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June 2012
A Message from the President of the CAR
Dr. James Fraser

Dr James Fraser

This year, the Canadian Association of Radiologists celebrated the 75th anniversary of its Annual Scientific Meeting (ASM). With the theme of Innovation in Imaging, the meeting proved to be a great success on both an academic and social front.

Over 500 attendees participated in the meeting which offered not only a great networking opportunity, but also a distinctive programming that is of particular benefit to Canadian radiology. One of the attendees noted that “This meeting had unique sessions I could not get at any other meeting!” When I hear feedback like this, I am confident that the CAR is accomplishing its goal of putting together a uniquely Canadian event.

Among the many highlights were the riveting talks by our keynote speakers: Dr. Marcia Javitt, from the Uniformed Services University of the Health Sciences, and Dr. Robert Novelline, from Harvard Medical School. Dr. Javitt, who opened the scientific meeting, discussed the responsibilities of the radiologist, the clinician, and the patient in making decisions about imaging examinations. Dr. Novelline spoke of the past, present and future of emergency radiology.

Another of the event’s highlights was the look back at the past 75 years of the CAR through a talk by Dr. Brian Lentle, as well as incredible CAR and radiology archives that were displayed at the Annual Dinner and Awards Gala. With nearly 100 participants, we were also very pleased to see that the Resident Review sessions continue to grow and draw the participation of future radiologists at our ASM.

The ASM is also a great occasion to recognize the dedication and tremendous work of our fellow colleagues. Among our award winners this year, Dr. Louise Samson received the CAR Gold Medal Award, Dr. Raquel del Carpio-O’Donovan received the Royal College of Physicians and Surgeons of Canada Mentor of the Year award, and Dr. Jonathon Leipsic was awarded with the 2012 CAR Young Investigator Award. Click here to see the complete list of this year’s award winners. Congratulations to all!

Working Together

This successful ASM marks the end of the first of my two years as your CAR president. Over the course of this last year, I have made a concerted effort to visit and participate in as many of the provincial association meetings as possible. I have also reached out to many of our other important stakeholders such as the Canadian Heads of Academic Radiology (CHAR), the Canadian radiology program directors and our group of past-presidents to get a better grasp of where Canadian radiology is presently, and where we need to go in the near future. I have enjoyed meeting many old and new colleagues and the discussions have been both informative and rewarding. I am grateful for the warm welcome and feeling of support shown to me from all these important groups.

In addition to these initiatives, I have been working with a number of national and international medical and radiology associations such as the CMA, CMPA, ACR and RSNA to help appreciate how radiology fits into the bigger context of healthcare delivery. Perhaps the most striking observation from these activities is the rapidity of change and expected change affecting radiology presently and in the near future.

Current Trends Affecting Radiology

While most of you are working hard in the “trenches”, dealing with increasing work demands and local medical issues, I feel it is the CAR’s role as your national specialty organization to be looking at the interests of Canadian radiologists in the bigger picture. This is complex in some respects, as medical care is delivered at a provincial level, but there are important trends throughout the country we should all be aware of:

  • The federal government has essentially disengaged its participation with healthcare delivery by announcing there will be no renewal of the Health Accord in 2014, and that there will be no strings attached to the federal transfer payments. This took the provincial governments and healthcare organizations by surprise. For the 2004 Health Accord, we were able to advocate successfully on wait times, which resulted in significant investment in imaging equipment and infrastructure. In light of the new federal direction, however, the CAR, like other organizations, has had to consider innovative ways to influence healthcare investment and policy to ensure all Canadians have equitable access to high quality medical imaging care. We believe this means a stronger need and opportunity for the CAR to work with our provincial radiology associations and colleagues to bring a unified voice for radiology to provincial jurisdictions as they set their healthcare directions.
  • The cost of imaging and questions around the value radiologists provide has become very public, mainly around the unilaterally imposed cuts to physician fees in Ontario. Not only have there been across the board cuts in radiology fees but even more worrisome is the indication of tendering of DI services in years 2-3 of the imposed changes. It is not clear at this point just what is meant by tendering, but it sounds a lot like outsourcing and commoditization of radiology services. This is a road I don’t think any of us want to head down. We know that physicians must be directly engaged in healthcare reform if it’s to be effective. On May 22, the CAR released a statement stressing this critical point. You will hear more in the future as we continue to promote the value radiologists bring to healthcare.

The models of healthcare reform suggested at various levels have indicated that more accountability is necessary. The Council of the Federation, the group of provincial and territorial Premiers working to have a unified voice on healthcare reform in Canada, has indicated that Clinical Practice Guidelines (CPGs) will be an important step. Provincial quality councils have also been set up in almost all of the provinces to address quality and safety as another important step in healthcare reform. These changes are all occurring in a time when the quality of radiology services delivered has been questioned due to a few unfortunate incidences scattered across the country. The combination of these isolated events with reports of the high income of radiologists, and our lack of visibility to the general public (and even some of our clinical colleagues) has put us in a difficult position. It also raises the question: are we facing the “perfect storm” for Canadian radiology?

Commitment to Quality Improvement

Whether this is the perfect storm or simply a short-lived squall, I think it behooves the CAR to set a proactive course to best position Canadian radiology. In my mind, this emphasizes the relevance of our recently developed five-year strategic plan. Two of our four main goals are based around the areas of advocacy and quality assurance and patient care. These are the very areas on which we need to focus, in addition to our longstanding quality efforts on referral guidelines and clinical practice guidelines (also referred to as standards). It is also becoming increasingly important to work on new initiatives in collaboration with the provincial associations such as peer review, potentially expanded accreditation and certification of scope of practice.

Developing a positive image and support for our specialty will be challenging and difficult to achieve on our own. We are fortunate, however, to have allies and supporters in this area. On May 17, 2012, for example, the CAR collaborated with five national medical associations in hosting the first Medical Imaging Team Day. Events surrounding the day included a press conference held at Parliament Hill, the release of a paper on appropriateness, meetings with Members of Parliament and a Senator, an announcement of the day during Question Period, and media interviews. The purpose of the day was to increase awareness of the professions involved in medical imaging as well as appropriateness to both the general public and politicians. The groups joining us in this initiative were the Canadian Association of Medical Radiation Technologists (CAMRT), the Canadian Association of Nuclear Medicine (CANM), the Canadian Interventional Radiology Association (CIRA), the Canadian Organization of Medical Physicists (COMP), and the Canadian Society of Diagnostic Medical Sonographers (CSDMS). For more information this initiative, visit www.imagingteam.ca.

We have close ties to the American College of Radiology (ACR) who have been effectively advocating for radiology for many years in a much more hostile environment than we face presently and they have made it clear they will support us in whatever way they can. There are other potential allies with which we can partner to gain support as we prepare for the challenges ahead.

The Future of Radiology Depends on You

Finally, and perhaps the most important point of my message, is that all Canadian radiologists have the opportunity to help ensure a bright future for radiology.

How can you help? We all need to strive to be a visible, integral part of the healthcare team. This means taking every opportunity to meet and interact with your patients. It means providing more radiology representation on key strategic committees and advisory boards such as provincial quality councils, provincial medical associations, hospital committees and community activities.

We need to be champions of quality and safety initiatives and prove that we believe the quality of patient services we provide comes first. We need to train radiology medical leaders to the point where every practice, no matter the size and circumstance, has individuals with leadership skills. I like the analogy of becoming so entwined in the practice of medicine that we cannot be easily extricated without disrupting the entire delivery of healthcare. And finally, we need to support our provincial and national associations to enable them to work effectively to protect your best interests. If you have not yet joined the CAR for 2012, I encourage you to do become a member today.

Sounds like a lot of time and effort? It will be; but over the past year I have been very impressed with the incredible talent and dedication of the volunteers who are working on behalf of the CAR and Canadian radiologists at the local, provincial, and national levels. It gives me great confidence that we can achieve a very successful future for Canadian radiology. I believe it will be crucial that we speak and act with a unified voice for Canadian radiology to be effective, and we need all radiologists to play a role. Thus, I urge you to spread this message to all your radiology colleagues.

Sincerely,

James Fraser Signature

Dr. James Fraser
President, Canadian Association of Radiologists

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