While she’s now best known as the first woman to chair the American College of Radiology’s board of chancellors, Geraldine McGinty, MD, MBA, didn’t come from nowhere.
A breast-imaging specialist, she’s been practicing, teaching and researching radiology for five years at Weill Cornell Medicine. There her current duties include serving as chief strategy and contracting officer for the Weill Cornell Physician Organization, which negotiates group contracts for the 1,500-physician Weill Cornell Physician Organization. And her past achievements include winning Weill Cornell’s Jessica M. and Natan Bibliowicz Award for Excellence in Mentoring Women Faculty, being named one of the most powerful women in healthcare IT by HealthData Management and making Irish America magazine’s list of the 50 most influential people in healthcare and the life sciences.
RBJ caught up with McGinty while she was beginning to prepare her address for RBMA’s 2020 PaRADigm conference. She took our questions on her talk—“Sharing a Dynamic Vision for Radiology”—and an array of other topics.
As a medical educator and researcher, you’re also a lifelong learner. What areas of learning have come to light for you in your time chairing the ACR’s board of chancellors?
So many. I’ve gained insights around how important good governance is for an organization and what we mean by good governance. And I’ve come to more fully appreciate the importance of strategic planning to help an organization achieve its goals.
I was already a firm believer in that, but when you’re sort of conducting the orchestra—which is essentially what you do as a board chair—it’s important to understand how you can enable people to contribute. You have to make sure you’re enabling discussions that will help move the organization forward. And you have to be willing to help groups work through difficult topics.
That, for me, remains a work in progress. You have to make sure people feel empowered to contribute, and you have to bring the right diversity of voices into the conversation.
As a breast specialist, you’ve seen various controversies heat up and cool back down—screening ages and intervals, density notification, preventative mastectomies and probably too many more to list. What do you see as the most nettlesome unresolved question facing your subspecialty in 2020?
It’s easy to get frustrated by the fact that there’s really good science out there showing the value of screening mammography in saving women's lives that seems to be ignored. The controversies are far from unresolved. When policy makers question the science, they may start to question things like coverage and payment policy for screening. And we have so much work to do on erasing healthcare disparities around breast cancer that, if we start to erode the coverage for breast screening, we’ll exacerbate those disparities.
So rather than get frustrated about what sometimes seems like a willful refusal to understand the science, we have to focus on communicating the message to patients more effectively. And we have to continue to advocate for access to screening exams, perhaps in places where we traditionally haven’t been active.
One of the projects I’ve been working on at the board level is helping us [the ACR board of chancellors] to better understand as a group the real stakeholder landscape in which we function. A lot of our advocacy is traditionally centered around Medicare and Capitol Hill. But we also have opportunities to influence other professional societies like the AARP and the American College of Physicians. Last June the ACP issued a set of guidelines that were, frankly, alarming to me. They had the potential to negatively impact women’s lives around mammography. That reminded us that we need to be creative with our influencing agenda.
What sorts of disparities continue to frustrate efforts at erasing them?
We know that African-American women who get breast cancer do worse [than other population segments]. From some of the work we’ve done through the Neiman Health Policy Institute, we know that, when we look at the uptake of screening mammography, it is not optimal especially for older women and women of color.
Another area of ongoing collaborative research with the Neiman Institute looks at the way benefits design has changed, exposing people to much higher out-of-pocket responsibility. While initial screening mammography is covered without any cost sharing, any follow-up breast imaging is susceptible to deductibles and cost sharing. If people have coverage that burdens them with a lot of out-of-pocket responsibility, are they less likely to get the follow-up care that we recommend?
Consolidation continues to change the profession, and private practices arguably feel the heat more intensely than hospital radiology departments. What are your thoughts on Wall Street’s interest in, and movement into, private-practice radiology?
I’m going to answer this with my ACR hat on. And I’m going to point you to the wonderful work of our vice chair [of the board of chancellors], Dr. Howard Fleishon, and [board member] Dr. Robert Pyatt Jr. They led the development of a white paper on this, “Corporatization in Radiology,” which JACR published in its October 2019 edition. The paper states that the ACR does not take a position on whether that kind of investment in radiology practices is a good thing or a bad thing.
It’s clearly important for a radiology group to think about their ability to determine the way they practice. And every practice considering selling certainly should consider what the longer-term horizon might look like, knowing the expectation in private-equity organizations is that there will be a certain return on investment within a certain time frame.
Where we were very comfortable taking a position in the white paper was to say that, as groups are considering these types of options, it is incumbent on all of them to be transparent with our trainee radiologists who are going out into the job market. It isn’t fair to a trainee coming into the world of radiology practice to think they’re joining one type of practice only to find that control has changed or ownership has changed.
From what you’ve seen working on Imaging 3.0, how are radiologists doing, overall, at adjusting to the economic realities of U.S. healthcare’s push for value over volume?
We know that we have a spectrum in our community in terms of adopting an Imaging 3.0 approach. There are people who continue to be incentivized according to RVU-based productivity, and we know that burnout is a real issue.
Any time I feel concerned, though, I look at our trainees. I look at the number of brilliant medical students who decide they want to go into radiology—who are the future leaders of our profession—and I’m encouraged. This is a generation of radiologists who are going to be comfortable advocating for balance in their lives. That’s not something anyone talked about when I was in medical school. Work-life balance wasn’t even something we thought we could ask about.
Is it your sense today’s trainees understand what the profession means when it talks about prioritizing value over volume?
Value is a word that different people define differently. When it’s applied to complex payment models, most radiologists—including myself—can’t capture all the complexities of those. I’d like to think our emerging leaders are going to have an approach to patient care and radiology that reflects our patients’ values.
Can you envision a day when the profession of radiology no longer needs dedicated initiatives and efforts to promote diversity and inclusion on behalf of women and underrepresented minorities?
Yes, I think we can envision that day. Let’s take gender. If you look at radiology across the globe, it’s almost half male and half female. There are countries—Spain, Saudi Arabia—where the majority of radiologists are women. And even in the U.S., we are moving the needle when you segment by age. If you look at younger radiologists, we’re making progress.
We still have much more work to do when it comes to underrepresented minorities. Honestly, I think that’s not just a radiology issue. We need to work really hard making sure medicine in general reflects the population we serve.
What mileposts must be reached before that day arrives, and how will we know we’re there?
I don’t know that I have an answer for you on that, but I suppose the nirvana is that we eliminate healthcare disparities. No matter what disease you have, your ability to be cared for and survive that disease isn’t impacted by your race or your gender. And that’s a goal that transcends radiology.
What will be the gist of your message at PaRADigm 2020?
It’ll be optimistic. It will really speak to who we are as a profession. We’re radiologists and radiology business managers who are excited by the interface of technology and medicine. We have always been innovators. We’ve always taken risks. We haven’t necessarily wanted to hold onto the old and the comfortable. We’ve been much more excited by the new.
That tees up the inevitable question about AI: Will technology eventually replace radiologists?
If you can provide me with an AI algorithm that is free from bias and improves the care I give to my patients, I’m all for it. That was my message in my talk on this topic at RSNA, and the theme is applicable to what I’ll say at RBMA: We need to make sure we adopt innovation in a way that’s safe and advances care while reducing bias. How do we balance our desire for innovation with making sure we’re keeping things safe for our patients? So at RBMA I expect to be very excited about the future, asking people to consider how we work together to craft a future that drives better outcomes for our patients.
What are you looking forward to seeing, doing, learning or otherwise experiencing at PaRADigm 2020?
I always learn a lot from the people I meet there. My own background is economics, so we’re clearly very aligned on that. There are a lot of people there with whom I’ve worked for a long time and who have been incredible collaborators for the ACR as well as for the profession. It’s just nice to catch up.
I talk a lot about governance and the importance of bringing a diversity of voices to the table. RBMA’s annual meeting is an opportunity for me to hear from a different constituency within our profession. I especially enjoy hearing the questions I get from this group dealing with governance, practice acquisitions and consolidation, patient- and family-centered care. I used to be in private practice and now I’m at an academic medical center. So being exposed to this group is an incredible opportunity for me.
You’re clearly confident radiology has a bright future, come what may.
How could I not be? I trained with incredible radiologists whose roots were in the “X-ray era.” I think of one in particular who, as a 24-year-old new graduate, established a field hospital in North Africa during World War II for Field Marshal Bernard Montgomery. Toward the last third or so of my career, I’m now thinking about artificial intelligence impacting my practice. I have seen this incredible march of technology. We’ve lost a little along the way in terms of patient contact and collaboration with referring clinicians, but with Imaging 3.0 we’re trying to bring those things back.
And if we’re going to see AI impact medicine, we have a real opportunity for it to make a huge difference in imaging. And not just in imaging but also in terms of integrated diagnostics, where we’re bringing together imaging with pathology and genomics. There’s so much to be excited about going forward.