ACR Bulletin

Covering topics relevant to the practice of radiology

Predicting the Practice of the Future

What does the successful practice of radiology look like in 10 years? One thing is for sure: It won’t be recognizable by yesterday’s standards.
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If anyone asked me if I would choose radiology again, I would say absolutely, yes. We've always been on the forefront of change.

—Kristen DeStigter, MD
December 01, 2023

A successful radiology practice may look completely different from today’s practice but with some of the same challenges and opportunities. The transition to value-based care along with the challenges of AI, personalized medicine, remote work and burnout will continue to require adaptive responses by practices.

“Image interpretation will remain central to radiology, but successful groups will be challenged by and adapt to these other pressures,” says Andrew Moriarity, MD, a diagnostic radiologist at Advanced Radiology Services in Grand Rapids, Mich.

And at a time when planning, data and daily improvements in technology seem to answer nearly every question, it’s still a challenge to piece together an accurate picture of what radiology will look like in 10 years. “The rate of change in healthcare and technology in the last 10 years is unprecedented, and it often feels like we've fit decades of change in that small period,” Moriarity says. “The rate of change in the next 10 years could accelerate event faster. Practices and departments will need to be nimble, to recognize the way they’ve been doing things and to identify and implement refinements quickly or risk falling behind.”

We need to be able to provide value beyond image interpretation. This, in addition to managing work-life balance, will be one of our greatest challenges.

—Reed Omary, MD, MS

But how does a practice where radiologists are regularly reading more complex studies, and with workloads that can lead to burnout, adapt to change quickly? According to Moriarity, radiologists and those on the business end will need to be experts in “understanding how data drives decisions in their group.”

Grading Previous Predictions

In other words, a prediction of the future ― whether that’s six months, five years or a decade from now — is only as good as the data behind it. And as Reed Omary, MD, MS, professor of radiology at Vanderbilt University in Nashville, says: “When I think about predicting the future, it's important to understand how well we have performed in the past. The ACR was ahead of the game in considering the importance of value-based care. We also saw an early willingness to advocate for diversity, equity and inclusion, the arts in radiology, and climate change — issues that are all now critically important.”

Omary says there are many possible pictures of the future, depending on the choices made by the specialty and each practice. “So if we look at these various futures, we can actually have them all at one time in various distributions,” he notes.

Practices will continue to behave differently depending on their settings — interventional versus diagnostic radiology versus radiation oncology, academic versus private, hospital-based radiology versus outpatient clinic-based radiology. “As we look at what's really happened over the last five years, there has been tremendous consolidation,” Omary says. “Academic medical centers have gobbled up regional hospitals, and are now in the midst of an identity crisis. What does it mean to go from an academic medical center that is geographically based to a health system that is more distributed?”

What we are seeing now, Omary says, is a way of dividing identities that is only going to become more prevalent.

As in many professions, changes in practice from the COVID-19 pandemic will continue, Omary says. “We're going to see a shift from on-site radiologists to remote, and there's a mistaken perspective that the only people who want to work remotely are millennials,” he adds. “During the pandemic, working from home occurred in practically every other field. Why would diagnostic radiologists be any different if they are not directly taking care of patients?”

Because many radiologists’ compensation plans are based on productivity, Omary worries that tensions will rise between those who are required to work on-site, with varying disruptions to their workflow, and those working remotely who are able to focus without interruption. Given the greater shift to remote, Omary suggests, it is then critical to find strategies to avoid the commoditization of the specialty’s services.

“We need to be able to provide value beyond image interpretation,” he says. “This, in addition to managing the personal needs for flexibility, will be one of our greatest challenges.”

Going Back to the Future — Radiology’s Hoverboard

The highest-grossing Hollywood film in 1985, “Back to the Future,” introduced its viewers to the hoverboard, something the film’s writers imagined might be available 26 years later. (True hoverboards are not yet available at an affordable price point, but the technology exists.) And much like those predictions, attempting to discern where radiology might be in just 10 years can be an exciting exercise.

“Imagine in the future that patients will go to an AI-enabled application on their phone, input their symptoms, and the software will spit out a care plan for which diagnostic services they need and where they can go to get them in a timely fashion. Even now, there are online programs that democratize patient care,” says Kristen DeStigter, MD, chair of the department of radiology at the University of Vermont Medical Center in Burlington. “I truly believe that in 10 years, radiology will not be a standalone service with respect to diagnosis. There will be a combination of diagnostic services — we may not have radiology practices but diagnostic practices that include imaging, pathology, laboratory medicine and other diagnostics that come together around the care of the patient, close to where the patient is located.”

This transition to decentralization, DeStigter says, results from a push from patients for easy access and cost transparency. “Radiology is one of the more expensive components of healthcare,” she says, “and we will start to see a bigger push toward offering services that align with patient preferences. The successful practice will embrace this and adapt. Right now, we're in a ‘mitigation mode’ where we're trying not to embrace all of the changes, especially related to AI/ML technologies, but that can't last. For our future and for our sustainability as radiologists and experts in radiology, we're going to need to embrace the changes and adapt appropriately.”

Taking the Pulse of Radiology’s Future

What is the overall sense of radiology’s future? If you’re DeStigter’s Magic 8 Ball (another piece of 1980s nostalgia), the answer is “Outlook Good.”

“I'm feeling positive about radiology, but in a decade, it's not going to look anything like it does today,” she says. “I am really excited about what's going to happen over the next few years. We have always been on the forefront of change. In the past, radiologists have adapted to new technologies that we feared would replace us. In the end, we all want to take good care of people and better meet the needs of our communities. If anyone asked me if I would choose radiology again, I would say absolutely, yes. Change is scary for sure. But it’s also very exciting. It’s the best time ever to be a radiologist.”

Author Raina Keefer,  contributing writer, ACR Press