Prey or Predator?

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A New York Times article published on March 27, 2013, revealed the new normal for incoming radiologists. “ Job Prospects Are Dimming for Radiology Trainees,” reads the headline.

The article describes how residents are coping with a shrinking job market and shrinking compensation should they land a position somewhere. Quoted in the story is 28-year-old Luke Gerges, MD, a radiology resident who has been out of medical school for four years. Gerges received his termination notice in March because his hospital, St. Barnabas in the Bronx, was ending its radiology residency program.

“Those days of raking in the dough with radiology are gone,” said Gerges, who is $300,000 in debt.

The article goes on to describe a bleak future for radiologists, thanks to a number of factors that include off-shore reading, reimbursement cuts — all the usual suspects we’ve known for years. But one reason was new: “… new measures to tilt public money to primary care” signals a shift that reveals the great divide between radiology and most other specialties.

Surgery, primary care and a host of other medical specialties require face-to-face interaction between a patient and a doctor. There is no way around it. Radiology, however, is mobile. Teleradiology services provide 24/7/365 coverage for far less than an on-site staff.

“From a cost-cutting perspective and from a quality perspective, you can have a lot more people reading X-rays remotely than you can inside the hospital,” St. Barnabas Hospital spokesperson Steven Clark is quoted as saying.

The lesson here is not to advise medical school students to avoid radiology, or to advise them to get out of medicine altogether, though one could not be blamed for telling them so.

The lesson is much larger than that and has to do with change. It was awhile ago in this space that I wrote that the key to survival in medical imaging is not to tolerate change or even to embrace it. The key, I wrote, was to initiate change; to make things happen before someone else makes them happen for you.

This is not my chance to say, “I told you so.” That is unproductive. Rather, it is my wish that in 2014, we all remember that the good times never last forever and that more than ever, a balanced life is the real key to success.

That balance is not something that happens to us, it is achieved through the choices we make. New radiologists may be suffering from a transformed job market but it is their choice to stay in the specialty or change to one that is less likely be affected by shifting political or business climates. Or, they can get out of medicine altogether. Radiologists who are established, particularly those who are in group practices, also have choices to make to help remain viable. In all of these cases, it is important to remember that we are not trapped.

The new year is not likely to bring any reversal of the trends in medical imaging. There may be even more of the same bad news we’ve been hearing for the past few years.

The easy thing to do now is to blame this person or that agency for our troubles and take what comes. That, too, is unproductive. The hard thing to do is sit down with the people who are important to us – the stakeholders in the practice – and realize that if public money really is tilting toward primary care, and if the other negative trends continue, it is time to create a strategic plan to adjust accordingly.

Your plan does not guarantee you success. But it does go a long way toward helping you control your own destiny. And there are a lot of radiology residents these days who would love to be in your shoes.


Steve SmithWith over 25 years of marketing experience — nine years as a former Vice President of Marketing for a leading health care marketing company — Steve Smith has consistently developed effective strategies to help fuel the growth of countless health care enterprises. Since 2007, he has specialized as a marketing and business development consultant to medical imaging facilities nationwide. Mr. Smith has been a featured speaker at imaging conferences and is a former member of the marketing subcommittee of the Radiology Business Management Association (RBMA). He has contributed marketing articles to numerous health care publications, including Physician’s Money Digest, Radiology Business Journal and more. Mr. Smith is the creator of “Ten Seconds to Great Customer Service™,” a medical imaging training program that provides easy-to-use tactical customer service support to