Radiology: Leaders needed in changing healthcare model

Diagnostic radiology will have to assert its value to patients and referring physicians in order to continue to grow in a challenging environment where cost-consciousness and value are the focus, according to an article published in the February issue of Radiology.

Hedvig Hricak, MD, PhD, of Memorial Sloan-Kettering Cancer Center in New York City, and colleagues began by pointing out that healthcare costs now account for around 18 percent of gross domestic product in the U.S. These high costs are a threat to the economy as a whole, and pressures to enhance the efficiency and effectiveness of healthcare are growing.

“Under these circumstances, it is not surprising that radiologic services, which are highly priced, rely on expensive equipment and sometimes lack evidence of effectiveness, are prime targets for budgetary restrictions,” wrote the authors. “For a number of reasons, despite widespread recognition of the value of radiologic services among clinicians, radiology is in a potentially weak political position.”

Hricak et al listed a few specific problems faced by radiology. Because there is such high compensation from high-volume radiologic services, it’s difficult to entice radiologists to take time for research and development, which are valuable for continued progress.

“Fifty percent of funds from National Institutes of Health grants to radiology departments in the U.S. are concentrated within just six academic radiology departments, suggesting that too few radiologists engage in original research as principal investigators,” wrote the authors.

Radiologists often have little or no direct patient contact and limited contact with referring physicians. Because of this, their contributions to patient care can be easy to overlook, according to the authors.

Another issue is that top hospital leadership positions are more often held by specialists in internal medicine, psychiatry or pediatrics rather than radiology.

“In short, radiology has not consistently translated its financial success into greater influence,” wrote the authors. “Thus, it often lacks a strong voice, both at an institutional level and in political decision-making bodies.”

Hricak and colleagues provided a few suggestions to ensure the survival of radiology in the face of these challenges:

• Invest in research: Radiologists need to become leaders in comparative effectiveness research in order to advocate for the value of imaging.
• Integrate with other clinical disciplines: “One of the central causes of the current inefficiency of our healthcare system is its compartmentalization,” wrote the authors, who added that IT investments by hospitals and departments can lead to more creative and integrated approaches to care.
• Patient portals: By connecting directly with patients through portals, patients can gain a better understanding of their conditions while also gaining awareness of the contribution of the radiologist.
• Subspecializing: Offering more precise, clinically-relevant image interpretation also enhances radiologists’ contribution to patient care.

“Ultimately, the pressure to improve quality and efficiency will shift the focus of our healthcare system from high-cost acute care to low-cost preventive medicine and control of chronic diseases,” concluded the authors. “Without doubt, radiology has much to contribute to that transition. But the imaging community cannot wait and hope that others will see this; we must show them it is so. More than ever, we need to lead–and not follow.”