10 Questions with David Levin, MD

Our "10 Questions" series asks the same questions to a diverse group of professionals in the imaging community.

Here, we profiled Frank J. Lexa, MD, MBA

- See more at: http://www.diagnosticimaging.com/practice-management/10-questions-frank-j-lexa-md-mba#sthash.wUaEBYdc.dpuf

Our "10 Questions" series asks the same questions to a diverse group of professionals in the imaging community.

Here, we profiled Frank J. Lexa, MD, MBA

- See more at: http://www.diagnosticimaging.com/practice-management/10-questions-frank-j-lexa-md-mba#sthash.wUaEBYdc.dpuf

Our "10 Questions" series asks the same questions to a diverse group of professionals in the imaging community.

Here, we profiled Frank J. Lexa, MD, MBA.

- See more at: http://www.diagnosticimaging.com/practice-management/10-questions-frank-j-lexa-md-mba#sthash.wUaEBYdc.dpuf

Our "10 Questions" series asks the same questions to a diverse group of professionals in the imaging community.

Here, we profile David Levin, MD.

1. Please state your name, title and the organization you work for. 

David Levin, MD, Emeritus Professor and Chairman, Department of Radiology, Thomas Jefferson University Hospital.

2. How did you get where you are today?

Almost by accident. I was co-director of what was then called the cardiovascular-interventional radiology division at the Brigham and Women’s Hospital in the mid 1980s. I greatly enjoyed doing IR and cardiac imaging and interventions (back then we shared the cardiac cases with the Brigham cardiologists). The last thing I wanted to do was get into administration. But then our chairman, Dr. Herbert Abrams, announced that he was retiring. The hospital asked me to take over as acting chairman. I decided I’d better do it because if I didn’t, they might go and pick someone I wouldn’t be happy with. [[{"type":"media","view_mode":"media_crop","fid":"42629","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_291033106225","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4636","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 250px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"David Levin, MD","typeof":"foaf:Image"}}]]

As I got more and more into that role, I realized that I enjoyed the challenge of running a large enterprise and having to be creative and resourceful. After doing that for a year and a half, I left Brigham and became chairman at Jefferson. I held that post for 16 years, then semi-retired. My successor as chair was a protégé of mine, Dr. Vijay Rao. I had appointed her as vice chair for education. In the late 1990s, she and I had formed a small group called the Center for Research on Utilization of Imaging Services (CRUISE). We had become quite active in health services research in radiology and Dr. Rao wanted to keep that effort going. So she recruited me back into the department.

When I had originally thought about stepping down as chairman, I figured I’d go off into the sunset, take courses in art and music, read lots of books, and so on. But I realize now that I’m much happier doing what I’m doing than I would have been if I had left radiology entirely and really retired. In addition to health services research and speaking and writing about health policy, I do some consulting for several companies and some coronary CTA. I guess I owe my friend, Dr. Rao, big time for allowing me to stay on in the department and pursue those things which are really my hobbies.

3. Why did you choose your profession?

Again, almost by accident. I went to med school at Johns Hopkins and had planned on becoming a surgeon. I went to UCLA to do a surgical internship and residency. But after a few months of holding the retractors in the OR and doing hundreds of histories and physicals, I realized I didn’t enjoy it and had made a mistake. At the time, UCLA had a really dynamic radiology department that was doing all sorts of things that were new and exciting for that time period. So I made the switch and have never regretted it. Radiology was a great field back then and still is.

4. What is your biggest day-to-day challenge?

Trying to get the research databases that we need to do our health services research. The commercial insurers are reluctant to give out their data and when they do, it’s often polluted. And Medicare charges a fortune for some of the more granular databases that we’d like to use. That’s the biggest challenge on the research side. If I were still a chairman, I think the biggest challenge would be dealing with the endless new administrative mandates and restrictions that the feds and the payers keep heaping on us. It’s almost impossible to find the time to get any real work done. And our university administration sometimes compounds the problem.

5. What worries, if any, do you have about the future of radiology? If none, where do you think the field is going?

There are many threats to the future of radiology. Here are some of them, not necessarily in order of importance: (1) Commoditization of our field. (2) The many reimbursement cuts that have hit radiology in recent years. (3) New payment models that are coming down the pike, such as ACOs, bundled payments, and reference pricing. (4) Code bundling, such as what occurred with CT of the abdomen and pelvis in 2011 and cardiac nuclear medicine in 2010. These 2 things – the new payment models and code bundling – are going to further reduce reimbursements. (5) High-deductible health plans. With patients now being faced with high deductibles, they’re going to start shopping around for the lowest prices for their imaging studies. This is going to be a real problem for radiologists, some of whom could find themselves priced out of their local markets if their fees or those of their hospitals are too high. (6) The teleradiology companies. I think it’s reasonable for very small radiology groups to outsource their night and weekend work to these companies. But it troubles me to see large groups doing it – groups that could easily cover their own night and weekend work. This commoditizes radiology; it gives their clinical colleagues the impression that they care more about their personal convenience than about their patients. Also, because the teleradiology companies charge such low fees for their reads, they devalue the work of radiologists. And then of course, some of those companies are trying to oust on-site radiology groups from their hospital contracts. (7) Turf battles. Over the last 15 years, we’ve been pushed out of peripheral vascular interventions. Before that, it was other things like cardiac imaging and OB ultrasound. Now the latest threat is “point of care” ultrasound. Over the years, radiologists have lost many turf battles to other specialists who don’t have proper training in imaging or image-guided interventions, but can get away with it because of they control the patients.

6. What one thing would make your job better?

Computers and software that always worked the way they’re supposed to. And no more demands to constantly change my passwords.

7. What is your favorite thing about radiology?

The way it’s grown so rapidly. MRI and CT didn’t exist when I began my career in radiology. In those days, nobody ever dreamed of cross-sectional or 3D imaging. And in my own field of interventional radiology (which used to be called “angio” or “special procedures” back then), none of us dreamed of the vast array of interventions that IRs now perform every day. The changes that have occurred in radiology in the last few decades have truly been breathtaking.

8. What is your least favorite thing about radiology?

A sense of apathy and entitlement that exists among some radiologists these days, and also too much focus on making money.

9. What is the field’s biggest obstacle?

The perception among many people in the health care industry that radiology is just a commodity. To some extent, we’ve brought it on ourselves by not engaging with patients and doing too much outsourcing of night and weekend coverage. For radiology to really be successful over the long term, we’ve got to turn that around.

10. If you could give the radiology specialty one piece of advice, what would it be?

Radiologists have to be willing to take some time away from simply churning out cases and trying to maximize income, and instead using that time to act more like true consulting physicians. It means doing things like: (1) Spending more time trying to eliminate inappropriate ordering through consultation with referring doctors before studies get done. Also, taking the time to educate them about appropriate ordering, through CME lectures, grand rounds, publications in primary care journals, etc. (2) Spending more time supervising the techs, making sure protocols are tailored to the patient’s clinical circumstances, standardizing protocols among different members of the group, and encouraging the techs to call if they have a question. (3) Developing portals to give patients direct access to their results. As part of this, I’d like to see radiologists adding their email addresses and cell phone numbers to their reports and encouraging patients to contact them if they have a question or concern. (4) Taking over the responsibility for the imaging care of the patient. When a patient needs follow-up imaging, we shouldn’t rely on the patient’s primary care doctor to arrange it. We should do it. (5) Talking more to patients – if not every single one, at least those who wish to see us. (6) Being more available to consult with referring doctors. (7) Developing multimedia reports that contain not just text, but also annotated images.

I should point out that when I make these suggestions, I’m not the only one urging radiologists to act more like “real doctors.” The last 3 chairmen of the Board of Chancellors of the ACR – Bibb Allen, Paul Ellenbogen, and John Patti – have all said the same thing in a variety of their writings. So has Geraldine McGinty, current chair of the ACR’s commission on economics. The four of them are important thought leaders in radiology and all have spent most of their careers in private practice. Radiologists should listen to them.

Is there someone in the imaging community that you want to hear from? E-mail us their name and we'll ask them 10 questions.

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E-mail us

 their name and we'll ask them 10 questions. - See more at: http://www.diagnosticimaging.com/practice-management/10-questions-bruce-reiner-md#sthash.vKQ0fGOa.dpufIs there someone in the imaging community that you want to hear from? 

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 their name and we'll ask them 10 questions. - See more at: http://www.diagnosticimaging.com/practice-management/10-questions-bruce-reiner-md#sthash.vKQ0fGOa.dpuf

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