Dr. Matsumoto is a Professor of Radiology and Director of
the Division of Angiography, Interventional Radiology, and
Special Procedures at the University of Virginia Health System,
Charlottesville, VA. He is also a member of the Editorial Board
of this journal.
The 1970s and 1980s were the glory days for diagnostic
radiology. New technological advances in CT, MRI, ultrasound, and
interventional radiology were being established. Referring
physicians were enamored by our diagnostic studies and
interventional procedures. Sure, our work was demanding when we
were at the hospital or in the office. However, the lifestyle of a
radiologist was pretty enviable; arrive to work at 8 am, leave by 5
pm, rarely disturbed in the middle of the night, lots of vacation
time, an excellent income, and not having the primary
responsibility for patient care issues. Let's face it, referring
physicians were teeing up the golf balls for us to hit.
Times have changed, the pie has shrunk, and the collective
medical community will no longer allow us to just hit the ball. If
we are going to be players, other referring physicians want us to
step up to the tee and absorb some of the paperwork and hassles
associated with the process of patient care. In addition, many of
our clinical colleagues are being forced into making real-time
patient care decisions based on their own interpretation of
radiology studies. Therefore, these physicians are requesting that
they be reimbursed for their efforts, not an unreasonable request
given that they are assuming the legal liability, even if they are
not appropriately trained.
So this is where Darwinism comes into play. The fittest and the
strongest will survive, and the passive and the meek will not
inherit the earth. Unfortunately for us, we as diagnostic
radiologists have been so high in the food chain that we have not
had to scratch and fight for survival, and we have become passive.
Therefore, we have lost some of those primal survival instincts.
How then can we minimize our chances of being put out to pasture?
As interventional radiologists, we can separate from the main body
of diagnostic radiology. Although this model appears to have been
successful under the leadership of Dr. Fred Keller at the Charles
Dotter Institute, I am unsure whether this paradigm will work for
all of us. Keep in mind, splitting off interventional radiology
from diagnostic radiology would allow interventional radiologists
to become more flexible and adapt to changes more rapidly. There
would be a more consistent work ethic and philosophy on how to
provide service. However, there can be strength in numbers, if used
appropriately. In addition, superior imaging skills have been our
trump cards and truly separate us from other medical
Well then, what can we do? Although most of us would like to
think that decisions are being made for the improvement of patient
care, reality can be quite disturbing. Except for doing things for
the "right reason," there are really only three great career
motivators in life: fear, power/control, and money. The idea of
radiologists striking fear into the hearts of our competitors or
politicians does not seem realistic at this particular moment. Our
cardiology and surgical colleagues, by nature, seem to have more of
a killer instinct. Our primary care colleagues have more influence
by sheer numbers. Radiologists suffer from their image of being
relatively lazy and "fat," and everyone wants and feels that they
deserve a piece of "our action."
In terms of power and control, radiologists have very little
power or control within the hierarchal system of a hospital.
Radiologists bring very little to the table, but rather, feed off
other physicians. The way hospital administrators look at things,
radiologists generate very little business for the hospital, while
being a large money sump for technology and equipment. Indeed,
having radiologists in the political hierarchy of hospitals should
be the rule of thumb; yet, it is a rarity in some institutions.
What about money? Radiologists have their share of money, but
what are they doing with it? How many of you are members of a State
or National Radiology Political Action Committee? How many of you
actively contribute to political campaigns so you can influence
legislation directly? In Virginia, there is still a Certificate of
Need (CON) policy. Having said this, the cardiologists have
recently been able to carve out the field of nuclear cardiology and
bypass the CON policy. How was this accomplished? You got it,
through money and political influence.
We, as diagnostic and interventional radiologists, can no longer
live with the status quo. The times are changing rapidly. All
parties (hospital administrators, the Healthcare Finance
Administration, Medicare, and clinicians) see us as an easy target
and, therefore, are moving into our neighborhood. Sure, we can be
passive and let "the chips fall"; however, many of us do not want
to let other disciplines' agendas control us. Since radiologists
have very little control over patient referrals, hospital
administrators, and legislators, we must use our money, time, and
manpower to try to minimize the changes that adversely affect
patient care and the field of radiology. I know money is tight, but
if your boat, summer house, or golf outing is more important to
you, then that's the choice you've made, and the choice with which
we and future radiologists must live. However, if you want to try
to influence the future of radiology, there are ample opportunities
for you to contribute. Become involved in the Society of
Cardiovascular and Interventional Radiology or the American College
of Radiology. Contribute to Radiology Political Action Committees,
and become more active in the campaigns of local politicians so
that you can influence the direction of legislation.
Radiology has been very good to you and your loved ones. Give
something back to it! We need your participation at some level.
Status quo--no more! This is a call to action. I once saw a quote
in the office of the late Dr. Charles Putman that read, "If you are
not moving forward, you are moving backward." It is time for us to
stop moving backward.