Laurence Spitzer, MD

In my now 15 years of being a radiologist, I have had the fortune/misfortune of being involved in two hospital takeovers. Not sure how that ranks in terms of other radiologists, but I can say that speaking from experience, the two transitions have been radically different.

There will always be that air of uncertainty amongst the medical staff and hospital employees as to what the new hospital or hospital system will bring. Will things be better when the new hospital or healthcare system take over? Will things be worse? Will my job change? Will I lose my job? Often the powers that be will start to send out information, usually via e-mail with the same politically correct, administrative rhetoric such as “All employees of Hospital X who are in good standing, can be assured that they will maintain their current position when Hospital Y takes over.” That’s all fine and dandy unless you’re the low man on the totem pole at work, and your boss tells you that he or she’s been told that everyone’s expendable. All of this creates a great deal of stress and angst.

As all of us with a little grey in our hair know, change can come in many different forms. Noticeable changes that are positive could mean upgrades to equipment, deeper staffing, improvement in benefits, or increase in salary. Other less impactful positive changes might include more time off, better food in the cafeteria, or even a better parking spot closer to the hospital entrance. All of these changes could of course go the opposite way, and as a result have a negative impact.

The first hospital takeover I was subjected to was of a very formal nature. It was meticulously planned, and calculated to the exact minute. We would be closing the doors on an old, physically deteriorating building that had existed for over 100 years and would be moving into a state of the art, breathtakingly beautiful $300 million facility. I will never forget the actual day of the move when the remaining 15 or so patients were put into ambulances and driven to the new hospital, while the doors of the hospital that I had spent the first 12 years of my career were padlocked shut, and the lights turned off. It was a very sad moment for me.

Meanwhile, the new hospital was opened, the lights were turned on, the CT scanners revved up, and we were open for business. Yours truly was selected to be on call the very first night, and I will never forget being the first radiologist to dictate an ankle X-ray as the first imaging study performed at the new hospital. Was I nervous? Absolutely. So much so that I blew right through a fracture of the calcaneous, before I recognized that I had overlooked it. Right away, change was evident. It was amazing to have brand new equipment that worked, doors that didn’t squeak, 5-star food in the cafeteria, spit shine floors and walls without scuff marks from stretchers banging in to them, comfortable chairs at my workstation, and even toilet paper in every bathroom!

Hospital staff smiled, security guards said hello to you, administrators walked the halls in a state of utopia, and patients were thrilled to be admitted to rooms that were all private, and had 42-inch flat screen TV’s in them. Things couldn’t have been better.

To contrast that, the second hospital takeover has been something of a totally different experience. Not necessarily for the worse; just different. This one occurred over a weekend, so from the get go; there was less hype and certainly less presence of the change, as it happened on a Saturday. The hospital was actually not closing as in the first situation, but had merely been sold to a new healthcare system. As in the first takeover, the months and days leading up to the takeover were filled with nervousness and anxiety amongst the staff members, as there had been little to no communication from the new hospital system as to what to expect.

All we were told was, “Wait until October 2, and then we can tell you everything and we will share everything with you, in terms of what to expect.” OK, fine, I could wait until October 2. I knew that my job was secure, I knew that I wasn’t going to be moving anywhere, and my experience had instilled in me that things wouldn’t be that much different. Well, guess what? Its now October 20, and I haven’t seen one measurable change since the new hospital took over. My parking spot is the same, my computer tinkers along and still crashes once or twice every day; the food in the cafeteria is the same. Even my ID badge still says the old hospital name on it. Oh wait a minute, check that. I did attend a banner roll out, on the hospital front lawn where they unfurled a 15-foot banner with the new hospital name on it, and they gave out free hand sanitizer and Chap Stick to all that attended. I guess it could have been worse. You know what they say; “A change would do you good.”

Articles

A tale of two hospital takeovers from a radiologist who lived through them.

A Change Would Do You Good

Just in case you have been living under a proverbial rock the past few weeks, you may have neglected to notice that a good portion of the Eastern seaboard which accounts for about 20% of the U.S. population, just withstood a major winter storm. Snowfall totals included: Washington D.C.: 28 inches; Philadelphia: 23 inches; and New York City: 27 inches. According to weather service records it was either the third or fourth biggest snowstorm, since records were kept.

The brunt of the storm struck on a Saturday, and (thank God!), I wasn’t on call. If I had been, there would have been no way I would have been able to drive in the near total whiteout that was happening during the day on Saturday, and therefore I would have been sleeping on a gurney in one of the ultrasound exam rooms in the hospital. Nevertheless, my first day back to work was Monday, following the massive snow dump. As I began to go through the caseload from the weekend, I came upon a routine X-ray of the left hand request from the ER. The history stated: “snow blower accident.” As one could guess, before even looking at the study, there were traumatic amputations of the distal second, third, and fourth digits.

I shuddered as I went about dictating the case, imagining how the accident might have happened: “hmmm clogged snow blower, let me shut it down, and then I can stick my hand in the intake and unclog it…AARRRGGHHH!!” Well, maybe the person didn’t exactly use that exact expletive, but you get the point. I felt very lucky, as it was only a couple days ago that I borrowed my neighbor’s snow blower (which I had never used before), to clear the 23 inches of snow from my driveway.[[{"type":"media","view_mode":"media_crop","fid":"45519","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_9436100804870","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5215","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 181px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Â©bilha golan/Shutterstock.com","typeof":"foaf:Image"}}]]

I finished dictating the case and began to think of all the seasonal-type injuries that we, as radiologists, are accustomed to seeing. As I mentioned, during the winter, besides seeing amputated fingers from snow blower accidents, you see a fair share of fractured ankles from ice skating, skiing, and snowboarding. Nuclear cardiac stress tests for the invariable “chest pain while shoveling snow;” MRI’s with ACL tears from skiing, and the innumerable fractured hips, elbows, wrists, and ankles from “slipped and fell on ice.”

Assuming you survive the numerous hazards of winter, the coming of spring and the warm weather brings a whole other host of outdoor related injuries to the EDs of hospitals. We have all seen the “hit in the orbit with a baseball” and the Achilles tendinopathy from “overuse running injury.” What about the fractured pelvis from “horseback riding injury,” or the dislocated shoulder from the overzealous weekend mountain biker?

Ultimately, summer comes; my favorite time of the year. Being cooped up inside for months, children emerge from school classrooms and adults awaken from winter hibernation. It’s time to go to the shore for the weekends! But, don’t go diving head first in the shallow water, or you might end up with a cervical spine fracture, requiring a MRI. Or, what about the subdural hemorrhage the 75-year-old man sustains from “fall from ladder while fixing the roof.” How about the severed forefoot seen on a foot X-ray from the drunken guy with a chief complaint of, “lawnmower accident while wearing flip flops?” This pales in comparison to the MRI elbow for “golfer’s elbow.”

Reading all of these different seasonal related injuries, one would think that the practice of radiology has worked out some sort of deal with mother nature, in order for her to continuously supply us with imaging studies to interpret. So, the next time it snows, and I sure hope we are done for the season, and you are at work reading cases, and you come upon that lumbar spine X-ray request that says, “slipped and fell on ice; back pain.” Think to yourself, it’s that time of the year again!

It’s That Time of Year

Roughly 15 years ago when I decided to pursue a career in radiology, I had a fairly good idea of what to look forward to. From what I had seen in medical school, to doing rotations in the hospital, to speaking with attending physicians, I felt confident that I would be getting into a field that was really interesting, constantly changing, and always seemed to be at the epicenter of patient care, while at the same time providing a comfortable financial life, in a low stress environment.

After finishing residency and fellowship, I joined a small group at a local community hospital. This was during the time of the “soft” job market when there were plenty of jobs, and not enough radiologists. It wasn’t uncommon back then for me to get about five to six e-mails every week describing practice opportunities that offered $500k starting salaries, offers to fly me in a private jet (no joke) to places like Ketchum, Idaho for an interview, and other offers from groups offering $10k to cover moving expenses. Whether these carrots on a stick were actually truthful or not, who knows, but certainly times were different back then.

The decade from 2000–2010 was great, and I loved my job and the practice that I was in. I really had my mojo going! The diversity of cases kept me interested, the people I worked with were happy and glad to come to work every day, and our department was always one of the highest revenue generating departments in the hospital; year in and year out. From a financial perspective, I still couldn’t believe it when I saw my paycheck every month, after living on a resident/fellow salary of $45k per year. Every day, it seemed like there was something new to learn, and the field seemed to be growing exponentially with the development of 64 detector, then 128 and 256 detector CT, cardiac CT, PET/CT, newer applications for MRI, the increased utilization of ultrasound, and on and on.[[{"type":"media","view_mode":"media_crop","fid":"41656","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_1965549669989","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4423","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 180px; width: 200px; float: right;","title":"Â©Sign N Symbol Production/Shutterstock.com","typeof":"foaf:Image"}}]]

My passion for radiology and being constantly active spilled over into other areas as well, and I was active in hospital politics, teaching residents, writing articles for journals, and participating in radiology advocacy and leadership at the local and regional level.

Then there was a gradual change for the worse. Our hospital and its governance came to the realization that, financially, it couldn’t exist as a stand-alone hospital in the volatile health care market, and it eventually succumbed to the takeover by a large health care network. Our hospital closed and we (literally speaking, as the last few patients were transported by ambulance!) moved to the next town to set up shop in a newly constructed, state-of-the-art tertiary care center.

We soon realized that our previous model of autonomy, independence, and happy atmosphere was quickly extinguished. Practicing radiology became very corporate and regimented, and it seemed like every day we were given another rule or mandate to follow. We not only lost vacation time, experienced a salary cut, lost our half day off per week, and the ability to make our own call schedule, but our work hours increased, our call increased, we were charged with driving to outpatient facilities, and our caseload increased significantly. All for the benefit of the “network”, with no doctor appreciation on the back end.

Right before my eyes, before I could read the writing on the wall, my mojo had been taken from me! And it wasn’t just confined to the radiologists. Technologist morale took a nosedive. I would often hear them arguing, back stabbing, and finger pointing at one another when something went wrong, rather than before, when they would all help each other out. This corporate culture of “my way or the highway” spread to other physicians as well, with many dedicated, competent, and well-respected physicians from our former hospital, either flat out quitting, being forced into early retirement, or being fired.

I was desperate, frustrated and depressed. How could things have taken such a turn for the worse? What happened to my passion for radiology? Every day, I felt bored, un-motivated and a lot like Fred Flintstone at the stone quarry; just going through the motions. To exacerbate things, while the decade was coming to a close, the job market had turned polar opposite. Jobs were now scarce, good radiology residents graduating from solid programs couldn’t find jobs and were being forced to either do a second fellowship or accept job offers in undesirable locations or for significantly less money. I was looking at the distinct possibility of having to move my family, doing locums work, or (egad!) leaving radiology altogether to work in industry.

I poured over all the job market websites; I dug deep into my contact list to ask around for possible opportunities, I asked for favors from former associates. No stone was left unturned. There was one glimmer of hope, though. I had a friend who was the director of a small group at a tiny hospital for whom I had done some moonlighting for, earlier in my career. We had managed to keep in touch and I had always had a great deal of respect for her. Her group was also undergoing some changes and although she wasn’t quite ready to commit to offering me a job, I continued to keep in touch with her, and basically kept nagging her. Deep down inside, I knew something would break. Sure enough, she thresholded over, and the offer came.

Although the salary is less, and the commute to work is longer, I definitely made the right choice. I am back to loving my job, I enjoy working with the staff, and even more importantly the leadership has respect for my opinions, and for me as a physician, rather than a mere laborer. I am reading the modalities that I enjoy reading, doing procedures that I am interested in, and have re-discovered my passion for radiology. To sum things up; my mojo is back!

Experiencing the transitions in the field of radiology has made for many ups and downs.

How I Got My Mojo Back

As work volume has increased and radiologists are burdened with reading more cases that get more complicated as patients live longer and, therefore, develop more medical issues, there seems to be less and less time to reach out to our colleagues to discuss interesting cases. Further leading to this decrease in physician-to-referring-physician contact is the omnipresence of PACS.

Work stations are now located in most of the nursing stations, ICUs, physician lounges, and many outpatient physician offices. Gone are the days when the surgeon would stop in the radiologist’s office to review a CT exam prior to operating on a patient. It’s been years since I can recall when a pulmonologist or urologist would meet me in the consultation room to review a CT chest or a renal ultrasound, just before heading off to the bronchoscopy suite or OR. Why bother with the radiologist, when I can just pull up the case on my monitor, or tablet, or even my iPhone and see where the tumor is or where the pulmonary nodule is that I need to biopsy?

In light of these recent changes to the field of radiology, some genius came up with the innovative idea of having critical values instantaneously sent to the referring physician. In theory, this idea would seem to have many advantages. First, it would avoid the legal issues of documenting that a critical value in a radiology exam was reported to and received by the ordering physician. We all know that one of the main reasons that radiologists get sued is because of lack of communication and lack of documentation of communication.

Second, by ranking these critical values into a level of priority, such as significant, emergent, or significant-document only (because I only want to document it in the report-not bother the referring physician), one can prioritize certain imaging findings, so that they get acted upon in an appropriate and timely manner.

Finally, the documentation gets embedded in the dictation and the patient’s legal medical record, with a date, time, and name of the health care worker that was notified of the finding.[[{"type":"media","view_mode":"media_crop","fid":"37703","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_4345636521131","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3732","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 107px; width: 160px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Â©Gajus/Shutterstock.com","typeof":"foaf:Image"}}]]

When I first was introduced to one of these critical value-reporting systems, I must admit I was quite skeptical. Call me old school, but very few things in radiology are more gratifying than hearing a close physician friend who just sent in his patient for a CT of the chest, say to you, “I really appreciate you taking the time to call me to tell me that Mrs. Jones has a lung cancer on her chest CT. I will call her right now, and get her in for a biopsy. Thank you for the call.” Nevertheless I began to use it, and found out very quickly that some of my initial doubts were proven to be true.

It was only after using the system for a short while, that I found out that, A) it doesn’t work after 5 PM, B) it doesn’t work on weekends, C) it doesn’t work for the emergency department, and D) it takes many months for the majority of referring doctors to register with the system, and the system needs to be constantly updated and refreshed for every new doctor. Not being told these facts before using the system, I recall reading a CT of the abdomen late one Friday that demonstrated hydronephrosis of the kidney secondary to a distal ureteral stone. Not knowing that they system did not function on the weekend, I used it to notify the urologist. Little did I know that he wouldn’t receive the message until Monday morning.

One of the more annoying faults of the system is that it doesn’t work for the emergency department, which just so happens to be one of the biggest referral sources for all imaging in the hospital. In summary, after learning from these mistakes and the shortcomings of this new technology, I only use the system to document that I spoke to a referring physician, after I go old school and call them on the phone. After all, like I said before, few things are more rewarding during a busy day, than five simple words, “Thank you for the call.”

Longing for the days when physicians called each other. 

Author | Laurence Spitzer, MD

Articles

A Change Would Do You Good

It’s That Time of Year

How I Got My Mojo Back

Thank You for the Call