Eight Trends With an Impact on the Practice of Radiology

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Lawrence R. Muroff, MD, FACRIt’s no longer business as usual. That was the main message that radiologist and consultant Lawrence R. Muroff, MD, FACR, brought to the California Radiological Society’s 2012 Annual Meeting & Leadership Summit in San Francisco. On September 9, he presented “Future Trends That Will Impact What You Do and What You Earn,” highlighting eight major trends affecting radiology practices today—as well as four nightmares that they might face in the future.

“The future of radiology is bright, but the future for radiologists is uncertain,” Muroff says. “What we have now is not guaranteed. Some people will thrive in the future, while many will be caught unprepared. Turbulent times offer unprecedented opportunity, and you’re going to have to decide on which side of the equation you will be found.”

Muroff says that part of the reason that so many radiologists are unprepared is that the profession tends to predict the future based upon past performance—when in fact, the future will include radical change. Radiology practices are caught up in major transitions due to both external and internal factors. With health-care reform, radiologists have, Muroff says, “taken it on the chin,” but the specialty’s difficulties are not all due to the federal government. Radiologists are often their own worst enemies: “We are also responsible for our own problems,” he says.

While radiologists face clear challenges, what is the likelihood that they will change in time to survive? Muroff cites a troubling statistic: 95% of ACR® councilors surveyed this year say that they believe that radiologists will not change until the pain of maintaining the status quo far exceeds the potential pain of changing, he says. Last year, the number was 92%. That’s a dangerous position for radiologists to take, Muroff says. “The problem with radiology is that the pain can be instantaneous,” he notes, citing the loss of a hospital contract as an example.

Muroff’s trends for radiologists to be aware of are:

  • declining reimbursement,
  • an unrealistic focus on productivity,
  • radiology’s image problem,
  • the availability of nonphysician professionals,
  • the cultural outlook of the millennial generation,
  • turf battles and competition,
  • hospital demands, and
  • competition from academic departments.

Declining reimbursement: Under health-care reform, radiology is shouldering more than its share of reimbursement pressures, he says. From consolidation of codes to homogenization of rates, the income picture is shrinking.

An unrealistic focus on productivity: As reimbursements decline, radiology practices are trying to make up the difference by focusing on productivity. Muroff warns them that this is not an effective long-term strategy. First, it trivializes other key practice activities such as service; relationship building; and participation in the medical, social, and political activities of hospitals and communities. Second, it treats radiologists as interchangeable, fungible commodities, which ultimately contributes to the devaluation of a radiologist’s special expertise.

Radiology’s image problem: Muroff points out that while the names of many radiology procedures are widely recognized, radiologists themselves are all but invisible in popular culture. In one focus group, he says, some participants did not even know that radiologists were physicians. Likewise, in political circles, the image of radiologists—the most highly paid specialists—suffers greatly in comparison with Washington’s love affair with the image of the overworked, underpaid family physician.

The availability of nonphysician professionals: Muroff predicts that radiology assistants, physician assistants, and nurse practitioners will come to play even greater roles in radiology practices, due to both their extensive professional skills and their lower salaries. He estimates that in a typical radiology group of five radiologists, probably at least one could be replaced by a nonphysician professional. While this substitution makes sense, given declining reimbursements, it also tightens the job market for new radiologists.

The cultural outlook of the millennial generation: Muroff cites several concerns about the millennial generation, newly hired staff coming into radiology at a time when the specialty is facing declining revenues and increasing challenges. Millennials tend to want both more money and more free time. This makes them more difficult for radiology practices to recruit aggressively,