ACR Bulletin

Covering topics relevant to the practice of radiology

Lessons From the RUC

Participating in the RUC can help ACR members become more effective leaders by honing skills such as communication and advocacy.
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Never underestimate how effective silence can be in a conversation. This may take the form of a long pause after being asked a question you are wary of, allowing another person to interject with another question.

—Kurt A. Schoppe, MD/ Melissa M. Chen, MD
January 01, 2023

For almost a decade, members of the ACR Commission on Economics have represented the ACR and the American Society of Neuroradiology (ASNR)at the AMA/Specialty Society RVS Update Committee, commonly known as the RUC. The RUC is comprised of a panel of physicians and other healthcare providers who debate the value of physician services and make recommendations to Medicare on how much to reimburse for medical procedures (relative value units or RVUs). The process is steeped in technical jargon and painful detail. Like a board meeting, RUC panel meetings involve members listening to presentations by specialty societies, asking questions and debating before deciding on the RVUs. By participating in the RUC, we have benefited from the lessons we’ve learned about communication and effective advocacy, which have helped us become more effective leaders.

Prepare Well

Preparation is key when you need to communicate complicated topics to an unfamiliar audience. Preparation facilitates brevity. It is tempting to drone on about a procedure you are the expert on and enjoy, but you run the risk of losing the audience. Your message should be focused on what the audience needs to hear to make a decision. Moreover, when you are well-prepared, you can succinctly answer questions you have anticipated. Conciseness projects confidence, preserves your audience’s focus and respects people’s time.

Preparation also helps you preserve your mental bandwidth. If you know your topic well, it allows you to “read” the audience to understand how your message is being received. Does the audience understand or need more detail? Does the room appear hostile or receptive to your message? Adjust your presentation appropriately. Perhaps shorten your presentation if you detect a friendly room with fewer questions. Or if your audience is hostile, work hard to close gaps by providing details the audience may need to hear based on the questions people are asking. 

Be Succinct

The adage “Loose lips sink ships” holds true here. You likely know more about your topic than anyone else in he room. However, being a know-it-all does not help you persuade an audience. Other people in the room may share your viewpoint and could sway the group’s opinion more effectively than you could, especially if you are considered to be on the “outside.” By reading the room, you can detect when you have support from others and allow them to speak up before you answer every question.

Verbosity is also your enemy. If your answers are filled with unnecessary details, an inattentive audience member may only catch pieces of your argument. In the absence of the context of your argument, people process these pieces with their own understanding, history or biases. This can lead to misunderstanding or even distrust — and a lost opportunity to persuade.

The ultimate use of the “Less is more” philosophy for persuasion is the use of silence. Never underestimate how effective silence can be in a conversation. This may take the form of a long pause after being asked a question you are wary of, allowing another person to interject with another question. The use of prolonged silence can make an emphatic point. For example, sometimes a detailed question is designed to bait you into a long-winded response when questioners are looking for ammunition to attack your argument. Don’t give it to them. If they have formulated their question as a binary question, answer “Yes” or “No” and then stay silent. You disarmed their attack and, without being seen as the aggressor, made it difficult for them to continue probing.

Don’t Panic

Things won’t always go your way. Maintaining your composure keeps the audience in a calm state and avoids escalating the environment to a hostile one. In the end, “being right” or “winning” never compels an audience. The respect you garner from your colleagues will serve you far better over time.

Effective communication to advocate for something is an art and an important skill in leadership. These lessons may seem cliché when read abstractly. Personal growth in this area requires intentional practice and self-reflection rather than just studying. For example, reading everything about the history of basketball, the rules of the game and the tactics of great coaches doesn’t make you a player. The same is true for many of us in our roles as physician leaders. You could know all about radiology, the physics of imaging and the rules for reimbursement, but until you’ve internalized the wisdom from many difficult wins and losses, you can’t really play the game. We share these lessons with you so you can feel more comfortable getting out there and playing your heart out.

Author Kurt A. Schoppe, MD and Melissa M. Chen, MD  Guest Columnists