Hospital employment: Panacea or peril?

Radiologists considering hospital employment should carefully weigh the circumstances of the model, as it carries both advantages and disadvantages, according to a white paper published in this month's Journal of American College of Radiology.    

As reimbursement continues its free-fall and administrative responsibilities multiply, radiology practices are increasingly exploring new practice models. Estimates of the employed radiology workforce range from less than 10 percent to 20 percent, according to Jonathan R. Medverd, MD, of the department of radiology at University of Washington in Seattle, and colleagues.

As the employment trend gathers steam, it may be wise for radiologists to observe evolving practice models in cardiology, which has shifted toward the employment model. “Only time will tell whether initial cardiologist satisfaction with recently minted arrangements will persist,” wrote Medverd et al.  

High on the list of advantages to employment are a predictable paycheck, job security and job stability. However, radiologists should proceed with caution as these arrangements are most likely to provide satisfaction if employment circumstance are appropriate. Medverd and colleagues suggested a few key questions to help providers considering hospital employment assess the local environment. These are:

  • Is the hospital partner providing suitable investment in equipment, workflow tools and personnel to maintain the quality and diversity of imaging services it desires;
  • Is outpatient imaging controlled by the hospital, and are the requirements of the business segment properly balanced with the demands of inpatient care;
  • How are nonradiologist physicians granted privileges to perform traditionally core radiologic activities;
  • How does the hospital value imaging compared with other services;
  • Are staffing and technology decisions based on the long-term view, or do short-term costs dominate the process; and
  • Does the hospital have its billing, contracting and human resources shops in order?

Under the right circumstances, the employment model can improve job satisfaction. For example, some marketing responsibilities that are essential in a competitive marketplace may be replaced with a focus on cultivating consultative relationships and care pathways with hospital-employed physicians.

However, a building block of such relationships is radiologists’ involvement in hospital governance structures. Participation in governance also may help minimize the risk of perverse incentives under the employment model.

If radiologists lack a voice in the governance structure, for example, some clinicians might be tempted to substitute imaging exams for proper clinical evaluation. In other cases, nonphysician managers may view physician salaries as an easy target for cost-cutting measures. Another salary consideration for radiologists? As the employment model takes off and the supply of radiologists interested in employment grows, hospitals may have more freedom to negotiate salaries.

Salaries are, to a degree, contingent on the value of the service provided. “[R]adiologists will need to document noninterpretive value-added services that will enhance the health enterprise they serve.” They may be best-positioned to share their value if they are part of the governance structure, according to Medverd et al.

Radiology practices across the U.S. are likely to encounter similar advantages and risks of hospital employment; however, every situation and market is unique. Radiologists and radiology groups considering employment need to carefully assess the local environment and whether circumstances are favorable for radiologists’ professional and financial success.

To hear what the next generation of radiologists are thinking about the future of employment, read "Who is the Radiologist of the Future?" in the latest issue of Health Imaging.