Dr. Stark is a Professor and Chairman of the Department of
Radiology at the University of Nebraska Medical Center, Omaha,
NE. He is also a member of the Editorial Board of this
journal.
Professions exist to develop and deliver knowledge from
generation to generation. In the face of competition, professions
necessarily transform or become extinct. Core knowledge and the
identity of professions evolve like genetic material. As in nature,
professions seek protected niches that last a short while and are
then inevitably lost. Radiation safety regulations, licensure, and
professional standards were barriers to competition, providing
temporary refuge while we populated and organized radiology. Now we
are threatened by removal of barriers, a wider field of
competition, and changed economic forces. Radiology finds itself
under-populated, exposed, and searching for refuge that may not
exist.
Radiologists' core competency is imaging technology. However,
imaging machines have become a commodity sold to anyone. The skill
to operate these machines, including mastery of cross-sectional
anatomy of the body, projectional imaging of the vascular system,
and less-invasive percutaneous surgical methods, is no longer a
protective barrier on which radiologists can rely.
Competing professional groups acquire technology and skills
developed by radiologists the moment these resources provide an
economic benefit. Self-referral gives nonradiologists an enormous
advantage. Hospital-based physicians are acutely aware of their
adaptive limitations and vulnerability in today's marketplace.
Certain clinical professions have learned to adapt rapidly to
scientific innovation, marketplace economics, and socio-political
forces. Competitive pressures from cardiology, surgical
sub-specialties, and many other groups threaten organized radiology
and its training programs.
To adapt and survive, interventional radiologists are poised to
break off from diagnostic radiology, just as radiation oncology did
decades ago. These sub-specialists will either compete more
effectively with their clinical counterparts or lose their identity
as radiologists and be absorbed into service lines based on market
demand.
The market seeks healthcare organized to respond to recognized
diseases or their symptoms, or a patient category such as
pediatrics. Walk-in and emergency facilities exist as a market
niche for triage services. The market does not recognize academic
traditions or invisible ancillary support teams, such as
radiology.
Increasingly, diagnostic radiologists will find their
interpretive and administrative skills insufficient to justify
their cost. Generalists practicing part-time interventional
radiology, neuroradiology, skeletal radiology, etcetera cannot hope
to survive as competing clinicians acquire similar skills. In just
one generation, shifting economics, technical innovation, and the
failure of organized radiology to adapt has already splintered
cardiac and obstetrical imaging. History is poised to repeat
itself.
The headwaters of our profession and its source of renewal is
academic radiology. Centers of higher learning innovate and
determine the planetary organization of the medical specialties.
Academic radiology needs your contributions and support.
Radiology is our future, and our legacy. Please help strengthen
it. To learn about the National Institute of Biomedical Imaging and
Engineering at NIH, browse this Web site: http://www.acadrad.org