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The Good News: What We Can Be Thankful For

¹ Diagnostic Radiology, Yale University, 333 Cedar St., New Haven, CT 06510-3206.

Received October 16, 2007; accepted after revision October 16, 2007.

Address correspondence to H. P. Forman, Associate Editor, Health Policy (HealthPolicy{at}arrs.org).

Keywords: compensation • cost inflation • information technology • nighthawk services • residency candidates • uninsured solution

It is my general intent, with this monthly column, to prepare the reader for the challenges that lie ahead. Thus, I have focused on the financial challenges and invited guest editors to write about many of the legal and strategic issues that the practicing radiologist does and will face. Some may believe that I paint a pessimistic picture; however, I would not want the reader to think that the radiology profession is destined to disappear or even falter. I have a great deal of confidence in the passion and ambition of our current and future colleagues and also in the market forces that have resulted in our current (most would say enviable) position. With that in mind, and in the spirit of the holidays, I would like to focus this brief, not on the challenges, but on what I believe we owe thanks for.

Outstanding Residency Candidates

With rare exception, our specialty has been extremely competitive among medical students. We attract the crème de la crème. In most medical schools, advisors readily dissuade applicants from even applying if they have not achieved certain quantitative and qualitative benchmarks. When one considers that medical school, in this country, is already extremely competitive, this should bode well for our capability and capacity for

• continuously improving our ability to provide high-quality service to our patients and referring clinicians,
  
• continuously reorganizing our processes to take on more volume and to accommodate the strong growth in demand for our various services, and
  
• developing novel techniques and tools for imaging.
  

24–7 Coverage

While the advent of "nighthawk" services can represent a threat, it also can mean that many practices are offering higher-efficiency, higher-volume imaging services on a full night's rest, rather than losing a full or partial day of work due to overnight responsibilities. Practices that use such services for convenience only may find themselves in a poor strategic position, as they lose the confidence of referring clinicians. On the other hand, most practices appear to be using such services judiciously to improve quality imaging interpretation during off-hours, and should maintain their clinical importance to their health system.

Efficient Information Technology

While information technology has been available to facilitate imaging interpretation services for more than 20 years, it is only in the past few years that most practices truly have taken advantage of their full potential. Speech recognition software, improved archiving capacity and capability, and Web-based remote access have greatly improved our ability to provide rapid interpretation and reporting. With further advancements and refinements in these technologies, we should become omnipresent in the clinical experience.

Moderating Health Care Cost Inflation

Readers of this column know that I have used two separate data surveys to correlate with public concerns about health care costs. While the public attention may lag these findings, they are remarkably accurate in predicting changes in attitudes. In 2004, both the Employment Cost Index and the Kaiser Family Foundation/Health Research and Education Trust peaked in health care benefit cost inflation relative to wages and salaries. By the time of the 2004 presidential election, the topic of health care cost increases was becoming an issue with the public. By early this year, our current presidential candidates had latched onto this issue and, combined with the important issue of the uninsured, had made it a central plank of their domestic agenda. However, while the issue of the uninsured remains a major and concerning problem, the issue of health care cost inflation actually has moderated (Figs. 1 and 2). To the extent that radiology was receiving some (or at times much) of the blame for these increases, we now are less threatened.

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Increases in health insurance premiums compared with other indicators, 1988–2007. *Estimate is statistically different from estimate for the previous year shown (p < 0.05). No statistical tests are conducted for years prior to 1999. Note—Data on premium increases reflect the cost of health insurance premiums for a family of four. The average premium increase is weighted by covered workers.

View larger version (7K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —Employment Cost Index for civilian workers, changes in wages and salaries, and benefit costs.

I believe that the problem of the uninsured is going to continue to worsen. While there is a connection between health care cost inflation, insurance rates, and relative rates of insurance, there are some special reasons why the uninsured problem in our nation is not going to improve without substantial government involvement: the difficulty in combating adverse selection, the current disconnect between perceived health care insurance value and health care insurance cost, and the persistence (if not worsening) of income disparities. The uninsured problem is at the top of the 2008 political agenda; any solution would help most of our practices, even if it just led to reducing bad debt and charitable write-offs.

Kinder Political Climate

While I have warned that our executive and legislative branch officials have been concerned about our compensation, it is also true that they have been strong supporters of our importance to the delivery of health care in this country. While Medicare legislation is pending before Congress as I write this, it is unlikely that we will see anything dramatic to challenge our practices, particularly as Congress investigates the impact of the Deficit Reduction Act of 2005 on our current operations.

I am always concerned about the threats we face, but quite optimistic about our future. Whether one is just entering the field, approaching retirement, or anywhere in between, there is much to be thankful for.

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This Article Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Forman, H. P. Search for Related Content PubMed PubMed Citation Articles by Forman, H. P. Social Bookmarking                      What's this?