That’s because the main message of his talk remained unchanged: There is no turning back from health care’s path toward value-based payments and digitized medicine.

“I don’t see that changing in the short or medium term,” said Wachter, a longtime leader in hospital medicine and the newly installed department of medicine chair at the University of California San Francisco, in an interview before his presentation.

Wachter believes the election of Donald Trump and the Republicans holding onto majorities in Congress likely will have a major impact on the Affordable Care Act’s “insurance functions,” but the move to digitization and the greater emphasis on safety, quality and value should continue.

Wachter says radiology is at the center of the digital revolution taking place in health care, and a chapter on radiology in his latest book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, has received the most attention of the 28 chapters. Radiologists have served as “the canaries in the coal mine” for digitized medicine because they adopted the technology 15 years ago and are 10 years ahead of everyone else, Wachter said. In so doing, they’ve seen a major change in their roles, the flow and nature of their work, their incomes and their relationships with clinical colleagues. Bundled payments have the potential to disrupt this further, according to Wachter.

Wachter describes in the book how, just a decade ago, other physicians felt that radiologists had “won the game” with the combination of their high income and predictable work schedule.

Culturally, radiologists once were firmly embedded in the hospital, and the chest reading room was a bustling hub of activity. Today, most radiologists work in isolation and under intense scrutiny to read more images and file more reports. Wachter likened it to the classic “I Love Lucy” scene in which Lucy and Ethel wrap chocolates on an ever-accelerating assembly line.

In addition to the current pressures they are facing, radiologists also face the ultimate existential threat of being replaced by the machines sometime in the not-so-distant future. “That’s not a happy place for radiologists to be,” Wachter said, but rolling back the clock to the old ways is not going to be a winning a strategy.

Instead, he said radiologists need to be clear-eyed and invest the time and political capital needed to reimagine their work and reinvent the field to concentrate on where they believe they add value to the health care system.

Some of this is already happening. In his book, Wachter wrote that “radiologists are waking up to their peril,” and relocating reading stations to just outside emergency rooms, intensive care units and other clinical areas; radiology staffs are being trained in customer service; and interdisciplinary conferences are being resurrected with communication tools like “John Madden-style telestrators” being utilized.

The RSNA meeting runs Nov. 27–Dec. 2. Almost 52,000 people attended last year’s event. Read for further coverage this week and next.