To Change or Not to Change: Is That the Question?

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By Brenda Rinehart, MBA, CRA, FAHRA

November 2012—Are you thinking about changing jobs? In this economy most people are trying to hang on to the jobs they have, especially if they’re good ones. Still, there are those who are looking for new opportunities to grow and stretch beyond their current capacities. You have to give something to get something, and that is a prominent reality when considering a new job. Balancing what a job offers with what you must give to get it can be challenging. If that golden opportunity shines before you, how do you decide if it is the best choice?

Change and Stress

The first consideration with any change might be current stressors. The change process will multiply stress. If you are at capacity for stress in your current situation, this might be a red flag to carefully consider. The scheduling demands of children, the care of ailing parents, the need to relocate, and the time commitments of a new position are examples of stressors that may multiply in intensity when undergoing a change process even when the end result is a positive one. Careful planning will be your best friend in this situation, but great planning will not abate the stress entirely.

Planning and Decision Making

Big or small changes require a decision to act or not. In the business of imaging, we are accustomed to making big decisions with regard to capital purchases, hiring, business plans, etc, but very few of us utilize decision making tools in the process of our lives at home. When considering a change in job roles, you might start with the basics of decision making and create a simple list of pros and cons. Next, spend some time weighing the pros and cons, just like you would when considering a new piece of imaging equipment. Don’t forget to consider the financial impact of the decision, both favorably and negatively. Finally, once you make a decision, stick with it. One potentially stressful and time wasting exercise is to keep rehashing a decision that was made utilizing analysis and thoughtful planning. Some additional items to research might be relocation expenses, changes in cost-of-living, taxes, educational opportunities, benefits, bonuses, and, above all else, job fit.


Does the new job require relocation? If it does, there are numerous things to consider, many of which have a financial impact. If you are leaving one state and relocating to another, have you considered the change in cost-of-living expenses? There are many online tools available that provide financial calculations to consider the difference in cost-of-living. In most areas, the largest cost-of-living change is mortgage or rental expense, followed by taxes, utilities, and fuel expenses. For instance, if you are relocating from Nashville, TN to Portland, OR you would expect to incur a 30-34% increase in cost-of-living expenses. A job that grossed $100,000 per year in Nashville would need to gross $130,343 per year in Portland just to maintain the same salary to expense ratios.


Taxes can be a big and nasty surprise when relocating. In the previous example, Tennessee has no income tax on regular wages, while Oregon has a hefty state income tax of 9.9% for this income bracket. That equates to more than $12,904 in additional taxes on a gross income of $130,343. It is important to remember that you may have to pay income tax in the state that you work in and in the state that you maintain a primary residence. So even if you don’t relocate, but take a job in a nearby city, income taxes are a big consideration. A great online resource to utilize is Bank Rate.

Educational Venues

If you have children who are school aged, the decision to relocate is layered with additional complexity. The best time to relocate is in the summer, and many parents choose to maintain two residences until the end of the school term. Adolescents are often negatively impacted when they are relocated due to the importance of their social groups to their development at this stage of life. Looking into schools, community educational options, sports participation, and other considerations will be a critical part of the decision making process.

Growth Opportunities

If you considered a position for the growth opportunities, have you considered the capacity for continued growth with the new organization? One indication of growth potential is the amount of succession planning within the organization. Does the facility promote from within? One clear indicator of this may be the internal candidates that were considered for the position. What are your long term career goals? Are you planning to obtain further education? Is this required or reimbursed? What is the depth of career opportunities in the new city in the event that the new job does not work out? For example, smaller towns and rural areas have little to no depth of career opportunities, so in the event the new position does not work out, relocating once again becomes the only viable job option.

Benefits and Bonuses

Smart phones, laptops, sign-on bonuses, relocation bonuses, incentive bonuses, and health insurance benefits and premiums should all be considered in your financial analysis. For instance, in one organization you may have a smart phone paid for, which could save you $100 or more in cell phone bills each month. At another organization, you may get a simple monthly stipend of $50 per month or nothing at all. Relocation bonuses are often given for management level and above and can be negotiated at some organizations. If you plan to rent an apartment while still paying your mortgage, consider asking for additional funds to manage this expense on a short term basis. The incentive bonus structure may be based on reachable, measurable goals or stretch goals that given the environment and economy may not be reachable. The questions you ask during the interview process may help you ferret this out during the decision making process.

Job Fit

Ask questions during the interview process to determine how you will fit within the organization’s culture, in your job role, and with your potential boss. For example, you might ask your potential boss: What are the top three goals for this position? Who are the informal leaders in the department? When you experience a difficult situation and need to ask your boss to intervene, how do you approach him or her? How often do you meet with your direct reports? How would you describe the culture of the organization? Does the organization subscribe to benchmarking metrics and how are they used? How are capital decisions made within each division? What are your pet peeves? How many internal candidates were considered for the position? This list is by no means exhaustive and you can probably think of many more questions, but questions like these can help you discern the personality, behaviors, and expectations you are likely to encounter in this new role. Asking questions that require detailed responses not only demonstrates that you have put some effort into considering your options, it opens the door for further discussions that may illuminate key issues or concerns. Remember, the number one reason people leave their jobs is the relationship they have with their bosses. Ensuring a great “fit” is crucial to success and happiness in any role.

Being a CRA

This topic has come up on more than one occasion from other directors and managers both inside and outside of imaging. Big decisions are often difficult to make and everyone wants to be certain they are making a sound one. Learning to take a step-wise and thoughtful approach to decision making is a part of being a Certified Radiology Administrator (CRA). The knowledge gained from research and the utilization of resources and tools is a natural part of what a CRA does every day.

Brenda Rinehart, MBA, CRA, FAHRA is the director of medical imaging at Overlake Hospital Medical Center in Bellevue, WA. She can be reached at

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