At the 2019 ACR/ARP Annual Meeting in Atlanta, Ellen M. Gravallese, MD, officially started her term as ACR president. A distinguished rheumatologist, immunologist and basic scientist, Dr. Gravallese also stepped into a new role in her professional career in October. She is now chief of the Division of Rheumatology, Inflammation and Immunity at Brigham and Women’s Hospital and Harvard Medical School in Cambridge, Mass.
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Dr. Gravallese was recently a tenured professor of medicine and cell biology at the University of Massachusetts Medical School, where she was named its inaugural Myles J. McDonough Chair in Rheumatology in 2013 and served as chief of the Division of Rheumatology and director for translational research at its Musculoskeletal Center of Excellence. She worked for many years both as an attending rheumatologist on the consult service and as a clinical preceptor for the rheumatology fellows at the University of Massachusetts Memorial Medical Center.
Dr. Gravallese graduated magna cum laude with a Bachelor of Arts in biochemical sciences from Harvard College in 1977, and earned her medical degree from the College of Physicians and Surgeons at Columbia University, New York, in 1981. At Brigham and Women’s Hospital, Dr. Gravallese completed her internship in internal medicine in 1982, followed by a combined residency in internal medicine and pathology in 1986 and a clinical fellowship in rheumatology and immunology in 1988. She completed a two-year postdoctoral research fellowship with Laurie Glimcher, MD, at Harvard in 1990. In 2013, Dr. Gravallese also completed a year-long program as a Fellow of the Hedwig van Ameringen Executive Leadership in Academic Medicine. She was named an associate editor of the New England Journal of Medicine in 2016.
Dr. Gravallese’s research laboratory identified osteoclasts as the cell type responsible for bone destruction in rheumatoid arthritis (RA) and elucidated pathways and factors responsible for promoting the differentiation and function of osteoclasts within the inflamed synovial tissues of patients with RA. Her laboratory’s work improved our understanding of the mechanisms that prevent repair of bone loss in the joints of RA patients and the factors that inhibit the ability of osteoblasts to produce bone at these sites. These inhibitors are currently being targeted to promote bone formation in conditions of bone loss, including osteoporosis. Her current research focuses on innate immune pathways in inflammation and bone remodeling in rheumatic disease, including the cytosolic DNA sensing pathways that allow for a rapid response to invading pathogens, but also have the capacity to recognize and respond to self nucleic acids.
Dr. Gravallese lectures widely on her laboratory’s research findings on the pathology of synovially based rheumatic diseases and on other clinical topics. Her past lectureships include the Oscar Gluck Memorial Lecture at the ACR/ARP Annual Meeting, the Charles Christian Lecture at the Hospital for Special Surgery, the Boland Visiting Lecture at the Mayo Clinic and the Gerald Weissmann Lecture at New York University School of Medicine.
She enjoys patient care and was selected as one of the Best Doctors in America in 2015. Dr. Gravallese’s honors for research, clinical and advocacy work include the Sandoz Award for Medical Research, the Scholars in Medicine Award from Harvard Medical School, the McDuffie Award and Marian Ropes Physician Achievement Award from the Arthritis Foundation, the Physician Achievement Award from the University of Massachusetts, the Steven M. Krane Award for Research from the American Society for Bone and Mineral Research and the Carol Nachman Prize for research accomplishments in the field of rheumatology.
In 1998, Dr. Gravallese embraced her first ACR volunteer roles as vice chair and then chair of the Subcommittee on Career Development. From 2000–03, she served as chair of the Committee on Journal Publications, and from 2003–06 she served on the Board of Directors. In 2005, she was a member of the Industry Task Force, helping shape guidelines for ACR interactions with industry partners. She was on the Research and Education Foundation (now the Rheumatology Research Foundation) Board of Directors from 2006–09 and served as chair of the Foundation’s Governance Task Force. She served on the ACR’s Nominations and Appointments Committee from 2009–11. In 2012, she was a member of the Blue Ribbon Task Force to assess the current state of academic rheumatology in the U.S. and also served on the Leadership Development Task Force.
From 2016–18, Dr. Gravallese served as the ACR’s secretary, and then in 2018 as president elect. As she begins her service as president, she chatted with The Rheumatologist about her vision for the College, top priorities for rheumatology and how she enjoys classical music and pulling weeds.
The Rheumatologist: Why is it the right time for you to take on this leadership position?
Ellen Gravallese: My desire to do this stems from my deep love of the field of rheumatology. The advances in rheumatology have been transformative over the course of my time in the field. It’s important at this point in my career to give back to the rheumatology community and to attempt to improve the lives of our members and of our patients. The ACR has been such an important organization for our field in the areas of education, training, research and advocacy. I hope to help the ACR move our field to the next level.
‘We need to identify the issues facing private rheumatologists, as well as those faced by physicians employed by large systems, & we need to choose our advocacy agenda wisely.’ —Ellen M. Gravallese, MD
TR: What are some of the unique characteristics or personal visions you bring to this role as ACR president?
EG: Honestly, my original decision to enter the field of medicine stemmed from my interest in basic science and immunology and my curiosity to understand basic mechanisms of disease. I’m a scientist at heart, but I am also a clinician, and it has been a tremendous privilege to care for my patients in rheumatology over the years. I’ve served in academic leadership for over 12 years now, as well. I hope that my experiences in these different areas of rheumatology place me in a unique position to understand the impact of each of these areas on others and to provide a bridge between them. The challenge for the ACR is to understand the issues that are important to all of our constituencies.
Based on the national averages, I see trends developing in the practice of medicine showing that more physicians will become employed by large health systems in the coming years. It’s important for us to understand the challenges faced by physicians coming to work in these settings. At the ACR, we need to identify the issues facing private rheumatologists, as well as those issues faced by physicians employed by large systems, and we need to choose our advocacy agenda wisely.
TR: What are the ACR’s top priorities for 2020, including ongoing initiatives and new challenges?
EG: Of course, not all of our priorities can be considered ‘top,’ but there are many issues we need to tackle simultaneously.
Access to care is certainly a top priority for the ACR. This is a multi-pronged issue. First, we are facing a serious workforce shortage in rheumatology and although we have attempted to address this, we have a ways to go. We must increase rheumatology fellowship program training slots and raise funds for training. Training and education continue to be top priorities for the ACR. We are in the fortunate position of having an ever-increasing number of highly talented MDs applying in rheumatology, and we need to be able to accommodate and train all of them. We should help physicians take advantage of telemedicine technologies and learn how we can work more effectively with our wonderful colleagues in the ARP to extend patient access. The ARP has already developed a number of excellent training programs so nurse practitioners coming from different areas of practice can easily train in rheumatology. We should advertise and use these resources.
Access to medications for our patients is the second prong of this issue. Drug pricing and transparency of pricing, providing transparency around the activities of pharmacy benefit managers (PBMs), advocating for the approval of biosimilars and for the elimination of step therapy are all high priorities in this area. We want to be the physicians who prescribe the right drug for the right patient at the right time.
We need to be able to continue to fund innovative research in rheumatology. The Foundation has made tremendous strides in this area, and we need to continue to expand these efforts. We also need to work with the NIH to find ways to expand research support for our field at the national level.
As for other priorities, the ACR must expand its global reach. Yes, we are the American College of Rheumatology, but we are part of a global community. We must reach out to our colleagues in different global regions to learn more about their experiences and training and research opportunities. Steve Echard, our newly appointed executive vice president, has a great deal of experience at global outreach from his past positions, and he has developed several programs with colleagues in other countries. Through such collaborations, we can better understand delivery of care issues around the world. I’d like to see more collaboration with other global societies.
Looking inward, the ACR is working toward modernization of our own structure, with the development of a new Governance Task Force that will allow us to ensure our optimal function.
TR: What are some of the ACR’s greatest current challenges, and how can we overcome them?
EG: One of the challenges we face is the rapidity of change in the field of medicine itself in the U.S. We need to be two steps ahead of these changes to plan our efforts most effectively. We have established a government affairs office in Washington, D.C., to further our advocacy efforts to protect our members’ interests.
We need to prepare well for generational shifts and consider how younger rheumatologists want to practice medicine, as well as to be mindful of how the younger generation wants to receive educational material and, thus, how our meetings can be best structured.
And we are constantly improving and modernizing our RISE registry and information technology systems to stay relevant there as well.
TR: Where will the ACR be in five years? How do you hope to lead the College to achieve its next milestones?
EG: In five years, the ACR should be a stronger, more nimble organization with more of a global presence. We will react quickly to changes in the workplace, including private and academic settings and other venues where our members practice. I hope that in five years practicing clinicians will continue to see the great value of membership in the ACR, and that the ACR will also be a major advocate for academicians.
It’s important for the ACR to support the academic enterprise. As my colleague, Abby Abelson [MD, FACR, chair of the Department of Rheumatology and Immunologic Disease at Cleveland Clinic] once said, ‘Every rheumatologist is born in an academic institution.’ And we must continue to facilitate interactions between research academicians and clinicians.
TR: Tell us more about your life outside of academia, research and clinical practice—your family, hobbies and interests.
EG: My family is very important to me. We have lived for 25 years in an old, historic house in the Chestnut Hill neighborhood of Boston. My husband and I have two sons, Andrew (Drew) and Gregory, who are my inspiration and joy. My husband, Tim, is a pediatric orthopedic spine surgeon at Boston Children’s Hospital, so he understands the importance of rheumatology and appreciates the work we do.
As for me, I am an avid flower and plant lover. It sounds odd, I’m sure, but I love to weed, and I love seeing the fruits of my labor every spring. I also play the piano, mostly classical music, but I was more serious about this in the past than I am now, due to time constraints. I hope to return to this at the end of my ACR presidency.
Susan Bernstein is a freelance journalist based in Atlanta.