ACR conference kicks off with reflections on the past, future of rheumatology

SAN FRANCISCO — In his opening remarks, E. William St. Clair, MD, president of the American College of Rheumatology, reflected on the changes in rheumatology since he began his career, and challenged members to shape the future, attract talented new rheumatologists and adapt to various changes in the profession.

“Has rheumatology reached a tipping point?” St. Clair said. “Will doctors continue to embrace the key tenets of medicine – promoting health, curing illness and relieving pain – or will they become disillusioned by the changes in our health care system and run for cover? Will the economic pressures to grow revenues divert our attention from doing whatever is best for our patients?

St. Clair said fellow physicians have told him the increase in time spent with paperwork and administration has created a need to see fewer new patients, and implementation of ICD-10 and electronic health systems has placed difficult financial burdens on practices. However, St. Clair said he is hopeful that rheumatology will continue to attract young physicians, and that “sharing our enthusiasm for rheumatology” is one step toward solving the shortage of rheumatologists.

St. Clair reviewed the positive changes he has seen since he began his practice as a rheumatologist in the 1980s. In 1988, he said FDA approval of methotrexate was “a seminal event.” In the same year, St. Clair said the roots of the American College of Rheumatology (ACR), then known as the American Rheumatism Association and section of the Arthritis Foundation, held its first conference in Cleveland. The 1989 meeting was held in Cincinnati and drew 3,693 attendees and featured 852 abstracts, compared to record attendance of more than 16,000 attendees this year, of whom more than 7,000 are international attendees.

“In the 1980s, the scientific underpinning of rheumatologic disease was fairly rudimentary compared to what it is today,” St. Clair said. “We were just learning about how to produce monoclonal antibodies. The practicing rheumatologist had far fewer diagnostic tools and medications at their disposal than I do now.”

The advances in the specialty may offset some of the frustrations related to paperwork and changes in reimbursement structures, he said.

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“We have a much deeper understanding of the science of rheumatology and new technologies to advance that science. We have created an abundance of new evidence that has improved clinical decision-making, and developed a host of new therapies that have been a godsend to our patients, and biosimilars are just around the corner, too.

He said the health care system has changed during the past 3 decades, which has created some chaos.

“There is no question that our workplace is changing. As rheumatologists are trying to decide how they want to design the way to deliver their services to provide higher quality patient care at a lower cost, they find barriers on the current system,” St. Clair said.

The ACR has been actively working with Congress to address these issues and has seen successes, such as the repeal of the sustainable growth rate, according to St. Clair.

Involvement in the RISE (Rheumatology Informatics System for Effectiveness]) Registry is a way for practicing rheumatologists to measure performance before the implementation of the merit-based incentive program that will guide value-based payment. He encouraged attendees to attend the RISE Registry sessions on Monday and to take an active role with the registry.

“If you see opportunities, get involved,” he said. “If you are unhappy about something, good. Get involved. It is a brave, new world.” – by Shirley Pulawski

Reference:

St. Clair ES. ACR/ARHP Opening Lecture and Awards. Presented at: American College of Rheumatology Annual Meeting; Nov. 7-11, 2015; San Francisco.

Disclosure: St. Clair reports no relevant financial disclosures.