Dr. Christine Molnar was named a Fellow of the CAR in May 2021. She practices nuclear medicine and diagnostic radiology in the Department of Diagnostic Imaging of Foothills Medical Centre in Calgary, Alberta. She has decades of experience in leadership roles with the Alberta Society of Radiology (ASR) and the Alberta Medical Association (AMA). She sees great opportunities for the CAR to foster a unified voice around humanity in medicine and navigating the virtual world; inter-specialty collaboration; and, mentorship.
Dr. Molnar was born and raised in Saskatoon. She attended medical school at the University of Saskatchewan. After obtaining her MD she specialized in diagnostic radiology. She then completed a fellowship in nuclear medicine at the University of Alberta.
She has been in practice as a staff radiologist at the Foothills Medical Centre since 1985 and is also currently an Associate Clinical Professor at the University of Calgary. She has been a partner in EFW Radiology, a diagnostic and interventional imaging facility in Calgary, during which time, among other things, she created a software-based QA/QI (quality assurance, quality improvement) program for the EFW community practice. Early in her practice Dr. Molnar developed an interest in QA, QI, patient advocacy and critical incident review based on “Just Culture” principles.
In the early 1990’s, working as a member of the ASR, she began her advocacy for women in Alberta to have access to a provincial breast cancer screening program that was community-based, a collaboration of community radiology practices in a provincial framework. In Alberta most breast imaging is provided in community practices and a programmatic approach was required. This was a long and politically charged journey during which she learned how to support change, how to get buy-in from large groups of people, how to create value and strategic direction. Over the span of more than a decade, during which time she experienced her own health challenges, her efforts helped to establish a fully partnered provincial breast cancer screening program. The program includes a mammography database that was operationalized with input from practitioners from across the province. The database provides both quality assurance reports to submitting radiologists and securely transmits data points required for the operation of the Alberta Breast Cancer Screening Program. This database is owned and operated by Alberta radiologists through the ASR, and acts as a foundation for provincial quality improvement in breast Imaging.
Dr. Molnar served as President of the ASR, Section of Diagnostic Imaging of the AMA at the time of transition to a single health region in Alberta, AHS. During this time, she worked closely with the AMA on a new model for office overhead methodology for community practice, fee issues, and a framework for provincial QA/QI program development.
In recognition of her extensive leadership experience and advocacy for patients, she was nominated to run for the Board of Directors of the AMA. She was elected in 2011 and served two three-year terms. She was elected to the role of President of the AMA, which she served from September 2019 to October 2020.
“I was given this incredible opportunity to provide a level of service to the profession. I identify first and foremost with being a physician. In addition, I have very specialized skills in diagnostic imaging. This is my calling.”
During her term as President of the AMA the organization confronted a wide range of complex issues including transformative and progressive health system changes, mental health, the opiate crisis, and COVID-19. In a year of turmoil, it was never clearer that physicians need a strong and united voice. One that is separate from regulatory and government institutions. A voice that advocates for the health and well-being of physicians.
Based on her experience as both an advocate for patients and physicians Dr. Molnar has identified areas where the CAR can be a force for changes that will strengthen the specialty of diagnostic imaging and improve patient care.
Humanity in Medicine and Navigating the Virtual World
“As medicine moves increasingly to virtual interactions with patients, we must look for opportunities to preserve and increase the meaning and value in our work. As diagnostic imaging specialists we face transformative changes with AI. In this setting we must develop and act on strategies to enhance our relationship with our patients and support each other in change.”
There are great and increasing pressures on radiologists to increase the volume of reads performed. “We risk losing sight of the patients behind the images we interpret.” Attention to the volume of work performed must be matched to other benchmarks including accuracy of reports, number of hours worked and the working conditions. Compassion towards patients and with each other needs to be supported. It would be helpful to have guidelines or recommendations to support health in the specialty. For example, evaluation of the impact on physician health and patient safety with consideration to recommendations on the hours of work (per day, per week and per year); assessment of call and overnight duties as they impact health and patient safety; work environments with respect to supporting efficiency, quality, and physician wellness.
Patients have expectations of convenient care, but a high standard of quality and efficiency still needs to be met. AI needs to be balanced with compassion for patient’s needs.
“It would be helpful for the CAR to explore how we, as a specialty, maintain humanity and clinical awareness in the virtual world.”
Inter-specialty Collaboration
Radiologists are well-positioned to become integral members of clinical care teams. Formalized, regular interactions with clinical colleagues results in excellence of patient care and the efficient use of imaging services. Community and hospital-based radiologists imbedded in clinical teams is strategically important in the expanding virtual world not only to add value but to maintain a strong connection to colleagues and the patients being served.
“Interactions between specialties are so important when they can occur. They help us to recognize that we’re all working toward the shared goal of improving patient care.”
The CAR could evaluate strategies to support the specialty’s engagement in clinical teams in the acute care and importantly the community settings.
Mentorship
The CAR is well-positioned to create opportunities or formalized strategies to mentor early-career radiologists. Diagnostic imaging has evolved dramatically over the past decades and continues to advance with unprecedented speed due to quantum computing and big data. There is a need to remain flexible, assimilate information, and embrace technological changes.
“Over the course of my career the technological changes have been amazing. In the 1980’s we had the earliest forms of ultrasound and CT. MRI was developed but not commonly available. PET/CT and SPECT in nuclear medicine were not available in practice. Creating excellence in our specialty requires that the physician’s needs are supported. Without adequate support, there is a risk of physician disengagement and burnout. This is particularly relevant as post-COVID Canada is facing uncertain economic times creating issues of access-to-care, funding challenges, and delayed diagnosis and treatment of many conditions.”
Congratulations to Dr. Molnar on becoming a Fellow of the CAR.