I’ve been advising a radiology app startup called LnQ. I think of it like Qgenda for radiology moonlighting. It can link up with your practice schedule and HL7 feed and helps groups/hospitals/etc leverage the excess capacity in their own workforce: a practice can activate LnQ when there is extra work to do and automate telling the people who aren’t currently working when additional work is available, how much work is available, and then allow those people to do that work and get paid quickly for doing it without the multiple manual steps those processes usually require. It was first developed by an independent private practice that was struggling with their lists; since implementation, they were able to not only clear the lists every day but were able to go after some lucrative contracts knowing they had more bandwidth than they’d initially thought.
I think it’s neat, and I think it fulfills a need that many practices have. On top of its purpose of facilitating internal moonlighting, LnQ is also building a network of independent contractor radiologists on the app platform so that LnQ can also be used to directly connect individual rads and groups together without a teleradiology company or locums middleman adding friction and heavy costs. A practice can then notify their ICs when there is work available and at what rate. One of the issues I’ve discussed with practices multiple times since starting Independent Radiology is that many of them could use an IC here or there but not with enough frequency and volume that makes the ongoing hassle worth it for either party. LnQ is taking care of some of the initial vetting, and multiple practices on the platform will mean that everyone has a better chance of cobbling together the excess work and excess labor in one place to help everyone get the patient care done (of course credentialing will still suck until someone fixes that broken system).
If you are a group who wants to hear more or an individual rad looking for contractor work, you can see more here (the direct physician interest form is here).
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When I first joined my practice in 2018, they’d already realized the importance of leveraging their workforce’s extra capacity so that when volumes were high, excess work could go to those with the energy and time to do it. Back then, however, we used to submit our after-hours cases as an Excel file attachment sent to payroll. It was tedious and prone to mistakes.
Flash forward several years later, and we have a full-time data analytics and computer dude who has built out workflows and internal apps to facilitate submitting reimbursement for expenses, paying for tumor boards and conferences, and essentially automating most of the tracking for our internal moonlighting from our worklist (Clario) database. Our moonlighting is per-click, and we know exactly which cases are being submitted for “after hours.” Our process is easy and fully transparent. We can run whatever analytics we want on it. For marking qualifying work, we’ve done things like mark the cases in Clario that are eligible (After Hours) or just used a list volume watermark, but the underlying principle is–when it comes to asking for help or providing help–friction is the enemy.
The reality is that with growing volumes and this volatile tight job market, recruitment isn’t always enough. And while, on the whole, the radiologist workforce is aging and burnout runs deep, we need to enable those with some juice left to squeeze more options so that those who have some bandwidth to trade time for money have the chance to do so in as many ways as possible.
Many practices have internal sales of call shifts or various swing shifts that are offered up as moonlighting, and if that’s enough to make everyone happy and get the work done? Great, you’re done. But even then…how much are those shifts paid? Does the rate get sweetened if no one wants to do them? How is that extra work tracked? Who does your payroll and how often do they mess up? How much time and effort does all of that take to coordinate? If no one is biting, can you offer up that shift to a contractor?
And, if extra shifts aren’t sufficient or desirable, that’s when ad hoc moonlighting on an hourly, RVU, or flat per-modality basis can become critical. A rad might have time for an extra scan here or there after the kids go to bed or be willing to work for an extra hour before or after their shift on occasion to avoid traffic but not be willing to commit to selling a vacation day or taking a complete extra shift or call weekend.
Taking it a step further, there are so many ways practices are structured to get the work done. Yes, a big practice with all work combined in one massive worklist and lots of overlapping shifts can make certain kinds of coverage very straightforward, but many practices have different kinds of work and multiple different systems to get it done. Is there a way you can choose to decompress a terrible call shift by asking others for a smidge of help?
What many practices need is a way to tell people who aren’t already scheduled to be working that there is work available to do, what/how much work there is (an hour? 7 RVUs?), and how much that work will pay. Maybe that payment amount changes or maybe it’s fixed. One thing you definitely don’t want is an uneven burden of easy or hard shifts disproportionately falling on certain individuals and be stuck with no way to make things fair. What do you do, for example, in a practice with multiple lists if some service lines are overly busy and those rads are stuck staying late to clear the hospital when other folks could just hop on sometimes and in a few minutes clear the list so everyone can go home on time?
Also for burnout mitigation, maybe someone who hates taking call wants to offer up some of their call pay to get some help or maybe it’s the practice just trying to get the work done when the number of warm bodies on the schedule isn’t enough without garnishing time off. Sometimes you can be a little more flexible on PTO or backup coverage if there’s an easy way to spread the work across willing people PRN.
Our group invested time and money into making a custom in-house solution that works for our practice (and, unsurprisingly, it doesn’t do all the things a dedicated company like LnQ has made possible; it’s a startup, so they can also easily add features as groups request them). Not all groups can or should bother creating a complicated tech solution to enable them to leverage their own workforce even if they do ultimately do need to leverage their own workforce.
Part of retention is meeting people where they are, and internal moonlighting is often one of those measures that can make both the slow vs fast and the lifestyle vs hungry readers happy. What more groups need to make the enterprise work is a system that makes it easy to tell the people who could potentially work extra when extra work is available, how much work is available, what kind of work is available, and then allow those people to do that work and get paid quickly for doing it without issues of tracking the work and other hassles.
We need more happy rads.