Golden years remain in sight, out of reach

At the beginning of each year, our group's accountant gives me a summary of my retirement plan's current value and performance for the year. Thanks to the recovery of the stock market, and figuring in my cost of living and current debt, I can finally plan on retiring from radiology. I'll be 96 years old. Obviously, the future of our specialty is important to me.

At the RSNA meeting this past year, I heard several discussions by better preserved and better informed minds than mine about the future of radiology. There was no consensus, except that things are going to keep changing.

Most of the studies I perform and interpret in a week's work did not exist when I started in radiology. My career has been a perpetual education, learning one exciting new technology after another. It has been a challenge, but I think I've kept pace about as well as anyone can in a field as broad as general radiology. I foresee problems, however.

At a holiday gathering of our extended family, someone asked my four-year-old if he thought his mom's new hairstyle was pretty. From that mysterious land of insight and truth that kids randomly access, he said, "Oh yeah, mom is young and foxy. Dad is old and tired."

That pretty much hits one problem on the head. I am tired of learning new modalities. Can't we just stick with what we have for a while?

Assuming I can keep up with the technological changes-or at least fool people into thinking I have-a bigger problem looms. No one is quite sure what the practice environment of radiology will be in the future. Will we all be working for megagroups? It seems most of the radiologists in Australia are reading our night-time studies during their day. Maybe we'll be reading their night call during our day.

Everyone wants a piece of our pie. I met one radiologist who reads multislice CT studies done on a scanner in the office of an eight-person internal medicine group. With cardiac CT and MRI on the horizon, you can be sure the cardiologists will want to own every scanner in the country. And given cardiologists' admission clout, the nation's historically bold hospital administrators will probably assert themselves and say, "Okay."

At RSNA 2004, Physicians for Patient-Centered Imaging (PPCI) were handing out a press release entitled "Patients belong in the imaging picture." That is a hard heading to argue with. I can't think of one study I've ever done that would have been better if it hadn't included a patient.

PPCI is an alliance of 18 altruistic medical societies, academies, and colleges that consider self-referral God's gift to humans. These are the same clinicians who cry foul if our reports even mention another study. Self-referral is like sex; it's great if you're included.

For me, this uncertainty about what I will be responsible for in the future is the toughest problem. If I know I will be doing MSCT and MRI of the heart, I can and will learn it. But I would have trouble investing time and energy in it if I'm just setting up a turnkey program for cardiologists to take over in a couple of years.

The same can be said for molecular imaging. This is a force that will revolutionize medicine, but who will be doing it? I've already invested a significant amount of time in PET. I don't know how many specialties are coveting this one, but you can be sure the line is already forming.

The future of imaging is bright. The future of radiology is a high-tech Thelma and Louise. At least I only have to put up with it for 44 more years.

Dr. Tipler is a private-practice radiologist in Staunton, VA. He can be reached by fax at 540/332-4491 or by e-mail at btipler@medicaltees.com.