The crisis facing radiology is no secret. However, crisis need not turn into catastrophe, according to an online opinion piece in the March issue of Journal of the American College of Radiology. The expert authors offered 10 strategies for radiology practices to consider to ensure a vibrant and profitable future. The first five are outlined below, and the second five will be profiled on March 19.

Each of the 10 steps is important, according to authors David C. Levin, MD, and Vijay M. Rao, MD, both from the Center for Research on Utilization of Imaging Services at Thomas Jefferson University in Philadelphia, and Jonathan Berlin, MD, MBA, from NorthShore University Health System in Chicago.

The first five steps are:

1. Refute the notion that radiology is a commodity by acting as true consulting physicians. Radiologists often abdicate responsibility for three key elements of clinical service: pre-exam of the imaging request for necessity and appropriateness, monitoring of exam quality and consultation with referring physicians. Focusing solely on image interpretation and failing to perform these duties crosses the line into commoditization, according to the authors.
2. Take back the night. Outsourcing night and weekend call coverage is problematic from multiple perspectives. Radiologists appear to care more about personal convenience than the patient. Teleradiology providers may operate at bargain-basement prices, which devalue imaging. And opening the door to teleradiology also provides an ‘in’ for encroachment by other specialties.
3. Create more job openings for young radiologists. When radiologists commit the time to consultation and bypass teleradiology, job opportunities for young physicians will follow, according to the authors. This brings two benefits. Younger rads can handle duties such as night call and supervision of advanced studies, and it leaves fewer physicians in the teleradiology hiring pool.
4. Consolidate into larger groups. Larger groups are better positioned to handle expanded duties and night and weekend coverage, and they may be able to leverage economies of scales in operational processes, such as billing and malpractice insurance. Finally, “a larger group may have more market power in dealing with payers and hospital administrations.”
5. Build bridges to your hospital administration and primary care physicians (PCP). Hospital administrators and primary care physicians will play essential roles in new payment models, while radiologists are expected to have less influence in these models. By participating in hospital committees, strategic planning and marketing, radiologists can seize an opportunity to educate these stakeholders about the value of imaging. “Radiologists might consider promulgating what could be termed 'the 90 percent rule': that a PCP working closely with a clinical laboratory and a radiologist can solve 90 percent of the diagnostic problems in that physician’s practice without referring the patient to a specialist,” the authors wrote.

Stay tuned for the final five tips on March 19.