The Commoditization of Radiology: Are We Our Own Worst Enemy?
In the past decade, many have described the field of radiology as increasingly commoditized with our work tantamount to that of untrained laborers producing a good for use or refinement by others, namely, referring physicians.2–4 Several actions, on the part of both radiologists and referring physicians, have contributed to this perception. With an understanding of these forces, radiologists will be better suited to help combat this growing trend, but we as radiologists need to recognize that in many ways we have become our own worst enemy in propagating this perception of our work.
If we accept the first definition of a commodity, then any effort by radiologists to focus on “mass-producing” reports could be construed as contributing to the commoditization of radiology. To a large extent, the wide availability of advanced imaging in the community contributes to the perception of commoditization among clinicians. The standardization of imaging and reporting that results from our radiology resident training programs has eliminated the individualization of our work. Referring physicians often falsely perceive that they should expect the same excellent result whether a study is done at an outpatient imaging center in a suburb or at a large referral center.
A recent article by Benjamin Strong5 published on the Web site imagingBiz makes several claims about the commoditization of radiology, including that “…commoditization is a very good thing for the consumer” because of quality and cost improvements for patients and referring physicians. This is untrue on several regards, however, especially when considering radiology benefits management. Radiology benefit management systems often contact patients whose physicians have ordered advanced imaging and provide suggestions for lower- or lowest-cost local imaging centers, often with a monetary incentive to the patients as a form of cost sharing, should they choose to have their imaging performed at one of the predetermined low-cost centers. One assumption that underpins these decisions is that all computed tomography (CT), magnetic resonance imaging, or other imaging studies are performed with equal technical specifications, resulting in equivalent quality images. Radiology benefit managers reinforce patient and referring provider misconceptions that all radiologists are equally skilled at reading reports and that the clinical judgment involved in interpreting imaging will result in the same findings, the same differential, and the same eventual patient care decisions. As any radiologist knows, the scope and breadth of radiology are such that subspecialized reads often provide more clinical value than that of nonspecialization.6
This is by no means limited to radiology; care provided by cardiologists to a complex patient with congestive heart failure is more tailored and specialized than that provided by a primary care physician. The disconnect, however, occurs when clinicians equate the generation of a report by a radiologist to the provision of a white blood cell count when blood is drawn.