Building the Model Practice

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Corporate-style governance, subspecialization, and choosing the right administrative staff members all play roles

What does the ideal radiology practice look like?

It is likely to include subspecialization, according to Lawrence R. Muroff, MD, FACR, president and CEO of Imaging Consultants Inc in Tampa, Fla. He believes that subspecialization strengthens the hand that a practice holds. “If, for example, you are a superb women’s imager, you may be seen as indispensable to your hospital’s breast surgeons, which makes your practice just that much less vulnerable to the institution’s administrative whims,” he says. “Subspecialization also serves as a defensive wall against encroachment by other medical specialties: Cardiologists and others tend to be less successful at capturing your turf if you can provide something they cannot.”

Subspecialization was a strategy that Riverside Radiology Associates, Columbus, Ohio, arrived at over time, the 70-radiologist group’s president, Mark Alfonso, MD, recalls. “Our doctors are fellowship trained in all of the radiology subspecialties, including musculoskeletal, neuroradiology, mammography, body imaging, nuclear medicine, and interventional radiology,” Alfonso says. “We did not start out this way; we evolved into subspecialization after realizing it’s not enough merely to describe findings. One must also speak the language of the referring physicians, which helps them tremendously with patient management. As a result, we have become well known as a center of excellence for radiology within Central Ohio, branching out statewide.”

The Corporate Governance Model

A highly efficient governance structure also is characteristic of exemplary radiology practice models. Without that, a group will find itself at a distinct competitive disadvantage, according to Muroff, a respected, nationally known practice advisor. “An efficient governance structure enables the group to act decisively, appropriately and—in the best of circumstances—proactively,” he says. “It also permits good decisions to be made speedily. Speed is important because you need it to help you get out in front of the competition. For example, if you’re going to introduce a new service, it’s better to be the first in the market to do so rather than the seventh, since the first one up with the new service is the one with the best chance of dominating the market.” You are less likely to be first if your decision-making apparatus is creakily encumbered, he explains.

Muroff believes that the optimal governance structure for radiology groups is the one embraced by companies outside of health care. “Call it the standard corporate model,” he says. “Radiology practices can benefit from adopting this model because they, themselves, are corporate-type businesses. They may see themselves as small, neighborhood businesses, but given that they typically bring in $5 million to well over $100 million a year, they hardly qualify as such. Neither can they be run like a neighborhood business.”

Some radiologists blanch at the suggestion of patterning their practices after the likes of Microsoft or Federal Express. They see medicine and business as mutually exclusive. Muroff contends that it is wrongheaded to view things that way. “There is nothing to say that good business and good medicine cannot coexist,” he says. “In fact, a compelling argument can be made that, if you practice good business, you will be able to practice far better medicine, since you’ll have more resources at your disposal.”

Two features of the corporate model of governance are a mission statement and a business plan. “Many organizations turn their mission statements into warm and fuzzy public-relations tools, but that is not their purpose,” Muroff insists. “A mission statement spells out the goals of the organization in a way that provides guidance to the leaders and to the rank and file of the organization. A business plan provides even more specific guidance in the form of timelines for accomplishment and structures for assigning tasks and securing accountability.”

Governance Infrastructure

The corporate model places the ultimate responsibility for carrying out the mission statement and business plan in the hands of a CEO, but a mistake that many radiology groups make after hiring one is failing to maintain frequent interaction with that leader. “I’ve seen radiologists, after finding and bringing aboard an excellent nonphysician business executive, think that