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Driving Change: Taking Ownership ofOur Profession and Its Future

Kay Denise Spong Lozano, MDa, C. Matthew Hawkins, MDb, Seth A. Rosenthal, MDc,

Alan H. Matsumoto, MDd, L. D. Ma, MDe, Kimberly E. Applegate, MD, MSf

The open-microphone sessions at the AMCLC provide a forum for the ACR’s membership to be heard. Thetopics in 2013 included a review of the annual radiology workforce survey, the impact of teleradiology ser-vices, and the rationale for the new Imaging 3.0 initiative. Comments from members at the 2013 AMCLCunequivocally illustrated a single overarching theme: anxiety—anxiety about the future of our practices andanxiety about our profession. In light of recent and anticipated changes in health care, radiologists, radiationoncologists, interventional radiologists, nuclear medicine physicians, and medical physicists—members of theACR—must continue to establish a leadership role in the health care system and serve as a cornerstone for allpatient-care delivery models. ACR commissions, networks, institutes, and initiatives will position us forsmoother transitions in the persistently altering health care landscape and will ensure that we have theexpertise and tools to serve as leaders in health care systems and advocates for our patients in current andfuture health care systems.

Key Words: Health care reform, radiology workforce, teleradiology, value-based imaging

J Am Coll Radiol 2014;11:359-361. Copyright © 2014 American College of Radiology

Those who expect moments of change to be comfortable and free ofconflict have not learned their history.

—Joan Wallach Scott

INTRODUCTIONThe open-microphone sessions at the AMCLC pro-vide a forum for the ACR’s membership to beheard. Questions, concerns, and declarations from thesesessions, once distilled, allow insight into the dailyresponsibilities of modern-day radiologists and radiationoncologists. Each year, session topics are selected andmoderated by the Council Steering Committee toencourage communication between the ACR Counciland the College’s leadership, as well as to identifyopportunities for potential policy development. The2013 topics included a review of the annual radiologyworkforce survey, the impact of teleradiology services, andthe rationale for the new Imaging 3.0� initiative. At the2013 AMCLC open-microphone sessions, comments

ing Associates and Invision Sally Jobe, Englewood, Colorado.

ldren’s Hospital Medical Center, Cincinnati, Ohio.

ssociates of Sacramento and Sutter Medical, Sacramento,

irginia Health System, Charlottesville, Virginia.

ology, PA, Baltimore, Maryland.

ity School of Medicine, Atlanta, Georgia.

g author and reprints: Kay Denise Spong Lozano, MD,ing Associates and Invision Sally Jobe, 10700 East Geddesood, CO 80112; e-mail: katie.lozano@riaco.com.

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36.00 � http://dx.doi.org/10.1016/j.jacr.2013.12.009

from members unequivocally illustrated a single over-arching theme: anxiety—anxiety about the future of ourpractices and anxiety about our profession.

CHANGING EXPECTATIONSYears of unbridled success may have surreptitiouslycrafted unsustainable lifestyle and financial expectationsfor radiologists and radiation oncologists in all types ofpractices. However, what was made clear at the open-microphone sessions is that the often lamented senseof complacency and entitlement [1] fed by these unre-alistic expectations has been replaced by concern, anxi-ety, and action. Anticipation of sweeping health carereform and cultural shift has motivated many of theACR’s members to implement a variety of innovativepractice models and reimbursement mechanisms and,most important, to focus on proving and improving ourvalue in the nation’s health care enterprise. These pro-active efforts aim to define, measure, and achieve qualityand value for new and existing health care deliverymodels and encourage members to reflect on whatconstitutes “success” and how we define professionalsatisfaction.

Specific issues discussed during the open-microphonesessions included the shift from volume-based to value-based practice models (including the ACR’s Imaging3.0 culture change initiative); the effects of teleradio-logy; the commoditization of imaging services; theimpact of health care reform on the practice of radi-ology, radiation oncology, interventional radiology, and

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nuclear medicine; and radiology and radiation oncologyworkforce issues. The discussion that follows summa-rizes content gleaned from the open-microphone ses-sions and highlights efforts by the College to meet theneeds of its members in the current, rapidly changing,anxiety-provoking practice environment.

VALUE-BASED RADIOLOGYA consistent message at the 2013 annual meeting was thatif working hours are composed solely of imaging inter-pretation, our craft will continue to be commoditized.Although we must provide value and actionable infor-mation in our reports, we cannot define ourselves as justproceduralists, image interpreters, and report generators.Richard Duszak Jr, MD, of the Harvey L. Neiman

Health Policy Institute, showed examples of unhelpful,confusing, and error-ridden reports and compared themwith standardized, thorough reports with clinical im-plications of the findings in light of patient history [2].In response, many members made suggestions and gaveexamples during the open-microphone sessions of per-sonal, group, and organizational efforts to increase thevalue of imaging services in their patient and referring-provider communities. These comments echoed thetheme of “value-added” radiology discussed at the 2012open-microphone session [3].Given the changing emphasis in health care delivery

systems and evolving reimbursement models, volume-focused practices may find it difficult or impossible tothrive. However, the conundrum we all face is that thetransition from volume-based reimbursement to value-based reimbursement will almost certainly not result inless work or allow for slower production of reports.More likely, radiologists will have to become moreefficient in the process of report production, so thatappropriate time may be paid before, during, and afterthe interpretation to ensure that the information weprovide is useful and relevant. We will also have toensure that the value provided is readily evident to themedical community, payers, and our patients. Althoughproductivity will remain a primary focus of manypractices, it is up to us, as a profession, to define anddemonstrate the value of our work to our patients, toour colleagues, and to health care systems [4].

TELERADIOLOGYEzequiel Silva, MD, introduced a discussion regardingthe practice and implications of teleradiology [5]. Anoften controversial topic, teleradiology certainly has aplace in some practice models to ensure that patientsand health care providers in all locales receive timelyimaging interpretation services. Although the imple-mentation of these practices and the creation of publiclytraded entrepreneurial corporations have presented newchallenges for many radiologists, it was made distinctlyclear during the open-microphone sessions that off-siteimaging interpretation or teleradiology can be practiced

ethically. ACR practice guidelines are intended for allACR members, regardless of practice type and practicesetting, and the ACR practice guidelines related to thistopic are not intended to target a single portion of theCollege’s membership. To meet the competition inducedby nontraditional entrepreneurial organizations and,more important, to establish and define value in patientcare, radiologists must demonstrate the value we bring tothe patients and the referring physicians we serve [6]. Thiscan be demonstrated by engaging in the entire continuumof professional service, including appropriate utilization ofimaging and documentation of it, consultation withclinical colleagues, interpretation, quality improvement,and serving as active leaders and information managers inhealth care systems.

THE WORKFORCE SURVEYRadiology workforce issues were discussed after a pre-sentation by Edward Bluth, MD, chair of the ACRCommission on Human Resources [7]. Several radiol-ogists pointed out the challenges associated with thetraditional classification of modern-day practices andwork patterns. Conventional classifications such as aca-demic, private practice, teleradiology, or local on-sitepractice are often too narrow in scope to be applied tothe work performed by contemporary members. Forexample, radiologists in private practice groups oftenteach residents and fellows or are in large group practiceswith both on-site coverage and local-regional tele-radiology services.Many academic radiologists experienceclinical productivity pressures that have traditionally beenfaced by those in private practice. In addition to thechallenges associated with classifying work type, theradiology job market was discussed at length. The ACRHuman Resources Commission survey results showedthat most radiologists are able to find jobs, but given thecurrent job market, those jobs may not be where theywant to live. The job opportunities addressed in the surveyincluded positions available to or taken by graduatingresidents or fellows, as well as those positions available toor taken by radiologists already in practice. Although thetight job market is unlikely to persist in its current orrecent state, it is increasingly unlikely that graduatingtrainees will get jobs doing exactly what they want to do,making the money they want to make, and living wherethey want to live. Good applicants may have to settle for 2out of the 3 aspects.

BEYOND ADAPTING TO CHANGEHow do we alter the current climate of concern, so thatour anticipation of the future is confident rather thanfearful? The tired phrase “we need to adapt to change”is not enough. If we are adapting to change, it mayalready be too late. Instead, our profession should takecollective ownership and direct change. The ACR hasa number of programs to help members not only sur-vive but thrive in this unstable environment. These

Lozano et al/Driving Change 361

initiatives include the Harvey L. Neiman Health PolicyInstitute�, the Radiology Leadership Institute�, theRadiology Integrated Practice Network, and a numberof highly active operational commissions, such as theeconomics, government relations, quality and safety, andhuman resources commissions. The quality and safetyactivities of the ACR give us the platform to link pro-fessional excellence and patient advocacy with theappropriate delivery of radiologic services. The eco-nomics and government relations commissions activelywork to eliminate, or at least mitigate, the effects ofmisguided legislation such as the multiple-procedurepayment reduction and to anticipate future challenges.The Radiology Integrated Practice Network bringstogether experts in optimizing radiology’s role in inte-grated practice settings, members with experience inintegrated practices, and members interested in learningabout best practices in an integrated setting. In addition,the College’s new Imaging 3.0 initiative provides tech-nological tools and a novel framework to help radiolo-gists thrive in new health care delivery models. TheseACR commissions, networks, institutes, and initiativeswill position us for smoother transitions in the persis-tently altering health care landscape. Most important,they will ensure that we have the expertise and tools toserve as leaders in health care systems and advocates forour patients in current and future health care systems.We face the difficult and anxiety-provoking task of

transitioning from the perceived “golden days” of radi-ology. However, nostalgia for the past should not pre-clude our ability to plan for the future. There will bemany challenges to overcome in the process of makingthe golden days of our profession yet to come [8]. To doso, in light of recent and anticipated changes in healthcare, radiologists, radiation oncologists, interventionalradiologists, nuclear medicine physicians, and medicalphysicists—members of the ACR—must continue toestablish a leadership role in the health care system andserve as a cornerstone for all patient-care deliverymodels. We must visibly position ourselves in thepatient-centered medical home, not in a dark closet. Wemust be unforgettable, not forgotten. The days of being

the wizard in the box are not over, but we must expect,of ourselves, to be more than that—for our colleagues,for our profession, and most important for our patients.

TAKE-HOME POINTS

� The topics of the AMCLC 2013 open microphonesessions included a review of the annual radiologyworkforce survey, the impact of teleradiology services,and the rationale for the new ‘Imaging 3.0’ initiative.

� Radiologists, radiation oncologists, interventional ra-diologists, nuclear medicine physicians, and medicalphysicists—members of the ACR must continue toestablish a leadership role in the health care system,and serve as a cornerstone for all patient-care deliverymodels.

� ACR commissions, networks, institutes, and initia-tives will position us for smoother transitions in thepersistently-altering health care landscape, and willensure we have the expertise and tools to serve asleaders in health care systems and advocates for ourpatients in current and future health care systems.

REFERENCES

1. Patti JA. Entitlement, complacency, and inertia: obstacles to progress,impediment to survival. J Am Coll Radiol 2010;7:825.

2. Reiner BI, Knight N, Siegel EL. Radiology reporting, past, present, andfuture: the radiologist’s perspective. J Am Coll Radiol 2007;4:313-9.

3. Matsumoto AH, Adams MJ, Bello JA, et al. Radiologists and radiationoncologists adding value to the health care system: a commentary. J AmColl Radiol 2013;10:99-100.

4. Duszak R. Value: imaging’s new wave imperative. J Am Coll Radiology2013;10:484-5.

5. Silva E, Breslau J, Barr RM, et al. ACR white paper on teleradiologypractice: a report from the task force on teleradiology practice. J Am CollRadiol 2013;10:575-85.

6. Muroff LR. Culture shift: an imperative for future survival. J Am CollRadiol 2013;10:93-8.

7. Bluth EI, Short BW, Wills-Walton S. 2012 ACR Commission on HumanResources Workforce Survey. J Am Coll Radiol 2012;9:625-9.

8. Patti JA. 2013 ACR presidential address: a personal view on the future ofradiology. J Am Coll Radiol 2013;10:665-71.