Radiologists must show their faces

November 26, 2007
Bradley M. Tipler, MD

I don’t know if it is my own insecurity or a real phenomenon, but I feel like corporate America is creeping further into radiology, and most of my life, every year. The number of teleradiology companies continues to expand, and now two of them are publicly held. Every year, more of us become employees of for-profit firms.

I don't know if it is my own insecurity or a real phenomenon, but I feel like corporate America is creeping further into radiology, and most of my life, every year. The number of teleradiology companies continues to expand, and now two of them are publicly held. Every year, more of us become employees of for-profit firms. Dr. James Borgstede gave an excellent talk on radiology's future, which made the issues a lot clearer for me. You can take off your shades, it ain't that bright.

He broke every exam we do into four steps:

  • pretest evaluation of appropriateness
  • monitoring and quality control of the test
  • interpretation of the results
  • postexam consultation with physician or patient

Teleradiology companies (and, I suspect, most hospital administrators) focus only on step three. This is the one that gets paid, whether you do the others or not. And this is the part being turned into a commodity. This "lab test mentality" diminishes our role in patient care and may ultimately make us expendable.

Unfortunately, we contribute to this undermining of our specialty. My group uses a nighthawk company, and it is really nice when they come online at 11 pm. Borgstede believes we may be thinking too short term, however. Do we want a good night's sleep this year, or 20 years of restful nights with a secure job?To preserve our specialty, we need to put a face on radiology. Consultation is the key service onsite radiologists provide, and we have to make time for it. Patients, referring physicians, and administrators need to connect your face with the quality of radiology in your hospital. Or, as in my practice, one of your partners who is easier to look at.Emphasizing consultations is easy to say but hard to do. There are just too many exams that have to be read. And, to be honest, I prefer doing work that gets reimbursed. This is going to require some Nascar-level gear shifting in our priorities and workflow, and I'm feeling like Billy Bobby.Nighthawks are not the only companies that seem to be multiplying like rabbits. There are a host of new PACS and RIS providers this year. Who buys from these companies? I come from a relatively small potatoes hospital and practice, but I would have real problems buying such a key component from a startup. They must hire some crackerjack salespeople.Corporate America isn't my only personal issue this year. After 25 years, my RSNA name tag still has only one ribbon taped on the bottom: "R & E foundation donor." I see folks with 10 or more ribbons on their badge. Ribbons hang down to their knees. I'm dealing with a serious case of ribbon envy.