Barbara McAneny applied lessons learned in oncology practice to lead the American Medical Association.
As Barbara McAneny, MD, hands off the baton as president of the American Medical Association to her successor, Patrice A. Harris, MD, the oncologist says she embraced her role in physician leadership as the healthcare sector shifted from fee-for-service medicine to value-based care models, she said in a recent HealthLeaders interview.
McAneny became a member of the AMA Board of Trustees in 2010 and is the founder and board chair at the National Cancer Care Alliance. Harris—a psychiatrist from Atlanta and the first African-American woman to hold the AMA presidency, is set to succeed McAneny on June 11.
McAneny never stopped seeing patients while leading the country's largest physician organization. She continued working as managing partner of the New Mexico Cancer Center in Albuquerque, where she pioneered the Community Oncology Medical Home (COME HOME) model to give cancer patients medical services when they needed care, rather than when it was convenient for the people providing the care.
"We reduced patients going to the hospital and, by intervening early for side effects, we saved about $2,100 per patient with that model as opposed to the accountable care organizations that crow about saving $36 per patient," she says.
The federal Centers for Medicare & Medicaid Innovation adopted the COME HOME program as the Oncology Care Model, which features more than 175 medical practices and 10 payers across the country. The model is based on the imperative to pay physicians for the services they need to provide to patients, McAneny says.
"In the COME HOME model, we had nurses on the phone talking with patients to check on them, and there was no fee for that under the fee-for-service model. We would sit down with patients and caregivers to educate them about how a disease works and how to manage the disease—there were no fees for that," she says.
'Comfortable with myself'
McAneny grew up in Southern Illinois, where her parents taught at Southern Illinois University—her father as a physics professor and her mother as a mathematician. Her home was in a rural area near the Mississippi River.
"There were very few other people living there, and it taught me to amuse myself. I learned to love books and walks in the woods, and to be comfortable with silence and being alone with my thoughts. At the time, I didn't know that I was going to choose a medical career but learning to be comfortable with myself served me well in later years," she says.
McAneny studied theater in high school and college, which was crucial training, she says.
"I've used those skills every day as a physician. To the patients sitting in the waiting areas, we, the doctors and staff, are on stage. They are watching to see if, as a team, we are good enough to save their lives. When I am training staff, I try to make sure they know how important it is to always project the image of being focused on the patients, rather than discussing extraneous things," she says.
After completing her residency in internal medicine at the University of Iowa and deciding to be a hematologist/oncologist, McAneny moved to New Mexico, drawn by its diversity and the drive to work in an underserved area. She fell in love with the state and has been on a mission ever since.
"My dream then and now is to prove that independent practices can do well by doing good, by taking care of people who are rich in culture but poor in money, and by making sure they receive the same care as people of affluent means," she says.
Perspectives on the profession
Following are highlights from a conversation between McAneny and HealthLeaders where she shares her perspective on medical economics, medical errors, and physician burnout.
"[The reformation of medical economics] is a process. This is not an event. We are not going to find one silver bullet that fixes all of healthcare. The needs of oncology are different from the needs of ophthalmology, or orthopedics, or any other specialty. We may need to think about payment models that are more granular and tailor-made to what the specialties and the communities need."
"The overall economics of cost-shifting and struggling with payers is probably the biggest challenge facing physicians."
"The challenge that faces the entire healthcare system is our care costs are rising at a rate that is completely unsustainable. I am very worried that we have an unsustainable healthcare system, and we all need to work together to redesign it to be sustainable and affordable for patients."
"I send out a plea to doctors to think about what kind of a payment structure would make it easier for them to do what their patients need to have done. I send out a plea to state and federal government to listen to physicians' ideas. The wisdom of the people on the ground should be drawn upon to help redesign the system to do a better job for patients."
"Cancer touches one-in-two men and one-in-three women personally, and it affects every family in some way. So, it is the example that gets used of what we need our healthcare system to do."
"Oncology gives me insights into multiple specialties. I can't do what I do for patients without a whole lot of specialties doing what they do for patients—from primary care to high-risk obstetrics to nephrology to surgery. You name it, oncology touches everybody. So, it has given me a bigger picture of the connectivity of delivering healthcare. It really does take a team."
"Whenever there is an example of someone whose drug is too expensive, it's usually an oncology patient. When we talk about the cost of end-of-life care, the example that is usually given is oncology. When President Obama talked about the need to reframe the healthcare system, he talked about his mother and her ovarian cancer."
"The rate of change in medical knowledge is astounding. In oncology, we get a new drug out every week that is amazing. These drugs are horrendously expensive, but they have less toxicity and more efficacy than earlier drugs. If I cannot keep up with this tsunami of information, I'm going to have a high risk of committing a medical error."
"If we are going to make healthcare highly reliable, we need to have electronic medical records that are way more than billing machines. We need to have electronic medical records that provide decision support, so the physician can access all of the data and information that is needed to manage the patient at the point of care."
"Last year, we did see a moderate downtick in physicians who report burnout, but I remain very worried. As I travel across the country, I am hearing significant concern among clinicians. Physician burnout levels are higher than for other workers."
"We need to work with personal resilience to make sure people can manage the stress of being a physician. On top of that, we need system redesign, so that we are not working in a system that is sometimes designed to thwart doctors from getting what they need to treat patients."
"Currently, there are too many physicians who do not feel accomplishment at the end of the day. They couldn't set up preventative care, or they couldn't manage a patient's condition. Then they go home and spend three hours putting information into a computer that does nothing for patient care but may get a better star rating for the hospital, so it gets more money that the physician will never see. That is a recipe for burnout."
"If a physician feels involved in trying to create a better system and fix problems, that physician is unlikely to be burned out."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Oncologist Barbara McAneny has led the American Medical Association for the past year.
Her successor, Patrice Harris, will be the first African-American to serve as AMA president.
While there have been advances in addressing physician burnout, McAneny says the problem remains deeply worrisome.