SPECIAL EDITION
Business

By Harold Abella

It's a common scenario: Complete residency, join a private practice. Spend a few years adjusting to the workload and refining skills, then become a partner. Spend time on committees, but remain focused on the clinical side. One day, by election or rotation, it's time to take a turn at leading the group. What happens next?

Radiologists lucky enough to have had a strong mentor or some business training along the way may not find the prospect of heading a practice daunting. Many others, however, discover that leadership demands skills-strategic thinking, negotiation, delegation-that they never learned. Some teaching programs are beginning to acknowledge this deficit, and a few fellowship programs offer a formal opportunity to learn administrative skills, but many private-practice leaders learn by doing-and learn a lot in the process.

The most important lesson is the most basic: Treat people with respect and dignity, said Dr. Myer H. Roszler, medical director of emergency radiology at Baptist Health South Florida.

"In my position, it is exceptionally important to interface with the administration of the hospital and my clinical colleagues," said Roszler, division chief in a group of about 50 radiologists. "My goal is to provide outstanding service. We always have to keep that in mind, and to do that, you need to meet often with the people you serve, who are the clinicians, and your administrators."

Part of the challenge of combining both management and radiology, Roszler said, is making sure he and his colleagues are constantly doing the right thing for patients and fellow clinicians.

"As radiologists, we are service-oriented and we have to see how we provide the service in the appropriate amount of time to our patients and clinicians," he said. "Suppose I make beautiful 3D images of the aorta, but it takes a week to get a patient scheduled for the CT. I'm not doing anyone any good. We have to make sure that we are really servicing the people who need us, and that entails the schedules, the reports, everything."

Practicing radiology while getting involved at the different levels his job required, Roszler said, gave him the experience and skills that none of the courses he took as a medical student and as a radiology resident could have provided.

"You could say I learned them over the years in the field of radiology. You don't learn these things at residency. And the best way to learn is to be on both sides of the table; in other words, you have to know how it feels when you are being managed, so you become a better manager," he said.

GOOD MANAGEMENT REQUIRES OTHERS

For radiologists such as Dr. James Bonifield, president of South Sound Radiologists in Olympia, WA, picking the right person to do the job is just as important as knowing how to run the business side of a private radiology practice.

"The most important thing is to have a very good radiology administrator, someone you can trust, who can take care of the business details of the practice," Bonifield said.

A dedicated administrator with inside knowledge of radiology or another medical specialty can make the difference between success and failure, he said. The job requires not only dealing with patients, referring clinicians, and radiologists, but handling the myriad administrative tasks associated with private practice: recruiting new radiologists, haggling with insurers over reimbursement, and working with technologists.

"Our chief technologist took care of all the business details of our practice from the early '70s until 1984, when we started expanding," he said. "When we added two radiologists and subspecialized, we found we had a scheduling problem that really stressed our officer manager. She finally retired, and we interviewed half a dozen people for her position, looking for somebody to do all the things we had to do after she left."

Eventually, in 1995, the group hired an administrator with experience in radiology practice, a microbiology degree, and best of all, an MBA. According to Bonifield, it was the best decision they could have made. Now the partners do only the scheduling, while the new business manager takes care of the rest.

"Having an office manager really helps, because I never had business training. There were things I didn't understand. He's the one dealing with vendors now, trying to get us good prices, but he's also a fair guy. He's the kind of person we are lucky to have," Bonifield said.

Bonifield wishes he had learned about money management in his residency. He also wishes that he had been taught how to deal with employees, insurance, retirement, and all the business basics that make a private practice efficient and profitable. Having the right person to handle nonclinical matters, however, frees him to do what he was trained for: working with patients and clinicians.

"If I had to do all those other things, I couldn't practice," he said.

LEARN EARLY AND OFTEN

The nine members of Hendersonville Radiological Consultants of Hender-sonville, NC, try to share business and management responsibilities so that no one person is overloaded. But the lion's share, including attending management and business courses, falls to the group's president, said Dr. Ken Shelton, the partner who oversees recruitment.

"If we could clone him, it would be fantastic," he said.

According to Shelton, there is no question that training in business and management should be a part of the residency curriculum.

"It would probably be worthwhile at some point, perhaps in the third year of residency, to have a general radiologist give a talk on what private practice is all about, and specifically the nonmedical part of the radiology practice.

I would encourage directors of residency programs to offer some sort of additional lectures on radiology business management skills," Shelton said.

Trying to implement some of these courses in residency programs on a purely voluntarily basis will not work, he said, unless they are sponsored by larger organizations in the field. Those skills would immediately make residents more attractive as recruits, but they would also give young radiologists more tools with which to assess the practices that court them. Such training would represent a major change in the way residencies are conducted, he acknowledged. In the meantime, he suggested a more homegrown approach: Watch everything, take advantage of opportunities to learn wherever they occur, and build skills that the practice will eventually need.

WHERE THERE'S A WILL . . .

Sometimes the most useful lessons don't come from radiology training at all. Dr. Mike Maresca, president and founder of St. Lawrence Radiology in Potsdam, NY, acquired most of his entrepreneurial skills long before he attended medical school, while working as a gas station attendant during the oil embargo.

"I worked from the time I finished school until midnight. If you asked me to work until three in the morning I worked until three in the morning, because it was a wonderful opportunity for me. I learned a lot about business at that time," Maresca said.

Maresca's group serves five hospitals. The best management skills involve a "never say no" attitude, self-trust, a heavy dose of optimism, and the belief that nothing should ever seem too difficult, he said.

After building his radiology group from the ground up over the past 10 years, Maresca knows what he is talking about. All of the hospitals his group serves, some of them hundreds of miles apart, are networked to the practice's main office. Each partner's home is linked up as well.

Technology and business expertise have made his group extremely efficient. For Maresca, however, solid ethics and fair play are just as important as practical, technical, or even medical knowledge.

"I try to guide myself by three basic principles," Maresca said. "I try to use sincerity; that is, in any business venture I try to be as sincere as possible about why I am doing it, and whether it is a good thing to do, and how I'm doing it. Then I try to use some integrity. The third piece is honesty. If you are not honest, you may be able to pull off one great business deal, but you won't pull off another one, because no one will trust you again."