Leadership

Members Move Medicine: Seeking better path for physicians

The AMA “Members Move Medicine” series profiles a wide variety of doctors, offering a glimpse into the passions of women and men navigating new courses in American medicine.

On the move with: Ronald Vender, MD, professor of medicine and chief medical officer, Yale Medicine. He is also associate dean for clinical affairs at Yale School of Medicine. In his leadership capacity, he has been heavily involved in efforts to improve physician satisfaction by reducing administrative burdens. 

AMA member since: 1977. 

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How I move medicine: Slowly! Patiently. In any way that I can. As a clinician, I attempted to be a role model and mentor for my colleagues and trainees. As a medical leader, my focus has been creating a vision for providing outstanding medical care in a humanistic fashion, promoting a supportive culture, inspiring others and shining a light on the stresses of a medical career.

What moving medicine means to me: Trying to do what I can to make the world just a bit better, beginning with the person in front of me. In all of my patient interactions, my focus is on bringing comfort, healing and hopefully cure to the patient, and always helping them to feel better than when they walked into my office or were admitted to the hospital.

I have always looked for opportunities to improve the care provided to my patients, and hopefully the patients of other physicians, by getting involved with systems improvement. Whether it was improving office efficiency or improving the comfort of post-operative patients in the endoscopy suite, I wanted to make the experience safer and more satisfying for my patients.

When these improvements were implemented, I had the pleasure of knowing that many other patients benefited as well. As my career progressed and I had the opportunity to lead a national organization (the American College of Gastroenterology), my focus always remained on how to improve the quality of care we provide our patients through research, education and direct patient care.

The work that means the most to me: Nothing is more important than caring for our patients. Each day we see human nature at its most trying moments, we hear intimate stories, we are entrusted by our fellow humans, and we have the opportunity to offer comfort, hope and healing.

At times in my career I thought teaching was the most important thing I did—helping to train the next generation and hopefully transmitting both skills and values. At other times, I was focused on systems improvements that could bring value to more than one person at a time. Now, as a physician executive in a large multispecialty academic medical group, my daily focus is on improving the medical care we provide to hundreds of thousands of patients each year, and on improving the personal and professional lives of our physicians. However, my primary focus is always on how we doctors can do a better job caring for our patients.

An experience from medical school that kept me going: Getting married after my first year of medical school!

My source of inspiration: There is no one source of inspiration. My wife Amy has helped me become a better person, and has helped me attempt to become the person I aspire to be. Our son James has always kept me on my toes, and inspires me with his questions, trust, love and with his parenting skills. Each day, I am inspired by my colleagues, who perform miracles in the most understated fashion, and who live their lives in such a selfless manner. And finally, I have been inspired by some of the world’s great leaders, the servant leaders who truly put the needs of their society ahead of their personal gain, and who made the world better. In my lifetime, it is people such as Anwar Sadat, the Dalai Lama Tenzin Gyatso, Michael Gorbachev, Nelson Mandela, and Barack Obama who represent this ideal for me.

My hope for the future of medicine: I am concerned that medicine is becoming a commodity, that the values that have sustained our profession are eroding, that our profession is losing any control we have, that our practices are becoming corporate, and that our leaders are so focused by necessity on finances and operations that they will neglect the real mission we are here to fulfill.

With that in mind, I hope doctors will be able to maintain their humanity, that they will be more concerned about patients than RVUs, and that they will have the strength and resilience to persevere. My hope is that our practices and organizations will refocus on our patients, and remember that money and operations are a means to an end, and not the end itself.

And at a national level, we depend on our professional organizations and leaders to take back control of the conversation. My hope is that measures like “meaningful use” will be replaced not by MIPS, but rather by truly meaningful measures of quality and that medical billing compliance rules will be simplified and will reflect high-value clinical care. I also hope that we can address the need for medical liability reform.

The hardest moment in medicine and how I got past it: The hardest moments have been when I have caused harm to a patient. I have caused endoscopic retrograde cholangiopancreatography-induced pancreatitis. One of my patients on immunosuppressive therapy developed a liver cancer that was fortunately cured by surgery. Another patient, with Crohn’s disease, developed a cancer of the colon between surveillance colonoscopies, although he was a year late coming in for his exam despite several requests from my office to have the procedure performed.

These are several examples where I have had to second-guess myself, punished myself emotionally for the suffering I may have contributed to, and questioned my skills as a physician. In each case, the recovery was slow, and accomplished with a variety of efforts, such as self-reflection, conversations with colleagues, discussions at M&M conferences, and, frankly, psychological counseling.

My favorite experience working with the medical team: Twenty years ago, I co-founded a new medical group, Gastroenterology Center of Connecticut, with two of my colleagues. By starting fresh, we were able to build a culture and instill values that reflected our strongest beliefs and desires. Our mission statement was simple: sophisticated medical care, close to home, in a warm and caring environment.

We designed our office to be a comforting experience for patients and their loved ones. We opened the first privately owned ambulatory endoscopy center in Connecticut, we established a robust clinical research enterprise, and we recruited outstanding physicians who share our vision.

The most challenging aspects of caring for patients: When you are an attending physician, you never get to change services. You can’t turn to the attending next to you to ask for advice, and you fully own the care of your patients. You can never leave that responsibility behind. And, you must fulfill your responsibilities every day, no matter how you feel, whether your sleep was disturbed the evening before or whether one of your own family members has issues.

Learning to balance the demands of a medical career with our own personal and family needs is incredibly challenging, and something that requires regular recalibration.

The most rewarding aspect of caring for patients: It is incredibly rewarding to solve a complex problem or perform a life-saving procedure. However, with time and experience these accomplishments, which initially seemed so impressive, become something that we take for granted.

What may seem miraculous to our patients becomes ordinary to us, and no longer provides us with the same level of satisfaction. What never gets old, however, is the faith patients put in us, their trust in our healing abilities, and their enormous appreciation for the care we provide. Ultimately, I learned to appreciate this as a form of love.

The skills every physician should have but won’t be tested for on the board exam: Emotional intelligence, compassion, integrity, honesty, trust, dependability, resilience, empathy, respect, selflessness, communication ability, perseverance, and humility.

One question students should ask themselves before pursuing medicine: You are about to embark on a long and challenging journey. Are you living up to someone else’s expectations of you, or is this something you really want to do?

A quick insight I would give students who are considering medicine: A career in medicine no longer has the same autonomy as it did many years ago, and doctors are no longer compensated as well as they were. However, the title of MD is still respected by society, you will be doing important work, and you will be learning and growing forever.

If you are looking for a career that is interesting, stimulating, meaningful, serves others as well as yourself, and for which you will be well compensated, then there is nothing better than a career in medicine.

Learn more about AMA members who are relentlessly moving medicine through advocacy, education, patient care and practice innovation, and join or renew today.