The ACR Resident and Fellow Section

2005 ACR Resident and Fellow Section Meeting Summary:

The ACR's 2005 Annual Meeting and Chapter Leadership Conference was a great success, with many new and familiar faces from the RFS convening in the nation's capital to discuss legislative matters pertinent to both the section and to the ACR and the profession of radiology. In all, 112 residents from over 35 states representing more than 65 programs joined together to form consensus opinions on issues such as self-referral and the proposed guidelines for communications in reporting. It also served as a forum for the residents to discuss issues particular to our level of training, such as the National Resident Matching Program Fellowship match and MRI education.

Residents continue to be an active voice within the ACR and in the council meeting. Increasing involvement through service on task forces, commissions/committees, and reference committees has fostered an environment of enthusiasm and eagerness to be involved, spreading even into the RADPAC donations. This year, 24 states had 100% contributions by their resident and ACR members at the meeting.

From leadership development to meetings on Capitol Hill, the AMCLC motivated residents to take hold of and embrace their future, while forming lasting friendships with colleagues from all over the United States.

Main issues addressed in the RFS:

Fellowship match violations and survey results
MRI education initiative
Turf battles and their impact on resident education
Communication guidelines and preliminary result reporting, particularly the logistical and medicolegal implications for residents

Main issues addressed in the ACR Council meeting:

Self-referral and selective qualifications for Designated Providers of Medical Imaging Services (DPMI)
Medical liability reform
Medicare conversion factor and reimbursement

Saturday, April 9
The RFS kicked things off with a welcome and brief orientation by executive members on the ACR and its mission, as well as ACR governance, ACR chapters, and an overview for the newcomers on what to expect at the council meeting.

The afternoon session started with a talk by Richard B. Gunderman, MD, PhD of Indiana University, who spoke on what it takes to be a great leader, contrasting the traits of James Bond, a hero figure, to that of a true leader, who, rather than working alone, engages others and seeks to motivate them as the key to success rather than seeing them as bothersome to the cause. An important point was that heroes remind us how great they are, while leaders remind us of how great we can become. Gunderman delivered an engaging, entertaining, and enthusiastic presentation and discussion.

The discussion of the resolutions began in the afternoon. The most discussed and debated resolution in both the RFS section, as well as the general meeting, was Resolution 2/2A, addressing self-referral issues and promoting advocacy for quality, ethical, and appropriate provision of high-cost medical imaging. After much debate, the RFS section supported both resolutions, recognizing a few key points:

The RFS supported the idea of the Designated Provider of Medical Imaging (DPMI)
The RFS supported the idea of ensuring that self-referral and inappropriate utilization continues to be part of the ACR agenda
The RFS wanted to give the BOC/CSC the power to change accreditation and guidelines during the year to comply with negotiations on the DPMI.
The RFS supported the exclusion of interventional radiology and radiation oncology from the resolution in regards to referral for imaging

The evening was concluded with a reception for the RFS section, which was attended by members of the Council as well as the RFS membership and the ACR staff.

Sunday, April 10
Sunday began with a recap on the past year's activities, with talks from the 2004-2005 RFS Executive Committee:

Aradhana M. Venkatesan, MD (MGH), A3CR2 representative, discussed an ongoing project, a survey regarding turf battles and the impact on resident education. The survey, still in progress, will evaluate resident perception of the educational impact of turf battles in interventional radiology, obstetric ultrasound, and cardiac imaging, hopefully leading to concrete solutions that will ensure that residents across the country get adequate training. This will be addressed more in the upcoming months. She discussed issues raised at the 2004 Association of University Radiologists meeting, including chief resident issues, why women are not choosing radiology, and medicolegal issues. Venkatesan has been appointed as the resident representative on the Radiology Review Committee of the Accreditation Council for Graduate Medical Education, the group that accredits residency programs across the country.

Greg M. Galdino, MD (UCSF), secretary, spearheaded efforts of the very productive membership subcommittee this year, putting together an RFS Chapter Handbook that will serve as an excellent resource to residents trying to establish state chapters. The membership committee continues to work towards increasing participation of residents at the annual meeting, and Galdino led a successful push to increase attendance from California. He also discussed ongoing changes in the ACR Web site and mentioned the RFS E-news, a quarterly publication representing issues pertinent to our section.

Sanjay K. Shetty, MD (MGH), vice chair, spoke on the results of his fellowship survey, which addressed the issues of how the positions are filled in regards to the match, post-residency plans for the 2005 graduating class, as well as match rules and violations. The following points were made:

87% of graduates are pursuing fellowship training
A slight majority agreed that the NRMP should continue, but with modifications
Residents are divided on the issue of allowing internal candidates outside of the match
The most important issue is adherence to the spirit and rules of the match, including fair treatment of applicants and clear expectations through the process, will be the focus of the RFS' advocacy efforts this year.

The 2004 powerpoint presentation of the AMCLC meeting was created and made available, an effective tool for membership and awareness of the pertinent issues. The RFS executive committee also responded to national discussions on the radiologist assistant program, with modest success.

Tara M. Lawrimore, MD (MGH), American Medical Association representative, spoke on issues pertinent to the AMA, such as liability reform, reimbursement, and coverage for the uninsured. She also addressed the AMA's position that actively opposes closing the in-office exemption clause for imaging, contrary to ACR's position. In particular, she presented an emergency resolution that was introduced at the AMA annual meeting in Chicago by a coalition of other specialty organizations that ensured that the AMA will fight any efforts to stem increasing self-referral.

Jesse M. Davila, MD (Mayo Jacksonville), chair, spoke on the ongoing involvement by the residents within the ACR as well as within the RFS. He also spoke on the MR Education project, spearheaded by Christoph Wald, MD, PhD in response to the general dissatisfaction with MR training across the country. The project hopes to create a freely available resources of MRI cases, with a particular focus on MSK, body, and cardiac, in order to create a universal tool for education available to residents across the country. The MR pilot project is up and cases are needed. Resident involvement in this project will be the key to its success. Case submission can be done at radcase.newriversdigital.com. You can also e-mail any of the executive council with submission questions.

Lunch on Sunday was with the ACR leadership, and included informal round table discussions of various issues, ranging from women in radiology to self-referral. This was an excellent means of getting to know the leadership in addition to addressing pertinent issues.

The resolutions were discussed for consensus opinions from the RFS:

ACR Communications Guideline: The draft guideline was felt to be problematic because it required communicating "unexpected" results without appropriately defining the term unexpected; there was concern that even non-urgent findings (osteoporosis, hemangioma) would necessitate direct communication, creating a significant burden on residents. The RFS also highlighted the importance of creating mechanisms to record preliminary interpretations at an institutional level, rather than leaving the burden to individual residents. The final recommendations from the Reference Committee eliminated the wording regarding communication of significant unexpected findings.

Young Physicians Section (YPS): Although the members of the RFS agreed with the idea of a YPS to increase participation after residency, the resolution under discussion offered no concrete plans. The RFS advocated referring the resolution for further discussion, and the Council agreed.

The ACR Council meeting convened on Sunday. The Presidential address was given by Dr E. Stephen Amis. Sunday concluded with a convocation ceremony honoring the newest fellows of the ACR followed by the president's reception outside in the courtyard, complete with celebration, food, and fun.

Monday, April 11
The final RFS meeting was held on Monday, and the new officers for the Executive Committee were elected. Although this marked the end of the resident-focused activities of the meeting, the RFS actively participated throughout the remainder of the meeting.

Elections for the RFS executive committee were held, with the 2005-2006 committee composed of:

Position	Name	Training Istitution
Chair	Sanjay Shetty, MD	Massachusetts General Hospital, Mass.
Vice-Chair / Chair-Elect	Greg Galdino, MD	University of California, San Francisco, Calif.
Secretary	Amy Kirby, MD	University of Oklahoma, Okla.
AMA Rep	Geoff Wile, MD	Wake Forest, NC
A3CR2 Rep	Maryellen Sun, MD	Beth Israel Deaconess Hospital, Mass.

This year's Moreton Lecture was given by ACR Fellow David C. Levin, MD, on the subject of inappropriate utilization of imaging through self-referral, followed by a panel discussion of the topic. The 3 key points made by Levin were:

If nonradiologists are allowed to self-refer, there is a conflict of interest and overutilization inevitably results.
If nonradiologists are allowed to interpret images, there will be errors.
If nonradiologists are allowed to perform imaging, the quality of the studies is likely to be poor

The panel discussion sparked lively comments from the Council in regards to radiologists who work for physician-owned facilities, as well as overwhelming acknowledgement of the problem of economic conflict of interest, and varying solutions that are being implemented in some states and will be watched closely for future outcomes.

Tuesday, April 12
Always a highlight of the annual meeting, residents had the opportunity to lobby on Capitol Hill as part of their state delegations. This is an exciting and eye-opening experience, allowing residents to meet with their representatives and senators and directly participate in the ACR's advocacy efforts. On center stage was the MedPAC recommendations on the concept of the DPMI and the ACR's effort to promote safe, appropriate, and quality imaging. The legislators were urged to support these recommendations:

Congress should direct the Health and Human Services Secretary to set standards for physicians who bill Medicare for interpreting diagnostic imaging studies with private organizations administering the standards.
Congress should direct the Secretary to set standards for all providers who bill Medicare for performing diagnostic imaging services with private organizations administering the standards.
Physician Owernership definition in the Ethics in Patients Referrals Act should be expanded to include interests in an entitiy that derives a substantial proportion of its revenue from a provider of designated health services.

MedPAC has estimated a $4 to $6 billion in savings with the implementation of these items. Liability reform and the Medicare Conversion Factor for physician reimbursement were also addressed, both ongoing topics of discussion on the Hill.

After a full day of congressional visits, the RADPAC gala ensued, and the honorable Senator Vittner (LA) spoke in support of the ACR's key legislative priorities, including efforts to stem self-referral and overutilization of imaging services.

Wednesday, April 13
The business portion of the meeting continued Wednesday, with the Economics Forum addressing topics such as coding, managed care / private payer relationships.

During lunch, William E. Shiels II, DO shared his experiences in helping to rebuild the health care system in Iraq. He told moving stories of the men and women who are on the frontlines, trying to rebuild a devastated health care system in a war-impoverished and often dangerous country.

Finally, upon the convening of the council, the final reports were given. RFS Chair Jesse A. Davila, MD addressed the Council and acknowledged the residents' growing interest and involvement and their increasing participation in both the RFS, and the ACR, and residents' unique perspective as long-term stakeholders in the future of radiology.

Thursday, April 14
The final ACR Council session began with introduction of the new officers, followed by the panel discussion "Testifying as a Radiology Expert Witness: Ethics and Rules, Rewards and Penalties".

The Executive Council of the RFS met to discuss future plans and issues to be addressed as well. These issues include:

Education in regards to training requirements and boards focus
Membership issues, including continued growth and involvement on both a state and national level
Communications in creating a "face" for the RFS section, and creation of a video for the AFIP with testimonials, based on an idea created by Daniel W. Entrikin, MD, the new chair of the membership subcommittee, who turned an idea of recording resident experiences in the ACR into reality in just a matter of hours at the annual meeting.
Turf wars and their impact on resident education
The continued growth and development of MRI education initiative.
Fellowship match violations
Educational time for residency programs
Inconsistency in radiology education nationwide and setting minimum standards in regards to MRI

All in all, this year's AMCLC was exciting, exhausting, eye-opening, and most importantly, a whole lot of fun. Residency only comes once, and you have one chance to affect your future. Be involved, and as I said at the meeting "Everyone ends up somewhere, few people end up somewhere on purpose!" Make it count. Contact anyone on the executive committee, your state chapter, or Kelly Foster for more information on how you can get involved. You can find out more at www.acr.org.

Hope to see you next year!

Respectfully submitted,
Amy B. Kirby, MD, secretary
Resident Fellow Section Executive Committee