The Tortoise and the Stack Burner

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You know the tale. In the end, the steady pace of the tortoise won out over the supreme confidence and sheer speed of the hare; the hare simply did not value the focus, commitment, skill set, and tenacity exhibited by the tortoise. There are lots of lessons to be learned from this story, and over the years, most of us have learned how to apply at least some of them in our careers. In radiology practices around the country, however, there is one lesson that still seems elusive. Among the many questions that I am asked about productivity and stack time is the consistent dilemma of how to value off-stack time. In other words, when partners in the group step up and perform functions other than meeting the required daily RVU count, how are these functions—this time away from the so-called real work—valued? Whether the function is the preparation of a CME lecture for the medical staff, a marketing luncheon for a referring office, administrative time spent on the business of the practice, or a meeting with hospital administration, off-stack time is valuable to the practice. It is real work in every sense of the word. I would argue that these activities are equally important to the production of RVUs: The ability to build lasting relationships and customer loyalty will be among the factors that will separate tomorrow’s successful practices from those that will struggle for survival. Not everyone is equally adept at burning through the stacks, and not everyone is cut out to manage the business side of the practice. Practices need to identify which partners have the unique skill set required to work through particularly thorny contract issues, or to use communication talents and powers of persuasion to build a customer relationship with a difficult referrer. Who in the practice seems most attuned to leadership and building a strong collegial culture? It’s not likely to be everyone. In far too many of today’s practices, though, the discussion still focuses on yesterday’s model, in which everyone is expected to produce equal amounts of output, measurable only by the number of work units attributable to each partner. Don’t get me wrong; it is supremely important that partners produce, and it is never acceptable to have the pendulum swing too far away from a minimum level of productivity. Accommodations need to be made, however, for the equal valuation of time spent by those in the practice who take on extra duties running the business side of the enterprise: those who help build the practice, and those whose skills help sustain it for future generations. What is that contribution worth? At the very least, those who contribute in these ways should be supported and encouraged by finding ways to endorse their work and make the processes involved easier. One school of thought is that each partner in a practice has a distinct responsibility to build the practice, to participate in the business, or to be otherwise involved in a committee or project in support of the practice. This is true on one level, and one cannot argue with the logic; however, today’s reality of increased competition; decreased reimbursement; complex business issues with hospital contracts; and sophisticated compliance, human-resources, and other issues makes it imperative that partners skilled in dealing with these issues are the ones who are empowered to manage them. This makes it incumbent upon the rest of the partners to support those who might, by assuming these duties, become unable to produce the daily volume of studies that they would otherwise be able to manage. That is the essence of the message. Today’s radiology practices require a certain level of sophistication on the business side. The interrelationship among business development, expense controls, staff alignment, customer service, and negotiation is not something that very many radiologists enter practice understanding. Those who take the time to learn these things (and who dedicate long hours, on behalf of the group, to get the combination right) need to be valued, not derided for being off the stacks and doing supposedly frivolous stuff. Who will win the race? I am betting on the practice that supports the effort that it takes to stop and develop the right relationships along the way. Curtis Kauffman-Pickelle is publisher of Radiology Business Journal and is a 30-year veteran of the medical-imaging industry. He facilitates strategic-planning retreats for radiology groups, is a strategic business consultant to more than 30 imaging centers and radiology practices, and is CEO of imagingBiz, Tustin, California. He is publisher of, where this article first appeared on April 14, 2010.