Attendees at the 89th Scientific Assembly and Annual Meeting of the Radiological Society of North America, held in Chicago in December 2003, were given many opportunities to learn something new to enhance their practices and, in the case of one particular course, to tackle some difficult issues. This session, entitled “Tough Issues in Radiology: Governance, Partial Retirement, and Dealing with the Problematic Partner,” addressed topics that radiologists often are unsure how to confront.

Resolving problems in a radiology practice is much simpler if certain necessary components are in place before the problems occur, notes Lawrence R. Muroff, MD, of Tampa, Fla, a veteran radiologist who has embarked on a consulting career.

Governance Strategies

With regard to governance, it is imperative that a practice have clear business and strategic plans. The radiologists should form a committee to draft a mission statement indicating the practice’s specific goals and services to be provided. Hiring a facilitator or consultant can be helpful, says Muroff, but he warns that this person must be knowledgeable about radiology practices and culture.

An important responsibility of the practice’s board of directors will be to review the mission statement and strategic plan yearly so that the radiology partners’ goals are in line with their services as the practice begins to grow. Although growth coincides with greater visibility and clout among managed care providers and in the community, problems also will grow exponentially.

Thus, the governance structure must include working committees to ensure its effectiveness. These committees help establish proactive policies. One mistake radiologists make is to rotate leaders in the practice every year or two because they believe some partners will not have the skills necessary to serve effectively. The better option is to choose leaders well and keep them in place, so that with tenure they will develop further in their leadership capacities. Notes Muroff, “Permanence has tremendous value.”

Just as the board of directors should be reflective of the demographics of the practice and is empowered to act on behalf of the group according to its mission and business plan, so too should shareholders share in the governing responsibility. Every partner should have assigned tasks, beyond reading films and performing procedures, that will enable their participation in the affairs of the practice. These tasks, which help build the practice and increase its efficiency, can include giving lectures, joining professional societies, and going to committee meetings.

An operations committee is essential for addressing issues that are potential causes of turmoil in any practice. Proactive credentialing can be an effective means by which the committee can prevent turf incursions within the practice. The committee should be flexible about workloads and vacation time, because some partners (younger affiliates, for example) may desire more free time rather than more money. One of the most problematic quality-of-life issues the operations committee must face is that of call. Practices should equalize call duties and make them proportional to the time worked. Call should be a commodity that can be traded, bought, or sold, but only through the committee (privately, so as not to be coercive). Nighthawks can serve on a rotational or moonlighting status, which will improve the quality of life for all practice members.

Partial-Retirement Strategy

The worst approach a practice can take is to require an older partner to work full-time when he has reached a half-time work mentality. A much better approach is to have this partner work part-time and to hire a new partner-track radiologist, who will have fresh, vigorous attitudes about work responsibilities. It is important to keep work status options simple: full-time, part-time, or no time.

Have an exit strategy for those partners heading toward retirement: let them work part-time for a defined period (3 years or so, up to a maximum of 5). Because benefits are nondivisible, the part-time radiologist usually can retain his or her full benefits package simply by working an extra 3 to 5 weeks per year.

The Problem Partner

Partners must keep in mind that operating policies should be in place before they are needed. When problems do arise, remember that any action sets a precedent, so policies must be followed strictly, warns Muroff.

It is wise for practices to seek a lawyer who is familiar with federal and state law to review their established guidelines, especially because groups can be held responsible for the “misbehavior” of any single member. To this extent, it would be helpful to arrange for a lecture on what constitutes a hostile workplace environment, so that issues such as sexual harassment (which can lead to loss of hospital contracts, for example) are clear to all members of the practice.

Muroff says that five important clauses must be included in contracts to protect a practice:

  • termination without cause, on the basis of a 75% to 80% vote of the shareholders and with a short termination interval (30 to 90 days);
  • a noncompete mandate (not allowed in California), which should involve geography (counties or miles) and time (2 to 5 years);
  • automatic resignation from all hospitals with which the practice is affiliated, within 3 business days of the end of employment;
  • full-time employment with the group, entailing the practice’s ownership of all records and materials relating to patients and all rights to bill for services (thus, all income earned by an individual member belongs to the group); and
  • protection against the sale or repossession of stock by an outside entity (as in divorce or bankruptcy proceedings), so that shares always revert to the practice in exchange for a value set by the board of directors (not book or market value).

Most important is to take action when a group member is presenting difficulties that conflict with the practice’s mission and policies. “A problem person can have tremendous repercussions on a practice,” attests Muroff. “Don’t keep him or her around.”

Working Committees in Radiology Practices

According to RSNA speaker Lawrence R. Muroff, MD, of Tampa, Fla, three types of committees are essential to a successful radiology practice.

  • Finance/Fees Committee
  • Operations Committee
    (1) Credentialing
    (2) Workloads and vacation time
    (3) Quality of life issues
  • New Business/Marketing Committee