-
How much time for new hires to get “up to speed?”
How much time would you say a new hire takes to get “up to speed?” Obviously, a seasoned partner coming into your practice from XYZ is going to have a different on boarding than a fresh fellow. Is it 3 months, 6 months, 12?
Just getting a feel. -
40 Replies
-
Our new hires are given 1 year off of the performance plan.
-
3 months should be enough to learn a new PACS, make templates, understand the workflow, and get into the groove. If they aren’t decently efficient by 3 months there is either a knowledge gap or a confidence issue.
-
Depends how fast your radiologists are reading, whether it’s average community practice pace versus Warp Speed Defcon 5 Nuts. In my group, by one year most new guys fresh out of training are doing okay. I’ve done moonlighting in some groups where some rads never quite get up to speed and are given nicknames by the other partners, one guy in his 50s was called “Roughin’ It.” I worked a weekend for a group that covered two hospitals including a level 1 and I fell behind by a hundred CTs by noontime, even the IR guys were hopping on to help clear my list.
-
to OP:
The new hire is desperately trying not to make mistakes as it is the first time for them signing off reports on their own. Everyone will take their own time. We give about 6 months.-
3-6 months should be good. Our good and or faster rads are usually up to speed in a couple weeks though. Fast PACS, somewhat fair worklist. The ones that are slow after a few weeks, stay slow forever.
-
how much are you taking advantage of them during their associate track?
if you’re doing a severe skim job i’d say 2 years
if you’re doing a moderate skim job i’d say 1 year
if you’re doing a mild skim job i’d say 6 months
no reason for a new associate to show the lazy senior partners how fast you can actually read because then they’ll expect you to do that all of the time and also get paid a fraction of your true worth. every associate should slow their speed so that their pay per RVU is close to partner level. if partners want fast associates they should pay for that service in this job market.-
Excellent. Not sure if it works this way, but it should. Lot of skimming in PP.
Quote from bluedeep
how much are you taking advantage of them during their associate track?
if you’re doing a severe skim job i’d say 2 years
if you’re doing a moderate skim job i’d say 1 year
if you’re doing a mild skim job i’d say 6 monthsno reason for a new associate to show the lazy senior partners how fast you can actually read because then they’ll expect you to do that all of the time and also get paid a fraction of your true worth. every associate should slow their speed so that their pay per RVU is close to partner level. if partners want fast associates they should pay for that service in this job market.
-
What is the typical expectation of being “up to speed”? Say, if one primarily reads cross sectionals.
-
My group has a “ramp up year” the first year where theres no rvu and “practice building” expectations.
-
What are typical private practice groups expectations for new/pre-partner wRVU per day or per hour for let’s say a general body imager, somebody who is body fellowship trained who reads primarily CT C/AP with body MRs and also takes day call on weekends?
Trying to gauge my job offers as a new fellow. I realize this varies all over, but just trying to ball park. One job is expecting 8-10 wRVU/hr in 8 hour shifts in the above scenario, which seems pretty busy. Idk what is expected of partners -
Very busy practice, at 8-12 months I can see how fast/slow someone is going to be.
-
one year.
Quote from PeachSnapple
One job is expecting 8-10 wRVU/hr in 8 hour shifts in the above scenario, which seems pretty busy.
That is too much. Way too much. -
If youre reading bunkered body imaging without a bunch of plain films, 8-10 RVU/hr is reasonable IMO.
If you have to do fluoro, drains, biopsies – different story.
-
Quote from gg1184
My group has a “ramp up year” the first year where theres no rvu and “practice building” expectations.
Sounds like a great old-school group. Unfortunately an anomaly these days.
-
-
-
-
-
-
-
-
Quote from RadCog
3 months should be enough to learn a new PACS, make templates, understand the workflow, and get into the groove. If they aren’t decently efficient by 3 months there is either a knowledge gap or a confidence issue.
Agree.By the end of 2 months, you will know that someone is a fast reader or a slow reader.
OCD types are very common in radiology and they are usually very slow. Many of them claim that they are more accurate similar to people who wash their hands 25 times snf believe that others are dirty.
-
Two related questions here:
1. What is an appropriate “ramp up” expectation for new hires? I think 6 months at least, maybe a year. People shouldn’t come into a group right out of fellowship with the full volume pressures of everyone else. Not necessary and not good for morale.
2. How quickly will you know how fast someone is going to be? Usually much earlier than that. Maybe a month or two, sometimes sooner. People usually declare their growth curves pretty quickly. Occasionally you get surprised down the road, but not often. -
Quote from OnsiteRad
Quote from RadCog
3 months should be enough to learn a new PACS, make templates, understand the workflow, and get into the groove. If they aren’t decently efficient by 3 months there is either a knowledge gap or a confidence issue.
Agree.
By the end of 2 months, you will know that someone is a fast reader or a slow reader.
OCD types are very common in radiology and they are usually very slow. Many of them claim that they are more accurate similar to people who wash their hands 25 times snf believe that others are dirty.
They also love to talk about how clinicians bring them cases to review that were read by other radiologists. Whenever I hear that I roll my eyes…like OK it happens maybe a few times a week at most. So why do you only read 15 cases a day again?-
with assigned worklists, everyone reads the same number of cases when on a given rotation. if they want to talk to clinicians all day long, have at it, they can stay late to finish up their work every night and eat dinner in the cafeteria.
-
Quote from Flounce
with assigned worklists, everyone reads the same number of cases when on a given rotation. if they want to talk to clinicians all day long, have at it, they can stay late to finish up their work every night and eat dinner in the cafeteria.
love this. Who does your assigning? Robo or a real person?
-
I hate to say it, but we can usually gauge someone’s speed and ability within 2-4 weeks of working in private practice (after training or coming from a different practice).
Can some people dramatically improve over time? Certainly, but these people are outliers, in my opinion.
Usually, you know quickly how productive (or not) a radiologist is or will become. It does not take a year, from my experience. -
RE: assigned worklists
on some rotations, clerk assigns “buckets” of fixed number of outpatient plain films or CTs or MRIs.
Other rotations are based on site: e.g. cover plain films at site X from 4:30pm yesterday to 4:30pm today; or cover CTs from this time to that time. The latter type of rotation does not require active “assignment” because we have a sense of how many average studies are done in that period and it is reasonable. This is still considered an assigned worklist because all the work at that site is yours, if you left some behind then it’d be obvious it belongs to you, if you are fast and want to have a 2 hour lunch break it’s fine, or but if you are slow because you like to call up clinicians and make small talk then you might finish at 7pm instead of 5pm.-
.
-
Same set up. Honestly anything else seems archaic in this day and age.
-
Quote from Flounce
RE: assigned worklists
on some rotations, clerk assigns “buckets” of fixed number of outpatient plain films or CTs or MRIs.
Other rotations are based on site: e.g. cover plain films at site X from 4:30pm yesterday to 4:30pm today; or cover CTs from this time to that time. The latter type of rotation does not require active “assignment” because we have a sense of how many average studies are done in that period and it is reasonable. This is still considered an assigned worklist because all the work at that site is yours, if you left some behind then it’d be obvious it belongs to you, if you are fast and want to have a 2 hour lunch break it’s fine, or but if you are slow because you like to call up clinicians and make small talk then you might finish at 7pm instead of 5pm.
Good set up. I assume it can be done if the group is not very subspecialized.
Otherwise, the MSK guys will claim that their worklist is longer than Neurorads and body imager complain that the Nucs guys have it better.
Having said that, I would love to have assigned worklist.
-
We do it in a fully subspecialized group, but requires a certain size to be able to even things out. Who cares what people “claim”, all volumes are auditable-just need to accurately quantify work as time spent on studies/procedures(not RVUs)
-
Quote from Diagnostix
We do it in a fully subspecialized group, but requires a certain size to be able to even things out. Who cares what people “claim”, all volumes are auditable-[b]just need to accurately quantify work as time spent on studies/procedures([/b]not RVUs)
That’s the hard part. -
The studies are easy-powerscribe dictation time. Use the median from tens of thousands of studies and you’ll realize a CT AP is about 5x work as a plain film etc. Can get as broad or minute as your infrastructure allows. Procedures you just survey for total procedure time and you’ll get pretty close (joint injection = 3 CTs = 15xrays for example) . If you don’t have the manpower to tally in real time, you use average procedural volume or study volume in a shift and just keeping working on it.
-
“Otherwise, the MSK guys will claim that their worklist is longer than Neurorads and body imager complain that the Nucs guys have it better.”
People worry about this, but if you really think about it, it doesn’t make sense when the alternative is a shared worklist and it is not an issue once assigned worklists are implemented well and tweaked over time.
Shared worklist: read at whatever speed you want so long as you don’t raise any red flags among your partners that day and at the end of the month or end of year audit. The difference in work done between the fastest readers and the slowest readers can be substantial with shared worklists. If group morale is good and people trust each other, this is the most productive and best approach IMO.
Assigned worklist: prevents cherry picking and large variations in productivity. yes, some people will always complain because they think their own subspecialty is the hardest to read and should be given the most time. BUT, over time, you can – by looking at data from various subspecialty radiologists and including input from people in different subspecialties (and often group leadership does include people who read a variety of studies) – iron out major issues with the “conversion factor” e.g. how many screening mammograms in four hours vs. how many MSK in four hours” such that it’s reasonable albeit not perfect. Even the neuro guy who thinks the neuro rotation assignment is more than it should be and that the MSK guys have it easy – even he can appreciate the benefits that his colleague the other neuro guy who is a goddang slowpoke is now required to read the same number of neuro MRs as him when on that rotation.
“Reasonable but not perfect” is infinitely better than it being the Wild West of letting the individual radiologist decide how much they want to read a given day. -
Good points.
Plus, if someone is really complaining about their own subspecialty that they choose to get extra training in so that they could read more of these exams (knowing which subspecialties had the highest RVUs [mammo, neuro, etc] in training…or at least, they should have known), then I really don’t have much sympathy (or empathy) for them.
If you are really sore about that point, then go back and get more training – it looks like most fellowships are wide open in this job market anyway. It’s just not a good excuse on the partner RVU front in my opinion. -
I would love to switch to assigned worklists. Our leaders, however, would never go for it.
-
To be fair, RVU changes with the stroke of a pen and the highest RVU subspecialties when many people trained are no longer highest RVU.
Choosing a subspecialty based on RVU is a fool’s errand.
Quote from DOCDAWG
Good points.
Plus, if someone is really complaining about their own subspecialty that they choose to get extra training in so that they could read more of these exams (knowing which subspecialties had the highest RVUs [mammo, neuro, etc] in training…or at least, they should have known), then I really don’t have much sympathy (or empathy) for them.
If you are really sore about that point, then go back and get more training – it looks like most fellowships are wide open in this job market anyway. It’s just not a good excuse on the partner RVU front in my opinion.
-
Assigned worklists are good because you are fine if you show up and get the work done.
WRVUs add another layer of stress and complexity.
-
Its radiology. How hard can it be? I don’t understand when people complain. Its not like I go home with a sore back. I click, I dictate, I sign, I repeat.
-
Outside of IR, which RVUs for common studies have changed significantly in the past 20 years in radiology (other than them all going DOWN across the board )?
I’d just like to see some data to support that claim.
-
OK.
Quote from DOCDAWG
Outside of IR, which RVUs for common studies have changed significantly in the past 20 years in radiology (other than them all going DOWN across the board )?
I’d just like to see some data to support that claim.
Yes, they have all gone down. Some more than others. Over the years our MSK rads used to be the top producers, then for a while IR, then for a while neuro. Right now mammo is king of the hill.
Of course we use the term ‘RVU’ but in reality the RVU, the wRVU, the conversion factor and other manipulations in the complex payment formulas play a role in what we are actually paid.
I’m sure you are very capable of using search tools yourself, so just as an example I’ll provide this publication of reimbursement comparison data from 2005 to 2020 for MSK.
A highlight
“After adjusting for inflation, mean reimbursement for all procedures decreased by 32.41% ([i]P[/i] = .013). The mean adjusted percentage change per year was 2.82%, and the mean compound annual growth rate was 1.03%. Compensation for the professional and technical components for all CPT codes decreased by 33.02% and 85.78%, respectively. Mean compensation for the professional component decreased by 36.46% for radiography, 37.02% for CT, and 24.73% for MRI. Mean compensation for the technical component decreased by 7.76% for radiography, 127.66% for CT, and 207.88% for MRI. Mean total relative value units decreased by 38.7%. The commonly billed imaging procedure CPT 73720 (MRI lower extremity, other than joint, with and without contrast) had the greatest adjusted decrease of 69.89%.”
(edited to remove a table that didn’t format legibly)
[link=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10034301/]https://www.ncbi.nlm.nih…./articles/PMC10034301/[/link]
-
Table 2[/h1] Mean 2005 and 2020 Unadjusted and Adjusted Reimbursement Rates and Percentage Change for Selected Lower Extremity Imaging Procedures: Technical and Professional Components[i] a[/i]
2005 Mean Reimbursement, US $2020 Mean Reimbursement, $Mean % Change, Year to Year (Adjusted) % Change, 2005-2020[i] b[/i] CPT CodeUnadjustedAdjusted to 2020CAGR (Adjusted), %UnadjustedAdjusted 73720 734.26 991.25 298.50 7.52 5.82 59.35 69.89 73723 734.52 991.60 345.50 6.63 4.90 52.96 65.16 73721 344.42 464.97 174.97 5.56 4.41 49.20 62.37 73719 413.12 557.71 233.18 5.46 3.74 43.56 58.19 73718 344.22 464.70 197.10 5.27 3.65 42.74 57.59 73700 171.76 231.88 108.36 4.68 3.02 36.91 53.27 73701 199.89 269.85 135.56 4.19 2.56 32.18 49.76 73722 413.12 557.71 280.45 4.33 2.55 32.11 49.71 73702 242.62 327.54 178.35 3.71 2.03 26.49 45.55 73620 18.69 25.23 19.36 1.68 +0.24 +3.58 23.27 73590 29.97 40.46 32.03 1.48 +0.44 +6.87 20.83 73650 18.18 24.54 19.61 1.42 +0.51 +7.87 20.10 73630 30.35 40.97 34.28 1.12 +0.82 +12.95 16.33 73560 29.97 40.46 35.04 0.88 +1.05 +16.92 13.39 73600 28.04 37.85 33.16 0.79 +1.12 +18.26 12.40 73610 30.35 40.97 36.53 0.71 +1.24 +20.36 10.84 73660 23.80 32.13 29.43 0.50 +1.43 +23.66 8.40 73562 33.00 44.55 41.03 0.41 +1.46 +24.33 7.90 73564 36.85 49.75 45.88 0.47 +1.47 +24.50 7.77 73565 28.81 38.89 40.66 +0.40 +2.32 +41.13 +4.54 Mean 195.30 263.65 115.95 2.82 1.03 8.75 32.41
[link=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10034301/table/table2-23259671221147264/?report=objectonly]Open in a separate window[/link]
[i]a [/i]CAGR, compound annual growth rate; CPT, Current Procedural Terminology.[i]bP[/i] = .013 for comparison between unadjusted and adjusted percentage change.
-
Yea, this information is basically useless. It looks like most modalities have simply been slashed across the board.
Unless you can give subspecialty specific reimbursement data over the years (which admittedly would be hard to find), then it’s going to be difficult to compare. I can’t find that data, either.
Doesn’t matter that much anyway.
Irrespective of modality reimbursement (and assuming you are not just reading plain films), the highest producers usually still just outwork everyone else (if you really drill down on the numbers). I would bet that holds true for nearly all groups.
-
It sounds like you’re asking for data comparing reimbursement cuts between subspecialties. There is probably someone that has that but I’m not going to look for it, it is a beautiful day.
I remember when our MSK readers went from the top $$ producers to the bottom half in one month, and their volume read did not change.
My original point was no one should choose their fellowship based on RVUs or which subspecialty is best paid at that moment.
Quote from DOCDAWG
Yea, this information is basically useless. It looks like most modalities have simply been slashed across the board.
Unless you can give subspecialty specific reimbursement data over the years (which admittedly would be hard to find), then it’s going to be difficult to compare. I can’t find that data, either.
Doesn’t matter that much anyway.
Irrespective of modality reimbursement (and assuming you are not just reading plain films), the highest producers usually still just outwork everyone else (if you really drill down on the numbers). I would bet that holds true for nearly all groups.
-
That’s fair. I agree, etc.
-
-
-
-
-
-
-
-
-
-
Good question..To me seems like groups are expecting the new grads to get up to speed sooner these days. Its a challenge as many of the newbies are coming from a world where sub-specialization is the new, then they are expected to read general (some of which can be complex) at a PP rate.
I’m about 10 years out and have bounced around a bit. Still progressively getting faster with each year/new practice.
