What If a Radiologist Who Specializes in Blocking Unnecessary Imaging Requests Was Added to Your Practice?

It was one of my periodic “clean out the worklist” sessions. Our group had a sequestered little reading room where a rad like me could go and just crank out cases without interruption. Barring crises, nobody was allowed to come knocking at the door or even call on the phone. The phone was only there for outgoing calls from the reader.

So, when the phone rang, of course I got a little rankled. “What do you need?” I grumbled into it.

“Hi, I am Dr. Nudnik. Your group is hiring, right?”

We were and it was actually my turn to field phone interviews that day, but not until the afternoon, and I said so. “Who gave you this number or did someone transfer you?” This was someone I would be giving a talking to.

“I would just as soon not get anyone in trouble … but I haven’t actually applied to your group yet. Before that, I wanted to see if my particular skills were something you would appreciate.”

Okay, maybe a quick exchange with you now will save me a bigger chunk of my afternoon later. “Fine. What skills? Do you have a subspecialty?”

“Yes. Unnecessary imaging.” Could I have heard that correctly? Yup, he repeated it for me.

“Is that supposed to be a joke?”

“Not at all. You can see it on my CV if you would like. Part of the reason I do this is because nobody else has yet. The supply/demand ratio is as good for me as it ever can be.”

“Okay, let’s get this over with. Make whatever pitch you’ve got.”

“When I chose radiology, the field already had a shortage. The number of imaging studies was exploding, rads weren’t getting more numerous at anywhere near the same rate, and the trend was getting worse. Most rads seemed to know that a lot of the extra volume was imaging that didn’t need to happen: unnecessary imaging.”

“Uh-huh. And?”

“Mid-levels who were in over their heads got scans hoping they would tell them what to do. Overburdened docs insisted on scans before they would even see patients or review their charts. Many studies got done — and continue to — when the answers they are supposed to provide are already known. There is research on this. For instance, one ER study in 2024 found about one in three CT, MR, and ultrasound cases added nothing to patient care. There was enough known about those patients that the scans could have safely not been ordered at all.”

“Bring it home fella. Where do you enter into all of this?”

“Since a huge chunk of our field’s growing problem isn’t getting settled with institutional things like utilization review, I decided that a smaller-scale approach was worth a try. While most of my residency department took the usual no-conflict, ‘just say yes’ approach to inappropriate studies, I fought the battles whenever I could. I would deny stupid STAT MR requests at 2 a.m. when ortho interns said ‘my attending wants it now.’ I learned how to push back.

“I would cite appropriateness criteria from the ACR. I would make the clinicians have to work for it whenever they wanted something dumb. I looked up studies their patients had already undergone and told them ‘No, you can’t have sono for cholecystitis when we already know the gallbladder is absent from last month’s CT. You don’t need to rule out ectopic or torsion when we have a study showing TAHBSO last year.’ Eventually I got nicknamed ‘The Wall’ and they stopped fighting me.”

“That might be helpful if we had a lot of hospital contracts with those kinds of problems, but we don’t. Most of our work is outpatient stuff. There’s still too much volume, and I hear what you’re saying about preventing unnecessary studies, but we really can’t take someone on who is just going to argue with our referrers and prevent the studies that keep our scanners full.”

“Well, that gets to the other half of what I offer, because I’m not only about prevention. I designed my own fellowship in unnecessary imaging to work on the bigger part of the problem: What do you do with all of the needless studies that get past the goalie and sit on our worklists? I studied and analyzed trends to determine what sorts of exam, clinical history, patient demographics, and profile of previous imaging are most associated with wastage.

“I even developed my own AI tools to analyze this stuff. This is nothing I would ever sell or make public. I wouldn’t even know how to go about that, but it works great for me. When I see that a study fits the unnecessary profile, the probability of significantly new or changing abnormalities drops like a stone. I can read them way faster.

“So, if I were to join your group and you let me do my thing, I am confident that I could clean up your worklists at least 30 percent faster than any other rad who is performing decently. I wouldn’t do it at the expense of a lot of sloppy or error-filled work. Best for you, I wouldn’t insist on getting paid 30 percent more than everyone else although we could talk about what sorts of incentive would be reasonable for that efficiency.”

More out of curiosity than anything else, I had him apply. I figured at the very least, we would get a kick out of what this character must be like in person. However, it turns out I was too much of a skeptic on this one. He is with us now and it is working out great. He will probably become a partner next year.