10 Questions with Bibb Allen, Jr, MD, FACR

August 31, 2015
Diagnostic Imaging Staff
Diagnostic Imaging Staff

For this “10 Questions” series, we spoke with Bibb Allen, Jr, 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 Bibb Allen, Jr, MD.

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

Bibb Allen, Jr, MD, FACR. I am a diagnostic radiologist in private practice at Trinity Medical Center in Birmingham, Alabama. I am also the current chair of the Board of Chancellors of the American College of Radiology.[[{"type":"media","view_mode":"media_crop","fid":"40871","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_6322246079216","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4242","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":"Bibb Allen, Jr, MD, FACR","typeof":"foaf:Image"}}]]

2. How did you get where you are today?

After medical school, I intended to do general surgery. I did two years of general surgery residency but changed to radiology after having back surgery in my second year of surgical residency and a year of research in general surgery. After diagnostic radiology residency, I did a fellowship in abdominal imaging and, although we have a diverse clinical practice, a large part of my clinical time is devoted to cancer care.

I became involved in organized medicine and organized radiology, in particular, beginning in my first year of practice by becoming involved in our state ACR chapter. To help solve inequities in our state’s Medicare coverage policy, I began working on coverage issues for the ACR and later became chair of the ACR’s Carrier Advisory Committee Network and a member of the Commission on Economics. I became more involved in national Medicare payment policy issues and served as a member of the ACR Coding and Nomenclature Committee. Next, I became the ACR’s advisor to AMA-Specialty Society Relative Value Update Committee, usually called the RUC. After a number of years as the ACR’s RUC Advisor, I became an ACR RUC member. Involvement in payment policy led to me being asked to become a member of the ACR’s Board of Chancellors as chair of the ACR Commission on Economics. After four years, I was elected vice chair and then chair of the ACR Board.

3. Why did you choose your profession?

The decision to change from general surgery to radiology was not an easy one, and without the interlude of back surgery I probably would not have had time to think about it. I enjoyed surgery very much but after being away after back surgery, I realized I enjoyed the diagnostic aspects of surgical diseases as much or more than the therapeutic side, and so the change to radiology made sense. I have no regrets. Every year of my career, our technological and scientific advances have allowed me to take better care of our patients and help ensure that appropriate medical and surgical treatment options are used by our colleagues.

I first chose to become involved in organized medicine so I could learn things that could help my practice thrive and improve. After a few years, I realized I had actually learned enough to give back something to our specialty by serving in the College’s national committees. Over the years, I have found that sharing our collective knowledge through involvement in organized radiology and packaging that knowledge in a way that can be used by radiologists to improve their practices in the ways that matter the most is the most important function of a specialty society. Being part of this process at the College has been very rewarding for me and, as the chair of the ACR Board, keeps me focused on the core purpose of the ACR.

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

Through my work with the College, I have realized that the challenges I face in my own practice are similar to the challenges faced by most radiologists. Many times our colleagues in other specialties see our role as to merely perform and interpret the examinations that are ordered, rather than seeing radiologists as true consultants that can help manage all aspects of imaging care, from choosing the most appropriate imaging examination to ensuring patients clearly understand the results of their imaging examinations and receive appropriate follow up. It frustrates me that sometimes when our recommendations are not followed (or forgotten), diseases progress unnecessarily.

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

My worry for the future of radiology is that if we continue down the path that makes image interpretation the sole purpose of a radiologist, we will drive our specialty into commoditization where we can only provide value to the health system by driving down the cost of an interpretation. By adopting the Merit-based Incentives Payment System (MIPS) or providing incentives for physicians to participate in alternate payment models to fee-for-service, Congress and CMS are driving payments towards rewarding value not volume. Most of this added value will be for non-interpretive providing care. The ACR is doing all that it can to help our practices adapt to this challenge.  

6. What one thing would make your job better?

Having informatics tools at our points of service, such as PACS, dictation software, and the electronic health record, to bring evidence-based medicine recommendations into our clinical practice will be the next major addition to our specialty. Numerous guidelines are available to inform our recommendations and developing the IT tools that will make workflow integration a reality will give us the ability to dramatically improve the care we provide and increase our value to our patients, referring physicians, and health systems.

7. What is your favorite thing about radiology?

In clinical radiology, my favorite thing is that I really like being involved in our referring physicians’ “best cases.” Although not all of our cases have positive findings and not all sick patients have radiographic abnormalities, for the most part, our sickest and most clinically interesting and challenging have positive radiographic findings. Participating in the care of those patients is quite rewarding for me.

By participating in organized radiology, there are almost too many favorite things to recount. Organized radiology provides a vehicle to make new and dear friends that share a goal of working together to make things better. Without organized medicine, most of us would not have had an opportunity to meet, collaborate with and learn from each other.

8. What is your least favorite thing about radiology?

Not always being able to control all of the imaging for some of our patients. At times, inappropriate examinations are ordered and, at times, our recommendations are not understood or followed. And it’s sometimes frustrating that we don’t have the ability to intervene. Radiologists need to find ways to play a larger role in the team-based care of our patients.

Participation in organized radiology also has had some challenges. Although everyone wants to be rowing the boat in the same direction, sometimes our 52 radiological societies do not also sing from the same hymnal. Most times this is not problematic, but, at times, it inadvertently sends policy makers mixed messages. The good news is our communication between societies is improving and hopefully we will be better prepared to speak with a unified voice to those outside of radiology.

9. What is the field’s biggest obstacle?

Commoditization of our work product is, in my opinion, the biggest risk to our specialty and our major obstacle is that current incentives – many of which are driven by our desire to maximize productivity as measured by the volume of cases we interpret. Unfortunately, this is the easiest part of our work to commoditize. To protect our future, our practices need to adopt a culture of providing value added care to patients and referring physicians that make us an indispensable part of the care team.

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

Make room for young radiologists in our practices and figure out ways to recruit medical students into radiological residencies. Our graduating trainees are our specialty’s future. We will all be better off if we allow their energy and knowledge to help us improve our practices. These young men and women are demonstrating an ability to promote team-based care, improve patient experiences, and, as new trainees, they of course can bring the newest and most up to date knowledge about our field to our practices. I also believe it is important that we recognize and accommodate generational differences that will make our new partners satisfied with their jobs. We also need to focus the attention of medical students and show them how the practice of radiology is becoming more and more team-based and patient-focused. It is the medical students who are ultimately our future, and creating an environment where they receive both knowledge and a positive experience about radiology during medical school is critical to recruiting them into radiology and, ultimately, to the viability of the radiological professions.

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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 their name and we'll ask them 10 questions. - See more at: http://www.diagnosticimaging.com/practice-management/10-questions-bruce-reiner-md#sthash.vKQ0fGOa.dpufIs there someone in the imaging community that you want to hear from? 

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 their name and we'll ask them 10 questions. - See more at: http://www.diagnosticimaging.com/practice-management/10-questions-bruce-reiner-md#sthash.vKQ0fGOa.dpuf

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