Interview with AGA President, July, 2005

An academic clinician from the University of Virginia, Charlottesville, Dr. Peura is the 100th president of the AGA. His term continues through May 2006.

What will it mean for you to serve as president of the AGA?

Dr. Peura: To be given the opportunity by my peers to lead the AGA is one of the greatest honors of my life and the culmination of a long career in gastroenterology.

One of the thrusts of the AGA Strategic Plan is to continually identify new forces affecting the science and practice of gastroenterology and be a leader in guiding the development of the field. What "new forces" do you see on the horizon?

Technology is a key issue - we are in a technological specialty. There are going to be technological advances that will change how we care for our patients. One major impact of these advances will be in the area of therapeutics. There are many procedures that we will be able to do less invasively in the future. With newer imaging capabilities, there will be a shift away from diagnostic procedures and therapeutic procedures will increase. Also the exciting prospect of functional imaging will enable us not only to structurally view the digestive tract and perhaps provide treatment, but in the near future will allow us to see how the GI tract really works and functions in real time.

Quality of care is also a big issue. While we always try to provide quality medical care for our patients, we're going to be held more and more accountable for this in the future. As a specialty we must come up with ways of measuring quality and ensuring that our non-GI colleagues, legislators and patients recognize that we are in a position to provide the best quality of care for GI and liver related conditions. We also need to preserve and ensure quality care, while maintaining efficiency in our GI practice. Ensuring that individuals have access to measurable quality care is currently a big political issue, especially given budgetary pressures on federal programs such as Medicare. The political climate portends that providers will likely be rewarded or possibly penalized based on the quality of care they deliver.

What steps is AGA taking in this area?

Dr. Peura: We are keeping abreast of what is going on legislatively. Should we see changes on the horizon that could pose a threat to quality of patient care and safety, then the AGA is poised to proactively speak out against the changes and work independently and with our sister organizations and like-minded coalitions to make our position known. To develop a cohesive approach to this issue, the AGA is establishing a Center for Quality. Among other things, the AGA Center for Quality will develop programs and tools for members to assist them in implementing evidence-based guidelines and measuring and reporting adherence to quality indicators as they are developed. We will assist GI training programs to integrate quality care education into the curriculum.

How can the AGA help members prepare for the future?

Dr. Peura: The AGA has a Future Trends Committee charged to track and suggest ways to prepare members for changes in the field. Part of this committee's work is to identify trends and technologies that will affect the future of gastroenterology. From a technological standpoint, we must make sure that new technologies add value rather than prove disruptive. New technologies should enhance our abilities to address clinical questions, and likely will pose new questions that we previously had not thought to ask.

From a public policy standpoint, what are the most critical issues facing the field of gastroenterology?

Dr. Peura: The uncertainty of adequate reimbursement for our services is critical to gastroenterologists. The sustainable growth rate initiative is a huge challenge. These concerns need to be addressed. At issue is coming up with monies to pay for services in an environment where there is a huge budget deficit as well as many groups competing for shrinking resources. Convincing legislators to fairly balance health care with other governmental priorities is important. We have to advocate for fair reimbursement for the care we deliver and access to appropriate care for all patients.

Declining federal funding for biomedical research is also a huge issue. The NIH budget doubling initiative by Congress from 1999-2003 was a major factor in revitalizing biomedical research. But now we're in danger of losing that momentum. The current and proposed levels of funding increases are abysmal, and this will have a major impact on gastroenterology. New initiatives may not get funded, and it's going to worsen an already difficult situation within academic centers: young GI physicians may not be attracted to careers in research, established investigators are going to re-evaluate their career choices and researchers are going to have to look for alternative funding sources. This is where the AGA plans to step up to not only advocate for more federal funding and explore unique sources of funding, but also to expand the already considerable grant support distributed by the AGA's Foundation for Digestive Health and Nutrition. I challenge everyone to also personally step up by contributing to the FDHD. Help protect the science and practice of gastroenterology.

You mentioned abysmal funding increases. What are your expectations for research funding?

While the projected increase for 2006 is expected to be 0.7 percent, I hope that compromise will prevail and that figure comes closer to 2 percent or even 3 percent. While that would be an improvement over the status quo, it is still far below what is needed. We the most robust and sophisticated biomedical establishment in the world and cannot afford to have the funding spigot turned on and off. Levels of federal research funding today influence a whole generation of investigators and impact career choices tomorrow. The AGA is working hard to address the research funding situation.

The AGA has approximately 14,000 members - how can they get more involved in the organization and give back to the field?

Each member has an obligation to pay back the specialty for the many benefits and blessings that they've received. The best way to do that is to volunteer within the organization: get involved and make a difference! Members should be proud of their association, attend its meetings, support its activities, make use of the many member services and promote the value of the AGA in their communities and among their peers.

Grassroots advocacy may be a way to begin to be actively involved. Every year, AGA hosts an "Advocacy Day" during which members visit their legislators on Capitol Hill to advocate for the needs of our patients and our specialty. I hope to increase the number of members involved in Advocacy Day and invite anyone who's interested in becoming involved to contact the AGA National Office. Another way to get involved is through a committee, council section or working group. Let us know your interests and how much time you can give. While we can't promise everyone a job, we can't ask you to help if we don't know what you want to do!

Volunteering your time with the AGA is a wonderful opportunity to give back to GI, and it's also exciting and rewarding and the right thing to do.

Why is it important for your GI colleagues to give back to the field and pay back the specialty?

Our future depends on it. Think back on those who volunteered to help you get where you are now. We need to do the same thing to ensure that the practice of gastroenterology and the professional environment of the future will be vibrant, self-sustaining and full of opportunities even though it will look different from today. That is our legacy and our responsibility as good stewards of our time, talents and money.

Is there anything else that you'd like to add?

My path in the AGA has been in education. I served on and was chair of the Education Committee, have been involved with innumerable educational initiatives to include the H. pylori DHI and was honored several years ago to receive the AGA Distinguished Educator Award. What pleases me most is AGA's commitment to high quality medical education. The association's remarkable success in this area reflects the dedication of many talented physician volunteers, council, committee and subcommittee members, planning groups and program chairs and faculty. One of AGA's strategic directions emphasizes further expanding educational programs. One such program is a clinically focused Winter Congress to be held in Florida in December of this year. In August, AGA has planned a course for mid-level providers, nurse practitioners and physician assistants, professional colleagues who are playing an ever more important role in GI practice. During my presidency, I hope to continue expanding such educational offerings.

AGA President-elect David A. Peura, MD

David Peura, MD, is a professor of medicine and associate chief of the Division of Gastroenterology and Hepatology at the University of Virginia School of Medicine, Charlottesville.

After graduating from the University of Vermont College of Medicine in 1971, he was an internal medicine resident and then chief medical resident at Letterman Army Medical Center and a fellow at Walter Reed Army Medical Center in Washington. He served on the clinical staff and later became chief of gastroenterology at Walter Reed and consultant in gastroenterology to the Army Surgeon General. Retiring from the Army in 1990 with the rank of Colonel, Dr. Peura then joined the faculty at the University of Virginia, Charlottesville.

Throughout his career, Dr. Peura has been actively involved in clinical investigation relating to acid peptic disorders, particularly peptic ulcer disease. Most recently, his research efforts have centered on Helicobacter pylori and its role in ulcer pathogenesis. He serves as a reviewer for most of the major medicine and gastroenterology subspecialty journals and has authored or co-authored more than 100 original articles, book chapters and reviews on a wide range of digestive disease topics.

Dr. Peura has demonstrated expertise and innovation in the area of medical education. While chair of the ACG Board of Governors and AGA's Clinical Practice Section, he assisted in the organization's annual clinical and scientific education program development. As chair of the AGA Education Committee and Digestive Health Initiative Ulcer Campaign, Dr. Peura coordinated the planning and implementation of a number of highly regarded physician and lay education programs. He continues to serve as an advisor and faculty for regional, national and international teaching projects.

A fellow of the American College of Physicians and Master of the American College of Gastroenterology, Dr. Peura has held several leadership positions with major national gastroenterology organizations. He has received numerous commendations and awards for his subspecialty contributions, including the AGA's Distinguished Educator Award in 2002.