Is it Time for Primary Care Radiology?

The following post was written by guest blogger Greg Mogel, MD, chief of radiology, Central Valley Service Area, Kaiser Permanente.

The subspecialization of radiology continues apace and for all the lamentations of loss of our general skills, I’ve never forgotten a bit of wisdom shared with me by an early subspecialist (though the word was unknown at the time, she was just “really good” at OB ultrasound): The radiologist interpreting the study should know at least as much about how to read it as the doc that ordered it.

While that seems obvious, for a few decades now the only indisputable measure of report ‘value’ has been whether it was reimbursable. (Sadly little talk about what clinicians need in a report; mostly what must be included to avoid medicare ‘fraud’). 24/7 subspecialization is becoming the norm although it is unclear whether it is marketing or medicine. In fact, a ‘chest’ radiologist may well thrill a pulmonologist but mystify a nurse practitioner.

I’d like to propose that a focus on the primary care provider be considered a specialty. Shared decision-making to help choose the proper study and generating ‘knowledge’ from the ‘information’ in a previously read dense report is an honest living, even if it’s somewhat RVU-poor.

Radiology might find itself more sustainable as a career if we try to swim in the ‘Blue Ocean’ of bringing value to the overworked primary care provider than the ‘Red ocean’ of fighting over smaller and smaller pieces of anatomic real-estate.

Let’s train for it. It’s good work.

Tweet the author @gregmogel

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