This article is a collaboration between ѻý and:
, serves as vice president of the American College of Cardiology and is slated to become president in 2017. She is medical director of heart failure and cardiac transplantation at St. Vincent Heart Center in Indianapolis and director of nuclear cardiology at St. Vincent's The Care Group. She is also clinical associate professor of medicine at the Indiana University School of Medicine there.
Walsh has been active as a long-standing member and past chair of the ACC Women in Cardiology Committee. She was honored for commitment to improving the lives of women living with heart disease with the Excellence in Medical Leadership award from WomenHeart at the in 2014. She has been elected by her peers to the annually since 2005.
She also chairs the ACC's Patient Centered Care and Cardiac Care Associates committees and serves as a member of the ACC's Budget and Finance Committee and on its Board of Trustees. She conducts clinical research in heart failure, nuclear cardiology, and systems approaches to quality initiatives in practice.
1. What's the biggest barrier to practicing medicine today?
Inadequate time with patients. We remain in an environment wherein we are straddling the divide between "volume" and "value." The system of relative value units and the ubiquitous EHR limit the meaningful time that physicians spend with patients. Until we are fully reimbursed on a "value" basis for providing care to a given population of patients, the individual patient will remain short-changed and the physician frustrated.
2. What is your most vivid memory involving a patient who could not afford to pay for healthcare (or meds, tests, etc.) and how did you respond?
I struggle to care for patients who reside in the United States but are not citizens and have no recourse to other than emergency healthcare. In my specialty area of caring for patients with advanced heart failure, options for ventricular assist device placement and cardiac transplantation remain limited for these individuals. Our care of one such patient, a mother with family in Mexico, was particularly poignant. Though she remained stable on medical therapy, not having other ready options was a stark reminder of the limitations of our system.
3. What do you most often wish you could say to patients, but don't?
Although I do speak frankly to patients who I believe have depression and who are obese, I sometimes find it difficult to challenge patients who attribute all of their symptoms and limitations to their cardiac diagnosis. Fatigue is not always related to heart failure, and treatment of depression and lifestyle changes involving diet and exercise can be life-altering.
4. If you could change or eliminate something about the healthcare system, what would it be?
Fee-for-service billing. Until we have a system wherein quality, and not volume, is rewarded, physicians and other clinicians will continue to provide services on a piecemeal basis. Many of these tests and services are not needed, but the waste will continue until the method of reimbursement changes.
5. What is the most important piece of advice for healthcare providers just starting out today?
Firstly, I don't like the use of the term "provider." It is a term used by insurance companies to identify skilled clinicians who "provide" services to our patients. I am dismayed that physicians and other clinicians have so readily adopted the term. That said, for those just starting out, I encourage them to keep asking questions of those around them. No one, neither a new partner in practice, nor a division chief thinks that a newly-minted clinician knows it all. Don't be afraid to ask for guidance from your more experienced colleagues. You will learn something and your patients will benefit, too.
6. What is your "elevator" pitch to persuade someone to pursue a career in medicine?
I don't try to convince anyone who is not interested to pursue medicine. Medical training is a long road and it is not for everyone. However, if I come upon someone who has an interest, I simply tell them of my own joy in the practice of medicine and emphasize that it is a joy that has been lifelong for me.
7. What is the most rewarding aspect of being a healthcare provider?
I won't repeat my dismay about the term "provider," but simply say that helping patients with fairly catastrophic disease is very gratifying. Meeting a patient at a time of diagnosis of severe illness and helping them through to stabilization and recovery is immensely rewarding.
8. What is the most memorable research published since you became a physician and why?
In my field, treatment of myocardial infarction first with thrombolytic agents and more recently with primary PCI has completely changed cardiovascular medical practice. As an intern, I was told to treat patients with myocardial infarction with morphine "until they were pain free or asleep." The TIMI (Thrombolysis in Myocardial Infarction) trials and other such advances began a revolution in the care of these patients.
9. Do you have a favorite medical-themed book, movie or TV show?
I am a huge fan of the writing of Atul Gawande, MD. He has a true gift and uses it to explore areas in healthcare that are unexplored by others. His most recent book, , is a must-read for all in healthcare today.
10. What is your advice to other physicians on how to avoid burnout?
Reinvent yourself. The job you have today doesn't have to be the job you have tomorrow.