For his kind generosity, I am thankful to Dr. Keats, who saw my recent letter to the editor of Diagnostic Imaging and invited this commentary. This riposte was to counter a gloom-and-doom piece written by a bitter, pseudonymous radiologist in the September 1997 issue of that journal. The author lamented all his perceived shortcomings of a career as a radiologist and praised none of the positive attributes. I believe he (and the journal, by publishing it not as an opinion piece but as a major article) performed a genuine disservice to the profession, especially to young people entering or considering the specialty. Alas, Diagnostic Imaging did not take me up on my charitable offer to respond, but Applied Radiology did, and for that I am most appreciative.

Radiology is still the best medical specialty, and if you don't believe it, just query most of the practicing radiologists in the country. Sure, they may grouse about managed care, complain of declining reimbursement and of working longer hours at less pay, but there is certainly no stampede out the door, no exodus toward alternative careers. I haven't seen many of my colleagues going back into family medicine or surgery or psychiatry. Radiology continues to have the most intellectual stimulation, the highest problem-solving position in medicine. It is the generalist of all of the specialties and is in universal demand.

The mental rewards of radiology are constantly changing and growing and I eagerly look forward to a day at the hospital because of the never-ending challenges. Certainly, we are all in the midst of change and anxiety. I recall my grandfather, also a radiologist, saying 30 years ago that the birth of Medicare would be the death knell for physicians. Instead, it brought on the golden era of radiology and medicine.Those days are gone, of course, but life is still full and rich!

A recent transition in our department serves as an analogy to the short-term angst experienced by many radiologists. After being one of the original academic medical centers to be aligned with Apple© computers, our department is leading the med center switch to PCs, simply due to incompatibility with the various software needed to run a large radiology department (not to mention other departments). Recently, I saw my beloved computer unceremoniously yanked out and an ungainly PC plopped in its place. The result: I can't even get e-mail to work properly with my new monstrosity. But amidst gnashing of teeth and pulling of hair, there is a faint light at the end of the tunnel: much faster speed and more applications available on a PC, even if the darn thing is more awkward and klutzy to this user. On the bright side, at least we have computers, something I would not have dreamed of when I started here as an attending ten years ago.

I practice in a department with a small residency program. I have seen no decline, and have arguably experienced an actual increase in the caliber of medical students entering radiology. About 70 students in our medical school are graduating this year, four or five of whom are venturing into radiology, and these future doctors are no slouches. Our graduating radiology residents universally obtain good jobs, sometimes after fellowship, sometimes not.

My radiologist friends in varied practice environments, from small community to large academic departments, have a different story to tell, a varied slant on how to craft the best possible practice. If you are new to the game, talk to a few of these people, see what works for them. I still haven't figured my philosophy out, but in the interim have adopted the "Murray Janower rule" (ACR presidential address, 1997): incorporate five direct patient contacts or encounters in every work day, and your practice will be that much more satisfying. It will also make us more recognizable and accountable as a profession to the general public.

There are the incessant turf wars, to be sure, but as long as we are training topflight radiology researchers and educators, we will win most of the battles and, I predict, the war. Not right away, and not without struggle, but eventually. I may not be living in the real world of medicine, here in an academic medical center in a largely rural state, where we are relatively isolated from the competition that has transformed radiology in the urban/suburban centers. But the winds of change are starting to blow our way, bringing us into the battle.

Some final thoughts: don't fret over the bottom line in your paycheck; we are making more than 98% of the population and pursue our careers in a warm, safe, and generally clean environment. This, by itself, is no mean feat. We never have to worry where our next meal is coming from, unlike a sizable percentage of the global population. So, if your glass used to be 3/4 full and is now 1/2 empty, remember that it is still half full. As radiologists, we would do well to remember the words of Mark Twain, "I have been through some terrible things in my life, some of which actually happened."

Dr. Harris is Associate Professor of Radiology at Dartmouth Medical School, Dartmouth-

Hitchcock Medical Center in Lebanon, New Hampshire; he is also the newest member of the editorial advisory board of this journal.