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Trying to fend off corporate radiology
Can anyone provide documentable evidence or hard numbers to support arguments that can be made to hospital admin why a corporate Radiology partner is bad for the hospital, quality radiology service, staff retention, etc? Need as much hard evidence as possible, not just, “they work us too hard and take all the money and your reads will suck and everyone will leave, and you wont be able to hire anyone, etc? While all of these things are true, in my experience, there will be a well-crafted counter argument from corporate radiology, honed over many acquisitions, to soothe the fears of hospital admin and other medical staff members, while the partners take their golden parachutes and ride off into the sunset after the 5 year vestment period, assuming they can make it that long after all the associates flee and theres no one left to do the work. Any help is appreciated. Thanks.
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19 Replies
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if this could be pulled together formally, it would be a wonderful resource to make available to everyone.
Including case studies.
There is one I know about, that many here know about also. That is Toledo Mercy. about 6-7 years ago was the focus of a 10,000 post thread.
the skinny –
A company called imaging advantage was contracted by the administration to consult with them about how to do radiology. Imaging Advantage was made of of businessmen and some radiologists with ties to Harvard. I believe the ACR Chairman of the Board of chancellors at the time, James Thrall, who was also chairman at MGH was on the board. At any rate, his vice-chairman was one of the principles of the company. They consulted, they interviewed all the radiology department members (who were an independent PP). In May, IA came to the members and told them they would be taking over the department in 2 weeks (I believe it was). They could either leave, or become employees.
Unexpectedly, all members of the department decided to leave. IA (pooping their pants) scrambled and got a bunch of locums to cover. This was before tele was robust enough to do it.I am aware of a few of the effects. I spoke to some of the techs at the hospital, and got intel from others in town. The new radiologists were as you would expect, not good. The techs couldn’t find anyone to ask questions, they just wanted to read. A patent bled out on the floor after a renal biopsy, and the radiologist never responded to his pages. There was another death I am aware of, but I have no details. (A friend was asked to give a deposition in the case).
They lost almost all their IR business, and much of the mammo business to other groups in town.
After a year and a half, halfway through the contract, IA and Mercy announced that Mercy was going to be starting its own radiology department. The administration wrote that they were so grateful to IA for teaching them how to run a department, and IA expressed satisfaction that they had been so helpful to the administration.
Right….Utter disaster.
The head administrator, who had been a family doc who had no use for radiologists, and who was responsible for the mess, ably covered his tracks (a very necessary skill at that level of administration), and moved on to higher levels of administration in the Mercy structure.
Be aware that many of these companies have learned by their errors. I am aware of a group in which the partners were painted a rosy picture of having their value increase dramatically, and in 5 years cashing out. Well, along comes covid. The PE company violated the contracts they had with the partners that specified a certain number of days at a certain pay. They re-wrote the contracts unilaterally, and cut numbers of days and pay per shift DRAMATICALLY – to less than half.
BUT THERE IS A CONTRACT!!! – well they are welcome to sue. One or two people against a PE company with attorneys on retainer who can draw it out 5 years or more. That is reality. (as one attorney told me – don’t make contracts with unethical people. They are good at what they do,
you aren’t).as for the payout… well….. that is tied to the value of the company and that assumed increase in value never happened. Or not to the degree. Also they determined that they wouldn’t give it as a payment, but as a payout over 3 years. (will that still be there after they sell the company??? that is a risk, you do not know). And they put in a rule that you had to give a years notice.
They are changing the contracts again, and making it a low base salary and “bonuses” when you exceed a certain base RVU. And the RVU system, they rewrote it and renamed it so it isn’t really RVU’s, it is an arbitrary system, redesigned to be “fairer”, and of course those in charge of the rewrite may be expected to have been sure that whatever they read is more fairly valued than what others read.Meanwhile, everyone is so miserable as a result of constant demands that productivity be increased, even to the point of working off the clock to meet the newly increased RVU requirement, that 20% have quit rather than wait for the payout. So they won’t be getting that.
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Great thread. There was an example of RP failing at a hospital in Victoria, TX I believe. This could be the most important topic on the forums IMO.
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There are a LOT of people on Auntminne, and a LOT have some experience with this. If someone were to collect these personal experiences in one place (anonymously), it could be a great resource. I have many irons in the fire, and can’t really devote time to this, but it is a very very doable and very valuable project.
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BTW – Poll:
have any of you personally experieneced, or heard of a PE deal that was presented as being very sweet, and then before the money could be given as promised to the radiologists, the deal changed?
Details if you can would be very helpful
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Theres no hope of fending them off. Theyre too big, rich and smart and radiologists too greedy, short sighted and pessimistic.
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Hospital admins and large radiology groups generally want the same things, and your assumption that the large corporate groups are performing “bad radiology” and unable to do the work feels divorced from reality, so I think your energies might be better spent elsewhere.
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You might have some luck showing them all the unfilled positions for rad partners on the job boards.
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Difficulty with recruiting might be a good starting point.
But are the job listings there due to recruiting difficulty or rapid growth? I have wondered the same about certain states with many job openings. NC is one for example.
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Quote from Takayasu
Difficulty with recruiting might be a good starting point.
But are the job listings there due to recruiting difficulty or rapid growth? I have wondered the same about certain states with many job openings. NC is one for example.
Recruiting difficulty -
It would be useful if you could show how long corporate jobs p
in your market sit unfilled. Not sure if you could do that retrospectively-
Corps will use their telerad wing until positions filled. Admins dont care if positions arent filled as long as films are read without too many complaints from medical staff. Remember, were a commodity, expense item, service now.
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Quote from Drrad123
Corps will use their telerad wing until positions filled. Admins dont care if positions arent filled as long as films are read without too many complaints from medical staff. Remember, were a commodity, expense item, service now.
All you need are a few rads in-house to do procedures and show face. Even committees could go remote. Then send out all the diagnostic to telerads reading at home for peanuts. It’s a race to the bottom for compensation. Mammo has some staying power with patient relationships.
Corporate radiology may be unstoppable. Like Walmart and Amazon (RP, Envision) running mom and pop stores (private practice) out of business. Eventually we all stopped shopping at the local places and gave in to the lower prices and convenience. Mom and pop now working as Walmart greeters or Amazon warehouse stockers.
Radiology margins are under relentless attack. I believe the only solution is to become financially independent before the corps come for you. The ship is sinking. -
We are vendors to the hospitals, not clinicians.
We are only there to produce a good, a good they want to pay minimally for. Its like them switching from Aramark to some other food services company. Easily interchanged. Need to make them see we are actually valuable and necessary part of the medical community. Uphill road because value is seen only by bringing in patients.
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Nibbler’s & Drrad123’s posts are exactly correct. Radiologists as vendors & service commodities are exactly what is happening as medical decisions are made by business people as corporate business decisions for lowest cost and increased profits for the hospitals.
A radiologist is a labor cost. -
Quote from Frumious
Nibbler’s & Drrad123’s posts are exactly correct. Radiologists as vendors & service commodities are exactly what is happening as medical decisions are made by business people as corporate business decisions for lowest cost and increased profits for the hospitals.
A radiologist is a labor cost.
A radiologist is a revenue producer and an administrator is a labor cost. Without the radiologist there is no revenue but without the administrator lower cost medical care can be provided -
Nothing generates revenue in medicine except for physicians. It’s a shame we have all allowed ourselves to be used.
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Quote from JTG
Quote from Frumious
Nibbler’s & Drrad123’s posts are exactly correct. Radiologists as vendors & service commodities are exactly what is happening as medical decisions are made by business people as corporate business decisions for lowest cost and increased profits for the hospitals.
A radiologist is a labor cost.
A radiologist is a revenue producer and an administrator is a labor cost. Without the radiologist there is no revenue but without the administrator lower cost medical care can be provided
Who controls the finance dept? Not radiologists.
The referrer makes the work and the department makes the profits through the technical charges.
Yes, an administrator can be replaced, but have no administrator? That won’t happen.
And depending on what administrator position is considered, most administrators do not make radiologists’ salaries, so they are cheaper in any case.
And as I have said many times, corporate management is already organized, radiologists are not and generally are opposed by temperment to organize. The group is the closest to presenting an organized front to administration, but the group is a smaller entity and in competition not only with the administration but can be with other radiology groups as well.
It is not as simple as all that, relationships with other physicians as well as administration play an important factor but with investors taking over groups, this is a big factor because your argument might be more in-house than with hospital administration.
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Quote from Takayasu
Quote from Drrad123
Corps will use their telerad wing until positions filled. Admins dont care if positions arent filled as long as films are read without too many complaints from medical staff. Remember, were a commodity, expense item, service now.
All you need are a few rads in-house to do procedures and show face. Even committees could go remote. Then send out all the diagnostic to telerads reading at home for peanuts. It’s a race to the bottom for compensation. Mammo has some staying power with patient relationships.
Corporate radiology may be unstoppable. Like Walmart and Amazon (RP, Envision) running mom and pop stores (private practice) out of business. Eventually we all stopped shopping at the local places and gave in to the lower prices and convenience. Mom and pop now working as Walmart greeters or Amazon warehouse stockers.
Radiology margins are under relentless attack. I believe the only solution is to become financially independent before the corps come for you. The ship is sinking.
If you’d like to stop them then learn from their model. Treat your remote radiologists as equals then you’ll have access to the best talent available. Take back your nights so there’s no backdoor mechanism to take your contracts. It’s not that hard, just be less greedy and lazy (rotate through the nights yourself if needed or merge with another practice if you need more staffing to do this).
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Thanks
