WORKLOAD MEASUREMENT
or accurately reflected in data relying solely on numbers of reports generated. These activities included interventional (IR) and procedural activity,
teaching
and administration and preparation for and conduct of multi-disciplinary team meetings (MDMs). The total number of hours engaged in these activities in each department was divided by the contracted working hours of a radiolo- gist to give the number of whole-time equivalents (WTE) not available for study reporting activity. Calculations were then performed for each reporting radiology department, giving the crude and net annual RVU numbers per Consultant Radiologist WTE. Crude RVU/WTE did not take any account of non-countable (IR, procedural, MDM etc.) activity, while net RVU/WTE allowed for the time- based non-countable activity.
RADIOLOGIST WORKLOAD IN IRELAND
The 2006 Australian survey upon which our method was based recommended 40000 crude RVU/WTE as an appropri- ate annual benchmark activity level for a Consultant Radiologist in a teaching radiology department [2]. In 2009, the same method was applied to a broader sample of Australian hospitals; annual activity levels had risen to 45000 crude RVU/WTE [3]. Crude RVU/WTE activ- ity numbers in Ireland in 2009 ranged from a mean of 48873 in University teaching hospitals without radiology trainees to 58788 in general hospitals. Net RVU/WTE numbers ranged from a mean of 63414 in University teaching hospitals without radiology trainees to 126376 in University teaching hospitals with trainees. It must be acknowledged that measurement of the amount of time spent by radiologists in non-countable activities introduces the potential for inaccuracy (and therefore net RVU/ WTE figures are subject to more debate than crude RVU/WTE); nevertheless, the fundamental finding of this aspect of our survey was that Irish radiologists are performing substantially more work annually than the previously-published Australian benchmark. The second key finding of our work
related to quantification of the amount of time a modern radiologist spends engaged in activities which would not even have been captured in workload measurements based solely on report numbers. While this varied among hospitals, depending to
APRIL/MAY 2012
some extent on the level of tertiary refer- ral, teaching and interventional activity, when averaged across all reporting hospi- tals (73% of all public hospital radiology departments in the country), a mean of 32.47% of radiologist time was devoted to these activites. Over 40% of this non- countable activity comprised interven- tional, procedural and nuclear medicine work (i.e. direct patient care activities).
LIMITATIONS There are inevitable shortcomings to
our data collection method, including, among others, the following: • “Lumping” different study types together into a small number of cat- egories implies that the full complexity of modern radiology practice is not fully-captured; however,
quate resources, and we have been actively engaged with the Irish Health Service Executive since publication of our survey in an effort to make this happen. Radiologists are well aware that demand for our services will continue to increase; this is, to some extent, a validation of the centrality of what we do in patient care, and we should welcome it. Recent data collection associated with the develop- ment of a national RIS/PACS system in Ireland found an annual average growth rate of 5% for radiology procedures and studies. Thus, we work in an environment that demands more year-on-year, with- out having a robust method of match- ing supply to that demand. Radiologists have increasingly found that
they are “splitting”
study types into large numbers of cate- gories would have made data collection and analysis, and comparisons across hospital sites and groups very difficult.
• The method of recording study num- bers in all participating hospitals is not uniform, as a variety of radiology information systems are presently in use in Ireland. This will be less of an issue in future, as a national PACS/ RIS system (NIMIS) is being deployed in all public hospitals in Ireland; this should improve uniformity of study registration in future.
• The presence or absence of postgradu- ate trainee radiologists in departments was not allowed for in data collection. The exercise we undertook related to measuring the workload of Consultant Radiologists, not radiologists in train- ing. Some critics of our work have sug- gested that the lack of allowance for the work done by trainees invalidates data from those hospitals where trainees are based. Conversely, published data sup- ports the contention that working with a trainee reduces a Consultant’s output by approximately 50% [6].
CONCLUSION So what have we achieved? Our survey
was designed with two main outcomes in mind: establishing an agreed, valid method of measuring radiologist workload in the current era, which could be used in future in our health system, and identifying what the workload was at a given point in time (2009). The next steps are to find a means of translating the method and data into a meaningful basis for provision of ade-
DI EUROPE
expected to cope with whatever is asked of them, without provision being made for the inevitable pressures created, such as longer working days, the requirement to work faster and the continued inter- ruptions to work generated by compet- ing simultaneous demands. Inflation in radiology demand is a worldwide issue. Recent data from Canada showed a 58 percent increase in CT examinations and a 100 percent increase in MR stud- ies betwen 2003 and 2011 [7]. We can respond to increased demand in many ways; the most constructive approach is to concentrate on obtaining hard data (such as we have done with our survey) demonstrating just how much work we are doing, to advocate strongly on the basis of this data for appropriate resources, and at all times to emphasise that the work we do must be safe and at the highest standards for our patients.
REFERENCES:
1. Royal College of Radiologists, 2008. How many radiol- ogists do we need? A guide to planning hospital radi- ology services. BFCR(08)17.
https://www.rcr.ac.uk/ docs/radiology/pdf/BFCR(08)17_Workforce.pdf
2. Pitman AG, Jones DN. Radiologist workloads in teach- ing hospital departments: Measuring the workload. Australasian Radiology 2006; 50:12.
3. Pitman AG, Jones DN, Stuart D, Lloydhope K, Mallitt K, O’Rourke P
. The Royal Australian and New Zealand
College of Radiologists relative value unit workload model, its limitations and the evolution to a safety, quality and performance framework. J MedImaging and Radiation Oncology 2009; 53: 450.
4. Brady AP. Measuring Consultant Radiologist workload: method and results from a national survey. Insights into Imaging (2011);2:247-260. DOI 10.1007/ s13244-011-0094-3.
5. Brady AP . Measuring Radiologist Workload: How to
do it, and why it matters. European Radiology 2011; 21: 2315.
6. Jamadar DA et al. Estimating the effects of informal radiology resident teaching on radiologist productivity: what is the cost of teaching? Academic Radiology 2005;12:123-128.
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