Imaging groups utilize ‘per diem’ radiologist employment to fill workforce gaps
Several imaging groups are utilizing “per diem” radiologist employment to help fill workforce gaps, according to new survey data.
These arrangements typically involve non-full-time employment, compensated on an hourly, shift or daily basis without benefits or annual salary, experts write in Pediatric Radiology. Per diem may take many forms, with rads of any age, often scheduled on an ad-hoc basis with no minimum participation requirements.
Richard I. Markowitz, MD, and colleagues aimed to better understand the landscape of this practice in pediatrics. They recently sent a survey to 103 members of the Society of Chiefs of Radiology at Children’s Hospitals, sharing their findings May 16.
“There is little known about the current prevalence and acceptance of this model by employers under different circumstances and environments within pediatric radiology,” Markowitz, a pediatric radiologist with Children’s Hospital of Philadelphia, and co-authors noted. “We wanted to learn whether this model of employment has become more prevalent and whether it is viewed as successful. We also wanted to understand the advantages and disadvantages of the per diem radiologist as perceived by leaders in pediatric radiology.”
A total of 38 department chairs filled out the anonymous survey for a response rate of 37%. About 66% said they offer per-diem employment, and 73% of those practices self-identified as academic. “In almost all cases,” the authors noted, per-diem work was available to senior or retired radiologists age 65 and older. Markowitz and colleagues noted an additional benefit of these arrangements, allowing practices to retain senior, experienced pediatric rads who don’t want to work full time but also aren’t ready to retire.
Of the 26 using per-diem employment, 58% said they’ve been doing so for more than five years. About 81% said they employ between one and five per-diem radiologists, while the other 19% use more. All paid either an hourly, daily or shift rate and only five said they sometimes also provide bonus compensation. All but two, meanwhile, provide malpractice insurance coverage to these physicians. Most work as hospital employees, while a smaller number work for the university. They reportedly contribute much less to the academic mission of the department, though several were still actively involved in teaching.
All but 1 of the 26 said they were satisfied with per-diem arrangements. And most said they’ve had little difficulty moving in this direction. Reported challenges included maintaining awareness of new policies, scheduling, lack of availability when needed, no help with on-call schedule and “calculating a fair rate of reimbursement.” Flexibility, filling holes in the schedule, covering open shifts, help during high-volume periods, and the ability to retain more rads all were reported as advantages, the authors wrote.
Markowitz and colleagues noted that radiologist shortages have been particularly challenging for pediatric radiology, given the small number of newly trained fellows, aging staff, increasing burnout rates and rising imaging volumes. Experts have previously suggested utilizing retired rads to fill these gaps, and this model provides a path to do so.
“Maintaining skills and credentials can be time-consuming and onerous,” they cautioned. “Nevertheless, the experienced senior radiologist may be more confident, efficient, and accurate at reading plain films and other more conventional imaging studies, especially compared to newly trained staff who may be more adept or interested in newer modality imaging and advanced techniques but lack the breadth and depth of experience reading ‘older modality’ imaging, which often constitutes a large portion of the workload volume.”
While calculating compensation may be one difficult aspect of this model, Markowtiz et al. believe radiology departments can overcome it. However, they believe a bigger challenge may be navigating attitudes among imaging staffs.
“A more insidious problem is overcoming cultural bias toward non-full-time employees who are not as involved or do not have as much stake in departmental affairs. If they are not physically on-site in the department, their impact may not be as visible,” the authors advised. “Also, per diems may not be as readily available for consultations with clinicians; and thus, continuity of care can be an issue. Nevertheless, their contributions are appreciated by their full-time colleagues, who are thereby relieved of a sizable portion of their clinical burden, thus allowing them to pursue their own academic and other obligations. Given the success of this strategy so far, it is expected that if the workforce shortage continues as anticipated, this will become a more widely utilized mode of physician employment for senior pediatric radiologists.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.