---

   Go to the List of Contents

The Latest Column

The State of Affairs
The Disappearance of a Medical Discipline
Impressions of 2026

Rinckside 2026; 37,1.

t won't happen over night, but you can watch its progress for some years. It be­comes apparent that radiology is slowly dis­ap­pear­ing as a recognized medical discipline; it dissolves in the mist of time. To sub­dis­cip­li­nes like pe­dia­tric radiology it will happen faster; they will be com­ple­te­ly neglected — they don't have a powerful lobby with ma­jor fi­nan­cial players. People from out­side me­di­cal care (in this case, in­­dus­try re­pres­en­ta­ti­ves and health ad­mini­stra­tors) have become more influen­tial and fi­nally taken over decision-making. The users, the radiologists, are often simply pushed aside.

Medicine is being commercial­ized with li­mi­ted respect for the human factor. Medical prac­ti­ces run by individuals or teams are in­creas­ing­ly be­com­ing in­vest­ment targets for pri­vate equity (PE) funds — thousands in Ger­many alone. Many PE companies are marred by opa­city. The lack of trans­pa­ren­cy has raised concerns of ex­ploi­ta­tion and money laun­der­ing. In addition, pri­vate equity owners often sub­ject medical practices to ri­go­rous cost-cutting measures aimed at maxi­miz­ing pro­fits in order to achieve annual returns of, at least, 10–15%.

A recent study on the consequences of the PE commercialization of nursing homes in the United States found the following:

"Our estimates show that PE ownership increases the short-term mortality of Medicare patients by 10%, implying 20,150 lives lost due to PE ownership over our twelve-year sample period. This is accompanied by declines in other measures of patient well-being, such as lower mobility, while taxpayer spending per patient episode increases by 11%. We observe operational changes that help to explain these effects, including declines in nursing staff and compliance with standards. Finally, we document a systematic shift in operating costs post-acquisition to­ward non-patient care items such as monitoring fees, interest, and lease pay­ments. [1]"

The pursuit of financial profit destroys the Hippocratic principles we were raised with — principles that call for upholding specific ethical standards.

Most MRI technicians and many radiologists currently have no idea how an MRI machine works — they just arrange to put the patient on the table and set up a con­trast drip as needed.

The next goal in magnetic resonance imaging, for instance, is to make the exa­mi­na­tions completely automated. Some imaging centers in the USA are aim­ing to staff these centers with the lowest cost people (equi­va­lent to shelf sta­ckers in supermarkets) and have specialists who basically run the exa­mi­na­tions remotely from long distance. The step that will follow is to make every­thing com­ple­te­ly automated by push button con­trol. Nowadays one needs four se­pa­ra­te screens to collate all the info for an exa­mi­na­tion. Post­process­ing is becoming routine. In other countries you see similar de­ve­lop­ments: spe­ci­a­list ra­dio­lo­gy chains as de­scrib­ed above with branch offices all over the coun­try [2].

Still, the cultures of radiological markets are different. The human factor plays a ma­jor role in the changes occurring in ra­dio­logy: A new generation of ra­dio­lo­gists starts climb­ing the career ladder. Many of them grew up pam­pered in comfort and affluence, exposed to the digital re­vo­lu­tion in a period when aver­age quality of school and uni­ver­si­ty edu­ca­­tion declined. They lack cri­ti­cal in­sight. At­tach­ed to playing computer games, digital imaging tech­no­lo­gies are extremely at­trac­ti­ve to them. On the other hand, lower work­ing hours and higher salaries are also im­por­tant to them.

During the last thirty years the generation gap has deepened to a chasm, and both youn­ger medical doctors and older ones complain about of a mutual lack of com­pre­hen­sion of their respective worlds. The suitability of can­di­da­tes for the existing, partly very demanding health system is de­creasing. By many sociologists and psy­chologists they are seen as a possible threat to the existing sta­ble society and workplace structures [3].

On a global scale, in particular for the opera­tion of specialized MR equip­ment, more and more ra­dio­lo­gists will be replaced by medical doctors from other dis­cip­lines, e.g., by on­co­lo­gists, car­dio­lo­gists, neuroscientists and nuc­lear medicine spe­cia­lists.

It is interesting to see that the sales re­pre­sen­ta­­ti­ves of some companies seem to have re­acted to these changes, but not company mana­ge­ment and de­ve­lo­pers. Companies target their potential younger customers with com­plete­ly different marketing methods than a generation ago.

An idea in the earliest times of MRI was tissue characterization by in vivo relaxation time measure­ments. This was 50 years ago and the methods had gone out of date already in the mid-1980s: they didn’t work in a clinical environment. More than 30 years later they were re-invented as “MR fin­ger­print­ing” and “biomarkers”. Even dressed in new clothes they cannot be validated in independent trials and are mostly inadequate and deficient in pre­ci­sion and accuracy [4, 5]. Still companies jump on this bandwagon be­cause they don't have anything novel to offer. Outdated ideas are re­packed and sold with marketing gags as revolutionary developments. Here today, gone tomorrow.

Many people believe that numbers (data) are the truth. Many people do not understand how the numbers were acquired and what they stand for. Nature, biology and medicine are more complex and don't care much about numbers.

The latest hype, an exploding volcano, is “artificial intelligence”. AI has entered the MR market; it’s business value is enormous. But AI is mindless, lacks con­scious­ness and cu­rio­si­ty [6]. These are fundamental short­comings that cannot be overcome and that distinguish them from the precise human col­lec­tion of information and data. The human mind will and must be cri­ti­cal; artificial intelligence won't be. The human mind is able to con­sider, re­con­sider and doubt. AI won't. Human intuition remains ir­re­place­able. But human laziness will rely on AI any­way. Let’s see what happens to it.

---

References

1. Gupta A, Howell ST, Yannelis C, Gupta A.. Does Private Equity Investment in Healthcare Benefit Patients? Evidence from Nursing Homes.. BFI Working Paper. 13 February 2021.
2. Rinck PA. New realities in medical imaging. Rinck­side 2021; 32,2: 5-6.
3. Rinck PA. Generation Y and the future of radiology. Or: Is Gene­ra­tion Y out­sourc­ing ce­re­bral activities to smartphones?. Rinckside 2012; 23,7: 13-15.
4. Rinck PA. MR fingerprinting returns to radiology — and ho­pe­ful­ly dis­ap­pears again. Rinckside 2015; 26,5: 13-14.
5. Rinck PA. Mapping the biological world. Rinck­side 2018; 29,1: 1-3.
6. Rinck PA. Some reflections on ar­ti­fi­cial in­telli­gen­ce in me­di­ci­ne. Rinck­side 2018; 29,5: 11-13.

---

After 37 years of Rinckside, there won't be any new regular columns on this web­site, but you will be able to read occasional thoughts.

There will be references to many of the old columns that are still "current affairs" and will be in the future … and hardly anybody dares to mention the topics discussed in them. Check them out and write to me if you want to comment.

---