Dog days of radiology entail new perspective


From a business standpoint, many decisions by hospital administrators make little sense

We have a one-year-old yellow Labrador retriever. My wife finds it cute when the dog eats my shoes or gnaws on my glasses. The dog wanders, so I installed an invisible fence. It wasn't quite invisible enough, as it was unearthed and chewed into multiple pieces. My wife considers the dog part of the family. I would rather have another mother-in-law. We see this crazy beast from different perspectives. The same process occurs in my hospital.

Every year our hospital has a wonderful weekend retreat for the hospital board, key administrators, and medical staff leadership. To nonattendees, it seems like a boondoggle. As chair of radiology, I am invited. I see the retreat as a small price to pay, considering the intangible benefits the hospital reaps from it. While I often write about conflicts here, I realize how mild our clashes are compared with most other hospitals. I believe the retreat is a key reason why our staff communicates well with those who run the hospital.

Every year a chunk of time is devoted to the financial state of the hospital, and every year my department is the biggest revenue generator. The meeting is full of love and kind words for radiology. Then the honeymoon ends and we come back to work.

In the hospital, there is a little more disagreement about what makes a successful radiology department. Perspective is often at the core of this debate.

Call me crazy, but I believe the members of my group know more about radiology than anyone else in the hospital. Our administration often consults us before making major decisions in radiology. In considering equipment purchases or other tangible decisions, they actually listen to our advice. But when it comes to most of the intangibles, like policy decisions, I get the feeling that our opinion is only important if we agree with the administration's preconceived resolution.

A few years ago, administrators asked what we thought about allowing vascular surgeons to perform angiography. Unaware that they had already committed to it, we said it would kill the service. Since then, the volume of angio work in our hospital has declined dramatically. I suspect that the hospital has lost millions of dollars.

When cardiologists wanted to read their own stress studies, we said nuclear medicine would suffer but cardiac would grow. Surprise, surprise. The volume of stress studies has increased nearly 200% in two years. The rest of the field is static.

Most physicians will seldom do anything that is not in their self-interest. But our specialty is unique. If I make one dollar, the hospital makes three. From my perspective, they should want me innovating. They should want me making lots of money. My practice is completely tied to this hospital (for now). Why would administrators not support me?

The current buzz term is "shared resource." The angio suite is not a radiology room, it is a "shared resource." As a shared resource, the room has been far less efficient. It is making me less money, and it is making the hospital a lot less money. Am I going to invest time, energy, and money on a shared resource? Does anyone expect me to spend hours of my time teaching technologists a new procedure for a shared resource?

Cardiac CT looms on the horizon like an 800-pound gorilla. Will CT become a shared resource? I think it's crazy to sacrifice the efficiency, onsite supervision, constant monitoring, and commitment of the radiology group just so some other physicians can cherry-pick services. We will suffer, the department will suffer, and ultimately, the bottom line of the hospital will suffer. Administration has a different perspective.

Dr. Tipler is a private-practice radiologist in Staunton, VA. He can be reached by fax at 540/332-4491 or by e-mail at

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