Convocation, April 4, 2016: Richard A. Chazal, MD, FACC
"These are changing times!" – an overused cliché, especially in a major election year. However, I think it aptly describes what we are experiencing at this very moment in health care – particularly in our field of cardiovascular medicine.
Advances in diagnostics and therapeutics are being made at a rapid pace. Over the last three days we’ve witnessed some of these advances in person. We engaged in discussions with experts and with each other around what these advances could mean for our patients living with heart failure, hyperlipidemia, hypertension, aortic stenosis – the list goes on! We are saving and improving the lives of patients who only a few years ago were considered untreatable … and we should be proud.
In addition to scientific advances, the geometric expansion of information technology and communications is enabling widespread clinician access to the latest research, evidence-based guidelines, continuing medical education resources, and point-of-care decision support tools. Our patients too have greater access to information about healthy living, disease states, treatment options… and even more access to information about us, their health care providers.
Our professional world is metaphorically becoming smaller as many of these changes make it 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.
But when it comes to the hard numbers – we are growing at a staggering pace! At the ACC, we now have 52,000 members from around the world, with more than 80 U.S. and international chapters. It is my pleasure to welcome each of you – the incoming FACCs and AACCs – to the ACC family.
The number of hospitals and practices in countries like China, Mexico, Brazil and Saudi Arabia that are involved with hospital or outpatient registries that fall under our National Cardiovascular Data Registry umbrella is growing rapidly. As global registry use grows, so too grows our ability to track and improve the quality of cardiovascular care around the world. I am honored to welcome the many accomplished dignitaries on the Dais who have been a part of this tremendous growth.
When it comes to research, nearly 60 percent of the submissions to the Journal of the American College of Cardiology are now coming from outside the United States, with this number only expected to rise. New open access journals are also proving successful in helping researchers broadly disseminate knowledge in a particular field of study. The opportunity for us to learn from one another is unprecedented.
How we learn and keep up with education requirements is an area of immense change. Online learning opportunities continue to grow and progress. There is tremendous development in the use of mobile apps at the bedside for care – and in shared decision making. Live educational programs, like ACC.16, have also changed over the years to support interactive and virtual learning.
It’s important that our lifelong learning offerings are developed in response to learner needs and to available technology. The College has made this concept of purposeful education one of its utmost strategic priorities, and it is written in stone as a pillar of the ACC’s strategic plan.
The demographics of patients and the profession continue to evolve as well. There is a global increase in the number of patients over the age of 65 who are living longer with cardiovascular diseases. In addition to this aging population, we also face a growing number of patients both young and old with significant cardiovascular risk factors like obesity, diabetes, hypertension and high cholesterol.
The tremendous strides in the treatment of children with complex congenital heart disease has resulted in a new wave of adult CHD patients whom many of us are inadequately trained to effectively manage. Cancer survivors with cardiovascular disease related to malignancy or treatment toxicity present new challenges. We cannot treat all of these patients in isolation, but rather need to work with our colleagues in primary care, pediatrics, oncology and other medical specialty fields. The ACC’s growing number of member sections and councils act as our ambassadors in these areas.
Professionally, the care team has grown and changed to span the continuum of care and now involves nurses, nurse practitioners, physician assistants, cardiovascular administrators, pharmacists, emergency medical personnel and more. In that vein, I would like to extend congratulations to the new class of AACCs – you are at the top of your field and this designation is proof of your deep commitment to the profession and the mission of the College. In the face of expanding populations of cardiovascular patients, the need for improved physician efficiency and improved access for patients demands that we learn the best processes to work together as a team.
Challenges in health care disparities also persist. We must respond better. One solution lies within each of us. While our profession has grown more diverse in terms of gender, race and ethnicity, we still have room for improvement in terms of pay equity, work/life balance and further diversifying our ranks to meet the needs of our colleagues and our diverse patients. Just like the general population, a large number of practicing cardiologists are also aging and we face shortages of those who would follow in our footsteps.
In the United States, technological and demographic changes are occurring in an environment of changing practice types, increasing scrutiny, burdensome documentation and administrative requirements and evolving – and often confusing – continuing education processes. These changes, layered on top of the need to care for an increasingly ill patient population, present a daunting challenge to simultaneously deliver state of the art compassionate care while fulfilling non-clinical requirements.
In the United States, the most dramatic systematic changes that I am likely to see in my professional lifetime are on the immediate horizon. The Medicare and CHIP Reauthorization Act of 2015 – known as MACRA – has the potential to have a bigger impact on U.S. health care than the 1965 creation of the Medicare and Medicaid programs themselves. While MACRA permanently repealed the flawed sustainable growth-rate formula used to calculate Medicare physician payment, it also established a definitive framework for moving Medicare from a volume to value-based system. This is a framework that other payers are certain to follow.
A tsunami of information, more challenging patients, rapidly changing technology, increased administrative/non-clinical burdens, an alteration of practice patterns – all with the backdrop of a likely major overhaul in the US reimbursement model!
How do we respond to these changing times? Do we fold up our proverbial tents and retreat to retirement? Do we simply accept a new world order and retreat to an hourly job, rather than enjoy a fulfilling and fruitful professional career? What are our options? What are your options as the future leaders of cardiology?
Some thoughts as we head into this uncertain future together: while we cannot control external events, we can control our reactions to said events and thus influence our future and the future of others, especially our patients. We can decide whether to emphasize the inherent challenges – or the inherent opportunities presented to us.
Cardiovascular medicine has traditionally attracted among the best and brightest in the medical and research fields. All of you sitting here today are testament to this fact. It is my belief that the best and the brightest are also most likely to be those who are most flexible and adaptable enough to find great success – both professionally and personally – in this environment.
Those well-educated, dedicated and adaptable physicians and team members who are practicing evidence-based medicine in a cost effective manner will likely (and hopefully) be the same persons who best succeed moving forward. Implementation of change is going to be difficult and the transition fraught with anxiety – but few real accomplishments are achieved without angst.
I challenge ALL of us to meet these changes – and the challenges and opportunities they present – head on. We cannot make them go away. We are unable to go back to a “simpler time.” We can only decide how we choose to respond.
We need to continue to find ways to best use the technologies and communications at our disposal to meet our professional needs and those of our patients, both present and future. We need to help develop and use new diagnostic and therapeutic drugs and devices in a responsible and evidence-based manner – making certain that we keep value to patients as our guide star.
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 on workable solutions. We need to reserve the energy spent on anger and frustration for more meaningful, productive endeavors.
We‘ve been given a great gift – to individually and collectively improve the lives of our patients. Few are so fortunate as to have such an opportunity. Let’s not squander our chance to truly “Transform cardiovascular care and improve heart health,” as directed by the ACC’s mission statement. Let’s take advantage of these changing times to do better for ourselves and, more importantly, for the patients whom we serve.
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