Imaging’s Conversation Has Changed

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If there was one lesson to be learned at last weekend’s meeting of the California Radiological Society—for which a great deal of the content was supplied by the ACR’s new Radiology Leadership Institute—the final words of a presentation by Dr. Larry Muroff may have been it: “The future of radiology is bright, but the future for radiologists is uncertain.”

Indeed, it was a weekend of striking polarity, with the very distinguished faculty of speakers oscillating between hope for the specialty’s future and dismay at its current state. I was relieved to learn that I am not alone in perceiving an untoward degree of doom and gloom in the radiology industry, but the conference speakers took that observation a step further. If radiology doesn’t take control of its own destiny—and do it quickly—it could become a fully commoditized service.

Just a few years ago, I can remember thought leaders at conferences being dismissive—even, perhaps, a bit haughty—about the possibility of health care reform changing the game for the specialty. The party line was that if capitation failed in the nineties, we had nothing to worry about today.

That, of course, has proven to be untrue, and now we are facing down a future in which fee-for-service medicine has gone the way of the dodo. Unfortunately, the transition to episode-of-care delivery models may be the final nail in the coffin for a specialty that has already experienced a high degree of commoditization. I was amused by how often Dr. Paul Chang referred to his role as an imaging informaticist as that of an “arms dealer.” It is undeniable that PACS and other technologies have paid off in the short term while creating a long-term problem for imaging. Its world is truly flat now, its competition global.

Last year I found myself on the receiving end of several spirited e-mails when I wrote about the idea, floated at RSNA by Dr. John Patti, that radiologists should be sacrificing 10% of their time and revenue to becoming more consultative with patients and referrers. This idea, which at the time felt radical to me (and, clearly, to many of our readers), was taken as an imperative by CRS speakers. “In the future, we’re going to be valued and reimbursed for managing imaging, and if we cede that position to others, we’re going to lose,” said Dr. Chang.

The conversation has changed enormously in a short period of time. Once about preserving radiologist income, today it is about preserving the field of radiology itself. The ACR’s RLI speakers are doing the state radiological society circuit for a reason: they are evangelizing at the regional level. We’re no longer speculating, on some abstract macroeconomic level, about the future of the field. The writing is on the wall. Now it’s time for radiologists in practice to change—before it’s too late.