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Radiology Is A Black Box


The term “black box” most often brings to mind the hidden, on-board flight recorder that provides crucial information in the event of an aircraft crash. There is now talk of requiring “black box” recorders for automobiles in the near future to similarly store important data. Another type of black box refers to a place where important processes occur but are hidden from view. I submit radiology is this latter type of black box.

Unquestionably, radiology is a critical part of modern healthcare. Having said that, few outside the radiology department have a full and accurate understanding of how the process of radiology occurs. Clinicians are accustomed to ordering imaging studies or interventional procedures at any time of day or night and having the results magically appear in the chart and the image guided procedure performed.  As long as the medical staff members are not complaining, hospital administration generally does not give radiology much thought. Quality and efficiency are assumed and are almost always present.

Around-the-clock coverage for every imaging modality is a given for radiology while some other specialties may be allowed nights where there is no coverage due to limited staffing. Administrators see no problem hiring hospitalists to assist admitting physicians to care for their inpatients. However, I have never known them to contribute to a radiology group to help pay for night time coverage from nighthawks or to hire additional personnel for that service – even in a period of declining reimbursements.

It has always seemed to me that administrators used two sets of accounting ledgers when it came to radiology. In virtually every hospital I have every worked in (and I have worked in quite a few), the imaging department has always been a major profit center for the hospital. When it comes to equipment purchases and staffing, however, one would think that imaging was a loser. Complaints of the expensiveness of radiology equipment are a frequent justification for a delay or refusal to purchase equipment. New equipment is more likely to be forthcoming if a competitor hospital has gotten a new high-tech gadget than if the radiologist has requested it.

Ergonomic workstations and chairs for radiologists are deemed unimportant in the overall hospital plan. It is a different matter when the hospital is attempting to attract other non-radiologist physicians who use imaging equipment, such as fluoroscopy or ultrasound. They can request and expect top-of-the-line equipment.

Replacement schedules for routine equipment, such as fluoroscopy and ultrasound units, are either non-existent or exceed their useful life expectancies. Hospitals are quick to offer services currently provided by radiology to other specialties as an inducement to join the medical staff. I have personally witnessed services being offered by a non-radiologist specialty during normal working hours with the expectation that radiology would provide that service after hours and on weekends.

Indeed, most hospital administrators appear to think of radiologists as interchangeable. One group is as good as the next. Literally, radiology is seen as a magic black box where the imaging request goes in one end and the result/procedure instantly appears out the other. In most cases this has been true, so far.

Perhaps I have been unlucky during my career and others have had a different experience. I would be interested in hearing about this. I do know that all of medicine and radiology, in particular, is undergoing a period of tremendous change and challenge. I hope that like the other type of black box, our specialty will survive the coming crash.

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