- Email: [email protected]
Reply of the authors
REPLY OF THE AUTHORS We are happy that our opinion piece has not gone unnoticed. We welcome Dr. Camponovo’s letter and agree with many points that he raises. It is true that there is a shortage of radiologists, that workloads are increasing while unit reimbursement decreases, and that radiologists work longer and longer hours. As cross-sectional imaging continues to be essential in diagnosis, choice of therapy, and follow-up, it is easy to predict further increases in workload. We understand therefore Dr. Camponovo’s frustration and reluctance to add another task to his busy day. It is true, however, that nothing is stable in medicine, and patterns of practice change constantly. It was not so long ago that jobs in radiology were scarce and that very few applicants chose our specialty. How things have changed! At this time, radiology is at its zenith, it is one of the highest income specialties, and imaging physicians are very much in demand, with practices recruiting prospects out of residency with perquisites as if they were future sports stars. It is easy to understand, because the reimbursement pressures are even worse for our colleagues in some other specialties, that many covet the imaging areas related to their areas of expertise. Cardiology, vascular surgery, and obstetrics are examples that need no lengthy elaboration. Coronary angiography, vascular interventional procedures, and obstetric sonography, to name just a few, have essentially been taken away from radiology. Neuroradiology and virtual colonoscopy may soon be on the endangered list. Yet the fact is that our specialty provides the highest quality of imaging and interventions and offers the highest expertise in interpretation. Academic radiology keeps advanc-
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ing the field with new techniques, new applications, and new modalities. It is therefore important to have patients understand that behind imaging, there is a physician-radiologist designing the procedure and interpreting it. With picture archiving and communications systems, it is easy today for patients to believe that there is no radiologist involved as they view their images in the offices of referring physicians. In addition, we are all familiar with examples in which speaking with or examining a patient leads to the avoidance of serious interpretive errors or the achievement of enhanced diagnostic accuracy, as well as more accurate and effective coding and billing. Because our referring physician colleagues are under exactly the same types of economic and workload stresses that we are experiencing, it is not unreasonable to anticipate that ample clinical information will become more rather than less unusual. Dr. Camponovo’s point that many imaging screening centers are going under has nothing to do with radiologists greeting patients. It has to do with competition, referral patterns, and the controversy as to whether there is a need for total-body screening without special indications. Nevertheless, reports about these practices make it clear that contact with radiologists is a patient satisfier. Likewise, although mammography is in financial trouble because of inappropriate reimbursement decisions nationally, patients increasingly demand personal contact with imaging physicians, and the control that some mammographers have over patient referrals makes them very powerful within the medical community. As for Dr. Camponovo’s assertion that academic radiologists have it easier and therefore can
afford the luxury of greeting patients, the fact is that they too generally do not have patient contact. Many academic radiologists, regrettably, are also so busy with increasing clinical duties and endlessly proliferating administrative tasks that it is difficult for them to take time for true academic pursuits, let alone heeding our call for more patient contact. We regret our attempt at being jocular by suggesting that an unkind observer might suggest that some radiologists went into our specialty to avoid patient contact. This attempt at being funny turned out to be offensive, and we apologize. We do not count ourselves among the unkind, although we all must recognize that they exist in ample number. However, the point is that if radiology is to survive as a vibrant, independent specialty, we must make our patients into our allies, make them aware that we conduct and interpret their studies and that we are the ones who advance the field, so that what we do for them today is so much better than what we were able to do just a few years ago. Radiology supported by patients will very likely change radically. It is conceivable that in the future, patients may even visit radiologists first, and perhaps this trend is already beginning. Alexander R. Margulis, MD, DSc(hc), Weill Medical College of Cornell University, Department of Radiology, 1300 York Ave., New York, NY 10021; e-mail: [email protected]. DOI 10.1016/j.jacr.2004.10.002 ● S1546-1440(04)00438-7
© 2004 American College of Radiology 0091-2182/04/$30.00 ● DOI 10.1016/j.jacr.2004.10.002
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ing the field with new techniques, new applications, and new modalities. It is therefore important to have patients understand that behind imaging, there is a physician-radiologist designing the procedure and interpreting it. With picture archiving and communications systems, it is easy today for patients to believe that there is no radiologist involved as they view their images in the offices of referring physicians. In addition, we are all familiar with examples in which speaking with or examining a patient leads to the avoidance of serious interpretive errors or the achievement of enhanced diagnostic accuracy, as well as more accurate and effective coding and billing. Because our referring physician colleagues are under exactly the same types of economic and workload stresses that we are experiencing, it is not unreasonable to anticipate that ample clinical information will become more rather than less unusual. Dr. Camponovo’s point that many imaging screening centers are going under has nothing to do with radiologists greeting patients. It has to do with competition, referral patterns, and the controversy as to whether there is a need for total-body screening without special indications. Nevertheless, reports about these practices make it clear that contact with radiologists is a patient satisfier. Likewise, although mammography is in financial trouble because of inappropriate reimbursement decisions nationally, patients increasingly demand personal contact with imaging physicians, and the control that some mammographers have over patient referrals makes them very powerful within the medical community. As for Dr. Camponovo’s assertion that academic radiologists have it easier and therefore can
afford the luxury of greeting patients, the fact is that they too generally do not have patient contact. Many academic radiologists, regrettably, are also so busy with increasing clinical duties and endlessly proliferating administrative tasks that it is difficult for them to take time for true academic pursuits, let alone heeding our call for more patient contact. We regret our attempt at being jocular by suggesting that an unkind observer might suggest that some radiologists went into our specialty to avoid patient contact. This attempt at being funny turned out to be offensive, and we apologize. We do not count ourselves among the unkind, although we all must recognize that they exist in ample number. However, the point is that if radiology is to survive as a vibrant, independent specialty, we must make our patients into our allies, make them aware that we conduct and interpret their studies and that we are the ones who advance the field, so that what we do for them today is so much better than what we were able to do just a few years ago. Radiology supported by patients will very likely change radically. It is conceivable that in the future, patients may even visit radiologists first, and perhaps this trend is already beginning. Alexander R. Margulis, MD, DSc(hc), Weill Medical College of Cornell University, Department of Radiology, 1300 York Ave., New York, NY 10021; e-mail: [email protected]. DOI 10.1016/j.jacr.2004.10.002 ● S1546-1440(04)00438-7
© 2004 American College of Radiology 0091-2182/04/$30.00 ● DOI 10.1016/j.jacr.2004.10.002