Technology has been a wonderful friend to the medical community, and the imaging sector is no exception. But one radiologist, Barry Pressman, MD, says that technology is driving the need for radiologists to choose a subspecialty in order to keep up with the continuous change in the field.
"As technology advances your ability to keep up with it diminishes and the only way to survive is to choose your area, or limit your areas," Pressman told Medical Device Daily.
Pressman addressed the changing field of radiology and the need for subspecialization in his speech, "Presidential Address: Distinction or Extinction," which he delivered at the American College of Radiology's (Reston, Virginia) annual meeting in May. The speech also appears in the October issue of the Journal of the American College of Radiology.
"Specialization is the wave of the future but it's not just the wave of the future, it is now," Pressman said. "I just felt it was important to address the issue in my speech because the American Board of Radiology, which does our board exams, has made some announcements changing their structure, such that subspecialization is not only available, it's encouraged."
This has caused subspecialization to become a hot topic in the radiology community, Pressman told MDD, because while there are many radiologists switching over to a subspecialty, there are also a significant number of them resisting it.
"So I just took an issue that was sort of smoldering and hopefully lit a fire to it."
Pressman has been a neuroradiologist for 35 years. When he became a subspecialist in 1973, he said, subspecialists were a minority. Now, he believes, they are a majority. "But not an overwhelming majority, we still have a large number of people who trained in my generation or half a generation later, who try to do the entire watershed of imaging," he said.
Pressman told MDD he was approached by one of his colleagues, a radiologist just a few years younger than himself, before delivering his speech who asked him, "are you going to piss me off?"
"And afterwards he said you pissed me off' because I addressed the issue head on ... I have more people thinking about it, hopefully young people thinking about it. There's no way to stop progress and subspecialization is progress."
As with anything, the big driver behind progress, of course, is technology.
"As technology advances and we become more sophisticated in its use and its abilities you need people who are more and more expert in applying those new procedures and interpreting those new procedures," Pressman said.
In his article Pressman points out that in 1970, when he was beginning his residency, ultrasound was in its infancy. "We couldn't even spell CT, let alone MR," he wrote.
He elaborated on this point during a phone conversation yesterday with MDD: "We did plain X-rays ... we couldn't see the brain itself as we could with CT and now with MR we can not only see the brain, but we can see the functioning of the brain."
That's why he believes it is so important for radiologists – especially those just entering the field – to choose a subspecialty rather than trying to "do it all."
"The things we can do now are so sophisticated compared to what we could do before ... its hard for any one person just to keep up with all of that and I don't do it all."
Pressman's speech also points out other challenges that radiologists have faced over the years as technology has progressed.
"Too often, especially recently, while the science of radiology has been moving forward, we radiologists have been pushed back," Pressman said.
Just one of several examples he used is the advance of radiation therapy: "We advance radiation therapy, only to hear every Tom, urologist, and Harry, declare himself a radiation oncologist."
Pressman also urges radiologists to take the lead in combating commoditization by continuing to deliver value to the healthcare system through frequent patient and referring physician interactions, initiating research opportunities, and delivering quality interpretive consultations, rather than just a list of findings, through their reports.