Practical Solutions -
[Cached Version]
Published on: 3/19/2003
Last Visited: 3/19/2003
The recruiting environment is dismal," said Scott Raymond, vice president of AGI Healthcare Consulting in Carlsbad, CA. "Economic, operational, and practice factors combined are putting the thumbscrews on radiologists.It isn't even an issue of making more money.It's quality of life."
This state of affairs also puts stress on the relationship between radiologists and hospitals.From the hospital perspective, productivity and staffing are the practice's problems.What counts is performance: efficient operations and happy referring physicians.
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"You've got hospitals saying, 'I'm not sure I want this group as a partner because it can't even provide the existing service that we expect,'" Raymond said.
What steps can radiologists take to improve their practices, increase efficiency, and grow their business?To find out, Diagnostic Imaging queried consultants, physicians, business managers, and administrators about their experiences working with and among private practices, imaging centers, and radiology departments.
The resulting tips target nearly every aspect of practice, from recruiting new partners to identifying and integrating PACS and information technology solutions, making better use of clinical time, and taking advantage of common communications tools like pagers and e-mail.Some require long-term planning or rethinking of the way critical decisions are made.Others can be adopted right away.
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"When we do a productivity analysis, it stems from the belief that radiologists ought to do radiology, technologists ought to do technologist tasks, and support folks do everything else," Raymond said."Considering that a radiologist's reason for being is to provide a safe and accurate diagnosis, what is he or she doing during the day that does not contribute to that goal?How can the process be restructured so that nonclinical tasks are more streamlined?"
Consider hiring an additional support person to relieve radiologists of nonclinical tasks.Here's justification: If each physician in a 10-member radiology group spends an hour a day on nonclinical tasks, over a year that becomes equivalent to another full-time radiologist.Compare the average radiologist's salary of $300,000 with the cost of hiring a professional assistant at $50,000, and the value of incremental time savings becomes clear.
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"Some interruptions don't have anything to do with medicine or aren't relevant to that radiologist's subspecialty," Raymond said."With e-mail, those can be triaged to the right person, at the right level in the operation: a technologist, support person, or another radiologist.The ability to get into a groove while reading an exam and know you are not going to be interrupted every five minutes is going to result in more exams being read."
3. Designate a "go-to" radiologist
Relatively low-tech tools such as pagers and cell phones can be put to use in making the radiologist's time more efficient while at the hospital.
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"It's just recognized under that scenario that the particular rotation on that day is not going to be as productive," Raymond said."But it's better than having 10 physicians being interrupted all the time."
4. Evaluate reading room ergonomics
In addition to assessing how radiologists use their time, it's also important to evaluate the room in which they spend most of that time.
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"We do a lot of work on the front end, asking practices what they want to do with PACS, for example," Raymond said."A PACS is going to have a dramatic impact on operations and finance, and you need to understand what that impact is going to be.Nine times out of 10, when people stub their toes, it's because they didn't do their homework, not because they bought the wrong system."
Even small practices that wouldn't have considered PACS a few years ago are taking another look at the technology today.
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That observation jibes with one made by consultant Raymond, who reiterates the importance of practices knowing what problem it is they wish their PACS application to solve.
"We get a lot of calls from groups that say they only need us to do the RFP for the PACS they want to buy," he said."Then we get there and find out that not all of the radiologists are ready to read soft copy.And even if they are, they still plan on printing film because they think 90% of the referring community wants film.Why would you get into archiving and buying workstations if you're going to keep printing film?"
For Summit, the decision to install a PACS with an ASP option was an economic one.
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Take the example of the hospital that installed voice recognition systems and promptly fired its transcriptionists, Raymond said.The radiologists were not only dictating reports but also editing them and trying to learn a new technology-that is not without its kinks-at the same time.
"I've seen places where the radiologist was ready to throw the system out the window," he said."It has to be implemented right.Don't fire your transcriptionists.Perhaps they become editors for a while.Ease into the technology."
14. Address investment opportunities
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"If everybody is reading films all the time, then no one is looking at the practice and evaluating communication with the hospital or thinking how to increase exposure among referring physicians," Raymond said.
Practices need to create a structure so that group partners have time, and pay for that time if need be, to perform strategic planning and solidify relationships.Evaluate the strengths and weaknesses of group partners and determine who would be best to perform this diplomatic role in the local healthcare community.
15. Get governed
Restructuring to allow time for strategic planning ties into another oft-overlooked aspect of practice operations that can affect both current and future business: governance.
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"All groups need an effective governance structure that allows 80% of the decisions to be made by 20% of the people," Raymond said."The other 20% of decisions are the key ones that can be made by the entire group."
Because every partner in a practice has a vested financial interest in decision-making, it's not uncommon for even the most trivial issues to be debated by all members of the group.A tentative decision is reached, but then the issue is rehashed the following month.A practice can provide the highest quality service in the local community, but if it can't make effective decisions internally, and exude cohesiveness outwardly with hospitals and payers, the group's long-term business will be affected, Raymond said.
"We're always hearing from administrators or business managers, 'We can't make a decision to save our life,'" he said."The key to effective decision-making is group governance.It's a huge issue."
16. Recruit like you mean it
Good radiologists are hard to find in a strong economy and hot job market.
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Groups that have been most successful in recruiting are those that devote time and resources to the task, according to Raymond.Get the whole staff involved in recruiting and go beyond merely placing an ad.Make recruitment an active part of everyone's responsibilities.
When candidates show up on the doorstep, be ready for them, Raymond said.Roll out the red carpet.Provide a tour of the area to a spouse or partner, while the candidate meets with members of the practice.
"But don't try to dress up a duck and make it look like an eagle," Raymond said."The best recruiting tool you have is to be a strong, cohesive group and to act it and live it."
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