Clinical Component

Navigating the Clinical Component

The Breadth and Depth of Your Clinical Practice

Imagine beginning your day reviewing overnight studies, then seamlessly transitioning between CT interpretation, fluoroscopy procedures, mammography screening, and interventional work—all supported by cutting-edge technology and a team of 58 skilled technologists who genuinely respect and support their radiologists. This is the clinical reality at Montrose Regional Health, where the variety keeps your skills sharp and your days engaging, but the support structure prevents the burnout that plagues so many radiologists today.

Your Patient Population

You'll serve a fascinating demographic mix that creates both clinical diversity and professional satisfaction. The population includes a substantial retirement community—meaning you'll see your share of Medicare patients with complex medical histories—but also includes weekend warriors from world-class ski resorts, professional athletes training at altitude, mountain bikers navigating challenging terrain, and families who've chosen this region for its exceptional quality of life.

The payer mix runs approximately 70% Medicare with minimal Medicaid, which is notably favorable for a rural hospital and reflects the affluent retirees and outdoor recreation economy that characterizes this region. Don't let the Medicare percentage concern you—this isn't a struggling rural hospital serving an impoverished population. There's considerable wealth in the surrounding communities, particularly in Telluride and among the second-home owners who frequent the area.

Modality Mix and Daily Workflow

Your daily case mix will include:

  • X-ray: High volume as the foundation of diagnostic imaging, though much of the preliminary screening can be handled efficiently
  • CT: Your highest-volume advanced modality, with substantial daily reads including emergency department cases, inpatient studies, and outpatient referrals
  • MRI: Significant volume driven by the robust orthopedic and spine surgery programs, with musculoskeletal studies being particularly common
  • Mammography: Substantial screening and diagnostic volume requiring MQSA certification—this is a critical service line for the community
  • Ultrasound: Including general, vascular, and breast ultrasound studies
  • Nuclear Medicine: Growing PET/CT program with occasional bone scans and other nuclear studies (though relatively limited compared to other modalities)
  • Fluoroscopy: Upper GI studies, contrast studies, and other fluoroscopic examinations as needed

The beauty of this practice model is flexibility—when multiple radiologists are working, you can focus on particular modalities or types of studies. Dr. Bernstein noted that when adequately staffed, radiologists can gravitate toward their areas of interest or expertise. However, the position requires true generalist capabilities because there will be days when you're the primary diagnostic resource, and the clinical need doesn't pause for subspecialty preferences.

Procedural Expectations

Light interventional capabilities are highly valued and frequently utilized. You should be comfortable with:

  • Paracentesis and thoracentesis: Regular procedures for both diagnostic and therapeutic purposes
  • Image-guided biopsies: Thyroid FNA, lung biopsies, bone marrow biopsies, and other biopsy procedures performed regularly (Dr. Bernstein mentioned thyroid biopsies specifically as a common procedure)
  • Breast interventional procedures: If you have mammography expertise, you'll perform stereotactic breast biopsies and place Savi Scout localization devices (the hospital uses this wireless localization technology rather than traditional wire localizations)
  • Fluoroscopic procedures: Barium studies, contrast examinations, and other fluoroscopic interventions

It's important to note that the hospital is actively recruiting a dedicated interventional radiologist to launch a comprehensive IR program, which will eventually offload the heavy vascular and complex interventional work. However, until that program is fully established, having some procedural capability—or at minimum, strong mammography skills—is essential for team functionality.

Call and Coverage: The Reality

Here's where this opportunity truly differentiates itself from typical rural radiology positions: there is no scheduled call.

Let that sink in for a moment, because it's rare enough to warrant repeating. You will not have mandatory evening call. You will not have scheduled weekend call. You will not be awakened at 3 AM to read a CT scan remotely.

The hospital utilizes V-RAD and Rad Partners for comprehensive after-hours teleradiology coverage, providing final reads for evening, overnight, and weekend studies. In the 12 years of current leadership, there have been perhaps a handful of instances where connection issues with the teleradiology service required a radiologist to briefly assist—Bodie estimates this happens approximately once per year and typically resolves within a couple of hours.

On those exceptionally rare occasions when technical issues might require assistance, there's a voluntary, paid arrangement where radiologists can help out if available. But this is truly voluntary—you're not on a call schedule, you're not expected to respond, and you're compensated separately if you choose to assist. This isn't the kind of "soft call" that masquerades as "no call" in many job descriptions.

Technology and Systems

You'll work with technology that rivals or exceeds what you'd find in many metropolitan centers:

  • PACS: Fuji Synapse—the latest version, running smoothly with exceptional on-site IT support
  • Dictation: PowerScribe 360—the industry-standard voice recognition system that most radiologists know and prefer
  • PET/CT: GE Discovery MI—a $2 million, state-of-the-art digital PET/CT system at the Ambulatory Care Center
  • MRI: Two high-field MRI systems, with plans for a third unit to meet growing demand
  • CT: 160-slice scanner at the main hospital with plans to upgrade to an Aquilion Serve, plus a 160-slice scanner at the Ambulatory Care Center
  • Mammography: Full digital mammography suite with stereotactic biopsy capabilities and advanced breast imaging technology
  • MinVista workstation: Dedicated workstation for PET/CT interpretation

The PACS Support Advantage

Unlike many hospitals where PACS issues mean submitting an IT ticket and waiting days for remote support, Montrose Regional Health maintains dedicated PACS administrators (Jeff and his team) whose offices are directly across the hall from the radiologist reading rooms. When you have a technical issue, you literally walk across the hall and it gets resolved immediately. This level of support is almost unheard of and speaks to the organization's understanding that radiologist efficiency depends on seamless technology.

EMR Environment

The current EMR is Meditech, though the organization is considering upgrading to either the latest Meditech version or transitioning to Epic (which most physicians prefer). Regardless of the EMR, your primary workflow will center on the PACS and PowerScribe systems, so the EMR is less critical to your daily efficiency than in many specialties. You'll have remote access capabilities for reviewing relevant clinical information when needed.

Volume Expectations and RVU Structure

The employment contract is structured around a base RVU threshold of approximately 12,000-13,000 RVUs annually—a reasonable expectation that reflects sustainable productivity rather than the exploitative volume demands that plague many private practices. Reading 80+ cases daily when present in the hospital, with a mix of modalities, should allow you to comfortably meet or exceed this threshold.

Importantly, the compensation structure includes performance bonuses above the base RVU threshold, so your productivity is rewarded without creating unsustainable pressure. Dr. Bernstein noted that he read approximately 23,000 RVUs last year while maintaining a reasonable work-life balance, demonstrating that the system rewards hard work without demanding burnout-inducing volume.

The Mammography Question

Let's address this directly, because it's an important consideration: the department strongly prefers radiologists with mammography capabilities, and MQSA certification is highly desirable. Here's why:

With Dr. Wolford joining next summer as a women's imaging specialist, the department will have strong mammography coverage. However, for vacation coverage and workflow flexibility, having multiple radiologists who can read mammography significantly benefits the entire team. Dr. Bernstein and Dr. Wolford will handle the bulk of mammography, but if you can contribute to screening reads or diagnostic cases, you'll be a more valuable team member.

That said, if you're a strong generalist without current mammography credentials but willing to learn, or if you have robust interventional skills that complement the team's needs, the department is open to that conversation. The key is bringing something valuable to the team dynamic—whether that's mammography expertise, procedural skills, or exceptional general diagnostic capabilities.

Teaching and Academic Involvement

While this isn't an academic medical center with formal residency training, you'll have opportunities for teaching and professional engagement:

  • Tumor board participation: Multidisciplinary case conferences where your input directly influences patient care
  • Weekly physician educational conferences: Wednesday morning meetings where interesting cases are discussed and continuing education is shared
  • Rad tech students: The department hosts radiology technology students from Colorado Mesa University's clinical training program, providing informal teaching opportunities if you enjoy working with students
  • Ultrasound tech students: Similar opportunities with ultrasound technology students gaining clinical experience

These activities are encouraged but not mandatory—you can engage at the level that suits your interests without pressure to participate in activities that don't align with your professional goals.

The Clinical Reality Check

Dr. Bernstein, who has practiced in multiple settings including private practice, offered this perspective: "I think the biggest selling point is that this is not the brutal torture like other practices where you can never go home. You will be able to enjoy quality time with your family and get to spend time in the community. "

This is the clinical reality—challenging, engaging work with a volume that keeps you sharp, supported by technology and staff that enable efficiency, within a structure that respects your time and prevents the burnout that has driven so many radiologists out of clinical practice entirely.

At Montrose Regional Health, the business is pushing down the doors, but the organization is committed to building the resources to meet that demand rather than simply squeezing more productivity from fewer physicians. You'll be busy, but you won't be broken.

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