The Radiologist’s Real Job Description

We often think of innovation as creating new technology, but innovation also comes in the form of new business models, new regulations, and new ways to perform a craft.  Radiologists are in crossroads among a myriad of such “news,” the more comprehensively discussed among which are the reimbursement changes and regulation changes which have been discussed ad infinitum (e.g. here, here, here, and more).

Rather than discussing the impact of the new healthcare regulations on radiology and the emerging high-tech, social-media-connecting, cloud-based, deep learning, big-data-supporting, iPad-friendly, segmentation-compatible solutions , maybe it is worthwhile to take a few minute to think about innovating at a much lower level.  On the level of our job description.

Photo Credit: debspoons; freedigitalphotos.net

The first question that Harvard Business School professor Theodore Levitt asks of an organization looking to innovate is, “What business are you really in?” primarily because most people don’t know.  Not only does the real description tend to differ from what we expect, it also tends to evolve over time depending on external and internal pressures.  In his iconic disruption theory, Clayton Christensen uses the term “job-to-be-done” to describe a customer-centered mindset rather than a product-centered mindset for defining the role of a business.

Amazon.com started as a bookstore. It sold used books and mailed them to the customers. If Jeff Bezos had defined the job description of Amazon.com as “an online bookstore,” it would look very different today. Bezos’s vision, instead, was an “online sell-everything superstore” business, a vision that allowed the company to transform with the evolving time and grow.  However, if Amazon only competed on the one product you wanted to buy when visiting it, then the only differentiating factors become price and shipping speed.  Instead, the web giant innovates on the shopping experience, a related but very different job-to-be-done.  You might find it very difficult to go to the web site without shopping around, and for good reason.

While an interest to buy a particular item draws a user to Amazon.com, the website’s recommendation algorithm, the  “other people also looked at,” and the Gold Box deals draw attention to tangentially-related but still interesting products.

Amazon’s patented 1-click purchase would be marginally helpful for the goal-oriented buyer but shines when it makes extra impulse-driven sales from the casual shopper. The various benefits of the Prime membership, including free shipping and free instant videos are not so much random features as they enhance the casual shopper with time to browse.  They are part of a strategy that defines a coherent customer experience.

Knowing its job description also helped Ikea thrive despite the advent of the internet and large-scale discount furniture stores. Being “a little cheaper than the other stores” might have helped the Swedish company but certainly does not explain its dominance. Ikea fulfills a specific customer job-to-be-done, “get furnished today.“ Designed as a whole-day trip for those looking to furnish large spaces, the compact design of the DIY packages, the food court, and the linear, room-by-room rather than open store flow are not just coincidental idiosyncrasies that all Ikea stores share. While the DIY packaging can be easily replicated by a competitor, the other elements are not so easily adapted.  They come together to deliver a specific value proposition for the Swedish furniture store.

Healthcare is not the same as electronics, groceries, or furniture. However, one element from these other industries does translate: The aspect of our profession that is the most obvious is probably not the right job description to fulfill the job-to-be-done for our clinician colleagues and our patients.

What is the job description for a diagnostic radiologist?

If you believe that diagnostic radiologists have a “create a report from imaging study” job, then thriving in this job would mean little more than higher volume and faster dictations. There are only so many ways this concept will play out – through economy of scale, geographic consolidation, virtual-organizations.  Some even argue that this is a job description robots are designed to fulfill.

But – if you believe that radiologists are in the “deliver an accurate diagnosis” business, then it becomes easier to define what our roles are in the future of healthcare.

Delivering an accurate diagnosis means using the right imaging modality at the right dose. It means scheduling the patient in a timely fashion. And it means – yes – efficiently creating an accurate report with the right recommendations. Having a job description of diagnostics also doesn’t end with the creation of the report. It also means taking ownership to ensure that appropriate imaging and/or pathologic follow-up occurs.

The job-to-be-done for clinicians and patients who come to radiology is not simply for a report (although they say they just want the report). They want a diagnosis.  When a diagnosis is not immediately available, clinicians and patients want to know what they would need to get the diagnosis. Going over the radiology studies with the clinicians, creating individualized protocols, and providing patient-centered recommendations are not just incidental services radiologists happen to provide. In a “diagnostics” job description, all of these elements come together to create a unique value to patients, values that can only be delivered by a radiologist.

The delivery of a radiology report can be replicated by a determined competitor optimized for price and volume. Like Amazon’s myriad of features pointing all toward the same experience and Ikea’s iconic store design, the radiologist’s attentiveness towards pre- and post-imaging facets of diagnostics are not so easily replaced.  Irreplacibility is the antonym of commoditization.

Some people call this value-based imaging, others call it Imaging 3.0, but it’s really just being a radiologist who understands the job description. After all, the word “radiologist” implies that we are the personification of the entire field of imaging.

Howard Chen

Vice Chair for Artificial Intelligence at Cleveland Clinic Diagnostics Institute

Howard is passionate about making diagnostic tests more accurate, expedient, and affordable through disciplined implementation of advanced technology. He previously served as Chief Informatics Officer for Imaging, where he led teams deploying and unifying radiology applications and AI in a multi-state, multi-hospital environment. Blog opinions are his own and in no way reflect those of the employer.