Signs of the Times

ACR CEO reflects on his tenure and the future of the specialty.signs of the times

Editor's Note: The ACR Bulletin sat down with Harvey L. Neiman, MD, FACR, CEO of the College, the state of the College, and what's in store for the ACR. Neiman recently announced that he will be retiring in the spring of 2014.

Q: You have been CEO for 10 years now. How has being CEO changed your perspective of the ACR?

A: I have developed a greater appreciation of the ACR's role in health care and a broader outlook on both the history of health care as well as the current dynamics. My role has expanded my perspective and has provided a unique opportunity to initiate change for the benefit of radiology and medicine in general. My time at the College has made me — if I can use the term — a wiser person, eager to affect positive changes in health care.

Q: How has your point of view evolved with respect to radiology?

A: Radiology has changed enormously since I entered the field. We've seen fundamental changes in both the capacity and accuracy of imaging, and that has led to more informed decision making and ultimately better outcomes for patients. When I started my career, there were plain films and GI work. There were also some minimal nuclear medicine and a few invasive procedures, but that was about it. Nonetheless, radiologists had an important role at that time. Radiology was an important field 30 or 40 years ago, and today it is an essential field. Virtually every patient who comes through a hospital or practice's doorway receives some type of imaging. It is critical to the delivery of quality health care in our country.

Q: How would define your greatest achievements?

A: There are a number of achievements that make me very proud — including the JACR®, the Education Center, a first-rate legislative team with an outstanding team on Capitol Hill, and the American Institute for Radiologic Pathology (AIRP).

Our first significant achievement is, I think, the JACR. At its beginning, we didn't have a clear path on where to go with it, and a number of members opposed it. Overcoming that opposition and designing a product that is now among the top reads for radiologists was a tremendous feat. The journal comes out every month filled with new ideas and new ways of doing things.

I also think the ACR Education Center is extremely important. I'm thrilled with it and think that we have developed it into a major contribution to medicine.

The new Neiman Health Policy Institute is another major development and should bring tremendous interest to health policy vis-à-vis radiology. There are those who say we can do without radiology, some who say we should do more radiology, and those who are somewhat in between. The HPI is helping to resolve some of that controversy.

In addition, the AIRP is clearly one of the key transitions in radiological education. To be able to take over the Armed Forces Institute of Pathology (AFIP) course and provide this service to residents on a continual basis is wonderful. When it was announced that the AFIP planned to close its doors, we had residents as well as staff come up to us and tell us that we needed to do something. "You are the only organization that can do it," they said. So we took over the course and made it the AIRP.

Q: Radiologists have always occupied a challenging middle ground in medicine. What, in your opinion, is the greatest threat to radiology and patient care?

A: I'm concerned that radiologists are going to let their place in patient care wither away and find themselves without any piece of the medical pie. For radiologists to remain a trusted resource going forward, it is paramount that they develop expansive knowledge and in-depth understanding of their subject area. It is critical that they remain at the center of critical decision making.dr neiman

Q: What is ACR's role in helping radiologists?

A: ACR must continually advocate for a central role in having the radiologist set the scientific agenda. We must understand physiology and molecular imaging and how it can be used for diagnosis. ACR will also continue to play a central role in equipping radiologists with the evidence-based, scientific information and thought leadership they need to improve the quality of care for patients.

Q: How do today's resident differ from when you were a resident?

A: I am impressed with the breadth and depth of knowledge today's residents are prepared to bear. Today's residents appreciate the level of expertise needed to be of value.

Q: What has been the greatest benefit of being a member of the ACR?

A: I think the greatest benefit is the contacts with others that one can make on a daily basis. There is opportunity to grow as a health policy expert and as a scientist. The breadth of information that is available through the ACR is amazing. In addition, membership has provided unique opportunities to interact with and learn from international leaders in the field.

Q: Who do you consider to be your most influential mentor?

A: That would have to be Bill Martel, MD, FACR. Bill was amazing. He taught me how to look at an X-ray. He taught me how to define the case, how to order the information that is on the film from the X-ray in a cogent and intelligent fashion, and how to relate that information to the referring physicians and other involved in the case. He is a brilliant diagnostician, absolutely brilliant.

I also would like to mention Lee Rogers. Lee can be shown an abnormal film, given no history, and he is able to put it together, including a differential diagnosis that is pertinent, cogent, and accurate. He pretty much hits a home run every time. It is a thrill to see him work. A truly great teacher.

Q: What aspects of radiology do you feel deserve increased attention?

A: I want to talk a little bit about interventional radiology (IR). It is a subspecialty that is very important because it puts the radiologist at the center of the case. One of the things I'm worried about is that IR is becoming marginalized by other specialties and subspecialties. They pick up a little bit of a case here and do a little bit of interventional there. I think that we need to protect that turf with everything we've got. It keeps the radiologist at the center of the patient's relationship with the hospital.

We in the United States are ahead of the curve, and I think it's important to stay ahead. Whatever's new and exciting is usually done here first, and it is really worrisome when that doesn't happen. For example, many phase-II and -III clinical trials are being conducted out of the country, and I think we need to get back into doing more of those types of trials.

Q: What has been the greatest challenge during your career?

A: When I started out as ACR's CEO, I called a meeting of the staff and I explained that we were going to continue to honor the non-profit methodology of operating a corporation. However, I also said that we would be able to better solidify our truths and beliefs through a for-profit business model. We will make sure to include private as well as publicly supported patients in our clinical trials so everyone can have a chance, if they qualify. I said that we were going to do it all right. In other words, we are going to make sure that the individual has received the finest care anywhere.

Now my challenge is to transition to a different role as I prepare to leave the College in capable hands. As we work to combine current and future leadership, I am reminded of the hard-working individuals that make up the College and contribute to our success. It has been an honor to lead and serve with them for the past 10 years.

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