But enough about me…

I am flattered that the publishers of Applied Radiology have asked me to be a regular contributor. Open Mouth View will present different topics and current items of interest related to radiology practice and imaging informatics.

Most industries are cyclical, and healthcare is no exception. In 30 years of practice, I have seen good times and bad. The ill-fated Clinton era healthcare reforms of the 1990s predicted an oversupply of radiologists to the extent that some might need to be retrained as primary care physicians. This incredible blunder resulted in a hiring moratorium in many practices, redounding to a multiyear radiology recession that I sometimes think of as a “nuclear winter.” Since that time, fortune’s wheel has made several turns, and I remain a bit skeptical when I hear current predictions on the future of radiology.

I spent the first 20 plus years of my career as a general radiologist in a small suburban Philadelphia private practice, and I served as Department Chair there for 10 years. During that tenure, I made many friends and not a few enemies. I made some good decisions and others of soft stone idiocy. In the late 1990s, our 4-person practice became an early adopter of picture archive and communications system (PACS)and speech recognition (SR). We worked closely with our SR vendor, hosting site visits and suggesting workflow improvements. I began traveling as a consultant and applications specialist. I became somewhat of a troubadour, some would say shill, teaching and espousing the advantages of an integrated PACS and SR workflow. These activities quickly expanded into more formal academic lectures and writing.

In 2002, I joined a larger and more academic department in central Pennsylvania in order to expand my informatics and teaching activities. Several years ago on a vacation trip, my wife and I fell in love with the Blue Ridge Mountains and planned to eventually move and retire there. I am convinced that the happiness of a department depends largely on the ability of the chair to filter the sometimes ill-advised decisions of central administration. When the department chair starts drinking the administrative Kool-Aid, it is time to get out of Dodge. In2009, a change in department leadership accelerated my original schedule to leave central Pennsylvania, and I am now very happy practicing body imaging and informatics in the beautiful Blue Ridge Mountains of Western Virginia.

My career path has been a bit unusual. I view my current informatics role as bridging the workflow requirements of radiologists in community practice and those in academia. One of the most frequent questions I am asked is my perception of current differences between private practice and academics. I often reply that in private practice the atmosphere has become dog eat dog, while in academics it is the other way around.