10 Questions with Ben Strong, MD

April 13, 2015

For this “10 Questions” series, we spoke with Benjamin W. Strong, MD about his work and the future of radiology.

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

Here, we profiled Benjamin W. Strong, MD.

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

Benjamin W. Strong, MD (ABR, ABIM). I serve as Chief Medical Officer for Virtual Radiologic (vRad), where I am responsible for the practice environment for our nearly 400 physicians.I am board certified in both internal medicine and radiology and have fellowship training in Musculoskeletal/Body MRI. After my internal medicine training, I worked as an ED physician for three years. I am licensed to practice in all 50 U.S. states and hold credentials in a number of foreign countries.

2. How did you get to where you are today?

Of course nine years of postgraduate medical training helped me many times along the way, but I mainly attribute my success to lessons learned in two activities from my youth. The first of these was working as a waiter, where I learned a strong service ethic and acquired the unshakable conviction that the customer is always right. The second lesson came from many hours playing arcade video games such as Space Invaders and Asteroids, where I learned to love the challenge of interacting with a screen-the emphasis on reaction time and efficiency strategies has stayed with me and is constantly applied in my radiology workflow.

3. Why did you choose your profession?

I was fortunate enough to attend an undergraduate university that offered human anatomy dissection, one of very few such schools at the time. I was a bit disillusioned by early course work in pre-medicine as I could not see specific application for the textbook knowledge I was acquiring, but the opportunity to dissect human cadavers changed all of that. I worked as a teacher’s assistant for five semesters and graduated from college having dissected over 100 human cadavers. I initially thought this was perfect preparation for surgery, but in my first surgery in medical school, I found myself peering into a poorly lit incision with little ability to appreciate the anatomic detail I had come to love. After more experience in clinical medicine and suffering the even worse inadequacies of physical examination, I eventually realized that radiology allowed me to do what I really wanted: to see virtually inside each patient and make a diagnosis after a thorough evaluation of all of the organ systems.[[{"type":"media","view_mode":"media_crop","fid":"34025","attributes":{"alt":"Ben Strong, MD","class":"media-image media-image-right","id":"media_crop_2157163824575","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3604","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":"Benjamin W. Strong, MD","typeof":"foaf:Image"}}]]

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

My biggest day-to-day challenge is that of acquiring as much patient information as possible and presenting it to our referring physicians in an easily interpreted format. Given my background in clinical medicine, this is especially important to me from a diagnostic accuracy standpoint, and in addition, is a major contributor to our workflow efficiency and radiologist job satisfaction. I look forward to the day when greater integration or even a nationally standardized format help us to achieve this goal, with improved workflow and accuracy that will benefit all clinicians, radiologists, and patients.

5. What worries, if any, do you have about the future of radiology? If none, where do you think the field is going?

I worry that radiology is slow to adopt technology to eliminate gaps in patient information and to make radiology workflow smooth and efficient. Any objective study data should be automatically included in any report, and any task not directly related to the interpretation of an image should be automated or otherwise offloaded. We could be making vast improvements in our accuracy by aggregating patient information and eliminating distractions, and we could, at the same time, be markedly increasing our efficiency without any real added effort. Both would obviously have a huge impact on the quality of patient care and the satisfaction of our referring colleagues.

6. What one thing would make your job better?

Standardization of nomenclature and greater patient information access would have the greatest impact on my (and I expect many radiologists’) job satisfaction. Routine access to secure patient data such as lab values, prior studies, problem lists, medication lists, pathology results, and EKG/echo interpretations would greatly enhance our diagnostic accuracy and our standing with our clinical colleagues. I think this is the path to greater and more productive clinical engagement. It is the way we can best demonstrate our value in the whole process of diagnosis and treatment-in contrast to the greater patient interaction some entities recommend.

7. What is your favorite thing about radiology?

I appreciate radiology on two levels: personal practice and global application. From a personal practice standpoint, I revel in the ability of radiology to evaluate so many organ systems at once-to allow me to take several nonspecific, disparate, and seemingly unrelated findings and create an exact diagnosis from them. That is a thrill that never gets old and that keeps me avidly collecting interesting cases to this very day. From a global healthcare perspective, I marvel at the potential reach of radiology-with modern teleradiology platforms, refurbished equipment, and portable units it seems as though radiologic diagnosis will be available to almost every inhabitant of the world soon, and I am pleased to have played a small role in that transformation.

8.  What is your least favorite thing about radiology?

Simply put, I have heard enough about declining radiologist compensation. Before becoming a radiologist I worked as an ER physician, and that is a specialty-along with internal medicine, family practice, and pediatrics-that is much more frustrating, uncertain, and thankless than radiology. And yet radiologists make multiples of what those specialties make. I see declining reimbursements more as a market correction than an unfair attack on our compensation. I would, of course, prefer to see this income disparity resolved by an increase in other specialties’ incomes, but that is obviously not realistic. While it is not a popular opinion among radiologists, I view recent reimbursement decreases as a step towards a more rational distribution of compensation across medical specialties. I wish that instead of spending so much energy on these unchangeable and overdue compensation trends, radiology would focus on improving those things actually within their control-the accuracy of their diagnoses and the efficient provision of their services. A demonstration of worth should come before any request for payment, and I think radiology has had that reversed for a long time.

9. What is the field’s biggest obstacle?

The field’s biggest obstacle is its inability to demonstrate its value objectively, which is ironic because this should be easier in radiology than in other medical specialties. Without normalized data, standardized nomenclature, and an ordered and vigilant peer review system, radiology will never be accepted as a critical link in the patient care chain. Quality is not the vague and nebulous concept or equation many would have us believe; it is instead a simple matter of whether or not a critical finding was identified or a specific and accurate diagnosis rendered. Therefore, quality should be easily quantified by an objective peer review and analyzed with statistical confidence. Educational, corrective, and even disciplinary action should then be taken based on that data to improve performance across the profession. Currently, radiology is not sincerely engaged in this process; the resulting lack of ability to demonstrate its value is indeed a daunting obstacle in today’s environment.

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

That would be to always pursue education. The field of radiology is always evolving, with new equipment, new modalities, and new applications of existing modalities. To remain valued, a radiologist must always be expanding his or her skill set. But education doesn’t stop there-all radiologists must master at least the basics of business and operational models, information systems, and finance in order to fulfill their roles as relevant healthcare providers. Education in these realms is perhaps less formalized and harder to come by, which makes it all the more rare and valuable in the radiology world.

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