Honoring the Values of Dr. Martin Luther King, Jr.

mlkquote_smallToday, once again, we have an opportunity to honor Dr. Martin Luther King, Jr.. This is a day to remember and celebrate the values that he demonstrated during his remarkable life — values like compassion, commitment, moral compass and service to others. These are values that drive our Health System and define our mission. We must never relent in our work to promote diversity and equity in all that we do, from the care we provide to the people we employ. We must continue to address disparities, fight injustice and challenge complacency in societal norms.

How will you honor Dr. King and these values today, tomorrow and beyond?

U-M Comprehensive Cancer Center: It Started With Notes on a Napkin

This month, we celebrate an impressive milestone with the 25th anniversary of our U-M Comprehensive Cancer Center’s NCI designation. To commemorate this wonderful moment in our history, I asked Center director Max Wicha to share some of his reflections of the past and hopes for the future. Max has been a member of the UMHS family since 1980, when he joined the faculty as an assistant professor of internal medicine in the Division of Hematology/Oncology. Since then, he has emerged as a passionate leader in the fight to understand and ultimately cure cancer, and as a world-renowned breast cancer expert. As we celebrate this silver anniversary, we celebrate Max’s dedication to medicine and to Michigan, as well as the incredibly talented, compassionate and engaged faculty, staff, patients and families who comprise our Cancer Center community. Congratulations to everyone who is creating the future of health care for cancer patients and their loved ones.

U-M Comprehensive Cancer Center: It Started With Notes on a Napkin

mw-2013There are certain moments in life that might seem mundane and ordinary at the time, but become quite consequential and important. Like joining U-M colleagues for dinner in the mid-1980s when I was chief of the Division of Hematology/Oncology at Michigan. We grabbed a napkin and doodled ideas about what it would take to develop a cancer center at Michigan.

Those notes from a late dinner quickly translated into a huge effort by many talented people to pool our resources, create a cancer center and earn cancer center designation from the National Cancer Institute.  We did it, and announced our NCI designation to the world 25 years ago in September 1988. Since then, it’s been the unwavering focus on innovation and collaboration in patient care and research by each and every person connected to the Cancer Center that allowed us to grow into one of the national leaders in research and patient care.

Outpatient cancer care looked very different in those days. Patients seeking a diagnosis and treatment came and went from the medical campus several times – often over the course of three weeks – to see a surgeon, and medical and radiation oncologists. Nobody thought to coordinate appointments with specialists, and this long, drawn out process was confusing and downright scary for patients. And it wasn’t unusual for each specialist to have a different recommendation to the patient on the ‘best’ treatment option. Again, most medical centers weren’t thinking about bringing doctors together to reach a consensus opinion on a treatment plan or to coordinate care. We decided to challenge the notion on a large scale.

Our breast center care model proved that the “radical” idea of coordinating outpatient care into teams of doctors from all departments seeing cancer patients, as well as nurses and other professionals, was a good model. Our model – including tumor boards with oncologists, radiologists and pathologists to coordinate care – worked, and to the great satisfaction of our breast cancer patients. Getting our new building in 1997 allowed us to duplicate this model for other kinds of cancer and fully realize our plan for comprehensive, collaborative patient care. Today, genetic analysis is transforming cancer care, and our latest innovation is to become the first cancer center in the country to add a molecular pathologist to a tumor board to provide that analysis. In time, all patients will have access to this kind of personal, precision treatment planning!

timeline-promoIn those early days at the Cancer Center, we started bringing together research teams across very different disciplines to focus on the cancer problem. Michigan had a great history in research, but at the time, research was typically organized around administrative departments, not diseases. This made interaction across these departments more difficult. We knew that no single researcher or lab could make the kinds of advances that will lead to a cure for cancer. We are proud of the fact that collaboration was part of our model long before this became popular. And starting in 1997 when the new cancer center building opened, we challenged existing dogma even further, because now the cancer research labs were located together, encouraging even more collaboration and innovation. As a result, our Cancer Center has been extremely successful in team science and we have more funding from NCI than any university-based cancer center in the country.

And our research model keeps getting better. Cancer Center researchers collaborate with 10 different schools from across the university and our labs are now close to each other in the North Campus Research Complex. Each school represented at the NCRC is recognized nationally as a top 10 school and only Michigan has so many top 10 schools and colleges working together in the same space on the cancer problem.

As an example for why this is important, my own lab, which was the first to discover stem cells in breast cancer, works closely with Sunitha Nagrath, Ph.D., from Chemical Engineering. Dr. Nagrath is developing microfluidic devices for isolating and studying cancer cells. Together, we study how cancer stem cells circulate in the blood and how they respond to cancer therapies. In the not too distant future, we hope patients can skip the painful biopsies and instead get a blood draw and quick genetic analysis to see if a therapy is working, or what other therapy might work better. Our own Cancer Center researchers will make major contributions in developing those targeted therapies, hopefully curing more patients.

Looking ahead to the next 25 years, I would like to see us become an international center for this new kind of personalized medicine.

Part of the reason for our clinical and research success is that the institution has been extremely supportive of us, from developing the Cancer Center in our early years, to ongoing investment of considerable resources. Its support has allowed us to develop so many outstanding programs – and without that kind of support from leadership, none of this would have been possible.

It’s been such a wonderful experience to lead this effort for 25 years. We moved from humble beginnings at a great research university to become one of the leading cancer centers in the world. And I believe our legacy is strong and will go forward another 25 years; perhaps this will be the place where cancer is finally cured.

maxwicha

Max Wicha, M.D.
Director, University of Michigan Comprehensive Cancer Center

Perspectives: The Importance of Gender Diversity in Health Care & Leadership

A couple of weeks ago, I received an invitation from second year U-M Medical School student Linda Li to celebrate female leaders in healthcare by participating in XX in Health Week, which takes place this week. XX in Health is an initiative of Rock Health, which aims to connect and empower female visionaries in health care. XX in Health Week is a time to share stories, create awareness and stimulate dialogue around the importance of gender diversity in health care. As such, I thought it would be a wonderful opportunity to share perspectives from female leaders who hold diverse positions at the U-M Health System and so I sent an email to several that asked two questions:

  1. What should young women in medicine begin doing early in their education and careers to prepare themselves for leadership roles?
  2. Why is gender equality and diversity in the workplace important? Is there a particular experience around gender diversity from which you’ve learned?

Below are the compelling and inspiring responses I received. Enjoy!

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bertoliniGina Bertolini, J.D.
Associate Vice President and Deputy General Counsel, UMHS

As a health lawyer in a leadership role at UMHS, I’ll answer this more generically to address what young professional women in any profession should be doing to prepare themselves for leadership roles.

On leadership: Embrace any opportunity to grow and develop, including accepting opportunities and tasks that will expand and challenge your comfort zone.  In order to excel and achieve success, it is not enough to simply meet expectations.  Seek growth opportunities, challenge yourself to learn something new, accept a task or a level of responsibility that is more than what you think you can do, and then do it.  Navigating this course will not be without its difficulties; shortcomings, even failure, will be part of the growth process.  But acknowledging shortcomings, admitting mistakes, and committing to grow and learn will help stretch your comfort zone, expand your area of expertise, and develop confidence.  It also will expose you to opportunities you might not otherwise get, such as putting you in contact with professionals who are senior to and more experienced than you, or with clients or third parties with whom you might not otherwise have contact early in your career.  Particularly early in your career, don’t shy away from opportunities to demonstrate leadership outside of your traditional day-to-day duties, such as by mentoring newer and less experienced professionals, establishing a summer program for students, planning the office charity drive, participating in a community event on behalf of your employer, or serving on a committee.

Additionally, young women should practice expressing their opinions and experiences with conviction and confidence, even when confidence is lacking.  Practice articulating your thoughts and ideas in a group setting, and put yourself in situations where you will be challenged to express yourself and defend your position.  Do not shy away from conflict; rather, learn to handle it with poise and intellect, and learn how and when to be assertive.

Lastly, don’t ever belittle those around you, or seek gain at their expense.  A true leader does not benefit from the shortcomings or failings of those around her; rather, she is someone who continually elevates everyone around her to achieve their best.

On gender equality and diversity: The presence of men and women from all walks of life help enrich a workplace by leveraging the unique experiences and perspectives of a diverse and gender-balanced workforce, ultimately better representing and caring for an increasingly diverse population.  A culture of inclusion helps foster creativity, confidence, appropriate risk-taking, and growth.

Frequently, I am the only woman, or one of just a few, in the room to address an issue crucial to the organization.  Some of my uniquely female qualities – as a consensus builder, excellent communicator, and compassionate advocate for the patients and community members whom we serve – have helped move the conversation beyond rhetoric and conflict to resolution.  But most importantly, I have learned that to be a woman in a leadership role is wonderful, and thankfully I am not alone, the way my sisters a generation or two before me were.  Rather than hide or minimize those “quintessential” female traits, I embrace them, and I use them to assist me in shaping my view of the world, my work, my colleagues, and my clients.

 

bradfordCarol Bradford, M.D.
Charles J Krause M D Collegiate Professor of Otolaryngology
Chair, Department of Otolaryngology-Head and Neck Surgery

Women should seek out leadership experiences and training early in their careers to prepare them to be the leaders of the future.  Examples include medical student council, leadership roles within the health system and hospital, national committee service, etc.  Valuable leadership training opportunities include ELAM (Drexel University), Linkage Leadership Institute, UMHS leadership day activities and our Health System Leadership Training with the Business School.

When it comes to gender equality and diversity, I would say that I have been fortunate to have outstanding mentors (both men and women) and that diversity is essential to achieve our goals and to represent the community that we serve.

In 2009, I presented at a national meeting on the topic of gender issues and I shared what I encountered over my career. Here are some excerpts:

What I’ve been told: “You know, they don’t take women in the Otolaryngology residency training program at the University of Michigan.” Faculty career advisor, 1986

What I’ve been asked: “You don’t plan to have children, do you?” Residency interview, 1986

What I’ve heard: “The reason our revenue is down is because one of our faculty members is out on maternity leave.” 1995, while on maternity leave following the birth of my second child

Advice I’ve received: “You know, women should really be at home raising their families.” SUO meeting, 2005

Fortunately, we’ve come a long way. In fact, each individual I quoted above has provided significant mentorship and support to me in my professional career. The last individual I quoted sent me a handwritten note stating how much he enjoyed my presentation on career/life balance. As more women are entering the field, making significant contributions and becoming leaders, there are more opportunities for mentorship and dialogue about gender issues.

Anesthesiology, Carmen GreenCarmen R. Green, M.D.
Associate Vice President and Associate Dean for Health Equity & Inclusion
Professor of Anesthesiology, Obstetrics and Gynecology & Health Management and Policy

I write today in the summer of 2013, as we approach the 50th anniversary of Dr. Martin Luther King’s “I Have a Dream” speech in Washington, DC.  Thus, I reflect on how far we have come while knowing there is still so much to be done.  I acknowledge the many people who protested, litigated, and faced jail, fire hoses, beatings in pursuit of educational justice for all in the summer of 1963.  Although I was not alive or do not remember many significant moments in the Civil Rights era, I remain fascinated by the time period.

I remember a 5-year old colored girl sitting on her great-grandfather’s knee.  She told him she wanted to be a doctor.  At that time there were few women doctors and even fewer women doctors who were racial and ethnic minorities.  I played with Barbie dolls, read interesting books and was intellectually curious, but never waivered from the dream of being a doctor.   My mother and grandfather gave me the inspiration, support and family narratives to live authentically and fully, even if the path was unfamiliar or uncharted.   They always encouraged me to dream big while betting on me to win, place or show!

Forty years after that conversation with my great-grandfather, I continue to benefit tremendously from mentors who selflessly invested in me and watched me grow.  They looked beyond race and gender and consistently and actively listened to a different voice.  They embraced new ideas, consistently believed in me, and encouraged me to create a path where there was none.   The power of my – and all - mentors who selflessly support and promote women and racial and ethnic minority physicians is desperately needed.  Their efforts will continue to transform medicine.  As the great-granddaughter of slaves, free people of color, Cherokees and Choctaws, and Irish immigrants,09o their guidance was transformational for my career in medicine and science.  I am grateful.

Despite the many changes in medicine and how we deliver quality health care, being called a doctor is humbling and reminds me that the work is a calling.  Being someone’s doctor is a sacred trust and we work in a sacred space.  Being a doctor can take you into a person’s shadows or into outer space. There are many more women in medicine than when I was in medical school and we have parity between men and women entering medicine today.  However, parity does not exist for racial and ethnic minorities physicians and their representation in society.  Furthermore, many of our patients have not experienced educational or health care parity.  In fact, many women and minority patients experience an unequal burden of acute and chronic diseases and their stories go unheard.  Hence the genesis of my moniker “unequal burdens and unheard voices.”   In an increasingly female, diversifying and aging society, all Americans do not uniformly enjoy similar access or the potential benefits of health care and education. More specifically, differences, disparities and inequities in the health care and educational experience exist for women and minorities across the lifespan.  These are our patients, as well.

Who is going to tell their story? Who is going to listen?  Whose stories do we hear? When do we hear them?  It follows that if we are to eliminate health care and educational inequities, we need to have a place for everyone at the table, including women, racial and ethnic minorities, and other individuals who bring a diverse and unique viewpoint.  In the spirit of inclusion, and as we seek to eliminate health disparities and promote health equity, we must recall that our strength is in our diversity, our ability to see through multiple and diverse lens, and to hear different and unheard voices.  Although challenges may exist, the wisdom, leadership and experiences of women and racial and ethnic minority women physicians continue to be needed.  Today, knowing how far we have come while knowing our journey is not finished, I remain optimistic. I see a picture of Dr. King standing next to a welcome sign!

 

Medical School, Lisa Fletcher

Lori L. Isom, Ph.D.
Professor of Pharmacology & Molecular and Integrative Physiology
Assistant Dean, Recruitment and Pre-Candidate Graduate Education
Director, Program in Biomedical Sciences

To prepare herself for leadership in the biomedical sciences, a young woman must first become a great biomedical scientist. She must find the courage to “dare greatly,” as Theodore Roosevelt would tell us, to be bold, to be innovative, to push the field forward rather than sideways. She must learn to be an effective communicator, conveying the excitement of her work in voice and on paper, and by doing so, establishing herself as a leader in her field.  After all, as one of my favorite mentors always says, if it’s not published, you didn’t do it! She must learn to teach in a way that is sensitive to learners from diverse backgrounds and with different learning styles.  It is critical that she understand how it feels to not understand. In parallel, she must gain administrative experience. How? By establishing a reputation for good-natured honesty and reliability, by being generous with her time, by volunteering her service, by learning to be a good listener, by learning the facts before offering an opinion and by being compassionate. I think it’s important to keep in mind the idea of paying it forward – altruism in honor of those who took the time to help you. When asked to describe her greatest professional accomplishments, one of my other favorite mentors (who is a fantastic scientist, by the way) lists the people whom she has mentored, rather than the Nature papers she has authored. That’s my idea of true leadership!

In the biomedical sciences, it’s rare to receive instant gratification.  In my lab we work on the mechanisms of inherited epilepsy and cardiac arrhythmia due to mutations in voltage-gated sodium channels. We generate transgenic mouse models and use human induced pluripotent stem cells. Believe me, the gratification is never instant!  However, as Assistant Dean for Graduate Education in the Medical School, I have the privilege of being able to change a young person’s life for the better in an afternoon – and that makes it all worth it.  The graduate students at Michigan do far more for me than I could ever do for them. I urge young women in science to dare greatly.  Consider a leadership role. It’s the greatest job in the world.

 

lypsonMonica L. Lypson, M.D., MHPE, FACP
Professor of Internal Medicine & Medical Education
Assistant Dean for Graduate Medical Education

Young women should take advantage of all leadership opportunities to learn new skills. These opportunities should be in areas for which you have a true interest and passion – regardless of whether they are in medicine.  Often for students these opportunities take the form of leadership roles in student groups, community activities and undergraduate studies.  In addition, seek out opportunities that expand your sphere of influence, such as national student roles and attending regional conferences.  This work early on will help solidify your decision whether or not to pursue leadership roles, identify the type of roles that are right for you and give you valuable experiences with operational issues, as well as the chance to engage, motivate and inspire others.  Those are often the key attributes of a strong leader.

When it comes to gender equality and diversity, it is important to see leaders and role models who look like you and have similar experiences. Diversity drives excellence and generates innovation. If we don’t have a portfolio of leaders that reflects everyone in the population, we lose out on critical viewpoints, experiences and knowledge that can enhance an institution’s effectiveness.  Harnessing diversity is really about ensuring innovation and excellence.

Another point I want to make is that mentors are critical to a career in leadership.  Mentors will help you learn the “rules of the road.” However, it is only when those mentors put themselves on the line and become sponsors that they really help leverage a career.  The key is to remember that sponsors can come in any gender, race or ethnicity, and that sponsors and mentors can learn just as much from you as you can learn from them.  For example, in the course of my career, I have made a point of taking advantage of all eligible maternity leave options. At times, this meant making new tracks for those who come after me and discussing with my male sponsors how important these options are for women. I used these discussions as educational opportunities for male sponsors and the learning turned them into advocates for other women.

 

muraszko_karin4x5_1286Karin Muraszko, M.D.
Julian T Hoff M.D. Professor of Neurosurgery

Chair, Department of Neurosurgery
Professor of Pediatrics, Surgery & Plastic Surgery

Medicine remains exciting and challenging for all who enter.  With the rapid accumulation of knowledge and communications now occurring in hyper speed, anyone choosing a career in medicine will find that they must constantly grow and learn to stay relevant and effective.   As a female Chair of a Neurosurgery department, I am used to a world that has largely been male dominated.  I am struck by the fact that the challenges I have faced are now not just the purview of women but are important to all neurosurgeons.

Over the years, I have learned that preparing for and adapting to change is important.  Acquiring skills can be useful, when you least expect it.  Learning how to read a budget, design an effective marketing strategy, speak in a public forum, or write an op-ed piece may not seem relevant to a medical career, but can give you talents that will be useful later in life.  Personally, I had never really wanted or considered being chair of a department.  As a woman, a person with a disability and a pediatric neurosurgeon, it seemed impossible that I would ever be considered for such a position.  I applied primarily because I believed it was important that someone from our department communicate the needs of the department to the search committee and to the greater administration.  I saw this as an opportunity to improve the department and to let folks know just how good we were.  When I was selected, these principles proved to be important to my success as a chair.  I truly believe that great leaders work hard to see that those around them succeed.  In that sense they are much more moon (reflected glory of their constituents) than sun (self-aggrandizing).

By making use of leadership development courses offered at the University and by enrolling in ELAM (Executive Leadership in Academic Medicine), I began to see myself in a larger picture and not just my role in my department.  These experiences gave me a skill set to navigate outside my department and helped me understand the role of neurosurgery in the larger institution.  And though all politics are local, I would advise individual physicians to sometimes step outside their departmental structure and participate in groups or committees that are institutional in nature.  These experiences can help you understand the larger institution but can also help you understand what a leadership position might look like.  It also gives you a bigger yardstick to measure your own abilities and accomplishments.  Self-assessment of your individual skills and evaluation by honest mentors can help you have a more accurate picture of who you are and what your talents really are.  It is important to remember that mentors need not be similar to us, but rather should be chosen because of their personal and professional skill sets.  Had I waited to find mentors that I could relate to or came from a background similar to mine….I would never have found them.  If you find you admire someone for what they have done or how they have handled themselves, they are likely someone you can learn from.

Gender equity is important in medicine if we are going to make use of all available talent.  Over 50% of medical school classes are now women and I expect that eventually leadership positions will reflect those changes.  When I started my residency, the locker rooms read:  “Doctors locker room” and “Nurses locker room,” implying that all nurses were women and all doctors were men.  That was only 25 years ago!  Changes have come and will continue to come.  It is important that women seek to make themselves well trained not just in their specialties but to also develop their leadership skills.

Reaching outside your comfort zone often produces the greatest growth and development.  Taking on difficult challenges is an important part of leadership development and creates or unearths a skill set that may be useful in the future.  In some ways, I believe that being so different from the traditional neurosurgeon, I was liberated from thinking about whose path I would follow and therefore I could create my own unique road.  It is liberating to feel comfortable in one’s own skin and know that the career I have chosen has been uniquely my own.  Had I listened to advisors that said that a career in neurosurgery was just not possible for a woman, let alone a woman with a disability, I suspect it would have been a much less fulfilling life.  Finding mentors who were willing to take the chance on me by being both my greatest supporters and also my most honest critics was important.  Most were men and many came from backgrounds other than neurosurgery, but each offered advice and honest criticism of areas that needed improvement.  Many had daughters, wives or mothers that had broken their own molds or were experiencing difficulty in their careers and these advisors sought to help someone else face less inequity.  Equity isn’t just about gender; it’s about the ability to harness the best from everyone and from every background.  It creates a rich and diverse tapestry that is stronger than any individual fiber and far more brilliant than a single colored cloth.

For any interested in knowing more about women in Neurosurgery, I would recommend reading essays in the book:  Heart of a Lion, Hands of a Woman:  What Women Neurosurgeons Do edited by Benzil and Muraszko.  It provides you with a glimpse into the lives of a variety of female neurosurgeons and their unique journeys in medicine.

 

santen-copySally Santen, M.D., Ph.D.
Clinical Associate Professor of Emergency Medicine & Medical Education

Assistant Dean for Educational Research and Quality Improvement

Becoming a leader involves working on your areas of strength, but also addressing your areas of weakness.  Early on, I believed that hard work would get me where I wanted to go and I worked to develop my areas of strength.  I wanted to be an medical educator. All of the medical educators I knew were physicians without other training.  They had learned to be teachers through the medical school model of  “see one, do one, teach one,” meaning students train by watching physicians take care of patients or do procedures, then do these same activities and then teach these activities. The teachers I knew had formal training in teaching and I was uncomfortable with the medical school model. This led me to getting a Ph.D. in education- working hard to get smarter and more qualified.

During this process, there were areas of my personal development – my weaknesses – that I neglected to address. By nature, we tend to prefer to do the things that we like and that we are good at. So, we focus our time and energy on our strengths instead of the areas in which we need to improve. It is important to confront and strengthen – even overcome – weaknesses that are barriers to your goals.

Diversity and gender equality are key components of a progressive and thoughtful workplace and team. When a group is not diverse, there is a tendency toward superficial, one-dimensional thinking that reinforces the views, norms and behaviors of the group. In these settings, there may not even be awareness of what is happening. Diversity of all kinds helps us examine and broaden our views, and discover and develop better ways of thinking and deeper understanding.

Patrick G. Awuah Jr. on Courage

I love this comment on courage made by Patrick G. Awuah Jr., founder and president of Ghana’s Ashesi University College, during a speech at Babson College:

To really make change, we must have courage: the courage to imagine something new, the courage to act, and the courage to persist through setbacks. We all recognize those leaders whose dramatic acts of courage changed the world.

We are well familiar with the actions of political leaders such Abraham Lincoln, Martin Luther King, Mohandas Gandhi, and Nelson Mandela; of innovators such as Steve Jobs, Thomas Edison, and Alexander Bell; and of pioneering scientists such as Isaac Newton, Albert Einstein, and Charles Darwin.

But courage is not always about big, dramatic events. It is often about quiet, determined action every day, at work and at home. The courage to say “Sorry” when you’ve wronged someone. The courage to be introspective and honest with yourself. The courage to join a cause you believe in and to do all you can to help it succeed. The courage to even imagine a different future.

Ora answers questions about the Affordable Care Act in AA.com

Ora and Rob Casalou, president and CEO of Saint Joseph Mercy Ann Arbor and Livingston hospitals (SJMHS), answer Betsy deParry’s questions about how the ACA will impact patients. I’ve pasted the article below. You can find the original on AnnArbor.com . ~Allison Krieger, EVPMA Communications

Beyond politics: the Affordable Care Act, your doctor and you
By Betsy de Parry
Community Contributor

The Supreme Court’s decision to mostly uphold the Affordable Care Act (ACA) set off an incessant roar about whom the decision helps or hurts politically. I’ve wanted to scream, “What about us – the patients? And what about our doctors?”

I’m not alone. The cyber world is flooded with concerns and assumptions, not to mention a whole lot of misinformation. And no wonder.

The debate has been framed in the context of politics and spun to benefit one side or the other, leaving most of us confused and some of us downright scared about how the law will impact that most vital and intimate of relationships: that between patients and doctors. We’ll be around long after this election cycle is over.

There are no simple answers to anything as complex as health care, but those who are on the front lines are best qualified to provide accurate insight. Dr. Ora Pescovitz and Rob Casalou are on those front lines, navigating the challenges of providing and improving our care every day.

Dr. Pescovitz is the CEO of the University of Michigan Health System (UMHS), which treated 1.8 million people in an outpatient basis and 45,000 people in the hospital last year.

Mr. Casalou is President and CEO of Saint Joseph Mercy Ann Arbor and Livingston hospitals (SJMHS), which are part of Trinity Health, the 10th largest health care system and the 4th largest Catholic health care system in the country, by total number of hospitals (49 in 10 states) and total bed count, respectively

I’m grateful to Dr. Pescovitz and Mr. Casalou for giving us a view of the law and our health care system from the standpoint of what should matter most – our health care. They point out that:

- doctors, not panels of bureaucrats, will continue to decide what is best for patients

- medical practices and hospitals are building capacity to care for more patients

- there is no evidence that doctors are leaving the practice of medicine

- medical school applicants are up, indicating that there will be more doctors to care for people in the future

- because our current health care system is not sustainable, doctors and hospitals began implementing more efficient systems that would reduce cost while improving patient care and outcomes even before the law was passed

And they tell us so much more, which is why I share their replies to my questions in their entirety.

Q. How – or will – the ACA change our relationships with our doctors?

Mr. Casalou: Our relationship with our doctors continues to change because of the laws of economics and not the laws created by our government. The fact is that our country cannot sustain the costs of the health care system as it is structured today.

The idea of managing populations and trying to reduce costly care is not because of the ACA, it is because of economic reality.

Health care can be expensive, it can be uncomfortable and it can take time away from other priorities in our lives. Yet, it is a product we need and it must be high quality and low cost. Thus, for us to deliver that product, doctors and hospitals must align closely and have common incentives to make sure we try and maintain a healthy population in the communities we serve. This is one of the major reasons we came together with IHA.

Dr. Pescovitz: One of the big things that the ACA emphasizes is quality of care – are doctors and their teams doing everything for patients that we know is proven to work and that can keep people healthy? And, it’s tying payment to performance on quality measures and patient satisfaction. This is a big change for our industry and, quite frankly, one that is a long time coming.

Now, hospitals and doctor’s offices will be working even harder to make sure patients get the right care at the right time. It will be financially beneficial to avoid unnecessary tests and procedures, reduce duplicative efforts and make process improvements that reduce readmissions, hospital-acquired infections and the like. All of this should help improve patients’ overall experience – and health.

For people who haven’t had a regular doctor, such as people without insurance, the ACA will make it easier for them to get the kind of regular care they need and build a relationship with a doctor who can work with them on their health issues.

One of the reasons health care spending is so out of control is that, as a nation, we don’t do a good job on the preventive side of care and, as a result, people develop preventable chronic conditions that are costly to their health and to the health care system.

With more people having access to care, we have an opportunity to take better care of patients early on and see them regularly as they age and their health needs change. This will have significant long-term impact on the health of our population and on health care spending.

We (UMHS) have a bit of a “head start” on making these kinds of changes because we have spent the last five years proving that we can provide exactly the kind of coordinated, high-quality care that the ACA is designed to encourage, while containing the growth of costs. We did this in a Medicare demonstration project that laid the groundwork for Accountable Care Organizations (ACO), and we’re doing it now through our new Pioneer ACO with the physicians of U-M and IHA (a multi-speciality group practice). We are also pioneering a “patient centered medical home” model that the ACA encourages.

Q. Because the ACA gives millions more people access to health care, there is speculation that the influx of new patients will strain the system beyond capacity. What assurance, if any, can you give patients that waiting for months to see doctors won’t be the norm?

Mr. Casalou: First, we believe creating the ability for all people to access care is a good thing. We also need to remember that many of the current uninsured patients in our community do access care and use the health care system now. Many pay out of pocket for their health care and we and other hospitals currently write off all or part of medical bills for the uninsured.

So, while there will be more patients accessing care, not all the newly insured will be incremental to our health care system.

Having said that, we are building capacity, particularly in primary care, to provide a medical home for all our patients. Just this past year our physician partner, IHA, added several primary care doctors and nurse practitioners and will continue to do so in the coming months and years.

We do not anticipate longer wait lists or lower quality in the care of patients as a result of increasing demand.

Q. Our doctors are already constrained by time. Do you anticipate that the time they spend with us will decrease?

Dr. Pescovitz: In my 30 years of treating patients, and working with medical students and residents, there’s one constant: we always want to be able to spend more time with our patients, and to be able to see all the patients who want to see us. But, more importantly, we want the time we spend with patients to matter.

I am hopeful that trends in health care, including those influenced by the ACA, will help doctors make the most of the time with patients. With millions more insured Americans, we will definitely see more people seeking access to care they haven’t previously had, so we will need to be diligent and responsive to this influx. The ACO model addresses this by suggesting a structure of more coordinated care amongst all members of an individual’s health care team.

Also, the ACA incentivizes hospitals and doctor’s offices to invest in technologies and care strategies that can make them run more efficiently – such as computer systems and physician extenders. So, these measures may help reduce the time doctors spend on things besides caring for patients. At the same time, there’s a great push to increase the supply of doctors.

Q. There is speculation that the ACA is driving doctors who are currently practicing out of medicine and that it will drive the best and the brightest young people to professions other than medicine, which, of course, will mean fewer doctors to treat more people. Are you seeing any evidence of this?

Dr. Pescovitz: I interact with faculty, residents, medical students and community physicians from all over the country all the time, and we all share a common drive to help people get better and live more productive and fulfilling lives. Whether we do that as physicians delivering care, scientists developing treatments or faculty teaching future generations of physician-scientists, it is part of our core. I don’t think that has changed or will change. Medicine remains one of the most rewarding and sacred professions.

I don’t think the ACA is driving people away from medicine. It would be premature to draw such a conclusion. Actually, more young people are applying to medical school than ever before – 7,000 more nationwide last year compared with a decade ago!

I do think that the profession is changing as lifestyles and priorities change, and as new generations enter the workforce. Today, people prioritize work-life balance differently and are making career decisions that reflect this priority. At the same time, we are seeing young professionals and students with more technological expertise bring new and exciting perspectives and skills that will certainly shape the future of medicine.

Q. We’ve seen drug shortages as recently as a few months ago. Won’t this only get worse as millions of new people enter the system? How is this possibility being addressed?

Mr. Casalou: The other way to look at this question is to say that if we have millions of people who are not receiving adequate care, including medications, isn’t it incumbent on us to build the capacity to meet the demand? Wouldn’t any other manufacturing or service industry do the same?

While we have dealt with shortages from time to time on various drugs, we have a very large and capable pharmaceutical industry that I am sure is already preparing for additional demand as they deal with current isolated shortages of some medications

Q. The ACA has been called government-run health care. Will the government now dictate what procedures we can or cannot have or will those decisions still rest with our doctors?

Dr. Pescovitz: Those who throw stones at “government run health care” often ignore the fact that huge numbers of Americans already rely on government-run plans such as Medicare, veterans’ care, Medicaid, and special programs for sick children.

All of these programs, and insurance plans from private companies, give doctors a lot of leeway to decide what is best for their patients, and will continue to do so. As the ACA takes full effect, that should still be true.

But, the other thing that will happen – and this is a very good thing for all of us – is that all forms of health coverage will focus hard on making sure that patients get the care that has been shown to work for people with the same condition as them. This is what is often referred to as “evidence-based medicine.”

And there will be more research at places like U-M to actually study what works best, so more patients can get proven care. In fact, our new University of Michigan Institute for Healthcare Policy and Innovation was conceived to bring together hundreds of health services researchers who share a common goal of studying health outcomes to ensure better, safer, more equitable and more cost effective health care.

Q. Serious illnesses such as cancer may require periodic, long term or lifelong treatment. Is there anything in the law that will prevent our doctors from treating us at any time in the course of our illnesses?

Mr. Casalou: I don’t see anything in this law that will prevent or withhold appropriate care to patients.

Q. There is speculation that the cost of administering the ACA and/or increased demand will drive up costs which in turn will drive up premiums. True or false and why?

Mr. Casalou: If the only outcome of the ACA is to have more people using the current system with the current cost structure and utilization of high-end services then, yes, costs will go up. However, this outcome would not be economically sustainable.

This is why accountable care was a centerpiece of the legislation. The idea is that we will increase access to care while lowering the cost of care per individual as we maintain health rather than have a system based on sick care. Both of these elements are crucial for this to succeed.

Q. What does the ACA mean to research, clinical trials and patients who want to participate in them?

Dr. Pescovitz: The ACA is already funding a wide range of research that compares medical treatment options and gives us valuable information on what works and what doesn’t.

As for clinical trials, the majority of funding for those comes from federal agencies whose budgets aren’t affected by the ACA, but are facing budget cuts because of the failure of the “super committee” last year. In fact, federal and state funding for all kinds of medical research, not just clinical trials, is going down – not up – and that’s posing a big challenge to research institutions like ours. Groups like Research!America offer a lot of information online about this threat and what members of the public can do about it.

Private companies also fund a lot of clinical trials, and there are new requirements outside of the ACA to make sure that these are done safely and transparently. Additionally, we are seeing a trend in philanthropic support for research, which will become more important as other funding sources dry up.

Q. What would you say to patients who are concerned about the new law?

Dr. Pescovitz: Learn more and get informed! When you strip away the politics, it is clear that most people simply are uninformed and rightfully concerned about what the ACA means for them and their families. Healthcare.gov is a good resource for information, as is healthlawguide.aarp.org.

Also, talk to your doctor and stay engaged in the ongoing conversation as we work through changes in health care. We want patients to be our partners in shaping this change.

Change is never easy, but these changes are long overdue. We must get American health care to a better place. Doctors and hospitals are already becoming more motivated to provide high-quality care and better customer service because of the ACA.

If you have children who are young adults, are in the Medicare prescription drug “doughnut hole,” or have a pre-existing condition that makes it hard for you to find affordable insurance, the ACA is already helping you. And no matter what your situation, the ACA is intended to make sure that we as a society spend our health care dollars more wisely, fairly and humanely.

This is a journey. We didn’t get here overnight and it will certainly take many years – even decades – to see the full impact of changes we are enacting today. But, positive change is necessary.

Mr. Casalou: I would say to try and filter through the politics and rhetoric of the law. It is complicated and people who are on both sides of the politics of the law spend a lot of time trying to create fear or overstating aspects of the legislation.

The law is far from perfect but so is our current health care system. Our system needs a transformation and, if the bill has done nothing else, it has put a spotlight on a problem that has been growing for several years, and has become too costly and not accessible to all Americans.

I suspect the law will get refined over time to deal with problems as they arise. For us, we are staying the course.

Q. Most everyone agrees that the current system of American health care is not sustainable. What steps are health care systems like yours taking to decrease costs without sacrificing patient care?

Dr. Pescovitz: For a country that wants to be the best at everything, health care is an area where we lag significantly. We have amazing options for people who have good insurance, and terrible options for people who don’t.

As a nonprofit, UMHS provides a large amount of care either for free or at reduced cost to those who don’t have coverage. But, we can’t do this for everyone. No system can.

As a society, we’re spending health care dollars badly, because we pay for emergencies and care for advanced disease that has gone untreated, rather than prevention and lower cost, early-stage intervention.

Make no mistake – if you have insurance, whether through private insurance or a government program, the truth is you already pay for the cost of caring for the uninsured, so it benefits the majority of our country’s population to get national health care spending under control. Inaction isn’t an option.

The ACA, and changes to health care reimbursement that were taking effect long before the ACA, are making hospitals, doctor’s offices and other health providers become more efficient. The ACA and insurers are driving us to make much-needed changes in computerization, quality measurement and customer service that other industries have long had in place. That means reducing waste, to reduce unnecessary costs, but it also means investing in things that will improve the patient experience and provide the care that patients actually need, rather than what pays the bills.

For nearly a decade, we’ve been working with Blue Cross Blue Shield of Michigan to lead efforts to improve care at hospitals statewide, in specialties such as heart care, cancer care and medical imaging. These are data-driven, cooperative efforts that have resulted in much better outcomes for patients and hundreds of millions of dollars in avoided costs because doctors and hospitals are doing things in consistent, proven ways instead of just the way they’ve always done them.

Mr. Casalou: For the past four years, we have been getting our health care system ready for the new realities of health care. The plan has many facets including reducing costs through redesign or elimination of costly programs and excess capacity. Examples include the elimination of our helicopter service and contracting with UM, and converting the St. Joseph Mercy Saline hospital into a outpatient health center that more appropriately meets the needs of the community.

In fact, the collaboration between St. Joe’s and UM in recent months is intended to benefit our community by eliminating redundancies and coordinating the delivery of services where appropriate.

The plan also includes investments in the front end of care, our physicians, and creating a medical community at St. Joe’s that is aligned and cohesive. Examples include the merger with IHA and the subsequent growth of our physician network.

The plan includes redesigning care to create a high quality and safe care environment. We are seeing great results as St. Joe’s has received national recognitions and awards this past year for high quality care and patient satisfaction.

And last, but definitely not least, we are working to keep our employees engaged as members of health care family by maintaining a work environment that enriches them as professionals. We keep what is called a “balanced scorecard” where we measure every aspect of our plan to make sure that we are achieving all of our goals and not focused just on one area.

Betsy de Parry is the author of Adventures In Cancer Land. Find her on Facebook or email her.

http://www.annarbor.com/health/beyond-politics-the-health-care-law-your-doctor-and-you/