F&S Chair Frank Seidelmann, D.O.: On the Radiologist of the Future

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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, and we're connecting its parts via various white-matter tracts of the brain. We're developing a national brain of subspecialists. ImagingBiz: What other factors are driving the trend toward subspecialization, both inside and outside radiology? Seidelmann: We've heard a little bit about pay-for-performance initiatives, and there's recognition that with the increasing demand for subspecialty interpretations, there's been an increasing error rate in radiology. It's commonly quoted that the error rate in radiology is around 30%. We can't afford to have errors in radiology reports. The goal is to make the correct diagnosis, with the most limited amount of necessary imaging, and eliminate unnecessary testing. In the coming days, we have a real financial crisis on our hands, and one of the things that will be looked at very closely is how you get it right. How can we attack and lower this error rate? ImagingBiz: Looking into your crystal ball, is there a role for general radiology in the future? Seidelmann: I actually think that this entity called the general radiologist is not going to exist. Young radiologists will be focused on practicing in specific areas of radiology. Even in this day and age, we're finding radiologists who, although they label themselves general radiologists, have carveouts of what they won't do. There will be people who call themselves body radiologists, women's radiologists, chest and cardiac interpreters, and musculoskeletal radiologists, and I can even envision a day when people will say, "I'm a musculoskeletal radiologist with a focus on small joints." The hardest thing to do now is find a general radiologist. They are starting to disappear, and the people who call themselves general radiologists are an aging population; they're going to be retiring in the next 10 years. We're in a real paradigm shift in radiology, and there are many factors pushing this beyond the control of what the radiologists want. It's the expanding imaging capabilities, along with the explosion of the information knowledge base. It's going to be third-party payors saying we cannot afford mistakes and unnecessary testing, radiologists saying they no longer feel capable of doing all these things, and malpractice lawyers saying they won't allow the radiologists to do all these things. It's what's happening to the world, and that's beyond the control of the radiologist. ImagingBiz: Unlike some other companies, Franklin and Seidelmann has positioned itself as a national radiology practice with no boundaries. Why are hospitals ready for this now? Seidelmann: I think hospitals are doing a couple of things. Over the past 10 to 15 years, they've bought all these wonderful machines. They're trying to compete in the outpatient market, and they're also looking at developing hospital-physician satisfaction. Administrators want to have successful hospitals that are financially viable, with very happy medical staffs. They don’t want to start their days with the chief of surgery complaining about radiology services. The hospitals want to maximize referral patterns and physician satisfaction, and they want to get the most out of their equipment. Hospital administrators used to say they had state-of-the-art radiology departments because they had all the newest equipment, but without the people who can provide the interpretations from the studies the equipment provides, you're not providing the services. Hospitals are also responding because they are sometimes finding it difficult to find radiologists, and they're having difficulty pleasing their physician base. It's myriad different issues. Imaging centers were very quick to realize they had to compete effectively. Hospitals are now saying the same thing. Everybody wants a report that is definitive and directive. ImagingBiz: Would you take another look into your crystal ball and tell us what is in store for radiology, as we move toward health care reform? Seidelmann: I wish I had that crystal ball. Coming out of Washington, you hear this focus on quality—that there's going to be a big quality initiative—and on lowering costs. Those are the two things you hear; I read between the lines. If you're saying you want higher quality, you need the right, correctly trained and experienced radiologists reading these studies. I hope that by doing that, there will be a significant cost savings by reducing unnecessary testing and unnecessary surgeries, and by lowering malpractice risk. I cannot predict, though, what Washington's going to do. I only hope that a quality initiative will look at who is interpreting what, and that will help achieve those goals.