The Future of Radiology

I would like to recommend that anyone interested in the challenges facing radiology today and its possible future read "The Sorcerer's Apprentice: How Medical Imaging is Changing Health Care," by Bruce J. Hillman, M.D. and Jeff C. Goldsmith, PhD.*

The clever title refers to the magic that we radiologists perform every day as we ply our craft. The magical aspect is alluded to by a quote from one of my favorite science fiction authors Sir Arthur C. Clarke, who wrote, "Any sufficiently advanced technology is indistinguishable from magic."

The authors do an excellent job of chronicling the growth of imaging and its financial importance. The number of imaging procedures done every year are more than double the total number of men, women, and children in the entire country. In any other business, this kind of growth would be a good thing; in medicine it is a bad thing, at least from the payers' and the epidemiologists' point of view. It is estimated that 1 percent to 2 percent of all future cancers will be caused by ionizing radiation from imaging procedures, mainly CT scans.

The authors point out the convoluted payment system that we use for our healthcare that leads to many of the problems and complaints about the cost of healthcare. The biggest problem is the removal of the patient from being accountable for the cost since most healthcare is paid for by "OPM" (other people's money).

The governmental responses to rising imaging costs, including the Balanced Budget Amendment of 1997 with its Sustainable Growth Rate and the Deficit Reduction Act of 2005, are nicely summarized along with their impact on the imaging business. Although I didn't like it, my own experience that "…the real dollar payment per case for imaging interpretation has not grown since the mid-1990s" was confirmed. The book doesn't cover Obamacare but the trends in healthcare are pretty obvious even without it.

The pressures we all face from competition by non-radiologists are well-covered. The fact that self-referring non-radiologists order imaging at four times the rate that they refer to radiologists explains why imaging has grown dramatically, while the radiologist's share of imaging income has steadily declined. The book also confirms something that we know all too well: There are different standards of care in imaging for the radiologist and non-radiologist.

One area of discussion that resonated with me and helped me understand much of my frustration as an radiologist, caused by the habits of referring physicians, was a discussion: "The Real Culprit: The Impossible Quest for Medical Certainty. Physician's discomfort with clinical uncertainty." The "impossible quest for medical certainty" explains a lot, doesn't it?

The authors state, "General radiology doubtless will persist, either in its definitive form or in hybridized generalist/subspecialist practices." They do caution, however, that the future will likely "witness a further breakdown in traditional patterns of providing imaging care and eventually, new imaging practice models."

The authors' view of the future is depicted in a brief account of a patient imaging encounter in the year 2036 involving an imaging device known as "the Omniscient." The concept of very early diagnosis of a condition with immediate non-invasive intervention and treatment is exciting and greatly to be desired. The only problem with the scenario from this radiologist's point of view is, just like today's medical shows on television, the radiologist is nowhere in the picture.

*With permission from Bruce J. Hillman, M.D., "The Sorcerer's Apprentice: How Medical Imaging is Changing Health Care," by Bruce J. Hillman and Jeff Goldsmith, copyright 2011, Oxford University Press, Inc.