ACG Presidential Address 2022 : Official journal of the American College of Gastroenterology | ACG

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EDITORIAL: General GI

ACG Presidential Address 2022

Shah, Samir A. MD, FACG

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The American Journal of Gastroenterology 118(1):p 1-4, January 2023. | DOI: 10.14309/ajg.0000000000002119
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Members, Fellows, Masters, and honored guests, welcome to Charlotte, and to the ACG Annual Meeting. We are celebrating ACG's 90th year, and it is with gratitude that I come before you for the privilege of serving as your President this past year. What a blessing it is to be gathered together in person to connect, collaborate, and celebrate as we strive to advance gastroenterology and improve patient care. Whether you are here in person or tuning in virtually, I hope you consider ACG your professional home, as I do.

My thanks to Brooks Cash, Chair of our Educational Committee, all the members on the Committee, our amazing ACG staff, Friday and Regional Course Directors, all our featured named lecturers, faculty for all the courses, and, of course, our postgraduate course directors, Drs Colleen Kelley and Christina Ha. If you attended the postgraduate course, you know it was fantastic, and noteworthy that it was the first ACG postgraduate course with all female course directors—but not the last. One year ago, as I accepted the role of president, I highlighted 3 words to guide my year of service: bold, beacon, and boom.

Let us start with boom.

Many of you learned about boom theory last year, as I did from our soon-to-be Vice President, Amy Oxentenko. She described how once a threshold is reached, boom! exponential growth, much like a nuclear reaction happens. For that kind of growth to happen, though, a threshold of 20%–30% needs to be reached. Although much work remains, we are making great progress. Currently, 27% of our membership is female. In terms of leadership, as of this meeting, 27% of our governors are female and growing, 30% of our board of trustees, 50% of our Editors-in-Chief of the Red Journal, and 30% of our Associate Editors are female. At this meeting, 100% of our postgraduate course directors, and approximately 51% of the faculty at the postgraduate course, annual meeting, pharmacology, pathology and imaging, and practice management courses were women. This past year, 41% of the regional course directors and 47% of the regional speakers were women. Forty-two percent of our committee chairs currently are women, and as of today, our Chair and Vice Chair of the Board of Governors are women. So, boom! If you are a woman in GI, your home in GI should be the ACG. We do more than talk; we proudly walk the walk. We also have initiatives focused on underrepresented minorities, diversity, equity and inclusion, and LBGTQ+ issues. We have expanded our DI Committee, under the leadership of Sophie Balzora, and received guidance from our Equity Think Tank and Trustee Renee Williams. Last year, the ACG Institute established the Center for Leadership, Ethics, and Equity, as well as a new health equity research award to support this additional clinical research in this space within GI. The work continues to grow and inform the college's path forward, including with our Vision Council of Industry Partners, under the direction of ACG Institute Director, Dr Neena Abraham. The linkage of leadership, ethics, and equity is not by chance. The college believes that they are inextricably linked, and one cannot truly succeed without the others.

Bold was the second “B.”

I promised that the ACG would be bold in its approach to tackling problems and issues facing our membership and the patients we serve. To that end, we have engaged with our sister societies and conferred with other specialties, including cardiology, to advocate for meaningful changes in ABIM in the maintenance of certification process to make it more relevant and about continual learning and not about continual testing. Although the pace of the change has been too slow for any of us, the new LKA (Longitudinal Knowledge Assessment) that was recently rolled out by ABIM borrowed heavily from the GOAL proposal that your President-Elect Dr Daniel Pambianco, along with many others, helped develop, and does represent tangible progress. We continue to encourage the ABIM to accelerate the changes in their process to reflect the realities of our subspecialization and to make the process less onerous and more relevant.

ACG recognizes that artificial intelligence will transform gastroenterology, and indeed all of medicine. I am grateful to ACG Trustee Seth Gross and Innovation and Technology Committee Chair Vivek Kaul for co-chairing a talented group that presented its report to the Board of Trustees, outlining a roadmap for the ACG to be positioned to lead in this area, advise, and educate members to be prepared for the many changes AI will bring, well beyond just polyp detection and endoscopy, but also, aspects of medical management. And the college is committed to helping our membership access and understand these exciting new resources that will enhance your practice and patient care.

With a goal of increasing member resources, I asked ACG Trustee JP Achkar, who also currently co-chairs the IBD Circle, and our current Vice President—soon to be President-Elect—Jonathan Leighton, with help from Meredith Phillips, the Vice President of Research and Learning, to lead a clinical slides initiative which provides slide sets space based on our updated ACG guidelines. The first 2 of these will be released very soon. One on colorectal cancer based on ACG Guidelines by lead author Dr Aasma Shaukat, who recently joined our ACG Board of Trustees, and who will also be giving the Emily Couric Memorial Lecture tomorrow.

The other is focused on ulcerative colitis based on ACG Guidelines by lead author Dr David Rubin and includes Drs Jill Gaidos, CS Tse, and Rachel Winters. I am grateful to all the contributors to this project that I am confident we will enhance our ability to educate colleagues. I hope you will use these new resources and others and a variety of topics that will be forthcoming in the months ahead.

To make progress, we must build bridges and connect with others. We have worked with our sister societies, the Digestive Disease National Coalition, the Crohn's and Colitis Foundation, and the WGO, and many GI societies studies from around the world, including Japan, India, Pakistan, Brazil, Central America, just to name a few. We recognized we must reduce our carbon footprint and working with our sister societies, a multisociety task force, which, just days ago, published a strategic plan to help us do our part to tackle this issue. My thanks to Swapna Gayam and Rabia de Latour for being our ACG representatives to this multisociety task force and to our Board of Trustees for providing extensive feedback to the task force.

One of our long-standing collaborations is the Train the Trainer Program, or TTT, with the WGO. This has been a huge success, training leaders to be better educators and leaders around the world. My thanks to WGO President Dr Macedo, who recently was made Master of the College, and our most recent participants in TTT, Past-President Dr Carol Burke, and Dr Truptesh Kothari from the University of Rochester Medical Center. Both traveled to Poland for this year's return of an in-person program and were able to interact with colleagues from around the world and bring back their new knowledge to the ACG. Our collaboration with our international colleagues at the WGO does not stop there. We are in early discussions about bringing leadership, education, and training for women in GI around the world. This proposal has been championed by ACG member Dr Nimisha Parekh at the University of California Irvine Health, and I thank her for her vision and leadership on this project and look forward to the initial pilot project in the near future.

I am also excited to announce that the college will be supporting the highly successful Harold Amos Medical Faculty Development Program, in collaboration with the Robert Wood Johnson Foundation, with a brand-new clinical GI focused award that supports a junior faculty member awardee for 4 years starting in 2023. The Herald Amos program has an incredible track record of success in supporting minorities in medicine, and we are excited and honored to partner to expand this critical program to clinical gastroenterology.

Our Board of Governors, led by Dr Patrick Young and Dr Dana Early, have worked with our Legislative and Public Policy Committee chair, Dr Louis Wilson, and VP of Public Policy, Brad Conway, to meet with Congress at our annual fly-in in April, pushing for increased coverage for the spectrum of colon cancer screening without cost sharing to patients. Understanding the burden of prior authorizations puts on our members and harms patient care, we have made step therapy reform a priority, and push Congress to pass the Step Therapy Act. We continue to work to stop the looming Medicare reimbursement cuts that will harm patient care by decreasing access and making it harder for practice to stay financially solvent given increased costs. Over the past 15 years, Medicare has cut inflation adjusted reimbursement by a whopping 33% for our 10 most common procedures. Louis Wilson has targeted this issue and was able to connect with the Doctor Caucus in Congress and grow our National Advocacy and Action Network, also known as NAAN. This network is critical in our ability to influence the legislative process for the benefit of the patients we serve. If you have a connection with your state or congressional legislature, or if you want to have one, we need you to be part of this NAAN. We also have been able to meet with the leadership of CMS several times this past year, including earlier this month, and advocate for increasing access to GI services by expanding access to surveillance colonoscopy without cost-sharing barriers, which hits our most vulnerable populations disproportionately. We also addressed with CMS, our members, and the public our concerns about the extremely misleading press coverage on the recent New England Journal of Medicine paper on colonoscopy. When the study was looked at critically, it still showed a large benefit of colonoscopy in terms of preventing colon cancer and death, notwithstanding low patient participation, perhaps due to a lack of regular use of colonoscopy in the countries that were included in the study, no use of sedation, very low ADR by many of the providers and too short a time of interval follow-up. Thanks to our staff and leadership for crafting a quick response, as well as resources, for you to use with your patients and referring network. We will continue to advocate and educate as needed on this and other issues. Thanks to consistent efforts by the ACG, you can rest assured that GI has a strong voice in Washington. My thanks to all the ACG governors and young physician leaders who came to DC this year, and past years, to make sure that gastroenterology has a seat at the table and is not on the menu. Be sure to reach out to your governor with issues you encounter in your practice, and when asked to message your legislature, please answer the call. The volume of e-mails and phone calls greatly influences whether Congress pays attention or not.

I am excited to announce that later this year, the ACG will have a new state-of-the-art headquarters in north Bethesda, Maryland, with a great office meeting space for amazing staff that allow some community meetings to take place in our new home. My personal gratitude to Executive Director Bradley Stillman, for leading us to find, finance, and secure this new space for the college that will serve us well in the decades to come. Also, my personal gratitude to Deputy Executive Director Maria Susano, who helped oversee the design process for the beautiful working and gathering spaces in the new office.

Finally, the last, but certainly not the least “B,” beacon.

The ACG has been a beacon for clinical gastroenterology for 90 years, and we continue to expand benefits to our membership by providing resources to help us keep up to date and meet the many challenges of daily practice. Our website, GI.org, and the mobile app have been updated to make it easy to access multiple resources in one place. With the pandemic, we enacted Virtual Grand Rounds, an idea we must credit to ACG Trustee Seth Gross. As of early October this year, there have been over 202 programs touching over 69,500 viewers. A huge success, and something that has become a staple for many to help us to stay up to date.

Our journal—the Red Journal, under the new leadership of Co-Editors-in-Chief, Jasmohan Bajaj and Millie Long, and their partner Managing Editor Claire Neumann, continues to innovate, and is a must read for clinicians with the most clinically relevant science. My thanks to our previous Red Journal editors Brendan Spiegel and Brian Lacy for all their work with the journal and handing off the journal to our new editors in such excellent shape. Our other journals include Clinical and Translational Gastroenterology under the leadership of Dr Brian Jacobson, the ACG Case Reports Journal with a group of talented GI fellows and training as editors. To help us keep up with the literature, ACG started Evidence-Based GI under the leadership of Dr Philip Schoenfeld and its diverse editorial board, which also includes supplemental podcasts. If you have not listened, I encourage you to do so. They are excellent.

While not a journal, the ACG Magazine provides unique insights into the life of the college and our members, with Vice President of PR and Communications Anne-Louise Oliphant as editor. This magazine has become a must read for me and I am sure for many of you. A new pregnancy and GI monograph is now available—an incredible resource to help us with GI issues in pregnancy, including endoscopy. My thanks to all the authors and to co-editors, Past-President and Sunanda Kaine, Shivangi Kothari, head of the Women's Committee, and Dr Vivek Kaul, head of our Innovation Technology Committee, for their work in editing this amazing project.

Our ACG Universe is expanding. David Rubin and the entire team at the ACG Universe deserve our thanks for updating and making the use of the Universe so simple and accessible through our website. There is a whole new DEI section with wonderful lectures, our APP committee has multiple lectures for our APP colleagues, especially new ones who have recently joined our practices. There is a section for fellows and program directors that continually gets updated and was invaluable during the pandemic. And for anyone who wants to look up any topic, you can simply go to the ACG Universe and listen to a state-of-the-art lecture on that topic. In addition to our annual meeting we have regional conferences, IBD, liver, and functional schools. This year we are excited to launch the endoscopy school in December to complement learning opportunities for all our members. Our ACG Circles continue to thrive. IBD Circle, which I am very active in, liver, functional, and our general GI, where members can post questions and get rapid input from colleagues and experts. The Edgar Achkar Visiting Professorship Program run by the ACG Institute continues to be an invaluable resource to bring experts to GI programs and community gastroenterologists over the past several years, with 12 programs supported this past year.

GIQuIC, our joint quality data repository, started with our colleagues from ASGE and the vision of Past-President Irving Pike, continues to set the standard for quality in endoscopy and remains a CMS-approved qualified registry with more than 4,700 participating gastroenterologists. We have surpassed 15 million colonoscopies in this registry, and over 3 million endoscopies. Those who participate in the registry have shown substantial increases in ADR over the years.

Under the leadership of Costas Kefalas and GIQuIC Executive Director, Laurie Parker, GIQuIC will be expanding to include ERCP, EUS, bariatrics, and nonprocedural quality metrics including IBD and liver disease. If you are not yet participating, consider this your personal invitation from me to do so and to help us improve the quality of the care we deliver to all our patients.

The ACG Institute, under the direction of Neena Abraham this year, awarded greater than 2.2 million in research funding, including 4 junior faculty awards at a level of $450,000 each and 2 new health equity research awards. This new record in funding support is critical to our profession. Please consider supporting this with an annual donation. I have made this a personal priority for support, and I invite you to do the same. The Institute also supports leadership training at all levels and will be launching in 2023 the Clinical Research Leadership Program.

Our committees work extremely hard and my thanks to all the committee members and the chairs. I encourage you to read about these in the ACG awards and leadership book and consider nominating yourself to get involved and serve on one of our committees. The committees' chairs meet with the ACG leadership several times a year to update each other and to work together on issues that cut across multiple committees and avoid silos.

I especially wanted to highlight the Practice Management Toolkit, which is an incredible resource for our membership. This was initially conceived by Louis Wilson when he was Chair of the Practice Management Committee, and has grown further by current Practice Management Committee under the leadership of Stephen Amann, with contributions and input from multiple committees. Soon to be available for all of our members is a new endoscopy unit manual to help us train new team members in the endo unit. This will be invaluable in orienting new technicians, nurses, schedulers, secretaries, and others working in our endoscopy unit, especially with all the turnover we have seen during the pandemic.

Let me now take a moment to thank our incredible ACG staff—the best staff of any medical organization in the world. I have witnessed this for many years and appreciate their dedication even more of this past year seeing them up close. I want to thank the Board of Trustees, Executive Director Brad Stillman, immediate Past President David Greenwald, and our President-Elect Dr Daniel Pambianco for their support and guidance this year.

I also need to take a moment to thank my parents, Dr Ashok N. Shah, MACG and Shobhana Shah. My mother-in-law, Dr Pramila Byahatti and my late father-in-law, Dr Veerappa Byahatti, who we lost back in 2009, and my entire extended family. My wife, Dr Seema V. Byahatti, who is my bedrock, for taking on so much at home so I can serve, and our sons Anand and Vijay, who bring us so much joy and are growing into fine young men who we are so proud of. I want to acknowledge my many teachers and mentors at Brown and Harvard and ACG; particularly at Brown, Dr Peter Shank, whose laboratory I worked in, Dr George Hagy, who I got to be a teaching assistant with in a course on genetics. At Harvard, I was in Cox Terhorst's laboratory and worked closely learning about IBD with Dr Mark Peppercorn and was fortunate to be mentored by great faculty including Dr Sanjiv Chopra who gave the Sun Lecture.

Sorry, I am getting a little choked up thinking about all the people who have helped me.

I want to thank my partners at GI Associates, particularly Dr Edward R. Feller who continues to mentor me, and our dedicated staff who have worked much harder this year to support me and allow me to serve as President despite my, shall we say, unique sense of time. It has been an incredible privilege and the highlight of my career. So, I thank all of you and I bow humbly to you with a namaste.

The ACG will continue to be a bright beacon for the members under the leadership of our incoming President, Daniel Pambianco. It is fitting that today is Diwali an auspicious day to install Dan as President. An important holiday for people of Indian origin, marking the victory of light over darkness and the new year in the Indian calendar. To my desi colleagues, and to all of you, I say Saal Mubarak, the traditional greeting on Diwali in Gujarat. With Dan at the helm, the beacon of the ACG will shine even brighter, dispelling darkness.

I firmly believe that we are at an inflection point in our history with incredible advances in technology, medical knowledge, and at the same time challenges including a pandemic, increase workload, staffing, burnout, and reimbursement. Whether we make advances and make progress or sink is up to us. Our collective resolve, ability to support each other, and tenacity will determine the outcome. Together I am confident we will succeed.

So, I leave you with a quote from Swami Vivekananda whose words have always inspired me.

“Be not afraid of anything. You will do marvelous work. It is fear that is the great cause of misery in the world. It is fear that is the greatest of all superstitions. It is fear that is the cause of all our woes, and it is fearlessness that brings heaven even in a moment. Therefore, “arise, awake, and stop not until the goal is reached.””

Thank you.

© 2022 by The American College of Gastroenterology