Charles E. Ray Jr., MD, PhD, FSIR
As a relatively new chair of an academic radiology department, I have been exposed to aspects of IR to which I was probably previously incompletely aware. I could probably end this short article by boiling down IR into one word: “relevance.” Or maybe “importance”; but that would be two words and double this article’s length.
There are, I believe, currently approximately 20–25 chairs of academic radiology departments who are IRs. It is more difficult to track the numbers in the private sector, but anecdotally I am hearing more and more about IRs in leadership positions. In addition, the recently retired Gary J. Becker, MD, FSIR (executive director of the American Board of Radiology) and the late, great Harvey L. Neiman, MD, FSIR (executive director of the American College of Radiology), were both IRs by training and by nature. These leadership positions in radiology are increasingly going to IR—I think because of the increasing relevance of IR to medicine as a whole and to radiology in particular.
Having IRs in leadership positions, whether as medical staff presidents, administrative hospital positions, state medical society officers, chairs of departments or in leadership positions for national radiology organizations can, in the end, only benefit IR as a field. The reason we are seeing this trend, I believe, is that people now know who we are and what we bring to the table. I truly cannot think of another field that is so widely known and regarded as IR—we touch all other fields of medicine and administrators at the local and national levels can’t help but take notice. Those of us in current positions of leadership inappropriately take the credit for that trend, but of course that ball was started rolling by the energetic and insightful IRs from a generation or two before us—we are simply the lucky beneficiaries.
There have been many concerns raised about whether IRs as a whole should divorce ourselves from the house of radiology. My answer to that remains a strong and unequivocal “no.” There are many publicly stated reasons for remaining intact with our diagnostic colleagues, most of which understandably focus on why staying together is good for IR. I now also understand that, to my mind, separation would also weaken radiology as a whole. Someone much wiser than me said something about “A house divided…”
Now—today—is an incredible time to be an IR. To say nothing of the exciting medical advancements that occur monthly, IR continues to become increasingly important and relevant by assuming leadership positions in medicine today. It is hard to hide the enthusiasm for what we should all feel is just around the corner.
J. Bayne Selby, MD, FSIR
William S. Rilling, MD, FSIR
When I began my IR fellowship, there was one attending physician—the division chief, Tunk Tegtmeyer, a great interventional radiologist and one of the fathers of our specialty. His role as chief, however, was nothing like the role of current chiefs today. His job was to innovate new procedures, perfect others, train those who would take over the specialty one day (his fellows), select the latest and best imaging equipment, and convince the department chair and hospital that IR was a field worth supporting. Though these things are still required, growth in our specialty has added a host of other duties for a chief.
In 1997 I joined the Medical University of South Carolina where we had two attendings, myself and Renan Uflacker. We were designated as co-directors, befitting the fact that we were both experienced IRs who would probably need some title after our names when we gave presentations. Although the IR division was still small, this period was highlighted by markedly increased interaction with hospital and university administration/management. Renan and I became very visible to the department chair, the dean, the CEO and the president. In other words, the job had become more complicated, but still hadn’t reached a need for real managerial skills.
From 2001–2004, I was interim chair of radiology, having been asked by the dean. I think this reflected what was happening around the country where IR physicians were being recognized as good leaders and often candidates for radiology chair positions. The role taught me what real administrative responsibility entails and, although I was honored to do my part for the institution, at the end of the period I not only was happy not to be chair but said I would not take a chief position again.
Unfortunately my partner and friend, Renan, died suddenly in 2011, as many of you know. I volunteered to be division chief for a few years with an aim to keep the division growing and then turn things over to a new younger chief. Although Renan had twisted my arm to accompany him to many meetings during this period, I was still flabbergasted to realize the increased administrative requirements that were now part of the chief position. These encompassed a variety of areas including fellowship training, billing and coding, hospital rules and regulations, national rules and regulations, more fellows, more nurses and technologists, more attending physicians and, quite simply, more university/hospital politics.
The position is still as rewarding as it ever was, but the skill set required has undergone major transformations. An IR chief today must recognize that administrative skills are part of the job and simply being the best operator/ clinician is no longer a good reason to be chief. You won’t be the one to score the winning basket, but hopefully you will be the one to guide your team to the championship.
William S. Rilling, MD, FSIR
In the days of Marcus Welby (which I am too young to remember, of course) the chief of staff (COS) was responsible for oversight of all medical affairs in the hospital. Currently, the COS role varies from one institution to another and has been in evolution as medical systems and hospital governance become more complex. The responsibilities of the COS, chief medical officer (CMO) and other physician leaders in the hospital are quite variable from one institution to another.
At my hospital, the COS is nominated by any medical staff member and elected by a vote of the entire medical staff for a three -year term. The COS sets the agenda for and chairs the Medical Executive Committee, which oversees the quality of care in the hospital and coordinates all activities and policies of the medical staff and its departments. The Medical Executive Committee consists of select department chairs, the CMO, the hospital president, select hospital vice-presidents and senior medical directors of surgical, inpatient and outpatient services. These meetings occur monthly and in reality the agenda is set by consensus between the COS, CMO and hospital president. We review sentinel events, significant quality reviews, set a variety of hospital policies and discuss evolving issues such as Ebola virus preparedness.
The COS also is a member of the hospital board of directors and has overall responsibility for monitoring and reporting to the board on the quality of the medical diagnosis, care and treatment provided to all patients in the hospital. One of my personal initiatives as COS has been to improve communication between physicians, nurses, other hospital staff and hospital administration. In the age of the EMR and increased time pressure on all of us, personal interactions have diminished in frequency and duration. This often leads to misunderstandings and frustrations that can be easily remedied by just a few minutes of personal communication. To that end, we have monthly rounding sessions with the CMO, hospital president and myself to various points of care in the hospital to observe and discuss opportunities for improvement.
As IR physicians, most of us are very dependent on our hospital partners for resources including IR suites, technologist and nursing staff, inventory and other clinical support such as mid-level providers. Serving in such leadership roles as COS in the hospital helps us to understand and participate in hospital governance and raises the overall visibility of IR in the institution. This role gives me a much broader perspective and understanding of hospital priorities. As a result, the IR division has a better perspective so we can work together with the hospital toward common goals rather than at cross-purposes.
