10 Questions with Eric Postal, MD

August 19, 2016

For this "10 Questions" series, we spoke with Eric Postal, MD, about his work and the future of radiology.

1. Please state your name, title and the organization you work for. 

Eric Postal, MD. I would say I’m just a plain ole diagnostic radiologist, independently contracting with vRad, but I suppose I do have something of a title as one of their Radiologist Representatives. Not exactly a Union rep, but close enough.

2. How did you get where you are today?[[{"type":"media","view_mode":"media_crop","fid":"51004","attributes":{"alt":"Eric Postal, MD","class":"media-image media-image-right","id":"media_crop_2661715680957","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6264","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 207px; width: 170px; float: right;","title":"Eric Postal, MD","typeof":"foaf:Image"}}]]

Like most radiologists, by spending entirely too many years in school and postgraduate training! My subsequent course was with a couple of local outpatient imaging centers, where there turned out to be no long term career path such as a partnership role. I decided to try my hand at teleradiology, and thus far it has been my most satisfying stint in the field.

3. Why did you choose your profession?

Well-meaning relatives programmed me from an early age to seek out a career in medicine. By high school, I was fairly certain of psychiatry…until med school. By then, I had worked in a psychiatric clinic, and familiarity bred contempt. Further, I was learning a lot of interesting medical and surgical stuff that I knew I’d be leaving behind if I proceeded with psych. Radiology seemed nearly the opposite-drawing upon virtually every aspect of my medical education.

4. What is your biggest day-to-day challenge? 

Fitting everything in! I’m often reminded of what Chris Rock said about the difference between having a job versus a career…if you’ve got the latter, there just aren’t enough hours in the day. I hasten to add that this isn’t purely about radiology, but other aspects of my attempted well-balanced life: Exercise, keeping up with current events, and God forbid being social once in a while.

5. What worries, if any, do you have about the future of radiology? If none, where do you think the field is going?

My biggest concern is that there seems to be an inexorable trend towards radiologists not, to use a trite phrase, “taking ownership.” I don’t see it as a deficiency on the part of the rads-most of them very much want to be professionals, working at their craft with appropriate control over it.

They have to fight tooth and nail to do it, though, more frequently and on more fronts than ever before. That gets fatiguing and demoralizing. Many experience zero control in their work environments, for instance having no input on protocoling the studies they read every day and being neutered of any ability to push back against the routine ordering of imaging studies with nonexistent clinical history.

It’s become a rarity for rads to have a realistic expectation of one day attaining partnership or some other sort of elevated departmental role. Employee or independent contractor status is the norm. The idea used to be that you put in time and effort, and rose through the ranks until you had some genuine ownership (equity, or at least authority); now, promises of a path to partnership are commonly retracted, lies from the outset, or simply not made in the first place.

At least that last one is honest and straightforward-but an employee or contractor essentially punching a timeclock for an organization within which s/he’ll never ascend is hardly likely to have a sense of ownership of much more than paychecks.

Maybe the last true bit of autonomy, how rads report their studies, is now being eroded: By insurers and the government mandating specific verbiage to see reimbursement (if not avoid punishment), and sometimes even by our own colleagues who see fit to impose my-way-or-the-highway reporting templates.

The message rads are getting from all sides seems to be sit down, do as you’re told, don’t make waves, and churn out RVUs. Taking ownership despite all of this would require prolonged swimming upstream against a powerful current.

6. What one thing would make your job better?

You might get a sense of a few major changes I’d like to see from my last answer! But in terms of smaller scale, day-to-day things: Better voice-recognition technology. I’ve written a couple of blogs on the subject; suffice it to say I think it would be nice for us users of the software to have more options of customization. That goes for PACS and our other tools, too-I wish the industry would make more of an outreach to the rads who use their products on a daily basis, since we’ve got plenty of feedback to help them hone their products.

7. What is your favorite thing about radiology?    

Getting back to my answer about why I went for radiology rather than psych: We see just about everything there is in the medical field. My daily workload keeps me in touch with what’s doing in most types of surgery, ob/gyn, peds, IM, etc.

8. What is your least favorite thing about radiology?

Channeling Rodney Dangerfield, “We don’t get no respect.” Or at least, not enough. Far too many clinicians (and nonphysicians) fail to see us as the consultants we are, and I believe that is one of the reasons we so routinely are given short shrift when it comes to clinical histories for exams, and left out of the loop when imaging is ordered. Only when we receive the images do we find that valuable contrast was not utilized…or the entirely wrong modality was employed.

9. What is the field’s biggest obstacle?

The lack of ownership I ranted about, earlier. It might only take a generation or two of disempowered rads populating the field, feeling they have no voice, no power over their profession, before outsiders step in and attain such control that it would be difficult or impossible for us to take back.

10. If you could give the radiology specialty one piece of advice, what would it be?

We need to grow more of a collective spine. So frequently, speaking up for ourselves is frowned upon, lest we scare away referrers, offend administrators or regulators, alienate politicians, etc. Yes, there’s value in diplomacy and sometimes one’s own ego must be suppressed for the longer-term game. But endlessly bowing and scraping, trying to be everyone’s malleable friend, can make one look weak and needy. Such a posture can result in a lack of respect-from oneself, as well as others.

Is there someone in the imaging community that you want to hear from? E-mail us their name and we'll ask them 10 questions.

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