Power to the Radiologist: Steps Toward Ensuring the Specialty’s Future

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John PattiPat BasuRadiology is at a crossroads, and the future of the profession will be determined by the decisions that radiologists make today, according to John Patti, MD, and Pat Basu, MD. In “Critical Issues Facing the Profession of Radiology: An ACR® Leadership Perspective,” which Patti copresented on November 28, 2011 at the annual meeting of the RSNA, he suggested that radiologists start by committing themselves to sacrificing some of their time and revenue to practice building, ensuring that the specialty will be a fulcrum for future payment and delivery models in health care. Patti, who is chair of the ACR board of chancellors, says, “If you look at the way radiology has evolved, not much of any kind of sophisticated diagnosis or treatment gets done without imaging. The problem is that we have not recognized that as forcefully as we should. Medicine cannot be practiced without us, and if we realize we are in a powerful position, we can use that power to create extra, added value beyond the mere interpretation and production of a report.” Basu, who is CMO of Virtual Radiologic (vRad), echoes this point. “This is a dynamic time in health care, and the question is this: Do we want to help drive the change, or do we want it forced on us? This is an excellent opportunity for radiologists. There’s still so much to be done, and there isn’t a lot of domain-specific knowledge among decision makers and legislators,” he says. Power to the Practice As Patti underscores, practicing radiologists often feel that they lack the time to improve referring-physician service, play a pivotal role in an accountable-care organization, or engage in other value-adding activities to reposition their businesses. “At the practice level, what we need is strong leadership,” he says. “Practice leaders need to understand the difference between leadership and management. Leadership should create the vision of placing radiology at the center of the health-care enterprise.” For example, Patti says, practices could use their advanced understanding of health-care IT to provide services to practices in other specialty areas of medicine. “We’re among the most innovative of all medical specialists, and we ought to leverage that knowledge to provide IT services to other practices,” he says. “We can use that opportunity to become more central and to be perceived as consultants, rather than people who carry out orders.” In order to be perceived as consultants, however, radiology groups will need to double down on service to their fellow providers—and that requires thought, time, and effort, Patti says. “Practices need to take the long-term view on this,” he observes. “So much of what we do is fighting about payment and responding to new payment systems. If all we do, as a specialty, is react to external factors, we won’t make as much progress as if we control our own destiny from within.” Power to the People The battle to move imaging to the forefront of medicine has another theater, Basu says: Radiologists should actively seek to influence local, state, and national policymaking. As a former White House Fellow, Basu has seen, firsthand, the paucity of both radiologists and other health-care providers on Capitol Hill. “I was the only radiologist working in the high levels of the federal government last year, and one of very few physicians, period,” he says. “Right now, there is no more important task than making sure we’re part of these decisions.” Radiologists need not decamp to the District of Columbia to get a seat at the legislative table, Basu stresses. “When you’re trying to influence these changes, the goal is to enlarge your sphere of influence,” he says. “I’m a firm believer that you can do a lot at the local level, serving on your school or hospital board, or on the city council. You increase the visibility of the profession while interacting with other key decision makers to get things done. Policy is an ecosystem, and influencing something locally can have great ramifications.” In addition, Basu says, radiologists can contribute to RADPAC to ensure strong advocacy in Washington, they can get to know their local lawmakers, and they can get involved with the ACR’s advocacy efforts. Radiologists can also fill part- or full-time appointed governmental/regulatory positions in agencies such as the US National Institutes of Health, the Centers for Disease Control and Prevention, CMS, and the FDA. “Unless more of us take appointments in the government or in hospitals, the profession will suffer,” he says. “It involves taking a pay cut, but there is a balance to be found between individual salvation versus what’s good for the profession at large.” Patti concurs. “You can’t be churning out RVUs 100% of the time and still have time to do these things,” he says. “Each practice has to look at itself and ask how much time and effort it can afford to spend on recreating radiology as the center of the health-care enterprise. An accurate interpretation and timely report are no longer sufficient to meet everyone else’s expectations. We have to offer more.” Cat Vasko is editor of Medical Imaging Review and associate editor of Radiology Business Journal.