Since Covid began, almost all practices have established a teleradiology presence from home. But, it is a work in progress. Some radiologists still need to man the forts, especially in hospital and imaging center-based practices. Contrast issues, treatments, complex studies such as cardiac CTAs, and on-site ultrasounds still involve a radiologist on-site. And many practices have been struggling to figure out the right mix. This dilemma leads to problems with structuring rotations, compensation, and making the staff happy. Therefore, I will discuss the most significant issues practices face and potential solutions to the most critical problems. I will divide these into rotations, compensation, and personal staff issues,
Rotation Problems Caused By Working From Home
Setting rotations to staff the practice from home versus in-house adequately can be daunting. Some radiologists typically have expertise in areas more conducive to work at home. Others need to be in the department more often. These lead to inherent problems of inequity and jealousy. So, setting up appropriate rotations to equalize home rotations can be very difficult. In addition, technologists and nurses need to be in contact for occasional events like contrast reactions and when to do so. If you create new rules, you must ensure the staff understands who to get and when.
To create equity, you have to recognize the following facts. First, only some people can work from home all the time in a non-teleradiology practice. And then, some specialties allow radiologists more freedom to work at home. Once we recognize these inherent problems with total equity and fairness, we can create rotations to equalize some of these issues. For instance, the practice can make some of the in-house rotations “easier” to compensate for inequities within the practice partially. Or, you can make some rotations on-call rotations. These are just simple ways to relieve some of the problems of unfairness among the staff.
Compensation
Should employees and partners receive the same compensation if they can do more at home? Is there an upcharge or premium for having to come in more often? These potential inequities in the fairness of compensation also lead to other problems. Some procedures you can read at home pay more per unit worked (MRI) than others involving in-house work (IR). How do you account for that when you compensate your radiologists for their work?
Well, there are a few simple models. First, you can make all work equal with the philosophy that all work is valuable to the practice regardless of the reimbursement. It would help if you had the low RVU fluoroscopers as much as the high revenue MRI readers because they all provide a helpful service. This philosophy works much better in a partnership. In addition, you can provide more revenue and moonlighting opportunities to increase income for radiologists who are more interested in making some extra money. These opportunities help out a bit.
You can also decrease pay for radiologists who only work by teleradiology since they do not provide the same on-site services, such as management of contrast reactions, consults, and procedures. A practice can adjust the rate depending on the time worked outside the office compared to an “average” practice radiologist.
Either way, these models provide some equity for the practice.
Personal Staff Issues
Finally, you have issues such as radiologists who have extenuating circumstances. You may have new mothers or radiologists who temporarily need to move far from the practice, and so on. Sometimes, you need to make accommodations for individual radiologists so they can continue to work. Again, compensation needs to reflect the amount of time that these radiologists work outside the office and the need for the radiologist once they return.
Working From Home: Not All A Bed Of Roses
On an individual basis, working from home can be a godsend. What’s better than being present at home with kids, dogs, spouses, contractors, and more? On the other hand, from a practice perspective, working from home introduces many additional problems. Fairness/equity of rotations, compensation issues, and individual staff issues are just some of the problems that group leaders need to contend with. Practices can work out most of these kinks. But getting the right mix takes a bit of effort and creativity. Having all radiologists working from home is more complex than it seems!
