Residents who are diligently honing their clinical skills may not realize that education and training in other radiology skillsets may bolster their career advancement. A deeper understanding of healthcare economics, for example, can round out residents’ experiences and expectations within the specialty and medicine as a whole. Opportunities to do just that are available, and the ACR Radiology Leadership Institute’s^® (RLI) Resident Milestones Program “Economics and the Physician Role in Health Care Systems” is the perfect place to start.

Developed by RLI, healthcare economics experts and residency program directors in 2014, RLI Milestones offers residents a unique educational experience focused on collaborative and interactive learning. The curriculum goes beyond the basics of reading articles and attending lectures — introducing residents to concepts that will help them navigate the complex and challenging economic facets of the healthcare system. At the same time, the program is designed to help satisfy the Accreditation Council for Graduate Medical Education’s (ACGME) Physician Role in Health Care Systems sub-competency requirement, a part of the Systems-Based Practice competency.

The popular Milestones Program is now in its ninth year, with 20-25 residency programs participating each year. Each residency program determines how many residents will participate from their site — ranging anywhere from 4-40 residents. Since the program launched, nearly 2,000 residents representing a wide variety of residency programs have participated.

The Bulletin recently spoke with Melissa Chen, MD, a neuroradiologist at MD Anderson Cancer Center in Houston and one of five faculty for the RLI Milestone Program covering advocacy and current trends in healthcare and radiology. Here, Chen breaks down the value of the program and why it is so critical for residents to broaden their knowledge beyond clinical learning to chart a successful and fulfilling career path.

The residents seem to enjoy the discussions we have because the issues we discuss are what residents will need to consider for future jobs.

What is your role within the Resident Milestones Program?

My portion of the course is in the seventh month – the very end – of the program, and it requires some synthesis of the material the residents have learned up to that point. In the preceding six months, residents are largely focused on developing a better and deeper understanding of the reimbursement process, types of payers, RVUs and measurements of productivity, and the overall radiology revenue cycle. I am then able to build on that knowledge as we discuss emerging trends and changes in healthcare, such as expanded roles of advanced practitioners, population health payment systems, artificial intelligence, price transparency, corporatization of medicine and the impact specifically on the field of radiology. I ask residents to dig deeper into one trend and answer questions such as: 

• How does this trend affect your practice as a radiologist?
• What are the reimbursement implications? 
• What are the potential impacts to patient care? 
• What opportunities does it present? What threats? 
• What changes would you make in your current environment to adapt to this trend? 

The residents seem to enjoy the discussions we have because the issues we discuss are what residents will need to consider for future jobs. The residents form their own perspectives on these trends that even many practicing radiologists don’t fully understand. They have the chance to figure out how to approach these complexities — it gives them a framework for questions to ask future employers gives them insight in how to tackle current and future challenges. Residents walk through a SWOT analysis to see where there may be a strength or weakness or opportunity or threat in the changing healthcare environment. 

What makes this program unique? 

When this program was developed in 2014, the course chairs were very deliberate in their design. It’s a turnkey program, developed with residents’ busy schedules in mind, while it also allows residents to play an active role in their learning. 

A big strength of the program is that it is not just didactic lectures. Rather, residents begin each topic with watching a short, pre-recorded lecture, reading a few articles that incorporate what was discussed in the lecture, then applying that knowledge as they complete a local activity at their own institution and then culminating with a presentation on a live group webinar. 

The live group webinars are also a unique component of the program. They take place five times throughout the seven months – once at the end of each topic. A group of up to five residency programs participates in a one-hour webinar, facilitated by the RLI faculty. The residency programs participating are from all over the country and from all different types of residency programs, which provides a unique opportunity to hear how things vary so much from one institution to another. Residents present to one another and are encouraged to make their points and ask questions related to what they have been researching. The discussions can be open-ended — there is no right answer. It’s great because they come up with unique ways to present complex topics. This interactivity promotes a deeper learning and a more comprehensive understanding of key healthcare economics concepts — preparing residents to effectively apply what they learn throughout their careers. By the time they finish the course, they may know more about healthcare economics issues than their attendings.

It sounds like a lot of this program is completed at the institutional level. Who helps facilitate that?

While the overall program is facilitated by RLI faculty, each participating residency program is asked to find someone to serve as a local faculty — intended to help facilitate local discussions and activities associated with each topic of the course. The RLI faculty provides a comprehensive guide to the local faculty on what needs to be addressed for each local activity. The local faculty serves as a sponsor for the residents and a champion for the program at their site. For example, residents may be asked to review their facility’s revenue cycle or their payer mix. Residents typically don’t have access to such information, and the local faculty can facilitate communication with appropriate administrative staff at their institution to navigate the assignments. Local faculty are not expected to be healthcare economics experts themselves but can really encourage learning within the group by guiding residents to resources while not making the work overwhelming.

Why should residency programs consider incorporating the RLI Resident Milestones Program into their curriculum?

Healthcare economics is a critical topic in a fast-changing radiology landscape. The US healthcare system is complex, and understanding the basics of how healthcare services are reimbursed is important in advocating for appropriate resources needed to provide high-quality care to patients. This course arms residents with the knowledge that may not be readily available that they will need as they transition to their jobs. Through the RLI Milestones program, residents are not only taught all the steps of the revenue cycle, but how to adapt to the changes in the broader healthcare environment. At the ACR meeting, residents told me they wished there were more opportunities to learn about current economic issues in radiology. Program directors have said they wished there were an easier way to teach healthcare economics. Well, there is — this course is designed to help accomplish both with the benefit of discussing these critical topics with leaders who are actively engaged in economics issues.

For more information on the program, direct questions to rli@acr.org.

For a perspective on why healthcare economics should be a part of residents’ curricula, read the new VOR blog.

Seeing All Sides 

There may be research and discussion around the use of advanced practice providers (APPs), who are healthcare professionals performing clinical tasks that are typically done by physicians. The residents are taught not to see things in black and white. For example, some may already assume that using APPs is horrible, though many practices use APPs successfully. Looking at those practices, the residents can explore what sort of guardrails they have in place. So, if they are worried about APPs, they can ask questions. What can we do? What guardrails might we put in place? What are specific opportunities within the healthcare system for radiologists? The perspective could evolve into a scenario in which APPs are running the ER. As a physician, they should be able to help direct patient care. As a radiologist, you are the one guiding APPs on appropriate care and testing when they are unclear about next steps.