Culture shift: an imperative for future survival.

Radiologists have experienced unprecedented prosperity for the past 3 decades. Technology has continually evolved, providing exciting opportunities for earlier diagnoses and improved patient care. The financial rewards enjoyed by radiologists have been impressive, and the quality of life has been difficult to beat. Circumstances change, and in the past few years, radiologists have been confronted with a variety of new challenges. These trends include declining reimbursement, an "image problem" at both the local and the national levels, more demanding hospital administrations, nontraditional competition from national entrepreneurial radiology entities for radiology hospital contracts, and alternative payment systems. The author outlines the genesis of these trends, describes strategies for meeting these challenges, and discusses the roles of both radiology practices and the ACR in preparing radiologists for the threats and the opportunities that lie ahead. Although it will be important for radiologists to "get to the table" to participate fully in the new health care environment, it will be imperative for radiologists to know what to do once they are at the table. This is not "business as usual," and for radiologists, there will be winners and losers in the coming years. It will take work to succeed, and the apathy, denial, and sense of entitlement that have characterized our practitioners must be replaced by service, visibility, health policy data, and "value-added" information for referring physicians and their patients. The future for radiology is bright; the future for radiologists is far less certain. Strategic planning, scenario planning, practice building, and the efficient provision of high-quality patient care are the keys for radiologists to succeed. Radiologists must integrate themselves into the medical, social, and political fabrics of their hospitals and their communities, and they will need to get the in-depth leadership training and the important health policy data that the ACR is structured to provide.