Med’s Dead, Baby

“Now, even at the most ‘academic’ of medical schools, the clinical faculty are paid directly by health systems, their salaries depend on their ability to generate fees, not research papers, and their time is managed by service line administrators.”

– Baylor University cardiologist, Milton Packer MD, arguing that the traditional med school business model (making great MDs and producing great research) is now “dead,” replaced by the new goal of generating fees. Sounds a lot like college sports.



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Med’s Dead, Baby
Baylor University’s Milton Packer MD made waves across the medical and academic communities, declaring the med school business model “officially dead.” Grant-funded production of great doctors and great research, along with providing great patient care, may have been the med school model between the 1950s and 1980s. However, Packard argues that increases in healthcare funding made producing doctors and research much less important over the last 30-something years. All you have to do is follow the money, as “even at the most ‘academic’ of medical schools, the clinical faculty are often paid directly by health systems, their employment and salaries depend on their ability to generate fees, not research papers, and their time is managed by healthcare and service line administrators. . .” Meanwhile, the folks in academic leadership positions (deans, etc.) who don’t have authority over the health system or service lines have been relegated to “figureheads . . . relics of an obsolete structure, which has no funding and little decision-making capacity.” Healthcare Twitter seems to largely agree with Dr. Packard on this one.


Konica Minolta Gets Precise
Konica Minolta’s late 2017 acquisitions of Ambry Genetics (genetic testing) and Invicro (imaging CRO) have been widely viewed as moves to help the company enter the Precision Medicine arena and diversify beyond radiology. Although this perception isn’t incorrect, Konica Minolta’s RSNA booth revealed a much stronger connection between its two healthcare pillars than many in the industry may realize. One of the best examples of this connection is Ambry’s new C.A.R.E Program, which can integrate genetic cancer risk data into imaging center workflows, giving clinicians greater patient insights to support their image diagnosis and follow-up recommendations (e.g. additional scans or ongoing screening). Konica Minolta isn’t the first to tie radiology into precision medicine, but it’s RSNA messaging and recent acquisitions reveal a far greater (and more-balanced) focus on precision medicine than most of its imaging rivals.


German Students, Not Afraid of AI
Several weeks after a survey revealed that an incredibly-high 67.7% of Canadian radiology students (n=322) believe AI will reduce demand for radiologists, University of Cologne professor, Dr. Daniel Pinto dos Santos, took the stage at RSNA to highlight very different findings. His study revealed that 83% of students at three of Germany’s major med schools (n=233) did not believe radiologists would be replaced by AI, although the vast majority believed AI would revolutionize (77%) and improve (86%) radiology. It’s debatable whether AI “reducing demand for radiologists” and “replacing radiologists” are directly comparable (the German study didn’t go into demand), but it’s very possible that both sides are right.


The Non-Rad Imaging Business
Non-radiologist physicians, especially cardiologists, can make a lot of money from medical imaging. This is according to research performed by a team of radiologists (you guessed it…), who found that the 25 non-radiologists with the greatest medicare billings generated a greater share of reimbursements from imaging than other lower-earning non-rads. The highest-earning Cardiologists stood out, attributing a whopping 18.3% of their billings from imaging ($578,265 mean), followed by vascular surgery (11.6%, $364k), obstetrics and gynecology (10.9%), and orthopedic surgery (9.6%, $113k), while the most common non-rad imaging payments were from ultrasound (45%) and cardiac nuclear medicine (40%) studies.


AI for Imaging Cybersecurity
Combining two of 2018’s hottest medical imaging topics (cybersecurity and AI), researchers from Israel’s Ben-Gurion University introduced an AI-based security system that can identify if a CT scanner received a malicious command and then respond by notifying an operator or potentially stopping the CT system. The security system features various advanced machine learning and deep learning methods that are trained on actual CT commands, allowing it to spot any illegitimate commands. Makes sense. The researchers focused on CT systems given a CT hack’s ability to harm patients (by increasing radiation exposure or altering imaging results), although this approach could likely be used on many connected medical device types. It’s been an interesting few years for medical cybersecurity, driving increased awareness of potential threats and increased debate over who’s responsible for protecting devices, and although this solution may not make it onto imaging devices (at least in the near term), this team’s approach and the goal behind it have some potential.



The Wire


  • Here’s another side of the med school business model story at the top of this issue. New research (n=47) from the University of Pittsburgh Medical Center found that radiology medical students using web-based radiology curriculum hosted on Radiopaedia.org achieved better mean knowledge scores (74%) than their peers who used traditional learning materials (68%).
  • MEDNAX continued its radiology practice acquisition spree, acquiring Boynton Beach, Florida-based Bethesda Radiology Associates, and integrating it with MEDNAX’s Radiology Associates of South Florida practice (was acquired by MEDNAX last year). This acquisition appears to have direct ties to the 2017 merger of Baptist Health South Florida (contracted with MEDNAX) and Bethesda Hospital (prev. contracted with Bethesda Radiology Associates), uniting the greater Baptist Health system under a single provider. It’s also another sign of MEDNAX’s increased acquisition focus, as five of the nine radiologist practice acquisitions in its history happened in the last 14 months.



The Resource Wire

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