The latest segment in the Radiology Leadership Institute (RLI) podcast series will be a treat for Strategic Radiology members as the interview subject is our CEO and Chair, Arl Van Moore Jr, MD, FACR. In this episode—the eighth in a compelling series of interviews with prominent leaders in radiology by RLI board member Geoffrey Rubin, MD, FACR—Moore shares a bit about his early years, leadership path, current tenure with SR, and passion for independent radiology. Below are highlights of the 1.5-hour interview.

Early Years

Born and raised in Arkansas, Moore is grateful to have grown up in a nurturing community with a lot of wide-open space. That was the epiphany while driving through the Bronx one day in his early Navy days. “I reflected that there were probably a lot of individuals who grew up in the Bronx and never left the Bronx,” he told Rubin.

Both of his parents were active leaders and contributors in the community, and he learned at an early age that in addition to shouldering great responsibility, leaders were human, “put their pants on one leg at a time,” and made mistakes on occasion.

Moore went off to college at the University of Mississippi to study engineering and joined the U.S. Naval Submarine Service after graduation. How did a boy growing up in landlocked Arkansas end up in the Navy? Rubin wondered.  Moore speculated that his interest may have been sparked by the classic children’s literature series featuring the adventures of Captain Horatio Hornblower by C.S. Forester, which led to an enthusiasm for military history. 

After six years in the Navy, Moore entered the University of Arkansas Medical School, and one of radiology’s great leaders was nearly lost to orthopedics. Those were heady times in radiology, though, with CT coming into the clinic and the emergence of interventional radiology. Moore chose IR —called “angio” at Duke University Medical Center where he trained—attracted by the potential for direct patient contact.

Choosing Private Practice

Moore spent a few years on faculty at Duke before he was invited to visit a practice at what was then called Charlotte Memorial Hospital. He found a group of talented radiologists practicing academic-level medicine in a department that had acquired the first MRI in the state of North Carolina. “At that time, I was looking at what I wanted to do for the rest of my life, and I made the decision to give [private practice] a shot,” Moore said.  

As the first interventional radiologist in Charlotte, Moore had the opportunity to drive and grow the IR service in Charlotte and the Carolinas.  “It was a great experience,” he recalled. “I took the initiative, and innovation was encouraged.”

Eventually, Moore was elected president and served 16 years in the role, a period during which the practice grew to be one of the nation’s largest. Moore relished having the opportunities to grow the practice, set vision and goals, and be instrumental in helping the practice achieve those goals. He also acknowledged that Charlotte had the good fortune to be anchored with Carolinas Healthcare System, now Atrium Health, which grew significantly during Moore’s tenure. “Carolinas was one of the systems that early on actively bought primary care practices,” Moore noted.

Leading Strategic Radiology

In his introduction to the podcast, Rubin aptly characterized Moore as “a tireless advocate for practices to remain independent, controlling their own destinies within a current environment in which capital-rich private equity is an attractive alternative to many groups feeling increasingly burdened by the rigors of self-management.”

A long-time leader himself, Rubin is a skilled interviewer, well-suited to his task of drawing enlightening interviews from his subjects for the RLI series. Rubin also included a few hardballs for Moore on his tenure as CEO and Chair of Strategic Radiology.

Rubin pressed Moore on why SR chose a physician as its CEO, and Moore replied that SR’s approach to leadership is in fact a team approach, with duties shared by himself and chief operating officer Randy Roat, who has the financial, operational, and leadership experience necessary for driving organizational improvement.  “You are really looking at a team approach, no matter what you call the executives, and it comes down to how well those individuals work together,” he said.

Rubin asked whether the drive in the physician volunteer workforce is enough to get the work done, and Moore replied: “There is an advantage to having a big pocketbook, but our members value the local control versus being owned by a national practice.” 

Moore explained the SR approach: Develop the infrastructure for all of the practices to pool resources and grow infrastructure—the Patient Safety Organization, Revenue Cycle Optimization, Group Purchasing Organization, and Business Intelligence—and collectively identify best practices.

“We are really providing the tools for practices to grow locally and regionally, to become stronger in their own right and not necessarily need any access to capital going forward,” he explained.

Addressing PE, National Practices

Acknowledging the challenges of competing in a changing environment in which private equity is pouring billions into aggregating practices, Moore distinguished SR’s unique path: “We are working together with the infrastructure we have to solve those problems gradually. Over the long run, there is no real driving mechanism to have a national practice, there is no national contracting, and there may never be.”

Asked to lay out SR’s biggest wins, Moore put trust among members as colleagues at the top of the list.  “We are looking at playing the long game,” he said. He also cited the Strategic Radiology PSO, recently re-listed by the Agency for Healthcare Research and Quality, as well as business intelligence activities, and collaboration in many different areas.

“We added [eight] practices in the last 12 months that are from 14 to 43 radiologists,” he said. “If you look at the options, SR really is a strong alternative for practices that want to remain independent, prefer not to sell their practices, and want to grow locally and regionally.”

“In the end,” he continued, “should there become a national driving force, like the obliviation of the interstate banking laws that caused massive rapid consolidation of the banking industry, or the deregulation of the airlines, which caused the airlines to consolidate, the SR practices will have built the trust, and are in the process of building the culture, so that we can become that platform down the road. Meanwhile, all of our practices are benefiting from the collaboration.”

Subject of Speed, a Look Back

In a final question before leaving the topic of Strategic Radiology, Rubin raised the subject of speed—has Strategic Radiology moved too slowly? In return, Moore provided a Goldilocks response: SR’s progress has been just right.

“I don’t see that we could have done it any other way, to be honest, not that I didn’t try to go much faster,” Moore replied. “It’s an evolutionary process within medicine as we look at where we want to be as a profession. Selling your practice to a private equity company or someone else, is that in the best interest of your practice, the best interest of your patients or your community?

“What about the radiologists that are not at the end of their careers and want to have a 30- or 40-year horizon?  In a way of paying it forward, I would like to see the radiologists that are coming into medicine today—not just radiology— to have the same opportunities that I have had. Having a strong group of independent practices, especially high-quality practices, is something that the profession needs long term.”

Rubin asked Moore to look back and share his most rewarding moments as a leader. Allowing that leadership is not all good or bad, Moore said it is better measured in challenges met. He cited his work at Charlotte in encouraging the subspecialization of the practice, his advocating for leadership education at the ACR, which helped launch the RLI, and working the past 20 years in medicine’s Big House to represent radiology at the AMA on behalf of ACR.

In conclusion, Rubin asked Moore to share what excites him the most about radiology. “If you had a room full of young radiology residents, what would you tell them?” Rubin asked.

Moore’s response was full of optimism, but characteristically, he also underscored the stewardship responsibilities inherent in entering the profession that still requires the Hippocratic Oath. “I think the field has no boundaries,” Moore replied. “The key thing is to develop a culture of teamwork and collaboration, learn how to work together not only to make yourself better but to make the team better, and make patients and our communities the beneficiaries.”

 “If I were king—could give the order and make it happen—there are a lot of things I’d like to do differently, but my message is this: There’s a huge bright future out there, and the key is to take charge of your profession, provide the leadership you need to do, work together, and the profession will know no bounds. It’s a great profession, and there is a lot more that needs to be done.”

Click here to access the podcast.