This, Too, Will Be Forgotten

“May you live in interesting times.”- Old Chinese curse

I always marveled at the changes that my grandmother witnessed in her lifetime. She was born the year the Wright brothers made the first powered flight, rode in horse-drawn buggies, lived through two hot World Wars and one cold one, saw the dawn of the atomic age, and lived to see men walk on the moon.

Likewise, my career in radiology has spanned a time of great change-very interesting times indeed. I have seen red goggles worn prior to fluoroscopy, great barrels of barium sulfate to be mixed into oral and rectal preparations, rectilinear nuclear medicine cameras, B-mode sonography, handmade angiography catheters, IV cholangiography, water bag head CT requiring several minutes per slice, and MRI when it was called Zeugmatography and thought unlikely to ever be clinically useful. I have used mirror optic fluoroscopy. I have performed Pantopaque myelograms, dacrocystograms, a pneumoencephalogram, marathon lymphangiograms, and had fluoroscopy schedules with over 20 patients in a morning.

I experienced the halcyon days of radiology income, the “Golden Years.” In those days, the numbers and types of new procedures were years ahead of the CPT codes, and Medicare reimbursement was a good thing. In those days, not everyone wanted a piece of our turf and there wasn’t all that much to do (or could be done) on call. Weekends consisted of a few hours on Saturday and Sunday and call backs were relatively infrequent.

I have witnessed tremendous change in the landscape that is medicine and radiology. I have experienced the explosion in the numbers of images, volume of studies, speed of performing studies, and increased stress that is part of the job of being a radiologist today. I have experienced the transitions from analog to digital imaging, xero to digital mammography, transcription by humans to computerized speech recognition, the change from a relatively active, highly interactive day to an isolated and sedentary workday, the depersonalization of medicine and disappearance of useful medical information and relevance, the ratcheting downwards of reimbursements, and the annexation of our turf by other specialties.[[{"type":"media","view_mode":"media_crop","fid":"32531","attributes":{"alt":"Game over","class":"media-image media-image-right","id":"media_crop_8908078475103","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3434","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 200px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©wongstock/Shutterstock.com","typeof":"foaf:Image"}}]]

This change has been painful, as most change is, and it seems to be accelerating at breakneck speed. Health care is under scrutiny from all sides and the government is taking it over (or has taken it over depending on your point of view). Our specialty is at particular risk because we have never really been understood or appreciated by patients or other physicians. It is at risk because we don’t have an effective voice and because we don’t appear to work very hard for what we earn. In fact, we are rarely “seen” working.

Radiology will survive, but will probably not be recognizable by those of my generation. Radiologists will likely be employed by hospitals or large mega-groups. They will be shift workers processing large volumes of digital information with little or no access to the patient or the referring physician. Computer generated studies such as bone densitometry will bypass us entirely. Many studies such as ultrasound will be reported directly by the technologist. Vascular access and dialysis maintenance procedures will be performed by non-physician personnel, as will the few fluoroscopic procedures still being performed.

This evolution will be painful but there will eventually be a generation of radiologists who have none of my memories. They will have no idea why reporting an urgent study would be called a “wet reading” or that there was a time when we were the doctor’s doctor and our expertise spanned all specialties. This generation of radiologist will be making more money than they ever have before and will not know there was a time when radiologists earned far more. They will be content. The interesting times we are living in will have been forgotten.