June 22, 2017 | Ben Kenigsberg, MD
Advocacy

William Borden, MD, FACC, is an associate professor of medicine and health policy, and the director of health care delivery transformation at the George Washington University Medical Faculty Associates in Washington, D.C. His clinical focus is in preventive cardiology, and he works both in policy and operationally on delivering high-value care.

How did you get involved in quality improvement and health care transformation?

During residency I had a hospitalized patient who was waiting for three days to get a CT scan. I went down to radiology to understand the delay and found unused CT machines, but no CT techs. I thought we should be able to figure out how to improve this process. I worked with the radiology department, who were responsive and enthusiastic about constructive system change, to identify opportunities for improving workflow and patient care. I found that I really liked helping systems to better provide high quality health care. 

What resources and support did you need to help grow your interest?

First, being observant and reflective about my own clinical experience was one of the best ways to start improving systems.  Second, I picked up additional operational and management skills by earning an MBA during my medical training, with tremendous support from my residency and fellowship programs. Third, I was able to grow my policy interest when a mentor nominated me during my cardiology fellowship as a FIT representative to an ACC health policy summit.

The past few years have seen significant legislative changes in health care, including the Affordable Care Act (ACA), the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the Quality Payment Program (QPP), and more recently, in Congress, the American Health Care Act of 2017 (AHCA). How should FITs anticipate these changes affecting their careers and clinical practice?

There’s no way to know what the future will bring. One piece that’s important to keep in mind though, is that this transition toward quality and value focused patient care started even before the ACA. Most recently, MACRA passed with broad bipartisan support. While these existing or future legislations may continue to change the insurance and healthcare landscape, physicians will certainly need to remain aware of quality and value improvement in their clinical practice. Understanding data is becoming increasingly important as well, given the prevalence of electronic medical records and expectations for quality reporting. While the use of data and the focus on health care value will continue to grow, ultimately, the medicine that fellows learn during training of providing one-on-one care for patients will remain paramount. 

Do you have any advice for how these changes should impact cardiology fellows making decisions on additional subspecialty training or beginning early career clinical practice?

While it is important for fellows to understand the changing landscape of health care, the day-to-day care of individual patients will largely look similar. Choose what you love to do clinically and find a practice environment that lets you do what you love.

How important is physician involvement in advocacy?

Physician advocacy is crucial at the local, state and federal levels. Physicians are on the frontlines of medicine and have a much greater understanding of the needs of our patients and the health care system than legislators. As physicians, it is essential that we advocate on behalf of our patients.

How should fellows get involved in quality improvement and health care policy advocacy efforts?

Fortunately, quality improvement is now a component of fellowship training. Choose a project that you think is meaningful and that can be impactful for your patients. Learn from the project in order to make quality improvement a part of your career in whichever path you choose. Even more important is not accepting the status quo and the assumption that the system is optimally designed. Instead, pursue changes that you think can provide the best possible care for your patients.

This article is authored by Ben Kenigsberg, MD, a Fellow in Training at MedStar Washington Hospital Center/Georgetown University Hospital.