Tag: administration

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What To Do When A Hospital Performs Procedures Without Radiologist Consent!

consent

Have you ever encountered this situation? A hospital acquires a new piece of equipment and starts doing studies on it. Yet, the hospital administration never inquires if the radiologists consent to read them. Or, the radiologists working there never vetted the reporting systems or the software to interpret them. The studies sit on the worklist for days until the radiology group can determine the next step. I’m sure some of you have experienced something similar to this. Some radiology residents may have noticed as well. So, what do you do with these errant studies? How do you discuss this topic with the administration? And, what are the following steps to ensure that these studies do not sit on the worklist forever?

Bring The Topic Up For Discussion With Administration And Appropriate Parties

At this point, there is no time to beat around the bush. It would be best if you communicated rapidly and directly with the folks who decided to start the program. Delays can only lead to the ire of the ordering referrer, the patient, and the administration allowing the new study. Even though you may not be directly responsible for the situation, your group can still be in a bind.

So, find the administrator who allowed the study and tell them you need to discuss the issue further. Also, it is crucial to let the referrer and the patient know that the interpretation of the study will be delayed. Communication is the essential element here.

Create A Radiology Committee to Determine If Radiologists Should Consent To The Study

Next, you need to ensure that you abide by the Hippocratic oath to “do no harm.” Some studies can only lead to other studies and procedures that may not be best for patient care. If that is the case, a committee should decide to nix the procedure from the imaging arsenal. The practice should recommend at a high level with objective data that the hospital or imaging center refrain from completing more of these procedures. 

On the other hand, if the study has clinical utility, it behooves the radiologists to ensure enough staff can read them. There needs to be more than an adequate number of radiologists to make the schedule work. A committee within the radiology practice should also decide to look into these issues before the hospital completes more studies.

Make Sure That The Radiologists Have The Appropriate Training

Assuming the study is clinically valuable, a committee must also determine how to ensure that the radiologist will have adequate training and experience to read the study. This preparation may include courses, webinars, direct patient encounters, or supervised learning. The practice should determine the necessary prerequisites.

Interpret The Studies And Build The Program

Once the program has begun, radiologists must start doing the readings as determined by the committee. Moreover, as part of practice building, it may be worthwhile for these radiologists to talk to community physicians, referrers, or other administrators to ensure the program grows.

Radiologist Consent And New Studies

Sometimes, hospitals and imaging centers can be overly eager to begin a new program to create new sources of revenue. However, a lack of communication with the interpreting physicians can lead to its downfall. Radiologists’ reputations and licenses can be on the line if the hospital and the radiology practice do not take the appropriate steps. So before you consent to start interpreting any new procedure, you need to discuss it with the correct parties, validate it to make sure it is appropriate, train the radiologists, and ensure a process to build a great program. Rome was not built in a day. Hospitals should not rush through new procedures, either!

 

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Seven Ways Administration Can Destroy A Radiology Residency Program

administration

Like it or not, all radiology programs need the backing of their administrators to succeed. Unless faculty and residents want to pay for residency out of their own pockets and manage all the day-to-day issues themselves, it is the only way to survive. So, with all this power in the hands of the administrators, it is no wonder that they can direct a residency in ways they see fit. And they can use their power for the good of the program or to the detriment of everyone. So, if you are wondering how the administration can pull strings to destroy a radiology residency program, here are the top seven ways!

Lack Of Financial Support

Unfortunately, a residency cannot run itself without money. Whether it is the reading resources, Radexam, equipment, or teaching, all these line items cost money. If the administration takes all the money for themselves and is unwilling to cough it up for the residency program, a residency cannot continue functioning.

Lack Of Human Resources

It’s not all about equipment and stuff. It would help if you also had the workforce to make a residency function. These folks include program directors, residency coordinators, faculty, statisticians, and more. If you can’t hire or maintain these folks, you may as well pack it all in!

Unrealistic Expectations By The Administration

We all want the best for our residents. But, when administrators expect to create an academic powerhouse but are unwilling to hire the proper faculty, or if you want a class of incredible residents but are not willing to pay for the latest and greatest equipment and technology, do not expect to create a residency that will function!

Administration Culture Clash/Backseat Driving

Administrators and faculty often have different ideas about how to run a program. Just because you, as an administrator, provide the funds to operate a radiology residency doesn’t mean you can control everything. For instance, recruiting residents from only certain institutions because you get a kickback doesn’t work.

And, just because you, as a radiologist or program director, think you know everything about running a residency doesn’t mean you know enough about managing a program’s business. Spending money without controls can lead to poor hospital financial outcomes. Either side pulling all the strings can lead to a disaster!

No Backup For Program Directors/Department

To maintain respectability within an institution, program directors need support from their administration. They may encounter problems getting a statistician to help residents with studies to meet the requirements of the ACGME. Perhaps there are conflicts with another department overstepping its bounds and using radiology residents for non-educational purposes. In either case, the administration must back up the program directors and radiology department to maintain the department.

Unwilling To Update Old Equipment To Save A Buck

Yes, institutions do like to keep that ancient CT scanner or MRI. Why? Well, it becomes a cash cow when it is all paid off. No more hardware expenses mean higher profit margins. But there comes a time when you are just out-of-date and can’t keep up with the competition. And guess what? That also affects the residency. Residents don’t get the training they need, and fewer patients come to the institution because they don’t get the advanced imaging they need!

Loathe To Adopt New Technologies- Too Many Hoops

Sometimes, you need to adopt new technologies, but there is so much bureaucracy that you can never push the capital budget through. Perhaps the administration makes it so hard to obtain the correct paperwork. Or maybe they only meet in committee once every six months and are not quick to decide. In any event, if you snooze, you lose!

Yes, Administration Can Destroy A Radiology Residency Program!

Radiology residency programs are only as good as their weakest link. And if that link is the administration, the whole residency can fall apart. Whether the issues are financial, cultural, or bureaucratic, each factor can result in the program’s demise. So, when you choose a training program, make sure to look into who administers it!

 

 

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Active Administrative Management: The Key For A Successful Training Program?

active administrative management

As many of you know, residency reputation and quality throughout the country vary widely. Sure, the Radiology Residency Committee (RRC) and the American College of Graduate Medical Education (ACGME) has set out specific guidelines for all radiology residencies to follow. However, over the years, I have discovered these instructions are merely a tool for individual programs to interpret as they will. As much as these organizations would like to have you believe, the current product is not standardized at all.  So, how can a hospital or system convert a program into the best it can be? It’s straightforward. Treat it like any other significant patient care initiative, whether it be a renal transplant program or oncology center of excellence. And what do they all have in common? Active administrative management!

How Successful Programs Model Their Residencies

Take a look at the most successful programs, ones that are rated highly on Doximity and Aunt Minnie. First of all, management takes residency education seriously. Unlike many administrations who only pay lip service, saying that they take residency education as their prime mission, these few do. They treat a residency like a renal transplant program or a multiple sclerosis center of excellence. They build a program with an initial plan to provide the best training possible.

The Plan

So, how do they do all this? First of all, they communicate with all the stakeholders, not just a few select administrators and high-up faculty onto themselves. They involve medical students, residents, fellows, section chiefs, chairs, residency coordinators, engineers, physicists, program directors, c-suite executives, managers, and more. Everyone plays a role, and everyone is aware of their educational role within the mission. They structure meetings with clear goals. Everyone knows the names of those folks in charge. It should not be that murky person with a cigarette in tow pulling all the strings like the nameless, faceless ones in charge of the government in the X-Files!

Second, these hospitals provide the resources that programs need to succeed. A renal transplant team cannot function without technical support from the surgical technologist or nurse. Nor could they survive without the highest quality equipment and tools for surgical intervention. Likewise, an excellent program cannot exist without the educational tools, numbers of involved faculty, and equipment.

And then finally, they establish buy-in from all members. And, I mean all members. Whether it is the CEO of the hospital or the janitors who need to take of the department, all are active participants. When a hospital establishes any other quality initiative, they all feed into a joint mission, and everyone wants it to succeed because they know their role within the system. That is how an organization does it!

An All-Too-Common Residency Model That Doesn’t Work

Unfortunately, this model contrasts markedly with the other all-too-common model. Many of you have seen these residencies on your interview trail or in your own experience. In this situation, orders arrive from a vague administrator whose command is to save money for a hospital or a system. These bureaucrats tell all the affected parties that they are going to have a great program. But, they establish no buy-in from the involved parties. And, they muzzle or fire individuals who seek to improve the system. This model would never work with a broad patient care initiative.

Moreover, these administrators do not communicate an effective mission statement to any of the players. In effect, they say they want an “Ivy League” program, but they do not provide any organization or structure to those that are on the front lines. They manage the world from thirty thousand feet in the air, hands-off, never uttering a word about their plans. And, then they cut the resources that a program would need to improve the education of its residents instead of facilitating improvements. These “saved” funds go back into the system to pad the pockets of the administration, instead of improving the education of what should be its targeted goal, the residents, and the residency program.

The Upshot Of Poor Planning In The Health Care System

Now, imagine the same happened to a formerly successful oncology program. It would have a short half-life. Eventually, it would dissolve due to the best oncologists, surgeons, primary care docs, nurses, and others wanting to leave the program for other better health care programs and facilities.

In this model of health care education, where entities want to save a buck or two,  administrators reap most of the rewards. However, in the long run, it is a losing formula for the residency and the hospital system. Education does not improve. And the residency/health care system deteriorates over time.

What Are The Returns Of Doing It The Right Way?

When you approach a radiology program the right way, first and foremost, you elevate the quality of the residents that graduate. These are the sorts of folks that you would eventually want to hire in your practice. And, they stick around long after they graduate.

Next, you stimulate more dollars to come back into the system. How do you do that? First, the quality of care increases because you have provided an excellent education. And, these are the folks that take care of patients. Then, more patients come to your facility because they are aware of the quality. It first happens locally, then nationally, and then internationally.

And finally, you receive more support. It may be from research dollars from grants for doing incredible research. Or, it may come in the form of additional donations to the cause of education. Regardless, the program has established a virtuous cycle, a continuing formula that supports the hospital and residency throughout the ages. Administrators and all healthcare-related staff win.

The Sad Truth About Residency Program Management

Not all administrations are created equal. And, not all have the primary goal of establishing residency education as a primary mission as much as they like to imply. And, there are many factors involved, whether it be poor planning, greed, declining reimbursements, and more. But, in the end, it is only those administrators that have the foresight to make education priority number one that will create training programs that will stand the test of time. So, when you decide on your residency, choose carefully. Management matters!