Solid Staffing Solutions

Everyone is doing more with less these days. In radiology, we're performing more procedures than ever - a good thing for business; but have fewer people to perform and read them - a bad thing for business. But there are sure-fire ways to balance the boat.

Current staffing shortages, amongst radiologists, particularly specialists, and radiologic technologists have hit epidemic levels. With no abatement in sight, dealing effectively is a matter of dealing with staffing issues smartly, strategically and creatively. The most successful and long-ranging initiatives need to be formulated in radiology, but gain support from the hospital executive suite, too.

"What has historically happened in many organizations is a lack of attention to the workforce shortage when things are good," says Kathy McEwan, manager of Radiology Consulting Group of Boston, Mass. Once the organization realizes the problem, it is too late; employees are overburdened and overworked; seeking employment elsewhere. Retaining staff suddenly becomes a priority.

What should you do? Take a look around at your "neighbor" institutions, their recruiting and retention tactics. Then take a look inside at your vacancy rates, evaluate what does and does not work in your department, what you offer potential employees in terms of salaries, benefits, training and bonuses. Formulate the best packages you can put together to get them to join - and more importantly - stay awhile.


A variety of factors are to blame for the current shortage of radiologists, especially in pediatrics, abdominal radiology and neuroradiology. And a look at the statistics proves there's no good news in sight. In 2001, 30 percent of full-time radiologists were between the ages of 65-69, and 68 percent of radiologists were between the ages of 55-74, according to the research department of the American College of Radiology (ACR). A recent survey conducted by Merritt, Hawkins & Associates, an Irving, Texas-based recruitment firm, indicates that 38 percent of doctors age 50 or older plan retirement within one to three years. Another 16 percent said they plan to significantly reduce their practice or refuse new patients.

As retiring radiologists deplete the workforce, we're also seeing a surge in imaging volume. In 1998-1999, the ACR estimated that the average workload per FTE (full-time equivalent) diagnostic radiologist had increased 8.5 percent since 1995-1996 to 12,800 procedures annually (these are the most recent statistics available).

Today, aging baby boomers are contributing to a 9 to 17 percent yearly increase in imaging study volume. The workload will reach 500 million annual exams by the end of the decade, says Frost & Sullivan.

By 2010, the American Society of Radiologist Technologists (ASRT) says the imaging profession will fall 30 percent below staffing needs. The nation will require an additional 55,000 radiologic technologists, 4,000 radiation therapists and 4,000 nuclear medicine technologists by 2008, reports the U.S. Bureau of Labor Statistics.

Currently, qualified radiation therapists are in the shortest supply - the American Society of Radiology and Oncology (ASTRO) reports an 18.3 percent shortage of radiation therapists. Specialties in radiology have higher demands too, such as abdominal radiology, mammography, neuroradiology, pediatric radiology, chest radiology and nuclear medicine.


Beyond worrying over the numbers, does your current staffing strategy combat or mitigate the shortage?

The most obvious choice, better compensation, is one way healthcare professionals have combated the shortage by luring radiologists and RTs to their facilities. Compensation for radiologists increased 6 percent in 2001 to $320,000, namely since it has been one of the top five recruited specialties for the last three years, says Irving, Texas-based recruitment and staffing company Martin, Fletcher in its Annual Physician Compensation and Benefits Report, May 2003. The ACR agrees that more of its members are depending on recruitment firms to help mitigate their staffing shortage.

But, the buyer must beware when engaging professional recruiters, says ACR. "You must address specifics into the recruitment contracts," explains McEwan, "such as if the employee leaves within 90 days: does the hospital get a refund or leaves within six months, does the department get a free replacement?"

You might need that free replacement, as research indicates that initial employees are more likely to leave within six months to a year, especially if he or she has fulfilled bonus requirements. If leaving so soon is a trend, the problem may be within the department.

Temporary staffing of imaging professionals is another popular - although very expensive - approach. The demand for temporary staffing jumped from 39 to 50 percent this year, says a 2003 Review of Temporary Healthcare Staffing Trends and Incentives produced by Staff Care, the temporary division of Merritt, Hawkins & Associates. Replacing a technologist is costly, depending on the region - ranging from $60,000 to $70,000, says the Radiology Consulting Group.


Increasing your organization's employee retention likelihood prevents staff from leaving but requires some well thought-out tactics.

"The real proactive [employers] are the ones who go out and get the data to find out why they are at risk, why people are leaving, conducting studies, surveying new employees, training managers, putting programs in place, and mentoring," says Jay Kleinman, consultant of JWT Specialized Communications of Los Angeles, Calif.

"And retention strategies are not universal - a hospital can't just decide to use a program across the entire facility. Instead, the strategies have to be driven by the specific group trying to be retained," explains Kleinman.

One such method is Kleinman's "Essential Retention Trinity":

Exit Interviews: "Use an anonymous, unbiased methodology to perform exit interviews after an unhappy employ quits. Track the trends why people are leaving and identify what is needed, such as managerial training, better communication or a staff change."

Incremental Interviews: "Collect, for example, 120 days of data and look for trends. If 50 percent [of employees] leave within eight months into the job, perform incremental interviews within six to seven months of a new employee joining to tell you why their attitude may change."

Employee Satisfaction Program: "Develop statistically meaningful surveys for employees to respond to. But remember, if you are going to ask employers whether or not they are happy at work, you have to be prepared to do something about it," explains Kleinman.


The Council on Graduate Medical Education (COGME) is calling for an increase of 3,000 U.S. medical graduates by 2015 to combat the estimated 200,000-strong physician shortage by 2020. While radiologists will contribute to these numbers, healthcare providers can mitigate the problem now by making employment attractive and sustainable. (See chart, "Be Retention Savvy.")
Look around at your managers, technology, scheduling and vacation policies and overall incentive packages. Make changes where you need to, and communicate the changes and involve the staff.

"There has to be some creativity within the departments to find out from your staff what they want," says McEwan. "Know employees, what jazzes them and what motivates them. Create an environment where there is exposure to new skills and training. Don't limit your staff on a career path they might not want to be on."

Be Retention Savvy: 8 Techniques to Include in Any Retention Plan

1. Market Analysis: Salaries

How do yours compare? On average, in the U.S.:

Diagnostic Radiologists:
$220,450 - $308,438

Radiologic Technologists:
$37,210 - $43,385

Radiology Directors:
$72,820 - $95,583


2. Create Career Ladders and provide educational opportunities.

Allow lateral as well as upward mobility to explore clinical, technical and management options. Educational incentives may include tuition reimbursement.

3. Chief Retention Officer

Make it a tangible component of the department, dedicate a person to revise and communicate the plan.

4. Benefits

Health benefits, CE reimbursement and pension plans are key, but also know the details of what differentiates your organization from others.

5. Retention Bonuses vs. Signing Bonuses

Signing bonuses for radiologists can run $10,000-$50,000. Some 90 percent of hospitals provide them. But remember that retention incentives are even more important.

6. Utilize Teleradiology

Increase department productivity by hiring an offsite radiologist to do night and weekend reads. Offer web-based PACS for remote reads. Install technologies to better productivity.

7. Cross-train Employees

Train a technologist to be an RA and take on more responsibility or train an x-ray tech to do head CTs so that the on-call CT tech gets a break.

8. Hire a Professional Consulting Company

Get help from companies such as these:

Radiology Consulting Group
Dowdy Management & Consulting Inc.

JWT Specialized Communications