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Latest JACR: Vertical Integration: The Case for Combining Emergency Radiology Into EM
Is this just a massive troll? Who is this guy? So many levels of FUBAR. This is our own ACR allowing such nonsense. What other speciality is so self deprecating and pathetic?
I am strongly considering cancelling my ACR membership.
[link]https://doi.org/10.1016/j.jacr.2020.06.018[/link]
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32 Replies
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“Often the referring ED physician or physician extender is unclear which imaging study to order, whether contrast should be used, and whether premedication is required, and sometimes orders are simply overly broad, all of which may require extensive back-and-forth discussions between the radiologist and the ED before a radiologist can correctly protocol the study”
This can be EASILY sorted out by having max 3 meetings with the ER medical providers. We did it ! Protocols are easy to follow and ER rad is always there if there is additional question by the medical provider. To destroy ER radiology and integrate it into ED medicine just because people are too lazy to coordinate to make protocols is bizarre and BS.-
In this “vertical integration”, who swallows who? Quite often, the radiologist is the only MD directly involved in an ER patient’s care already right now.
The article addressed this:
“One could obtain the same efficiencies and decreased liability inherent in vertical integration by taking the opposite approach: absorbing emergency medicine into emergency radiology, whereby physician extenders working directly for the radiology department would examine the patients, imaging would be obtained and reviewed by a radiologist, and the radiologist would thereafter address disposition of the patient. (In fact, the original genesis of this article took this radiology-centric approach but was recast out of concern that radiologists were less likely to want to become effective ED clinicians than vice versa). Although emergency medicine personnel are already delving into imaging, most diagnostic radiologists prefer the consultant role rather than that of directly managing patients, with some choosing the field precisely because of limited patient contact, so a merger into emergency medicine seems more viable, albeit controversial.”-
How long does it take to read a study and how long does it take to address the disposition of the patient. I thought radiologists are smarter than that.
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Quote from RADD2010
How long does it take to read a study and how long does it take to address the disposition of the patient. I thought radiologists are smarter than that.
Apparently not, if you work at Yale.
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Quote from mskrad1
Quote from RADD2010
How long does it take to read a study and how long does it take to address the disposition of the patient. I thought radiologists are smarter than that.
Apparently not, if you work at Yale.
Is this from Yale? I recall recently reading about an article/”study” from their ED department comparing ED residents and ER PAs and (if I recall correctly) wanting to create a ED residency/pathway for PAs or something along these lines. A lot of p*ssed off postings at the ED forum on SDN
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Let ER docs deal with emergency medicine. Let radiologists determine imaging of ED patients. Clinical decision support from ACR offers algorithms, and these are readily available with online search of appropriateness criteria (AC) of various clinical situations. These ACs fulfill impending PAMA requirements which CMS will soon require. ACR’s R-SCAN promotes collaboration to improve imaging appropriateness.
I can foresee future integration proposals: integration of orthopedic imaging into rheumatology/orthopedics ; integration of GU imaging into nephrology/urology; integration of thoracic imaging into pulmonology/thoracic surgery; integration of neuro imaging into neurology/neurosurgery, etc. Troublesome for patient care, to say the least, imho.-
Lets have gas combined with surgery. They can put their patients to sleep. One bill for patient.
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Did you read the entire journal? This issues is supposed to stir the pot. If we are truly the specialty of innovation, we shouldn’t be so reactionary to ideas. Although I do not support most of the premises in this issue, I am glad the ACR isn’t afraid to add diverging viewpoints to the typical echo-chamber.
“Rarely do we start an issue of the [i]JACR[/i] with a trigger warning: This special issue will provoke strong reactions from our readers, including shock, offense, and even disgust. The articles were deliberately selected to elicit these responses and will challenge the conventional wisdom across the imaging community.”-
Stirring the pot is one thing, its another ballgame entirely to actively advocate destruction of the profession.
Most ER docs arent going to want to read imaging. They have a different skill set and mindset. This would make their residency longer. One attraction to EM is the short 3 year residency.
Not to mention all the lawsuits for missed findings, cancer, aneurysm, etc. do they want to slow down their workflow going through this stuff w the patient, assuming they even see the finding?
There is a reason Radiology residency is as long as it is.
And the alphabet soup of credentials this individual has makes me wonder what his real motives are.
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Just a quick note from an old timer
Dont sweat this stuff
It comes up
Every 5 or so years. Everyone knows its stupid and unworkable and it dies off5 years later some other genius usually an ER doc with an inferiority complex convinces himself that radiology is easy and writes an article
I laugh all the time at FAST ultrasound and how it was supposed to be the death of radiology
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Stupid academics.
It makes more sense to vertically integrate academic radiology into creative writing field (read creative BS).
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We used to do FAST scans in the ER as a rad resident. We had to go every level 1-2 traumas to scan or be at the bedside ready to do one at the behest of the surgeons.
If it was negative boom CT. If it was positive unless the person was unstable boom they get a CT anyhow.-
A poorly timed April Fools Joke?
This thing reads like high comedy. Even the author’s bio makes me chuckle… [link=https://medicine.yale.edu/profile/jonathan_mezrich/]https://medicine.yale.edu.rofile/jonathan_mezrich/[/link]-
Quote from MD20/20
A poorly timed April Fools Joke?
This thing reads like high comedy. Even the author’s bio makes me chuckle… [link=https://medicine.yale.edu/profile/jonathan_mezrich/]https://medicine.yale.edu.rofile/jonathan_mezrich/[/link]I mean the “frosted tips” in the profile pic really tell you about all you really need to know. [:D]
That and all the “degrees” tells you he couldn’t cut it in the real world in any field. I’m sure he’s super “woke” too. #rolleyes-
All I can say is the profile pic looks ripped right off a by line from an article in The Onion.
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[b]”But what if (and I suggest this largely as a devils advocate to inspire conversation or debate) emergency medicine simply absorbed the imaging step in its assembly line process?” From the Article.[/b]
Based on my read, I don’t get a sense that he is suggesting it be done…-
Nothing surprises me in a world where people convinced bread and butter radiology to become a separate field with its own fellowships. ED radiology, LOL. Sounds like residency
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Well, I disagree. I found my ER fellowship useful. I think part of the problem highlighted in this article is that traditional radiologists and departments, do not want to meet the operational demands of the ED.
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I agree with NYC on this. Rad departments need to work with ED to chart out how the studies are protocoled. Since there are more “physician extenders” in ED medicine ordering studies than there are ER rads, this becomes more acute.
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I will add that it is a 2 way street. EM and ED need to understand their operational demands impact on radiology and radiologists.
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Physician extender algorithm: Order imaging where it hurtey.
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Quote from MD20/20
All I can say is the profile pic looks ripped right off a by line from an article in The Onion.
From the linked article: “”Another alternative to this overlapping or combined training could be for radiology to offer sequential training and fellowships to ED physicians, with the result that they will be dual boarded in both emergency medicine and emergency radiology. (This dual-boarding approach has been used in multidisciplinary fields such as palliative medicine.)””
These sentiments might have well been written for the Onion.
What do academic (or any) rads think about educating PGY 2-3 ER residents? With any rotation out of the ER, these residents would pretty much use it as gym-workout time. And one could just imagine academic rads being real calm facing arrogant young ER clinicians, instead of typical eager first year rad residents.
Just wondering if this ever were to happen, how frequently over and undercalled PEs would be? BTW if an individual physician wants to be “dual boarded” in EM and DR, nothing is preventing that. However, the authors of this article must realize that there is a four year DR residency with its own board to pass.-
This is a really strange article and not in a fun what if? way. Its silly across the board. Feels so disconnected from how the sausage is made that Id expect the idea from a child. Honestly Im strangely depressed that academics are so detached from medicine this got published.
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I understand what these people are getting at. In a bizarro world, radiology could have evolved as specialty-specific, with clinical / surgical experts in the fields also interpreting the imaging studies, perhaps with formalized sub-specialized training programs.
But that’s not the world we have…. and it is going to now be virtually impossible to peel off one little slice of ED practice. -
I dont understand the premise either, its not like somebody with UIP , a horrible lung cancer or crazy neck mass etc etc dont present to the ED. This kind of concept makes it seem like the cases in the ED are just cranking out normals, appy and kidney stones. While that is true often times, there still are a lot of complex cases that no Ed doctor would ever want to touch with a 10 foot pole .
Also I dont think this makes sense in the ever growing world of specialization. Why should a radiologist spend time learning how to intubate, manage shock , resuscitate etc ?
Academics just love their endless training pathways . Maybe next the radiologists can learn to do surgery too . We could just have general practitioners that manage every aspect of the patients care. Admit them, read their ct , chop their osteo toe off and manage their diabetes. Funny how everything is a circle
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ACR isnt doing anything noteworthy to help our specialty, or please correct me if they have done something significant to help with reimbursement cuts, mid level creep, etc. By publishing this, they demonstrate a degree of implicit support. Otherwise they are just trolling us which is pretty despicable too.
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I bet you the “physician extenders” will be the 1st one to hop on this bandwagon. Something they haven’t been able to do traditionally as there haven’t been a huge backlog of studies for radiology as it is for the patients. The backlog of patients is the reason why physician extenders have been able to extend themselves as ER medicine, anesthesiologists, FP, surgery, derm etc. Oh that and the corporations !
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To be clear, this is a ridiculous suggestion and would require a complete revamping of residency.
ER residency would be 5-6 years minimum. There are way too many complex cases and incidental findings that aren’t simply looking for positive appy/PE/bleed etc.
Was just pointing out above that the article addresses the idea that radiology could also take over ER in a similar manner.-
MD 20/20: Yikes!
Yes we would be better at ED than they would at Radiology.
Farm out each symptom/abnormality to the appropriate specialist. Give haldol to the aggressive ones. If the patient comes in with a blanket, they are getting admitted.
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Some people just love to see their name on paper. So we would supervise a mid level who examined the patient and tell them what imaging is indicated without seeing the patient ?
This isnt the dumbest thing Ive heard but its close.
Academics love extended pathways. If they had their way everyone would do 10 years of residency , 3 years of research and a couple fellowships and youd first start working on your own when you are 40
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Quote from IR27
Some people just love to see their name on paper. So we would supervise a mid level who examined the patient and tell them what imaging is indicated without seeing the patient ?
There are a huge number of places that have very minimal MD/DO involvement in patient examination and ordering already. They basically have no supervision unless the radiology report or labs comes up with something interesting.
As I said above, the only MD truly involved in the patient’s care is the sometimes radiologist.
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Quote from irfellowship2020
Is this just a massive troll? Who is this guy? So many levels of FUBAR. This is our own ACR allowing such nonsense. What other speciality is so self deprecating and pathetic?
I am strongly considering cancelling my ACR membership.
[link=https://doi.org/10.1016/j.jacr.2020.06.018]https://doi.org/10.1016/j.jacr.2020.06.018[/link]
It is one person’s opinion piece, maybe not even his true opinion
Why cancel ACR on an opinion piece
Write a counter piece with others on this thread and submit it
