Breaking through barriers: Incoming AMA president ready to tackle tough issues
■ In an interview with American Medical News, J. James Rohack, MD, outlines his goals for the next year.
By Amy Lynn Sorrel — Posted May 18, 2009
Texas cardiologist J. James Rohack, MD, is as comfortable pulling up a pair of muddy boots to care for his 23-acre ranch as he is putting on a crisp, white coat to care for the hearts of his patients.
He's ready to use that down-to-earth work ethic and compassion for patients to tackle challenges facing medicine and the nation's physicians. Dr. Rohack will be installed as president of the American Medical Association during the organization's Annual Meeting in June.
The first in his family to attend college, the medical graduate of the University of Texas Medical Branch at Galveston charted a path toward a career in cardiology at Scott & White Clinic in Temple. These days, his routine consists of a pre-dawn, two-hour drive from his home in Bryan through Central Texas to the community-based, multispecialty clinic.
As he embraced the Lone Star state's culture and diversity, Dr. Rohack, 55, has worn many hats, including the occasional ten-gallon one. An affinity for education led him to a professorship at the Texas A&M University System Health Science Center College of Medicine. His roots at UTMB -- whose primary mission until the late 1990s was caring for the state's uninsured and indigent -- and at Scott & White Clinic -- which started as a prepaid health care system for railroad workers -- now drive Dr. Rohack to help usher in health system reform, one of his top priorities.
His other goals include Medicare payment reform, eliminating waste and redundancy in the health care system, and eradicating racial and ethnic disparities.
Despite a full agenda, he doesn't plan to sacrifice too much time on the ranch with his wife of 30 years, Charli, and stepdaughter, Elisha. He's committed to toiling the land, often while catching a football game on the radio.
AMNews: What are some highlights of your career that helped define you as a physician?
Dr. Rohack: Since I was the first one to go to college, I didn't have specific aspirations of getting into the medical profession. Clinical psychology was something that interested me. When I finished at the University of Texas El Paso, the president of UTMB came on campus and he talked about the mission. And at the time, if anyone didn't have health insurance they were sent to UTMB for their health care. So as the major referral center for the state, it highlighted to me what the mission of giving back really was. ...
I also had the opportunity as an intern to start a continuity clinic, something new at the time. It was a way you could start seeing patients in your first year and then follow them over time. So I actually had patients that I had cared for for six years. So it gave me the important lesson that, if the education system teaches about the body parts and not the whole person, then patients get frustrated because they are not sure who their physician is.
AMNews: What particular passions in medicine do you want to see realized this year?
Dr. Rohack: We have to make sure people have health care access and insurance coverage. We also recognize that we as physicians have to be part of the stewards of the health care dollar. And who best to know when one is talking about technology or different therapies, what really is the best for patients on an evidence basis. So in this next year, I'm convinced that with the $2.3 trillion we're spending in health care and [a predicted] increase of 6.7% per year, we can slow that curve by getting rid of some of the waste we have in our system.
And clearly we have to do more on racial and ethnic disparities. ... Just like cardiologists have to break through the barriers that heart disease is a man's problem, physicians also need to break through the barriers that racial and ethnic disparities are solely due to a lack of health insurance. ... In Texas, we are going to become a Hispanic majority state in a very short period of time. Every day I have patients in minority populations come in, and because they are not aware of certain medications or ways I'm talking about disease, they go home and they don't take their medications or they may not have access to medications.
AMNews: Health system reform seems to be at the top of many lists. Where is the AMA in that conversation?
Dr. Rohack: Health system reform that doesn't have the physicians as part of the solution is doomed to fail. ... If physicians aren't at the table, we've got 1993/1994 all over again where physicians were excluded. And when it came out, it was clearly something that was not going to be implementable or acceptable. Now as opposed to the past, the AMA is involved in coalitions with other groups -- the business community, insurance community, hospital community -- saying, how do we continue to evolve our system so we can meet these basic principles of affordable, quality care and choice ... without stifling innovation. ...
I'm excited. The first nine months of presidency are going to be crucial ones, because it appears the stars are lining up in Congress, as well as in the White House and the private sector, and businesses, patients, physicians are all saying keeping our current health sector status quo is unacceptable. ...
Clearly, the [May 11] meeting at the White House with the president and the other components of the health sector highlight the AMA's representation of America's physicians to assure patients have affordable high quality health care. It also signaled that the private sector, when focused on a common goal, can achieve that goal when working together with the public sector as a facilitator and not a barrier. ... Our pledge was to try to reduce [health care spending] to a 5.2% growth. We want to make sure that, with this whole process of quality improvement and focus on variation tools we really didn't have 30 years ago, that we can put that into action to reduce unnecessary costs.
AMNews: Where does the discussion on Medicare payment reform stand?
Dr. Rohack: We have to fix a broken Medicare physician payment system. The danger of that is, at the time we're talking, there's a proposal in the Senate to not have this changed and just kick the can down the road another couple of years. That's just fiscally irresponsible, because three years down the road, the first of the 4 million baby boomers are going to hit Medicare. We already have silos where if I, as a physician, see that patient with heart failure five times a year to keep them out of the hospital, the hospital payment actually gets the reward and the physician doesn't get any share in saving the Medicare system as a whole. So it's a [contradictory] message when, on the one hand, the Medicare program is saying we want to improve care, control certain chronic diseases ... and oh, by the way doctor, when you do that, we're going to cut your payment.
AMNews: Texas has touted the successes of its 2003 tort reform measures, yet national activity seems to have quieted.
Dr. Rohack: The reason medical liability reform was successful in Texas is that people who normally would not vote that way saw the impact of [having] no doctor. ... We've had a change in Congress, and the discussion on medical liability reform has taken a different way. [It's] a recognition that reform has to be part of the solution in controlling health care costs. But it may not be a global cap, like we have in Texas. It may be some alternative mechanism like health courts, expert witness qualifications, alternative dispute resolutions. Mechanisms that still try to provide efficiency if someone is injured, but also recognize that the current jackpot justice lottery system doesn't really drive improvement in quality and safety.
AMNews: How have you adapted to the transition to the AMA presidency?
Dr. Rohack: This year I stopped seeing new patients, because I felt it wasn't good for patients for me to see them once and then not see them again for a few weeks. But my nurses always have access to me, so every day I get e-mails. We are also blessed with an electronic medical record system ... so if a patient has a problem and I don't recall the fine details, I can go through our Web system. ... Some patients I've been seeing for over 20 years, so many were concerned I was no longer going to be their physician. It reminded me very tangibly that we are put in a trusted place with our patients.
AMNews: Are there any family activities you will miss during this time?
Dr. Rohack: Elisha and Charli are very important to me. Elisha is a special child. She's 41. She's mentally handicapped and she is like pure love. That's another reason in my travels ... I try to be home for her because mentally handicapped kids don't have abstract thought, so she'll get depressed if I'm not there.
The other big thing I'm going to try to make sure I have time for is the manual labor on the ranch. I help my wife on our wildlife rehabilitation facility. And I thoroughly enjoy mowing the grass and cutting down trees ... It's fun. It's relaxation to me. Charli has evolved her [animal rehabilitation] practice to specializing in birds of prey, hawks, vultures ... so yes, you have the president-elect of the AMA transporting animals to the Texas A&M [University] College of Veterinary Medicine. Charli has been taloned more than me because obviously she deals with this all the time. The other thing is, out on the ranch, I also protect my ears when using a mower, things like that, because as a cardiologist that's very important.
AMNews: Texas is a big football state. Any particular loyalties?
Dr. Rohack: There are five seasons in Texas: winter, spring, summer, fall and football. So I am a proud graduate of UTEP. ... And as a faculty member [at Texas A&M University] I live in the community and I'm supportive of the Aggies. If A&M ever plays UTEP, I'm for UTEP. But when it comes to the rivalry games, the University of Texas in Austin is the big gorilla. ... so any time A&M can beat Texas, I feel UTEP is vicariously supported.