The ACR Resident and Fellow Section

2003 ACR RPS Annual Meeting Report:

The 2003 ACR Annual Meeting and Chapter Leadership Conference: A Resident's Perspective

The 2003 ACR Annual Meeting and Chapter Leadership Conference drew residents from all corners of the country to the nation's capital for an exciting week of sessions that will help shape the future of radiology. Through a well-attended series of Resident Physician Section meetings, approximately 80 residents had the opportunity to meet each other, share experiences and promote their interests within the ACR.

With support from the Board of Chancellors and the Council, residents increased their presence and influence at this year's meeting, actively participating in several key roles and setting an agenda for the coming year. Thanks to a new meeting structure, residents were able to participate in the chapter leadership conference for the first time. They had the opportunity to work directly with local state chapter leaders and participate in lobbying efforts on Capitol Hill.

An important focus of the meeting was finding ways to increase the involvement of the ACR Resident Physician Section in the activities of the College. In addition to allowing residents to participate in lobbying efforts on the Hill, several other changes were introduced at the AMCLC to accomplish this goal:

Each of the ACR Council reference committees now has a resident member. These committees are central to the functioning of the Council at the annual meeting because they collect comments on each resolution and suggest changes. These changes are then brought to the Council at its formal meeting.
The chairman of the RPS Executive Committee will now be one of the 15 members of the Council Steering Committee.
The ACR will sponsor the attendance of two residents at the Intersociety Meeting.
A regular resident column will keep residents actively involved in the upcoming Journal of the American College of Radiology.
A formal Resident Physician Section report was presented to the full ACR Council for the first time by Executive Committee Chairman Christoph Wald, M.D., Ph.D.

The meeting opened with a daylong categorical course on molecular imaging. Attendees took a break from the proceedings to attend the RPS lunch, during which ACR President Valerie Jackson, M.D., provided an overview of the ACR structure and how the College pursues its many mandates for radiology and radiation oncology. (The presentation is available on the ACR Web site, www.acr.org, under Residents.)

The RPS went into high gear on Sunday, the first day of formal meetings. The second annual Resident Leadership Seminar was held in the morning under the guidance of Richard Gunderman, M.D., a radiologist from Indiana University. His dynamic presentation offered many important lessons about the traits and skills of an effective leader.

The resident physician caucus began discussions shortly after, under the guidance of three alternate members of the reference committee who were assigned to review the resolutions and help direct discussion to those particularly relevant to residents. It was enlightening to see how radiology residencies differ throughout the country. Sunday concluded with a ceremony honoring the newest fellows of the College.

During the Sunday sessions residents also discussed issues of concern to the RPS, including:

Timing of the oral boards: Thanks in large part to the leadership of the outgoing RPS Executive Committee, the proposal to delay the oral boards for a year following residency was tabled at the most recent ABR meeting, although the discussions are set to continue. The new RPS Executive Committee is planning to lobby several organizations and ensure that the resident perspective remains visible. It is particularly important for each training program to minimize conflict within its department and ensure that fourth-year residents' involvement in clinical activities is monitored and discussed locally. This will help address the concern that "hysteria" over the boards distracts from the educational and clinical responsibilities of senior residents, a worry often voiced by those who support changing the timing of the boards. The radiation oncology residents, who reported that their written and oral examinations were recently moved with little warning, were able to share their experiences with the group during the Sunday sessions.
Resident call: Several residents expressed concerns about increasing call (particularly due to the rise in teleradiology), minimal or absent attending backup overnight and instances of impending ACGME work hour guidelines being misinterpreted to justify skipping readout and teaching after overnight call. The RPS Executive Committee has brought these issues to the attention of the ACGME Residency Review Committee for Diagnostic Radiology and is also planning a comprehensive survey to look at them.
MR training survey: Wald presented a summary of the results of last year's MR training survey, which identified perceived deficiencies in MR training, particularly in body MR and MSK MR. The results of this survey are being compiled for publication and have already been shared with the ACGME Residency Review Committee for Diagnostic Radiology to help identify deficiencies in residency programs. The RPS Executive Committee also is working with the Board of Chancellors to create teaching materials that will help standardize exposure to the modality.

The final meeting of the RPS was held on Monday morning, at which time its 2003-2004 Executive Committee was elected. Its members are:

Kay Spong Lozano, M.D.,
chair
University of Washington

Jesse Davila, M.D.,
vice chair/chair-elect
Mayo Clinic in Minnesota

Sanjay K. Shetty, M.D.,
secretary
Massachusetts General Hospital

Joshua L. Rosebrook, M.D.,
AMA representative
Brigham and Women's Hospital, Massachusetts

Greg Galdino, M.D.,
A3CR2 representative
University of California, San Francisco

Although this marked the end of the resident-focused activities, the RPS actively participated throughout the remainder of the meeting. Residents spoke out on several issues at the full ACR Council meeting on Wednesday, during which resolutions were discussed and then passed or referred. Highlights of the meeting include:

A resolution, jointly sponsored with the American Society of Radiologic Technologists, supported the creation of programs to train radiologist assistants. RAs are advanced technologists who will work under radiologists to perform certain procedures and studies; they will not, however, provide interpretations, either preliminary or final.
After a heated debate at last year's meeting and exhaustive work by a task force, it was decided to change the name "ACR Standards" to "ACR Practice Guidelines and Technical Standards."
The ACR adopted resolutions in support of additional research to evaluate the outcomes of CT screening procedures and responded to deceptive advertising regarding the claimed accuracy of screening breast MR examinations.

The Tuesday sessions of the AMCLC provided a glimpse into the many areas in which the ACR provides leadership, including:

Economic issues: The ACR represents radiology and radiation oncology on reimbursement issues by working with CMS and outside groups advocating the ACR position. The ACR is also involved at a more local level with resources that help provide cost-effectiveness data for new imaging techniques to private payers; these efforts have led to coverage for certain PET indications, MR spectroscopy, and MR angiography for renal artery stenosis and other indications in the abdomen.
Medicolegal issues: Several facets of the national crisis in liability insurance were discussed, including the rapid increases in premiums (up 570 percent since 1976 nationally, with smaller increases in states with damage caps) and statistics for malpractice claims.
RADPAC: Now the third largest subspecialty political action committee, RADPAC has given radiology increased visibility on Capitol Hill. After a presentation detailing its many real successes, even many debt-laden residents were seen sporting buttons that indicated financial support of RADPAC.

On Thursday, the remaining stalwarts among the RPS were able to participate in one of the most exciting activities of the week: the visit to Capitol Hill. Each participant was briefed on the issues of particular interest to radiology and given the chance to meet with senators, representatives and members of the congressional staff. The three issues that were brought to each member's office were:

"Assure Access to Mammography Act of 2003" (S.869 and H.R.817): These bills would increase reimbursement for the technical portion of hospital-based diagnostic and screening mammography, hopefully helping to curb a trend that has led to the closure of over 700 mammographic facilities in the last two years. The bill would also permit funding for additional radiology residency training positions.
"Help Efficient, Accessible, Low-cost, Timely Health Care Act of 2003" (S. 607 and H.R. 5): Already passed by the House, these bills would cap noneconomic damages at a fixed amount, hopefully providing some relief from skyrocketing liability insurance premiums. This is particularly important for mammography.
Revision of the Medicare conversion factor: Physicians are unique among health care providers because Medicare reimburses with a fixed overall expenditure target (the sustainable growth rate) tied to the gross domestic product. Unfortunately, health care costs are not accurately reflected by the gross domestic product, particularly because of changes in technology and the increasing age of the population. Although there was one adjustment in 2003, the old formula resumes in 2004 and predicts a 4.2 percent decline. The ACR advocates tying the sustainable growth rate to the medical economic index, which is more closely related to the true costs of health care.

The next ACR Annual Meeting and Chapter Leadership Conference will be held in Washington, D.C., in May 2004. The agenda is already beginning to take shape and several issues are moving to center stage:

Interventional radiology: At this year's meeting, Michael Pentecost, M.D., of the Task Force on Clinical Practice for Interventional Radiology presented a new paradigm for the practice of interventional radiology that involves providing a complete clinical service. He promised that redefining interventional radiology within the broader house of radiology would be a topic for next year.
ACR Practice Guideline on Communication: The ACR Council referred a resolution proposing changes to the current ACR Practice Guideline on Communication, which addresses communication between radiologist, referring physician and patient. E. Stephen Amis Jr., chairman of the Board of Chancellors, appointed a task force to evaluate all aspects of this guideline and report to the BOC at its January meeting.
Self-referral laws: Radiologists are increasingly forced to compete with other specialties that are investing in imaging technology and referring patients to centers in which they have a financial interest. This creates an obvious threat to radiology. Several strategies to address this trend were discussed at this year's meeting, including more study of the issue and enlisting other allies in the health care enterprise. An open discussion spurred passionate debate, and this will certainly continue at next year's meeting.

Get involved in your local ACR chapter and make plans to attend next year's annual meeting. Not only will you have a great time, you will learn about the forces shaping our profession and our role in protecting our future.

Sanjay K. Shetty, M.D.,
Secretary of the RPS Executive Committee.