February 1997

Cognitive Ability for Hire

By Michael J. Katin, MD

I was impressed with the response to January's column on "Our Professional Identity". This was not only because it proved that people are actually reading this material, but also because of the widespread interpretation that I was critical of the perceived relationship between the specialties of diagnostic radiology and therapeutic radiology. Any idea of this was by inference and certainly not intended.

This having been said, I want to further clarify that there remains an immutable relationship among radiologists of every type. Specifically, among medical specialist only radiologists sell an actual product to the public. There will undoubtedly be people responding with other examples, but in general there are no other fields of medicine in which a product is transferred as the primary function of the specialist. When one goes to a diagnostic radiologist that person can go home with a radiograph of some type. In practice, these are not actually given to the patients but are available to them and their designees, and with further moves towards patient autonomy, could actually end up being the physical property of the patient. Similarly, radiation oncologists sell radiation. One might quibble that the skill involving the decision on treatment and the technique of treatments are being sold, but in fact radiation oncologists who cannot sell radiation would be intellectually rich but also receiving food stamps. We are at a disadvantage in that most people do not suddenly decide to buy radiation, either on special occasions or as a gift, although these kinds of marketing would be able to be pursued if things get worse.

Taking this further, this means that radiation oncologists who do not own their equipment can be compared to automobile or appliance salesman who at no time own the product that they are selling and, therefore, serve at the whim of the manufacturer or distributor. If there are not enough customers for the radiation then the franchise ceases to be operational. It can become possible through sophisticated techniques to sell a greater quantity of radiation by delivering it in special ways, such as with 3D conformal therapy or b.i.d. fractionation. By selling different variations of radiation therapy, such as brachytherapy, the product line becomes more diversified and one can sell more radiation in total. Again, this is similar to having more than one type of automobile or appliance to sell. This is the same as with the diagnostic radiologist who only does routine studies and does not offer CT scanning, ultrasound, etc., who will have a hard time staying in business.

It has been shown over and over that physicians are not ever going to be rewarded for their cognitive abilities and the time has come to accept this and to admit that our business is sales (and, occasionally, service after the sale). This will mean negotiating the third-party payers to give discounts for volume and have loss leaders (discounted external beam in order to gain access to the system for selling radiation in the form of brachytherapy, for example). It is then only a matter of time before "early bird specials" and "end of year clearance sales" become common place.

You will have to excuse me now since we have to get the Frequent Fryer cards off to the printer.

email: mkatin@radiotherapy.com