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LOS ANGELES RADIOLOGICAL SOCIETY INSIGHTS ON-LINE NEWSLETTER, June 2007 |
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Resident’s Perspective: Commodization of Radiology As the California Radiological Society Resident Representative, I had the privilege to attend the 15th ACR Annual Meeting and Chapter Leadership Conference this past May in beautiful Washington, DC, for the first time. More than 120 residents and fellows from around the nation attended the meeting. This increased enthusiasm and interest among junior members was impressive and uplifting. While the primary focus of the college was still the Deficit Reduction Act (DRA), a relatively new phrase, “commoditization of radiology”, was the hot topic of discussion within the residents and fellows section. Dr. Richard Gunderman, Dr. Alan Kaye, and Dr. Greg Butler all gave their perspectives on this particular subject. What is a commodity? As Dr. Gunderman humorously responded, “Potatoes, paper, and pork bellies”. Commodities are undifferentiated items for which society is not willing to pay more to one supplier than another. [1] That is, only price and quantity matter. The direct consequence of commoditization is a lower price. However, the negative impact of commoditization of radiology seems to be a lot more than simply a smaller profit margin. It endangers the existence of our profession, a profession that is a major driver of medical technological advancements, a profession that is the most accessible and knowledgeable consultant to the rest of the medical community, and a profession that improves the quality of patient care by ensuring the appropriate use, selection, interpretation, and application of imaging. However, like it or not, commoditization started long before this decade. Uniform quality was assumed ever since the institution of Medicare/Medicaid reimbursement laws. During periods of excess, however, few practices worried about this lack of differentiation. Unfortunately, with the implementation of DRA and more pending future reimbursement cuts, commoditization will undoubtedly become a bigger player in shaping the future of radiology. Some of the current major driving forces of commoditization include: (1) Demand markedly exceeding supply. (2) Availability of information technology, such as PACS. (3) Teleradiology and nighthawk services. (4) Radiology extenders, such as radiology assistants. [2] In addition, widespread overseas outsourcing, while still facing legal barriers, is not entirely impossible. In October 2006, Nighthawk Radiology Holdings, Inc. filed a registration statement for a proposed public offering of common stock, which makes one wonder if the time when radiology reports being officially traded in the Chicago Board of Trade along with pork bellies is near. This time, dear friends in training, may very well be the day we step out of the protection of academia. Nonetheless, creating fear is certainly not the purpose here. The future of radiology is very bright. In fact, our senior members have proposed many excellent solutions during AMCLC and CRS RFS annual meetings and in journals such as JACR (www.jacr.org). However, this promising future can only be ensured if we abandon our apathetic attitude and face real issues like commoditization of radiology with courage and optimism. We can start by getting actively involved in organizations including LARS, CRS RFS, and ACR RFS and by staying abreast of the big picture by reading not just radiology journals but articles for the general medical community as a whole. We should also start perceiving ourselves not just as craftsmen but also as guardians of our beloved profession, a profession that makes a huge difference in saving and improving lives. Hui Jenny
Chen, M.D. References:
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