Alexis Smith, DO

At the recent Pennsylvania Radiological Society meeting, I was asked to speak about the “cons” of the new board certification format recently instituted by the American Board of Radiology. The change has created quite a few problems for residency programs across the country as they attempt to satisfy requirements for both the upper year classes still under the old system and second year residents who will be the first to complete the new testing. 

Besides these short term issues created by the collision of two resident classes with different board certification processes, I have a few concerns about the new format regarding the long term consequences on radiology education.

1. The current second year class will be the first not to take a dedicated physics exam this September. Instead, physics will now be combined with clinical testing in a computer-based, multiple choice exam which will be administered in the third year of residency. There will be a 70/30 split between general radiology and physics questions. Being that physics is the basis for all image creation, I feel that the third year is too late to be testing such basic radiologic knowledge.

Under the old system, there was a dedicated period of time to study physics and consolidate that knowledge to enhance our daily radiology practice. Also, no matter what many of my fellow colleagues may think, I believe that physics training is an important distinguishing characteristic of a radiologist. It should not be relegated to the back seat with so few questions dedicated to testing so many important concepts.

Particularly at a time when there is so much discussion about other specialties taking our business, we need to focus on how we can add value as consultants.

2. My class (the current third year residents) will be the last to take the oral boards at the end of our fourth year. There are several reasons why the new certification process is inadequate with the lack of an oral component.

First, problem solving and communication with other physicians are important skills that are better assessed with the oral format. Under the old system, the end of the fourth year is currently a dedicated period of time to study and consolidate all of the knowledge gained during residency. There is a transformation that occurs during this process where a resident matures into an attending radiologist.

In the new system, the test administered in the third year is the closest replacement. Unfortunately, this exam is too early in residency to foster the development seen with the oral boards. Besides, with technology rapidly evolving and our knowledge base continually expanding, general competence cannot be expected in less time than in the past.

3. In the new system, there will be a second computer-based, multiple choice exam fifteen months after finishing residency. The exam will be composed of general radiology questions in addition to questions from three subspecialties chosen by the resident. Never mind the fact that residents will no longer be board certified when finishing residency.

The more important issue is if 90 percent of us will eventually become private practice radiologists that read a little bit of everything, why are we not concerned about testing those subspecialties that a resident is least proficient in? (Obviously, I am assuming that the resident will choose the subspecialties that they are strongest at, but I think this is a fair assumption.) The ABR believes that in the near future, radiologists will work in more subspecialized practices, however that is not the current state of radiology in the US. Aren’t we putting the cart before the horse?

I realize that complaining about these changes after they have already taken effect seems pointless. I think most people including myself have accepted that the new certification process is here to stay, but I hope that the ABR will seriously consider and rectify the deficiencies of the new system.

After all, no matter what format we are tested in, the end product is most important. As long as we are producing competent radiologists that satisfy the needs of patients, radiology groups, and other specialists, that’s really all that matters.
 

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The Cons of the New Radiology Board Certification Format

In March, I had the opportunity to work in the American College of Radiology (ACR) Government Relations Department (GRD) as a 

. 

I wanted to do more than just read films. I could not wait to get a taste of the politics of radiology.

When I arrived at the government relations office, I began a whirlwind tour of the Capitol, ACR style. I spent the week attending Congressional hearings, fundraising events for Congressmen and internal ACR meetings about current legislative issues important to radiology.

Let me tell you, it was an eye opening experience. While we are reviewing images in the reading room everyday, they are fending off attacks on all sides. The government wants to cut Medicare reimbursements, every other specialty wants to self refer to their own in-house imaging equipment and to top it off, many of our patients are just looking for a reason to sue us. It’s a jungle out there.

I don’t want to scare you…too much. I mean, it’s not as bleak as it sounds; however I do want you to realize how important policy and regulation are to the long-term survival of our specialty.

Another noteworthy part of my Rutherford experience was getting to know the GRD staff. Many people you talk to think that lobbyists are “bad” people. Truthfully, before my experience as a fellow, I thought of lobbyists as those guys in the back room of a smoky bar making shady deals to keep some old white guy up to his ears in money. Honestly, it’s nothing like that at all. Every cause known to man has a group of lobbyists in DC including every specialty in medicine.  I found the GRD lobbyists to be caring and passionate people who truly believe in the radiology profession. Their knowledge and ability to speak about the issues and legislation affecting radiologists often made me forget that they were not radiologists themselves. I enjoyed my time with them so much in fact that by the end of the week, I found myself wishing that I didn’t have to leave.

My Rutherford fellowship was a one of a kind educational experience. Having the opportunity to shadow the GRD lobbyists helped me to realize how important both the GRD and ACR are to radiologists.

Radiology has become the target for cost savings in healthcare to many politicians in DC. This affects not just radiologists, but also hospitals, radiology staff and most of all, patients. We need to support our profession or risk our very existence as a specialty.

I learned about the ACR fellowships a few years ago when Ted Burnes from the GRD spoke at a Pennsylvania Radiological Society meeting I had attended. He stressed that the ACR is only as strong as its members and with only 8 percent of practicing radiologists contributing to RADPAC (the political action committee for the ACR), there was much to be desired.  I remember thinking that eight percent just isn’t going to cut it if radiology is going to survive as a specialty.

The government wants to cut Medicare reimbursements, every other specialty wants to self refer to their own in-house imaging equipment and to top it off, many of our patients are just looking for a reason to sue us. It’s a jungle out there.

Alexis Smith, DO

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