Time Management Tips for Radiologists

Radiologists have always been busy. But with decreasing payment for increasing amounts of work, along with administrative pressures, managing time is of paramount importance.

“Radiologists in general do twice the amount of work volume than we did 10 years ago,” said Mike Esposito, MD, president of Radiology and Imaging Specialists in the southern Tampa Bay area. One reason for the explosion in work is technology; digital images replaced the hanging X-ray film. “But that’s twice as many cases you have to sit and think about, and every year it grows even more.”

The best way to manage the work is by having a smoothly operating system. “You really want to have your group working efficiently,” Esposito said. “The biggest expense in your group is the physicians.” In order to hire top talent, you have to maintain a certain income and quality level to attract them. “We have to be efficient to compete.”

One way to start looking at efficiency is to examine what’s getting in the way of radiologists managing their time. Are they designating specific reading time? Are they physically interrupted or interrupted via phone? Are personal issues getting the way?

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Interruptions
One of the most important time management techniques is controlling interruptions in the reading room. “The way to get through readings quickly is to have no interruptions,” said Judy Capko, founder of Capko and Morgan a medical practice management consulting group, and author of Take Back Time: Bringing Time Management to Medicine.

While some interruptions are inevitable, radiologists should decide for themselves what’s worth being interrupted for. “It should be pretty darn important if it’s in the reading room,” Capko said. “If you’re focused and it can wait, let it wait. You’re taking away valuable time. You could have answered a phone call when you’re in transition or in the car, not when you have important rich time to be dedicated to a topic.”

Halting interruptions can mean setting boundaries with colleagues and staff members. Sometimes the matter doesn’t require the radiologist’s attention, but someone else can solve the person’s problem. “If they’re allowed to interrupt they’ll do it. They won’t think about how it impacts you,” she said. “People learn to solve their own problems if left to it.”

Handling Phone Calls
Phone calls are disruptive, said Esposito, even though they’re often helpful from a clinical perspective. While he takes calls from referring physicians, he recommends having a phone screener and someone like a physician assistant or technologist to run interference when necessary. “They’re very good at being extenders for us, interacting with physicians and doing some procedures. That helps keep us in our chairs,” he said.

Phone calls can pile up quickly, especially if left until the end of the day when it’s more difficult to reach people. Capko recommends calling early in the day, and if the person isn’t free, leave a message saying when you’ll be available, so you control when you’ll accept interruptions. If a question can be answered by email or text, do it that way. “Take the shortest route to get there,” she said.  

Staff members taking down a message clearly and completely can save radiologists a lot of time. Ask your staff members to get as much information as possible, so you have all the information needed when calling back. The staffer should also ask the best time to call back, to ensure the parties can connect more easily.

Worklists
Radiologists used to get their films in a stack, like a deck of cards, with everything computerized; the to-do list now comes electronically. By using a smart worklist system that assigns cases based on a radiologist’s specialty and availability, doctors know their workload. “Now with individualized work lists, it makes you feel like you have your day back again,” Esposito said.

Not all radiologists use this type of feature, he said, and he helped develop one at PACS Harmony, a workflow distribution software company. The technology was licensed to the Mach7 Enterprise Imaging Platform that his radiology group is now installing. “Every large group wants [worklists] but some doctors don’t like to be told what to do. But everything is moving this way,” he said.

Without worklists, it’s hard to manage productivity of individuals in radiology groups. “The discrepancy between high and low producers can be 50%; that’s a big difference,” he said. Most PACS don’t have workflow management, said Esposito, and it’s a big problem when one doctor spends too much time online, and only reads 10 cases while another is reading 100, yet they both go home at the same time and get paid the same.

Don’t Procrastinate
Spending time online is a big time suck and doctors are no exception. “E-mail and internet surfing – it’s a big problem with doctors,” Esposito said. “We strive to have everyone read about 75 cases a day. If you want to be on the internet all day, that’s fine but you still have to do your work.”

Set realistic boundaries for your schedule, said Capko, and get to work on time. “For all of us with a demanding schedule, and radiologists certainly do, if we’re disciplined about it, we can manage,” she said.

Prioritizing
Prioritizing work is important, but radiologists have their own preferred way. After completing the emergency cases, they can focus on the rest.

“Some people will read all X-rays first if they’re faster to read, to make their list look shorter. Others like to get through the difficult cases first when they’re not tired. It’s all the same volume of work whether you do it one way or the other. If you read the harder cases when you’re fresh and just came in, you have more time and you don’t feel rushed,” said Esposito.

When reading the same type of films repeatedly, you get a momentum going, said Capko. “Package your readings according to the nature of the reading.”

Use Technology
Technology, when used appropriately, can mean that prior studies are available for viewing when you need them, and they’re in the format you need as well. Esposito said that the enterprise imaging platform they’re installing does this. “What you don’t want to be doing is waiting for priors,” he said. “As soon as you open your case you want to be ready to go. That means technology has to be correct, the network has to be at the appropriate speed.” Esposito said that they have a large budget for network speed so that the radiologists don’t have to wait for something to load in order to begin reading.

With technology constantly changing, doctors sometimes get used to what they already have and don’t want to learn something new. Adding new technology is only beneficial if it’s used, so any changes should be communicated, with radiologist buy-in, said Capko.

Templates and Voice Recognition
Dictating reports from scratch is time consuming. “We’ve gone almost exclusively to voice recognition,” Esposito said. With voice recognition they use templates with a normal report broken into segments. “You only change the part that’s abnormal. Not having to speak so much has improved efficiency,” he said.

Take Breaks
Taking breaks is a personal preference, said Capko. “If you take breaks that are too frequent, you do yourself a disservice, because it’s hard to get back up and running and it takes longer to finish,” she said. You risk taking what you think is a five-minute break and it turns into 20 minutes. “You have to honor your time and understand how valuable it is.”

System-wide Problems
Even if everyone is using their time wisely, system errors can cause time delays. Sometimes a film gets lost or is of low quality and no one caught it, said Capko. “Wherever the bottlenecks are, visit them and understand how they’re inhibiting the progress and get it solved. You can do a time study to find the glitches,” she said.

Meetings
Meetings are often time-consuming, and it helps if the organizer has an agenda and sticks to it. An attendee can tell the organizer that if it goes on longer than planned, that the attendee will need to leave at the scheduled stop time. If there’s something the physician wants to say at the meeting, they should ask to say it early to make sure their voice is heard. Capko said she doesn’t have a problem as an attendee asking to table a topic that’s not on the agenda. “There’s nothing wrong with chiming in in a polite way. What you don’t want to do is revisit the same thing over and over that you can solve.”

If you’re feeling there’s not enough time in your day, look at where you’re sabotaging your time. “There are solutions,” Capko said. “Some are behavioral. Some are other people’s behavior, putting boundaries in place.”