ACR past president and former chair of rheumatology at Gundersen Health System, LaCrosse, Wis., Douglas White, MD, PhD, recently joined Articularis Rheumatology Specialists in Atlanta. Dr. White shared his reflections on his transition to private practice and the ACR’s role in serving the needs of a range of rheumatology specialists.
The Rheumatologist (TR): What were your main reasons for transitioning to private practice?
Dr. White: Scientific research teaches you how to recognize, be skeptical of and test your assumptions. In that sense, my research training affects nearly everything I do, from arriving at a diagnosis, to supervising a clinic, to reading the newspaper.
TR: Historically, some in the field have referred to tensions between providers in academic settings vs. private settings. Is this something you observed during your term as ACR president?
Dr. White: The ACR is a bit unusual in that it serves rheumatologists from a range of practice settings. This approach brings enormous benefit, but forces the organization to deal with this tension between rheumatologists who face very different challenges in their day-to-day lives. The ACR is well aware of this tension and is constantly striving to serve the interests of everyone under its umbrella.
Dr. White
When I was president, I encouraged ACR leaders to think about their members’ personal income. How do they earn a living? Are they worried about their next grant being funded—or these days, their current grant being rescinded? Trying to meet RVU [relative value unit] requirements? Going underwater on a drug in their infusion suite and being on the hook for the deficit? It’s not the only thing that separates rheumatologists, but it’s the big one, and it’s the one that nobody wants to talk about.
Importantly for the ACR, especially as academic centers put more emphasis on clinical revenue, there is more and more common ground. Trying to simultaneously serve people with diverse interests always feels a little dissatisfying. But I think the benefits of bringing everyone together, recognizing the common ground and using our collective strength to row in the same direction vastly outweigh the difficulties.
TR: Now that the Community Practice Council (CPC) has been incorporated into the Committee on Rheumatologic Care (CORC) as the Independent Practice Subcommittee (IPSC), with the stated goal of supporting independent rheumatologists, do you anticipate there being a more visible platform for addressing the challenges of those in independent practice?
Dr. White: An almost universal exclamation by new ACR volunteers who hail from private practice is, ‘I had no idea the ACR did so much for private practitioners.’ I think part of the problem is getting the word out about the work that has already been done by the private practitioners volunteering at the ACR.
A participation barrier also exists. Recruiting academicians has historically been easier than recruiting private practitioners because time and effort working for the ACR is often rewarded by promotions in academic centers. That same time may just be lost revenue for someone in private practice. So I’m not sure that the organizational structure of the CPC/IPSC matters as much as the ability of the ACR to attract the visionary and inspirational rheumatologists who did not choose careers in academia. When there is a robust pipeline of volunteers, then the ACR becomes more visible and more responsive to private practitioners.
TR: Do you have advice for rheumatologists in private practice on the best ways to strengthen their collaboration with ACR leadership and elevate their concerns about care delivery?
Dr. White: The answer is: Engage. But that’s a frustrating response to anyone who has applied only to not be placed on a committee. So I have three suggestions.
First, think beyond traditional private practice committees. I think the private practice community has its biggest impact on the ACR when private practice rheumatologists serve alongside academicians on committees that, at first glance, don’t appear to have much to do with the special interests of private practitioners. However, guideline development, quality management activities, RISE, the Annual Meeting Planning Committee, the Committee on Ethics & Conflicts of Interest, the Insurance Subcommittee and other committees and activities benefit tremendously from the insights of non-academicians.
Second, start with a subcommittee because subcommittees are not populated through the nominations process. Reach out to committee chairs and subcommittee chairs and ask them how to get involved.
Third, seek first to understand and to facilitate the work of the committee. Your influence and your ability to elevate your concerns depend on first developing those relationships and that trust.
Gretchen Henkel is a health and medical journalist based in California.
