Steven Stack, a 43-year-old Lexington emergency room physician, recently became the youngest president of the American Medical Association since 1854.
He will need all of the youthful energy he can muster.
The nation's largest physician organization has some ambitious challenges, from helping sort out health care reform laws to rethinking medical education and trying to stem epidemics of diabetes and high blood pressure.
Stack is the second Lexington doctor in three years to head the AMA. Ardis Hoven, an infectious-disease specialist, was AMA president in 2013. She now chairs the council of the World Medical Association.
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"We live in the same ZIP code," Stack said. "But we never see each other in Lexington."
Stack and his wife, Tracie, a physician and a University of Kentucky graduate, moved to Lexington in 2006 to be closer to family in Ohio. He is from Cleveland and got his education from Holy Cross and Ohio State universities.
He is director of emergency medicine at St. Joseph East and St. Joseph Mount Sterling hospitals. Before moving here, he directed emergency medicine at Baptist Memorial Hospital in Memphis.
When I caught up with Stack by phone Monday, he was relieved that the U.S. Supreme Court had rejected a technical challenge to the Affordable Care Act, popularly known as the ACA or Obamacare.
"If it had come out the other way," he said, "there was the risk of over 6 million Americans losing their health insurance that they had just recently gotten and throwing the entire delivery system into a whole new type of chaos with no clear path forward."
The AMA has been generally supportive of the ACA, especially its goal of increasing insurance coverage. That doesn't mean doctors don't think the law needs improving. "But you have to be willing to want to correct it and make it better, as opposed to just ripping apart and destroying it," he said. "If we want to make some things better about it, then we need to focus on those things and not on trying to cut the whole law."
The ACA has good and bad aspects, Stack said. A bigger issue is how it and other health-reform laws do or don't work together. Insurance companies also have regulation and bureaucracy that makes doctors' jobs more difficult and interferes with patient care.
"We spend too much to provide care to too few people with results that are not as good as they need to be," he said.
In 2012, the AMA identified several broad areas where it hopes to have an impact over the next decade.
One is medical education. Stack said the AMA has invested $11 million in 11 medical schools around the country to pioneer ways of incorporating new technology, new learning methods and new leadership skills in the training of doctors.
Another big initiative is addressing the diabetes and high blood pressure epidemics through early diagnosis and prevention.
About 86 million Americans are thought to be pre-diabetic, "and nine out of 10 of them do not know they are," Stack said. With better diet and more exercise in proven intervention programs led by partner organizations such as the YMCA, many pre-diabetic people can be prevented from developing type 2 diabetes.
Early diagnosis and disease management also are crucial for hypertension, which affects 70 million Americans, or 1 in 3 adults.
"Those are two of the most prominent and prevalent conditions of chronic health in the United States, and they cost over a half-trillion dollars a year in health care expenditures," Stack said.
"If we can improve the care of those conditions, ... then we could profoundly improve the health and wellness of the nation, improve their capacity for work and fulfilling lives, and improve the economy of the nation all at the same time."
Kentucky's diabetes and hypertension rates are some of the nation's highest, but Gov. Steve Beshear's embrace of the ACA, by creating a state insurance exchange and expanding Medicaid, has helped get more Kentuckians treatment for a variety of health problems, Stack said.
Another AMA goal is to help "restore the joy to the practice of medicine," he said.
Doctors "have so much intrusion from governments and private payers and other regulators in their lives," he said. "If we want to have a healthier, happier nation, we have to have healthier, happier physicians ... ."