The Tightrope-Walk of Radiology Coverage

July 11, 2018

Too many rads or too much work? A balance can be hard to find.

Sometimes I wonder whether I overuse the metaphor of “walking a tightrope,” at least in conversation. As far as this column goes, I probably haven’t used it…at least, in the past few months.

One of the aspects of our field that fairly screams out to me as an apt comparison, however, is that of getting the radiologist-to-workload ratio right. Partially because, like trying to maintain your balance as you walk on a tightrope, circumstances are constantly forcing you to waver in one direction or another.

The metaphorical tightrope-walker would be a radiology group. Stay on that tightrope and move forward, and you are at least remaining viable if not gradually progressing toward prosperity and a happily-ever-after business success story. If you’re perfectly balanced, you have precisely the rads you need to get your work done.

Metaphorically leaning to one side (we’ll call it the right), you’ve allowed yourself to take on too many obligations for the radiologists you have. Maybe that’s one too many hospitals’ worth of coverage, maybe it’s an imaging center you shouldn’t have opened just yet. Maybe it’s an existing site that unexpectedly got busier. Or maybe it’s that your radpower (our version of ‘manpower’…get it?) is less than expected: Someone retired, stopped working as hard, etc.

Leaning to what we’ll call the left, you’ve got the opposite issue. Now you have more work capacity than actual work to do. Maybe you expected a hospital or imaging-center to provide more scans than it actually is churning out, and hired too much. Perhaps the rads you took on as newbies a few years ago are now hitting their stride, and burning through the worklists faster than cases can get done.

The problem with leaning too far to the right is that your people get burned out from trying to keep up. Or they can’t manage it, and your referrers start getting annoyed that their reports aren’t showing up as timely as expected. Maybe you even had contractual obligations regarding average TATs (turnaround times, for those of you blessed enough not to know the term), and there might be consequences for failing to meet them.

But overcompensating by leaning further left puts you at risk of having too many rads for the RVU volume that’s paying you. That means that your pie hasn’t grown, yet you have more slices to dole out than before. Your referrers might be happy, but not necessarily your own team members. Or they might just get accustomed to having lots of downtime between cases…and then, when you find a way to pick up the volume later, they might not be as industrious to deal with it as they used to be.

So you adjust as you go, taking note of where you stand and trying to figure out what’s coming down the pike so you can take on new rads or work-sources appropriately. Nothing wrong with that. It’s an honest effort to maintain, and hopefully grow, a business.

Well, sometimes it is, anyway. There’s one variation of leaning right that I’ve seen more than a couple of times, and I wouldn’t rush to call it an honest effort. Not necessarily dishonest (although sometimes that is the case). Lesser offenses would include greediness, or willful ignorance.

I’ve seen it mostly with larger practices, including some of the megagroups that are out there right now. Here’s the approach: You gobble up as many contracts as you possibly can, then open as many imaging centers as possible. It doesn’t matter whether you have the rads to do the work or not.

Once you’ve successfully overextended yourself and leaned dangerously to the right, now you try to get yourself back to the left by hiring rads. Or by flogging the ones you already have to read more, take on more hours, whatever it takes.

The really flagrant offenders in this regard stand out because their leaders, even if sporting MD or DO after their names, don’t actually ever do any of the radiological work. Handling the workload to which they’ve committed is for other, lesser beings...although the “leadership” will still help itself to a nice percentage of the others’ productivity (which, of course, grows as more and more contracts are gobbled up.) When you see the leadership rolling up its sleeves and pitching in along with everyone else, it’s not quite the same animal.

Because they’ve played this game more than a few times, such groups are actually pretty good at not falling off the tightrope, even when they have leaned so dangerously to the right. Time and again, they somehow get their center of gravity back over the tightrope…and then, uncannily, they quickly find new contracts to take on, starting the cycle all over again.

Some of these groups are so good at it, even when they fail to right themselves and their groups spectacularly implode, they just reorganize and start over, doing precisely the same thing. And, heaven help them, the same hospitals they disappointed before will sign contracts with them to repeat the process.