But for one telling detail, Nancy Adams could be called the Zelig of Rochester health care.
Like Zelig, a Woody Allen character who appears as a background figure at historic early 20th century events, Adams, 62, executive director of the Monroe County Medical Society, is ubiquitous on the local medical scene.
A key difference between the two: The sum and substance of Zelig’s contribution lies in his ubiquity. A virtual cypher, he is present but makes no discernible contribution and scarcely leaves a trace.
Not well known outside the local health care community, Adams appears at most area health care-related announcements and sits on many local health care councils. Unlike Zelig, she does a lot and wields more influence than a relatively low public profile might lead one to believe.
Duties directly traceable to Adams’ job running the medical society, a 1,300-member physician organization with a staff of seven and a $1 million annual budget, are only a start.
Despite its designation as Monroe County’s physician organization, the society serves doctors in six other counties as well: Livingston, Ontario, Seneca, Wayne, Yates and Steuben. Those counties technically have their own medical societies but the organizations are not staffed, so the Monroe County society picks up the slack.
It and other similar county-level medical societies, as well as their statewide and national counterparts, the Medical Society of the State of New York and the American Medical Association, admit all physicians as members. But they particularly look to the interests of private practice doctors, a group some see as likely to disappear.
In 2014, 49.2 percent of U.S. doctors were salaried employees of hospitals, health systems and other practice owners, data collected by the AMA show. That is up from 46.8 percent in 2012.
Economic uncertainties related to changing physician reimbursement models and heavy new overhead costs are increasingly driving newly minted doctors away from private practice and into careers as employees, a 2014 New England Journal of Medicine article noted.
Surveys showed 61 percent of residents were looking for jobs with health systems, hospitals and other practice owners rather than going into private practice. “The trend is taking hold so rapidly that it is difficult to quantify it,” the journal noted.
The Rochester area is ahead of that curve and has been for some time. Fifty percent of its 3,500-strong physician contingent was salaried a decade ago. Since then, the University of Rochester Medical Center and Rochester Regional Health System have extended their influence, bringing area hospitals’ physician practices into their networks.
Recent local figures on private practice versus salaried physicians are not available. Adams believes the ratio has risen as high as 70 percent salaried. She has one caveat: as many as 70 percent of the region’s primary care doctors, who account for 35 percent of the area’s 3,500 physicians, are in private practice.
For the time being, she says, most area primary care doctors see maintaining control over their relations with patients as worth the extra effort of keeping their practices afloat in an uncertain health care environment.
Supporting private practices
As a trade association, the medical society offers support to private practices. It sponsors a group health plan that medical offices and solo practice doctors can sign onto. It also offers a continual stream of business and clinical informational programs and workshops dealing with topics ranging from medical records system management and requirements to dealing with third-party payers and personnel management.
While most county medical society directors rightly see representing physicians’ interests and offering such programs as a full-time job, Adams, a significant actor in area public health initiatives, casts a broader net, says Thomas Mahoney, M.D.
“I don’t think there are many medical issues she isn’t involved in,” says Mahoney, Finger Lakes Health Systems Agency’s chief medical officer and a part-time partner in a small, private internal medicine practice.
When flu vaccines were in perilously short supply a couple of years back, Adams worked tirelessly behind the scenes to make sure local doctors had access to vaccines, Mahoney says.
Adams also played a key role in helping FLHSA, a non-profit that helps the state Department of Health set priorities for the Rochester and Finger Lakes region, win a $26.6 million grant from the Centers for Medicare and Medicaid Services’ Innovation Center several years ago.
The grant, which FLHSA is using to support local medical home initiatives, was the largest award of its type CMS handed to any U.S. applicant.
As one of FLHSA’s longest serving board members, Adams has been an invaluable resource and mentor for newer members and for staff, says Trilby de Jung, CEO of FLHSA.
“She’s been a mentor for me,” de Jung says. “Nancy is an anchor. She’s a calming influence. She is truly collaborative.
“She has a constituency, private practice doctors, and she never forgets them, but she puts their interests in a larger context. She has a sense of what’s appropriate. She calls it as she sees it. And when there’s a problem, you can count on Nancy to point it out. That’s incredibly valuable.”
Through the medical society, Adams several years ago won a $3.1 million state grant to help local medical practices install electronic medical records systems. When that initiative ended in 2010, she spent the next two years overseeing a state e-collaborative grant to help area practices meet CMS’ Meaningful Use electronic medical records goals.
Adams speaks proudly of those efforts. Still, despite her considerable personal investment in the local EMR push, she does not shy from criticizing the program’s shortfalls.
“Meaningful Use needs an overhaul,” she says bluntly, echoing widespread physician concerns that government standards for EMR implementation have not been well thought out and too little attention has been paid to creating a system that would let all health care providers easily share information.
“If I had my way,” Adams says, “physicians and other actual users would have more input into the program.”
Adams also won a $600,000 Greater Rochester Health Foundation grant as part of a hypertension initiative run by the society’s Quality Collaborative. She also has served on an array of area non-profit boards and health-related task forces.
“She does so much,” marvels de Jung.
Adams serves on Lifespan of Greater Rochester Inc.’s Community Connects Advisory Board as well as the boards of the Rochester Regional Health Information Organization and Monroe Community Hospital. Her curriculum vitae includes a two-and-one-half pages, single-spaced list of current and recently completed professional and community activities.
“I think of it as part of my job,” Adams says.
Growing up here
As for spare-time pursuits, Adams names fishing, a pursuit she indulges on the occasional getaway she and her husband, Peter Adams, a retired Rochester Gas and Electric Corp. employee, arrange at their cottage in the Adirondacks.
Growing up in Rochester’s northeast, Adams met her husband when they were first-grade students in a Catholic school. They started going steady as high school freshmen.
“I went to Nazareth; he went to Aquinas. He saved me a seat on the bus,” Adams recalls.
When Peter started college in Ohio, Nancy followed, enrolling in a medical assistant program.
“It was a good fit,” she says. “I’d always been interested in medicine. I was a candy striper at Rochester General.”
The couple married in 1974 when she was 20. In 1975, she earned certification as a medical assistant. After they returned to the area, she worked in a Rochester internist’s office.
Adams attended Monroe Community College at night, an endeavor she persisted in despite greater demands on her time after her children were born. It took her a decade to earn a two-year associate’s degree in liberal arts and science. She went on to earn a bachelor of science in organizational management in 1999 and a master of science in management in 2001 from Roberts Wesleyan College.
“I love learning. I’d go back and get a Ph.D. if I had the money,” Adams says.
In 1997, former medical society executive director Lisa Brubaker hired Adams as project coordinator, assigning her to tasks including development of physician and physician office-staff training programs.
A year later, Brubaker agreed to take over management of the American Academy of Pediatrics’ New York Chapter 1, a physician organization covering 50 Upstate New York counties, including Monroe. She turned the job over to Adams.
In 1999, Brubaker left to take an executive position with Preferred Care, a Rochester HMO that is now part of the Schenectady-based MVP Health Care. She recommended Adams as her replacement.
Adams was one of several candidates in line for the job, says Brubaker, now a senior vice president of Centene Corp., a St. Louis-based health plan that offers Medicare and Medicaid plans in several states.
“When you’re going through a transition, you look inside and you look outside the organization. We looked at both. Nancy really stood out,” Brubaker says.
Brighton pediatrician Edward Lewis, M.D., was the society’s president when Brubaker ran it.
Medical society membership is less now than it was then, Lewis says, a consequence of the thinning ranks of private practice. Still, the organization under Adams has not only stayed relevant but vastly widened its scope.
Adams, who folded the American Academy of Pediatrics’ New York Chapter 1 into the medical society and does double duty as Chapter 1’s executive director, has gained national recognition and influence as an American Academy of Pediatrics official, Lewis says.
In 2014, the academy tapped Adams as interim executive director for its statewide organization. She served for six months, developing a plan to bring the state organization’s finances into line and organizing a search committee to seek out her permanent successor.
To Lewis, “Nancy is a gem, one of the hardest working people I ever met. If she asks me do to something, I do it.”
Says Adams, “Physicians are stressed. I worry about them.”
Titles: executive director, Monroe County Medical Society; executive director, American Academy of Pediatrics, New York Chapter 1.
Education: A.S. in liberal arts and science, Monroe Community College, 1986; B.S., organizational management, 1999, M.S., management, 2001, Roberts Wesleyan College.
Family: Husband, Peter; son, Dale, 35; daughter, Kristen, 33; granddaughter, 2.
Leisure pursuit: Fishing at a family cottage in the Adirondacks.
Quote: “I love learning. I’d go back and get a Ph.D. if I had the money.”
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