Axis Imaging News received several reactions—on both sides of the issue—to our article on neurologists and self-referral titled “Turf War?” (by Amy Lillard), which was published in our April 2009 issue. Clearly, this is a debate that is not going away anytime soon. Our readers get the last word.

—M. Matthews

To the Editor:

First, I think this was too balanced an article. Although it was about neurologists, the same can be applied to orthopods, surgeons, ob-gyn, etc. Self-referral is self-referral! The bottom line is that this is NOT a turf war; it is about money—GREED. All those non-radiological practices that own imaging equipment and send their patients for studies are making money from it. Look at every study done on utilization and you will find that there is abuse under these arrangements. And there is a large expenditure of health care dollars for it. The only way to cure this is to PROHIBIT ownership of this equipment for all but radiologists and payment for studies done this way. Once that occurs, utilization and money will drop by at least 1/3.

Steven Hirsh

To the Editor:

Doctors have been self-referring since medicine started. When you see a cardiologist and you need an EKG, he/she does it in the office and does not refer you down the hall. A surgeon decides you need surgery and he/she does it, again you are not referred elsewhere. Radiologists refer to themselves all the time. In the body of their reports, they say “repeat in one month” or suggest a CAT scan, etc. They don’t expect you to go to the Mayo Clinic to have this done, but come back to them.

There are 18,000 hospitals in the US and only about 3,000 neuroradiologists, so the greatest majority of neuroimaging (MR/CT) is being done by general radiologists and you see what Dr Atlas says about that. He is a premier neuroradiologist and tells the truth about the situation. It is an economic reason that the general rads read brain images—not to help the patient. Neurologists study neuropathology and MRI is a live autopsy. Let all who interpret brain and cord images take the same exam and those who pass read. The UCNS exam given by the American Society of Neuroimaging is tougher than the qualifying exam for neurorads.

Jack Greenberg, MD
Founding member and former president of
the American Society of Neuroimaging