Practices must address on-call disparities between diagnostic and interventional radiologists, experts charge
Radiology practices and hospital departments must address on-call disparities between diagnostic and interventional radiologists, experts charge in a new study published Tuesday.
An increasing number of diagnostic specialists (about 40% according to some estimates) are working solely in a remote capacity, and 82% of practices allow at least some portion of this work to be performed off-site. This can help to reduce burnout and improve quality of life, researchers detail in the Journal of Vascular and Interventional Radiology.
However, interventional rads are not afforded the same benefits, with employers often requiring them to be available 24/7 for in-person management of emergencies. Some organizations even mandate specific on-call response times in certain healthcare settings.
“These duties cannot be managed remotely and can have significant impacts upon quality of life for the physicians and upon their quality of care,” R. Torrance Andrews, MD, a professor and IR specialist with the University of Washington, Seattle, and co-authors wrote Feb. 10. “Providing compensation for call is independently protective against burnout, but there are many options for doing so.”
To better understand this landscape, Andrews and colleagues interviewed roughly 800 IR specialists, logging a response rate of 24%. Replies revealed a wide array of practice patterns, call arrangements and compensation models, the survey of Society of Interventional Radiology members found. About 67% reported receiving some form of monetary or “time for time” compensation—where they get extra days off in exchange for working additional hours—for call.
Andrews and colleagues found that monetary payment was more likely in private radiology practices, with the likelihood increasing with greater call frequency across all practice settings. Physicians in traditional academia also were more likely to cover level 1 trauma centers and report more burdensome call shifts. However, academics often are on-call less frequently and less likely to have responsibilities in diagnostic imaging, basic fluoroscopy and needle aspiration procedures, the survey found, factors that were more commonplace for private practice IRs.
The study unearthed widespread variation for call compensation among different practice environments. But the best predictor, financial and overall, was being in private practice, the authors reported. About 76% of those in such settings received call pay versus 43% elsewhere. Likelihood of on-call pay also increased with higher frequency of this extra work, a difference the authors deemed statistically significant. Time-for-time arrangements, reported by about 12% of respondents, typically carry no financial cost. However, additional staffing is needed to replace radiologists who earn this time off.
“This approach can be more costly, overall, than direct financial compensation, as hiring additional physician staff has associated costs for health insurance, malpractice coverage and other expenses,” the authors wrote.
Researchers also reported other arrangements to compensate interventional radiologists for their extra work. Some may reorganize daily schedules to shorten or eliminate call shifts, reported by about 8% of respondents. One example is having IR workers start and end their weekday shifts at different times. Others may reassign Saturdays or Sundays from on-call days to scheduled shifts, with routine procedures undertaken as they are during the week, an arrangement reported by 13%. Another 14% said they use a nigh-float model, with after-hours responsibilities separated from daytime work.
There’s lots more in the study, including data on specific compensation amounts, which the authors said are “challenging” to analyze, given variability. One key takeaway is the need to begin thinking about these conversations in today’s staffing climate.
“The data point to the need for clearer definitions of practice environments, a broader understanding of compensation mechanisms and more equitable expectations for IR call,” Andrew et al. concluded. “Addressing call-related quality-of-life discrepancies between IR and DR and among practice environments is essential for job satisfaction, patient safety, physician recruitment and retention, and—by extension—the long-term viability of interventional radiology.”
Read much more in JVIR, including potential study limitations.
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.