A Dagger in the Heart of Radiology

I read with great interest the opinion piece written by Michael Brant-Zawadzki, MD, FACR, in your June 2006 issue. I head a small group practice in rural western Pennsylvania, where recruiting is difficult to say the least. I personally read 30,000 to 40,000 exams a year spanning all modalities of radiology as well as performing most types of interventional procedures, typically four to six per day. We utilize nighthawk services and it has been a godsend. There is no way in the world that I could do what I do every day and then get pummeled by the ER at night and get essentially no sleep. As a pilot, I could point out multiple studies in the aviation literature describing the deleterious effects of sleep deprivation upon cognitive function (ie, airplane crashes). I take a great deal of offense at the “lazy” accusation. I submit that there aren’t too many radiologists willing or able to do what I do. As for the proposition that we’re overpaid, well, I do believe that with the current fiscal pressures on Medicare and Medicaid, the politicians will see to that little problem.

Frederic T. McDermott, MD
Meadville, Pa

Integration in Indianapolis

I read the article “Integration in Indianapolis” by Rich Smith in the August 2006 issue with interest and have to say, Mr Smith (and the editor, too, via editorial comment), was fed a line, which you swallowed hook, line, and sinker.

As one of the principals involved in that debacle, I can say [that] some very important aspects of the whole affair were left out.

The whole reason the “merger” succeeded is that the private practice at Methodist group was simply pushed out. The group dissolved. What had been a 45-member group at one time, the largest, most subspecialized, and most well-respected group in the state, simply dissolved. Essentially, what happened was that the board of trustees of the organization that governed the combined hospitals was slowly populated with university-friendly private practice-unfriendly individuals until a majority voted to not renew our contract. That ended 6 years of wrangling.

A few individuals who were too close to retirement, or had personal reasons not to move or who had subspecialized skills that were incompatible with most private practice jobs, stayed.

The greatest beneficiaries of the merger were the other hospitals in Indianapolis [that] absorbed the highly trained subspecialists who, quite surprisingly, largely retained their referring physicians and their patients at their new hospitals. Two of the three musculoskeletal radiologists who went to work at an independent imaging center retained the referrals of a 50-plus member orthopedic supergroup, and the sports medicine group that cared for the local professional athletes. As the third MSK radiologist, the number of [my] MRIs then went from around 50/day to around six, and I left the area at that point. Interventional radiologists, such as the experts in aortic stent grafts and uterine embolization, also retained their referral base.

The referrals that have been lost from that system will almost certainly never be recovered. The building of the “suburban” hospitals was an attempt to keep physicians of all specialties within the system. Physicians were offered minority ownership positions in the suburban hospitals as an inducement to not move their practices to competing hospitals.

Those fleeing the academic radiology department also populated other hospitals in Indianapolis to the point that the academic department instituted a noncompete clause for all faculty hirees (and possibly for fellows, too), a highly unusual move for a university department.

It’s a long story, replete with intrigue that even Machiavelli would find arcane, but essentially, the medical school was deathly afraid of the private practice group. We were the larger, more subspecialized, more productive, and more academically inclined department. Besides having a residency that went kaput, members of the group wrote well-known books [and] papers in peer-reviewed journals, and were board examiners and session moderators at national meetings.

A similar merger had happened in Cincinnati a few years before, when the university merged with Christ Hospital in Cincinnati, resulting in a decimation of the academic department. The dean of Indiana University (a radiologist) was deathly afraid this would happen in Indianapolis. After years of negotiations, the private practice group arrived at an equitable agreement with the academic department, only to have the dean torpedo the effort at the signing ceremony.

Mr Smith’s article also failed to mention the human cost involved. The 45 members of the group, almost all of whom left Methodist Hospital, had to find new jobs, and a number of individuals, including me, left the area altogether, uprooting families and spouses. In addition:

  • the CEO of the organization “retired”;
  • the academic radiology chairman was fired; and
  • the dean of the medical school also retired; in his acceptance speech for a gold medal he received from the ARRS during the heyday of the merging negotiations, his speech included wording to the effect of “I can’t wait to get the hell out of radiology” or some such.

I realize you’re not a peer-reviewed journal…but you really quite blew it with this article.

David R. Pennes, MD
Grand Rapids, Mich

It was with some personal interest that I read your article in the August issue of Axis Imaging News entitled “Integration in Indianapolis.” I spent about a year with Radiologic Specialists of Indiana in 2001–02. While it is good to hear that it “worked out” for those who stayed, it hardly tells the whole story. In the year [that] I was with the group, more than one third of the radiologists left, in large part due to the prospect of a potential merger with IU radiology. While the IU/Riley radiologists considerably outnumbered the RSI group, the RSI radiologists produced the majority of the RVUs. Those not academically inclined did not relish the idea of continuing that discrepancy in productivity while sharing the monetary benefits with those less productive. As the radiologists left the group, RSI’s bargaining position weakened until it had no choice but to go along with the merger.

The last sentence of the first paragraph about the success of the merger ends with “only in this case, everyone survived.” I guess all the radiologists who didn’t “survive” the merger have been forgotten.

Part of the success of the merger appears to be due to the fact that those who stayed were less opposed to what they saw as a takeover by IU radiology, and anyone with a strong opposition to the merger was driven out. I suppose that is the way mergers usually work, though.

Allen Chantelois, MD
Appleton, Wis

To Be or Not To Be an IDTF?

In an April 2006 article, “Should you be an IDTF?,” Tamara Greenleaf stated that IDTFs must have orders in writing. That is not true. An IDTF may accept orders by phone, e-mail, or fax as long as the communication is documented by both the ordering physician and the IDTF in the patients’ medical records.

This information may be found under the “Order” section defining the term “order” on page 18 and 19 of the Trailblazers 2006 IDTF Part B manual. Just thought you should know.

Barbara Crane, MBA, RTR, CNMT
San Antonio, Tex