Living on Borrowed (or Bought) Radiological Time
How does onboarding factor into radiologist compensation?
How much is your professional time worth?
Some folks have a snap answer to the question. They know what they typically make in a given interval, and they can spit out that number with reflex-like speed. Others need a moment to think about dividing their income to arrive at whatever fractional amount is relevant. Yet others would respond with questions of their own. It depends. What would I hypothetically be doing in the interval you’re talking about?
There was a time when I was earning a little north of $200/hour, but if a “physicians-only” survey came along that gave a $20 gift card for 10 minutes of my time, I would probably do it. Docs doing case reviews for lawyers (med mal, workers’ comp, etc) routinely quote rates far exceeding what they get at their day jobs.
Adjust circumstances and some folks will practically condemn you for putting a price tag on your time at all. Some of the more contentious moments in my career have been when working “per click” and my (now former) employers couldn’t supply me anything to click on, whether it was due to their rad/case balance being askew or technical problems. When I suggested that I deserved something above $0 for being at my post, they reacted like I was demanding their firstborn.
An anonymous online rad this past week asked peers their thoughts about payment for onboarding: “Why after completing hours of unpaid time doing credentialing, do we expect new hires to do anywhere from 0.5-2 days worth of unpaid onboarding and/or ‘required trainings’?” The rad went on to ask if folks felt the appropriate answer might vary depending on W2 vs 1099 status, salaried/hourly/per-click, etc.
As with any faceless social media, opinions ranged widely. Thinking back along the course of my medical career (26 years if you count internship), I saw that this issue always followed paths of least resistance.
In salaried jobs (house staff positions at three hospitals, two subsequent spots at outpatient imaging centers, and one W2 telerad), that meant onboarding took place during regular working hours after my “start date.” I was on their paid clock. It didn’t matter whether I was reading cases or being bored to death in orientation. It would have been more of a hassle for the employer to withhold pro rata wages for the time I spent onboarding.
Meanwhile, in my per-click jobs, payment was tied to productivity. The path of least resistance was not to pay when there was no productivity. It would have been more of a task to create a mechanism to assign fake RVUs for completing onboarding requirements.
The real world might run according to paths of least resistance, but that doesn’t stop people from wanting otherwise, citing things like what’s “right” and “fair.” It does seem reasonable that a professional whose time is respected will receive some sort of compensation when that time is demanded of him or her.
A counter argument might be that the time is compensated, just not directly. It might be “baked in” to whatever the rad will subsequently receive while doing the job for which onboarding was necessary. Suppose, for instance, onboarding takes two days, and a year of the subsequent employment means 200 workdays. Might it be reasonable to consider 1 percent of the year’s salary as oblique compensation for the onboarding?
My suggestion to anybody tempted to wrestle with the issue: Don’t bring it up unless you are doing it in a way that is beneficial to the other party. Folks generally like it if you go out of your way to give them things, so if you are doing that, you might as well take credit for it.
Thus, if you are recruiting rads, you might boast that you will pay for their onboarding, which will underscore that other jobs might not be as generous as the one you are offering. If you are a job-seeking rad and you really want to land a particular gig, asking if you can make their life easier by onboarding before your paid work actually begins can be a nice token.
On the other hand, if you bring up the subject as a demand — that you want to get 0.5-2 days’ worth of money out of the other side — it just seems nitpicky. You might feel like a shrewd individual, but you may cast yourself in an annoying, petty light, burning up political capital before you have even earned any. You certainly won’t seem like someone who thinks in terms of the longer term or “big picture.”
If the other side brings up the matter, of course, you don’t want to be caught flat-footed. You also don’t want to respond by shaming them for trying to nickel-and-dime you. (However, you might take it as a warning that the prospective employer will behave similarly with other issues in the future and wonder if this a relationship you really want to cultivate).
Part of my comment in the social media thread pertained to this, specifically for employers who aren’t paying for onboarding (like per-click 1099 gigs). If the rates you pay are competitive, you can reasonably boast that you will swiftly surpass whatever The Other Employer is offering to pay for onboarding.
For instance, suppose you are paying $38/RVU, and another rad group is doing $30. Assume your prospective hire does a modest eight RVU per hour and works eight-hour days. Every day he or she works for you rather than the other group, he or she is pocketing an extra $512. Even if The Other Employer is offering, say, $4k for two days of onboarding and you are not, it’s only going to be a couple of weeks before working for you will leave the recruit in a better position.
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