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 current dilemma leads to multiple problems with structuring rotations, compensation, and making the staff happy. Therefore, I will discuss the most significant issues that practices face and potential solutions to solve the most critical problems. I will divide these into rotations, compensation, and personal staff issues,
Rotation Problems Caused By Working From Home
Setting up rotations to adequately staff the practice from home versus in-house can be daunting. Some radiologists typically have expertise in areas that are 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 that attempt to equalize home rotations can be very difficult. In addition, technologists and nurses need to contact for occasional events like contrast reactions and when to do so. If you create too many rules, you can confuse the staff about who to get and when.
Therefore, some of the guidelines need to be as follows. Not everyone can work from home all the time in a non-teleradiology practice. Some specialties allow some radiologists more liberties to work at home, and all of us are not trained the same. 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 partially compensate for inequities within the practice. Or, you can make some rotations on-call rotations. These are just simple ways to relieve somewhat some of the problems of unfairness among the staff.
Compensation
Should employees and partners receive the same compensation for work 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 lead to some other problems as well. Some procedures that you can read at home pay more per unit worked (MRI) than other more involved in-house work (IR). How do you account for that when you decide to compensate your radiologists for the work they do?
Well, there are 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. You need 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 those radiologists that are more interested in making some extra money. These opportunities tend to help out a bit.
Or, you can decrease pay for radiologists that 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 can provide some equity for the practice.
Personal Staff Issues
Finally, you have issues such as radiologists that have extenuating circumstances. You may have new mothers or radiologists that temporarily need to move far from the practice, and so on. Sometimes you need to make accommodations to individual radiologists so they will be able to 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 may 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 able to be 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 issues that group leaders need to contend with. Practices can work out most of these kinks. But, it takes a bit of effort and creativity to get the right mix. Having all radiologists working from home is not as simple as it seems!
