In 2022, we had the most requests to recruit CT Technologists and Radiologic Technologists. Here is a breakdown of the most requested ARRT specialties by our clients.

As you will notice, 73% of the recruiting requests were for Computed Tomography (CT), Radiography (R), and Magnetic Resonance Imaging (MR) Technologists. As the lifeblood of medical imaging, the demand for recruiting and retaining individuals who work in these three modalities is still top priority. While the cath lab department sometimes falls into the areas of cardiology or cardiopulmonary, many Cardiovascular Techs are ARRT certified, so we include these individuals as part of our services. Rad Techs overtook the second most requested search in 2022, just barely edging out MRI.

In previous years, we reported only small increases or decreases in compensation. However, 2021 was very different, showing double digit pay increases in several modalities. 2022 was more modest due to the market corrections that many organizations made the previous year in order to attract and retain providers. However, for the second straight year, almost every modality showed an increase in the high and mean wage being offered. As previously noted, we did see a slight uptick in the hiring of junior level technologists from 21% in 2021, to 27% in 2022. This can likely be attributed to the lower wages remaining rather unaffected. Our compensation review showed double digit increases in both CT and MRI in 2021, but there were only modest increases in this year’s review. We believe that is largely due to many organizations making wage adjustments during the height of the pandemic, but this did not continue for some organizations in 2022. However, many organizations did increase relocation and bonuses in order to attract potential workers.

Changes in the mean wage for general sonography were negligible when comparing data from 2021. We also noticed a slight decrease in demand for sonographers overall, but we do not perceive this as a negative, but possibly only a temporary shift in the demand. The overall highest wage offered by our clients did increase when combining all pay rates for sonography, regardless of certification. With the average wage being among the highest of all radiology modalities, ultrasound is still a very stable profession with a lot of demand.

Requests to recruit general Sonographers decreased slightly in 2022 from 71% to 66%. We also observed a modest increase in requisitions to recruit both Cardiac Sonographers and Vascular Sonographers which is interesting compared to previous years. We believe this might be due to our client base which is becoming more diverse. While most of our clients are hospitals, many are smaller facilities that need Sonographers who can perform routine ultrasound and vascular studies. In the past year, we have been hired by larger hospitals and health systems that have designated vascular and echo departments that are not combined with medical imaging. As noted below, general sonographers are still the most in-demand and account for 66% of the ultrasound job requisitions, down from 71% in 2021. Both echo and vascular requisitions increased respectively.

The Bureau of Labor does not provide data for all imaging modalities, but it does appear they have updated their website and provided much needed revisions to the healthcare sector. According to their most recent report dated May 2021, the median wages for the modalities they have are as follows.

One observation from The Bureau of Labor information is the lack of data for CT Technologists, which is a modality in high demand by many radiology departments. As noted in last year’s compensation review, Rad Tech wages were lumped into the same category as MRI Techs, and they did not differentiate general ultrasound from cardiac ultrasound. It makes us wonder if this might still be the case this year, but it is not clear. With the exception of Cardiovascular Technologists, their numbers do align closely with our data.

Regarding the incentive amounts listed above, we are unsure how employers determine what financial assistance to offer a new hire for relocation and bonuses. It might be an arbitrary number, or it could be an amount determined by years of research. One thing is certain, it is expected to be offered as part of a full-time financial package, just like insurance and other customary benefits. Relocation can sometimes be more negotiable than the pay itself due to the ol’ “internal equity” justification that employers give us on a regular basis. Essentially, they’re saying they cannot pay a new hire more than an existing employee because that might upset someone in the department, should they find out. Relocation is a bit more transparent. Bids can be obtained from moving companies and negotiated accordingly, if needed. Bonuses are discretionary, and some employers are more willing to negotiate this rather than wage. Many times, bonuses are just a way for the employer to sweeten the job offer and provide the new hire with additional monetary resources that might be needed when making a move. 

As a standard practice, repayment agreements are usually required by an employer in return for receiving relocation assistance and/or bonuses. These agreements simply allow the employer to legally recover these discretionary payments through payroll deductions or other means in the event a person leaves before fulfilling their agreed upon employment contract. In some cases, employers do prorate the amount and will give credit for the actual time worked under their contract should the employee leave before fulfilling their agreement upon term. While this varies from hospital to hospital, most agreements are usually for one or two years. To be clear, this only applies to stipends, relocation assistance, and bonuses. Employees can leave for any reason, at any time, otherwise. United States labor law also allows “at-will employment”, meaning an employer has the legal right to dismiss an employee for any reason, and without warning, if the reason is not illegal. 

These days, relocation and bonuses are all but expected as part of an employment offer. Like everything else, relocation has become more expensive. Inflation, due to supply chain issues and the Feds decision to raise interest rates seven times in 2022, did not help matters. These financial issues directly affect an employer’s outcomes when trying to recruit providers who live outside of their service area. We observed this same scenario back in 2009 during the last recession, so all indications point to a similar scenario in 2023, or until the Fed decides to roll back these increases. The point being, new hires will incur expenses for relocation, deposits for rent, utilities, internet, and many other expenses when moving to a new community. If you are competing with the hospital down the road and they are offering a sign-on bonus and you are not, you are likely going to end up being a candidate’s Plan B if everything else is equal.

RSG Health Services does not break down compensation by individual states. While we understand this specific information might be helpful, there are certain states that produce limited data for us. For example, the state of Wyoming has approximately thirty-three hospitals, and we worked for only three of them in 2022. By comparison, Texas has almost four-hundred hospitals and we received more than two-hundred and fifty job requisitions from our clients in Texas. Therefore, you can understand how this compensation review can be heavily weighted to represent some regions over others. Wages in states like California, New York, Virginia, and Washington State, to name a few, can be much higher than other states. However, most people should also recognize that everything from real estate, gasoline and taxes can be substantially more expensive in these areas as well. While it is true that no one likes to take a reduction in pay when they change jobs, it is important to consider your standard of living when making a move, not what’s necessarily on your W-2. It is very possible to have a better standard of living in another state that pays you less than what you might be currently making. For example, if your mortgage payment drops from $5,000 per month to $2,500 per month when you move from California to Wyoming, that’s a $30,000 savings. This does not include many other factors like reduced taxes, fuel and other necessities. So, making $60 per hour in California means you can likely have the same standard of living making $20 per hour less in Wyoming, in this basic example.

While our company specializes in providing recruitment services, not temporary staffing, our team speaks to travel technologists and Sonographers on a daily basis. Since late 2020, the travel sector has been a gold mine for many providers who were able to perform contract work. With the amalgamation of Covid-19, vaccine mandates, planned retirement, providers leaving the profession, and the already short supply of healthcare workers, it made for the perfect storm for which travel companies could take advantage. We have heard from many of our hospital clients who were being charged Bill Rates in excess of $120 per hour to staff a single provider for a thirteen-week assignment. At that rate, a hospital is paying the temporary company over $62,000 for one provider, for one assignment. It is not uncommon for many departments to have multiple travelers on staff to fill vacancies while they attempt to recruit full-time employees, and this has caused unsustainable labor costs for many organizations. As of this writing, we have heard from numerous providers that some staffing companies are reducing pay rates and not extending some assignments. This might be an indication that some hospitals are just not willing to be taken advantage of any longer, have discovered other means to provide coverage, or are just operating at a deficit. Our guess is it’s a combination of all these things.

In a survey we conducted on LinkedIn during the summer of 2022, we did hear from several travelers about the abuses they experience on some assignments. While I’m sure some of the negative responses might have been one-sided in nature, there were many of them. To sum it up, many travelers feel as if the distribution of the workload in some departments is highly unproportionate. Meaning, they are seeing the majority of the patients during their shift, while the full-time employees in the department have a lesser workload. There were many complaints about this issue along with a few others such as constantly changing hours/shift, on-call abuses, and being chronically short staffed. However, if earning top dollar is your number one priority, becoming a travel technologist can still be a good option for those who can be away from home for months at a time.

Whether you agree or disagree with the vaccine mandates, they are likely here to stay. That said, most, if not all of our hospital clients now allow providers to have a vaccine exemption. This is usually a simple process of acquiring a religious, or medical exemption. While the panic of being stricken down by Covid has pretty much dissipated, healthcare employers are always more cautious than others, and for good reasons. However, we are no longer having daily conversations with our clients and providers about vaccine mandates and related policies. Unlike the previous two years, as it relates to compensation and jobs, these mandates have not caused much of an issue now that Covid is not at the forefront of the national news.

While wages have increased significantly over the past two-years, many hospitals still find it difficult to attract and recruit providers even if they have offered pay increases. That’s because, money is not everything. We’ve heard that old saying many times throughout our lives, and it is still very true today. In a recent article we wrote titled, “Work/Life Balance for the Win”, it was clear that quality work, time off, and a good schedule are the most important factors for many providers when seeking new employment.

If you are a hiring manager or recruiter, I cannot stress enough the importance of quick engagement and follow through. If you receive an application or resume, do not sit on it for a week. If you do, there is a high probability that this provider will already have a handful of other recruiters contacting them while you wait for a good time to call them. It’s important that you engage them immediately, describe the benefits that are offered, and try to differentiate your role from the other five positions they are also considering. If you are unsure what separates your job from the others, then you will likely struggle to attract people to your job. Here are a few reasons providers make a job change, not necessarily in order of importance.

A Better Schedule ~ Significantly More Money ~ Family Reasons ~ Promotion/Title Change

There are obviously numerous other reasons, but these four reasons make up the majority. So, look at your openings and ask yourself if these things are present. If not, then why should they come to work for you? This can be a hard question to ask yourself, but if you are not getting quality applicants, you are likely not offering any of these things. You must go beyond “our town has nice people”, or “it’s cheap to live here”. Everyone says this, and it does not work.

Other than quick engagement, it is also important that you differentiate yourself from the other negligent employers who just rush people through the interview process. If you choose to bring them onsite for a meet and greet before making them a job offer, make sure you make it a special event. Take them and their spouse to dinner. Have a “welcome gift” in their hotel room. Set them up on a community tour with a realtor, or personally show them around town. These things absolutely work, and if you are not doing them, you are going to lose the most talented candidates to those organizations that are doing these things. 

Finally, whether you are an employer or a job seeker, be willing to negotiate. This is a job market like none we have seen before. If you are unwilling to negotiate a dollar or two to get the right job, then you might just miss out on working for some good employers. Understand, negotiation is almost always part of the deal and should be done within reason, on both sides. As an employer, there is nothing more frustrating than losing someone over a dollar per hour when it’s within your company’s pay range. Especially if you have a department full of travelers. What is that traveler costing you per year? As a job seeker, it is also not feasible to think you’ll start out at the same pay rate, or higher, at a new job. Remember, you didn’t start out at that amount when you started your current job five years ago. You received pay increases to get where you are. So look at the entire package, the benefits, the schedule, the insurance, the PTO, and yes, the pay.

As of this writing, the U.S. labor market has been a source of strength in the economy, with an unemployment rate still close to an all-time low. However, last week cracks started to show in the otherwise healthy job market. The ADP private-payrolls report for the month of March 2023 showed an increase of approximately 145,000 jobs, far less than the expected 250,000 increase. The report also indicated that the rate of wage growth slowed from the February report. Additionally, the job openings data last week showed that openings in February fell below 10 million for the first time in almost 24-months, signaling that the labor market may be cooling off a bit. The positive in all this might be wage growth, specifically in healthcare, which would support better inflation tendencies.

The bigger issue when it comes to recruitment might be the housing market. Over the past few weeks, we have seen housing data come in softer than anticipated. The housing and rental elements of inflation have remained high, and this can cause hesitation when it comes to relocating to a new area. One major home price index (Case-Shiller) saw moderate gains for seven straight months, coming in at 3.8% year over year, which has not been seen since the pre-pandemic period. From our perspective, higher mortgage rates did seem to affect our recruiting efforts in the first quarter of 2023. Since most of our clients find it necessary to relocate providers to their communities to fill open positions, many will likely continue to struggle should mortgage-lending standards continue to tighten. As we noted on page 10 of this review, this is huge when it comes to recruitment, and we saw this same pattern in the previous recession of 2009. Afterall, no one wants to move from a current interest rate that might be close to 3%, to an interest rate of 6.5%. 

 In our view, the most likely situation in the coming months is a mild recession. Recent economic data seems to confirm this view, and a softening labor market is often one of the last signals. All of this said, the overall assessment from our recruiting team is that the job market for medical imaging professionals is still very strong. Yes, the economy might make it more difficult to change jobs, but it can be done. Wages are still on the rise, there are plenty of available jobs, and this means many healthcare providers who have weathered the storm might now have opportunities that were not available to them just a couple of years ago. Sometimes those who are reluctant to change jobs due to fear or improper planning miss out on great opportunities due to short-term conditions. So, we are optimistic that 2023 should be a good year for those healthcare providers who are interested in seeking new opportunities. Many will sit on the sidelines waiting for conditions to improve, and this will create less competition for those job seekers who choose to test the waters.

Benefits are not something we usually cover in this review. In a recent survey we conducted on LinkedIn back in September 2022 to determine what additional information providers would like to see, many were interested in knowing more about PTO accrual, retirement plans, and insurance costs. We have found that most employers offer similar packages, and many are fundamentally the same. The biggest variables might be the participants cost for insurance, the rate of PTO accrual, and the employer match on the offered retirement plan.

Paid Time Off (PTO) – Most organizations use an hourly accrual method that commonly ranges from 6 to 10 hours of accrued PTO per week, with a maximum of approximately 280 to 320 hours (7 to 8 weeks) per year. This largely depends on a person’s years of service and usually accrues to no more than 3 to 4 weeks during the first year of employment. PTO usually begins accruing immediately with no waiting period, but in many cases, it cannot be used until completing 90 days of employment.

Insurance Costs – This can be a wide range. Some organizations cover 100% of insurance premiums for the employee, with only a cost for spouse or family coverage. Others have premium costs ranging from $20 per pay period, to as high as $300 per pay period. Like many other industries, multiple options are normally offered depending on budget and services that are provided under the plans. There are usually waiting periods for insurance coverage, but the most common start date seems to be the first day of the month following 30 days of employment. This waiting period can also be as long as 90 days, and in lesser cases, start immediately.

Retirement Plans – Most retirement plans are fundamentally the same. Again, the biggest variable will be the eligibility to participate, vesting, and the employer match component. We’ve found that most retirement plans are optional, but some employers will automatically contribute to your plan. It seems the most common allowable contribution is 3% to 5% of your annual base compensation, with an employer match on the contribution up to 100%. We’ve seen others that will match dollar for dollar up to 9%. Many employers consider you full vested in three to five years.

There are obviously many other benefits offered by organizations, but these three seem to be the most important. However, if you plan to look for a job down the road, ask for a Summary of Benefits from the Human Resources Department that outlines all benefits offered by the organization. Most job seekers we speak to only ask about the pay and the hours, not benefits. However, a company that offers exceptional benefits in lieu of higher pay can sometimes be the way to go. If you are in your 50’s for example and can get low-cost health insurance, a 9% match on your retirement plan, and four-weeks of PTO your first year, that might be better than taking a job that pays $3 per hour more. If you are a younger person, ask about these things, as well as tuition reimbursement, college loan repayment programs, scholarships for your kids, and stock purchase discounts. Many of our hospital clients offer these types of incentives, which can really add up over time. So, break out your calculator, sharpen your pencil, and add up the benefits before taking a job that pays you a little more per hour.

RSG Health Services is a healthcare recruiting firm that specializes in helping medical imaging and cardiology professionals find suitable employment opportunities. Our leadership team has decades of industry experience, and we hope this specialization sets our organization apart from the hundreds of other firms that operate in the same healthcare space. We hope the tools and information provided in this compensation review are helpful and informative.