Reflections from a Decade of Transformation

William T. Herrington, MD, FACR, Immediate Past President of the American College of Radiology^® (ACR^®), contributed this piece.

After more than a decade of service, radiology luminary William T. Thorwarth Jr., MD, FACR, is stepping away as Chief Executive Officer of the ACR to embark on a new chapter. As we prepare for his retirement on June 30, join me in celebrating his profound impact and unwavering commitment to advancing the field of radiology. In this blog, Dr. Thorwarth reflects on his journey.

1. As a radiologist and CEO with more than 10 years of service to the College, you've had a significant impact on the field. What inspired you to pursue a career in radiology, and how did your journey lead to the ACR?
   
   I had intended to become a doctor at a very early age. This was likely inspired by my father being a radiologist but also by an interest in science in general and a fascination for the workings of the human body. During the summer between my first and second year of med school, I did an elective in the radiology department constructing an anatomy/radiology teaching aid. One afternoon I wandered into the angiography suite, and the resident on duty allowed me to assist him doing a cerebral angiogram on a young patient with a brain tumor (well before CT and MRI). Watching him direct the catheter into the various vessels (he even allowed me to selectively catheterize one), I was hooked. My involvement with the ACR began with the very good fortune that the senior partner of the practice I joined after residency was very involved in the ACR, and he mentored and sponsored me at both the state chapter and national levels. I was impressed that our national organization was focused on quality and safety of patient care and ensuring that radiologists were appropriately reimbursed for our valuable procedures. Though I enjoyed my clinical practice every day, having the opportunity to contribute at a “30,000 foot” level was very professionally satisfying. It also gave me the opportunity to work with like-minded leaders across radiology and all of medicine and develop relationships that will last a lifetime.
   
   
2. What do you believe are the biggest challenges facing the field of radiology today, and how is the ACR working to address them?
   

   The workforce shortage is our biggest challenge, and it is not just radiologists. I have a slide that says “The good news is that we have made ourselves indispensable. The bad news is that we have made ourselves indispensable.” Radiology, including all our specialties/subspecialties, contributes to virtually every significant episode of healthcare, and the demand is rising. That means providing 24/7/365 access with rapid turnaround times and an expanding demand for subspecialty expertise. This has put an incredible strain on the radiology workforce with only about 1,200 new residents/fellows graduating each year. There is no “quick fix,” but the ACR has done several things to address this. We have supported increasing the number of available training slots, but this requires congressional action and is not a short-term fix. Another major effort is the development of the ACR

   Appropriateness Criteria which are designed to guide referring physicians and other providers as to whether any imaging exam will help their patient and, if so, which one. This could eliminate unnecessary and inappropriate exams thus decreasing the overall workload and allowing radiologists to concentrate their time and effort on those exams that really provide benefit. Finally, I want to mention the incredible work being done by our Data Science Institute investigating ways that artificial intelligence and machine learning can make radiologists and all radiology personnel more efficient, while preserving high quality care. There are exciting developments ahead.

   
   
3. As you transition into retirement, what advice do you have for the next generation of radiologists and leaders in the field?
   
   To my younger colleagues, look for a chance to get involved beyond your clinical responsibilities. Though there is a tremendous amount of professional satisfaction in providing high quality care to your patients, there are a whole host of opportunities to look at our professions through a large lens and expand your horizons and skillsets. These may be within your department/practice, your local medical staff, or at a state or national level with one of the many radiology/medical societies. In addition, there are many ways you can get involved in your communities. Each of these will expose you to talented people from whom you can learn and with whom you can build a professional network. To the more “seasoned” leaders, continue to innovate and explore new ways that our profession can improve, not just related to statistical results but, equally importantly, in the area of patient and family centered care and health equity. We are, after all, in the business of improving health and well-being.
   
   
4. Looking back on your career, what are you most proud of, and what legacy do you hope to leave behind?
   
   From my clinical career, I hope that my colleagues, including the technologists, partners and referring physicians, felt that I was always there to assist them as a partner and team member. I hope that my patients (I practiced predominantly IR) believed that I was compassionate, listened to their needs and always had their best interest as my “true north.” Regarding my time as ACR CEO, I hope that the staff and volunteers that I have had the great fortune to work with over this decade recognize that I was simply the “orchestra conductor,” empowering each and every one of them to contribute to the symphony of successes and improvements in patient care and population health that exemplify the mission of the ACR.
   
   
5. I know Nancy, your wife, is eager to have you around more often, your penchant for saying yes to any challenge and devotion to organized radiology taking up so much of your time up to now. With a less full inbox and much more time for non-radiology endeavors, what are your plans for retirement?
   
   Many have asked me “What are you going to do in retirement?” My answer has consistently been that it is what I am “not” going to do. I am not going to set an alarm and, if someone says, “Let’s go have dinner next Wednesday evening,” I am not going to check my calendar to see if I have a Zoom call. After 50 years in the working mode, Nancy and I are ready to have some control of our time and “fly by the seat of our pants.” With a host of places we have never been, and 10 grandchildren scattered around, we are very much looking forward to the flexibility to get up and go when the whim hits. We will both be forever connected to the universe of friends we have made during this journey which provides an additional incentive to get up and go.