Still a lowly MS3, so take my thoughts with a huge grain of salt. That being said, here are a few of those thoughts...
Organ specific imaging... so what are the cards, GI, pulm, or whoever going to do with all of the other stuff on the image? As far as I know, this has always been a sticking point. I know that people have been toying with digital subtraction, so that for example a cardiologist could remove everything but the heart, but that raises an ethical question if the machine captured much more and the cardiologist simply "deleted" everything he didn't want to see. Not much different IMO than it being on the screen and the card just not looking at it. This results in a radiologist needing to over-read the image for everything that isn't specific to that organ, and you generally don't get to pay two people for reading the same image. This greatly limits, for now at least, the amount of non-rads (final) reading of imaging.
Interventional procedures... yes, other specialties are doing many similar procedures... cardiology, vascular surgeons, neurosurgeons, even the brave general surgeon here and there, and I have heard of nephrologists being trained to do renal artery stenting. I can imagine them jumping at that idea. But the bottom line is that the use of image guidance during procedures is likely to blossom, both in quantity and variety of procedures. So there will probably be plenty of this to spread around to the other specialists, and probably plenty of new "IR" specific procedures that are cutting edge. Remember, technology is only going to increase and radiology always gets the cool toys first. Which also happen to usually pay well when new.
While I'm at it...
Outsourcing overseas... sure, there is a bit of this now. I had someone just today when they found out I was interested in rads try to dissuade me with the following scenario, paraphrased roughly as "sure, Mr. Gupta in India will happily allow you to cover night reads and be the 'guy on the ground' do push contrast and such, while he sits overseas and does the reads for a fraction of your fee, thus taking your business." Sounds scary. But India is on the other side of the world... their day is our night. They would be doing our night reads. Besides, the bigger point is that Mr. Gupta would have to be a US trained radiologist carrying US insurance and subject to the same regulations, malpractice exposure, etc. as anyone practicing stateside. Sure, a few will chose to "go back home" to India or wherever, or maybe take up residence in Australia or Hawaii to do night coverage for us and "live the good life" there, but it isn't hard to see why this will be largely self-limiting. You don't have to worry about outsourcing overseas until the time comes when reads can be done by a technician, or a non-US credentialed doctor, etc. And that time will never come. How are you going to sue the guy who missed the lung cancer when he wasn't even required to be fully trained in recognizing them and understanding the implication? And if he isn't trained, who in their right mind would provide him malpractice coverage? Not going to happen unless tort reform here evolves in a way no one can imagine. The doomsday scenario of a divergence of radiology specialties into IR, DR, and "field radiologists" is just a fantasy of people who never considered the field in the first place.
Teleradiology... a bigger "threat" than overseas outsourcing. But we're already seeing a decline in their popularity. It's useful to actually have someone there in person as much as possible, especially when they have real people skills. Teleradiology will likely continue to be a major competition (if you want to call it that, others might call it an option) for night coverage and rural clinic and outlying hospital coverage. Most radiologists don't want to work those jobs anyway, not in the traditional sense, so that's understandable. Though the field needs to be careful to keep a balance and not let them overgrow into more mainstream coverage... and it looks like this self-regulating is already taking place.
Reimbursement cuts... this is a real issue, and one that can't be easily dismissed. They're going to happen. People already think imaging fees are too high, so they're going to be on the chopping block in one way or another. Radiologists have a well funded voice on the hill, and are generally a bright group, and have traditionally been able to defend their turf and payment quite well, but the economy is in the crapper and a new sheriff is in town who looks determined to cut healthcare reimbursements in major ways. It wouldn't surprise me if much of today's imaging reimbursement rates were cut as much as 50% in the coming years. At that pay, I still think rads beats any other specialty, especially considering that the others are not immune from cuts either. On the other side of the coin, as I said above, radiology by its technology driven nature gets the new toys first. And new toys get paid well. There was a time not too long ago when plain films were all we had. Well, there was that weird CT precursor, can't remember the name, but its use was limited. We added US, which was and continues to be useful but limited. Then along came CT and it drastically changed the way we view the body. Also remember that MRI is a fairly new technology. And we've already seen maturation of these into CTA, MRA, etc. It is hard to imagine that MRI is the last great advance of imaging modalities. Who knows what the future holds, but one thing that is almost certain is that whenever it comes, radiologist will have the first crack at it and will get paid well for it. I can't see radiology ever becoming a stagnant field for that reason.
