This article is a reprint of a piece originally published in the RBMA Bulletin July-August 2026 issue.
At some point, the competition for new physician talent became a veritable cage fight, and if your group is playing by old rules, it is probably losing more often than winning. According to a recent RBMA “Hot Topics” survey, approximately 94% of radiology practices experienced staffing shortages in the previous 12 months. The survey report went on to note, “This near-universal experience underscores the urgency of developing comprehensive recruitment and retention strategies. The question is no longer whether practices will face staffing challenges, but rather how effectively they can respond to them.”
So what the heck happened? We all knew about dealing with geographic challenges. It could be difficult to attract physicians from a lush green climate to the desert—or overcome a community’s lack of educational, sports, or cultural opportunities for the family. Money overcame certain objections, but we accepted the fact that those who wavered were slightly riskier hires. If our compensation package was stronger, that could outweigh other factors—and there were fewer other employment options available. That changed quickly and dramatically with the shortage of radiologists and the ability to read cases remotely.
Radiologist shortages and increasing workloads
The shortage of radiologists has been a topic of discussion for several years, with the issue intensifying in recent years. Educational programs for the American College of Radiology (ACR), the Radiological Society of North America (RSNA), and the RBMA have featured the topic and continue to do so. These leading organizations agree the problem is long-term, with the Harvey L. Neiman Health Policy Institute predicting the shortage will persist through at least 2055 unless residency slots expand significantly or other technological interventions, like artificial intelligence (AI), boost efficiency and reduce workload strain. Added to the incoming supply shortage are issues with increasing burnout and accelerating attrition among existing groups.
All of this happened as the demand for imaging services increased and the environment adapted to an aging population, the expansion of imaging capabilities, and a higher dependency on diagnostic imaging by non-physician practitioners.
How have radiology practices responded? Not only has the definition of market-competitive compensation changed, but so have coverage options. Schedules have moved from demands for daily on-site coverage to everything from full-time remote work to a hybrid mix of on-site and remote coverage. Brutal call coverage schedules have been modified by night shift positions. In terms of compensation, new physicians were offered options for “internal coverage” shifts, signing bonuses, performance/production bonuses, and retention “stay” bonuses in addition to more traditional relocation and benefit costs.
If every practice hiring is offering some variation of these features, why is retention problematic? A recent Radiology Business article reported radiologist turnover had increased sharply in recent years, up 61% when activity in 2022 was compared to 2013, with turnover rates greater for female radiologists, those living in metropolitan areas and among early career physicians [emphasis added].
Let the games begin
The crisis is real and the challenge has been confirmed: recruitment and retention. To frame it another way, how does it feel to know this is a competition? And you are up against the world. It is no longer a world where you simply run an ad, arrange for an interview and make an offer. Or engage a recruiter and assume the work is done.
In terms of recruitment, review your most recent offer to determine if it is still market-competitive and discuss why you may have lost any recent candidate. If you are working with a recruiter, that person should be able to tell you what it will take to compete in terms of compensation, incentives and schedule, along with any specific negatives your group is dealing with (geographic location, quality of facilities served, partnership track requirements and so on). The latter will help determine the needed “extras” in the offer package.
Next, prepare for the interview. This is where the varsity needs to step forward. Some physicians represent the practice well in public and there are some you hope never talk to a TV reporter during a crisis. You know who they are. Remember, you are competing nationally for a prime recruit. You are both interviewing and being interviewed. A couple of illustrative examples:
ABC Radiology just lost a good recruit. In a follow-up communication, he noted the call schedule was especially intimidating and he opted for a better schedule with XYZ Radiology. I knew both practices. The call schedule was not worse in frequency or intensity at ABC but during the interview, the recruit spent time with two radiologists who could not control themselves when it came to complaining about call. I’ve never met a radiologist who is happy about covering call on top of a regular workload and all are grumpy when on the verge of a call shift. The difference was that most radiologists realized it was a shared misery supporting the success of all group members and they largely accepted that reality. A few took it as a personal affront and felt singled out and punished. The latter will not represent you well during the interview process. The interview team should instead include the physician with whom everyone would like to share a call shift. Chances are that person will also demonstrate a strong work ethic so he/she will represent the professionalism of the group.
There are also “the characters.” They’ve often been around for a while, partly because they are not sought after by competitors and partly because they are good survivors who are not in a high-visibility leadership positions. You know who they are too and they pop up in most groups. They are the eccentrics, the socially awkward, the unfiltered or the plain weird—but competent physicians. When I was driving recruits between sites so they could interview with several members of the practice, I cautioned the interviewee that he/she would find the next doctor to be interesting/somewhat offbeat/possessing lots of personality. Following that part of the interview process, I asked for feedback and often heard, “Yes, that was interesting. I’m glad you warned me.” It was a good opportunity to reinforce the group contained a wide variety of talents and personalities. In today’s terms, “diversity.” But think about the task of the interview process—selling the group—and the risk if the unaware recruit accepts the characters as representative rather than fringe.
Why should someone want to join your practice? Make sure you talk about the strong points—strong subspecialty expertise, the support of colleagues, opportunities to expand services in your area of expertise, a reputation for excellence, relationships with the medical staff and support of the hospital, cutting edge technology. How do you best explain the desirability of joining your team?
It would be worth a physician meeting to discuss interview strategy, to include:
- Identification of things that attracted each person to the practice
- Top 3-4 things to emphasize (beyond money) during interviews
- How to respond to awkward questions that have previously arisen, with the goal of having a prepared response, not a deceptive one.
- Things not to emphasize, especially if you’re having a bad day. (The goal is not to be deceptive but rather not to overload conversations with negative points.)
- Positive points about the community and available activities
Recruitment marketing
This stage goes beyond advertising for a position and there are multiple venues in which to present the information, from developing a special website to printed pieces in a packet to “printed” (formatted) electronic pages that can be sent to prospects during the process of arranging the on-site interview. Again, the goal is to present the practice in a positive light, recognizing that interview conversations alone may omit key points or otherwise not be memorable when the recruit is comparing opportunities. The idea is to control the message and taking the time to develop a professional presentation of strengths, values and group personality can support individual representations.
Topics to include:
- Photos and brief bios of groups members, including personal interests outside of work and professional/community involvement. (You never know when cycling, skiing or barrel racing might bridge the gap).
- History of the group, especially the accomplishments of a charismatic leader who established the distinctive personality of the practice. This doesn’t have to be a long, scholarly piece but can be bullet points and is especially helpful if you are conveying a commitment to entrepreneurial activities, innovation or expansion.
- Information about the community, including notable activities, landmarks, cultural offerings and activities. The local Chamber of Commerce and/or a leading realtor will often have excellent materials promoting the area.
- A very valuable extra: a statement outlining the group’s values and how they translate to the culture of the organization. You may (or may not) already have this in terms of a mission statement but check to ensure it remains relatable and pertinent to today’s operation.
Orientation: retention begins here
Physician turnover is disruptive, expensive, and sometimes disheartening. I once worked with a practice that was successful in attracting high-potential physicians only to lose many of them within only a few years. Doctors came into the group with enthusiasm and a strong work ethic, contributed new ideas and skills, attracted a following among referring physicians, and then left, discouraged and beaten down by a dysfunctional organization.
It turns out the group began to fail them from day one. The first six months of any job will prove challenging, but how can we make it easier for new physicians? Few corporations invest heavily in training, but it seems radiology is especially Darwinian, from the demands of reading cases in a busy hospital to handling the complexities of coding or denials as part of the revenue cycle team. Our orientation seems to consist of “Welcome to the team. Contact Joyce for your password, jump in the pond with us, and I hope you can swim.”
There is an unfair educational mystique following our physicians, and we don’t talk about it. Because they survived years of intense stress learning to be radiologists, we assume they will somehow effortlessly glide into the world of private practice and thrive—all on their own and in spite of new work environments, cultures, and demands. Let’s look at day one for our dysfunctional group, which provided services at two busy urban hospitals and ten outpatient imaging centers owned by a corporation. Our new doctor was, for example, provided with an imaging center address and start time. Fortunately, the owner corporation’s website provided a list of the imaging centers, maps showing their locations, and a list of modalities by site. She walked into the imaging center cold, asked for the reading room, and received the usual sign-on instructions for the technology. Then it was “go” time, with a full worklist (including MRIs from other sites) and a backlog from the previous day. She knew her productivity was being tracked and was concerned about the fact that her work was slow while she learned how to use a new voice recognition system and PACS. She appreciated that the lead technologist was friendly, introduced herself early in the shift, and assisted when the PACS froze up during the afternoon. She had to call her husband to report she’d be staying late to finish up the list and dragged out after 7 in the evening, with a 45-minute drive home and knowing she had to adjust to another site in a few days.
I asked one of the new physicians in the group how he felt about his orientation and support during his first days with the practice, including any suggestions. He politely unloaded on me and then suggested we provide new physicians with essential information by site before they showed up for the assignment. Our lack of preparation was embarrassing, especially since the following requests seemed baseline and logical:
- Name of the lead technologist and/or department manager by site
- Equipment by site. This was more important because there was no standardization across the imaging center sites, which were acquired over time so equipment was of varying vintages, brands, and protocols.
- Contact list. Who to contact for questions or problem resolution, including for VR, PACS, RIS, and related technology.
- Top referring physicians, including any special protocols or processes for key referral offices.
- Details by site: personnel, hours of operation, modalities, and other things it would be helpful to know.
Baseline information by site was developed, and corporate information was updated, including who did what within the practice, how to request vacation time, and other policies and processes formerly handled only verbally or on request.
Operations and physician retention
Relying strictly on compensation to ensure physician retention turns out to be an outdated concept. Yes, a competitive compensation package is a baseline requirement, but what did you discover former employees are seeking when they opt for greener pastures? Turns out it’s often a quest for a better day-to-day work environment, which in radiology can mean getting to work a schedule that includes remote coverage part of the time. At least that’s what one group discovered when they began the quest to improve retention. While developing that option means defining new rules and setting productivity expectations for remote work, flexible schedules have been identified as a desirable offering.
Another practice offered new physicians an option to generate additional compensation by selecting extra shifts up front as schedules were being developed. Yet another group established a mentoring program so each new physician was assigned to a senior member of the group to answer questions, provide guidance regarding how to navigate the hospital system or deal with a particular referring physician—or just be there to listen after a frustrating day. While the official assignment was set for the first-year transition into private practice, the relationships endured beyond that term.
Where have new physicians in your group struggled to adapt and fit in? Or better yet, feel like they fit in? You’ll probably have to ask rather than wait for a newbie to start the conversation (or turn in a resignation) and then discuss operational implications if changes in work patterns are indicated.
An especially problematic relationship can involve physicians who strictly work remote positions and may not even live in the immediate geographic area. How can you make them feel like a valued part of the group, especially if they aren’t able to attend regular group meetings? Who talks with them regularly or, more importantly, listens and can provide support?
And finally, how do we address those situations involving good radiologists opting to retire early due to burnout or career fatigue? How can the group offer phased-down schedules or other moderated scheduling considerations rather than forcing a full retirement decision? One group even offered a once-in-a-career sabbatical option to retain physicians. It was strictly rules-based and limited, but took a unique approach to a growing problem.
Developing a retention strategy
Radiology functions in a high-pressure work environment, and it is difficult to slow down to develop a strategy. However, the shortage of radiologists and the fact that the situation is predicted to continue should elevate the importance of formally addressing the problem, beginning with a frank discussion of both strengths and weaknesses of the group’s culture with the goal of building on its strengths and improving weaknesses. What few things could potentially make the biggest difference in terms of improving physician engagement in the practice?
Relationships and employee engagement represent recurring themes in several Gallup workplace surveys and reports. It begins with having simple conversations that occur frequently and as part of the regular workday, not waiting until there is a crisis. “When a manager has one meaningful conversation a week with each direct report, employees are four times as likely to be highly engaged, regardless of whether they are a frontline, hybrid or fully remote worker. Gallup research shows these conversations are more meaningful when they focus on goals and priorities, recognition for recent work, collaboration, and using employees’ strengths. When done routinely, they can even be as short as 15 to 30 minutes.”
The C.A.R.E. framework (Community, Advocacy, Recognition, Empowerment) is presented in a 2026 Academic Radiology paper and emphasizes remote and hybrid settings. The paper explains how collegial interactions that occur naturally in on-site reading rooms can be replicated both virtually and supported by periodic in-person settings.
Radiologist shortages are predicted to last throughout our career lifetimes. The practices that emerge as winners in the varsity sport of recruitment and retention will include those who actively work to establish a supportive work environment.
Prior to joining MSN Healthcare Solutions as Director of Education and Corporate Communications, Pat Kroken had nearly 30 years of experience in radiology management as both a practice manager and consultant to radiology groups, billing companies, software vendors and hospital radiology departments.
Pat has had more than 200 articles published, is a regular contributor to the Radiology Business Management Association (RBMA) Bulletin and a frequent speaker on practice management topics. She served two terms as President of the RBMA, is Editorial Advisor for the national RBMA publication, The Bulletin, and represented the “business side of radiology” as RBMA Liaison to the Radiological Society of North America (RSNA) Associated Sciences Consortium for 7 years.
