Dr. Steven Stack is a student of Greek mythology. The American Medical Association president -- the first emergency physician to serve in the role -- sees parallels between the struggles of Sisyphus and those of doctors. And in an exclusive interview with Healthcare Dive, he talked about those challenges.
Sisyphus was forever sentenced to push a boulder up a hill -- only to lose control just as it reached the top, forcing him to start over. "What we're finding is the healers themselves are not well because the burdens the system has placed upon them are not at times surmountable," Stack said. "If we want healthier, happier patients, we're going to have to have healthier, happier physicians working in partnership with them."
In a wide-ranging interview, Stack also talked about the future of medical schools, improvements in hypertension and diabetes care, and the challenges of interoperability.
Stack has presided over rapid change in the industry since taking over the office in June for a one-year term. Since becoming the youngest president AMA has had in the last 160 years, ICD-10 finally was implemented, value-based payments has grown in focus thanks to rules and regulations like MACRA, and the varied levels of government began aggressively tackling prescription practices to curb opioid-related deaths.
Coming into the role, Stack notes he saw challenges in the industry more as opportunities.
"I think it's not lost on anybody that healthcare is fast-changing," Stack told Healthcare Dive. "And as it changes, the need for the people working within [the industry] to evolve and be supported to be able to succeed is incredibly important. It's important to the patients who rely on all of us to provide care for them and be their partners in their wellness. It's also important for the healers themselves, who sometimes have a hard time keeping up with the pace of change and also face an incredible burden of government regulations and interventions."
And just like the industry at large, Stack and the AMA have been busy this past year. The AMA has taken on three big projects:
- Creating a medical school of the future: While the content within the medical education model has clearly changed a great deal, the general structure has largely remained unchanged. In hopes of spurring change, AMA has provided grants to 32 schools to create a "learning consortium" and share new practices in medical education.
"We are working doggedly and aggressively to completely reinvent the model of medical schools so hopefully at the end of a decade, in which we're only roughly in our third year, we will have been able to reinvent the medical school model so that physicians of tomorrow come out with a different, better tailored skillset and knowledge base to help them in today's health system which is very different than it was in 1910 when the current model was created," Stack said.
- Unlocking the health data: Late last month, HHS Secretary Sylvia Burwell announced a commitment among the industry, including companies that provide 90% of EHRs used by U.S. hospitals, toward creating a more user-friendly, physician-usable EHR. AMA was one of the organizations that signed the pledge.
"Physicians are avid adopters of technology," Stack said but added, "Health IT is kind of late to the game as far as its sophistication and it's taken a long time to mature to the point where it's a helpful tool."
Improving hypertension and diabetes care: Stack estimates there's about 86 million Americans with pre-diabetes and about 70 million with hypertension, "many of whom have the opportunity to have their quality of life and health improve --- if we can bring to bear innovative ways of population health to do lifestyle modifications." The AMA is working to improve the diagnosis, treatment, and maintenance of people with high blood pressure and is helping to address their need for healthier lifestyles.
Ultimately, the work is to help support physicians with tools, information, and education so they can be the best possible contributors to team-based medical care and work in collaboration with patients and other caregivers, he said.
Not an easy task
Nearly one out of every five dollars in the U.S. economy is spent on healthcare. "In this environment, as the business has escalated in its size and the government has become an ever-larger purchaser of healthcare through programs like Medicare and Medicaid and more involved in efforts like Meaningful Use, the burden of regulations has escalated substantially," Stack said. "So the politics and the business of healthcare have put extra strain and challenge on the humanism of healthcare, which fundamentally is what most patients rely upon in their moment of deepest need."
There's another parallel with Greek mythology here, he noted. Stack said patients sometimes face a struggle similar to that of Tantalus, who was made to stand in a pool of water beneath a tree with low-hanging, fruit-bearing branches that he could not reach, providing constant temptation without satiated satisfaction.
Patients try to navigate the health system and often feel what they need -- for an insurer to accept a claim or a less expensive premium -- is often just outside of their reach, he said. "Policymakers want to make healthcare more efficient and cost-effective -- and that's a good thing -- but in doing so, they promulgate excessive burdens of regulation and create complexity that actually interferes with their goals," Stack noted.
New burdens, but new opportunities
The business and politics of medicine aren't going away. But, as Stack noted, the industry never has been able to do more to help patients and improve human health and wellness than it can today.
"The pragmatic part is we have got to pay attention to the human actors in the system so we make sure that we don't let science, business, and politics overwhelm the very human thing that takes place between a patient and a doctor which is a person in need and a person there to help," Stack said.
Stack noted that providers and patients have a counterbalancing obligation to ensure the humanistic work of healthcare isn't lost in the shuffle of managing spreadsheets. "My hope is we will be able to make that bond between patients and physicians a central and inviolable part of what we do in healthcare because I do believe we'll have better outcomes for patients.”
In order to do that, Stack said the approach to educating physicians must change to provide them the tools and resources and support to equip them with the necessary skills. That's why he's excited about creating the medical school of the future: To help restore joy to the practice of medicine for physicians and support them and improve health outcomes for Americans.