Leading ACP through the ever-changing tides of health care means continual innovation and outreach the world over, but pulmonologist Steven E. Weinberger, MD, MACP, isn't out of breath.
In his 6 years as the College's Executive Vice President and Chief Executive Officer, he has overseen changes in policy, advocacy, and patient care. Some of his efforts include launching the High Value Care initiative, navigating members through the passage of the Affordable Care Act and MACRA, and helping shape modifications to the Maintenance of Certification (MOC) program.
Dr. Weinberger graduated from Harvard Medical School in 1973 and was on the full-time faculty of Harvard and Beth Israel Deaconess Medical Center for 26 years before coming to ACP in 2004 as Senior Vice President for Medical Education and Publishing. In addition to internal medicine, he is board certified in pulmonary medicine and has single-authored or cowritten 6 editions of the textbook “Principles of Pulmonary Medicine.”
Dr. Weinberger stepped down as EVP/CEO this fall but will remain at the College through September 2017 in his new half-time role as associate EVP and CEO emeritus, helping his successor, Darilyn Moyer, MD, FACP, transition into the EVP/CEO role. After that, he hopes to teach, travel, spend time with family—and even make a little music.
He recently spoke with ACP Internist about his time spent leading the College and touched on his personal plans, internal medicine's changes and challenges, and his expectations for the future of health care delivery.
Q: How has internal medicine changed since you first started as EVP/CEO?
A: There are 3 main changes I would identify. I think there has been much more of a concern about physician satisfaction and the kinds of things that physicians are going through in the course of their daily practice—concern that what had previously been more of a profession has morphed into a job with administrative burdens, which, from my point of view, is really too bad. It still remains an absolutely spectacular calling or profession to do as a lifetime activity.
Another thing that has come into play is more of a recognition that physicians need to be working much more closely with patients, both in terms of partnering with them in their own care, as well as understanding their perspectives about how practices and health care systems need to deliver care in a way that is much more patient-centered.
The third change is that we now have a much greater recognition of the financial implications of everything we do as physicians, the resulting cost of health care to society, and the responsibility of the medical profession to be controlling health care costs.
Q: How has ACP changed along with internal medicine?
A: I think that our positions and our advocacy efforts have been addressing some of the new areas that I just mentioned, such as the importance of patient-centered care and the concern about improving physician satisfaction and well-being. As part of patient-centeredness, we have been putting an emphasis on the patient-centered medical home model. We've also had a major interest in how the physician community can control health care costs by avoiding overuse and misuse of care and by reducing both unnecessary hospitalizations and escalating prescription drug costs.
ACP has begun to look more broadly at the health care environment. We've become more involved internationally, and we also have become much more involved in those public health issues that affect individuals but also have broader societal impact, such as firearms violence. We've also become much more interested in such public health issues as health care disparities and LGBT health.
The other timely issue that we're very much interested in is climate change. One might think, ‘Why should a membership organization like ACP become involved with climate change?’ Well, the long-term impact on health, both for individual and societal health, is enormous. It cannot be ignored by the medical profession or by any other health care professionals.
What we've tried to do is to keep as our core value improving the health of individuals and the health of society. This is the North Star that guides much of what we are trying to do at ACP. And we work with our physicians in ways that will simultaneously benefit them, their patients, and the health care system.
Q: Looking back, what were some of your proudest moments leading the College?
A: I'm very proud of the Center for Patient Partnership in Healthcare that we established in 2013, because I think it really put ACP at the forefront of medical professional societies promoting the concept that care needs to be a partnership between health care providers and patients. I'm also very proud of the High Value Care initiative that we started in 2010. We focused quite early on the need to control health care costs by reducing overuse and misuse of care, in fact before the ABIM Foundation started the Choosing Wisely campaign. In our High Value Care initiative, we committed to identifying areas of overuse and misuse of care, and to educating physicians and patients about these areas.
I'm also very proud of some of the social positions that we've taken, such as our efforts relating to firearms violence, which included our lead role in organizing many other groups to become partners in this effort. One of my “15 minutes of fame” was when my name was on the National Rifle Association website after our position paper on firearms violence was published. That is not something I ever intended or wanted, but it did demonstrate the visibility and impact of our position statement.
Recently, I've had to spend a significant amount of time working on the whole issue of MOC. In my opinion, I think we have navigated those difficult waters in the most appropriate way, strongly stressing that the MOC program needs to be reformed, but we have also been trying to work with the American Board of Internal Medicine (ABIM) to get those changes made most efficiently and effectively. In this effort, we get pressure from both ends of the spectrum of opinions about MOC, and we've tried to position ourselves in a way that would be best able to achieve our desired outcomes for MOC reform. I suppose when we get equal criticisms (as well as equal praise) from both extremes, that probably means we're in the right spot.
Another area I am proud about is our international expansion. This is actually the fastest-growing segment of our membership, and we now have about 13,000 international members. We also have a number of new international chapters, now with a total of 19 international chapters from diverse areas across the world. Sometimes people ask why we are involved internationally. It's because “the world is flat” when it comes to health care; we learn a lot from our international colleagues, and I believe we provide a lot of value to them, as well.
Q: Five years from now, what do you think internal medicine will look like? What changes do you anticipate?
A: I think we're going to see a lot of changes in the way that care is delivered. In this Internet age, patients are becoming much more empowered to look things up themselves, to become more knowledgeable, and also to have greater demands—and I'm saying that in a positive way—for how care is delivered to them.
Nowadays, when you want something, either a product or a service, you want and often can get it essentially right away. However, that's not typically how we provide health care. We often think of care as being based on a longitudinal relationship with a primary care provider, but the way we implement that model may need to adapt over time.
When people will have an individual health care need, they may not be willing to wait for weeks, days, or even 3 hours to see a physician. Rather, they may want advice or care delivered to them at their house, maybe remotely through a computer, or at either retail clinics or clinics that are at the site of employment. The health care profession will need to be pretty agile in responding to these preferences for when and how individuals wish to get their care.
I predict that care will be increasingly driven by how patients or consumers of health care wish to receive their care, and much less by the traditional ways we as physicians have been delivering care. We have to be able to adapt to these changing preferences and needs while maintaining the importance of longitudinal patient-physician relationships.
Another area that I believe will be evolving is assuring that care in the outpatient setting more effectively allows us to reduce emergency room visits and hospitalizations and, as a result, both better meets patients' needs and reduces the huge costs associated with hospitalization. Right now, care is very fragmented, and there is (and should be) a drive to assure that care is provided in a much more coordinated way.
Physician satisfaction and burnout is an increasingly important issue, in large measure because there's such huge time pressure on physicians. The idea that you can establish a relationship with the patient, take his or her history to find out what's going on, do a physical exam, evaluate any data from diagnostic testing, arrive at a diagnosis, explain your thoughts to the patient, and do the documentation, all in 15 minutes, is an incredible challenge.
If there's one thing I'd love to see, it's an expansion of the time for the physician-patient interaction so that those things can be done in a much more thoughtful, appropriate, and non-rushed way. I'd like sufficient time to be available so that the physician at the end of the day doesn't have to spend an extra 2 hours documenting things that should have been done on site right at the time of the visit. To me, the dirty 4-letter word in health care is “time.” In many ways, I think that has become even more of an issue and a concern than money.
Q: What does the next year look like for you clinically?
A: I'm continuing to teach as an adjunct professor of medicine at the Perelman School of Medicine at the University of Pennsylvania. I also continue to have a faculty appointment at Harvard, and I go back there occasionally and do some teaching. During the coming year and beyond, I hope to continue and perhaps expand my teaching of medical students, residents, and subspecialty fellows. A project that will also occupy my time over the course of the next year relates to a pulmonary textbook that I have written for 30 years and that has gone through 6 editions. The publisher wants me to do a seventh edition, for which I fortunately now have 2 coauthors, and the content for the new edition is due in April 2017.
Q: When next September rolls around, are you going into complete retirement?
A: Probably not. I'm currently thinking I would like to get back and do some more teaching, which I have always loved. Whether or not I get involved with other boards or consulting types of activities, I'm not really sure yet. I have a lot of outside interests that I would like to pursue more than I have been able to do in the past. I'm a fairly serious amateur pianist, I have 2 grandchildren that I want to spend more time with, as well as with my children, and I would like to do more reading, more traveling, and more learning. I'm particularly looking forward to spending more time with family and hopefully becoming more accomplished as a pianist.