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Commentary |
1 Departments of Radiology and Obstectrics/Gynecology, Dartmouth Medical School and Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03755.
Received January 11, 2007; accepted after revision January 11, 2007.
The opinions expressed in this commentary are those of Robert Harris; they
do not necessarily reflect the viewpoint or position of the editors,
reviewers, or publisher of the American Journal of Roentgenology.
Readers are encouraged to submit letters to the editor in response to this
commentary.
Keywords: radiology practice
As a radiologist, I am trained to see things—shapes, shadows, subtle attenuation differences, a focus of echogenicity. And as a radiologist, I discern them better than any other medical specialist. When I glimpse into the future, however, I do not like what I see for the U.S. medical "system." There are more than 46 million (and growing) people without health insurance; employers are reducing or eliminating health insurance for employees; and American corporations are losing market share with foreign-based companies, largely due to burgeoning health insurance costs, extensive medical errors and waste, and expensive administrative overhead costs.
The list seems to be endless. More and more physicians are calling for health care reform, and we, as radiologists, should add our collective voices to the public outcry. We need to become active in health policy discussions. It is only a matter of time, perhaps 2 years or 5 years, certainly by 10 years, as to when health care reform will take shape. Radiologists, as a specialty, need to be proactive and become an integral part in the planning of health care reform—reform that will accommodate a several-tiered system that will still allow choice in providers and types of coverage for all citizens, with increased coverage features for those able to afford it.
This policy brief will outline the basic problem, how radiologists contribute to it, and some possible solutions. To illustrate the basic problem, here are a few meaningful statistics from various governmental sources:
I work at an academic medical center where we perform a large number of second interpretations of outside studies, primarily to get a report into our electronic medical record system. I find (from personal experience) that 90-95% of these second interpretations add nothing significant to patient care. These second interpretations add to medical costs (the third-party payer is billed again for the second interpretation) with little to no added value to the patient or physician.
So, what are the solutions? There are several steps we can take to address the current unjust system. First, the organizations that represent radiology should establish a task force to look at methods of reducing radiologists' errors and "no-value-added radiology," so that we can devote our limited resources to areas in which we do make a difference and participate in the eventual national health care insurance solution before it becomes mandated to us. Just as the American College of Radiology was the vanguard for the relative value units (RVU) system some 10 years ago, we can be leaders in this effort and preserve our needed presence at the health care reform bargaining table.
Second, reforming the health care system must be looked on as a "war" on inefficiency and waste, and it is likely that all physicians will have to sacrifice a little economically to fund increased health care access. I suggest that all radiologists donate a small portion of their income (let's say, for example, 10% for private practitioners and 5% for academicians) to help establish a universal health access pool. This contribution could be cut in half for those who are 5 years or fewer past training.
Although this sacrifice will be painful to all of us, it will be seen as a tremendous goodwill gesture and would elevate organized radiology's status in the Congress as a generous and justice-minded constituency, not just a self-serving lobby. I hope and believe that, once this plan is initiated, other medical specialties would soon join us in making similar contributions. I am hopeful this essay will generate some response from readers—be they critical or supportive. At the very least, let us open discussion on this issue.
Recently, on a physicians' salary Website I read that a radiologist's salary in the North-east has a mean range of $350,000-460,000, whereas a family practitioner's income in the same region ranges from $135,000-177,000 [2]. This salary discrepancy seems unjust and unfair, and the U.S. reimbursement system seems obviously out of whack. I, as most of us, would be most displeased if the financial numbers were reversed.
I do think that we deserve fair compensation for our work. We also deserve, and have earned, the right to perform imaging studies in areas for which we are eminently trained above all other specialties. Clinicians should see patients in their offices or practices and, in most cases, leave the imaging to the imaging experts—radiologists. One way to win the turf war, which seems never ending, is to reduce the financial incentives for imaging. What we might lose in per-case reimbursement, we could counterbalance with the increased volumes and lack of interspecialty competition that aggravate our stresses.
We need to get on board and start to convince our recalcitrant radiology community members, and other specialties, that there is genuine need and demand for a national health care policy reform. The other major players in this arena—the drug companies, the biotech firms, and the health insurance companies—will certainly fight this attempt as they have done in the past. For this reason, physicians must stand up for what is right and equitable, and we can eventually win. Remember the Hippocratic Oath we all took as newly graduated physicians? To summarize, it was to serve all the population for all their health care needs and, first, to do no harm. Now, we as a profession must take the first step toward an equitable and just universal health care system.
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