1. ABNM-ABR Proposal Principles New single training pathway –3 DR + 2 NM –with multiple entry points (undefined) –NM/DR certificate under ABR ABNM Dissolution –NR fellowship dissolution (including ABR-NR CAQ) –Single NR trustee replaced by NM/DR trustees (number and make-up undefined) Jadvar

2. ABNM-ABR Proposal Timeline April 3, 2015 –Original TF letter describing the proposal –Published in JNM August 2015 April 8, 2015 –ABNM-ABR-SNMMI leadership conference call June 3-5, 2015 (Annual Meeting) –HOD informed –SNMMI letter (signed by PH) not supportive of proposal due to lack of detail, mailed to ABNM and ABR Exec Dirs –SNMMI & SNMMI-TS survey established soon after July 17, 2015 –SNMMI received response letter from ABNM along with FAQ Jadvar

3. ABNM-ABR Proposal Timeline July 24, 2015 –ABNM, ABR (MG), and SNMMI leadership meeting during ACR-ISC meeting, Tabernash, CO August 17, 2015 –HOD conference call August 24, 2015 –BOD conference call September 9, 2015 –-HOD conference call September 18, 2015 –Joint SNMMI-ABNM BOD conference call Jadvar

4. ABNM-ABR Proposal SNMMI Survey Summary ~20% response rate (547 of 2695 full physician members) ~80% US, ~20% international responses ~80-90% physician respondents (makes sense since they are most directly affected) On average: ~55% “against” (either straight or agree with original non-supportive SNMMI letter); ~29% “for” the proposal Board status seemed to predict decision (against/for): –ABNM only (n=199, 60%/17%) –Dual-boarded (n=90, 37%/50%) –ABR only (n=18, 17%/56%) ABNM-only MDs most motivated (11:1 compared to ABR only) to respond and felt disenfranchised by proposed ABNM dissolution Jadvar

5. ABNM-ABR Proposal Request for SNMMI Response Need YES or NO answer to proposal (no shades of gray!) Response by early October 2015 (ABR deadline, inflexible) Learned critical features based on prior meetings: –ABNM dissolution is not negotiable and is prerequisite to move forward –4 m NM during DR for full scope of practice: off the table –Single pathway geared toward recruitment from med school –No pathway for non-imaging specialists –No definition of “broad consensus” –No defined “exit strategy” Jadvar

6. ABNM-ABR Proposal Timeline (Cont’d) September 30, 2015 –SNMMI letter sent to ABR and ABNM re BOD decision to decline proposal as presented –Invited broad stakeholder dialogue to address current challenges November 6, 2015 –ABNM letter from Dr. Louise Thomson sent to diplomates –Published in December 2015 issue of JNM December 2015 –SNMMI TF: “Pathways to the Future of Nuclear Medicine“ –Invitation letter sent to NM community stakeholders January 30, 2016 –First meeting of the SNMMI TF Jadvar

7. Pathways to the Future of Nuclear Medicine Goal: high-quality value-driven clinical nuclear medicine practice 2-step process Step 1 (NM community representatives) –SNMMI leadership, Academic Council, Young Professionals Committee, ABNM, ACNM, NMRO, ACGME (NM-RRC), NMPD Step 2 (Radiology community representatives) –ABR, ACR, RSNA, Society of Chairs of Academic Radiology Departments, Residency Review Committee for Diagnostic Radiology, Association of Program Directors in Radiology Jadvar

8. Pathways to the Future of Nuclear Medicine Step I (NM Stakeholders) SNMMI Leadership: Hossein Jadvar (President; TF Chair); Sally Schwarz (President-Elect); Bennett Greenspan (VP-Elect; TF Associate Chair) SNMMI YPC: Erin Grady SNMMI AC: David Brandon SNMMI BOD: Vasken Dilsizian SNMMI HOD: Leonie Gordon SNMMI-TS: (Aaron Scott, Sara Johnson) ABNM: Munir Ghesani (George Segall as observer) ACNM: Patrick Colletti (Rathan Subramaniam as observer) ACGME (NM RRC): Jon Baldwin NMRO: Shana Elman NMPD: Daniel Lee Jadvar

9. “Roundtable on the Future of Nuclear Medicine Training” Osborne JR, Beylergil V, Samitt C, Graham M; JNM December 2015 Perspectives from a dual-certified physician-scientist, NM chief resident, NM leader, and neutral health care management consultant Quotes: –“The beginning of wisdom is to call things by their proper name; choose a job you love, and you will never have to work a day in your life” (Confucius) –“A genuine leader is not a searcher for consensus but a molder of consensus” (Martin Luther King, Jr.) –“The optimist sees the opportunity in every difficulty” (Sir Winston Churchill) –“In the middle of difficulty lies opportunity” (Albert Einstein) Jadvar

10. “Roundtable on the Future of Nuclear Medicine Training” Osborne JR, Beylergil V, Samitt C, Graham M; JNM December 2015 “top-down strategy will not work; bottom-up rather than top-down” “provider will need to think as retailers do and develop products that meet consumers’ needs” “evolving from path of traditionalism as volume player to path of innovation and transformation as value leader” “Real commitment and leadership will be required at the highest level of the SNMMI, the ABNM, and the ACGME, as well as collaborative efforts with their counterpart radiology organization” Jadvar