ACC.17 Opening Showcase Session Presidential Address

Expo

This morning, I want to talk to you about change — a fitting topic given our venue in Washington, DC. This place is no stranger to frequent and sometimes significant change.

Much can be learned from this city. For one, the mantra that "change is inevitable" could be Washington’s motto. Each election cycle brings change, sometimes big and sometimes small. As new individuals take office — others leave — shifting the balance of power and potentially the course and direction of the nation.

The rate of change in DC — and everywhere for that matter — also means one can never get too comfortable with the status quo. Those that embrace and accept that change is occurring are best positioned to succeed.

So what about us?

As a whole, the practice of medicine has seen its fair share of change since the first prehistoric surgery around 5000 BCE. For millennia, physicians and healers practiced intuitive medicine that relied on observation, anecdote and experience to treat specific symptoms.

It really wasn't until around the mid-20th Century, when rapid growth in technology and the ability to capture and quantify data began to transform the practice of medicine into what is now referred to as evidence-based medicine. Evidence-based care has allowed us to go beyond simply treating symptoms and instead focus on preventing and treating diseases based on specific populations and patterns.

Having relatively recently evolved from anecdotal to evidence-based medicine we are already on the cusp of the next evolution … personalized medicine. Personalized, algorithm-based precision medicine is increasingly available and will undoubtedly have significant impacts on the way care is delivered going forward.

Rapid advances in diagnostics and therapeutics are promising break-through treatments in heart failure, managing hyperlipidemia and hypertension, and saving and improving the lives of patients who only a few years ago were considered untreatable. We can catch a glimpse of this future over the next three days, whether on the Expo Floor, at sessions dedicated to the future of medicine, or at Late-Breaking Clinical Trial presentations.

That’s the macro snapshot of the changing health care landscape; but there is plenty of other change afoot when it comes to care delivery, both in the U.S. and globally.

Over the past several years, health care reform efforts in the United States have forced practices and cardiovascular professionals to rethink the way we deliver care. Economic pressures related to health care costs and concerns about quality and overall patient outcomes have resulted in the passage of laws like the Affordable Care Act and the Medicare Access and CHIP Reauthorization Act, or MACRA.

MACRA itself is likely to bring about some of the most dramatic systematic changes that we may see in our professional lifetime. It establishes a definitive framework for moving Medicare from a volume- to value-based system. While details on implementation continue to emerge, the early years of MACRA will pose some very real challenges to physicians and to patients accustomed to the current system.

How we learn and keep up with educational requirements is another area of immense change. Online learning options, as well as mobile applications for use at the point of care and as part of shared decision making, continue to be developed. Live educational programs have changed over the years to support interactive and virtual learning. Successful educational organizations, ACC included, are increasingly leveraging available technology to provide "needs-based learning" options. Options developed in response to learner’s needs rather than in response to presenter or institutional preference.

Evolving and often confusing continuing certification processes also pose significant challenges for cardiovascular professionals, particularly in the United States. One of the ACC’s strategic priorities is to assist our members in maintaining documentable professional competence. As part of this effort, the College has spent the last several years advocating for a solution or solutions to the American Board of Internal Medicine’s Maintenance of Certification process. Although there is still work to be done, we have made some headway. For example, many of you can now earn dual MOC/CME credit at this meeting! The College is also involved in developing a society pathway that would be an alternative to the 10-year high-stakes exam.

Our professional world is metaphorically becoming smaller as well. It is now easier to collect and share information, submit and publish research, stay up-to-date on lifelong learning, and connect with colleagues from around the globe. A growing number of hospitals and practices in countries like China, Mexico, Brazil, India and Saudi Arabia are involved in one or more of the College’s National Cardiovascular Data Registries.

When it comes to research, nearly 60 percent of the submissions to JACC, our principle journal, come from outside of the United States, with this number only expected to rise. New open access journals, like JACC: Basic to Translational Science, are also helping researchers broadly disseminate knowledge in a particular field of study. The opportunity for us to learn from one another is unprecedented.

I’d be remiss not to address the changing demographics of patients and our profession itself. The number of patients over the age of 65 who are living longer with cardiovascular diseases continues to grow exponentially. In addition, an increasing number of individuals of all ages are presenting with preclinical cardiovascular disease, based on risk factors like obesity, diabetes, hypertension and hyperlipidemia.

While diseases of advancing age are increasing in prevalence, effectively treating the growing number of adults living with congenital heart disease, as well as treating cancer survivors with cardiovascular disease, also present new challenges. Additionally, health care disparities continue to persist, demanding our response. We cannot treat all of patients in isolation, but rather must work with our colleagues in primary care, pediatrics, oncology, and other medical specialty fields to improve the health of all.

On the professional front, although we have grown more diverse in terms of gender, race and ethnicity, there is still a lot of room for improvement. A 2015 study by former ACC President Pam Douglas, incoming ACC President Minnow Walsh, and others, showed not only substantial salary differences between male and female cardiologists, but also dramatically different job descriptions. More recently, data from a Professional Life Survey conducted by the ACC’s Women in Cardiology Section suggest an opportunity for cardiovascular leaders (men and women) to focus on ensuring future cardiologists represent the best and most inclusive group possible, free of discrimination.

Just as in the general population, a large number of practicing cardiologists are also aging, and we face potential shortages in those who would follow in our footsteps. The good news: the care team is growing to span the continuum of care. These Care Team members are playing increasingly larger and critical roles in the care and treatment of patients. Additionally, international cardiovascular professionals training in the United States are critical in helping to manage and treat patients, particularly in rural areas of the country. We must continue to learn the best processes for working together across the spectrum.

These changes are undoubtedly having impacts on the College itself. The ACC is now home to more than 52,000 cardiovascular professionals around the world. Our international members and our CV Team members are two of the fastest growing member segments. In addition, a growing number of hospitals and institutions around the world are taking advantage of the College’s quality improvement resources, including our clinical data registries, quality improvement campaigns and, more recently, our accreditation services.

How do we address all of these changes without feeling overwhelmed and frustrated?

First, we take a page out of the DC playbook and accept that change is occurring regardless of what we may wish. Next we prepare to address it. Over the last year the ACC has been working to implement the first phase of its new governance structure that allows the College to be more strategic, nimble and accountable in meeting the challenges ahead. We have adopted a core set of governance principles and continue to reduce the size of our Board of Trustees — actually increasing opportunities.

Our mission statement, operationalized by our five-year strategic plan, serves as the roadmap through all of this change. It is the lens through which we assess new ideas and re-assess old ones to make sure we’re on track and best helping members succeed and thrive in the new health care environment.

Educating ourselves, our patients about the changes ahead and what it means both personally and professionally is another important step in the change process. Nelson Mandela said: "Education is the most powerful weapon which you can use to change the world."

We need to find new ways to best leverage the technologies and communications quite literally at our fingertips. We need to help develop and use new diagnostic and therapeutic drugs and devices in a responsible and evidence-based manner. We need to embrace colleagues with varying backgrounds and viewpoints and learn from one another. We need to engage in respectful discourse that focuses not just on problems and challenges, but also on workable solutions. We also need to share our findings and personal stories and educate lawmakers and others in positions to influence change.

Cardiovascular medicine has traditionally attracted the best and brightest in the medical and research fields. Last year, during Convocation, I noted that it’s my belief that the best and the brightest are also most likely to be those flexible and adaptable enough to find great personal and professional success in this environment of change.

Implementing change is difficult and the transition fraught with anxiety—but few real accomplishments are achieved without angst. And, although we cannot control external events, we can control our reactions to these events. We can decide whether to emphasize the inherent challenges or the inherent opportunities presented to us.

Today, in a city long accustomed to change, I challenge ALL of us to meet change head one. Epictetus said, "It's not what happens to you, but how you react to it that matters." We are unable to go back — our path is forward.

Let us not squander our chance to truly "transform cardiovascular care and improve heart health," as directed by ACC’s mission statement. Let us take advantage of these changing times to embrace challenges and find new solutions. Let’s also be patient — take time out for our families, the arts and nature. Dr. Skorton will talk about that in moment. Cardiology has long been at the forefront of change and innovation — let’s ensure this legacy continues on.

Thank you and again, welcome to ACC.17!

Keywords: ACC Annual Scientific Session, Leadership, ACC History, ACC Scientific Session Newspaper


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