10 Questions with Jonathan Flug, MD, MBA

For this 10 Questions series, we spoke with Jonathan Flug, MD, MBA, about his job and the future of radiology.

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

Here, we profiled Jonathan Flug, MD, MBA.

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

Jonathan Flug. I am currently a junior faculty member of the musculoskeletal section in the department of radiology at the University of Colorado Denver School of Medicine. I am now the immediate past chair of the American College of Radiology's Resident and Fellow Section. This opportunity has opened up the door for involvement in multiple committees within the ACR and within the other various radiological societies.

2. How did you get where you are today?

I had an interest in leadership and organized medicine beginning in medical school where I was enrolled in a dual degree MD/MBA program and was involved with the American Medical Association’s Resident and Fellow Section. I actively sought out opportunities within the ACR and the state radiological society once I began radiology to achieve my desired goals. The true key was developing mentors, both at the attending level and trainee level, who began to trust me and knew they could count on me when they needed something done. Too many residents today turn down opportunities because they are afraid to take on commitments. As Dr. Orlando Ortiz, the chair of my radiology residency program, told me early on in my training, “Never underestimate the power of yes.”

3. Why did you choose your profession?

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I knew I wanted to work in healthcare the day my father, who was a dentist, came to my elementary school class and taught us about brushing and oral hygiene. Once in medical school, I began to notice a lot of the negativity in various departments of the hospital. On the contrary, the radiologists were some of the happiest physicians in the hospital. Visiting the radiology department was a nice break from the daily grind on medicine, surgery, ob gyn and pediatrics. When I was finally sitting down to make my decision, I realized that radiology gave me the opportunity to impact the greatest number of patients on a daily basis in a positive way and allowed for a degree of career flexibility that other subspecialties could not provide.

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

While I entered radiology due to the positive outlook of radiologists, that has since changed drastically due to a variety of factors. One of the biggest challenges in radiology right now is maintaining a positive outlook on a day-to-day basis with all of the challenges that surround us. That being said, I truly believe that every challenge presents an opportunity to continue to improve our field and the role we play in the healthcare delivery spectrum. The ACR has embraced many of these ideas in their Imaging 3.0 campaign, which I truly believe can lead our field down a path that will be beneficial for patients and radiologists.

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

First and foremost, the job market in radiology is extremely worrisome. We have so many high quality radiologists who are finishing training, with record levels of educational debt who cannot find employment or may be accepting employment positions which are suboptimal for a variety of reasons.  This problem will ultimately affect all radiologists, in private and academic groups if we don’t address this as a field, even if it means taking pay cuts and considering early retirement. Thirty-year-olds with families and over $200,000 in debt from college and medical school will have to find a job somewhere, and it may be with a national entrepreneurial radiology company trying to compete for your hospital contact.

6. What one thing would make your job better?

Many of my more senior attendings during training spoke about the “golden age of radiology” and how great the field used to be. What I envy most about those stories is the collaboration that used to occur between the radiologists and referring clinicians when they were required to physically come to the reading room to review images. While PACS and cloud computing offer the potential for remote consultation and collaboration, we have not been able to realistically achieve this in clinical practice.

7. What is your favorite thing about radiology?

What I enjoy most during my practice are the unexpected opportunities to act as a patient advocate. We have many opportunities during exam protocolling and consultations with clinicians to advocate on behalf of our patients for appropriate imaging with dose reduction. My practice includes a good number of interventional procedures, which allow me to speak with patients about their care. I am often times amazed how many questions patients have regarding their conditions and their care which have been unanswered by their other physicians because of time pressures in the office setting.

8. What is your least favorite thing about radiology?

My least favorite thing about radiology, and really medicine in general, is the pager system, and our inability to embrace current methods of communication and social media. I have no problem being available and responding to messages in a timely manner, but every single other profession in the world has figured out a way to do it without pagers, except for medicine. The other day I had a 14-year-old patient who asked me if I was wearing a pedometer on my belt. He was truly shocked when I explained it was beeper, and he replied that he had never seen one outside of old movies. We consider it rude when a cell-phone ringer goes off in conference or in a meeting, but are willing to accept hearing a symphony of pagers interrupt those same meetings.

9. What is the field’s biggest obstacle?

Many people speak about the threats facing our field including self referral, payment cuts, defensive medicine, but in my mind the biggest threat to our field is apathy. Though the overall situation in radiology is not as good as it has been in the past, it is still a great field. That being said, radiologists cannot be complacent given the fact that so many patients undergo unnecessary harm from medical care, at a substantial cost to society. I believe that radiology is one of the few fields where we interact with patients from the entire spectrum of care in the inpatient and outpatient settings. This places us in a unique position to be leaders in quality improvement and patient safety. We cannot be complacent merely coming to work, dictating reports and clocking out at the end of the day. We need to take ownership of the entire spectrum of medical imaging and do our best to improve the patient experience and patient outcomes.

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

There are a lot of challenges facing our field and the future practice of radiology. I believe the key to future success is for all of us to focus on the patient, the patient experience and patient outcomes. That is a message we can take to the payers, congress and the patients themselves to affect the change we need for the continued success of medical imaging. That is part of the message behind the Imaging 3.0 campaign that the ACR has developed, which is why we should all consider embracing the campaign. However, we can only be successful if we have a unified voice and collaboration from radiologists, technologists and support from vendors to develop the tools required to achieve this goal. If we can improve outcomes for the patient, then we also improve the outlook for our profession.


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