The Reading Room

Should you outsource after-hours and weekend radiology shifts?

by Lea Halim and Noam Yossefy

It's 2 a.m. A patient rushes into the emergency department with what appears to be appendicitis and is in need of an urgent CT scan. Does an on-site radiologist read the exam—or should it go to a remote teleradiologist?

After-hours radiologist coverage is an evergreen challenge for imaging leaders. Many radiology programs struggle to ensure that enough radiologists are available to provide timely reads, without having physicians sitting idly on night and weekend shifts. We're not surprised that our members are asking us about after-hours coverage, mainly because:

  • After-hours shifts are difficult to staff and manage since they're burdensome for physicians, but outsourcing raises quality concerns for imaging leaders.
  • Providing coverage for after-hours shifts is expensive, and there is not yet a consensus regarding radiologist compensation.
  • Data sharing enables radiologists to read remotely, opening the door to new approaches to manage after-hours staffing.

With over 90% of late-night reads being conducted remotely and less than 10% requiring supervision, many hospitals are considering whether to keep these services in-house, or to outsource after-hours shift coverage.

Below are some questions that our members have asked about providing coverage for after-hours and weekend shifts. Read on to better understand cost, quality, and productivity considerations for whether you should keep after-hours coverage in-house or outsource these services.

Member question: How are organizations structuring their internal after-hours radiology team?

Leveraging IT to maximize radiologist workforce: Leaders at Sunshine Radiology, an independent radiology group in Florida, were preparing to hire additional radiologists to meet contractual agreements for productivity and overnight coverage needs for their hospital partners. But after realizing that disparate IT infrastructure was compromising efficiency and quality, they deployed a universal viewer to allow physicians to read images across the system.

By using a unified system workstation, Sunshine Radiology was able to leverage a single radiologist to provide coverage for overnight shifts across its facilities, eliminating the need for an additional radiologist. Now Sunshine staffs a single physician to provide after-hours reads for nine hospitals.

Sunshine Radiology

Constructing a data-driven staffing model: While Sunshine Radiology only requires one radiologist to support their after-hours coverage needs, it is crucial that you leverage data and consider volumes to construct appropriate on-site staffing models around high RVU-generating times. As you can see in the graph below, the midhawk and deephawk shifts account for the most hours in a radiologist's day, but only drive 11% and 19% of total RVU value, respectively.

Economic Value of Radiology Shifts

Member question: What are some compensation considerations for internally staffing after-hours radiology shifts?

Salary-based model: Some hospitals with employed radiologists deploy a dedicated nighthawk team. They pay the nighthawks a salary (plus bonus and benefits) that is identical to that of their day-time readers. However, this results in very expensive night coverage that is beneficial only for large health systems that have higher coverage needs.

Productivity-based model: Other health systems pay their nighthawk physicians on pure productivity ($ per exam read). To give you an idea as to how other providers are paying their radiology coverage teams, we've provided benchmarks for on-call compensation for nonsurgical specialists:  

Considerations for Outsourcing After-Hours Coverage

Member question: What are the advantages and challenges of outsourcing after-hours radiology coverage?

An example of successful outsourcing: At UC San Diego Health (UCSD), the radiology department contracted with NightHawk Radiology Services (NRS) to cover services from 11 p.m to 7 a.m. All of the NRS radiologists providing coverage worked out of Sydney or Zurich, obtained California medical licenses, and were American-trained and board-certified.

These offshore teleradiologists interpreted studies during their daytime to ensure that attentive subspecialists performed emergency reads during UCSD's night shifts. Coverage services were provided by the same essential group of NRS radiologists from night to night, which had developed relationships with residents and ED physicians through consistent telephone communication.

Considerations for Outsourcing After-Hours Coverage 

As we see with Sunshine Radiology, advances in radiology IT capabilities have increased radiologist flexibility in recent years and reduced the need for radiologists to be physically present to provide reads for the system. However, it is crucial that radiology groups engage hospital leaders and take into account how outsourcing imaging services may impact hospital partnerships. While outsourcing night reads may lead to an easier lifestyle for radiologists, this shift can lead to various unintended consequences for radiologists, including the commoditization of the specialty, lowering of fees and quality, and displacement of private groups from reading contracts.

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