The Golden Years of Radiology

I feel very fortunate to have been able to practice radiology during what appears to have been the “Golden Years.” From the days of very basic radiography, fluoroscopy, and ultrasound to modern multislice, high-speed CT scanners, MRI, and interventional capabilities that have changed the landscape of medicine, medical imaging has been the fastest growing segment of healthcare for many years.

Although many times payers lagged behind our technological innovations, our ability to increase our efficiency, expand into new modalities such as interventional radiology, MRI, and PET as well as investment in outpatient imaging centers meant rising incomes with no end in sight. The imaging department was the center of the medical kingdom and we were royalty - not quite kings or princes but at least dukes or earls.

There was a time when I was a pediatric radiology fellow, when the radiology request simply said, “2-year-old male with abdominal mass. Please evaluate.” This was an actual medical consult in the truest sense of the word. We applied the appropriate imaging modalities to arrive at the diagnosis as expeditiously as possible.

Those were the days!

Now the requests come in ICD code. If we are fortunate, the technologist has taken the time to ask the patient what is going on and provided that information under the technologist’s notes. That is, of course, assuming that the patient is coherent enough to provide that information or has any idea why they are having the study that has been ordered.

The studies come anonymously on work stations usually without even the briefest human interaction. The work comes and comes and comes on the never-ending work list and I feel much more like Lucy at the chocolate factory (for those of you who are of an age to remember “I Love Lucy”) than royalty or even a professional.

There are still a few times when referring physicians come by our digital dungeon to go over studies or try and develop a plan of investigation and action on a difficult patient. Today we are more likely to get a call from a nurse practitioner or other physician extender who frequently lacks the knowledge to fully understand all that we have to share or to equally participate in the consultation process. More than once I have been asked a question by one of these physician extenders that should have been directed to their supervising physician, causing me to wonder just how closely they are being supervised.

At least, I did experience the golden years of radiology for which I am extremely grateful. Having experienced the good times does inevitably lead to a certain melancholy that those days are gone. The torch is being passed to a new generation that will know only government regulation and increased pressure to provide more care for less reimbursement. From near royalty to serfdom in one lifetime, that is a bitter pill to swallow.