A time to apply lessons learned

During the 1980s, Ardis Dee Hoven, MD, was the only infectious diseases doctor in private practice in Lexington, Ky. Men with AIDS were moving from urban areas back to their childhood homes in Kentucky to die.

In their final months and days, Dr. Hoven often was the physician who provided their care.

“I became the person whose office every day was filled up with AIDS patients,” said Dr. Hoven, an internal medicine and infectious diseases specialist who still practices in Lexington.

At the epidemic's peak, her most seriously ill patients occupied an entire hospital wing. She worked around the clock trying to care for patients' physical problems and emotional grief, while comforting their distraught families and friends. Throughout the night, her phone rang with hospital updates on patients' deteriorating conditions.

“I was exhausted,” Dr. Hoven said. “All I did was work.”

But she always got up the next morning to do it again.

“As a physician, I was the person who was supposed to bring hope to the bedside,” she said. “That was my job.”

Dr. Hoven considers those years a gift, because she had an opportunity to make a difference during a historic time in medicine when there was great uncertainty and fear. She hopes to make a great impact during the current period of unprecedented change in the health care system when she becomes the 168th president of the American Medical Association on June 18. She will be the third female physician to be president of the organization.

“You're on the cutting edge, doing things that have long-term implications, and you're excited about being a part of it,” said Dr. Hoven, who has stopped regularly seeing patients at the University of Kentucky's outpatient clinic so she can focus on her new role at the AMA.

During her presidency, many provisions of the Affordable Care Act and the 2009 economic stimulus package will take effect. Those provisions include expanded Medicaid coverage (effective Jan. 1, 2014) and required implementation of electronic health records at physician practices by January 2015.

To bring about change in this environment, Dr. Hoven said, the AMA must regularly evaluate what's happening across the spectrum of health care and establish strategic plans based on those findings. As president, she wants to ensure that the AMA listens to physicians and helps pave the way for new models of payment and delivery of care.

Also on the agenda: advocating for medical liability reform; eliminating Medicare's Independent Payment Advisory Board; and repealing Medicare's sustainable growth rate physician payment formula, which she said should be replaced with a more viable alternative.

“I understand that change is scary … but my job as president will be to help [doctors] navigate this and understand that they can be happy in practice and their patients will do very well,” said Dr. Hoven, a member of the AMA Board of Trustees since 2005.

“Well-prepared” for leadership

Dr. Hoven brings to the position about 30 years of experience in organized medicine, during which she chaired the AMA Board of Trustees (2010-11) and was president of the Kentucky Medical Assn. (1993-94). She has been active in educating physicians, particularly on HIV/AIDS, and helping shape health care policy since early in her medical career.

Robert R. Goodin, MD, who nominated Dr. Hoven in June 2012 for the AMA presidency, said she is “exceptionally well-prepared” for the position.

“She's come up through the whole works­ — the national, state, delegate level and through [AMA] council. And in each she has” held a leadership position, said Dr. Goodin, a retired cardiologist from Louisville, Ky., and Dr. Hoven's friend of about 25 years.

Just as important as Dr. Hoven's professional achievements in shaping her as a physician leader are her personal experiences. The home she shares with husband, Ron Sanders, PhD, showcases some of her passions outside medicine.

A rosewood piano she played as a child and hopes to return to when there's more time occupies a front room. Floral pastels by Jaline Pol, a favorite artist, hang among other paintings on the walls. Imagery of horses, a love of both Dr. Hoven and her husband, decorate the downstairs.

Dr. Hoven incorporated her love of art and music into her care for patients with HIV/AIDS by encouraging them to share their creations with her. A local architect often brought her drawings of buildings he was working on in the city, and a child showed his geometry lessons. An artist with AIDS dementia gave her a painting depicting what his brain felt like.

“Early in the epidemic, many of these young men were artistic and just enthusiastic about lots of things,” Dr. Hoven said. She urged them to continue pursuing their passions despite their deteriorating health and wanted them to know she cared about them as individuals.

That deep care for her patients led Dr. Hoven to take a child born with HIV to University of Kentucky basketball games for years with the hopes of helping make the boy's possibly short life a rich one.

The right time for change

After 17 years of marriage, Sanders still is struck by the depth of his wife's compassion. Although she never had children, she considers her husband's two grandsons her own. “She cares about her patients, the AMA and she certainly cares about her two little grandsons,” who have beds and a play space in the basement, Sanders said.

Even on their occasional vacations, Dr. Hoven can't leave medicine for long. During a trip to Hawaii, Sanders searched for a golf course while Dr. Hoven inquired about Hansen's disease colonies on the islands that she could visit.

As caring as she is, she's also resilient and tough, friends say. That was apparent in her perseverance during the start of the AIDS epidemic when most of her patients died. In many ways, that resiliency was rooted in her upbringing.

Born in Cincinnati to a father who was a preacher and a mother trained as a dietitian, Dr. Hoven always was encouraged to pursue her interests. She chose medicine despite there being few female physicians at the time.

Dr. Hoven was among five women, out of a class of 75, to graduate in June 1970 from the University of Kentucky College of Medicine. She said she had to work harder than her male colleagues, but she never saw that as an obstacle.

Similarly, she wasn't discouraged by the interview for her first job at Lexington Clinic, when she had to prove herself to a room of male physicians. They grilled her for two hours on the differential diagnosis and treatment plans for one case presentation after another. She became the second female doctor they ever hired.

“My whole life, I didn't see anything as an obstacle,” Dr. Hoven said. “I always thought I could manage it.”

She is applying that same resolute attitude to her AMA presidency. She said there might be some challenges in the next year, but the time is right for change.

A voice for physicians

One key area of interest will be ensuring that the AMA listens to physicians about their concerns and the challenges they face, so to best meet doctors' needs.

“Simply pushing out information [to doctors] is not enough,” she said. “We've got to be able to listen and learn, and change and adapt, and meet the needs of physicians in their practices and the patients they take care of.”

Dr. Hoven learned the importance of this bidirectional communication, as she calls it, at the beginning of the AIDS epidemic. When she heard that physician colleagues and other medical staff were scared to treat patients with AIDS because they feared contracting the disease, she listened to their concerns and educated them.

Her other chief goal is to help pave the way for new payment and delivery care models “to allow physician practices to grow and thrive, and [to enable] doctors to be happy in what they're doing.”

She said the current one-size-fits-all approach isn't practical, considering that physician practices vary greatly depending on their specialty, location and the economics of their region. A new pay system would need to promote delivery models that focus on quality and value of care instead of simply volume of services provided, she noted in an Aug. 30, 2012, letter to the Senate Finance Committee.

During her presidency, Dr. Hoven plans to continue the AMA's work to promote change in medical education so physicians are better prepared to meet the evolving needs of the health care system.

“We turn young men and women out with a lot of science, but they get out the door and they don't know how to make it work,” Dr. Hoven said.

Barney R. Maynard, MD, a retired urologist in Hilton Head, S.C., who has known Dr. Hoven for more than 20 years, said she is the right person to be AMA president at this time in medicine.

“We need people who are thoughtful, insightful and calm to help lead us down the road as change is coming,” he said.