10 Questions with Robert S. Pyatt, Jr., MD

September 21, 2016

For this "10 Questions" series, we spoke with Robert S. Pyatt, Jr., MD, about his work and the future of radiology.

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

Robert S. Pyatt, Jr., MD, FACR. I am the co-founder and president of Chambersburg Imaging Associates, PC. We are a small, 10-radiologist practice serving two hospitals in a rural setting, in South Central Pennsylvania.[[{"type":"media","view_mode":"media_crop","fid":"52109","attributes":{"alt":"Robert S. Pyatt, Jr., MD","class":"media-image media-image-right","id":"media_crop_8905777780583","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6462","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":"height: 213px; width: 170px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Robert S. Pyatt, Jr., MD","typeof":"foaf:Image"}}]]

2. How did you get where you are today?

During my radiology residency at Bethesda Naval Hospital, and subsequent staff position, I submitted my CV for moonlighting radiology work in Chambersburg, PA, about 90 minutes from where I lived. I received a phone call from the hospital administration a few months before I completed my Navy payback time. They stated that they were looking to form a new radiology practice, as the current group had been terminated, was splitting up, and going elsewhere. I was in the process of looking at several positions at the time, but became very interested in this unique opportunity, assisted with other colleagues who were also leaving the Navy. Chambersburg Imaging Associates was then birthed, in Nov. 1981, and I have been CEO ever since.

3. Why did you choose your profession?

I had the very fortunate blessings of a radiologist mentor while in high school. I spent every Saturday morning with him, learning how to read X-ray studies, perform upper GIs, present cases at Grand Rounds, etc. I was very energized by interacting with physicians, and they were very accepting, and encouraging of me as a student. By senior year in high school, I knew I wanted to be a radiologist!

I accelerated my college and medical school years completing everything in 6.5 years, graduated from SUNY Upstate Medical Center for my MD, and entered the Navy for internship/residency and payback time for my Armed Forces Medical School Scholarship. I was fortunate to be a resident when CT first arrived in the US, and with my colleague, Dr. Toe Thane, we created a “Body Imaging” service in 1979 at Bethesda Naval Hospital. This was emerging as a new concept nationally at that time. Besides teaching Navy residents and interns, I also spent many years teaching at George Washington University and at Penn State Hershey Medical Center, in a clinical faculty position.

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

Our practice is the imaging provider for our health system, Summit Health. We need to put forth our best effort possible every day to provide a full range of services. In the small 10-rad group setting, we are quite different than an academic practice, or 100-rad group. However, we provide various specialty reads, and support many procedures. We are also active in the Medical Staff leadership structure, where I serve as chief of staff for both hospitals in our health system. There are so many daily challenges for us, some completely out of the blue, like when our busy mobile MRI unit was hit head-on on the interstate highway, and two people died.

I am fortunate to work with many talented administrative staff (including IT), technical staff, radiologists, and other medical staff who work well together and find strong solutions. My biggest regular daily challenges are to provide quick turn-around times for STAT readings of all types, to provide the highest quality patient interactions, answer the many needs of medical providers with questions of various sorts, and to get the PACS worklist in good shape when call starts at 5 PM.

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

I have several worries, some of which are local, some of which are global, but I also have positive hopes. My worries are these:

- Recruiting radiologists to rural practices is a challenge, but on-site radiologists are very necessary. Not everything can be done remotely. Most radiologists looking for positions are not interested in rural locations.

- As health systems continue to acquire hospitals, including rural hospitals, in order to manage population health and reduce risk, how does this affect the small rural practice like ours and many others? I envision more rural practices becoming part of larger practices of various types. This is a dynamic that will involve our practice in the next few years. Considering that the “average” radiology practice is still in the range of 5-12 rads, much change will occur in the years ahead for many radiologists. As a radiologist involved in the GSR (General, Small and Rural Practice) Commission of the ACR, I am hoping that the ACR can provide resources and help with the challenging issues for these many practices.

- I have concerns about future young physicians not going into radiology for various reasons and a radiologist shortage occurring. Ron Arenson, MD, RSNA president at RSNA 2015 showed why our future is bright, I believe. We need to cultivate future rads and get the best medical students to consider our field.

- With ever improving technology, and associated interventional procedures, I believe there is a strong future for radiology. I follow the potential implications from Watson/IT and associated technology, but I have the belief that there will be a definite strong role for the future radiologist to lead all these efforts, and further improve patient diagnoses and treatments.

6. What one thing would make your job better?

There are many things that are so positive every day, I don’t think of this question. Most days are very good because of the technical and support staff, and positive interactions with patients and medical staff. Having a very positive regular daily experience helps a lot.

To make things better, I would ask for more time to teach and learn together, and to make more sustaining quality improvement efforts. We do work on this, but there is not enough regular time for it.

7. What is your favorite thing about radiology?

I greatly enjoy many aspects of my daily work – telling patients that their breast biopsy is negative, or as simple as diagnosing acute appendicitis on an ED patient. I know that my readings/procedures significantly affect many people every day, and I know that medical staff value our readings/procedures. I greatly enjoy my technical and support staff every day.

8. What is your least favorite thing about radiology?

There is not enough time to discuss challenging cases with each other, or to attend enough meetings which should have a radiologist in an active role. There is not enough time to mentor potential future radiologists.

9. What is the field’s biggest obstacle?

Not being considered when clinical or other leadership-related issues are being discussed. We need to be in the front row, always. We need to earn that seat everyday with our efforts. Radiologists who do administrative functions must be supported by the practice.

It’s a challenge to do that with support from everyone in the practice at times, as the workload must be addressed, so everyone doesn’t have to stay late getting the PACS list under control before night duty. But staying late so that radiology is involved with administrative decisions is worth it.

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

My best advice is not simple. Today’s radiologist must devote time and energy to stay informed and involved on issues involving DI quality/safety, economics, patient and family centered care, practice management, leadership, radiology political issues (RADPAC), and professional society involvement. If a radiologist thinks that all that he/she needs for their entire career is to professionally get along well with good diagnostic/interventional skills, it may not be enough to assure life-long success. Go beyond your DI/IR skills and strive to be a leader in whatever way works best for you. The future needs every one of these radiologists with extra skills to ensure our bright future.

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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