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Making the Case for Making the Grade: Why the CRA Matters for Radiology Leadership

– By Matt Skoufalos –

Like many other health care specialties, credentialing in the medical imaging field is an indication of technical proficiency, professional expertise and the persistence required to complete a vetted process. Yet among imaging leadership, one such credential – the Certified Radiology Administrator (CRA), issued by the Radiology Administration Certification Commission (RACC) – remains off the radar of many professionals.

The CRA exam tests the knowledge and expertise of prospective credential holders in five categories: human resource management, asset resource management, fiscal management, operations management and communication and information management.

David Partridge, CRA, FAHRA, an account executive for Prestige Medical Imaging of Newburgh, New York is a commissioner on the RACC. The commission oversees development of the exam through which prospective CRAs are credentialed. Even after administrators pass the CRA exam, they must complete 36 continuing education units (CEUs) in those five domains every three years to demonstrate their continued proficiency in the subject matter, or else re-test.

Prior to sitting for the test, prospective CRAs must accumulate seven points of eligibility reflecting their experiences, education and credentials. Points are awarded for years of “management, supervisory, or administrative experience in radiology or medical imaging” across the five domains, and levels of education attained, from certificates to doctorates. One additional point may be added for any existing, imaging-related credential the prospective CRA already holds from a nationally recognized credentialing authority.

Partridge, who has held his CRA since 2006, works with the other members of the commission to review the 185-question test to ensure that the topics are still valid and relevant to the current practice environment for administrators. The test was created four years before Partridge earned his certification. Originally, those seeking the certificate would have had to compile information from “somewhere in the neighborhood of 35 to 40 reference materials,” Partridge said. AHRA now offers prospective CRAs one book on each of the domains involved in the test.

“AHRA has condensed the knowledge base within those five books and has done a nice job keeping them up to date,” he said. “With the rules changing for government reimbursement, HR policies, and so many other leadership responsibilities, making sure we keep the test up to date as a valid assessment of knowledge is important.”

When it is time to update the questions, the RACC works together with a team of other CRAs to make sure the questions are relevant and valid. They work with the educational testing company Scantron, which administers the exam, as well as “making sure we don’t have too many questions that are too similar, and that they’re statistically valid,” Partridge said.

The CRA exam was most recently reviewed in 2016, and the exam review committee also overhauled all the online practice tests in 2019, Partridge said. Scantron maintains a question bank that provides the basis for their reviews, and the committee updates related questions on the test whenever AHRA updates one of its five core textbooks. Partridge may spend five to eight hours a month on work for the RACC when the voluntary commission is not actively developing a new test, and much more when the answers need revision. In all, the rewriting process takes a significant amount of time, and question writing is supplemented by as many as 15 people not on the commission, Partridge said.

Sitting for the exam takes as many as four hours; of the 185 listed questions, 150 count toward the applicants’ scores, and 35 are experimental questions that do not. Prospective CRAs visit one of 1,350 Scantron locations to complete a web-based assessment in a proctored environment. AHRA members pay $325 plus $100 for application verification; non-members pay $600. Normally, the exam is offered twice a year, in May and November. In 2020, the novel coronavirus (COVID-19) pandemic stretched the May date into June, but most people have deferred their tests to November 2020, Partridge said.

“Normally, somewhere in the neighborhood of 150 people take it per year,” he said. “Currently, 1,221 people hold the certification. Eleven years after passing my [CRA] test, I got the opportunity to take it again as a part of the test review; I believe the test does a really nice job making sure that you have current knowledge.”

Before switching to his current sales role, Partridge worked in imaging administration for 15 years. He still leans on his CRA when connecting with new clients, and said the certificate helps build trust and rapport. “It gives them a different angle that I’ve been in their position,” Partridge said; “that I understand the challenges they’re going through in getting equipment or building a site.”

Although he no longer works in imaging administration, Partridge said he advocates for professionals to pursue a CRA because it helps advance their prominence in the health care workspace.

“I think that it allows for more respect among all of your peers, not just in radiology,” Partridge said. “When you’re working with your leadership team throughout the hospital and you can say, ‘As an imaging administrator, I passed this certification’ and a little more trust is built within your team and peers.”

A CRA can also prove to prospective employers “that you’re the right candidate for a position,” he said. “As we continue to ask our techs to be certified in different imaging modalities as opposed to being trained on the job, it’s the registration for our administrators.”

However, having a CRA does not necessarily mean a bump in pay or responsibilities in the workplace, even as more hospitals list “CRA preferred” or “CRA required” job descriptions for radiology administrators.

“One of the big efforts for our commission is seeing the benefits of the certification,” Partridge said. “The big piece is the recognition of the understanding that you’ve tested and proven that you have the knowledge to do the job.

“People face different challenges every day, and they can vary by where you’re at in the country and type of facility you are working at,” he said. “Once you move into administration, you’re making more changes in the lives of your staff. The ability to see staff enjoy coming to work is why I enjoyed administration.”

Sandra Phillips, director of radiology at Hartford Hospital in Hartford, Connecticut, said the CRA “lets people know that you’re competent and well rounded” in a hospital environment. At the administrator level, expertise in clinical operations and technical proficiency with imaging equipment must be supplemented by facility in human resources, fiscal operations, communications and staffing needs. Even those who boast a strong imaging background may not have had the opportunity to develop competency in those specific skills that are demanded by a leadership role, she said.

“I definitely think in any type of world, your assets and people are definitely important,” Phillips said, “and you have to be in the role to understand what you’re doing.”

Phillips, a RACC member like Partridge, believes the CRA certificate also demonstrates pride in being a radiology director to hospital leadership. Even though the superiors who interviewed her for her current director position weren’t familiar with the credential, they were impressed when she explained what the CRA entailed to them during the process.

“If people want to promote themselves or become a director, a CRA really is eye-catching,” Phillips said. “I think it helped me obtain my position, honestly. You know if people become a CRA, they had that experience and knowledge, as well that they are invested in what they do, and they take pride in being a radiology manager.

“[When I see it], I know that person understands what it takes to pass this test, and that they have the knowledge, skills, experience and education,” she said.

Phillips said AHRA is doing everything it can to raise the visibility of the CRA among human resources decision-makers, recommending to HR departments across the country to include it in job descriptions, and to seek it out in applicants’ resumes.

“A couple years ago, you really didn’t see the CRA credential listed as a recommended qualification on job sites; now you see it’s more consistently listed on things like Indeed.com,” she said.

She’s also seeking to cultivate potential CRAs from within her staff by issuing challenge coins to inspire them to pursue the credential. Once they earn their CRAs, she asks them to “pay it forward” and challenge another colleague to do the same. Currently, two of her staff members are preparing for the exam.

“I give the coin to people and I say, ‘I want you to make this a goal. I think you’re ready for this; you should practice and take this test,’ ” Phillips said. “I found that my staff at my new position had never really heard of it, and they weren’t AHRA members. The first thing I did was sign them all up.”

“You find out you have these leaders that have never been given an opportunity to grow,” she said; “there’s no real radiology school for leaders.”

Curt Bush, vice president of the Houston market for the Houston, Texas-based Touchstone Imaging, agreed that although he’s held a CRA since 2012, there’s not many positions for which he’s applied or been hired that mentioned it as a preferred credential. Like Phillips, he’s made it a goal for his imaging leadership team to earn their CRAs as a demonstration of their practical aptitude for their roles.

“I don’t want to have to teach you these things that you should already know if you’re in this position,” Bush said. “It’s easier to focus on what the real-world needs are, and also what their strengths are [once they have it].”

Many institutions reimburse or offer bonuses to employees who pass advanced certification exams, and Bush thinks they could regard the CRA similarly. For one, the availability of relevant electronic study guides makes the materials more easily and affordably acquired. He also believes that employers could make attainment of a CRA a condition of continued employment to further drive administrators to pursue it. Until such time as it’s more widely recognized or incentivized, however, the value of a CRA “depends on who you are,” Bush said.

“[The] Magnet [Recognition Program] has given nursing a tremendous amount of power; every type of specialized nurse now has a certification for it,” he said. “The CRA is another feather to place in a hat to have the allied health areas keep up with nursing foundations that they’ve set nationally.

“A lot of organizations have really looked at some basic education requirements for people moving into leadership positions, even including lead techs and supervisors, and the CRA credential is really a validation of overall leadership,” Bush said.

Although he already had a significant amount of experience and other credentials, including a master’s degree, prior to taking the CRA, Bush said he took the test “to validate that I knew what I was doing,” and to give him a leg up in applying for larger-scale operations given a resume that was heavy on experience in small, community hospital environments.

Like Partridge and Phillips, Bush also serves on the RACC, and he believes that broader adoption of the CRA as a credentialing standard for radiology administrators can happen if hospital leaders get involved and have strong enough imaging leadership “to really work with human resources” and raise the overall profile of the credential. With fewer than 6,000 AHRA members and only about 20 percent of those CRA holders, he estimates that “probably only 25 or 30 percent of the total imaging administrators in the country” are CRA-certified.

“I would have never heard of it if I hadn’t been a part of AHRA, and there’s a lot of people in AHRA who weren’t overwhelmingly familiar with it,” Bush said. “There’s people in other imaging associations that have no idea what it is. It kind of just depends on the circle you’re hanging with.”

“If you really believe it’s important, and can work with HR and go to bat for your people, there’s a lot of things that can be accomplished with it,” he said.

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