Summary: Private Practice: Open Mouth View speaks to Applied Radiology’s private practice radiologists through the voice of Applied Radiology
Board member, David L. Weiss, MD, Physician Coordinator of Imaging
Informatics, Carilion Clinic and Associate Professor of Radiology,
Virginia Tech Carilion School of Medicine, Roanoke, VA.
“You arrogant ass. You’ve killed us!” This is the final lament of a
Russian submarine commander in the cold war genre film, Hunt for Red
October. His ship is about to be destroyed by a torpedo previously fired
by his own overaggressive first officer.
PACS and related imaging informatics tools are the crowning
achievements of image interpretation of the past decade. PACS has
recently become an enabling technology not just for radiologists but
also for all who view images—sometimes to our own detriment.
Private radiology practice groups today compete head on with
cardiologists, neurologists, surgeons, neonatologists, and others who
are all more than happy to collect the seemingly easy pickings.
Teleradiology groups, content for a time to read nighttime leftovers,
are now competing with private practices for full-service hospital
contracts. In order for a practice to maintain its own legitimacy, it
must take steps to carefully control this potentially self-destructive
force. Gone are the days when we can protect our own turf simply by
hiding the keys to the film library. Since nonclinical on-site tasks,
such as teaching and research, are often absent or at least not
emphasized, private practice groups are more exposed than others.
Nighttime image interpretation has historically been the
Achilles’ heel of radiology and has been largely avoided. Even today, we
are often viewed by our peers as “9 to 5-ers.” This seems particularly
unfair to me when I leave work at 1 a.m. and my car is one of very few
in the physician section of the parking garage. PACS is a modern cure
for this malady, but not without side effects. After years of
increasingly oppressive third-shift coverage, use of PACS by
teleradiology services has, in many cases, given us back a semblance of a
normal life. This is an arrangement where all benefit. Reports are
accurate and timely. Radiologists can now recharge and be ready for a
full next day workload. Some, but not all, of these vendors of late have
been eyeing the bigger imaging pie with a lean and hungry look. Stories
abound of private practice groups losing their contracts to offsite
teleradiology. Choose carefully. Make sure your vendor has a strong
reputation and demonstrated history of partnership rather than
competition. Become involved personally with vendor choice and contract
negotiations. This is not a relationship that can be left to hospital
In the eyes of a hospital administrator, what is wrong with
Balkanizing image interpretation? Many studies can be read by their
respective clinical specialists. The rest can be interpreted off-site by
the highly accurate, cost saving, 100% fellowship trained
teleradiologists. After all, what administrator does not harbor a
subliminal desire to be rid of those tiresome sophists who sit in the
dark and can easily bust the hospital budget with just one of their
mysterious George Jetson gadgets?
As radiologists, we know that our value transcends mere image interpretation. It is our job to disseminate that message.
- We must regularly attend clinical conferences and present
cases. It is easier to demonstrate our unique knowledge and added value
in person than through lifeless textual reports. We may even learn
- Committee service, while time consuming and often oppressively
boring, is another way to let colleagues and administrators know we
- Document everything we do—QI projects; technologist
instruction; protocol optimization; management of JCAHO and other agency
inspections; and equipment and software evaluation and purchase.
These important on site services will otherwise go unnoticed.
Consider these words from Captain Ramius, another character in
The Hunt for Red October: “For … years your fathers before you and your
older brothers played this game and played it well. But today the game
is different. We have the advantage.” PACS is a live torpedo in the
water, one that we ourselves created. It has provided our specialty with
benefits and potential pitfalls that were unimaginable a mere 15 years
ago. We radiologists must continue to control it with skill and care in
order to maintain our relevancy.