It was fascinating to read a rather existential blog written by Douglas G. Burnette, Jr., M.D., a practicing radiologist, in the online edition of Diagnostic Imaging.
In his August 22 blog, Dr. Burnette says this: “Radiologists along with the rest of society are becoming digitally detached and the more detached we are, the harder it is to assert our value. Our virtual omnipresence and digital efficiency may have sown the seeds of our destruction.”
Further, “Have you noticed how often websites offer live chats lately?” he asks. “I believe that while this is a very efficient way to communicate, it also removes the barriers and stigma of language and ethnicity from the exchange of information. The frustration of dealing with someone in a phone bank in India is gone. It will be just that easy to replace us someday.”
Then, Burnette asks, “What do we offer to counter this? Radiology services are being effectively commoditized. I admire the efforts to educate the public and put our best face forward to patients and referring physicians. Unfortunately, in today’s busy practice, it is rarely practical to speak directly with patients on a routine basis. I have found that my pace has gradually increased to cope with peak work flow times and I am unable to slow the pace even when there is a lull in the action.”
What Burnette worries about—quite legitimately—is this: “Radiology services are rapidly becoming commoditized.”
Thus, arguably the most technology-focused and technology-enabled medical specialty is facing a rather existential conundrum: the same advances in medical, imaging, and information technology that have made radiologists hyper-efficient have also potentially made their specialty the very easiest (and one of the few in actuality) to offshore.
And Burnette is far from the only radiologist pondering the place of himself and his colleagues in the emerging healthcare. How will radiologists show their value to their referring physician peers? Inevitably, with offsite, sometimes offshore, radiologic studies having become commonplace, how can those radiologists affiliated with hospitals, medical groups, and integrated health systems feel themselves integrated with their physician colleagues anymore?
In fact, Burnette concludes his blog with this thoroughly pessimistic statement: “Over the years it has been difficult to earn the respect of my medical colleagues even to the extent on occasion of having to assert that I am a real doctor not a technologist. I suspect that as medicine evolves or devolves (depending on your point of view) we may, indeed, become essentially technologists. One day we may even become an app on a digital device—the ultimate in digital detachment.”
That viewpoint seems a bit dystopic to me. But what is true is that radiologists need to begin to concretely demonstrate their value to the care delivery process in their organizations. Back in December of 2013, Rasu Shrestha, M.D., vice president of medical information technology and medical director for interoperability and imaging informatics at the vast University of Pittsburgh Medical Center (UPMC) health system, told me this, about radiologists in the new healthcare: “[L]et’s focus on two challenges. One challenge is that of what I call efficiency pressures; everyone is being challenged to do more with less. And the other type of pressure is quality of care pressures. And that means you’re being challenged to make sure to give the appropriate treatment to a patient at the point in time of care. So even if we focus on these two specific challenges, for that average Joe radiologist or chief of radiology or CMO—the average radiologist knows he’s being judged on his throughput and productivity. But what that’s evolving into is being measured on value.”
As Dr. Shrestha went on to say, “The problem is that in today’s siloed systems, it’s very difficult to measure real value. So you have metrics that say, I read 40 studies and yesterday, I read 50. Does that make me less valuable? If the outcomes were better today, and I was able to close the loop better with the ordering physician, or able to communicate test results more efficiently, that’s value. And without data liquidity, if the transformation of healthcare is in the balance, we need to have the right metrics in place. So what’s my value score at a particular point in time? Where are my peers, and what’s my target? I need a dashboard and I need it to be ingrained into the fabric of my workflow.”
And that’s where CIOs, CMIOs, CTOs, directors of imaging informatics, and other healthcare IT leaders need to step in, both to support radiologists in their work, and to partner collaboratively across all medical specialties, to help shift patient care organizations towards new, value-driven missions and visions. Will such efforts towards shifting the fundamental mentality of healthcare organizations and the healthcare system be difficult? Of course they will.
But radiologists won’t be alone in this. Instead, everyone will be in this together, as the healthcare system begins to move forward in this conceptual shift—one with a very strong practical component—away from a purely volume-based incentive system to one based on a combination of volume, efficiency, and true value. And inevitably, what radiologists do and how they work, will be impacted very strongly by that shift, going forward.