I spend much of my day hearing success and failure stories from both radiologists and hospital administrators about this turbulent but exciting time in radiology. This experience follows five years of working as a radiologist in private practice, and the two perspectives offer insight into some trends in radiology over time.
The 1980s changed radiology with cross-sectional imaging, and the millennium launched the age of teleradiology. A critical difference between these two is that the first change generated more opportunities for onsite radiologists, while the second potentially generated fewer.
There was never a better time for radiology groups to reevaluate their value to hospitals. Why should radiologists care about what various hospital contingencies think of them if they are solid, stable, and onsite and can't be replaced? Because they can be.
Flexible, entrepreneurial radiology groups and hospital administrators are actively discussing new relationships, perhaps without the knowledge of the current onsite radiology group. We regularly see hospitals replace the long-standing radiology practice with a more progressive, business-oriented radiology group.
These new groups are listening to the administrator's complaints, offering options, and providing onsite radiologists while doing the majority of the work through teleradiology.
Reasons for these replacements vary, but the upshot is that even hospital radiology practices are not permanent or invulnerable. If you are not progressing or working with hospital administrators to seek out improvements, your practice may be on someone's radar.
NEW APPROACHES
Hospital radiology practices can fend off replacement through a new approach to management. Start by understanding what radiologists and hospital administrators like and dislike about their radiology service. This includes desired items absent from both sides. I have heard from both sides of the table regarding radiology services, and solutions exist to address conflicts between radiologists and hospital administrators.
It's worth taking time to identify the "sores" and "soars" of onsite radiology. Some of these sores and soars appear on opposite lists for some radiologists. Table 1 lists radiologists' most common sores and soars. Table 2 lists them for hospital administrators.
Onsite radiologists can do some simple things to solidify their relationship with the hospital and reduce the likelihood that the hospital administrator will choose a solution that doesn't include them. A complaint and response list may help the onsite radiologists identify problems and build a pital.
The local radiologists can reduce the sores and increase the soars for the hospital, which may in turn become open to helping the radiology group do the same.
This approach is based on the most commonly heard complaints and requests from hospital administrators, emergency department docs, referring clinicians, and directors of radiology services. These issues are not being addressed and ultimately lead hospital administrators to seek other options. Possible solutions follow each complaint.
• Complaint one. The hospital states, "We never see the radiologists anyway. We might as well do the whole thing though teleradiology and get a rotating specials person or locums."
Make rounds. Be seen. Radiologists may want to take turns eating lunch in the doctors' dining room to build relationships with the medical staff. It may be worth walking through the administration office once a month to find out what's going on in the hospital. Contact the hospital's communications department and introduce yourself. Write an article about radiology at the hospital and ask if you can put it in any of their publications. Offer yourself up as an expert on radiology, letting administrators know you are willing to comment on trends, technology, and changes in the industry when they are seeking media coverage for the facility.
Are they looking for speakers? Can you submit an article for the monthly physician newsletter?
• Complaint two. It is stated in the medical staff meeting, "The rads' turnaround times are awful and unreliable. Clinicians are screaming and sending their paying cases elsewhere." Review the structure of your department and consider some simple changes. Have at least one radiologist a day work in an undisturbed office reading the big cases most hampered by interruptions. Use the rest of your team for consults and shorter reads. Consider offering each radiologist the opportunity to work remotely one day a week. This worked for me when we had six onsite radiologists. It brought great efficiency and always occasional reading from home or without interruption is a great recruiting tool.
Consider using a teleradiology group for final reads at night. This allows your radiologists to start reading the day's work at 7 a.m. without overreading cases. The teleradiology group takes the liability for the case, you have more time for better reimbursed cases, and ER docs and hospitals appreciate getting finals throughout the night.
• Complaint three. The hospital's finance department is reviewing annual budgets and says, "We're wasting all this money on transcription each year when we could save with voice recognition and cut our turnaround times in half." Just do it. It's hard, but VR is here. I have used VR with self-edit for the past three years. Our clients love the lightening- fast turnarounds. Most progressive groups coming after your practice offer this.
• Complaint four. The hospital senior leadership is reviewing issues and says, "The radiology group doesn't care about our issues. There's never anybody in charge that you can actually speak with and have it make a difference." Perceived or actual lack of leadership in radiology groups is a common complaint. I highly recommend identifying a managing partner to interface with the hospital and clinicians. It streamlines communication and provides a structure that can quickly identify issues that need to be addressed.
Develop a true quality assessment program allowing for peer review of difficult cases and directing follow-up for cases with missed reads. Create consistent reporting for the hospital that communicates what you are doing for them. It does not need to be a newsletter, just graphs identifying number of reads, quality, etc. Again, this is an opportunity to increase communication with the hospital. Take to lunch—outside the hospital—some key stakeholders, including the disgruntled ER doc, administrator, and director, to listen to complaints and offer solutions.
