Tag: employed

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Why Can’t Hospitals And Radiologists Just Get Along?​

hospitals

We often hear about radiologist practices and radiologists who cannot seem to get along well with the hospitals with which they work. Perhaps, it is the revenge of the grade C student hospital executive? Maybe, it is the lack of capital intensive resources for the radiologists? Or could it be that some hospitals take every opportunity to cheat radiologists of their next dollar?

Sure, these factors may contribute to a bad experience of working with a hospital. But, I believe that these factors are not the leading causes of conflict. Instead, the answer is simple. Our mission differs sharply with the employers with which we work.

So, how exactly does the primary mission of the employed radiologist or the hospital based radiology group differ from the organization for which they work? And how can we resolve that conflict? Well, these are the topics for today!

Mission Statement For The Employed Radiologist

What is it that radiologists want? Well, let me give you some sentiments from radiologists in the form of some familiar complaints. 

“Constant phone calls are constantly interrupting my workflow.”

“We don’t have enough technologists to keep the workflow going in interventional radiology.”

“The PACs system went down again, and I can’t dictate any cases.”

And finally, of course, “How many times do I have to tell the technologist to complete the study!”

So, what do these complaints have in common? Basically, they are all saying the same thing. Radiologists want seamless workflow. And, if I had to think of the mission statement for a practicing radiologist, it would be, “let me do my work without interruption!

Mission Statement For The Imaging Center/ Hospitals

What about the hospital or imaging center owners? Well, let me give you some of their sentiments in the form of some statements.

“We need to get the SPECT-CT operational so that we can get new patients into the system.”

“Clinicians are continually complaining that radiologists are not getting the reports out in time!”

“We have several obstructionist radiologists that are refusing studies to clinicians. We need to talk to them!”

“The layout of the department is making it impossible for patients to get their tests promptly.”

So, what do these statements from the guys in the executive suite have in common? They all are about the bottom line of the hospital. Or, “how can we maximize revenue for the organization and decrease costs?”

Misalignment Of Mission Statements

Fortunately, most of the time both owners and radiology employees are on the same page. Hospital executives usually want to create a seamless work environment for the radiologist to improve revenues. Likewise, radiologists aim to bring in the most revenue possible for the organization by improving workflow. However, many times these two mission statements will butt heads.

Occasionally, increasing system revenue may mean impeding the workflow of the radiologist. For instance, the hospital sees that picking up the phone while in the midst of a busy rotation makes their clinicians happy. At the same time, it delays the readings of the radiologist. The hospital continues to allow this to happen.

Likewise, increasing efficiency of the radiologists sometimes costs more to the system than doing nothing. Maybe, the reading room is not ergonomic, and the hospital cannot see how the hospital expense will improve the bottom line.

And, herein lies the crux of the problem. How can we reconcile the two missions?

Solving The Employed Radiologist/Owner Misalignment

Both parties need to have skin in the game to solve the misalignment dilemma. Employed radiologists need to have some ownership stake in the operations of the hospital. And just as importantly, owners/managers performance should be tied to improving the seamless workflow of the radiologist. You can’t expect either an employee or a manager to implement changes actively without incentive or experience. In some institutions, minimal incentives exist for these liaisons. Additionally, some managers have little experience with understanding the radiologist’s workflow.

So, how can we allow hospitals and radiologists to have better relationships? Well, we need to align the fundamental misalignments.

First, radiologists should receive some compensation for increasing the revenues and decreasing departmental costs. Tying rewards based on increasing institutional profits make the radiologist more likely to find favor with less radiologist friendly policy but excellent institutional benefit.

Moreover, hospital/practice management should not hire a random secretary within the building at a lower cost to run the business side of the practice. They should find a seasoned business manager who understands the trials and tribulations of the radiologist. How frustrating can it be to have someone who has no clue about radiologist operations?

Additionally, hospitals should tie the business manager to the efficiency of the radiologist practice. How? They can create a reward system not just based on hospital goals, but instead meeting the efficiency goals of the radiologists as well.

Tying The Knot

You cannot expect two groups to be on the same page when some of the most critical goals of each organization differ so widely from one another. Instead, you need to marry the two organizations mission statements into one. Creating a system to align the priorities of both groups should be a top priority. And, hiring the appropriate individuals is critical. Let’s resolve the differences instead of complaining about what both hospitals and the radiologists do wrong!

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Should I Be An Independent Gun For Hire?

independent gun

Nowadays, new radiologists may face a new choice, not as prevalent years ago. As such, you may work for one or more than one firm that allows the option of independent contracts or employed work. Most commonly, this decision exists for those who choose teleradiology. But other arrangements are also possible. So, what do you do? Do you operate as an independent contractor getting yearly 1099 forms? Or do you take employment wages and receive a W-2 at the end of the year? Although this decision may seem innocuous, significant consequences await those who don’t think about how to proceed. So, today we will discuss the advantages and disadvantages of contracted work. In addition, we will talk about a significant pitfall you must avoid when you begin your first independent contractor job. Let’s start!

Reasons To Become A Gun For Hire

Independence allows radiologists to contract out with multiple groups. Many employed positions muzzle the worker by outlining in the contract that they may not work with other groups or outside work. On the other hand, theoretically, as an independent contractor, you can work with five or more different groups and facilities. Similarly, the more the independent contractor works, the more you can get paid. This workflow differs dramatically from an employed worker that often has a fixed salary with, perhaps, a small production bonus.

In addition to the ability to work with multiple facilities, the independent contractor can also deduct expenses from their income taxes. As a typically employed radiologist, you cannot write off items like fax machines, paper, health insurance, 401k plans, and more. When you work for yourself, all these deductions can significantly reduce your taxable income. Therefore, making more take-home income with the same salary is possible.

Then, of course, depending on how you structure your business, you may be able to take advantage of the new tax laws that favor corporations. For instance, you may depreciate capital equipment more rapidly over time. And, if your income dives below a lower threshold, you can deduct additional earnings as a pass-through corporation. Additionally, you may be able to put more retirement account funds away in a SEP-IRA versus an employed 401k plan. Whatever the case, I highly recommend discussing the consequences of different corporate structures and tax ramifications with your accountant.

Becoming A Gun Is Not All Peaches And Cream!

What issues do independent contractors need to contend with? Maintaining contracts with different entities becomes your responsibility if you independently contract with multiple facilities. And the loss of one or more contracts can devastate your finances if you rely on this income to sustain your household. No longer can you rely on your employer for your paycheck.

Working for yourself as an independent contractor can also become a lonely business. Instead of working in an extensive practice with many other radiologists, some independent work can isolate you from your colleagues. For some, this can be a potential deal breaker.

Other issues arise, such as traveling from facility to facility to work. (if you work at multiple locales) If you have a more capital-intensive business and, for instance, you run remote computer software, you may need to fix the equipment if it goes down. Or, if you work from home and have a power outage, how do you run your business? These questions do not have to cross the mind of the employed radiologist.

Finally, if you employ other workers/services, you also rely on their work. If they don’t show up, you don’t get paid!

A Major Independent Contractor Pitfall

For those of you who go down the road of an independent contractor, you must remember what you take home; you do not entirely keep. Naturally, you always have to save additional money for the taxman. More than that, you will also likely need to pay quarterly estimated taxes to prevent IRS penalties. Again, I would talk to your accountant about the details of your situation.

To Be Or Not To Be An Independent Contractor

Becoming an independent contractor as a radiologist certainly can have significant benefits. But, no job comes without its pitfalls as well. Suppose you like the independence of working for multiple groups, getting paid as much as you work and being able to deduct certain work expenses. In that case, independent contracting has a certain allure. At the same time, it also involves different risks you must take. Additional rewards never come without some sacrifice!