By Kate Madden Yee, AuntMinnie.com staff writer
March 8, 2017

Turf battles in medicine are nothing new, and radiology is not alone in the struggle to protect territory, as outside specialties such as cardiology and orthopedics eye procedures once reserved for radiologists. So how can radiology ward off turf fights in a proactive, rather than reactive, manner?

Dr. Christian Loewe.
Dr. Christian Loewe.

To cope with territory incursions, radiology must embrace its role as a clinical specialty, rather than solely a diagnostic one -- and radiologists need to commit to sticking together, said presenter Dr. Christian Loewe from the Medical University of Vienna. He spoke on the topic at ECR 2017 last week.

"We need a clear analysis of the specialty's strengths and weaknesses, and to keep in mind that we're radiologists first," he said. "Turf battles, both outside radiology and inside it, only weaken us."

8 ways to win turf battles

Radiology must find smart ways to deal with turf battles that do not involve fighting another specialty to the death -- a practice that can negatively affect patient care, according to Loewe. He offered eight proactive measures radiologists can take to ensure they are in their rightful place in the healthcare continuum:

  1. Be one step ahead. Radiologists must continue to expand the limits of the specialty, looking for new techniques and therapies. "Our specialty's borders are not naturally defined, and we can take advantage of that," Loewe said.
  2. Be available. After introducing or developing a new technique, exam, or treatment, make it available. "If we convince referring physicians of the value of a new exam, but don't provide it, we're opening the door for others to fill the gap," he said.
  3. Be accessible. "We have to shift from diagnostic radiology to clinical radiology, and take the lead as advocates for our patients," he said. "This will help us avoid being replaced by machines."
  4. Be well-trained. "Our training and education is the basis of our success," Loewe said.
  5. Be subspecialized. The imaging field has become too big for general radiology to cover everything, Loewe said. So subspecialization is key to radiology's success -- but keep it balanced. "We're radiologists at base -- the subspecialization is in addition," he said.
  6. Be together. Radiology needs to stay together rather than fragment into other specialties, according to Loewe. "We don't want turf battles between radiology subspecialties to dilute our strength," he said.
  7. Be transparent. Document what radiology contributes to the healthcare enterprise and what it means for patients, and then share it with referring colleagues and hospital administrators, Loewe said.
  8. Be focused. The patient should be at the center of radiologists' interest. "Patients are first," Loewe said.

What's the bottom line? Fights over territory incursions -- whether from inside or outside the specialty -- can negatively affect patient care.

"In the end, the most qualified person to perform a procedure or treatment should be the one responsible for doing it," he concluded. "So we should ensure that, in as many situations as possible, radiologists are the most qualified providers."

How radiology can find new roles in post-PACS, networked world
An unexpected consequence of PACS is that radiologists are increasingly sidelined by referring physicians, who can look at images to make a diagnosis...
'Get clinical' to tackle growing threat posed by turf battles
VIENNA - Besides nonradiologists taking a greater share of imaging, complacency among radiologists themselves poses a significant threat to the profession,...
Turf battles may be impeding growth of CCTA compared to MPI
The use of coronary CT angiography (CCTA) has fallen faster than that of radionuclide myocardial perfusion imaging (MPI), and CCTA may be underused due...

Copyright © 2017 AuntMinnie.com

Last Updated hh 3/8/2017 2:31:12 PM

5 comments so far ...
3/12/2017 8:41:36 AM
Jan the Third
"Be accessible. 'We have to shift from diagnostic radiology to clinical radiology, and take the lead as advocates for our patients," he said. "This will help us avoid being replaced by machines.'"
 
Agreed. What I'm wondering is: with the jam-packed daily workload of the radiologist, how will we find time to do this?
 
 

3/12/2017 10:15:59 AM
Dr.Sardonicus
 
 
How do you find time to do this - it is really very simple. You just leave time in the day, hire a fraction of a new person, and make a bit less. It will cost, but no one will lose their house due to default on mortgage, and longterm, you may retain the more lucrative turf (after all, this is what the others are going for -the lucrative turf).
 
OR......
you can read like a bat out of hell, short reports, don't call referrings, don't talk to patients, don't go to conferences, don't go to administrative meetings, thereby insuring you are totally anonymous to those who control your future, and become a commodity to be replaced by the first fast talking entrepreneur who walks in your administrator's office and promises to do it cheaper.
 
Your choice
 
 
-----------------------------------
 
This is not mysterious in anyway.
 
This was obvious 15 years ago, and radiologists proved unequal to the task and lost a lot of turf.
 
will it change?
 
Your bet?
 
Live like there is no tomorrow is, I guess, the motto of radiologists. 
 

3/12/2017 6:02:02 PM
halorad
Another thing to add to his list would be to support you colleagues when possible.  
I think it's tempting to make yourself 'the only one' who can provide the level of service a referrer is looking for.  
While that may be the case, I think it's important to try and self promote without making it seem like your partners or colleagues aren't capable.  
 
I have always felt turf battles are somewhat overblown.  
It boils down to whether the service being provided in don't to a certain standard that isn't achievable by someone else to the point where they could efficiently earn revenue from it.  
Vascular is generally lucrative enough to where the person who controls the patient will perform it if they are trained to do so.  Magically, rads still gets declots as well as several other vascular procedures.  I wonder why that is.
 
Cards wanted in on CTA coronaries because they thought there was an opportunity to cut a fat hog.  It's probably a more valuable study for pt care than to the degree it's used but since they couldn't figure out a way to make money off of it at a rate proportionate to what they make from other things that they already have in their paradigm.  See nuclear cards.
 
IR is still more open in general (outside of the vascular work) but it certainly required a much more clinical approach ie having clinic and participating in patient management before and after the procedure.  
At the end of the day, it's important to provide a level of service that gives your referrers enough confidence in what you have done that it's not worth their time to pursue other options.  
 
I think that for the most part, we have been able to achieve that with non-procedural studies.  
 
Another thing is our favor is data and advanced metrics.  As long as we maintain a certain level of quality and efficiency, we will continue to be the preferred option.  The ED US example is a good one.  Payors being able to track the downstream effect these little 'experiments' are useful.   

3/12/2017 6:11:35 PM
jd4540
Quote from Jan the Third


"Be accessible. 'We have to shift from diagnostic radiology to clinical radiology, and take the lead as advocates for our patients," he said. "This will help us avoid being replaced by machines.'"

Agreed. What I'm wondering is: with the jam-packed daily workload of the radiologist, how will we find time to do this?



What exactly does this mean? Walk to the ER to tell the doc and the patient that they have acute appendicitis and that we recommend surgical consultation?

3/12/2017 6:16:14 PM
Cabinfever
Going from volume to value. Lol. What total bs