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jprovenzale{at}ajroffice.org
The issues posed by the conference participants are important ones for radiologists. At a time when NIH grant funding is at an all-time high, the opportunities seem ripe for substantial increases in funding for radiologists. Yet radiologists are finding that they continue to be at a competitive disadvantage compared with researchers in other fields. The Consensus Conference report addresses the question "Why is it difficult for radiology departments to be competitive when increasing emphasis is being placed by federally funded agencies on imaging-related proposals?" and suggests some remedies. In light of the Consensus Conference findings, it is worth reflecting on a number of impediments to successful funding of radiologists.
First, radiology has traditionally been more of a service specialty than other fields of medicine. Radiologists as a group are generally accustomed to answering questions raised by colleagues in other medical fields. Because of a great increase in demand for clinical imaging, many radiology departments in academic medical centers are having substantial difficulty in simply meeting clinical service needs. Therefore, in many departments the desire to develop research, as would be expected, is being superseded by the more immediate demand to provide the best possible clinical service. The Consensus Conference report appropriately notes that, in many institutions, the perception of radiology as solely a service provider is a major barrier to research success. However, the most successful academic radiology departments at once not only provide good clinical service but also refuse to be defined solely by the clinical endeavor. In other words, such departments have remade their image and changed the manner in which they are perceived by other departments at their institution.
Second, radiology departments often lack a research culture, which, as the Consensus Conference report indicates, is an important component in developing a competitive research environment. For an example of the influence of a successful research culture, the reader is directed to a recent article in a major newspaper [2]. A "research culture" hastens the transition of radiologists from descriptive research to hypothesis-driven research needed for successful grant-writing. Such a culture requires groups of thinkers who are intellectually curious and who are accustomed to framing research questions in the form of important testable hypotheses. The reader may reflect on how many of those components are actually present at his or her institution by asking the following questions: Is there a community of clinical or basic science radiology investigators who regularly meet to discuss research issues? Do these researchers think in terms of testable hypotheses, or does the level of inquiry simply consist of review of case series looking for similarities between individual cases? Unfortunately, a review of any radiology journal shows that relatively few articles consist of studies that actually test a hypothesis. For radiology to be successful in the grant funding environment, more radiology investigators must think in terms of testable hypotheses; a research culture strongly promotes this form of thinking.
Third, historically a tendency has existed to divide academic radiology personnel into two types of individuals: clinicians and researchers. According to this standard dichotomy, clinicians hold a medical degree, are many in number, and generate revenue through clinical work (while occasionally writing descriptive retrospective reports); researchers hold a doctoral degree, are few in number, and primarily generate research funding. To use a basketball analogy, it is as if the radiology team has two mutually exclusive types of scorers: one type provides offense by scoring close to the basket and the other group depends on jump shots away from the basket. However (extending the analogy), truly successful basketball teams often have a few players who are at once both great inside scorers and superb outside shooters. The most competitive academic radiology departments may prove to be those that groom the most (and best) individuals who can score both ways, by being highly competent clinical radiologists as well as designers of important hypothesis-driven research studies. Nevertheless, a basketball team doesn't reach championship caliber without time to practice, proper training facilities, and excellent coaching. As the Consensus Conference report notes, radiology chairs with vision who provide protected time and appropriate space for competitive research, publicly recognize the importance of scientific investigation, harness institutional support, and encourage research training courses are needed to ensure success.
The Consensus Conference report provides some well-diagrammed plays and an excellent game plan for overcoming difficulties. Radiology departments must respond with coordinated efforts to design programs for training radiologists in scientific principles as well as providing incentives for pursuing research. However, success will ultimately depend on individual radiologists who are willing to take their game to the next level.
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