Subspecialization drive casts doubt on future of general radiologists

"The general radiologist is dead. Long live the specialist."

On a crisp, bright morning in Budapest last October, this concept sent shockwaves through the audience at the Management in Radiology congress. Dr. Nicola Strickland, a radiologist from the Hammersmith Hospital in London, gave compelling reasons as to why the future of imaging lies in ever-greater specialization by body part and disease process. She argued that specialist knowledge of the breast, lungs, and gynecological, neurological, and vascular organ systems is essential for today's radiologists and that they can play a meaningful role at multidisciplinary team meetings only if they can add value to the interpretation of an image over and above that provided by nonradiologists.

"Whether we like it or not, radiology as an independent specialty will cease to exist," Strickland said. "Radiology is becoming a subspecialty of organ-based clinical team members."

This is not a new idea. For more than a decade, the radiology department at Stockholm's Karolinska Hospital has had separate sections for neuro, pediatric, thoracic, and central radiology. Thoracic radiology, for instance, is part of the thoracic department, which includes cardiology, thoracic surgery, and pneumonology. Splitting radiology anatomically rather than by modality helps radiologists get very close to clinicians and serve them better, as explained in DI Europe's cover story from November 1996 ("Specialization brings benefits at Karolinska").

Within this broader debate, one of several hotly contested issues is pediatric radiology and where it fits in the emerging organizational structure. There seems to be a growing consensus that the Karolinska has got it right by regarding the imaging of young people as a separate entity and not lumping it together with general radiology. In his regular column in this edition of DI Europe, Prof. Peter Rinck explains why pediatric radiology deserves to be treated as a special case.

At some institutions, such as the Stanford University Medical Center in California, the pediatric radiology section itself is going down the subspecialist route. Prof. Ulrich Willi from the University Children's Hospital in Zurich is now a visiting professor of radiology at Stanford, bringing expertise in pediatric urology. This approach will not be a viable option for most pediatric sections, but it can make sense, given the complexity of procedures and technology, as well as the general trend toward subspecialization.

Such a fast-changing environment means that training must also evolve, and I am sure you will want to read Prof. Hans Blickman's Big Picture column at the back of this edition. If you have any comments on this article, the subspecialization debate, pediatric radiology, or anything else, please contact us at di-europe@btconnect.com.