New technologies put the squeeze on us rads

My goals and objectives while attending the annual RSNA meeting have evolved over the years. I used to cram my daily schedule with refresher courses and scientific paper sessions. In recent years,  I've found it much more efficient to get this practical information at the bezillion courses offered year-round at various resort destinations. In Chicago, I focus more on equipment, the keynote lectures, and the various controversies du jour.

Some of the turmoil is predictable. You know The New England Journal of Medicine is going to print some inflammatory article about our specialty the week of the RSNA meeting. This year's gauntlet article showed conclusive data that CT scanners are giving every man, woman, and child in the world cancer. Popular media frenzy ensues, and many “authorities” from both camps will be interviewed and quoted for days. How convenient that all the radiology authorities just happen to be in one town! I assume it is a PR move approved by all sides.

The opening session this year dealt with the changes to our field in this age of technology. Dr. Gil Jost gave an excellent talk, other than his prediction that the general radiologist will go the way of the GP. The future/plight/demise of the general radiologist always surfaces in Chicago. I take these comments with a grain of salt, as the RSNA is dominated by subspecialists, which is not a bad thing, just an inherent bias. Jost illustrated how, in a technology-driven era, the world can change completely in just one generation, and he did it using my specialty and my generation. He cocentrated on the actual imaging, but I've noticed some other changes.

When I entered radiology, it was an intellectually challenging, pretty well paid, 8 to 5 job. The hours evolved over two decades into 24/7, only to go back to 8 to 5 in the last five years, provided you are willing to send half your money and your first-born child to readers in Australia. The rest of our income is being coveted and nibbled at by every medical specialty in the U.S. That's lots of change in one generation.

The commercial exhibits continue to grow. Fewer companies are offering actual imaging equipment but far more offer  support systems, disposable gizmos, and services. Teleradiology nightvultures are an obvious example. Over 30 of them were exhibiting. In his keynote talk, Dr. James Borgstede suggested the growth of nighthawks is helping turn radiology into a commodity. He thinks we may be thinking too short term. Do we want a good night's sleep this year, or 20 years of restful nights with a secure job?

Losing my job to a teleradiologist is not my biggest worry, though I'm sure some hospitals  will try to replace their onsite radiologists with remote readers. I predict they will fail. The rise in unnecessary and inappropriate inpatient tests will eat up any potential profit. And hospitals will quickly tire of paying full price for readings on every nonpaying patient.  

Merge Technologies has introduced a new twist on teleradiology. The company now offers a prereading. Two “radiologists” in India will read each study. When they agree on findings, the films will be annotated and a prereading report sent to the facility that originated the exam in the U.S. A U.S. doctor can increase his or her efficiency by concentrating on the annotated findings and then approve or modify the prereading report.

No room for abuse or cutting corners here! One doctor, who doesn't even need to be a radiologist, with a rubber stamp saying “AGREE WITH PREREAD” could do the work of five or six trained specialists.

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.