Dear Colleagues in the GME Community,
Over the past nearly 18 years, I have had the privilege of writing to you about major topics, challenges, and opportunities facing our profession, and graduate medical education (GME) in particular. Whether it be work hours, the Milestones and competencies, the COVID-19 pandemic, heroic acts of professionalism, civility and civil unrest, violence, and our journey toward true health equity, you granted me the grace to speak to you and be part of the discourse on these pivotal issues of our time. This letter is more difficult for me to write, as it will be my last letter to you in my current position. For these last 18 years, I have had the privilege of serving you and your educational missions. So let me start by expressing my gratitude to you for granting me all those opportunities, and then I will leave you with some thoughts about the future of our profession and those of us charged with the preparation of the next generation of physicians to serve the public.
I am grateful and often surprised, not only by your unselfish and generous sharing of your gifts, expertise, and wisdom, but also by your kindness and compassion. These past several years have seen us continue to support and advance the Mission of the ACGME in the face of a pandemic, instability in the clinical learning environment, pressures for productivity on faculty members, and threats to the well-being of all members of the health care team, including our residents, fellows, and faculty members. Despite these challenges, you have remained focused on opportunities, supported each other, and demonstrated in your actions the values that we collectively espouse as a community. GME continues to expand to meet the needs of the public, and to fulfill the social contract with the public to meet those needs based on your efforts.
As it always is, the future is uncertain and will present us with new challenges, even to the very core of the profession. The basic tenets of the profession, scientific enquiry, evidenced-based treatment, and the sanctity of the patient-physician relationship are all being tested by the circumstances of health care delivery. Whether it is the conflicting demands of employers versus the needs of our patients, or the time needed for patient care, education and research, the profession, one clinician at a time, is being pushed to its limits. In addition, the principle of effacement of self-interest is under strain due to our employment relationships, structural conflicts of interest, and in some cases, our modern lifestyle and priorities. Yet, we also see great opportunities. The promise of molecular medicine, immunotherapy, advances in transplantation, explosion of knowledge in the neurosciences, advances in surgical technology and expertise, and the promise of assisted and artificial intelligence present a new horizon of advances that will shape and enhance our ability to help and heal.
As you continue in your mission to nurture our future physicians, these challenges and opportunities will demand your creativity, your commitment, and your core values to remain at the fore.
While I step down as President and CEO of the ACGME and Chair of the ACGME International Board of Directors, I will continue to engage with our community as you confront these challenges in a new role as Senior Fellow and Director of the Center for Professionalism and the Future of Medicine. The Center will be engaged in exploration of the potential futures that medicine faces, including the implications for ethical challenges and the evolution of the clinical learning environment. Its work is designed to contribute to the discussions on how to equip physicians with the moral framework, ethical decision-making skills, courage, and perseverance to shape the evolution of the clinical care and learning environment in a fashion that places the needs of the patient and public first in the uncertain future ahead. The Center aims to provide conceptual frameworks that we hope will contribute to the Public Trust between the profession and the public we serve. This will be effectuated by the profession’s evolution as we serve public needs while preserving and enhancing physician trustworthiness and ethical decision-making at the individual, group, institutional, and national levels.
These aims arise from a belief that we can understand the range of ambiguity of the future and deduce the pressures that range of circumstances will levy on physicians and the profession. By understanding the range of pressures, we hope to provide useful frameworks that assist the profession in preparing future generations of physicians to serve the public. In this fashion, I hope to continue to work with you and provide guidance and resources that may help ease the burdens of your work and make it even more meaningful.
Your dedication to the profession and its future has inspired me for the last 18 years at the ACGME and during my entire career as a teacher, mentor, and educational leader. As I transition into this new role, it is my hope to capture the creativity of the profession in mutual support and inspiration as we confront challenges and opportunities before us in advancing the profession, and preserving and strengthening its values and dedication to the public good.
As I have in previous letters, I will close with a request and a wish. I ask that you grace the next leader of the ACGME, Dr. Debra Weinstein, with the same kindness, honesty, support, and encouragement that you have provided to me over these many years. Dr. Weinstein brings a career of engagement and leadership in GME, a lifetime commitment to excellence, and new perspectives on the challenges and opportunities ahead. She will be an outstanding leader for the ACGME!
And my wish is that each of you is successful in your educational, clinical, research, and leadership careers, that you achieve your dreams, that you and your families are well and happy, and that we as a profession continually commit to meeting the needs of those we promised to serve.
Thank you for everything.
Tom Nasca
Thomas J. Nasca, MD, MACP
President and Chief Executive Officer
ACGME
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