Two Venerable Organizations Explore a Shared Future

With a dramatically increased need for professional education made necessary by maintenance of certificate requirements, the ACR and the ARRS are in talks to collaborate—and possibly merge This is not the first time that radiology’s senior society, the American Roentgen Ray Society (ARRS), has considered joining forces with the more junior ACR to meet members’ needs better. Four years ago, cultural differences stymied the effort, but it was resurrected last year through informal talks among senior leaders of both organizations. Discussions are currently underway to explore a closer collaboration between the two organizations, including the potential for a complete merger. Anton Hasso, MD, professor of the department of radiological sciences and director of neuroimaging research and development at the University of California Irvine School of Medicine and past president of the ARRS, agreed to share his perspective on the project with the readers of Radiology Business Journal. RBJ: Please describe the respective roles of the ACR and ARRS in serving the specialty.  Hasso: The ARRS has a very narrow focus, which is to serve as a medium for education for all radiologists. It has a strong focus toward general radiology, but we also cover the subspecialist, and our program for the annual meeting is geared along all the subspecialties. It is basically education for radiologists, and in this day and age, it includes not just the journal and the annual meeting, but things like online CME and means for certification (being able to qualify for it with various courses) that can be taken online. On the other hand, the ACR represents all of radiology in multiple areas. The largest area is socioeconomics, but also standards and accreditation, which have become a major focus of the ACR. Out of its 350 staff people, I’ve heard approximately 125 are involved with accreditation. It also is involved in research, the ACR Imaging Network trials, and developing new programs in education. It has built the new education center in Reston, Va, across the street from the headquarters building, where people get hands-on time on various workstations —for example PET/CT, CT colonography, and MR angiography—in hands-on courses that usually run the better part of a week, and involve a certificate based on how many cases an individual can participate in and diagnose during that period of time.  The ACR is most important, of course, in government relations: things like lobbying, congressional visits, and direct testimony on legislation on a national level. That is the focus of the ACR. RBJ: How did this idea of collaboration emerge, and why is it attractive to the ARRS? Hasso: It started informally with Arl Van Moore, Jr, MD, and me, discussing some of the options that might be available to the two groups. One focus that we both have, individually as well as with the societies that we represent, is the AMA. Van Moore is the head of the ACR delegation to the AMA, and I happen to be one of the members of the delegation, so we spend a lot of time together discussing things; that is why this started. Previous discussions of a merger, some four years ago, fell apart because, I think, the ACR was not sensitive to the unique culture of the ARRS, which I described to you as one focused on education and not one for any other purpose. Van Moore felt that in his role as chair of the chancellors, and now president, of the ACR, there was enough commonality, particularly as the ACR is becoming more and more involved in education. It has made this major investment in the education center, and it has other programs that have been developed, including regional courses. We go around the country and hold courses for radiologists, and in many cases, not only are we covering the same topics, but also we may have the same speakers. Why not combine these? Why not hold everything from a joint meeting to joint regional courses? It is not inconceivable, in the future, that we would have one journal; certainly the electronic versions of what we do could be integrated. Why are we duplicating? We have a couple of things I think we do very, very well, and it would be nice to share them with a larger audience. The annual meeting continues to increase in size, and there could be some way of organizing our meetings so that they are in succession, or even at the same time. RBJ: How much overlap is there in membership? Hasso: How many members of the ACR are not currently members of the ARRS? I think the number is around 7,000 to 8,000. How many members of the ARRS are not currently members of the ACR? I think it’s 3,000. There is a tremendous overlap. I don’t want to give anyone false hope—this may not happen—but obviously, the dues could be structured in such a way that there would be savings for members, since there is so much overlap, but again, this has not been determined in any way. RBJ: What about the drawbacks? How does radiology benefit from having a second and independent association and peer-reviewed journal, and what could be lost? Hasso: There are some drawbacks. It may be like trying to mix oil and water; they don’t mix, in terms of the culture and identity. The ARRS is much older. It is the most senior society, in terms of both the journal and the society. The ARRS was incorporated in 1900. The journal started in 1905. The ACR didn’t come about until 1924, many years later, and RSNA, even later than that. The drawback is the loss of this culture of ARRS and the focus toward the education of radiologists through whatever means were available at the time. In the early days, that was mainly through the journal and the meeting was held in a small hotel somewhere, in one of the major Eastern cities. Now, we have a national focus, if not an international one. RBJ: The ACR required a change in its bylaws even to consider this. Why is that? Does ARRS have any such constraints? Hasso: The bylaws change was very narrow. It was to expand the board of chancellors to include additional representatives from the ARRS board. That was under the advice of facilitators who met and discussed, with senior leadership of both societies, how mergers take place. Dr. Van Moore felt very strongly that even though the development of the merger had not progressed very far, it was important to get that bylaw change in, and it could only be debated at the time when the council meets. The ACR Council, which has councilors from all components and societies throughout the country, only meets once a year, and he didn’t want to wait a full year for that to occur, so clearly there was some need to develop this resolution, which was debated and passed by the council. RBJ: How might a closer collaboration enhance each organization’s ability to achieve its mission? Hasso: The need, now, is to continue with maintenance of certification (MOC). Residents in radiology, beginning from the year 2002, have to renew their certification in radiology completely [every 10 years], not just by taking an exam, but by MOC, which includes items such as professionalism and practice quality improvement. By being able to deliver the product effectively to the largest number of trainees who need to be recertified, obviously, the joint societies can serve the members better. The Board of Radiology has already said the exam will be an electronic one of some sort, and may be taken in different centers around the country, so getting ready for it is going to be primarily an electronic effort on the part of the individuals taking it. Not only are the graduates since 2002 expected to maintain their certification, but so am I, as a neuroradiologist. Having taken my first certificate of added qualification in neuroradiology in 1995, I had to renew it 2005, but before I am eligible to renew it again, I have to do the whole MOC. Anybody with a time-limited certificate (including neuroradiologists, the vascular interventional radiology people, and pediatric radiologists) has to do MOC, which is six points that you have to accomplish. You not only have to take the exam and the orals (which will probably be electronic), but you have to prove that you have improved the quality of your practice and you have to prove your own professionalism. Are your reports of professional quality? We are talking about standardized reports in a few years, so people can review and compare. Here is a guy like me who has spent close to 35 years in this business, and I’m not sure what I have to do to qualify completely the next time I have to renew my certificate, so you can imagine how other folks may feel. Some don’t feel that way, but I am sure there are those who feel like me. We are not quite in a desperate moment, but we can easily get there. The hue and the cry from the rank and file will be awful if things are not in place, and they are not clear, so we have some concerns there. RBJ: Does the responsibility to prepare members for MOC lie exclusively with the ACR? Hasso: No, every society of reasonable size is involved. The RSNA is doing a lot of it, with the ARRS and the ACR. I am going to the American Society of Neuroradiology next week. The advantage there is that I can sit through the lecture and they have an audience participation system, so I can earn some of my credits just by passing some of the questions that are asked at the end of that lecture. That’s easier for me, being a bit older, than getting on the Web site and answering a lot of questions there. Everybody is involved with this, including the vascular interventional radiology people and the pediatric radiologists. That goes back to the earlier question about the advantages of such a merger, and those are to avoid duplication and to make this easier. When you think of that mountain out there that we have to conquer, remember: Everybody does not see the mountain the same way. The majority of radiologists who do not have time-limited certificates don’t have to participate in the MOC, although the board of radiology has highly recommended that every person do it, even if you don’t have a time-limited certificate. RBJ: What are the possibilities being considered? Is a complete merger of the two organizations a possibility? Hasso: When I read a report and say, “possible tumor,” that is 5%. Probable is the other way around. I would say yes, there is definitely a possibility, with me defining possibility as a 1 in 20 chance. Probable would be a 95% chance, and I do not think it is probable—I think it is possible. RBJ: What has been the initial response from membership? Hasso: Yesterday, I spoke to Susan Capatelli, our executive director of ARRS, and she said she had one call. It’s not known yet; I’ll be honest with you. Will we get some response? Yes, I think we will, and the response will be, “Where’s the benefit to me as a member of such-and-such organization?” Really, that’s the most difficult, don’t you think? That is how I got into this: to increase benefits for less cost.