Radiology Resolutions for the New Year

As 2013 kicks off, are you vowing to lose weight? Stop smoking? Be more charitable?

Let’s be honest. You’ve been resolving to do this stuff year after year, and yet here you are again. These noble plans might feel slightly more achievable in late December, but usually all they manage to do is get the year off to a lousy start by handing you your first round of failures.

Let’s focus on more realistic targets, shall we? Fortunately, health care - and radiology in particular - has no shortage of outside influences telling us how we’ll be spending the ensuing months:

I resolve to read more studies. Not for more compensation. Not because there will magically be more hours in the day to get the work done. And not because distracters will be removed.

We’ve been assured that dropping reimbursements will be counterbalanced by millions more insured patients in the populace, and that these folks will be increasingly seen by nurses and PAs because there just won’t be enough physicians to do the job. And those physician-extenders statistically order more studies (you decide why that is). More work, less budget, stable or declining number of radiologists - you do the math.

I resolve to be more responsible. It’s no news that there’s an ever-increasing push to hold rads accountable for more than making findings on imaging studies, and even to spell out how and to whom results get communicated. Inroads are being made, as you read this, to require specific phrasing in your reports - density of breast tissue, for instance.

Next up is the government’s grand plan to “vertically stratify” us into ACOs, the latest incarnation of capitation - meaning that there’ll be a finite amount of funding per patient, parceled out to the health care system tending said patient. If costs exceed allocated funding… too bad for the ACO and its members! This is punishment to them for not being efficient enough (forget about silly things beyond their control, like patient noncompliance or plain ol’ bad luck). As the radiologist who read the films diagnosing somebody’s pneumonia, you will actually be held financially responsible for its treatment and outcome.

I resolve to complain less. Well before ACA (the health care “reform” law) came along, there were things to be non-ecstatic about in medicine. Even if we weren’t particularly vocal, family and friends tended to ask us, as representatives of the profession, about our experiences in it and thoughts regarding the future. Such conversations got more frequent as we saw the ACA taking shape in… suboptimal ways.

We may have felt a sense of urgency to get the word out before it was too late, so that maybe damage could be averted (or, heaven forbid, improvements actually made). Near as I can tell, such discussions had no impact on the politicians, administrators, and lawyers deciding our fate. At most, a vocal physician was painted as a “downer” or even a “disruptive” individual if she or he was talkative enough in the wrong setting. Who needs that? Besides, there are more satisfying uses for one’s energy than yelling into the wind.

I resolve to laugh more. This will be easier if you remember to include laughter of the hollow, bitter, sarcastic, and derisive varieties.