Radiologist: Commoditize thyself

There is little in the health care world as amusing as watching radiologists work themselves into a froth over some real or perceived threat to their profession. Usually the villain is non-radiologists daring to encroach on radiologists’ turf. See, for example, Radiologists pull out the long knives as the radiology community attacks self-referral by non-radiologists. But the latest story (JACR article fires broadside against teleradiology firms) is about radiologists going after one another.

Gentlemen, we have met the enemy, and he is us! I didn’t pay $30 to access the article itself, but instead refer to an extensive summary on AuntMinnie.

David Levin, MD, and co-author Vijay Rao, MD, of Thomas Jefferson University in Philadelphia, make their case that teleradiology outsourcing contributes to the commoditization of radiology, lowered reimbursement, displacement from hospital and outpatient reading contracts, greater encroachment by other specialties, and lowered quality.

Here’s the problem:

Radiologists have been content to live off the fat of the land, working bankers’ hours and outsourcing inconvenient night and weekend duties to teleradiology firms rather than taking call themselves. Even when they’re around, radiologists in general don’t do a good job of serving the physicians who refer to them, staying in their dark rooms and not being proactive or even responsive. As radiology groups are finding, if they demonstrate they’re not crucial to the success of a hospital on nights and weekends, that also makes a pretty good argument for why they’re not necessary during weekdays either. Once hospitals understand the truth they can dispense with the local, intransigent radiology group entirely.

It may be news to radiologists that their actions are leading to commoditization, but it’s something I’ve been talking about for years. See Let the commoditization of medicine begin! for a taste of the argument.

Here’s what the authors propose as an antidote:

The authors recommend radiologists take a number of different steps. For starters, radiologists should cover their own practices 24/7, “just like in the old days before the easy-life mentality took over.”

“Don’t outsource night and weekend imaging to the teleradiology companies,” they wrote. “Without the business we give them voluntarily, they will cease to exist. This will not be easy, but it must be done if we hope to remain a respected and well-compensated specialty, rather than a commodity.”

The authors also recommend that radiologists not work for teleradiology firms, even on a part-time basis.

Those proposed responses are logical but I don’t see radiologists moving down that path en masse any time soon.

From a policy standpoint we should be pleased that this commoditization is taking place. If board certified radiologists credentialed by a high-quality hospital want to compete on price, I say bring it on!

February 1, 2011

3 thoughts on “Radiologist: Commoditize thyself”

  1. This is a naive diatribe against radiologists. While I agree that radiologists could be more proactive in maintaining their profession, the problem of coverage is alot more complicated than the author implies. First of all, “call” has become a misnomer in reference to radiology coverage. The volume of imaging studies at most practices and facilities off-hours has escalated to the point that “call” has been replaced by continuous coverage. Also, the degree to which the field has developed technologically has bred subspecialization to the point where mastery over the entirety of radiology is no longer possible. At the minimum, diagnostic call is separated from interventional call (interventional radiology is generally beyond the skill set of radiologists without dedicated fellowship training). Consider a radiology group of 8 radiologists in which there would be 2 such off-hour coverage groups. Realistically, only 2 or 3 interventionalists can constitute the interventional pool because of the need to maintain skills and not dilute the volume amongst too many, because this interventional call is actually call with cases arising infrequently. This leaves 5 or 6 radiologists to cover everything else. I would envision a 12-hour overnight shift, which would have to be approximately every 4 days (factoring in vacations). The overnight radiologist would have to be off the next day (because it’s coverage, not call and the nature of radiology requiring high-level concentration on thousands of images so as not to miss findings millimeters in size or smaller). Also, this system would require 2 people to do the weekend (1 daytime and 1 evening) and they would probably need a day off after the weekend. Basically, this system leaves no one available for the daytime work.

    Ultimately, I agree that we have to find a way, but it’s not just a “suck it up and do it” situation. Groups need to be big enough to have a cadre of overnight radiologists and specialists (such as interventionalists) to replace smaller groups to approach this problem with numbers. The off-hour demands on radiology have changed dramatically in the last 2 decades or so and alot of the problem lies with traditionally smaller groups unable to meet these demands.

Leave a Reply

Your email address will not be published. Required fields are marked *