ACR Bulletin

Covering topics relevant to the practice of radiology

Building Strategic Resilience

Radiology practice leaders exchange ideas about tough challenges, including how to recruit and retain the best people in a fast-changing market. 
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The people who work with you are not robots. It's important to get to know them as people.

—Steven Lev, MD
March 21, 2023

Keeping up with changes in medicine and technology can be daunting enough for radiologists. Add in the responsibilities of running a department or practice, and the challenges multiply: recruiting and retention, training, scheduling, billing, vendor selection, continuing education and more. In January, radiologists and business managers gathered in Orlando, Fla., for the 2023 ACR-RBMA Practice Leaders Forum, where they exchanged critical strategies to boost the resilience of their operations in today’s fast-paced business climate. Here are some of the highlights:

Optimal Versus Reasonable Productivity

In his keynote address titled “Radiology Practice Management: Navigating the Tension Between Optimal and Reasonable,” Kurt A. Schoppe, MD, asked for a show of hands from people in the room who were having trouble competing to hire radiologists, especially in subspecialties like pediatrics and mammography. Many hands were in the air. He has stayed up to date with trends in practice management as a member of the ACR Commission on Economics, former chair of the Reimbursement and Practice Expense Committee and an alternate radiology RUC member, among numerous volunteer roles at the College, and in his new position as the president of Radiology Associates of North Texas.

“A doctor’s role is not just to cure disease — it’s to cure disease within the confines of what’s reasonable and tolerable to the patient,” Schoppe said. “But we don’t always give ourselves the same grace.”

The key to keeping top talent is in staying flexible and looking for new ways of operating that will meet the evolving needs of radiologists and the teams that support their work, Schoppe said. “It’s a dynamic market that’s changing constantly. I would argue that rigid, inflexible work policies are just not going to play in this market.”

Your productivity policy demands flexibility because there’s a difference between optimal productivity and reasonable productivity, he said. Optimal is the maximum level of productivity achievable, while reasonable is the level that can be sustained without straining team members. According to Schoppe, it’s not sustainable to demand that people all perform every task the same way in the same amount of time. There are too many variables.

Schoppe’s keynote set the tone for discussions that would continue throughout the conference. He spoke about fairness — not only in handling radiology work but in hiring. It hurts when you’re 18 months into a new job and a new hire comes in making exactly what you’re earning, he said. It hurts when you see new hires getting a signing bonus when you never received one.

“You can’t count on what you did last year, five years ago or 10 years ago to work in the future because our economic landscape is moving, our relationships are changing, your reimbursements are changing, the rules are changing,” he told the audience. “You can’t lean on the past to enjoy the benefits of the future. We can try but it’s not going to work. You can’t ignore it. That can lead to financial risk, leverage risk, burnout of physicians or staff, safety and quality concerns. The past is not a reliable predictor of the future.”

Innovative Retention Strategies

In a session titled “Feeling the Pinch: Radiology Department Recruiting in Times of Shortage and Explosive Imaging Growth,” three groups shared innovative strategies for keeping their radiology teams engaged and satisfied. Eric A. Brandser, MD, representing Radiology Associates of Northern Kentucky, shared how his 33-radiologist practice solved an issue that came up repeatedly during team meetings: frustration with long daily worklists and how best to combat the anxiety that accompanies the long worklists. The number of daily work relative value units (wRVU) per doctor in the group could vary from 45 to more than 100 a day. Slower readers said they were being more thorough than their peers. Faster readers said the burden of reading most of the studies led to frustration and burnout.

The dilemma led to the birth of the “bunker shift,” a technique that involves working a shift to read a certain number of wRVU worth of studies, with focus only on reading cases and not handling consultations, phone calls, procedures or meetings. Doctors who are off duty on any given day can volunteer for an extra shift to read 40 wRVU worth of studies, no matter how long it takes. Cherry-picking for what they want to read is not only acceptable but encouraged. Doctors read what they like at the speed they like.

Faster readers jumped onto the concept, seeing it as a way to earn extra money. They stopped complaining about their co-workers. Slower readers saw it as a relief that no one was leaning on them to work at an uncomfortable pace.

The interesting result, Brandser shared, is that the practice increased its revenue by handling more cases more quickly. That way, all doctors in the practice, regardless of which camp they counted themselves in, earned more money. Another result is that bunker shifts eliminated “long list anxiety syndrome,” described in an August 2022 JACR ® article as a state caused by a long unread worklist and the dread of another never-ending day.

The practice’s CEO, Josh Dorsey, offered tips on another challenge Radiology Associates of Northern Kentucky solved through innovation: holiday scheduling. The practice instituted a reverse auction for radiologists to bid on voluntarily filling holiday shifts. The auction is set for a predetermined amount of time, and each doctor bids progressively lower shift values from a high starting point. The object is to determine how much pay you’re willing to accept to take on the shift.

You can't count on what you did last year, five years ago or 10 years ago to work in the future because our economic landscape is moving, our relationships are changing, your reimbursements are changing, the rules are changing.

—Kurt A. Schoppe, MD

According to Dorsey, Thanksgiving typically goes for the highest bid, with pay at three times the normal rate for that day. Christmas Eve might go for 2.6 times the rate and New Year’s Day 2.2 times. Mid-year and year-end bonuses for all the radiologists are adjusted to cover the costs of the auctions.

“If you never want to work a holiday shift again, you don’t have to,” Dorsey said. “You just have to pay for it.” About 50% of the doctors have taken the option to give up $5,000 to $6,000 a year to avoid working a holiday shift, he said. Meanwhile, those who are willing to work holidays can use this as a way to increase their earnings quickly.

Remote Work

The COVID-19 pandemic changed the world’s collective philosophy about working from home and whether it is possible and even preferable in some instances. Radiology was no different. A growing number of physicians prefer to read from home — a view especially popular among millennials, said Samir S. Shah, MD, FACR. He also spoke as part of the “Feeling the Pinch” session and later helped lead a breakout discussion about work-from-home strategies.

A new model some practices are trying is to allow radiologists to work from home at least part of the time — maybe two or three days a week. This will become more critical as organizations try to recruit younger radiologists.

Some practices are handling this new work-from-home model by implementing financial disincentives. For instance, they pay at-home radiology shifts 22% to 28% lower, Shah said. “If they are remote, there has to be a discount for that.”

A People Focus

After seeing it was losing too many good radiologists, Nassau University Medical Center, a safety net hospital in Nassau County, New York, decided it had to “stop the bleeding” and come up with a retention plan, said Steven Lev, MD, and Marc Fischer, MBA, LRT, CNMT, RT(N), who also spoke as part of the “Feel the Pinch” session.

The radiology department’s job descriptions were woefully outdated, and the salaries were below market. A lengthy onboarding process was slowing down new hiring, which created more pressure on the team members who were trying to cover the workload.

The department focused on a few changes to hold onto its team members — which eventually would make recruiting easier as well. First, it conducted some research to bring the salaries in line with similar organizations in the geographic area. The department gave radiologists a voice by listening to what they wanted. It gave them a sense of purpose by touting things like the hospital’s residency
program for people who love teaching and mentoring. And leaders personalized the experience by getting to know the radiologists better through group activities, including barbecues, marathon races and fun décor that turned the reading room into a mini art museum. All the efforts have turned things around, and the hospital has seen positive results.

“The people who work with you are not robots,” Lev said. “It’s important to get to know them as people.”

Advocacy Efforts

Several sessions dealt with reimbursement for radiology work and how the latest governmental actions have not met the expectations of the medical community. Radiologists are taking a stand on multiple fronts for issues ranging from Medicare reimbursement and preventive services coverage to non-physician scope of practice and surprise billing.

In a session titled, “How a New Congress Will Impact Your Practice,” Ted Burnes, MPA, ACR’s senior director of political affairs and RADPAC®, presented an overview of what the ACR is trying to do in Washington. Radiologists and their offices need to keep providing data and muscle to the advocates on Capitol Hill, he said, especially because there are 75 new members in the House of Representatives and six in the Senate for radiology advocates to bring up to speed on what is important to the specialty and how their concerns affect patient care.

In Congress, out of 535 members, only 19 are physicians — 15 in the House and four in the Senate — and none are radiologists, Burnes said. Healthcare is not top-of-mind this year for Congress, which is expected to be more focused on topics including inflation, crime and oversight. It will be hard to pull lawmakers’ attention to issues that matter to radiologists, like Medicare reimbursement and surprise billing.

That means radiologists need to continue speaking as one voice and making sure the specialty’s concerns become a priority on Capitol Hill, Burnes said. “We need to stop getting hit and just taking it.”

Author Diane Sears  senior content specialist, ACR Press