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How do private groups measure production?
RVU’s? Shift time? Revenue generation?
We are a democratic group and everyone is paid equally. But our productivity measurement is in serious need of revision.
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28 Replies
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measuring productivity between different divisions is exceedingly difficult IMO. i think the best way is to ensure that within each division there are no outliers.
i don’t see any good way of comparing someone doing fluoro, US, and body CT to someone doing mammo or neuro.-
I’m assuming using wRVU’s are better that total RVU? Are they still wildly inaccurate for things like mammo and Neuro?
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Quote from Nightrain
I’m assuming using wRVU’s are better that total RVU? Are they still wildly inaccurate for things like mammo and Neuro?
Yes
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Quote from RadCog
measuring productivity between different divisions is exceedingly difficult IMO.[b] i think the best way is to ensure that within each division there are no outliers.[/b]
i don’t see any good way of comparing someone doing fluoro, US, and body CT to someone doing mammo or neuro.
That’s what we do here.
The MSK section is now 70% plain film at the minimum … just no way to compete with an all advanced imaging neuro section-
The best PP groups, with like minded hard workers don’t need to measure. They trust each other.
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Quote from Thread Enhancer
The best PP groups, with like minded hard workers don’t need to measure. They trust each other.
Trust only works up to a certain group size and with significant skill overlap among radiologists. I never worked in a pp group that looked at rvus.
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General wrvus are tracked. Most people know what a shift should feel like wrvu wise. The slow rads are usually confirmed in the data.
No wrvu bonuses though for the most part.
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Correct Drad. That why I said the best. Probably impossible to find the right mix above about 12.
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I like this a lot but there are so many people who raise their voices in protest and blow it up. I think there are ways to even things out with extra days off or some such way without making everyone nuts
Its impossible to get even and anyone who thinks its possible is likely to always be unhappy.
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wrvu, more for CTA runoffs than brain MRI.
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For what its worth, my experience with productivity measures and observations.
[ol][*]Measuring productivity is unavoidable. Understanding RVUs and where you stand is helpful. I had times I thought I was killing it, only to find I was average. Reality testing is helpful to all.[*]RVUs are flawed and need to be put in context. Comparing similar rotations/specialties has merit; comparing between them can be destructive.[*]RVUs can be weaponized. The RVU rich environs of say mammo or ED might use them for $, time off or shorter shifts etc. Road to perdition; like reading some screening mammos is comparable to an IR TIPS procedure? This is where it can be destructive. If your president or scheduler is a mammographer using RVUs as a basis for their management, your group is in trouble.[*]We dont contemporaneously report RVUs; as it becomes an unhealthy obsession, but rather report them periodically. A daily metric on the work station is unhealthy.[*]The best way to distribute work is with worklists, which has been discussed extensively. Balancing the worklists can be a challenge though.[*]Subspecialization frequently sequesters rads into silos; competing against one another rather than promoting the group. Mammo wants best for mammo, neuro for neuro etc. Again, potentially using RVUs as a weapon. This has to be overcome with centralized thoughtful leadership.[*]In small to medium PP, overly subspecialized radiologists are not sustainable. A certain amount of generalization is needed. Otherwise, the silo mentality overtakes group productivity and fairness. By doing different rotations you understand the travails of the oncoradiologist, fluoroscopist etc; empathy ensues. Its easier to try to make someone else eat a sheet sandwich, but when you have to periodically dine on it, it is less likely served.[*]Trying to slow down fast readers is almost impossible. Thats how they roll. Some are fast and great; many fast and mediocre. You can hardly ever get the latter to slow up and improve. If you give them more time, they will still read fast and play solitaire between cases.[*]Trying to speed up slow readers can be frustrating as well. Most will adapt to a workable pace. Slow doesnt mean good, with the really slow readers typically being broken on some level. The best rads I know are average speed, they know when to move on from a case. [*]We all like to work with the speedsters, but we just rarely ask most of them for advice. There is a reason for that. No-one wants to work with the slow readers.[*]Anyway, in a decentralized group RVUs can be a problem in that they are commonly weaponized by those in high RVU rotations. In a well led group, they can be a reality test and a source of insight towards communal accountability. There are always some slackers, and they need to be managed; fortunately they are less common than you might think. Same for incompetence, relatively rare. Ultimately, outliers of both ilks are the problem we need to address, not micromanaging the Bell curve.[*]Lastly, there is a physical limit to productivity. Too many groups are breeching that physical limit by cramming unrealistic upward trending quotas down the throats of rads. Expecting everyone to be above the 50% is silly on many levels. The problem is not the RVU, but the psychopathology of those prostituting them. [/ol]-
assigned worklists
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wRVUs with a fair bump for peds. No trouble making avg at all.
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Quote from Midwest Eastern Rad
I like this a lot but there are [b]so many people who raise their voices in protest and blow it up[/b]. I think there are ways to even things out with extra days off or some such way without making everyone nuts
[b]Its impossible to get even and anyone who thinks its possible is likely to always be unhappy[/b].
Bold #1 true.
Bold #2; my experience is the ones being subsidized are the unhappy ones and “blow it up”. The right partners don’t expect “even”. They do expect some form of fairness and bend over backwards to help colleagues.-
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Please just use assigned worklists. It’s 2023.
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Nate and MIR, you have me convinced.
I still like the idea of working with a small group of partners that see eye to eye. It’s getting harder and harder to find that mix.-
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But how do you assign what studies goes to what rad? AI software? IT?
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Clerk assigns outpatients twice a day.
Stat rotations like covering ER or inpatient or urgent care centers is still by shift and cobbles together sites based on annual audit of volumes to make sure its reasonable and comparable to other coverage rotations. If not enough , add sites or assign X number of outpatients to that ER CT coverage rotation.
As long as people all rotate through the stat coverage rotations with similarly frequency , it all evens out over time.
Assigned worklists are not some experimental or novel workflow. Its done in many practices and is tweaked until its reasonable and fair, and evolves over time with the practice.
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There is too much variability in groups (size, subspecialization, in house vs tele, call, etc.) to say what will work the best for your individual group. Once you open the Pandoras box of RVUs, you cant close it. Half of the group will think they are working too hard and its not fair. The other half will have excuses about why their RVUs are lower (the types of cases they read, teaching, conferences, marketing, etc.)
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Which worklist does the overread of the fast partners already signed post op oncology NCAP CT with comparison PET/CTs , and useless report go on? And as long as Im here, can you look at a couple others for me?
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Quote from Thread Enhancer
Nate and MIR, you have me convinced.
I still like the idea of working with a small group of partners that see eye to eye. It’s getting harder and harder to find that mix.
It’s so easy to say you have a “like minded group of partners” when there is no accountability and zero objective data. We thought we had a “like minded group of partners” but when the financial pressures of running a business made evaluating overall productivity necessary it was shocking the disparity that existed between rads, really stunning and depressing. And this is grouping rads based on their typical rotations so its an apples to apples comp. Some of the loudest voices that thought they were the most productive people werent even covering a 1/3 of their salary.-
There is a thread about this every 2 weeks. Its been discussed ad nauseum with a few different perspectives. Bonusing out RVUs usually doesnt work because then nobody wants to pick up the plain films or other scut work.
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Quote from Nightrain
RVU’s? Shift time? Revenue generation?
We are a democratic group and everyone is paid equally. But our productivity measurement is in serious need of revision.
Definitely not rvu or revenue generation. Figure out average time to dictate for different types of studies (dictation start to sign time) , and average time to perform certain procedures etc and use that to equalize work between subspecialties.
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Quote from Nightrain
RVU’s? Shift time? Revenue generation?
We are a democratic group and everyone is paid equally. But our productivity measurement is in serious need of revision.
Are there any private groups left?
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The best scenario is PE groups balance out with pp groups. Both will be forced to behave. Not sure PE can survive if there are always pp options for radiologists though.
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