At the Dana Farber Cancer Institute in Boston, outside radiologic consultations make up more than half of the daily workload of radiologists, who generally aren't paid for the time. Armed with this knowledge, Dr. Pamela DiPiro and colleagues from the institute decided to quantify this service as a step toward getting reimbursed for second opinions.
"We run a busy oncoradiologic service, where there are numerous clinician consultations that cause interruptions, without compensation, be it relative value units (RVUs), monetary [compensation], or manpower," said DiPiro, who presented her study at the RSNA conference on November 29 in Chicago. "The purpose of our study was to assess their impact and help design resources necessary to provide this consultation service."
From October 1999 to October 2000, DiPiro and colleagues surveyed referring doctors who sought radiologic consultations, which were defined as reviews of studies from an outside institution; from the institute's partner institution, Brigham and Women’s Hospital; or from the Farber institute itself.
"The reason we included the latter was that, many times, we had performed the [initial] study, and the clinician came back to us with previously unavailable films and wanted a comparison. Alternatively, they’d come to us with a patient who was now placed on a new protocol for which they needed multiple bidimensional measurements," DiPiro said.
For comparison purposes, the average daily workload during this time period was calculated, she added.
The results revealed that over the 254 working days, 4,664 additional consultations were performed. The majority, 78%, consisted of cross-sectional studies such as CT, MR, and ultrasound. Mammography made up 14% of the consults, plain films 5%, and 3% were nuclear medicine scans. One galactogram also was performed.
A sizable portion of consult studies, 76%, came from outside medical centers, while the Farber institute itself generated 13%. Brigham and Women’s Hospital made up 11% of the consults.
During this time period, the radiologists' average workday consisted of about 34 studies, many of which were complex -- chest, abdomen, and pelvis -- and required the review of one or more older studies as well, DiPiro said.
"This calculates to a mean of 18 additional consultations per day with a range of 4 to 32," she explained. "Measurements were requested in 28% of these consultations, and these would often be quite time-consuming, lasting anywhere from 30 seconds to 30 minutes, depending on the number of bidimensional measurements that were requested. We almost always do 3 to 10 bidimensional measurements. We also perform our own ultrasound exams, and we perform contrast injections."
Radiologists worldwide are grappling with the consultation issue. Recently, researchers from the University of Trieste in Italy surveyed their radiologists and clinicians about their working relationships. In the course of 220 work days, 20 radiologists individually spent 21.65 minutes per day on consultations, for a total of 7.08 hours per day -- the approximate equivalent of one full-time radiologist.
The authors concluded that while clinical-radiological consultations do have a beneficial diagnostic and therapeutic impact, they are time-consuming (Clinical Radiology, August 2000, Vol.55:8, pp.602-605).
Other specialties at the Farber institute, such as pathology and surgery, already have accepted second-opinion plans between referring clinicians and specialists. DiPiro said the next step will be to devise a compensation strategy for radiology modeled after those plans. And because most patients at the Dana Farber Cancer Institute are in clinical trials, the radiology department should consider pursuing compensation through the hospital’s clinical trial budget, she said.
By Shalmali PalAuntMinnie.com staff writer
January 16, 2001
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