ACG Presidential Address 2023

It is with great pleasure and a deep sense of gratitude and humility that I address you as the President of our esteemed organization with recent highlights of our professional home at work for the advance of our profession, members, and patients. Let me begin with some background as to why Vancouver, Canada? The Canadian Association of Gastroenterology was founded in 1962. The ACG's held its first meeting outside the US in Montreal in 1972 which included both US and Canadian faculty which lead to our close collaboration ever since. We are grateful for our current Canadian Governors, Drs Steven Gruchy, Nikila C. Ravindran, Yvette Leung, as well as current Canadian Association of Gastroenterology President, Dr Paul Moayyedi who was also a previous ACG journal editor and Board of Trustee's member. Also, I want to acknowledge Dr Neena Abraham who is Canadian expatriate and an ACG Board of Trustee's member and director of our Institute. So, we are delighted to be here in beautiful Vancouver with our Canadian compatriots. Succinctly, as a state of the union address, I enthusiastically report to you that our college is exciting, energetic, effective, and financially sound as we continue to follow our visionary strategic plan of advancing gastroenterology and improving patient care through excellence and innovation based upon the pillars of patient care, education, scientific investigation, advocacy, and practice management. As we organizationally usher into our 10th decade, I would like to use our ACG acronym to guide my presentation as well as give some historical perspective for our growing younger membership, that continues to be not only our guide but has produced all the shoulders of brilliance that I stand upon today as the 79th ACG president. To know the future, you know the past! I would like to emphatically note that the ACG has always been on the forefront and proactive on nearly every issue and continues to do so! Starting with “A” our ACHIEVEMENTs, chronologically: Our origins began when Dr Isadore Ritter became our first president after presiding over the meeting at the New York City home of Samuel Weiss, MD, in November 1932, when a small group of physician-clinicians met to form a new medical association, one that would address the interests of practicing gastroenterologists and would be “a more inclusive organization of physicians interested especially in the clinical aspects of digestive disorders.” What an auspicious commencement to now the largest gastroenterology society with nearly 20,000 members and growing nationally and globally currently through the work of Hetal Karsan and Sarah McGill, chairs of our credentials and international relations committees. We have affiliate GI societies from around the world, including Japan, India, Pakistan, Brazil, and Central America to mention a few. Our journal began as The Review of Gastroenterology first published in 1934 and Dr Weiss was the Editor in Chief until 1964. It was renamed The American Journal of Gastroenterology in 1954. Dr Eamonn Quigley was the last sole Editor until 2003. Today our “Red Journal,” under the leadership of Co-Editors-in-Chief, Drs Jasmohan Bajaj and Millie Long, and their partner Managing Editor, Claire Neumann, is and continues to be one of the most widely read publications in gastroenterology here and worldwide. Jas and Millie have been amazingly ingenious in a most challenging and competitive environment in keeping the flagship of our organization a major resource for clinicians with the most clinically relevant science. In addition, our publications now include Clinical and Translational Gastroenterology, led by Dr Brian Jacobson, and the ACG Case Reports Journal, managed by a team of accomplished GI fellows who also serve as editors. As an aid to our busy members to stay current with the latest research, ACG has included Evidence-Based GI, a synopsized curation of the literature, spearheaded by Dr Philip Schoenfeld and supported by a diverse editorial board, complete with additional podcasts. If you haven't had a chance to listen, I wholeheartedly recommend exploring these podcasts; they are truly outstanding. And lastly our ACG magazine under the creative genius of Anne Louise Oliphant, our VP of communications, with the latest edition—“Tales from GIQUIC.” Regarding Education, the first Annual Post Graduate Course was in 1940. We have since evolved through our Educational Affairs Committee, chaired by Dr Anita Afzali and our amazing Meridith Philips, VP of Research and Learning to include not only the Post Graduate Course but also the Friday Courses, and the Annual Scientific Meeting. The ACG uniquely also brings educational programing to our members with Regional Courses and Schools for Endoscopy, IBD, Hepatology and Functional GI Disorders. Our programs have been a huge success. I want to offer our greatest thanks to monumental work, as you could imagine that goes into keeping us educated. I additional would like to recognize Drs Shivangi Kothari, Baharak Moshiree, and Renka Umashanker, our first triumvirate female, Post Graduate Course Directors for a remarkable course. “Early Experience in Flexible Gastroscopy” by Dr G. McNeer was published in 1940 in Review of Gastroenterology. What an incredible technological contribution and advancement this has made to our discipline and patient care. Currently continuing education is offered to learn new techniques or enhance our endoscopic skills. Dr Seth Gross, a Board of Trustee member has been instrumental in creating our Endoscopy School which brings this expertise to our regional meetings. In addition, he and Dr Vivek Kaul who chairs the Innovation and Technology Committee are bringing the next generation of innovation to endoscopy with the advances of artificial intelligence to help our members improve polyp detection, endoscopy reporting, and practice efficiency. Our founding fathers saw an integral part representation of clinical practice was the Board of Governors which originated in 1955 with the stated purpose as depicted in the original bylaws: The Board of Governors shall act as liaison between the Board of Trustees and the fellows and act as a clearing house for the Trustees on general assigned subjects and in local problems. Today under the outstanding leadership of Dr Dayna Early and Vice Chair, Sita Chokhavatia, who is also a Master of the College, we continue this ACG unique and vital grassroots force, with 77 governors throughout the United States and aboard, enabling us to keep pulse of the issues facing our members and patients. In 1987 the ACG awarded Dr Leonidas Berry with the inaugural clinical achievement award. He was an African American pioneer in endoscopy and gastroenterology who also served as president of the National Medical Association from 1956 to 1966. Dr Berry is one example of a comprehensive program to acknowledge contributions made to the College and to GI patient care by outstanding individuals. Both the College's Awards program and its special invited lectureships serve to recognize some of the leaders in the field of clinical gastroenterology. This year I am proud to announce the Invited lecture will include Marcia Cross who is the first patient and advocate to be included in our tradition and a much welcomed and valued addition I must add. The practice-oriented side of ACG really began to blossom in the mid-1980s. Among other activities, ACG developed and expanded educational programs, starting an annual practice management course in 1988 with William D. Carey as the first course director. Another practicing gastroenterologist who became an ACG president, Sarkis Chobanian, paid special attention to the needs of the gastroenterologist in private practice. He established a panel of outstanding gastroenterologists from model practices that produced the first published guideline entitled ACG Task Force Report on the Future of Clinical GI Practice, and their conclusions and recommendations on enhancing private practice. Today, our Practice Management Committee, led by Dr Stephen Amman has evolved to be an outstanding group working on the most challenging and ever-changing aspects of clinical gastroenterology. This amazing group has been prolific in providing both independent practices and hospital owned/affiliated members of the ACG with pertinent information to help manage and run our medical practices efficiently and in a fiscally responsible manner while delivering high quality and low-cost care to their patients. We all know this is the quintessence of establishing “order out of chaos” and I can't commend this group enough! New this year is educating our membership on the ecologic aspects of the care we provide and attempts at improving our practice and health ecology will be vanguarded by addition of Drs Swapna Gayam and Rabia de Latour to lead this subcommittee effort. As the practice of gastroenterology became more complex due to costs and technological advances in the 1990s a coalescence of conflicting interests of payors, government, pharmaceutical companies, and physicians, necessitated the need for navigation to continue providing the best patient care regarding colorectal cancer screening with colonoscopy versus barium enema as a Medicare benefit. Dr Seymour Katz, our 1995–1996 president, asserted the college's guiding principle in these deliberations: “Place the interests of our patients first, and we will always be best served.” This sage maxim has survived the test of time and remains a benchmark in the College's strategies and policymaking today and has contributed to the early detection and lives saved from colon cancer. The ACG Institute for Clinical Research and Education was formed under the aegis of Drs William Carey and Joel Richter in 1994 for the purpose of spawning young investigators by funding patient care-oriented research. Today, under the leadership of Dr Neena Abraham, the ACG Institute granted over $2.2 million in research funding in 2023, which included 4 junior faculty awards at $450,000 each and 2 novel health equity research grants. This notable increase in funding plays a pivotal role in advancing our discipline. I highly encourage you to contemplate making an annual contribution to support this cause as I and my family have. The Institute is also committed to fostering leadership development at all levels and this year has introduced the Clinical Research Leadership Program. As a result, our “bench” of upcoming young scholars is deep, ensuring the future of the ACG and gastroenterology. Drs Jamie Barkin and Robyn Karlstadt could hardly have foreseen the enduring ramifications of a conversation they had in late 1989. Dr Karlstadt, an ACG member eager to increase her involvement in the College's activities, approached then president Dr Barkin, who both had realized the limited representation of women. Dr Barkin promptly established the ad hoc Committee on Women in Gastroenterology and appointed Dr Karlstadt as its inaugural chair. Today, our Women in GI committee, under the leadership of Dr Kara De Felice is an integral part of the ACG. Currently, 24% of our membership is female. In terms of leadership, 30% of our Board of Trustees, 28% of our governors are female and growing, 39% of our committee Chairs and Vice Chairs and at this meeting, 100% of our postgraduate course directors are female. In addition, in conjunction with the WGO, we are involved with the International Women's Leadership pilot, represented by Dr Carol Burke, an ACG past president, and Drs Nimisha Parekl, Sarah McGill, and Kara DeFelice. In 1998, Dr Christina Surawicz assumed the role of ACG's inaugural female president. One of her major concerns was the sustainability of clinicians within the academic medical field, given the challenges posed by reduced patient care reimbursements, strict regulations for teaching physicians, and operational inefficiencies in clinical practice settings. To address these issues, Dr Surawicz initiated the formation of a GI Private Practice Task Force, and together with volunteers from clinical practices within academic institutions produced a concise guide, essentially a survival manual tailored to clinical academic practices. During the late 1990s the College began to investigate strategies for proactively addressing health disparities in digestive diseases. The College leadership established an Ad Hoc Committee on Minority Affairs. In 2003, its name was changed subsequently to the Committee on Minority Affairs and Cultural Diversity and most recently to Diversity, Equity, and Inclusion, to more accurately reflected its areas of emphasis. The first 2 committee chairs were Drs Anthony Kalloo, and Duane Smoot. Guided by their leadership, their committee developed an action plan that brought to the attention of the College membership the issues of minority-related health disparities. Dr Kalloo's group developed a vanguard presentation at the annual meeting in 1999 addressing esophageal cancer, colorectal cancer, and hepatitis C—that disproportionately impact minority populations entitled “Gastrointestinal Disease in Minorities: Emerging Trends for the Twenty-First Century,” Today under the leadership of Dr Sophie Balzora, committee chair and Trustee Dr Renee Williams, they expanded the committee and have initiatives focused on underrepresented minorities, diversity, equity and inclusion, and LBGTQ+ issues. Great job Sophie and Renee and congratulations on your promotions to professorship! In 2003, Past president Douglas Rex together with then committee chair Dr Frank Hamilton produced the sentinel publication “Colorectal cancer in African Americans” in the Am J Gastroenterol in 2005. They found that African Americans were less likely to have undergone colorectal cancer screening and because their cancer tends to present earlier, they should hence be advised to seek screening at age 45 rather than 50. This was an ACG first recommendation. If the A in ACG represents “Achievements,” I think the “C” is for COLLEGIALITY. “By your commitment, you make a difference. Individual College and committee members via the Board of Governors recognize the issues and guide the Trustees and the elected executive leadership. The blend of private and academic gastroenterologists, researchers, and teachers, makes the ACG the premier GI clinical organization.” That was a statement by past president Dr Jack DiPalma in 2007. This well depicted synopsis statement is an example of the degree of collegiality that has and continues to exist in the ACG. In our continued strive for excellence, the conduit of informational transfer and response between the board leadership and our membership is a key to an impressive evolutionary process. We have focused in recent years on our committee's cross pollination. A stellar example is this past April, our Board of Governors, led by Dr Dana Early, have worked with our Legislative and Public Policy Committee chair, Dr Louis Wilson, our VP of Public Policy, Brad Conway, and our Institute Early Career Leadership program mentees, under the direction of Drs Allon Kahn and Elizabeth Paine. We met in DC at our annual Fly-In to meet with Congress which included visits to our legislators in the Senate and House of Representatives. Under the tireless work of Dr Louis Wilson and Brad Conway, we all had lunch with the 6 of the physician legislators from the Doctor's Caucus, who provided insight as to the status of the congress, on the ACG sponsored bill “Strengthening Medicare for Patients and Providers Act” and “Step therapy Act.” These are bipartisan bills introduced by some members of this group to address payment uncertainty and avoid possible physician shortages for Medicare beneficiaries by providing annual physician payment updates tied to inflation. Medicare has cut inflation adjusted reimbursement by an incredible 33% for our 10 most common procedures. We also met with the leadership of CMS at this meeting and several additional times this past year, to advocate for increasing access to GI services by access to colonoscopy which our most populations These issues are patient access to care and to colon cancer screening and previous Dr Wilson and Brad have the of the and also as This is in our to the for the of the patients we This year Drs Dana Early, Sita Chokhavatia, with from our and our societies had several with United to to their of from every GI endoscopy The would patient access to care, increase practice impact colorectal cancer early detection, and patient the the of this the ACG the and in a outside the in as a of and to patient United of their of the I am proud of our members, patients and leaders together in the of and an to our of patient care. the work of past president Dr Trustees Dr and Dr the College has been a proud and in the Disease National a group of patient and physician in the GI As a of the under the of our past president, and the of Trustee Seth Gross, was which an of GI and every at and at As of early this year, have been over programs over of of This remains a remarkable addition to our of educational programing and our of bringing education to our Our ACG resource has an amazing of under the leadership of Dr In collaboration with our Practice committee led by past committee chair, and current and Sarah an was to support the on our new to GI with over of This has been a addition and resource for our academic and private practice I would like to commend this group highly for this our quality with our from and the of continues to the for quality in endoscopy and remains the only GI with more than This year, under the leadership of and will be to include and quality including and is an ACG collaboration with is a to care to private practice. Under an a cancer and program has been to the need for the of GI cancer This program family education, and by This is a remarkable addition to our of colon cancer under the of Drs and Dayna Early, an endoscopy has been and now for the education and on our endoscopy This is a addition for our membership given our recent and could not be more We have our “A” and our that which is represented by I would like to acknowledge and my Dr from my of and at the of I would also like to recognize and my to Drs and as some of most in my like to also this to my gratitude to our ACG who I are the most team in medical organization worldwide. for their has only over the past year as had the of working with I my thanks to the Board of Trustees, all the ACG the membership, Brad Past President and our Dr for their support and throughout this the of and programs that make the ACG I want to also acknowledge all who do to time I could not I would like to acknowledge my beautiful and and And especially my beautiful of years for the my It has been a to serve as your president and an amazing professional and from my ACG I am proud to be part of the ACG and together our future is under the leadership of Dr I would like to you with some of my is not the key to is the key to success. If you you are you will be is not only the greatest of but the of all key of the ACG is that part your

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