A Trailblazer for Inclusivity Shares Her Lessons for a New Generation

Geraldine McGinty_MGF1866Geraldine B. McGinty, MD, MBA, FACR, president of the American College of Radiology, contributed this post.

I recently spoke with Elizabeth “Betty” A. Patterson, MD, FACR – socially distanced, that is, during the pandemic—as she shared her story with me. She recounted her journey rising through the ranks as a Black, female breast imager with a passion for advocating for diversity in the field and quality patient care.

I asked her when she first considered science as a career and she pointed to her parents, both scientists, as an early inspiration. And yet in her small high school in a suburb of Pittsburgh, her guidance counsellor insisted that she could only select brochures from the “girls’ side” of the office, brochures that would have steered her to a career in nursing or teaching. She had to get her older brother to pick up the university brochures for her. Ironically, she did start in a combined nursing degree program, lacking the confidence that she could get into medical school, but switched to pre-med after a year.

During her internship, Dr. Patterson realized how much she enjoyed her interactions with one of the radiologists. She found him knowledgeable but, equally importantly, focused on asking the right questions to get to the diagnosis, so radiology became her career path. Dr. Patterson began her attending career at Mercy Hospital in Pittsburgh, now part of the University of Pittsburgh Medical Center system.

At that time, the newest member of the group held the responsibility of reading the mammograms. As a result, Dr. Patterson became an “accidental” breast imager, went on to start the first screening program in Western Pennsylvania in collaboration with the American Cancer Society, and became the first woman and the first Black physician to lead the Pennsylvania Radiologic Society. Rising through the ranks of organized radiology, she served as the first female chair of the Radiology Section of the National Medical Association and is a fellow of the American College of Radiology® (ACR®). Dr. Bruce Hillman appointed Dr. Patterson as Chair of the Special Populations Committee of the ACR’s Research initiative with the goal of increasing both the diversity of populations included in research cohorts but also of the profession. She also took on leadership roles in the broader healthcare arena. As the Food and Drug Administration took on the regulation of mammography following the passage of the Mammography Quality Standards Act (MQSA), Dr. Patterson served as chair of the MQSA Advisory Committee.

She emphasizes the importance of seeking a mentor who’s in your corner and willing to encourage you to go forward, as well sponsors who open doors to opportunity. For example, leaders and mentors like Joseph A. Marasco, Jr., MD, FACR, former chair of the ACR Board of Chancellors, and 1995 ACR Gold Medal honoree, were critical to opening the doors to increased diversity in organized radiology.

Dr. Pattern points out, “Back then, almost nobody looked like me.” Throughout her career, and even in retirement, she remains an influential voice in breast imaging, especially with regard to the importance of diversity and the need to drive better outcomes.

As we all continue to adjust to our new normal, Dr. Patterson shared with me that she has been cleaning out closets and going through old photos. The contents of those drawers and photo albums document a luminary career. Her work has moved our profession forward not only towards more inclusive leadership, but also to better healthcare for our community.

  • How are you and your practice working to pave the way for a diverse, inclusive future for our specialty?

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Radiation Oncology in the Era of COVID-19

Cyberknife photoAnupriya Dayal, MD, radiation oncologist at Temple Health-Fox Chase Cancer Center and Pennsylvania delegate, American Medical Association Resident and Fellow Section House of Delegates, contributed this post.

Opinions are the author’s own.

The impacts of COVID-19 on the field of radiation oncology are ever evolving. We face unique opportunities – and challenges – as we work to prioritize safe and quality patient care while we navigate this pandemic.

At the start of the pandemic, most non-emergent healthcare was halted, including cancer screening. Unfortunately, cancer incidence does not stop with the pandemic. For some patients, decreased screening now will delay diagnosis and/or increase cancer burden and worsen outcomes.

Having cancer care and/or end of life care discussions is already difficult for cancer patients and providers. Sometimes patients may feel like they have to make an impossible choice– whether they would like to risk their cancer becoming incurable by delaying treatment or whether they would like to risk contracting COVID-19 by leaving the security of their home to obtain treatment. As radiation oncologists, we continue assisting cancer patients in these difficult conversations.

For other patients receiving daily radiation treatment for cancer, we’re the only healthcare providers they may be seeing on a daily basis, especially if their primary care practitioner has limited services available due to the pandemic. We may have to step up to help the patient in the interim for their non-radiation oncology medical needs as well until they are able to seek treatment from their primary care provider.

Patients who don’t require in-person treatment, however, may seek care through telemedicine. In the field of radiation oncology, telemedicine may make it easier for patients to seek second opinions, and removes challenges such as transportation, scheduling or other conflicts that can arise with arranging in-person care.

Telemedicine also has unique limitations. Patients may appear healthy and functional on a telephone or video conference, but may not be doing nearly as well in person. Another unique example concerns anatomy. What appears on 2D video examination may be very different in person, so previously prepared simulation or treatment plans might have to change when the patient arrives for the first time in the department. However, these scenarios can be addressed with proper planning and flexibility.

Radiation oncologists in hotspots around the country are adjusting to a new normal, as many are being called to the frontlines alongside internists, surgeons, physician assistants, respiratory therapists and others, according to a recent blog from the American Society for Radiation Oncology. Radiation oncologists are researching new ways to identify the characteristic COVID-19 pneumonia concerns on CT Simulation scans (otherwise used for radiation treatment planning) and daily cone beam CT scans (otherwise used for daily set up alignment).[1] Further, radiation oncologists are also investigating the use of low dose lung radiotherapy to treat some COVID-19 patients.

While these times are challenging, the field of radiation oncology is responding to the call and adjusting our course as necessary to provide the best care for our patients.

  • How does your facility approach care in the era of COVID-19?
  • How can radiation oncologists continue to improve the safety and quality of patient care?

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[1] The American College of Radiology (ACR), Centers for Disease Control and Prevention (CDC), Canadian Society of Thoracic Radiology, Canadian Association of Radiologists, Royal Australian and New Zealand College of Radiologists and the (UK) Royal College of Radiologists currently recommend against use of computed tomography (CT) to diagnose COVID-19.

Radiology Corporatization is Here (to Stay?)

CollinsPortraitJannette Collins, MD, MEd, FACR, director of medical content, MRI Online and editor of Seminars in Roentgenology, contributed this post.

In radiology, corporatization refers to the corporate radiology groups that provide hospitals with specialty radiology services and 24/7/365 radiology interpretation via on-site services and teleradiology. The radiologists are employees and receive salaries and benefits determined by the corporations, which, in aggregate, employ thousands of radiologists and operate hundreds of imaging centers across the country.

What can a large corporate entity offer to private practice owners and managing partners?

Let’s start with the good:

  • Access to centralized resources (such as access to capital, administration, recruiting, contracting, nighttime support, advanced technology, lower malpractice insurance rates, and sharing best practices)
  • Better positioning to participate in population-based care, alternative practice models, and federal and private payer value-based payment programs
  • Ability to subspecialize
  • Greater market power and leverage when negotiating payer contracts

And the bad:

  • With acquisition comes relinquishment of control and decision-making to a remote group of owners/investors whose primary allegiance may emphasize profitability over patient care

What can it mean for partners of private practice groups that are bought by a corporate entity?

The group can still offer partnership, which may mean owning a share of the group’s assets if they own equipment, and/or it may mean owning equity in the larger corporation. Partners can be eligible for elected and appointed leadership positions locally and nationally at the corporate level. However, although salaries for those on the partnership track may not change, full partners generally see a drop in salary, which could be substantial after a buy-out/partnership with a corporation.  

Large groups are attractive to some radiologists, especially those more recently finishing their training who value flexibility, stable salary and other lifestyle considerations over practice ownership. However, younger radiologists may be more apprehensive of corporations.

A recent survey of over 600 early career radiologists found that 86% believe that corporate entities harm radiology as a specialty. And another 83% said they’d prefer to work for an independent practice, rather than one owned by a corporation. Many are worried about a national chain “gobbling up their workplace, driving down salaries and prioritizing profit over patient care.” They don’t want to work in any system in which “executives, non-physician administrators and public stockholders are reaping the financial rewards of radiologists’ work output.” They’re also frustrated that when they interviewed with a provider, they were not informed about merger and acquisition talks occurring behind the scenes. Some say that when asking interviewers about plans for acquisition, these plans were hidden, often because of nondisclosure agreements during negotiations of an acquisition.

Shifting payment models, hospital consolidation, new technological and data analytic expectations, and heightened competition have altered the longstanding status quo for many independent groups around the country, and in response, the opportunity for physician shareholders to align with a partner through mergers, acquisitions, or private investment has become more compelling.

Many private practice groups are in trouble, and corporations are offering a solution. Is there a better solution? Can radiology groups work in partnership to come up with alternative solutions? Or — as the prevailing sentiment of my social media feed might suggest — will corporatization of radiology be the downfall of the specialty? Will corporate groups survive? Only time will tell if corporatization in radiology is here to stay.

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