Robert Gabbay, M.D., Chief Medical Officer and Senior Vice-President at Joslin Diabetes Center, joined Joslin this past summer.
How did you come to CMO position at Joslin?
It was a circuitous route starting with my degree in biochemistry at McGill University and a doctorate from Wisconsin. I always wanted to go into research and I was overjoyed after I published my first journal article, but that elation started to fade quickly after paper number three. I really wanted to help people and it seemed to me that the time between small, incremental discoveries in the lab and the impact on peoples’ lives was too far apart.
So I took the next logical step and went to medical school. Along the way in my career, I did a joint fellowship at Beth Israel Hospital, Brigham and Women’s and the Joslin Diabetes Center. Dr. Abrahamson, the previous Medical Director at Joslin was my attending.
I became hooked on diabetes; it allowed me to combine my research interests with my desire to work with patients who needed help on an ongoing basis. For many years I held the position of Director for the Hersey Diabetes Institute at Penn State where I founded the program on Diabetes and Obesity and Clinical Research.
Why is diabetes so interesting to you?
Caring for people with diabetes is a challenge: we know what needs to happen to both treat and prevent the disease. Yet at present less than 15 percent of people with diabetes have their blood pressure, cholesterol and A1C at goal. Our current health care system is designed for treating acute care problems, like an ear infection for example. You come to your doctor, she gives you an antibiotic, and you take it and five days later you’re cured.
But that model doesn’t work very well for diabetes, because you can’t hand over a pill and say “poof, all better.” Research on how to help patients treat diabetes started many of the innovations in health care, certainly in the area of education. Our entire understanding of how to provide education in chronic disease started with the work on diabetes.
And Massachusetts is ground zero for health care reform. I couldn’t be in a better place
What do you see as the challenges in this role?
One of the major factors we have to work in is the changing health care environment. We have to adapt how we practice or we won’t have enough money to pay for care. We need a better reimbursement model. Providers are now paid only when they see people face to face in medical offices and hospitals.
But that needs to change. We need to engage people where they work and through the use of information technology. For example, technology has made virtual office visits a reality. People don’t have to lose time from work; they can be cared for in the comfort of their own home. Now it is time for reimbursement to catch up. And I think that is going to happen, not in some far off future, but in our lifetime.
You talk a lot about using teams to provide diabetes care. What’s special about a team?
Joslin has been team oriented from the beginning. Elliot Joslin, MD used a team approach back in the 20s. Diabetes is a complex disease that requires more than just a physician’s directives on how to take medication; patients need to understand how to eat and how to exercise, for example. They also need help figuring out how to cope with the disease long-term. So we have nurses, dietitians and psychologists available.
But that isn’t the case at most primary care offices. Since most people with type 2 diabetes are cared for by their primary care physicians (PCPs), how would this work?
Joslin is a test model or paradigm for providing diabetes care. One of our goals is to disseminate what we have learned works into the community: both the local community and the national one. Even though primary care practices don’t have all the practitioners we do they can simulate a good part of the care we provide at Joslin by getting everybody in the practice to work at the top of their license.
For example, the medical assistant that takes heights and weights in the office can also be trained to give basic healthy lifestyle tips to patients with diabetes. And we can help PCPs be better leaders of their teams. Instead of issuing directives they can facilitate a conversation. It is amazing the plethora of ideas people can generate when given the chance.
You seem so enthusiastic; do you think you will have the same zeal for the job a year from now?
When you look around at the Joslin you see people working, people who have a real passion for their work. I don’t think they are here for the short-term or for money, for that matter. I think I landed exactly where I want to be.