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A Word from the President: Our Moment of Truth

AAMC Reporter: November 2013

Editor’s Note: The following column is adapted from Dr. Kirch’s address at Learn • Serve • Lead: The AAMC 2013 Annual Meeting.

Having just returned from Learn • Serve • Lead: The AAMC 2013 Annual Meeting in Philadelphia, I cannot help but reflect on how lucky I am to work with such an energized, talented, and creative group of people. In fact, at no other AAMC annual meeting have I gotten the pleasure to interact with so many of you. A record number of constituents—nearly 4,800—registered for the meeting, representing medical schools and teaching hospitals at the forefront of education, health care, and scientific discovery.

Among my favorite parts of the meeting is the opportunity to learn directly from all of you—to hear about the advances you are making, to get a reading of where we need to direct our focus, to learn what your own change imperatives are. The challenges we face today cannot be understated. Each day, the decisions facing us seem to become more difficult. What we do in these moments shapes not only our personal future and the future of our organizations, but even the future of our nation.

Two years ago at the annual meeting, I described what was perhaps my own most dramatic moment of truth. I was a 21-year-old doing road construction and adrift regarding my future. The moment of witnessing dozens of people die in a plane crash on a golden autumn afternoon high in the Rocky Mountains drove my decision to pursue medicine.

The challenging moments kept coming. Not too many years later, I experienced how agonizing clinical moments of truth could be. All too often as a psychiatry resident, I had to decide whether I would honor the passionate request of a depressed or psychotic patient to leave the emergency room, or I would deny their personal freedom and involuntarily hospitalize them. Decades later, as a health system CEO, it was equally agonizing to decide whether to close psychiatry beds and open operating rooms, not because there were fewer psychiatric patients in need, but because we needed to overcome a budget deficit, and in America, surgery is reimbursed at a much higher level than mental health care. And I vividly remember the struggle when, as a dean, I faced the difficult decision of approving the dismissal of a student unable to overcome academic or personal issues, knowing they would be losing their lifelong dream—but not their debt.

Many of you have generously shared with me similar experiences in confronting challenging decisions. These moments have tested and shaped each of us as individuals. But today, I want to look forward and talk about the shared moments of truth we face as a nation, as an academic medicine community, and as a profession—a profession that has taken an oath to be true to our values.

There is no denying that the United States faces a national moment of truth when it comes to our health care system. We spend nearly $3 trillion on health care each year, far more than other comparable nations, yet our health outcomes in vital areas lag far behind many of them. All too often, when I travel internationally on behalf of the AAMC, a conversation occurs that I always dread. Often it comes over dinner, when our international colleagues ask me, “How can you reconcile spending so much on health care, but falling short on so many health outcomes?”

Yet our national leaders seem bent on avoiding decisive action on this moment of truth. Just consider what happened in Washington during the last month. The Affordable Care Act has become the law of the land, withstood a Supreme Court challenge, and hopefully will bring millions of Americans in from the uninsured cold and help them achieve better health outcomes. But in recent weeks, the nation watched in disbelief as the entire federal government was shut down in yet another effort to defund or delay the law from taking effect. Although Congress fought back successfully against attempts to unravel the law, it once again has “kicked the can down the road” and avoided its moment of truth on our nation’s budget and the devastating sequestration cuts to medical research.

Faced with problems like this, it is all too tempting to look to others to somehow fix them. But now we know how unrealistic it is to imagine that Congress will solve these problems. In the face of that, I firmly believe that you and I bear the responsibility to take decisive action. This is our profession’s moment of truth.

Unfortunately, as physicians we seem inclined to point a finger at everyone but ourselves. Dr. Jon Tilburt and his colleagues conducted a fascinating survey of physicians that appears to prove just that point. Published in JAMA this last July, they reported the results of a survey that asked nearly 3,000 physicians this question: “Who bears major responsibility for health care costs?” Sixty percent said that major responsibility for our nation’s health care costs belongs to the trial lawyers, followed by health insurance companies, pharmaceutical and device companies, and hospitals. Closely following all these groups, 52 percent of the physicians surveyed assigned major responsibility for costs to patients! Only 36 percent thought that they, as practicing physicians, had a major responsibility to reduce health care costs. Not surprisingly, an overwhelming majority, 70 percent of responding physicians, said that as a way to reduce health costs they were “not enthusiastic” about eliminating fee-for-service payments that reward volume, not health outcomes.

Please know how much I appreciate the many moments of truth when our community of medical schools and hospitals is at its very best as physicians and caregivers. But how can [physicians] be part of the solution, if we do not believe we are major contributors to the problem? These are our opportunities to act positively, courageously, and decisively. We can sit on the sidelines, or we can embrace responsibility for transforming our health care system.

Dr. Martin Luther King was fond of quoting an early 19th century social thinker, Theodore Parker, who said, “The arc of the moral universe is long, but it bends toward justice.” Each of us confronts moments of truth in which we can actually affect that arc, moments in which we can bend the arc toward justice in health care. We are in a unique position to demonstrate leadership in academic medicine. This is a moment of truth our nation desperately needs us to seize!

To view the video and read the entire text of the address, go to www.aamc.org/meetings/annual/am2013.