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Leading through a landscape of constant change is going to be key in taking the specialty of radiology into the future. Tomorrow’s leaders must be well-versed not only in imaging but also in skills surrounding work-life balance, advocacy and AI. This is how they can make a difference in medicine and especially in patient care.

Those were among the observations shared in a recent panel discussion among rising leaders in radiology during one of two podcast episodes the ACR’s Radiology Leadership Institute^® (RLI) recorded to mark the celebration of the College’s centennial in 2023–2024. The other podcast featured a panel of radiologists who have decades of experience in the specialty. Both the rising and seasoned leaders focused on the past, present and future of radiology. 

In this article, we join host Geoffrey D. Rubin, MD, MBA, FACR, as he speaks with four rising radiologists about the present and future of radiology. The panel members were: Kurt A. Schoppe, MD; Judy W. Gichoya, MD; Mathew Hawkins, MD; and Amy K. Patel, MD.

Meet the Radiologists

Kurt A. Schoppe, MD, is a body imaging radiologist who completed his residency and fellowship in abdominal imaging at Wake Forest University. He works at Radiology Associates of North Texas, one of the largest private radiology practices in the nation. Schoppe has been working with the ACR in economics and payment policy since his James M. Moorefield, MD, Fellowship in Economics & Health Policy during his third-year residency in 2010. He realized his passion for radiology by pure accident, taking it as an elective in between surgery and medicine in medical school.

Judy W. Gichoya, MD, is an associate professor at Emory University, where she has worked for about four years as an interventional radiologist. She focuses on validating machine learning models for health in clinical settings, exploring explainability, fairness and how algorithms fail. Gichoya has spent time in Africa educating the next generation of interventional radiologists and has devoted time to researching informatics and AI. 

Mathew Hawkins, MD, is a pediatric interventional radiologist who has been the medical director of the pediatric interventional radiology department at Children’s Healthcare of Atlanta and Emory University since July 2014, when he finished his fellowship. He also serves as medical director of the facility’s multidisciplinary vascular anomalies clinic. His path to radiology was an unforeseen one, as he was eyeing a career as an orthopedic surgeon and general surgeon. While taking electives at Indiana University and Duke University, however, he learned about IR and made the switch in career paths. Hawkins then noticed an abundance of interventional radiologists for adults, but not as many wanted to be involved with children, so he decided to specialize in pediatrics.  

Amy K. Patel, MD, is a breast radiologist and a medical director of the Breast Care Center at Liberty Hospital in Kansas City, Mo, as well as the chair of the Radiology Advocacy Network (RAN) and RADPAC. She is an associate professor of radiology at the University of Missouri, Kansas City School of Medicine as she enters her sixth year in practice. Patel is also a partner with Alliance Radiology, a midsize private practice that serves multiple hospitals, mainly in Missouri and Kansas. Her initial goal was to return to her hometown of Chillicothe, Mo., to be a primary care doctor with an emphasis on women’s health. However, a friend from medical school suggested taking an elective with her mother, who was a breast radiologist, and Patel’s career changed paths. 

Lead by Adapting to Change

The world of radiology is always changing, causing practices and radiologists to adapt to new situations and technology they had not considered before. It can be challenging and difficult, but all the panelists agreed that adapting to change is a necessary trait of a good leader. 

Patel recounted the time she moved from Boston, where she initially worked, to her home area in Kansas City for a leadership opportunity at a practice. The goal of her new role was to build up a comprehensive breast program since that area of the country didn’t have subspecialized breast care. “It was quite daunting,” she said. “But I had encouragement from so many mentors along the way who said, ‘If you don’t go, who’s going to go?’ From just my few years of experience and all the leadership hats that I now wear, it’s definitely a grind.” 

Patel discussed how some situations required a “fake it till you make it” mindset as she navigated through numerous leadership situations. Schoppe agreed with Patel, saying everyone strives to make friends, acquaintances and networking connections. 

“You’re getting to make decisions, you’re taking on new responsibilities, really digging into the details and layers of how we actually deliver radiological care in hospitals and imaging centers,” Schoppe said. He also noted that sometimes, when attempting to improve and implement change, it can be frustrating to see how long it takes for change to come to fruition, but it is a rewarding feeling when you are able to improve patient care.

Change isn’t an easy thing to go through, especially in a complex field like radiology. But Gichoya sees change as an opportunity to grow as a leader by adapting to difficult situations. “To be young and in a place where there’s a lot of change in leadership can be quite stressful,” she said, “but it also presents a great opportunity for you to redefine yourself. When you get into an organization that is almost resetting, that can also present an opportunity in itself.” Using the experience to learn what to do and not to do can help a physician grow, she added. “If I have to ever undergo that change again, I know what to expect and how to manage my expectations.” 

Hawkins responded to Gichoya’s comments by adding that the first year out of residency is eye-opening about how stressful and chaotic the specialty can be. “If you ever thought you worked hard as a resident and a fellow, you had no idea until that first year out,” he said. “Your heart is going to stop multiple times. You’re going to be in situations that you’re trained for, but you never really realized what it would be like, and I think that’s important for everybody to realize.”

To be young and in a place where there's a lot of change in leadership can be quite stressful, but it also presents a great opportunity to redefine yourself.

The panelists all agreed that adaptability is an important part of the job, from changing your routine to balancing clinical and administrative work. Schoppe spoke about how balancing clinical and administrative work was stressful out of the gate, but he has adapted new ways to improve his well-being. 

“In the past 10 years, the one thing I’ve done that improved my overall well-being the most was going to bed when I put my kids to bed,” Schoppe said. “Usually, that may be between 8 p.m. and 8:30 p.m., and that sounds crazy to people. But sleep is the only legal performance-enhancing drug. We think we’re tough by denying ourselves adequate sleep, but this is a real game-changer for me.” 

Build and Define Success

The definition of success can vary from person to person. But Hawkins sees success for a radiology practice as retention and development of staff. With some institutions having a radiologist shortage, developing staff and keeping them involved for the foreseeable future really stands, he said.

“That’s our faculty, but also our technologists, our nurses and our APPs,” he said. “In fact, the five nurses at one of the hospitals where I work are the same five charge nurses who have been there since I started. So we haven’t lost a nurse. We’ve only had two technologists since 2014 who left to take other jobs — one left to go to industry and another had to move out of state because of her family. Those are the types of things that I think mean a lot and define success.”

Staff development and retention is important, but Patel pointed out that growing a staff is a sign of success as well. She recounted that in 2018 at the hospital system where she was medical director, the system didn’t understand it needed more personnel in its breast program than three roles of fellowship-trained breast radiologist, a fellowship-trained breast surgeon and a nurse navigator. Patel knew three people wouldn’t cut it, and she immediately got to work on finding a solution and building up the program. 

“I was really fortunate over these last five years spearheading the development of a plastics program, which has really done well at our hospital system,” Patel said. She spoke about how her system now has a genetics program and breast oncology to work with the breast imaging center’s growth, which is something Patel sees as speaking volumes about the hospital system. “When you have people who are really committed to the cause and wanting to grow, from a multidisciplinary comprehensive standpoint in the subspecialties where you need to look at the big picture like pediatrics or breast, that can really set you up for success when it’s a team mindset.”

There are many ways to achieve success in this specialty, but the plan may change because of a number of factors. Geographic location, resources, staff, funding and more may come into play, Schoppe said. “You would like to think there’s some consistency in what breeds success in a practice, and I’m not convinced that it is broadly applicable as we would like it to be,” he said. “While it is tempting to take examples of success from different parts of the country, or different parts of your own state, and try to put them in play at a different facility, it’s really easy to have some culture mismatches and missed expectations and to mishandle some of those transitions.” While there are some fundamentals that can be easily adapted for success, there is no one size fits all, Schoppe said. “You have to “read the room.”

Learn to Advocate

A field that continues to grow in importance, in the eyes of the panelists, is advocacy. Patel discussed how she got involved in advocacy as a first-year resident with the ACR after attending the annual meeting. She enjoyed the advocacy work so much that she became a Rutherford-Lavanty fellow in government relations during her senior year of residency. Through her experiences, Patel has seen the importance of not only embracing advocacy in radiology but getting involved early. 

“As I say when I give these advocacy lectures, I do feel that political advocacy on behalf of our patients is arguably just as important as your clinical day-to-day,” said Patel, who is the current chair of the ACR Radiology Advocacy Network. “And the earlier you can garner these skills, the better off you’ll be. I don’t how many mid-career-level radiologists reach out to me now and say, ‘I feel so behind.’”

There’s more to advocacy than lobbying federal and state government leaders. Schoppe has been involved in indirect government advocacy throughout his career, opening his eyes to the wide range of advocacy efforts within the specialty. 

“My advocacy tends to be more committee-based within AMA and economics forums like the AMA RVS Update Committee, where we work through RVU values for the CPT® codes. We look at how you actually get paid and then that advocacy levels up to directly discussing some of those reimbursement rates with CMS,” he said. 

“It's indirect government advocacy. I'm not going to our legislators, unless Amy tells me to,” Schoppe joked, “but there's a lot of advocacy and networking, horse trading, negotiating that happens in the background among physician specialties, especially organizations and organized medicine in general, before you ever get to the halls of Congress.”

Hawkins and Gichoya both agreed there are numerous ways young radiologists can get started in the field of advocacy earlier in their careers. Gichoya highlighted that while her strength may not be standing in front of a room full of people and talking, there are other ways to communicate, research and have an impact on advocacy. Writing about your work and sharing it is another way to advocate on an individual level, she said. So is lending your expertise. 

“Like today, one of my meetings was talking to a journalist, and there's no paper that is being published or anything — that kind of conversation is just to educate them,” Gichoya said. “But they know they can call on me as a resource when they don't understand something.”

Live and Learn With AI

AI has been a growing topic of discussion within radiology and is likely to remain a hot topic for years to come. When asked about the next decade of AI, Gichoya was reassuring about one thing: “I can start by saying radiologists are not being replaced,” she said. “I think that's been one of the big concerns over the years about these AI technologies.” 

Schoppe agreed, citing how a lot of writers thought ChatGPT would replace them, when in reality they’re still needed to ensure ChatGPT is correct. “I read something, a description of some future where you have a lot of average-skill writers or other people having their work product being replaced by ChatGPT,” he said, “but it actually puts a premium on somebody who is an expert.”

However, Gichoya says there are issues within AI that could negatively impact the field. Her first worry is that, with an increase in venture capitalists purchasing radiology practices and also purchasing or supporting AI companies, those firms might not hire the right people to construct and operate the new technology. 

The second worry she has is about the current AI systems themselves. “If we think about the stroke algorithm or these triage algorithms, whether it’s for PE or any acute ailment, most of the recent research is not showing that they're better or they improve productivity. They don't,” Gichoya said. “People are not discussing that a lot. You could ask, have we really tackled the problem that radiologists are struggling with versus a hypothetical problem?” 

Gichoya spoke about how big tech companies, which are heavily involved in making and spreading AI technology, might just want some money from healthcare and may not work as hard to fix the issues radiologists are noticing. However, if the technology continues to improve, it presents an opportunity to help radiologists with their day-to-day duties, taking on smaller tasks to allow radiologists to focus on other issues. 

The panel shifted the conversation to discuss how training for future radiologists may change thanks to AI technology taking on certain tasks. Gichoya said she wonders how new generations of radiologists will become experts if they are not going over simple cases due to AI taking the reins on those cases. 

Hawkins agreed with the worry. “I just don't understand how we train the expert in a setting of AI,” he said. “How do you become an expert if you don't ever look at the simple cases, like Judy said, or see the million different variations of what normal is? I just can't formulate what that looks like. And I know it means training has to change, but if we think of who are experts now in our minds — the luminaries we would call for all of our complex cases, how do those people become experts in the setting of AI?”

Look to the Next Decade 

As time came to a close, the panelists were asked about where they see themselves over the next decade. Patel said she aims to keep all options open. With so many interests — such as advocacy, clinical and breast radiology and AI — she wants all avenues available to continue to get the best care possible for patients. 

“I'm just going to continue to do what I'm doing, keeping all doors open to see where I can be the most effective,” Patel said. “Because at the end of the day, as much as I want to make a difference in the lives of our patients in the field of radiology, I sometimes wonder, do I have a calling that is greater to affect not just the house of radiology, but possibly the house of medicine and beyond?”

Gichoya aspires to change the AI game by branching away from big tech companies. “In 10 years, if I were leading the organization that will most likely be formed by some future governments to be away from big tech and help navigate safe AI for medicine, that would be a dream come true to make that type of impact,” she said. But until then, she plans to make an impact on students and help them with their research regarding AI.

Hawkins plans to continue with pediatrics and help kids set up to be their best adult selves — and complete a dream of his. “Currently, I'm completing an executive MBA program,” he said. “I think leading and running a big pediatric healthcare organization would be the dream.”

Schoppe said his goals have changed over time. Previously, he thought he would want to lead a large healthcare organization or hospital, but now he is focusing on helping steer the specialty into the future. “I would say my more audacious goal for the next 10 years is to help set up radiologists for success with better work environments and a better technology stack to help their quality of life,” he said. “Maybe extend career longevity or provide the flexibility they need to live their best lives.”

Read the other articles in the project

Centennial Perspectives: A Look at Radiology From All Sides. To determine where the specialty is headed in the future, it's important to first understand where it has been and where it stands today. 

Centennial Perspectives: Longtime Radiologists Recall the Past and Welcome the Future. In the first of two RLI podcasts episodes, host Geoffrey D. Rubin, MD, MBA, FACR, talks to five radiologists about what they have seen in their decades in the field: Johnathan S. Lewin, MD, FACR; Carolyn C. Meltzer, MD, FACR; Lawrence R. Muroff, MD, FACR; Mary H. Scanlon, MD, FACR; and Elliot L. Siegel, MD, FACR. Topics range from technological advancements that have affected the way radiologists work to changing how new generations of radiologists are trained based on their learning habits. The panelists bring great insight to the table as they discuss how things have changed in the specialty and where things are headed in the future.

Behind the Microphone with Geoffrey D. Rubin, MD, MBA, FACR. Rubin shares some of his thoughts on what radiology leaders revealed in both panels. He also talks about his observations from other leaders in the field based on previous podcast episodes.

Observations of a CEO: A Chat with William T. Thorwarth Jr., MD, FACR. The ACR's CEO discusses how the views of both panels align with the future vision for the College and its commitment to serving members — who, in turn, can best serve their patients today, tomorrow and always.