Speedy Reads and Slower Deliberations: Key Factors that Impact the Pacing of Radiology Interpretation

Is there an optimal pace for navigating the ebbs and flows of our worklists in radiology?

I have mentioned in this blog that one of my main forms of exercise is running. I prefer distances as I have never been a sprinter. An hour or so running every other day is my norm.

I spend about the same amount of time on each outing and follow the same course. One might reasonably imagine my pace to be pretty steady throughout and indeed, it doesn't vary greatly in the grand scheme of things. However, subjectively speaking, individual sessions feel far from uniform.

There are too many factors to keep track of, even if I wanted to. For example, some factors may include how well-rested I am, what I have eaten in the past day or so, how much caffeine I have got on board, mood, weather, etc. The sum total effect is that when I hit the road (or treadmill, at this time of year), sometimes I am ready and raring, and off I fly with a spring in my stride. At other times, it feels like I am barely putting one foot in front of the other. No matter how I begin, I will likely shift gears more than once during the ensuing miles.

Maybe because of this experience, I find myself regarding reading radiology cases the same way. Reading cases is also never a sprint for me as I tend to work nine to 10 hours per shift. I wouldn't call what I do a marathon. I leave that term to ordeals such as the 24-hour shifts I painfully recall from residency. Let's call my typical workday a 10k.

(Editor’s note: For related articles, see “Handling Work Volume: What Constitutes ‘Speeding’ for Radiologists?” and “The Top Five Blogs of 2022 from Eric Postal, M.D.

As with running, my reading pace varies for any number of reasons, not the least of which being case mix. Putting relative value units (RVUs) values aside, it feels "faster" to open, read, and close a bunch of X-rays than it does to work through a few computed tomography (CT) or magnetic resonance imaging (MRI) scans in the same amount of time. Sometimes, I want that "fast" feeling. On other days, slowing down and smelling the roses on more complex imaging feels right.

I have written before about a couple of jobs in which I had some "fast" shifts with X-ray, ultrasound, and other "bite-sized" cases predominating. That can be undesirable, regardless of one's speed preferences: Such cases tend to have lower financial values, and one can literally pay a price for reading them as opposed to "slow" stuff. I explained in those prior blogs why this didn't turn out to be an issue for me. I actually missed the fast shifts after moving on from those gigs.

It was therefore welcome news when my current employer determined that it had a problem with a glut of X-rays and rolled out a new program to deal with it. Rads could sign up for extra hours and during this time, they would have nothing but X-rays to read but at an elevated per-case value to make it more worth their while. Of course, extra money was nice, but the extra shifts gave me a chance to relive those old, happily fast times.

Meanwhile, for other rads who never felt my need for speed, it was also good news. Folks like me siphoned away the low-value cases they eschewed, and their worklists were more purely populated with complex, slower stuff.

I still get plenty of X-rays on my worklist during regular shifts by the way. Like most rads, I don't have the ability to juggle what I'm reading to suit my mood. Maybe a bunch of X-rays happens to turn up when I'm feeling speedy, but maybe a cluster of follow-up CTs gets in the way instead. The worklist fills as it will and not every rad job allows one to pluck one's choice of cases. There are issues of workflow and RVU fairness at hand.

Being able to schedule my designated extra "fast" shifts is a close second-best situation. I can't guarantee that I will be in a speedy mood when those hours come around, but there are a few things I can do to prepare and psych myself up. At the very least, I will have scratched my speedy itch within a few days of my more typical workflow.

It would, of course, be nice to live in a read whatever you feel like world. What if I show up to my speedy X-ray shift, but am in a slower frame of mind? Maybe I'm just feeling quiet and contemplative that day, or maybe I didn't get the best night's sleep.

I can imagine setting things up to allow for on-the-spot adjustment of case mix. Quality, sophisticated worklist software would go a long way toward making it possible. It would also help if participants weren't living and dying by RVUs. Someone reading higher-ticket MRI and CT might not be so eager to swap responsibilities for even part of a day if it meant he or she would be giving away a bit of bonus money (or risking falling behind his or her productivity quota).

Very large rad groups might more easily enable this. If you have dozens (or hundreds!) of rads receiving cases from shared sources, there is enough slack in the system that individual preferences du jour could probably be tolerated without trouble. Heck, such redundancy enables rads to be completely out of the mix (taking a sick day, suffering an outage of software or hardware, etc.) with numerous others compensating in a near seamless manner.

In smaller outfits, a "buddy system" or alliance of interested rads would probably be necessary. This would involve a certain group of rads who like the idea of being able to shift workloads whenever they wish without having to involve the chain of command each time. The more willing participants you have, the easier it gets to find a trade partner when you are feeling more (or less) speedy than your worklist is liable to satisfy.