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ACC president: ‘Continue to advocate’ for the future of cardiology
ORLANDO, Fla. — Advocacy is key for the future of cardiology, Mary Norine Walsh, MD, FACC, told the audience during her presidential address at the American College of Cardiology Scientific Session.
“Everyone needs an advocate,” according to Walsh, president of the ACC.
“We all serve as advocates every day in many areas of our lives, but some of the most important ways we advocate is as health care professionals, members of a cardiovascular team and as member of the American College of Cardiology,” Walsh, medical director of the heart failure and transplantation program at St. Vincent Heart Center in Indianapolis, said. “Some of our efforts as advocates are more visible than others.”
Walsh highlighted three pivotal ways by which cardiologists can — and do — advocate every day.
Advocate for quality leadership
Members of the ACC can be quality leaders on both a national and local scale, Walsh said. One example on the local scale is working in dyad leadership teams with administrative partners, a situation in which “it’s incumbent on us to keep the focus on quality and patient safety,” she said.
On a bigger scale, the field of cardiology has “reams of quality data to back [cardiologists] up,” with more randomized controlled trials and guidelines than other fields of medicine as well as large-scale registries that track real-world data, she noted.
“Keeping an eye on quality and patient safety is our job. We can advocate for quality by using data to innovate,” she said.
Walsh described a recent example at her institution, where she and colleagues analyzed available literature on hepatitis C-positive cardiac donors, as well as their institutional-level data, after which they made the decision to consider hepatitis C-positive cardiac donors as options after discussion with patients awaiting cardiac transplants.
“Each year, about a hundred donor hearts aren’t donated due to donor hepatitis C, but ... there are several highly effective drugs that are known to clear hepatitis C close to 100% of the time,” she said.
Advocate for the support system
An increasing number of physicians are experiencing burnout. Survey results published in JAMA Internal Medicine in February showed that approximately one-third of physicians experience characteristics of burnout, such as emotional exhaustion and depersonalization. Cardiologists, nurses and other health care professionals are not immune to burnout and stress. As previously reported by Cardiology Today, in the ACC’s 2015 Professional Life Survey, more than one-quarter of U.S. cardiologists reported burnout, with burnout identified as 29% likely among female cardiologists.
However, Walsh noted that physicians do not typically seek help for burnout.
“The wellbeing of doctors, nurses and all members of the care team needs to be a primary concern of our health systems, our institutions, our practices and even our patients. It starts with us: We must advocate for the health and well-being of our colleagues,” she said.
The ACC’s Task Force on Diversity emphasizes a diverse workforce for many reasons, among them to improve team care and prevent burnout, according to Walsh.
She encouraged the audience to “do your part to improve diversity in our profession, whether that’s improving the pipeline in cardiology, encouraging recruitment, helping with retention or fostering leadership, your active engagement can make a difference.”
Further, Walsh underscored the need for bystander support in the workplace.
“Modeling bystander support to our students, residents and fellows can help change culture and support,” she said.
Advocate for patients
Beyond the clinical care of patients, Walsh said cardiologists are “on a new playing field of advocating for [patients]. Never have we been so restricted by external forces with regard to how we diagnose and treat disease.”
She noted, however, some “huge advocacy wins” for patients recently. One, soon physician assistants, nurse practitioners and clinical nurse specialists will be able to supervise cardiac and pulmonary rehabilitation on a day-to-day basis under Medicare, a result of a 2-year budget deal approved by the House and the Senate in February that included provisions that expand access for telestroke and cardiac rehabilitation services, removes restrictions on Medicare therapy caps and helps improve the health of patients with CVD. Two, the Children’s Health Insurance Program (CHIP) “appears to be safe,” after announcement in February that the Senate reached a budget agreement to continue to fund the program.
“These wins are big, but the daily skirmish continues in our advocacy for our patients,” she said. “Prior authorization and other insurance restrictions are not just daily hassles in our practices that contribute to burnout, they’re clear threats to the well-being of our patients. Filling out the endless prior authorization forms, e-requests and taking the time to talk to an insurance physician for a peer-to-peer discussion of an imaging or other diagnostic test is important advocacy that we do every day.”
Looking ahead
With these three focuses for advocacy in mind, “let’s continue to advocate,” Walsh said. “When barriers to care are erected, let’s surmount them. Let’s not take no for an answer. Let’s take care of each other. Let’s advocate.” – by Dave Quaile, with additional reporting by Katie Kalvaitis
Reference:
Walsh MN. ACC Presidential Address. Presented at: American College of Cardiology Scientific Session; March 10-12, 2018; Orlando, Fla.
Disclosure: Walsh is president of the ACC.