It’s no longer business as usual. That was the main message that radiologist and consultant Lawrence R. Muroff, MD, FACR, brought to the California Radiological Society’s 2012 Annual Meeting & Leadership Summit in San Francisco. On September 9, he presented “Future Trends That Will Impact What You Do and What You Earn,” highlighting eight major trends affecting radiology practices today—as well as four nightmares that they might face in the future.
“The future of radiology is bright, but the future for radiologists is uncertain,” Muroff says. “What we have now is not guaranteed. Some people will thrive in the future, while many will be caught unprepared. Turbulent times offer unprecedented opportunity, and you’re going to have to decide on which side of the equation you will be found.”
Muroff says that part of the reason that so many radiologists are unprepared is that the profession tends to predict the future based upon past performance—when in fact, the future will include radical change. Radiology practices are caught up in major transitions due to both external and internal factors. With health-care reform, radiologists have, Muroff says, “taken it on the chin,” but the specialty’s difficulties are not all due to the federal government. Radiologists are often their own worst enemies: “We are also responsible for our own problems,” he says.
While radiologists face clear challenges, what is the likelihood that they will change in time to survive? Muroff cites a troubling statistic: 95% of ACR® councilors surveyed this year say that they believe that radiologists will not change until the pain of maintaining the status quo far exceeds the potential pain of changing, he says. Last year, the number was 92%. That’s a dangerous position for radiologists to take, Muroff says. “The problem with radiology is that the pain can be instantaneous,” he notes, citing the loss of a hospital contract as an example.
Muroff’s trends for radiologists to be aware of are:
- declining reimbursement,
- an unrealistic focus on productivity,
- radiology’s image problem,
- the availability of nonphysician professionals,
- the cultural outlook of the millennial generation,
- turf battles and competition,
- hospital demands, and
- competition from academic departments.
Declining reimbursement: Under health-care reform, radiology is shouldering more than its share of reimbursement pressures, he says. From consolidation of codes to homogenization of rates, the income picture is shrinking.
An unrealistic focus on productivity: As reimbursements decline, radiology practices are trying to make up the difference by focusing on productivity. Muroff warns them that this is not an effective long-term strategy. First, it trivializes other key practice activities such as service; relationship building; and participation in the medical, social, and political activities of hospitals and communities. Second, it treats radiologists as interchangeable, fungible commodities, which ultimately contributes to the devaluation of a radiologist’s special expertise.
Radiology’s image problem: Muroff points out that while the names of many radiology procedures are widely recognized, radiologists themselves are all but invisible in popular culture. In one focus group, he says, some participants did not even know that radiologists were physicians. Likewise, in political circles, the image of radiologists—the most highly paid specialists—suffers greatly in comparison with Washington’s love affair with the image of the overworked, underpaid family physician.
The availability of nonphysician professionals: Muroff predicts that radiology assistants, physician assistants, and nurse practitioners will come to play even greater roles in radiology practices, due to both their extensive professional skills and their lower salaries. He estimates that in a typical radiology group of five radiologists, probably at least one could be replaced by a nonphysician professional. While this substitution makes sense, given declining reimbursements, it also tightens the job market for new radiologists.
The cultural outlook of the millennial generation: Muroff cites several concerns about the millennial generation, newly hired staff coming into radiology at a time when the specialty is facing declining revenues and increasing challenges. Millennials tend to want both more money and more free time. This makes them more difficult for radiology practices to recruit aggressively, but easier for national practices to recruit. He also notes that millennials are not always well mentored in terms of good practice citizenship, such as participation in hospital activities, committees, and practice ownership.
Turf battles and competition: Radiologists are not the only ones who can read images, and they are often more expensive than the other options. For other specialists who can undercut the radiologist’s price, “we are ripe pickings,” Muroff says.
Hospital demands: “I’m seeing an epidemic of radiologists losing hospital contracts,” Muroff says, “and this is happening across the country.” The reasons range from limited service options to poor social skills. “Hospitals know they don’t have to put up with bad behavior and personality quirks,” he says.
Competition, though, is probably the biggest factor. Hospitals are asking for more subspecialty expertise, more on-site radiologists, and 24/7 coverage. Hospital administrators often question whether their current radiology practices can provide this extended range of services.
Muroff also points out that some radiologists don’t have a good grasp of negotiation practices or hospital administrators’ positions. “They own the hospital, they own the department, they pay the technologists, and they buy the equipment,” he says. “It’s not that we should roll over and play dead; it’s just that we should understand the rules of negotiations.”
Competition from academic departments: Academic department are increasingly cash starved and are becoming competitors for clinical work and hospital contracts. Muroff observes that this trend is just beginning and will probably intensify. He says that progressive academic departments are likely to see business-development opportunities in today’s radiology landscape.
Four Nightmares
In addition to his eight trends, Muroff lists four nightmares, or additional pressures with the potential to become problems: Commoditization and outsourcing, corporatization, retail medicine, and alternative payment models. Underlying all these problems is the issue of putting a consistent value on radiology services without turning radiologists themselves into commodities. “If they believe a study can be read by anyone, at any time, at any place, we really become a commodity, and commodities can be traded solely on price,” Muroff says.
He notes that at the previous year’s Economics of Diagnostic Imaging meeting, for the second consecutive year, almost half of the radiologists surveyed reported declining incomes. He predicts that in the future, many radiologists will lose significant income, and that “things will be far more difficult than they have for the past 10 years. Nontraditional entities will compete vigorously for our traditional business, and in many cases, they are going to win,” he says.
To protect what they have, radiologists are going to have to change. “We have to take control of our specialty,” Muroff concludes, “because others would be happy to have what we now enjoy.”
Maril Hazlett, PhD, is a contributing writer for ImagingBiz.com.