In today’s health care environment, interventional radiologists can choose between multiple different practice settings, all with their own unique advantages and challenges. One’s choice of a practice setting will depend on how comfortable one might feel in a specific setting, with those particular characteristics. In this article, we will investigate some of the advantages and challenges inherent to three common practice models in which IRs practice:
- Large private radiology groups
- Direct employment by nonacademic hospitals and health systems
- Freestanding interventional outpatient centers
Large private radiology groups
During the past decade, the average size of radiology groups grew substantially, and the largest increase has been in groups with 30 or more radiologists.1 This trend applies to both private and academic groups. Advantages of the increased group size include more effective economies of scale relative to smaller groups, resulting in reduced unit costs of operation, and stronger market power, resulting in improved negotiating abilities with insurance companies. These factors have allowed larger groups to more effectively manage their cash flows compared to smaller groups, which may not have the same ability to control costs or improve revenue.
Larger groups may also help keep the IR in the group by allowing for greater subspecialization. According to R. Torrance Andrews MD, FSIR, a Seattle, Wash., IR in a large hospital-based group, you have the “freedom to chase down whatever aspect of IR happens to catch your interest.” For example, you may subspecialize in interventional oncology, or peripheral vascular disease, because there are usually a greater number of patients with the condition than may be seen by an IR who is part of a smaller group.
A large group facilitates marketing as well: branding one’s IR practice can be made easier by the group’s existing name recognition within the patient community as well as among referring physicians. Also, a large group may have a significant marketing budget and dedicated marketing staff to assist the IR division with its own marketing efforts.
On the other hand, marketing the IR division may be dictated to varying degrees by the group’s hierarchy, who may not always agree with certain strategies. Another challenge for a large group may be greater difficulty with physician retention because the groups may be seen as being less personal; the physicians within the larger groups may feel less loyalty to those groups and therefore may be more likely to leave the group.1
Additionally, according to Bret Wiechmann, MD, FSIR, an IR in Tampa, Fla., an IR section within a larger group may “require buy-in from the majority of the main group” in order to “develop consensus within the traditional radiology group that IR is a distinct clinical specialty, and therefore requires a totally different infrastructure [including] dedicated space for patient examination, retraining administrative personnel” and marketing.
Employment by nonacademic hospitals
In the early 1990s, hospital employment by physicians reached a plateau but then declined. Many felt that one reason was that hospitals and health systems did a poor job of managing the private practices that they acquired.2
Today, the integrated health system (IHS) is contributing to an increase in physician employment directly by hospitals and health systems. An IHS, also known as an organized delivery system, may be defined as “a network of organizations that provides or arranges to provide a coordinated continuum of services to a defined population and is willing to be held clinically and fiscally accountable for the outcomes and health status of the population served.”3 A main goal of an IHS is to reduce waste by coordinating care between many different providers and using economies of scale to further reduce costs.4 Presently, about 10 percent of radiologists are employed directly by nonacademic hospitals and health systems.2
Employment certainly carries its advantages: financial stability by way of a regular paycheck, not having to worry about running a business in the form of a private group, billing done by the hospital’s billing department, and the hospital covering large expenses such as equipment and electronic medical records. In addition, physician recruitment may be primarily handled by the hospital’s HR department, relieving the individual physicians of having to find a qualified associate physician to fill a vacancy. Geogy Vatakencherry, MD, an IR with Kaiser Permanente in Los Angeles, Calif., agrees, and cites another advantage that is more patient-centered: a stronger focus on preventive care. The fact that it is not fee-for-service may take out some of the incentives that foster unnecessary procedures. In this environment, there seems to be more collaboration between the various practitioners as they work for an end goal of providing cost-effective, evidence-based comprehensive quality care.
But some challenges are associated with hospital employment as well. Dr. Vatakencherry states that, historically, relative to traditional private group practice, salaries in the employed setting may not be as high, and scheduling personal time may be more restricted; for example, vacation days may need to be scheduled several months in advance and there is less flexibility in physician scheduling.
Freestanding outpatient centers
Interventional radiologists in independently owned freestanding facilities are directly responsible for making financial decisions that affect their practice. Some are entrepreneurs running their own businesses; others are employed by regional or national companies. Those who are owners of outpatient centers directly feel the effects of declining reimbursements and increasing costs. As such, they must be exceptionally good business-people, or have access to good business managers, and make sound strategic decisions to carefully maximize revenue and manage costs. In addition, when it is time to hire an associate physician, independent IRs are on their own to find a partner who fits in the uniquely demanding environment of outpatient IR.
While these may seem like disadvantages, IRs in outpatient practice also enjoy a relatively higher level of control over their business—e.g., with marketing and branding. Physicians who own their own facilities can brand themselves and their practice exactly as they desire and appeal to a specific patient population or group of referring physicians.
In the author’s experience, owning and operating an outpatient IR center brings challenges and rewards—such as financial risks, personal scheduling flexibility and ability to do a variety of procedures—that must be considered carefully before undertaking such a venture.
Conclusion
IR physicians work in a range of different practice settings today. Each practice setting may be affected differently by outside forces in the current healthcare environment. After a careful consideration of the advantages and disadvantages of these different practice settings, one will hopefully identify a practice setting that ideally matches his or her professional aspirations and personal lifestyle.
References
1. Bhargavan and Sunshine. The Growing Size of Radiology Practices. J Am Coll Radiol 2008;5:801-805.
2. Medverd et al. ACR White Paper: New Practice Models—Hospital Employment of Radiologists: A Report From the ACR Future Trends Committee. J Am Coll Radiol 2012;9:782-787.
3. S.M. Shortell, R.R. Gillies, and D.A. Anderson, et al. Remaking Health Care in America, San Francisco:Josey-Bass (1996) , p. 7.
4. Maggar M. Integrated Systems Put Patients’ Health First. The New York Times, March 26, 2-13. From: www.nytimes.com/roomfordebate/2013/03/26/re-engineering-health-care/integrated-health-systems-put-patients-health-first
