Activity-based cost analysis: a method of analyzing the financial and operating performance of academic radiology departments

PURPOSE: To develop a methodology for an activity-based cost (ABC) analysis in an academic radiology department, to test the hypothesis that the business of academic radiology can be separated into three distinct businesses-clinical activity, teaching, and research-and to determine the effect of the current teaching paradigm on clinical productivity. MATERIALS AND METHODS: Forty-seven key departmental activities were defined and distributed among the teaching, research, and clinical businesses. Individual radiologists determined the time spent in each of these activities by completing a detailed log of every activity performed during 2 weeks. All departmental revenue and costs were assigned to each activity in each of the three businesses. RESULTS: The methodology provided a successful understanding of the relative costs of each of the businesses of teaching, research, and clinical activity. It also provided the departmental costs of performing the separate activities typical of each business. Key findings included the following: Faculty spends 72% of time in clinical activities, research is the most expensive service per direct activity hour, and clinical reads (23%) are the single largest departmental cost element. CONCLUSION: ABC analysis can separate academic radiology into three businesses-teaching, research, and clinical-and provide a detailed understanding of the cost structure of each. This analysis identifies opportunities for improved quality of service, productivity, and cost within each business.     

Research and research training in academic radiology departments. A survey of department chairmen

We surveyed 121 chairmen of academic radiology departments to assess how these departments select and educate their residents and fellows in research. Eighty-six chairmen responded (71%). The majority of their programs select at least some of their trainees for their potential as researchers and nearly all encourage trainees to perform research. The more the selection process focuses on research, the greater the percentage of residents and fellows that participate in research during training. Nonetheless, only about one-third of residents and half of the fellows perform and publish research. Only half the programs offer formal research seminars and few trainees opt for additional research training. These results may relate to the relatively small percentage of faculty performing prospective clinical and laboratory research. These findings are disappointing in the light of previous results suggesting that performing research, publication, and formal research education during training correlate highly with the development of successful research careers. Chairmen could increase the likelihood of trainees choosing research careers and being successful in publishing research by providing early exposure to research experiences and providing formalized research training.     

Emerging strategic themes for guiding change in academic radiology departments

Academic radiologists are faced with increasing demands on their time and energy, particularly in the clinical arena, where larger examination volumes and higher service expectations are the norm for most medical centers. These demands are intensified by the continuing shortage of academic radiologists. If academic radiology departments continue to devote most of their resources to the clinical mission at the expense of research and educational missions, then there are potentially serious adverse consequences for long-term viability of the profession of radiology. This dilemma represents a critical strategic problem, not just for academic radiology but also for the entire profession of radiology. In this article, the success and growth of academic radiology during the 20th century are framed as the result of the dogged pursuit of certain key strategic themes. With the concept of paradigm shift, introduced by Kuhn, several new strategic themes are identified that are just emerging from changes in work practices, organizational structure, and mind-sets in radiology departments at academic medical centers. One benefit of this approach is that it facilitates the ability of radiologists to articulate and focus on those strategic themes that will help academic radiology departments to adapt more rapidly and successfully to environmental changes during the 21st century.     

Internet use in radiology: results of a nationwide survey

PURPOSE: To determine the number of radiologists who currently have Internet access, their use patterns on the Internet for Radiology purposes, the web sites they would recommend, and the potential site access to the Internet that they would like to see in the future. In addition, this study analyzed the best way to find nationwide radiological sites and their content. MATERIALS AND METHODS: In a nationwide survey, 854 Austrian radiologist were asked to fill out and return a questionnaire about Internet access, current problems, current and future use, which web site they recommend, and about the use of e-mail. Next, the available nationwide radiological sites were searched with seven major search engines using 37 different keywords, as well as by category search, and by searching for links on the homepages of the radiological departments of all Universities of Austria. Then, the offered information of the founded pages was classified in categories. RESULTS: Of the 210 (24.6%) radiologists who returned the questionnaire, 154 (73%) had Internet access. Time expenditure was considered the main problem using the Internet. The Internet was used for literature research by 69% of the radiologists with Internet access, for e-mail by 60%, and for congress information by 57%. In future, 43% would like to read electronic journals more often and 39% would like to use the web more intensively for scientific congresses. At the present time, we found 17 radiological web sites in Austria. The most promising way to find these sites was to use the search engines Alta Vista and Hotbot. Fifteen (88%) sites offered information for patients, seven (41%) for radiologists, five (29%) for students, and four (24%) for researchers. SUMMARY: Many radiologists in Austria already have Internet access, although time expenditure was considered the main problem with Internet use. Survey responses showed a need for electronic journals. To our point of view, Universities and radiological societies are urged to publish journals electronically on the Web. Alta Vista and Hotbot were the best search engines for radiological sites in our setting, and a careful reading of the specific search engine's instructions is recommended. In our experience, Web pages with clear structure, small file size, precise HTML keyword editing, and page titles, facilitate more accurate discovery of specific sites. In addition, there seems to be a need for regular publication of reviewed radiological link collections and the establishment of standards for teleconsulting.     

Enhancing research in academic radiology departments: Recommendations of the 2003 Consensus Conference

Opportunities for funded radiologic research are greater than ever, and the amount of federal funding coming to academic radiology departments is increasing. Even so, many medical school-based radiology departments have little or no research funding. Accordingly, a consensus panel was convened to discuss ways to enhance research productivity and broaden the base of research strength in as many academic radiology departments as possible. The consensus panel included radiologists who have leadership roles in some of the most well-funded research departments, radiologists who direct other funded research programs, and radiologists with related expertise. The goals of the consensus panel were to identify the attributes associated with successful research programs and to develop an action plan for radiology research on the basis of these characteristics.     

Enhancing research in academic radiology departments: recommendations of the 2003 Consensus Conference

Opportunities for funded radiologic research are greater than ever, and the amount of federal funding coming to academic radiology departments is increasing. Even so, many medical school-based radiology departments have little or no research funding. Accordingly, a consensus panel was convened to discuss ways to enhance research productivity and broaden the base of research strength in as many academic radiology departments as possible. The consensus panel included radiologists who have leadership roles in some of the best-funded research departments, radiologists who direct other funded research programs, and radiologists with related expertise. The goals of the consensus panel were to identify the attributes associated with successful research programs and to develop an action plan for radiology research based on these characteristics.     

Enhancing research in academic radiology departments: recommendations of the 2003 Consensus Conference

Opportunities for funded radiologic research are greater than ever, and the amount of federal funding coming to academic radiology departments is increasing. Even so, many medical school-based radiology departments have little or no research funding. Accordingly, a consensus panel was convened to discuss ways to enhance research productivity and broaden the base of research strength in as many academic radiology departments as possible. The consensus panel included radiologists who have leadership roles in some of the best-funded research departments, radiologists who direct other funded research programs, and radiologists with related expertise. The goals of the consensus panel were to identify the attributes associated with successful research programs and to develop an action plan for radiology research based on these characteristics.     

Radiation exposure in dental radiology: a 1998 nationwide survey in Switzerland

OBJECTIVES: To measure the frequencies of dental radiological examinations in Switzerland and to determine the associated collective radiation doses. METHODS: To evaluate the frequencies, a sample of 376 dental practitioners and other institutions performing dental radiology were requested to fill in questionnaires designed to measure, amongst others, frequencies of dental radiodiagnoses according to type of examination, patient age and gender, dental specialty and type of surgery. The associated collective radiation doses were determined by multiplying the relevant frequencies with dose estimates obtained from recent measurements and calculations. RESULTS: The total number of dental examinations performed in Switzerland in 1998 was 4.1 million (581 per 1000 population). Periapical, bitewing and panoramic radiographs were the most frequent types of dental examinations. The collective dose associated with dental radiology was 71 person.Sv. This amounts to an annual average effective dose to the population of 10 muSv per caput, which is in agreement with the figures reported for countries of similar healthcare level. Various features such as the age distribution of the radiographed patients, the forms of collimators used, film consumption and the use of digital imaging systems are presented. CONCLUSIONS: Several recommendations for dose reduction are made. These include the re-evaluation of the patterns and justification for prescribing some particular types of dental examinations as well as the avoidance of unnecessary irradiation by the use of rectangular collimation and high sensitivity F-speed films.     

The relationship of clinical and academic productivity in a university hospital radiology department

OBJECTIVE: The purpose of this study was to evaluate the relationship between clinical and academic productivity over a 2-year period in a university hospital radiology department. MATERIALS AND METHODS: Clinical productivity, as determined by the number of total professional relative value units generated, was compared with academic productivity, which was determined by the number of published peer-reviewed articles, published non-peer-reviewed articles, published abstracts, and presentations delivered by each full-time clinical faculty member. The relationships of age, academic rank, administrative position, and division within the department were also assessed for their effect on relative value units and academic productivity. RESULTS: We found a significant inverse relationship between relative value units and the number of published peer-reviewed articles, published abstracts, and presentations. Age, academic rank, and administrative responsibilities had no effect on the number of relative value units. Faculty in the neuroradiology and cardiovascular-interventional radiology divisions generated more relative value units than did other faculty members. CONCLUSION: Faculty members with higher levels of clinical productivity showed significantly lower levels of academic productivity. This finding is consistent with the idea that increases in the clinical workload may diminish research output.     

Promotion as a clinician educator in academic radiology departments: guidelines at three major institutions

Faculty promotion within an academic department of radiology may place emphasis on scientific research, administrative contributions, educational contributions, or a combination of all endeavors that enrich the department and further its academic mission. For those departments considering the establishment of a promotion pathway that emphasizes teaching talents and education-oriented research, the authors provide examples of three different clinician-educator faculty appointment and promotion schemes. Faculty development and defining scholarly work as a clinician-educator, as well as documentation of academic productivity within this pathway, are discussed.     

Measuring the academic radiologist's clinical productivity: survey results for subspecialty sections

RATIONALE AND OBJECTIVES: The purpose of this project was to understand better the academic radiologist's clinical workload in order to determine faculty staffing requirements more accurately. MATERIALS AND METHODS: Surveys performed by the Society of Chairmen of Academic Radiology Departments (SCARD) collected data for radiologists in 20 departments in 1996 and 1998; the data included work relative value units (RVUs) per full-time equivalent (FTE). Radiologists in each subspecialty were compared with their counterparts in other departments. The data were collected for each radiologist. Summary statistics showing averages, medians, and quartiles were used to describe workload (in RVUs per FTE) for each department and each subspecialty. RESULTS: Overall, the average clinical workload was 4,458 RVU/FTE, with 0.62 RVU per procedure. In those sections for which the faculty performed similar types of procedures across departments, the results were useful. The workload data, however, proved inadequate to compare across subspecialty sections. Between 1996 and 1998, the workload increased from 3,790 to 4,458 RVU/FTE. CONCLUSION: The SCARD survey provided very useful clinical workload data, measured in work RVUs per FTE for specific subspecialty sections. At practically all surveyed institutions, increasing clinical workload is competing with academic activities.