The Declining Radiology Job Market: How Should Radiologists Respond?
2012; Elsevier BV; Volume: 10; Issue: 4 Linguagem: Inglês
10.1016/j.jacr.2012.08.012
ISSN1558-349X
Autores Tópico(s)Radiation Dose and Imaging
ResumoRecent research by our group has shown that Medicare utilization rates of CT, MRI, and cardiac nuclear imaging (the largest component of nuclear medicine) grew rapidly until about 2005 but plateaued thereafter until 2009. A noticeable downturn then occurred in 2010 [1Levin D.C. Rao V.M. Parker L. Physician orders contribute to high-tech imaging slowdown.Health Aff (Millwood). 2010; 20: 189-195Crossref Scopus (40) Google Scholar, 2Levin D.C. Rao V.M. Parker L. Frangos A.J. Sunshine J.H. Bending the curve: the recent marked slowdown in growth of noninvasive diagnostic imaging.AJR Am J Roentgenol. 2011; 196: W25-W29Crossref PubMed Scopus (99) Google Scholar, 3Levin D.C. Rao V.M. Parker L. Trends in utilization of outpatient advanced imaging after the Deficit Reduction Act.J Am Coll Radiol. 2012; 9: 27-32Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar, 4Levin DC, Rao VM, Parker L. The recent downturn in utilization of CT: the start of a new trend? J Am Coll Radiol. In press.Google Scholar, 5Levin DC, Parker L, Intenzo CM, Rao VM. Recent reimbursement changes and their effect on hospital and private office trends in utilization of radionuclide myocardial perfusion imaging. J Am Coll Radiol. In press.Google Scholar]. Payments have dropped as well [6Levin D.C. Rao V.M. Parker L. Frangos A.J. The sharp reduction in Medicare payments for noninvasive diagnostic imaging in recent years: will they satisfy the federal policymakers?.J Am Coll Radiol. 2012; 9: 643-647Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar]. These trends have important ramifications for the job market in radiology.Job Market TrendsIt seems like just the other day that there was a serious shortage of radiologists. Those who were just coming out of fellowships could command high salaries, accelerated pathways to partnership, a lot of vacation time, and freedom from night call responsibilities. All that has changed abruptly. Instead, there is now a shortage of jobs in radiology. The large physician recruiting firm Merritt Hawkins recently reported that although radiologists had been the most sought after of all specialists in 2003, by 2012, they had dropped to 18th on the list [7Demand for radiologists nose-dives. Health Imaging Online.http://www.healthimaging.com/index.php?option=com_articles&view=article&id=34646:demand-for-radiologists-nose-divesGoogle Scholar]. Several factors have contributed to this turnaround. First, the aforementioned slowdowns in imaging utilization and reimbursements have reduced the demand for new additions to radiology groups. Second, radiologists (like everyone else) want to maintain their income levels, so they seem to have started working longer hours and taking less vacation. Third, the advent of PACS and other digital enhancements have enabled them to work more efficiently [8Forman H.P. Larson D.B. Kaye A.D. et al.Masters of radiology panel discussion: the future of the radiology job market.AJR Am J Roentgenol. 2012; 199: 127-132Crossref PubMed Scopus (7) Google Scholar]. Fourth, because of the recession and its effect on the value of retirement savings, older radiologists are choosing to defer retirement.Then, early in 2012, two new initiatives were announced in an effort to reduce unnecessary and inappropriate testing. These will likely further reduce the use of imaging. One was promulgated by the American College of Physicians, which published a list of 37 tests it believed were overused [9Qaseem A. Alguire P. Dallas P. et al.Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care.Ann Intern Med. 2012; 156: 147-149Crossref PubMed Scopus (197) Google Scholar, 10Laine C. High-value testing begins with a few simple questions.Ann Intern Med. 2012; 156: 162-163Crossref PubMed Scopus (31) Google Scholar]. Of the 37, 18 were imaging tests, 13 commonly performed by radiologists and 5 commonly performed by cardiologists. The second initiative came from the American Board of Internal Medicine Foundation, working in conjunction with Consumer Reports [11Cassel C.K. Guest J.A. Choosing Wisely Helping physicians and patients make smart decisions about their care.JAMA. 2012; 307: 1801-1802Crossref PubMed Scopus (670) Google Scholar]. Dubbed the Choosing Wisely initiative, it included the collaboration of 9 other major medical specialty organizations, 1 of which was the ACR. Choosing Wisely identified 45 tests or treatments that were felt to be overused (there was some overlap with the previously identified 37). Of the 45, 24 were directly related to diagnostic imaging (the list of all 45 can be found at www.choosingwisely.org). We applaud the ACR's participation in this campaign, as did the New York Times, which stated in an editorial on April 8, 2012, that “the groups showed admirable statesmanship by proposing cuts that would affect their incomes, as when radiologists proposed limits on various tests they perform” [12Do you need that test? The New York Times.http://www.nytimes.com/2012/04/09/opinion/do-you-really-need-that-medical-test.htmlGoogle Scholar]. The ACR did the right thing for our patients and for our health care system, and the term admirable seems justified. But awareness among the medical community that some imaging tests are overused will likely lead to a further reduction in their use, and that will further reduce the need for radiologists. Whether the job market will bounce back with the increase in the insured population resulting from the Patient Protection and Affordable Care Act or the aging of the baby boomers remains to be seen, but the outlook at the moment is questionable.How Should Radiologists Respond?We believe that practicing radiologists have an obligation to our younger colleagues to help them through this difficult time in the job market. The way to do this should be fairly obvious: hire more young fellowship graduates, even though it might mean a small drop in income for the existing members of the group. Instead of outsourcing night and weekend call to a teleradiology company (thereby helping transform our specialty into just a commodity), create a night and weekend or emergency radiology section, and fill the positions with those new young radiologists. As Hillman [13Hillman B.J. The seed corn.J Am Coll Radiol. 2011; 8: 377Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar] noted, if jobs in practice groups are not available to newly trained young radiologists, they will end up going to work for the teleradiology companies, where they will accept lower payments and ultimately help bring down payments for all radiology services.Besides covering nights and weekends, there are other things new hires can do as well, things radiologists should have been doing all along. Following are some examples.First, evaluate imaging requests as they come in to determine their appropriateness. If they are unnecessary or inappropriate, contact the ordering physician to try to get the order dropped or changed to a more appropriate test.Second, directly supervise the performance of advanced imaging tests. Thrall [14Thrall J.H. Radiation exposure in CT scanning and risk: where are we?.Radiology. 2012; 264: 325-328Crossref PubMed Scopus (44) Google Scholar] noted that at the Massachusetts General Hospital, there are more than 380 CT protocols from which to choose, depending on a variety of factors. Likewise, Khorasani [15Khorasani R. How IT tools can help improve current protocolling performance gaps.J Am Coll Radiol. 2011; 8: 675-676Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar] noted that at the Brigham and Women's Hospital, a similar situation exists with respect to MRI protocols. A trained radiologist should be the one choosing which of these many protocols to use and then supervising them, but at too many imaging facilities, those decisions are left to the technologists, while the radiologists are elsewhere reading cases. Interestingly, at some large Canadian hospitals, radiologists review all imaging requests for appropriateness, substitute more appropriate tests as needed, and protocol all advanced imaging procedures [16Kielar A.Z. El-Maraghi R.H. Schweitzer M.E. Improving equitable access to imaging under universal-access medicine: the Ontario Wait Time Information program and its impact on hospital policy and process.J Am Coll Radiol. 2010; 7: 573-581Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar].Third, talk more to patients. This is something radiologists have discussed increasingly in recent years [17Smith J.N. Gunderman R.B. Should we inform patients of radiology results?.Radiology. 2010; 255: 317-321Crossref PubMed Scopus (40) Google Scholar, 18Michael S. Why, and how, radiologists should deliver results to patients. Diagnostic Imaging.http://www.diagnosticimaging.com/print/article/113619/2031265?printable=trueGoogle Scholar]. There are pros and cons, and the logistics could be challenging, but doing more of this would certainly help identify radiologists as “real doctors.”Finally, designate one or more radiologists each day as consultants, who are available to help referring physicians with any questions or problems they may have with imaging studies on their patients. We are aware of at least one large community hospital in our area at which this has been instituted, and it has proven quite popular with clinicians (Joseph Stock, MD, and Richard Taxin, MD, personal communication).Will Some Object?All the above ideas will create new work in radiology groups, although some of it will be unreimbursed. No doubt some in our field will object to these suggestions (or just ignore them) on the grounds that it is not feasible or desirable to hire more radiologists and thus have to reduce the incomes of existing group members. But think of the consequences of simply maintaining the status quo. For one thing, if there are no jobs, no one will want to go into radiology, and we will no longer be able to feel secure as a specialty because we are getting “the best and the brightest.” A few years ago, radiology was one of the most sought after career fields in medicine, and virtually every residency slot in the country was filled. But in 2011, 24 of the 187 radiology residency programs failed to completely fill in the match, and there were 33 unfilled slots nationwide. In 2012, 42 programs didn't fill, and there were 86 unfilled slots nationwide. At this rate, we will soon have a crisis.Another consequence of maintaining the status quo will be the further commoditization of radiology. Borgstede [19Borgstede J.P. Radiology: commodity or specialty.Radiology. 2008; 247: 613-616Crossref PubMed Scopus (25) Google Scholar] wrote eloquently on this issue several years ago. He pointed out that if radiology is to be considered a specialty, it is necessary to integrate 4 major practice components: preexamination evaluation for necessity and appropriateness, monitoring of examination quality, interpretation, and postexamination consultation with the referring physician. Currently only 1 of these components, interpretation, is carried out regularly in most radiology departments. That takes us down the road to commoditization. In solving this problem, he wrote, we must first and foremost demonstrate patient primacy and patient benefit and comport ourselves like valuable consultants. The likelihood is that our colleagues in other medical specialties don't currently view us that way. But if we create new jobs for young radiologists and the aforementioned new responsibilities for them, that perception can be reversed. And in the process, we will have helped decommoditize the field.The ChoiceIt isn't likely that radiologists currently in practice are losing a lot of sleep over the state of the job market, but perhaps we need to start thinking more about it. There is a choice facing us. On one hand, we could focus primarily on preserving income and let the status quo prevail. In that case, the job market will continue to deteriorate, no one will want to enter the field, young radiologists will be forced to go to work for the teleradiology companies (which may then come in and try to steal our business), and radiology will continue down the path toward commoditization and loss of respect within the house of medicine. Or, we could instead sacrifice some income, create new positions within our practices, take back the nights and weekends, and start acting like real consultants to our colleagues and patients. And we will have answered Borgstede's [19Borgstede J.P. Radiology: commodity or specialty.Radiology. 2008; 247: 613-616Crossref PubMed Scopus (25) Google Scholar] question as to whether radiology is a specialty or a commodity. Recent research by our group has shown that Medicare utilization rates of CT, MRI, and cardiac nuclear imaging (the largest component of nuclear medicine) grew rapidly until about 2005 but plateaued thereafter until 2009. A noticeable downturn then occurred in 2010 [1Levin D.C. Rao V.M. Parker L. Physician orders contribute to high-tech imaging slowdown.Health Aff (Millwood). 2010; 20: 189-195Crossref Scopus (40) Google Scholar, 2Levin D.C. Rao V.M. Parker L. Frangos A.J. Sunshine J.H. Bending the curve: the recent marked slowdown in growth of noninvasive diagnostic imaging.AJR Am J Roentgenol. 2011; 196: W25-W29Crossref PubMed Scopus (99) Google Scholar, 3Levin D.C. Rao V.M. Parker L. Trends in utilization of outpatient advanced imaging after the Deficit Reduction Act.J Am Coll Radiol. 2012; 9: 27-32Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar, 4Levin DC, Rao VM, Parker L. The recent downturn in utilization of CT: the start of a new trend? J Am Coll Radiol. In press.Google Scholar, 5Levin DC, Parker L, Intenzo CM, Rao VM. Recent reimbursement changes and their effect on hospital and private office trends in utilization of radionuclide myocardial perfusion imaging. J Am Coll Radiol. In press.Google Scholar]. Payments have dropped as well [6Levin D.C. Rao V.M. Parker L. Frangos A.J. The sharp reduction in Medicare payments for noninvasive diagnostic imaging in recent years: will they satisfy the federal policymakers?.J Am Coll Radiol. 2012; 9: 643-647Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar]. These trends have important ramifications for the job market in radiology. Job Market TrendsIt seems like just the other day that there was a serious shortage of radiologists. Those who were just coming out of fellowships could command high salaries, accelerated pathways to partnership, a lot of vacation time, and freedom from night call responsibilities. All that has changed abruptly. Instead, there is now a shortage of jobs in radiology. The large physician recruiting firm Merritt Hawkins recently reported that although radiologists had been the most sought after of all specialists in 2003, by 2012, they had dropped to 18th on the list [7Demand for radiologists nose-dives. Health Imaging Online.http://www.healthimaging.com/index.php?option=com_articles&view=article&id=34646:demand-for-radiologists-nose-divesGoogle Scholar]. Several factors have contributed to this turnaround. First, the aforementioned slowdowns in imaging utilization and reimbursements have reduced the demand for new additions to radiology groups. Second, radiologists (like everyone else) want to maintain their income levels, so they seem to have started working longer hours and taking less vacation. Third, the advent of PACS and other digital enhancements have enabled them to work more efficiently [8Forman H.P. Larson D.B. Kaye A.D. et al.Masters of radiology panel discussion: the future of the radiology job market.AJR Am J Roentgenol. 2012; 199: 127-132Crossref PubMed Scopus (7) Google Scholar]. Fourth, because of the recession and its effect on the value of retirement savings, older radiologists are choosing to defer retirement.Then, early in 2012, two new initiatives were announced in an effort to reduce unnecessary and inappropriate testing. These will likely further reduce the use of imaging. One was promulgated by the American College of Physicians, which published a list of 37 tests it believed were overused [9Qaseem A. Alguire P. Dallas P. et al.Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care.Ann Intern Med. 2012; 156: 147-149Crossref PubMed Scopus (197) Google Scholar, 10Laine C. High-value testing begins with a few simple questions.Ann Intern Med. 2012; 156: 162-163Crossref PubMed Scopus (31) Google Scholar]. Of the 37, 18 were imaging tests, 13 commonly performed by radiologists and 5 commonly performed by cardiologists. The second initiative came from the American Board of Internal Medicine Foundation, working in conjunction with Consumer Reports [11Cassel C.K. Guest J.A. Choosing Wisely Helping physicians and patients make smart decisions about their care.JAMA. 2012; 307: 1801-1802Crossref PubMed Scopus (670) Google Scholar]. Dubbed the Choosing Wisely initiative, it included the collaboration of 9 other major medical specialty organizations, 1 of which was the ACR. Choosing Wisely identified 45 tests or treatments that were felt to be overused (there was some overlap with the previously identified 37). Of the 45, 24 were directly related to diagnostic imaging (the list of all 45 can be found at www.choosingwisely.org). We applaud the ACR's participation in this campaign, as did the New York Times, which stated in an editorial on April 8, 2012, that “the groups showed admirable statesmanship by proposing cuts that would affect their incomes, as when radiologists proposed limits on various tests they perform” [12Do you need that test? The New York Times.http://www.nytimes.com/2012/04/09/opinion/do-you-really-need-that-medical-test.htmlGoogle Scholar]. The ACR did the right thing for our patients and for our health care system, and the term admirable seems justified. But awareness among the medical community that some imaging tests are overused will likely lead to a further reduction in their use, and that will further reduce the need for radiologists. Whether the job market will bounce back with the increase in the insured population resulting from the Patient Protection and Affordable Care Act or the aging of the baby boomers remains to be seen, but the outlook at the moment is questionable. It seems like just the other day that there was a serious shortage of radiologists. Those who were just coming out of fellowships could command high salaries, accelerated pathways to partnership, a lot of vacation time, and freedom from night call responsibilities. All that has changed abruptly. Instead, there is now a shortage of jobs in radiology. The large physician recruiting firm Merritt Hawkins recently reported that although radiologists had been the most sought after of all specialists in 2003, by 2012, they had dropped to 18th on the list [7Demand for radiologists nose-dives. Health Imaging Online.http://www.healthimaging.com/index.php?option=com_articles&view=article&id=34646:demand-for-radiologists-nose-divesGoogle Scholar]. Several factors have contributed to this turnaround. First, the aforementioned slowdowns in imaging utilization and reimbursements have reduced the demand for new additions to radiology groups. Second, radiologists (like everyone else) want to maintain their income levels, so they seem to have started working longer hours and taking less vacation. Third, the advent of PACS and other digital enhancements have enabled them to work more efficiently [8Forman H.P. Larson D.B. Kaye A.D. et al.Masters of radiology panel discussion: the future of the radiology job market.AJR Am J Roentgenol. 2012; 199: 127-132Crossref PubMed Scopus (7) Google Scholar]. Fourth, because of the recession and its effect on the value of retirement savings, older radiologists are choosing to defer retirement. Then, early in 2012, two new initiatives were announced in an effort to reduce unnecessary and inappropriate testing. These will likely further reduce the use of imaging. One was promulgated by the American College of Physicians, which published a list of 37 tests it believed were overused [9Qaseem A. Alguire P. Dallas P. et al.Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care.Ann Intern Med. 2012; 156: 147-149Crossref PubMed Scopus (197) Google Scholar, 10Laine C. High-value testing begins with a few simple questions.Ann Intern Med. 2012; 156: 162-163Crossref PubMed Scopus (31) Google Scholar]. Of the 37, 18 were imaging tests, 13 commonly performed by radiologists and 5 commonly performed by cardiologists. The second initiative came from the American Board of Internal Medicine Foundation, working in conjunction with Consumer Reports [11Cassel C.K. Guest J.A. Choosing Wisely Helping physicians and patients make smart decisions about their care.JAMA. 2012; 307: 1801-1802Crossref PubMed Scopus (670) Google Scholar]. Dubbed the Choosing Wisely initiative, it included the collaboration of 9 other major medical specialty organizations, 1 of which was the ACR. Choosing Wisely identified 45 tests or treatments that were felt to be overused (there was some overlap with the previously identified 37). Of the 45, 24 were directly related to diagnostic imaging (the list of all 45 can be found at www.choosingwisely.org). We applaud the ACR's participation in this campaign, as did the New York Times, which stated in an editorial on April 8, 2012, that “the groups showed admirable statesmanship by proposing cuts that would affect their incomes, as when radiologists proposed limits on various tests they perform” [12Do you need that test? The New York Times.http://www.nytimes.com/2012/04/09/opinion/do-you-really-need-that-medical-test.htmlGoogle Scholar]. The ACR did the right thing for our patients and for our health care system, and the term admirable seems justified. But awareness among the medical community that some imaging tests are overused will likely lead to a further reduction in their use, and that will further reduce the need for radiologists. Whether the job market will bounce back with the increase in the insured population resulting from the Patient Protection and Affordable Care Act or the aging of the baby boomers remains to be seen, but the outlook at the moment is questionable. How Should Radiologists Respond?We believe that practicing radiologists have an obligation to our younger colleagues to help them through this difficult time in the job market. The way to do this should be fairly obvious: hire more young fellowship graduates, even though it might mean a small drop in income for the existing members of the group. Instead of outsourcing night and weekend call to a teleradiology company (thereby helping transform our specialty into just a commodity), create a night and weekend or emergency radiology section, and fill the positions with those new young radiologists. As Hillman [13Hillman B.J. The seed corn.J Am Coll Radiol. 2011; 8: 377Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar] noted, if jobs in practice groups are not available to newly trained young radiologists, they will end up going to work for the teleradiology companies, where they will accept lower payments and ultimately help bring down payments for all radiology services.Besides covering nights and weekends, there are other things new hires can do as well, things radiologists should have been doing all along. Following are some examples.First, evaluate imaging requests as they come in to determine their appropriateness. If they are unnecessary or inappropriate, contact the ordering physician to try to get the order dropped or changed to a more appropriate test.Second, directly supervise the performance of advanced imaging tests. Thrall [14Thrall J.H. Radiation exposure in CT scanning and risk: where are we?.Radiology. 2012; 264: 325-328Crossref PubMed Scopus (44) Google Scholar] noted that at the Massachusetts General Hospital, there are more than 380 CT protocols from which to choose, depending on a variety of factors. Likewise, Khorasani [15Khorasani R. How IT tools can help improve current protocolling performance gaps.J Am Coll Radiol. 2011; 8: 675-676Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar] noted that at the Brigham and Women's Hospital, a similar situation exists with respect to MRI protocols. A trained radiologist should be the one choosing which of these many protocols to use and then supervising them, but at too many imaging facilities, those decisions are left to the technologists, while the radiologists are elsewhere reading cases. Interestingly, at some large Canadian hospitals, radiologists review all imaging requests for appropriateness, substitute more appropriate tests as needed, and protocol all advanced imaging procedures [16Kielar A.Z. El-Maraghi R.H. Schweitzer M.E. Improving equitable access to imaging under universal-access medicine: the Ontario Wait Time Information program and its impact on hospital policy and process.J Am Coll Radiol. 2010; 7: 573-581Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar].Third, talk more to patients. This is something radiologists have discussed increasingly in recent years [17Smith J.N. Gunderman R.B. Should we inform patients of radiology results?.Radiology. 2010; 255: 317-321Crossref PubMed Scopus (40) Google Scholar, 18Michael S. Why, and how, radiologists should deliver results to patients. Diagnostic Imaging.http://www.diagnosticimaging.com/print/article/113619/2031265?printable=trueGoogle Scholar]. There are pros and cons, and the logistics could be challenging, but doing more of this would certainly help identify radiologists as “real doctors.”Finally, designate one or more radiologists each day as consultants, who are available to help referring physicians with any questions or problems they may have with imaging studies on their patients. We are aware of at least one large community hospital in our area at which this has been instituted, and it has proven quite popular with clinicians (Joseph Stock, MD, and Richard Taxin, MD, personal communication). We believe that practicing radiologists have an obligation to our younger colleagues to help them through this difficult time in the job market. The way to do this should be fairly obvious: hire more young fellowship graduates, even though it might mean a small drop in income for the existing members of the group. Instead of outsourcing night and weekend call to a teleradiology company (thereby helping transform our specialty into just a commodity), create a night and weekend or emergency radiology section, and fill the positions with those new young radiologists. As Hillman [13Hillman B.J. The seed corn.J Am Coll Radiol. 2011; 8: 377Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar] noted, if jobs in practice groups are not available to newly trained young radiologists, they will end up going to work for the teleradiology companies, where they will accept lower payments and ultimately help bring down payments for all radiology services. Besides covering nights and weekends, there are other things new hires can do as well, things radiologists should have been doing all along. Following are some examples. First, evaluate imaging requests as they come in to determine their appropriateness. If they are unnecessary or inappropriate, contact the ordering physician to try to get the order dropped or changed to a more appropriate test. Second, directly supervise the performance of advanced imaging tests. Thrall [14Thrall J.H. Radiation exposure in CT scanning and risk: where are we?.Radiology. 2012; 264: 325-328Crossref PubMed Scopus (44) Google Scholar] noted that at the Massachusetts General Hospital, there are more than 380 CT protocols from which to choose, depending on a variety of factors. Likewise, Khorasani [15Khorasani R. How IT tools can help improve current protocolling performance gaps.J Am Coll Radiol. 2011; 8: 675-676Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar] noted that at the Brigham and Women's Hospital, a similar situation exists with respect to MRI protocols. A trained radiologist should be the one choosing which of these many protocols to use and then supervising them, but at too many imaging facilities, those decisions are left to the technologists, while the radiologists are elsewhere reading cases. Interestingly, at some large Canadian hospitals, radiologists review all imaging requests for appropriateness, substitute more appropriate tests as needed, and protocol all advanced imaging procedures [16Kielar A.Z. El-Maraghi R.H. Schweitzer M.E. Improving equitable access to imaging under universal-access medicine: the Ontario Wait Time Information program and its impact on hospital policy and process.J Am Coll Radiol. 2010; 7: 573-581Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar]. Third, talk more to patients. This is something radiologists have discussed increasingly in recent years [17Smith J.N. Gunderman R.B. Should we inform patients of radiology results?.Radiology. 2010; 255: 317-321Crossref PubMed Scopus (40) Google Scholar, 18Michael S. Why, and how, radiologists should deliver results to patients. Diagnostic Imaging.http://www.diagnosticimaging.com/print/article/113619/2031265?printable=trueGoogle Scholar]. There are pros and cons, and the logistics could be challenging, but doing more of this would certainly help identify radiologists as “real doctors.” Finally, designate one or more radiologists each day as consultants, who are available to help referring physicians with any questions or problems they may have with imaging studies on their patients. We are aware of at least one large community hospital in our area at which this has been instituted, and it has proven quite popular with clinicians (Joseph Stock, MD, and Richard Taxin, MD, personal communication). Will Some Object?All the above ideas will create new work in radiology groups, although some of it will be unreimbursed. No doubt some in our field will object to these suggestions (or just ignore them) on the grounds that it is not feasible or desirable to hire more radiologists and thus have to reduce the incomes of existing group members. But think of the consequences of simply maintaining the status quo. For one thing, if there are no jobs, no one will want to go into radiology, and we will no longer be able to feel secure as a specialty because we are getting “the best and the brightest.” A few years ago, radiology was one of the most sought after career fields in medicine, and virtually every residency slot in the country was filled. But in 2011, 24 of the 187 radiology residency programs failed to completely fill in the match, and there were 33 unfilled slots nationwide. In 2012, 42 programs didn't fill, and there were 86 unfilled slots nationwide. At this rate, we will soon have a crisis.Another consequence of maintaining the status quo will be the further commoditization of radiology. Borgstede [19Borgstede J.P. Radiology: commodity or specialty.Radiology. 2008; 247: 613-616Crossref PubMed Scopus (25) Google Scholar] wrote eloquently on this issue several years ago. He pointed out that if radiology is to be considered a specialty, it is necessary to integrate 4 major practice components: preexamination evaluation for necessity and appropriateness, monitoring of examination quality, interpretation, and postexamination consultation with the referring physician. Currently only 1 of these components, interpretation, is carried out regularly in most radiology departments. That takes us down the road to commoditization. In solving this problem, he wrote, we must first and foremost demonstrate patient primacy and patient benefit and comport ourselves like valuable consultants. The likelihood is that our colleagues in other medical specialties don't currently view us that way. But if we create new jobs for young radiologists and the aforementioned new responsibilities for them, that perception can be reversed. And in the process, we will have helped decommoditize the field. All the above ideas will create new work in radiology groups, although some of it will be unreimbursed. No doubt some in our field will object to these suggestions (or just ignore them) on the grounds that it is not feasible or desirable to hire more radiologists and thus have to reduce the incomes of existing group members. But think of the consequences of simply maintaining the status quo. For one thing, if there are no jobs, no one will want to go into radiology, and we will no longer be able to feel secure as a specialty because we are getting “the best and the brightest.” A few years ago, radiology was one of the most sought after career fields in medicine, and virtually every residency slot in the country was filled. But in 2011, 24 of the 187 radiology residency programs failed to completely fill in the match, and there were 33 unfilled slots nationwide. In 2012, 42 programs didn't fill, and there were 86 unfilled slots nationwide. At this rate, we will soon have a crisis. Another consequence of maintaining the status quo will be the further commoditization of radiology. Borgstede [19Borgstede J.P. Radiology: commodity or specialty.Radiology. 2008; 247: 613-616Crossref PubMed Scopus (25) Google Scholar] wrote eloquently on this issue several years ago. He pointed out that if radiology is to be considered a specialty, it is necessary to integrate 4 major practice components: preexamination evaluation for necessity and appropriateness, monitoring of examination quality, interpretation, and postexamination consultation with the referring physician. Currently only 1 of these components, interpretation, is carried out regularly in most radiology departments. That takes us down the road to commoditization. In solving this problem, he wrote, we must first and foremost demonstrate patient primacy and patient benefit and comport ourselves like valuable consultants. The likelihood is that our colleagues in other medical specialties don't currently view us that way. But if we create new jobs for young radiologists and the aforementioned new responsibilities for them, that perception can be reversed. And in the process, we will have helped decommoditize the field. The ChoiceIt isn't likely that radiologists currently in practice are losing a lot of sleep over the state of the job market, but perhaps we need to start thinking more about it. There is a choice facing us. On one hand, we could focus primarily on preserving income and let the status quo prevail. In that case, the job market will continue to deteriorate, no one will want to enter the field, young radiologists will be forced to go to work for the teleradiology companies (which may then come in and try to steal our business), and radiology will continue down the path toward commoditization and loss of respect within the house of medicine. Or, we could instead sacrifice some income, create new positions within our practices, take back the nights and weekends, and start acting like real consultants to our colleagues and patients. And we will have answered Borgstede's [19Borgstede J.P. Radiology: commodity or specialty.Radiology. 2008; 247: 613-616Crossref PubMed Scopus (25) Google Scholar] question as to whether radiology is a specialty or a commodity. It isn't likely that radiologists currently in practice are losing a lot of sleep over the state of the job market, but perhaps we need to start thinking more about it. There is a choice facing us. On one hand, we could focus primarily on preserving income and let the status quo prevail. In that case, the job market will continue to deteriorate, no one will want to enter the field, young radiologists will be forced to go to work for the teleradiology companies (which may then come in and try to steal our business), and radiology will continue down the path toward commoditization and loss of respect within the house of medicine. Or, we could instead sacrifice some income, create new positions within our practices, take back the nights and weekends, and start acting like real consultants to our colleagues and patients. And we will have answered Borgstede's [19Borgstede J.P. Radiology: commodity or specialty.Radiology. 2008; 247: 613-616Crossref PubMed Scopus (25) Google Scholar] question as to whether radiology is a specialty or a commodity. Re: “The Declining Radiology Job Market: How Should Radiologists Respond?”Journal of the American College of RadiologyVol. 10Issue 6PreviewThe remonstration by Levin and Rao [1] to practice groups to employ more junior radiologists, even at the cost of a lower salary, is timely and noble. However, to purposefully not pursue one's economic interest in favor of fostering the common good is not easy; hence the tragedy of the “commons” [2]. Had the radiologists who inaugurated the remote reading services of teleradiologists to escape overnight call heeded such advice, we might not have been in the position of being as easily “Walmarted” as we are today. Full-Text PDF
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