A voice of one

In 1998, I was a councilor for Pennsylvania to the American College of Radiology (ACR). While most radiology societies have predominantly academic membership, the ACR represents all of radiology – academics and private practice, and functions to establish practice standards, provide education, manage economic issues, and serves as the political arm for the profession. Among a councilor’s duties at the College’s annual meeting is to vote upon the myriad of resolutions introduced since the previous year. The procedure for managing the resolutions is akin to that used in the U.S. Congress. Once a resolution is submitted, it is then given to one of four Reference Committees, who present it to the membership for comments. The Reference Committee, in turn, and based on the comments made, will then decide to recommend one of four courses of action: adoption as written, adoption following amendment(s), defeat, or referral for further consideration to either the Council Steering Committee or to the Board of Chancellors.

In 1998, the job market for residents and fellows leaving their training programs was soft, reaching an all-time low. Although the job market fluctuated much like a sine curve, reimbursement reductions by Medicare (and the “Blues” following suit) had led many radiology groups to defer new hiring. Furthermore, the usual attrition rate due to retirement was slowed, as many senior radiologists continued to work because of drops in the stock market and hence, their retirement accounts.

It was against this background that the Residents and Fellows Section (RFS) of the ACR proposed a resolution asking that the College use its influence and “good offices” to reduce the number of residency slots available, and thus reduce the competition for the few jobs that would be available when they finished their training. Historically, resolutions introduced by the RFS were adopted and became College policy. Furthermore, opposition to resolutions proposed by the RFS was viewed by the membership as akin to spitting on the flag. And so, this resolution was presented to the appropriate Reference Committee, who, hearing no objections, recommended that it be adopted. I was attending another Reference Committee hearing and was unable to raise any objections to the resolution.

The resolution was presented to the ACR Council for a final vote, with the recommendation of the Reference Committee that it be adopted. The Speaker of the Council opened the floor for discussion. I went to the microphone and said, “Mr. Speaker, I speak against the resolution.” This was followed by a large chorus of boos. After the Speaker restored order, I presented my reasoning for opposing the resolution. I asked how many of the delegates were from practices that had residency training programs. About 20% raised their hands. I then told them that I was from an academic private practice that had a total of 12 residents. Each year, prior to 1998, we received an average of 300 applications for three available resident slots. That year, we received only 10! To me, this indicated that the system was correcting itself, adjusting the numbers to reflect the job market. As I looked around, I saw most of the academicians nodding in agreement. They had similar experiences. More importantly, I also pointed out that the total number of residency positions was determined by the Residency Review Committee (RRC) as well as by Congress, who reimbursed training programs. I concluded that the system was correcting itself and that the ACR should not intercede.

As soon as I sat down, several other academicians from large and small programs spoke, supporting what I had said and mentioning their own experiences in a decline in residency applications. They, too, agreed that the system was correcting itself and felt the resolution should be defeated. The net result was that the Council voted the resolution down, and I truly believe we made the right decision. Had I not spoken up, the resolution would have unanimously passed and become ACR policy.

There are several lessons to be taken from my experience. In a free society, everyone is entitled to express their opinion. If they make a cogent argument for their position, reasonable people will listen and their opinions can change. A voice of one can and does make a difference. And, most importantly, everybody’s vote counts.