Seeing what matters most when expectations are high yields the intangible dividends that reinforce why you serve the specialty and your patients.
At ACR 2026, outgoing ACR President Timothy L. Swan, MD, FACR, began his address with a personal story that led to a renewed commitment and prominent roles within the College. The annual keynote speech sets the tone for the conference — highlighting major accomplishments and offering insights into the challenges facing radiology.
“I don’t mean this as a figure of speech when I tell you that 12 years ago, I did not expect to be standing here,” Swan said. “In 2014, I had a general tonic-clonic seizure while watching a Monday night football game. A workup in the ER found a left frontal lobe brain tumor. All who have looked at those and subsequent diagnostic imaging studies, including folks in this room, believed that this mass was a low-grade glioma. Fortunately, since that diagnosis the mass has not changed and is likely benign. But at the time, the life I had built around my work and my community — and around the relentless pressures of another study or procedure, turnaround times and productivity metrics — all came to a full stop. I couldn't read images for a while, I couldn't drive. There were things I had done every day for years that I simply couldn’t do. And in that enforced stillness, in the margin that the illness carved out of my schedule, I found myself with something I had not had in a very long time — time to look around me. I had time to think about what was important.”
With that time, Swan decided to get involved with the ACR in a larger capacity than he had when he was well. “Wellness, as it turns out, had made me too busy to invest in anything beyond the next study or procedure. I joined committees. I showed up at meetings. I met colleagues who I would never have met while stuck behind a workstation,” he said. “Then slowly, and unexpectedly, I found my way to this podium. The tumor, in a roundabout way, led to this presidency. I'm still working out how I feel about that, but what I’m certain of — and what I want to talk about today — is what that experience taught me about gratitude.”
The conditions in radiology are quietly destroying our capacity for gratitude, Swan said. “It matters more than most of us have stopped to consider, and I believe we think about it too casually. Gratitude is something that is freely given and beyond transaction.”
The psychologist, Robert Emmons, PhD, defines gratitude as an acknowledgment that there are good things in the world — gifts and benefits we have received; something valuable from a source outside of ourselves. “It involves recognizing the contributions these external sources have made to our well-being and happiness. It requires us to stop, to look outward and to recognize something more than the immediate task in front of us,” Swan said. “Sustained, deliberate, outward-facing attention is precisely what our working conditions are systematically stripping away from us.”
Swan notes that imaging volumes in the U.S. have grown by roughly 25 to 30% since 2018, and the radiology workforce has not kept pace. “The average radiologist today reads significantly more studies per shift than their counterpart did 15 years ago. Despite expectations, turnaround times have doubled in the last decade,” Swan said.
The average radiologist today reads significantly more studies per shift than their counterpart did 15 years ago. Despite expectations, turnaround times have doubled in the last decade.
“Administrative burdens have grown and the pressure to clear our work lists, to hit metrics and to keep the medical care train moving is now the dominant rhythm of the workday,” Swan said. “Over time, that pressure narrows our attention to the task directly in front of us. It trains us implicitly and relentlessly to treat each study or procedure as a unit to be processed rather than a patient to be seen. It erodes the margins, the small pauses between procedures or studies where human contact used to happen — where a technologist might stop by or a colleague might ask how you’re doing and actually mean it.”
What is the human cost of this erosion? “We are becoming less grateful, not because we care less, but because the conditions of our work make gratitude structurally harder to practice. Before I became ill, I had stopped saying ‘thank you’ at work. It wasn't a decision, it was erosion,”’ Swan said. “The worklists were long and administrative tasks never ceased and at some point, I stopped acknowledging the people around me. I told myself I was being efficient. What I was actually doing was losing something I couldn’t name until illness forced me to stop and look.”
When he assumed a leadership role with ACR, Swan quickly found through work on committees and conversations with colleagues (who became friends) exactly what Emmons describes. “I had a restored sense of connectedness. It was a recognition that earthly good had come into my life from sources outside myself and that I had been moving too fast to see it,” Swan said.
It is painful to watch the profession succumb to pressure and burnout, Swan said. “The more disconnected we feel, the less likely we are to practice gratitude. And yet, practicing gratitude in those situations is precisely when its effects are greatest,” he said.
Practice gratitude on a small scale, at least at first, Swan said. “That might be as simple as pausing for 30 seconds before your first case of the day to name one thing that you value about the work you'll be doing that day. It might mean saying something specific to a colleague — not just ‘good work today,’ but the exact thing at the precise moment — that mattered to you,” Swan said.
“Against the grain of a work environment that is always pushing increased productivity, I want to ask something of you,” Swan told the audience. “This ask is not to present a resolution before the Council or to contribute to an ACR initiative, but from one radiologist who had to learn the hard way — express gratitude to someone you admire in this room full of people,” he said.
Swan concluded his address with heartfelt advice. “Don’t wait for a seizure to tell you what matters. You don’t need a life-altering diagnosis to look outward from your work. Practice that now, while you are busy and your workload is pressing. I am grateful for the ACR and for this podium — and for every person here who does the work of the College — with seriousness and care.”
By Chad Hudnall, senior editor, ACR Bulletin.
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