Radiologists press for imaging as 'infrastructure' amid fee cuts, staff shortages

The celebration came with a ledger. In a hotel ballroom in Seoul, the Korean Society of Radiology marked its 80th year by counting what it says the system is losing: fees for CT and MRI cut over the last decade, professors draining from provincial hospitals, and old scanners reimbursed like new. 

The group used its annual meeting on Wednesday to press for a reset: treat imaging as infrastructure, verify medical AI before it spreads, and route patients through regional centers that curb waste.

The government has begun an “essential care” push that channels money and training to eight shortage-hit specialties, such as internal medicine and neurosurgery, a list that excludes radiology.

The society says “essential” should be tied to clinical situations and care settings where scans decide the next move, from stroke and major trauma to cancer pathways, the emergency room, the operating room and the ICU, with imaging designated as a required service.

“Without imaging, essential care doesn’t function,” said Choi Joon-il, the society’s policy research director and a professor of radiology at The Catholic University of Korea’s Seoul St. Mary’s Hospital. Framed that way, he added, it becomes obvious that radiology is “infrastructure,” not an optional add-on.

Numbers led their case. On a relative-value basis, the society said, CT fees fell about 20 percent in the early 2010s and MRI about 30 percent, then another 5 percent with a later overhaul, along with the removal of add-ons that once recognized the complexity of tertiary hospitals. 

By the society’s accounting, reimbursement for advanced imaging now sits at roughly half of pre-2010 levels. Each reduction, Choi said, pushes hospitals to run scanners harder, which lowers unit costs and invites the next reduction. “We have gone around that loop three or four times,” he said.

The human side is fraying. Since last year’s physician-government dispute, about 30 to 40 percent of university radiology professors in the Busan and Gyeongnam region have resigned, the society said. 

Many left for better-paid non-university posts or moved to Seoul. Some departments outside the capital now rely on a single subspecialist. Training has become a paradox. Residency positions were rebalanced to a 50-50 split between the capital and the rest of the country, which means more trainees outside Seoul and fewer senior doctors to teach them. Keeping regional programs viable in two to three years, Choi warned, will be “very hard.”

Equipment policy sends its own signal. A 15-year-old CT scanner and a new low-dose model are paid the same. Hospital managers learn quickly to keep the older machine running, said Do Kyung-hyun, who leads the society’s archives and records. The society is asking for quality-based differential payment, not only by device age but by audited maintenance, dose control and staff training. The goal is to stop rewarding what Kyung called “cheap and busy” and start paying for “safe and accurate.”

Overuse, they argued, is a routing problem as much as a clinical one. Most scans at the largest centers are outpatient, about 70 percent by the society’s estimate, yet smaller clinics hesitate to refer.

A scan at a flagship hospital can become a one-way transfer. The fix on offer is a network of regional imaging hubs with shared CT and MRI capacity and routine image exchange. A clinic could order a scan without losing the patient, duplicate studies would fall, and true referrals would move faster. “If only big hospitals own the scanners, clinics fear referrals will become one way,” Do said. A neutral hub, the society contends, restores two-way traffic.

AI figured prominently in the briefing, framed as a safety checklist rather than a marvel. Radiology accounts for much of medical AI in use, said Jung Seung-eun, the society’s president, and a verification framework to protect patients is no longer optional. As models evolve from chat tools to agent-style software, approvals cannot catch every failure mode.

Education, several speakers said, must shift from how AI works to how to use it. The comparison was plain. A stethoscope requires training. AI, “far more complex,” should be taught as user-level “Education 2.0.”

That pivot would build on steps already taken. The society runs an eight- to twelve-week AI course and packed this year’s program with AI sessions. The next task is standardizing user-level curricula so clinicians become, in Jung’s phrase, “smart consumers” who can sort helpful tools from hype. If they do, he added, the good systems will survive contact with practice and the rest will fade.

Leaders also urged separating professional fees from machine time so cuts to scanner minutes do not automatically slash radiologists’ labor, and naming radiologists as required staff in cancer and major-trauma pathways. To show how price shapes behavior, they pointed to international comparisons shared at the event. 

Korean CT fees are about one quarter of United States Medicare rates and roughly half of those in Japan, Germany and Australia. Low prices alone do not prove bad policy, they said, but in imaging, prices determine who scans, what gets scanned and why.

The politics may be harder than the bullet points. Earlier this month, health officials named eight specialties as essential and promised to bolster them, without adding radiology. Choi called that framing misguided, then softened it. Consider the list a starting point, he said, not a creed.