10 Questions with Alan Kaye, MD, FACR

February 11, 2015

For this “10 Questions” series, we spoke with Alan Kaye, MD, FACR, about his work and the future of radiology.

Our “10 Questions” series asks the same questions to a diverse group of professionals in the medical imaging community.

1. Please state your name, title and the organization you work for. 

Alan D. Kaye, MD, FACR; Chairman, Department of Radiology, Bridgeport Hospital; and Managing Member of Advanced Radiology Consultants, LLC.

2. How did you get where you are today?

I cannot say “NO.” Seriously, like many specialties, radiology has a limitless depth of knowledge that is needed to be the best one can be. I have been very fortunate to have chosen a specialty where the breadth of desired knowledge is wider than any field. That affords one with the challenge of never being complacent, yielding opportunities to always do better, and rewarding that proclivity. Because of the above, and the socioeconomic challenges of the hospital and health care environment, I have had many “careers” in radiology, albeit without ever changing my employer or place of work. Thus, where I “have gotten to today” is unlikely to be where I will be tomorrow. More “opportunities.”

3. Why did you choose your profession?

See my answer to question #2. In the socio-economic and cultural milieu in which I grew up, medicine and law were the career options most desirable and accessible for bright, young people.  I was exposed to so much more when I went to college, but medicine kept calling me. I was a good science student, and the ability to apply one’s aptitude to helping people in need was the attraction. When I did my medical school elective in radiology, I met a role model in Dr. Harold Moskowitz, a valued leader of his medical staff, and a true consultant (on patient care and life).  A good radiologist is “every doctor’s doctor.”

4. What is your biggest day-to-day challenge? 

As a leader of a hybrid, hospital-based group in a teaching hospital, and with private, outpatient imaging offices, every day brings a different challenge. So, my biggest day-to-day challenge is managing a never-contracting to-do list. I wish I had either learned to say “no” or taken a time management course, and also had the kind of tutelage that the JACR brings to radiology leaders.

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5. What worries, if any, do you have about the future of radiology?

One of the things that attract good people to radiology is what has been a perpetual march of science and technology. Our researchers, the innovation of radiologists and engineers, and the funding from government and private industry have been the lifeblood of our specialty. New, effective tests were not only developed, they were quickly reimbursable. The pendulum of approval of new imaging tests for reimbursement has swung too far to the wrong side, with CT colonography as the poster child for this problem. Despite multiple trials showing that CT colonography is as good as, almost as good as, or even better than traditional colonoscopy, Medicare has found every reason to deny reimbursement. The repercussions of the above and the decrease of funding have created a “stenosis” of the pipeline for new developments. The above situation and the perceived commoditization of our services may narrow the pipeline of new radiologists, which has always been one of the most attractive specialties for the best and brightest medical students.

I am also concerned about declining utilization, regardless of appropriateness, as a result of economic incentives, in that they reward physicians for not ordering imaging. Self-referral of imaging has always been abhorrent to me. To the extent that you interject personal economic factors in the person who is directing care, you have the potential for doing harm to patients.  That works in both directions – ie, incentivizing referring physicians to lower costs can deprive patients of care they need. 

6. What one thing would make your job better?

Better, more appropriate metrics. As a person (amateur) who runs a (professional) business, I understand metrics are helpful in management. On the other hand, when those being used conflict with one’s concept of the best care, the cognitive dissonance is uncomfortable.   

7. What is your favorite thing about radiology?

The radiologist’s central role as clinician, always a teacher and diagnostician. It bothers me a lot when I hear our referring physicians referred to as “clinicians,” which implies that we are not. I look forward to passing the baton of leadership to the next generation and spending more time as consultant and teacher.

8. What is your least favorite thing about radiology?

Self-referral – a corruption of the doctor-patient relationship. The incomplete addressing of the issue has magnified the cost of imaging in the eyes of the regulators, whose knee-jerk reaction is: “If it were not overpaid, self-referral would not be taking place,” with negative ramifications for our pipeline and our patients

9. What is the field’s biggest obstacle?

See my responses to question #5 and #10.

10. If you could give the radiology specialty one piece of advice, what would it be?

One of the reasons we are in danger of being commoditized is that we have managed others’ expectations of us in a downward direction. Our job going forward is to elevate our expectations of ourselves and, thereby, exceed the expectations of others. That is not as difficult as it first appears. We need to be engaged clinicians. Realize that buried in the header on the PACS is the name of a referring physician who is seeking our input. More importantly, the images on the screen are from a patient who is in need.

Is there someone in the imaging community that you want to hear from? E-mail us their name and we'll ask them 10 questions.

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