“For the times they are a-changin'.”
—Bob Dylan, 1964
After 21 years as executive director of the American Academy of Sleep Medicine (AASM), and 37 years in medical society management, the time for me to retire has arrived. My official retirement will begin June 30, 2017, closing the most rewarding professional chapter of my life. Before I leave, I hope to challenge every member of the AASM to work together to make your profession better and stronger. Those who will follow me have a greater opportunity to make a difference in this field than any of us who were around two decades ago.
The iconic song title that I've quoted was true in 1964, and it was visionary. The changes that began in 1964 have only accelerated since. Those involved in sleep medicine and sleep research today must be aware that change is happening now, and the pace of this change is rapidly accelerating. It's easy to acknowledge that things will be different when change occurs; the challenge is to adapt. As leadership author John C. Maxell has said, “Change is inevitable. Growth is optional.” You must embrace and actively shape change rather than standing in the distance as a passive observer.
When I joined the AASM in April 1996, clinical sleep medicine was maturing, similar to a teenager growing out of pre-adolescence. The times certainly were changing. Like all teenagers, sleep medicine was bold, confident and invincible, certain that growth and prosperity would last forever. The next decade reinforced this notion, as it ushered in a period of tremendous growth and widespread success. In a matter of 10 years, sleep medicine had moved from relative obscurity to indisputable prominence.
Sleep medicine soon discovered, however, that staying on top of the hill proved to be far more difficult than climbing it. One undeniable truth about the growth of specialized clinical medicine is that it fuels entrepreneurism, providing a gateway to prosperity for commercial entities to capitalize on clinical advancement, and potentially exploit it. Industry consistently creates products and services that shift the focus from the treating physician to technology-based solutions. Sleep medicine was not immune to this innovation. After all, it is the “American Way.”
Industry's rapid movement into a field of medicine forces clinicians to reinvent how care is delivered. The role of the professional society is to be the impetus for the paradigm shift that is necessary for a field to remain relevant. Andy Grove, the former president, CEO, and chairman of the board of Intel Corporation said, “There is at least one point in the history of any company when you have to change dramatically to rise to the next level of performance. Miss that moment - and you start to decline.” I believe that the AASM, and the field of sleep medicine, are facing that moment.
The field is woefully short of board-certified sleep medicine physicians to provide treatment to the millions of people who are in need. The geographic concentration of accredited sleep centers across the country leaves more gaps than sleep specialists are able to cover. Polysomnography, the “Gold Standard” diagnostic test, is expensive and restricts access to care because of the limited number of available beds. As a result, the field is unable to reduce the number of patients with an undiagnosed sleep disorder, which is estimated to include 23.5 million people who have undiagnosed obstructive sleep apnea (OSA).1 To complicate the matter, health care in the United States is on the verge of being overhauled once again.
For the past five years, your board of directors has been working to develop plans that address the problems I've highlighted.2,3 The AASM now has in place the “Future of Sleep Medicine” plan, which is a roadmap for the years ahead. This plan is thoughtful, and it is designed to advance the field while continuing to offer patients the best possible care. The question, however, remains: Is this plan bold enough to make the difference that is necessary? As you consider this question, keep in mind these two things, which are certain and should never be forgotten: (1) industry is rapidly developing technology intended to eliminate the need for a diagnosing sleep physician; and (2) the country cannot afford health care as it is currently practiced.
The time for sleep medicine to come together is now. You must confront these challenges by adopting the changes that are necessary for patients to continue to benefit from the advances in sleep medicine. From my perspective, as a field, you must:
Increase the number of those who are qualified to practice sleep medicine by reaching across disciplines to offer an added qualification for other health care providers. Will these clinicians be as competent as board-certified sleep medicine physicians? No. Will they make valuable contributions to the field and safely deliver care to those who are in need? Yes, especially if you, the sleep specialists, share your expertise and provide guidance.
Leverage technology. Think about what the development of in-laboratory polysomnography and continuous positive airway pressure (CPAP) therapy did for the field. Imagine how emerging and future technological innovations will be able to impact the field: You will reach more patients, faster and less expensively, and you will make a lasting difference in the lives of all you treat by improving their health and quality of life.
Use the inevitable implementation of changes in the Unites States health care system as an opportunity to prove that you have the drive to innovate and remain a critical part of the health care equation.
Challenge industry to improve current treatments and invest in the development of new, more effective treatment options.
Most importantly, do not despair.
As I wrap up my last weeks as your executive director, I must thank all of the wonderful people who have made my journey so incredibly rewarding and fulfilling. It all starts with the wonderfully talented staff I have had the privilege to lead. Many have been with me for more than half of this journey, and I never could have enjoyed the success I have achieved without them. Even those I have worked with for less time have made similar contributions to my personal and organizational success.
The 21 presidents I have worked for all have been incredible leaders. Hard-working and selfless, they have pursued one common objective: to advance the field (and survive the year working with me). I have nothing but sincere gratitude for each of them. Those members who have served on the board of directors have taken on the responsibility to do all the work, with little credit, and have done it with a dedication and concern beyond what you can imagine; they are the backbone of the society. Finally, there are all of the volunteers who have served over the years as unsung heroes. It is the AASM members who have made all of the work worthwhile. I hope to see as many of you as possible in Boston next month to say goodbye.
In a few weeks, I will move on to play golf, grow organic vegetables, and make a little furniture in the shadow of the Smoky Mountains. One day, when I am sitting around wondering why the hell I'm an organic gardener, I suspect that I will start to write the much-anticipated history of the AASM (1996–2017). I can assure you of two things. First, to paraphrase what Mr. Winston Churchill said, the history of the AASM will be kind to me, for I intend to write it! Second, it will be entertaining and riveting, to say the least.
It has been an amazing ride, and I am thankful to have made the journey. I will miss the AASM and all of you. I'll conclude with another appropriate lyric from Bob Dylan, this time from “Restless Farewell,” the closing track on his timeless 1964 album: “And the corner sign says it's closing time, so I'll bid farewell and be down the road.”
Jerome A. Barrett has been executive director of the AASM since 1996.