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How bad are your lists?
Realize theres a shortage, but our volumes keep going up. Having difficulties hiring. Now 48-72 TAT for outpatients.
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49 Replies
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we are fully staffed thankfully. it’s fairly rare if outpatients sit for over 24 hours and when that happens our PACS guy emails all the rads in the department so someone can pick it up next.
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Fully staffed but always cranking. TAT for bread and butter outpt exams is same day; though some PET/CT, MSK/Body/Neuro MR cases we will let roll a day until the more specialized reader is available to pick off.
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Nearly fully staffed. Volumes are at all time highs. Turnaround time not that bad though given home readers helping for overtime
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OP TAT can reach 48-72 hours. Volumes higher than last year.
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We’re about 5-6 FTEs short (compared to >20 FTEs low in 2018)
Volumes at an all-time high. Internal moonlighting gets the >24 hr list back down to zero by the end of the day just about every day.
We’re paying the equivalent of ?4 FTEs in compensation to internal moonlighting now…. we’ve grown very dependent on it.
(Oh … and we *also* are sending some cases to our telerad company … doesn’t include MR, Nucs, breast. For a few brief months they had their act together on TAT, but now they’ve fallen back below performance goal again. Must have lost some people and/or tried to bite off some new work)
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What are total list volumes looking like for you all mid week, for example?
Before volumes really ramped up this past year or two, and we lost some rads, we were routinely 0’ng the list out. Now it is almost always sitting at 100-200 studies overall. Obviously our ER / stat turnaround time is easily under an hour, some of our OP TAT has creeped up to 3 days once in a while.-
The absolute lowest our unread all list gets is around 300 usually late Sunday afternoon. All that is left at that point are specialty studies that only have one or two rads who read them, some straggler breast/ nuc/cardiac and a few trainwrecks
Average end of the day unread all is around 1800 cases
(System volume is about 2 million studies per year)
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Quote from dergon
The absolute lowest our unread all list gets is around 300 usually late Sunday afternoon. All that is left at that point are specialty studies that only have one or two rads who read them, some straggler breast/ nuc/cardiac and a few trainwrecks
Average end of the day unread all is around 1800 cases
(System volume is about 2 million studies per year)
For a large academic type setup and given your volume that’s not too terrible I guess – as you mentioned must still make for some great moonlighting opportunities.-
everything done same day at our site. TAT for outpatients is hours at most, never more than 24 hours on the list unless it’s the rare exception of a challenging outpatient neuro/MSK case etc and corresponding subspecialty trained guy isn’t on that day. I’d say that happens like once every 6 weeks. Most of us can handle everything that is thrown at us every day of the week including Sundays. We do a decent amount of outpatients on Sundays as well.
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If you can’t grind, better to avoid PP Radiology…… -
^^ what setting in radiology other than maybe VA is not a non stop grind these days?
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Quote from Drrad123
^^ what setting in radiology other than maybe VA is not a non stop grind these days?
At my place the grind is opt-in
Any radiologist can choose not to grind and as long as they make a pretty easily attainable base level of clinical performance, they get their salary. -
I am OK with grinding from my lovely home office setup, but I have actually found it difficult to find such side gigs with good per RVU pay…. So people are complaining a lot out there but also don’t want to pay up to help alleviate the issue…. typical Rad behavior not a shock. -
Hey Dergon, can you only internally moonlight before or after the shift? Are the time stamps for dictations tracked? It’s an interesting issue. Some rads have bandwidth to read more studies during their shift, but why bother if it isn’t compensated.
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Quote from Umichfan
Hey Dergon, can you only internally moonlight before or after the shift? Are the time stamps for dictations tracked? It’s an interesting issue. Some rads have bandwidth to read more studies during their shift, but why bother if it isn’t compensated.
Only after hours or when taking vacation etc.
Yes studies are time stamped and audited.
Only recently have we been able to differentiate moonlighting from non-moonlighting productivity (by adding a special PACS tag to submitted moonlighting exams)
In order to participate in moonlighting a rad must have a baseline level of pre-moonlighting clinical productivity (63rd percentile)
Yes… there is the expected unintended consequence of people doing just enough routine work during their normal shift to make it over the line and then doing as much moonlighting as possible. That’s one of the reasons the program has ballooned.
But we’ve had the administration under-comping us for decades … so the current level of comp with base salary +moonlight to me feels fair for the moment.
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I was thinking 72 was bad, then I realised you meant hours and not days!
We report (nearly) all in-patients the same day, but <72 hours on out-patients is considered an excellent result and we have some unreported cases dating back to mid-March.
The joys of UK practice! -
Sounds like a good strategy with the “pre-moonlighting clinical productivity” criteria and PACS tag of moonlighting exams. Well thought out. It’s impressive that an academic hospital is allowing this.
There’s talk of rads losing quality due to reading too much (usually academic institutions). However, many excellent rads can maintain excellent quality while reading much more than average production. The lower quality rads stay low quality regardless of # of studies read. Just the way I’ve seen it over the years. -
Ortho hospital practice, usually list is 0 with cases read as completed for inpatient and majority of outpatient studies.
Non priority outpatient cases read within 1-2 days. -
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Yea same at our academic place. Our neuro outpatient list is generally clear within 18 hours of study completion, most studies within 2 hours. Our chest section is understaffed without hope of reinforcements and is at 250+ unread CTs, about a week old.
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Quote from maximusdecimus
Yea same at our academic place. Our neuro outpatient list is generally clear within 18 hours of study completion, most studies within 2 hours. Our chest section is understaffed without hope of reinforcements and is at 250+ unread CTs, about a week old.
Why don’t you throw these out for the general/ER rads to read? Is it a case of the thoracic imagers thinking only they can read chest? That’s what it was like where I was. -
We don’t go home until all the lists are clean.
It’s just a different culture. Once you allow stuff to spill over into the next day and people expect that they can walk out the door at 5, you get the 1000 study backlogs. -
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Quote from Catamount
That might work in a private group or where the rads have a say in the operations. But that doesnt work in academics. Admins would just continue to understaff FTEs for the volume, not increase pay for the increased work, and pocket the extra $$ for some bs pet project or vice chair of asshattery.
Yep. That’s PP. You ARE admin. Unread studies in the list are money that is waiting to be made.
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We based our outpatient TAT requirement on the movie, The Ring: 7 Days! Mortality of radiologists hasnt increased. Cant comment on patients.
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Quote from fw
We don’t go home until all the lists are clean.
It’s just a different culture. Once you allow stuff to spill over into the next day and people expect that they can walk out the door at 5, you get the 1000 study backlogs.Quote from Catamount
That might work in a private group or where the rads have a say in the operations. But that doesnt work in academics. Admins would just continue to understaff FTEs for the volume, not increase pay for the increased work, and pocket the extra $$ for some bs pet project or vice chair of asshattery.
That won’t work in any employed model.
That’s how you end up with AM threads titled “Radiology Group makes their rads stay all night until list are clean! [b]Do NOT JOIN THIS GROUP[/b]!”
It only works in an egalitarian true PP partner model.
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Quote from dergon
That won’t work in any employed model.
That’s how you end up with AM threads titled “Radiology Group makes their rads stay all night until list are clean! [b]Do NOT JOIN THIS GROUP[/b]!”
It only works in an egalitarian true PP partner model.
It’s called ‘mandatory overtime’ and every cop, firefighter, miner and amazon warehouse picker knows how it works. Boss-man tells you ‘you gotta hold over until 8 today, its time and a half’. You grumble and you stay until 8. That’s the downside of being a wage slave.
The other option is to hire adequately. -
The other option is to hire adequately.
and retain.
Nurture your rads to the best of your ability. Losing good rads is very expensive, in real dollars but also in morale and future recruiting. If you are losing people, you are poorly managed.
It is competitive and difficult to find good rads. But to use that as an excuse is lazy.
Its been said before, but to purposefully run lean is a naive mistake. It will backfire, and spiral. Its a policy dependent on hope; that there will be no obstacles down the road. Redundancy is a key to any successful practice, being prepared for illness, retirements, volume increases, new contract opportunities etc.
Anyway, same old -
The problem is that in this market stay late and clean the lists is in severe tension with retain your rads
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The fact is that there arent enough radiologists for all the groups out there to be adequately staffed
The undesirable jobs (PE backed RP/Luci/US, Envision, and crap low pay academia in name only) are going to become worse and eventually will be unable to keep up.
This is already BAKED INTO THE CAKE. No way mid levels or new residents could be trained in time. No way AI will be available at an acceptable level in time. The implication is that radiologists will work more and more and make a ton of money but at the cost of terrible work-life balance.
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Quote from seagull
The fact is that there arent enough radiologists for all the groups out there to be adequately staffed
The undesirable jobs (PE backed RP/Luci/US, Envision, and crap low pay academia in name only) are going to become worse and eventually will be unable to keep up.
This is already BAKED INTO THE CAKE. No way mid levels or new residents could be trained in time. No way AI will be available at an acceptable level in time. The implication is that radiologists will work more and more and make a ton of money but at the cost of terrible work-life balance.
Basically sums it up. -
Any news on the VA upping salaries? haha
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Quote from Dream Run
Any news on the VA upping salaries? haha
Think there is some variation between Va’s…..but from what I know in our area they are still in the 300’s….idk how they are retaining rads tbh…most rads I work with could make that in PJ’s doing 3-4 days from home without working weekends.
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Quote from ar123
Quote from Dream Run
Any news on the VA upping salaries? haha
Think there is some variation between Va’s…..but from what I know in our area they are still in the 300’s….idk how they are retaining rads tbh…most rads I work with could make that in PJ’s doing 3-4 days from home without working weekends.
I don’t think life-long VA rads could cut it doing tele for either a PP or PE group. Most VA rads already don’t work weekends AFAIK. -
loosing good rads is the worst. Rad managers are probably not trained to retain good rads. Agree with boomer on everything in the post. Our stat and OP lists get behind , but get cleaned up quickly. We are short on weekend radsperpetually.
Quote from boomer
The other option is to hire adequately.
and retain.
Nurture your rads to the best of your ability. Losing good rads is very expensive, in real dollars but also in morale and future recruiting. If you are losing people, you are poorly managed.
It is competitive and difficult to find good rads. But to use that as an excuse is lazy.
Its been said before, but to purposefully run lean is a naive mistake. It will backfire, and spiral. Its a policy dependent on hope; that there will be no obstacles down the road. Redundancy is a key to any successful practice, being prepared for illness, retirements, volume increases, new contract opportunities etc.
Anyway, same old
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Typically agree with boomer but disagree that churn in the current market is a sign of poor leadership. Its ubiquitous in most fields at the current time.
Would argue retaining key talent is more important than turnaround on the fringe
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Yup, lk ftw
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Quote from fw
Quote from dergon
That won’t work in any employed model.
That’s how you end up with AM threads titled “Radiology Group makes their rads stay all night until list are clean! [b]Do NOT JOIN THIS GROUP[/b]!”
It only works in an egalitarian true PP partner model.
It’s called ‘mandatory overtime’ and every cop, firefighter, miner and amazon warehouse picker knows how it works. Boss-man tells you ‘you gotta hold over until 8 today, its time and a half’. You grumble and you stay until 8. That’s the downside of being a wage slave.
The other option is to hire adequately.
I’ve never heard of that being used in a radiology practice before. Is that what your group does? Pays the associates time and a half of the equivalent of their hourly rate then tell them they have to stay as long as it takes?
Most employee radiologists are salaried. I know we are.
If some administrator at my hospital system… or even my chair…. tried to say “You all have to stay late tonight and nobody is leaving until the lists are at zero” you’d have 6 people stay and work diligently, 12 people stay logged on but barely working while milking the system for $350.hr to spite them, 80 who would simply ignore the order and go home at their regular time, and one or two who would fire back an email the equivalent of “go f*ck yourself”
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Quote from Catamount
Our outpatient chest lists are 2+ weeks out and that is with internal moonlighting. Nobody has anymore capacity. ER group is being crushed by volume and is about 60% staffed. If admin doesnt want to pony up the $ to finally hire then the lists will continue to explode and more people will leave.
Sounds pretty bad, imagine there are a lot of patient and clinician complaints, hopefully admin getting an earful -
Is there any potential liability to the radiologist having images sitting there for days or weeks?
At the end of the day, if I leave and there are studies left on the list, I feel a personal responsibility to quickly go through things like CT scans to make sure there is not something that cant wait till the next day to be discovered.
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Quote from acpce1
Is there any potential liability to the radiologist having images sitting there for days or weeks?
At the end of the day, if I leave and there are studies left on the list, I feel a personal responsibility to quickly go through things like CT scans to make sure there is not something that cant wait till the next day to be discovered.
Yes.
Sure, as a radiologist you can claim that you simply read what is given to you at the time … but that doesn’t protect you from being sued over a delayed diagnosis
Back in 2018 I seeing acute burst fractures 5 days out, a really delayed compartment syndrome read (somehow ordered routine) etc.
Yes, it puts the rads and the institution and the referrers all at risk.
(early in my career I was named in a lawsuit on a delayed interpretation of a CXR by 4 days. Circumstances were different … it was the 90s and an ICU fellow had removed an x-ray from the department without signing it out and personally mis-interpreted it. By the time it was recovered, associated, and put on an alternator 4 days later for me to see the free air bad things had happened.
I got dropped eventually but had to get deposed etc )
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Fully staffed. List cleared daily. Established partners now leaving earlier than designated shifts by 30-60 minutes.
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I used to work at a place that allowed lists to spill over day to day. It wasn’t all that uncommon to find PEs on cancer patients, perf’d diverticulitis and other things ordered as ‘routine outpatient’. I dreaded opening those ‘box of chocolate’ cases 3 days later. Its a very bad bad practice to do this. Not so much from a liability but a patient care perspective. The nuttiest thing we did was to leave plain films from outlying 1 provider rural clinics in the list for weeks. The only persons who saw that film prior to you was a part-time tech (the techs at those clinics also did phlebotomy, roomed patients and did registration) and a NP or PA who was often fresh out of school. Spooky!
The only thing that should roll over day to day are ortho clinic plain-films. -
What fw said
Extended TAT is bad on many levels. Its also the sign of a poorly managed practice. If you are understaffed for whatever reason; thats not a good practice. There are many reasons for it ranging from greed, bureaucracy to incompetence. But if people are leaving and you cant hire, its not just fate.
The team ethic to clean the list is essential to practice healthand patient safety. -
4-5 days behind on Neuro, body, and ultrasound. Demoralizing for sure.
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^^ why is it demoralizing when your practice has chosen not staff adequately? Did you make the decision to not staff properly?
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Quote from boomer
The team ethic to clean the list is essential to practice healthand patient safety.
There is a triumvirate of us MSK guys who read the bulk of the left over internal moonlighting x-rays.
One of the things I stressed to them was for us, to the best of our ability, to make sure that the list is at 0 by 8 am the next morning.
Part of that is political/ operational … I don’t want our leadership thinking we can’t handle it internally and deciding to send it out to telerads … my guys want the extra $$
But some of it is for safety. We’re now set up in such a way that no radiographs go unread for more than 36 hours after completion. It’s as good as we’re gonna get with current staffing and, imho, is quality enough.
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what is vrad paying their rads these days per rvu? And how do vrad lists look for those that work for them? just curious.
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