During the last few months, I have been visiting with as many of the 21 ASCO committees as I can in order to understand the issues that they have identified as most critical for cancer education, research, and patient well being. I have been impressed by the richness of vision and dedication that is so evident in ASCO’s committees, and it renews my conviction that we as oncologists continue to retain significant influence in defining our professional character and the course of oncology care in the United States and throughout the world. These days I am traveling to ASCO on almost a weekly basis, and I have been able to visit with community and academic centers to learn about the models of cancer care delivery and research that are able to thrive in this often inhospitable environment.
Two weeks ago I came to ASCO for our Government Relations Committee, chaired by Deny Hammond, and visited with the health care policy staff of House Majority Leader Eric Cantor to receive updates on the progress of the House Ways and Means, House Energy and Commerce, and Senate Finance Committees bipartisan and bicameral legislation to replace the failed SGR legislation with legislation that is more likely to result in sustainable quality improvement, cost containment, and viable physician practices, as well as to advocate for ASCO’s vision of how this might be achieved. Before returning to California, I visited Dr. Ed Kim at the Levine Cancer Center, Carolinas Health Care System. Dr. Kim is Chair-Elect of the ASCO Cancer Research Committee, and I invited him to serve in this capacity because of the innovative model of cancer care delivery and research that is developing at the Levine Cancer Center.
The Carolinas Healthcare System is a community-based health care delivery system that has made a serious long-term commitment to foster a new model of cancer care that blends the strengths of academic leadership and community oncology commitment to patient care. The early results are most impressive with refocus of cancer research on industry trials, including investigator-initiated trials, a phase 1 unit, a new transplant program supported by basic science laboratories, and a commitment to education that includes a future oncology fellowship program
This week I returned to ASCO for our Quality of Care Committee (QCC), which is one of the most vibrant and productive of ASCO committees, led by community oncologist Carolyn Hendricks and ASCO Director of Quality Kristen McNiff. The QCC oversees ASCO’s portfolio of quality improvement, which include QOPI, the QOPI certification program, and the evolving eQOPI, which will re-engineer QOPI to allow integration into electronic health records. The QCC is also the home of ASCO’s Health Information Technology Workgroup, which is leading ASCO’s efforts at improving interoperability of electronic health records. With the February 6th release of the proposed SGR Repeal and Medicare Provider Payment Modernization Act which emphasizes the role of digital reporting of quality and resource use, ASCO’s eQOPI is positioned to help oncologists meet the demands of the proposed changes to the Medicare Program. The QCC has developed innovative programs of active learning to teach oncologists the methodology and science of quality improvement such as ASCO’s inaugural Quality Improvement Training Program wherein diverse practices from university and community backgrounds acquire the skill sets of managing cultural change, statistical tools for measurement of variability and rapid cycle improvement.
The ASCO Virtual Learning Collaborative for Palliative Care is an AHRQ funded project that ASCO is conducting in collaboration with the Academy of Hospice and Palliative Care Medicine that engages 25 practices representing academic and both large and small community practices in learning how palliative care can be integrated into oncology care delivery. The QCC leadership will transfer to Dr. Michael Neuss of Vanderbilt University, a medical oncologist who has spent the majority of his oncology career in community practice in Cincinnati.
After the QCC, I traveled to Brown University, my alma mater, to spend a couple of days visiting the School of Public Health, School of Medicine and with medical students, residents and oncology fellows. With a projected 40% increase in the incidence of cancer by 2030, our workforce needs necessitate reaching out to medical students and residents and presenting a career in oncology as an opportunity to fully realize their talents and professional aspirations. Managing our professional commitment to our patients while preserving our own quality of life by ensuring time for family and personal needs has become a part of residency training. The medical residents and chief residents I met with expressed frustration that the limitations on their work hours have curtailed the ability of residents to learn their craft. I asked the medical residents if they agreed that the reduction in clinical experience would need to be made up during the first few years after they enter practice and at a time when they do not have the mentorship provided by a residency and fellowship program. Not only did they agree with this, but the residents informed me that they seek out additional clinical care exposure through moon lighting on their hospital services.
It appears that the intended beneficiaries of reduced work hours themselves feel that the pendulum has swung to the opposite extreme. However, ASCO has recently documented that professional burnout is a prevalent problem among oncologists and a problem that ASCO needs to address to better support our membership. Dr. Fred Schiffman, Vice Chairman of Medicine at the Warren Alpert Medical School of Brown University, is a medical oncologist-hematologist who has recognized this challenge and is working to develop professional support for oncologists. These are concerns that the ASCO Professional Development Committee will need to evaluate closely.
Without a doubt, ASCO committees provide leadership for our Society by identifying emerging issues and devising innovative solutions. It is one of the better kept ASCO secrets and I believe that we will have a stronger Society if we consciously make an effort to communicate the work of ASCO committees to ASCO membership, solicit feedback about whether we are on or off target, and engage broader participation by our membership in the wealth of our Society’s activities. Let the secret out!