Addressing leaders of the nation’s medical schools and teaching hospitals for the final time as president and CEO of the AAMC, Darrell G. Kirch, MD, lauded the accomplishments of his predecessors and reflected on the challenges still facing the field.
Using a metaphor from his home state of Colorado with its 53 mountain peaks, Kirch noted that when climbing these mountains, each step brings a higher and more expansive view of the landscape. "Academic medicine advances the same way," he told more than 4,600 attendees during his annual address, held Sunday, Nov. 4, during Learn Serve Lead 2018: The AAMC Annual Meeting in Austin, Texas. "Over time, our key mission domains remain constant, but as we ascend, we gain clarity when we look back, and with each step higher we are better able to see what lies ahead."
What lies ahead, he said, are the "mountaintops" of expanding diversity in academic medicine and preserving a clear immmigration pathway for physicians and researchers from around the world.
“The AAMC will remain a clear voice about the important role of immigrants in our nation, many of whom have made such valuable contributions at our institutions,” Kirch said. “And we will not forget the Dreamers and their aspirations.
“We must be relentless in surmounting the obstacles still in our path, from unconscious bias to overt harassment to gender- and race-based gaps in salary equity,”
Darrell G. Kirch, MD
AAMC President and CEO
“We must be relentless in surmounting the obstacles still in our path, from unconscious bias to overt harassment to gender- and race-based gaps in salary equity,” Kirch continued. Academic medicine has yet to bring more black males and American Indians and Alaska Natives into the field, he said.
“I think you agree that seeking equity in the health professions and equity in health care is a climb worth making,” he added.
But, he noted, there has been much progress in improving diversity and inclusion in academic medicine, as there has been in many of the association’s other core missions, including clinical care, education, and research.
The Affordable Care Act, for example — which AAMC has long supported — has greatly expanded health care for individuals nationwide, he said to wide applause from the audience.
Medical school curricula have also improved, he said, to focus on more “interactive, problem-based learning.”
“We no longer view students as empty vessels to be filled with facts,” he said.
On the research front, studies conducted at the National Institutes of Health (NIH) continue to produce breakthroughs in the lab and demonstrable progress in clinics.
He referenced technological strides like CRISPR gene editing and immunotherapy, along with their benefits that can be seen in numbers like declining cancer deaths.
“And a recent analysis showed that every drug approved in the United States between 2010 and 2016 can be traced back to NIH-studies — many on our campuses,” Kirch said. “Supporting all this, advocacy by the AAMC and its partners over the last three years has put research funding back on a trajectory of meaningful, sustainable growth.”
But he said one threat could derail many of the advances that academic medicine has made, and that is the threat of burnout.
"We cannot climb mountains if we are not strong, if we have lost our resilience," he said.
Indeed, Kirch shared for the first time his own struggles as a medical student. “In my first year of medical school, during a brutal winter quarter of gross anatomy and never seeing the sun, I — like too many students — became burned out," Kirch said. “I regret that only now, in my last annual meeting speech, am I telling you about my own struggles. My fear of being judged negatively and the dark shadow of stigma nearly kept me from seeking help.”
Thankfully, Kirch did seek help from a student affairs dean, empowering him to continue his academic journey. But he urged others to tell their stories and get the help they need.
Finally, he talked about the importance of culture – and of leaders who embrace a culture of respect and inclusivity “while compassionately recognizing that we all are human and vulnerable.”
Kirch ended his speech by expressing his gratitude for the opportunity to represent the AAMC for 13 years, and for the commitment from academic medicine to advance health care for every single person.
“Together,” he said, “we will continue climbing mountains, however high they prove to be.”
Kirch wasn’t alone in divulging details of his personal and professional journey to highlight important issues in medicine.
“We must do more to ensure that all segments of the public are included in our profession and that biases, even if unintended, do not systematically exclude persons of certain population groups.”
M. Roy Wilson, MD
Chair, AAMC Board of Directors
President, Wayne State University
M. Roy Wilson, MD, president of Wayne State University and chair of the AAMC Board of Directors, called his presence in academic medicine “a statistical anomaly.”
“My younger sister and I basically raised ourselves as our parents were never around,” he said. “Our mother was addicted to gambling and our father to alcohol. Left to ourselves, we were subjected to experiences that no child should ever have to endure.”
While speaking about “The Most Important Lesson I Learned in Medical School,” Wilson echoed the words he heard from a clinical faculty member during his surgery clerkship: “Be good to medicine, and medicine will be good to you.”
Being good to medicine, he said, involves a handful of basic actions, including truth-seeking during a time when science is under attack.
“In this time of ‘fake news,’ ‘alternative facts,’ and overall distrust of science among some, there cannot be any daylight between medicine and truth,” Wilson said. “Truth must be the primary driver for our biomedical research; must form the basis for our patient-doctor relationships; must guide what we teach our learners of medicine.”
But hard facts are only a piece of the puzzle.
To fully develop knowledge and compassion, it is important to have an appreciation for the arts and humanities, which Wilson called a leg “of the stool as a foundation of medicine and health care.” He referenced a 2011 AAMC report, Behavioral and Social Science Foundations for Future Physicians, which says that “a complete medical education must include, alongside the physical and biological sciences, the perspectives and findings that flow from the behavioral and social sciences."
He also stressed the importance of mission over profit.
Though he acknowledged the truth behind the saying “no money, no mission,” he added that there should not be an aim for profit to the detriment of the public.
Academic medical centers in particular should focus on serving their patients and communities, and “take a principled stand against profit as a primary driver of our health delivery.”
“To be good to medicine we must steadfastly affirm our commitment to better health for our patients and for our community as priority number one,” he said.
The final action Wilson discussed was the most personal for him, he said: fostering diversity.
He cited gender disparities in medicine, saying there must be a larger effort to ensure women have access to training and post-graduate opportunities, along with equal pay.
And, he emphasized, no woman should have to endure sexual assault.
In not committing to this issue of diversity, “we are not being good to medicine — we cheat medicine,” he said.
“Earlier I gave you a glimpse of my own situation in life and, as a black male from an incredibly dysfunctional family, how fortunate I feel to be here with you today,” Wilson said. “We must do more to ensure that all segments of the public are included in our profession and that biases, even if unintended, do not systematically exclude persons of certain population groups.”