Early-Career Radiologists' Perceptions of National Corporations in Radiology.

PURPOSE: Radiology, like many medical specialties, has experienced an increase in nationalized corporatization. The most vulnerable cohorts affected by this trend are early-career radiologists (ECRs), including trainees and recent graduates, particularly those entering or who have recently entered private practice. The aims of this study were to examine the awareness and perspectives of ECRs regarding this trend and to share salient examples of the impact of corporatization. METHODS: From February 20, 2019, through May 28, 2019, an online survey of the members of the ACR's Resident and Fellow Section and Young and Early Career Professional Section was conducted. Respondents were queried about their awareness of corporatization, their opinions of how it affects radiology, their preferred practice type, whether they know other ECRs affected by corporatization, and whether they worry about their practices or future practices being acquired. A free-response opportunity was also provided for respondents to share their relevant personal experiences. RESULTS: A total of 602 ECRs returned completed surveys. Of this total, 85% of respondents were aware of national corporatization, 86% believe that corporate entities harm radiology as a specialty, 83% prefer to join independent private practices with 79% wanting to be involved in leadership or business, and 72% worry about their practices or future practices being acquired by national entities. Twenty-five percent of respondents submitted unique free responses regarding their experiences with corporatization. CONCLUSIONS: The majority of ECRs surveyed have negative perceptions of corporatization in radiology, prefer to join independent practices, and worry about their practices selling to national corporations.

Speed Versus Interpretation Accuracy: Current Thoughts and Literature Review.

OBJECTIVE. Whether there is a precise relationship between reading speed and diagnostic accuracy has been an elusive and much debated issue. We discuss the literature and include practical considerations and relevant experience. CONCLUSION. To our knowledge, no credible relationship has been established between the speed of diagnostic image interpretation and accuracy. Furthermore, no nationally recognized guidelines address these factors, and it would be irresponsible to attribute widespread credibility to anecdotal studies. A variety of factors influence diagnostic accuracy, and length of interpretation time is not an established one.

Change Management for Radiologists.

Change management refers to the research, science, and tools that prepare, equip, and enable individuals to adopt transformation successfully. Implementation of this discipline involves familiarity with an organization's culture, people, and structure. Several frameworks exist within which radiologists can successfully apply these concepts. With changes occurring within health care and within the field of radiology itself, it will be increasingly important for radiologists to familiarize themselves with and adopt the principles of change management in their practices.

Forecasting the Effect of the Change in Timing of the ABR Diagnostic Radiology Examinations: Results of the ACR Survey of Practice Leaders.

The results of a survey sent to practice leaders in the ACR Practice of Radiology Environment Database show that the majority of responding groups will continue to hire recently trained residents and fellows even though they have been unable to take the final ABR diagnostic radiology certifying examination. However, a significant minority of private practice groups will not hire these individuals. The majority of private practices expect the timing change for the ABR certifying examinations to affect their groups' function. In contrast, the majority of academic medical school practices expect little or no impact. Residents and fellows should not expect work time off or protected time to study for the certifying examination or for their maintenance of certification examinations in the future.

Culture shift: an imperative for future survival.

Radiologists have experienced unprecedented prosperity for the past 3 decades. Technology has continually evolved, providing exciting opportunities for earlier diagnoses and improved patient care. The financial rewards enjoyed by radiologists have been impressive, and the quality of life has been difficult to beat. Circumstances change, and in the past few years, radiologists have been confronted with a variety of new challenges. These trends include declining reimbursement, an "image problem" at both the local and the national levels, more demanding hospital administrations, nontraditional competition from national entrepreneurial radiology entities for radiology hospital contracts, and alternative payment systems. The author outlines the genesis of these trends, describes strategies for meeting these challenges, and discusses the roles of both radiology practices and the ACR in preparing radiologists for the threats and the opportunities that lie ahead. Although it will be important for radiologists to "get to the table" to participate fully in the new health care environment, it will be imperative for radiologists to know what to do once they are at the table. This is not "business as usual," and for radiologists, there will be winners and losers in the coming years. It will take work to succeed, and the apathy, denial, and sense of entitlement that have characterized our practitioners must be replaced by service, visibility, health policy data, and "value-added" information for referring physicians and their patients. The future for radiology is bright; the future for radiologists is far less certain. Strategic planning, scenario planning, practice building, and the efficient provision of high-quality patient care are the keys for radiologists to succeed. Radiologists must integrate themselves into the medical, social, and political fabrics of their hospitals and their communities, and they will need to get the in-depth leadership training and the important health policy data that the ACR is structured to provide.

National entrepreneurial radiology initiatives: what are they, and what can they do to and for you?

National entrepreneurial radiology companies have evolved over the past 3 decades. In the 1990s, a few initiatives were established to implement business principles and reward shareholders with gains derived from management expertise, practice efficiencies, and economies of scale. The next decade saw the emergence of night call coverage and "specialty read" companies. As the market for these services became saturated, the established corporate entities scrambled to find new revenue streams. Hospital radiology contracts were the obvious source for this needed capital. The pursuit of these contracts led to aggressive, nontraditional competition. If radiologists are to respond appropriately, they must understand the reasons behind the strategies used by these national entrepreneurial radiology companies. The author explores the goals and actions of these entities and describes why hospitals may find these national companies to be an attractive alternative to their incumbent radiology practices. Both the benefits and the problems associated with entrepreneurial companies are covered, and concepts such as disintermediation are discussed. Finally, the author suggests appropriate actions for radiologists seeking to retain their hospital contracts. Nontraditional competition is now a way of life for many radiology practices. Relationships, subspecialization, service, and measurable quality indicators are the foundation for the maintenance of tenure at hospitals.

ACR white paper: New practice models--hospital employment of radiologists: a report from the ACR Future Trends Committee.

In response to the current era of rapid evolution of health care delivery and financing, radiologists are increasingly considering, as well as confronting, new practice models. Hospital employment is one such opportunity. Within this report to the ACR membership, the potential advantages and risks for radiologists considering hospital employment are examined.

Measuring and managing radiologist productivity, part 2: beyond the clinical numbers.

Radiology practices endeavoring to measure physician productivity, identify and motivate performance outliers, and develop equitable management strategies and policies often encounter numerous challenges. Nonetheless, such efforts are often necessary, in both private and academic settings, for a variety of professional, financial, and personnel reasons. Part 1 of this series detailed metrics for evaluating radiologist productivity and reviewed published benchmarks, focusing on clinical work. This segment expands that discussion to evaluating nonclinical administrative and academic efforts, along with professionalism and quality, outlining advantages and disadvantages of addressing differential productivity, and introducing potential models for practices seeking to motivate physicians on the basis of both their clinical and nonclinical endeavors.

ACR task force report: relations between radiologists and hospitals and other health care organizations.

The vast majority of US radiologists are affiliated with hospital-based group practices, making professional relationships between radiologists and hospitals one of the most crucial factors for a successful practice. However, tensions between radiology groups and hospitals have been increasing and have led to some well-publicized breakdowns. The ACR Task Force on Relationships Between Radiology Groups and Hospitals and Other Healthcare Organizations was charged to identify key factors affecting these relationships and to make recommendations and propose positive steps that could improve relationships and benefit radiologists, hospitals, and patients.

Measuring and managing radiologist productivity, part 1: clinical metrics and benchmarks.

Physician productivity disparities are not uncommonly debated within radiology groups, sometimes in a contentious manner. Attempts to measure productivity, identify and motivate outliers, and develop equitable management policies can present challenges to private and academic practices alike but are often necessary for a variety of professional, financial, and personnel reasons. This is the first of a two-part series that will detail metrics for evaluating radiologist productivity and review published benchmarks, focusing primarily on clinical work. Issues and limitations that may prevent successful implementation of measurement systems are explored. Part 2 will expand that discussion to evaluating nonclinical administrative and academic activities, outlining advantages and disadvantages of addressing differential productivity, and introducing potential models for practices seeking to motivate physicians on the basis of both clinical and nonclinical work.

Why radiologists lose their hospital contracts: is your contract secure?

Previously, a hospital contract meant tenure for the incumbent group of radiologists; however, those days are long gone. Exclusive contracts have morphed into exclusive contracts with carve-outs. Turf erosion has become a fact of life for radiology practices. Now radiologists are losing their hospital contracts in record numbers. Group size, though helpful for a variety of reasons, does not ensure that a practice will be secure in its hospital setting. The reasons that groups lose their hospital contracts are varied, and in this paper, the author discusses the most common ones. Suggestions to help practices avoid this unfortunate fate are presented.

Challenges facing the mature radiologist: a guide.

Radiologists who are chronologically advanced (or mature, as the authors prefer to call them) are faced with many special issues, obstacles, and opportunities. These are in many ways unique and different from the circumstances involving those who are recently out of training or in midcareer. The authors discuss some of these circumstances. They look at the challenges facing mature radiologists through the prism of considerable personal experience, and they hope to offer some insight and suggestions as to how one might respond to these issues.

Taking your radiology practice to the next level.

The majority of radiology practices are governed haphazardly and act unpredictably, and if they are successful, it is in spite of what they do, not because of it. A few exceptional practices ensure their success with good governance, a proactive approach to problems, and a clear sense of direction provided by group-developed and group-approved mission statements and business plans. This paper describes what great practices do to differentiate themselves from the vast majority of radiology groups. The importance of appropriate structure, governance, strategic planning, decision making, marketing, and decisive action are covered. Readers should easily be able to implement into their practices the suggestions offered in this paper.

Dealing with the problematic partner or associate.

Problematic physicians can sap the morale of practice members and rend the very fabric of the group. When problems are ignored, the physicians who cause them become emboldened; their bad behavior persists, and the entire practice suffers. An appropriate employment contract must be structured; this provides a mechanism for the group to take action against a practice member. The development and implementation of practice policies that are in place before they are needed are key to dealing with a spectrum of practice issues. Failure to have prospective policies in place mandates that a practice reacts to a specific concern, and the action taken is usually either too punitive or too permissive. To be effective, policies must have meaningful consequences for breach. Finally, the practice president must confront and deal with the problematic radiologist in the appropriate manner specified by the group-adopted policy.

Buy-sell options for radiology: what works and why.

Buy-sell agreements for shareholders entering and leaving a radiology practice are different from those commonly used in other business endeavors. This paper explores the reasons for these differences, focusing on the culture of radiology and its unique influence on the buy-sell process. Buy-sell methodologies commonly used in most business transactions are described, and basic principles that influence these methodologies are discussed. The reasons these traditional methods are not applicable to most radiology groups are explored in depth. The paper concludes with a presentation of several workable buy-sell options for radiology practices. The strengths and weaknesses of these options are enumerated, so that each group can customize the option that best suits its needs.