undergraduate school, four years of medical school, and a five-year residency in diagnostic radiology (inclusive of an internship/transitional year) or six-year interventional radiology (inclusive of an intern year with built-in surgical rotations and an additional year of interventional radiology, essentially inclusive of a 1-year fellowship).
(For you college and medical students out there, you can learn all you need to know at How to Become a Radiologist: The Comprehensive Guide.)
Radiologist Job Description
The life of a radiologist can be quite variable as radiology jobs come in many different forms. There is a significant overlap of job types as well as numerous opportunities within leadership, quality, advocacy, governmental policy, etc. within most jobs. Most practices, regardless of the work setting, are involved in interdisciplinary conferences such as tumor boards.
Common practice settings include academics, private practice, hybrid practices, hospital or healthcare organization employed (e.g. Kaiser Permanente), teleradiology, and locum tenens. There is wide variability between and within each practice setting, which means you’re bound to find something that fits your desired work environment.
Radiologist Hours and Call
Full-time radiologists generally work an average of about 40-60 hours per week and work a combination of day shifts, swing shifts, and/or night shifts.
Typical day shift hours are in the neighborhood of 7:30 a.m. to 5 p.m. and include onsite coverage (hospitals and clinics) and remote/virtual shifts.
Swing shifts generally fall in the 7-12 hour range and provide evening/”after hours” coverage. Swing shifts are highly variable with examples ranging from 11:00 a.m. – 9:00 p.m. to 5:00 p.m. – 3:00 a.m. from my personal experience.
Night shifts span the deep hours of the night and early morning (e.g., 9:00 p.m. – 7:00 a.m.). Some practices use teleradiology services to outsource evening/night cases or may have their own internal teleradiology set up on an opposite coast or in Hawaii to allow for more palatable working hours.
Interventional radiologists may take night calls a night at a time or via a night float system (1 week at a time) on a weekly or monthly basis, which may consist of a pager call from home or include diagnostic radiology responsibilities. Interventional radiologists may get called in to perform critical, life-saving interventional procedures and occasionally urgent procedures in very sick patients that are unable to wait until the next morning such as transhepatic biliary drainage or nephrostomy catheter placement for patients with an underlying mechanical obstruction.
For practices with swing shifts, a diagnostic radiologist does not typically take call. Instead, they sign off their reports and go home with the knowledge that they can put work aside until their next shift (peace of mind is a wonderful thing).
Average Radiologist Salary
How Much Does a Radiologist Make in a Year? A radiologist’s salary can vary depending on experience, location, and other factors. However, the average annual salary of a radiologist is $430,890 (ranging from $374,590 to $498,390) according to Salary.com (as of February 25, 2022).
Radiologists are either paid by time (how many hours they work) or by productivity (how many relative value units – RVUs – they read within a shift). There are pros and cons to both models and some groups use a hybrid method, paying based on time and having the potential for a productivity bonus. Annual income can vary widely between and within radiology practices as there are frequently opportunities to pick up extra shifts or sell shifts.
Radiologists working night shifts and swing shifts at some groups will have higher pay, shorter hours, more time off, or some combination of these factors to incentivize people to work these less desirable hours. Some groups will also do this for other less desirable shifts such as weekends and holidays.
Academic radiologists typically have lower salaries and less vacation. The average day in the life of an academic radiologist is typically less grueling than private practice and hybrid groups in terms of productivity expectations (though they may have other stresses related to their research productivity).
Salaries and rates are incredibly variable as mentioned above. Regardless, suffice it to say, you should be okay financially. If your $400k+/year job isn’t enough, you may be living beyond your means.
Oh, and taxes. Radiologists pay a LOT in taxes. High W2/1099 salary jobs result in a large amount of taxable income and quickly put you in one of the highest tax brackets. A $400k annual income will result in $120-170k in taxes (rough estimates), depending on where you live, leaving you with take-home pay of $230-280k.
Day in the Life of a Radiologist
A Typical Day
7:30 a.m.: Clean workstation (COVID-19 era), login to the workstation, and start reading cases. Radiologists will start by reading any unread inpatient or emergency room cases from the night before/early morning and ICU exams (for optimal patient care) and then switch to reading outpatient cases and new emergency room and inpatient cases throughout the day.
12:00 p.m. (+/- an hour): Eat lunch at your workstation while reading cases, give noon conference or tumor board. Then resume reading cases until 5:00 p.m.
5:00 p.m.: Finish up any pending cases or communicate unexpected findings to referring clinicians and go home. Radiology falls into shift work for those not taking call. That means when we go home, we generally don’t have to think about work – yay!
While this may sound pretty simple, radiologists are operating at a high level essentially nonstop for 9-10 hours, which can be quite exhaustive.
The life of a radiologist is also sprinkled with interruptions throughout the day, consisting of phone calls from referring clinicians to go over perplexing or interesting cases they have questions on, protocol questions from ordering providers or technologists, and procedures such as fluoroscopy studies and light paracentesis, lumbar puncture, joint injections, or an image-guided biopsy. Surprisingly, we don’t just sit in our reading rooms all day long (mind blown, right?).
Caveat: There may be occasional morning or evening meetings or conferences such as tumor boards and educational conferences.
Swing and Night Shifts
Radiologists working swing shifts focus on STAT cases and inpatient cases, covering hospitals, emergency departments, urgent care facilities, and occasionally STAT outpatient examinations. The focus is on high acuity imaging studies where the reports can have an instant impact on patient care – diagnosing appendicitis, pneumonia, an aortic dissection, or brain bleed.
Night shifts consist of diagnostic radiology coverage by onsite radiologists (including residents and/or attending radiologists in radiology residency programs) or outsourced to teleradiology groups.
A Typical Week
Most practices will have radiologists work 4-5 days per week. Academic groups may have some dedicated time for research or lecture preparation and larger practices may grant radiologists in leadership positions an occasional administrative day.
Typical weeks range from working the same shift at the same location all 4-5 days/week to a smattering of different shifts and sites – at a hospital Monday, working a swing shift Tuesday, off on Wednesday, at a diagnostic imaging site Thursday, and working remotely from home on Friday. It’s a wide spectrum.
Weekends
Radiologists generally work anywhere from 0 to 26 weekends per year (1 week on, 1 week off schedule). Weekend shifts are generally similar to weekday shifts but with a skeleton crew as most outpatient imaging facilities are closed or operating at decreased capacity. The scope of work is similar to a swing shift with a focus on STAT, urgent, and inpatient cases, though some practices may have a dedicated outpatient focus as well (luckily it’s uncommon, but we run across the occasional incidental urgent finding such as an unexpected pulmonary embolism in routine outpatient exams).
I bet you’re starting to see a theme here… variability!
Vacation
One of the best parts about finally becoming an attending physician in radiology? Vacation!
We’ve all been delaying gratification for decades and the time to start living and enjoying life finally arrives! You’ll find yourself suddenly with more vacation/time off than you’ve probably ever dreamed of. And, you’ll have some disposable income to actually travel!
Radiologists will typically get the most vacation in private practice and hybrid groups (I’ve seen ranges of 6-16 weeks). Academic radiologists have less vacation but generally get dedicated time for attending conferences, which frequently make nice vacations, depending on the location, local weather, and how much of the conference they attend.
While this seems like a lot of vacation, you’ll likely find that you need it to recharge throughout the year. Radiology can be quite stressful; working at a high level for 9-10 hours straight day in and day out can take a toll.
Vacation picking is also group-dependent. Some groups may go by seniority, round-robin style, etc. There will be restrictions on the number of radiologists who can be off at a specific time to ensure overall volume and subspecialty coverage.
A radiologist working only swings or nights will generally have a set schedule, frequently 1 week on 1 week off or 1 week on 2 weeks off (26-35 weeks off).
It’s never too early to start on your bucket list. Go snorkeling in the Maldives, on an African safari, or see the Northern Lights in Norway.
Continuing Medical Education
Continuing medical education (CME) is a universal requirement, though each state has its own specific continuing medical education requirements. Suffice it to say, you have to check with your state as to what your CME requirements are.
Most states require 25-50 CME credits per year averaged over 3-4 years. You’ll want to sprinkle in 2-4 hours of CME a month. Luckily, there are a lot of options for CME in radiology both in-person (conferences and courses) and online and you will even earn some CME simply by doing your job (tumor board, multidisciplinary case conference).
The Best Aspects of a Radiologist’s Work
Radiology is a ROAD (radiology, ophthalmology, anesthesiology, and dermatology) lifestyle specialty. The hours are favorable and the pay is good. There is good work-life balance inherent to shift work as you can separate work from personal life.
The work is fascinating. You see all aspects of medicine. You have opportunities to teach medical students, residents, and residents in other specialties such as internal medicine and family medicine about imaging, imaging modalities, imaging technologies, and what studies to order for various clinical situations to help them provide excellent patient care. It can be truly gratifying training the future of medicine and thinking about the number of patients you will impact via your trainees (this is my favorite pyramid scheme…if I teach two people, and they teach two people…eventually everyone will know radiology!!!).
Radiologists will be around for a long time. Artificial intelligence will help us long before it replaces us if/when it ever does. The technology is always improving, and artificial intelligence solutions are already beginning to impact our efficiency and are highly likely to improve patient outcomes.
Diagnostic radiology is one of the few medical specialties where a physician can continue to work into old age if they choose.
What You Won’t Like About Radiology?
Working as a radiologist is excellent but not perfect. When a critical diagnosis is made it is not likely that you’ll receive any gratitude from patients. As a radiologist, your patients are all referrals and you don’t usually see them personally.
For me personally, the most difficult aspect is missing a clinically significant finding. Sadly, none of us are perfect and we all make mistakes. We’re expected to read high volumes of complex cases, frequently interrupted with procedures, calls from referring providers and physicians, and technologists with protocol questions, which can distract us from making or reporting a significant finding. Some findings, such as early cancers, are very subtle and easy to miss. As a practicing radiologist, there’s nothing that bothers me more.
Radiology is not a field where you will receive gratitude from patients or even really physicians for that matter. You will be an unsung hero in medicine – saving lives with life-saving or life-altering diagnoses on x-ray, ultrasound, mammography, CT, MRI, and nuclear medicine exams and rarely, if ever, get a thank you (I’ve received one thank you from a patient over my 6 years out of training, which made my year).
Final Thoughts
There is great variability between and within the different radiology practice settings. Similar to Goldilocks, there’s a job out there that is “just right” for nearly everyone! My personal opinion – find a job that will maximize your happiness – it’s out there.
I am fortunate and grateful to have followed my path into radiology and can’t imagine myself in any of the other medical specialties. All of those years of training were worth it đŸ™‚
