A radiologist told me something recently that I keep thinking about.
He’s three years into private practice. No GMI from day one, by choice.
When he told the hospital he was declining the guaranteed minimum income, management looked at him differently.
“Nobody rejects the GMI,” they said.
He signed anyway. By the end of his first month, he had already earned more than the GMI would have covered.
What most specialists don’t do before signing
The standard private practice journey looks like this: receive the offer, negotiate the terms, accept the GMI, and trust that the hospital will bring enough patients to make it work.
It’s not a bad strategy. For many specialists, especially in established hospitals with strong referral networks, the GMI period does its job. The volume builds. The practice matures.
But it starts from an assumption that most never question. That the hospital is the right fit. That the volume is there. That the dynamics inside the department will support, rather than hinder, a new consultant finding their footing.
This radiologist questioned all of it before he signed.
The three things he studied
Before accepting the offer, he spent time understanding three things about the centre.
Case volume. Not the hospital’s general reputation, but the specific demand for radiology at that centre. Screening programmes. Treatment monitoring. Post-treatment imaging. He mapped where the referrals would come from before he walked in. He knew the centre needed what he did. He didn’t hope it did.
Colleague dynamics. Who was already there. How the department worked. Whether the existing team was collaborative or territorial. The politics in any department decide whether referrals flow toward you or around you.
Sustainability. Was this a centre investing in its future, in equipment, in programmes, in the clinical infrastructure that creates steady demand? Or was it coasting on its existing reputation?
He made a business decision. Not a career leap.
What “nobody rejects the GMI” actually means
When management said nobody rejects the GMI, they weren’t being dismissive. They were telling him something true: most specialists need the safety net, because most haven’t done the analysis that makes it unnecessary.
The GMI exists because hospitals can’t always promise volume. It’s a risk-sharing arrangement. The hospital takes on some of the financial risk of a new consultant’s slow start in exchange for the consultant’s commitment.
A specialist who has done the homework, who knows the volume is there, understands the dynamics and has assessed the sustainability, doesn’t need the risk shared. They’ve already managed it themselves.
The honest close
Most specialists treat the GMI as the starting point. The radiologist treated the analysis as the starting point, and the GMI became irrelevant.
That’s not arrogance. That’s preparation.
The specialist who understands the business they’re entering before they enter it is in a different position from day one. Not because they’re smarter. Because they asked different questions before signing.
One milligram at a time.