Centralized reading stations spell the demise of local radiology! Congress to pass nationwide certificate of need legislation! Every last voxel of hospital-based radiology transmitted to Calcutta for preliminary reads!

It is tempting in this rapidly evolving medical environment to dwell on the many doomsday scenarios circulating in radiology. And the issues at hand definitely require sober reflection. But it is actionnot reactionthat will carry the day. A new report from a hospital and health system consulting company (see page 10) that does a nice job of describing the market pressures currently facing hospital imaging departments includes a chart that projects demand outpacing the supply of US radiologists through 2030. The supply in 2030 (projected at 34,000) is roughly half of the projected demand for about 62,000 radiologists. Without a crystal ball that could  reveal what radiologists will do in 2030, it is difficult to know how many will be required. Today, however, the supply of radiologists is the number-one problem facing the profession.

Fueling the supply problem is the escalating demand for imaging. In a paper published on the Health Affairs web site, Baker et al1 analyze the relationship between the supply of new technologies and health care utilization and spending. The authors found the strongest association between availability and spending in the freestanding diagnostic imaging segment. There is not space here to go into detail, but suffice it to say that the data and observations of the authors were thought-provoking, particularly in their observation that the higher availability of diagnostic imaging technology appeared to result in lower prices for commercially insured patients, but higher prices for the Medicare population. The authors did not differentiate between imaging by radiologists and nonradiologists, but other studies have associated significantly greater rates of increase where the imaging is performed by nonradiologists.

Nonetheless, the demand is real, and who will accommodate the escalating requirement for diagnostic reads? A recent article in the New York Times commented on the controversy surrounding a New Delhi, India-based service providing overreads to hospitals and radiology practices in the United States.2 If radiology does not have enough radiologists to handle the workload, should we allow patients to languish in hospital beds and emergency departments rather than ship studies abroad? Surely, the medicolegal and regulatory environments here in the United States will limit the threat to the solvency of the profession?

There is no question that payors, including the federal government, are looking at imaging with greater scrutiny as imaging costs rise faster than most other medical costs. And radiology must heed these concerns. With this in mind, we bring you our cover story, “A Parallax View of Diagnostic Imaging,” by Thomas G. Dehn, MD, a radiologist who left private practice to work first in health policy at the American College of Radiology and then in radiology benefits management. We welcome your comments on the article.

As for Chicken Little, yes, the sky may be falling. But beyond lies a universe of new possibilities. They are what must be found in the new year. Best wishes to one and all for a healthy, happy, and prosperous one.

Cheryl Proval
[email protected]


  1. Baker L, Birnbaum H, Geppert J, Mishol D, Moyneur E. The relationship between technology availability and health care spending. Health Affairs (online). http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w3.537v1. Accessed Nov 12, 2003.
  2. Pollack A. Who’s reading your x-rays? New York Times. Nov 16, 2003;section 3:1,9.