Utilization Review Work- Flexibility and Family. A Radiologist’s Story.


Today I’m excited to bring you an in-depth interview with Dr. Carroll, a board-certified radiologist who transitioned into working remotely for a Utilization Review company that focuses on imaging studies.

If you’re looking for flexibility and less direct patient care, this non-clinical job might be for you.

Q: What made you decide to consider a non-clinical career?
Honestly, I’d been considering a non-clinical career since the beginning of medical school. But I also thought that I might be able to find an area within clinical medicine where I could be happy. I did find an area of medicine that I enjoyed but I still felt a lot of stress from the work volume and the potential threat of being sued. Once I had young kids, I wanted to decrease the length of my days so that I could be around more and find a position where needing to stay home with a sick kid wouldn’t be as stressful.

Q: How did you decide what non-clinical career to transition into?
In our coaching work together, you and I explored non-clinical options that might be suited to my interests and background as a radiologist. At that time in my life, I was most interested in work that could give me flexibility in scheduling and less day to day stress. I also liked that I could transition into utilization management with the background I already had. 

I talked to two different physicians who worked at the company before I interviewed. I had a good idea before talking to them what the job was like but talking to them was also helpful. When I interviewed for the position, the interviewer was frank about what the work was going to be like and that the most stressful part of the job would be the peer-to-peer calls. Everyone has to be willing to do peer-to-peer calls. I don’t feel like anything was falsely advertised.

Q: What kind of utilization review company are you working for?
I’m working for a healthcare company that is contracted by insurance companies to do imaging utilization review. We review pre-authorization requests for advanced imaging.

Q: Can you describe a typical day or week?
I typically work 20 hours a week, divided up over four days a week. I work five-hour shifts with a 15-minute break in the middle. Usually about half of the shift I am doing straight case review and the other half of the shift I am available for peer-to-peer calls. I could also divide those hours over as little as 2 days or as many as 5 in a week.

Q: What kind of schedules are possible at this company?
The physicians work between 20 and 40 hours a week. For the most part, people can divide up those hours as they wish. Evenings and weekends are optional. Sometimes the caseload is high at the end of the week and there will be an option to do weekend work; it is never required.

Some people think you can work in a coffee shop but you can’t. Your set up needs to be HIPAA compliant.  

Q: How do you find working remotely?
I like working remotely. I don’t find it all that different from my time as a radiologist as I really spent a lot of my time working independently in that role as well. Is it lonely or isolating? Not much more so than being a radiologist.

Q: What do you like about your job?
One of the biggest things I like about the job is the flexibility in hours and scheduling. I like that I can take my kids to school in the morning, work for five hours, do some other things, and then pick up my kids again and still be home at a reasonable time. I like that if one of my kids is sick, it’s not a huge deal to reschedule my hours. I like that the job is detail-oriented, that I get to use my expertise as a radiologist, and that the decisions are made using guidelines based on literature review.

Q: What are some challenges in your work?
I think one of the challenges comes from working remotely in that my only interaction with my colleagues and supervisors are electronic, and it is sometimes difficult to convey tone in these interactions. I think it is also difficult to sometimes see inconsistency in the way in which the guidelines are applied to different cases. The company works hard to train people well and support as much consistency as possible, but there is still some inconsistency. Lastly, the peer-to-peer calls can be challenging. The job would be pretty stress-free without them. Most interactions are very reasonable but you never know what the next call will be like.

Q. Do the peer-to-peer calls get easier?
The calls do get easier with time, but there will always be tough ones. What is a bad call like? You might get someone who is very assertive and says something like, “How do you sleep at night, how do you do this job?” I do totally get it and understand why doctors can be frustrated.

Or sometimes you get someone who is not really making any sense and it can be hard to sort through.

Bottom line – I try to understand what they’re looking for with the imaging study and guide them through the steps they would need to take to get the study approved if possible.

Q: Did you receive training on peer-to-peers?
We did receive training including listening to some of the mentors take actual peer-to-peer calls. We also have a lot of training guides including one that helps walk you through a peer-to-peer. During the first several months, you just do cases without calls while you’re getting used to the work.

Q: Do you find the peer-to-peers easier because you are a radiologist?
Yes, I think it is sometimes harder for some of the clinicians who are not radiologists or other imaging heavy specialties. For example, why you would order an MRI vs an MRE in a particular scenario. We also review a lot of PET scans. These can be kind of overwhelming for those who don’t have a radiology or oncology background.

Q: Can non-radiologists fill in the knowledge gaps in imaging studies?
Yes, there are guides for the different imaging tests and clinical indications and what would be appropriate. A lot of the cases are similar scenarios, such as back pain or following up on a pulmonary nodule. You get more comfortable with the guidelines.

Q: Do you miss clinical practice? Would you go back?
I would say I miss clinical practice a little. I do miss some of the interactions with my physician colleagues, the support staff, and my patients. I also miss some of the satisfaction that came from doing procedures. Overall, I don’t have a significant desire to go back but I also don’t want to entirely close that door. I don’t know that I see myself doing this for the long term and I’m still thinking about what’s next.

Q: What kind of physician might enjoy this kind of utilization review work?
I think for someone wanting flexibility and less stress, i.e. those who worry about getting sued, this could be a good option. These positives need to outweigh the potential negatives of doing peer-to-peer calls and the decreased compensation. I think you do need to be a levelheaded person so that peer-to-peer phone calls don’t get to you too much. I think oncology, radiology, and neurology backgrounds are particularly well-suited due to their familiarity with imaging.

Q. Can you share any guidance on compensation?
I’m under the impression that most physicians are making between $80-$100 per hour plus benefits. You can work 20 hours per week and still have benefits. Health insurance is prorated on the hours you work.

Q: What has it been like to take a significant decrease in income?
The decrease in salary has been worth it for me. I also know that I could increase my hours doing what I’m doing now and make more money if I wanted or needed to do so. My partner works full-time, so I am not the sole bread-winner.   

Q: Any tips for doctors considering this area of utilization management?
Read what other people have to say about it and talk to people already at the company you’re considering so that you can assess whether it may be a good fit for you.

Q: What specialties does your company hire?
The company is always in the need for cardiology, neurology, radiology and heme-onc specialties. If physicians from other specialties are interested, they will often be connected to a recruiter to discuss their availability, licensure, and specialty to determine if there is an immediate need or if they would be a candidate for the near future.

A big thank you to Dr. Carroll for her great interview and for sharing her transition experience!

A question for you – what is most important to you in your career at this time? Is it having flexibility? Earning a certain income? Having more autonomy? Identifying what’s important helps you find the right path forward for yourself.

If you missed the most recent blog, “Do you have a loose wire keeping you stuck?” you can read it HERE.

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  1. Sylvie on March 5, 2020 at 12:03 pm

    For me, I realized that I am not fond of speaking to and meeting people all day long because I am an introvert. Utilization review has been great for me. I also like that the schedule is flexible and it’s not boring, it’s actually entertaining.

  2. Heather Fork on March 5, 2020 at 2:56 pm

    Thanks so much for sharing your experience with how utilization review works better for you and your personality. I’m an introvert too, and I never factored in how seeing patients every 15 minutes all day long would feel once I was actually in practice. I love interacting with people, but much prefer a number of hour-long coaching calls rather than 25 – 35 short visits. This can be draining even for extroverts. I’m really glad you have been able to find a way to use your talents in a way that works for you!

  3. Brooke on March 7, 2020 at 6:08 am

    Hi Heather-I, too, am a radiologist who works for a UR company. My experience has been very similar to Dr. Carroll’s and I find that I am learning more than I ever imagined in this job. I recommend it to others who are looking for a different way to use their medical training.

    • Heather Fork on March 7, 2020 at 7:50 pm

      Hi Brooke! It’s great to hear from you. I’m so glad that you’re enjoying your work and getting to learn a lot. I hear this often from physicians doing U/R as they see a much greater breadth and depth of cases than when they were in practice.

  4. Leah on December 4, 2020 at 2:28 am

    For those of us interested in this line of work, can you give any tips of companies that may be looking for radiologists at this time? Thanks!

    • Heather Fork on December 4, 2020 at 3:36 am

      The best way to find companies that are hiring for your specialty at a given time is to search online – my favorites are Google, LinkedIn, and Indeed.com. You can try different search titles such as “Medical Director Radiology”, “Utilization Review Radiology”, “Clinical Reviewer Radiology”, “Physician Advisor Radiology,” etc. Which companies are hiring varies significantly depending on a lot of factors, including their budgets, the contracts they have, and attrition. In the New Year, there tends to be more hiring than during the end of the year, where we are right now, but you still might find some opportunities by searching.

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I had been a practicing Internist for 20 years when I reached a point when I needed to make a serious change in my career path. While I enjoyed seeing patients, I was not satisfied with my life-work balance. My job was taking me away from my family and left me little time and energy to do other things that are important and meaningful to me. I came across Dr. Fork's podcast; The Doctor's Crossing Carpe Diem Podcast, it is such an informative and enjoyable podcast for any physician who wants to do more with their career and life in general. Then I had the pleasure to get career coaching from Heather, it was truly an amazing experience. Heather has broad knowledge of all the different career paths that are available for physicians, she is so insightful and very easy to talk to. She helped me clarify my goals, examine my own mindset and definition of success. Together we developed a clear plan and actionable steps to reach these goals. I eventually made a career transition to a remote non-clinical position that allows me to do meaningful work which aligns with my personal and professional goals and priorities. 

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I am deeply grateful that I can continue my work in the emergency department and serve my community as a physician as well as a coach. Working with Heather was a transformative gift that enabled me to rediscover my true self, find clarity in my life's purpose, and unlock my full potential. Through her guidance, I not only reignited the powerful, confident, and bold version of myself I had lost sight of but also realized the boundless possibilities that lay ahead.

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