New Radiologists Learn to Navigate the Realities of Independent Practice
Mentorship, autonomy and self-directed learning can ease the transition to practice
New radiologists entering independent practice must quickly learn to balance speed and accuracy, communicate effectively with clinicians and seek guidance without the built-in supervision of training.
For Jorge Abreu Gomez, MD, the biggest difference between training and independent practice was not the volume of cases or the pace of the work. It was knowing that his report would stand on its own.
“During training, there is always another layer of supervision. In independent practice, I quickly understood that my interpretation would directly guide the clinical team and influence the care of a patient and their family,” said Dr. Abreu Gomez, assistant professor of medical imaging at the University of Toronto.
That responsibility was both humbling and motivating, he said. It reinforced that a radiology report is not simply a description of images, but a clinical communication tool with real impact.
In a recent Radiology: Imaging Cancer editorial, Xiaoyang Liu, MD, PhD, FRCPC, and coauthors Dr. Abreu Gomez and Brian J. Burkett, MD, MPH, reflected on the anxieties, surprises and learning curves that come with moving from training into independent practice.
From Interpreter to Consultant
The authors said one of the central lessons of independent practice is that radiologists must move beyond image interpretation and function as clinical consultants.
Dr. Abreu Gomez said overnight shifts and communication with referring physicians during training helped prepare him to understand clinical questions and guide patient care.
Dr. Liu, an abdominal radiologist at the University Health Network Joint Department of Medical Imaging and assistant professor of radiology at the University of Toronto, described a tumor board experience in which a surgeon encouraged her to move beyond imaging descriptors and explain whether a mass was benign or malignant, and what could be done if she was unsure. “The experience helped me realize that radiologists must translate, not transcribe,” she said.
“What surprised me was how much the value of a radiologist extends beyond producing an accurate report,” Dr. Liu said. “In practice, our clinical colleagues often need us to go one step further: What does this finding mean for this particular patient, and what should we do next?”
Conversations with colleagues across the care team have helped her understand which imaging distinctions change management. “I increasingly came to see the radiologist not simply as an image interpreter, but as an imaging consultant who is part of the clinical team,” Dr. Liu said.
Dr. Abreu Gomez said participation in multidisciplinary discussions similarly helped him build confidence as a consultant.
Building Support Early
The authors note that early-career radiologists may benefit from building a small network of mentors and colleagues who can provide clinical guidance, career advice and opportunities.
Dr. Liu said she benefited from mentors who provided clinical and career guidance and connected her with multi-institutional opportunities.
“Look for people whose careers and values you respect, but also for people who are willing to give you candid feedback and who take a genuine interest in your development,” she said.
Dr. Abreu Gomez agreed. “I don’t believe that meaningful career growth happens in isolation. Most important achievements are built through teamwork, trust and positive professional relationships,” he said.
That network also becomes important when an early-career radiologist needs a second opinion. Dr. Liu said asking for help can initially feel uncomfortable after years of supervised training.
“Once you become an attending, however, you are suddenly the interpreting radiologist who is supposed to know the answer,” she said. “Particularly early on, asking another radiologist for an opinion can feel as though you are exposing a weakness.”
With experience, she came to view consultation differently. “Knowing when to ask for another opinion is part of being a good radiologist,” Dr. Liu said. “Independent practice does not mean practicing in isolation.”
“I don’t believe that meaningful career growth happens in isolation. Most important achievements are built through teamwork, trust and positive professional relationships.”
— JORGE ABREU GOMEZ, MD
Balancing Volume, Speed and Accuracy
Adapting to higher clinical volume while balancing speed and accuracy can be a hurdle for new attendings, but hurrying may predispose radiologists to errors without saving time.
“This was one of the biggest adjustments for me,” Dr. Liu said. “Early on, it is tempting to give every examination the same amount of time and attention, but that is neither sustainable nor necessarily the best solution.”
With experience, she learned to interpret straightforward examinations efficiently, while devoting more time to complex cases or those with major management implications.
“For me, efficiency is not simply about reading faster,” she said. “It is about developing a systematic approach and learning where your attention has the greatest value.”
Dr. Abreu Gomez said busy call shifts can require radiologists to supervise trainees and technicians, interpret studies and respond to referring physicians simultaneously. “Efficiency should not mean shortcuts. Some cases need more time, and we must recognize that,” he said.
Dr. Liu said graded autonomy can expose trainees to attending-level workflows while supervision remains available.
“For an early-career radiologist, I think it is important not to allow a productivity benchmark to become a measure of personal competence,” Dr. Liu said. “For someone just beginning independent practice, I would prioritize developing a safe, consistent and reproducible workflow. Efficiency generally improves naturally with experience.”
“The goal is not to maximize academic output every month, but to build a sustainable academic trajectory over many years.”
— XIAOYANG LIU, MD, PHD, FRCPC
Rethinking Work-Life Balance
For Dr. Burkett, assistant professor of radiology at Mayo Clinic in Rochester, MN, who addressed work-life balance in the editorial, the term itself can be limiting.
“I know that in the article we used the phrase work-life balance, but as I’ve gotten more experience, I’d like to add that I think the word ‘balance’ is sometimes misleading,” Dr. Burkett said. “It may be more helpful to accept that trade-offs exist and be intentional about how much time and energy to devote to career pursuits outside scheduled work.”
“You have to decide how much (if any) extra time and energy you want to give to your career,” he added. “Being honest with yourself about those trade-offs and what is important to you may be more helpful than worrying about the correct amount of balance.”
Dr. Liu cautioned early-career radiologists against trying to do everything, noting that academic work becomes more sustainable when they focus on one or two areas in which they want to develop expertise.
“The goal is not to maximize academic output every month, but to build a sustainable academic trajectory over many years,” she said.
“You have to decide how much (if any) extra time and energy you want to give to your career. Being honest with yourself about those trade-offs and what is important to you may be more helpful than worrying about the correct amount of balance.”
— BRIAN J. BURKETT, MD, MPH
Preparing Before Practice Begins
Training programs can help build autonomy before graduation by giving trainees staff-like responsibilities with supervision and feedback. Dr. Abreu Gomez pointed to fellowship experiences, while Dr. Burkett cited independent call and “moonlighting” as valuable preparation.
Dr. Liu said formal feedback can disappear almost overnight after training. Early-career radiologists therefore need to create their own feedback loops by reviewing clinical outcomes, participating in multidisciplinary conferences and continuing to consult peers.
“The transition is really from passive feedback during training to actively seeking feedback throughout your career,” she said.
RSNA also supports the authors at different career stages through research funding, educational resources, publishing and presentation opportunities, and professional connections. “I think that is one of the strengths of RSNA: it can support you differently at different stages of your career,” Dr. Liu said.
Dr. Abreu Gomez similarly said RSNA educational materials, research presentation opportunities, courses, journals and networking helped him refine ideas and projects, meet colleagues and feel part of a larger radiology community.
Dr. Burkett said his involvement with RSNA led to speaking invitations, writing opportunities and radiology friendships.
“I wish I had understood earlier that becoming a good attending does not mean reaching a point where you know everything,” Dr. Liu said. “Confidence is being comfortable recognizing what you know, recognizing what you do not know, asking for help when you need it, and continuing to learn.”
For More Information
Access the Radiology: Imaging Cancer article, “From Training to Independent Practice in Radiology: Reflections and Early-Career Lessons.”
Read previous RSNA News stories on early-career radiologists: