In the early part of her career, Barbara L. McAneny, MD, learned a fundamental lesson in medicine: There are certain things beyond your control.
Rotating through oncology clinic as an internal medicine resident in the 1970s, she was assigned the case of a young man with Hodgkin's disease. The patient insisted that he didn’t want to do any treatments that would cause him to lose his fashionably long hair.
“It made me crazy,” said Dr. McAneny, now an oncologist and co-chair and chief officer of advocacy and government affairs for the ONCare Alliance. The organization is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Dr. McAneny pondered getting a court order to force the patient to get the treatment for his curable disease. But her attending physician cautioned against it because, he told her, “He is an adult, and adults may make decisions that you don't like.”
A physician can make the case that the patient won’t be handsome anymore if he grows cancerous lymph nodes and gets very sick, but “if you've explained that to him in terms he understands and he says, ‘No, I'm not taking treatment,’ then you have to respect that,” her attending physician explained.
Watching this patient die of Hodgkin's disease “ate my heart out,” Dr. McAneny said. But the experience helped her grow as a physician. She has since made it her life’s work to construct new ways to deliver better care and collaborate with her fellow specialists to optimize cancer care.
Organized medicine, whether it's the county or state medical society, national specialty society, or AMA, “is how doctors work together to improve health care and to make sure that that patients get what they need. And that is such a necessary force for good,” said Dr. McAneny, who served as AMA president in 2018–2019.
Her drive to achieve optimal care earned her a lifetime achievement award from the Greater Albuquerque Medical Association.
The award was a great honor, said Dr. McAneny. “It means I've had an impact … that hopefully I've made my little corner of the world a bit of a better place than it would've been if I hadn't done the things I've done.”
In an interview with the AMA, Dr. McAneny revealed more of her insights about care delivery, new cancer therapies and future projects.
AMA: What are some highlights from your career that led to this lifetime achievement award?
Dr. McAneny: The first one was creating New Mexico Oncology Hematology Consultants Ltd. with my partner, Dr. Clark Haskins. I figured out better ways to manage patients to keep them healthier and the practice let me implement those ideas to see if they worked. They did.
I also created a value-based care model that I sent to the Centers for Medicare and Medicaid Innovation (CMMI), and received the $19.8 million CMMI award called Come Home, which used nurse driven triage pathways to get patients in immediate need of care to be treated in the office rather than the ED. Admission rates were much lower, as patients were kept healthier. COME HOME allowed me to demonstrate with other practices that changes in care could be scaled—that it could be done not just in this one little practice in New Mexico but could be a means to changing care everywhere. I submitted another model called MASON, which stands for ‘making accountable sustainable oncology networks.’ What it would do is use AI [augmented intelligence] data science to figure out what the optimal cost is, what it would truly cost me to deliver care that is optimal, and then also pay me a margin. Unfortunately that model was not funded.
Going from the county to the state to the AMA gave me the incredible opportunity to learn so much from other physicians, some in other specialties who had experience and issues dealing with other problems and barriers to care and projects that worked well. I could learn so much from them and I could bring it home and try to put it into my little practice.
The work with AMA was incredible, getting to be president, traveling around the country and hear firsthand from doctors working in private practice, academic practices, hospital-based practices, industry insurance companies—every place that they're working in—to be able to talk to them and hear firsthand what they were feeling and seeing.
AMA: How has the field of oncology changed during your career?
Dr. McAneny: So much. When I started out, we had half a dozen drugs, and they were all toxic. And now we have amazing drugs. I mean, there's a new drug about every four days approved by the Food and Drug Administration. There are immunotherapies and there are personalized, genetically modified therapies. And they’re incredibly effective and they're enormously less toxic. It is just astounding what can be done now.
AMA: What do you see as the future of oncology and what advancements are you most excited about?
Dr. McAneny: The science behind genomic based medicine, understanding the genetic mutations that drive cancer cells to grow and allow them to take advantage of the rest of the body and overrun it, is huge. Immunotherapy, which teaches the immune system to target the cancer is a life changing advance
The second thing that I think about is that we will not have enough oncologists to see all the patients in the country. So, we have to redo how we do academic medicine by democratizing the information instead of having the expert in this cancer type living at this university. And everyone should go see that person who has that cancer. That's just not possible.
When I started, you were supposed to memorize and know all these drugs and what they did and all the details of the cancers. There are too many drugs for that. And you cannot figure out the mutations. The science is like drinking from a fire hose. We need to have our academics start thinking about getting information out as concisely as possible to every physician in the country, every oncologist, so that they have at their fingertips the information they need to offer that patient their best choice.
AMA: How can the medical community better support oncologists and patients?
Dr. McAneny: Continue with early diagnosis. Stop telling people that cancer is a death sentence. Getting people over to see us and collaborating with us. Oncology—more than any other part of medicine—is a team sport. I can't do what I do without primary care doctors finding the cancers and sending them to me and pathologists reading the tumor type and geneticists helping figure out what the driver mutation is. And surgeons and pulmonologists and everybody else. There are a lot of people involved in managing cancer.
One of the things that we really need to work on is better ways to communicate with one another. And unfortunately, the electronic medical record is a colossal flop for doctors communicating with each other. It's a great way to document a bunch of charges and make diagnosis codes. But it is not a good way to say: This is what I think. What do you think?
AMA: Do you have any advice for young physicians or medical students aspiring to enter oncology?
Dr. McAneny: Make sure you love it, that you're good at talking to patients about the tough questions, that you know how to transmit scary information—with honesty, without taking away hope. And then figure out how you are going to make sure that you have the information you need at the point of care.
AMA: What are you looking forward to in the next year?
Dr. McAneny: I'm working on a couple of projects. One is with the ONCare Alliance, which is a group of 33 independent practices across the country who are all working together to do research, data projects, to address the social determinants of health through foundations and to teach the next generation of oncologists how to run the business of oncology. Because nobody's teaching this. This will give oncology practices who wish to remain independent the ability and the resources to do so.
Locally, I'm working on a clinically integrated network, which is different specialties trying to work together to create a health care system that truly works for patients and communities and is less expensive. We currently live in a health care system that is perfectly designed to make large corporate entities very wealthy but, increasingly, is badly designed to give health care to individual patients.
