ACR Bulletin

Covering topics relevant to the practice of radiology

A Decade of Leadership Training

The RLI celebrates 10 years of teaching radiologists the business and management skills to successfully navigate a shifting healthcare environment.
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We provide leadership education for everyone — as residents go out and get first jobs, as radiologists get promoted, as they lead change in their organizations, and as they become practice leaders.

—Frank J. Lexa, MD, MBA, FACR
October 27, 2021

The challenges facing today’s radiologists are greater than ever. Navigating an increasingly complex practice environment requires an additional skillset that goes beyond traditional clinical training.

The ACR recognized this need more than a decade ago, and in 2012 launched the Radiology Leadership Institute® (RLI) — the specialty’s first program dedicated to professional development and leadership training for radiologists. Since then, more than 9,000 radiologists from across the U.S. and around the world have participated in one or more of the numerous RLI programs — gaining the non-interpretive skills that are necessary to survive and thrive in today’s healthcare landscape.

In 2022, the RLI celebrates a decade of educating strong leaders. In the first of a four-part series commemorating its 10-year anniversary, the Bulletin looks back at the history of the RLI and examines how the challenges of the 21st century healthcare landscape led the ACR to offer formal leadership training to its members.

Addressing Decades of Challenges

The American healthcare system is notoriously challenging. Federal policies — and politics — have created a quagmire that affects patients and physicians alike. A confluence of factors that began in the 1990s highlighted the need for strong physician leaders. Government and private insurance payers began shifting from a fee-for-service model to a value-based care model 25 years ago with the Balanced Budget Act (BBA) of 1997. The BBA was designed to significantly reduce Medicare spending in anticipation of the projected financial drain by retiring baby boomers, but also negatively affected physician reimbursement. Congress passed additional legislation to reduce Medicare spending with the Deficit Reduction Act of 2005, which included further reimbursement cuts for imaging services. Meanwhile, healthcare delivery systems were grappling with how to address patient safety and prevent errors in light of the Institute of Medicine’s 1999 report on patient safety, “To Err is Human: Building a Safer Health System.”

In the midst of these industry-wide changes, radiology groups began losing longstanding hospital contracts, as many hospitals consolidated into regional healthcare delivery systems. This transition presented significant business challenges for radiologists, including a lack of opportunity to participate in and shape decision-making. “For most people in complex organizations with complicated skillsets, it’s hard for outsiders to lead us well,” says Frank J. Lexa, MD, MBA, FACR, chief medical officer for the RLI.

The business of medicine was swiftly becoming more complex and demanding, and radiologists who wanted to advance their careers, or simply improve the quality of patient care, increasingly realized they needed more than just clinical expertise to make a difference. At the same time, radiologists had limited avenues to gain the business and leadership skills that would give them a seat at the executive table. Many top clinicians rose through the leadership ranks by gaining business and management experience on the job. Few options existed for medicine-focused business training.

Radiologists who wanted to play a meaningful part in healthcare reform and advancing patient care quickly recognized they needed more formal training to obtain critical leadership skills. The traditional medical school curriculum, internship programs, and residencies weren’t providing the business and management skills necessary to successfully navigate the new healthcare environment. With these forces aligning, the ACR recognized an opportunity to provide important skills to its members and created the first formal program tailored to meet the needs of today’s radiologists. “And so, the seeds of the RLI were sown,” Lexa notes.

Starting a Leadership Evolution

Even before the idea of the RLI was formulated, leadership training was a point of interest for the chairs of the ACR BOC, beginning with the 2006–2008 tenure of Arl Van Moore Jr., MD, FACR. A stint as a nuclear engineer with the U.S. Navy Nuclear Submarine Service gave Moore insight into the importance of leadership development, which begins in the earliest stages of naval officer training. According to James H. Thrall, MD, FACR, his successor as chair of the BOC, as Moore progressed along his radiology career, “He saw that the lack of leadership training had left a void in the ability of radiology groups to function efficiently and effectively.”

I believed that radiologists in particular should play a key role because we reach so many patients, influence the direction of so many patients’ care, and command a particularly broad knowledge across medical specialties.

—Cynthia S. Sherry, MD, FACR

As chair of the BOC, Moore implemented a series of annual meetings for group practice leaders, with the goal of providing leadership and management education to practicing radiologists. His insights made leadership training a priority within the ACR, and efforts by Moore and Thrall raised the visibility of the issue. Thrall created a Commission on Leadership and Practice Development and tapped Cynthia S. Sherry, MD, FACR, to lead as medical director.

“I had been interested in the field of physician leadership development since my early years in clinical practice and had furthered my own leadership education and promoted leadership development on a national level,” Sherry recalls. “I pitched my idea of the RLI to Dr. Thrall at an ACR meeting, and I was very surprised to find how interested he was in my proposition.”

Sherry was passionate in her belief that physicians are best equipped to lead change within healthcare. “I believed that radiologists in particular should play a key role because we reach so many patients, influence the direction of so many patients’ care, and command a particularly broad knowledge across medical specialties,” Sherry says. “With the proper education and training, radiologists would be far better than hospital administrators and politicians at guiding the changes needed to improve healthcare for patients.”

Launching the RLI

Sherry worked closely with the ACR’s then-CEO, the late Harvey L. Neiman, MD, FACR, and John A. Patti, MD, FACR, past chair of the ACR BOC, to lay the groundwork for what would become the RLI. After creating a planning committee, Sherry and Neiman identified radiologists from across the country to serve on the first RLI board. Six radiologists comprised the original board, including Sherry, who served as chief medical officer of the RLI. The other board members were Cheri L. Canon, MD, FACR, Arl Van Moore Jr., MD, FACR, Lawrence R. Muroff, MD, FACR, Alexander M. Norbash, MD, MS, FACR, and Geoffrey D. Rubin, MD, MBA, FACR. The board members were selected to represent private practice and academic radiologists to develop a balanced and robust program relevant for all radiologists.

The development of the RLI was supported financially by the ACR’s “Leading Radiology into the Future” fundraising campaign. The RLI received significant support from generous corporate, individual, and chapter donors that funded scholarships, program development, and educational technology.

Creating programming that would provide participants with the applicable tools and skills to become successful leaders was paramount, and the board researched the fundamental disciplinary areas that the leading business schools had to offer. Sherry and the board created a common body of knowledge centered around seven core competencies that are critical for leadership skill development: finance and economics; ethics and professionalism; legal and regulatory issues; strategic planning; practice management; professional development and service, quality, and safety.

When it launched in 2012, the RLI’s original curriculum featured four levels of leadership proficiency to appeal to radiologists at any stage of their career, with certificates awarded at the completion of each level. The official launch took place at a leadership summit hosted by the Kellogg School of Management at Northwestern University. “The tradition of partnering with a business school for our annual leadership summit continues to this day,” explains Anne Marie Pascoe, senior director of the RLI. “Combining a business school approach with content that is specifically designed by radiologists and for radiologists is something that many of our participants find extraordinarily valuable as they lead their organizations and effect change in their practices.”

According to attendees, the annual leadership summit is an accessible and efficient introduction to fundamental leadership education. “As healthcare delivery models and payment structures are changing, the RLI Summit is even more important,” notes attendee Chrystal N. Obi, MD, a radiologist in Victorville, Calif. “All radiologists are leaders within the medical profession. We control a lot of the patient decisions that are made, and it’s important for all radiologists to be exposed to leadership content and opportunities in learning how to be advocates for patients, hospitals, and communities.”

Looking to the Future

Since its inception, the RLI has provided the most up-to-date and essential leadership programming to participants and continues to promote the message that leadership is for everyone. The strength and expertise of its world-class faculty sets the RLI apart from other leadership programs, and participants receive practical training and tools that can be immediately applied within their own practice.

Several years after the initial launch, the RLI transitioned from the original level-based ladder to a career milestone orientation. Now, participants can choose programs that are designed for where they are in their radiology career. Residents and fellows can receive training in professional development, leadership, and career management. The RLI also offers mid-level radiologists the skills to tackle higher-level leadership responsibility, while senior radiologists can become equipped with the knowledge and tools to address new service requirements and reimbursement models. Regardless of where radiologists are in their careers, they need to develop leadership skills to gain buy-in from others, negotiate, and navigate the evolving health system landscape.

“We provide leadership education for everyone — as residents go out and get first jobs, as radiologists get promoted, as they lead change in their organizations, and as they become practice leaders,” says Lexa. “There are all kinds of things that can happen in the future, but the RLI will be there to help you.”

Author Meredith Lidard Kleeman  Freelance Writer, ACR Press