- Email: [email protected]
Our New President—John I. Allen, MD, MBA, AGAF
Gastroenterology 2014;146:1408–1412
AGA SECTION Our New President—John I. Allen, MD, MBA, AGAF
John I. Allen, MD, MBA, AGAF
I
t is our privilege to introduce John Allen, who will become the 109th president of the American Gastroenterological Association at the 2014 Digestive Disease Week in Chicago, IL. He is one of only a handful of physicians to achieve this distinction while working as a community gastroenterologist.
AGA SECTION
John’s Family John’s father, Carlton, grew up in Plano, Texas where John’s grandfather owned “Allen Drug Store” on the town’s main street. Carlton was the first from his family to go to college and eventually earned doctorates in religion and theology from Princeton and Columbia Universities. While at Princeton, he met Barbara Swink, a New Jersey girl who was a freshman at New Jersey College for Women (now Douglas). They became engaged when she was a college sophomore and shortly thereafter, Carlton left for missionary service in India. He spent 2 years at Ewing College in
Allahabad and during his stay, met and interviewed both Mahatma Gandhi and Jawaharlal Nehru. Carlton married Barbara just days after her graduation, and he continued his academic studies at Princeton. During the early years of their marriage, World War II erupted and Carlton felt a strong need to serve his country. He became a Wing Chaplain for the 20th Air Force B-29 bombing squadron and was based on the island of Guam, where he built his chapel out of bomb crates and ministered to our troops for almost 3 years. John visited Guam 4 years ago to better understand this important chapter in his Dad’s life. After the War, Carlton and Barbara settled in San Antonio, Texas where Carlton was a Professor of Theology at Trinity College. John was born in 1951 (the couple’s second son) and 2 years later, Carlton left academics to work as lead minister at the First Presbyterian Church in Bound Brook, New Jersey, a position he held for 10 years. This was followed by ministerial positions in Rochester,
New York (4 years) and Albuquerque, New Mexico, where John spent his high school years. Growing up, John was influenced to become a doctor by several adults, especially his grandmother and his childhood family doctor. John saw examples of strong community service in his mother and father, both of whom were early advocates for civil, racial, and women’s rights. Family dinners often turned into debating forums where politics, theology, and science dominated conversations. The sciences were an abiding interest of his father, who published a sermon about man’s landing on the moon in Reader’s Digest a decade before it became a reality. The family’s fascination with space exploration influenced John’s older brother Carl, who now is the United States’ Astromaterials Curator at NASA’s Johnson Space Center, planning for new acquisitions of extraterrestrial materials and protecting current collections, including the repository of moon rocks from Apollo missions. “When we realize the everlasting truth that everything changes, and find our composure in it, we find ourselves in Nirvana.” —Shunryu Suzuki In high school, John excelled in both schoolwork and athletics. He graduated near the top of his class of 1100 students and was New Mexico State Champion in the 100yard breaststroke for 2 consecutive years (1968–1969). As a high school junior, he won the West Point Leadership award given to the state’s outstanding studentathlete. John’s favorite times were summers working as a lifeguard and swimming coach and devoting countless hours perfecting both his tan and diving form (Figure 1).
Education and Training John followed his brother Carl to Rice University in 1969. Texas culture was a shock to John since racial tensions were high, segregation was still evident, Vietnam War protests were in full swing, and Houston’s first public radio
Figure 1. “It doesn’t get better than this” –– John as a lifeguard in Albuquerque, 1970.
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station (a progressive listener-supported station) was firebombed twice during his freshman year. John had decided on Rice because of its excellent record at placing students into medical school. In addition to his studies, John competed on the swim team and set 21 school records by the time he graduated. His 100-yard breaststroke record stood for 10 years and he was the first Rice swimmer to qualify for the NCAA championships. His achievements earned him the 1973 Bob Quin award, the most prestigious award given to a student-athlete at Rice. After finishing college, John returned to Albuquerque to attend the University of New Mexico’s School of Medicine, graduating in 1977. John decided to focus on internal medicine as a specialty, being attracted to the cognitive aspects of the specialty and opportunities to pursue academic clinical research. While in medical school, he studied anti-lymphocyte antibodies in patients with systemic lupus with Ralph Williams and Ronald Messner from the Rheumatology faculty. His research mentors were from the University of Minnesota, and influenced him to apply and subsequently match at the University of Minnesota Internal Medicine program, leading John to a 30-year life in the North Star State. In 1977, John moved from Albuquerque to Minnesota to begin his internship. He had interviewed in Minneapolis during a beautiful fall week when the lakes were magical and the leaves golden. He did not know about the polar vortex that grips Minnesota for 6 months each year. His first winter in Minneapolis was the coldest in decades and he survived despite the fact that his car (a beloved 1968 red Mustang) had no functioning heater. His internship, residency, and fellowship all were completed at the University of Minnesota. “When the student is ready, the teacher will appear.” —Talmud During training, John was exposed to outstanding GI academic clinicians, including Jack Vennes, Steven Silvis, John Bond, Les Zieve, Michael Levitt, Joseph Bloomer, Don Wilson, and Craig McLain. These influential role models were key to John’s attraction to gastroenterology. John appreciated both the cognitive and procedural aspects of our specialty. Endoscopy was evolving rapidly and a number of Minnesota faculty members were innovative endoscopists and leaders of national GI societies. In both his residency and subsequent GI Fellowship, he worked with Craig McLain (hepatology) and Neil Kay (immunology) and was first to describe T-cell dysfunction in zinc-deficient patients who received parenteral nutrition prior to its containing trace elements. During his 3-year fellowship and subsequent early faculty years, he continued his research, now focused on immunological disorders seen in patients with alcohol-induced hepatitis and cirrhosis. He is grateful to his skilled mentors who helped launch his academic career. John’s research accomplishments led to his receiving the J. Jacob Kaplan award for outstanding achievement in medical research. Most of John’s GI fellowship was spent at the Minneapolis VA Medical Center where he came to
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May 2014
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appreciate the VA’s unique culture and the debts we owe these men and women who become our patients.
Professional Life: Academics During John’s fellowship (1980–1983), John Bond (VA Chief of GI) offered him a faculty position at the VA. Over the next 10 years, John’s academic career was successful: he published over 40 original research articles, chaired the University of Minnesota Gastroenterology Research Committee, received continual extramural funding, and was promoted to Associate Professor of Medicine, in 1991. John was both successful and interested in research, but had a persistent and nagging feeling that he was not following his true passion. When John turned 40, like his father before him, he began to consider moving from an academic to a community-based career. Although he had just received a 5-year research grant, John changed his career trajectory to lead a colon cancer program at Abbott Northwestern Hospital’s Virginia Piper Cancer Institute, a clinical program built to coordinate care for cancer patients. As part of this position, Drs Arnold Kaplan and Cecil Chally (both AGA Distinguished Clinician Award recipients) offered him a position at Digestive Disease Associates, a private practice group that would become Minnesota Gastroenterology (MNGI). When John joined MNGI, there were 18 physicians and Abbott Northwestern Hospital was their major practice location. “To cure sometimes, to relieve often, to comfort always.” —Eyd
Minnesota Gastroenterology
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John began practicing with MNGI in 1991 and quickly realized the potential of a large, integrated specialty practice. He distinguishing himself as a superb clinician and became interested in practice management and the business of health care. Within the first few years, he became a managing partner and began pioneering new ways to manage and improve the culture of private practice GI. In talking to the doctors and nurses at MNGI, it is clear that John was a treasured clinician, and his colleagues repeatedly comment on his kind, caring, and compassionate nature. John has a wonderful bedside manner that makes patients feel as if they are the only person in the world, when he visits with them. John is an astute, thorough, and excellent diagnostician, and the breadth of his clinical skills, managing complex patients across the spectrum of GI diseases, is impressive. Besides his clinical interests in colon cancer genetics, John pioneered the MNGI gastric pacer program and cared for many difficult patients with complicated gastroparesis. Among his most treasured memories is his introduction of nurse practitioners and physician assistants into MNGI’s practice. John was a wonderful colleague at MNGI—he is funny and is a great person to “kibitz” with. Furthermore, his
Gastroenterology Vol. 146, No. 5
colleagues could always approach him with any issue and he would stop whatever he was doing, pull his glasses over his nose (in later years), put his hands to his mouth, and listen with undivided attention. John would then ask a series of questions to focus and refine the issue, providing a clearer way of thinking about the problem and helping to determine the most appropriate answer. He was a great mentor and teacher to the younger associates and later to the mid-level practitioners. John is a great believer in people and never gave up on any of the MNGI hires. He always believed that a person could achieve more than they thought they were capable of. In 1999, John decided that his career was taking a decidedly business turn and enrolled in a 27-month long MBA program in Medical Group Management, based at the University of St. Thomas (Minneapolis). In 2000, John met and subsequently married Carolyn Scales, an advanced endoscopy nurse at Abbott Northwestern Hospital. Six months later, during a busy endoscopy morning, John felt an intense pain in his abdomen and developed a high fever. After he self-diagnosed gallstone pancreatitis, John walked to the hospital for an ultrasound exam. His friend and radiology colleague suggested that he return later for a CT exam and in the early afternoon (1:17 PM according to John) on November 11, 2001, he and Carolyn sat in a CT reading room looking at a 6 cm mid-abdominal mass in John’s abdomen. This turned out to be an advanced seminoma. With this diagnosis, he entered the same “Kingdom of the ill” (Susan Sontag, as quoted by Siddhartha Mukherjee in The Emperor of all Maladies)1 as did Brian Piccolo and Lance Armstrong. John (and Lance Armstrong) avoided the fate of Brian Piccolo thanks to federal funding of cancer trials and the bravery, intellect, and personal commitment of a dedicated oncologist at Indiana University, named Dr Lawrence Einhorn (John’s personal medical hero). From this experience, John’s continuing advocacy for medical research and innovations became very personal. After surgery and 4 rounds of chemotherapy, John emerged from a chemotherapy induced fog and successfully finished his MBA; proudly graduating with the help of Carolyn but without hair (Figure 2).
Figure 2. Carolyn’s support during John’s cancer treatment was unwavering.
May 2014
John’s family is a blended family in many senses (Figure 3). John and Carolyn help parent 2 children, Jennifer (26) and Josh (21) both adopted from Korea. Jennifer is a tutor and returning to a pre-medical academic focus. Josh is a personal trainer, musician and black belt in multiple martial arts. Further blending comes from the 5 dogs (total of 18 legs) that the family has adopted from ACT V Rescue and Rehabilitation (www.actvrescue.org), a non-profit animal rescue organization started by Carolyn and 3 other dedicated women who have rescued, fostered, and provided permanent homes for over 1000 injured and abused animals to date. “The conduct of our lives is the true reflection of our thoughts.” —Michel de Montaigne John’s list of accomplishments at MNGI is impressive. He was a proponent of Deming’s philosophy that there is a best way to manage complex processes, and he wanted to standardize care, decrease variability, maximize outcomes, and control costs. With a focus on quality improvement, outcomes measures, and patient satisfaction, John was 15 years ahead of his time. He helped manage the cultural change of MNGI from a mom-and-pop group, to a large, well-oiled, cohesive organization. John’s modus operandi was, and is, to look at a sub-optimally performing system, break it apart, and figure out ways to make the system and its people work more effectively. At MNGI, John had a number of administrative roles: member of the Board of Directors, West Metro Managing Partner, creator of the Quality Committee, and finally Medical Director for Quality. He helped institute MNGI’s electronic health record and from the start, imbedded a system to measure performance and outcomes. He started MNGI’s initiative to measure adenoma detection rates in 2004 and introduced the concept of monitoring patient cycle times: ie, the time it takes to complete a patient interaction from check-in to discharge. He made MNGI’s revenue cycle transparent by graphing partner revenue against expenses
and instituted correct coding practices that greatly enhanced revenue. While at MNGI, John developed relationships with national research coalitions led by Sid Winawer and John Baron and participated in clinical trials published in the New England Journal of Medicine and JAMA among others. MNGI became a recognized center for cooperative trials and device innovation (balloon based radio frequency ablation for Barrett’s was developed by John’s partner and co-author of this article, Robert Ganz). In addition to his work at MNGI, John worked closely with Allina Health, a not-for-profit organization serving Minnesota and Wisconsin with 3.4 billion dollars in annual revenues, 24,000 employees and 5000 associated or employed physicians. Since 2012, he has been the Chair of the Quality Committee, which oversees the collection of 748 quality and performance metrics. He also serves as 1 of 2 physician members of the Board of Directors, which oversees the entire Allina Health system.
A Return to Academics: The Move to Yale After 22 years in practice, John once again changed his professional life. With MNGI thriving and positioned well for the new era of integrated healthcare delivery, John had accomplished much of what he set out to do and wanted new challenges. John and his colleagues at MNGI had shown that a community practice could become a high-quality, efficient practice and a center for clinical research. John was curious to see if he could apply the same skills he had developed in the private sector to an academic GI Division, since they too face enormous financial and business challenges as health care reform unfolds. Last year John moved to Yale University School of Medicine as Professor of Medicine and Clinical Chief of the Section of Digestive Diseases. His charge was to develop the clinical practice and transform it into an efficient, qualitydriven practice integrated within the larger Yale healthcare system.
Involvement in the AGA John became involved in the AGA when one of his senior partners, Cecil Chally (who was a member of the AGA Governing Board) suggested John be placed on an AGA Task Force for Quality in Practice. John’s tremendous expertise in the area, his ability to clearly synthesize and present information, and his ideas and recommendations greatly impressed the AGA staff, committee members, and leadership. The AGA was beginning to develop major quality initiatives at the time, and John quickly rose in the ranks. He chaired the AGA Electronic Medical Record Task Force in 2006 and was appointed Chair of the Clinical Practice Committee in 2007, a committee responsible for all aspects of clinical practice, including quality measures and practice management. John was nominated and elected to be a Community Practice Councilor to the AGA Governing Board in 2009.
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Figure 3. Jennifer, Carolyn (with Mulligan), John (with Jonas) and Josh. These are 2 of their 5 dogs, and both live large with 3 legs.
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During his tenure, John was one of the hardest working, productive, and valuable members of the Board, leading crucial efforts in practice-related initiatives. It was no surprise (and well-deserved) when John was elected VicePresident in 2012, with succession to President in 2014. John’s vision for the AGA is shaped by his personal experiences (as physician, clinical researcher, teacher, and patient) and his view that the specialty of GI faces enormous challenges. The accelerated consolidation of health care–delivery systems, reduction in fee-for-service reimbursement, and increasing cost of regulations and electronic medical records all present both challenges and opportunities for everyone from independent community practices to academic medical centers. John sees unprecedented opportunities for those willing to risk new and disruptive solutions. John’s work at a single specialty GI “mega-practice”, on the Board of Allina, and now as Clinical Chief of Digestive Diseases at Yale provide him with a unique and broad perspective on virtually all aspects of GI care. Traditionally, the AGA had been focused mainly on academic issues with more limited activities related to clinical practice matters. John believed the AGA needed to be more responsive to the GI practitioner while remaining true to the science and research that has distinguished the AGA since 1897—and the AGA leadership agreed. John’s election as a Presidential officer is an important illustration of the AGA’s current multiple strategic priorities. Anticipating the coming changes in healthcare, the AGA has been focusing resources on programs that assist practicing gastroenterologists to meet the challenges of healthcare reform. John felt there was no single place a practice could go to understand the framework that will be needed in the new era of health care delivery (eg, coordinated population care, management of practice variation, demonstration of practice quality, cost efficiency, bundled payments and accountable care) and thought the AGA should be a leader in this arena. John has led the AGA in developing a series of programs under the “Roadmap to the Future of GI”, designed to provide a portfolio of tools that directly help practitioners thrive in a period of great change in healthcare. The goals of the Roadmap are to deliver high-quality care, demonstrate quality, and maximize revenue.2 During his Presidency, John plans to continue the AGA’s tripartite mission of Research, Clinical Practice, and Education. All 3 pillars will be supported by robust
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advocacy and networking with national organizations that create health care law, regulations, and policies. Important research endeavors include the growing endowment for research support targeted especially at investigators beginning their academic career (AGA Research Foundation) and the Center for GI Innovation and Technology. AGA education will transform into new, exciting modalities that speak to both beginning and advanced-career gastroenterologists. John believes strongly that an AGA President is a trusted steward of the AGA’s legacy. His Presidential year (2015) coincides with the 50th anniversary of Lyndon Johnson’s signing of legislation that created Medicare and Medicaid, thus forever placing federal and state governments into a central focus of health-care delivery. The passage of the Affordable Care Act will increase the role of government in medicine for better or for worse. John’s role as AGA President comes at a time when all gastroenterologists find themselves in a new world. It will be an interesting year. LOREN LAINE Yale University School of Medicine New Haven, Connecticut and VA Connecticut Healthcare System West Haven, Connecticut ROBERT A. GANZ Minnesota Gastroenterology, PA and University of Minnesota Medical School Minneapolis, Minnesota
References 1. 2.
Mukherjee S. The Emperor of All Maladies: A Biography of Cancer. New York: Scribner, 2010. AGA. Roadmap to the future of GI. Available at: http:// www.gastro.org/practice/roadmap-to-the-future-of-gi. Accessed March 27, 2014.
© 2014 by the AGA Institute 0016-5085/$36.00 http://dx.doi.org/10.1053/j.gastro.2014.03.031
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AGA SECTION Our New President—John I. Allen, MD, MBA, AGAF
John I. Allen, MD, MBA, AGAF
I
t is our privilege to introduce John Allen, who will become the 109th president of the American Gastroenterological Association at the 2014 Digestive Disease Week in Chicago, IL. He is one of only a handful of physicians to achieve this distinction while working as a community gastroenterologist.
AGA SECTION
John’s Family John’s father, Carlton, grew up in Plano, Texas where John’s grandfather owned “Allen Drug Store” on the town’s main street. Carlton was the first from his family to go to college and eventually earned doctorates in religion and theology from Princeton and Columbia Universities. While at Princeton, he met Barbara Swink, a New Jersey girl who was a freshman at New Jersey College for Women (now Douglas). They became engaged when she was a college sophomore and shortly thereafter, Carlton left for missionary service in India. He spent 2 years at Ewing College in
Allahabad and during his stay, met and interviewed both Mahatma Gandhi and Jawaharlal Nehru. Carlton married Barbara just days after her graduation, and he continued his academic studies at Princeton. During the early years of their marriage, World War II erupted and Carlton felt a strong need to serve his country. He became a Wing Chaplain for the 20th Air Force B-29 bombing squadron and was based on the island of Guam, where he built his chapel out of bomb crates and ministered to our troops for almost 3 years. John visited Guam 4 years ago to better understand this important chapter in his Dad’s life. After the War, Carlton and Barbara settled in San Antonio, Texas where Carlton was a Professor of Theology at Trinity College. John was born in 1951 (the couple’s second son) and 2 years later, Carlton left academics to work as lead minister at the First Presbyterian Church in Bound Brook, New Jersey, a position he held for 10 years. This was followed by ministerial positions in Rochester,
New York (4 years) and Albuquerque, New Mexico, where John spent his high school years. Growing up, John was influenced to become a doctor by several adults, especially his grandmother and his childhood family doctor. John saw examples of strong community service in his mother and father, both of whom were early advocates for civil, racial, and women’s rights. Family dinners often turned into debating forums where politics, theology, and science dominated conversations. The sciences were an abiding interest of his father, who published a sermon about man’s landing on the moon in Reader’s Digest a decade before it became a reality. The family’s fascination with space exploration influenced John’s older brother Carl, who now is the United States’ Astromaterials Curator at NASA’s Johnson Space Center, planning for new acquisitions of extraterrestrial materials and protecting current collections, including the repository of moon rocks from Apollo missions. “When we realize the everlasting truth that everything changes, and find our composure in it, we find ourselves in Nirvana.” —Shunryu Suzuki In high school, John excelled in both schoolwork and athletics. He graduated near the top of his class of 1100 students and was New Mexico State Champion in the 100yard breaststroke for 2 consecutive years (1968–1969). As a high school junior, he won the West Point Leadership award given to the state’s outstanding studentathlete. John’s favorite times were summers working as a lifeguard and swimming coach and devoting countless hours perfecting both his tan and diving form (Figure 1).
Education and Training John followed his brother Carl to Rice University in 1969. Texas culture was a shock to John since racial tensions were high, segregation was still evident, Vietnam War protests were in full swing, and Houston’s first public radio
Figure 1. “It doesn’t get better than this” –– John as a lifeguard in Albuquerque, 1970.
AGA Section 1409
station (a progressive listener-supported station) was firebombed twice during his freshman year. John had decided on Rice because of its excellent record at placing students into medical school. In addition to his studies, John competed on the swim team and set 21 school records by the time he graduated. His 100-yard breaststroke record stood for 10 years and he was the first Rice swimmer to qualify for the NCAA championships. His achievements earned him the 1973 Bob Quin award, the most prestigious award given to a student-athlete at Rice. After finishing college, John returned to Albuquerque to attend the University of New Mexico’s School of Medicine, graduating in 1977. John decided to focus on internal medicine as a specialty, being attracted to the cognitive aspects of the specialty and opportunities to pursue academic clinical research. While in medical school, he studied anti-lymphocyte antibodies in patients with systemic lupus with Ralph Williams and Ronald Messner from the Rheumatology faculty. His research mentors were from the University of Minnesota, and influenced him to apply and subsequently match at the University of Minnesota Internal Medicine program, leading John to a 30-year life in the North Star State. In 1977, John moved from Albuquerque to Minnesota to begin his internship. He had interviewed in Minneapolis during a beautiful fall week when the lakes were magical and the leaves golden. He did not know about the polar vortex that grips Minnesota for 6 months each year. His first winter in Minneapolis was the coldest in decades and he survived despite the fact that his car (a beloved 1968 red Mustang) had no functioning heater. His internship, residency, and fellowship all were completed at the University of Minnesota. “When the student is ready, the teacher will appear.” —Talmud During training, John was exposed to outstanding GI academic clinicians, including Jack Vennes, Steven Silvis, John Bond, Les Zieve, Michael Levitt, Joseph Bloomer, Don Wilson, and Craig McLain. These influential role models were key to John’s attraction to gastroenterology. John appreciated both the cognitive and procedural aspects of our specialty. Endoscopy was evolving rapidly and a number of Minnesota faculty members were innovative endoscopists and leaders of national GI societies. In both his residency and subsequent GI Fellowship, he worked with Craig McLain (hepatology) and Neil Kay (immunology) and was first to describe T-cell dysfunction in zinc-deficient patients who received parenteral nutrition prior to its containing trace elements. During his 3-year fellowship and subsequent early faculty years, he continued his research, now focused on immunological disorders seen in patients with alcohol-induced hepatitis and cirrhosis. He is grateful to his skilled mentors who helped launch his academic career. John’s research accomplishments led to his receiving the J. Jacob Kaplan award for outstanding achievement in medical research. Most of John’s GI fellowship was spent at the Minneapolis VA Medical Center where he came to
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May 2014
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appreciate the VA’s unique culture and the debts we owe these men and women who become our patients.
Professional Life: Academics During John’s fellowship (1980–1983), John Bond (VA Chief of GI) offered him a faculty position at the VA. Over the next 10 years, John’s academic career was successful: he published over 40 original research articles, chaired the University of Minnesota Gastroenterology Research Committee, received continual extramural funding, and was promoted to Associate Professor of Medicine, in 1991. John was both successful and interested in research, but had a persistent and nagging feeling that he was not following his true passion. When John turned 40, like his father before him, he began to consider moving from an academic to a community-based career. Although he had just received a 5-year research grant, John changed his career trajectory to lead a colon cancer program at Abbott Northwestern Hospital’s Virginia Piper Cancer Institute, a clinical program built to coordinate care for cancer patients. As part of this position, Drs Arnold Kaplan and Cecil Chally (both AGA Distinguished Clinician Award recipients) offered him a position at Digestive Disease Associates, a private practice group that would become Minnesota Gastroenterology (MNGI). When John joined MNGI, there were 18 physicians and Abbott Northwestern Hospital was their major practice location. “To cure sometimes, to relieve often, to comfort always.” —Eyd
Minnesota Gastroenterology
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John began practicing with MNGI in 1991 and quickly realized the potential of a large, integrated specialty practice. He distinguishing himself as a superb clinician and became interested in practice management and the business of health care. Within the first few years, he became a managing partner and began pioneering new ways to manage and improve the culture of private practice GI. In talking to the doctors and nurses at MNGI, it is clear that John was a treasured clinician, and his colleagues repeatedly comment on his kind, caring, and compassionate nature. John has a wonderful bedside manner that makes patients feel as if they are the only person in the world, when he visits with them. John is an astute, thorough, and excellent diagnostician, and the breadth of his clinical skills, managing complex patients across the spectrum of GI diseases, is impressive. Besides his clinical interests in colon cancer genetics, John pioneered the MNGI gastric pacer program and cared for many difficult patients with complicated gastroparesis. Among his most treasured memories is his introduction of nurse practitioners and physician assistants into MNGI’s practice. John was a wonderful colleague at MNGI—he is funny and is a great person to “kibitz” with. Furthermore, his
Gastroenterology Vol. 146, No. 5
colleagues could always approach him with any issue and he would stop whatever he was doing, pull his glasses over his nose (in later years), put his hands to his mouth, and listen with undivided attention. John would then ask a series of questions to focus and refine the issue, providing a clearer way of thinking about the problem and helping to determine the most appropriate answer. He was a great mentor and teacher to the younger associates and later to the mid-level practitioners. John is a great believer in people and never gave up on any of the MNGI hires. He always believed that a person could achieve more than they thought they were capable of. In 1999, John decided that his career was taking a decidedly business turn and enrolled in a 27-month long MBA program in Medical Group Management, based at the University of St. Thomas (Minneapolis). In 2000, John met and subsequently married Carolyn Scales, an advanced endoscopy nurse at Abbott Northwestern Hospital. Six months later, during a busy endoscopy morning, John felt an intense pain in his abdomen and developed a high fever. After he self-diagnosed gallstone pancreatitis, John walked to the hospital for an ultrasound exam. His friend and radiology colleague suggested that he return later for a CT exam and in the early afternoon (1:17 PM according to John) on November 11, 2001, he and Carolyn sat in a CT reading room looking at a 6 cm mid-abdominal mass in John’s abdomen. This turned out to be an advanced seminoma. With this diagnosis, he entered the same “Kingdom of the ill” (Susan Sontag, as quoted by Siddhartha Mukherjee in The Emperor of all Maladies)1 as did Brian Piccolo and Lance Armstrong. John (and Lance Armstrong) avoided the fate of Brian Piccolo thanks to federal funding of cancer trials and the bravery, intellect, and personal commitment of a dedicated oncologist at Indiana University, named Dr Lawrence Einhorn (John’s personal medical hero). From this experience, John’s continuing advocacy for medical research and innovations became very personal. After surgery and 4 rounds of chemotherapy, John emerged from a chemotherapy induced fog and successfully finished his MBA; proudly graduating with the help of Carolyn but without hair (Figure 2).
Figure 2. Carolyn’s support during John’s cancer treatment was unwavering.
May 2014
John’s family is a blended family in many senses (Figure 3). John and Carolyn help parent 2 children, Jennifer (26) and Josh (21) both adopted from Korea. Jennifer is a tutor and returning to a pre-medical academic focus. Josh is a personal trainer, musician and black belt in multiple martial arts. Further blending comes from the 5 dogs (total of 18 legs) that the family has adopted from ACT V Rescue and Rehabilitation (www.actvrescue.org), a non-profit animal rescue organization started by Carolyn and 3 other dedicated women who have rescued, fostered, and provided permanent homes for over 1000 injured and abused animals to date. “The conduct of our lives is the true reflection of our thoughts.” —Michel de Montaigne John’s list of accomplishments at MNGI is impressive. He was a proponent of Deming’s philosophy that there is a best way to manage complex processes, and he wanted to standardize care, decrease variability, maximize outcomes, and control costs. With a focus on quality improvement, outcomes measures, and patient satisfaction, John was 15 years ahead of his time. He helped manage the cultural change of MNGI from a mom-and-pop group, to a large, well-oiled, cohesive organization. John’s modus operandi was, and is, to look at a sub-optimally performing system, break it apart, and figure out ways to make the system and its people work more effectively. At MNGI, John had a number of administrative roles: member of the Board of Directors, West Metro Managing Partner, creator of the Quality Committee, and finally Medical Director for Quality. He helped institute MNGI’s electronic health record and from the start, imbedded a system to measure performance and outcomes. He started MNGI’s initiative to measure adenoma detection rates in 2004 and introduced the concept of monitoring patient cycle times: ie, the time it takes to complete a patient interaction from check-in to discharge. He made MNGI’s revenue cycle transparent by graphing partner revenue against expenses
and instituted correct coding practices that greatly enhanced revenue. While at MNGI, John developed relationships with national research coalitions led by Sid Winawer and John Baron and participated in clinical trials published in the New England Journal of Medicine and JAMA among others. MNGI became a recognized center for cooperative trials and device innovation (balloon based radio frequency ablation for Barrett’s was developed by John’s partner and co-author of this article, Robert Ganz). In addition to his work at MNGI, John worked closely with Allina Health, a not-for-profit organization serving Minnesota and Wisconsin with 3.4 billion dollars in annual revenues, 24,000 employees and 5000 associated or employed physicians. Since 2012, he has been the Chair of the Quality Committee, which oversees the collection of 748 quality and performance metrics. He also serves as 1 of 2 physician members of the Board of Directors, which oversees the entire Allina Health system.
A Return to Academics: The Move to Yale After 22 years in practice, John once again changed his professional life. With MNGI thriving and positioned well for the new era of integrated healthcare delivery, John had accomplished much of what he set out to do and wanted new challenges. John and his colleagues at MNGI had shown that a community practice could become a high-quality, efficient practice and a center for clinical research. John was curious to see if he could apply the same skills he had developed in the private sector to an academic GI Division, since they too face enormous financial and business challenges as health care reform unfolds. Last year John moved to Yale University School of Medicine as Professor of Medicine and Clinical Chief of the Section of Digestive Diseases. His charge was to develop the clinical practice and transform it into an efficient, qualitydriven practice integrated within the larger Yale healthcare system.
Involvement in the AGA John became involved in the AGA when one of his senior partners, Cecil Chally (who was a member of the AGA Governing Board) suggested John be placed on an AGA Task Force for Quality in Practice. John’s tremendous expertise in the area, his ability to clearly synthesize and present information, and his ideas and recommendations greatly impressed the AGA staff, committee members, and leadership. The AGA was beginning to develop major quality initiatives at the time, and John quickly rose in the ranks. He chaired the AGA Electronic Medical Record Task Force in 2006 and was appointed Chair of the Clinical Practice Committee in 2007, a committee responsible for all aspects of clinical practice, including quality measures and practice management. John was nominated and elected to be a Community Practice Councilor to the AGA Governing Board in 2009.
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Figure 3. Jennifer, Carolyn (with Mulligan), John (with Jonas) and Josh. These are 2 of their 5 dogs, and both live large with 3 legs.
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1412 AGA Section
During his tenure, John was one of the hardest working, productive, and valuable members of the Board, leading crucial efforts in practice-related initiatives. It was no surprise (and well-deserved) when John was elected VicePresident in 2012, with succession to President in 2014. John’s vision for the AGA is shaped by his personal experiences (as physician, clinical researcher, teacher, and patient) and his view that the specialty of GI faces enormous challenges. The accelerated consolidation of health care–delivery systems, reduction in fee-for-service reimbursement, and increasing cost of regulations and electronic medical records all present both challenges and opportunities for everyone from independent community practices to academic medical centers. John sees unprecedented opportunities for those willing to risk new and disruptive solutions. John’s work at a single specialty GI “mega-practice”, on the Board of Allina, and now as Clinical Chief of Digestive Diseases at Yale provide him with a unique and broad perspective on virtually all aspects of GI care. Traditionally, the AGA had been focused mainly on academic issues with more limited activities related to clinical practice matters. John believed the AGA needed to be more responsive to the GI practitioner while remaining true to the science and research that has distinguished the AGA since 1897—and the AGA leadership agreed. John’s election as a Presidential officer is an important illustration of the AGA’s current multiple strategic priorities. Anticipating the coming changes in healthcare, the AGA has been focusing resources on programs that assist practicing gastroenterologists to meet the challenges of healthcare reform. John felt there was no single place a practice could go to understand the framework that will be needed in the new era of health care delivery (eg, coordinated population care, management of practice variation, demonstration of practice quality, cost efficiency, bundled payments and accountable care) and thought the AGA should be a leader in this arena. John has led the AGA in developing a series of programs under the “Roadmap to the Future of GI”, designed to provide a portfolio of tools that directly help practitioners thrive in a period of great change in healthcare. The goals of the Roadmap are to deliver high-quality care, demonstrate quality, and maximize revenue.2 During his Presidency, John plans to continue the AGA’s tripartite mission of Research, Clinical Practice, and Education. All 3 pillars will be supported by robust
Gastroenterology Vol. 146, No. 5
advocacy and networking with national organizations that create health care law, regulations, and policies. Important research endeavors include the growing endowment for research support targeted especially at investigators beginning their academic career (AGA Research Foundation) and the Center for GI Innovation and Technology. AGA education will transform into new, exciting modalities that speak to both beginning and advanced-career gastroenterologists. John believes strongly that an AGA President is a trusted steward of the AGA’s legacy. His Presidential year (2015) coincides with the 50th anniversary of Lyndon Johnson’s signing of legislation that created Medicare and Medicaid, thus forever placing federal and state governments into a central focus of health-care delivery. The passage of the Affordable Care Act will increase the role of government in medicine for better or for worse. John’s role as AGA President comes at a time when all gastroenterologists find themselves in a new world. It will be an interesting year. LOREN LAINE Yale University School of Medicine New Haven, Connecticut and VA Connecticut Healthcare System West Haven, Connecticut ROBERT A. GANZ Minnesota Gastroenterology, PA and University of Minnesota Medical School Minneapolis, Minnesota
References 1. 2.
Mukherjee S. The Emperor of All Maladies: A Biography of Cancer. New York: Scribner, 2010. AGA. Roadmap to the future of GI. Available at: http:// www.gastro.org/practice/roadmap-to-the-future-of-gi. Accessed March 27, 2014.
© 2014 by the AGA Institute 0016-5085/$36.00 http://dx.doi.org/10.1053/j.gastro.2014.03.031
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