The radiology industry is undergoing tectonic changes as a result of declining reimbursements, ever-improving technology, and the emergence of innovative new delivery models. Though much has been written about the impact of these changes on the industry as a whole, the role of the radiologist in this evolving marketplace is often overlooked. Frank Seidelmann, DO, chair of the board and clinical director of neuroradiology at Radisphere National Radiology Group, Beachwood, Ohio, discusses with ImagingBiz how the role of the radiologist has evolved and predicts what today’s radiologists-in-training will seek from practices in the future.
ImagingBiz: We’ve seen some rapid evolution in radiology delivery in the past couple of years. What forces are behind these changes in the industry?
Seidelmann: I’ve practiced radiology for 35 years, so I’ve lived through a lot of changes in the industry. When I trained, in the 1970s, radiology was bone and barium: There were vast areas of the body we couldn’t begin to evaluate that, today, we can image down to the molecular level. As imaging capabilities have so vastly increased, the knowledge base of radiology has exploded, as have the demands of referring physicians in terms of expertise, volumes, communication, and timeliness of reports.
In the 1980s and going into the 1990s, subspecialization developed, and radiologists started having issues with medical staffs at hospitals requesting neuroradiologists, musculoskeletal radiologists, and so forth. The hospital demand for radiology services changed dramatically at that point. We saw the advent of new technology, and with the development of PACS, we gained the ability to move images and provide final interpretations without being geographically bound. It changed the whole practice.
Outpatient imaging is the largest profit driver for community hospitals now, and radiology is a key influence in length of hospital stay; it’s important that radiologists make the correct diagnosis as quickly as possible, without unnecessary testing, for the financial health of patients and hospitals. All of this underscores how the demand for radiology has changed at the community hospital, but for the most part, radiology groups have been slow in changing; there are 3,400 groups in the country, of which 2,500 have 10 radiologists or fewer.
It’s going to be difficult for these kinds of groups to continue to provide their services as referrers, patients, and payors continue asking for more value from radiology. The traditional delivery model is going to struggle with all the demands placed on it now. The supply side of radiology needs to change to meet the rapidly changing demand.
ImagingBiz: Where do you believe the radiology practice will be in five years?
Seidelmann: Whatever the delivery model is going to be, it will have to provide a number of elements to survive. There’s going to be an increased demand for subspecialization, an increase in the volume of studies, and declining reimbursement. There’s also an increased demand, from both hospitals and payors, for defined quality measures and transparency in areas such as peer review, turnaround times, and consultation-report times.
I think the per-unit reimbursement will decline dramatically and will be replaced with some kind of quality measure, so that better radiologists will be paid more. The only groups that will be able to deliver this level of care will be larger groups that make a significant investment in technology and human resources. We will have to do more—and do it better.
ImagingBiz: Are radiologists moving away from working as part of traditional groups as a result of these changes?
Seidelmann: By the nature of their training and what they want to do clinically, radiologists are tending to subspecialize more; radiologists coming out of training are looking for the types of models or radiology organizations that will allow them to practice their subspecialties and won’t force them into the full gamut of radiology services.
The traditional partnership structures of most radiology groups also are based on tenure; they’re not meritocratic, in the sense of rewarding subspecialty radiologists and their productivity. Today’s radiologists want to practice in their fields, to do it very well, and to continue to train and learn with radiologists similar to themselves in experience. They want to maintain their incomes, enjoy their lifestyles, and get paid for the value they