#ACGME2024 Session Summary: Dr. Nasca Looks Back, and Ahead, in his Last President's Plenary

In the earliest days of his nephrology fellowship, ACGME President and Chief Executive Officer Thomas J. Nasca, MD, MACP met a patient who had a profound influence on his career. Elaine suffered from every imaginable complication of Type 1 diabetes. But despite constant pain, disfiguring ailments, and endless procedures, she persisted. A young Dr. Nasca had difficulty understanding why she endured it all. His mentor suggested he ask.

Over time, Dr. Nasca’s and Elaine’s trust with each other deepened, and Dr. Nasca did ask. Elaine shared that her sister suffered from substance use disorder, and that Elaine’s niece and nephew relied on her to have clean clothes, food to eat, and attend school; Elaine needed to live so those children could live.

In a more personal President’s Plenary, and his last as President and CEO, Dr. Nasca discussed many issues facing graduate medical education (GME), all viewed through the lens of trust. The plenary was delivered March 8 at the 2024 Annual Educational Conference.

Dr. Nasca said he tells Elaine’s story to fulfill a promise to her – because she asked him to – and because it epitomizes the sacrosanct doctor-patient relationship.

“What she was manifesting is the social contract. That trustworthiness of the promise that we make at graduation to serve others… and to care for others among our profession.”

The plenary was delivered on International Women’s Day, and Dr. Nasca called on the community to recommit to protecting women in the GME community, and women seeking care. “As physicians, we need to commit to the quality of women’s health. We can’t allow disparities in health to persist,” he said.

Growth of GME
Dr. Nasca organized his plenary into sections, first discussing the growth of resident/fellow positions over the last few years. Most growth is in mid-sized institutions, and the three specialties adding the most positions were emergency medicine, neurology, and psychiatry. An area that is not growing, he said, is general surgery, which he called “the backbone of care and clinical care in many institutions.”

While the ACGME cannot and would not mandate how GME positions are developed, Dr. Nasca said it is important for the organization to understand those patterns, and help other organizations understand those patterns.

On the other hand, he said that what the ACGME can and does control is the quality of physicians coming out of the programs being created. “We take graduates no matter where they come from, and we produce board-certified physicians,” he told an audience of 4,000+ GME professionals, adding, “You’re doing a good job.”

Post-COVID-19 Clinician Well-Being
Dr. Nasca also emphasized the ACGME’s ongoing commitment to the well-being of residents, fellows, faculty members, and professional and administrative staff members, who were all significantly affected by the COVID-19 pandemic, and many of whom are still feeling the ramifications of that stress today.

“We have not given ourselves the time to recover,” he said.

To assist in that recovery, the ACGME will resume its in-person conference dedicated to well-being (the ACGME hosted Well-Being Symposia 2015-2017) and will help the community infuse meaning and trust back into the patient-physician relationship by “manifesting professional values and the centrality of patients.”

The Opioid Crisis
Moving on to another national and ACGME priority, Dr. Nasca noted that the number of opioid prescriptions is dropping, and the rate of opioid-related deaths is flattening. He shared charts demonstrating how the crisis has evolved. He noted the role of the medical community in creating the crisis through a lack of understanding and overprescribing and said that now it’s time to build back the trust that was broken by this crisis.

The flattening of the curve shows that didactic education about prescribing opioids is helping to alleviate the problem, but now it’s time for residents and fellows to receive more hands-on learning in how to identify patients with substance use disorder and in how to treat substance use disorder.

The ACGME is part of the National Academy of Medicine (NAM) Action Collaborative on Countering the US Opioid Epidemic and held a GME Stakeholder Congress on Preparing Residents and Fellows to Manage Pain and Substance Use Disorder in 2021.

“We have a huge potential positive impact we can make on this problem if we do this well,” Dr. Nasca said.

Climate Change
Shifting gears a bit, Dr. Nasca noted that health care accounts for 8.5 percent of carbon emissions. He outlined ways the ACGME is working to reduce its impact on climate change, sharing that the organization’s efforts have halved its carbon footprint in recent years. In 2022, the ACGME joined the NAM Action Collaborative on Decarbonizing the US Health Sector, recognizing the need for health care organizations to lead the way in reducing their environmental footprint. The ACGME is now working toward establishing more targets and broader sustainable goals, Dr. Nasca said, encouraging everyone in GME to look for ways to reduce harm to the environment.

The ACGME’s Evolution and Trust
In acknowledging his forthcoming transition out of the ACGME’s leadership role, Dr. Nasca discussed the “evolutionary eras” of the organization,” explaining how it was founded and how it has matured over the last four decades. Underscoring a theme of trust, he said his greatest accomplishment as president and CEO was establishing trust among the ACGME, accredited Sponsoring Institutions and programs, and the public. This trust, he said, is why the medical profession is accredited by an independent, non-governmental body, and is key to medicine’s position as a profession.

“We promise to be self-evaluating,” Dr. Nasca said of the medical establishment. “The ACGME is responsible to do that self-evaluation, you’re [the institutions and programs are] responsible to provide that back, and we’re responsible to be transparent about what we give back to you. And that building of trust over time, one brick at a time, is the most valuable thing that we have and that we’ve accomplished, I believe.”