The Radiologist as a Capitalist

In my 48 years in healthcare, I’ve been fortunate to experience waves of innovation that led to sweeping changes in our industry and society. My first experience was with the advent of cross-sectional medical imaging, including CT, MR, PET, nuclear imaging, and modern 2D/3D ultrasound. These inventions changed medicine for the better forever and continue to evolve today. Capitalism drove money into these businesses, but radiologists—often conservative investors burdened with student loans—mostly participated not as owners, but as professional service providers. There were exceptions, such as physician-owned imaging centers. Radiologists who were perfectly positioned to understand the impact these technologies would have, and who were willing to take entrepreneurial risks, generally did extremely well.

The next wave I experienced was the advent of modern interventional radiology. I was a neuroradiology fellow at UCLA in 1985 when I witnessed the late Dr. Grant Heishima work with industry to develop balloons, steerable catheters, embolic materials, and later coils that enabled the field of interventional neuroradiology to emerge. At that time, industry was risk-averse but eventually came around, providing life-saving and life-changing value to patients. Again, there were some radiologist entrepreneurs who did extremely well, but most radiologists were too risk-averse or too busy to capitalize on the many inventions that made interventional neuroradiology possible.

The next wave I experienced was the massive transition from file cabinets, snail mail, and typewriters to the widespread use of personal computers and the internet. PACS was radiology’s slice of this sea change. Not surprisingly, there were some radiologists—myself included—who started or invested in PACS companies, but from an investment standpoint, most were skeptical and sat on the sidelines. Other waves followed, such as digital mammography and teleradiology, with similar results.

So here we are again. A massive sea change is sweeping the world: the advent of AI-enabled cloud computing. The influx of this broad technology seems likely to relegate client-server applications, on-premises storage, and VPNs to the obsolete Hall of Fame, alongside the typewriter and myelogram table. Once again, there is an opportunity for radiologists—who are uniquely positioned to understand how these technologies will impact our field and medicine—to participate as capitalists in addition to their roles as physicians and humanitarians.