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 

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

Author | Sarah Bruyn Jones

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Measuring Productivity On The Rise; More Direction Needed

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Mentors Needed Throughout Careers

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