MSV president installation address

24 October 2009
The Homestead

Thank you Dr. Eppes, Dr. Hazel, MSV past presidents, Officers and Directors of the Society, members, MSV staff, and honored guests. Good evening and thank you so very much. I stand before you immensely appreciative of the honor that you all have bestowed upon me in electing me to this position. I am also truly humbled by the great responsibility that this office has for enhancing service to our members, service to our profession, and service to our patients and the citizens of the Commonwealth. It is my singular goal for the coming year to serve in a manner worthy of the trust you have placed in me. Simply stated, I will give it my all.

As I address you this evening, I am acutely aware that I do so because of all the guidance and support of so many. In some ways, we are each individually an amalgam of all that we have experienced and of all of those who helped and nurtured us on our journeys. I am reminded of a passage from a letter from Sir Isaac Newton to his fellow scientist Robert Hooke in 1675: “If I have seen further it is by standing on the shoulders of giants.” Now I am no Isaac Newton, and I am not sure I have seen all that far, but I think we all stand—daily—on the shoulders of the giants around us in our personal and professional lives. On this occasion, I would like to acknowledge and thank some of the giants that have helped me so very much and led the way.

I am truly blessed to have both of my parents here for these festivities. My father, Major General Gerald J. Carey, and my mom, Joan Carey, who is, as the Bard says, the general’s general. Growing up in our household, with a fighter pilot dad and school teacher mom, often moving from base to base every two to three years, was never dull. My parents provided my brothers and sister and me with boundless love and support, and you two remain models for us of hard work, tireless service to others, intellectual curiosity, and integrity. Thank you for being who you are, for what you have done for me and, perhaps most important, for your high expectations that required high achievement.

My three siblings are also here, and I thank you all for making the effort to share this weekend with me and to be away from your own families. My brother John and his wife Ann are here from Jacksonville, FL, and my sister Cathy and my brother Kevin are here from Tampa, FL. If I can hold my own in a debate or come up with a quip at the right time, I can attribute that to our loving—but also intense and occasionally volatile—family of Irish ancestry—no surprise there. It was a fast crowd and I, the youngest, had to strive to keep up, and you contributed greatly to who I am. Thank you all again for being here.

So by now you have guessed that I am proceeding in chronological order, so Kim do not distress. To have a spouse who understands (always) and supports (mostly) my professional and organizational activities beyond the strict practice of medicine is indeed a great gift. Kim, I am so very aware that you are the reason I can be here. It is your competence, and independence, and love that keep our family going and keeps my life going. You are the reason I can have any semblance of balance or completeness in my life. I thank you with all my heart.

Our daughter Frances, a 1st-year student at UVA, and our son Brian, a freshman at E.C. Glass High School are also here. The children of physicians often pay a high price in the time their physician parent or parents are not at home, and in the time that those parents have their energies focused outside the family on the needs of others, and I think Frances and Brian you are well aware of that phenomenon. I appreciate your understanding of this, and I have been grateful for your forgiveness when I wasn’t there when you needed me. I am very proud of you both, for who you are and for who you are becoming.

I also want to thank my partners in The Cardiovascular Group of the Centra/ Stroobants Heart Center, who make it possible for me to serve in this way, to be away from our practice, to switch call schedules and other responsibilities at the last minute. I could not imagine a more gifted group of physicians. I am truly proud to be a member of our group these past dozen years, and as with my brothers and sister, I have to move fast to keep up with this group. Thank you for your support and encouragement and, at times, forbearance. Mike Valentine, through his service with the American College of Cardiology as Governor of the Virginia Chapter, and then Chair of the Board of Governors, and now as a trustee, has been a mentor to me in many ways.

To the Lynchburg Medical Community, of which there are many representatives here, I thank you all. Past and present leaders of the Lynchburg Academy of Medicine are here. I thank especially Dr. George Hurt, Peter Houck, Tom Eppes, Janet Hickman, Tom Carrico, Brenda Stokes, Janet Hickman, Bill Jones, Anita Schmidt, and Jim Wright for encouraging my involvement in MSV. I cannot name everyone, but thank you one and all.

I wanted to also thank Centra, my health system. George Dawson, CEO is here and so is Skip Meador, VP for Cardiovascular and Neurosciences. Thank you for encouraging me through the years, and in particular for your support of the MSV Foundation and its programs, of which Centra have been a great benefactor. I think the citizens of Central Virginia and the doctors of Central Virginia gain a great deal from the type of relationships that exist between our health system and its leaders and our community’s physicians. There are always conflicts and that is natural, but how we have worked together, regardless of one’s practice setting, is remarkable. If your values are similar, namely clinical excellence and cost-effectiveness, then you have the basis to do great things together. Thank you all.

And lastly, I want to thank all of the leaders and staff at MSV, the Foundation, and all of our family of entities with whom I have worked these last years. If not for their competence and energy that inspired and guided me, I wouldn’t be serving in this role. Nothing is more attractive and inspiring than committed and talented people making things better and making it happen. That has been my MSV experience. So to Beth Bortz at the Foundation and her staff and our Foundation Board, to the Tort Reform Task Force members and staff and Russ Libby, and to the Medical Liability Advisory Group members and staff, thank you for allowing me to serve on great teams doing great things. Of course, these are just the great teams with which I have worked; many of you have worked with others just as wonderful and dynamic, all examples of the kinds of activities and successes that are happening at MSV every day.


As I approach my service to our organization in the coming year, I can’t but acknowledge that our profession is indeed at a crossroads. At no time have we as healers had more tools and resources to cure disease and reduce suffering than we do now. In addition, however, at no time since I entered medical school 27 years ago have I sensed the current level of uncertainty in our professional lives brought about by the true crises in health care financing, health insurance access and affordability, and the lack of consensus—within medicine and without—about just how we as a country should proceed. It is into this space that we in organized medicine are called to make a difference. How do we seek solutions to these very real challenges in ways that support rather compromise our professional values? I think it is in these times of crisis that we in medicine can either live our values or lose our values.

I think many of you have read Dr. Atul Gawande’s piece, entitled “The Cost Conundrum: What a Texas town can teach us about health care,” in the June 1 edition of The New Yorker. This article is important in its own right based on its content but also because it has been on the short reading list of every staff member in Congress and in the White House involved in the Health Care debate. Gawande interviewed physicians and hospital administrators to figure out why McAllen, Texas should have a cost per Medicare beneficiary of $15,000 (almost twice the national average and $3000 more than the per capita income there) compared to just over $7000 per Medicare beneficiary up river in El Paso, which has similar demographics and health statistics, economic and cultural issues, as well as health outcomes. I am oversimplifying, I know, but Gawande concludes, rightly or wrongly, that a spirit of entrepreneurism has permeated the McAllen medical community, the doctors and the hospital administrators and board members, and that has lead to an explosion of utilization, with the net result being dramatically increased incomes for doctors and hospitals. The disturbing question he raises is not how this came to be but rather, given the economic and medical-legal incentives to test more and do more, why all communities are not like McAllen? I suggest that what have stood against the McAllenization of every community are in fact our professional values.

I present this here because in times of plenty—when we are well paid for the cognitive and procedural care that we provide—it is frankly easier to put the patient first, to make sure that economic incentives don’t cloud our judgment, that conflicts of interest don’t arise. Whatever the final shape of health care reform, those lofty principals—whether they come from the Oath of Hippocrates, the Prayer of Maimonides, the Declaration of Geneva, from our own religious or ethical beliefs, or from the Golden Rule—will be tested in both overt and insidious ways. Now I am no choir boy, and I am not counseling that we roll over as a profession to be the doormat of every other economic interest. I acknowledge that our very professional value to keep seeing patients—no matter what—has been used cynically against us in our goal of sustainable compensation, for example, under Medicaid and Medicare. I am not counseling that we stand down from being tireless and aggressive advocates for the practice of medicine, whether it is in fair business practices, tort and medical liability reform, scope of practices issues, or in the many regulatory issues affecting the practice of medicine. But we have to know that if we behave in ways that demonstrate that patients don’t come first, or that our economic interests corrupt our recommendations for individual patients, then we have lost the most valuable thing we have: the trust of those who need us; whose lives, often, depend on us.

Abraham Verghese, the physician and author, has his narrator contend in his recent novel Cutting for Stone, “Few doctors will admit this, certainly not the young ones, but subconsciously, in entering the profession, we must believe that ministering to others will heal our woundedness.” If we were to reflect on how we came to be doctors, I think many of us would relate very closely to this notion. I think those of us active in organized medicine recognize, too, that part of what we as physicians need to support, and yes—in some way heal—is our profession itself, especially in the current climate and the very turbulent times that we know are to come.

After my cardiology training, I did a tour of duty in the Air Force, and was stationed in Biloxi, Mississippi. I was the medical director of a cardiac cath lab and taught in the Internal Medicine training program. During my officer training, I was introduced to the Air Force’s Core Values: Integrity First, Service Before Self, and Excellence In All We Do. As a physician, those values were nothing new to me. They were not a slogan because those values capture authentically what we try to accomplish with patients every day.

So as we work together in the coming year, whether it is in our lobbying efforts at the state and national level, in our negotiations with the trial lawyers, in our efforts to integrate safety into our own practices, or in the work our AMA delegation does on our behalf with health system reform, let us remain true to those values that are at the core of the practice of medicine in its highest sense. It matters what we support and it also matters what we are willing to do and not do to achieve our goals. In the end, the survival of our profession depends on the trust of our patients. That, indeed, is for what we have to fight hardest.

Tomorrow, in the House of Delegates, there will be time for reviewing our agenda going forward, reviewing our many accomplishments at MSV for the past year, and for conducting the business of the Society. Tonight, let us enjoy the fellowship of our peers, our families, and our guests. Thank you all again so very much.