C. MATTHEW HAWKINS, MDRESIDENTS’ AND FELLOWS’ COLUMN

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Call for Action: A Resident’s Perspective

Anil Chauhan, MD, M. Jordan Ray, MD

Radiology residents are challengedin today’s era to remain up to datewith current political and eco-nomic issues facing the field. Ofcourse, this comes in addition tothe ever increasing volume of clini-cal knowledge that must be learnedin a short period of time. Thesechallenges vary from patient expec-tations to governmental legislationsand from technological advances toturf wars. As we settle down on onechallenge, more always seem to riseto the surface, some predictable andsome not so predictable.

The ACR is a platform in whichwe all have a common interest. TheACR provides a kind of fatherly as-surance to many residents acrossthe country that someone caresabout our present and future. Thisassurance, however, comes with theexpectation that every generation oftraining radiologists continue topursue this idea of togetherness forthe greater good of radiology as awhole. Hui and Vaughn [1] sug-gested,

Ironically, those with the most to gain, orlose, from changes to radiology are thosewho are not yet radiologists: the residents.With their entire careers ahead of them,residents have arguably the greatest interestin ensuring radiology’s future is as bright asits past.

Keeping this very concept in mind,radiology residents across the coun-try are organizing in defense of ourfuture profession and in defense ofour patients.

The reason for organizing this“call to arms” is simple. If we fail tobond together as the younger gen-eration of this professional societythat stands up for our interests andthe interests of our patients, thelong-term ramifications will bedevastating. As Ben Franklin once

said, “We either hang together, or

2012 American College of Radiology1-2182/12/$36.00 ● DOI 10.1016/j.jacr.2011.12.020

we hang separately.” Remaining onthe sidelines equates to allowingnonradiologists to encroach intoour world of expertise and to per-form substandard image acquisi-tion and interpretation. Therefore,allowing nonradiologist physiciansto work as imagers for their ownfinancial interests will lead to detri-mental increases in the health carecosts of this country and the over-utilization of ionizing radiation,providing, in many cases, substan-dard image interpretation and put-ting patients’ lives at risk. Further-more, allowing these transgressionsto occur will result in radiologypaying for the indiscretions of others,as evidenced by recent reimburse-ment cuts targeted at imaging. Thesewere a few of the key points we em-braced while pursuing the ACR’sJ. T. Rutherford Fellowship.

OUR EXPERIENCE AT THEAMERICAN COLLEGE OFRADIOLOGYThe J.T. Rutherford Fellowship atthe ACR’s governmental relationsoffice in Washington was an infor-mative and enlightening experience.As young, impressionable physiciansin training, we will take this experi-ence with us for the duration of ourcareer. As a J.T. Rutherford fellow, aradiology resident is accepted andwelcomed into the lobbying commu-nity of the capital city. This type ofwork and activity is foreign to mostmedical trainees, who embark on ca-reers based on science and charity,with little or no interest in politicaland economic issues and the rolesthey play in organized medicine.

Our fellowship at the ACR oc-curred at a critical time for the futurepractice of radiology. We worked onthe possible blockage of the CMS

idea of a 50% payment reduction

(which as a final rule on November 1,2011, was projected at 25%) on theprofessional component for studiesperformed on the same patient in thesame session by the same physician orphysician group, referred to as themultiple-procedure payment reduc-tion (MPPR). To radiologists, theidea of the MPPR is obviously flawedbecause there are minimal efficienciesgained in the professional compo-nent when studies are performed onthe same day, as detailed in a study byAllen et al [2].

As fellows at the ACR, we wereable to meet with and express opin-ions related to the current issuesfacing radiology and medicine atlarge to numerous legislators, in-cluding Senators John Cornyn,Harry Reid, Amy Klobuchar, andAl Franken, and RepresentativesKevin McCarthy, Pete Olson, JohnBarrow, Betty McCollum, Bill Ow-ens, Keith Ellison, Janice Hahn,Marsha Blackburn, and HeathShuler, among many others. It wasthese meetings with staff personnel atwhich the issues regarding MPPRand its unintended consequence werediscussed. The meetings seemed tobe very productive, with the staffmembers expressing understandingof the issues.

The result of the hard work bythe ACR’s government relations of-fice was the introduction of a bipar-tisan MPPR bill in the house byRepresentatives Pete Olson andBetty McCollum. Over the pastfew weeks, the number of cospon-sors has increased significantly (110as of December 10, 2011) with ef-forts still on at our grassroots level.

The real work in Washington getsdone around the dinner table and atfund-raising events. This is wherelobbyists have a critical role in influ-

encing government intrusion into

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their prospective industry. Withoutthis system, legislation would be ini-tiated with no understanding of howlegislative decisions affect both thepopulation and individual industries.It is critical that we as a specialty sup-port the ACR, so that we have a voicein Washington as our lobbyists pro-tect our field from governmentalregulation.

In addition, the J. T. Rutherfordfellows are thoroughly introduced tothe ACR office. We had meetingswith health informatics technologyofficials and the liaison for state gov-ernment relations. We were able tosit in on conference calls with leadersin governmental relations with theAmerican College of Cardiology, USOncology, and several imaging ven-dors, such as GE and Siemens. Dur-ing these discussions, it was interest-ing to see the brainstorming of ideasto influence legislative opinion andpublic awareness. It is through thistype of discussion that educationalavenues such as the Web sites Radi-ology Saves Lives (http://www.radiologysaveslives.org) and RightScan Right Time (http://www.rightscanrighttime.org) have beendeveloped.

IDEAS FOR THE FUTUREThe medical profession has alwayssuffered from a lack of “real-world”training, with young doctors oftennot understanding the business, leg-islative effects, or practice manage-ment issues they will face upon thecompletion of training. The reasonsfor such a shortfall are obvious: thecomplexity of medical training oftenprevents this type of education dur-ing the typical time frame of medical

education. Many doctors, therefore,

are forced to delegate and observefrom the sidelines on many of theseissues. But as you can see, importanteducation can be gained in a shortperiod of time through programssuch as the J. T. Rutherford Fellow-ship offered by the ACR. As a spe-cialty, we have an obligation to ourfuture colleagues to help cultivate aninterest in these issues for the protec-tion of both radiology and medicine.

One proposed idea in this regard isa state-level fellowship on a platformsimilar to the J. T. Rutherford Fel-lowship. We understand that somestate chapters do not have active lob-bying groups, but this idea wouldwork efficiently where we do have ac-tive lobbying groups with respectivestate chapters. This would helpyoung residents to learn about cur-rent political and economic chal-lenges we face and how best to dealwith them through governmentrelations.

Although limited by funding inthe current economic scenario, in-creasing the number of residents forthe J. T. Rutherford Fellowship orother fellowships, such as the JamesM. Moorefield Economics andHealth Policy Fellowship, shouldbe considered. This can potentiallybe done through state chapters’funding residents from their constit-uencies. Similarly, the fellowshipssponsored by subspecialty groups,such as Society of Interventional Ra-diology and the American Society ofNeuroradiology, might also prove ef-fective for resident education.

The radiology business and lead-ership conferences such as theACR’s AMCLC are a perfect plat-form for residents to learn aboutpolitics and the business of radiol-

ogy. The funding and time away

are crucial for residents’ attendancein such meetings. The MinnesotaRadiological Society has set up afeasible model whereby it has beensponsoring airfare and lodging ofall first-year residents for the past 3consecutive years to attend theAMCLC, with only 1 day of trainingmissed [3]. The Minnesota Radio-logical Society also published a studydemonstrating a significant increasein residents’ knowledge of politicaland economic issues facing radiologyafter this experience [3,4].

We consider didactic confer-ences on the business of radiologyat the department and state levelsan effective measure for educatingresidents. Although “business in ra-diology” conferences are a require-ment in many departments, thisneeds to be explored in a broaderspectrum. Increasing the frequencyof such conferences and, more im-portant, making it a part of example-based day-to-day conversations inreading rooms or elsewhere wouldcertainly increase awareness amongresidents.

REFERENCES

1. Hui FK, Vaughn ME. Resident involvementin the ACR early is healthy self-interest. J AmColl Radiol 2005;2:195.

2. Allen B Jr, Donovan WD, McGinty G, et al. Pro-fessional componentpayment reductions fordiag-nostic imaging examinations when more than oneservice is rendered by the same provider in thesame session: an analysis of relevant payment pol-icy. J Am Coll Radiol 2011;8:610-6.

3. Chauhan A, McMenomy B, Smith K. Invest-ing in radiology’s future: ongoing efforts bythe Minnesota Radiological Society to pro-mote resident participation and leadership.J Am Coll Radiol 2011;8:666-8.

4. Chauhan A, Everist BM, Siebert D, Smith BC,McMenomy B, Eckmann DR. The heart of radi-

ology in Minnesota. J Am Coll Radiol 2011;8:450.

Anil Chauhan, MD, is from the Department of Diagnostic Radiology, University of Minnesota, Minneapolis, Minnesota. M. JordanRay, MD is from the Department of Radiology, Baylor University Medical Center, Dallas, Texas.Anil Chauhan, MD, University of Minnesota, Department of Diagnostic Radiology, B-211 Mayo Building, 420 Delaware StreetSE, Minneapolis, MN 55455; e-mail: chauh009@umn.edu.