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Admin time in private practice
Hey all.
I’m wondering how various private practices do admin time. We are around 50 radiologists and we have a president that is over 50% admin and overall 2-4 people on admin every day. Seems excessive to me and a waste of resources.
How do other groups handle administrative duties?
Do medium and large groups have a physician performing the majority of administrative tasks or can a non physician administrator be paid to do the majority of those tasks while coming to the president and board for guidance? In this way the president can theoretically still generate clinical revenue at a higher hourly rate than the non physician administrator is paid. -
39 Replies
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To answer your question, yes we have non-physician administrators that do almost everything other than read imaging.
Non-physician administrators can handle the vast majority of tasks at a much lower cost than taking radiologists out of practice to perform unpaid administrative tasks.
What are 2-4 radiologists doing that is administrative every day?
Quote from Jbachler
Hey all.
I’m wondering how various private practices do admin time. We are around 50 radiologists and we have a president that is over 50% admin and overall 2-4 people on admin every day. Seems excessive to me and a waste of resources.
How do other groups handle administrative duties?
Do medium and large groups have a physician performing the majority of administrative tasks or can a non physician administrator be paid to do the majority of those tasks while coming to the president and board for guidance? In this way the president can theoretically still generate clinical revenue at a higher hourly rate than the non physician administrator is paid.
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Admin days are a great scam. You should be happy to pay your fat cat senior partners to not work while you work even harder to feed both mouths.
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[b]What are 2-4 radiologists doing that is administrative every day? [/b]
I have no clue. It’s the president and various site directors and/or division directors.
It’s definitely not translating to higher pay or less hours of work.-
Radiologist presidents are important and they have obligations that bring value to the group and demand time. However, it should not be 50% FTE (IMO), and having 2-4 radiologists doing unpaid admin work on a given day seems unwise from a financial point of view.
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Radiologist presidents are important and they have obligations that bring value to the group and demand time. However, it should not be 50% FTE (IMO), and having 2-4 radiologists doing unpaid admin work on a given day seems unwise from a financial point of view.
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Most of them get a car wash that day.
Quote from Jbachler
[b]What are 2-4 radiologists doing that is administrative every day? [/b]
I have no clue. It’s the president and various site directors and/or division directors.
It’s definitely not translating to higher pay or less hours of work.
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Im sure there is no one size fits all. I get one day every month and it isnt near enough time. Meeting with hospital administrators, committees, reviewing and editing department/hospital policies and procedures, PACS/IT personnel, renegotiating commercial payor and hospital contracts, reviewing denials, reviewing quality concerns/misses, addressing professionalism issues, recruitment, scheduling, the list goes on.
Id give it up in a heartbeat if anyone else wanted to deal with all the s***. Id much rather read for 9-10 hours at my workstation. In fact, Id rather read studies whilst having my eyebrows pulled out than the last admin day I had. Careful throwing stones. One day you may be sitting in the glass house being judged.
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You sir/madam, are the exception. My comment was not meant for you at all. You seem like packing everything in one day of admin. I have seen 1-2 per week with witnessed misuse. Thats what I was referring to. Please ignore.
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It’s a tough cookie to crack. Was at a group where chair was paid extra for being chair, had extra days off, but also was taking hours off from reading to go to random meetings all the time. Seemed like too much.
When I was a resident, our chair was also paid more and had admin days, but if he got busy with meetings on his clinical days, he stayed late or read from home to make sure he was reading as much as others. That seemed more reasonable.
Regardless, no way to avoid this kinda stuff I think – pretty much every rad I know complains about it.-
Admin time needs to be enough so that someone will do it, but not everyone wants to do it.
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We have no admin time. If there is a meeting, it’s during a regular shift and its transparent to everyone on the schedule why X is gone for an hour.
We rotated with a group during residency that had the admin time scam going. They don’t exist anymore as an independent group.
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I’m with Jah. If I had a choice between doing admin and going back to clinical work, I’d go back to clinical work. Admin is a 24/7 headache and not often contained in daily work hours. You probably don’t need multiple people at once on admin day but with a group of 50, total 1-2 days of protected admin per week are likely optimal for the group long term.
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With a group of about 50 rads, you have plenty of revenue and meet the size criteria to have a high level non-MD CFO. This person should have an MBA or equivalent degree, solid experience running larger/more complex organizations and would have some knowledge of ALL facets of the business needs/requirements of a larger radiology group. This person should work hand-in-glove with the MD senior partner/president/CEO (whatever title you decide to give him). Even with the high level non-MD CFO in place, that one radiologist working as the leader of the group to the outside world will need at least 2 full days of admin time per month (can be broken up into 4 half days or other combinations). As far as the other 2 – 4 rads with “admin time” — nope. They are just milking it.
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in a prior practice we had a ‘General type’ Radiologist president who did about 20% daytime radiology work. This person did still take some call. This person had been in the position a very long time. That group desperately needed that person to step down. The practice was stuck in the 1990s way of doing things. It was his/her way or the highway.
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Quote from Jbachler
Hey all.
I’m wondering how various private practices do admin time. We are around 50 radiologists and we have a president that is over 50% admin and overall 2-4 people on admin every day. Seems excessive to me and a waste of resources.
SEEMS is the operative word here.
To those who haven’t been in the administrative side of a practice – you have no idea how much time this takes. Not just to go to meetings, but to prepare, to deal with phone calls, etc.
I did the schedule for our group, and of course used the software we bought (i.e. effieicent as possible, not by hand). I got 1 admin day per month for this, and spent at least 2 times as much time on it, usually at home at night, answering emails, logging who needed what days off, etc. Then there were the calls during the day to fix the schedule, etc. I knew some would **** about the time off I took, so I kept a log, and it was easily 16 hours a month, sometimes more. I showed them the log. and asked if they wanted to do it. No takers.
But, of course there were constant baseless complaints. Like the guy who thought he was getting too many Friday night 4-11 shifts. I of course had the counts, and I took every other friday night (in a pool of about 8), and he got one every two months or so. STILL he was pissed, He wanted zero. Then the other guy, who gamed the system so he had no weekend work through the summer. I called him on it and he was pissed. I think maybe one other person knew I took care of the problem, so I got no credit. This is the kind of BS you have to deal with and it makes for an unpleasant day.
For my trouble, these two gathered a bunch of proxy votes for one meeting, and voted me out. They gave it to a power mad guy who wanted to control things, and he made a mess of it, was gone in a few months, gave it to another ethical, trustworthy person, who was overwhelmed in 6 months, and so it came back to me.And yes, on my assigned day off – I would do what I needed to do, which sometimes was work on the schedule, but often it was not, and it was considered to be comp time – because the tasks needed to do for this don’t generally come at the assigned times.
My best friend is currently medical director at our largest 1000 bed hospital. Same story for him – he gets a token day or two a month, and spends FAR more time in formal meetings, Impromptu meetings in his office at all times for someone who has a problem that needs to be attended to, at night working on issues, on the phone for sometimes hours during the day putting out fires.
Your option here is to be managed by a business person who knows nothing of medicine, and will be your overlord – telling you what to do. Think Envision, or RP.
And what is the real cost to you?… let’s think of it in 100k increments. Say your income is 100k. Then the management of your group by the president is taking one half of one fiftieth of that 100k – so 1k. Then, after taxes that is ~$600 per year.For this the person is dealing with all the headaches, and (hopefully) keeping admins happy so that they don’t take your contract to RP, or something equally odious. This is not a fun job, nor is it pleasant. It protects you, though. Cheap insurance.
I have no real idea if your presidents 50% time on admin is too much. but, neither do you. I get annoyed at people who criticize from a position of no data. You need to investigate to see if your instinct is correct, don’t just shoot from the hip. I recommend that you find some of the meetings that the president attends – ones that you could go to as well, and talk to the president beforehand about what will happen in the meeting and what sort of background there is. What each issue means: Is there a hidden agenda that will hurt the group? Who are the friends and enemies in the room in this meeting? it takes a lot of time to develop this local knowledge that is crucial to effectively represent the group.
Of course – do it on your own time, and make sure to fulfill your RVU quota for the day, because that is what you are asking the president to do. Better yet, get on some hospital committees, like credentials, medical executive committee, IRB, and again do it on your own time. Experience for yourself what it is like, over some months of time, then report back.
There are many many radiologists on this board who would kill to have one of their own representing them, and protecting them, as opposed to being run by a businessman who is employed by a PE company or the hospital.
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There are many presidents who read way below average RVU on the days they’re on clinical service, causing a greater burden on everyone else, all the while taking home the same pay for the day.
Then they have excessive amounts of admin time where they sit on the phone all day talking to their buddies about how the young millennial radiologists are so awful and it was better back in the day when they were young guns.
I’ve listened to you people for years in the reading room next door. You’re not working on your admin days (or on your clinical days where you are still doing “admin” stuff).
Then on top of that you sold out your group to private equity so there’s no future for any new radiologists joining the group. Shame on you!-
admin time is BS
I do admin work and you cant fit into some preplanned day
the only solution is for the group to accept that those doing admin work may have times where they are less productive.-
The two groups I have worked with, the president was either the highest producer or in the top quartile, even when they were considered ‘80% clinical’. Even with a employed MBA type CFO/COO, there are things that require a physician to represent the group. Your CFO is not going to be of much use if you need to meet with ‘Dr X the abrasive neurosurgeon’ or there is a need to meet with a rad about tardiness, focking a tech or productivity issues.
If the president does his job, the protected admin time may be the best investment you can make as a group.The other issue is scheduling. If you don’t delegate that as a clerical task and your schedule is difficult to build, the person who does it should get some protected time.
Radiologist time is the most expensive resource you have in a practice. The cost for an hour of admin time is not an hour of partner pay, it’s an hour of partner revenue.
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If the president runs the group well, I don’t care how little clinical work he/she does, I will support them.
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I agree with FW.
Generally speaking (there are obvious exceptions to everything), these CEO type rads are high producers, even when you count the added burden of administrative responsibilities. Typically these are guys who are workaholics / driven to go above and beyond as they know very well there is no extra compensation (or recognition for that matter) for the extra work and headaches. Usually they put work and group responsibilities ahead of other facets of their life such as family time, health and vacations, etc. etc.-
Admin time is essential to acknowledge leadership roles. It rarely adds up in the administrator’s favor. It needs to be standardized and protected.
There are rare groups who get carried away, and pay for every minor meeting etc; which becomes ridiculous. That in fact is the result of a lack of leadership. Everyone needs to accept some responsibility for group management, it’s part of the job; including accepting delegated responsibility. If a group can’t establish that expectation, not much hope success.
You need leaders and followers. In too many groups everyone thinks they are a chef… -
A quality non corrupt leader who sacrifices for the group is worth their weight in gold. They are often the highest achievers and ask for minimal in return; they simply want the group to succeed.
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Youre right. But even such a person acquires enemies. There will always be a few resentful problem children.
Heavy is the crown.-
Agree, even the best leaders receive little credit during their tenure. Its only realized when average or poor leader comes after or people from outside groups who are hired
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We do not have administrative time off. We also do not have business types in management.
As has been said on here from many- the administrative work often cannot be controlled by a schedule.
The hospital CEO wants to talk to you and you make it happen. Phone calls and complaints don’t happen on a schedule and neither do issues that individual radiologists run into everyday.
There still needs to be considerable time keeping a group running well especially in today’s environment. Those in leadership positions get paid extra monthly. If you have a meeting you come in early and clean up before and after, etc. -
A group needs physician leadership. That leadership needs to hire non-MD professionals to do work when appropriate and get better results for less cost. Makes no sense for a radiologist to be doing stuff they were not trained to do, while getting out of revenue-generating clinical work.
But there will be things that legitimately require a physician leader to do, and they need to be given time or money to do that, you can’t expect them to do it for free. It might be making out the physician work schedule. It might be taking phone calls of various radiologists who need to complain or vent and to hold their hand.
If you refuse to give admin time to the group president or whatever title you give them, you are basically asking them to volunteer their time to do it, and the people you want doing this may not want to do it. Then you’re left with the few people who are willing to do it, and they may do a crap job at it.
They definitely should not be “milking” the position to have their feet up or get easy days. But the fact is that in every group, there will be rank and file who will always balk at the group leader getting time they need and say, “he’s just sitting on his azz.” But then when you tell those rads, “okay tell you what, you go meet with those vendors/hospital admin/technologists etc, just go into the meeting prepared and do X Y Z,” they will be the first to say, “no thanks, I’d rather sit here on my butt and read CTs.”
And the compensation given to the group leader can be time or money – if time, that means they do less clinical work some days and are getting paid the same. If money, it means they are still doing their full clinical load that day but then getting paid something for the admin time they are billing. If the amount the group gives them for admin time is too little, no one will want to do it, as you’d rather pickup some shifts or do other paid clinical work than do admin stuff and get paid much less. -
I spent time in physician leadership in a large pp group. Usually the physician president or top leader of a rad group is not a position sought after. We would have early AM and after work meetings; difficult interactions w/ hospital admin; etc.
Looking back, I would have rather just been someone showing up, reading cases and then taking off for home or whatever. So much more simple. It’s a stressful job being in physician leadership b/c often times decisions you make are met w/ pissed off partners on the one hand and compliments from others. Sometimes you just can’t win. Over time it takes its toll.
I don’t think there is a one size fits all answer for admin compensation. But you need rads in physician leadership.
Quote from Flounce
A group needs physician leadership. That leadership needs to hire non-MD professionals to do work when appropriate and get better results for less cost. Makes no sense for a radiologist to be doing stuff they were not trained to do, while getting out of revenue-generating clinical work.
But there will be things that legitimately require a physician leader to do, and they need to be given time or money to do that, you can’t expect them to do it for free. It might be making out the physician work schedule. It might be taking phone calls of various radiologists who need to complain or vent and to hold their hand.
If you refuse to give admin time to the group president or whatever title you give them, you are basically asking them to volunteer their time to do it, and the people you want doing this may not want to do it. Then you’re left with the few people who are willing to do it, and they may do a crap job at it.
They definitely should not be “milking” the position to have their feet up or get easy days. But the fact is that in every group, there will be rank and file who will always balk at the group leader getting time they need and say, “he’s just sitting on his azz.” But then when you tell those rads, “okay tell you what, you go meet with those vendors/hospital admin/technologists etc, just go into the meeting prepared and do X Y Z,” they will be the first to say, “no thanks, I’d rather sit here on my butt and read CTs.”
And the compensation given to the group leader can be time or money – if time, that means they do less clinical work some days and are getting paid the same. If money, it means they are still doing their full clinical load that day but then getting paid something for the admin time they are billing. If the amount the group gives them for admin time is too little, no one will want to do it, as you’d rather pickup some shifts or do other paid clinical work than do admin stuff and get paid much less.
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Usually the physician president or top leader of a rad group is not a position sought after.
I learned one important lesson – if it was obvious the person was pushing to be the chair/president – you need to be VERY suspicious. the best ones are the ones who don’t seek the job, but do it out of a sense of duty
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Agree w/ you P.S.
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Agree with the last two posters. Being the President of a private practice is a difficult and thankless job. Even if the group does have competent back office administration it is still a private practice and must be governed effectively. It is amazing to me how many groups skimp on the management side due to cost but have the radiologists run the group. If you look at the production of just one FTE radiologists you can buy a whole lot of professional infrastructure.
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Quote from Daniel Corbett
Agree with the last two posters. Being the President of a private practice is a difficult and thankless job. Even if the group does have competent back office administration it is still a private practice and must be governed effectively. It is amazing to me how many groups skimp on the management side due to cost but have the radiologists run the group. If you look at the production of just one FTE radiologists you can buy a whole lot of professional infrastructure.
So in your opinion is it more appropriate to have the majority of radiologists doing clinical and non physician administrators doing most of the group administration? -
Quote from Jbachler
Quote from Daniel Corbett
Agree with the last two posters. Being the President of a private practice is a difficult and thankless job. Even if the group does have competent back office administration it is still a private practice and must be governed effectively. It is amazing to me how many groups skimp on the management side due to cost but have the radiologists run the group. If you look at the production of just one FTE radiologists you can buy a whole lot of professional infrastructure.
So in your opinion is it more appropriate to have the majority of radiologists doing clinical and non physician administrators doing most of the group administration?
There are a limited number of tasks in managing a practice that are most $$ efficiently by a radiologist.
Some glad-handing/politics, some strategic work, complex negotiations, performing oversight of and providing direction to hired administrators, etc …
But the nuts and bolts are going to done better and more cheaply by hired non-physicians.
Trying to find a physician leader who excels at the above skills, delegates efficiently, and only takes as much time administrating as they need so that they continue to support the group with billings … that’s not easy.
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The politics of many small to medium radiology groups would make Machiavelli proud. In my experience, there is frequently a cohort of rads who prefer to control things from behind the scenes, and try use leadership as their mouthpiece.
It can be exhausting trying to keep the various factions in a group satisfied, if not impossible. Some will expect leadership to promulgate policies and demands no matter how unreasonable, to embarrassment. It is especially easy for them, as they don’t interact with the outside, and don’t have to deal with the conflict. The leaders are the ones who have developed outside relationships, and who need to manage them.
Some groups are so decentralized, their governance is simply a tally of votes, with a mouthpiece. No way do you want to be in that position. Lead with a transparent agenda, and if unacceptable to the group, don’t accept that leadership position.
So having sufficient grown-up administrative support, and potentially outside independent consultation, can keep things above board. Some groups are so provincial and dysfunctional, there is a core who will do anything to maintain a flawed status quo, no matter how bad for practice viability and longevity, because it is good for them. The last thing they want is independent or honest outside assessment bringing to light practice inequities.
Most people don’t want to be in group leadership because it is frequently more stressful dealing with your own group than it is with the outside. So be careful before being sucked in. If it’s a remedial situation, leadership can be a rewarding experience. On the other hand, some groups can’t get out of their own way and are simply not sustainable. Knowing the difference between the two isn’t always easy. Caveat emptor.
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Quote from Daniel Corbett
Agree with the last two posters. Being the President of a private practice is a difficult and thankless job. Even if the group does have competent back office administration it is still a private practice and must be governed effectively. It is amazing to me how many groups skimp on the management side due to cost but have the radiologists run the group. If you look at the production of just one FTE radiologists you can buy a whole lot of professional infrastructure.
I think it is because many want what they want now, with long term group viability not being a concern. This is especially problematic for young partners, as they have the most to lose.
investing in infrastructure, which includes appropriate management, is fundamental to the success of any organization. Physician groups in general skimp, and so frequently give up and ultimately sell out.
It’s so typical. -
Quote from boomer
Quote from Daniel Corbett
Agree with the last two posters. Being the President of a private practice is a difficult and thankless job. Even if the group does have competent back office administration it is still a private practice and must be governed effectively. It is amazing to me how many groups skimp on the management side due to cost but have the radiologists run the group. If you look at the production of just one FTE radiologists you can buy a whole lot of professional infrastructure.
I think it is because many want what they want now, with long term group viability not being a concern. This is especially problematic for young partners, as they have the most to lose.
investing in infrastructure, which includes appropriate management, is fundamental to the success of any organization. Physician groups in general skimp, and so frequently give up and ultimately sell out.
It’s so typical.Nice narrative but I don’t know of any group who sold out because administrating the group was too difficult.
-Not saying pp groups are well run- quite the opposite-
Group demise likely multifactorial in most situations.
Also HCA wanted to give Envision a run a threw many groups under the bus. Other systems likewise.
I’ve also noted that dysfunctional groups that sell are more dysfunctional than before the sale, not less. -My limited experience with PE groups. -
2-4 people on admin every day in a group of 50 rads is excessive and a waste.
What is best will greatly depend on the type of group. A hospital based group which mainly just collects professional fees and has minimal employees is a far different beast from an outpatient group with lots of assets and hundreds of employees.
Nothing will ever beat the involved, capable and fair business owner/partner that is motivated by the desire for their own company to thrive. The million dollar question will always be does your group possess such a thing. -
All depends:
Is it one hospitals or more?
Is there some funding from the hospital, expecting the care and feeding of the modalities’?
Is there a residency program?
Is there an affiliatio with a Univ that requires admin work in the Univ -
In a similar size group, with several people getting admin. Chair gets the most, about 20% and usually 1 person on admin each day. (I get 1 a month to help with scheduling) . We’re an extremely transparent group and all that recieve admin do far more work in a month that could be covered in one day. And there are several that contribute outside clinical duties without admin, it’s an imperfect system. We also structure daily workload to allow some down time for meetings etc
To those saying to hire out all the duties to non – MDs, that pretty short sighted just to squeeze out more RVUs. There’s a lot more to success that the maximum $ per rad-glad I found a group that practices that way. -
Quote from frank the tank
We do not have administrative time off. We also do not have business types in management.
As has been said on here from many- the administrative work often cannot be controlled by a schedule.
The hospital CEO wants to talk to you and you make it happen. Phone calls and complaints don’t happen on a schedule and neither do issues that individual radiologists run into everyday.
There still needs to be considerable time keeping a group running well especially in today’s environment. Those in leadership positions get paid extra monthly. If you have a meeting you come in early and clean up before and after, etc.
Kudos to your group for maintaining such a healthy environment.
I imagine you have good leaders who manage this though.
That’s the key; good leaders, and members who are willing to follow.
Also, it only takes a few dysfunctional colleagues who can poison the well.
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