In a time and age when complex studies can be interpreted remotely for dimes on the dollar and sent back to the source within minutes, teleradiology's appeal to hospitals is greater than ever. Competition is pointless if everything boils down to just reads. There are many other essentials, however, that define radiologists' jobs. And these may not necessarily make the hospital's list of things that can be cheaply or conveniently outsourced. In this new environment, collaboration and value can go a long way toward job security. What can radiology groups do to protect their jobs and regain some leverage? Here are some ideas from the experts:
• Be nice to them. Administrators sometimes may get an earful from medical staff complaining about radiologists' bad attitude when providing their services. Sometimes radiologists just cannot get along with the medical staff. In many cases, it is simply a radiology group's view of its job as a 9 to 5, no-nights/no-weekends gig that vexes administrators.
“If you have a radiology group that just wants to read the films and go home, I can understand why a hospital would be frustrated with that and want to go with teleradiology,” said Dr. J. Raymond Geis, a radiologist at Advanced Medical Imaging Consultants in Fort Collins, CO.
• Get political. For plenty of good reasons radiologists stay away from their institution's politics. But if they choose to avoid sitting on committees or participating in the hospital's strategic planning, they can be replaced.
“There may be an exception, but I have yet to see a group replaced when a member of that practice is the chief of staff of the hospital or a member of that practice sits on the board,” said Dr. Lawrence R. Muroff, president and CEO of Imaging Consultants of Tampa, FL.
• Add value to reports. A lot of reports are not helpful to clinicians because they do not help referring physicians take care of their patients. Protecting against marginalization requires maximizing the value and quality of reports, said Dr. Paul Chang, vice chair of radiology informatics and medical director of enterprise imaging at the University of Chicago.
“If you find a mass, do some little extra work online using the available electronic decision-support tools while looking at the image to provide a much more specific diagnosis,” he said.
• Be a team player. Radiologists must integrate themselves into their hospitals and communities and participate in their medical and social affairs to protect their tenure at their institutions, Muroff said. Providing services that may not carry a monetary reward, like setting up protocols or choosing new equipment, is truly valuable to hospitals and clinical colleagues.
• Improve overall service. According to Muroff, when hospitals use the word quality, it usually is a keyword for service.
“If people are complaining about you, is it because you are habitually late or not responsive, can't be found, or don't want to give conferences? There are a variety of things that make up the issue of service, but adiologists must understand that service is by far the leading cause of practices losing their hospital contracts” he said.
• Avoid competition. Hospitals hate it when their radiology groups compete with them.
“This is a very important issue in contract negotiations, and I've seen this be a problem with several groups and their hospitals” Muroff said.
• Boost subspecialty expertise. More than ever, hospitals want a steady and consistent provision of subspecialty expertise. Imaging is no exception.
“One of the major selling points of teleradiology firms is their supply of subspecialty, board-certified, CAQ [certificate of added qualification] radiologists,” said Dr. Eliot Siegel, chief of radiology and nuclear medicine at the VA Maryland Health Care System.
• Offer timely, optimized communications. Matching the right kind of message with the right delivery medium is extremely important in this day and age, Chang said. Sometimes e-mail is appropriate, but sometimes text messaging might be better. In some cases, however, you may need to call your referring docs directly.
“What is the value of getting a report in 30 minutes when the patient may die in a few seconds?” Chang said.
• Size matters. Small groups may become an interesting target for someone, but there are no guarantees that bigger groups are better off, said Fred Gaschen, executive vice president of Radiological Associates of Sacramento, CA. In an interview with Diagnostic Imaging, the California executive acknowledged that his own group, comprising 17 diagnostic centers and seven radiation oncology sites, is under threat of outsourcing. But having a big group helps.
“If you've got a large group and all the doctors are willing to stick together, you are less vulnerable,” he said.
