Ten Years Later

What will the radiologist’s job description look like in a decade? ACR June16 P5 10

“Change is certain, success is not.” At least that’s what Richard Duszak Jr., MD, FACR, professor and vice chair for health policy and practice in the department of radiology and imaging sciences at Emory University in Atlanta, often tells his colleagues. The statement is a play on a quote from historian E.H. Carr: “Change is certain, progress is not.”

Duszak’s slight language shift is fitting. With an ever-changing landscape of technology, health policy, and patient care, progress is perhaps the only way to ensure radiology’s future success.

It’s often said that radiologists are, perhaps more than many medical specialties, accustomed to change. But that doesn’t mean the next decade won’t be challenging to the way radiologists practice. How will the imager’s job description change specifically over the next ten years? And how can they continue to thrive?

The Effects of AI

The past several decades have seen strides in all sorts of technology — everything from Wi-Fi to hybrid imaging — and the next decade is sure to keep pace. “Technology is changing with an amazing, exponential speed related to computers, processing, and synthesis of text, data, and imaging,” says Duszak. “And what radiologists do is in all of those spaces.”

What will this mean for the specialty? With more robust machine learning (think: IBM’s Watson), radiologists will continue to play a bigger role in non-interpretative activities, says Saurabh Jha, MBBS, assistant professor of radiology at the Hospital of the University of Pennsylvania in Philadelphia. The real question, Jha says, is “How much of radiology’s slack will computers pick up?”

It’s impossible to answer Jha’s question with certainty, but we do know computers will be more involved in image interpretation. According to Duszak, deep learning, a part of artificial intelligence (AI) used in devices like Apple’s Siri virtual personal assistant, will be greatly influential. He says this concept may allow computer algorithms to take a radiologic image and predict a correct diagnosis with greater than 95 percent accuracy. Perhaps those images are then reviewed by a radiologist, or maybe a certain amount go to radiologists for quality assurance, says Duszak, but either way, “the role of technology is going to dramatically change our level of interpretation.”

The Business of Diagnostic Information

Likewise, in a world where cars drive themselves and the autopilot on planes sometimes outperforms human pilots, Duszak says the radiologist’s biggest fear may indeed be that AI will put them out of work. He notes that throughout history big companies have gone under because their vision of their business was too narrow. He draws on the example of a coal company that became obsolete rather than redefine its business to focus on energy more broadly.

The solution? Radiologists need to broaden their perception of themselves as image interpreters and instead see themselves as in the business of diagnostic information, says Duszak. With machine learning and auto-generated reports, it’s likely that our day-to-day responsibilities will evolve, he explains, “freeing expensive human capital to do more complicated interpretations, consult with referring physicians, or manage utilization and appropriateness.” The bottom line: “If I had to predict with my best crystal ball, radiology in the future will involve things not currently part of interpreting services at a workstation,” says Duszak.Sidebar

Costs and Utilization

But what will those non-workstation responsibilities include? The answer may lie in one of life’s greatest pressures: costs. Increasing health care expenditures in the United States and worldwide have demonstrated that we don’t have infinite resources to provide services. According to Duszak, radiologists will play an increasing role in helping referring physicians determine appropriate imaging tests and utilization to help manage resources most effectively.

On a day-to-day level, embedding tools like the ACR Appropriateness Criteria® and ACR Select® can help ensure appropriate imaging utilization. A first step in this direction is R-SCAN, an ACR program that brings together radiologists and referring clinicians to collaboratively improve imaging utilization. In addition to using informatics tools for utilization, it also means that radiologists will have to be more judicious in their ordering recommendations, as a way to reduce costs. On a broader level, Kristina E. Hoque, MS, MD, PhD, a fifth-year resident at the University of Southern California in Los Angeles, says the mounting pressure to keep costs down also mean it’s time for radiologists to take “an active role in the discussion on national health care.” In doing so, you can help shape the dialogue about our country’s health-care costs and utilization. To get involved, visit R-SCAN.

Patient-Centered Radiology

In addition to keeping down costs and ensuring appropriate utilization, it’s clear that the shift to Imaging 3.0™ is also the era of the patient. In thinking about radiologists’ daily roles in ten years, Duszak says that patient engagement and centricity will be critical. “We’ll see the radiologist increasingly engage with patients in decision-making prior to imaging, consultation services, and even reviewing images,” he explains. “At our center, we’re already piloting a program in which radiologists meet with patients in the clinic after their exams and review images together.” Jha agrees, claiming that patient interaction will increase measurably, but perhaps not drastically. He believes this is because the payment model, either capitation or fee-for-service, will not be employing or incentivizing radiologists to have direct patient communication, and there are already plenty of doctors whose job is to speak to patients.

This shift toward the patient, like most of radiology, will also be affected by technology. Those hospitals with patient portals and user-friendly reports — with less medical lingo and more layman’s explanation — may attract patients who are able to choose where they go for testing. Other ways to increase patient satisfaction, like quick turnaround report time, easy scheduling, inviting reception areas, and transparency in pricing, may become more common or even essential.

For radiologists, it’s important to realize the importance of these changes and communicate with their administrators, hospital committees, or employers about how to implement them. “We are going to have to understand more about what patients want from us, rather than what we think they want,” says Duszak.pullquote

Hospitals or Private Practice?

We know that how radiologists provide value is going to change, but where will radiologists be as their roles expand? Jha believes there will be many more salaried radiologists — at academic centers, hospitals, teleradiology groups, and radiology chains. “Many radiologists would happily be salaried so long as their hours are predictable,” says Jha.

Duszak notes that an increasing number of physicians across the country are leaving independent private practice and becoming hospital employees — particularly in cardiology. He believes that radiologists will follow that same trend, but that private practice isn’t going anywhere either.

From the resident perspective, Hoque isn’t so sure about how the environment will evolve. “There will always be a need for academic radiologists, hospital-based services, and private practice physicians,” she says. However, Hoque also believes imagers can play a big role in shaping what happens to them over the next decade: “Different models of private practice are constantly emerging as we learn to care for an aging population. The future at this point is unknown, but by maintaining active leadership positions and a willingness to evolve, we ensure that we as radiologists shape the future direction.”

The Importance of Progress

Preparing for these massive changes has become not just a suggestion, but a necessity. So what should ACR members keep in mind? “Radiologists must be strategically smart and nimble,” says Jha, who suggests looking ahead only three years, rather than ten or more, as one way to best adapt incrementally as needed.

For those seeking some external guidance, Hoque says she often turns to the ACR. “Through the Radiology Leadership Institute®, through the numerous ACR conferences, through online educational materials, the ACR continues to ensure that we enjoy the challenges of being radiologists and that we arrive in the new Imaging 3.0™ era ready for the trials before us,” she says.

Regardless of what the next decade has in store, Hoque has some reassuring words about what will undeniably remain the same: “We are doctors caring for patients. This simple beautiful art will always maintain itself. The logistical schedule of our day may shift. However, our ultimate responsibility for caring for human life will always remain at the heart of our interactions.”

By Alyssa Martino, freelance writer for the ACR Bulletin


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