Radiology gets sent off to the washhouse

Two years ago, my 70-yearold father-in-law decided his 3500-square-foot house was too big and his household needed to downsize. They bought a lot on the edge of our farm and built their new house of 5700 square feet.

I resist correcting him on the meaning of “downsize” for several reasons. First, it is very convenient when your eight- and 10-year-old sons can drive themselves to the baby-sitter in a go-cart. Second, their six-car garage includes a complete shop with a 10-ton auto lift. Finally, there is the 11th commandment, “Thou shalt not criticize thine in-laws if thou wantest anything from thy spouse.”

The house has a kitchen fit for Martha Stewart and a shower the size of her jail cell. My boys love it. It has handheld sprayers and nozzles on the walls and ceiling. While I like a shower big enough for two, room for eight does not really appeal to me. Still, if it makes the boys want to spend Friday night at grandpa's, I love it.

Recently, our hospital hired a new CEO. She has brought fresh approaches, new ideas, and new challenges for our hospital and my department. This is a good thing. It would be a great thing if I weren't facing so many different challenges and changes already. It seems everywhere I turn there are forces aimed at my practice, like those nozzles in the showersaurus.

The past few years have seen an onslaught of articles and editorials from radiology pundits on the impending demise of the general radiologist. Most are published by the radiology alphabet groups (the ACR, ARRS, RSNA), which seem to be dominated by subspecialists.

That doesn't mean they are wrong, they just need to be taken with a grain of salt.

Teleradiology has made access to subspecialists easier but not mandatory. I believe I add a lot to the overall care in my hospital by my presence. I answer questions about “the best test” for a clinical problem, and I give patients a professional to deal with when they have questions.

But it doesn't take much imagination to picture my eight-person group replaced by three onsite generalists and a network of subspecialists. The snag may be that this network wants to be paid.

This detail is another nozzle aimed at my back. In our hospital, the computer codes patients by insurance category. The fastest growing group is “sp” for self-pay, which, translated into English, means nonpay. How many teleradiology networks accept nonpay? Do the network neuroradiologists really want to read the 2 a.m. C-spine series on the migrant farmworker for free? As the economy worsens and the uninsured population rises, we'll see if the publicly traded nighthawk companies and specialist networks volunteer their services.

Fortunately, we have a new president. The poor guy is walking into a storm of guano, and he is expected to fix it all. How will President Obama handle healthcare? He is a lawyer. His closest friends are lawyers. We know upfront which issue in healthcare will not be fixed.

What about the rest? I like the idea of universal health insurance, and I hope he can make it happen. But I wonder if this will help my income or hasten the demise of general radiology. Finally, there are those guns aimed at us by other specialties who want to do their own imaging.

This is the most fixable cause of rising healthcare costs in the U.S. Just stop self-referrals and watch imaging volumes stabilize. And it wouldn't hurt general radiology.

The future of radiology, especially general radiology, is getting harder to predict, but given all the forces in play, I suspect we may get hosed.