Choices: The Business Side of Radiology

You have a choice quote, business side of radiology

By: Patricia Kroken, FACMPE, CRA, FRBMA
RBMA Bulletin
Originally published 2012; updated 2021

Where we are right now represents the culmination of choices we have made up until this point.  This is not to diminish the impact of devastating events beyond our control, but to recognize it is how we chose to deal with those events that shaped our lives.  The same challenges that forge strength, character and leadership in some individuals will send others cowering into a corner—or perhaps out of a profession entirely.  It is interesting that our lives are shaped not only by those pivotal major choices, but in the small patterns of choices we face every day in our lives and careers. 

At some point you made the choice to work on the business side of radiology.  Some people probably did so because they heard the income was good, some because it was a job that was open when they were looking and some because it offered career mobility.  But no doubt for everyone, it seemed like an interesting choice at the time. 

Ironically, as a marketing person I went into radiology because I wouldn’t have to travel as much as I was working for a regional food company—ironic because I then spent more than 20 years traveling two or three weeks of the month.  It also looked interesting (one of my relentless mind’s criteria for staying more than two years in any one position without looking for something new to experience).  I have never been bored in radiology—not even for an afternoon.

So let’s look at some of the major choices we face in our noble profession. 


We work in a profession where the business environment is largely out of our control and on many levels, almost nonsensical.  And it’s getting worse, as those who do not work in healthcare try to “fix” things for those who do. 

We are also at the mercy of physicians who must send us patients, the hospitals where we provide services, the insurance companies who seem to pay based on arbitrary rates with equally arbitrary rules for determining what is payable. 

We have generational gaps and varying priorities among our employees and at least one of them with marginal competence and an overinflated sense of entitlement.  As administrators of a radiology practices, we also work for multiple highly intelligent and frequently opinionated bosses who have virtually no understanding of our jobs. 

Are you a victim of these circumstances?  Are you railing in frustration and lamenting the fact you have to do so many things that seem so very stupid?  And that nobody knows (or cares) about the problems you face?  And that no matter what you do to attain a level of control of your environment, someone else seems to be working overtime to muck it up?

That’s called job security—at least to the degree there will be a challenging, frustrating, unending-stack-of-stuff-to-do job in radiology.  Can you handle it, bucko?  You get to decide. 

You Choose!

You can choose victim or you can choose student, warrior, puzzle-solver, amateur psychologist, arbitrator, negotiator or interpreter—and sometimes all of those in the same day!  Granted you need a couple of personal checkpoints to review as life rolls out its challenges:

  1. There was obviously nobody from radiology at the table when the group of idealists sat down to make new laws—and we have lots of “committee” results to contend with. “This is stupid, but if you insist…”

  2. “My life is a test,” “What does not kill me makes me stronger,” “If I can get through this I can get through almost anything” (add other reassuring motivational quotes here).

  3. “Now that’s interesting…” (the appropriate comment for many situations).

  4. “If this crisis was happening to someone else, would I think it was funny?” This is valuable in situations such as preparing for the conference call with the labor board regarding the manager you fired for viewing porn on the company computers, when he thought he’d deleted everything (but didn’t) and said it was because you didn’t like him—and you’re uncomfortably assembling documentation.  (It happened).       

I Chose: Radiology Warrior

I chose to be an optimistic radiology warrior (with no apology to the flower-wielding “can’t we just group hug instead” ranks of my colleagues).  I am an optimist to the degree I think I can actually make a difference. 

Each day I arrived with my well-planned task list and greeted the chaos central to my career.  I worked quickly in spite of a myriad of interruptions by people and events determined to de-rail my progress.  They were usually successful to some degree, but as a warrior I continued on just to annoy them.

 I acknowledged the absurdity of certain regulations while at the same time attempting to understand how someone with a college education and this much experience can struggle with the inept instructions for filling out the “new and improved” series of  Medicare 855 forms. 

Exhausted but not beaten, I often ended the day by battling a soul-draining 45 minutes of rush hour traffic—or airport screening and a packed flight, depending on the day. 

Were there bad days?  Absolutely, especially when you found out someone made a big billing error and you got to report a revenue dip at the next board meeting. There were days I was so beaten I wanted to run away to become a waitress in Montana.  I thought about that on the flight home. 

When it was an especially bad day, I sometimes chose to wallow in misery for the entire evening—with the goal of diving deep into those feelings so they could be all done by morning.  In the morning, it was time to be warrior again.

You really do get to decide.  And the right attitude will be key to success, longevity and satisfaction.

Taking sides

As a Practice Manager

As a practice manager, one of our toughest and most treacherous areas involves taking sides.  There will be radiologists in the group you like working with better than others.  There are some you don’t like at all and even seeing their names pop up on e-mail can stir a visceral reaction.  There are also factions in the radiology group.  You may personally agree with one faction more than another.  All of this is like gears in a complex machine and if you make a false step, the gears can crush you. 

As a manager, your ultimate goal is to ensure the practice remains viable as a business—and you need to remind yourself of this on a regular basis so it can regulate your behavior and decisions. 

It frequently means running through the drill of how each faction (or shareholder) will react to certain situations and over time, you’ll get pretty good at predicting reactions.

It means asking yourself, “What’s the worst that could happen if we go in this direction?” and going through that exercise even when the decisions or directions seem innocuous.  Even when you do this conscientiously, you will miss some.

Taking sides can be career fatal, even if you can do everything in your power to remain neutral while being perceived as taking sides. 

As an Administrative Leader

If you are an administrative leader, you are perceived as the lieutenant of the senior physician leaders of the group—and in fact you serve in that role.  As new physicians become partners, they do so with a vote and some opinions.  If enough of them share the opinion there needs to be a physician leadership change, you may find it could have been a good strategy to get to know them and make sure they knew you. 

They need to know just because you said “no” to some of their excellent ideas, it was for a reason—like they were in violation of numerous Medicare regulations, which regularly negate good business ideas—and not because you just don’t like their ideas.   

Pay Attention

The message here is to pay attention to the gears, know that dynamics in the group will change and be aware of where you are at all times.  Make the decision to focus on maintaining the financial viability of the business and keep that as your “true North” compass direction.  Even then the subsequent decisions may be difficult but it’s easier than pinging back and forth between personalities and factions (which will occur anyway, but hopefully to a lesser degree). 

It’s best to start with the choice to be personality and faction neutral rather than going with personal inclinations.  It’s also essential to remember a change in physician leadership can literally occur over night—or with one critical vote.     


Ethical choices are easier when there is a clear “violation of the law” consequence and in radiology, they are often thrust upon us as vague Medicare regulations. 

Radiologists, by their very scientific nature and native intellect, are quick to identify potential loopholes in new regulations so when in doubt, make sure you have contact information for a leading healthcare attorney at hand. 

Perhaps the most frustrating ethical situations occur in imaging center marketing.  You maintain strict guidelines for anti-kickback implications and gifts, only to watch the center down the street gain financially for handing out baseball tickets and gift cards for MRI referrals.  And the frustrating thing is they have done so for a decade without consequences.  Do you do the right thing even if it hurts financially or join the competition in the mud? (Recommendation: stay out of the mud, no matter how tempting it may be).

Stand your Ground

How do you stand your ground when the group shareholders (innocently) ask “Why can we just do…?”  Two answers have worked pretty well:

  1. “It’s against the law. No matter how much I like you, I’m not willing to do time for you.”

  2. Then as they ask how many radiologists are in fact doing time, you remind them of the more likely penalty scenario—exclusion from the Medicare program, which in effect ends their ability to practice medicine. This usually has a greater impact than discussing prison time.

Very honestly, it would probably be possible to violate some Medicare provisions without getting caught.  On the other hand, it is difficult enough to conduct business without making an honest error and inadvertently being in violation—facing sometimes significant penalties for those errors.  In my mind, it simply has never been worth trying to manipulate the system and it’s more professionally gratifying to do the right thing. You’ll also sleep better.

And over the years, it was easy to decide not to manipulate the gray areas for short-term gain.  It has been more difficult remaining a diligent student of emerging regulations and knowing when a seemingly logical operational decision might have just violated one.  Or knowing what to do when an error is uncovered.  (Hint:  ignoring it is not the best choice and see comment about having a great healthcare attorney on speed dial).

You Choose: Victim or Warrior?

In our business lives, just as in our personal lives, each day brings dozens of choices with obvious, and less obvious, risks and rewards.  We function in a highly regulated and frustrating business environment.  You can’t change that, but you can decide whether to be a victim or a warrior.  It’s the same job either way you decide, but there are wide variations in the element of fun associated with the decision.  Here’s to the warriors!  (And a quick squeeze to the group-hug folks—it’ll be OK). 

Patricia Kroken, FACMPE, CRA, FRBMA,
has an extensive background in radiology practice management and directs education and corporate communications for MSN Healthcare Solutions

She worked as a consultant for radiology practices, billing companies, software developers, and hospital radiology departments for 20 years before joining MSN.

She is a regular contributor to the RBMA Bulletin and a frequent speaker on topics related to radiology practice management. 
Pat can be reached at
or 505-856-6128