NEW ORLEANS - According to a presentation at the American Healthcare Radiology Administrators conference, the battle over what medical specialty conducts which imaging procedure is raging across the U.S. The past few years have seen a slew of specialties -- cardiology, vascular surgery, general surgery, orthopedics, emergency medicine, ob/gyn, endocrinology, anesthesiology, and pulmonary medicine -- all make inroads into radiology.
"I talked to one cardiologist who noted that in 10 years none of these turf issues with radiology will matter. His view was that there won’t be a need for radiologists to read anything, except maybe plain-film chest x-rays, because all the specialties will be performing and reading their own exams," said Georgann Bruski, manager of invasive cardiology at Beth Israel Deaconess Medical Center in Boston.
Bruski, a radiologic technologist and former director of radiology, and Sara Cutler, a principal at Advance Healthcare Consulting in Schenectady, NY, discussed their experiences in the turf wars. The view from the trenches is grim.
"Who’s to blame? A lot of radiologists are refusing to work with other disciplines in these procedures because they feel the other specialties aren't qualified to perform them. (American College of Radiology) standards are much higher for imaging procedures than other disciplines. But that’s not going to stop these specialists from performing the procedure. And refusing to work with them, well, that’s like burying your head in the sand to avoid an oncoming truck," Bruski said.
Two principal services offered by most hospitals are cardiology and orthopedics, according to Bruski. The specialists who manage these major revenue generators are also some of the most active in buying their own equipment and conducting and interpreting their own exams. Advanced Healthcare's Cutler said that radiologists shouldn't turn to their institution’s management to stop this type of poaching, as executives are extremely reluctant to upset their cash cows.
"Radiologists are admitting there are too many exams, too few (radiologists) to interpret them, and that they’re reading too much. Other specialties are using this as a justification to grab the procedures for themselves," said Bruski.
Another problem is the perception of radiologists by other clinicians.
"I’ve heard other physicians refer to radiologists as ‘shadow doctors,’ ‘nine to fivers,’ ‘the bank’ (because they’re available only on their terms), and ‘the invisible doctor,’" Bruski said. "And this is too bad, because radiologists are among the smartest people in medicine."
It’s not just procedures that are slipping through radiologists' fingers. The other specialists are recognizing that they need trained personnel to conduct exams. Radiologic technologists are increasingly being courted away to other disciplines with offers of higher salaries and career advancement.
Contrary to the cardiologist’s belief that radiology will be irrelevant, Bruski sees no apocalyptic future for the specialty. But wholesale changes in business practices will be needed to avoid disaster, according to the presenters.
Cutler and Bruski offered several ideas for mitigating turf battles that administrators could take back to their institutions. Chief among them is the need to establish an interdisciplinary executive review team with CEO or senior management support and involvement.
This group would be charged with researching standards and determining what level was in the best interest of patient care. It would also jointly establish guidelines and protocols, develop a business plan, and craft a way for the various specialties to share revenue. Finally, the group would establish a quality assurance process to establish and monitor outcomes of the performed procedures.
Another idea was to establish interdisciplinary sub-teams comprised of representatives from the specialties -- with no group retaining permanent leadership. Pooling resources was also cited as a bridge-builder between specialties. Bruski said that the duplication of capital equipment, staff, and services was fiscally tearing some hospitals apart at the seams.
Perhaps the most important task is to begin to build a dialog between radiology and the other specialty services, said Bruski.
"I’d like to see all the walls between radiology and the other specialties come down," she said. "I don’t think it’s impossible. Even Berlin knocked down its wall."
By Jonathan S. Batchelor
AuntMinnie.com staff writer
August 2, 2002
Related Reading
Research and education will win the radiology turf wars, according to Dunnick, July 8, 2002
Medicare database shows radiologists losing turf, December 27, 2002
Turf Wars in Radiology, Part III: All is not lost in nuclear cardiology, August 31, 2001
Turf Wars in Radiology, Part I: Rads, attendings duke it out in the ER, August 10, 2001
Copyright © 2002 AuntMinnie.com
Radiology administrators from hospitals and imaging centers across the U.S. shared tales of other specialties wrestling away procedures from their departments. Nuclear medicine, angiography, ultrasound, MRI, CT, plain film, and interventional procedures are flying out the door, audience members complained.
