Imaging's Déjá-vu Moment

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My conversation with a prominent radiologist was startling, even as it piqued my journalistic interest. He was all doom and gloom, resigned to the fact that, in his strongly held opinion, the best days for radiology had passed. Nothing lies ahead except the detritus of a once lucrative and satisfying profession. The pending election was creating chaos in the imaging market, especially with the young and inexperienced candidate talking tough on health care reform. There was much hand wringing, with sighs of exasperation.

I got depressed just listening to this physician, who closed his diatribe with the announcement that he was getting out; he was going to do something else and cut his losses. As he left, I wished him well and pondered the meaning of the encounter, along with what I might do to help others in his state of mind find some silver linings in the otherwise dark clouds.

That meeting was in the fall of 1991. Bill and Hillary were promising government solutions to the health care dilemmas. Equipment buying was starting to dry up in anticipation of the coming squeeze. The InterStudy Group’s Paul Ellwood, MD, and his fellow think-tank members were forming their Jackson Hole Group to invent managed care, and radiologists everywhere were trying to figure out how to do more with less. The once predictable field of radiology was in a bit of chaos. Sound familiar?

You know the rest of the story. Bill became president, and Hillary became famous for the Hillary Care that brought the health care market to a virtual standstill. Everyone was looking for signs of the end and saying that the best years were behind us. It was over; done. It was time to get out, maybe to become an employee again. Investors on Wall Street call it the flight to safety.

Anyone looking at the subsequent rise in health care spending in the imaging sector, from that point on, would notice the rather distinct image of the proverbial hockey stick. The growth was nothing short of incredible, and radiologists who have stayed the course for these past 17 years have benefited from an unprecedented level of professional satisfaction, an enviable lifestyle, technological superiority, collegial respect, and unmatched levels of security.

Here we are, though, watching our déjà-vu moment unfold before our very eyes. Once again, some are saying that the best years for radiology are behind us, and I, for one, don’t buy it. There are some very good reasons.

Sure, the purchase of new equipment has slowed, but innovation has not. We continue to see vendor activity that reveals an understanding that research, innovation, and breakthrough products will be a solution for the health care system overall. As payors demand outcomes-based models of care, pay for performance, appropriateness, quality, and other prudent cost-management solutions, medical imaging’s story becomes increasingly cogent and penetrating. We have the capacity to save money for the system, period, but we need to find better ways to tell that story, and tell it to the right people.

Beyond this, I believe that we have not yet seen the true impact of consumer-driven health care. Patients will demand the best available diagnostic capabilities. They understand imaging’s ability to explore our anatomy, musculoskeletal system, molecular makeup, and functions all too well. This will not diminish, but will, rather, build demand for imaging services beyond current expectations.

Despite the latest calls by the presidential candidates for health care reform, there is much reason for optimism about the medical imaging sector in hospital and outpatient settings, and at the practice level. The profession is poised to emerge from the current financial squeeze and payor scrutiny to assume even more prominence in the system-wide arena, but there will be a cost, and not everyone will be willing to pay that price.

The cost is this: Attention will need to be paid to the fundamental responsibility that accompanies the rewards that we have enjoyed for these many fruitful years. Radiologists will need to take seriously the fact that payors and customers will not look kindly on excesses in pay, vacation, light workloads, and other seeming birthrights of the profession. Note that I said excesses. No one will deny entrepreneurial radiologists the right to earn a great living and to enjoy the benefits of a superior lifestyle as appropriate compensations for their hard work and investments. I will defend that right to