I'm not going so far as to say that radiology shouldn't exist, but the specialty strikes me as one that exists out of, perhaps, fear of getting sued rather than a real medical need.
I'm an ENT resident. I was on trauma call last night and sure enough we had an MVA involving some facial injuries. I read the CT myself. Went over it with my chief resident. Discussed it with our attending. And we took the patient to the OR without ever seeing the "official read" from the radiologist on call. In fact, the official read wasn't available until a few hours after the patient was wheeled into the PACU. This is the routine. Not just for my service, but for most services. The official read on images is often an after-thought.
In reading the official read, the radiologist noticed a calcified cervical lymph node. Great.
I do hope you follow up about this patient. If it turns out to be metastatic disease, I bet we never hear from you again...Edit: Or we might never hear from you again because you're banned...
My problem with radiology is this:
First, what other service in any hospital, with infectious disease being perhaps the only other, is automatically consulted for every test, diagnosis, or treatment that falls within its scope? For example, could you imagine if hematology was automatically consulted to evaluate every CBC/diff that was ordered? Or nephrology consulted for every urinalysis? Or plastic surgery for every wound? So why is it acceptable for every last image ever taken in a hospital from a brain MRI to an ankle x-ray to be required to be evaluated by a radiologist (who will then make money for reading the film....often a couple hours after the fact even in the middle of the day).
Pathology...Your problem has been rectified.
Every single surgical specimen that is taken out in a hospital is analyzed by Pathology. Even obvious things like objects taken from patients (wherever they might be taken from) are signed out as a "gross only." Private practice pathology can make a salary comparable to Radiology, as I know a number of people in the field.
If you had a microscope available, or at least microscopic images available on the computer, would you feel comfortable with acting on what you "think" is correct, or would you still want the pathologist to take a look? This is the direction that Pathology is moving. After all, you have had a semester of histology and a year of pathology. That's much more formal training than you've had to become a radiologist, I'm sure. The reason that you feel the specialties you've noted can read images just as well as radiologists is that you're ignorant to the scope of the field. You can look at the head and neck and your respective approaches to the surgeries involving those structures, but I'm willing to bet that you're rather oblivious to more subtle findings...Like a calcified lymph node.
I had asked this of the radiology residents at my hospital and he said this: "Because we may catch something that other people missed".
This statement really angers me because 1. It applies to consulting every specialty out there, and 2. because it justifies radiologists' automatic involvement in every study by incidental, serendipitous, irrelevant findings (e.g. the calcified node I mentioned above).
This is a rather ignorant view. Do you think that the Chest radiologist really wants to be involved with every single CXR performed in the hospital? Do you have any idea what the reimbursement rate is for a CXR? I'm guessing not...I bet you get paid twice as much for cleaning ear wax. No, that's not a sarcastic or insulting statement.
Yes, radiologists make plenty of findings on images that the doctor ordering the study was not even looking for. Even if some of these findings are serious and worthy of further investigation, it needs to be noted that radiologists aren't doing this for free as a favor for patients. They are getting paid ungodly amounts of money to make these incidental findings. And the key word here is incidental. If a patient gets an abdominal CT for a uterine mass and the radiologist identifies the the uterine mass (after the OBGYN identified it), but also identifies an inguinal hernia or a kidney stone or whatever, this does not justify paying a radiologist.
Does assessing the extent of the disease justify paying the radiologist? This allows the OB/GYN to make the proper approach to the surgery, not to mention if they will perform the surgery at all.
Having a radiologist read the image to make extraneous findings unrelated to the "targeted" pathology is a luxury. But in our system, it is a luxury that takes place by default, and radiologists have been raking in piles of money for this.
It seems as if your biggest problem with Radiology/Radiologists isn't so much that they exist, and they are consulted on every radiologic study in the hospital, but rather that they are paid well to do so. This is purely because of volume. Much like dermatologists (which are often consulted on nearly every skin finding, as I'm sure you know), they have increased their volume to obnoxiously high levels in the recent past. A decade or so ago, it might have been true that the Radiologists of the day would pontificate on a few studies all day, but that is no longer true. So, if Radiologists made ID salaries (since you suggested them earlier without antagonism), would you have made this post?
Combine that with the fact that any cardiologist can read an echo every bit as well as a radiologist (and identify its clinical significance far better)
Radiologists don't read ECHOs, typically. This is a beautiful example of the fact that, if what you were saying through most of this were true, Radiology would no longer exist as a field, as each respective specialty would take over their associated imaging modality. Can you do me a favor and find a Cardiologist that can read a triple rule out?
any neurosurgeon can read a head/spine CT or MRI as well as a radiologist
They think they can.
any pulmonologist a CXR or chest CT
Have a discussion with your friendly, local (not arrogant) pulmonolgist about this one. I think the results might surprise you.
As you've mentioned, radiology is a consult service. Just like infectious disease. Anyone can throw out antibiotics, but when you come to the tough cases, you want back up. Trust me in saying that most radiologists (at least academic) would MUCH prefer to only be consulted on the interesting/hard cases, but that's never going to happen. As a society, we've established that it's worth paying a Radiologist "so much money" to detect that one calcified lymph node in the trauma patient, even if it means having a negative study in 9 other patients. Edit: I just read through the other posts. Since I'm so early in my training, I (much like you) don't know what's important in these studies. Shark listed out a number of things that are more important than the fractures you diagnosed. Just because the Radiologist didn't include it in the report doesn't mean they weren't looking for it.
one becomes very hard-pressed to see why it is that radiologists make so much money. And the reality on the ground supports this question, as I mentioned above. Clinical decisions are made routinely without even bothering to look at the radiologist's read. And there seems to be a lot of out-sourcing of images for evaluation.
Anyone care to discuss this?
Again, it seems that your problem isn't so much that Radiology exists or that Radiologists are involved in every study, as you originally claimed as your thesis, but rather that they make a significant amount of money. Again, I ask if Radiologists made ID money, would that make you happier, or should they just not exist at all? Anything to move up one place in the physician salary Olympics, I suppose.
By the way, as a future IR physician, I love the fact that you didn't even mention the ridiculous salary that I'll make for, as you would probably put it, "doing stuff that everyone else can do like putting in drains, G-tubes and ports." <3 you so much.
I literally laughed out loud when you mentioned something like, "embolizing a tongue mass wouldn't be very hard."
This thread is a gem.
