Wachter at RSNA: Radiologists, tear down this paradox

The technological “productivity paradox”—the lag between a given technology’s implementation and its delivery of anything of real value—is a problem in all industries but may be worst of all in healthcare.

Radiology being one of the most tech-driven specialties in healthcare, what can and should radiologists do to help lighten healthcare’s productivity-paradox load?

That question was taken up by Robert Wachter, MD, chair of medicine at UC-San Francisco, author of The Digital Doctor and a founder of the hospitalist specialty, during Monday morning’s opening session of the Radiological Society of North America (RSNA) in Chicago.

“The work [of medicine] needs to be reimagined,” Wachter said by way of answering his own question. “Let’s reimagine what the work looks like, rather than just digitizing the old paper processes. That’s when the productivity paradox gets better. That is the path that I think we’re on, although in the rest of healthcare we’re relatively early.”

Once again: What should radiology do?

“It’s important to recognize that the monopoly that you held over this world called ‘Radiology’ when the film lived in your province—and for me to enter it, I had to enter a space that you had to give me permission to enter—that monopoly has ended. You are all well aware of that.”

Wachter said the “monopoly” ended because of the risk of commoditization, which makes it possible for others to wrest control over power and money from radiology.

He also noted the risk of replacement by cheaper alternatives such as teleradiology, international radiology and specialist clinicians who increasingly read their own patients’ imaging exams.

“It is crucial that you demonstrate the value of what you do—not just that you get the reading correct but that your reading leads to better, safer, cheaper care for patients,” Wachter advised.

Radiologists also have to help reimagine the work, he emphasized.

For example, what would constitute optimized rounds through radiology by patient-facing physicians?

“It may not look like me schlepping down to the radiology department to see you,” Wachter said. “You may be across the street. You may be across town. But it probably is something where I have an opportunity to talk with you, where you can circle something and show me something [using a technology] that we may have invented but haven’t yet made ubiquitous.”

The risk of digital replacement is real, but Wachter doesn’t see it happening anytime soon.

“For the foreseeable future,” he said, “you’re going to see hybrid models in which technology augments rather than replaces people.”

The productivity paradox usually takes 10 years to resolve, Wachter said, adding that, in healthcare, the process will take longer to play out.

“I’m guessing 15 or 20 years because the stakes are higher and the regulations more onerous,” he said.

It’s also going to take longer because the disruption in healthcare is not going to be in big, complex hospitals, Wachter said. “It’s going to start in the wellness world and maybe move to prevention and chronic-disease [management]. The last thing it will hit is the sick-care system.”

“Don’t underestimate the power of the guilds to block changes,” Wachter said. “Physicians start with a lot of power, a lot of prestige, decent lobbies.

“There will be pushback from our professions. Some of it will slow things down. And in the end I think highest value care will … undoubtedly be tech-enabled. We have to re-think our work for that situation.”

Wachter was introduced by RSNA president Richard Baron, MD, who delivered the president’s address and moderated the session, held in the Arie Crown Theater at McCormick Place.

Exact attendance figures weren’t available at press time, but the venue seats more than 4,200 and there weren’t many empty seats in the house.