[W]hen doctors organize together [they can] accomplish some pretty remarkable things….[W]orking with the state’s medical society made me realize that medicine is a team sport; to get things done we need cooperation from all the specialties.
—Barbara L. McAneny, MD
Barbara L. McAneny, MD, grew up on the outskirts of Alton, a small city on the Mississippi River in Madison County, Illinois. It is an area rich in history, famous as the site of Abraham Lincoln and Stephen Douglas’s last debate and for its role preceding and during the American Civil War. “We lived outside of town, so there were not a lot of other kids to play with. Both my parents taught at Saint Louis University, my father as a physicist and my mother as a mathematician. Education was an important part of my early home life,” said Dr. McAneny.
A Hands-on Education
“The schools in our area were not very good, so I left high school at 16 and went to college at Grinnell College for my first 2 years of undergrad. I planned to follow my father’s footsteps into physics, but I soon learned that my brain doesn’t work that way. My undergraduate major was in mathematics. In my junior year, I switched to the University of Minnesota,” she said.
When a friend asked about her postgraduation plans, Dr. McAneny recalled that it was a wakeup call. “Most mathematicians end up in computer science or in the insurance industry, which was not me. I’d taken a lot of science and I wanted something that interacted with people, so I decided on medicine,” explained Dr. McAneny, adding, “I took the MCATS and applied, so I’m not someone who decided at age 3 to become a doctor.”
“I really got to like Minnesota while there as an undergrad, but they weren’t accepting any out-of-state medical students, so I pursued my MD at the University of Iowa. It was a great experience, a hands-on practical education which worked perfectly for me because I’m a practical hands-on kind of person,” said Dr. McAneny.
After receiving her MD, Dr. McAneny toured the country interviewing for residency positions. “But after spending all my money on travel, I realized that I really liked the University of Iowa’s approach to learning, so that’s where I did my internal medicine residency,” she said.
Treating the Whole Person
During her residency, Dr. McAneny’s first rotation was on the acute leukemia ward, which had a profound influence on her decision to pursue a career in oncology. “I fell in love with all the leukemia patients on the ward. Dr. Jim Armitage was there doing work in bone marrow transplantation, and it was the most astounding thing I could ever think of. Plus, oncology appealed to me because you treat the whole person, not a specific organ like the heart,” said Dr. McAneny.
“I loved the personal interaction with the patients,” she continued. “When I was on the leukemia ward, I learned that with cancer patients you bypass the 20 years of building a friendship and you get close very quickly. Cancer patients don’t sweat the small stuff; they focus on what matters, and their resilience continues to amaze me. Ultimately, my decision to become an oncologist was simply because I wanted to help cancer patients get through the scariest thing that had ever happened to them.”
Asked about her oncology fellowship, Dr. McAneny recalled a subtle message permeating the inner sanctum of the university that guided her decision. “The professors let you know that the really good doctors are in academic medicine. But looking at the papers I was reading, I knew I’d never write a paper that I’d bother to read if I came across it in a journal. More important, my personal strength and source of professional satisfaction was one-to-one interaction with a patient over the course of their illness. So, at that point I decided against academics; I was going where I could take care of as many patients as possible.”
Drawn to the West
One of Dr. McAneny’s professors told her that doctors going into private practice tend to locate their practice near where they did their fellowship. “For the first time in my life I started to think about which part of the country I wanted to live. I considered Minnesota, Iowa, and the upper Midwest. It’s a wonderful region, but I realized that I craved diversity and I was also tired of living with 7 months of winter so I decided to look at the Southwest and Southeast,” said Dr. McAneny.
She traveled to the University of New Mexico, which she described as small, newly established, and “not very high on anybody’s academic list.” But it was love at first sight with the state of New Mexico. “I was immediately taken by the people and diversity of the cultures including 19 different Indian tribes. When you go into the desert, you either hate or love it. I loved it so much that it won a place in my heart that has never left,” said Dr. McAneny.
In 1987, following her fellowship in hematology/oncology, Dr. McAneny opened a community practice, New Mexico Oncology Hematology Consultants Ltd, with a colleague from the University of New Mexico. “We built our two-oncologist practice into a large group practice and beyond. We’ve been partners ever since,” she said.
The Collective Power of Doctors
Dr. McAneny eventually took over the practice management side of her growing clinic, a transition that was partly related to her serendipitous career move into organized medicine, she noted. “I was in the hospital’s doctor’s lounge after a consult with a young lung cancer patient, bemoaning the fact that so many people still smoke. A urologist came over and said, ‘So, are you just going to bitch about smoking, or are you going to do something about it?’”
The urologist was president of the local medical society, which worked with the Department of Health on smoking cessation initiatives. He invited Dr. McAneny to join the committee and push for antismoking legislation. She jumped at the opportunity. “It took about 15 years of hard work but we got a clean indoor air act passed city-by-city in New Mexico. The experience taught me that when doctors organize together they could accomplish some pretty remarkable things. And working with the state’s medical society made me realize that medicine is a team sport; to get things done we need cooperation from all the specialties,” said Dr. McAneny.
“I’ve been as ASCO member, from the day I decided to become an oncologist,” she continued. “I just got one of the alarming 30-year-member badges, reminding me of how old I am. ASCO is essential in moving forward everything related to oncology. But I’ve also been a long-time member of the American Medical Association [AMA]. The current situation in health care does a very good job at dividing doctors and keeping us relatively powerless as we fight over pieces of a decreasing pie.”
Designing a Better Health-Care System
“Physicians sit in the exam room listening to their patient’s hopes and fears and struggles, so we should design our health-care system. To effect change I needed to learn how the current system works and its flaws, so I sat on the Practicing Physicians Advisory Counsel for 4 years. It was an organization of various specialties from across the country that advises the Secretary of Health and Human Services. It was an enlightening experience that helped me design a system that works best for cancer patients,” said Dr. McAneny.
Dr. McAneny’s philosophy of streamlining the care continuum so that the doctor-patient experience is as seamless and productive as possible was realized in 2000 when she got to design the New Mexico Cancer Center in Albuquerque. “I asked patients what they wanted in the center and they said color and beauty. So we built the center focusing on natural light and art. I pay a curator who brings in new art regularly. On Sundays we open the center as a gallery and serve wine and cheese and we sell art. The proceeds go to our foundation that helps patients with the nonmedical expenses of having cancer, such as gas and food,” said Dr. McAneny.
She explained that the cancer center is currently having a war of sorts with the local hospital because the center wants to remain independent. “We’ve created ways to keep patients out of the hospital and ER by offering our cancer center as an alternative. We take emergency cancer patients so they don’t have to sit for hours in the hospital’s ER while doctors take care of people with a heart attack or gunshot wound. After a while, I looked at our data and saw that the money our approach was saving the payer was huge. We were eating the expenses, and the payer was reaping the profits,” said Dr. McAneny.
The COME HOME Project
Armed with her data, Dr. McAneny went to the local payer. “After showing the payers how much money the innovations in our cancer center had saved them, I said that they should share the savings with us to help us defer our center’s costs. They said ‘Thank you very much, but that money should be going to our hospital.’ So, I brought my data to Medicare. At the time, the agency was creating awards for innovative health-care systems. I wrote a paper and waited,” said Dr. McAneny.
In 2012, Dr. McAneny was awarded a $19.8 million Health Care Innovation Award from the Centers for Medicare and Medicaid Services to test how private practices could provide better cancer care at a lower cost. To that end, she created Innovative Oncology Business Solutions, serving as its Medical Director and CEO. The project, titled COME HOME (“Community Oncology Medical Homes”), aims to replicate the care and cost-saving practices that Dr. McAneny created at the New Mexico Cancer Center at six practices across the nation.
Asked about the project’s status, Dr. McAneny replied, “We’re halfway through the project. We’re working to get certified as an oncology medical home. Everybody has extended hours, and we’ve created triage pathways to make sure that patients get to the right site of service. We’ve changed the mindset. If a patient calls with a problem, we don’t say ‘We’ll see you next Thursday,’ we tell them to come in today at 2. We can do that because of our increased efficiencies.”
A Day in The Life
Along with patient care and her work on the COME HOME project, Dr. McAneny was recently elected Chair of the Board of Trustees for the AMA, after having served as Chair-Elect for the past year. “I hope to help AMA to continue to lead the way in providing the support and structures needed to unleash the creativity of American physicians to provide the highest possible level of patient and physician satisfaction," she said in a statement.
Dr. McAneny, a self-proclaimed exercise hater, is on the elliptical at 5:00 AM every day. “The only way I talk myself onto the elliptical is by reading a good novel at the same time. I see patients at our Gallup clinic, which is the heart of the Navaho Nation. Most of my time is devoted to managing the clinics in the project and keeping the CMS Innovation Award up to date with our triage pathways and other requirements. And I work on AMA policy issues. So it all blends together to make for one hectic day after another,” said Dr. McAneny.
She concluded with a parting message to her colleagues: “I encourage everyone to join the AMA for national issues, the state societies for state issues, and ASCO for oncology-specific issues. We are stronger when we work together.” ■