The Reality of Radiology: A Synopsis

March 21, 2014

Radiology is changing, and some of my other musings.

It’s been a brutal winter in my neck of the woods. Record snowfalls, arctic temperatures…while this helped me remain a shut-in during my prep for the MOC exam, I’ve been aching for spring, along with most of the population in my area. So, while there’s still some time left for another frigid wallop, a couple of days of temperatures above 50 and the daylight-saving shift have us feeling hopeful.

In a lot of households, this means it’s almost time for spring cleaning. As I mentioned in a column last year, I like the principle more than the practice of physically cleaning my house. So, since a number of partially-completed columns have been sitting on my computer’s desktop for awhile, I shall “clean” them away after offering some of their points here:

It’s a shame more of us aren’t trying to outrun the lion. There’s an oft-referenced joke about a couple of fellows who encounter a lion in the wilderness. One comments on the futility of trying to outrun the lion. The other responds, “I don’t have to outrun the lion-I just have to outrun you.” Healthcare has gotten so mired in adherence to guidelines, paper-pushing, and just plain trying to remain solvent that there’s little time (or motivation) left to go above and beyond.

Strategic discontent. When I decided to pursue radiology as a specialty, part of the reason was that the rads I saw were generally happy. Certainly, more so than most of the other docs I saw. I guess some folks in DC noticed, too, based on the lopsidedness of governmental abuse of radiology during the subsequent 10–15 years. Lesson learned: Even if you’re pretty content with your lot, act at least as grouchy and doom-ridden as everyone else around you, lest you appear most capable of sustaining more bad news.

Bat .980…or else. In baseball, batting .300 is pretty darned good, and exceeding .400 practically makes you a god. Put another way, failing 70 percent of the time makes you competitive at what you do. I have yet to hear of a peer-review program that wouldn’t make life miserable for rads batting below .900 (10 percent error rate), and usually the bar is set considerably higher. Some might object to the metaphor, since MLB batters are facing hostile pitchers who are trying to make them miss. Well, the day I routinely get clinicians giving me good histories, ordering appropriate modalities and protocols (or, God forbid, asking my opinion before ordering), I’ll consider them to be on my “team.”

A constant state of emergency. I’ve noticed an increasing number of facilities are instituting policies whereby all results of STAT cases, positive or negative, are to be personally phoned from the radiologist to the clinician. This seems a classic example of ideas spawned by committees of people who rarely or never actually do the work themselves. If a case was positive, the rad would have called it in without this silly routine. And if it’s negative, what is being accomplished other than disrupting the work of the radiologist and the clinician? Believe it or not, I haven’t yet found a clinician who appreciates being woken up by me at 4 a.m. to tell him that his patient’s study is normal.

Heading for the exits. It never ceases to amaze me how administrative and managerial types wait until employees are bailing out of the workplace before considering that maybe some policies and procedures are in need of revision, or that new initiatives to boost morale are warranted. I would imagine that it takes far less to proactively keep your talent satisfied in the first place, than to try recovering them after they’ve mentally begun to clean out their desks.

Cost of doing business. My accountant advised his clients this year that, as a result of various increases in overhead, his office would be upping their fees an average of 2–3 percent. This came along with a bunch of tidbits about taxes going up, deductibles being limited or disallowed, etc. which of course increases my overhead. Gosh, I’d sure like to be allowed to do what he (or any other professional) does, and hike my charges to compensate. Do you think Medicare and the private insurers who tell us what we’re allowed to earn factor in that stuff?