Practice’s lifestyle and financial needs can coexist

November 2, 2010
Richard Woodcock, MD

Radiology groups often describe themselves as being lifestyle-driven or financially driven. This distinction is helpful in describing a group’s philosophy, and in terms of workflow, these approaches can coexist.

Radiology groups often describe themselves as being lifestyle-driven or financially driven. This distinction is helpful in describing a group’s philosophy, and in terms of workflow, these approaches can coexist. In fact, most medical practices have members who lean toward one or the other philosophy.

Lifestyle-oriented practices may offer more days off and regulate the average amount of work each individual must perform. Practices that emphasize finances usually expect their radiologists to work more and longer hours. The latter is the “old school” style. Leaders may have set the expectation that a radiologist stays on the job if there is work to do, regardless of what work has been done. Lifestyle-focused group members may resist that mentality, pointing out that some radiologists read more quickly than others. Those who read a large quantity may resist being asked to stay to work if they have already read a considerable amount.

Ultimately, the goal of practice leadership should be to encourage great service, superior read quality, productivity - and fairness. There is really no reason why a practice can’t accomplish all these goals. But how can you achieve them? We’ll attack the fairness and productivity issues here.

Use your technology:
Many PACS now allow you to calculate how much work each assigned rotation or individual reads. You can then determine an average amount of work for each staffing spot. You may need to come up with a fair way to evaluate plain films relative to CT and CT relative to MR, etc., to arrive at a reasonable number of studies for each spot. This is harder in a practice with more modalities and a little easier in one with mostly cross-sectional reads. Another option is to use relative value units (RVUs) to figure an average amount of work per person across the practice and use that for your mean.

When a radiologist reaches the practice’s threshold or average amount of reading, he or she then has the opportunity to read for pay. Salary can be based on fulfilling the average responsibilities; bonuses can come from the reads over and above this. Base the fulfillment of average responsibilities on several days at a time or a running average, rather than one day only.

What are the benefits of this plan? Those who want to read more can do so - and get paid for it. The approach also encourages people to read multiple modalities, which incentivizes all physicians to keep up with technology. It also may offer flexibility to those who read more advanced outpatient work that is less time-sensitive than inpatient images. Outpatient studies can be read for pay, after routine hours.

Optimize your staffing to fit the timing of work: This is one of our biggest challenges because radiologists are partly hospital-based. It seems the hospital always wants more staffing, despite few studies at some of the times the hospital wants it. Demand for staffing is a necessary evil of a good relationship with a hospital, but use it as an opportunity.

Be smart about work that is not time-sensitive. If you have to staff areas with little local work, make sure that work from other areas or other days - not time-sensitive - can be made available to the staff there. When the hospital asks your practice to increase coverage, sell this model. Make some guarantees, but ask that the hospital allow you read work from prior days that is not time-sensitive at those times. If you have teleradiology contracts outside the hospital, ask for network access so your physicians can read them in the hospital.

Review your contracts critically to see if any are less time-sensitive than others. Target those to be read by radiologists staffing low-volume sites or shifts. Be creative in providing work to the people toiling at off hours to fulfill your hospital’s requirements. Consider assigning those with administrative time to such rotations, as they can still be productive without films to read.

Employ a creative staffing model
: Retain employees willing to work flexible hours and consider offering internal moonlighting. You might make it possible for some people to work remotely, if you have the technology and teleradiology contracts. Set the expectations for volume high for those readers. Give them a minimum number of required studies and require that they share in busy days. On some days, on-site staff will be busy with a heavy work load. However, if the off-site reader has a high minimum number of studies to read every day, then days with less volume will result in the on-site staff having lighter days too.

Dr. Woodcock is medical director for MRI at St. Joseph’s Hospital in Atlanta. He is also a member of the executive board of Atlanta Radiology Consultants and is the practice’s executive officer for finance. He may be reached at rjwatlrad@gmail.com.

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