The Times They Are a-Changin’

Recent developments could have a substantial impact on radiologists — particularly junior ones.

20180522-ACR18_dh-3432.jpgDaniel Ortiz, MD, ACR RFS Chair, Guest Columnist

The practice of radiology is drastically different than it was 30 years ago and will continue to evolve. A major trend has been practice consolidation, buyouts, and commercialization. The drivers of this trend include increased regulatory burden, including that associated with the MACRA legislation. Smaller private practices may struggle to build the infrastructure to meet these requirements and to compete as penalties start to ramp up in the coming years.

 Many graduating radiologists seek to join private practices with the goal of becoming equity partners. Opportunities to do so may be impacted by the trends toward corporatization described above. During a recent discussion with a senior radiologist, I was told that our generation of radiologists should just give up on this model because we are going to become “just like the cardiologists,” who have seen a similar migration to an “employed” model. Whether or not I agree with my colleague, I would articulate my generation’s aspiration to enjoy the wide variety of opportunities and autonomy afforded to our predecessors and to ask that practices be transparent when interviewing us about their plans for the future.
Another topic that weighs on the minds of the RFS community is student loan debt. Over the last decade or so, the cost of undergraduate and graduate programs has skyrocketed, as have the interest rates on student loans. Student loan debt undoubtedly contributes to burnout, another hot topic in radiology. Studies show burnout is increasing within our specialty, with radiology now the 7th highest specialty for burnout (previously 20th highest in 2017 and 10th highest in 2016). Other causes include rising volumes, decreasing reimbursements, and increasing difficulty to achieve work-life balance.
And then there’s AI, which will certainly impact our generation of radiologists in the years to come. Instead of being anxious and hesitant, we must learn to embrace it and use this incredible set of tools to make us more efficient at what we do — both from a workflow and a patient diagnosis perspective. The true test will be how to not only integrate, but maintain such technology, regardless of practice type — a focal point of the ACR Data Science Institute™. As the landscape changes to offer packages to improve practice efficiencies, there is the potential for a perception that fewer radiologists and groups will be needed. However, rather than limit opportunities for radiologists, we will have to shift
our roles to focus more on high-level interpretations, informatics, and patient/referrer relationships, as has been advocated for by the ACR Commission on Patientand Family-Centered Care. If we pair the responsible, ethical use of AI for our menial, time-consuming tasks with a focus on the ideals of the Imaging 3.0® initiative, our specialty will be able to flourish and sustain all those who rise through the ranks. As a community, we should support algorithm developers who work with radiologists to provide tools that support us in the care of our patients. We should be wary of developers who seek to work around us.
We look forward to seeing continued transformation of radiology leadership. ACR BOC Chair Geraldine B. McGinty, MD, MBA, FACR, the first female chair in the College’s history, is making a concerted effort to ensure that qualified women are equally represented in leadership roles, particularly at the national level, where we are seeing female leadership on committees, commissions, and the BOC. This year, the ACR RFS and
YPS Executive Committees have at least equal numbers of elected male and female officials. The RSNA RFC has also achieved gender parity due to the efforts of its chair Courtney M. Tomblinson, MD. In addition, the Pipeline Initiative for Enrichment of Radiology program, founded by the ACR Commission for Women and Diversity, is also working to increase minority medical student exposure and preparation for radiology postgraduate training. This diversity of thought and action will be crucial as we work together to ensure we thrive as a profession and effectively serve our patients.
Even with the changing landscape of radiology, it is important to never lose sight of the strong foundation of our specialty, to remain optimistic in times of uncertainty, and, above all, to ensure that our ultimate focus is our patients.
Dr. Ortiz would like to acknowledge the role of Amy K. Patel, MD, medical director of women’s imaging at Liberty Hospital, clinical assistant professor at the University of Missouri-Kansas City School of Medicine, and RFS liaison for the ACR YPS, in the development of this column.
By Daniel Ortiz, MD, ACR RFS Chair, Guest Columnist
1. Kaplan, DA. Stop Burnout in Radiology Before It Starts. Diagnostic Imaging. Feb. 27, 2018. Available at Accessed Oct.15, 2018.

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