Increasingly, way back when, as I was sizing up the options for my first post-fellowship job, I interviewed for a post I had no real intention of taking. Shades of a “safety school” in the college application game, it seemed worthwhile to have options, as well as to have a “practice interview” before I visited jobs I actually wanted.
Some might have considered the place a radiology sweatshop. For its day, it had high expectations of productivity (without particularly strong compensation to match), and as one of its rads you were never going to be more than a cog in its machine. Not much to like, eh?
Even their broken clock got a couple of things right, however. I forget what term they used for the personnel, but they assigned each radiologist an assistant. The assistant’s role was to do anything non-doctorly that might take the rad away from generating RVUs—handling the bulk of stuff pertaining to phone-calls, for instance. The interviewer happily told me that they encouraged their rads to really make (ab)use of these assistants, even sending them out to fetch lunch, pick up dry-cleaning, you name it.
Fast-forward about 6.5 years, past the next couple of jobs I worked (long-term readers may recall that those venues were far from models of efficiency), and I was in my first telerad gig. Another model where productivity was king with relatively low pay per case. They justified this with efficiency: The tools they gave you would boost your output to the point where you could match, if not exceed, what you’d be earning elsewhere. There were shades of the slave—er—assistant at the sweatshop mentioned above, except here it was a pool of non-doctors serving all of the working rads. And no, they wouldn’t physically run errands for you. Couldn’t, as they were hundreds, if not thousands, of miles away.
In a blog I wrote not long ago, I discussed the potential hazards of removing everything but reading cases from a rad’s daily routine. As mentioned there, your mileage may vary—some rads would be perfectly happy with such a setup. Perhaps fueled by anything from caffeine to Ritalin, they would blaze through a full workday with nothing in-between cases other than an occasional bathroom-break. Others might welcome some non-doctorly things in the mix to avoid monotony.
There are some inefficiencies, however, that I’d wager few, if any rads, would consider a welcome break in between reading cases. Consider the following all-too-common scenario:
A rad is plugging away at cases, or whatever else he needs to be doing. The phone rings with some clerk who has a referring clinician on the line. The rad drops what he’s doing to take the call and (perhaps after being connected with the clinician’s secretary or nurse who puts the rad on hold for however long it takes to get the clinician), learns that clinician wants to talk about some imaging that patient X had.
Assuming the rad didn’t just read the case(s) in question and remembers every detail, he now has to pull up the case in order to be able to discuss it. He’s also going to want to pull up the report for the case so he can be aware of what he (or some other interpreting radiologist) said.
At the very least, this retrieval takes a minute or three, during which the clinician might not refrain from proceeding with his query. Even if he’s able to wait patiently, the rad is going to have the sense of someone breathing down his neck while he’s trying to quickly get up to speed on the matter. And, some clinicians don’t have the time or patience to give the rad the time he needs, turning the exchange into a weirdo subspecialty of radiology-under-the-gun that just begs to create errors and omissions.
This also assumes that the transaction can even be completed in one go, especially if you’re a remote telerad. It’s not at all uncommon for the cases and/or reports in question to be unavailable to you unless somebody “pushed” the study to your server. If this hasn’t happened, you wind up having wasted the clinician’s time and yours. After getting off the line with the dissatisfied referrer, you have to get ahold of clerks, techs, whoever to have the cases uploaded, at which time they can interrupt you to start the process all over again.
Now, let’s take that exact same situation, with a couple of tweaks that some practices have incorporated better than others (telerad is generally a step or two ahead of other rad groups, which might not be quite as attuned to efficiency):
Rad is plugging away at cases, or whatever else he needs to be doing. His workstation’s instant-message alert chimes: A clerk notifies him that a referring clinician wants to discuss patient X’s imaging. Clerk’s message might even contain a brief synopsis of the clinician’s question.
The message has an embedded link which the rad can click that will immediately open the patient’s imaging files. All of the relevant stuff is there—the clerk made sure to check this before messaging the rad, and if there had been any missing items, the clerk had them uploaded before sending the message. The rad now looks over the case at his next opportunity (perhaps first finishing the stroke-protocol scan he’d been reading when the message came in), and messages the clerk back that he’s all set, and the clerk can get the clinician on the line.
This, and other efficiencies like it, are far closer to common sense than rocket science. As a telerad, for me most of them fall under the heading of “please only interrupt me when there’s something I can do for you right away.” It probably wouldn’t take a radiologist to come up with them. Really, anybody doing this stuff day in and day out with a view to getting things done would start to notice recurrent issues which hindered his productivity or were just plain annoying. The question then becomes what might be done to improve things—and how or whether such remedies might be implemented.