Cardiology Magazine — January - February 2011
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Cover Story

Leadership: A 21st-Century Imperative Medicine by Pamela S. douglas, M.d., M.A.c.c., and c. Michael Valentine, M.d., f.A.c.c. for Cardiovascular

Every aspect of cardiovascular medicine is undergoing rapid and profound change, including clinical care delivery, research and education. Navigating this change successfully will require transformational leadership on the part of cardiovascular professionals and their organizations. Because medical training is scientifically and technically oriented, there is a great need to actively acquire the leadership skills, tools and experiences essential to continuing to improve cardiovascular health in a changing world.

Health care reform has been and continues to be gamechanging and a major instigator of the swift transition. Under the broad umbrella of health reform, physician reimbursement also is particularly relevant to cardiovascular professionals.Despite a broad consensus surrounding the need for a new payment model(s) to replace the flawed Sustainable Growth Rate (SGR) formula, additional payment cuts like those experienced as a result of the final 2010 Medicare Physician Fee Schedule have upended the traditional private practice model in just a few months in favor of hospital employment for more than half of cardiologists.

According to Leland Kaiser, a noted “health care futurist,” these large-scale changes mean a move for health care providers from their roles as caregivers to positions as designers of care; from being reactive to patient complaints to proactively constructing systems of care; from direct personal engagement with patients with immediate rewards to indirect involvement with delayed organizational goals; from the bedside application of scientific evidence, to the solution of problems, to the adaptation of concepts in community health.

While sometimes lost in the health reform frenzy, some fundamental alterations also are underway in cardiovascular science. The much heralded “omics revolution” and personalized medicine are finding their way to the cardiovascular bedside. A recent ACC CardioSurve survey of cardiovascular professionals found that in the next five years, 73 percent of cardiologists believe personalized medicine will have some measurable impact on patient treatment, and within the next 10 years, more than nine out of 10 cardiologists believe that personalized medicine will have a larger role in cardiovascular patient treatment. Another paradigm shift is represented by the sudden explosion of interest in — and funding for — comparative effectiveness research and translational research.

The roughly 30 percent of cardiologists who work at academic health centers also are seeing change when it comes to education. As the economic engine of clinical revenue sputters, regulatory strictures inhibit clinical research, industry support dwindles and requirements for educational oversight escalate, academic cardiovascular professionals are witnessing a perfect storm. Couple that with skyrocketing student debt (currently a median of $155,000 for 2008 graduates — a 53 percent increase since 1998, after controlling for inflation),11 choosing an academic career is increasingly becoming a difficult choice for the next generation.

Workforce is another major issue. The number of cardiovascular professionals available is close to being outnumbered by the ever-increasing number of patients with, or at risk of, heart disease. Not to mention the global burden of cardiovascular disease will require a large and diverse cardiovascular team. There is a need to engage the next generation of cardiovascular specialists, including non-physician professionals, to meet the needs of an aging population, as well as the needs of minorities and women.

The magnitude, pervasiveness and profundity of change in cardiovascular medicine today demand a thoughtful and significant response — the ACC is rising to the occasion.

We have a unique opportunity to fill a clearly-stated need and play a critical role in not only addressing the myriad of changes occurring now, but also helping mold the future of cardiovascular medicine and training the leaders of tomorrow.We need vision, execution, communication, team building, inspiration, enthusiasm and deliberate action to navigate these turbulent waters. To that end, the ACC is developing the Cardiovascular Leadership Institute (CLI), a comprehensive portfolio of management and leadership training for all members of the cardiac care team.

Over the last year and a half, the College has held 12 new educational meetings including three focused on evolving models of clinical practice, three on clinical practice management, two on ACC organizational leadership, and one each on effective teaching strategies, academic leadership, Fellows in Training (FITs) and practice administrators. In addition, long standing leadership courses on “Emerging Faculty,” “How to Become a Clinical Investigator” and “Women in Cardiology” are coming under the CLI umbrella.

As we move into the new year, the goal is to build upon these education opportunities and partner with key stakeholders to produce additional training resources, including live programs, e-learning, career development curriculum and enduring materials for developing executives, business management, etc. Our ultimate goal: to develop a well-defined roadmap for leadership and business training for all members of the cardiac care team at all stages of their respective careers.

As health care providers, we know the problems with our current system, and we need leaders that can clearly articulate solutions and be effective advocates for ourselves, our profession and most importantly our patients. Management guru Peter Drucker famously opined that “the best way to predict the future is to create it.” The magnitude, pervasiveness and profundity of change in cardiovascular medicine today demand a thoughtful and significant response — the ACC is rising to the occasion.

New Council Addresses Academic Cardiology

The entire house of cardiovascular medicine hinges on academic cardiology — we are the ones who train the next generation — and the whole pipeline could be at risk if we don’t address critical issues.”

In order to address the numerous changes in the health care environment affecting academic cardiology, the American College of Cardiology (ACC) recently established a new Council on Academic Cardiology. The council will serve as the voice of the academic cardiovascular community and will help inform ACC policies and programs related to academia and research to ensure that cardiovascular professionals in academic settings are able to continue to train the next generation of cardiovascular professionals, as well as conduct the research so critical to advances in the field.

“We are in no way at cross purposes with private practice cardiologists — but many of us are concerned that the academic career path is in jeopardy,” said Joseph A. Hill, M.D., Ph.D., F.A.C.C., the council’s chair and chief of cardiology at the UT Southwestern Medical Center in Dallas. “[AS] much as health reform is causing mergers and staff reductions, and these changes certainly affect us in academics, there are additional issues that are of great concern to academic cardiology, as well.”

Hill said there are dynamic challenges in education policy, public policy and research that need to be monitored and influenced on behalf of cardiovascular medicine. The council has identified some concerns, including the viability of the academic career path; the impact of health care reform on academic medicine; the adequacy of the future supply of cardiologists and CV sub-subspecialists; Accreditation Council for Graduate Medical Education (ACGME) regulations; National Institutes of Health (NIH) funding; and An ever-changing environment for Fellows in Training (FITs). Given the breadth of academic and research concerns, Hill noted that the Council on Academic Cardiology will be advantageous for the ACC.

“The entire house of cardiovascular medicine hinges on academic cardiology — we are the ones who train the next generation — and the whole pipeline could be at risk if we don’t address critical issues,” said Hill. “Research, new developments in therapeutics, drugs and devices, all hinge on the success of the academic community.”

Hill noted that since about one quarter of ACC members are academic cardiologists, their voices have been a part of the College for years, if somewhat less audible given the dramatic changes in health care delivery and clinical practice.Moving forward, the new council will enhance the visibility of the academic and research perspectives. When ACC is called upon to consider relevant policy, regulations, and meeting patient needs, the council will be integral to the College’s response.

The council is working on a formal set of prioritized objectives and plans to meet face-to-face twice a year, with conference calls and other communication throughout the year.

“Right now, the time is ripe for this council to emerge,” said Hill. “It is a constructive and highly positive win-win situation which the ACC has recognized as an enormous benefit to all of us.”

Members who have questions about the Council or are interested in getting involved should contact the staff liaison to the Academic Council, Amalea Hijar, at