ASTROnews: Charlottesville

It is hard to imagine the time when Charlottesville, Va., was the westernmost extension of our nascent country. Almost all of the population at that time lived on the coast. In pre-revolutionary Virginia that meant the tidewater region, where George Mason and George Washington managed their respective plantations, and to the south Williamsburg was the seat of government and culture. If you lived inland, even if you were active in colonial government, you were considered a backwoodsman, relatively uncivilized and without refinement or higher culture. Think Patrick Henry, for example.

Except for Monticello. Intentionally and specifically located at the edge of the wilderness, Thomas Jefferson’s home was (and is) a monument to the intelligence and wisdom of one of the greatest minds in the history of civilized man. It has been said that George Washington fought for the revolution, but Thomas Jefferson thought for the revolution. More than any other founding father, it was Jefferson who wove the great themes of the Enlightenment into the public discourse of the late 1700s, and it was Jefferson who took those themes and formally expressed them in the Declaration of Independence, elevating it to the status of the Magna Carta and the Code of Hammurabi.

And thus it was that Charlottesville was chosen for the ASTRO Strategic Planning Retreat, and some 30 radiation oncologists representing all aspects of the membership were invited to attend. They included radiation oncologists in private practice and academics, as well as physicists, biologists, physician researchers, young physicians and academic program chairs, from resident to retired. Our goal was to lay out a roadmap for the specialty for the next 10 years, considering changes in not just radiation oncology but also all of oncology. These themes were considered in the context of ASTRO’s mission, and a framework emerged, which will allow the current and future ASTRO Board to prioritize projects based on their strategic context.

As we reflected back on how ASTRO has changed over the past 10 years, we noted with pride that the organization has doubled in size, not only in terms of members but also staff and annual budget. Ten years ago we had only a minimal presence in healthcare policy and government relations. Now we are the undisputed leader on these matters. ASTRO has gone from a small sub-specialty society, essentially a division of radiology, into a blue ocean organization that shares the same stage as the largest societies in medicine. The FDA, NRC, CMS, the AMA RUC, CPT and APC Panels, the MedPAC, Congress, and commercial insurance carriers now routinely seek ASTRO’s opinion on matters associated with radiation oncology. No other society comes close to the broad acceptance ASTRO has as the primary resource for information and opinion on matters relating to economics and government relations. It was universally accepted at the meeting that ASTRO would continue giving the support needed to maintain its dominance in this area.

The strategic planning workgroup did, however, also agree that we need new initiatives in research and education. As the leader in education for radiation oncology, ASTRO will develop new tools for distance learning. Also, we will continue to develop both the smaller meetings and the joint meetings with other specialty societies. All radiation oncologists from residents to practicing physicians who require maintenance of certification to physician-researchers and even “GLMs” (Guys Like Me, mid-career physicians not required to participate in recertification) will benefit from these new initiatives. Ten years from now, the specialty will have many new ways to stay up-to-date on new therapies, and ASTRO will lead the way.

But it is in research, I think, that ASTRO’s new strategic direction will have the largest impact. We will be developing clinically relevant and comprehensive treatment guidelines for radiation oncology. These will be useful in many venues, and their development will commence almost immediately.       

As the Radiation Oncology Institute continues to develop, many new projects that cannot find support from traditional sources will find succor. ASTRO will also be seeking to expand and increase our relationships with research consortiums, facilitating new opportunities for patients to enter clinical trials. In 10 years, ASTRO will be a recognized leader in clinical research, much as they are now in healthcare policy and government relations.

There is much work to be done. It is likely that we will develop a new governance structure, possibly with changes in the Board of Directors composition. A workgroup will make suggestions at the upcoming summer Board meeting. It was the perfect spring weekend in Charlottesville. The dogwoods, azaleas and redbuds were all out in full bloom. The weather was warm and the sky a perfect blue. Spring is a time of renewal, and I think Thomas Jefferson would be proud of the fine work of the strategic planning committee. I know I was.

Dr. Williams practices at Boca Raton Community Hospital. He welcomes comments on his articles at communications@astro.org.