Examine | Teleradiology: Viewpoint: Is Radiology Flat?

In this month’s installment of Examine | Teleradiology, Stephen Kahane, MD, discusses how the game has changed in teleradiology and what practices should be doing to keep pace with these changes.


That might sound like an odd question to ask about radiology, since there’s so much change and uncertainty swirling around. But if you interpret “flat” as Thomas L. Friedman does in his book The World Is Flat: A Brief History of the Twenty-First Century (Farrar, Straus, and Giroux, 2005), well, it gets a bit more interesting.

As happens in other social and business endeavors, those truly paying attention to change can benefit by identifying opportunities during times of uncertainty. What’s key is exploiting those opportunities – at precisely the right time.

Clearly, Friedman doesn’t focus specifically on the radiology business in his book, but many of his insights are relevant for our industry. He uses the word “flat” to describe dramatic changes in terms of the competitive landscape in business.

As Friedman sees it, “flat” also means “connected,” so advances in technology and changes in traditional political barriers have made it possible to do business with billions of other people across the planet – with relatively few barriers.

A key point to take away from Friedman’s book is that companies and individuals must change if they wish to remain competitive in a global market where traditional barriers to business are becoming increasingly irrelevant. So, what does this mean for imaging centers, radiology practices, and teleradiology businesses? A lot.

I should say that, while Friedman writes about the world-at-large, I’m going to focus on needs within the U.S. healthcare system. That said, radiology is ripe with growth opportunities because there are three powerful forces driving increases in utilization today:

While increases in utilization do create growth opportunities, we have to be realistic about the challenges we face. Reimbursements are down; there’s a geographical mismatch of where radiologists are and where exams are performed; and the supply of radiologists to provide interpretations has remained relatively constant.

This combination of variables creates a significant economic challenge, due to an imbalance of supply and demand. Another key take-away for imaging centers, radiology groups, and teleradiology businesses is that the need for radiology services is – or will be – outpacing their ability to provide those services in the same way that they have for the last 20 years.

So, if you want to grow your practice, you’ve got to do more with less and you’ve got to think differently. Knowing that, it’s time to consider this very important question: Where do you want to take your practice in the next five to 10 years?

You could accept the “old-school” view of the landscape: Radiology groups focus most of their energies on gaining contracts from local hospitals and physician practices. For decades, this worked out just fine. Radiologists provided a vital service in the healthcare delivery chain by interpreting exams for local hospitals and physician practices.

It’s no surprise to any of us that the landscape has changed – big time. What would it mean for your practice if you thought beyond the boundaries of your state? What would it mean for your practice if you thought beyond the boundaries of your region of the country? Would you be able to increase your opportunities for new contracts?

What if you were no longer competing with just the two or three other groups in your market? What if, all of the sudden, you had 100 competitors? Consider, for example, that your practice is in the greater Boston area. You might have considered practices within a 50-mile radius to be your competition.

But, today, you can add a subspecialty practice in Dallas to that list. Yes, indeed, times have changed. Like that practice in Dallas, perhaps you should consider taking geography off the table and embrace the possibilities of teleradiology.

I’m not saying that a local radiology practice presence is no longer necessary or that teleradiology is the answer to all of the issues facing our industry – I don’t think that any of us are quite ready to jump to that conclusion. But I’d like to suggest that those of us in the radiology industry need to think about our challenges and opportunities in a different way.

For insight, I’ll share a few observations from conversations I’ve had with various radiology practice clients of Boston-based Amicas Inc. over the last 12 months. First, let’s consider radiologist productivity. One of our clients claims that their most productive radiologist is 1,200 miles away from where the exams are performed.

Not only does this provide a new paradigm for thinking about recruiting radiologists, but it demonstrates that technology has evolved dramatically to enable a very productive remote radiologist. Second, let’s consider radiologist efficiency. What really hurts radiologist efficiency is the inability to leverage a distributed work environment.

For example, another one of our clients identified “downtime” by their radiologists at one of the hospitals where they have a contract as a major drag on their productivity. Inevitably, one of their hospitals would have a slow day and another would be much busier.

The radiologists at the hospital with lower volume often spend three to four hours a day without enough cases to read – a very inefficient use of their time. By implementing a new technology and workflow to enable remote reading, this radiology practice has been able to balance the workload across these different hospitals.

The same argument can be made for subspecialty reading or nighthawking. If your practice has expertise in a certain subspecialty – for example, neuroradiology or musculoskeletal – you can offer that as a service to smaller groups in your region and beyond. If you have nighttime coverage and your radiologists are busy only 60 percent of the time, you can branch out and offer nighttime reading to smaller groups or hospitals in your region and beyond.

Finally, let’s consider radiologist recruitment and extending radiologists’ careers to offset the mismatch of supply and demand that I mentioned earlier. Still another one of our clients was able to recruit and retain radiologists who were getting ready to retire because they wanted to move to an exotic location.

By enabling their practice with tools so their radiologists could read remotely, this practice was able to extend the careers of their two key radiologists. What’s vital to the success of each of these practices is that they are embracing teleradiology as a means of improving how they do business.

Whether their focus is on maximizing the efficiency of their existing radiologists, recruiting new radiologists, retaining existing radiologists, or offering new services – such as subspecialty reading or nighthawking – all of these practices are exploring new ways of offering reading services without the geographic constraints typically cited by most practices.

The improvements they’ve made enable these practices to deal effectively and efficiently with the mismatch of supply and demand. So, let’s get back to my original question. Is radiology flat? There’s no doubt that traditional geographic boundaries are changing as technology advances and new business models emerge.

We all need to understand what this means for radiology businesses and understand how and when we can capitalize on the opportunities being created. I’m very excited about the future and look forward to watching it unfold. As Friedman might say, “Change is inevitable.”


— Stephen Kahane, MD, is president, CEO, and chairman of Boston-based Amicas Inc. Questions and comments can be directed to editorial@rt-image.com.