Who is the Radiologist of the Future?

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Advances in imaging modalities and technical infrastructure have occurred at a head-spinning pace over the last three decades. The bread and butter of the radiology business—CT, digital x-ray, PACS—were mere concepts for radiologists who started practicing in the 1970s. As baby boomers ponder retirement, millennials are just beginning to embark on their careers.

Health Imaging asked millenial radiologists, born in 1982 or later, about their futures, how they envision practicing radiology and how tomorrow’s radiologists will differ from today’s. A few findings include:

  • Many display a pervasive sense of optimism and a comfort with the corporatization of medicine.
  • Young physicians understand the pressing need to deliver value and service beyond image interpretation.
  • Many are eager to communicate and collaborate with referring physicians and patients.

Farewell to a bygone era

The easy days are behind us, observes James H. Thrall, MD, radiologist-in-chief at Massachusetts General Hospital (MGH) in Boston. Imaging has entered a new era characterized by reimbursement cuts, the pending demise of the fee-for-service payment model, the advent of corporate structure and increased competition among radiologists and between radiologists and clinicians.

Young radiologists face additional challenges. The average medical student graduates with $160,000 in debt, according to the American Association of Medical Colleges. In addition to facing a nearly crippling debt burden, many trainees recognize that the practice of radiology will continue to undergo massive changes. “One of the hardest realizations is that the way we are going to practice radiology is not the way we are trained or mentored,” says C. Matthew Hawkins, MD, pediatric radiology fellow at Cincinnati Children’s Hospital Medical Center (CCHMC).

Despite these challenges, radiology has retained its appeal among residents. Consider, for example, Lisa M. Mabry MD, a first-year radiology resident at University of Alabama at Birmingham. “Once I started clinical rotations, I thought radiology was a great field. You aren’t limited to one area of the body or one disease, and because many other physicians look to radiology for consults, you can get involved in a lot of great cases.” In fact, greater involvement with physicians and patients will be a defining characteristic for future radiologists.

Hawkins foresees an increasingly collegial atmosphere, characterized by multidisciplinary teams and problem-solving. The basic duties of radiology—image interpretation and reporting—will remain essential functions but will not be radiologists’ only roles in healthcare delivery.

For starters, radiologists of the future will need to help clinical colleagues order studies and develop appropriate patient management and follow-up plans.

This change is partially fueled by the rise of chronic diseases rather than acute illnesses. Take, for example, diabetes. Radiologists can add value to the management of a patient with diabetes by including the sequalae from the disease, such as hypertension in the brain or parenchymal changes in the kidney in their interpretation, which could help inform appropriate follow-up studies, says Hawkins.

In other cases, a physician may order one imaging study when another may be more appropriate for the indication. “We have to take responsibility for the images we are viewing. It is in the patient’s best interest to ensure the physician has ordered the appropriate study,” says Mabry.

“A physician might order a high-resolution chest CT for suspected malignancy or metastasis where a CT with contrast would be more appropriate. On the other hand, a high-resolution chest CT would be more appropriate for evaluating interstitial lung disease,” she says. “It is the radiologist’s job to communicate with the ordering physician and understand the test indication, so that together they can decide the best, most appropriate test for the patient.”

Clinical and patient care needs also intersect with economic realities. “With rising costs, radiologists will increasingly direct smart use of imaging. We will have more responsibility in containing costs appropriately,” predicts Mark D. Mamlouk, MD, of the radiology department at the University of California, Irvine. “We need to provide what is best for the patient in a safe, cost-effective manner. That may not mean more studies, which is one of the hardest concepts for physicians to grasp.”

Thrall of MGH explains that the hospital