Turf wars in radiology: Other causes of overutilization and what can be done about it

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Abstract

The overutilization of noninvasive diagnostic imaging (NDI) is a complex problem with many other aspects aside from self-referral. This article discusses (1) other causes of overutilization, (2) the rationales used by nonradiologist physicians to justify self-referring their patients for NDI, (3) the extent of self-referral by radiologists (called “autoreferral” by some), and (4) steps that could be taken to curb the overutilization of NDI in the United States. It is important for radiologists to be familiar with these issues and to support efforts to control overutilization.

Section snippets

Other causes of the overutilization of noninvasive diagnostic imaging

Although self-referral is the principal cause of the overutilization of imaging, there are other factors at work as well (1). Defensive medicine is likely the next most important reason for overutilization. The fear of malpractice liability pervades the thoughts and daily activities of most practicing physicians these days. One way physicians protect themselves is to get imaging studies on patients of theirs just so no one can ever accuse them in court of not having gotten those studies, no

Rationales used by nonradiologist physicians to justify self-referral for imaging

After the publication of the Hillman studies on self-referral for imaging in the New England Journal of Medicine [10] and the Journal of the American Medical Association [11], a number of physicians in other disciplines wrote letters to the editors attempting to justify self-referral for NDI by nonradiologists. Temple [15] argued that an ordering physician can integrate clinical with imaging information better than a radiologist and also pointed out that outpatient imaging in a private

Self-referral (or autoreferral) by radiologists

Varipapa [16] has charged that self-referral is also rampant among radiologists, a practice he termed autoreferral, and some radiologists have acknowledged that this is a concern 17, 18. Baumgarten and Nelson [18] carried out the only systematic study of this phenomenon of which we are aware. They reviewed 545 consecutive abdominal CT scans and tracked recommendations for additional imaging. In 105 (19%), the interpreting radiologists recommended additional imaging, but the treating physicians

Steps that could be taken to curb the overutilization of noninvasive diagnostic imaging

There are a number of steps that could be taken to curb the overutilization of NDI, regardless of the cause. Some are steps that should be supported by radiologists. Others are steps that the radiology community should actively undertake. Still others are steps that could adversely affect radiologists, albeit not to any great degree.

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