Less than 15 years ago, a radiology group’s professional service agreement with a hospital was, according to Lawrence Muroff, MD, equivalent to “a relatively hassle-free tenure.” But Muroff, writing in the March issue of the Journal of the American College of Radiology (JACR), said things have changed. Radiology practices now have PSAs that are “more restrictive, more controlling and more demanding. . .”

Recent data suggest that three-quarters of all radiology practices have noncompete and clean-sweep provisions (clauses that state that a group’s medical staff’s privileges automatically lapse upon the termination of a contract, for any reason), Muroff said. Turf erosion has “become a fact of life,” and the professional relationship between radiology groups and hospitals has changed dramatically.

Why? The commoditization of radiology services means that many hospital administrators perceive radiology groups as commodities, he said. Consequently, radiologists “must understand that commodities are relatively indistinguishable and therefore are traded solely on the basis of price,” which means they serve at the pleasure of the hospital system and can be replaced.

Radiology groups have long argued that they are good at what they do and “that fact alone should be sufficient for those who interact with them,” said Muroff. But he also pointed out that radiologists need to understand that being “good” is no longer enough—“Radiologists are expected to be good, but they are also expected to provide services," he said.

“If radiologists are not providing service and not providing a quality experience, why should they be surprised that they are suddenly being treated like an interchangeable commodity?” he said.

Muroff suggested several reasons why hospitals replace radiology groups:

• They are tired of hearing complaints from referring physicians and hospital employees (service issues).

• They don't like radiologists competing with them.

• They want more control (hours, numbers on-site, subspecialists).

• They want radiologists' turf to attract referring physicians.

• They want to own radiologists' practices (integrated service model) and make them employees.

• They don't like their radiologists (personality clashes).

When the time comes to replace a radiology service, hospitals can take a number of different approaches:

• Send an RFP for radiology services to competing private practice groups.

• Contract with a local medical school to take over the PSA.

• Convert the radiology practice from an independent consultant relationship to an integrated service model (employment model) or hire new radiologists as employees.

• Contract with an established outsourcing company to provide both on-site and outsourced coverage.

• Contract with a company organized to take total responsibility for the PSA.

Radiologist groups that want to protect their contracts first need to understand some crucial “principles,” Muroff said. They must be willing to recognize the necessity of providing reasonable service to referring physicians, patients and hospital administrations.

In addition, they have to be visible and available within their hospitals and must provide “value added” if they expect to be valued as contributing staff members, he said.

Radiologists must also integrate themselves into the medical, social and political aspects of their hospitals (by sitting on key boards or participating in hospital events), and establish mutually loyal relationships with physicians and patients.

 “When those physicians whom radiologists serve are merely satisfied, they will most likely be satisfied by the group that replaces yours; when they are loyal, they will work diligently to see that you are not replaced,” Muroff said.

“If radiologists are to thrive in the turbulent times ahead, they must understand the importance of service and relationships,” said Muroff. He added that he's not calling for a one-sided capitulation, but rather that all radiologists "educate their patients, their referring physicians, and their hospitals about the value added by and importance of radiologists within the hospital setting. Failure to accomplish this will have dire consequences for radiology practitioners and for the specialty as a whole."