Stephen Chang, MD, discovered his interest in health policy as part of an educational program initiated not by radiology mentors, but by radiology residents. Today, Chang, who is completing his fellowship training in breast and body oncology imaging, is an ACR® Moorefield Economics and Health Policy fellow, but as a resident at Columbia University, he found his education in these areas lacking. “We were able to invite speakers with an interest or expertise in those areas, but in general, many residents don’t get a lot of exposure to coding or reimbursement issues,” he says.
Chang’s recent experiences in residency and fellowship training mirror those of emerging radiologists nationwide, who are in the unique position of finishing their education in a field that was quite different when they selected their area of specialization. For example, Chang says, “There are a lot of radiologist partners in practice who would have retired by now, but with the economic downturn, their retirement funds were cut in half. Now, they are staying on in their positions, and there are economic factors driving them to take on more work to maintain the same level of income, instead of hiring more people.”
Subspecialized and Fancy Free
The trend toward increased subspecialization in radiology has often been remarked upon, and given the perspective of the radiologist in training, it is clear that the movement away from general radiology will only continue to gain momentum. Chang explains that because of the economic factors affecting radiologists currently in practice, radiologists now joining the field have to subspecialize just to be competitive.
“It’s pretty unheard of not to do a fellowship at this point, especially if you want to live in a big, coastal city,” he notes. “Fellowship training is much more important than it used to be for marking yourself as someone the practice should turn to when hiring.”
Concurrent with this trend, Chang sees more and more radiologists becoming employees of hospitals and larger radiology organizations in the future—perhaps, he notes, because so few radiologists of his generation have taken an interest in the entrepreneurial side of imaging. “The health-reform legislation and the changing value of reimbursement are shifting people toward hospitals and larger organizations, where they can have strength and bargaining power,” he says.
He adds that radiologists emerging from training have a stronger investment in lifestyle than their forebears in the specialty. “I think people are a lot more open to and interested in being employees,” he says. “People don’t want to worry about the business aspects—they just want to work a shift. That’s why this generation of students is more into anesthesia, emergency medicine, and radiology—they are all fields where you can have that freedom.”
As a Moorefield fellow, Chang bucks the trend that he observes in his fellow young radiologists—and he intends to continue doing so. “A lot of the work I have done, so far, is with the ACR,” he says. “I spent two weeks at ACR headquarters in Reston, Virginia, and met with the different staff members to learn what the ACR is doing on behalf of radiologists to advocate and influence reimbursement rates and health-care policy.” Chang is now a member of the AMA/Specialty Society RVS Update Committee, which meets quarterly to help influence Medicare payment determinations for various procedures.
Like many radiologists his age, Chang is subspecializing in breast imaging; he also cites interventional radiology as a currently popular fellowship area. “There were a lot of people who didn’t want to read breast imaging; they find it boring, and it’s litigious,” he notes. “There was a dearth of people willing to do it. I went into breast imaging because I want to maintain some patient contact.”
That relationship with patients might be a key factor attracting young radiologists to both breast imaging and interventional radiology. “If you’re a breast imager or an interventional radiologist, you can have more of a role in patient advocacy,” Chang says. “Otherwise, you’re relegated to sitting in the reading room.”
He notes that this desire for patient connection might be linked to residents’ dislike of economics and health-policy education. “I noticed, going through medical school and residency, that there was a distaste associated with talking about these issues. If you mentioned money, you were perceived as not