ACR Annual Meeting and Chapter Leadership Conference 2003

2003 ACR Annual Meeting and Chapter Leadership Conference
Hilton Washington, Washington D.C.

The 2003 ACR Annual Meeting and Chapter Leadership Conference (AMCLC) 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 (RPS) meetings, approximately 80 residents had the opportunity to meet each other, share experiences, and promote the interests of residents within the ACR.

With support of ACR leadership in the Board of Chancellors and the ACR Council, residents continued to increase their presence and influence at the ACR 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, allowing them to work directly with local State Chapter leaders to participate in lobbying efforts on Capitol Hill. Meanwhile, the camaraderie continued outside of the council hall, thanks in no small part to the benefits of Washington D.C. in springtime, including the great restaurants of Dupont Circle, the nightlife of nearby Adams Morgan, and a world-famous collection of museums.

An important theme of the meeting was increased involvement of the ACR Resident Physician Section in the activities of the ACR. Among the changes introduced at the 2003 ACR AMCLC were:

• Each of the ACR Council Reference Committees now has a resident member. These committees are central to the policy making process when the full Council convenes at the Annual Meeting. During the reference committee hearings, which are open to all ACR members, the committee members listen carefully to the debate about resolutions including suggested amendments. The committee then meets in a closed session to make a recommendation to the council whether to adopt, amend, or reject resolutions. Recommendations of the reference committee are presented back to the council for debate and vote.
• The Chair of the RPS Executive Committee will now be a member of the 15 member Council Steering Committee
• The ACR will be sponsoring two residents to attend the Intersociety Meeting, each funded by the ACR, to be selected via an election by the ACR Council
• Because of a new structure of the meeting, residents participated in lobbying efforts on Capitol Hill for the first time (see below)
• Residents will be actively involved in the upcoming Journal of the American College of Radiology (JACR) with a regular resident column in the works
• A formal Resident Physician Section Report was presented to the full ACR Council for the first time by EC Chair Christoph Wald, M.D., Ph.D. on Wednesday morning

The meeting opened with a daylong categorical course that discussed Molecular Imaging, the cutting edge of radiology that exists on the frontier of radiology, molecular biology, nuclear medicine, and physics. Attendees took a break from the proceedings to attend the RPS Lunch, at which ACR President Valerie Jackson provided our section with an overview of the ACR structure and the means through which it pursues its many mandates for Radiology and or Cheap Online Pharmacy and Radiation Oncology. (The presentation is available online at www.acr.org/departments/residents/aboutRPS/rps_overview.ppt.) The ACR Council, composed of 303 voting councilors from state chapters, the military, and subspecialty organizations, serves as the legislative branch of the ACR. The Resident Physician section is represented on this council by a Councilor and an alternate. Residents were able to relax after the Molecular Imaging course at a RPS reception attended by many of the senior members of the ACR.

The RPS went into high gear on Sunday, the first day of formal meetings and an opportunity for residents to prepare for the business of the Reference Committees and Council in the coming days. The Second Annual Resident Leadership seminar was held in the morning under the energetic guidance of Dr. Richard Gunderman, a radiologist from Indiana University. His dynamic presentation was surprisingly relevant and engaging, offering many important lessons to the audience on the traits and skills of an effective leader; his advice was broadly applicable and was met with many positive reviews. (His presentation is available online, using your ACR member number, at www.acr.org/departments/residents/members_only/leadership.ppt, although the slides will provide only a limited taste of the flavor of his talk.)

The Resident Physician Caucus began its discussions shortly thereafter, under the guidance of three alternate Reference Committee members who were assigned to review the resolutions and help direct discussion to those that were particularly relevant to residents. The discussions were lively; particularly enlightening was the chance to see how radiology and radiology residencies differ considerably throughout the country. Each of the Executive Committee members presented a report on their activities. Sunday concluded with a ceremony honoring the newest Fellows of the American College of Radiology; it was like being at a college graduation, with happy families in attendance, and was followed by a great reception.

The Sunday sessions also allowed residents to discuss issues of concern to the RPS, including:

• Timing of the Oral Boards:
  Thanks in large part to the leadership of the outgoing RPS Executive Council, 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 Executive Committee is planning to lobby several involved organizations and ensure that the resident perspective remains visible. Particularly important for each program is to minimize conflict within the department and ensure that 4th year involvement in clinical activities is monitored and discussed locally. The radiation oncology residents in attendance reported that their written and oral examinations were recently moved with little warning, and they were able to share their experiences with the group.
• Resident Call and Abuse:
  Several residents expressed concerns about increasing intensity of call (particularly given widening use of teleradiology), minimal or absent attending backup overnight, and misinterpretation of impending ACGME Work Hour Guidelines to justify skipping readout and teaching after an overnight call. The RPS EC is planning a comprehensive survey to look at this issue in the next couple ofweeks. During the latter half of the meeting, EC Chair Christoph Wald and our new Vice Chair Jesse Davila had an opportunity to communicate these concerns directly to Carol Rumack, MD, the current chair of the Radiology Residency Review Committee. Dr.Rumack shares our concern and will alert the site visitors to pay attention to the call issue during the upcoming cycle of site visits.
• MR Training Survey:
  Executive Committee Chair Christoph Wald presented a summary of results obtained through an MR Training Survey performed last year, identifying 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 RRC to help identify deficiencies in residencies. Drs.Wald and Davila and Kelly Foster met with members of Commission on MRI and the Commission and the Department of Education to explore ways of creating a comprehensive teaching resource that would help balance the training shortfall in many programs and may help standardize case exposure to the modality. During yet another meeting, Dr.Amis, the current chair of the ACR board of chancellors indicated possible support for such an endeavor.

The final meeting of the Resident Physician Section was held on Monday morning, at which time the 2003 – 2004 Executive Committee was elected (see below). Although this marked the end of the resident-focused activities of the meeting, the RPS actively and visibly participated throughout the remainder of the meeting.

The Reference Committee meetings were held on Monday, allowing open discussion of the resolutions pending before the ACR Council. Their recommendations were then discussed and further amended in the full ACR Council meeting on Wednesday before final passage or referral. Residents spoke out on several issues, both on their own and on behalf of the RPS. Some of the most contentious issues were:

• Radiologist Assistants:
  A resolution, jointly sponsored with the American Society of Radiologic Technologists (ASRT), supported creation of programs to begin training of Radiologist Assistants (RA), an advanced technologist who will work under the radiologist to perform certain procedures and studies but who will provide no interpretations, either preliminary or final. It was felt that this would allow the ACR to actively shape and limit the scope of practice and to be involved in regulatory legislation in an organized way.
• Guidelines and Technical Standards:
  After a heated debate at the previous meeting and exhaustive work by a Task Force convened to address the issue, it was decided to change the name of “ACR Standards” to “ACR Practice Guidelines and Technical Standards” to address concerns that “Standards” might be misinterpreted as standard of care and expose practitioners to liability.
• The ACR adopted resolutions that supported the need for additional research to evaluate the outcomes of CT screening procedures and responded to deceptive advertising regarding alleged perfect accuracy of screening breast MR examinations.
• Several resolutions increased involvement of residents in the ACR (see above)
• Numerous new ACR Practice Guidelines and Technical Standards were adopted, although some discussions were surprisingly contentious, including heated debate on the Guideline on Scoliosis Radiography (!) that was eventually referred for further modification.

The sessions on Tuesday of the AMCLC provided a glimpse into the many areas in which the ACR provides leadership. Most of these are pretty bewildering (particularly for those of us still trying to get a handle on the clinical issues of radiology), but it didn’t take long to realize that each is crucial to the way in which we practice radiology:

• Economic Issues:
  The ACR represents radiology and radiation oncology in issues related to reimbursement by providing data and information that helps shape the decisions of national committees involved in policy, including the Relative Value Update Committee (RUC) and the Practice Expense Advisory Committee (PEAC). 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.
• Medico-legal Issues:
  Several facets of the national crisis in liability insurance were discussed, including the rapid increases in premiums (up 570% since 1976 nationally, with smaller increases in states with damage caps) and statistics for malpractice claims (67.7% dropped or dismissed, 27.4% settled, 4.0% won by defendant, and 0.9% won by plaintiff). Dr. Leonard Berlin spoke about the need to educate expert witnesses on the standard of care and mechanisms to ensure that experts testify as impartial experts rather than advocates.
• RADPAC:
  Now the 3rd largest subspecialty political action committee, RADPAC has given the ACR increasing visibility on Capitol Hill. After the presentation detailing its many real successes, even many poor, debt-laden residents were seen sporting buttons that showed 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. Plus, Mark Shields (of CNN) provided some entertaining Beltway humor. 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):
  This bill would increase reimbursement for the technical portion of hospital based diagnostic and screening mammography (which are currently performed at a financial loss), 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.
• Tort Reform – “Help Efficient, Accessible, Low-cost, Timely Health Care (HEALTH) Act of 2003” (S. 607 and H.R. 5):
  Already passed by the House, these bills would cap non-economic damages at a fixed amount, hopefully providing some relief from skyrocketing liability insurance premiums. This is particularly important in mammography, the most commonly involved modality, for which increasing liability premiums are reducing physician involvement and limiting patient access to an important and potentially life-saving test.
• Revision of the Medicare Conversion Factor:
  Physicians are unique among providers because Medicare reimburses with a fixed overall expenditure target, the Sustainable Growth Rate (SGR), which is tied to the Gross Domestic Product. Unfortunately, health care costs are not accurately reflected by the GDP, particularly because of changes in technology and increasing age of the population. Although there was a one-time adjustment in 2003, the old formula resumes effect in 2004 and predicts a 4.2% decline. Rather, the ACR advocates tying the SGR to the Medical Economic Index (MEI), which is more closely related the true costs of healthcare.

Elections for the RPS executive committee were held, with the 2003 – 2004 committee composed of:

Don’t let this long list of activities and meetings fool you: while this was a productive meeting, residents took advantage of the time away from clinical duties to relax, meet each other, and enjoy Washington DC. It was great to spend time with everyone involved in the conference, a really friendly and energetic bunch, over a few too many beers and great food. One of the highlights of next year’s meeting for many will be to rekindle the friendships made at ACR 2003 and meet the next group of residents who are eager to participate.

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

• Interventional Radiology:
  Dr. Michael Pentecost of the Task Force on Clinical Practice for Interventional Radiology presented a new paradigm for the practice of IR on Monday that involves providing a complete clinical IR service, including clinics and admitting privileges. He promised that redefining IR within the broader house of radiology would be a topic for next year.
• ACR Practice Guideline on Communication:
  The ACR Council referred (sent back for further review and modification) a resolution proposing changes to the current Guideline on Communication; this important issue, which refers to communication between radiologist, referring physician, and patient, will undoubtedly surface again next year.
• Self-Referral Laws:
  Radiologists are increasingly being forced to compete with other specialties that are investing in imaging technology and then referring patients to centers in which they have a financial interest. Apart from the conflict of interest and potential strain on the medical system that such a practice could create through overutilization, this creates an obvious threat to radiology. Several strategies were discussed at this year’s ACR, including the need for study of the problem and enlisting other allies in the healthcare enterprise. An open discussion on Wednesday of the AMCLC spurred passionate debate, and this will certainly continue into next year’s meeting.

This is a great opportunity to get involved in your local ACR Chapter and even make plans to attend next years annual conference: not only will you have a great time, but you will learn about the forces that shape our profession and our role in making sure that our future is protected. Please send an email to the executive committee members, Kelly Foster, or your local state chapter resident delegates if you would like to find out how you can get more involved with the ACR activities. The email addresses can be found on our website (acr.org/dyna/?doc=frames/main-residents.html). There are many roles for residents throughout the year. Your executive committee would be delighted to coordinate involvement of as many residents and fellows as possible!

Report respectfully submitted by
Sanjay K. Shetty, M.D.
Secretary, ACR Resident Physician Section Executive Committee