Physician Productivity Tracking Takes Hold

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With reimbursement declining, more practices are wading into the dangerous waters of tracking radiologists’ productivity

No matter how common measuring productivity becomes, there is a deficiency behind it: tracking does not always reflect reality and, as a result, can cause diligent workers to appear less productive. Output-tracking authority Richard Duszak, MD, a diagnostic and interventional radiologist with Mid-South Imaging and Therapeutics in Memphis, Tenn, warns, “When looking at productivity, groups must always use objective benchmarks so that there is a real, honest, legitimate discussion, rather than finger pointing and recriminations.”

imageFred Gaschen, MBA

Fred Gaschen, MBA, is executive vice president of Radiological Associates of Sacramento, Sacramento, Calif. His group is composed of more than 75 radiologists and radiation oncologists operating 17 imaging centers, in addition to providing services at five hospitals. He believes there is no escaping the need to measure productivity. “Groups are interested, as never before, in quantifying who is working hard and who isn’t because there is a general feeling that physician compensation has been eroding and will continue to erode. The thinking is that if it’s going to get harder to earn a living, then let’s at least make sure everyone in the boat is pulling the oars with the same amount of effort,” Gaschen says. “If work is not being performed well, groups want to know that in order to be able to make the necessary improvements.”

The Hawthorne Effect After collecting the data that will provide such insights, groups then often publish report cards on their physicians’ performance and distribute copies of the data to every partner, associate, and medical employee. “Some organizations blind the data first before releasing them,” Gaschen says, explaining that the anonymity allows individual radiologists to know where they stand in relation to all the other radiologists, without fear of becoming stigmatized if they happen to be less than genuinely productive. Other groups, however, release the data unblinded, with the name and performance of every radiologist in the group disclosed to all.

Either way, the hope, according to Duszak, is that radiologists will be spurred to work more efficiently. “Just knowing you’re being measured can be all it takes to motivate you to change your behavior—the Hawthorne effect,” he says.

The Hawthorne effect is a social phenomenon first observed during a multiyear study conducted by Harvard University researchers in the late 1920s at a Western Electric plant (called Hawthorne) outside Chicago. The researchers wanted to understand how employees are motivated to become more productive. Among other things, they learned that workers put their shoulders to the wheel more if they know that they are being observed, whether by superiors or through the collection of productivity data. Moreover, they found that it is not necessary to reward observed improvements in performance in order to encourage more improvement: the Hawthorne effect suggests that mere awareness of being monitored causes employees to imagine themselves receiving approbation for their productivity (or, conversely, punishment if they fall short).

Baseless Fear

The Hawthorne effect explains why some groups find it unnecessary to engage their radiologists in a conversation about productivity, once tracked output data have been disclosed, Gaschen says. More than a few groups, however, elect not to have the follow-up conversation out of fear that talking about who is (and is not) productive will tear at the cohesiveness of the group. The thinking, Gaschen says, is that it’s better not to go there.

Such fears may be baseless, though. One group with which Gaschen is familiar went ahead and initiated a productivity discussion with its radiologists, to good effect. “The radiologists were gently told that if the next year’s numbers did not show increases in individual productivity, each underperformer would be penalized through the loss of vacation time,” he says. “For the most part, everybody’s productivity improved after that. The combined improvement was so good that it was the equivalent of having added 2.2 FTEs. The gains in output were the same as if no one on the team had changed any habits and the group, instead, had recruited two more full-time radiologists.”

The radiology group at Massachusetts General Hospital in Boston is among those that track radiologist