On Dec. 6 of last year, Diagnostic Imaging released a survey instrument asking radiology residents what their biggest concerns were. The results? The overwhelming majority of respondents to the online survey, 75 percent, said, a “dismal job market”; 11 percent said “medical school debt”; 7 percent said the “new radiology board examination”; 4 percent said “the demand for non-clinical skills; and an additional 4 percent cited other concerns.
Clearly, the world of radiology is changing these days. Indeed, offered James Borgstede, M.D., professor and vice chair of radiology at the University of Colorado and president of the American Board of Radiology, “Will I have a job when I finish my residency?” has recently become a legitimate concern for radiology residents. “They will have a job, but they are going to have to be a little more adaptable,” Dr. Borgstede wrote, in a short piece accompanying the survey questionnaire release.
And even though it is hard to imagine people graduating from radiology residencies not getting jobs, given the still-growing demand for diagnostic imaging procedures spawned by an aging population, it is quite true that the medical specialty of radiology is undergoing significant change. Most significantly in terms of their professional lives, radiologists are once again being asked to participate more collaboratively as members of multidisciplinary teams, even as the temptation is actually intensifying to simply climb into their radiologist bunkers and push the limits of volume, as they work to recoup compensation losses coming out of ongoing changes to physician reimbursement.
As Rasu Shrestha, M.D., vice president for medical information technology at the vast, 20-plus-hospital University of Pittsburgh Medical Center (UPMC) health system, told me in my reporting for the second article in the November/December cover story package, "Up to now, we’ve been very heavily focused [as practicing radiologists] on dealing with a series of images at a time. And we’ve improved our efficiencies. But where things are moving is away from an image-centric workflow and towards a patient-centric workflow, towards treating the patient as a whole,” Dr. Shrestha told me. “And that’s where it needs to go, in terms of value-based imaging," by which he means radiologists, radiology departments, and the IT and other professionals who facilitate such work, "significantly demonstrating the value that [they] bring to the healthcare enterprise,” far beyond speed and volume capacity of imaging and of diagnostic study report production.
Interestingly, technology plays a complex, somewhat contradictory, role in all this. On the one hand, the shift from film-based diagnostic imaging and manually managed workflow and work processes in radiology, to PACS- (picture archiving and communications systems) and RIS- (radiology information systems) facilitated radiology practice, has transformed radiology in many wonderful ways in the past two decades. On the other hand, when combined with reimbursement cuts and increasing volume- and time-driven demands from referring physicians and others in the healthcare system, technology has pushed radiologists farther and farther into what some have called the “hamster wheel” of diagnostic report-writing production. Is there any solution to this?
As UPMC’s Dr. Shrestha has suggested, the real answer lies in re-forming the once-more-collaborative interaction of radiologists with referring physicians, but now, in a more multidisciplinary, patient-centered working environment, in the new healthcare. I do believe that Dr. Shrestha’s is a vision that radiologists and other clinician, senior executive, and IT leaders should embrace, but it will also require that CIOs, CMIOs, imaging informatics leaders, and others, be involved, in order to help the clinicians optimize their interactions and ultimately, their work-lives. Radiologists can and should become re-involved more fully as consultants rather than simply report-writers; but such a shift will necessarily have to involve a shift towards population health management, accountable care, and patient-centered care delivery and operations. And in that, IT leaders will need to be at the table and facilitators of new or revised processes and workflows.
It will be fascinating to try to get a sense of the radiological Zeitgeist once again as the RSNA Conference unfolds the week after Thanksgiving, at McCormick Place in Chicago. The future of radiology and imaging informatics appears fascinating, challenging, and exciting, all at once, these days. One can only hope that radiologists feel themselves leaders, not just followers, in shaping the new healthcare—both for their own sakes, as well as for the sake of the healthcare system more generally and of patients and their families specifically.
