Mark Glass-Royal, a radiologist in suburban Washington, D.C., and Jerry Fosselman, COO of a 63-physician imaging practice in Sacramento, Calif., work on opposite coasts, but agree on one point: Radiology has never faced more challenging times. At issue isn't just ballooning workloads, shriveling reimbursements, or sluggish recruitment. It's managing call coverage in an era of do-it-now, 24/7 expectations.

"When I started working 18 years ago, things were laughable compared to today," recalls Glass- Royal. "There were nights when I didn't get called at all — not once. These days we get called 10 or 15 times a night."

Providing 24-hour coverage to a Maryland hospital that's growing fast keeps the 50-year-old radiologist busy. When he and his eight partners aren't tethered to the emergency department by pager, fax, or PACS, they are awaiting rotation on evening and/or weekend duty. It's a grueling schedule, yet one that thousands of radiologists sustain daily.

With coverage demands at an all-time high, we asked several radiologists to share their strategies for success. Here are the six best.

1. Serve your customers. Nighthawk's global reach — and the long-awaited emergence of Dayhawk — have fundamentally changed the landscape of radiology forever. No longer is a practice an island, nor a hospital part of its fiefdom. Groups that once dictated coverage terms to hospitals today find hospitals rewriting the rules with a perform-or-perish bottom line. The key to making coverage work in our 24-hour world thus begins and ends with exceptional customer service.

"Radiology is a service business that serves a number of masters, be they hospitals, referring doctors, or patients," Glass-Royal observes. When a hospital requests 24-hour radiology coverage, successful practices find a way to make it happen, knowing competition can come from the next city, next state, or a continent away.

Today's patients are similarly demanding. Educated and empowered, they expect "special" treatment, Fosselman observes. Treatment that's "good enough" just isn't. Customer service guru and radiologist Thom Meyer agrees. He champions customer service in radiology as a win-win proposition that "makes everyone's job more pleasant and less complicated." Don't do it for others, he says. Do it because it will make your life so much easier.

Practices that provide outstanding coverage inoculate themselves against outsourcing. A slow, lackluster response invites opportunistic competitors. Glass-Royal asserts that radiology long ago "dropped the ball" when cardiac catheterization and noninvasive vascular imaging hit the scene, and as a result other specialists today crowd the field. 2. Be a problem solver. Providing effective coverage goes beyond plugging holes in schedules. It means problem-solving with referrers in a cooperative, collaborative, collegial manner.

Communication is key. Practices that take time to educate hospital staff about the who, what, when, where, and how of sending and receiving reports reduce their own headaches down the road. A reporting system that is fast, simple, and bulletproof will always win the day over high-tech bells and whistles. Fosselman traces part of the coverage success of Radiological Associates of Sacramento (RAS) to its reliable fax system and request that hospitals send paperwork and pertinent notes with their images. RAS serves six counties, employs more than 60 physicians, and provides radiology services at 25 sites.