The title, a quote by the 16th U.S. President Abraham Lincoln, underscores exactly my personal opinion on how to handle the issue of turf battles between radiology and cardiology for noninvasive cardiac imaging.
Dr. David C. Levin comments on the AuntMinnie.com article, "Cardiac imaging dazzles, but radiologists can't compete alone," that references my recently held honorary lecture during this year's European Congress of Radiology (ECR) in Vienna.
He is convinced that we radiologists can win the battle for coronary CT angiography using rhetoric very similar to that of former American College of Cardiology (ACC) President Dr. Michael Wolk, FACC, who is also convinced that they -- the cardiologists -- will win the fight for imaging services.
I totally agree with Dr. Levin's view that under certain local circumstances -- and even in certain regions or certain countries -- well-organized, well-trained ambitious radiologists may win the turf battle against many of their colleagues. However, in large parts of the world our profession is struggling with increasing workforce shortages. Due to this and for many additional reasons, winning the turf battle for radiologists will not be assured.
Dr. Levin correctly and very plausibly argues that financial reasons and referring policies will support radiologists in their fight against cardiologists. However, were these arguments less true a couple of years ago?
Dr. Levin himself gave the most convincing answer in his article entitled, "Why radiologists lost coronary angiography and what can be done to prevent future similar losses" (Investigative Radiology, 1994, Vol. 29, 482-484).
Dr. Levin explained that although most of the methods used for cardiac imaging were developed by radiologists, they were successively and ultimately completely taken over by cardiologists. The reasons were that cardiologists were controlling the patients, and that radiologists were passive, lacking in necessary clinical expertise, and less involved in research and development than their colleagues in cardiology.
Not only did the report become a self-fulfilling prophecy, but exactly the same thing could happen today. Only about 5% of the radiologists worldwide are involved in cardiac imaging, while most of the cardiologists already perform echocardiography, cardiac scintigraphy, or catheter angiography. Moreover, even modest estimates of the present economic impact of diagnostic catheter coronary angiography in Europe alone result in revenues of around 3.5 billion euros per year and the amount could reach $25 billion in the U.S. I do not think that any radiologist can seriously assume that we will be able to take over this substantial amount without any opposition on the part of cardiologists.
Since cardiologists still control the patients, I am personally convinced that on a broad scale, entering into formal cooperation arrangements will at least secure the participation of our profession in this highly exciting field of imaging. The wise Chinese General Sung Tzu stated: "Strategy without tactics is the slowest route to victory." I strongly encourage all radiologists to adopt the right tactics in order to establish strategic alliances with cardiologists and seek an ultimate victory in keeping an important share in this area of our profession.
By Dr. Gabriel P. Krestin, Ph.D.
AuntMinnie.com contributing writer
May 29, 2006
Dr. Gabriel Krestin, Ph.D., is professor and chair of radiology at Erasmus Medical University in Rotterdam, Netherlands, and a permanent visiting associate professor of radiology at Stanford University in California.
Click here to return to Dr. David Levin's article.
Related Reading
Radiologists can win the battle for coronary CTA, May 24, 2006
Cardiac imaging dazzles, but radiologists can't compete alone, April 10, 2006
Interventional radiology needs rebranding, revitalizing, March 7, 2006
Radiologists maintain dominance in breast biopsy procedures, January 10, 2006
Radiologists retain MRI turf, for now, December 1, 2005
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