I did the road for about 15 years, and switched to medical HP tech about 6 years ago.
The size of the radiation safety dept is mostly dependant upon the size of the hospital, and the size of the research program if that hospital has one at all. In smaller hospitals the RSO duties are usually handled by a Radiologist (MD) who also practices, or Senior Nuc Med or Nuc Pharm Staff, who slip in the RSO duties in addition to their regular staff work. HP tech type of things are handled by the nuke med techs, or techs in the field where the isotopes are used. You might remember that the most commonly used radioisotopes used in medicine have a short half life, and so RA's are not common, it's mostly RMA's. It's predominantly about contamination control, and cleaning up spills now and again. Oh yeah, and handing out the dosimetry badges every month. Some of the folks do get dose that would rival that of plant workers, but it's uncommon. Researchers don't get much dose at all.
The hospitals have rad waste programs of course, and they often vend out the work to contract companies, but don't have full time waste staff. We here have the largest broadscope license in the country, and do have a permanant rad waste staff...The manager and the handler. The entire rad safety office staff consists of 11 people.
Academics are important to hospital heirarchy. The hospital where I work, a MS degree, for the most part, means you're not done yet.
I have worked a job where my little AS, NRRPT and experience got me hired, but that can be unusual, and those opportunities don't often pop up. I'm sure they would have preferred an MS if they could have gotten one.
As always, private industry, like pharmaceutical companies, will pay better. Most hospitals are non-profit status, so only their professional staff will make the big bucks. The rest of us may get a maximum 3% pay raise every year.
Since I started working here, more than 50% of the radioisotope use in the research laboratories has dropped. 99% of all the radioisotopes purchased are used is in the clinical areas. As I work in the research areas, it gives me concern once in a while, but not too much. While the chemoluminescent methods are taking over where they once used radioisotopes, there is still a need, so I'm secure for a few more years.
The pluses of hospital HP: Steady, I'm home every night, 40 hours, good benefits, health care, access to a 403(b) and a pension, now that I'm vested. I also get to interact with some of best and brightest minds in the world. I often don't have a clue as to what they're talking about, but do appreciate the passion and dedication I see.
Down side: No great wealth in site, no outage rushes and the fun you can have at plants, with new friends and old, and running around the country. I still occasionally dream about being in a drywell, but in the dream it's all fun.
Pet Snake was right in talking about many 2 year programs around for radiology techs, sonogram techs and positions like that. There is some good money to be made in those fields, and will be so for at least the next 20 years. You can also travel like you do now. Plenty of per diem, it's usually higher and the pay is better than plant HP.
Well that's my 2 or 3 cents from my view.
Good luck,
Melissa
