A Guide to Career Ladders for Radiology Techs

The medical imaging profession has entered uncharted territory. According to an American Society of Radiologic Technologists (ASRT) report, several factors have led to unprecedented numbers of job openings, including an aging population requiring more health care, fewer students entering the profession, and more people leaving for various reasons.

ASRT surveys show vacancy rates are at their highest levels since the society started tracking staffing metrics in 2003. The estimated radiographer vacancy rate reached an all-time high in 2023, essentially tripling in just two years, from 6.2% to 18.1%.

"It's very competitive for imaging professionals, and it's been challenging in all modalities," said Brian Lentz, vice president of imaging services at Phoenix Children's Hospital.

Longitudinal tracking of estimated vacancy rates

Changes in vacancy rates in medical imaging disciplines from 2003-2023. Reprint permission granted by the ASRT.

Vacancy rates for some complex modalities nearly doubled, with MRI reaching 16.7% and CT reaching 17.7%.

"It is seemingly impossible to find a CT tech or an MRI tech or specialist," said Aaron Wiles executive director of medical imaging at Ann & Robert H. Lurie Children's Hospital. "We have had to use agency quite a bit in those spaces because we can't seem to find that elusive full-time role."

Other hospitals can't get enough X-ray techs, which has traditionally been the easiest modality to fill. Most hospitals are struggling with night and weekend positions no matter the modality. And many technologists only want to work within one modality.

As vacancies have increased, the number of incoming professionals has decreased. In 2006, 17,487 people took the American Registry of Radiologic Technologists certification exam in radiography; in 2022, the number fell to 14,330.

Supply and demand (Radiography)

Total number of radiography certification exam takers compared with the job vacancy rate for radiographers over time. Reprint permission granted by the ASRT.

"The shortage started pre-pandemic, got worse during the pandemic, and just has continued on," said Patricia Giorgio, radiology technical director at Boston Children's Hospital. "Schools aren't putting out more technologists, but the need for them is growing as health care and technology grow."

Retention will be a critical facet of future success, said Andrew Ruiz, director of imaging services at Children's Hospital of Orange County (CHOC). "If we can't keep our people at our institutions, then the turnover rates will continue to be extremely high, and we're just going to take two steps forward and two steps backward."

Why career ladders?

More and more children's hospitals are developing career ladders to help attract and retain top talent.

Career ladders help reduce vacancy rates by keeping staff motivated and engaged and by making the job attractive to those entering the workforce. "Ladders spark interest,” said Wiles. “It allows people to grow roots and develop a career, as opposed to a stop in the road."

Increases in scope of work, education, and contributions — along with pay and title — transform a traditional technologist role from a static job into a dynamic career.

The career ladder program at CHOC emerged directly from feedback from its medical imaging staff. "Almost everyone wanted to grow in some capacity, and a lot of them weren't necessarily wanting to grow into leadership roles per se," Ruiz said.

The ladders are paying dividends for Ruiz. First-year turnover rates for radiology techs decreased substantially since implementing the program.

Ladders also foster increased competency among employees as they learn additional skills, become mentors, and pursue continuing education to advance up the ladder. The result is better productivity, efficiency, and outcomes for the hospital.

This detailed guide based on interviews with several freestanding children's hospitals will help you design a technologist career ladder best suited to your organization.

What is a career ladder?

A career ladder is a specified track for advancement within a role. As one advances, their scope of work expands and their salary increases.

For example, a radiographer may start at Tech 1 (the bottom of the ladder) and move to Tech 2 and finally to Tech 3 (the top of the ladder). Each level requires additional qualifications in engagement, education, and professional development, along with credentials and years of service.

Career ladders are different from career paths.

In the career ladder, technologists remain technologists. The fundamental job function does not change; they simply make additional contributions. "It's about rewarding those technologists doing more difficult, more specialized work. It's more about contributions to the team and less about seniority," Lentz said. Promotions are granted to any tech that meets the qualifications for the next level.

In the career path, technologists are hired into a new role with a different job function, such as a manager or educator. Promotions are granted with an additional FTE either through attrition or expansion, and it is generally a competitive process. Techs at the top of the ladder are better positioned to qualify for these roles.

Though the basic structure of career ladders is the same, they are designed and implemented differently among hospitals. The main goal is to provide a clear avenue for individuals to advance within their role as they increase skills and make extra contributions.

Technologist career ladder examples

Advancement criteria considerations

In addition to years of experience, education, and certification, individuals must contribute to key areas to advance in the career ladder. These can include things like leading quality improvement or assurance projects, designing education programs, participating in committees, and mentoring new staff.

This keeps the different levels distinct, provides continued motivation and engagement for the techs, and benefits the organization.

The distinct roles on the ladder don't alter the basic job functions of a tech. Each continues to perform imaging studies and the associated tasks. "It's about being able to demonstrate that they're doing something outside the scope of traditional tech work and demonstrating advanced knowledge and skills in their discipline," said Lisa Ulland, vice president of radiology at Cincinnati Children's.

Potential areas for additional contributions

• Project or quality improvement work.
• Expert-level knowledge and skills in a modality.
• Educating, mentoring, and training.
• Organizational engagement.
• Professional development.
• Committee participation.
• Leadership opportunities.
• Interpersonal and problem-solving skills.

"You're no longer doing solely images every day, all day," Wiles explained. "And if you're on, say, a project or a committee, you get some protected time."

Criteria of this kind goes by different names, but this guide will use the term "qualifiers," coined by Ruiz. "Qualifiers are basically various categories centered around not just a technical skill set, but also staff, employee, and organizational engagement," he said.

Some hospitals design the qualifiers as a rubric, others as job descriptions.

 

Three keys to qualifiers

Every department will need to develop qualifiers best suited to their organization. Lentz recommends starting with needs: "What could you reward that would meet a need in the department?" For example, it used to be a challenge for his department to find unit-based-council chairs, but after making it count toward qualification in the career ladder, people lined up to become chairs.

Wiles emphasized that additional roles must create clear value for the organization. "They've got to provide a return on investment," he said. "You have to differentiate roles with increased responsibility and scope. Otherwise, it doesn't warrant the advancement and title, which has the related monetary changes. You really have to be thoughtful about that."

In the end, the qualifiers must keep staff engaged. "That's one of the most important facets about the program itself," Ruiz said. "It's an ever-evolving practice to figure out ways to keep the employees engaged and make sure we're utilizing the ladder for what it should be utilized for, which is to not just allow growth opportunities or incentivize staff but to help drive engagement and involvement within the department."

Evaluation process

The evaluation process also differs greatly from hospital to hospital. Generally, there are two common options:

Quantitative. A quantitative evaluation approach uses a point system to assess if a tech has met the criteria. The employee must meet a certain point total to advance. Tasks are divided into categories, and those tasks are worth a certain number of points. They get tallied up for a final point total.

Qualitative. A qualitative evaluation approach relies on the judgment of supervisors and managers to make an assessment. Job descriptions or criteria are outlined for each level of tech, and, working with the employee to set specific goals, the supervisor ultimately decides whether they meet those descriptions.

Every hospital uses both qualitative and quantitative elements, but different programs are driven more by one than the other.

Typically, there's a review by a manager or a committee that involves a portfolio submission and interview. Some programs offer multiple opportunities a year to apply while others offer it annually, often during performance reviews. Most programs require an annual review to maintain their current level.

Technologist advancement criteria examples

How to determine pay progression

For ladders to work, progression to a new level must come with a progression in pay, independent of other merit- and experience-based raises. How that is determined depends on various internal factors. Here are some common options:

Standard dollar amount. Techs receive a flat increase in salary for advancing. The amount may vary from level to level.

Standard percentage increase. Techs receive a standard percentage increase to their current salary. The percentage increase might vary from level to level but not from person to person.

Individual-based percentage increase. Techs receive up to a certain percentage increase based on individual evaluation.

Salary range increase plus percentage increase. Techs not only receive a percentage increase to their current salary but also receive a higher total salary grade, meaning their ceiling is higher.

Tips for successful career ladders

Here are some best practices for a successful career ladder.

Articulate the value proposition.

"You need a mutually beneficial value proposition that will offer techs that career growth and incentive to stay in a longer tenure and offer the organization a return for the increased investment. That can come in many forms, but it certainly should come at the bare minimum of helping the department and ideally moving up their scope to where they can help the organization, whether that's quality, safety, projects, and so on." – Aaron Wiles, Executive Director, Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago

Start slowly.

"One of the things an organization may be concerned about is turning the workforce into automatic higher-level techs, thus increasing the salaries of everyone. To get buy-in, you might have to start slow. Like in year one, we will only promote X number of people in the ladder, thus costing us this estimate. Then, as it starts to get traction, the increase doesn't even come up anymore. Also, it's important to require maintenance with annual evaluations. ‘Once a Tech 3, not always a Tech 3' seems to be easier for people that are funding their career ladder to buy in. However, this doesn't mean to not go all in. If you're going to roll it out, it needs to be a massive campaign that fuels the excitement and fuels the engagement." – Brian Lentz, Vice President, Imaging Services, Phoenix Children's Hospital

Know your needs.

"Every facility is structured and organized differently. And depending on the mission, vision, and values of the facility, and the direction it is headed at that moment, that's going to have a huge impact on the way you structure your individual departments. The key element is making sure you identify that before you make decisions on any type of ladder or career advancement program." – Andrew Ruiz, Director, Imaging Services, CHOC Children's

Make it objective.

"It's important to have good jurisdiction over the advancement criteria and process to avoid inconsistencies in evaluation and advancement outcomes. We have an advancement policy that outlines the requirements and process as well as specific applications by modality." – Lisa Ulland, Vice President, Radiology, Cincinnati Children's

Differentiate roles.

"Organizations are very astute. You're not going to be able to move from sonographer one to sonographer two, or junior to senior, just based on years of experience. You must have an increased role and responsibility and scope. You don't want to take away from the junior sonographer, but you want to make sure to look at the periphery for what additional responsibilities the senior sonographer may have. It could be a variety of things, but at the end of the day, you need clearly define roles with a noticeable difference in what one's doing from one day to the next. Otherwise, it loses its effect and value in the eyes of the staff and certainly the organization." – Aaron Wiles, Executive Director, Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago

Emphasize accountability.

"It's extremely important to make the program voluntary for the staff. There's a level of accountability on their part that we have to instill as a core quality of the program, making sure they know it's not going to be just handed over to them — they're the ones turning in all their documentation and maintaining it. But at the same time, leadership is accountable to check in with them regularly throughout the year, making sure they continue to be engaged with the program and reiterating the benefits and pride of the program. It's a meticulous task but necessary." – Andrew Ruiz, Director, Imaging Services, CHOC Children's

Additional career roles

Recently, two roles have emerged in medical imaging: assistants and specialists. One provides less-experienced professionals with an entry point to the career; the other provides more experienced and trained professionals with opportunity for advancement.

Frequently Asked Questions

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