(1)
Department of Radiology, UMDNJ-New Jersey Medical School, Newark, NJ, USA
Abstract
How do the various specialties and specialists in American medicine get along? Idealists might say that all differences and disputes are resolvable. For them the overall picture is one of collaboration and cooperation. Separation of responsibilities are agreed to in principle and have been authorized and validated by the formation of board certification from way back in the 1930s and by the creation of distinct curricula in the post war period which was strengthened by the increasingly specific regulations of the (ACGME) the Accreditation Council for Graduate Medical Education from the 1970s to today. Moreover, while state medical boards are concerned with licensure of physicians, a whole range of policies and regulations indicating criteria for insurance reimbursements, hospital payments, and malpractice case law, as well as focused accreditation programs have further defined the boundary conditions separating the work of each specialty.
How do the various specialties and specialists in American medicine get along? Idealists might say that all differences and disputes are resolvable. For them the overall picture is one of collaboration and cooperation. Separation of responsibilities are agreed to in principle and have been authorized and validated by the formation of board certification from way back in the 1930s and by the creation of distinct curricula in the post war period which was strengthened by the increasingly specific regulations of the (ACGME) the Accreditation Council for Graduate Medical Education from the 1970s to today. Moreover, while state medical boards are concerned with licensure of physicians, a whole range of policies and regulations indicating criteria for insurance reimbursements, hospital payments, and malpractice case law, as well as focused accreditation programs have further defined the boundary conditions separating the work of each specialty.
Yet that splendid picture has a certain Currier and Ives quaintness quality to it, at least that is how the realists and skeptics might see it. Although there is perhaps a consensus regarding the separation of responsibilities among the treating specialists, such as between surgery and medicine (with the exception, perhaps of the face where oral surgeons, plastic surgeons, ophthalmologists, and otolaryngologists contend for turf) with regard to ancillary services, however, the situation is unsettled despite the perceived content and intent of its traditional practitioners in radiology, pathology and anesthesiology. These various fields are considered fair game by medical imperialists wishing to expand into new territory.
Thus, we are all aware that more imaging is performed, interpreted and is the recipient of compensation by non-radiologists than by radiologists, at least in volume terms if not in dollars terms. Despite ostensibly congenial relationships, the imaging terrain is the locus for thrusts and parries by those who wish to compete with us. Until recently, the most promising ground for a non-radiologist was the imaging center. Many of our contending cardiologists or gastroenterologists function in these settings, some of them owning or at least leasing equipment there which indicates to all but the most naive that Stark regulations have a gap in it so wide that a tank could drive through them.
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