SBI Podcast
The official podcast of the Society of Breast Imaging (SBI). This quarterly podcast will cover different breast imaging themes each year. The theme for the first year is: Breast Imaging Economics.
SBI Podcast
Championing Health Equity and Price Transparency in Radiology
Understanding the complexities of economics is vital for breast imaging radiologists to deliver quality care effectively. Our engaging conversation with Dr. Geraldine McGinty unraveled insights on financial literacy, job preparation, and the importance of price transparency in healthcare.
• Importance of financial acumen in breast imaging
• Integrating financial education into residency training
• Navigating job offers and contract negotiations
• The role of trust in establishing career satisfaction
• Understanding the dynamics of private practice versus academic roles
• Advocating for policy changes like the Lower Costs, More Transparency Act
• The impact of price transparency on patient care
• Embracing leadership and activism in the radiology community
This quarterly podcast will cover different breast imaging themes each year. The theme for the first year is: Breast Imaging Economics.
Hello, welcome back to the SBI podcast. This is the second episode of our inaugural year for the podcast and today I'm joined by Alyssa Cubison, who will be co-hosting with me today. She has been very helpful in planning out the various discussions that we'll be doing for the podcast and, alyssa, I just want to give you a moment to introduce yourself, please.
Speaker 2:Yes, thank you so much, carla. It's been wonderful seeing your vision come to light and being a small part of it. I am so grateful to be here and, yeah, just to be able to have a discussion with you ladies today. My name is Alyssa Cubison Again. I come from the Ohio State University Wexner Medical Center, where I am a breast imaging radiologist. I did my fellowship at Northwestern in Chicago and I'm about four years out from training now.
Speaker 1:Wonderful, wonderful. I love having you, I love being able to bounce ideas with you and I love also that the more early career perspective you're bringing into our discussion. So, thank you, thanks for everything you're doing for this. Well, I have to say it is an absolute pleasure and I am so delighted to welcome our guest for today's podcast. She is no stranger to breast imaging or the broader radiology community. It's Dr Geraldine McGinty. She is a professor of radiology at Well Cornell Medicine. She's the senior associate dean for clinical affairs and a professor of clinical population health science. Her credentials also include being the chair of the commission on economics of the ACR and the first woman elected to be chair of the ACR Board of Chancellors. Any titles that I need to add there, geraldine?
Speaker 3:No, I think that'll do Proud breast imager hanging on to my breast imaging commitment. Don't get to do it enough.
Speaker 1:True, I feel the same. I feel the same, you know. On a personal note for the introduction, I just want to certainly add she is a respected leader for both women and men in radiology. I think a lot of us in the field, particularly women, see you very much as a trailblazer and also a huge health policy advocate for sometimes controversial topics and several that are very important to women's health. So thank you for all you do and thank you for being here today.
Speaker 3:Well, thanks for those kind words, carla. What I always need to say it's an incredible honor to have been the first woman to be chair of the board of the ACR in its almost 100 year history. That said, I'm not the first woman who could have done it. I'm not the first woman who should have done it. I stood on the shoulders of incredible giants in that field. So, yeah, I just feel like I always need to qualify that a little bit.
Speaker 1:Okay. So so many topics that I would love to have the opportunity to discuss with you, but today we are keeping with the theme of this first year of the SBI podcast and that is economics. And certainly with your past credentials, you're a perfect person to have for this podcast. When I first approached Dr McGinty about the podcast, I sent a few topics that I thought might be of interest and she made a really great recommendation that perhaps, as the backbone for the conversation, we could use an article that she recently published in the JBI. It was published in June of this year and it's developing financial acumen as a breast imaging radiologist. In. As a breast imaging radiologist, and in my mind, what a very thorough, practical approach to this topic. I loved it. Almost the end of each section you provided some very helpful resources that people could turn to. May I ask you first what was your motivation for?
Speaker 3:writing. Ask you first, what was your motivation for writing MARTHA MINERA my motivation was Martha Minera. I was visiting professor at Brown, or did the Rhode Island Radiologic Society, and it was Martha's idea that I should do it. And she just kept upping the pressure and yeah. So thank you, Martha, for the inspiration and the nudging MARTHA.
Speaker 1:MINERA there we go. In a sense. It sense I felt like this was an article that could have been shared in the JACR or even more broadly, and yet you kept it more personal for the breast imaging community and I wondered your thoughts on that.
Speaker 3:Yeah.
Speaker 3:So I don't think you can be an effective breast imager without understanding the impact the payment policy has on our ability to deliver breast cancer screening, breast cancer diagnostic care to our patients, whether it's payment for screening, whether it's now payment for the additional diagnostics, without cost sharing for patients.
Speaker 3:You know those are things that we have to understand as breast imagers because you know, unfortunately, we have to keep as breast imagers because you know, unfortunately we have to keep advocating for that. You know that's not, that hasn't been a one and done for us. Remember the provisions around, you know, protecting access to breast screening are not in the Affordable Care Act, they're in a separate piece of legislation that we have to keep going back over and over again to Congress. You know, every time Congress turns over, I think we've got five physicians in this incoming Congress, which is great, but you know, think about how many more of our elected representatives we have to keep educating. So we have a responsibility, if we're going to care for our patients at all with regards to breast screening and diagnosis, to understand the economics of it.
Speaker 1:Yeah, absolutely. And you know, I thought about how many breast imaging people I see as advocates and I've been thinking about that as sort of what's the origin of that, and I'm thinking a lot of us are drawn to breast imaging out of our passion for women's health and caring for women passion for women's health and caring for women and so in a sense I think that passion for that topic easily transfers into advocating similarly for breast imaging is sort of my recent thought on it. Okay, so if we go into the article a bit, alyssa, you are the associate program director and Dr McGinty starts the article in part of it from an educational perspective and the need for this even within residency, this developing the financial acumen with radiologists in general. Alyssa, can you speak to that some from your perspective as an associate program director?
Speaker 2:Absolutely yes. So I think because of that role I tend to see things oftentimes through the educational lens and things where I wish I had and maybe this is my own personal I wish I'd had a lot of these teachings as a resident. Perhaps I had a more narrow scope and I wish I'd had more of a financial acumen perspective. So it's certainly top of mind for me in terms of training our residents and I want that incorporated as early and often as we can into our residency. Your article provided excellent resources to be used both at all career, at the early and mid-late career stage, but also for trainees. So I was just curious for you to elaborate a little bit more on those resources, how we can provide maybe a foundation for our trainees with breast imaging clinical acumen.
Speaker 3:For sure. And obviously the ACGME has milestones around trainees of all flavors developing these kinds of skills. But you know it is a big lift for a program to cram those skills in, as well as all the other things we have to teach our residents and fellows. So you know, I think the ACR's Radiology Leadership Institute has put together some great programming to support training programs in that regard. The other thing is using our colleagues, the colleagues who are doing our billing, or our government relations teams and our institutions. I think that can be really helpful to round out that content.
Speaker 2:That's excellent, I agree. I think it's so important from the advocacy perspective that I would love for our trainees to get involved as early as possible, but also just for their own personal education. When it comes to jobs, you know those things come up quickly. I think you're just in the mindset of training and learning breast imaging, which is, of course, the priority. I think you're just in the mindset of training and learning breast imaging, which is, of course, the priority, but then you have to have a mindset shift when you're looking for jobs. So it's so important. I really appreciate that.
Speaker 3:Sure, and I always like to remind our medical students that membership of the American College of Radiology actually for medical students and residents is free.
Speaker 1:There's a lot of great resources on the resident and fellow section on the ACR's website. True, and just to add to that, alyssa, you know well, I see it with our residents Somehow, when you start talking economics and how you'll be paid in your practice, residents' ears really perk up and I find that these economics lectures are actually very popular with the residents. We in our residency have actually started doing some specific financial literacy and so forth because they were so popular. But okay, another topic covered in the article was preparing for the first post-training position and how you consider economic factors in that. And, alyssa, I'm going to have you lead that as well, please.
Speaker 2:Oh, absolutely yeah, Sort of kind of pivoting or I guess on the last question is residents transitioning into looking for jobs. So I guess, generally speaking, is there any advice you might have from the financial, educational side when they're looking for their first jobs, things they should be thinking about. I know your article outlined it really beautifully, but I guess, more briefly, if you have any things to mention.
Speaker 3:Yeah. So a number of things. Bill Thorworth, who was the previous CEO of the college and a great mentor for me, always focused on the importance of trust. And you know how do I feel about these people that I'm interviewing with, because you'll spend a lot of time with the people you work with, so to me that sort of probably should be primary above financial considerations. But look, I'm not naive. You're coming out of medical school with a lot of debt. You have family commitments. Out of medical school with a lot of debt, you have family um commitments.
Speaker 3:Uh, it's clearly a red hot job market right now. Um, I will say, when I came out in 1994 I couldn't get a breast imaging job to save my life. Um, I was in the northeast and I was kind of constrained and anyway, that's a whole other story. But but you know sometimes that you know that can be a little confusing. You're seeing, you know numbers being waved around that seem very attractive. I think let's put that trust piece first. Let's also think about what is it that you're going to be doing and then, specifically, what are the performance metrics you're going to be held to and what's your ability to change your mind. A surprising number of people changed jobs in the first year or around then, and I know that the Federal Trade Commission, at least under this administration, has been seeking to make restrictive covenants a thing of the past. But you know they're still there. There's a lawsuit going on sort of trying to hold that change up, and you know, having a restrictive covenant that prevents you from looking elsewhere for a job can just be a real impediment to your future progress if you found that you're in the wrong place.
Speaker 3:So I think it's really important to think about the people you're going to be working with, think about what you're going to be doing, although I always say be as flexible as you can. Coming in and saying I'm only going to do this or I'm only doing you know I want to work there. Coming in and saying I'm only going to do this or I'm only doing you know I want to work. There is, you know, people want to feel that you're a team player. But read your contract and get a lawyer to read your contract when people tell you that it's not negotiable. It's always negotiable and that may be a red flag, especially in this job market, if people aren't willing to think about what's going to make you successful. So, for example, if you know that you want to be at home reading from home two days a week, you know, if a practice isn't even willing to consider that, that's, perhaps you need to look elsewhere.
Speaker 3:Um, but in terms of of the, the financial um piece of this, what is your potential path to partnership? Is that clearly stated in your agreement? Because if it's not clearly stated in your agreement, then you don't have an assurance that it's actually going to happen. And then I think it is important to think about practice governance, practice ownership, right, um, no job is perfect, but understanding how the decisions will be made on resourcing your practice or growing your practice, um, whether that's. Are you in an academic institution where you know we in the on the clinical side of an academic institution are expected to underwrite our research programs because they never bring in enough dollars to actually support the research, and that's our mission. If you're working for a private equity funded group, understanding the economics of that world where there's an expectation of shareholder return and probably a turnover of the practice ownership within a certain amount of time, I know people who work in all types of practices, who are happy and the converse. But the more you know, the more you can make a decision that will be informed.
Speaker 2:Thank you so much.
Speaker 1:Well said and I'm bringing a little bit. You have witnessed, as I have, the transition in the radiology practice and venture capitalist backed groups purchasing While you were in the leadership of the ACR. That was something that was very much transforming the practice. How do you advise people in terms of that? I hear awareness, being sure to be aware, but when people express concerns on you know physician-owned practices versus not, how do you decide? How do you discuss that?
Speaker 3:Yeah, I mean I. First of all I want to make sure that every radiologist feels that they are part of our community, that we are not going to demonize somebody because of the company they work for, as long as they're practicing ethically and you know are that you know they are doing the right thing for the patients. So my feeling has always been let's bring everyone to the table, because whatever type of organization you work in, whether it's an act, whether you're employed by a health system or an academic medical center, or employed by a group that's owned by private equity, I want radiologists to have as much influence, as big a voice as possible in how at least the radiology operations run, but actually the operations of the entire center. Because, if you think about it, for us in breast screening it's critically important that we have primary care GYN colleagues who are empowered, who understand the guidelines, who know how to use our services. So I would, you know I don't want it to sound like a cop out, but I think that figure out where you can be as influential as possible in any organization right Now.
Speaker 3:Obviously, as I say, there are some drivers of perceived value in private equity owned and venture capital owned practices, which often target physician productivity. So that's where I think it's really important for radiologists, especially in this type of job market, to make sure that the things that you need to be successful whether it's your working conditions, whether it's the productivity targets or whether it's your ability to continue to be involved in organized medicine. When I went into private practice, I negotiated that I would still get to volunteer with the ACR and that I would be able to travel for the ACR. That was really important to me and, candidly, if they hadn't given me that, I wouldn't have gone. So I think, understanding what's important to you and finding a way to be as influential as possible.
Speaker 1:Within that framework, I hear you, I hear you Okay. Contract negotiations.
Speaker 3:Yeah, wow.
Speaker 1:That's what I mean.
Speaker 3:Look, I, before I moved into the Dean's office, I used to negotiate our insurance contracts and it was my favorite subject in business school and I think it's fun and I, but I know for a lot of people it is really scary. And the unfortunate truth given that we're three women on this and the majority of breast images, I think, are probably women is that women are penalized for negotiating. So you know, I feel like I should be advocating for system change. But if you have to negotiate, which you often have to do, whether it's with your kids to get them to go to bed or buying a new car or on your salary, the data shows that you will always do better if you're prepared. That seems obvious. You, to the extent that you can use data, benchmark data, third party data that's always helpful. You know, if you're in the private practice world the medical group management association, the amc they do salary surveys every year. It's 50 bucks or something to buy the report on their website. Spend the 50 bucks right. Understand what the benchmark in your area of the country is for your area of experience, right, so you can go in and level set on that. Um, and then, in terms of the preparing yourself. You know it can be nerve wracking for sure.
Speaker 3:Focusing on questions, focusing on precedent. If you're being told, for example, well, we can't let you work two days from home, framing the question in terms of has anyone ever worked from home? What would be the kinds of performance metrics that would reassure you that someone working from home was contributing? What would be the metrics of success from your point of view? What are the ways in which this division performs that you need to be able to report to your, the people you report to, and what is your chair? If you're talking to a division director, what is your board asking you for? What are the problems that you're dealing with as a leader that I can help you so that you can then find things? You can find it in yourself to actually accommodate my request.
Speaker 1:I appreciate that you mentioned in the article in general that women are more challenged with being successful with negotiation. I think it's a great skill to recommend building knowledge in, and I think people that are really good at it actually find it fun.
Speaker 3:And practice, get a trusted person. You be the person you're negotiating with and they be you and see how you see what it feels like on the other side Exactly.
Speaker 1:Great point, great point, okay, just.
Speaker 2:Oh, oh, I'm sorry, I was just just going to reiterate that point. I think, again, the trainees, it's their first opportunity, maybe, to make a mindset shift where they do really need to advocate for themselves. I think, there again, the trainees, it's their first opportunity, maybe, to make a mindset shift where they do really need to advocate for themselves. I think there might be a trainee mindset where you know to be confrontational, which of course they shouldn't, but when you're contract negotiating that is a virtual virtue, that is your right, you want to. So I just like to get that statement out there, that sometimes I think that mindset shift can be hard, but so necessary For sure. Couldn't agree more.
Speaker 1:Absolutely Okay. We are going to transition to, as people that love health policy, some topics that I think you will enjoy, and we'll frame it as the section on price transparency. And why don't we start with the policy initiative around price transparency, the Lower Costs More Transparency Act? And as I was reading about it, I saw that a recent poll of Americans with health insurance ranked reducing healthcare costs as their top healthcare priority, and I absolutely understand, you know, even as I have family members that are needing to access healthcare more frequently now as they age.
Speaker 1:This is a challenging topic and you can certainly understand in a country where I think it's somewhere near 60% of people are living paycheck to paycheck, where the expensive healthcare costs of our system are a challenge and something that needs attention. So certainly I understand the background to the need for the policy initiative. It's House Bill 5378 that requires healthcare providers and insurers to disclose certain information about healthcare costs. It also has some other provisions, but we'll focus on that provision for now. Yeah, Talk to me about price transparency. And then I'd also love to hear you are so involved at a systems level. I'd love to hear how you view it as a practicing radiologist and then part as a system leader.
Speaker 3:Yeah, so it really does seem like a no-brainer, doesn't it, to understand the cost of your health care. Um, uh, let's start with the affordable care act, although we could go back to any number of other milestones, but you know, the key provision of the affordable carrot was to allow more people to access health insurance. Unfortunately, what's happened at the same time as more people have insurance is that they are paying more out of pocket, especially when we're looking at the programs that, as more people have insurance, is that they are paying more out of pocket, especially when we're looking at the programs that are offered, the benefits offered by, say, smaller employers or people buying their own insurance on exchanges. Their deductibles are very significant. You could be a family of four paying a deductible of several thousand dollars, so it can almost feel like you don't have insurance. And even you know, 14 years after the passage of the Affordable Care Act, medical bills are the leading cause of personal bankruptcy, right? So we clearly have an issue where patients are being exposed to costs that they simply can't manage. So why would we not want to tell patients how much their care costs?
Speaker 3:To tell patients how much their care costs, I think that we have to think about the relative interest and I'm not saying that doctors are always, as we have, self-interest and we have perhaps sometimes acted more in that than we should. But when we put ourselves up against large publicly traded insurance and benefits administrator companies whose deliverable, whose fiduciary responsibility, is shareholder value, trainees and also continuing to support care to patients who simply cannot pay or whose insurance simply does not cover the cost, there's a lot of cost shifting. That goes on from the commercial insurance the United, the Cigmas, the Aetnas to help us, especially in a state like New York, be able to provide care to our patients who have medicare and medicaid right. So we have a very complex economy of trying to provide care to our communities. It's much crisper on the health insurance side. I have to return value to my shareholders. So when you put us together and try to adjudicate what's a fair price, I think the way that the the process has gone so far, I think the way that the process has gone so far, feels to me as if there's a very significant advantage in favor of the insurers.
Speaker 3:And I do think, although you know there can be quite a large spread in terms of payments for services across different sites of care I think that you know and of course I'm going to acknowledge I'm biased, I work in a quaternary academic medical center. But we have to be open 24-7. We have to be able to give you a heart transplant 24-7. We have to be able to do the most complex care 24-7. There's a cost to that right. And we have to also, at the same time, support research. You could argue that you know the cost of clinical care shouldn't have to support that, but we also have to train residents and fellows and medical students, so there's a cost to that. So I think I think where we find ourselves and, carl, I'm going to confess I'm not. I'm not up to date with where the latest lawsuit is. You guys in Texas have been such leaders in that, but it feels to me like right now the patient's getting lost because the interests of some of the large interested parties, such as the insurance companies, seem to be overweighted.
Speaker 1:Yes.
Speaker 1:Well, so if we go to the root of the idea of the price transparency and we think about, okay, how, if I am a patient that you know I am a, let's just say, a middle America, you know, middle class, just not super versed in this I try to think, okay, what is the perspective on price transparency here?
Speaker 1:And then I think it goes to as you're suggesting, with changes in insurance, where there's more and more cost sharing with patients and to the point of linking that together. If the patient has to pay more than you can see in this world of of Amazons and everything else online, why aren't we able to see the cost and shop? But then I think we take it a step further and we go okay, it is such a complicated field of insurance in the first place, and are they truly able to understand? Even if we make this best effort to be transparent, are patients truly able to put it all together and understand? What will this be in terms of? For me, is it simplified enough to where someone that is not super well-versed with medical care even those of us who are, who work in it, can find it confusing, just to the point of cost sharing and this trend of cost sharing. What are your thoughts on that?
Speaker 3:Yeah. So, as you likely know, I've really focused on this because you know, cost sharing can be a powerful behavior modification tool, right? If we say to someone you know you have to pay out of pocket for something, we're less likely to do it. It's as simple as that and you know realizing that in our breast screening world. Okay. So we know best practices.
Speaker 3:We read 100 screening mammograms. We should be calling back five to 10 of those for additional, either mammography, ultrasound and the idea that, while the screening is covered 100%, if patients have to come back for a diagnostic that we recommended, if they have one of these high deductible plans, they could end up paying the full cost of that diagnostic study. It could be, you know, thousands of dollars by the time they're finished. And while it might seem obvious sometimes, it's just really important to actually do the research. So we this was work that we did with the ACR's Neiman Health Policy Institute and we looked at thousands of commercial insurance claims and not surprisingly realized the more you make patients pay out of pocket for that follow up care, the less likely they are to come for the follow up and the less likely they are to come for screening next year. So why are we disincentivizing patients for the care that we've been hammering home that they need to get?
Speaker 3:So I'm really thrilled at the progress of the Find it Early Act and there's been state-level initiatives all over the country. Our governor signed ours into law, kicking off Breast Cancer Awareness Month. Now I will say it's always important to realize that a lot of these changes at the state level, which are great and a great start, only apply to what we call fully insured plans. So those are plans where your employer buys insurance. A lot of employers self-insure and then just use companies like Aetna and Cigna and United to administer benefits. So a lot of these changes don't impact that self-insured business. But it's always good to start there and hopefully we can advocate with employers because of course, from an employer's point of view, the reason we want our patients to get their screening is because we want them to stay healthy to keep doing a good job.
Speaker 1:Yeah, absolutely, and I think something that you're doing a good job yeah, absolutely, and I think something that you're referring to here, which I think breast imagers can very much relate to, is how legislation on Brent's sorry, dense breast notification started at the state level, moved progressively state by state and, with momentum, ended up being passed on a federal level. And I think that's very much what many of us are hoping with the Find it Early Act that as more and more states are passing these state level bills, that will hopefully have some national legislation for it. And actually we have an example with colon cancer. Right, they did modify how they're covering colon cancer screening, so I'm very hopeful that they will follow suit. If anyone is interested in reading more, I have to say Geraldine, when this was published, it was so exciting for me. The article that she's referring to is in JAMA Open Network. It was published in March of 2023 about patient cost sharing and utilization of breast cancer diagnostic imaging by patients undergoing subsequent testing after screening mammogram and really, to me, I had been involved in some of the Texas legislation and while it is, as you say, such common sense that this would be something that would easily make we want, the goal here is that people with cancer are found and treated early, right, and so it's an easy conversation. But to me, this was you mentioned data earlier in our discussion bringing data to the conversation, and that's exactly what I thought this Bringing data to the conversation and that's exactly what I thought this did. It brought data to that conversation. So thank you for that work.
Speaker 1:Okay, I am going to close on a personal note here. A few years ago, at one of the ACR meetings and Bill Harrington was introducing you on the council floor and he was mentioning you, you know always being the busy lady and, oh my gosh, if you try to catch her at arsenae, you know she's everywhere all at once. And I think you leaned into the microphone and you said in high heels, and it was such a moment that, um, you know, it was just so off the cuff and the women in the audience there was cheering, it was so well received and laughing and just it was a great moment. And why I'm bringing it up now is because, um, I think something that I've always enjoyed in observing your leadership style is, I think, perhaps more than some leaders, I think you lean into perhaps your activism and an authentic Some people would say your authentic self, and I think by nature you are an activist. I think you're passionate about many things and let me tell you a story about there was an opportunity I won't get specific here, but there was an opportunity for a policy issue that several other medical organizations had approached the ACR to get support and the ACR ultimately leaned into staying neutral on it. And I happened to be at a happy hour somewhere and one of the leaders was there and I have an activist side as well, so I was. I wanted to understand how the ACR landed on going neutral and I was informed that.
Speaker 1:You know, this is an organization we don't represent. My personal belief on this is this I'm not here to represent that. I'm here to represent the organization and you know this is something I know well in Texas when I have had leadership positions in Texas. We have a very diverse group involved and now I think we see very much in our country more broadly, we are 50-50. If we look at or barely the numbers, we're very close and divided as a leader. How do you? You know that moment at the ACR? I think a lot of women are shy to lean into their femininity as leaders. They're in a room of all men and they're shy to lean into that high heel moment. How do you and all of the other activist things you have taken on, whether it be, you know, reproductive rights for women, being healthcare, underrepresented minorities, giving light to those in our field that are, you know, health equity how have you leaned into that? How have you threaded that needle? Where do you find the compass there?
Speaker 3:Yeah, so the real joy for me as an ACR leader was building connections and community across the country going to state chapter meetings, making friends, learning about people, learning their stories, enjoying their stories, which were often very different from my own. Add to that, really getting to know the organization, understanding the importance that when the ACR has a policy, that's what the ACR represents to Congress, that's what the ACR comments on. But for the ACR to do that, you have to get it into the policy and understanding the way that that happens. So I think, on these issues recently and we'll take maybe climate change, which is understanding how do you get this, how do you get this on the ACR's to do list for them to put resources? So I think what I've been able to do is bring together people who care about an issue and guide them through the ACR's policy so that this is voted on. This is not a fringe group or an activist group pushing the ACR. This is voted on. And what I've always said, especially to our young radiologists, is even if it doesn't get voted on, you've discussed it on the council floor. That's meaningful. So I think you know building coalition and knowing people so that when we've gone out to do the stakeholder engagement around wanting to bring a resolution through.
Speaker 3:I can typically you know, maybe my network's getting a little bit less fresh now but reach out to state chapter presidents and say we'd like to bring this issue forward. We'd really love if your state chapter's executive committee would consider discussing it to see whether or not you would support it. One of us will show up, I'll show up. So I think for me it starts with building community, so that when you want to bring an issue, you've got people that you actually know.
Speaker 3:But at the end of the day there will probably be issues where I will. I think maybe all of us will have to stand up and say I respect that you don't agree with me or you don't believe what I believe, but I believe and perhaps the data shows that my position is different than yours and I'm going to have to stick to it. And I think you know I am fortunate. I'm in a stage in my career where you know I've done all the leadership stuff and you know if I'm never invited to a party again or a committee again, it's probably okay, but you know. So I have to use that platform.
Speaker 1:I hear you, I hear you, I, you know what you're saying about bringing it to the council floor. Bringing to the people, I think has been very effective, um, over the past several years and um, I admire the work that you and several other breast imagers, elizabeth and absolutely, have done really great things. Well, unfortunately, I think we're at time. We want to keep this at a good amount of time so it's easily consumable by our listeners. So, dr McGinty, thank you. Thank you so very much for your time. Pleasure pleasure to visit with you. Dr Covison, thank you very much for being here today and for joining in the conversation. Both Alyssa and I will be here early in the spring with our next episode and we hope that you will be joining us for that as well.
Speaker 3:Thanks so much.
Speaker 2:I was honored to be here. Thank you so much no-transcript.