Turf Battles - Will They Ever End?
Turf battles are not new in medicine in general or in diagnostic sonography in particular. In fact, they are practically as old as the modality itself.
Early investigations by pioneers such as Professor Ian Donald (an obstetrician), Dr. Eugene Strandness (a vascular surgeon) and cardiologist Harvey Feigenbaum helped define the role of sonography in their respective disciplines. Without their efforts, sonography would likely not have developed into the important clinical tool it is today.
Fortunately, many of the early investigations were the result of collaborations between clinicians (including imaging specialists and non-imagers), engineers and others. However, as the practice of sonography became more widely adopted, turf battles arose in such areas as cardiology, vascular imaging and OB/GYN. In many cases, turf battles took place within individual institutions or practice settings, or they were avoided by compromises or by sharing services. This continues to be the case today.
Unfortunately for sonography professionals and imaging laboratories, the clinician specialists who have a desire to perform their own sonography exams gradually win-out over the imaging specialists in most turf battles. This is primarily because imagers lack their own patient base and instead rely on referrals, whereas the other disciplines have a captive patient population (i.e., they've got the patients!). For example, an obstetrician is motivated to provide sonography services so that they can improve patient management, quickly obtain the results of sonograms and rake-in more revenue (an increasingly important aspect in the current healthcare atmosphere).
Recently, the cost of ultrasound technology, including compact scanners or USB transducers that can turn an ordinary laptop computer into a clinical scanner, are making the modality increasingly more affordable and attractive to professionals in non-imaging disciplines such as rheumatology, emergency medicine, endocrinology, sports medicine-the list seems to grow with each passing day. These so-called "emerging markets" are leading to more turf battles which in some cases can become quite nasty.
This is cause for concern in terms of the impact on patient care. I'd love for you to share your experiences:
1.) Does your institution experience turf battles over the use of sonography?
2.) How are those battles handled or mishandled?
Let me know what you think; we can all learn from each other.