Arenson RL, Garzio C. A Practical Guide to Leadership and Management in Academic Radiology. Charles C. Thomas Publisher LTD; 2012; 268 pgs.; $37.95.
This is an excellent introduction to management of an academic radiology department. Written by the chair and business manager of one of the top departments in the country, the text covers a wide range of topics one would confront in the position of chair. The authors provide sufficient detail for this book to be a handy reference on the job, as well as a quick read before getting started. There is less attention paid to the personal interaction aspects of the job. Of course, these concepts are much harder to teach, particularly in a book.
There are chapters on compensation plans and incentives, billing, budgeting and financial management, clinical services, workload, research, education, recruitment and retention, and strategic planning, among other topics. Throughout, the authors discuss the opportunities and requirements for dealing with stakeholders within and outside of the Radiology Department. They pay appropriate attention to relations with and expectations of the Dean and hospital leadership.
Having been published just as these were coming into being, the book does not address Alternative Quality Contracts, or Accountable Care Organizations, and has only brief reviews of more established entities such as bundled payments and service lines. Overall, the authors advise caution in any of the newer structures, all of which have the potential to reduce the autonomy of the Radiology chair and direct revenue away from the Department. Since these have yet to penetrate deeply into the Radiology market, the advice to avoid the newer approaches may be tenable for a while longer, but it would have been helpful to hear the authors’ thoughts on how to make the best of it if Departments have no choice but to participate.
The only drawback this reviewer can find is the limited audience. The authors have produced an excellent introduction to the job for radiologists becoming department chairs. However, at any one time, there are only a few such people in the country. Division chiefs might find this valuable to increase their understanding of the pressures faced by their chairs. Those considering chair jobs might use this book as a reality check. Reading through it gives one a clear picture of the work of a chair, and readers can ask themselves whether this is what they want to do with their lives. The authors’ deep experience at the top of academic medicine comes through, and the text might be of less value for those running academic departments with less intensive research and educational missions, or private radiology groups. Although some of the financial considerations are the same, the mandates of research and teaching drive much of the discussion throughout the book. Chairs of radiology at community hospitals might benefit from some of the chapters, but the academic orientation, considerations of relationships with the Dean, research funding, and education are given a great deal of attention. These are critical for those in academic jobs but are less important for others.
Incoming academic department chairs in other disciplines might find some of the book valuable. However, the discussion is so focused on radiology that it provides little help for some concerns that would absorb a chair of another clinical department. There is essentially nothing about managing the inpatient service or outpatient clinics, for example. The discussions of quality are perfect for a radiology chair, but would not be particularly useful for someone whose performance is assessed with outcome metrics. Radiology departments increasingly are expected to devise and apply clinically relevant outcome metrics of their own. Therefore, more development of this important topic would have been helpful.
The authors discuss performance assessment for radiologists and scientists in terms that are fully appropriate for a Radiology department. The authors do not address the sorts of clinical performance measures and challenges that can arise in direct patient care departments.
Chairs of other hospital-based departments, such as Radiation Oncology or Pathology might find much of the discussion helpful, although lacking in details specific to those fields. The considerations of contracting, capital budgeting, and managing in a field that brings in few of its own patients will be particularly relevant for these fields. The requirements to maintain high quality technical resources with limited funds, the need to attract top clinical and academic faculty, who expect state of the art equipment, and trainees with the same expectations, will be quite similar.
This book is recommended for those considering moving into department chair positions, and it will prove invaluable to those just starting out in the job. By the time one has been running an academic department for a year or two, it is likely that these lessons will have been learned, sometimes the hard way. The text might be helpful to provide perspectives for sitting chairs confronting a new issue. They may well be curious about how Arenson and Garzio would have handled the problem. The challenge in this situation is the generality of the text. Appropriately, the book does not dwell too heavily on details at a particular institution. Thus, existing chairs might not find sufficiently specific advice to be useful when confronted with real-world problems. This book might provide a starting point for approaching some of the issues, but still more thought might be required before any action is taken.
Overall, this is an excellent text for the relatively limited audience of emerging Radiology Department chairs, and it would be valuable for those considering moving into such positions in the near future. For all the obvious effort and expertise the authors have brought to this publication, the audience beyond radiology division chiefs and department chairs may be limited.
