The Herding of Cats in Radiology

December 20, 2011
Eric Postal, MD

Is it any wonder that getting physicians to form ranks, toe the line, and obediently comply with subsequently-imposed rules and regulations is a mite challenging? Let alone agree and join together in common cause on matters social and political. Why would you expect them to? This is an entire population of smart folks who spent many years of their lives learning how to gather and assimilate data to arrive at well-thought-out conclusions, ready to defend their reasoning if challenged.

What got you into your competitive radiology residency? Or medical school, before that?

The question wasn’t why you chose your career path, or what your goals were. Nobody could blame you for having such a knee-jerk response; you’ve been rehearsed at saying things like “I wanted to help people” ever since your first round of essays and interviews.

Instead, we’re talking about what qualified you. You had a certain set of strengths, skills, and characteristics that propelled you over a long series of hurdles and through a good many hoops.

One major ingredient in that mixture, if not the Number One factor, was willpower. Focus, drive, determination, whatever you want to call it - chances are you didn’t sleepwalk to your current position. If you’d tried that approach, chances are those degrees and/or board certificates which now grace your wall would have borne other people’s names. You were in a long, drawn-out marathon, competing with a large pool of hopefuls for a relatively small handful of positions.

Not only was this selection process intended to yield the best and brightest, but it was geared towards honing their edges even further. Qualities like leadership and confidence were not merely requirements for entry; they were actively cultivated during the educational and training process.

Med schools and teaching hospitals didn’t want to churn out walking textbooks that could regurgitate memorized factoids when asked. They needed physicians who were ready to lead their healthcare teams and transact with physicians of other specialties as equals. Hopefully, a few innovators would emerge from the ranks as well, to make new discoveries and advance the field of medicine itself.

Is it any wonder, then, that getting physicians to form ranks, toe the line, and obediently comply with subsequently-imposed rules and regulations is a mite challenging? Let alone agree and join together in common cause on matters social and political. Why would you expect them to? This is an entire population of smart folks who spent many years of their lives learning how to gather and assimilate data to arrive at well-thought-out conclusions, ready to defend their reasoning if challenged.

Responses to such challenges are, understandably, tempered by who’s doing the challenging. If another physician is involved and the inquiry is posed with professionalism and respect, it’s going to go a lot differently than if the challenger is, say, an insurance-company employee without a medical degree who’s trying to issue rulings on what was “medically necessary.” Or if the challenger is a nurse sitting on a committee which makes up rules as to how our studies will be protocoled.

Even if the challenger is a Congressman who unilaterally decides that we should be reimbursed substantially less for imaging contiguous body parts, citing some nebulous “efficiency” without allowing us a chance at rebuttal.

Perhaps independent thinking has become an undesirable quality in physicians. It could be that today’s society places greater value on tractability and meek submission. Who knows, it might be cheaper and easier to turn medicine into a field where there are established cookbook guidelines for every circumstance, and healthcare practitioners are expected to obediently complete checklists and never try to think for themselves. ACOs and the ever-increasing role of nonphysicians in primary care certainly seem to favor this.