Radiologist asks: Why do young docs lack interest in high-paying extra shifts?

A radiologist is pondering why younger members of the specialty seem to have little interest in picking up well-compensated additional shifts.

X.com user RJ (who tweets under the handle @northwoods1980) shared his thoughts on the social media website Aug. 16, calling the trend “somewhat unusual.” He questioned whether some younger radiologists “have fat trust funds waiting for them” and urged others to take a different mindset.

“It's always smart to knock down your loans and front load your investments,” wrote “RJ,” a musculoskeletal radiologist. “You never know what the future will bring. I never had this opportunity when I started about 15 years ago with such a different market than the current, but would have been working my tail off with extra compensation shifts in order to pay down debt and potentially start early on investing.”

The message had garnered 30 responses and nearly 30,000 views late Monday, with radiologists speculating reasons why others might be uninterested in adding extra hours.

“1. 25% of medical students have no debt at all. 2. Some medical students have spouses with well-paying jobs. 3. Some medical students will inherit wealth or have trust funds. 4. Some just don’t buy into the BS ‘work as hard as you can;’ they appreciate a balanced life,” responded Scott M. Truhlar, MD, MBA, an Iowa-based private practice radiologist and personal financial planning educator for physicians and medical trainees.

“There's no money that can compensate the [loss] in health from night shifts/[24-hour] shifts,” one unidentified X.com user responded. RJ, the original poster, clarified that the shifts are “anytime one wishes,” including weeknight evenings, vacation days and weekends, with rads compensated at a high hourly rate.

“Maintain balance in life. I wish I had spent more time with my children,” added David Yousem, MD, MBA, a professor and director of neuroradiology with Johns Hopkins Medicine in Baltimore.

“Damn millennials don’t want to work anymore,” joked one user who goes by the name “Average Money Joe MD.” “I’m trying not to be negative but honesty it seems that way,” the original poster, MSK rad RJ, responded.

“In talking with young rads I see a wide variety of responses on this,” wrote Tarang Patel, MD, a podcaster and Banner University Medical Center physician based in Arizona. “Some work very, very hard and others are more relaxed about it. I understand both approaches. But one thing is time moves on and no one cares how much you worked.”

“Relative to demand it feels like there is unlimited radiology moonlighting supply for those who are interested,” wrote Alaska-based radiologist Ned Holman, MD. “The best of it being flexible hour per click side gigs at high $/wRVU. Grinding outpatient MRI and CTs at your leisure is much less stressful than more hospital work.”

“Perhaps your definition of well compensated is not the same as theirs,” added M. Suhail, MD, a radiologist based in San Diego. “I see a lot of rads taking shifts at outside groups (quietly) for higher rates. I’ve even seen rads sell shifts at their main jobs at a loss to take higher paying outside shifts.”

“It’s their loss; best time to learn, improve your skill and elevate your expertise,” wrote Rajkamal Khangura, MD, medical director of neurointerventional radiology at Sutter Health in Sacramento. “I’ve had the most amazing opportunity to partake in diagnostic imaging and perform procedures. I am living the dream.”

“I’m a 3+ year rad and I still pick up those shifts on the regular,” wrote Michael Cellini, MD, a board certified diagnostic and interventional radiologist based in New Jersey.

“7-hour shifts going for $6,800—about $850 an hour or so,” another anonymous user added. “But it’s tons of volume. Most of the young people don’t want it. 7 hours of bone crushing work with half going to [the government] not worth it. Meanwhile the old guy in my group in his 60s worth millions but has nothing to do takes ’em.”

“I’m a couple years out of fellowship. I’m very well compensated during normal business hours. I don’t take call. My wife and I contribute 40% towards investments. You couldn’t pay me enough to work outside normal business hours. It’s time I’d much rather spend with wife and kids,” added X.com user “Todd.”

“Highly dependent on single/married, young kids/adolescents/no kids, other family care needs/no family, more thorough vs. just fast re: work, interests/obligations outside medicine vs. whole identity, bad boss vs. good boss,” wrote Mohammad R. Islam, MD, a minimally invasive gynecologic surgeon with the Mayo Clinic in Arizona. “This is why ⬆️ money doesn’t always = ⬆️ job satisfaction.”

You can read more of the discussion and add your own thoughts here.

The Twitter thread mirrors previous writings and research on the topic. Radiologists and other providers are increasingly occupying temp roles to relieve burnout and add flexibility into their schedules, staffing firm AMN Healthcare reported in May. COVID-19’s aftermath continues to reshape workplace expectations for radiologists and other providers, AMN reported. About 97% of those surveyed cited “freedom/flexibility” as one of the most rewarding aspects of temp work. Roughly 52% of those working as locum tenens are women, possibly owing to their additional duties as family caregivers.  

Another analysis published in February found that about 77% of radiologists are experiencing signs of burnout. Prevalence was significantly associated with increased workload, poor sleep quality, suboptimal working conditions, reduced job satisfaction and the “negative interplay between work, family, life and health.”

“In the U.S., the COVID-19 pandemic has had profound implications for the physician workforce nationwide,” researchers wrote in JAMA Network Open in October. “We found increasing burnout during the pandemic. Pandemic-related uncertainties have also taken an emotional and physical toll at the personal level and affected the labor force scarcity.”

Yet another survey published last year found that “not enough work-life balance” and “too low of a salary” are the two factors most associated with breast radiologists’ desire to leave a job. In a challenging recruitment/retention climate, radiology leaders must learn how to balance these two concerns.

“Individuals place different value on these factors, and practice leaders could endeavor to address both issues by increasing opportunities that allow radiologists to prioritize either income or work-life balance,” experts wrote in JACR. “Effective leadership is inversely related to burnout, and radiology leaders need to engage with physicians and understand what motivates them on an individual level.”