The Skunk Works

Socioeconomics from the general, small, rural practice perspective


September 2015

If you are an aviation buff, you may have heard of the Skunk Works, a top secret aerospace engineering division that has developed the most advanced aircraft in history.

From the high flying U2 Dragon Lady to the first stealth fighter, from the Mach 3 SR-71 Blackbird to the elusive F-22 Raptor, the principle vision behind the Skunk Works has always been unencumbered innovation. In operation since the 1950s, the Skunk Works’ (a reference to the name of L’il Abner’s moonshine factory) success and structure have inspired technology companies such as Apple and Google to create their own so-called “skunk works” divisions in an effort to distill originality and creativity outside the organizational norm, something every business needs to survive and thrive.

How does this relate to the General, Small, and Rural (GSR) Committee on Economics, you might ask? The collective voice and direction of the ACR is a blend of many voices. The more grassroots, less structured arm of that voice comes from state constituents and individual members of national committees. These chapters and committees discuss issues, collect data, and make recommendations to the overarching commissions within the ACR who direct and develop national policy, practice standards, as well as public awareness initiatives, among others. They thrive on individual participation.

One of the most active ACR constituencies in the last five years has been the GSR subset. This group includes general radiologists and radiologists working in small or rural practices. According to Dr. Robert S. Pyatt Jr., MD, FACR, vice chair of the ACR Commission on GSR, this increased activity is related not only to the increased regulatory pressure that all radiology practices face, but also to the entrepreneurial spirit that drives small practices to provide top-line care in an increasingly competitive regional and rural environment. This innovative, skunk works spirit is crucial to the continued transformation of our profession, a transformation that we must continue to lead.

As leaders in this transformation, Drs. Catherine Everett (current chair of the GSR Committee on Economics) and Bob Pyatt (chair of the GSR Committee on Quality and Safety) identified the following hot topics for this subset of members:

1)Subspecialization. Professional and economic pressure from clinicians and third-party payers makes it potentially advantageous to have subspecialist coverage 24/7.
2)Communication. Practices are establishing more efficient, timely, and interactive communication pathways and resources within and outside the ACR to support smaller practice structures.
3)Access. Radiologists are balancing advanced equipment standards and regulations, quality of care, and increased cost in the setting of decreasing revenues.
4)Recruiting and Retirement. Many practices are navigating how to balance the decreasing resident pool with an uptick in retirements and hiring needs.

The GSR Committee on Economics would love to hear your thoughts on these and any issues your practice is facing. The committee takes our proposals to the ACR Commission on Economics in October. Please email your thoughts to This email address is being protected from spambots. You need JavaScript enabled to view it. or This email address is being protected from spambots. You need JavaScript enabled to view it..

By Eli C. Tate, MD, radiology resident at University of North Carolina at Chapel Hill and RFS representative to the GSR

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