I Am Stumped

I am stumped. Usually, I write these editorials on whatever comes into my mind, but tonight I can't seem to think of much. Perhaps it is still the effect of 9/11, which makes everything else seem unimportant. Still, I thought I might give you a few of the thoughts that have ``popped'' into my mind recently.

Radiology is under siege, and the question is, how should we respond? This is not a new topic, but recently, in our hospital, we have seen a resurgence of ``turf battles.'' I am not sure how to react; my emotions say, ``Screw you guys.'' You are ``trivializing'' radiology by saying that after taking a one-week course you can do something that we do after years of training. You are patronizing me by saying, `` it is not about the money.'' Isn't it interesting that your colleagues or ex-colleagues come up with a statement like that? They will say they want to do ultrasound or biopsies in their offices or do stent grafts because it is easier on their patients or ``everyone in my specialty is doing it,'' or something like that. Your colleagues are like ``professional'' athletes. When they say it is not about the money, believe me, it is always about ``the money.'' The question is, how can we fight it or can we fight it? I know the standard answer is that we should admit our own patients; we should go to primary care physicians, or we should fight them at their own game. Have a clinic! Admit patients! Advertise!

Well, I am not sure that is the correct strategy. Maybe I am pessimistic, but I don't see future radiologists doing it. Radiology has become a highly sought after specialty for a number of reasons, but we are crazy if we don't admit that ``lifestyle'' is the primary one. One can work full time, part time, nightly, daily, hourly, 1 week on, 1 week off, or any combination of these in radiology. But we are not recruiting enough people who want to do all the clinical work that needs to be done to fight these turf battles.

I am not criticizing us or people who don't want to ``admit'' patients. That is reality and I think we have to come up with a new strategy to deal with the takeover and trivialization of what we do. I believe our thinking on fighting ``turf'' battles, although admirable, is a no-win situation. Believe me I don't like our ``colleagues'' performing radiology procedures any more than you do, but let's step back and reassess. We have a CAQ; we have a powerful interventional society; we have begun admitting patients; and, it is not working. I believe we need a new approach. We need to think like a defensive coordinator for a National League football team; we need to rethink our strategy. Our current approach stinks. I think we could do several things. I am not saying anyone agrees with me or that I am correct. But I do believe we aren't getting anywhere with anything we have done so far. I believe that the compromises we have arbitrated, such as working in the operating room with the surgeon and getting paid with them on stent grafts, is a temporary solution that will fade as more ``stent-trained'' vascular surgeons become available.

There are a couple of radical ideas out there that I think we should examine. How about forgetting all the fluoroscopy bases procedures and concentrating on CT and MR procedures and developing these even more than they have been? There are numerous procedures out there that require CT and MR, but many people are not doing them. Part of this is because many vascular radiologists are undertrained in nonvascular intervention and undervalue these procedures. Similarly, many ``imaging'' radiologists don't aggressively market or develop these procedures and, in fact, reluctantly use ``valuable CT time'' for procedures. The thought of using MR as an interventional tool makes many so-called imaging MR radiologists apoplectic.

How about consolidation of interventional practices across hospitals? I am in Boston and I feel that the academic hospitals are fragmented in their approach to IR. In some hospitals, we perform portable intervention; in others, we market gallbladder drainage; in others, we are strong in fibroid embolization and chemoembolization. Our strength lies in numbers and individuals. Is it not the stupidest thing to have a small community hospital with one or two interventional guys and have a rival practice with the same set up? Why shouldn't we set up a Traveling Interventional Consortium? Of course there are problems with this, but it also can provide services and expertise for everything we do.

I don't like the phrase, ``think outside of the box,'' but even though it is trite, it makes the point. I think we have always been one step behind fighting ``turf'' in intervention. The fact that the American Board of Radiology has now approved a new tract for Intervention for incoming residents is too little, too conservative, and too late in my estimation.

I have always been prone to sports analogies, and I think one applies here. The New England Patriots should not have won the Super Bowl. They won by doing the unexpected, by being aggressive, by being imaginative, and by catching their opponent unawares. If we don't do that, we will lose this battle in IR.