Frank Seidelmann, D.O., is cofounder and chair of Franklin and Seidelmann Subspecialty Radiology, Beachwood, Ohio. After bearing witness to countless imaging booms and busts over the course of 30-plus years in the field, Seidelmann looks to subspecialization as the trend that will change the face of radiology as we know it in the years to come.
Frank Seidelmann, D.O.
ImagingBiz: You began your career in a traditional radiology-practice model, but started pushing the envelope early. Tell us about your first foray into national radiology.
Seidelmann: I was part of a traditional large radiology group, and at its peak, the group had 19 hospital clients. There was a lot of consolidation and shrinkage, so the size varied, but near the end of that period (which was in the late 1990s), we started seeing that the traditional model of having a hospital contract and having a good board-certified general radiologist on-site wasn't really fulfilling the needs of the hospitals. As we got into the 1990s, we started seeing people who were focused subspecialists—neuroradiologists, as well as musculoskeletal radiologists who were capable of reading knees, ankles, wrists, and elbows. We started bringing on clients who felt that the traditional model would not fulfill their needs.
In our group, we attempted to have a support system using telecommunications. I don't like the term teleradiology, because all radiologists are now practicing a form of teleradiology; I think it's a term that should be discarded. Really, what people are practicing is subspecialty radiology using the advanced digital world in which we now live. We started trying to provide support with telecommunications in our advanced modalities, creating an advanced interpretation area with a limited number of subspecialists who could read images for our hospitals. Our group was later purchased by a large radiology staffing company.
ImagingBiz: Would you speculate on the reasons that this model hit a wall at that time?
Seidelmann: In the 1990s, as new imaging technology came into play, we had greater imaging capabilities, and that pushed the subspecialty areas of expertise. With the advancement of MRI and CT, you started getting into finer and smaller detail. The necessary knowledge base was very difficult to encompass in a handful of people on-site who were also forced to focus on different areas, like body radiology. There was also a radiologist shortage in the 1990s, but if you drill down and see how the field was starting to break apart, with people doing fellowships and specialty training and having a high comfort level in practicing their specialties, soon they had less comfort in reading areas that weren't their specialties. The field has become too large and too encompassing. It is almost impossible for any one radiologist to provide the highest level of interpretive services in areas that aren't his or her own.
Of course, there's always going to be a need for radiologists on the ground. I've often used the analogy that we used to fight with trench warfare, but the way the war is going to be fought in the future is with on-site radiologists as needed, coupled with subspecialty experts and a nighttime support staff to take care of acute issues with immediate final interpretations. It will evolve into one organization taking care of patients—not one legal organization, but one functional organization providing the necessary services.
ImagingBiz: When did you first start thinking about building a subspecialty-based company? What was happening in the marketplace, and what did you perceive as the opportunity?
Seidelmann: Our main concept is that everybody is developing a comfort level and focal expertise, and even if they're not recognized subspecialists, radiologists are now focusing on their areas of subspecialty, where they feel comfortable because they can do a better job. The greater the level of expertise, and the more focused the subspecialty, the more distributed it will need to be. The only way it works is if you don't move bodies—you move the information to where the bodies are.
We concentrated on finding the very best people; we wanted to find the people with high-level expertise, wherever they lived, and move the digital images to them. We felt it was the only way to get the expertise, at the level we were seeking. As a neuroradiologist, I look at this and say that it feels like a developing brain. The cortex of the brain is all over the country,