AJR: Can rads adapt to a changing job market?
The quarterly Masters of Radiology panel discussion tackled the topic of the future of the radiology job market. The challenge is intrinsically tied to the larger political and economic environment, which has created a slew of pressures. Two are particularly significant. The economic downturn has persuaded some radiologists to postpone retirement. Meanwhile, the Deficit Reduction Act, coupled with reimbursement cuts, has forced radiologists to hone in on efficiency and productivity.
Although increased efficiency and productivity are worthwhile outcomes, there may be a cost, or missed opportunity, in terms of value.
“The challenge we’re facing is our inability to fundamentally and eloquently verbalize the added value we bring to every single interaction and transaction,” wrote Alexander Norbash, MD, of the department of radiology at Boston University Medical Center.
Norman J. Beauchamp, Jr., MD, of the department of radiology at the University of Washington in Seattle, framed the opportunity in terms of changing the nature of the practice rather than increasing volume. He noted opportunities in several areas, including guiding clinicians to the appropriate study and helping to integrate imaging information.
In addition to boosting efficiency, radiologists need to increase the impact per study, according to Beauchamp. Marcia C. Javitt, MD, of the department of radiology at Uniformed Services University of the Health Sciences in Bethesda, Md., echoed the need for increased impact and called for a parallel shift to outcomes-based reporting.
In this model, the expanded focus would include factors such as report quality, consideration of prior studies and impact on patient management. “Quality should be used as a metric for productivity and compensation,” wrote Javitt.
Employment and practice models are likely to adjust to a value-added radiology model, offered David B. Larson, MD, of the department of radiology at Cincinnati Children’s Hospital Medical Center. Unreimbursed value-added activities, such as quality assurance, specialty overreads and 24/7 availability, will become a requirement of doing business, a shift that could favor employment models or larger, more organized radiology groups.
“[Although] volume-based reimbursement has served us well in the past, I believe that a reimbursement system that better reflects the value rather than just volume is in radiologists’ best financial long-term interest,” wrote Larson.
Such value-based activities, which are difficult for teleradiology groups to provide, may spark a differential reimbursement model, in which teleradiologists are compensated at a lower rate than local providers. Alan D. Kaye, MD, of Advanced Radiology Consultants in Westport, Conn., has tried to persuade the American College of Radiology to advocate for differential reimbursement, but the shift has not yet gained traction.
The panelists referred to additional external trends impacting the radiology job market. The demographic reality, for example, points to increasing incidences of cardiovascular disease, coronary artery disease, cancer and stroke, diseases in which radiology plays a key management role.
However, other factors differentiate the current tight job market from previous contractions. For example, it is becoming harder to gain reimbursement for new imaging procedures and the focus on “harms” related to imaging studies may impact utilization.
Norbash concluded with a call for change, urging his colleagues to rethink radiology. “We need to understand that we are at the tiller of this ship of radiology. We have to be more patient-care oriented. We have to understand that referring physicians have certain needs... Rather than being concerned about being subjected to arbitrary quality measures, we need to participate in the discussion and show leadership by creating the necessary scorecards and defining which quality metrics we should subject ourselves to.”