Most radiologists may not consider spending 20 minutes a day socializing with patients as time well spent, but Dr. Harvey Neiman, executive director of the American College of Radiology, considers it a crucial investment for the profession's survival.

Speaking to radiology residents Saturday at the California Radiological Society annual meeting, Neiman laid out strategies that could help radiologists successfully weather threats from imaging technologies and practice trends that threaten to end more than four decades of generally good times for board-certified radiologists.

Neiman stressed that radiology has enjoyed a particularly good run from their stewardship over MR, multislice CT, and PET, technologies that have transformed medicine while making radiologists among the best paid practitioners in healthcare.

"The past 40 to 50 years have been wonderful." he told about 50 radiology residents during a luncheon speech at the 2009 California Radiological Society meeting in Newport Beach, CA, "Over that time, radiologists have had more fun in practice than most physicians."

The good times have rolled with the help of productivity-enhancement tools such as PACS, voice-recognition software, and nighthawk services, despite a chronic radiologist shortage since 2000. Each year about 1400 new residents enter practice to replace the 500 or so radiologists who retire annually. Even with a 5% growth rate, manpower gains have fallen short of meeting imaging volume increases, which has contributed to a 5% to 12% annual increase in relative value units, an indicator of physician workload.

Productivity improvement has reduced the gap, but in doing so it has tended to isolate radiologists from the social mainstream connecting them with ordering physicians and patients, Neiman said. Additionally, the intrusion of outside medical specialties into imaging, including imaging training for their residents, and the expansion of nighthawk services to the daytime final read market have added to the growing anonymity of radiologists and the threat of commoditization for the field.

Disruptive technologies, exemplified by the iPod-sized ultrasound system pictured with GE CEO Jeff Immelt in the Wall Street Journal on Oct. 20, add another level of threat, Neiman said. Radiologists should take care to recognize the implications of imaging technologies that enable untrained physicians to perform radiological procedures.

Neiman recounted a conversation with a Chicago commodity trader about the valuation of commodity products.

"A soy bean is a soybean is a soybean, and you don't want to become one," he said. "We need to create a new business model where patients ask specifically for a radiologist."

The profession has come far from the days of patient-focused radiology, he said. Consumer focus group research sponsored by the ACR has found the public is generally in the dark about who radiologists are and what they do. Neiman said 48% believe radiologists perform medical imaging and leave its interpretation to the ordering physician.

The ACR has demonstrated that public perception can be changed, but at a high cost, Neiman said. Intensive public relations campaigns in three cities in 2008 found that 79% of healthcare consumers said radiologists are the best doctors for performing medical imaging, up from 65% before the media blitz.

The "Face of Radiology" program has run in Washington, DC, in an attempt to influence policymakers and is available to address problems in specific states. But the ACR can't afford the $50 million to $100 million cost of implementing it nationally.

As an alternative, the ACR has proposed a grassroots program urging radiologists to "touch five patients a day." Widespread compliance could add up to 34 million patient contacts per year, Neiman estimated. Radio spots, brochures, bill stuffers, and some PowerPoint presentations are available for local use. All discuss what a radiologist is and does.

"Over time, by being a little less productive, we can have a significant influence on public attitudes," he said.

Radiologists can refer patients to www.mypatientconnection.com and www.myradiologist.com for print and video stories describing their place in medical practice. Brochures, posters, and videos can be downloaded.