Practice Corner What

Radiologists

Richard

Really

S. Heilman,

Richard

Do1

1 Radiology consultation (ie, helping design imaging workup) 2 Performance or supervision of imaging studies 3 Interpretation of imaging data .

the

.

.

terms:

Editorials

RadloGraphics ‘From

the

1990; Department

mont, 111 Colchester II. 1989; accepted author. RSNA.

#{149} Radiology

departmental

1990

and radiologists

#{149} Radiology

and

management 10:13-14

o Radiology. Ave. October

4 Correlation of imaging and clinical data 5 Communication of results 6. Administration of the imaging department. Some of these activities are well known and date back to the earliest days of providing radiology services. Most of these traditional tasks deserve no amplification. One that does require elaboration if radiologists are to be given their due is departmental administration, which has become extraordinanily complex and time consuming. Burdensome as these responsibilities have become, radiologists’ performance of a bewildering array of administrative tasks is taken completely for granted by health care administrators and is often poorly remunerated. In addition to supervising personnel and providing state-of-the-art menus of increasingly sophisticated imaging studies, radiologists are asked to make decisions of remarkable complexity, importance, and expense about the purchase of equipment. These decisions are virtually always made in a setting of resistance, if not outright antagonism, perpetrated by various regulatory agencies. These agencies, in their attempts to contain costs, have created certificate-of-need schemes of such infernal complexity that their goal seems to be the rationing of the new technologies (and the old) by means of baffling and frustrating the petitioners. It is the replaceable “vendor” who must find his or her way through the bureaucratic maze to make the marvelous new tools of diagnosis available to the disdainful orthopedist. Quality definition, quality control, and quality assurance-all subtly different, and each requiring its own supervision and documentation-all represent time-consuming and frustrating new administrative responsibilities. Radiologists have atways provided in-service instruction for technologists and house officers, but instructional sessions .

administrators misunderstand and underestimate what radiologists add to medical care. The phases of radiologic activity include all of the following:

radiologists.

MD.

.

MD

I confess to mixed feelings about being responsible for a new feature in RadloGraphics. Although it seems a great chance to present discussions on practice issues, the risk of falling flat seems substantial. This is, after all, the end of the fall season when high-priced television producers are bringing out new shows, most of which will be so dreadful that serious individuals will wonder how anyone could have seen a glimmer of hope for them. My hope is that this column proves to be a “Bonanza.” Most doctors I know still bristle at being labeled “providers,” although a steady diet of this label has tended to dull the senses a bit. A radiologist friend was recently treated to what must be a new level of pejorative language when he was threatened by an orthopedist that he was in peril of being replaced by another “vendor.” The unfortunate language (and spirit) of this conversation reflects a widely held misconception about the scope of radiology services. The abovementioned orthopedist sees radiology only as a film-reading service, when, in fact, film interpretation is fast becoming one of the easier tasks performed by radiologists. Clear delineation of the scope of radiologists’ responsibilities seems critical as more and more physicians, health care bureaucrats, and hospital

Index

S. Heilman,

Medical

Center

Hospital

Burlington. VT 0S40 1. Received 16. Address reprint requests

of \‘erOctober to the

for hospital administrators, health care technocrats, and even legislators represents a new level of educational responsibility for radiologists. Leadership and teaching responsibilities at the increasing number of conferences and teaching sessions offered by other departments can require an enormous time commitment, and woe to the radiologists who balk at participating in a new conference, which nearly always is scheduled at the convenience of the requesting department. Of all the unsought administrative chores newly assigned to radiologists, none is likely to generate

13

as many problems as so-called appropriateness screening. Although the role of radiologists in this new task is still in its nascent state, it seems certam that the radiologist of the 1 990s will in some way become the “gatekeeper” or rationer of imaging services. This new assignment is a bastard offspring of the radiology consultation (1), which was conceived a decade ago as a way for radiologists to help the clinical services construct rational, cost-effective imaging workups in an era of increasingly complex imaging possibilities. It was not conceived as a tool of hospital administration or the health care bureaucracy, used to station the radiologist with pike and halberd at the door of the imaging department to turn away requests for services.

14

U

RadioGrapbics

U

Heilman

How well radiologists accept the challenge of an extended role in creating an imaging workup that promotes rational, cost-effective use of the imaging department will determine whether or not the radiologist of the 1 990s will have to don body armor before going to work in the morning. Let us hope that the transition from provision of radiology services on demand to whatever the 1 990s hold will be rational and the product of consensus services-and nameless

between radiologists and the clinical not at the behest of a battalion of and faceless cost containers.

REFERENCE 1.

Shuman

WP, Heilman

aconsultant.JAMA

RS. 1979;

The

radiologist

as

242:1519-1520.

Volume

10

Number

1

What radiologists really do.

Practice Corner What Radiologists Richard Really S. Heilman, Richard Do1 1 Radiology consultation (ie, helping design imaging workup) 2 Perform...
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