Meet the ACR Leadership: Alexander Norbash, MD, FACRacr leadership

This is an installment of a series titled “Meet the ACR Leadership.” Throughout the series, we interview the ACR Leadership to get insight into their background and involvement in the ACR. For this installment, we talk with Alexander M. Norbash, MD, FACR.

You have held and currently hold several leadership roles in the ACR. How did you get involved and what continues to motivate you?

I understood the importance of legislation and preserving the vitality of our specialty even as a resident. I was a resident in Pittsburgh at the time Joseph A. Marasco, Jr., MD, FACR, was the chair of the Board of Chancellors (BOC). He was very gracious and eloquent as he spoke of the significance ACR had in affecting legislation. Joe Marasco and others on the ACR BOC had a significant impact in guaranteeing the future of radiology when it was a time of crisis. I carried that with me and it compelled me to support the ACR over my lifetime and to accept responsibility in other radiology societies, specifically the Society of Chairs of Academic Radiology Departments.

As my toolkit expanded to include not only interventional neuroradiology, but also educational systems and strategic planning, the work my department was doing came to the attention of ACR senior leadership. We were asked to give a presentation on strategic planning. That led to several activities, such as being involved with the strategic work the ACR was doing. At the same time, the presentation created friendship and similarities between the two groups in terms of specific projects that could benefit from the expertise of the ACR.

I saw how open, optimistic, effective, and energized the ACR leadership was. It impressed me and I chose to spend a greater portion of my time with the ACR. That has been extremely gratifying for me personally because I see the effects of my work in a more expanded way I could not otherwise experience by myself or with a different society. In the area of radiology, the ACR is unparalleled in terms of what it can accomplish.

What has been your favorite activity or most proud project in the ACR?

When you see an idea go from a a nebulous conversation or a meeting of minds, to a real thing radiologists across the country know about, there's really nothing that compares to that level of satisfaction and gratitude. Whether it’s value-based imaging, data registries, the Diagnostic Centers of Excellence (DICOE)® program, the Learning Center, or the Radiology Leadership Institute (RLI)®.

The volume of activities and the ability to bring conversations and ideas to completion is something only the ACR permits. It’s one thing to discuss solutions and ideas with your colleagues, and an entirely different experience to actually participate in architecting true change. We often talk about things that could be transformative without actually doing them. Now imagine how gratifying it would be if you and a few of your colleagues and like-minded radiologists could generate a set of ideas and if you had the resources nearby to actually help you carry it out and realize it. That's a special thing.

You are the current chair for the ACR Institute for Radiologic Pathology (AIRP). What does this role entail?

Radiology residents come from across the country to participate in this particular forum. It gives remarkable access to trainees in one physical location and we understand how significant that opportunity is. These residents are coming to be taught radiology pathology. As they complete the courses and give us feedback, we have to make sure the course and experience reviews they write are carefully scrutinized and the appropriate changes are implemented. It’s an important feedback role for understanding what the residents are getting out of it. While we're listening closely to the original attendees, we're also trying to assemble the best and brightest faculty from across the country to teach. That involves negotiation with home departments and construction of the curriculum ensuring that it is being done correctly.

There are also opportunities to add information other than radiologic-pathologic correlation that we feel is valuable. For example, we are having RLI lectures. We want to make sure it's fresh, exciting, and it's financially viable. So far, we've been very fortunate. The vast majority of resident reviews are extremely positive and we believe the enhancements we've put in place have only added luster.

As a leader in the field, where do you envision radiology heading in the next 10‒20 years?

There are going to be dramatic changes. We are going to be focusing on rapid and safe imaging methods. I have seen a head scan sequence that included seven series completed in under 4 minutes 40 seconds. That's only going to get shorter. As the price of imaging drops, the number of scans are going to increase. We're rationing imaging right now because it's extremely expensive. You can imagine, if the price were to drop to a fraction of what it is currently, the disincentive and barrier mentality for imaging becomes a thing of the past.

I believe we're going to have a lot of imaging studies necessitating computer aided detection (CAD). If you’re a radiologist currently looking at 40 MRIs, imagine a future where you're looking at five to ten times that amount easily and effortlessly. I think CAD is going to address that increased volume and at the same time radiologists are not going to be as essential for the individual practitioner’s interpretation. We'll be doing reconciliation and interpretative crowdsourcing, and serving in a more direct and robust capacity, communicating with clinicians and patients.

We’ll need to learn how to ration time for consulting with physicians and patients. Radiologists have been willing to allow ourselves to be disintermediated and allowed the specialty to be recused from patient interaction. In the future, if we're interested in securing our position, we have to establish value by ensuring we're spending sufficient facetime as consultants. That's going to be transformative for us. The way our departments are set up is going to change. The way that we spend time is going to change. Where we're located in the hospital will change. We will need to be physically front and center as the diagnosticians communicating with our patients.

What advice would you offer to residents interested in pursuing leadership roles in the ACR?

Start early. There is no best time for significant events in your life. It's undeniable if you do not start, you won't finish. Once you realize you're interested, even if you're doing a little bit of it at a time, you have to have the discipline to start. Take an occasional evening course or listen to a webinar and you'll find out if it’s suitable to your disposition. Even though you may feel overwhelmed with responsibilities, if you are simultaneously motivated by your ambition, I urge you to take a first step. If you hunger for it, you will find a way to do it. Whether it's subscribing to Harvard Business Review and reading the abstracts in the back when it arrives, promising yourself to do three webinars a year, taking the RLI courses, or attending an RLI summit meeting in person. Set yourself personal goals and try your best to achieve them, whatever it may be. If you are interested in leadership, that means you have to put your toe in the water and acquire this body of knowledge which is specialized. Just because you're extremely motivated and you've been successful, does not mean you intuitively possess the jargon and the science of leadership administration. That is work that demands exposure to this specialized body of knowledge. You have to recognize you have to take the first step.


By James Reese, MD, fourth year resident at Eastern Virginia Medical School

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