Bread Lines and Cab Lines

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I’ll admit it. The constant drumbeat of depressing news in the business and popular press about the downturn in the world economy had me spooked as I traveled to the RSNA last week. Day after day, the relentless narrative of job losses, housing foreclosures, lost retirement wealth, and mind-boggling federal bailouts prepared me for the worst. I have been attending this mega event for more than 20 years, and I have seen the effects of economic upheaval on our profession in the past, but I was certain that this one would be, well, nothing but doom and gloom. I prepared myself to do a bad-news wrap-up of one of the world’s largest association-sponsored trade events. As the taxi approached the entrance to McCormick Place, I half expected to see bread lines and guys in business suits selling apples on the corner instead of CT scanners inside the exhibit hall. Because of the press reports, I certainly expected to see depressed faces with grim expressions, in some type of third-world experience. Imagine my surprise when I discovered that the RSNA was, in fact, much as it had been in past years. There was a bustling crowd, along with huge exhibits, an opening session packed with attendees, and professional representatives determined to conduct business. It appears that health care is, in fact, weathering this economic storm better than most segments of the economy. Yes, RSNA attendance was down, but down over what, exactly? Is that the right measurement for the profession’s vital signs? It was pointed out to me that the anecdotal evidence was clear. “Just look at the cab line,” one exhibitor said. “It’s a lot lighter than last year.” True enough, but based on my experience, physicians and other attendees typically do not use taxis as their primary mode of transportation. They use the free shuttles. The exhibitors are the ones typically seen in the cab lines, so the message should be related to vendors cutting back somewhat, which makes perfect sense. If there was no strategic need for particular vendor representatives to be at RSNA this year, they passed. That is just good and prudent business sense. The official international and physician attendance numbers were actually quite good, and comparable with those of the past year or two. Although technical/administrative attendance was down this year, anyone looking out at the sea of humanity with blue (physician attendee) badges walking from the meeting rooms in the east hall to the other exhibit halls had to be impressed by the fact that the medical imaging profession is alive, well, and continuing to navigate this particular part of the economic obstacle course. It’s a matter of perspective. It’s also a matter of influence. A few interviews with key radiologists representing some of the top practices in the country revealed nothing close to a depressed outlook. Some were up in scan volume and revenue over last year, many were flat over last year (a major victory in a down economy), and many were looking for new ways to enhance and expand their practices into new modalities, service offerings, and enhancements to their efficiency, productivity, and workflow models. They were out in force at the meeting. It was all about serious business, with serious people, looking for ways to succeed despite the current financial headwinds. I don’t consider that a setback, but rather a fairly typical business challenge for those determined to make lemonade out of the lemons they have been handed this year. As I wandered through many of the exhibitors’ booths, the distinction between those with some innovative solution to offer and those without was pretty clear. Some exhibitors were packed with appointment after appointment, some with attendees looking at their current product enhancements and glimpses of what the future of imaging technology will look like. There were interesting discussions about dose, workflow, analytics, speed, efficiency, product design, worldwide perspectives, strategic partnerships, and competitive advantage. All of this is good for our profession and was very encouraging, to say the least. The question for medical imaging is this: Is the glass half full, half empty, or simply a container of the wrong size? One could probably find evidence to support the pessimistic, optimistic, or realistic points of view, and the best 3D example of this is the RSNA, with some of each readily apparent. Unlike certain buggy-whip industries, however, medical imaging is clearly here to stay, and it will be an important—arguably, the most important—segment of health care well into the future. Innovation is evident, research-and-development activity is moving us forward, demand for provider services remains robust, and the business itself continues to grow, albeit along a somewhat slower trajectory. Growth is still growth, and many in the automotive industry would gladly change places with a profession continuing to show positive momentum. Here is the right five-part formula for 2009, whether you are a vendor, physician, center administrator, hospital executive, technologist, or someone allied to the field of medical imaging. First, the low-hanging fruit has all been picked, so you will need to climb a little higher and reach farther. Second, your expectations for how good business will be will depend more on your creativity and innovation than on how much more milk you can get out of your existing cow. Third, new business models and new types of strategic relationships will emerge to replace rusting old strategies. Fourth, superior customer service will make the difference between those who will win and those who will not. Fifth, a positive attitude about the profession will do more to ensure your success than perhaps any single factor next year. If you insist on finding the doom and gloom, go to the auto dealers’ show. I’m sure they will be sympathetic to your stories about being flat over last year.