Purpose: To compare radiology practices that use external, internal, and no off-hours services.Methods: From August 2005 to June 2006, 300 nonspecialty hospitals randomly selected from the AHA Guide 2005 Edition were contacted by telephone, e-mail, and mail, with attempts made to speak to the chiefs of radiology. A total of 115 responses were obtained (a 38.3% response rate), with 64 from radiology practices that used external off-hours services, 13 from practices with internal services, and 38 from practices with no services. The demographics of the practices in the 3 categories were compared, and answers to category-specific survey questions were tabulated. Responses were analyzed using descriptive statistics.Results: Radiology practices using internal off-hours services were significantly larger (mean size, 19.9 full-time radiologists) than those using external off-hours services (mean size, 8.2 full-time radiologists) and those not using any off-hours service (mean size, 10.7 full-time radiologists). A sufficient number of radiologists or residents covering nights had the highest reported importance in the decision not to adopt an external service. Cost and quality concerns were also cited. The consistency of interpreting radiologists known to a practice had the highest importance in the decision to use an internal rather than an external off-hours service. Frequent reasons cited for radiologists to take regular internal off-hours employment were financial incentives provided and a preference for off-hours shifts.Conclusions: As long as there are sufficient numbers of radiologists and residents to handle the volume of interpretations, many practices will not use external off-hours services. Such services could help increase their adoption by offering lower cost and proven quality.
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