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Canadian Association of Radiologists
74th Annual Scientific Meeting
Register Now! April 28 to May 1, 2011
Montreal, Quebec


A Message from the President of the CAR

Dr. E. A. (Ted) Lyons, O.C.
March 2011

 

 

Where will Canadian Radiology be tomorrow? Our future can be bright.

 

I have just participated in the national Specialists Forum meeting in Ottawa, sponsored by the Canadian Medical Association (CMA), as your CAR representative. The forum provides the CAR with the opportunity to represent our members' interests within the CMA and contribute to the development of physician advocacy and health advocacy policies at the national level.

The main topics of discussion were the Health Care Transformation (HCT) initiative, the proposed changes to the Maintenance of Certification Program and Credit system, Distributed Medical Education (DME), and the challenges and opportunities for collaboration in developing and disseminating clinical practice guidelines. Dr. Martin Reed, Chair of the CAR Guidelines Working Group, provided an insightful presentation and CAR perspective on the latter topic. For further details on the issues discussed, click here. It is enlightening and I encourage you to read through it.

According to the President of the CMA, Jeff Turnbull, the CMA continues with their program of Health Care Transformation. There will be a push to create a dialogue with Canadians, physicians and patients alike to define how to create a sustainable healthcare system that meets the needs of Canadians along a continuum of care. This must not only include patient care within hospitals, but also in care homes and as outpatients. The change must happen; what is now in question is whether we as physicians will decide to take hold of this transition to create our own future or whether we will allow politicians to do it for us. Given our knowledge and experience, we are arguably in a better position to make the most appropriate decisions with regards to our profession. Why, then, would we choose to abrogate our responsibility?

The CAR and Canadian radiologists must be willing participants and help to generate a new or revised paradigm for the delivery of imaging services. In the United States, Medicare and Medicaid fees for outpatient CT and MRI have been targeted for significant cuts stressing the profitability of private units. The American College of Radiology has recently expressed concern for the sustainability of the fee for service model in the US. Would it be any more sustainable in Canada? Which alternative funding model will work best for the system as well as for the radiologists in the US and in Canada? Is salary the only option?

The American system does not seem to be working. There have been instances where radiology groups have been let go for little or no apparent reason. Should we expect American radiologists to begin the pilgrimage north to enter the Canadian healthcare system and to compete with recent graduates for jobs? Initially, most would be able to practice in Canada with only their American Board Certification. For the first time Canadian radiologists may be earning more for the hours worked than our American cousins. All radiologists are working very hard to meet the growing demand for diagnostic imaging; however relative to 10 years ago, Canadians are doing much better than our American counterparts. Who would have thought?

Hospitals are afraid of what “Obamacare” will mean for their bottom line. Some have fired entire radiology groups and then hired a few back on salary to do most of the work. The extra cases, including subspecialty reads, are being sent to some of the 150 American teleradiology groups. Nighthawk, which was the largest teleradiology group in the US, was recently bought out by VRad (www.virtualrad.com). The company now reads for 2700 facilities in the US with 325 radiologists, most of which are US-based allowing them to do final reads and bill for them. Hospital administrators may see this as an opportunity to bypass radiologists altogether in the negotiation process in favour of dealing directly with teleradiology companies.

It seems that radiologists in the United States are becoming a commodity and valued ONLY for their ability to read cases. My guess is that some of the radiologists who were fired were NOT seen to be “an integral member of the healthcare team” and not enough colleagues stood up to support them. It appears that they did NOT bring ADDED VALUE to their institution; do you?

Radiology MUST change the way it delivers service to the healthcare team. Compared with the past, we seldom meet with clinicians nowadays to discuss cases. How hard do we try? Do we go to the ICU to read cases and make ourselves available for consultation? If not, why is that? How much research is done by radiology? Not much anymore. These are broad generalizations which I know don’t apply to all Canadian radiologists all the time. All of you that I have met on my travels, however, understand and share these concerns.

The CAR is embarking on several ambitious projects to determine our future. We are beginning to develop a comprehensive strategic plan that will cover the next 5 years. To help us with this process, we have engaged an experienced consultant group.

As always, accreditation plays a significant role in the CAR’s mandate. In addition to our Mammography Accreditation Program, which has been in operation for 17 years, and our BMD Accreditation Program, which is now ready to be rolled out, we are also working on strategy to meet the accreditation needs in Canada for multi-modality accreditation that is of the highest calibre.

This accreditation exploration is a part of more intensive research we are undertaking to enable the CAR to develop a national strategy on quality for imaging to meet the varying needs across the country. Canadian radiologists need its national association leading the way for the best interests of Canadian radiology and patient care. Recent events in British Columbia demonstrate just how important it is both for the integrity of our profession, as well as the safety of our patients, for radiologists to lead the way in establishing standards at a national level. Following the announcement that three radiologists in BC would be undergoing investigation for discrepancies in their readings, the CAR joined the British Columbia Radiological Society (BCRS) in mitigating media scrutiny. We have, and will continue, to offer our support to our colleagues at the BCRS as well as to all provincial associations.

A comprehensive peer review process is lacking in radiology as in many other areas of medicine. This must be done by radiologists and not by others, especially non-physicians. The CAR is developing a strategy to include peer review that will meet emerging requirements for Canadian radiologists.

We do not need to be pessimistic about our future BUT change is already upon us. If we are smart, we will help create a future for radiology that meets the needs of radiologists as well as the system; a future that is patient focused, sustainable and addresses clinically relevant healthcare problems. Finally, we will succeed when we are and are seen to be “an integral member of the healthcare team.” You ARE a member of the team when you pursue your role and are recognized as a consultant (interpretation, case review, rounds, administration, committees); available as a problem-solver and involved or support radiology research. These are the roles in which radiologists excelled in for many years but recently have lagged behind.

Help the CAR work for you and our profession for the betterment of the Canadian healthcare system.

We hope to see you at the Annual Scientific Meeting in Montreal April 28 – May 1, 2011.
To register, please go to www.car.ca


Dr. E. A. (Ted) Lyons, OC, FRCPC, FACR
President, Canadian Association of Radiologists


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