On September 30, the editors at Healthcare Innovation presented Healthcare Imaging Virtual Day, a day on which radiologist, imaging informatics, and radiology business leaders from across the U.S. and Canada gathered together virtually to discuss the present and future state of the radiology profession and of imaging informatics.
In the final panel discussion of the day, Healthcare Innovation Editor-in-Chief Mark Hagland gathered together five national leaders among radiologists for a discussion around “The Changing Landscape Around Radiology Practice—the Radiologists’ Perspective.” He was joined by Cheryl Petersilge, M.D., a musculoskeletal radiologist and a consultant with her firm, Vidagos (Cleveland); Alex Towbin, M.D., associate chief for clinical operations and informatics, and the Neil D. Johnson Chair in Radiology Informatics at Cincinnati Children’s Hospital Medical Center; Eliot Siegel, M.D., professor and vice chair in the Department of Diagnostic Radiology at the University of Maryland School of Medicine (Baltimore); Gary Wendt, M.D., chair of informatics and professor of radiology, and enterprise director of medical imaging, at the University of Wisconsin-Madison and UW Hospitals and Clinics; and Max Rosen, M.D., chair of radiology at the UMass Memorial Medical Center in Worcester, Mass.
Below is an excerpt from the first half of the panel discussion.
Hagland: What has the impact of COVID-19 pandemic been on radiological practice?
Wendt: We did see a fairly significant drop in volume at the initial onset of COVID, where we were down to about a third of our normal volume; but that has actually rocketed back up, and we’re now above baseline and are trying to accommodate imaging procedures that had been put off.
Towbin: Like Dr. Wendt, we had a pretty significant drop-off in the March-April timeframe, and have slowly been climbing; and most of our service areas are at 100 percent in pediatric imaging. We’re still slightly lower in volume in terms of emergency imaging; and the question is, was all the emergency imaging necessary? For example, ordering a chest x-ray to screen for pneumonia. If you wait a few days, you can usually confirm the pneumonia without imaging. Also, in terms of process, we’re slowly moving back into the reading rooms, but they’re less populated, and we don’t want people come into the reading rooms as much as in the past [per guarding against infection].
Petersilge: Alex alluded to not wanting the radiologists to come down to the reading rooms. I totally understand that. One of my concerns is that we’re becoming more and more removed physically from our referring physicians; and I’ve had a long-term concern over the commoditization of radiology. On the other hand, I see many vendors are now adding in collaboration tools, so that a radiologist and a clinician can both be at home, and share the same radiology screen and communicate with one another. I’m just curious if anyone working full-time clinically on a regular basis is seeing an increased use of collaboration tools.
Rosen: One of our oncologic imagers now has office hours on Monday from 11 a.m. to 1 p.m. where all the oncologists in the community know they can call her and conference in to review cases; and it’s been enormously successful. And the technology was there before COVID, but wasn’t being used. But now that everyone has a Zoom account, it’s happening.
Siegel: I had actually written a journal article about the decrease in interaction following PACS (picture archiving and communication system): with PACS, the number of in-person consults dropped dramatically after film was dropped. Ironically, we’re seeing more communication now, in the wake of COVID, with our entire hospital on Microsoft Teams, so ironically, in our own facility, we’re actually seeing more consultation; it’s electronic, though, rather than in person.
Hagland: One of the things I’ve heard about, with the growth of these large teleradiology firms, is the emergence of this commoditization of radiological practice, as you had referred to, Dr. Petersilge. Dr. Siegel, as you mentioned, presumably, you could interact with more radiologists, remotely.
Siegel: Yes, I am actually consulting with more referring physicians now than before.
Wendt: And we’ve been seeing that consolidation of teleradiology. And at the UW Hospital and Clinics system—we were serving patient care organizations all over the state, but it was essentially the University of Wisconsin system. But now, over half of our book of business has nothing to do with the UW system.
Petersilge: In whatever format it comes, the essence of what we need to preserve in radiology are the radiologist-physician relationship and the radiologist-patient relationship, and that latter relationship is still emergent, except in interventional radiology. I’ve seen teleradiology practices that can be extremely successful when the radiologist makes the effort to develop relationships with the physicians they’re reading for. And the practice is set up so that the referring physician really knows several key radiologists and knows their reading style; the opposite situation is the most detrimental. Now, when you’re part of an organization and are making operational efficiency improvements in your organization, that’s one setting for teleradiology.
But as the venture capitalists are moving into the teleradiology market, you’re facing challenges because of the ways in which the practices are structured; but also, those VC firms are entering the market to make money. And many smaller groups need the cover of larger groups; and personally, I’d rather see that happening in the guise of physician-owned practices or ownership by large academic medical centers—those can offer a lot of the benefits of being in an employed model, while not depleting their practice.
Hagland: Dr. Petersilge, you put your finger on something interesting, the ultimate fear of some radiologists, that radiological practice in the hands of some corporatists could become, well, corporatist; practice could feel very anonymous or miscellaneous. What other panelists would like to comment on the idea of the danger of anonymization, versus having collegial relationships that feel supportive all around?
Rosen: I think there’s a Goldilocks sort of size, where you’re not too big or too small. I encourage our radiologists to leave the hospital and meet with referring practices; for example, we’ll do a lunch meeting with a large urology practice; and even if you do it just once a year, that contact and face-time is enough. And if they’re going over a case over the phone or remotely, if they’ve interacted with that person at least once, it makes it a more personal relationship. Now, you can’t do that on a national level, but you can do it on a local level.
Wendt: I agree; we went from one organization to seven in the time I’ve been here. But to avoid anonymization, we do have a core director of radiology at each site. If there were a hundred faces rotating through a rural hospital in a year, the referring physicians would be disenchanted with that. Also, we use the organization of the group to keep the turnaround time brief, but try to keep a small core group, so we don’t get that total revolving-door-type feeling.
Towbin: Thinking about the consolidation of radiology practices, there are two main benefits. One is around economy of scale and allowing services to grow, leading to 24/7 coverage and rapid turnaround times; those things are possible because you have a large practice. The other major benefit ties into that, and that’s super-specialization. I can be that pediatric abdominal radiologist, focusing on liver tumors. That’s possible in a large group. And that super-sub-specialization is where we can start to really add value, in addition to 24/7 coverage and rapid turnaround. And that also can help to build research collaboration and partnerships. And with my specialization of interests, we can build a focus around a specific clinical area. What it gets to is, how do we as radiologists and radiology departments show value? Per commoditization, any radiologist can read studies, but this adds value to that.
Wendt: In our environment, we have an academic group that’s very subspecialized, with, for example, pediatric neuroradiologists,but also a significant body of generalists. Some people do not want to be looking at head and neck tumor cases all day; for others, that’s appealing. So creating that variety is satisfying to everybody. And if it’s a referring community physician, if they see a bizarre head-and-neck case, it’s great that they can connect to that head-and-neck neuroradiologist with just a right click, and we can improve service to everyone.
