Radiologists as Gatekeepers? No thanks..

There has been a lot of discussion in the imaging community about Dr Saurabh Jha’s opinion piece published last week in the New England Journal of Medicine (From Imaging Gatekeeper to Service Provider — A Transatlantic Journey http://www.nejm.org/doi/full/10.1056/NEJMp1305679).

Dr Jha makes some excellent points about how radiologists must move to the center of the care delivery process if we are to thrive in the new value-based healthcare universe. The Imaging 3.0 initiative at the American College of Radiology (http://www.acr.org/Advocacy/Economics-Health-Policy/Imaging-3) aims to help radiologists do just that. I’ve been fortunate enough to work closely with ACR board of Chancellors Vice Chair Dr Bibb Allen Jr on this project and it is already inspiring radiologists all across the country to look at how they can enhance their value in their own practice settings.

What seemed to generate most discomfort was the idea that radiologists should embrace the role of gatekeepers. Those of us who are old enough to remember the “good old days” of Managed Care in the 1990s shudder to think that we’d play that role. I don’t think Dr Jha meant it in those terms but some of the Twitter activity suggests that that was how it was read. You can see a summary here http://storify.com/DrGMcGinty/radiologists-as-gatekeepers-no-thanks

Rather than act as a gatekeeper I want to be an integral part of the care team. I am fortunate in that I already work closely with my physician colleagues to determine the best course of care for our shared patients. As a breast imager, I examine patients, consult with them on their imaging findings and regularly discuss their care with both their primary care providers and the specialists to whom they are referred.

One Tweeter, a young Emergency Department physician, called the concept of radiologists being involved in guiding appropriate imaging “a laughable concept” he goes on to say “in what fairy tale land will radiologists start examining pts and taking liability for refused scans?” I am acutely aware that any decision I make carries a potential liability risk but that doesn’t mean I want to subject my patients to unnecessary imaging that might discover false positive “incidentalomas” that will add to rather than reduce their concerns.

@DrPaulDorio probably put it best when he suggested that an alternative to “gatekeepers” might be “facilitators” or “collaborators”. I actually like “clinical colleague”, pretty much says it all for me.