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It's like the Serengeti out there.

DW: Dr. Haruspex, you've been an observer of medical specialty behavior for quite some time. What are some of the recent trends?

Dr. Haruspex: Well, in the last decade, we have seen radiologists being run off their established breeding grounds by aggressive packs of clinical specialists. Some have been forced into a nomadic existence as semidomesticated locum tenens. Interventional radiologists, in particular, no longer have access to their traditional prey and consequently have lost their hunting skills. A number of interventionalists have shared their specialty with young cardiologists, only to be driven out of their own lairs when the cubs became fully grown. Today there are very few interventional radiologists left in the wild. Those that remain have become herbivores, eking out a meager existence foraging for abscess drainages and line placements. I am afraid they are nearing extinction.

DW: Why don't you appeal to the American Medical Association (AMA) to make them an endangered specialty?

Dr. Haruspex: We have, but so far the AMA has turned a deaf ear. They say this is nothing more than the process of Darwinian fitness, and that we should let natural selection take its course.

DW: And how are the cardiologists faring in their new environment?

Dr. Haruspex: At first they were doing quite well, breeding like lawyers. But now other specialists, such as vascular surgeons and the occasional renegade neurologist, have moved in and challenged them for the best turf.

DW: How has the recent reimbursement drought affected physicians?

Dr. Haruspex: It has been devastating. Watering holes are shrinking, and with upcoming implementation of the Affordable Care Act, there is no relief in sight. Some primary-care physicians have even started eating their young.

DW: I understand that the general radiologists' diet is changing as well.

Dr. Haruspex: Yes. For some reason the younger radiologists have been refusing plain films, their historical staple food. They are increasingly demanding a diet of CT and MR images, which are richer in RVUs.

DW: Is that healthy?

Dr. Haruspex: Of course not. We have told them that they need the roughage for proper nutritional balance, but they don't listen. A few have been known to starve themselves to death rather than accept CR images. The number of radiologists who can still digest plain films is dwindling at an alarming rate. In some practices, the images are left to decompose in large celluloid and silicone landfills. Cervical spine images can be particularly toxic. Several physicians living near C-spine dumps have seen their dens eroded.

DW: Isn't there a danger of cross-sectional image shortages?

Dr. Haruspex: We were concerned about that several years ago, but now there seems to be an abundant supply due to increasingly defensive behavior by swarms of ED physicians. As a matter of fact, in recent months, there has been overproduction. Consequently, a number of other specialists, such as orthopods, are abandoning their traditional habitats and trailing the radiologists, doing quite well scavenging left over MR carcasses.

DW: How are administrators responding to some of these challenges?

Dr. Haruspex: Many have determined that they can no longer rely on survival of the fittest. A handful of health care ecosystems are taking concrete steps that would have been unthinkable just a few years ago. Several have made early, but so far futile, attempts at treating what seems to be a widespread epidemic of legal parasites. In addition, some hospitals have tried crossing imagers with ED docs in an attempt to get a radiologist willing to work nights and weekends.

DW: Was that successful?

Dr. Haruspex: No. Instead they got a physician who ordered too many head CTs and would only work from 9 to 5. Quite a few of these mixed breeds are now migrating to other continents to join the growing wild herds of teleradiologists.

DW: Are you concerned that there eventually won't be anything left for radiologists to eat?

Dr. Haruspex: Oh, no. One diet remains exclusively indigenous to radiologists. In fact, it seems to be highly poisonous to all but a small group of imagers.

DW: And what is that?

Dr. Haruspex: Mammograms.

Editor's note: Dr. Weiss recently landed an exclusive interview with Xavier Ray Haruspex, the world-renowned medical professional behavioral expert with I.C. Thruyu Consulting, LLC. The following is a transcript of their conversation, which focused on Dr. Haruspex's thoughts on current trends and the future of medical imaging.

David L. Weiss, MD

Dr. Weiss is Physician Coordinator, Imaging Informatics, Carilion Clinic, Roanoke, VA. He is also on the editorial board of Applied Radiology.
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Author:Weiss, David L.
Publication:Applied Radiology
Article Type:Guest editorial
Geographic Code:1USA
Date:Aug 1, 2013
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