As healthcare delivery models continue to evolve, radiology must be proactive in addressing the imaging needs of the future. A large part of this effort will entail solidifying the role of the multispecialty radiologist (MSR), according to an article published in the August issue of the Journal of the American College of Radiology.

The article was authored by members of an American College of Radiology (ACR) task force, appointed by ACR president, John Patti, MD. The task force, co-chaired by Lawrence Liebscher, MD, of Cedar Valley Medical Specialists in Waterloo, Iowa, and Cynthia Sherry, MD, of Texas Health Presbyterian, Dallas, proposed that a model of MSRs is a viable option for building both academic and private radiology practices.

“Considering the combined aspects of the foregoing environmental survey and historical perspectives, the assessment of this task force is that radiology and the medical community at large would be best served by maintaining a strong and well-trained cadre of general MSRs who also develop additional focused expertise in a number of subspecialty areas,” wrote the task force.

As opposed to a general radiologist, who trains in a radiology residency but does not complete a fellowship or train in a subspecialty, MSRs have multiple subspecialty areas of focused mastery, explained the authors. During the fourth year of residency when residents are allowed to explore subspecialty interests, those wishing to practice as an MSR would choose three or four specialty areas to study.

The reason MSRs are becoming more important, according to the authors, is that healthcare organizational models are changing. Radiology practices are consolidating into larger groups capable of providing subspecialty expertise. Value-based payments are the talk of healthcare, with risk-sharing, bundled payments and accountable care slowly replacing fee-for-service models.

“The MSR can potentially serve a vital central role in each of these models,” wrote Liebscher et al. "If a large percentage of routine examinations can be managed by an MSR, the group members have more flexibility in work schedules and staffing. The MSR can help direct the more complex examinations to the appropriate subspecialists within the larger organization.” They added that off-hours coverage has become a problem in many practices, and it has become difficult to meet demands by relying solely on single specialty radiologists.

“Seeing this vision to fruition will require years of effort on the part of the ACR, as well as a variety of associated radiology organizations,” wrote the task force, which offered five recommendations for the college to take:

• Establish a steering committee to coordinate efforts supporting the MSR.
• Develop a centralized reference for all materials related to the MSR project.
• Develop data on current radiology practice, such as the future needs of employers and residents and the implications for both private and academic practice.
• Investigate and disseminate best practices for dividing workload and compensation between MSRs and single specialty radiologists.
• Investigate and recommend changes to residency and training programs.