Economic Summit 2008: Audience Response
A survey of attendees at a May 2008 meeting has yielded a snapshot of today’s primary concerns for radiology practices. Educational Symposia, Tampa, Fla, sponsored the Third Annual Economics Summit 2008: Solving Practice Issues, which was held in Las Vegas on May 1–3. Lawrence R. Muroff, MD, program director, asked the summit’s 106 attendees to answer 49 questions concerning the needs and characteristics of their practices, as well as their productivity and compensation.
Most of the survey’s respondents (56%) are physicians in private practice; another 36% are senior practice executives, with the remaining 8% consisting of academic physicians, hospital administrators, chief technologists, consultants, accountants, attorneys, and industry representatives. Of the physicians represented, the majority are practice CEOs, presidents, or chairs. Most groups (58%) have both hospital and office practices, although roughly one third have only hospital practices.
Compensation and Partnership
For groups that collect technical-component reimbursement, the average annual compensation, excluding benefits, is $500,000 to $599,000 in 47% of practices and $400,000 to $499,000 in another 31%. No practices report radiologist incomes of less than $399,000 or more than $799,000. With benefits added, compensation rises somewhat, but usually remains in the range of $400,000 to $600,000.
Compensation is similar in groups that do not bill for the technical component, and 87% of practices pay diagnostic and interventional radiologists at the same rate (although call pay differs for interventional radiologists at 56% of practices). Starting salaries for newly trained radiologists are lower than for experienced radiologists (Figure 1). 
Figure1. Starting salary offered to new radiologists who join the practice directly after fellowship training
No clear pattern emerges for vacation time, which ranges from less than 9 to more than 16 weeks per year. About 30% of practices forbid buying and selling vacation time (and 34% do the same for call time).
At 62% of practices, hospitals offer no subsidy for the medical director, although another 21% receive a stipend of less than $25,000 for this work. Slightly more than half of group presidents are allotted some administrative time, although 67% receive no extra compensation. About one fourth receive a stipend, and 7% are given added vacation days. Other radiologists performing administrative tasks are uncompensated in 69% of cases. No hospital compensation for night call or indigent care is paid to 76% of groups. 
Figure 2. Practice's recruiting status.
Buying into the practice costs less than $300,000 in 68% of practices collecting for the technical component and less than $50,000 in 64% of practices that do not get technical-component reimbursement. In 75% of practices, partnerships is offered one to three years after hiring.
Staffing and Recruitment
Staffing remains a serious concern for most practices (Figure 2), which usually have 6 to 40 radiologists. Mammographers are the most difficult subspecialists to recruit (Figure 3). About 21% of practices are funding a resident or fellow who will eventually join the practice, and another 56% would consider doing so. To varying degrees, however, practices report that unrealistic compensation expectations, a decreased work ethic, little interest in practice building, and expectations for call or buy in can be problems with new radiologists. 
Figure 3. Subspecialists who are most difficult to recruit.
One response has been to delay retirement. Four of five practices have no mandatory retirement age, and 71% offer the option of partial retirement (and most of these programs have neither fixed lengths nor participation requirements).
Approximately 41% of practices provide 24/7 in-house coverage, although half of these apply some selective criteria to determine which studies will be read at night. Most (63%) cover emergency-department call at night using an outside service, and of those who do not, 30% are contemplating external night-call coverage. About 23% of practices are also interested in adding radiologist assistants or radiology practitioner assistants to their staffs, and 48% already have them. 
Figure 4. Procedures performed/interpreted per year by private-practice radiologists.
Radiologists report high productivity (Figure 4), although 61% of those surveyed do not know how many work RVUs they generate per year. About 45% feel that interventional radiologists generate fewer RVUs than diagnostic radiologists do, but a third call their output equal.
Contracts and Costs
Of the groups with hospital practices, 83% report having exclusive contracts, either with carveouts (72%) or without them (11%). Nonexclusive contracts or letters of agreement are each held by 4% of practices, but another 9% hold neither. Nearly half of the hospital contracts contain clean-sweep provisions, and almost three fourths have noncompetition clauses.
More than 95% of practices state that their contracted hospitals have given (or are trying to give) some of their turf to specialists outside radiology, with most of the lost revenue going to cardiologists (Figure 5). Half of practices derive only 10% of their incomes from technical-component billing, respondents note, while 32% of practices attribute 20% to 50% of income to it. 
Figure 5. Specialists to whom the group has the most turf.
Only 9% of practices plan to change their billing/collections methods; 54% expect to continue in-house billing and the rest are satisfied with their outside billing companies. About half of practices estimate their billing/collections costs at 6% to 8% of collections, although costs range from less than 5% to more than 12%.
The other expense affecting a group’s competitive ability is malpractice insurance, which costs most practices (71%) $10,000 to $25,000 per diagnostic radiologist. Only 4% pay less, and 25% pay $25,000 to $75,000.
Figure1. Starting salary offered to new radiologists who join the practice directly after fellowship training
No clear pattern emerges for vacation time, which ranges from less than 9 to more than 16 weeks per year. About 30% of practices forbid buying and selling vacation time (and 34% do the same for call time).
At 62% of practices, hospitals offer no subsidy for the medical director, although another 21% receive a stipend of less than $25,000 for this work. Slightly more than half of group presidents are allotted some administrative time, although 67% receive no extra compensation. About one fourth receive a stipend, and 7% are given added vacation days. Other radiologists performing administrative tasks are uncompensated in 69% of cases. No hospital compensation for night call or indigent care is paid to 76% of groups. Figure 2. Practice's recruiting status.
Buying into the practice costs less than $300,000 in 68% of practices collecting for the technical component and less than $50,000 in 64% of practices that do not get technical-component reimbursement. In 75% of practices, partnerships is offered one to three years after hiring.
Staffing and Recruitment
Staffing remains a serious concern for most practices (Figure 2), which usually have 6 to 40 radiologists. Mammographers are the most difficult subspecialists to recruit (Figure 3). About 21% of practices are funding a resident or fellow who will eventually join the practice, and another 56% would consider doing so. To varying degrees, however, practices report that unrealistic compensation expectations, a decreased work ethic, little interest in practice building, and expectations for call or buy in can be problems with new radiologists. Figure 3. Subspecialists who are most difficult to recruit.
One response has been to delay retirement. Four of five practices have no mandatory retirement age, and 71% offer the option of partial retirement (and most of these programs have neither fixed lengths nor participation requirements).
Approximately 41% of practices provide 24/7 in-house coverage, although half of these apply some selective criteria to determine which studies will be read at night. Most (63%) cover emergency-department call at night using an outside service, and of those who do not, 30% are contemplating external night-call coverage. About 23% of practices are also interested in adding radiologist assistants or radiology practitioner assistants to their staffs, and 48% already have them. Figure 4. Procedures performed/interpreted per year by private-practice radiologists.
Radiologists report high productivity (Figure 4), although 61% of those surveyed do not know how many work RVUs they generate per year. About 45% feel that interventional radiologists generate fewer RVUs than diagnostic radiologists do, but a third call their output equal.
Contracts and Costs
Of the groups with hospital practices, 83% report having exclusive contracts, either with carveouts (72%) or without them (11%). Nonexclusive contracts or letters of agreement are each held by 4% of practices, but another 9% hold neither. Nearly half of the hospital contracts contain clean-sweep provisions, and almost three fourths have noncompetition clauses.
More than 95% of practices state that their contracted hospitals have given (or are trying to give) some of their turf to specialists outside radiology, with most of the lost revenue going to cardiologists (Figure 5). Half of practices derive only 10% of their incomes from technical-component billing, respondents note, while 32% of practices attribute 20% to 50% of income to it. Figure 5. Specialists to whom the group has the most turf.
Only 9% of practices plan to change their billing/collections methods; 54% expect to continue in-house billing and the rest are satisfied with their outside billing companies. About half of practices estimate their billing/collections costs at 6% to 8% of collections, although costs range from less than 5% to more than 12%.
The other expense affecting a group’s competitive ability is malpractice insurance, which costs most practices (71%) $10,000 to $25,000 per diagnostic radiologist. Only 4% pay less, and 25% pay $25,000 to $75,000.