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Plan for Success in 2008

David A. Fox, MD  |  Issue: December 2007  |  December 1, 2007

David A. Fox, MD

In the months leading up to the start of my year as ACR president, I’ve heard two questions over and over: Are you ready? and What do you plan to do as ACR president?

Ready or Not!

The first question might well be regarded as a sign of skepticism on the part of the questioner. An interpretation only slightly less disquieting might be that this inquiry is an indirect expression of sympathy for the inevitable disruption of any ACR president’s professional and personal life that accompanies the year’s hectic travel schedule.

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One way of answering this question is to consider what the ACR does to prepare a member to lead the college for a year. The time spent as an ACR officer (following prior years as a volunteer on various ACR committees) is really an apprenticeship that gives a future president ample opportuinity to learn about the ACR’s structure and constituencies, the talents and responsibilities of the staff, the types of issues that can arise quickly, and the long-term challenges that take many years to solve. It’s vital that the ACR president understand how the staff, board of directors, and committee functions intermesh.

Equally essential is the appreciation of how necessary it is for ACR members to be kept up to date about what’s happening in the College, and for the officers and staff to know about and respond to concerns of the members in a timely manner. Better communication has been a consistent focus of each ACR president over the past few years and is the foundation for a cohesive college that actively engages the skills and creativity of its membership. In the coming year we can look forward to the expansion of the Regional Advisory Council (RAC) to allow state rheumatology societies to each have a representative on this important body. The RAC, under the umbrella of the Committee on Rheumatologic Care, focuses on practice and reimbursement issues that challenge ACR members across the country. The RAC serves as a vital communications link to ensure that the staff and leadership of the ACR are constantly kept aware of the concerns of our practitioners.

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I’ve been especially fortunate to serve as an officer with three outstanding ACR presidents—Betsy Tindall, MD, Peggy Crow, MD, and Neal Birnbaum, MD—and I have learned a great deal from each of them. The ACR structures its officer team to include both academics and practitioners, not just to reflect the diversity of its membership but to bring together the broadest combination of experience and ability. This is essential to tackling the full range of issues that we face, from fair reimbursement for office procedures to the training of future physician-scientists.

The officers as a group—together with the terrific ACR staff led by Mark Andrejeski—truly function as a team. The accomplishments of any ACR president are always the result of a collective effort by many talented people. The chance to work closely with the recent ACR past presidents and with the current officers who will be ACR presidents in the years ahead has been a uniquely rewarding experience.

So hopefully I’m ready to be ACR president. The ACR has certainly done everything that it can to prepare me.

Big Plans for Small Improvements

The next question—What do you plan to do?—also needs to be placed in context. The ACR is in excellent shape. Its core functions, such as its annual meeting and its publications, have never been stronger. We have enough money in the bank to consider a range of new initiatives. The expansion of the ACR Research and Education Foundation (REF) to include a major targeted research initiative in RA, while continuing its unique and vital role in training and career development, has been spectacular.

Nevertheless, there is no shortage of challenges or concerns. Although available rheumatology fellowship slots are being filled, we know from the ACR’s workforce study that we face a worsening shortage of rheumatologists that seems to stretch permanently into the future.

Further, the inescapable impression is that many of our academic rheumatology units are in trouble, and that some have experienced a significant depletion of faculty. Slippages in research funding from the National Institutes of Health and from other sources during the past few years have hit academic rheumatology very hard and have contributed to an unprecedented efflux of talent from our academic units to attractive positions in industry.

Pressures on practice income challenge the great majority of our members—rheumatologists who deliver patient care—whether they work in private practice, academic units, or settings that are a hybrid of these two environments. The leadership of our academic health systems does not consistently value the role of the rheumatologist, and many of us are under pressure to justify our existence on the balance sheet while being denied credit for the procedural and downstream revenue that we produce. Healthcare issues are on the front burner nationally, and the 2008 elections could lead to major healthcare system reforms.

These issues will not be solved in one year, and there are limits to what any one ACR president can contribute to their resolution. From my perspective, an important goal is to balance the attention given to day-to-day issues with efforts to tackle the bigger problems in a way that produces long-term benefit. We have several important building blocks in place to tackle the workforce issues. These include the current ACR and REF strategic plans, the core career development programs of the REF, and a superb ACR Workforce and Training Committee led by David Daikh, MD

From my perspective, an important goal is to balance the attention given to day-to-day issues with efforts to tackle the bigger problems in a way that produces long-term benefit.

Ambitious Training and Advocacy Targets

Recent years have seen a new curriculum and in-service exam for rheumatology fellows, establishment of a rheumatology match for fellowship entry, development of outstanding and cohesive programs for our fellows at the ACR meetings, and other highly successful initiatives. In 2008 we will inaugurate a new ACR Research Conference, focused primarily on rheumatology fellows who are training in research. The Committee on Research, led by William St. Clair, MD, is supervising the planning for this initiative, and details will be available soon.

In the coming year, the ACR will produce recommendations on how to address the shortage of rheumatologists and the perceived decline of many of our academic units. A portion of the shortage could be addressed by expansion of the numbers of rheumatology nurse practitioners (NPs) and physician assistants (PAs), who are among the most rapidly growing segments of the ARHP. The years 2007 and 2008 will see new ACR/ARHP initiatives in curriculum development and training opportunities for NPs and PAs. I suspect that even significant growth in the numbers of physician extenders will still leave us needing some additional number of rheumatologists, and more fellowship positions will be required. Can the ACR develop new ways of enticing academic health systems to better support rheumatology units, including an expansion of the number of fellowship positions? I welcome input from ACR members on this (or any) issue.

The ACR is increasingly called upon to take a stand on public policy issues that affect its members and their patients. Our Government Affairs Committee, which in recent years has been ably led by Joseph Flood, MD, and some hard-working ACR staff, has done a terrific job keeping up with everything from draconian cuts in dual energy X-ray absorptiometry reimbursement to legislative initiatives that affect the Food and Drug Administration. Our activity on Capitol Hill has intensified; I, along with many other ACR/ARHP members and teams of ACR staff, visited three times in 2007 to lobby on behalf of the ACR. An important focus has been to pass the Arthritis Act—a top priority for the ACR.

We hope to bring even greater numbers of ACR members, including new RAC representatives, to Washington, D.C., in 2008 in order to make our views known to our elected representatives. Please review the public position statements of the ACR by checking the ACR Web site and by keeping a close watch on The Rheumatologist and the other communication vehicles of the ACR. I want to hear your perspectives on public policy issues on which the ACR has taken a stand—or should potentially take a stand.

In this first column, I’ve touched on only a few of the many issues and tasks that await us in the coming year, but I’ll have the opportunity to cover a range of topics in future issues. To all members of the ACR, I wish you a fulfilling and successful year—for each of us individually and for our profession collectively.

Dr. Fox is president of the ACR. Contact him via e-mail at [email protected].

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Filed under:Career DevelopmentEducation & TrainingPresident's PerspectiveResearch Rheum Tagged with:AdvocacyAdvocates for ArthritisBasic researchfellowshipREFReimbursementRheumatoid Arthritis (RA)

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