As it does every year, this year’s RSNA Conference, held at the vast McCormick Place Convention Center in Chicago, has flown by like a meteor. And, as always, there has been a blizzard of sessions, meetings, discussions—and of course, marketing messages from vendors. And yet, somehow, this year’s RSNA really did feel different. One could feel the seismic shift taking place under the feet of everyone at the conference. Not only that—there was explicit acknowledgement this year of the transformative changes taking place in healthcare these days, to the extent that this year’s theme was “Beyond Imaging.”
What’s more, the “beyond imaging” theme worked its way into the opening keynote address of the conference, which took place on Sunday. According to the RSNA Daily Bulletin, RSNA president Richard L. Baron, M.D. told attendees in a packed opening session in the Arie Crown Theater at McCormick Place that “We should congratulate ourselves on the hard work and creativity that has pushed our specialty to this level. Yet we have to keep moving forward.” And, in a president’s address entitled “Beyond Imaging: Ensuring Radiology Impact in Clinical Care and Research,” Dr. Baron went on, according to the Daily Bulletin, to focus on four “ripple effects” that radiologists’ daily practices have on healthcare and the patient experience: delivering value under shifting reimbursement; working collaboratively as part of the healthcare team; continuing to innovate; and focusing on patients. “This shift does not require revolutionary changes to our practices and culture. I see it more as a return to basics,” he said.
Dr. Baron went further, saying that while radiologists have become adept at working with thousands of diagnostic images, the development of that skill set has come at a cost. “The best radiologists have learned to combine science and art,” he told his audience. “But most of us focus only on the image, practicing an extreme of science at the expense of art.” He further urged radiologists to refocus how they practice, going back to such practices as seeking face-to-face consults with referring and ordering physicians, something that has become rare in recent years.
Here’s the thing: it’s hard to imagine that speech being given even three years ago. Maybe even two years ago. But the reality is that, at a time of accelerating change in healthcare, it made sense of Dr. Baron, the president of RSNA, to give it at this year’s conference, because if any medical specialty is facing wrenching change right now, at least in the United States, it is radiology.
As one of the highest-paid specialties in U.S. medicine, radiology is inevitably going to be in the crosshairs of policy and payment leaders in the U.S. Congress and elsewhere. Consider this: according to a July report in AuntMinnie.com, a physician compensation survey conducted this summer by the American Medical Group Association (AMGA) found that the median annual salary for radiologists in 2016 was $490,399. Radiologist compensation had been fluctuating somewhat, though within relatively narrow confines, recently, with 2011 average compensation at $461,250, and that number falling to $453,216 in 2013. Nevertheless, the AMGA survey had found that radiologists made on average somewhere between $450,000 and $500,000 a year. What’s more, smaller medical groups actually saw higher compensation--$524,214, whereas medical groups with more than 300 FTEs saw median compensation of radiologists at $487,195. And this is at a time when, according to the “Medscape Physician Compensation Report 2016,” the average pediatrician made $204,000, the average endocrinologist made $206,000, the average family physician made $207,700, and the average internal medicine physician made $222,000. To be absolutely fair, Medscape’s survey found an average radiologist compensation level of $375,000, considerably lower than the $490,399 that AMGA’s survey found. But still.
In any case, it is hard to imagine that, long-term, radiologists’ incomes will stay where they are right now relative to those of other physicians or even those of other specialists, given the massive cost cliff that the U.S. healthcare system is about to go over, with the Medicare actuaries estimating that total U.S. healthcare expenditures are set to increase on the order of 70 percent over the next decade. The simple truth is that radiological services cost too much relative to our society’s ability to support them over the long term.
And, as the U.S. healthcare system inevitably shifts from being volume-based to being value-based, radiologists will find themselves under increasing pressure to prove their value to the care delivery chain, particularly as more and more patient care organizations take on financial risk and develop accountable care organizations (ACOs), participate in population health management, and use analytics to improve their efficiency, cost-effectiveness, and patient outcomes.