In radiology, staffing for average volumes is the easiest way to staff, because most times things work out—in the same way that just-in-time manufacturing is the most efficient way to make products when everything is going well. Unfortunately, all systems designed for a typical day or ideal circumstances fall apart when confronted with the reality of unavoidable variability.
If most days produce a certain imaging volumes, some will be less and some will be more—and, less commonly, some will be way less and some will be way more.
If there is less work to do than typical—let’s say when staffing a typical call shift—then that radiologist is either less busy (so that they can relax but generate less revenue), or, if there is an integrated worklist and specific RVU demands, then they can read from a different bucket of work in order to hit a certain level of productivity.
In most cases without a productivity model, this can put the onus on the individual radiologist to choose how hard to work: they have the option of embracing the benevolence of the list gods and reading fewer cases, or—if they want to hit some predetermined productivity metric for reimbursement—they can still bust the stack somewhere else to make up the shortfall.
Dealing with a busy shift is a harder problem. You would need to be consistently busy in order to change staffing. Most people don’t have two FTEs of work for a shift that used to have one person working, so adding a second person is undesirable in that both are unlikely to be busy (and nobody generally wants to work more shifts, especially if those fall during evenings or weekends).
In some cases, when there is a consistent amount of extra work, dealing with the volumes can be achieved through some amount of overlap—particularly at the busiest parts of the shift—while mitigating the amount of time people might be twiddling their thumbs.
But the reality is there are many situations where a radiologist is busier than they want to be but has no recourse to get help, and the group or practice has no reason to—or ability to—change staffing on an ongoing basis.
This is a situation where there are two solutions:
One is a generous productivity component such that a busy shift beyond some predetermined threshold results in extra money. This doesn’t make the work any less stressful, but it does mitigate the perceived unfairness and frustration of the suffering, which occurs when the work is more than you can handle and you end up spending longer to do it without a commensurate increase in compensation for that extra effort.
The other solution is internal moonlighting. That’s where a radiologist or practice could activate internal moonlighting in some capacity to get list support. Some practices do this by having optional scheduled shifts, but this doesn’t actually solve the variability problem. True ad hoc moonlighting could be activated automatically via software if the number of RVUs hitting the list per unit of time (e.g., hour) reaches a certain threshold, if the number of RVUs on the list hits a predetermined number, if turnaround times fall behind some metric, or just if the person working wants help.
All approaches are valid, and a group could decide whether they should pay the extra money for high volumes, or if the person working should pay some amount of money for requesting relief from their call pay.
This is one of the use cases for LnQ (+ teaser video) that I mentioned in a previous article (as well as this “surge” staffing post), and it illustrates how a one-size-fits-all practice works less and less well in our current era of radiologist shortage and rapid job turnover—at a time when many people are feeling conventional positions because want to do teleradiology work during business hours reading outpatient imaging and mitigating stress.
We need to find ways to make sure that people don’t burn out. While generally removing work can be part of the equation, recognizing work, fairly compensating work, having backup, and making sure people don’t feel resentful is the other part.