The Business Case for Robust Radiologist Education
Malcolm ShupeckContinuing education for radiologists has become a more complex proposition as subspecialty expertise has deepened—and their level of education is poised to have a stronger influence on revenue, according to some analysts. At the 2012 Fall Educational Conference of the RBMA in Chandler, Arizona, on October 8, Kevin McDermott copresented “The Emerging Trends in Payor Pricing and Patient Notification Strategies.” McDermott, vice president of provider and consumer programs at benefits-management company AIM Specialty Health, notes that his company compares imaging providers using a formula in which radiologist/technologist certification accounts for 50% of the factors under consideration. Malcolm Shupeck, MD, associate medical director of ProScan Imaging and program director of the ProScan Imaging Education Foundation, says that the business case for emphasizing radiologist education is clear. “In our case, radiologist education is our business,” he notes. “Being right is the most cost-effective way to practice medicine. If we make a proper diagnosis in the proper clinical setting, then that patient will do better without unnecessary further evaluation.” Teaching and Technology Radiology groups continue to grow in size and geographic distribution, and ProScan Imaging is no exception, with 26 imaging centers and a national network of teleradiologists. Shupeck says that the advances in technology seen in the past decade have revolutionized continuing education for such a broad and geographically disparate array of clinicians. “The availability of online content has really changed the dynamics for didactic material,” he says. “The widespread availability of PACS and image transfer has given rise to a situation where it’s very easy to share an educational case and create educational activities that are case based.” ProScan Imaging uses an internally developed teaching-file architecture to take advantage of these new capabilities, allowing any of its radiologists to add interesting cases with ease. “Our fellows are able to look at the cases submitted, sort them, and arrange them appropriately so that anyone can very quickly look at a whole set of cases of a particular body part or entity,” he says. “All of our radiologists are subspecialists, and in subspecialization, one of the challenges is having access to a wide range of interesting and unusual cases on a regular basis. We have a very broad case volume, which allows us to put together the kind of case experience from which our radiologists can benefit.” The group also disseminates continuing education courses, including a daily lecture series, via Internet, Shupeck says. “Those lectures are updated continuously by the presenters to include the newest information from conferences and journals,” he notes. “Our radiologists who are off-site can then view those presentations anytime they want.” Peer-to-peer Learning ProScan Imaging’s radiologists also benefit from the wisdom of their more experienced colleagues, Shupeck says. In addition to participating in the ACR® RADPEER™ program, ProScan Imaging has an image-management platform that allows for review of completed studies by appropriate subspecialists. “Our younger colleagues get the opportunity, every day, to review their studies with more experienced or specialized colleagues before the results are finalized,” he says. “We do a lot of case sharing.” Three times a week, the group holds a readout, in which cases of interest are reviewed with staff and fellows. “We’re able to work together to piece together everyone’s expertise,” Shupeck says. “I trained at the Mayo Clinic, where they have a very similar system—a patient’s problem gets input from a number of subspecialists, and that input is synthesized. We do the same thing.” Part of that input is contextualizing an exam with regard to its appropriateness, he adds. “We take appropriateness very seriously, and in order to understand it, you have to know the clinical factors,” he says. “A big part of our training is focused not only on interpretation of the images, but on putting them in their appropriate clinical context. Several of our teaching-faculty members were clinicians in other specialties before getting into imaging, and that allows us to give lectures and talks not only on what is on the films, but on what the next step might be. That allows us to make useful comments on further workup and limit unnecessary evaluation.” Key Differentiator Looking ahead, Shupeck sees continuing education becoming even more important as radiologists’ levels of subspecialization grow. “Radiologists have always been busy, and now they are busier still, so trying to maintain competency and excellence are always going to be big challenges,” he says. “Subspecialists are more likely to be dealing with things that are not seen that frequently. Getting enough exposure to those kinds of cases is critical to maintaining excellence." Size will be an advantage to practices working to keep their radiologists ahead of the curve, he says. “At ProScan Imaging, we are able to add value based on the fact that our subspecialty radiologists are constantly getting exposure to new or difficult cases (because of our large case volume),” he notes. “Our education program is one of our biggest focus areas. We give courses nationally and internationally and have materials available on every subject in advanced imaging. Our training is always going on and is an integral part of what we do.” The business’ educational focus will continue to be its key differentiator, Shupeck concludes. “There are many organizations out there that are very busy interpreting films, but there are few that have a robust educational arm and the service culture that we have,” he says. Cat Vasko is editor of and associate editor of Radiology Business Journal.