Sarah Bruyn Jones

Measuring the productivity of radiologists is on the rise, with more practices, hospitals, and corporations implementing some form of RVU monitoring system.

An estimated 80 percent of radiology practices are measuring productivity levels, according to the consensus of experts who gathered at the annual Economics of Diagnostic Imaging symposium in October, said Lawrence Muroff, MD, president and CEO of Imaging Consultant, Inc. who was also a featured speaker at the conference.

That’s up from an estimated 50 percent of practices when the data was presented at the same symposium in 2010, he added.

Even as more practices are capturing the data, several big questions remain. Is the process fair? Should non-clinical productivity also be measured and incorporated into a rating system? And how should the results be used?

“I don’t think any one answer is the right answer for any particular practice,” said Charles McRae, CEO of Columbus Radiology Corporation in Ohio and a member of the Radiology Business Management Association Board of Directors. “It’s a very practice-dependent type of decision.”

With 32 radiologists employed in his practice, McRae said measuring productivity by monitoring RVUs has improved efficiency, but it isn’t the sole way a physician’s contributions are evaluated. Attending tumor boards, picking up the phone to talk to a referring physician, and participating on medical executive committees are all seen as vital for the practice’s survival, even if that time isn’t documented in RVUs, he said.

“Here is the thing that is very difficult to try and determine – and the piece that is most important,” McRae said. “If I want a radiologist to be productive, I can stick him in the room, turn off the lights, turn off phone and chain him to the desk and say, ‘work.’ The radiologist will be productive and read a lot of images, but I won’t have the hospital contract for as long.”

Helping traditional private practices see the importance of non-clinical work is something Muroff said distinguishes practices from the pack as hospitals continue to consider employing radiologists in-house and non-traditional national companies grow.

“The problem is, I think that people are becoming aware of the need to assess other things in their practice other than work RVU output, but I think they haven’t taken that giant step of what it is they have to measure and how can they measure those contributions,” he said.

Muroff said more organizations need to think about how to measure and value the crucial hours spent networking within the local medical community in order to show there is value beyond being able to read films accurately and quickly.

“If all we are doing is grinding out films, then anyone can grind out studies and interpretations. Then, people become interchangeable,” he said. “Relationships, practice building, aligning ones goals with hospital systems, tapping into not only the medical, but also the social and political fabrics of the hospital and community – those are of equal,  if not more, importance to the success of radiology practice than just clinical excellence.”

A study published in the October issue of the 

Journal of the American College of Radiology

 found radiologists spent 36.4 percent of their time on image interpretation. Non-interpretative tasks, such as protocolling requisitions, supervising and monitoring studies, performing image-guided procedures, consulting with physicians, and directly caring for patients, accounted for 43.8 percent of their work hours.

“Modern radiology has evolved in a positive direction for patients and other physicians because the radiologist spends a considerable amount of time servicing referring physicians and patients by performing tasks beyond image interpretation, including quality and patient safety-related issues,” the authors wrote.

The study, which consisted of a one-month observation of staff radiologists at three independent hospital facilities in Canada, suggested practices consider a new framework for characterizing the work radiologists perform and that the amount of time spent outside reading images was indicative of the difficulty in replacing on-site practices with off-site, non-radiologist image interpreters.

“This study characterizes the on-site radiologist as a health care service provider who not only leads interpretative activities but also spends more than half of his or her workday on critical clinical non-interpretative activities that drive the medical imaging department,” the authors emphasized in the paper’s conclusion.

Even as more leaders within the specialty recognize the importance of the non-RVU components of a radiologist’s job description, there is little clarity on how to incorporate those duties into productivity measurements.

Muroff said there is not a one-size-fits-all formula for measuring the non-clinical value, nor should there be. Instead each group must determine their own values and the needs within their medical community, he suggested.

McRae said he is aware of one practice that has a formula for adjusting the RVU measurements by including a way for deducting the time spent in job-related meetings or physician consultations.

“It’s a very sophisticated portal and system for offsetting the RVU data,” he said.

Even as practices have incorporated RVU-data tracking measures, experts say there are some common themes that groups would be wise to consider:

· Make sure your RVU data collection doesn’t simply include the billing pages from the large hospital system work. If practices don’t include all the one-off readings that come from smaller referring partners, the data will be imperfect and could negatively affect the way each physician is measured.

· Have a clear understanding of how the data will be used and shared with each physician. Will it be anonymous? Will only the outliers and “poor performers” be coaxed into improving? Will there be any incentives or penalties associated with the ratings?

· Be cognizant of the practice’s overall thoughts on the fairness of the RVU system as it relates to specific subspecialties. Do you think the values given for interventional radiology are appropriate? Do neuroradiology scans deserve the higher ratings? Is the bundling of codes making it appear as though productivity is decreasing when really the lower RVUs are a result of changes to the payment system?

“[Productivity measurements] can be a very divisive issue,” McRae said. “It can cause far more harm than good, and it has torn practices apart. You need a well-thought out process and buy-in from the entire practice.”

Articles

More practices are measuring radiologist productivity, but questions remain about how to evaluate providers well.

Measuring Productivity On The Rise; More Direction Needed

Retirement planning for radiologists has taken on new meaning as the specialty has faced pressures from flattening image volumes and a weak economy.

The situation isn’t one faced solely by the greying radiologists nearing 65 years old. Instead, retirement planning has become a process that involves everyone in a radiology group, including the newest to join and those contemplating a mid-life switch to a new career.

It is also a subject that has proven contentious within radiology practices across the country, said John Cronan, MD, chairman of diagnostic imaging at Rhode Island Hospital and professor at Brown University School of Medicine. 

“There is a generational impasse,” said Cronan, who was part of an American College of Radiology (ACR) task force that recently looked at ways for practices to more effectively handle retirement. “How do you make it a graceful exit on one side and make younger people feel like they are not giving away the farm on the way out.”

The crux of the problem rests with more newly-minted radiologists entering the workforce each year than are retiring, while the need for radiologists nationwide has stagnated, Cronan said. About 1,000 new radiologists are licensed each year while only about 600 retire.

The situation has created an environment where individuals and group practices must ensure they are effectively planning for retirement throughout a physician’s career to ensure the best outcome for all, experts say.

While retirement advisors have long urged workers of all ages to save for retirement, they say planning and saving is even more important for today’s radiologist.

“For physicians, and particularly for radiologists, they get a very late start compared to other people [in the workforce] because the training is so long,” said Jeffrey Brown, MD, a principal with the Saint Louis, Mo.-based investment advisory firm Shearwater Capital which caters to physicians. “Most people are out of college at 22 years old. That would give you 40-to-45 years before retiring. It’s a very long period of time to save. But a lot of our clients are in their early-to-mid-30s. They don’t have as long; that’s a shorter time period. They really have to get started saving immediately because there is less time to make up for mistakes if there is a big pitfall.”

Cronan and his task force recently published a two-part 

 urging practices to have constructive conversations on how to structure retirement and suggesting that implementing a phased-incentive retirement, which includes a reduced work schedule over several years, may be the best option for both individuals and groups.

“It is better to discuss options and make decisions for the group rather than for individuals,” the authors wrote. “The development of a formal retirement policy would satisfy senior radiologists and open jobs for newly-trained radiologists, who would be highly desirable and beneficial to the well-being of all groups.”

Experts from both the financial industry and ACR task force suggested radiologists consider the following:

Cronan said taking call is the single biggest debate among practices when it comes to reducing a physician’s hours as he or she nears retirement and is one that must be openly discussed.

Younger physicians tend to be adamant that call continue to be shared equally among all radiologists, Cronan said. But radiologists nearing retirement believe they could continue to contribute to the practice, if they could reduce their after-hours call shifts on weekends and nights.

“Their whole attitude is they don’t believe anything is going to be there when they get there,” Cronan said of younger radiologists. “So, in groups it’s causing conflicts, and it’s most apparent in discussing call. The younger people are not willing to support the older radiologists, and the older guys don’t want to work fulltime but still want to stay involved.” 

While part-time hours can work well for both individuals and practices, per diem hours tend to be of a larger benefit for practices, the ACR report found. Both allow senior radiologists to utilize long-standing relationships during reduced work hours, the authors wrote. But with per diem hours, the retiring radiologist could have long periods of time when they were not needed and there is less structure to his or her schedule, Cronan said.

An option with many ways to structure it, a retirement phased ideally over four years provides both the practice and the senior radiologist a nice transition to leaving the field. The retiring physician gradually reduces his or her roles and time on a pre-determined and set schedule and allows the practice to recruit and plan for filling that role.

Brown said he has seen this option recently grow in popularity among his clients, adding that the way it is structured can vary widely.

“I see some work one day a week, some do a few half-days a week. You’ll see a lot of different arrangements,” he said.

Another option that appeals to radiologists looking to retire from their regular practice, Brown said, is finding part-time work through a new employer in teleradiology or locum tenens, temporarily filling in for another radiologist.

“Sometimes they can make enough that they don’t have to take any money out of savings,” Brown said. “So they are making enough to cover their living expenses. That can have a very beneficial effect on retirement planning.”

Whether it’s a 401K, a 403B, or some other employer-sponsored plan, radiologists, like all workers, should take advantage of these options from the moment they get out of medical school, Brown said. “It is much easier out of residency or fellowship get a good savings built and harness compound interest,” he said.

Additionally, Bob Tucker, MD, a vice president with the investment advisor firm Plancorp, said that radiologists in private group practices can take advantage of some unique financial planning structures that allow them to save above the maximum limits allowed in stand-alone 401K programs. This consideration primarily works for groups where everyone is earning around the same compensation level, he said. Since radiology groups often rely on support staff supplied by hospitals they are more likely to be able to take advantage of the additional savings, he said.

“If you have a group of five radiologists who own the corporation and are the only employees, this is an option,” Tucker said. “If one [of the physicians] hasn’t been too good about putting away money but would like to retire in 10 years, this would allow him to put the standard $51,000 a year in a profit sharing/401K plan, but also fund another plan on the side and that can literally double or triple the amount of money he can put away toward retirement. And all five physicians can do something a little different.”

Both Brown and Tucker said Roth 401K and Roth IRA accounts - which are funded with after-tax dollars but can grow indefinitely without paying additional taxes - are important to a diversified retirement savings plan.

“It is particularly a great option for those early in their careers,” Tucker said.

Even once a physician reaches the income limit that prevents a direct contribution to a Roth account, they can take advantage of Roth conversions, Brown said.

Planning to retire from your radiology group? Here are six considerations for a graceful exit and secure financial future.

Six Options for Retiring Radiologists

Some radiologists are working to expand mentoring, calling it a vital component for securing the future of the profession and critical for empowering individual careers.

The effort to facilitate post-training mentoring relationships is being championed, in part, by those who see a direct relationship between the need for leadership as radiology faces the challenges that come with health care reform and the changing landscape of the profession.

While there is a long history of mentoring medical students through the various components of their training, the formalized relationships between young and experienced radiologists often disappears as careers take hold.

“After residency and fellowship, you just drop off to this big machine of radiology,” said Peter Van Geertruyden, MD, a radiologist at Virginia-based EagleEye Radiology, who is among those actively trying to establish mentoring networks for practicing radiologists. “Some are looking for more direction because it is intimidating not to have anything.”

Last year Van Geertruyden, working with the American College of Radiology (ACR), helped launch a mentoring network for the Young and Early Career Physician Section at the College. The network, which is still in its infancy, is intended to help connect mentors with radiologists who are either under 40 years old or are within eight years of their training.

The concept behind the network is that radiologists can reach out to peers with questions about their career paths by finding others who share similarities in research interests, sub-specialty, or geographic location.

Questions surrounding establishing a private practice, or navigating a path in academics inevitably come up as radiologists consider first jobs or next steps during a point in life that is typically dominated by many major transitions, said Arun Krishnaraj, MD, an abdominal imaging and intervention radiologist at Massachusetts General Hospital who also serves as a mentor and was also involved in establishing the network.

"We thought, there is a void and a great opportunity to establish intermediate mentors as people are getting settled in their careers,” Krishnaraj said.

Additionally, by providing a venue for addressing early career questions, Van Geertruyden said he hopes it sparks an interest among young radiologists to assume leadership positions within the profession and engage in the broader issues facing radiologists from political, economic, and clinical standpoints.

So far few have used the network, something Van Geertruyden said he suspects is because few realize the service, which is housed on ACR’s website, exists.

Even as the two radiologists, both of whom are early in their own careers, tackle the mentoring needs of their peers on a national scale, others in the field are calling for more to be done at a local level.

“I would suggest we look at midcareer mentorship,” said Ruth Carlos, MD, professor of radiology at the University of Michigan.  “In academics there is a lot of focus on launching junior faculty to be productive members of society, but there is a little less focus on helping radiologists navigating midcareer – for those in practice 10 years, who are asking ‘what’s next, how do you navigate the next phase?’ … That path isn’t as well defined. I think it can be a struggle, that’s why people have a mid-life crisis.”

Establishing mentoring relationships at the local level and through employers would go a long way to helping radiologists navigate their careers, said Lawrence Muroff, MD, CEO and president of Imaging Consultants Inc. and a clinical professor of radiology at both the University of Florida and the University of South Florida Colleges of Medicine.

“In private practice, we do a bad job allowing young persons the opportunity to discuss issues and concerns in a non-judgmental way,” Muroff said. “So they stay quiet until they are full partners, and then the real individual emerges. There is no one that the practice designates to a young individual that they can talk to without fear of retribution.”

Mentors within a practice could help to curb issues down the road and create an environment that allows the entire practice to navigate the complexities of the changing healthcare landscape together, Muroff said.

“We don’t tell them what it takes to be a good citizen of my practice,” he said. “All we tell them is to churn out the work, and this unreasonable emphasis on clinical productivity really takes away from the broader needs and skills that are important, the non-RVU producing things like consulting, going to conferences, imbedding into political and social medical structures of hospital and community.”

Carlos has seen the value of mentoring through her involvement with the Association of University Radiologists GE Radiology Research Academic Fellowship (GERRAF) award program – she currently chairs the board of review. For the fellows mentoring is a major component, with the program facilitating exchanges through retreats, encouraging phone calls, and identifying mentors who bring an outside and valuable view to the research projects being pursued.

“We are a small program, hosting four fellows a year,” she said. “But it has been around 25 years. And I would say that this small cadre has had an outsized contribution to the field of radiology.”

Facilitating lifelong mentoring relationships and encouraging fellows to seek out advice as they pursue their research and careers are among the factors that have built the program’s success, she said.

Trying to figure out a way to translate the success of mentoring in programs, such as GERRAF, and other educational environments with the needs of midcareer physicians is difficult, though.

“It’s hard because the transition is not as well defined in midcareer,” Carlos said. “I don’t think as much attention has been given to it. We need the structure to encourage people to seek out these relationships and to make it feel natural so you don’t feel weird calling up and saying, ‘Hey, I need advice.’ ”

Plus, mentoring is a two-way street, where there is also a need for the experienced in the field to be willing to share their expertise, Muroff said.

“To me, mentoring is the ultimate way that you can pay it forward and pay back what the specialty has done for you,” he said. “It is about ensuring, in a forward sense, the strength and ability of new people to keep the specialty going forward.”

Some radiologists are seeking to revive mentoring both locally and nationally as a way to support the specialty.

Mentors Needed Throughout Careers

An optimal workstation isn’t just about having the flexibility to comfortably stand, sit, and interact with the monitors. Once the desk, chair, monitor arms, keyboard, and mouse are perfectly positioned to reduce strain and improve performance, radiologists should consider adding the bells and whistles that will promise even more comfortable and improved efficiency.Click through to see the peripherals that offer relief for each of your five senses.Â 

Slideshows

Upgrading your workstation with ergonomically-designed technologies can improve performance and decrease work-related discomfort.

Optimizing Your Reading Room

As digital reading rooms are leading radiologists to discover the aches and pains of repetitive motion disorders, like carpal tunnel syndrome, and neck, back, and eye strain, ergonomic products and practices are being introduced to combat problems and optimize workstations.

Diagnostic Imaging spoke to several experts in ergonomics who offered their insight into the top ways radiologists can position themselves for hours of pain-free image reading.

Poor posture and awkward body position can account for a number of problems among radiologists, including nerve damage, said Alan Hedge, PhD, CPE, director of the Human Factors and Ergonomics Laboratory in Cornell University’s design and environmental analysis department.  

An ergonomic, dynamic-back chair can go a long way to fixing those aches and pains, he said.

“The chair should move with you and have head and neck support,” Hedge emphasized.

But even after selecting the perfect chair, it must be adjusted properly, said Woojin Kim, MD, an assistant professor of radiology at the Hospital of the University of Pennsylvania.

“Back away from your workstation,” Kim said. “Sit on the chair. Be very comfortable in the chair. Make sure your feet are not hanging in the air, but are firmly on the ground.  The arm rest should be symmetrically raised and depressed so that your arm is resting at a 90-degree angle.”

Height- and tilt-adjustable monitors that swing in different directions are among the biggest improvements available for enhancing the ergonomics of a radiology workstation, said Mukesh Harisinghani, MD, associate professor of radiology at Harvard University and assistant radiologist with the department of abdominal imaging at Massachusetts General Hospital.

Hedge also suggested radiologists take a page out of the Wall Street trading room playbook and look for monitor arms that arch horizontally.

“When you go to see an OMNIMAX movie, the screen is curved because that is how our visual world works. It’s not a flat world,” he said.

Similar to using dynamic-back chairs, it doesn’t help to have the top-of-the-line monitor arms if they aren’t adjusted properly, Kim said. To properly adjust the monitor, push it away from you.

Since the ideal viewing distance is 18-to-24 inches, Kim said he recommends radiologists begin by pushing the monitors back as far as they will go.

“If the screen resolution is too small, it is better to enlarge the font size and still sit back from the monitors,” he said.

Next, lower the monitors so you are looking straight or, ideally, down at a 14-degree angle, Kim said.

“If you ever find yourself looking up, then the monitor is too high,” he said.

Workstations should be height-adjustable so they fit a radiologist who is 5-feet-2-inches tall as easily as one taller than 6 feet.

Finding one that allows radiologists to sit or stand offers the best range, letting radiologists change positions throughout the day.

“Somebody could sit and adjust the height to suit them, and another person can get rid of the chair and stand,” Harisinghani said, adding that someone can still slouch or sit improperly in a properly-adjusted chair.

“If you stand, you are forced to maintain a good posture,” he said.

Hedge recommends the 20-20-20 micro-break.

"After 20 minutes, take a 20-second break, and look at least 20 feet away,” he said. “Your eyes relax when you look at a distance. By doing this you’re maintaining the ability of the eye to focus on images over the day.”

These breaks eliminate the eye-muscle fatigue that comes with looking at the same distance all day. Without them, it becomes difficult to focus.

Radiologists tend to set the monitors at a brighter level than needed because they use the monitor light as ambient light, Harisinghani said. But that practice contributes to visual fatigue.

Instead, floodlights, task lighting, or other designated ambient lighting are a must have inside any reading room.

“There should be no direct light hitting from the ceiling,” Kim said. “I tell my residents, ‘That’s not for you. They are for the janitors. Turn them off.’”

A floodlight should be on the back of the workstation on the wall and should be bright, so that the light matches the luminance from the monitor, Kim said.

Task lighting, used for looking at paperwork and documents, should be attached to the furniture and should include a good blue light component because it helps the pupil constrict, making it easier to see, Hedge said.

Use a matte finish. It reduces glare and, therefore, reduces visual fatigue and strain, Kim said.

When looking for the newest, most advanced solutions, pay attention to video gamers, Kim suggested.

“If you want to see who are the most efficient, look at the gamers,” he said. “Every second counts for the competitive ones, and since they can’t waste a single second, you see all kinds of useful peripherals that they use.”

For instance, Kim has found left-hand devices that save repetitive clicks of the mouse or keyboard, as well as microphones and headsets that can make reaching for the phone obsolete.

Bluetooth rules the day in a car, but many radiologists are still picking up a handset to talk on the phone.

A microphone or headset can be used for conference calls or dictation, Kim said.

And voice recognition software can significantly reduce the turnaround on reports while eliminating injury-associated motions, such as typing and clicking.

It’s costly, but many radiology departments have found cost benefits with major ergonomic overhauls, Hedge said.

But those re-designs can be complicated, and there is not a one-size-fits-all solution for every radiologist or radiology department. Oddly-angled walls and tight corners might mean working with a vendor that can customize workstation designs.

“You need to be able to change the module to fit those tight spots,” Harisinghani said. “You need some kind of a company that offers solutions, not just products.”

Optimizing workflow, down to the placement of a coffee cup, improves efficiency and wards off musculoskeletal disorders. But don’t forget the empty space. A workstation should include areas to the left and right where there are no permanent features except a plain desktop.

“Adequate workspace is really important,” Hedge said. “To find the optimal amount of space, sit down at the space. If you put your elbow on edge of work surface and make two windshield wiper areas with your arm … that shouldn’t be cluttered up.”

The top 10 things that will help optimize reading room comfort and efficiency while reducing fatigue and strain.

Reading Room Ergonomics

When Arun Krishnaraj, MD, accepted a new job in Charlottesville, Va., in July, he not only wanted to acquaint himself with his new colleagues, but also with service opportunities within his new community.

Since becoming the newest chief of the body imaging division for University of Virginia Health System’s radiology and medical imaging department, Krishnaraj has been contemplating just how he can launch a program where radiologists volunteer as a team within the community.

“To me, it is part of being a physician that you are part of your community and you have a unique aspect to giving back,” he said.

Krishnaraj is among a group of radiologists who are vocal in persuading their colleagues to think about stepping out of their reading rooms and volunteering their time to any number of causes.

“This is about making sure that radiologists have a greater purpose as physicians and are plugged into their communities,” Krishnaraj said.

Plugging into volunteerism is something that Richard Gunderman, MD, has devoted a lot of time to thinking about, doing, and encouraging others to do.

“Most people harbor inside a real need to contribute something, not to just contribute things we pay for, but to contribute something because we think it is going to make a real difference in a patient’s, colleague’s, or neighbor’s life,” said Gunderman, a professor of philanthropy and vice chair of radiology at the University of Indiana.

“A lot of us are worried,” he said. “Our incomes are stagnated or declining. And that puts us in a deficit or scarcity mentality. We are having to make do with less. Woe is me. The answer to that is, perhaps, radiologists’ incomes aren’t going up as fast or are even declining, but there aren’t too many starving radiologists. We’re still doing pretty well, and if we could still find some time to give of ourselves it might help to put it in perspective.”

As radiologists within the field push to encourage broader programs to recognize and promote volunteers within the profession, some have sought to emphasize it as a vital part of the field.

When University of Washington Medicine assistant professor of radiology and breast imaging fellowship director Christoph Lee, MD, and his co-authors proposed a way to define and measure citizenship within the field, volunteering was included among the activities that currently go unrecognized but serve to bolster not only the people being served but the profession, as well.

, Lee and his colleagues suggested that activities outside of directly interpreting images are important to securing the future of the profession. Volunteering on local boards, political involvement, participating in Rotary or religious organizations, mentoring students all play vital roles in familiarizing the community with the profession, Lee said.

“During the interactions you have when you are in these roles, people are getting to know what radiologists do and who radiologists are,” Lee said, noting that previous surveys and studies have outlined just how little the general public often know about radiology.

While there is a push among some to encourage radiologists to be active in their volunteer efforts, Brad Short, senior director of member services at the American College of Radiology, said that there is no shortage of people who are willing to give themselves to the profession, with an estimated 1,200 to 1,500 members volunteering at any given point in time.

The forms of volunteer vary, with some participating in international work, such as in Haiti, and others engaging in some of the organization’s advocacy work.

“We have 36,000 members all dedicated to providing radiological care, but they also have other interests so that we get a wide range of people who want to volunteer for different kinds of things,” Short said. “There is a way to find something for anyone.”

Gunderman said the biggest barriers to volunteering are often identifying the time and thinking creatively enough.

“Sometimes it is the very busiest people who still find time to volunteer,” he said. “To them, it is an essential time to a full life, and they look for three, two, one hours a week they can give.”

As for Krishnaraj, he first began to encourage radiologists to give back during his training years, and in a 

 proposed the Heart of Radiology program that sought to encourage residents and fellows to volunteer their time. Now he would like to see it translated into something embraced not only by trainees, but also by the entire specialty.

“We have an unique opportunity when people are more energized and engaged to improve our image on a local level and help people,” Krishnaraj said. “Most community service-based projects are likely driven by one or two motivated people. It only takes that one or two to get it started, and I hope others follow.”

A growing trend toward volunteerism brings radiologists closer to communities. 

Volunteering: Good for the Community, Good for Radiology

The market for mobile health care services, like smartphone and tablet apps, is expected to swell to $26 billion globally by 2017.Apps have become nearly ubiquitous with helping guide consumers to healthy lifestyles by tracking exercise regimes and daily calorie intake. But they’re also appealing to healthcare providers looking for more efficient daily routines including allowing radiologists to view and share images. About 15 percent of mobile health apps are designed for healthcare professionals according a report by research2guidance.Radiologists are quickly adopting mobile apps to view and share images, collaborate with other physicians, and review files and databases.We combed through best-of lists and consulted experts in search of the apps that every radiologist should consider downloading. Here are eight must-haves.Did we miss one? Tell us your favorite in the comments section below.For more on these apps:OsiriXMobile-MIMDoximityRadiology 2.0: One Night in the EDEpocrates CMEGoodreaderPapersRadiopaediaSources: Asim F. Choudhri, MD, iMedicalApps.com, Garry Choy, MDCheck out our updated top apps here.

Mobile apps are helping radiologists view and share images, collaborate with other physicians, and review files. Here are several must-have radiology apps. 

Top Mobile Apps for Radiology

Michael McNeeley, MD, wanted to set one thing straight: "radi-holiday" is a myth of medical education.

"The big thing here is radiology has always been one of those lifestyle specialties," said McNeeley, a senior radiology resident at the University of Washington in Seattle. "Meaning, it's known for reasonable work hours, being well-compensated and not having a lot of intense patient contact. There is this image that we are sequestered away, below the radar, working bankers' hours.

"It's not true these days; it's not realistic. I don't think we've really done ourselves by allowing that myth to be perpetuated. But in general, radiology clerkships are notorious as vacations: a radi-holiday. That skews expectations of those entering the field."[[{"type":"media","view_mode":"media_crop","fid":"14200","attributes":{"alt":"","class":"media-image media-image-right","height":"106","id":"media_crop_4739336934867","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"711","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":"margin: 5px; float: right;","title":" ","typeof":"foaf:Image","width":"148"}}]]

McNeeley knew his training in the field was far from stress-free. But, when he decided to debunk the long-standing lifestyle myth, McNeeley didn't rely on antidotal evidence of long-hours, the shrinking job market, and the increased pressures of patient centeredness. Instead, he did what his medical education taught him and turned to science.

McNeeley designed a study that sought to capture the burnout rates of radiology residents. But he also decided to focus on the role the growing financial burden most young doctors must incur plays on inducing burnout.

What his study, which was published last month in 

, found wasn't entirely surprising to him.

Of the 249 radiology residents who completed the survey that was the basis for the study, McNeeley found they had slightly higher burnout levels than what was measured in previous studies looking at internal medicine residents.

Secondly his decision to focus on the role money plays in leading to burnout in radiology residents proved enlightening.

"Finances may be an underappreciated contribution to burnout," he said. "But it isn't about the financial balance sheet, it's all about attitudes about money."

At first glance the results may seem counter-intuitive, McNeeley said, because burnout didn't correlate to hard established facts like income or debt. Instead, radiology residents were more likely to burn out simply because they felt a huge financial strain. The trainee's financial perception, and not his or her financial reality, was the better predictor of burnout, he found.

"If [radiology residents] are feeling a sense of financial scarcity," McNeeley said, "I think that is more important because we're dealing with emotions and feelings, and that's where dysphoria springs from."

To evaluate burnout, McNeeley incorporated a modified version of the Maslach Burnout Index into the survey, which was emailed to 1,389 residents and fellow junior members of the Association of University in January 2012. (The study had a response rate of 19 percent).

In general, McNeeley found the survey results on burnout aligned with his perceptions of stress among his fellow trainees. The findings included:

• 53 percent of respondents described emotional exhaustion at least weekly

• 49 percent of respondents reported feelings of depersonalization on a weekly basis

When it came to the measurements of financial strain, McNeeley was deliberate in noting the statistically significant associations between burnout symptoms and financial perceptions, including:

• 55 percent of respondents said they somewhat agreed, agreed, or strongly agreed that their financial situation is a "serious strain."

• While 25 percent reported at least some trouble playing for housing and utilities, 42 percent said it was difficult to pay for mandatory work-related expenses such as American Board of Radiology dues and licensing costs.

• As the values for subjective financial strain increased so did the levels of emotional exhaustion and depersonalization, while measurements of quality of life decreased.

His hope is the study builds awareness that radiology trainees are not immune to burnout despite some of the traditional stereotypes of the specialty. He also said he hopes program managers take note that small steps to ease the perception of financial strain could go a long way to reducing burnout in radiology trainees.

"I saw a lack of that data in this area and realized there was a need that hadn't been addressed," McNeeley said, noting that he had seen many papers addressing burnout in other physician specialties but not his own.

"Residency is a tough period, and there is a big, steep learning curve coming into radiology because you don't get a lot of it in medical school. When you're finished with your internship you come out knowing, 'I can keep a ward full of people alive.' But you come in on day one of radiology and you're back to nothing. … The psychological challenges are unavoidable."

But he suggested with awareness of the situation program directors and other leaders in the field working to mold new radiologists should look for ways to ease burnout rates. Minimizing out-of-pocket expenses may also help to reduce perceived financial strain, he said. But programs should take note of other studies that have shown workers provided with good time structure, collective purpose, social contact and stimulating activity fair better emotionally and are less likely to burnout.

"Keeping residents focused on the bigger picture of patient care and reminding them of their place in broader healthcare system can go a long way," he suggested.

That's something Mary Scanlon, MD, vice chair of education for the Department of Radiology and the University of Pennsylvania School of Medicine, said she is conscious of in working with her residents.

In addition to trying to cover as many expenses are possible for the students by providing money for books and conferences and identifying moonlighting work, Scanlon said she focuses on giving them power to control some things in their highly regulated lives.

Long hours, tightening government regulations and hours of reading are most likely fueling burnout, Scanlon said, but money and the struggle to find the well-paying jobs once guaranteed to radiologists is likely also a significant stressor.

"They are burned out from the gloom and doom of radiology and doom and gloom of there being no jobs out there," she said.

While many of those factors are beyond individual control, she said residents should control some things in their work life. So, for instance, when they complained about a run-down and uncomfortable resident lounge, she asked how they would like to redesign it.

"Now they have a brand new resident lounge," she said. "If you feel like you can be a master of your own fate and solve problems and make a difference that helps. … If people think they can be in control of problems and fix them, that's a big way to control burnout and improve morale."

Radiology residents are facing high burnout levels, thanks to stress about finances. Here's what researchers found and what can be done.

Money Woes Spell Burnout for Radiology Residents

Ezequiel Silva III, MD, knew he had a delicate balancing act ahead of him.

Charged with leading the American College of Radiology taskforce for creating the first 

, Silva set out to acknowledge the positive of the bourgeoning field while reigning in any activities that had previously gone unchecked.

He and his fellow authors were quick to acknowledge the rapid expansion of teleradiology that has lead to critics and fans alike. And they were deliberate in tackling the unique challenges facing the field.

“We’re not condemning or commending it either,” Silva, a radiologist at the South Texas Radiology Group in San Antonio, Texas, and the University of Texas Health Science Center radiology department, said of teleradiology. “We tried very purposefully to go about it objectively. We looked at experts, regulatory issues, technology, standards and quality. This was not in reaction to concerns we had. It was not a response to complaints. It was an objective exercise to create the standards.”

As they formed the guidelines over nearly a year and half, Silva and his colleagues took on a wide range of subjects including licensing, credentialing, billing, ghost reading, peer review and workplace environment.

Even as the authors refrained from denigrating teleradiology, they did make one clear judgment on the practice: On-site radiology and radiologists are preferred.

“Although the task force understands and appreciates the benefits teleradiology brings to the profession and the communities we serve, we also believe the traditional practice model of having on-site, local radiology groups may better serve the overall interests of most communities,” the authors concluded. They recommended the ACR focus member education on how to take on leadership roles and other noninterpretive services within their hospitals and communities.

What emerged, however, is a document that Joe Moock, CEO of the national teleradiology company StatRad, called a must-read tool for the industry.

“It discusses a lot of the things that are very relevant,” he said. “I think it is a great tool for us to use and it is showing that ACR is saying this is important. My hope is that all telerad companies follow this guide and provide expert care.”

To begin, the task force formed a broad definition of the subject that includes not only the large teleradiology companies that take on work throughout the country, but also the common practice of local groups helping to cover smaller regional and community hospitals. Any time a diagnostic image is transmitted for interpretation beyond the immediate vicinity of where the image was taken, that’s considered teleradiology, Silva said.

“Even within the same hospital system,” he noted.[[{"type":"media","view_mode":"media_crop","fid":"12274","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_2759538557936","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"419","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":"float: right; margin: 5px;","title":" ","typeof":"foaf:Image"}}]]

Most importantly, Silva said, was their decision to keep the patient first. Teleradiologists, after all, should operate at the same high standards of any other radiologist, he said.

“The needs of the patient supersede everything else,” he emphasized.

ACR’s teleradiology guide tackles privacy, credentialing, and other elements to help establish best practices for the burgeoning field.