Dec. 23--As an emergency room physician, Dr. Steven J. Stack sees the bloody aftermath of shootings, car crashes and workplace accidents at his hospital in Lexington, Ky. His job is to stabilize patients and get them on the road back to health.
Now he is trying to do the same thing for the nation's doctors. As president of the American Medical Association, based in Chicago, Stack is pushing an urgent message. He believes doctors are overwhelmed by the demands of government regulators and insurance companies, and are losing job satisfaction and burning out.
He wants the government to allow physicians to do what they did for decades: treat patients without spending hours a day arguing with insurance companies or filling out a seemingly endless number of government forms.
Stack, 43, is the youngest president in 160 years at the AMA. He was elected in June and is the first emergency medicine physician in the position.
He grew up in Cleveland and graduated with honors from the College of the Holy Cross in Worcester, Mass., where he studied Latin and Greek. He earned his medical degree at Ohio State. He has practiced medicine in Kentucky and Tennessee, and still works part time as an emergency room physician. His wife, Tracie, is also a doctor, specializing in allergy and immunology.
He spoke to the Tribune at the AMA's headquarters in Chicago. This interview has been edited for length and clarity.
Q: Has practicing medicine lost some of its joy?
A: Yes. There are so many people who have intruded between the patient and the doctor. We have such excessive regulation. We are now not only told to take good care of patients, but how to provide care. We're told what tools we must use. Then we're measured by metrics that may not even be germane to what we're doing.
So I think physicians feel very frustrated. We have a long commitment to doing right by patients and putting their needs and interests first. But when regulators and insurers are ever more intruding into that relationship, it's interfering with that physician-patient relationship, which is really the secret sauce to successful outcomes.
Q: What's the leading frustration?
A: There are many, but electronic health records are particularly a point of infuriation. We live in a world where a 2- or 3-year-old can pick up a smartphone and use it with no instructions. If you're not careful, they'll order from Amazon and have something delivered to your house two days later.
But we have graduate-educated physicians who are being forced to use software that looks like it's on an old-fashioned, DOS-based system, a Tandy, an Atari, the kind of software you can only see in a museum. And that's the software we've been given to manage patients' health and well-being. So you have physicians whose efficiency is decimated. Their ability to communicate with each other is completely crippled. And then they're told you're not doing a good job.
Q: Other frustrations?
A: Consolidation in health care, with the insurance industry, has led to decreased patient choice. Plan design has led to very narrow networks that have deprived patients' access to the physician of their choice and disrupted their continuity. Shortage of pharmaceuticals. Generics' prices skyrocketing so that physicians have limited access to drugs that patients with limited means used to be able to afford. So a lot of these things are very, very frustrating.
Q: What drew you to medicine?
A: I was someone who liked science and people and figured pragmatically that medicine was a good combination of the two.
Q: Of all the specialties, emergency medicine seems stressful. What appealed to you?
A: I like the diversity. You really do not know what's going to come through the door in a given minute, and you have to be able to adapt and improvise. I sometimes get to tell a wife that her husband who suffered a heart attack is getting better. And I sometimes have to deliver tragic news and help people deal with that.
Also, you have to be the consummate innovator, because you have to trouble-shoot situations where you don't have the things you need or the resources you want, and you have to somehow make lemonade out of lemons repeatedly. It's kind of my personality.
Q: You're the youngest AMA president in over a century. Why run a huge organization rather that being in an emergency room full time?
When I go to work in the ER, I make a difference, one patient at a time. But if I want to have an impact on a broader scale, then we have to come together and we've got to tackle some really big problems. Like how do we make sure that every American has access to high-quality, affordable health care? And you don't do that one person at a time. You do that at the population level. And so the power of an organization like the AMA.
Q: You denounced the "corporatization of medicine" in a speech to medical students at Ohio State.
A: The business side of medicine is on the upswing, and the humanism of medicine is challenged by it. There's so much money and business in health care that it's creating these frustrations for physicians and for patients. All these other variables are intruding and interfering. So it's an uneven balance between the two.
Q: But physicians do pretty well financially.
A: Society should want its physicians to be among the best and the brightest. And in our culture, that brings with it compensation. But at the end of the day, that's really not what motivates a majority of physicians. And when you ask physicians, "Why did you go into health care? Why did you want to become a doctor?" they say overwhelmingly, "I want to help people." That's what really motivates us.
Q: American doctors: still a group of mostly older white men?
A: The profession has become more diverse with time. Our board of trustees, for example, has 21 people on it, eight of whom are women. We have our first Asian-American president, who preceded me last year. We are going to have our first African-American female chair of our board next year. And we had our first openly homosexual board member elected two years ago. So we are a far more diverse crowd than we used to be. And diverse teams lead to better results.
Q: Why did the AMA call for a ban on direct-to-consumer drug advertising?
A: Our concern is that advertising for newer, more expensive drugs that may or may not be the best treatment for patients drives demand. We would rather be able to have an informed discussion with patients, unbiased, about what the right treatment might be.
Q: So you oppose drugmakers pitching products on the evening news?
A: What it does is sets the patients up sometimes for perhaps a misunderstanding or a limited understanding of their disease condition and the right role of certain pharmaceuticals. It makes it sometimes more difficult to guide the patient on the correct journey to what they need.
Q: Historical figures who inspire you?
A: I studied classics in high school and college. You've got people like Socrates, who valued reflection and a well-placed question. There's Cicero, for the value of eloquence and the power of persuasion. I love U.S. presidential history. You've got Abraham Lincoln, who persisted in the face of adversity, and Teddy Roosevelt for his boundless curiosity and energy for life. There's countless people to draw learning experiences from.
Q: What is the best mistake you ever made, and what did you learn from it?
A: I have learned that it's better to debate ideas and policy, and not people. I have learned that it is a value to dare to do great things, but sometimes to accept that good is as good as you're going to do, and it beats failure. And I have also come to believe that it's worth embracing humility and equanimity as more fulfilling and effective alternatives to bluster and pride.
Q: What would you do differently if given a second chance?
A: I wish I'd learned to say "thank you" more frequently at a younger age. Because with a passage of time and a budding experience, I've really become quite sincerely thankful for the efforts and sacrifices that others make.
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