Radiology Resident Success Will Depend on Non-Interpretive Work

CHICAGO - To be successful amid declining reimbursement and healthcare reform, radiology residents - and perhaps all practicing radiologists - must do more than perfect their study interpretation skills. Pressures from the industry will require them to do what Bibb Allen, MD, FACR, vice chair of the ACR Commission on Economics, calls “no-pay work.”

The future has radiologists being responsible for more than just worklists and reports, and “I hope your college is on top of this and will provide you these tools to do this,” Allen told the audience of an RSNA session Wednesday around the topic of whether too many radiologists are being trained.

The solutions may be counterintuitive, Allen said, as there is little incentive to perform uncompensated duties. But this “no-pay work” will be a differentiator for residents, as well as other radiologists. “An accurate and timely interpretation is one of the easiest things we do” and one of the easiest to duplicate and outsource, he said. The tasks that aren’t reimbursed are much harder, and that’s where radiologists must put some energy. “We have to think about changing the paradigm,” he said.

For example, radiologists should get involved with utilization management programs at their hospital or practice. They can collaborate with hospitals on the formation of Accountable Care Organizations for value-based payments and savings on equipment, Allen said. They can take time to promote quality, safety and best practices in medical imaging.

As Allen called on residents to focus on these skills, he also reminded those who train residents to consider these goals. How can the profession stay valuable in the changing healthcare landscape? How will it transform to succeed?

In an earlier RSNA session, John Patti, MD, chair of the ACR board of chancellors, even suggested radiologists and practices devote 10 percent of their resources on this non-interpretive work - talking with patients, collaborating with the hospital, participating in governance and program development. Will this be a full time equivalent at some practices? Allen wondered.

It may be a tight job market for radiology residents now, but that could change. In previous sessions at RSNA, experts have recalled that the surplus of radiologists of the early 90s became a shortage a few years later, and that will likely happen again. In the meantime, residents must find a way to differentiate themselves from their colleagues.

Yet there are jobs out there. Vanessa Van Duyn Wear, MD, a young radiologist who is past chair of the ACR Resident and Fellow Section, who also spoke at the session, noted that there were 202 positions listed on the ACR site, plus 22 at RSNA and dozens more on other job boards. They might not be the most ideal positions, but they are options.

In a small, unofficial survey Wear conducted, she found that a vast majority of young residents landing positions did so through networking through friends, family, colleagues and societies. Residents should be ready to use those connections, and to demonstrate what sets them apart from their cohort and make them a valuable addition to a hospital or group.

“Use your tools,” Wear told the audience, “Call on former colleagues, ask previous faculty, and at the end of the day be persistent. These groups are getting calls all day from people like you.”