Radiology goes down to crossroad, meets the devil of remote reads

The RSNA over the years has shown itself to be adept at sensing the winds of change. Nowhere was this more apparent than at this year's opening symposium, when leading thinkers in radiology economics and technology pointed a spotlight at the growing importance of remote reads and teleradiology and their threat to traditional forms of practice.

The questions posed were stark: Are U.S. radiologists destined to become part of a commodity market, in which image interpretations are sent via the Internet all over the country and the world and brokered to the lowest bidders? Or can we retrain and rethink the practice of radiology in ways that keep it vital and central to medical practice at a local level?

Although the society wrapped its opening session presentation in a positive spin- RSNA president Dr. R. Gilbert Jost and University of Chicago professor Dr. Paul Chang discussed how radiology can prepare for the future and protect itself-it was a presentation by former American College of Radiology Board of Chancellors president Dr. James P. Borgstede that was the most tangible and immediate. It was not a comforting view.

Using slides that included one of an eBay ad showing price bids for MR and CT scan intepretations, Borgstede showed how the separation of image interpretations into a discrete work element apart from the rest of radiology services had allowed them to be treated as a price-driven commodity.

Particularly chilling was a scenario Borgstede described in which a hospital lays off existing radiologists and contracts with a teleradiology company to pick up the interpretive work.

In fact, most teleradiology firms insist that they want to work with existing radiologists, not directly with the hospitals or imaging facilities. Still, just the threat of a teleradiology takeover reduces the bargaining power of the local radiology practice.

Borgstede's suggested solutions to these problems included more cooperation locally and regionally, better public understanding of what radiologists do, bans on arbitrage of professional fees, and refusal by radiologists to be employed by nonradiologists.

Jost discussed how radiology will need to change by embracing new training strategies and a broader focus. Future radiologists will need to be skilled in biosciences and the physicial sciences such as engineering, chemistry, and physics. They'll need to move from imaging at the gross anatomy level to imaging at the cellular level. They'll need to know enough about general medicine to mine electronic medical records to aid in diagnosis.

Chang, drawing on a wealth of experience as a radiology innovator, explained how radiologists can become "value innovators" who use their knowledge of what referring physicians and patients need and the tools provided by technology to improve their service in ways that make them vital to the medical process.

Unfortunately, all of these solutions are challenging and difficult to implement, even if they do make good sense as strategies for coping with a changing world. Certainly, the easier course for now is to let the marketplace prevail. As Borgstede noted at one point, "The short-term perspective is to have someone take night call so I can sleep. The long-term perspective is to have a secure practice so I can sleep at night for the next 20 years."

Shortly after these presentations, the RSNA commercial exhibits opened. Among the exhibitors were three dozen teleradiology companies, an increase of about a third from last year, and a new service offering by a RIS/PACS vendor that involves providing "consultant" prereads of images by radiologists trained and based in India.

The world of imaging is changing. Will U.S. radiologists manage the changes or be swept aside by them?

What are your thoughts on this topic? Please e-mail me at jhayes@cmp.com.