The Culture Ultimatum

It is time for radiology-group culture to change. We need to counter our negative stereotype. More than once, television dramas have portrayed radiologists as pseudophysicians or weird technicians sitting in dark rooms drinking coffee, an upside-down chest radiograph in the background. We are partially to blame for this portrayal (but not the upside-down radiograph). We have not been uniformly engaged with our physician colleagues, the hospitals, or (sometimes) even our patients. Changes in the health-care arena now demand that we leave our dim reading rooms, join our hospital administrators, embrace a culture of service, and actively pursue leadership roles in our medical communities. In addition, we should make extra efforts to interact with all of our patients—not just those undergoing invasive procedures or fluoroscopy. This more engaged approach might run counter to the philosophies of some radiology groups because practice-development activities can be viewed as a threat to productivity. Instead, these activities should be viewed as a necessary investment for a viable practice. From the late 1990s to the mid-tolate 2000s, radiologists saw tremendous growth in their business. Not only were more exams being ordered, but there was an exponential increase in more complex (and, therefore, labor-intensive) cross-sectional imaging. Then, when the DRA came into effect in 2006, imaging volume plateaued and reimbursement dropped, driving more efficiency as groups faced an uncertain future. CMS Multiple Procedure Payment Reductions continued, further decreasing incentives to perform any activity not producing a clear RVU. Imaging is an expensive (but important) investment for hospitals. It is key to disease diagnosis and management, and for many hospitals, outpatient imaging provides important revenue. Like radiology groups, hospital administrators face threats of increasing costs coupled with decreasing reimbursement. These, in turn, are compounded by challenges of quality-based reimbursement, increasing accreditation requirements, and myriad contractor audits. The Radiologist–Administrator Relationship For both hospitals and physician groups to be successful, medical-staff members—including radiologists— must be productively engaged with their administrators to ensure that goals are aligned. If the radiologists and hospital administrators are unwilling to work together, patient care will suffer. Consider the issue of patient satisfaction. Many hospitals have worked for years to improve patient satisfaction, relying on various survey tools and indicators to provide input and, they hope, to improve the patient experience. In contrast, only relatively recently has this become a discussion priority for some radiology groups. Many patients are unable to tell technologists and nurses from radiologists, and customer surveys measure the total experience in radiology, not just encounters with the staff. It’s no wonder, then, that—in the past—hospitals were unsuccessful in improving patient encounters; they often implemented changes without including the radiologists. These improvements have to be determined and implemented by the hospital and the radiologists in lockstep. A process for open review of data is a necessary driver, aligning the patient-satisfaction goals of the hospital and the radiology practice to ensure success for both. Closely related to patient satisfaction is customer service. What is the radiologist’s role in customer service? Who are our customers? A customer is defined as someone who buys a product or pays for a service. Of course, patients are our customers, but that means that referring clinicians are also our customers. We must provide them with prompt and accurate service, and it is important for us to be readily available. The latter factor is key in the battle against commoditization, which is a significant threat to the viability of radiology. Let’s not forget our other customers: third-party providers pay us for a service, too. Many people also consider the hospital a customer of radiology groups. While that is strictly true, I would argue that the hospital should be considered a partner rather than a customer. The radiologist is a consultant: an expert who provides accurate and timely reports that are directive, not merely descriptive. The radiologist should actively participate in the hospital capital process, providing necessary technical input but also understanding the hospital’s financial constraints. In turn, hospital administrators must be candid about capital-budget expectations. To become a part of the process, radiologists must actively pursue leadership opportunities within the hospital structure and must take the steps necessary to acquire the skills needed to be effective. The current health-care climate is complex and rapidly changing. We must understand the environment and be able to maneuver nimbly. If we don’t make the important decisions for our profession, those decisions will be made without us. In radiology, leadership training should not be focused only on the practice leaders and department chairs; it should be implemented throughout radiology, beginning in residency. It is time for radiologists to become leadership savvy, step up, and engage their hospital associates. To address these challenges, the ACR® launched the Radiology Leadership Institute™, an innovative, multilevel leadership academy designed specifically for the field of radiology. This program equips radiology professionals—in both private practice and academia—with the leadership skills required to navigate the complex business of medicine successfully. To learn more, visit