Thomas Pope, MD, a musculoskeletal MRI and breast-imaging specialist with Radisphere National Radiology Group (Beachwood, Ohio), began his career in subspecialty imaging before it was common for radiologists to be fellowship trained. “I never did a fellowship, but I received on-the-job training in musculoskeletal radiology from my mentor at the University of Virginia,” he recalls. Later, when the university opened a primary-care facility with a focus on providing breast imaging, Pope became its director of imaging. “It was part of the job, so I got into that specialty area as well,” he says.
That was in the early 1980s; 30 years later, Pope believes that the radiology industry has fallen behind on subspecialization, at least in the private-practice environment. “In academic radiology, there has been subspecialization over the past 15 to 20 years, so it isn’t as big of an issue,” he says, “but in private practice, the rule is you have to read everything. Because you have to take call, you have to be a generalist, to a certain degree. I don’t know how we’ve gotten away with not subspecializing before now.”
New Delivery Models
Pope points to the increasing degree of subspecialization in other clinical areas as the primary reason that radiologists are under increasing pressure to subspecialize. “Having a practice of generalists didn’t create a problem until about a decade ago, when non-radiologist members of the medical staff began to subspecialize more,” he says. “You have orthopedic surgeons coming out of training well qualified to do knee arthroscopy. When they go to a small town and encounter a general radiologist who’s been out of training for 15 years, and that person generates a report that doesn’t really help the orthopedist, it’s a problem.”
Pope joined Radisphere on a part-time basis six years ago, and he recently joined the practice as a full-time member of its radiologist staff. He explains that he was motivated to do so, in part, by the desire to bring subspecialty interpretations to rural areas. “Now that the technology has advanced so that we can move images around seamlessly, there’s a lot of opportunity for small hospitals, like the one in the town where I grew up,” he says. “A lot of them have always been able to get good (or even excellent) equipment, but it doesn’t matter what kind of equipment you have if you can’t get a talented or fellowship-trained radiologist to interpret those images.”
Delivering subspecialty radiology services to community and county hospitals also opens up clinical—and financial—opportunities for them, Pope observes. “Some of these hospitals can’t recruit subspecialists because they don’t have the imaging support,” he says. “An orthopedic surgeon, for instance, would want the equivalent of subspecialty interpretation of musculoskeletal images. Having an imaging service that is high level can help recruit other subspecialists to the staff of that hospital.”
Research and Academics
Pope also calls for the industry to represent itself better through research that substantiates radiology’s role in augmenting patient care. “Radiologists contribute positively to patient care, but studies that validate that are few and far between,” he says. “One of the long-range goals of our organization is to create a parallel organization that would be a research arm. We know research is important and do more than pay lip service to that.”
In addition to contributing to the kind of research that has traditionally been the purview of large academic medical centers, Pope believes, there is an opportunity for nationwide practices such as Radisphere to partner with academic centers. He feels that it is time for radiology to quantify the value it provides to health care.
The Quality Imperative
Pope notes that many of his radiologist colleagues have leveled the accusation that national practices (like Radisphere) risk reducing radiology services to the status of a commodity. He believes, however, that the group’s focus on quality assurance, quality control, and subspecialization stand to benefit the industry as a whole—especially at a time when health-care reform’s provisions have linked reimbursement to quality. “Organizations like this, who are committed to best practices, are the key to our survival,” he says. “We’re going to help keep the specialty alive with what we’re doing—and with how we’re doing it.”
He observes that the ability to bring subspecialty coverage to rural facilities is an appealing concept to legislators—and much of the pain felt by imaging, in the past few years, is owed to regulatory and legislative changes. “Think about how powerful it is to be able to demonstrate that we can elevate hospitals’ overall impact on their communities,” he says. “As radiologists, we’ve had it pretty good until now; as a resident, I could never understand how radiologists were able to go home at 5 pm. I don’t know how we’ve gotten away with not proving ourselves to be a more important component of the care of patients.”
Pope believes that proving radiologists’ necessity to the care cycle will require a strong commitment to quality assurance and transparency on the part of practices. “There’s no question we have worth in the health-care system. We have training and expertise that no other physicians have,” he says, “but we haven’t done a good job of marketing or selling that expertise. One of the reasons I was excited to join Radisphere was its internal quality measures. This model of quality assurance will be the leading model for imaging services in the future.”
Pope concludes that with a stronger commitment to quality, subspecialization, and research, radiologists can create a more satisfying paradigm in which to ply their trade. “For job satisfaction, for personal satisfaction, and for the survival of the field in general, we have to become just as good in subspecialties as those clinicians we consult with,” he says.
Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.