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10 Questions with Rajan Agarwal, MD, MBA

March 23, 2016

Article

For this “10 Questions” series, we spoke with Rajan Agarwal, MD, MBA, about his work and the future of radiology.

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

Rajan Agarwal, MD, MBA. I am a private practice radiologist for the Radiology Group of Abington. I am also a co-founder and on the board of directors for the radiology analytics company, Montage Healthcare Solutions.

2. How did you get where you are today?

With amazing support from my family, teachers, and mentors as well as serendipity. If you asked me at the beginning of medical school, ‘do you want to be a radiologist?’ My answer would have been: ‘why would I want to be in a dark room the rest of my life?’ I want to help patients and have a significant impact on public health.’ I have always had a passion for helping others, science, public policy, and business. As an MD/MBA, I almost chose to stay in business as a consultant for McKinsey. However, when I looked at what I wanted to do when I was 60 and at the end of my career, patient care was at the top of my list, not traveling the world making power point presentations. This made the decision to stay in medicine easy.

3. Why did you choose your profession?

I lucked into diagnostic radiology. My initial interest in radiology came through interventional radiology. I saw IR as a way to help patients with innovative new devices. I also saw radiology as a discipline that has driven innovation in health care, which piqued by entrepreneurial business side. I never thought I would be a diagnostic radiologist. However, as I began my diagnostic radiology residency, I found that I enjoyed the diagnostic side of radiology more than the interventional side. I had to diagnose diseases I had never learned about in medical school. There was so much to know and continue to learn in our rapidly changing profession. I began to see that diagnostic radiology touched every field of medicine, that our technologies were quickly replacing the traditional physical exam, and that our field truly was at the nexus of patient care.

I chose private practice for one principal reason: I liked reading all modalities from head to toe and could not see myself reading one modality or body part the rest of my career. Also, I felt that there were many ways in which I could give back to my profession and community while being a private practice radiologist. While my day job is focused on clinical radiology, my early mornings and evenings are focused on radiology advocacy, health policy, and entrepreneurial activities. I am willing to give up my personal time because I truly care about the future of our profession.

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

Finding the time between my clinical activities, to try to improve and demonstrate the value of our services at the practice and broader level. With declining reimbursements, changes in the way we are being paid, increasing volumes, and increasing complexity of cases, it is challenging enough just to get your clinical work done.

However, if you have a long term view on your career, just trying to get your work done will not cut it. While getting your clinical work done pays the bills today, if you want to lead the change that is occurring in medicine, improve patient care, ensure your long-term financial success, and be at the table instead of on the table, we all need to do more. I completely embrace an idea that has been promoted by many of our profession’s key leaders: dedicate at least 10% of your work day to non-RVU generating activities that add to your value; for example, talking to patients, speaking with referring physicians, quality improvement projects, advocacy, research, participating in multi-disciplinary conferences, etc.[[{"type":"media","view_mode":"media_crop","fid":"47040","attributes":{"alt":"Rajan Agarwal, MD, MBA","class":"media-image media-image-right","id":"media_crop_707299941392","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5507","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":"float: right; height: 278px; width: 200px;","title":"Rajan Agarwal, MD, MBA","typeof":"foaf:Image"}}]]

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

I worry that we will be too slow to adapt to the major structural changes occurring in medicine. There are still many in our profession who are focused on the daily grind of getting the work done to maintain certain levels of income without enough attention to the nonrevenue producing value-oriented activities that will allow our field to grow and flourish in the future. We need to fight the commoditization of radiology, and the only way to do that is become more integrated and valuable to our other clinical colleagues.

We also need to prove our value, which requires objective data analytics. How can you know what needs to be changed and show that you have achieved positive change through an intervention without robust data analytics to measure and monitor your practice? One of my activities that I am most proud of is my role as co-founder of Montage Healthcare Solutions. Designed by radiologists for radiologists, our goal has been to empower practices to improve and demonstrate their value with radiology specific analytics.

6. What one thing would make your job better?

Anything that will improve my clinical efficiency so that I can get the work done faster without a decrease in quality. Improved PACS and voice recognition would be the first step. Often I feel that my system is slower than I am, it should be the reverse.

7. What is your favorite thing about radiology?

Innovation. Radiology got to where it is today, because we kept developing new diagnostic tools and life-saving therapies. Innovation leads to value (eg, improved patient care, increased efficiency) which leads to reimbursement which leads to even more innovation. We must continue this positive feedback cycle, but realize that value will be measured in a different manner in the future, with a focus on cost-containment and quality.

8. What is your least favorite thing about radiology?

The perception by many outside of radiology that we are in a dark room, isolated from the patient care team. Unfortunately, we are, in large part, guilty for creating this perception. This perception diminishes our critical role in patient care, and if we do not change this perception, patients will lose as declining radiology payments will result in decreased innovation. We need to prove our value, so society continues to invest in future innovation led by radiology. MRI, PET/CT, interventional oncology, and molecular imaging are just a few of the innovative technologies that have changed patient care over the last two decades or so. Imagine life without these technologies.

9. What is the field’s biggest obstacle?

Commoditization of radiology. And while we can try to blame others for this, our biggest obstacle in fighting commoditization is ourselves. Every single radiologist needs to be involved in creating and demonstrating our value from developing the most cost-effective diagnostic technologies, to monitoring appropriate utilization, to ensuring that scans are performed and read in the highest quality manner, to operating efficient departments, and to integrating our services with our clinical colleagues to ensure the best outcomes possible for our patients.

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

Dedicate at least 10% of your work day to non-RVU generating, value-based activities.

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