1. D. Williams M.D. C. Harnain M.D. P. Gerard M.D. A. Gilet M.D. Z. Levkovitz M.D.

2. Purpose  To discuss how in current economic times, radiologists may be required to take on more responsibilities, many of which may not have been practiced for several years. Additionally, we discuss how many radiologists will have to leave the comfort zone of their training and learn new modalities.

3. Introduction  The practice of radiology has evolved into one which demands a more efficient and effective service to patients and referring clinicians.  Due to significant change in the way healthcare is practiced, the onus has been placed on radiologists to become more diversified in the practice of radiology.  It is the expectation that radiologists will promote standardized health care by providing the highest quality of diagnostic imaging and interventional services.

4. Professionalism General Core Values in Radiology Innovation Patient Safety Quality Health care Teamwork Patient Satisfaction

5. Core Values Revamped Body CT/MRI Nuclear Medicine MSK Increased radiologist responsibility Maintain adequate RVUs Patient Safety Maintain core values Quality healthcare Innovation Pay practice expenses and salaries Professionalism Increased work flow Patient Satisfaction Images adapted from http://www.rsna.org/Informatics_Tools_Flow_Chart.aspx

6. Diversity in the Dark Room  Diminishing compensation for radiologists has forced many diagnostic radiologists to diversify their workload.  Many fellowship-trained radiologists are reading multiple modalities on a daily basis in order to achieve the same level of productivity in RVUs in a private practice or hospital setting.  In addition to reading multiple modalities, this endeavor requires the radiologist to do this efficiently with excellent patient care and radiation patient safety as the ultimate goal.

7. Methods More visible and clinically-oriented Diagnostic Radiologist Provide web portals for patient communication Serve on administrative hospital committees Attend rounds with clinicians Strategies for creating a visible radiologist

8. Results  The workload for the clinical radiologist has grown not only in volume but also complexity.  Several tools can be used to improve diagnostic skills, particularly in attending physicians who have been in practice for a long time and now require new training to accommodate the volume and complexity of cases. Some of these include: Attending interactive training workshops Participating in webinars Taking refresher courses for continuing medical education credit Pursuing a second radiology fellowship  Miglioretti et al demonstrated that radiologist’s ability to interpret screening mammograms showed vast improvement after targeted medical education. This has significant implications for the unnecessary workup of benign breast lesions and early detection of malignancy.  A similar principle could be applied to multiple modalities with the promise of great success in improved diagnostic abilities for physicians who take on the responsibility of reading new modalities after being in practice for several years.

9. Results  A review of recent attending radiology job advertisements including locum tenens and permanent positions requested board-certified radiologists who could also read 3-4 additional modalities in addition to their subspecialty.  This expectation was for a typical workday and also when taking call.  Radiologists must also remain relevant by demonstrating a strong commitment to patient care. This can be seen in communication between a radiologist and clinician. A radiologist who is available for consultation by clinicians will add value to the practice of radiology. Adapted from http://www.doccafe.com/jobs/physician/radiology/646271/perm anent-night-position-in-texas-from-locumtenenscom.html Permanent Night Position in Texas for 26 weeks per year Willing to license Competitive salary and benefits RADIOLOGIST JOB DESCRIPTION LocumTenens.com is currently recruiting two board certified, fellowship trained radiologists (preferably in neuroradiology) to join a large and established practice in the DFW area. You will be working 26 weeks per year (7 days on, 7 days off), covering 9 hour night shifts at their teleradiology center, providing ER and stat reads. There is no mammography or IR required for this position and the caseload is approx. 10 reads per hour consisting of plain film, CT, ultrasound, MRI and nuc med. They offer competitive salary and benefits and are currently reviewing applicants. Radiologist Job Posting

10. Ensuring Quality Assurance in the Practice of Radiology  Radpeer is advertised as a main source of peer review data which is integrated into the PACS system.  When a ‘miss’ is identified and deemed clinically relevant, the physician is notified confidentially and the case undergoes anonymous review by two other radiologists.  A plan of action is formulated for physicians with unacceptably high rates for errors.  Implementing a rigorous peer review process for the reinvented radiologist will help to improve diagnostic skills while enhancing patient care. ACR Bulletin March 2014 Volume 69 Issue 3, page 18.

11. Discussion  The methods discussed can be used to tackle complex cases and will force radiologists to become experts in more modalities.  Evolution of the practice of radiology also means enforcing a remediation system for physicians re-learning modalities for the sake of patient safety.  The need for 24-hour radiology coverage has resulted in longer work hours for radiologists which will require the ability to adapt to progressive change in the field.

12. Conclusion  Changing economic times have forced radiologists to become more marketable by reading multiple modalities in a private practice or hospital setting.  Radiologists must also become instrumental in the patient’s plan of care by attending multidisciplinary rounds, serving on hospital committees and advocating for patients in communities.  This new approach to the practice of radiology means new goals are set to be achieved, the most important of which is superior patient care while reinforcing diagnostic skills.

13. Contact Information  “Bridging the Gap Between Practicing Radiology and Being a Leader.” R. Cury MD  http://www.rsna.org/Informatics_Tools_Flow_Chart.aspx http://www.rsna.org/Informatics_Tools_Flow_Chart.aspx  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2786195/  http://www.diagnosticimaging.com/articles/interactive-workshops-boost-imagers- interpretive-skills http://www.diagnosticimaging.com/articles/interactive-workshops-boost-imagers- interpretive-skills  Linver MN, Paster SB, Rosenberg RD, et al. Improvement in mammography interpretation skills in a community radiology practice after dedicated teaching courses: two year medical audit of 38,633 cases. Radiology 1992;184:39-43. For further information please contact: Dr. Danielle Williams, M.D. Westchester Medical Center Valhalla, NY 10595 williamsd1@wcmc.com References