The Big Question: Radiologists as Consultants—Could It (and Should It) Happen?

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 - David C. Levin, MD
David C. Levin, MD

Outside the world of radiology, there seems to be a growing perception that imaging is nothing more than a commodity. If you don’t think that’s happening, just read a recent article in the New England Journal of Medicine (Emanuel E et al, N Engl J Med 2012;367:949). In that piece, 23 authors, many of whom are well known in health policy circles, suggested that one way to contain healthcare costs would be to use competitive bidding for all commodities—and radiologic diagnostic services were specifically identified as one such commodity. It’s important for the radiology community to vigorously refute this notion.

One way to accomplish this is to take steps to become better consulting physicians. Our medical colleagues, hospital administrators and policymakers need to recognize us not just as docs in a black box spewing out reports, but as physicians who relate to our patients and referring doctors and participate actively in patient care.

For example, we need to take a more active role in assessing the appropriateness of imaging requests that come to our departments, instead of just automatically going ahead and doing the study. If there’s a request for an exam that isn’t the right one for the patient’s clinical condition, a radiologist should call the referring doctor and get it changed. Maybe no imaging should be done at all. We have to be better gatekeepers.

Wider publicizing of the ACR’s Appropriateness Criteria could help. So could more use of order entry with decision support (DS). But DS has met with some resistance in certain places where it’s been tried, and even when it works, it shouldn’t substitute for personal involvement by radiologists.

We also have to communicate better with our patients (some of whom don’t even know radiologists are doctors). There’s been discussion lately about giving results directly to patients. I believe that’s the wave of the future. Interventional radiologists and mammographers have already been doing it for years, and we need more of it. Naysayers will complain that doing this will take time away from reading cases and thereby hurt productivity and revenues.

They should heed the words of Paul Ellenbogen, MD, chairman of the board of chancellors of the ACR. In a recent article in the JACR, he pointed out that constantly striving to read more and more cases so as to become more productive is an unsustainable path. Instead, we have to devote more time to noninterpretive activities like consulting with patients and referring doctors, even if it results in a somewhat lower income.

One of the most urgent priorities for radiologists right now should be to elevate our status in the eyes of the rest of the medical world to that of true consulting physicians, and these are ways to do it.

About the author: David C. Levin, MD, is professor emeritus of radiology and founder of the Center for Research on Utilization of Imaging Services (CRUISE) at Thomas Jefferson University Hospital in Philadelphia.