As healthcare continues to shift its focus from quantity to quality, radiologists have a chance to demonstrate their value and show that, yes, they deserve a seat at the table when it comes to discussing the present and future of patient care in the United States. So will they seize that opportunity?
Medical imaging has long been seen as an ancillary service line, similar to pharmacology or anesthesiology, notes Satoshi Minoshima, MD, PhD, chair of the department of radiology and imaging sciences at the University of Utah School of Medicine in Salt Lake City. “Radiologists are not often exposed directly to the patient or to the [referring physicians],” he says. “More or less, it’s the nature of the work. We are not very visible sometimes in the health system.”
And while advances in radiologic technology have brought tremendous benefits to the healthcare system, such as fast image transmission that saves referring physicians trips to the radiology department, they’ve also relegated radiologists to the periphery—and that’s not a place specialists necessarily want to be. So how can radiologists work against this trend and make radiology more empowered and visible within the healthcare system?
Here are some tips from the trenches:
Take Time to Connect with Patients
One benefit radiologists have going for them is the sheer number of patient encounters they experience on a daily basis, says Howard Fleishon, MD, MMM, chief of radiology services for Emory Johns Creek Hospital in Johns Creek, Ga. By making the the most of each encounter and establishing a real connection with the patient, he says, specialists can go a long way toward showing how important they are patient care.
“One of our core competencies should be patient-centered care,” Fleishon says. “We can make it a priority to be leaders in that field so that it’s not just administrators coming to us and saying, ‘We have to practice patient-centered care.’ It can be us going to the administrators and saying, ‘This is what we can do to improve patient-centered processes in our hospitals and our departments and how we can be innovators rather than reluctant followers.”
Radiologists can study their colleagues in mammography for ways to increase patient interaction and improve the quality of the exchanges, Fleishon adds. In mammography, for example, radiologists usually discuss results in person with the patient. And many radiology practices guide patients on next steps if cancer is detected, often on day one.
At the very least, Fleishon thinks all radiologists can take time to embody the role of a healthcare provider and make themselves available to patients to discuss results. By taking a more active role in patient care, he says, radiologists can grab the attention of leadership and solidify their place in the care team.
Meanwhile, Jennifer Kemp, MD, a diagnostic radiologist at Diversified Radiology in Denver, explains that she and her colleagues use a variety of methods to connect with their patients. For example, they put their direct radiology phone number—and sometimes even their personal email addresses—at the bottom of every report. They also create informational videos about radiology and thank-you postcards for patients that explain what radiologists do and how the patient can reach out to a radiologist with any questions, comments or concerns.
Work Closely with Referring Physicians
Minoshima and his colleagues closely studied online surveys of individual examinations to get a better understanding of what referring physicians are looking for from their radiologists. What they found at the top of that list were superior communication skills, top-quality care coordination and, most importantly, fast results. “We have to provide outstanding imaging for patients, but communication and good report turnaround time are also critical,” Minoshima says. “These are our major quality indexes for referrals.”
Kemp says she takes communication between a radiologist and his or her referring physician very seriously, sharing a recent story to help make her point. She had recommended to an oncologist that a particular metastatic cancer patient was a good surgical candidate and she suggested that she and the oncologist continue the discussion at a tumor board. “I felt like we might be missing something, so I stopped and made a phone call,” Kemp says. “It’s kind of taking a risk that you might be stepping on people’s toes, but it’s just a way of saying, ‘I care about patients and this is my patient, too.’”
Sync Up with Hospital Administrators
When the American College of Radiology (ACR) asked hospital CEOs to characterize a successful radiology group, the common thread was whether or not a group aligned with hospital priorities, says Geraldine McGinty, MD, MBA, vice chair of the ACR’s Board of Chancellors. Radiologists should seek to understand what their health system is trying to achieve, she says, and consider the challenges standing in the way.
It’s crucial for health system leadership to know there are radiologists they can turn to with questions about imaging. To establish a relationship, a radiologist can ask an administrator to sit down for a cup of coffee or a quick meeting. That’s when the two parties can discuss challenges the hospital is facing—and how the radiology department can help. “It’s making sure that when they think about imaging, they know there are people they can talk to,” McGinty says.
It’s particularly important for radiologists to be visible to a CEO when the CEO is not also a physician, explains Frank Lexa, MD, MBA, vice chair of the medical imaging department at the University of Arizona Medical Center in Tucson, Ariz., and CMO of the ACR’s Radiology Leadership Institute. And it’s not just radiology group leaders who should make themselves visible to administrators. “The department chair should be pushing to have all of their section chiefs, their service line specialists, visible,” Lexa says. “It should really be a form of distributed leadership.”
Since it is an administrators job to worry about hospital finances, it makes sense that radiologists should be able to speak that same language if they want to truly make an impact. “We need to be prepared to say how the things we want for the hospital could potentially impact the finances of the hospital,” Kemp says.
And it may not always be the case now, but there was a time when hospitals would not make a decision about imaging equipment without a radiologist in the room. It would benefit the entire specialty, McGinty explains, if radiologists could get back to that point by educating health system leadership about the importance of choosing the right radiologic equipment. “You want to make sure you’re buying equipment that will help the health system succeed,” she says.
Lexa adds that radiologists can advise hospital administrators on technology development, quality metrics and information technologies. “We have to show the value of radiology in helping to reduce costs by reducing medical misadventures, by helping to promote health and by detecting cancers earlier,” he says.
Volunteer Your Time
Another way radiologists can get noticed is taking a more active role in their work environment. Radiologists can embed themselves in the clinic, attend conferences, join committees, research new equipment and even aspire to be on the hospital board. “In big hospital systems, sometimes it’s hard to find doctors who want to be engaged and sitting at the table,” Kemp says. “There’s plenty of opportunity if we just show our interest.”
In addition, Kemp favors multidisciplinary conferences and tumor boards, and she has participated in task forces for lung and colon cancers. The medical executive committee is typically a key decision-making board that should include a radiologist, she notes, and other committees to consider would be any focused on credentialing and peer review.
Unsure of where to start? “Think of a problem that irritates you or a question that you have,” McGinty says. “Now, think about your involvement tied to that. There’s a place for you, whatever you’re interested in.”
She adds that there also is significant value in volunteering for a committee no one else wants to touch. It can be worthwhile to dig into the most intractable problems, because then you might find yourself being a part of the most needed solutions; that’s one guaranteed way to get noticed by leadership as a crucial part of patient care.
Embrace Innovation and Look Ahead
Radiologists should keep advancing their skills during their careers and not be afraid to try new ways to get noticed. McGinty says she’s an advocate of the way social media applications such as Twitter can connect radiologists with patients. “As we think about trying to become more visible, using social media helps patients understand who we are,” she says. McGinty’s group has used Twitter chats to ask patients questions such as, “How do you feel about a radiologist giving you your results?” and, “What does value in radiology mean to you?” The answers taken from such conversations can then be used to make changes, and patients will feel encouraged by the way they were able to interact directly with a specialist.
At the University of Utah, Minoshima and his team were able to use advanced technology to demonstrate the value radiology can bring to patient care. He and his team, including Vivian S. Lee, MD, PhD, MBA, CEO of the University of Utah Health Care System, introduced the school to Integrated Management and Governance for Enterprise-wide Radiology (IMAGER), a dyad model that merges the finances of its clinical and academic sides in a way that is transparent to the entire health system.
Minoshima wrote about the experience in the April/May 2017 issue of Radiology Business Journal.1 “Radiology is one of medicine’s newest fields, less than a century old,” he wrote in his column. “We are pioneering new values in healthcare every day. Discoveries and innovations in our field can truly catapult the practice of medicine forward. We are medicine’s R&D engine.”
Fleishon agrees with this philosophy, noting that it’s up to today’s leaders to ensure radiologists continue to do everything they can to demonstrate their value to the entire healthcare system. “Keep it in the literature, emphasize it during training,” he says. “Seeing their mentors prioritizing and emphasizing that radiologists need to be not only leaders of their groups, but also their medical staffs, instills that philosophy in the next generation.”
SM. Radiology's Role as a Value Center. Radiology Business Journal . 2017;10(1):34-35.