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- Michael J Wolk, MD, President, American College of Cardiology* ()
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Dr. Michael J. Wolk, 520 East 72nd Street, New York, New York 10021.
In one of my favorite books, the wonderful and wise The Little Prince,author Antoine de Saint-Exupéry reveals an important secret of life. “One sees clearly only with the heart,” the little prince learns. “Anything essential is invisible to the eyes.” These words express my feelings this evening. The seamless support and encouragement I have received from my colleagues and family, although perhaps invisible to others, are clearly apparent to me.
First, I heartily congratulate our new Fellows and extend a warm welcome to you as members of the American College of Cardiology. This evening, I would like to reflect on the challenges and opportunities you face as you establish your careers in cardiology.
With all the marvels of medical science at your fingertips, it would be easy to suggest that there has never been a brighter time to be inducted into the College as a Fellow. All of us are in awe of the wonderful opportunities that lie ahead of you. We can only imagine the contributions you will make to improve cardiovascular care for patients worldwide.
As new Fellows, you may dream of following in the footsteps of the distinguished physicians, investigators, and academic leaders in this room. Many of us on the podium, however, wonder what the outlook would be like if we were to have an opportunity to begin our careers again at this moment. Those of my generation recall treating a patient with an acute myocardial infarction with morphine, oxygen, rotating tourniquets, and intramuscular mercuhydrin. Now you see a patient with the same condition and limit the size of the infarct with thrombolytics and, perhaps, angioplasty. Next, you use marvelous imaging methods, intracardiac pacer-defibrillators, and combinations of effective drugs to maintain cardiac function. These fantastic advances, critical to the development of cardiology as a specialty, have come to pass—amazingly—in just one generation.
Even more exciting advances lie ahead. In the next 10 years, you will probably add to your practice:
• Proteomics—for predicting the risk of cardiovascular disease;
• Pharmacogenomics—to target individual needs, and distinguish those patients most likely to respond well from those apt to exhibit adverse drug effects;
• Cell therapy-induced regeneration of heart muscle to help patients who might otherwise have inadequate ventricular function for survival;
• Imaging modalities that will help make diagnosis less invasive; and
• Molecular imaging of the metabolic processes of plaque instability and inflammation—these last two will provide novel approaches toward diminishing the burden of atherosclerosis.
That is a lot to look forward to.
You are truly fortunate to be able to take advantage of the great cardiovascular achievements of the last century as well as some exciting discoveries already emerging in the 21st century. But, the real advancement for you will be the inevitable paradigm shift from intervention to prevention—protecting patients who are still healthy, instead of treating patients while heart disease is rampant. In the short run, more effective interventions will be necessary for a larger population at risk. But in the long run, as molecular medicine becomes more mainstream, your primary role will likely expand into prevention: counseling patients and working to decrease the personal and economic impact of heart disease.
Dr. Eugene Braunwald summarized this point in the Simon Dack Lecture last year. “The application of genetics and genomics to cardiovascular disease will tip the balance, and the need for intervention will decline,” he said, “at first gradually and then rapidly.” Youare the profession's instruments of change. And your new role, though an exciting breakthrough, may extend cardiology's traditional reach, further exacerbate current workforce issues, and require new team-based preventive models of care.
But for now, cardiovascular disease remains the number-one killer in the U.S., accounting for nearly 40% of all deaths. That figure includes more women than men. And the numbers may worsen as you confront the twin epidemics of obesity and diabetes, the nation's most insidious health threats. Health policy solutions continue to lose ground to the epic trilogy of TV-watching, Web-surfing, and “Happy Meals.” Add to that the artery-clogging, hot-fat favorite: Krispy Kremes, by the dozen. Cardiologists must return health to the heart. We must support dietary reductions of fat, sugar, and salt. And we must continue our vigilant emphasis on regular exercise.
Putting the habits of our patients aside for the moment, let us focus on your role going forward.
Your dreams of practicing cardiology cannot be separated from the challenges that face every physician in this country. Many factors, economic and societal, have shaken the foundations of medicine. Some who dreamed of careers as cardiologists have turned elsewhere to earn their livelihood. Cardiologists and their patients are victims of unfunded government mandates, a tangle of regulations, an avalanche of paperwork, a seriously flawed Medicare payment system, and skyrocketing medical liability insurance premiums. And still, there remains a need to divert significant financial and human resources to strengthen our public health system in the face of clear and present danger.
Dr. Jordan Cohen, President of the Association of American Medical Colleges, recently outlined a number of unstoppable trends that will certainly affect you, our new ACC Fellows, in the years ahead. He noted that—
• Health care is fast becoming unaffordable, rising at double-digit rates of inflation for the third consecutive year;
• Government and private payers are demanding more accountability for physician performance;
• Cost-effective care or value-for-money-spent is fast replacing quality at any price;
• Variations in the provision and outcomes of health care are increasingly indefensible;
• Management of chronic illness consumes two-thirds of health care expenditures, compared to the treatment of acute events such as a myocardial infarction;
• Reducing medical errors and improving patient safety are non-negotiable, both morally and practically.
Physicians are not the only ones concerned about failures of the current health care system. Patients hope for a better way, too.
Tens of millions of uninsured and underinsured Americans face heightened risk of illness, with limited or no access to quality health care. The numbers are troubling. Too many people find cost to be an insurmountable obstacle into the current health care system. For the first time, the Institute of Medicine has recommended that the federal government make health care available to all citizens by 2010. I am proud that the College supports the position that every American has the right to basic, adequate health care coverage, starting with the lowest-income children and families.
These challenges may give you pause, as well they should. Fortunately, two allies stand ready to support you. As a supportive institution, the ACC is your best ally in preparing for the future. It will serve as your essential partner in the discoveries and application of medicine and health care. The College has a clear vision to help you address the enormous challenges medical practice presents today. I borrow from sports great Yogi Berra when I tell you, “We will not let you make the wrong mistakes.”
The College's vision is reflected in a carefully developed strategic framework adopted by the Board of Trustees last December. This strategic framework renews the College's mission to advocate for quality cardiovascular care through education, research promotion, and the development and application of standards and guidelines. The framework creates new emphasis on education, not just for physicians, but an open-ended commitment that includes patients, policymakers, and members of the entire cardiac care team. It identifies the core values important to all of us: professionalism, knowledge, the value of the cardiovascular specialist, integrity, and inclusiveness.
The ACC's strategic framework is tied to activities that will enable the College to reach its goals. Let me define several of the College's programs, their objectives, and the value they can add to your practice.
First, the College helps cardiologists commit to lifelong learning so that you can be the best possible provider of patient care. The College provides quality continuing medical education to its members, and that commitment is as strong as it ever has been. There is an ambitious annual calendar of 37 live programs, plus numerous education products, and our wonderful journal, JACC.And each year the Annual Scientific Session brings together under one roof the most challenging topics and brightest minds in cardiovascular science. With Cardiosource, the ACC online knowledge site, the College brings day-to-day service to members, providing informational tools and educational resources, literally, at your fingertips.
Still, there is more to do. We cannot ignore or afford to diminish the strength of our collective advocacy. We have set our sights on reducing both regulatory burdens and the onerous costs of medical liability. I encourage you to actively participate in chapter activities. This will create the crucially important grassroots strength we need to achieve positive change in health care legislation. This is important to achieve at every level of government.
When we work together, we can make great gains. I am pleased to report that our collective efforts during the last year have resulted in more than $16,000 in Medicare reimbursement increases for cardiologists. That is a per capita increase. And without the College's leadership and member support, the increase might not have occurred. It might have eroded to nothing—or worse, to decreased reimbursement payments by a flawed payment system.
The ACC excels in promoting the delivery of quality patient care. Our partnership with the American Heart Association (AHA) makes us the leading authority in clinical practice guidelines, data standards, and performance measurements. But we need your participation to close the gap between science and practice. Together, we must develop reliable yardsticks to measure performance measures and outcomes of patient care. We need to use them to better assess individuals, institutions, and systems responsible for health care delivery. Guidelines are essential to minimize non–evidence-based variations in the provision and outcomes of health care. We cardiologists must contribute to the wise, equitable use of health care resources while still meeting the needs of individual patients. We must assume a significant role in critically evaluating the use of potentially valuable but costly diagnostic procedures, interventions, and drugs.
Your second ally is, lest you think I forget, your patients. Our patients educate us, trust us, depend on us, and hold us in the highest esteem. They support us in numerous ways. Over many years, and often over lifetimes, their bonds with us testify to the quality of our care and the strength and durability of the patient-physician relationship. Each patient represents a source of rich, professional satisfaction. Each enhances our reputation as caring, competent professionals. And on a daily basis, they provide us with the opportunity to do what we do best. Above and beyond all that, patients frequently become generous contributors to causes we care deeply about.
With two strong allies in your corner, it would seem hard to falter. Yet, in these times, when public images are carefully crafted by professionals for leaders in every field, including politics, entertainment, and criminal law, physicians need to uphold public trust and deliberately manage real or lurking conflicts of interest. Like all professionals, we have many opportunities to compromise our professional integrity. Fortunately, the creation of an ethical code is underway by the ACC and the AHA. Together, we are working on a code that outlines the best in professionalism and ethics, and that trains a watchful eye on patient care, clinical research, and our relationship with industry.
Many of your dreams can be realized if you become meaningfully involved in College activities. The principal task before you is simple to state, but hard to do well. Take a seat at the table. Help shape solutions. Do not have edicts produced for you by others. Take action. Not only will you give energy to the process and improve patient care, but just as importantly, you will build wonderful lifelong friendships. Each challenge I have mentioned takes the power of many more than one physician to tackle. That is why joining with your colleagues in state chapters and ACC committees is critical. We embrace you, incoming Fellows, as the College's newest owners, customers, and volunteer workforce.
The ACC leadership and staff do all that we do, in large measure, to help develop the next line of men and women who will support what we now preserve and discover. Our single most important commitment is the degree to which we actively mentor the newest Fellows among us. As the College's 55th president, I personally invite you into an essential partnership with College leaders and Fellows at large.
Just as the little prince uncovered an important secret during his voyage, you, too, will discover during our professional journey that what is most important is often hidden from your sight. Resolve. Accountability. Justice. Integrity. These are invisible but essential elements of successful careers in cardiovascular medicine. You must find these with your heart. Once you see them clearly, you will be able to add strength to our College. And you will find that it is a potent, professional association that enables us not only to improve our profession, but also to improve ourselves and the care we always strive to provide to our patients.
- American College of Cardiology Foundation