A Time for Introspection

The question that I am most often asked is why I remain so confident and bullish about radiology’s future, given all of the bad news that continues to drain our collective will. Granted, medical imaging is under siege from the regulators, is in the crosshairs of the health reformers, and is not particularly embraced these days by hospital administration—and frankly, radiologists are not likely to be seen as those most in need of bailouts. It’s all rather gloomy and depressing—or is it? Let’s put today’s trials and tribulations into a bit of radiologic perspective. I recently learned about physician Takashi Nagai, one of the founding fathers of radiology who truly sacrificed himself for the greater good of humanity and the profession. Nagai was one of the people who, against all odds, helped create this fascinating profession of ours. His is a lesson worth thinking about when we bemoan the fact that the profession has disappointed us and has not proven to be inspiring or fulfilling. His story will awaken even the most apathetic among our colleagues. Nagai was an early radiologist practicing in Nagasaki, Japan, and was working at his hospital post the day the atomic bomb that ended World War II destroyed the city. He had already contracted leukemia from radiation exposure—our radiologic forefathers did not yet fully understand the power of radiation to harm—and although he survived the bombing, he lived only another few agonizing years. During those years, and against unbelievable odds, he continued as a radiologist, committed to science, humanity, and living with a positive outlook on life. He exemplified commitment, dedication, integrity, and service—familiar words that one can usually find included among the stated core values of contemporary radiology practices. Let’s take a closer look at what has been learned from those who made sacrifices in this way. Some of today’s radiologists are embracing an ethic of cynicism, due to emerging circumstances within health care that suggest they will be asked to work more (probably for less pay), and they might even be required to enjoy less time off work. Their attitude towards their chosen profession is apathetic, they are complacent, and some act as if their “entitlement” to a nine-to-five job with great pay and benefits is being diminished. Thinking about Nagai, however, I find it difficult to see the drudgery and burden in today’s typical radiology practice. This is especially troubling when the apathetic and complacent are full partners, who should be expected to exhibit some measure of leadership. Don’t get me wrong: Radiologists today have a right to be concerned about the future shape of the profession. There are significant forces trying to dial back the meteoric growth that medical imaging has experienced these past 15 years, and with this attenuation, very real unintended consequences will combine with those that are actually intended, creating confusion and instability. Such adjustments and their results are not pleasant for any profession; would that they could be avoided. Compare these adjustments with real trauma, however, and you’ll find that there really is no envisioned scenario that leaves one breathless with worry about continued existence. Concern is one thing, but cynicism is quite another. It’s interesting that within all of today’s bad news emerge the most recent numbers from the DHHS about growth in health care spending in the United States for 2008. Spending grew overall by 4.5%, and although it was lower than in previous years, it still clearly outpaced overall growth in the gross domestic product (GDP). We hit 16% of the GDP being spent on health care in 2008, for a total expenditure of around $2.3 trillion. What does this mean to you? If you are a dedicated and honorable radiologist, with respectable skills and the right attitude about serving your customers and partners, here is your new entitlement: You are entitled to compete for a fair share of this wealth. In competing by distinguishing yourself in some way that makes you the one selected for precious referrals, you need not worry about the things that the earliest radiologists dealt with in their practices. I also feel safe in predicting that you will never face the kinds of obstacles and odds with which Nagai had to deal. You can still earn an envied lifestyle, despite these current headwinds. Think about this: More money was spent for health care services in 2008 than was spent in 2007, and this in the worst economic year in this country since the Great Depression. We can debate long and hard about how these dollars are allocated, and that is what the health-reform agenda is all about. Nevertheless, if you work hard, practice high-quality medicine, provide superior service, and do so with the types of core values that we like to think set us apart, you will still not be entitled to earn a great living. You can do so, and you can certainly go a long way toward ensuring that this happens for you by working smarter and with a competitive point of view, as well as by keeping your attitude calibrated based on gratitude that you have not had to endure what Nagai did in order to call yourself a radiologist. The short answer to my often-asked question is this: I know that most radiologists are dedicated professionals who appreciate the opportunities that they have been given, and this is the primary reason that I remain supremely optimistic about this wonderful profession.Curtis Kauffman-Pickelle is a strategic business consultant to more than 30 imaging centers and radiology practices, and is CEO of imagingBiz, Tustin, California. He welcomes your comments at ckp@imagingbiz.com.