Article In Brief
Orly Avitzur, MD, MBA, FAAN will become AAN president after the AAN's 2021 Virtual Annual Meeting. Here, she discusses what led her to this point in her career and her vision for the Academy.
On April 23, one day after the end of the AAN 2021 Virtual Annual Meeting, Orly Avitzur, MD, MBA, FAAN, officially becomes Academy President. She has been a leader in the AAN for more than 20 years, serving on the Medical Economics and Management Committee since 1999, joining the Board of Directors in 2013, and serving on the editorial board of Neurology Today since 2006. Since 2014, she has been the editor-in-chief of Brain & Life magazine. She has also served on and chaired a number of other key AAN committees, including the Audit Committee, the Electronic Health Records Task Force, and the Practice Management and Technology Subcommittee.
As she assumes her latest leadership role, Neurology Today asked Dr. Avitzur to tell us about her journey to this point in her career and her goals for the Academy.
What early formative experiences shaped your resolve to become a doctor?
I was born in the US while my dad was a grad student at the University of Michigan but moved to Israel soon thereafter and did not return until age nine, when he got a position in the engineering department at Lehigh University. I couldn't remember any English, and during that first year, I was faced with doing a lot of menial tasks in the classroom because of that. As I made my way through that year and a lot of sharpening pencils and washing blackboards, I developed a conviction to prove that I could be academically competitive in school. At home, academics were always reinforced by my parents as well. I was the oldest of four children and schoolwork, as in many immigrant families, was thought to be critically important.
I remember in third grade teaching myself how to read in English, starting with easy books and working my way up to the Nancy Drew series. I inhaled those and then moved on to the Hardy Boys series. By the end of the year, I was speaking and reading English fluently. I had a fire lit under me to prove myself, which was formative for me as it is for a lot of immigrant children who come here.
By the time I was a teenager, I knew I wanted to be a doctor. I come from a family of engineers and I liked math and science, but I didn't think engineering was for me. I really loved children and always worked summers as a camp counselor, so I thought that being a pediatrician would be very rewarding. I had also had good experiences with my own pediatrician and other doctors and imagined medicine would be a very fulfilling profession.
How did you decide to make the shift to neurology?
I started out as a pre-medical student at Johns Hopkins and have followed a very linear path since then. I'm interviewing international medical graduates now and I see how many have had so many obstacles placed in front of them, and it really makes me appreciate how straightforward it was for me.
While at Johns Hopkins, I did research in developmental pediatrics focused on parietal lobe function, looking at right-left orientation in schoolchildren. I remember going to schools and doing the testing with the children, and I found it really engaging and enjoyable. My first two years of medical school at Penn State were very academic and straightforward, but my third-year pediatrics rotation at Penn State Hershey was largely a rotation through a tertiary care program that gave me exposure to caring for incredibly sick children. I found that I couldn't handle it emotionally.
In that same year I also had a neurology rotation at Penn State Geisinger Medical Center with a phenomenal teacher, Bill Jeffreys, who retired in 2015 at the age of 89 after 58 years as a practicing neurologist. The outpatient part of the rotation was at a clinic in central Pennsylvania, about an hour away, and I remember long conversations with him in the car about neurology. It was almost like those Nancy Drew mysteries I read as a child. I loved the puzzle: if you had all the right clues and you put them together properly, you would end up with an anatomical answer and a neurological diagnosis. I enjoyed the building blocks of the clues: the history and the physical examination and how it all ended up in achieving a diagnosis.
I followed that rotation with another in my hometown the next year, with Larry Levitt, the founder of the neurology division at Lehigh Valley Hospital. He was another brilliant teacher and I think my path was sealed after my experience with both of them. Then I did my neurology residency at Yale under Jonathan Pincus, who was a very gregarious program director. [Dr. Pincus spent 25 years at Yale before becoming chair of neurology at Georgetown University in 1986. He passed away in 2015.] Rounds with him were incredibly fun. He found humor in everything and made it the best experience. He was a wonderful human being, the consummate educator who wanted us all to succeed, and really invested in our learning and our education. I feel very fortunate to have had these mentors who were such great role models.
How did you decide to become a private practice neurologist?
When I finished my residency, I was unsure about whether to go into private practice or do a fellowship in stroke, which was my favorite part of my residency. I had spent a year at the VA hospital in West Haven, CT, and I really enjoyed the stroke service. I even applied to a couple of stroke fellowships and was accepted to one at the MGH. But in the end, I chose a private practice in Westchester. After a couple of years as the third in a group with two other neurologists in a very busy practice, I decided to build my own solo practice. I officially opened my doors on January 1, 1990. By then I was married and thinking about starting a family, and I thought if I had my own practice I could finish office hours before the school bus brought my children home. I was able to carve out my own schedule, care for my patients, and spend time with my two sons as well. I was even able to be a class mother some years.
When I started my own practice, I also decided that I was going to learn how to excel at practice management, the business side of the practice. I had seen how much work that was, and none of us are taught that in medical school or residency. So I hired a consultant who taught me everything about the back office function. I wanted to be able to perform every task that the staff handled so that if there was a problem, I could help problem solve myself. If there was a day someone was on vacation, I would be able to have the skills to deal with that. I wanted to make decisions about the business side of the practice more confidently.
Is that what led you to pursue an MBA?
In the mid-1990s, I was asked to be on the steering committee of an independent practice association for neurology that formed in my area of New York. We worked hard for two years meeting with payers, industry, and various business consultants, and it became increasingly clear to me that none of us neurologists even had the skills to hold a conversation with that side of the business. We were not speaking the same language, so we were not having successful conversations. I remember that the leaders on my steering committee said something like, “We would like to negotiate higher fees with you because we're all board-certified neurologists who are extremely qualified.” Rightfully so, the insurance providers asked us what metrics we followed and how we could demonstrate quality. These were concepts that were completely foreign to us at the time. I remember coming home and thinking I needed to get business skills; they wanted to see spreadsheets and data and I didn't even know how to understand what they were asking for.
So in 1997, I began an executive MBA program at the University of Connecticut, with classes every other Friday and Saturday for two years. It was probably the hardest thing I ever did. During the first week of school a boot camp in PowerPoint and Excel was held, and I had no idea what I was doing! There were five physicians in that class, and we were all at the bottom of the class as we struggled to make sense of everything. But I didn't know how much I would enjoy it. I realized that I absolutely loved economics and marketing.
But after finishing the program in 1999, I didn't know exactly how to utilize what I'd learned. Then I went to an AAN annual meeting and attended the practice courses. There were these neurologists throwing up spreadsheets showing practice expenses and ways of looking at revenue, and I was enthralled. They were speaking my language!
One of the speakers was Neil Busis. [Now a clinical professor of neurology at NYU Langone Health, Dr. Busis served on the AAN Board of Directors and is currently vice chair of the AAN Health Policy Subcommittee.] I nervously cold called him and said, “I'm a neurologist from Tarrytown and I want to know more about the Medical Economics Subcommittee.” He invited me to attend one of the subcommittee meetings at the AAN meeting in 2000. After that, they asked me to join the committee. By 2006, I had become chair of the Practice Management and Technology Subcommittee, and then in 2012, chair of the Medical Economics Committee. I was also on the Board of Directors as all the major AAN committee chairs are.
How did your “second career” as a writer, including writing and editing for Neurology Today and Brain & Life, begin?
I remember saying a couple of times during our committee meetings that I was very interested in writing a practice management manual. I never did do that, but someone must have heard me at one point, and when Neurology Today was established in 2001, that staff person put up my name as someone who could write a practice column. It took me two or three months to write my first column, “Do Neurologists Need an MBA?” But the experience was so cathartic, I was hooked. I found it immensely enjoyable to interview colleagues and hear about their experiences. Then I started pitching ideas and began to write very regularly after that. Every semester, I'd sign up for a new writing class at the Hudson Valley Writers Center and courses at the American Medical Writers Association.
I wrote about the early days of electronic health records, the regulations that seeped in, the transformation of health care, coding, billing and insurance changes that occurred over the years, from my own perspective. By the time I had written about every practice topic I could think of, the editors allowed me to expand to other topics. I interviewed the last neurologists who were at Charity Hospital during Hurricane Katrina, and that article was followed by articles about a series of disasters and how neurologists responded with courage and ingenuity.
In 2005, the Academy launched Neurology Now, now Brain & Life. I thought it would be really fun to try to write for consumers. I wrote a series of stories that paired with my stories for Neurology Today, such as how patients with neurologic conditions can prepare for disasters and how the patient can get more involved with their own electronic health records. I loved having a 360 view of an issue: how is this topic relevant to physicians, my colleagues, and how is it relevant to their patients? I then became the editor of AAN.com, the Academy's website, which let me learn a lot about the platform of the web and work with a great group of neurologists who were incredibly passionate about the site. (Among them, Jose Merino, the current editor of Neurology, Gordon Smith, the recent chair of the Education Committee, Neil Busis, the incoming chair of the Telemedicine Subcommittee, and Lily Jung Henson, an incoming board member.)
How did you get involved with Consumer Reports?
In 2008, I learned about an opening for a part-time health editor position at Consumer Reports. I thought it would be wonderful to expand my writing to all of health care, beyond neurology. For ten years, I worked there and had the time of my life. My practice was part-time, and I was working about half time in each role. Every day was different depending on patient care and my responsibilities for Consumer Reports. I loved it because it was a mission-driven organization, much like the AAN. I worked with health services researchers and writers and editors, and it was all about making health care better for the consumer.
Unfortunately, in 2018, they shut down the health division and let go of my whole team. It was just before another AAN annual meeting, and as I was looking for my next adventure, more than one person suggested to me that I should run for AAN President. That had never been something that had been on my mind, but the more I thought about it, it seemed incredibly appealing, with its mission of working to improve health care.
What would you like to accomplish as AAN President?
I would like to expand upon the public's understanding of the value of neurology and promote this organization's expertise in brain health more widely. Towards that end, I have established a “Patient and Public” Committee to support public education of neurologic conditions and publicize the critical role neurologists play. The Academy has had many initiatives that are public facing, such as Brain & Life and the Brain Health Fair, but I think we can accomplish even more if all that work is consolidated in one place, under a committee that will be able to coordinate existing initiatives and create new ones.
Notably, I was president-elect for one year and then the COVID-19 pandemic changed all our lives. As a result of that, our members were faced with incredibly difficult challenges both professional and personal, including our younger members who were raising children, as well as so many neurologists on the front lines who risked getting sick as well as bringing home infections to their families. They also faced previously unimaginable grief of at so many deathbeds. I worry about the emotional toll on our membership and how that will affect them for years to come, so we've established a wellness subcommittee to look beyond individual mitigation strategies to help with the healing that we all will need after the pandemic.
Throughout this time, the delivery of medicine has also changed, with telemedicine becoming the way so many of us delivered care for many months. So we created a Telemedicine Subcommittee to study the delivery of neurologic care through telemedicine, to assess quality as compared with face-to-face care delivery, identify the gaps, and find ways to improve that care. The government has extended the health care emergency such that telemedicine delivery is probably going to continue for the rest of the year with many payers, but we are going to have to try to advocate for our members and their patients to retain those services long term. Similarly, I look forward to expanded delivery of science and education programming, which is so important to members, and hope that we will see new hybrid meetings in the future. Our science and education initiatives are vital to the mission of this organization and continue to sustain and evolve the field of neurology.
In an effort to get more members involved, I have added virtual seats on AAN committees. In the past, many people have been unable to participate either because they are raising young children, or they were unable to leave private practices because it can be very difficult to get coverage, so I've tried very hard to remove the barriers of travel in order to have a more diverse group of volunteers. Additionally, I have focused on our members who are under-represented in neurology and am so pleased to see the inclusion of more BIPOC [Black, Indigenous and People of Color] members on committees. Issues around gender and being underrepresented in neurology have been critical for me and I look forward to continuing this important work.
Finally, with health policy advocacy encoded in my DNA after so many years as a MEM volunteer, I also want to emphasize the work the AAN is doing in this area and make sure that we continue to advocate for our members, that we work with legislators and regulators in making sure that our services are fairly reimbursed so that we can continue to deliver truly excellent care.
Tell us about what the AAN has meant to you.
For two decades the Academy has given so much to me: collegiality and a sense of community that is incredibly meaningful, and myriad chances to learn and hone my skill and my craft. I compare it to being in a candy shop: every time I've been at the AAN meeting, someone has approached me with an idea that has led to a wonderful new endeavor. I've gotten so much more out of being part of the Academy than I ever put in. My goal was never to be president but always to learn something new, and now I feel like I have the opportunity to give back. This journey has been immeasurably rewarding, and I'm very appreciative of this organization. Its work is a team effort, with incredibly talented and dedicated staff and an army of generous volunteers. I am lucky to be working with all of them.