More than half of radiologists in private practice, along with a majority of those in academia, now find themselves compelled to measure their productivity, according to presenters of an RSNA 2008 session.

When conducted thoughtfully, measurement can have a positive impact on employee morale as well as performance, said Richard Duszak Jr., M.D., a diagnostic and interventional radiologist in practice in Memphis, Tenn. Less productive physicians work harder and respond more willingly to non-clinical demands, he said, while productive physicians feel more comfortable in the work environment.

"Proper management now requires that we get more bang for the buck," said Stephen Chan, M.D., who along with Richard Duszak Jr., M.D., presented "Tracking Radiologist Productivity: Is It Necessary and How Should It Be Done?"

Dr. Chan, an academic radiologist at New York's Columbia University, said measurement is absolutely necessary for increased productivity in the academic setting, as competition for imaging dollars increases and fewer dollars exist to pay radiologists and support research and education.

In the clinical setting, productivity measurement is imperfect but still useful, said Dr. Duszak, a diagnostic and interventional radiologist in practice in Memphis, Tenn. All too often, "groups don't go down this pathway because of pure academic, intellectual and business reasons, but instead want to validate their subjective, emotional or political reasons," said Dr. Duszak.

Practices that do see a need to measure productivity, he said, should address desired behavior: administrative work, practice and relationship development and support of those motivated physicians he called "good sandbox players."

Drs. Chan and Duszak cautioned that ill-considered productivity measurement may not reflect reality and may harm conscientious workers, lead to cherry-picking of responsibilities and damage morale. When conducted thoughtfully, measurement can have a positive impact on morale as well as performance, they said.

When measurement begins, discontent often abates, said Dr. Duszak. Less productive physicians work harder and respond more willingly to non-clinical demands, while productive physicians feel more comfortable in the environment. Radiology practices measuring productivity often reward or penalize individual or group performance outcomes with monetary bonuses or fines or by offering or withholding vacation time, said Dr. Duszak. "Pride, money, embarrassment and vacation are strong motivators," he said.

Stephen Chan, M.D.

Clinical practices are measuring productivity by examinations read, by revenue or by relative value units (RVUs), the CPT code-based measurement of physician services that provides benchmarks for evaluating productivity in clinical radiology. So as not to penalize those also responsible for critical but non-clinical services, practices may separate non-quantifiable responsibilities and measure a physician's clinical work as a percentage of full-time employee status.

In academic radiology, measurement involves a more complex effort, said Dr. Chan, tabulating clinical performance, numbers of peer-reviewed publications, time devoted to administration and community service, research grants and grant dollars and educational evaluations. The RVU system has no relevance outside of clinical medicine, said Dr. Chan, so practices develop their own ways to quantify non-clinical work.

Dr. Duszak cited a useful "academic RVU" template created by Reuben Mezrich, M.D., and Paul Nagy, Ph.D., of the University of Maryland School of Medicine. The template, for evaluating work performed in research, education and administration, was published in the July 2007 issue of the Journal of the American College of Radiology.

Meanwhile the very measurement of productivity has been found to increase work output, even when results are never communicated, presenters said. This so-called "Hawthorne Effect," asserts that perceived attention provides a short-term incentive such as that observed by researchers at Western Electric's Chicago-area Hawthorne Works in the 1920s.

RAs Add Time and Value to Radiology Practice

Another study presented at RSNA 2008 described how radiologists can dramatically increase their productivity by adding a radiologist assistant (RA) to their staff.

Donna Wright, Ed.D., R.T.

In 2005, students at Midwestern State University (MSU) in Wichita Falls, Texas, identified certain procedures that they performed, for which they collected productivity data over a period of 336 hours. "They found that the RA was saving the radiologist in their group an average of about 99 minutes a day," said Donna Wright, Ed.D., R.T., who presented "The Radiologist Assistant: Extending the Reach of the Radiologist."

"That's a lot of time when you're thinking about what a radiologist could be doing with those 99 minutes," said Dr. Wright, a professor of radiologic science at MSU.

The students calculated that a radiologist could hypothetically earn $373,000 a year with the time saved by an RA. In a similar study performed in 2007, MSU students focused on nine mandatory procedures and one elective procedure, and found that an RA averaged 0.79 procedures per hour. "What they found was that the RA was saving the radiologist about 27.86 minutes per procedure," Dr. Wright said. "They extrapolated the numbers out again and concluded that a group could potentially receive about $570,000 for this timesaving."

RAs can take care of the necessary but time-consuming duties that pull radiologists away from interpreting images, Dr. Wright said, including pre-procedure care, histories and physicals, follow-up after procedures, checking for necessary lab studies, evaluating lab results and looking for medication complications. All registered RAs are trained to perform upper gastrointestinal, small bowel, cystography, arthrography, lumbar puncture and placement of nasoesophageal/nasogastric tubes and peripherally inserted central catheter lines. RAs also have a subset of skills that include ductography, myelography, breast needle localization and many other procedures.

"We have found over time that during the first year an RA is credentialed, the list of what physicians have RAs perform may be fairly small," said Dr. Wright. "As they become more familiar with the person and more familiar with the concept of having this physician extender, the list gets longer."

Importantly, RAs extend the reach of the radiologist by helping provide more one-on-one contact with patients, Dr. Wright said. Increasing patient contact, she said, helps reduce medical errors, improves the quality of care and increases patient satisfaction.

The abstract for "The Radiologist Assistant: Extending the Reach of the Radiologist" is available at RSNA2008.RSNA.org/event_display.cfm?em_id=6005441.

Note: These articles were adapted from stories that appeared in the RSNA 2008 Daily Bulletin. Daily newspapers from the annual meeting are available online at RSNA.org/bulletin.

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RAs Add Time and Value to Radiology Practice

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