Understanding the business-side of radiology is important but current programs for residents and fellows might be falling short, according to a new report.

It's been a heady past few years for diagnostic imaging: declining reimbursements, health care reform and other pressures have all led to headaches for providers and require serious business savvy for practices to survive.

Plus, since 1999, the national body that accredits graduate medical education has called for residency programs to teach along six domains related to health care delivery and the business of medicine.
It's no surprise then that in a series of recent surveys, residents and directors of residency and fellowship programs say business and health care policy education are important. However, they also say current programs while often moderately effective don't offer the "soft skills" of leadership training and "hard skills" of performance metrics and accounting.

In the study, published in the Journal of the American College of Radiology on Thursday, researchers tried to suss out the community's opinions, ultimately polling 495 respondents from the American College of Radiology's residents and fellows section (ACR RFS) and 65 program directors with the Association of Program Directors in Radiology (APDR).

The researchers, led by Dr. Jonathan R. Medverd, a radiologist with the University of Washington, used a mixture of online and paper surveys. The APDR respondents completed their survey online, as did 399 respondents from the RFS group (the surveys were emailed in 2009 and 2010). Another 55 RFS survey-takers filled out a paper questionnaire in person at an ACR RFS delegates meeting in May 2010.

According to the study, 89 percent of APDR respondents and 96 percent of the RFS delegates said business topics were important. Similar numbers said the same about teaching health care policy.

About 91 percent of program directors, and 74 percent of residents, said their programs offered "noninterpretive" curricula -- that is, instructions on topics other than the interpretation of medical images and performance on related procedures, the obvious primary focus of radiology residencies and fellowships.

However, only 45 percent of APRDR, and 52 percent of RFS groups, said current programs for teaching these nonmedical topics were "moderately" effective," and almost a third said they were only marginally or minimally effective. Few thought they was "very effective" (12 and 6 percent of directors and residents, respectively), according to the survey.

In general, legal and ethical questions, informatics, negotiating contracts and billing and reimbursement were widely tackled, with over half of APDR respondents saying these were included in their programs. However, fewer than half said their programs included instruction on leadership, health care policy, practice governance, strategic planning, accounting, performance metrics and finance.

Interestingly, there was also some confusion. Although the survey was anonymous, respondents could fill in their institution's name. About two out of 5 of respondents answered differently when asked if their program offered noninterpretive curricula.

"National accrediting authorities, radiology program directors, and radiology residents and fellows all value business practice and health care policy education, but our data on the perceived effectiveness of individual program educational efforts suggest that current curricula, although providing some value, may be suboptimal when present," the authors wrote.

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