Radiology Efficiency: Metrics, Bottlenecks, Staffing & AI with a Practice CEO

Overview

In this episode of Radiology Efficiency, Andy Milkowski sits down with Wayne Baldwin, CEO of GemState Radiology and Intermountain Medical Imaging, for a grounded, operator-level discussion on what it truly takes to run a modern outpatient radiology practice.

With decades of leadership experience, Wayne offers a candid look at the financial metrics, workflow realities, staffing pressures, and technology decisions that define success—or failure—in today’s radiology environment. Rather than focusing on silver bullets, he describes radiology operations as a “death of a thousand cuts,” where small inefficiencies quietly compound into major constraints.

This conversation is particularly relevant for practice owners, CEOs, COOs, administrators, and radiologists responsible for balancing growth, quality, staff well-being, and financial sustainability.

Key Themes Discussed

Financial & Operational Metrics That Matter

Wayne explains why financial and operational metrics cannot be separated in radiology. He highlights the growing importance of:

• Time-of-service patient collections as deductibles rise
• Understanding true reimbursement per study
• Equipment utilization as a primary driver of margin

Radiology, he notes, increasingly resembles the airline industry—expensive assets must stay full and operational, without turning care into a “cattle call” for patients or staff.

Watch the Full Interview

Workflow Bottlenecks: No Single Fix

Rather than one dominant constraint, Wayne describes operational challenges as a series of small breakdowns:

• Patient intake and scheduling variability
• Order processing and communication gaps
• MRI safety workflows and implant screening

Incremental improvements, staff education, and accountability across the workflow are often more impactful than large system overhauls.

Staffing, Retention & Culture

Operating in a fast-growing market like Boise presents unique challenges:

• Competition with hospital systems for technologists
• Radiologist shortages and rising productivity pressure
• Burnout risk in high-volume practices

Wayne outlines a leadership framework built around exceeding expectations for patients, referring providers, owners, and internal teams—creating a workplace where people understand how their role fits into the whole.

Technology, PACS & the Reality of AI

AI remains early-stage for radiology efficiency and operations. Wayne discusses:

• Rising IT and AI-related costs
• The challenge of evaluating fragmented AI tools
• Likely consolidation driven by PACS vendors

Rather than chasing novelty, he emphasizes productivity gains, workflow fit, and long-term vendor stability.

Get in touch with us at Imorgon

Did you enjoy this episode? Sign up for the R&E series to receive future expert interviews. Click here to subscribe.

Andy Milkowski CEO

I am proud to have made a meaningful impact on many lives by improving the utility of diagnostic ultrasound worldwide. For over 20 years, I have been part of the diagnostic ultrasound community in various corporate roles, including leadership roles in sales, product management, and research.  Working with both committed clinicians and extremely talented scientists, we have brought new capabilities to ultrasound.  We have enabled ultrasound to provide more information and across a large habitus of patients to Radiologists – allowing for a diagnosis without follow-up exams using contrast agents or radiation.  I have been thankful for my early training and education in statistics and engineering, which has allowed me to see the ‘signal from the noise.’  

See Full Bio

Ultrasound Fat Fraction Ultrasound Shear Wave Factorial Design Queueing Theory Jobs to be Done Six Sigma Ultrasound Transducers Automated Breast Ultrasound