Guest Editorial: Radiology in crisis: 2009
Dr. Barnhardt is the founding partner of Western Carolina Radiology, Asheville, NC, and the founding partner of McDowell Radiology, Marion, NC. He is a past president of the North Carolina Radiology Society and is a Fellow Emeritus of the American College of Radiology. He retired in 1998 after practicing for 35 years.
Radiology has operated within a "procedure-oriented" paradigm. Those of us who began practice in the 1950s and 1960s actually performed the procedures. We did the GIs and BEs and injected the IVPs ourselves. When we introduced nuclear medicine, mammography, ultrasound, and CT into our practices, we had to learn those procedures through "mini residencies," weekend courses, and conferences. Then we had to actually perform those procedures ourselves, then teach our technologists. We had direct contact with our patients, which was gratifying to us and to them. Today, with highly skilled technologists and radiology physician assistants (PAs), we have become "image interpreters." The patient deposits his or her "images" with our technologists and PAs, and then leaves. We dealwith the images.
As American Board-Certified Diagnostic Radiologists, we have secured the right to be the "official" image interpreters and are paid a fee for our skilled services. We are not necessarily required to do the procedure, talk to the referring physician, or talk to the patient to receive that fee. Talking takes time, and this is time away from interpreting images, our revenue source. We have enjoyed a monopoly. That is, until the digital age.
With high-quality digital images and high-speed image transmission, images can be sent to the distant corners of the earth in less time than it took to develop "cut film" through the original automatic processors. Very intelligent, U.S. fellowship-trained radiologists in India can skillfully interpret images-at a much lower cost to the patient. This has precipitated the current era of our radiology in crisis.
In the United States, the survival of radiology, as we know it, depends on our progressing to a "patient-oriented" paradigm. As U.S. practicing radiologists, we have the ace-in-the-hole over our radiologic colleagues in other countries: We have the patient.
As "image interpreters," we are becoming a commodity. As "patient-oriented" radiologists, we can secure our future and re-establish our position as physicians.
But can we "walk the talk"? That is our current challenge.