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Radiology 1999

Survival of Excellence

¹ Emory University Hospital, 1364 Clifton Rd., N.E., Ste. E118, Atlanta, GA 30322.

Received November 12, 1999; accepted after revision January 26, 2000.

 
Summation statement of the annual summer conference of the Intersociety Commission of the American College of Radiology, Montreal, Quebec, July-August 1999.

Address correspondence to K. H. Vydareny.

Introduction

Top Introduction

 
The 1999 Intersociety Commission Summer Conference was held July 30—August 1, 1999 in Montreal, Quebec. Ninety-two representatives from 42 radiology societies met for two and one-half days to discuss "Radiology 1999: Survival of Excellence." Discussions centered on the health care revolution and its effects on the organization of radiology societies, radiology departments, and patient care.

Friday morning was devoted to discussion of the organization or reorganization of radiology societies. The attendees of the meeting were surveyed in advance on their funding sources for professional activities and their opinions of professional organizations. Of the respondents, 26% were in private practice, and 74% were in academic practice. For three quarters of the participants, funds for professional activities were available, paid by their department or practice; 25% of participants funded these activities themselves; and 30% of the respondents billed their department or practice for each professional expense. The others had a predetermined maximum amount set from year to year. Sixty-three percent of individuals had more than $4000 allocated for professional activities, which typically was the same amount as 5 years previously. Three fourths of participants were allowed 3-4 weeks for meetings, whereas one fourth had more than 6 weeks of meeting time. Typically, time for meetings did not include vacation time and was the same allocation as 5 years ago. The participants typically belonged to two or more general radiology societies and two or more subspecialty societies. They believed that the general societies were less important to them personally than the subspecialty societies. Seventy percent had not joined or resigned from any societies in the past 3 years.

Keynote talks were given by Philip O. Alderson, representing the Fleischner Society; E. Stephen Amis, Jr., representing the Society of Uroradiology (SUR); William S. Ball, representing the American Society of Neuroradiology (ASNR); and William G. Bradley, representing the International Society for Magnetic Resonance in Medicine (ISMRM). Because the topic centered on "change," these speakers discussed the various changes which each society had recently undergone, ranging from merging two societies (ISMRM), accommodating various interest groups (ASNR), changing the leadership process and changing the annual meeting (SUR), and attempting to keep the society intact and financially secure (Fleischner Society).

Representatives of all societies discussed these and other common problems in the work groups after the plenary session and emphasized the following points:

• The roles of the small subspecialty and the large general societies are different. The larger societies should strive to promote the economic and political aims of our specialty and encourage research. The identity of the specialty of radiology as a whole is found in the larger groups. The smaller societies should also promote research and, in addition, should promote the educational and scientific aims of their subspecialties. Whereas political and economic activism is the role of the larger societies, ways of enfranchising the interests of the subspecialty societies must be established within the larger societies. Subspecialty societies should be asked to help develop accreditation programs. To focus and conserve resources, the political and economic issues could be addressed by the American College of Radiology (ACR) with federal and state governments. The ACR is encouraged to include subspecialty representation on commissions and committees.
  
• The ACR, with help from the staff of the Radiological Society of North America (RSNA), the American Roentgen Ray Society (ARRS), and the American Society for Therapeutic Radiology and Oncology should develop and maintain a Web-based meeting calendar. This could be available on the ACR Web site with appropriate security measures so that information can only be entered by ACR staff. The societies bear the responsibility of ensuring accurate and current information. This calendar should extend at least 5 years into the future, be cross-referenced to individual society's Web pages, and should include relevant nonradiology meetings and the dates of the written and oral American Board of Radiology (ABR) examinations and major national and religious holidays.
  
• The development of a Web-based common membership directory, containing names, addresses, telephone and fax numbers, and e-mail addresses is encouraged. A section could list the Internet addresses of societies, current officers, and a history or mission statement of each society, which could be cross-referenced to societal Web pages. This directory could serve the purposes of the previous ACR pamphlet, "Organizations in Radiology." Appropriate security measures must be utitized.
  
• Subspecialty societies should look for ways to work together whenever possible to minimize expenses. Some suggestions would include common publication of journals or collaboration between several societies for an annual meeting. The larger societies should accommodate the interests of the smaller societies in their meetings.
  
• All societies should reassess their mission and strategic plans. For some, their raison d'être may no longer be valid.
  
• Subspecialty societies should find ways to encourage nonradiology clinicians to become members. Conversely, imaging professionals are encouraged to join multidisciplinary societies to make certain that radiology's voice is heard.
  
• All imaging professionals should be cognizant of the necessity to devote time and energy to the specialties of diagnostic radiology and radiation oncology as a whole and to their sub-specialty interests. All need to be aware of ACR political activities. In communicating these activities, the ACR should strive to keep its publications as succinct as possible.
  

Friday afternoon began with a discussion by. Rodney F. Hochman, chief medical officer of Sentara Healthcare, a health services organization with more than 200 physicians, a 300,000 member health maintenance organization, six hospitals, five nursing care centers, and a home health care division. He outlined an integrated health care delivery system from the viewpoint of administrator and internist. Barry T. Katzen, medical director of the Miami Cardiovascular Institute, discussed his experience in developing a product line for cardiovascular imaging. There was also a discussion of the ACR/ABR/RSNA/ARRS combined initiative on cardiovascular imaging and the importance of enhanced educational opportunities and training programs in this area, particularly in cardiac imaging. These presentations led into work group discussions on the organization or reorganization of imaging departments. The following recommendations were proposed:

• Reorganization of imaging departments along organ systems, product lines, and centers of excellence should maintain radiology as a discipline. Thus, radiologists should be proactive in the formation of such centers, being involved early to make certain that radiologists have a key role. Strong leadership from the top is important.
  
• Radiologists must be available whenever needed and continue to provide the highest quality care to maintain control of imaging services for optimum patient care.
  
• Departments should be structured to provide timely information and help to clinicians in the appropriate sequencing of examinations. In academic departments, a senior resident might be the best person to provide this service as long as adequate faculty supervision is provided.
  
• Imaging specialists should take advantage of digital imaging techniques to improve the quality of patient care.
  
• Training programs in cardiovascular imaging must be expanded.
  

Saturday morning, C. Douglas Maynard discussed how the reengineering of the health care system has impacted both positively and negatively on patient care (see accompanying article). The work group discussions focused on the following points:

• Radiologists and other imaging specialists should take a more proactive role in local and national arenas to promote the interests of radiologists and our patients when medical care systems and policies are being established.
  
• The public should be aware of the value of radiologists in their medical care. Radiologists should play active roles at their hospitals and medical staffs, and personal interactions with patients should be emphasized. Increased involvement in medical student education is encouraged to promote awareness of radiology and radiologists among future clinicians. The Commission applauds the efforts of the RSNA and others who have helped to develop the ongoing exhibition at the Disney World EPCOT Center.
  
• Imaging specialists are encouraged to provide results of studies to patients when appropriate.
  
• Skills of effective communication should be taught to imaging specialists and ancillary personnel.
  
• Imaging departments should continue to explore ways to increase their efficiency. Improvements would include the use of physician extenders for nonimaging tasks, the use of macros for dictations, and the development of mechanisms to expedite imaging for the "usual" patient. Outcome studies to evaluate management changes are encouraged.
  
• All radiologists should help combat the devaluation of academic medical centers. Partnerships of academic departments with practice groups and academic departments with industry are to be encouraged.
  
• Imaging specialists have ethical and professional commitments to their patients, their referring clinicians, and the payer but must remember that patients' interests must be the primary consideration. Radiology is not solely a business.
  

As a result of the Intersociety summer meeting, two resolutions were submitted to the 1999 annual meeting of the ACR Council and were adopted by the Council (Appendix 1 and Appendix 2).

The 1999 meeting of the Intersociety Commission was a valuable meeting for its participants, and hopefully, radiology societies and imaging departments will reap additional benefits. The next meeting of the Intersociety Commission will be held July 2001.

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