Text of the speech delivered this morning by ACOG’s 66th president, Mark S. DeFrancesco, MD, MBA, FACOG:
Come gather ’round people…
…If your time to you’s worth savin’
Then you better start swimmin’ or you’ll sink like a stone
For the times they are a-changin’
WOW… Bob Dylan wrote that in the 1960’s, 50 years ago, but his message still speaks to us today. The ’60s were a time of tremendous change in American society, and in many ways, Medicine began a process of change then too, which has continued to this day. We DO need to listen to Dylan’s message. THAT’s what we’ll be talking about today.
But first, I want you to meet my family and my honor guard. My AMAZING wife Helen has been my life partner, best friend and confidant for more than 30 years. Without her, I wouldn’t be standing here this morning. Yes, she’s beautiful….and loving…. and supportive, but she also routinely beats me at golf, and in many other ways keeps me grounded and real. Thank you Helen. After all these years, I still love you and look forward to our next 30 years together! By the way, our anniversary is May 4th, so every year we celebrate with you — several thousand of our closest friends!
Our son Chris is a builder and home improvement entrepreneur, and he’s here with his wife Mary and their three children, Will, Matt, and Emma, all of whom are very sad to be missing school this week, just for Poppy!
Erin is the artist and naturalist in the family, and our unofficial dog and cat-whisperer. She’s here with her friend Ned.
Bethany, an attorney, is here with her husband David, also an attorney, and Lily, who is almost a year old and is NOT yet an attorney. They live in Washington, D.C. — just like ACOG.
Our youngest, Katie, is an empathetic educator who will soon be a school psychologist. She is here with her friend Stuart.
I am very happy that my older brother Jim is here, along with his wife Laurie. (I love reminding him that he is indeed older.) Our younger sister, Janice, is unable to be here, but I have to thank both of my siblings because growing up as the middle child helped me develop diplomatic and negotiating skills, beneficial throughout my career.
My mom is 88 and is still doing very well, but she wasn’t up to the cross country travel, even for me, her favorite son (sorry Jim); and my father passed away about 20 years ago. I am indebted to them both for making me who I am. Family — thank you.
Today though, we are all family — a professional family — ACOG. My escorts today are also like family. My longest and closest friend, Dr. Thomas Stellato is a renowned general surgeon in Cleveland, Ohio. He and I have been like brothers since second grade. Tom was actually my inspiration to leave the world of business and politics for medicine many years ago, and he encouraged me every step of the way.
Dr Jose Eguia and I worked together until his retirement several years ago. I joined his solo practice in 1984, and the rest is history. He delivered Bethany and Katie, and has always been a great mentor and a very good friend.
Sue Ann Niesobecki, RN, was a labor and delivery nurse before joining Jose and me in 1984. After demonstrating outstanding managerial and people skills as our office nurse, she assumed the role of our practice manager. Before long in fact, Jose and I felt that we were working for her… BUT, we always worked as a team!
Finally, fast forward almost 30 years. Dr. Eghon Guzman is a maternal fetal medicine expert in Chile. He was the first chair of the Chilean ACOG section, and is a past president of the Chilean ob-gyn Society. Eghon represents all of the wonderful friends that Helen and I have in Chile, most of whom are here today. He also represents the expanded ACOG collaboration with other ob-gyns around the world. Eghon…, bienvenidos a San Francisco, y muchas gracias amigo!
Please help me thank Tom, Jose, SueAnn and Eghon for being here today. (APPLAUSE)
Now, my first official action as your new president is to formally thank our now past president…
Dr. Jennings, would you please return to the podium?
John, on behalf of the entire College, I want to thank you for your leadership, and your friendship, during this past year.
You continued to build on the excellent work started by Jeanne Conry, on well woman care, and helped us move forward as we tackle some of the very difficult issues facing our practices and our workforce.
Your initiatives have focused on delivering integrated team-based healthcare, and undoubtedly will help us provide better care for more people.
I look forward to the challenges the next year will bring, and appreciate that you will be near, as past president, to offer your counsel. I hope to continue your fine work and advance it on behalf of our patients, our specialty and our organization.
John, thank you for all you have done and will continue to do for ACOG. This past president’s medallion is a token of our appreciation and continued good will.
TAKING CHARGE OF HEALTHCARE
“What is the future of Obstetrics and Gynecology as a specialty?” Dr. Reuben Peterson asked this question in 1920 in the Journal of the American Medical Association. At that time, obstetrics and gynecology were two distinct specialties, suffering from a major identity crisis. As we know, the ultimate resolution was to merge into one specialty, which obviously has worked very well and has advanced health care focused on women. Doctors combined the therapeutic armamentaria from both obstetrics and gynecology to provide care over the entire spectrum of a woman’s life. We provide prenatal care, even when medical problems threaten the lives of mother and child, and deliver babies — healthy babies. When needed, we perform surgery that makes a difference — a real difference — in times of crisis or trouble. And we provide care to help keep women healthy. Clearly, ob-gyn as a specialty has it all!
How PRIVILEGED we all are as obstetrician-gynecologists to have the HONOR and the RESPONSIBILITY of being entrusted by women with their healthcare. How amazing it is to witness the beginning of so many new lives, bringing such joy to so many families.
But here we are in 2015, and are again posing the same question asked by Dr. Peterson almost 100 years ago. So do times REALLY change? Today let’s talk about our SPECIALTY, our PATIENTS and our ORGANIZATION: ACOG.
For many years, we have been debating the nature of our specialty. Are we “primary care” or are we “specialists”? Well, WE know what we are — we are OB/GYNs — and more importantly, our PATIENTS know what that means! So let’s just do away with the term “generalists” and simply call ourselves what we are: “ob-gyns.”
During the past 30 years, our nation’s population has grown some 34 percent, with essentially no growth in the number of ob-gyns. Furthermore, more than a quarter of our graduates sub-specialize in some manner, and will not be practicing the “comprehensive” specialty of obstetrics and gynecology. So today there are FEWER ob-gyns to provide care and MORE people who need it. If WE don’t do something about this, WHO will provide the care? WHO will deliver the babies?
Let me be candid: When I chose our specialty some 35 years ago, it was because of the ability to provide a continuity of care over the course of a woman’s life, and the privilege of witnessing the birth of a new family. But now I worry that the EXCITEMENT and ENTHUSIASM that I felt are being THWARTED by many external forces, resulting in significant physician dissatisfaction. The healthcare world talks about the “Triple Aim” of providing HIGHER quality care, at LOWER cost, while at the same time enhancing patient satisfaction. BUT — no one talks about physician satisfaction. UNHAPPY PHYSICIANS CANNOT PROVIDE HIGH QUALITY CARE. We need to expand the Triple Aim to the “Triple Aim Plus One” and include physician satisfaction as an important metric.
A major study in 2013 surveyed 25 specialties for physician satisfaction — and ob-gyn was fourth — FROM THE BOTTOM! More recent studies put us near the TOP when measuring burnout. Not surprising though! The increasing burdens of regulatory guidelines, electronic documentation and medical liability concerns, amid a worsening national economy, are all very depressing. Perceived loss of autonomy and decreased societal respect also contribute to this problem. So to help our specialty, I will be asking our district and section leadership to help us assess the depth of this problem, determine its root causes and develop strategies to cure the malaise so that we restore wellness to our doctors and our practices. ONLY THEN CAN WE HOPE TO KEEP OUR PATIENTS HEALTHY.
Keeping our patients healthy? Isn’t that really why we are here this week? To learn even more about how we can help our patients become or stay healthy…?
My two immediate predecessors began addressing how we can provide more care for more people. Dr. Conry’s landmark task force on Well Woman Care defined the important elements of women’s healthcare, and Dr. Jennings encouraged us to team up with collaborative providers to provide more care more efficiently. Now, it is time to really take charge of healthcare by focusing on two problems which together contribute MORE TO MORBIDITY AND MORTALITY IN THIS COUNTRY than all of the cancers and specific diseases for which we routinely screen and treat: smoking and obesity.
Smoking causes 480,000 deaths per year in the United States alone, or about one of every 5 deaths in this country. Obesity results in another 300,000 deaths annually — combined that is 780,000 deaths per year, which is more than the total number of American deaths during WWII, and represents about one third of the deaths in the United States each year. THINK ABOUT IT… THAT IS 3 DEATHS EVERY 2 MINUTES. In the 15 minutes or so that have passed since I came to the podium, MORE THAN 20 PEOPLE HAVE DIED from the effects of smoking or obesity.
By contrast, total annual deaths from cervical, uterine, ovarian and breast cancers are estimated at fewer than 70,000. This is largely due to the critically important work we do in these areas. Just think of how much more we can do if we can work together to provide more comprehensive care.
These two problems directly affect our care: we all know that obesity increases the Cesarean delivery rate and other pregnancy-related morbidities. Even worse perhaps, we now also know that obesity in pregnancy may be condemning the newborn to a medically complicated life, because the fetus is programmed by the epigenetic influences of maternal obesity.
The economic costs arising from complications of smoking and obesity are astronomical and mind-boggling. Annual direct and indirect costs attributable to smoking and obesity are estimated to range from $500 billion to $1 trillion. That exceeds the amount of money needed to fund healthcare reform.
Let’s DO something about this! Look at the ACOG seal. We ARE, after all, “women’s healthcare physicians.” Remember, BEFORE we became ob-gyns, we FIRST became doctors. For most of us the decision to become a doctor was based on an altruistic desire to heal, and to save lives.
I don’t need to tell you that we are the only regular contact many of our patients have with the health care system. We meet many of our patients when they are very young, often before they become obese, certainly before they build up 20 or 30 or more pack years of smoking. WE can prevent it — we really CAN — and we should. We must challenge our patients to stop smoking. We must challenge our patients to lose weight.
70 percent of smokers do want to quit, and over 40 percent of smokers at least made an attempt to quit in the past year. They want to do the right thing, so let’s help them.
It begins with talking with our patients. Do you DIRECTLY ask your patients to stop smoking and lose weight? Do you offer local or technical resources to help? If not, you may be tacitly condoning their unhealthy life choices — and you will not be alone. Many of us don’t do this for our patients and we owe it to them to start.
To help you help your patients, I will ask ACOG’s standing committees to develop a toolkit specifically designed for obstetrician-gynecologists to address obesity and cigarette smoking in their daily practice. First do no harm? Let’s go way beyond that: let’s do even more good than we do right now!
Now let’s talk about ACOG. Today is not about me, but about our organization moving forward. ACOG, now 64 years old, includes almost every board certified ob-gyn in the country, virtually every ob-gyn resident and Junior Fellow in practice, and many members from other countries. The ACOG mission has always been to advance women’s health, through education, advocacy and support of our members.
Yes, our world is certainly changing, but our commitment to remaining relevant and dedicated to our mission will never change. Regardless of how successful we have been, we can and must always do better. We have an obligation to ACOG as an organization, to the many thousands of ob-gyns who have preceded us, and most importantly, to you, the newly inducted members here today, and those who will join us in the future, to ensure that we hand down to you an organization of which you can continue to be proud. An organization that continues to advance women’s health. An organization that will so inspire you to get involved that one day one of you will be standing up here, giving your own inaugural address!
For that reason, the last initiative that I announce today will be introspective, something for ACOG: “ACOG 2020.” We will re-assess our Strategic Plan, with emphasis on governance and operations, to ensure that we continue upholding our mission and values, both home and abroad, for our members and for the women we serve.
TOGETHER…2020 — and beyond.
Finally, I want to leave you with a few words about the future. This year’s annual meeting revolved around team care: Teaming up for Women’s Heath. It’s about providing more care for more people. More than ever, we must collaborate with other providers, and use new tools such as EMRs, smart phone apps and secure patient portals to provide more integrated care for our patients.
While not yet perfect, the electronic information systems we are using today were in fact envisioned by Dr. Fred Frigoletto in his 1996 inaugural address. Almost 20 years ago, Dr. Frigoletto grasped the relationship between data and quality, and predicted that one day we would be using these tools. Almost a decade ago, Dr. Ken Noller focused on changing practice in the 21st century and exhorted us to “Practice Smarter, Not Harder.” This has never been truer than it is today. We NEED to WORK in TEAMS.
As healthcare changes and we move into team care, we, the doctors, must lead it. The sacred trust immortalized in the Hippocratic Oath that we all took when we became doctors is threatened today by the pressures placed upon us by a system that is growing ever hostile to the doctor patient relationship. Regulatory and administrative systems should ENABLE, NOT OBSTRUCT, good healthcare.
Our patients know that WE, the doctors, are the true experts… and they want us to take charge of healthcare. Like it or not, healthcare is now an industry, but with all due respect to the business people, the administrators and the lawyers in the healthcare industry, there would be no healthcare industry if we, the doctors, were not dedicated to caring for our patients. Along with our patients, we, the doctors, must always be the ones making the healthcare decisions, not the ADMINISTRATORS and certainly NOT THE POLITICIANS. While there has been a need to come together in larger groups and integrated health systems in many areas, these new models should always be centered on the patient, NEVER, EVER ON THE INVESTOR.
No matter how large or complex the healthcare system grows, it doesn’t begin to approach the complexities of the human body, and we’ve spent our LIVES studying and understanding that… we can do this too! ONLY DOCTORS will really put the patient first. Doctors must TAKE CHARGE of HEALTHCARE…
We are in a time of great disruption in healthcare, but I do have equally GREAT expectations for the future. Looking at the bright faces of the many new ACOG Fellows who walked across the stage today, I believe these expectations are well founded. No question, it will be difficult, but I have no doubt that we will not only survive, but thrive. YOU know how to collaborate, YOU know how to work as a team, and YOU ARE LEADERS! When doctors like YOU lead the teams, PATIENTS WIN!
So today I’m CHALLENGING you to TAKE CHARGE OF HEALTH CARE. I’m CHALLENGING you to step out of your comfort zone of Pap smears and pelvic exams and provide care for the whole patient. I’m CHALLENGING you to be a good team player and at the same time LEAD OUR WOMEN’S HEALTH CARE TEAMS TO VICTORY. And for us, a VICTORY means saving MANY, MANY lives… and THAT’S why we became doctors!
Thank you very much.