‘In pursuit of excellence’: New ACR president discusses advocacy, equity and solo practice

The American College of Rheumatology in November announced the appointment of Deborah Dyett Desir, MD, as its 87th president.

A practicing rheumatologist for more than 30 years, Desir has been an ACR member since 1986. In the ensuing years, she has held numerous appointments and leadership positions, including chair of the corporate relations committee, co-chair of the membership and awards committee, and secretary for the ACR’s Rheumatology Research Foundation board of directors. She has personally advocated on Capitol Hill on behalf of the rheumatology community and spent time as a member of the strategic planning task force. In the leadup to her presidency, Desir held the titles of president-elect and secretary.

She is also the first Black woman to serve as ACR president — as the organization enters its 90th year.

“When I became president-elect of ACR, I left the meeting and just sat in a room by myself for 15 minutes,” Desir told Healio. “I reflected on the fact that when my father graduated from medical school in 1954, he was unable to join the American Medical Association or his state medical society. They did not admit Black members. There was nothing in the official AMA bylaws that prevented them from admitting Black members. They just did not do it.”

Desir is, in fact, part of a multigenerational family of physicians. Her father, husband and two of her children are all MDs.

Healio sat down with Desir to discuss plans for her tenure as president, priority projects she hopes to accomplish, and how being part of this physician family has impacted her outlook on the job.

Healio: What are your plans for advancing the careers of women in leadership positions in rheumatology?

Desir: Advancing the careers of women in leadership positions within rheumatology is crucial for diversity, innovation and equitable representation. With this in mind, we have already established a Women in Rheumatology Task Force. Task forces in the ACR are established by the president.

We have plans to develop mentorship programs, connecting experienced female leaders with aspiring women in rheumatology. Some activities might include pairing mentors with mentees, offering guidance on career paths, leadership skills and work-life balance. We would like to develop leadership training workshops addressing barriers faced by women in leadership roles. Workshops will also focus on specific skills such as negotiation, communication, conflict resolution and strategic planning.

Networking is important, too. We would like to create networking events, forums, or online communities specifically designed to connect women in rheumatology. The hope is to facilitate opportunities for collaboration, idea-sharing and professional growth. I am certain more ideas will come to light as the task force meets.

Healio: How much of that is underway?

Desir: The task force was just formed, and they have yet to have their first meeting. When that happens, they will create an outline of where they would like to go and how to go about accomplishing these goals.

Healio: What kind of interest have you had in these initiatives thus far?

Desir: We have had a lot of volunteers willing to work on it, at least in part because we are hoping to cover a lot of aspects of the roles women in rheumatology play.

Healio: What are your plans for enhancing ACR resources for members in solo or private practice?

Desir: I would like to start by saying that private practice is near and dear to my heart. I owned and ran a private practice for nearly 30 years. In 2023, the ACR launched a Community Practice Council (CPC) that includes 12 to 15 rheumatology professionals from small or independent practices around the United States. This council focuses exclusively on issues confronting our members in small practices. Additionally, the CPC will have two slots for fellows who are interested in independent practice, with hopes of providing insight into barriers newly minted rheumatologists might face.

We will also be working to provide resources that help members in private practice thrive, including practice management support. Extensive practice management support is currently available, but it is one of the hidden gems of the ACR. It is important for us to make sure members in private practice are aware of all of the benefits membership can provide for them. We will strive to increase awareness of what is currently available while simultaneously enhancing the resources.

Healio: What are some of those resources?

Desir: There is tailored educational content, information on mentorship programs, and recommendations for networking events and online forums. Financial guidance and support, including assistance with negotiating contracts with payers, is available, as are strategies for setting up a practice for early career members and strategies for running a practice effectively.

Healio: What are your thoughts on the future of private practice in rheumatology? Some experts believe that private practice rheumatologists are becoming a dying breed.

Desir: I hope they are not becoming a dying breed. Private practice rheumatologists perform a tremendous role in providing rheumatology care to patients nationwide. At ACR, it is our job to make sure that they have the resources they need to continue.

Healio: How do you plan to advocate for increased research funding?

Desir: Much like the scenario with our private practice members, ACR members who are primarily research-oriented need our support and a home in the College. The ACR has a multifaceted approach to this issue. Among other efforts, the ACR will strive to increase impactful NIH biomedical research and NIAMS funding while advocating for the establishment of a dedicated arthritis study section. Another goal is to actively support targeted research funding initiatives by the CDC.

We will also maximize the possibilities provided by the new incorporation of dedicated arthritis research funding within the U.S. Department of Defense’s Congressionally Directed Medical Research Program (CDMRP).

It is noteworthy that the inclusion of dedicated arthritis funding in the CDMRP through the U.S. House appropriations bill for the Department of Defense, initially at $10 million, marks a significant achievement after persistent ACR and Arthritis Foundation advocacy and education. I was actively involved in this effort, having had many discussions with my congressperson, Rep. Rosa DeLauro, D-CT, who was a member of and later chair of the House Appropriations Committee, and her staff about the importance of this issue. Every dollar counts.

Healio: What are the current plans for ACR advocacy efforts at the state, local and federal level?

Desir: Advocacy is another one of my passions. As an ACR member, I have been part of advocacy efforts for as long as I can remember. It is essential for citizens in a representative democracy to take their concerns to their elected officials.

We will continue going to Capitol Hill twice a year. Additionally, we have developed a four-fold focus for ACR advocacy efforts for 2024. This includes better patient access to treatment, including addressing prior authorization and step therapy; Medicare reimbursement and access to care; research funding; and addressing workforce shortages. We have already discussed research funding a bit, so I would just like to add that our aim is to keep our eyes trained on the future. This will require appropriate investments in biomedical research and technology to improve the quality of patient care, but also our ability to provide it.

Healio: What about advocacy at the state level?

Desir: A lot of the regulations surrounding step therapy and prior authorization are controlled at the state level. Medicaid reimbursement is often part of state government, as well. If Medicaid doesn’t adequately reimburse patient care, it can present a major barrier to treatment.

Healio: What advocacy efforts are underway to address the rheumatology workforce shortage?

Desir: It is essential that we find solutions to the workforce shortage, which is depriving our patients of timely care. One example is the marked shortage of pediatric rheumatologists. There are states with no pediatric rheumatologists at all. The reasons are multifactorial. One reason is that pediatric subspecialties across the board are generally paid less than a pediatrician. Another is that most pediatric rheumatology patients fall under Medicaid, which reimburses less than Medicare, which results in pediatric rheumatologists bringing in less income to a hospital or medical practice.

In many of our visits to Capitol Hill, we discussed with members of the House and Senate why addressing the shortage of pediatric subspecialists should be a top priority.

Healio: Whare are some of the diversity, equity and inclusion (DEI) initiatives you have in mind for the ACR, and why are they important?

Desir: At the ACR, we recognize that empowering rheumatology professionals and advancing the specialty means being a diverse, equitable and inclusive organization. Our members are the foundation of the organization, making ACR a vibrant community of individuals whose skills, expertise, lived experiences and perspectives reflect differences in career stage, professional setting, gender and gender identity, race, ethnicity, physical abilities, sexual orientation, and geographic location.

As rheumatologists, we care for a diverse population. A similar diversity among rheumatology professionals brings different ideas and perspectives to the table leading to innovation in patient care, research and treatment paradigms enhancing the quality of care for our patients.

Healio: Could you highlight some of the recent DEI initiatives of the ACR?

Desir: One is our Underrepresented in Medicine (URiM) pathway initiative. For the past 2 years, the Rheumatology Research Foundation and the ACR Committee on Training have offered scholarships to an invited group of students to attend ACR Convergence, with programming and special networking sessions geared toward them and the opportunity to network with URiM rheumatology professionals.

Our Collaborative Initiatives Committee developed the Project LEAD — Leadership Education and Development — of Underrepresented Medical Students Program, which is a series of roundtables designed to cultivate interest in a career in rheumatology. I believe this will help to build a larger, culturally responsive workforce.

The Global Summit, which brings together rheumatologists from all over the world to talk about topics of mutual relevance and concern, like access to care and cost of medications that are critical to the treatment of rheumatic diseases, is another example of the ACR’s focus on diversity.

The ACR’s Collaborative Initiatives, also called COIN, advances health equity and takes on special projects to help reduce health disparities and improve patient care. One such example is a recent summit focusing on participation in research and clinical trials. Expanding to a diverse group of subjects can lead to more broadly applicable research outcomes. These are all in addition to the CPC and the Women in Rheumatology Task Force.

Healio: On a personal note, it seems you come from a family of doctors — father, husband, and children. How has this impacted your outlook and plans for this position?

Desir: When I became president-elect of ACR, I left the meeting and just sat in a room by myself for 15 minutes. I reflected on the fact that when my father graduated from medical school in 1954, he was unable to join the American Medical Association or his state medical society. They did not admit Black members. There was nothing in the official AMA bylaws that prevented them from admitting Black members. They just did not do it. So, he joined the National Medical Association, the medical association for Black physicians that was founded in 1895.

Ultimately, he joined the AMA following the civil rights movement of the 1960s. In fact, 25 years after his death, I still get his bills for AMA dues. Anyway, after I thought about this, I went to speak to a group of underrepresented medical students and I told them that story. I expressed to them how proud my father would have been to see all of them present in the room and to see me elected president of the ACR.

Healio: That’s an amazing story.

Desir: It does not stop there. I have been elected president of ACR, and my husband is chair of the department of medicine at Yale Medical School. Recently, my son, a young attending, was elected to the executive committee for the Connecticut Academy of Family Physicians. I said to him, “It was years of volunteer service before I was on the executive committee.” My husband added, “Well, I have never been on one for my professional society.” To which my son, ever the comedian, replied, “I’m glad to give you something to aspire to, Dad.”

Healio: Our readers are primarily practicing rheumatologists. Could you offer a final word to them?

Desir: The state of rheumatology is vibrant and promising because of the professionals whose efforts shape the present and future of our specialty. Our commitment to advancing knowledge, advocating for patients, and supporting each other is the cornerstone of our collective success. Together, we can continue to break new ground, push boundaries, and provide the best care possible for our patients. As we face the ever-changing landscape of medicine, we must remain united in our pursuit of excellence.