Rising workload puts squeeze on academic departments

A survey of academic radiologists' clinical productivity shows that workload continues to increase, in both exam volume and complexity. Academic department heads could use the survey data to help set staffing levels and evaluate the performance of individual radiologists.

"It's a great tool to decide when to add a new chest radiologist or abdomen imager," said author Dr. Ronald Arenson, chair of radiology and biomedical imaging at the University of California, San Francisco.

Ying Lu, Ph.D., Shoujun Zhao, Ph.D., and Philip W. Chu contributed to the report, published in the July issue of Journal of American College of Radiology.

The authors used data from a 2006 survey performed by the Society of Chairmen of Academic Radiology Departments. That survey collected data for 1134 radiologists in 24 departments, including 10 departments that also reported productivity in an earlier 2003 survey.

Arenson's group reported the mean clinical workload in 2006 was 9671 examinations, up 15% in 2003. The mean number of work relative value units per full-time equivalent was 7136, a 22% increase over the three-year period.

The biggest change to radiology productivity occurred because of PACS, to which Arenson attributes a 25% to 30% increase.

Another factor is a surge in the numbers of commonly ordered procedures, such as MR and CT, which have risen for the same patient populations.

"That's due in part to improvements in technique, but also because of the aging population," Arenson said.

The combination of the two factors is driving productivity increases for radiologists at Massachusetts General Hospital, said radiologist-in-chief Dr. James H. Thrall.

"Beyond these factors, many practices in both academics and the private community have found the need to become more productive to maintain income levels in the face of increasing practice expenses not offset by lagging increases in reimbursement," Thrall said.

With the exception of plain films and non-PET nuclear medicine, radiologists at Wake Forest University are also feeling the productivity squeeze. Dr. Allen D. Elster, chair of radiologic sciences, predicts that as more pediatric work is consolidated toward children's hospitals, big academic centers will experience an increase in the total volume of pediatric cases.

"Not many residents are electing to do pediatric radiology fellowships nationwide," Elster said.

He's concerned supply won't match demand for a few more years.

Survey data included the numbers of procedures performed by radiologists, percentage of clinical effort, subspecialty sections, and number of clinical days. The numbers of CPT codes were converted into total work RVUs per FTE faculty member. By grouping the CPT codes into six prespecified examination categories, adjustment factors were created to adjust the RVUs for CPT categories to ensure that the median total adjusted work RVUs from different subspecialty sections were comparable.

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