ACR Bulletin

Covering topics relevant to the practice of radiology

Behind the Microphone with Geoffrey D. Rubin MD, MBA, FACR

The host of the ACR RLI podcast series weighs in on thought-provoking similarities and differences in the views of two sets of panelists in special episodes of Taking the Lead.
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There has been a sense that, in radiology, there's always something new on the horizon.

—Geoffrey D. Rubin, MD, MBA, FACR
December 01, 2023

To mark the celebration of the ACR centennial in 2023–2024, the ACR Radiology Leadership Institute® (RLI) recorded a pair of podcast episodes that look at two different generations of radiologists: those who have decades of experience in the specialty and those with less than 10 years in practice.

Play Button Listen to the experienced and rising radiologists podcasts                

In this article, the Bulletin sat down with the RLI Taking the Lead podcast host, Geoffrey D. Rubin, MD, MBA, FACR, to discuss areas of overlap and divergence in the views among the two generations of radiologists, as well as the thought processes behind his questions.

What differences between the two panels struck you as being most eye-opening or particularly interesting?

Both groups shared far-ranging perspectives about our past, present and future in radiology. What struck me was how differently they discussed one key topic: AI. The younger panel shared concerns about AI and the challenges they expect to face soon. They believe it's crucial for us as a field, and for them personally, to get involved with AI to avoid heading down the wrong path. On the other hand, the more experienced panel shared a brighter outlook, focusing on the positive possibilities they expect AI to bring.

Why do you think senior radiologists are more optimistic about AI than their younger counterparts?

I believe longtime radiologists’ rosy perspective about what’s coming next stems from their past experiences with the favorable innovation glide path they experienced throughout their careers based on all the incredible technological developments they have lived through. They witnessed the birth of digital radiology and the evolution of technologies like CT, MRI and PET. They’ve experienced firsthand how technological advancements can transform the way radiology is practiced to improve the breadth and depth of information available to direct patient care.

That major sea change hasn't occurred yet for the younger group because there hasn't been that same level of transformative technological reform during their careers, outside of the emergence of AI. The experienced panelists have lived through decade after decade of technology upheaval, learning new diagnostic and treatment approaches and figuring out how to harness them to serve their patients. I think that leads to a divergence of opinion about how AI might impact our specialty.

When technologies like MRI and CT came to the forefront, there was never a fear that those technologies could diminish the profession like we hear today around AI. In fact, it was energizing, because radiologists were essentially “gift givers” to medicine. We brought these amazing new technologies into our departments, figured out how we could use them to improve patient care, and shared that with our clinical colleagues. There was a sense that radiology seemed uniquely privileged to be inundated with so much incredible technology consistently positioning it at the forefront of innovation. From the 1970s through the 2000s radiologists could always expect something new and empowering on the horizon.

What are the changes and challenges the younger panel highlighted?

A lot of the younger group's discussion focused on daily challenges like time management and how to administer their practices, take care of patients and grow programs at the same time. Plus, there have been other elements of disruption for this group, such as the COVID-19 pandemic, which looms particularly large because it has impacted a much bigger percentage of their career.

The biggest fear expressed by the younger panelists concerned AI getting rolled out in a way that is not sufficiently safe for patients and not sufficiently protective of the responsibility of radiologists to serve as caregivers to their patients. What came through loud and clear is that they will always feel a primary sense of responsibility to their patients — whether AI is reading the cases or not.

They worry about a future where they might be presented with an AI-generated report and expected to just look it over and sign it off — facing the dilemma of determining which part of a seemingly well-articulated report might be incorrect. Are they going to be afforded the opportunity to scrutinize the imaging study sufficiently to protect the patient from AI’s shortcomings?

There was also a concern that even if AI gets particularly good on average — where it's right more than 90% of the time — will radiologists in training have enough exposure to the full spectrum of image interpretation that will enable them to find the 10% or 2% or 3% of instances where AI is wrong? They’re wondering: How do we train radiologists to be the final arbiter and do what’s best for our patients in an environment where the expectation is, “Do more and do it quicker with AI”?

What advice do you think experienced radiologists should give to the next generation?

My advice is: Hold on; it's going to be a wild ride, but it will be alright. We have a tremendously talented community of radiologists, and people who are allied with us, working together to figure it out. Historically, we have always found the pathway where we serve our patients with ever-increasing impact and relevance. When you align with that mission as your North Star and lean into radiology’s pedigree for innovation, you will continue to expand our capabilities and grow our importance within the healthcare community.

That said, remain clear-eyed and prepared to recognize and respond to the inevitable threats that will emerge. I am so inspired by the young leaders in our field and am confident that your successes on behalf of our field will be greater than we can possibly imagine today.

What role does leadership training play in preparing newer radiologists for the future?

Thanks to the ACR and the RLI, we've built up a culture that recognizes the importance of leadership training, supporting it through excellent program development. Consequently, access to leadership training opportunities within the house of radiology is unprecedented in its breadth and depth. It is gratifying to see that access resulting in radiologists gaining the confidence to engage in leadership roles earlier in their careers.

Being a leader in radiology presents a lot more demands now than in the past. Organizations are larger, more complex and highly matrixed. The idea that radiology operates as an independent silo is obsolete, so learning leadership and business skills is more important than ever before. Based on the accomplishments of the talented group of radiologists who sat on the younger panel and many other generationally similar colleagues across the specialty, we can see that leadership training is working. But we need to continue to lean in, further build competencies and communicate the importance of radiologist empowerment through leadership training.

From a personal perspective, I've been tremendously privileged to have experienced evolving phases of my career, ranging from developing new technologies and introducing emerging clinical practices to realizing leadership positions and advisory roles. What’s been an epiphany for me is recognizing my need to continuously invest in my own leadership development in order to most effectively serve my organizations and the people I lead. I know I am not alone in this recognition and believe that is an important message experienced leaders should convey to the next generation.

Let me ask you a question that you asked the podcast panelists: How has the ACR contributed to your own career, and what are the key priorities for the College in the coming years?

I've been involved in some major activities with the ACR that, in retrospect, paralleled where I was in my career at the time. In the early to mid-2000s, I served as the ACR’s expert to get the first six-level 1 CT Angiography CPT codes adopted by the RUC, chaired the writing group for the first CT Angiography Practice Standards, and served a term as chair of the Panel on Cardiovascular Imaging. I then chaired the Writing and Oversight Committee for the Advanced Proficiency Certification Examination in Cardiac CT when that technology was new.

My goals were aligned with those of the College: namely, to help our field move forward by embracing new technologies and ensuring competencies in using them. That same goal continues today with new innovations like applying AI to further elevate the practice of radiology.

Harvey Neiman, then-CEO of the College, invited me in 2012 to join five exceptional radiologist leaders in founding the RLI, and that was tremendously empowering and transformative for me both personally and professionally. Rotating off the board earlier this year after 11 years of service, I take great pride in what we've accomplished with the RLI. It's a tremendous privilege to help people become great radiology leaders.

As for the future of the ACR, I agree with the sensibilities described by the experienced panel. In particular, advocacy efforts need to remain a strong focus, especially on the economic side, to ensure that radiology continues to have a strong platform to support the best in diagnostic and image-guided therapeutic care for our patients. Leadership training, mentorship and a laser-beam focus on developing strong leaders in our field is the way to exponentially grow our impact on a national and, in fact, a global scale. We must continue to embrace leadership training as a core mission of the College and strive to make sure it endures.

One of the attributes that stands out from the younger panelists was their consistent articulation that engagement with the ACR at an early stage, typically from their days as residents, strongly influenced their growth into effective leaders. I am gratified to see how the ACR has grown in so many ways to engage our radiologists at their earliest stages much more effectively and proactively than was available during the early days of my career. It’s fantastic that we are getting young radiologists involved right away, developing their networks, and through involvement in the ACR helping them to be the future leaders our field needs.

These young leaders have grown up with the ACR as a part of their identity as radiologists, whereas that just wasn't possible in the past. The tangible outcomes of that foundational engagement will be fully realized down the line.

Last question: Why should someone listen to these two podcasts?

Often in our busy, day-to-day engagement with our profession, there's just not an opportunity to take a step back, stand at 30,000 feet and look down on where we have been, where we are and where we're going. At this moment of celebration of the ACR centennial, it's an ideal time to do that.

Within the relatively short timeframe of listening to these two podcast episodes, the amount of perspective that can be gained and the opportunity for reflection that any radiologists can have on their individual journeys is profound. Anyone engaged in the field will feel a sense of reward and satisfaction from taking the time to listen and to experience everything these panelists are discussing. I hope it gives us all tremendous pride for today and hope for the future.

Read the other articles in the project

Centennial Perspectives: A Look at Radiology From All Sides. To determine where the specialty is headed in the future, it's important to first understand where it has been and where it stands today. 

Centennial Perspectives: Longtime Radiologists Recall the Past and Welcome the Future. In the first of two RLI podcasts episodes, host Geoffrey D. Rubin, MD, MBA, FACR, talks to five radiologists about what they have seen in their decades in the field: Johnathan S. Lewin, MD, FACR; Carolyn C. Meltzer, MD, FACR; Lawrence R. Muroff, MD, FACR; Mary H. Scanlon, MD, FACR; and Elliot L. Siegel, MD, FACR. Topics range from technological advancements that have affected the way radiologists work to changing how new generations of radiologists are trained based on their learning habits. The panelists bring great insight to the table as they discuss how things have changed in the specialty and where things are headed in the future.

Centennial Perspectives: Rising Leaders in Radiology Look at How the Specialty Will Evolve. In the second episode, Rubin talks to four radiologists who are early in their careers but have already made their impact in radiology: Kurt A. Schoppe, MD; Judy W. Gichoya, MD; Mathew Hawkins, MD; and Amy K. Patel, MD. They discuss how they’ve grown as leaders, how they define success, how they see the next decade of radiology shaping out and more. It’s a lively and informative discussion from some of radiology’s brightest rising minds.

Observations of a CEO: A Chat with William T. Thorwarth Jr., MD, FACR. The ACR's CEO discusses how the views of both panels align with the future vision for the College and its commitment to serving members — who, in turn, can best serve their patients today, tomorrow and always.

Author Interview by Linda Sowers,  freelance writer, ACR Press