Eating Our Seed Corn

Our youngest members are entering practice amid tectonic changes in the landscape of medicine. How are we supporting the next generation of radiologists?

Commission on Economics: Eating Our Seed Corn

One of the most rewarding aspects of my job as chair of the Commission on Economics is the work I do with the Resident and Fellow Section.

I’ve written before about our virtual economics journal club (read more at, and I’ve recently created a new RFS Economics Group that will be diving into the issues we face and adding the valuable trainee perspective to our work through the commission.

I’ve learned so much from this group and all the residents and fellows with whom I interact. As we have discussed issues ranging from price transparency to how to define radiologists’ value, I have been impressed by the younger members’ willingness to embrace the turbulent world in which we all now practice. They see themselves as a critical part of the health care delivery team, but they know that radiologists have their work cut out to demonstrate and define that value to an often skeptical world. I am inspired by a wide range of younger members, from the residents at my own institution who are establishing a presence on rounds to trainees from NYU, Beth Israel, and Massachusetts General Hospital who presented the award-winning poster at this year’s AMCLC, documenting the role that residents can play in the Imaging 3.0™ initiative (see the poster at

Our trainees understand the value of participating in organized medicine both in our radiology societies (more at and in the greater house of medicine (more at They know the importance of political advocacy (more at They are passionate about the ability of radiology and radiologists to contribute to high value care. Far from being despondent about the health care landscape, they are enthusiastic and willing to do whatever it takes to practice their specialty.

In addition to their proactive outlook, our trainees are technologically savvy. They’ve created their own websites and apps. Social media do not scare them, and they know how to leverage the power of these tools and use them safely. As hyper-communicators, the notion of discussing results with patients represents an opportunity not a threat. All in all, if our resident and fellow group is the future of our specialty, then our future is bright despite all the challenges we are facing.

This issue of the ACR Bulletin focuses on jobs. With cascading reimbursement cuts compounded by the financial crisis that has stalled retirement, for many it can be difficult to think about bringing someone new into your practice. You might argue that it is not fair to offer a job in these uncertain times. But I would suggest to you that this is exactly the time to think about making an investment in what is the most valuable asset your practice can acquire: talent.

We’ve talked about the Imaging 2.0 mindset in which individual productivity is emphasized above all. We’ve realized that it does not represent the road to future success for our specialty. Taking the leap to Imaging 3.0 is undoubtedly scary. Whether it is making time to attend meetings and conferences in your institution, changing the way you communicate with patients, or finding a place for one of our talented graduates, moving forward requires a willingness to change. And the difficulty of that is not to be underestimated. But leap we must if we are to survive and thrive.

The leadership of the ACR is committed to advocating for payment models that will support this change. Admittedly, the payment system has been slow to recognize radiologists’ value, but we are encouraged by developments such as the legislation of clinical decision support for advanced imaging. We are working diligently to build upon that success. Read more about decision support in a recent JACR® column by Bibb Allen Jr., MD, FACR, at

Having graduates who can do the legwork of educating your referring physician community on the implications of clinical decision support could be a game changer for your practice. They can help you set up the communications tools to provide the consultation support that is essential to making decision support function optimally and differentiate your group. The return on this investment could be huge!

What we cannot afford is to see a generation of our graduates marginalized and forced to seek work in settings that reinforce the creeping commoditization of our specialty. We will lose if we fail to recognize the value that our graduating residents and fellows can deliver.

A shockwave rippled through the specialty earlier this year when many residencies failed to fully match for the first time. If we are losing potential trainees because they were only seeking out our specialty as highly remunerated, then we may not have lost much. But if we are failing to recruit the best and brightest because medical students see us as unwilling to allow new graduates to flourish, then we will truly have eaten our seed corn.

geraldine.b.mcgintyBy Geraldine B. McGinty, MD, MBA, FACR, Chair


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