And they definitely do not do “admin”.

A dilemma facing today’s increasingly complex radiology practices is an interesting one, given the fact that the forces of business are converging in a kind of perfect storm on the practice environment, creating an increasing need for a fundamental understanding of the value of the commercial side of the medical group from each partner.

The issue is fairly clear. Radiologists graduate from medical school with, at best, a course or two on economics under their belt. Their residency is rightfully focused on the clinical equation, followed perhaps by a year or two of intense subspecialty work in a fellowship. The recruitment process often leads the new physician to a partner track position with a group that has built a rather significant enterprise over many years, with lots of employees, millions in revenue, and a host of business elements to be paid attention to by the partners. Welcome to the eye of the storm and a challenge for which you might feel completely unprepared—balance sheets, lease deals, LLC agreements, debt management, people issues, risk assessment, revenue generation, and so on.

Without a clear understanding of the complexity, time requirements, level of sophistication, and skill set required to manage a large and sophisticated “business,” the new radiologist often assumes a familiar and comfortable mind set toward the business office. That is either apathy, disdain for the function, an assumption that it essentially runs itself, or that the older partners have made too big a deal about it and spend too much time on it.

This is a familiar refrain being raised in many radiology practices today, especially when there exists significant internal controversy surrounding how best to govern a growing enterprise. It is full of outdated perceptions of the business of radiology, replete with opinions about the value (or more likely the lack of value) of the contribution to the practice from these “administrative” activities that some partners assume. It is oddly out of sync with the otherwise successful trajectory of many of these groups.

The refrain goes something like this: I don’t want one of my partners wasting his/her time on admin stuff. Or this: I don’t mind if one of my partners spends some time on all of that admin stuff, but I don’t want to vote any work time for him/her to do it. A radiologist should be reading exams and doing procedures, not wasting time on the business. Let the business office do it.

And then there is this: John, I am glad you are taking care of the admin side because I really am not interested in it, but I really don’t feel that we should allocate any of the valuable time for you to do it. And, finally: Why were you gone so long at lunch with that referring doc (or hospital administrator)? We needed you here doing real work.

Valuable time? Wasted time? Admin stuff? Real work? One gets quite a picture of the lack of respect on the part of many radiologists for the time necessary to govern, run, feed, and grow what in any other sector would be considered a significant business. Make no mistake about it; the business of radiology is going to continue to consume significant portions of partners’ time, especially those on the executive committee or in key leadership assignments. This is going to be the case even if the practice is fortunate enough to have a supremely capable business team in place, including a top notch CEO. And how the group handles the allocation of time to conduct this business will mean the difference between success and failure in an increasingly competitive marketplace.

This is especially true when it comes to the contemporary notion of building brand value, customer loyalty, and a consultative relationship with referrers through the direct contact by radiologists with their referring physicians. Today’s radiology groups are busy places full of activity and action. It is understandable that each partner needs to assess the value of any administrative duties that take a physician away from clinical duties while the others are sequestered in their reading rooms.

However, the practice is also a business, one in which the everyday elements of commerce apply. Competitive pressures, legal issues, HR risk management, marketing, strategic planning, revenue and cost management, workflow and productivity, are all a part of this equation. As owners of this business, it is incumbent upon the partners to understand, appreciate the value of, allocate sufficient resources to, and support those partners voted into the position of overseeing these activities on behalf of the rest of the group. And they should do so enthusiastically by endorsing the commitment through the allocation of sufficient time away from the reading room to build an effective structure able to guide the business activities to success.

Those practices that respect the business side, pay attention to it, and allocate quality time for it will be the ones that thrive in the new competitive arena facing radiology today.

The bottom line is this. There is no substitute for a business owner taking personal interest in the business. No staff member can engage a referring physician in the same way that the radiologist can. No executive team can create a vision for the future of the practice with the same degree of commitment and passion that the practice’s owners can. The nonphysician managers can chart a course to achieve successful realization of that vision, but the radiologists should devote significant time to envisioning their future and aligning their business in such a way that will inspire and motivate the stakeholders to realize it.

Go ahead, eat some quiche, perhaps at a marketing lunch with a top referring physician. You can still be a real radiologist. And a very successful one at that.