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Subspecialty expertise is becoming widely adopted as a key competitive differentiator resulting in high quality reports, increased physician satisfaction, improved patient outcomes and a niche marketing tool to increase referrals. A variety of factors have converged to increase demand for access to subspecialty expertise on a broader level and in some instances, “hyper-subspecialists” are beginning to emerge as subspecialists narrow the focus even deeper by only interpreting high volumes of vary specific cases such as MSK MRI of the foot/ankle. Imaging facility and group practice administrators and owners must understand how subspecialty expertise will shape their service offering going forward as they build their business, operations, staffing and marketing plans. Factors Driving the Demand for Subspecialty Teleradiology • Radiologist Shortage (not enough radiologists and even fewer subspecialists to support procedure increases), only 25% are qualified subspecialists vs. 28% in 1994 and fewer residents are taking fellowships. It typically takes 12-13 years for a subspecialty radiologist to get through school and have at least two years of post-graduate experience.  • Advancements in Modality Complexity (requires more of a radiologist’s time, education, and focus and it becomes very challenging for any one radiologist to be great at everything.) “ …the level of diagnostic sophistication required by those who perform and interpret imaging examinations has been elevated by the greater sensitivity and specificity of advances in imaging technology. Each improvement in technology is accompanied by the need for added knowledge on the part of interpreting radiologists.” (Editor in Chief of AJR) • Medicine Specialization (specialty physicians expect complimentary interpretations from their radiologists which requires the radiologist to understand their specific medical/surgical terms and to “speak the same language” as clinicians in order to help them provide the best patient care and surgical outcomes. Physicians are requesting advanced applications that require detailed clinical pathology in reports and radiologists have to be up to speed. • Lack of high volume subspecialty cases at most imaging facilities Once a radiologist decides to dedicate his or her career to a subspecialty area (i.e., MSK, neuroradiology, body imaging, etc.) the next challenge is to practice at an imaging facility that generates enough volume of specific subspecialty cases in order to build and/or maintain expertise. “I joined Franklin & Seidelmann Subspecialty Radiology because it allows me to maintain a higher level of expertise in musculoskeletal interpretations to enable me to be a more effective teacher, and this is important because the more you read, the better you are,” explains Dr. Javier Beltran. “Everybody that works at F&S gets access to a high volume of studies and I found F&S to have a better organization due to experienced, available personal, including IT support and a better infrastructure model,” adds Beltran. These factors have driven the need for the subspecialty teleradiology model to emerge as a viable solution. Subspecialty teleradiology can be used as the only interpretation resource or it can be integrated with other staffing models to provide the most optimal staffing strategy that supports procedure types and volumes and physician needs. This model works because it serves the hard-to-find subspecialists, imaging facility clients and their specialized physicians who require high quality, clinically focused interpretations. Franklin & Seidelmann is the only dedicated subspecialty teleradiology network and has experienced much success based on its ability to attract leading subspecialty radiologists, develop a high performance teleradiology platform and operational processes and provide consultative client services, which have several advantages for its stakeholders: For Subspecialty Radiologists: 1) Convenience of working from any location 2) Interpret studies in your dedicated subspecialty area only 3) Collaboration with a team of industry and academic leaders 4) Experience a high volume of subspecialty cases aggregated from a national client base 5) Case load flexibility to meet your work and lifestyle 6) Provides security and stability for the group For Imaging Facilities: 1) Easily access a network of dedicated subspecialty experts no matter what your location – get the best in the country vs. the best in your local area 2) Large national network guarantees full-time coverage across time zones 3) Optimize or complement staffing model with subspecialty expertise when it's needed 4) Increase physician satisfaction with clinically focused reports and proactive consultations 5) Increase referrals and resulting revenue by niche physician targeting with subspecialty reports 6) Mitigate malpractice exposure 7) Build credibility with local physician market via subspecialty expertise For Radiology Group Practices: 1) Optimize or complement staffing model with subspecialty expertise when it's needed 2) Easily access a network of dedicated subspecialty experts no matter what your location 3) Increase physician satisfaction with clinically focused reports and proactive consultations 4) Retain existing or acquire new contracts and resulting revenue by adding subspecialty expertise required by physicians 5) Mitigate malpractice exposure “Small groups cannot provide subspecialty expertise—it makes no economic sense for them to attempt it—and yet, subspecialty expertise is what the market wants," he says. "A group of five would simply have no viability if it consisted of a nuclear medicine specialist, a body imager, an interventionalist, a mammographer, and a neuroradiologist, for instance. But each of those subspecialists could be very viable in a group with 20 or more generalists." (Decisions in Imaging Economics, June 2006) - Lawrence R. Muroff, MD, president and CEO of Imaging Consultants Inc, Tampa, and a clinical professor of radiology in the colleges of medicine at the University of Florida and the University of South Florida How Does Franklin & Seidelmann Subspecialty Radiology Define a Subspecialty Expert? • Has a narrow focus by clinical specialty, modality, pathology, and body part • Provides definitive answers to difficult clinical problems • Provides repeatable and consistent interpretations • Understands clinical issues, terminology and procedures relevant to each specialty • Is an essential colleague and consultant to physicians, participating in the “team approach” to medicine • Uses very high case volumes to build and maintain expertise – 40-60 interpretations per radiologist per day • Has extensive experience and academic affiliations
Acquiring this level of expertise is difficult in the traditional on-site radiology environment, because there is not enough annual case volume to adequately support subspecialty MSK training:
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