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 disciplines.

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.