By Lawrence R. Muroff, MD, FACR

The previous articles in this series have stressed the qualities of effective leaders and the importance of obtaining and cultivating leadership skill sets. This article will deal with the leadership challenges that radiology practices face on a daily basis.

These are turbulent times for Radiology and radiologists. Reimbursement is declining, turf wars are escalating, and radiologists are losing their hospital contracts in record numbers. Hospital administrators are making greater demands for subspecialty expertise, longer hours of onsite coverage, the development of meaningful quality assurance/quality improvement (QA/QI) programs, and radiologists who partner in the initiatives of the hospital and are willing to align their goals with those of the health care system. The specialty is facing the threats of non-traditional competition, commoditization, alternative payment models, and pressures to shift from an independent contractor status with hospitals to an employment arrangement.

To date, the responses from radiologists faced with these challenges have been varied. Some groups have proactively planned to cope with these problems. For these practices, awareness and preparation most often equate to a successful resolution. Unfortunately, the large majority of radiology groups, when faced with practice-threatening issues, are ill-prepared to cope. These radiologists feel overwhelmed, embarrassed, and without the necessary knowledge to act in a manner that would optimize the chances for success.

Most often, the problems that challenge practice leaders have come from within. The existing practice governance structure does not permit group leaders to make appropriate decisions efficiently; if decisions are reached at all, it is too often after the window of opportunity for effective action has closed. Far too frequently, the shareholders in a practice put their individual self-interests above the interests of the group. Most destructive to a practice are the radiologists who refuse to unite behind the actions and decisions of the practice members but instead complain about those decisions and actions to referring physicians and hospital administrators.

On a daily basis group leaders are faced with a multitude of issues- the problematic partner/associate whose behavior jeopardizes the hospital contract or demoralizes the other radiologists, the group member whose skill sets have eroded, the impaired radiologist, the sexual predator, and the shareholder or associate who forgets that Radiology is a service specialty.

Too many practices fail to do effective strategic planning; even fewer groups do scenario planning. These types of exercises would enable groups to confront problems before these issues become manifest (or successfully solve them once they are apparent). Most groups do not have a business plan that would outline goals for the coming year, designate responsibilities to specific individuals, and establish timeframes for the completion of these group-mandated tasks.

To be successful in developing a strategic plan, widespread input and buy-in is fundamental. All participants must understand the premise and processes involved in the plan.

How can radiologists deal with these issues in an appropriate manner? We are, after all, physicians. Nobody prepared us to confront these “non-clinical” issues, and for most of us, our training did not adequately prepare us for the possibility that we would have to learn non-clinical skills. Shouldn’t being a good radiologist be enough to insure tenure at our hospitals? Shouldn’t being a good radiologist protect us against predatory competitors? Actually, being a good radiologist is a given. Our patients, the referring physicians, and the hospital administration expect us to be good, but being a good radiologist is not sufficient. It is what else we do and what else we know that differentiates us from the large majority of our colleagues.

Fortunately, the ACR has taken steps to make it possible for radiologists to obtain the leadership skills that are required to navigate the turbulent times that we face. The Radiology Leadership Institute (RLI) has developed a curriculum that is designed to arm radiologists with the non-clinical skills that are needed to confront and solve the problems that practice leaders encounter on a daily basis “in the trenches”. This curriculum is based on a common body of knowledge (CBK) that is reflective of the information that radiologists need to be effective participants of their practices, valuable partners of their hospitals, and contributing members of their communities.

The major national Radiology organizations and the American Board of Radiology have all recognized the value of non-clinical skill sets. For individual radiologists, the question no longer can be, “Should I make the effort and devote the time to learning these non-clinical skills”? Rather, the question must be, “How soon can I acquire these skills which are essential to the survival of both my practice and my specialty?”

Dr. Muroff is CEO & President of Imaging Consultants, Inc., Clinical Professor of Radiology at the University of South Florida College of Medicine and University of Florida College of Medicine