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Research Awards Program
Each year, the AGA Research Foundation provides research funding to transform the lives of talented investigators.
What will the practice of gastroenterology look like in 20 years? It is our hope that physicians have an abundance of new tools and treatments to care for their patients suffering from digestive disorders.
How will we get there? New treatments and devices are the result of years of research.
To help make this dream a reality, AGA – through the AGA Research Foundation – has made a commitment to support investigators in GI and hepatology with its Research Awards Program. In the past year, the AGA Research Foundation provided $2.5 million in research funding to 61 highly qualified investigators. These diverse researchers range from young investigators to more seasoned leaders in GI, all embarking on novel research projects that will advance our understanding of digestive conditions and pave the way for future discoveries in the field.
The AGA Research Foundation sincerely thanks all of its donors – without their contributions, this work wouldn’t be possible.
You can help spark the scientific breakthroughs of today so clinicians will have the tools to improve care tomorrow. Donate your tax-deductible gift today at www.gastro.org/donateonline.
Each year, the AGA Research Foundation provides research funding to transform the lives of talented investigators.
What will the practice of gastroenterology look like in 20 years? It is our hope that physicians have an abundance of new tools and treatments to care for their patients suffering from digestive disorders.
How will we get there? New treatments and devices are the result of years of research.
To help make this dream a reality, AGA – through the AGA Research Foundation – has made a commitment to support investigators in GI and hepatology with its Research Awards Program. In the past year, the AGA Research Foundation provided $2.5 million in research funding to 61 highly qualified investigators. These diverse researchers range from young investigators to more seasoned leaders in GI, all embarking on novel research projects that will advance our understanding of digestive conditions and pave the way for future discoveries in the field.
The AGA Research Foundation sincerely thanks all of its donors – without their contributions, this work wouldn’t be possible.
You can help spark the scientific breakthroughs of today so clinicians will have the tools to improve care tomorrow. Donate your tax-deductible gift today at www.gastro.org/donateonline.
Each year, the AGA Research Foundation provides research funding to transform the lives of talented investigators.
What will the practice of gastroenterology look like in 20 years? It is our hope that physicians have an abundance of new tools and treatments to care for their patients suffering from digestive disorders.
How will we get there? New treatments and devices are the result of years of research.
To help make this dream a reality, AGA – through the AGA Research Foundation – has made a commitment to support investigators in GI and hepatology with its Research Awards Program. In the past year, the AGA Research Foundation provided $2.5 million in research funding to 61 highly qualified investigators. These diverse researchers range from young investigators to more seasoned leaders in GI, all embarking on novel research projects that will advance our understanding of digestive conditions and pave the way for future discoveries in the field.
The AGA Research Foundation sincerely thanks all of its donors – without their contributions, this work wouldn’t be possible.
You can help spark the scientific breakthroughs of today so clinicians will have the tools to improve care tomorrow. Donate your tax-deductible gift today at www.gastro.org/donateonline.
Following the CHEST Foundation in 2022
by supporting initiatives to educate, empower, and improve, but this may have been one of its most exciting and impactful years yet. As 2022 draws to a close, look back at the progress made over the past 12 months and the initiatives that will help the Foundation continue to support clinicians and patients in 2023.
Collaboration and communication key in 2022
2022 saw the launch of two new initiatives that will be integral to improving patient care in the years to come: The First 5 Minutes™ and Bridging Specialties™: Timely Diagnosis for ILD Patients.
A collaborative partnership between CHEST and Three Lakes Foundation, Bridging Specialties brings together pulmonologists and primary care physicians to define a clearer clinician-guided approach to diagnosis for ILDs like pulmonary fibrosis (PF).
A Steering Committee of multidisciplinary clinicians – including pulmonologists, primary care physicians, and a nurse practitioner – have led the development of important resources including a white paper highlighting the most recent data into delays in diagnosis.
Plus, a newly launched ILD Clinician Toolkit offers the following and more:
- An early detection learning module offering information about reasons for delayed ILD diagnosis, symptoms to watch and listen for (like crackles on auscultation), suggested patient workups, and recommendations on proactive steps to take, including when to refer to a pulmonologist;
- A decision-making tool offering interactive simulated patient visits; and
- Radiologic imaging videos covering key patterns, common CT scan appearances and imaging features that can help in diagnosis of ILDs.
Clinicians can access the toolkit at bit.ly/Bridging-Specialties.
The First 5 Minutes
The First 5 Minutes initiative, developed in response to themes identified during the Foundation’s Listening Tour in 2020, kicked off in Bexar County, TX, in June with an in-person pilot training program at the University of Texas Health Science Center.
There, relationship-centered communication trainers from the Academy of Communication Healthcare led 18 clinicians through interactive activities on empathetic listening and trust-building communication skills.
Attendees at CHEST 2022 had the opportunity to participate in a similar interactive session on Monday, October 17, where they practiced empathetic listening skills with fellow attendees and learned how establishing trust with patients in the first 5 minutes of interactions can lead to more efficient communication and improve patient adherence. Learn more at bit.ly/First-5-Minutes.
CHEST gratefully acknowledges the following founding supporters of the First 5 Minutes™: Amgen, AstraZeneca, Bexar County, Novartis, Regeneron, Sanofi, and VIATRIS.
Making medicine a more inclusive practice
In February 2022, the American College of Chest Physicians (CHEST), the American Thoracic Society (ATS), and the American Lung Association announced a partnership with the prestigious Harold Amos Medical Faculty Development Program (AMFDP), a Robert Wood Johnson Foundation initiative, to sponsor a scholar in pulmonary and critical care medicine.
The recipient of that grant, George Alba, MD, Instructor of Medicine at Harvard Medical School and Pulmonary and Critical Care Physician at Massachusetts General, was announced earlier this year. Through his AMFDP award project, “Pulmonary Endothelial NEDD9 and Acute Lung Injury,” Dr. Alba seeks to advance NEDD9 antagonism as a potential therapeutic target in acute respiratory distress syndrome (ARDS).
“Growing up, I saw through my father’s example how education unlocks opportunities. Our community came together to help him on this path. Now a retired doctor of osteopathy in neonatology, it inspired me to pursue a career in medicine,” said Dr. Alba. “This award comes at a critical time in my junior faculty career: it allows me to continue pursuing my research in a meaningful way while also gaining new skills that will be critical for my ongoing career development.”
Visit bit.ly/3X4VphB to learn more about the AMFDP initiative and Dr. Alba.
Fun and fellowship – for a good cause
In addition, to all of this, the CHEST Foundation continued to host engaging events throughout the year to encourage connection, raise awareness, and fundraise for important initiatives.
This included the annual Belmont Stakes Dinner and Auction on June 11 in New York City. The fun-filled evening included a viewing of the 154th running of “The Championship Track,” a cocktail reception and plated dinner, a silent auction, a rooftop party, and insights from two patient advocates who turned their own experiences of living with chronic lung disease into incredible action on behalf of patients.
Three virtual wine nights in April, August, and December also invited numerous guests to learn more about imbibes from France, Italy, and California. Led by CHEST’s own resident wine aficionado, CEO Bob Musacchio, PhD, these events benefited the AMFDP, as well as other initiatives to improve patient care.
Another event that brought support to battling lung disease was the 9th Annual Irv Feldman Texas Hold 'Em Poker Tournament and Casino night jointly hosted by the Feldman Family Foundation and the CHEST Foundation. For the first time since early 2020, the event was held in-person after years of virtual tournaments. Funds raised from the event support education and resources to provide for a better quality of life for patients battling pulmonary fibrosis, a fibrotic lung disease with no cure.
2022 is special in another way. This year, the CHEST Foundation is offering an unmatched opportunity to one donor to attend CHEST 2023 in Honolulu, Hawai‘i for free. For every $250 you donate to the CHEST Foundation by December 31, 2022, you will receive an entry into a drawing for free registration, airfare (US only), and hotel accommodations.
Learn more about how you can donate to support initiatives like these – and make your mark on the practice of pulmonary, critical care, and sleep medicine – at foundation.chestnet.org.
Twenty-five years of life-changing grants
In addition to all of this, the CHEST Foundation provides financial grants to advance medicine and support to those in need. More than 12 million dollars later, the CHEST Foundation is proud to bolster the field of medicine and enhance patient care through this support. Learn more about the impact of grants from recent recipients in the September issue of CHEST Physician.
by supporting initiatives to educate, empower, and improve, but this may have been one of its most exciting and impactful years yet. As 2022 draws to a close, look back at the progress made over the past 12 months and the initiatives that will help the Foundation continue to support clinicians and patients in 2023.
Collaboration and communication key in 2022
2022 saw the launch of two new initiatives that will be integral to improving patient care in the years to come: The First 5 Minutes™ and Bridging Specialties™: Timely Diagnosis for ILD Patients.
A collaborative partnership between CHEST and Three Lakes Foundation, Bridging Specialties brings together pulmonologists and primary care physicians to define a clearer clinician-guided approach to diagnosis for ILDs like pulmonary fibrosis (PF).
A Steering Committee of multidisciplinary clinicians – including pulmonologists, primary care physicians, and a nurse practitioner – have led the development of important resources including a white paper highlighting the most recent data into delays in diagnosis.
Plus, a newly launched ILD Clinician Toolkit offers the following and more:
- An early detection learning module offering information about reasons for delayed ILD diagnosis, symptoms to watch and listen for (like crackles on auscultation), suggested patient workups, and recommendations on proactive steps to take, including when to refer to a pulmonologist;
- A decision-making tool offering interactive simulated patient visits; and
- Radiologic imaging videos covering key patterns, common CT scan appearances and imaging features that can help in diagnosis of ILDs.
Clinicians can access the toolkit at bit.ly/Bridging-Specialties.
The First 5 Minutes
The First 5 Minutes initiative, developed in response to themes identified during the Foundation’s Listening Tour in 2020, kicked off in Bexar County, TX, in June with an in-person pilot training program at the University of Texas Health Science Center.
There, relationship-centered communication trainers from the Academy of Communication Healthcare led 18 clinicians through interactive activities on empathetic listening and trust-building communication skills.
Attendees at CHEST 2022 had the opportunity to participate in a similar interactive session on Monday, October 17, where they practiced empathetic listening skills with fellow attendees and learned how establishing trust with patients in the first 5 minutes of interactions can lead to more efficient communication and improve patient adherence. Learn more at bit.ly/First-5-Minutes.
CHEST gratefully acknowledges the following founding supporters of the First 5 Minutes™: Amgen, AstraZeneca, Bexar County, Novartis, Regeneron, Sanofi, and VIATRIS.
Making medicine a more inclusive practice
In February 2022, the American College of Chest Physicians (CHEST), the American Thoracic Society (ATS), and the American Lung Association announced a partnership with the prestigious Harold Amos Medical Faculty Development Program (AMFDP), a Robert Wood Johnson Foundation initiative, to sponsor a scholar in pulmonary and critical care medicine.
The recipient of that grant, George Alba, MD, Instructor of Medicine at Harvard Medical School and Pulmonary and Critical Care Physician at Massachusetts General, was announced earlier this year. Through his AMFDP award project, “Pulmonary Endothelial NEDD9 and Acute Lung Injury,” Dr. Alba seeks to advance NEDD9 antagonism as a potential therapeutic target in acute respiratory distress syndrome (ARDS).
“Growing up, I saw through my father’s example how education unlocks opportunities. Our community came together to help him on this path. Now a retired doctor of osteopathy in neonatology, it inspired me to pursue a career in medicine,” said Dr. Alba. “This award comes at a critical time in my junior faculty career: it allows me to continue pursuing my research in a meaningful way while also gaining new skills that will be critical for my ongoing career development.”
Visit bit.ly/3X4VphB to learn more about the AMFDP initiative and Dr. Alba.
Fun and fellowship – for a good cause
In addition, to all of this, the CHEST Foundation continued to host engaging events throughout the year to encourage connection, raise awareness, and fundraise for important initiatives.
This included the annual Belmont Stakes Dinner and Auction on June 11 in New York City. The fun-filled evening included a viewing of the 154th running of “The Championship Track,” a cocktail reception and plated dinner, a silent auction, a rooftop party, and insights from two patient advocates who turned their own experiences of living with chronic lung disease into incredible action on behalf of patients.
Three virtual wine nights in April, August, and December also invited numerous guests to learn more about imbibes from France, Italy, and California. Led by CHEST’s own resident wine aficionado, CEO Bob Musacchio, PhD, these events benefited the AMFDP, as well as other initiatives to improve patient care.
Another event that brought support to battling lung disease was the 9th Annual Irv Feldman Texas Hold 'Em Poker Tournament and Casino night jointly hosted by the Feldman Family Foundation and the CHEST Foundation. For the first time since early 2020, the event was held in-person after years of virtual tournaments. Funds raised from the event support education and resources to provide for a better quality of life for patients battling pulmonary fibrosis, a fibrotic lung disease with no cure.
2022 is special in another way. This year, the CHEST Foundation is offering an unmatched opportunity to one donor to attend CHEST 2023 in Honolulu, Hawai‘i for free. For every $250 you donate to the CHEST Foundation by December 31, 2022, you will receive an entry into a drawing for free registration, airfare (US only), and hotel accommodations.
Learn more about how you can donate to support initiatives like these – and make your mark on the practice of pulmonary, critical care, and sleep medicine – at foundation.chestnet.org.
Twenty-five years of life-changing grants
In addition to all of this, the CHEST Foundation provides financial grants to advance medicine and support to those in need. More than 12 million dollars later, the CHEST Foundation is proud to bolster the field of medicine and enhance patient care through this support. Learn more about the impact of grants from recent recipients in the September issue of CHEST Physician.
by supporting initiatives to educate, empower, and improve, but this may have been one of its most exciting and impactful years yet. As 2022 draws to a close, look back at the progress made over the past 12 months and the initiatives that will help the Foundation continue to support clinicians and patients in 2023.
Collaboration and communication key in 2022
2022 saw the launch of two new initiatives that will be integral to improving patient care in the years to come: The First 5 Minutes™ and Bridging Specialties™: Timely Diagnosis for ILD Patients.
A collaborative partnership between CHEST and Three Lakes Foundation, Bridging Specialties brings together pulmonologists and primary care physicians to define a clearer clinician-guided approach to diagnosis for ILDs like pulmonary fibrosis (PF).
A Steering Committee of multidisciplinary clinicians – including pulmonologists, primary care physicians, and a nurse practitioner – have led the development of important resources including a white paper highlighting the most recent data into delays in diagnosis.
Plus, a newly launched ILD Clinician Toolkit offers the following and more:
- An early detection learning module offering information about reasons for delayed ILD diagnosis, symptoms to watch and listen for (like crackles on auscultation), suggested patient workups, and recommendations on proactive steps to take, including when to refer to a pulmonologist;
- A decision-making tool offering interactive simulated patient visits; and
- Radiologic imaging videos covering key patterns, common CT scan appearances and imaging features that can help in diagnosis of ILDs.
Clinicians can access the toolkit at bit.ly/Bridging-Specialties.
The First 5 Minutes
The First 5 Minutes initiative, developed in response to themes identified during the Foundation’s Listening Tour in 2020, kicked off in Bexar County, TX, in June with an in-person pilot training program at the University of Texas Health Science Center.
There, relationship-centered communication trainers from the Academy of Communication Healthcare led 18 clinicians through interactive activities on empathetic listening and trust-building communication skills.
Attendees at CHEST 2022 had the opportunity to participate in a similar interactive session on Monday, October 17, where they practiced empathetic listening skills with fellow attendees and learned how establishing trust with patients in the first 5 minutes of interactions can lead to more efficient communication and improve patient adherence. Learn more at bit.ly/First-5-Minutes.
CHEST gratefully acknowledges the following founding supporters of the First 5 Minutes™: Amgen, AstraZeneca, Bexar County, Novartis, Regeneron, Sanofi, and VIATRIS.
Making medicine a more inclusive practice
In February 2022, the American College of Chest Physicians (CHEST), the American Thoracic Society (ATS), and the American Lung Association announced a partnership with the prestigious Harold Amos Medical Faculty Development Program (AMFDP), a Robert Wood Johnson Foundation initiative, to sponsor a scholar in pulmonary and critical care medicine.
The recipient of that grant, George Alba, MD, Instructor of Medicine at Harvard Medical School and Pulmonary and Critical Care Physician at Massachusetts General, was announced earlier this year. Through his AMFDP award project, “Pulmonary Endothelial NEDD9 and Acute Lung Injury,” Dr. Alba seeks to advance NEDD9 antagonism as a potential therapeutic target in acute respiratory distress syndrome (ARDS).
“Growing up, I saw through my father’s example how education unlocks opportunities. Our community came together to help him on this path. Now a retired doctor of osteopathy in neonatology, it inspired me to pursue a career in medicine,” said Dr. Alba. “This award comes at a critical time in my junior faculty career: it allows me to continue pursuing my research in a meaningful way while also gaining new skills that will be critical for my ongoing career development.”
Visit bit.ly/3X4VphB to learn more about the AMFDP initiative and Dr. Alba.
Fun and fellowship – for a good cause
In addition, to all of this, the CHEST Foundation continued to host engaging events throughout the year to encourage connection, raise awareness, and fundraise for important initiatives.
This included the annual Belmont Stakes Dinner and Auction on June 11 in New York City. The fun-filled evening included a viewing of the 154th running of “The Championship Track,” a cocktail reception and plated dinner, a silent auction, a rooftop party, and insights from two patient advocates who turned their own experiences of living with chronic lung disease into incredible action on behalf of patients.
Three virtual wine nights in April, August, and December also invited numerous guests to learn more about imbibes from France, Italy, and California. Led by CHEST’s own resident wine aficionado, CEO Bob Musacchio, PhD, these events benefited the AMFDP, as well as other initiatives to improve patient care.
Another event that brought support to battling lung disease was the 9th Annual Irv Feldman Texas Hold 'Em Poker Tournament and Casino night jointly hosted by the Feldman Family Foundation and the CHEST Foundation. For the first time since early 2020, the event was held in-person after years of virtual tournaments. Funds raised from the event support education and resources to provide for a better quality of life for patients battling pulmonary fibrosis, a fibrotic lung disease with no cure.
2022 is special in another way. This year, the CHEST Foundation is offering an unmatched opportunity to one donor to attend CHEST 2023 in Honolulu, Hawai‘i for free. For every $250 you donate to the CHEST Foundation by December 31, 2022, you will receive an entry into a drawing for free registration, airfare (US only), and hotel accommodations.
Learn more about how you can donate to support initiatives like these – and make your mark on the practice of pulmonary, critical care, and sleep medicine – at foundation.chestnet.org.
Twenty-five years of life-changing grants
In addition to all of this, the CHEST Foundation provides financial grants to advance medicine and support to those in need. More than 12 million dollars later, the CHEST Foundation is proud to bolster the field of medicine and enhance patient care through this support. Learn more about the impact of grants from recent recipients in the September issue of CHEST Physician.
Race and spirometry
The European Respiratory Society (ERS) and American Thoracic Society (ATS) just published an update to their guidelines on lung function interpretation (Stanojevic S, et al. Eur Respir J. 2022; 60: 2101499). As with any update, the document builds on past work and integrates new advances the field has seen since 2005.
The current iteration comes at a time when academics, clinicians, and epidemiologists are re-analyzing what we think we know about the complex ways race and ethnicity intersect with the practice of medicine. Several experts on lung function testing, many if not most of whom are authors on the ERS/ATS guideline, have written letters or published reviews commenting on the way accounting for race or ethnicity affects lung function interpretation.
Race/ethnicity and lung function was also the topic of an excellent session at the recent CHEST 2022 Annual Meeting in Nashville, Tennessee. Here, we’ll provide a brief review and direct the reader to relevant sources for a more detailed analysis.
Spirometry is an integral part of the diagnosis and management of a wide range of pulmonary conditions. Dr. Aaron Baugh from the University of California San Francisco (UCSF) lectured on the spirometer’s history at CHEST 2022 and detailed its interactions with race over the past 2 centuries. Other authors have chronicled this history, as well (Braun L, et al. Can J Respir Ther. 2015;51[4]:99-101). The short version is that since the British surgeon John Hutchinson created the first spirometer in 1846, race has been a part of the discussion of lung function interpretation.
In 2022, we know far more about the factors that determine lung function than we did in the 19th century. Age, height, and sex assigned at birth all explain a high percentage of the variability seen in FEV1 and FVC. When modeled, race also explains a portion of the variability, and the NHANES III investigators found its inclusion in regression equations, along with age, height, and sex, improved their precision. Case closed, right? Modern medicine is defined by phenotyping, precision, and individualized care, so why shouldn’t race be a part of lung function interpretation?
Well, it’s complicated. As clinicians and academics, we must analyze the root cause of differences in health outcomes between racial groups.
Publications on pulse oximetry (Gottlieb ER, et al. JAMA Intern Med. 2022; 182:849-858) and glomerular filtration rate (Williams WW, et al. N Engl J Med. 2021;385:1804-1806) have revealed some of the ways our use of instruments and equations may exacerbate or perpetuate current disparities. Even small differences in a measure like pulse oximetry could have a profound impact on clinical decisions at the individual and population levels.
The 2022 ERS/ATS lung function interpretation guidelines have abandoned the use of NHANES III as a reference set. They now recommend the equations developed by the Global Lung Initiative (GLI) for referencing to normal for spirometry, diffusion capacity, and lung volumes. For spirometry the GLI was able to integrate data from countries around the world. This allowed ethnicity to be included in their regression equations and, similar to NHANES III, they found ethnicity improved the precision of their equations. They also published an equation that did not account for country of origin that could be applied to individuals of any race/ethnicity (Quanjer PH, et al. Eur Respir J. 2014;43:505-512). This allowed for applying the GLI equations to external data sets with or without ethnicity included as a co-variate.
Given well-established discrepancies in spirometry, it should come as no surprise that applying the race/ethnicity-neutral GLI equations to non-White populations increases the percentage of patients with pulmonary defects (Moffett AT, et al. Am J Respir Crit Care Med. 2021; A1030). Other data suggest that elimination of race/ethnicity as a co-variate improves the association between percent predicted lung function and important outcomes like mortality (McCormack MC, et al. Am J Respir Crit Care Med. 2022;205:723-724). The first analysis implies that by adjusting for race/ethnicity we may be missing abnormalities, and the second suggests accuracy for outcomes is lost. So case closed, right? Let’s abandon race/ethnicity as a co- variate for our spirometry reference equations.
Perhaps, but a few caveats are in order. It’s important to note that doing so would result in a dramatic increase in abnormal findings in otherwise healthy and asymptomatic non-White individuals. This could negatively affect eligibility for employment and military service (Townsend MC, et al. Am J Respir Crit Care Med. 2022;789-790). We’ve also yet to fully explain the factors driving differences in lung function between races. If socioeconomic factors explained the entirety of the difference, it would be easier to argue for elimination of using race/ethnicity in our equations. Currently, the etiology is thought to be multifactorial and is yet to be fully explained (Braun L, et al. Eur Respir J. 2013;41:1362-1370).
The more we look for institutional racism, the more we will find it. As we realize that attaining health and wellness is more difficult for the disenfranchised, we need to ensure our current practices are part of the solution.
The ERS/ATS guidelines suggest eliminating fixed correction factors for race but do not require elimination of race/ethnicity as a co-variate in the equations selected for use. This seems very reasonable given what we know now. As pulmonary medicine academics and researchers, we need to continue to study the impact integrating race/ethnicity has on precision, accuracy, and clinical outcomes. As pulmonary medicine clinicians, we need to be aware of the reference equations being used in our lab, understand how inclusion of race/ethnicity affects findings, and act accordingly, depending on the clinical situation.
Dr. Ghionni is a Pulmonary/Critical Care Fellow, and Dr. Woods is Program Director – PCCM Fellowship and Associate Program Director – IM Residency, Medstar Washington Hospital Center; Dr. Woods is Associate Professor of Medicine, Georgetown University School of Medicine, Washington, DC.
The European Respiratory Society (ERS) and American Thoracic Society (ATS) just published an update to their guidelines on lung function interpretation (Stanojevic S, et al. Eur Respir J. 2022; 60: 2101499). As with any update, the document builds on past work and integrates new advances the field has seen since 2005.
The current iteration comes at a time when academics, clinicians, and epidemiologists are re-analyzing what we think we know about the complex ways race and ethnicity intersect with the practice of medicine. Several experts on lung function testing, many if not most of whom are authors on the ERS/ATS guideline, have written letters or published reviews commenting on the way accounting for race or ethnicity affects lung function interpretation.
Race/ethnicity and lung function was also the topic of an excellent session at the recent CHEST 2022 Annual Meeting in Nashville, Tennessee. Here, we’ll provide a brief review and direct the reader to relevant sources for a more detailed analysis.
Spirometry is an integral part of the diagnosis and management of a wide range of pulmonary conditions. Dr. Aaron Baugh from the University of California San Francisco (UCSF) lectured on the spirometer’s history at CHEST 2022 and detailed its interactions with race over the past 2 centuries. Other authors have chronicled this history, as well (Braun L, et al. Can J Respir Ther. 2015;51[4]:99-101). The short version is that since the British surgeon John Hutchinson created the first spirometer in 1846, race has been a part of the discussion of lung function interpretation.
In 2022, we know far more about the factors that determine lung function than we did in the 19th century. Age, height, and sex assigned at birth all explain a high percentage of the variability seen in FEV1 and FVC. When modeled, race also explains a portion of the variability, and the NHANES III investigators found its inclusion in regression equations, along with age, height, and sex, improved their precision. Case closed, right? Modern medicine is defined by phenotyping, precision, and individualized care, so why shouldn’t race be a part of lung function interpretation?
Well, it’s complicated. As clinicians and academics, we must analyze the root cause of differences in health outcomes between racial groups.
Publications on pulse oximetry (Gottlieb ER, et al. JAMA Intern Med. 2022; 182:849-858) and glomerular filtration rate (Williams WW, et al. N Engl J Med. 2021;385:1804-1806) have revealed some of the ways our use of instruments and equations may exacerbate or perpetuate current disparities. Even small differences in a measure like pulse oximetry could have a profound impact on clinical decisions at the individual and population levels.
The 2022 ERS/ATS lung function interpretation guidelines have abandoned the use of NHANES III as a reference set. They now recommend the equations developed by the Global Lung Initiative (GLI) for referencing to normal for spirometry, diffusion capacity, and lung volumes. For spirometry the GLI was able to integrate data from countries around the world. This allowed ethnicity to be included in their regression equations and, similar to NHANES III, they found ethnicity improved the precision of their equations. They also published an equation that did not account for country of origin that could be applied to individuals of any race/ethnicity (Quanjer PH, et al. Eur Respir J. 2014;43:505-512). This allowed for applying the GLI equations to external data sets with or without ethnicity included as a co-variate.
Given well-established discrepancies in spirometry, it should come as no surprise that applying the race/ethnicity-neutral GLI equations to non-White populations increases the percentage of patients with pulmonary defects (Moffett AT, et al. Am J Respir Crit Care Med. 2021; A1030). Other data suggest that elimination of race/ethnicity as a co-variate improves the association between percent predicted lung function and important outcomes like mortality (McCormack MC, et al. Am J Respir Crit Care Med. 2022;205:723-724). The first analysis implies that by adjusting for race/ethnicity we may be missing abnormalities, and the second suggests accuracy for outcomes is lost. So case closed, right? Let’s abandon race/ethnicity as a co- variate for our spirometry reference equations.
Perhaps, but a few caveats are in order. It’s important to note that doing so would result in a dramatic increase in abnormal findings in otherwise healthy and asymptomatic non-White individuals. This could negatively affect eligibility for employment and military service (Townsend MC, et al. Am J Respir Crit Care Med. 2022;789-790). We’ve also yet to fully explain the factors driving differences in lung function between races. If socioeconomic factors explained the entirety of the difference, it would be easier to argue for elimination of using race/ethnicity in our equations. Currently, the etiology is thought to be multifactorial and is yet to be fully explained (Braun L, et al. Eur Respir J. 2013;41:1362-1370).
The more we look for institutional racism, the more we will find it. As we realize that attaining health and wellness is more difficult for the disenfranchised, we need to ensure our current practices are part of the solution.
The ERS/ATS guidelines suggest eliminating fixed correction factors for race but do not require elimination of race/ethnicity as a co-variate in the equations selected for use. This seems very reasonable given what we know now. As pulmonary medicine academics and researchers, we need to continue to study the impact integrating race/ethnicity has on precision, accuracy, and clinical outcomes. As pulmonary medicine clinicians, we need to be aware of the reference equations being used in our lab, understand how inclusion of race/ethnicity affects findings, and act accordingly, depending on the clinical situation.
Dr. Ghionni is a Pulmonary/Critical Care Fellow, and Dr. Woods is Program Director – PCCM Fellowship and Associate Program Director – IM Residency, Medstar Washington Hospital Center; Dr. Woods is Associate Professor of Medicine, Georgetown University School of Medicine, Washington, DC.
The European Respiratory Society (ERS) and American Thoracic Society (ATS) just published an update to their guidelines on lung function interpretation (Stanojevic S, et al. Eur Respir J. 2022; 60: 2101499). As with any update, the document builds on past work and integrates new advances the field has seen since 2005.
The current iteration comes at a time when academics, clinicians, and epidemiologists are re-analyzing what we think we know about the complex ways race and ethnicity intersect with the practice of medicine. Several experts on lung function testing, many if not most of whom are authors on the ERS/ATS guideline, have written letters or published reviews commenting on the way accounting for race or ethnicity affects lung function interpretation.
Race/ethnicity and lung function was also the topic of an excellent session at the recent CHEST 2022 Annual Meeting in Nashville, Tennessee. Here, we’ll provide a brief review and direct the reader to relevant sources for a more detailed analysis.
Spirometry is an integral part of the diagnosis and management of a wide range of pulmonary conditions. Dr. Aaron Baugh from the University of California San Francisco (UCSF) lectured on the spirometer’s history at CHEST 2022 and detailed its interactions with race over the past 2 centuries. Other authors have chronicled this history, as well (Braun L, et al. Can J Respir Ther. 2015;51[4]:99-101). The short version is that since the British surgeon John Hutchinson created the first spirometer in 1846, race has been a part of the discussion of lung function interpretation.
In 2022, we know far more about the factors that determine lung function than we did in the 19th century. Age, height, and sex assigned at birth all explain a high percentage of the variability seen in FEV1 and FVC. When modeled, race also explains a portion of the variability, and the NHANES III investigators found its inclusion in regression equations, along with age, height, and sex, improved their precision. Case closed, right? Modern medicine is defined by phenotyping, precision, and individualized care, so why shouldn’t race be a part of lung function interpretation?
Well, it’s complicated. As clinicians and academics, we must analyze the root cause of differences in health outcomes between racial groups.
Publications on pulse oximetry (Gottlieb ER, et al. JAMA Intern Med. 2022; 182:849-858) and glomerular filtration rate (Williams WW, et al. N Engl J Med. 2021;385:1804-1806) have revealed some of the ways our use of instruments and equations may exacerbate or perpetuate current disparities. Even small differences in a measure like pulse oximetry could have a profound impact on clinical decisions at the individual and population levels.
The 2022 ERS/ATS lung function interpretation guidelines have abandoned the use of NHANES III as a reference set. They now recommend the equations developed by the Global Lung Initiative (GLI) for referencing to normal for spirometry, diffusion capacity, and lung volumes. For spirometry the GLI was able to integrate data from countries around the world. This allowed ethnicity to be included in their regression equations and, similar to NHANES III, they found ethnicity improved the precision of their equations. They also published an equation that did not account for country of origin that could be applied to individuals of any race/ethnicity (Quanjer PH, et al. Eur Respir J. 2014;43:505-512). This allowed for applying the GLI equations to external data sets with or without ethnicity included as a co-variate.
Given well-established discrepancies in spirometry, it should come as no surprise that applying the race/ethnicity-neutral GLI equations to non-White populations increases the percentage of patients with pulmonary defects (Moffett AT, et al. Am J Respir Crit Care Med. 2021; A1030). Other data suggest that elimination of race/ethnicity as a co-variate improves the association between percent predicted lung function and important outcomes like mortality (McCormack MC, et al. Am J Respir Crit Care Med. 2022;205:723-724). The first analysis implies that by adjusting for race/ethnicity we may be missing abnormalities, and the second suggests accuracy for outcomes is lost. So case closed, right? Let’s abandon race/ethnicity as a co- variate for our spirometry reference equations.
Perhaps, but a few caveats are in order. It’s important to note that doing so would result in a dramatic increase in abnormal findings in otherwise healthy and asymptomatic non-White individuals. This could negatively affect eligibility for employment and military service (Townsend MC, et al. Am J Respir Crit Care Med. 2022;789-790). We’ve also yet to fully explain the factors driving differences in lung function between races. If socioeconomic factors explained the entirety of the difference, it would be easier to argue for elimination of using race/ethnicity in our equations. Currently, the etiology is thought to be multifactorial and is yet to be fully explained (Braun L, et al. Eur Respir J. 2013;41:1362-1370).
The more we look for institutional racism, the more we will find it. As we realize that attaining health and wellness is more difficult for the disenfranchised, we need to ensure our current practices are part of the solution.
The ERS/ATS guidelines suggest eliminating fixed correction factors for race but do not require elimination of race/ethnicity as a co-variate in the equations selected for use. This seems very reasonable given what we know now. As pulmonary medicine academics and researchers, we need to continue to study the impact integrating race/ethnicity has on precision, accuracy, and clinical outcomes. As pulmonary medicine clinicians, we need to be aware of the reference equations being used in our lab, understand how inclusion of race/ethnicity affects findings, and act accordingly, depending on the clinical situation.
Dr. Ghionni is a Pulmonary/Critical Care Fellow, and Dr. Woods is Program Director – PCCM Fellowship and Associate Program Director – IM Residency, Medstar Washington Hospital Center; Dr. Woods is Associate Professor of Medicine, Georgetown University School of Medicine, Washington, DC.
Toward a healthy and sustainable critical care workforce in the COVID-19 era: A call for action
The COVID-19 pandemic has caused unprecedented and unpredictable strain on health care systems worldwide, forcing rapid organizational modifications and innovations to ensure availability of critical care resources during acute surge events. Yet, while much attention has been paid to the availability of ICU beds and ventilators, COVID-19 has insidiously and significantly harmed the most precious critical care resource of all – the human beings who are the lifeblood of critical care delivery. We are now at a crucial moment in history to better understand the pandemic’s impact on our human resources and enact changes to reverse the damage that it has inflicted on our workforce.
ICUs, where critical care delivery predominantly occurs, increasingly utilize interprofessional staffing models in which clinicians from multiple disciplines – physicians, nurses, clinical pharmacists, respiratory therapists, and dieticians, among others – bring their unique expertise to team-based clinical decisions and care delivery. Such a multidisciplinary approach helps enable the provision of more comprehensive, higher-quality critical care. In this way, the interprofessional ICU care team is an embodiment of the notion that the “whole” is more than just the sum of its parts. Therefore, we must consider the impact of the pandemic on interprofessional critical care clinicians as the team that they are.
Even before the COVID-19 pandemic, the well-being of critical care clinicians was compromised. Across multiple disciplines, they had among the highest rates of burnout syndrome of all health care professionals (Moss M, et al. Am J Respir Crit Care Med. 2016;194[1]:106-113). As the pandemic has dragged on, their well-being has only further declined. Burnout rates are at all-time highs, and symptoms of posttraumatic stress disorder, anxiety, and depression are common and have increased with each subsequent surge (Azoulay E, et al. Chest. 2021;160[3]:944-955). Offsets to burnout, such as fulfillment and recognition, have declined over time (Kerlin MP, et al. Ann Amer Thorac Soc. 2022;19[2]:329-331). These worrisome trends pose a significant threat to critical care delivery. Clinician burnout is associated with worse patient outcomes, increased medical errors, and lower patient satisfaction (Moss M, et al. Am J Respir Crit Care Med. 2016;194[1]:106-113; Poghosyan L, et al. Res Nurs Health. 2010;33[4]:288-298). It is also associated with mental illness and substance use disorders among clinicians (Dyrbye LN, et al. Ann Intern Med. 2008;149[5]:334-341). Finally, it has contributed to a workforce crisis: nearly 500,000 health care workers have left the US health care sector since the beginning of the pandemic, and approximately two-thirds of acute and critical care nurses have considered doing so (Wong E. “Why Healthcare Workers are Quitting in Droves”. The Atlantic. Accessed November 7, 2022). Such a “brain drain” of clinicians – whose expertise cannot be easily replicated or replaced – represents a staffing crisis that threatens our ability to provide high-quality, safe care for the foreseeable future.
To combat burnout, it is first necessary to identify the mechanisms by which the pandemic has induced harm. Early during the pandemic, critical care clinicians feared for their own safety with little information of how the virus was spread. At a time when the world was under lockdown, vaccines were not yet available, and hospitals were overwhelmed with surges of critically ill patients, clinicians struggled like the rest of the world to meet their own basic needs such as childcare, grocery shopping, and time with family. They experienced distress from high volumes of patients with extreme mortality rates, helplessness due to lack of treatment options, and moral injury over restrictive visitation policies (Vranas KC, et al. Chest. 2022;162[2]:331-345; Vranas KC, et al. Chest. 2021;160[5]:1714-1728). Over time, critical care clinicians have no doubt experienced further exhaustion related to the duration of the pandemic, often without adequate time to recover and process the trauma they have experienced. More recently, a new source of distress for clinicians has emerged from variability in vaccine uptake among the public. Clinicians have experienced compassion fatigue and even moral outrage toward those who chose not to receive a vaccine that is highly effective at preventing severe illness. They also suffered from ethical conflicts over how to treat unvaccinated patients and whether they should be given equal priority and access to limited therapies (Shaw D. Bioethics. 2022;36[8]:883-890).
Furthermore, the pandemic has damaged the relationship between clinicians and their institutions. Early in the pandemic, the widespread shortages of personal protective equipment harmed trust among clinicians due to their perception that their safety was not prioritized. Hospitals have also struggled with having to make rapid decisions on how to equitably allocate fixed resources in response to unanticipated and unpredictable demands, while also maintaining financial solvency. In some cases, these challenging policy decisions (eg, whether to continue elective procedures during acute surge events) lacked transparency and input from the team at the frontlines of patient care. As a result, clinicians have felt undervalued and without a voice in decisions that directly impact both the care they can provide their patients and their own well-being.
It is incumbent upon us now to take steps to repair the damage inflicted on our critical care workforce by the pandemic. To this end, there have been calls for the urgent implementation of strategies to mitigate the psychological burden experienced by critical care clinicians. However, many of these focus on interventions to increase coping strategies and resilience among individual clinicians. While programs such as mindfulness apps and resilience training are valuable, they are not sufficient. The very nature of these solutions implies that the solution (and therefore, the problem) of burnout lies in the individual clinician. Yet, as described above, many of the mechanisms of harm to clinicians’ well-being are systems-level issues that will necessarily require systems-level solutions.
Therefore, we propose a comprehensive, layered approach to begin to reverse the damage inflicted by the pandemic on critical care clinicians’ well-being, with solutions organized by ecological levels of individual clinicians, departments, institutions, and society. With this approach, we hope to address specific aspects of our critical care delivery system that, taken together, will fortify the well-being of our critical care workforce as a whole. We offer suggestions below that are both informed by existing evidence, as well as our own opinions as intensivists and researchers.
At the level of the individual clinician:
- Proactively provide access to mental health resources. Clinicians have limited time or energy to navigate mental health and support services and find it helpful when others proactively reach out to them.
- Provide opportunities for clinicians to experience community and support among peers. Clinicians find benefit in town halls, debrief sessions, and peer support groups, particularly during times of acute strain.
At the level of the department:
- Allow more flexibility in work schedules. Even prior to the pandemic, the lack of scheduling flexibility and the number of consecutive days worked had been identified as key contributors to burnout; these have been exacerbated during times of caseload surges, when clinicians have been asked or even required to increase their hours and work extra shifts.
- Promote a culture of psychological safety in which clinicians feel empowered to say “I cannot work” for whatever reason. This will require the establishment of formalized backup systems that easily accommodate call-outs without relying on individual clinicians to find their own coverage.
At the level of the health care system:
- Prioritize transparency, and bring administrators and clinicians together for policy decisions. Break down silos between the frontline workers involved in direct patient care and hospital executives, both to inform those decisions and demonstrate the value of clinicians’ perspectives.
- Compensate clinicians for extra work. Consider hazard pay or ensure extra time off for extra time worked.
- Make it “easier” for clinicians to do their jobs by helping them meet their basic needs. Create schedules with designated breaks during shifts. Provide adequate office space and call rooms. Facilitate access to childcare. Provide parking.
- Minimize moral injury. Develop protocols for scarce resource allocation that exclude the treatment team from making decisions about allocation of scarce resources. Avoid visitor restrictions given the harm these policies inflict on patients, families, and members of the care team.
At the level of society:
- Study mechanisms to improve communication about public health with the public. Both science and communication are essential to promoting and protecting public health; more research is needed to improve the way scientific knowledge and evidence-based recommendations are communicated to the public.
In conclusion, the COVID-19 pandemic has forever changed our critical care workforce and the way we deliver care. The time is now to act on the lessons learned from the COVID-19 pandemic through implementation of systems-level solutions to combat burnout and ensure both the health and sustainability of our critical care workforce for the season ahead.
Dr. Vranas is with the Center to Improve Veteran Involvement in Care, VA Portland Health Care System, the Division of Pulmonary and Critical Care, Oregon Health & Science University; Portland, OR; and the Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania; Philadelphia, PA. Dr. Kerlin is with the Palliative and Advanced Illness Research (PAIR) Center, and Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine, University of Pennsylvania; Philadelphia, PA.
The COVID-19 pandemic has caused unprecedented and unpredictable strain on health care systems worldwide, forcing rapid organizational modifications and innovations to ensure availability of critical care resources during acute surge events. Yet, while much attention has been paid to the availability of ICU beds and ventilators, COVID-19 has insidiously and significantly harmed the most precious critical care resource of all – the human beings who are the lifeblood of critical care delivery. We are now at a crucial moment in history to better understand the pandemic’s impact on our human resources and enact changes to reverse the damage that it has inflicted on our workforce.
ICUs, where critical care delivery predominantly occurs, increasingly utilize interprofessional staffing models in which clinicians from multiple disciplines – physicians, nurses, clinical pharmacists, respiratory therapists, and dieticians, among others – bring their unique expertise to team-based clinical decisions and care delivery. Such a multidisciplinary approach helps enable the provision of more comprehensive, higher-quality critical care. In this way, the interprofessional ICU care team is an embodiment of the notion that the “whole” is more than just the sum of its parts. Therefore, we must consider the impact of the pandemic on interprofessional critical care clinicians as the team that they are.
Even before the COVID-19 pandemic, the well-being of critical care clinicians was compromised. Across multiple disciplines, they had among the highest rates of burnout syndrome of all health care professionals (Moss M, et al. Am J Respir Crit Care Med. 2016;194[1]:106-113). As the pandemic has dragged on, their well-being has only further declined. Burnout rates are at all-time highs, and symptoms of posttraumatic stress disorder, anxiety, and depression are common and have increased with each subsequent surge (Azoulay E, et al. Chest. 2021;160[3]:944-955). Offsets to burnout, such as fulfillment and recognition, have declined over time (Kerlin MP, et al. Ann Amer Thorac Soc. 2022;19[2]:329-331). These worrisome trends pose a significant threat to critical care delivery. Clinician burnout is associated with worse patient outcomes, increased medical errors, and lower patient satisfaction (Moss M, et al. Am J Respir Crit Care Med. 2016;194[1]:106-113; Poghosyan L, et al. Res Nurs Health. 2010;33[4]:288-298). It is also associated with mental illness and substance use disorders among clinicians (Dyrbye LN, et al. Ann Intern Med. 2008;149[5]:334-341). Finally, it has contributed to a workforce crisis: nearly 500,000 health care workers have left the US health care sector since the beginning of the pandemic, and approximately two-thirds of acute and critical care nurses have considered doing so (Wong E. “Why Healthcare Workers are Quitting in Droves”. The Atlantic. Accessed November 7, 2022). Such a “brain drain” of clinicians – whose expertise cannot be easily replicated or replaced – represents a staffing crisis that threatens our ability to provide high-quality, safe care for the foreseeable future.
To combat burnout, it is first necessary to identify the mechanisms by which the pandemic has induced harm. Early during the pandemic, critical care clinicians feared for their own safety with little information of how the virus was spread. At a time when the world was under lockdown, vaccines were not yet available, and hospitals were overwhelmed with surges of critically ill patients, clinicians struggled like the rest of the world to meet their own basic needs such as childcare, grocery shopping, and time with family. They experienced distress from high volumes of patients with extreme mortality rates, helplessness due to lack of treatment options, and moral injury over restrictive visitation policies (Vranas KC, et al. Chest. 2022;162[2]:331-345; Vranas KC, et al. Chest. 2021;160[5]:1714-1728). Over time, critical care clinicians have no doubt experienced further exhaustion related to the duration of the pandemic, often without adequate time to recover and process the trauma they have experienced. More recently, a new source of distress for clinicians has emerged from variability in vaccine uptake among the public. Clinicians have experienced compassion fatigue and even moral outrage toward those who chose not to receive a vaccine that is highly effective at preventing severe illness. They also suffered from ethical conflicts over how to treat unvaccinated patients and whether they should be given equal priority and access to limited therapies (Shaw D. Bioethics. 2022;36[8]:883-890).
Furthermore, the pandemic has damaged the relationship between clinicians and their institutions. Early in the pandemic, the widespread shortages of personal protective equipment harmed trust among clinicians due to their perception that their safety was not prioritized. Hospitals have also struggled with having to make rapid decisions on how to equitably allocate fixed resources in response to unanticipated and unpredictable demands, while also maintaining financial solvency. In some cases, these challenging policy decisions (eg, whether to continue elective procedures during acute surge events) lacked transparency and input from the team at the frontlines of patient care. As a result, clinicians have felt undervalued and without a voice in decisions that directly impact both the care they can provide their patients and their own well-being.
It is incumbent upon us now to take steps to repair the damage inflicted on our critical care workforce by the pandemic. To this end, there have been calls for the urgent implementation of strategies to mitigate the psychological burden experienced by critical care clinicians. However, many of these focus on interventions to increase coping strategies and resilience among individual clinicians. While programs such as mindfulness apps and resilience training are valuable, they are not sufficient. The very nature of these solutions implies that the solution (and therefore, the problem) of burnout lies in the individual clinician. Yet, as described above, many of the mechanisms of harm to clinicians’ well-being are systems-level issues that will necessarily require systems-level solutions.
Therefore, we propose a comprehensive, layered approach to begin to reverse the damage inflicted by the pandemic on critical care clinicians’ well-being, with solutions organized by ecological levels of individual clinicians, departments, institutions, and society. With this approach, we hope to address specific aspects of our critical care delivery system that, taken together, will fortify the well-being of our critical care workforce as a whole. We offer suggestions below that are both informed by existing evidence, as well as our own opinions as intensivists and researchers.
At the level of the individual clinician:
- Proactively provide access to mental health resources. Clinicians have limited time or energy to navigate mental health and support services and find it helpful when others proactively reach out to them.
- Provide opportunities for clinicians to experience community and support among peers. Clinicians find benefit in town halls, debrief sessions, and peer support groups, particularly during times of acute strain.
At the level of the department:
- Allow more flexibility in work schedules. Even prior to the pandemic, the lack of scheduling flexibility and the number of consecutive days worked had been identified as key contributors to burnout; these have been exacerbated during times of caseload surges, when clinicians have been asked or even required to increase their hours and work extra shifts.
- Promote a culture of psychological safety in which clinicians feel empowered to say “I cannot work” for whatever reason. This will require the establishment of formalized backup systems that easily accommodate call-outs without relying on individual clinicians to find their own coverage.
At the level of the health care system:
- Prioritize transparency, and bring administrators and clinicians together for policy decisions. Break down silos between the frontline workers involved in direct patient care and hospital executives, both to inform those decisions and demonstrate the value of clinicians’ perspectives.
- Compensate clinicians for extra work. Consider hazard pay or ensure extra time off for extra time worked.
- Make it “easier” for clinicians to do their jobs by helping them meet their basic needs. Create schedules with designated breaks during shifts. Provide adequate office space and call rooms. Facilitate access to childcare. Provide parking.
- Minimize moral injury. Develop protocols for scarce resource allocation that exclude the treatment team from making decisions about allocation of scarce resources. Avoid visitor restrictions given the harm these policies inflict on patients, families, and members of the care team.
At the level of society:
- Study mechanisms to improve communication about public health with the public. Both science and communication are essential to promoting and protecting public health; more research is needed to improve the way scientific knowledge and evidence-based recommendations are communicated to the public.
In conclusion, the COVID-19 pandemic has forever changed our critical care workforce and the way we deliver care. The time is now to act on the lessons learned from the COVID-19 pandemic through implementation of systems-level solutions to combat burnout and ensure both the health and sustainability of our critical care workforce for the season ahead.
Dr. Vranas is with the Center to Improve Veteran Involvement in Care, VA Portland Health Care System, the Division of Pulmonary and Critical Care, Oregon Health & Science University; Portland, OR; and the Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania; Philadelphia, PA. Dr. Kerlin is with the Palliative and Advanced Illness Research (PAIR) Center, and Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine, University of Pennsylvania; Philadelphia, PA.
The COVID-19 pandemic has caused unprecedented and unpredictable strain on health care systems worldwide, forcing rapid organizational modifications and innovations to ensure availability of critical care resources during acute surge events. Yet, while much attention has been paid to the availability of ICU beds and ventilators, COVID-19 has insidiously and significantly harmed the most precious critical care resource of all – the human beings who are the lifeblood of critical care delivery. We are now at a crucial moment in history to better understand the pandemic’s impact on our human resources and enact changes to reverse the damage that it has inflicted on our workforce.
ICUs, where critical care delivery predominantly occurs, increasingly utilize interprofessional staffing models in which clinicians from multiple disciplines – physicians, nurses, clinical pharmacists, respiratory therapists, and dieticians, among others – bring their unique expertise to team-based clinical decisions and care delivery. Such a multidisciplinary approach helps enable the provision of more comprehensive, higher-quality critical care. In this way, the interprofessional ICU care team is an embodiment of the notion that the “whole” is more than just the sum of its parts. Therefore, we must consider the impact of the pandemic on interprofessional critical care clinicians as the team that they are.
Even before the COVID-19 pandemic, the well-being of critical care clinicians was compromised. Across multiple disciplines, they had among the highest rates of burnout syndrome of all health care professionals (Moss M, et al. Am J Respir Crit Care Med. 2016;194[1]:106-113). As the pandemic has dragged on, their well-being has only further declined. Burnout rates are at all-time highs, and symptoms of posttraumatic stress disorder, anxiety, and depression are common and have increased with each subsequent surge (Azoulay E, et al. Chest. 2021;160[3]:944-955). Offsets to burnout, such as fulfillment and recognition, have declined over time (Kerlin MP, et al. Ann Amer Thorac Soc. 2022;19[2]:329-331). These worrisome trends pose a significant threat to critical care delivery. Clinician burnout is associated with worse patient outcomes, increased medical errors, and lower patient satisfaction (Moss M, et al. Am J Respir Crit Care Med. 2016;194[1]:106-113; Poghosyan L, et al. Res Nurs Health. 2010;33[4]:288-298). It is also associated with mental illness and substance use disorders among clinicians (Dyrbye LN, et al. Ann Intern Med. 2008;149[5]:334-341). Finally, it has contributed to a workforce crisis: nearly 500,000 health care workers have left the US health care sector since the beginning of the pandemic, and approximately two-thirds of acute and critical care nurses have considered doing so (Wong E. “Why Healthcare Workers are Quitting in Droves”. The Atlantic. Accessed November 7, 2022). Such a “brain drain” of clinicians – whose expertise cannot be easily replicated or replaced – represents a staffing crisis that threatens our ability to provide high-quality, safe care for the foreseeable future.
To combat burnout, it is first necessary to identify the mechanisms by which the pandemic has induced harm. Early during the pandemic, critical care clinicians feared for their own safety with little information of how the virus was spread. At a time when the world was under lockdown, vaccines were not yet available, and hospitals were overwhelmed with surges of critically ill patients, clinicians struggled like the rest of the world to meet their own basic needs such as childcare, grocery shopping, and time with family. They experienced distress from high volumes of patients with extreme mortality rates, helplessness due to lack of treatment options, and moral injury over restrictive visitation policies (Vranas KC, et al. Chest. 2022;162[2]:331-345; Vranas KC, et al. Chest. 2021;160[5]:1714-1728). Over time, critical care clinicians have no doubt experienced further exhaustion related to the duration of the pandemic, often without adequate time to recover and process the trauma they have experienced. More recently, a new source of distress for clinicians has emerged from variability in vaccine uptake among the public. Clinicians have experienced compassion fatigue and even moral outrage toward those who chose not to receive a vaccine that is highly effective at preventing severe illness. They also suffered from ethical conflicts over how to treat unvaccinated patients and whether they should be given equal priority and access to limited therapies (Shaw D. Bioethics. 2022;36[8]:883-890).
Furthermore, the pandemic has damaged the relationship between clinicians and their institutions. Early in the pandemic, the widespread shortages of personal protective equipment harmed trust among clinicians due to their perception that their safety was not prioritized. Hospitals have also struggled with having to make rapid decisions on how to equitably allocate fixed resources in response to unanticipated and unpredictable demands, while also maintaining financial solvency. In some cases, these challenging policy decisions (eg, whether to continue elective procedures during acute surge events) lacked transparency and input from the team at the frontlines of patient care. As a result, clinicians have felt undervalued and without a voice in decisions that directly impact both the care they can provide their patients and their own well-being.
It is incumbent upon us now to take steps to repair the damage inflicted on our critical care workforce by the pandemic. To this end, there have been calls for the urgent implementation of strategies to mitigate the psychological burden experienced by critical care clinicians. However, many of these focus on interventions to increase coping strategies and resilience among individual clinicians. While programs such as mindfulness apps and resilience training are valuable, they are not sufficient. The very nature of these solutions implies that the solution (and therefore, the problem) of burnout lies in the individual clinician. Yet, as described above, many of the mechanisms of harm to clinicians’ well-being are systems-level issues that will necessarily require systems-level solutions.
Therefore, we propose a comprehensive, layered approach to begin to reverse the damage inflicted by the pandemic on critical care clinicians’ well-being, with solutions organized by ecological levels of individual clinicians, departments, institutions, and society. With this approach, we hope to address specific aspects of our critical care delivery system that, taken together, will fortify the well-being of our critical care workforce as a whole. We offer suggestions below that are both informed by existing evidence, as well as our own opinions as intensivists and researchers.
At the level of the individual clinician:
- Proactively provide access to mental health resources. Clinicians have limited time or energy to navigate mental health and support services and find it helpful when others proactively reach out to them.
- Provide opportunities for clinicians to experience community and support among peers. Clinicians find benefit in town halls, debrief sessions, and peer support groups, particularly during times of acute strain.
At the level of the department:
- Allow more flexibility in work schedules. Even prior to the pandemic, the lack of scheduling flexibility and the number of consecutive days worked had been identified as key contributors to burnout; these have been exacerbated during times of caseload surges, when clinicians have been asked or even required to increase their hours and work extra shifts.
- Promote a culture of psychological safety in which clinicians feel empowered to say “I cannot work” for whatever reason. This will require the establishment of formalized backup systems that easily accommodate call-outs without relying on individual clinicians to find their own coverage.
At the level of the health care system:
- Prioritize transparency, and bring administrators and clinicians together for policy decisions. Break down silos between the frontline workers involved in direct patient care and hospital executives, both to inform those decisions and demonstrate the value of clinicians’ perspectives.
- Compensate clinicians for extra work. Consider hazard pay or ensure extra time off for extra time worked.
- Make it “easier” for clinicians to do their jobs by helping them meet their basic needs. Create schedules with designated breaks during shifts. Provide adequate office space and call rooms. Facilitate access to childcare. Provide parking.
- Minimize moral injury. Develop protocols for scarce resource allocation that exclude the treatment team from making decisions about allocation of scarce resources. Avoid visitor restrictions given the harm these policies inflict on patients, families, and members of the care team.
At the level of society:
- Study mechanisms to improve communication about public health with the public. Both science and communication are essential to promoting and protecting public health; more research is needed to improve the way scientific knowledge and evidence-based recommendations are communicated to the public.
In conclusion, the COVID-19 pandemic has forever changed our critical care workforce and the way we deliver care. The time is now to act on the lessons learned from the COVID-19 pandemic through implementation of systems-level solutions to combat burnout and ensure both the health and sustainability of our critical care workforce for the season ahead.
Dr. Vranas is with the Center to Improve Veteran Involvement in Care, VA Portland Health Care System, the Division of Pulmonary and Critical Care, Oregon Health & Science University; Portland, OR; and the Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania; Philadelphia, PA. Dr. Kerlin is with the Palliative and Advanced Illness Research (PAIR) Center, and Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine, University of Pennsylvania; Philadelphia, PA.
What the election results mean for GI
In the Senate, Democrats clinched the majority with 50 seats. Only one race, Georgia, is still undecided where a December runoff is planned. This race will not flip the majority since Vice President Kamala Harris casts tie-breaking votes as the President of the Senate.
Republicans recaptured control of the House after reaching 218 seats – enough to take control but the sweeping flip “red wave” did not occur as predicted. Republicans currently hold 220 seats to 213 Democratic seats, while two seats remain undecided. Margins in both chambers are slim, reflecting the division in the country.
What does this mean?
The majorities in both chambers are razor thin and compromises will need to be made to pass funding bills and other priorities.
AGA will continue to prioritize our bipartisan efforts with congressional champions on both sides of the aisle, including Rep. Ami Bera (D-Calif.), Rep. Larry Bucshon (R-Ind.), Sen. Sherrod Brown (D-Ohio), and Sen. Bill Cassidy (R-La.). For the remainder of this Congress, we will fight to:
- Encourage the Senate to take a vote on the House-passed prior authorization reform bill.
- Support robust federal research funding for gastroenterology.
- Reduce dangerous cuts in the Medicare Physician Fee Schedule, effective Jan. 1, 2023.
In the Senate, Democrats clinched the majority with 50 seats. Only one race, Georgia, is still undecided where a December runoff is planned. This race will not flip the majority since Vice President Kamala Harris casts tie-breaking votes as the President of the Senate.
Republicans recaptured control of the House after reaching 218 seats – enough to take control but the sweeping flip “red wave” did not occur as predicted. Republicans currently hold 220 seats to 213 Democratic seats, while two seats remain undecided. Margins in both chambers are slim, reflecting the division in the country.
What does this mean?
The majorities in both chambers are razor thin and compromises will need to be made to pass funding bills and other priorities.
AGA will continue to prioritize our bipartisan efforts with congressional champions on both sides of the aisle, including Rep. Ami Bera (D-Calif.), Rep. Larry Bucshon (R-Ind.), Sen. Sherrod Brown (D-Ohio), and Sen. Bill Cassidy (R-La.). For the remainder of this Congress, we will fight to:
- Encourage the Senate to take a vote on the House-passed prior authorization reform bill.
- Support robust federal research funding for gastroenterology.
- Reduce dangerous cuts in the Medicare Physician Fee Schedule, effective Jan. 1, 2023.
In the Senate, Democrats clinched the majority with 50 seats. Only one race, Georgia, is still undecided where a December runoff is planned. This race will not flip the majority since Vice President Kamala Harris casts tie-breaking votes as the President of the Senate.
Republicans recaptured control of the House after reaching 218 seats – enough to take control but the sweeping flip “red wave” did not occur as predicted. Republicans currently hold 220 seats to 213 Democratic seats, while two seats remain undecided. Margins in both chambers are slim, reflecting the division in the country.
What does this mean?
The majorities in both chambers are razor thin and compromises will need to be made to pass funding bills and other priorities.
AGA will continue to prioritize our bipartisan efforts with congressional champions on both sides of the aisle, including Rep. Ami Bera (D-Calif.), Rep. Larry Bucshon (R-Ind.), Sen. Sherrod Brown (D-Ohio), and Sen. Bill Cassidy (R-La.). For the remainder of this Congress, we will fight to:
- Encourage the Senate to take a vote on the House-passed prior authorization reform bill.
- Support robust federal research funding for gastroenterology.
- Reduce dangerous cuts in the Medicare Physician Fee Schedule, effective Jan. 1, 2023.
AGA makes its first investment through new GI innovation fund
Virgo provides gastroenterologists, clinical trial sponsors, and trial site investigators with artificial intelligence–fueled, always-on endoscopic procedure recording and patient recruitment tools for clinical trials in gastroenterology, starting with inflammatory bowel disease clinical trials.
Virgo provides gastroenterologists, clinical trial sponsors, and trial site investigators with artificial intelligence–fueled, always-on endoscopic procedure recording and patient recruitment tools for clinical trials in gastroenterology, starting with inflammatory bowel disease clinical trials.
Virgo provides gastroenterologists, clinical trial sponsors, and trial site investigators with artificial intelligence–fueled, always-on endoscopic procedure recording and patient recruitment tools for clinical trials in gastroenterology, starting with inflammatory bowel disease clinical trials.
Joint society task force releases strategic plan on climate change
Key takeaway: As a procedure-intense subspecialty, gastroenterology, and in particular endoscopy, is a major contributor to health care’s carbon footprint and other environmental impacts. Endoscopy is the third largest generator of medical waste in a hospital (2 kg total waste per procedure) with most ending in landfills. With this strategic plan, the participating societies are committed to promoting and supporting a sustainable, high-quality GI practice.
The U.S. GI multisociety strategic plan, which has also been endorsed by 23 GI societies globally, is a collaborative effort that invites members to undertake initiatives to establish an environmentally sustainable, high-quality practice and promote planetary health. Each society will prioritize and adapt their initiatives in accordance with their individual societal goals. Some initiatives may be undertaken by a single society, whereas other objectives and initiatives may be approached jointly. It is a 5-year plan that covers seven major domains:
- Clinical setting.
- Education.
- Research.
- Society efforts.
- Intersociety efforts.
- Industry.
- Advocacy.
The plan was developed by the U.S. Multi-GI Society Task Force on Climate Change, which is composed of leading experts from AASLD, ACG, AGA, and ASGE.
For more information, view the full publication: GI Multisociety Strategic Plan on Environmental Sustainability, published in Gastroenterology, Gastrointestinal Endoscopy, HEPATOLOGY, and The American Journal of Gastroenterology.
Key takeaway: As a procedure-intense subspecialty, gastroenterology, and in particular endoscopy, is a major contributor to health care’s carbon footprint and other environmental impacts. Endoscopy is the third largest generator of medical waste in a hospital (2 kg total waste per procedure) with most ending in landfills. With this strategic plan, the participating societies are committed to promoting and supporting a sustainable, high-quality GI practice.
The U.S. GI multisociety strategic plan, which has also been endorsed by 23 GI societies globally, is a collaborative effort that invites members to undertake initiatives to establish an environmentally sustainable, high-quality practice and promote planetary health. Each society will prioritize and adapt their initiatives in accordance with their individual societal goals. Some initiatives may be undertaken by a single society, whereas other objectives and initiatives may be approached jointly. It is a 5-year plan that covers seven major domains:
- Clinical setting.
- Education.
- Research.
- Society efforts.
- Intersociety efforts.
- Industry.
- Advocacy.
The plan was developed by the U.S. Multi-GI Society Task Force on Climate Change, which is composed of leading experts from AASLD, ACG, AGA, and ASGE.
For more information, view the full publication: GI Multisociety Strategic Plan on Environmental Sustainability, published in Gastroenterology, Gastrointestinal Endoscopy, HEPATOLOGY, and The American Journal of Gastroenterology.
Key takeaway: As a procedure-intense subspecialty, gastroenterology, and in particular endoscopy, is a major contributor to health care’s carbon footprint and other environmental impacts. Endoscopy is the third largest generator of medical waste in a hospital (2 kg total waste per procedure) with most ending in landfills. With this strategic plan, the participating societies are committed to promoting and supporting a sustainable, high-quality GI practice.
The U.S. GI multisociety strategic plan, which has also been endorsed by 23 GI societies globally, is a collaborative effort that invites members to undertake initiatives to establish an environmentally sustainable, high-quality practice and promote planetary health. Each society will prioritize and adapt their initiatives in accordance with their individual societal goals. Some initiatives may be undertaken by a single society, whereas other objectives and initiatives may be approached jointly. It is a 5-year plan that covers seven major domains:
- Clinical setting.
- Education.
- Research.
- Society efforts.
- Intersociety efforts.
- Industry.
- Advocacy.
The plan was developed by the U.S. Multi-GI Society Task Force on Climate Change, which is composed of leading experts from AASLD, ACG, AGA, and ASGE.
For more information, view the full publication: GI Multisociety Strategic Plan on Environmental Sustainability, published in Gastroenterology, Gastrointestinal Endoscopy, HEPATOLOGY, and The American Journal of Gastroenterology.
What to know about 2023 Medicare payments
The Centers for Medicare and Medicaid Services released its final rules for 2023 Medicare payments.
Good news! The full CRC continuum will be covered in Medicare.
In a win for patients and thanks to our collective advocacy efforts from AGA and partner societies, CMS expanded the regulatory definition of “colorectal cancer screening tests” and will waive cost sharing for a necessary follow-up colonoscopy after a positive stool-based screening test.
Bad news: Looming cuts on the horizon, GI societies to take action.
The rule finalizes more than 4% in mandated Medicare physician reimbursement cuts through decreases in the conversion factor and expiration of temporary fixes passed by Congress. The CY 2023 conversion factor is $33.06, an unacceptable cut for our members. The GI societies continue to work with a coalition of national and state medical societies to urge Congress to prevent these cuts before Jan. 1, 2023.
Good news: ASC + hospital payments on the rise.
ASC payments and facility fee payments increase 3.8% for institutions that meet quality reporting requirements. The CY 2023 ASC conversion factor is $51.854 and the hospital outpatient conversion factor is $85.585.
CMS removed motility codes 91117 and 91122 from APC 5731, where their payments would have been cut 21%, and finalized their placement in APC 5722, where they get a 3% payment increase beginning Jan. 1, 2023. Thank you to the motility community for helping us secure this win.
CMS raises the hospital payment for ESD code C9779 to $3,260.69, a $765.65 increase from 2022. We continue to work with CMS on our request for separate codes for lower ESD and upper ESD and payments that better reflect their unique resource costs.
The Centers for Medicare and Medicaid Services released its final rules for 2023 Medicare payments.
Good news! The full CRC continuum will be covered in Medicare.
In a win for patients and thanks to our collective advocacy efforts from AGA and partner societies, CMS expanded the regulatory definition of “colorectal cancer screening tests” and will waive cost sharing for a necessary follow-up colonoscopy after a positive stool-based screening test.
Bad news: Looming cuts on the horizon, GI societies to take action.
The rule finalizes more than 4% in mandated Medicare physician reimbursement cuts through decreases in the conversion factor and expiration of temporary fixes passed by Congress. The CY 2023 conversion factor is $33.06, an unacceptable cut for our members. The GI societies continue to work with a coalition of national and state medical societies to urge Congress to prevent these cuts before Jan. 1, 2023.
Good news: ASC + hospital payments on the rise.
ASC payments and facility fee payments increase 3.8% for institutions that meet quality reporting requirements. The CY 2023 ASC conversion factor is $51.854 and the hospital outpatient conversion factor is $85.585.
CMS removed motility codes 91117 and 91122 from APC 5731, where their payments would have been cut 21%, and finalized their placement in APC 5722, where they get a 3% payment increase beginning Jan. 1, 2023. Thank you to the motility community for helping us secure this win.
CMS raises the hospital payment for ESD code C9779 to $3,260.69, a $765.65 increase from 2022. We continue to work with CMS on our request for separate codes for lower ESD and upper ESD and payments that better reflect their unique resource costs.
The Centers for Medicare and Medicaid Services released its final rules for 2023 Medicare payments.
Good news! The full CRC continuum will be covered in Medicare.
In a win for patients and thanks to our collective advocacy efforts from AGA and partner societies, CMS expanded the regulatory definition of “colorectal cancer screening tests” and will waive cost sharing for a necessary follow-up colonoscopy after a positive stool-based screening test.
Bad news: Looming cuts on the horizon, GI societies to take action.
The rule finalizes more than 4% in mandated Medicare physician reimbursement cuts through decreases in the conversion factor and expiration of temporary fixes passed by Congress. The CY 2023 conversion factor is $33.06, an unacceptable cut for our members. The GI societies continue to work with a coalition of national and state medical societies to urge Congress to prevent these cuts before Jan. 1, 2023.
Good news: ASC + hospital payments on the rise.
ASC payments and facility fee payments increase 3.8% for institutions that meet quality reporting requirements. The CY 2023 ASC conversion factor is $51.854 and the hospital outpatient conversion factor is $85.585.
CMS removed motility codes 91117 and 91122 from APC 5731, where their payments would have been cut 21%, and finalized their placement in APC 5722, where they get a 3% payment increase beginning Jan. 1, 2023. Thank you to the motility community for helping us secure this win.
CMS raises the hospital payment for ESD code C9779 to $3,260.69, a $765.65 increase from 2022. We continue to work with CMS on our request for separate codes for lower ESD and upper ESD and payments that better reflect their unique resource costs.
New AGA guideline ranks the most effective drugs for weight loss
The following medications, paired with healthy eating and regular physical activity, are first-line medical options and result in moderate weight loss as noted as a percentage of body weight (reported as the difference compared to percent weight loss observed in the placebo group).
- Semaglutide (Wegovy®), weight loss percentage: 10.8%
- Phentermine-topiramate ER (Qsymia®), weight loss percentage: 8.5%
- Liraglutide (Saxenda®), weight loss percentage: 4.8%
- Naltrexone-bupropion ER (Contrave®), weight loss percentage: 3.0%
Read the AGA Clinical Guidelines on Pharmacological Interventions for Adults with Obesity for the complete recommendations.
The following medications, paired with healthy eating and regular physical activity, are first-line medical options and result in moderate weight loss as noted as a percentage of body weight (reported as the difference compared to percent weight loss observed in the placebo group).
- Semaglutide (Wegovy®), weight loss percentage: 10.8%
- Phentermine-topiramate ER (Qsymia®), weight loss percentage: 8.5%
- Liraglutide (Saxenda®), weight loss percentage: 4.8%
- Naltrexone-bupropion ER (Contrave®), weight loss percentage: 3.0%
Read the AGA Clinical Guidelines on Pharmacological Interventions for Adults with Obesity for the complete recommendations.
The following medications, paired with healthy eating and regular physical activity, are first-line medical options and result in moderate weight loss as noted as a percentage of body weight (reported as the difference compared to percent weight loss observed in the placebo group).
- Semaglutide (Wegovy®), weight loss percentage: 10.8%
- Phentermine-topiramate ER (Qsymia®), weight loss percentage: 8.5%
- Liraglutide (Saxenda®), weight loss percentage: 4.8%
- Naltrexone-bupropion ER (Contrave®), weight loss percentage: 3.0%
Read the AGA Clinical Guidelines on Pharmacological Interventions for Adults with Obesity for the complete recommendations.
An appeal from Michael Camilleri, MD, DSc, AGAF
This holiday season is a good time to reflect on our many blessings and thank those who have helped make our lives and careers worthwhile, successful, and prosperous. What better way than to pass on something to those who will ensure that gastroenterology will advance in decades to come?
Progress in this lifesaving work is made possible by the generosity of many supporters, like you, who understand the devastating physical, emotional, and financial costs of digestive diseases. We simply cannot allow a slowdown in the pace of GI research, and we cannot afford to lose talent when research offers so much promise for the future.
You can make a difference to ensure the progress continues.
The AGA Research Foundation funds promising young investigators who might not receive funding otherwise at crucial times in their early careers. The research of these talented individuals, while important to the field, if left unfunded, could end prematurely. That’s something the field can’t afford, and that’s why I’ve supported the AGA Research Foundation over the years through my donations.
We must maintain a robust pipeline of research that will help safeguard the success of clinical medicine. I urge you to support the future of GI with a generous donation to the AGA Research Foundation. Your investment of $100, $250, $500, $1,000, or any amount you can give today will make a difference.
Help close the gap in research funding and make a difference. Make your tax-deductible donation online at www.gastro.org/donateonline.
Thank you in advance for support and best wishes for a happy, healthy holiday season and prosperous New Year.
Three easy ways to give
Online: www.gastro.org/donateonline
Through the mail:
AGA Research Foundation
4930 Del Ray Avenue
Bethesda, MD 20814
Over the phone: 301-222-4002
Dr. Camilleri is chair of the AGA Research Foundation, past-president of the AGA Institute, and a consultant in the division of gastroenterology and hepatology, Mayo Clinic, Rochester, Minn.
This holiday season is a good time to reflect on our many blessings and thank those who have helped make our lives and careers worthwhile, successful, and prosperous. What better way than to pass on something to those who will ensure that gastroenterology will advance in decades to come?
Progress in this lifesaving work is made possible by the generosity of many supporters, like you, who understand the devastating physical, emotional, and financial costs of digestive diseases. We simply cannot allow a slowdown in the pace of GI research, and we cannot afford to lose talent when research offers so much promise for the future.
You can make a difference to ensure the progress continues.
The AGA Research Foundation funds promising young investigators who might not receive funding otherwise at crucial times in their early careers. The research of these talented individuals, while important to the field, if left unfunded, could end prematurely. That’s something the field can’t afford, and that’s why I’ve supported the AGA Research Foundation over the years through my donations.
We must maintain a robust pipeline of research that will help safeguard the success of clinical medicine. I urge you to support the future of GI with a generous donation to the AGA Research Foundation. Your investment of $100, $250, $500, $1,000, or any amount you can give today will make a difference.
Help close the gap in research funding and make a difference. Make your tax-deductible donation online at www.gastro.org/donateonline.
Thank you in advance for support and best wishes for a happy, healthy holiday season and prosperous New Year.
Three easy ways to give
Online: www.gastro.org/donateonline
Through the mail:
AGA Research Foundation
4930 Del Ray Avenue
Bethesda, MD 20814
Over the phone: 301-222-4002
Dr. Camilleri is chair of the AGA Research Foundation, past-president of the AGA Institute, and a consultant in the division of gastroenterology and hepatology, Mayo Clinic, Rochester, Minn.
This holiday season is a good time to reflect on our many blessings and thank those who have helped make our lives and careers worthwhile, successful, and prosperous. What better way than to pass on something to those who will ensure that gastroenterology will advance in decades to come?
Progress in this lifesaving work is made possible by the generosity of many supporters, like you, who understand the devastating physical, emotional, and financial costs of digestive diseases. We simply cannot allow a slowdown in the pace of GI research, and we cannot afford to lose talent when research offers so much promise for the future.
You can make a difference to ensure the progress continues.
The AGA Research Foundation funds promising young investigators who might not receive funding otherwise at crucial times in their early careers. The research of these talented individuals, while important to the field, if left unfunded, could end prematurely. That’s something the field can’t afford, and that’s why I’ve supported the AGA Research Foundation over the years through my donations.
We must maintain a robust pipeline of research that will help safeguard the success of clinical medicine. I urge you to support the future of GI with a generous donation to the AGA Research Foundation. Your investment of $100, $250, $500, $1,000, or any amount you can give today will make a difference.
Help close the gap in research funding and make a difference. Make your tax-deductible donation online at www.gastro.org/donateonline.
Thank you in advance for support and best wishes for a happy, healthy holiday season and prosperous New Year.
Three easy ways to give
Online: www.gastro.org/donateonline
Through the mail:
AGA Research Foundation
4930 Del Ray Avenue
Bethesda, MD 20814
Over the phone: 301-222-4002
Dr. Camilleri is chair of the AGA Research Foundation, past-president of the AGA Institute, and a consultant in the division of gastroenterology and hepatology, Mayo Clinic, Rochester, Minn.