VIDEO: Issues with the great resignation and lower reimbursements in breast imaging


Stamatia Destounis, MD, FACR, a radiologist and managing partner at Elizabeth Wende Breast Care in Rochester, New York, chair of the American College of Radiology (ACR) Breast Commission, and member of the Public Information Advisors Committee for Radiological Society of North America (RSNA) and Society of Breast Imaging (SBI) Communication Committee, discusses post-COVID-19 economic issues facing breast imaging centers, including static problems from the "Great Resignation" and lower reimbursements making it difficult to attract experienced radiologists. 

"We are dealing with some issues in staffing with COVID-19, but we are trying to open up our doors and allow patients to come back in again full steam ahead for their screenings," Destounis said. "However, we are having some concerns because we do have a reduced number of technologists, call center staff, reception and even physicians because of the situation with our economy."

How an outpatient breast imaging center adjusted to the post-COVID staffing issues

The Great Resignation, which started during the pandemic and is still ongoing, has made many physicians rethink what they want from a job. Many have realized they can move to locations with more opportunities for their families and to warmer climates. Teleradiology also enables many to live wherever they want and not necessarily need to be at a brick-and-mortar healthcare facility. Destounis said this new mindset, combined with lower reimbursements and rising costs, has impacted her ability to attract and retain radiologists in upstate New York. 

Burnout from working at medical facilities during is also playing a major role in clinicians' decisions to leave medicine or change jobs.

"It's just a lot of burnout at this point because it has been very stressful worrying about COVID-19, patients being very anxious, trying to create places on the schedule for patients to safety come in," she explained. 

Burnout among staff led many to reconsider working in healthcare or staying with their job as facilities opened back up after the height of pandemic restrictions waned. She said a handful of staff also were let go because they would not comply with the New York mandate that all healthcare workers get vaccinated against COVID-19 to make healthcare facilities safer for patients and other staff. Although she said about 99% of staff did comply with the mandate. 

"So now that we are able to bring the patients back, we are trying to get to pre-COVID levels. But the workflow is so different now because we sterilize the rooms between patients, the appointments are not as close together and we are trying to get the same number of patients in we had before COVID. So our days are longer. [We have] to get started earlier and we finish later," Destounis said. 

This has led to efforts to try and maintain moral among staff and try and reduce burnout, such as by allowing staff who can work from home to do so on a more regular basis so they have extra time with family and kids. These staff include transcription, billing, IT and PACS. They also reworked the workdays so some staff that can work longer hours on the days and end up with a four-day work week.

Lower radiology reimbursements and higher costs impact the bottom line

She explained reimbursements across radiology have been reduced, impacting breast imaging. Destounis said the exams and procedures at her outpatient center are reimbursed less than hospitals, which also takes a toll. "For the same procedures, we may be reimbursed at a lower rate than a hospital, including breast ultrasound, stereotactic needle biopsy, breast MRI."

While reimbursements are going down, the costs for biopsy systems, markers and MRI contrast are all going up. In addition, because of supply chain disruptions since the start of COVID-19, many supplies are often delayed or on backorder for long periods. 

Issues regaining patient volume as COVID-19 declines

"Our patient numbers have come back to about 80%-90% of pre-COVID levels, but we are still having issues getting all the patients back that did not come in in 2020 and 2021 during COVID. Some patients continue to be anxious about COVID, or now that so much time has passed, they are nervous about coming back because they have missed several screenings and we may find something," Destounis explained. "Also, lot of women have lost jobs during COVID and many still do not have health insurance. We are trying to partner with some of New York State government organizations that offer underinsured or uninsured women free mammograms. We are opening our doors on some Saturdays so they can come in and have a free mammogram. We are trying to get the patients to come back, but it has been a little bit of a challenge."

She said her center is calling, texting, emailing and sending letters to patients who have not come back to try and get them to schedule appointments. 

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