An agenda for the new millennium: improved care and more members
By By Whitney W. Addington, FACP
In the coming year, I hope to use this column to present an agenda for internal medicine in the new millennium. My agenda is a series of challenges for the College. I am confident that the College will respond to the challenges. The individual and collective wisdom and inspiration of the College's membership, Governors, committees and Regents, as well as the superb leadership and strength of the College's staff, assures that our goals can be met.
My initial two goals are to improve clinical management and to increase membership. In future columns I will discuss other goals.
The College is the foremost education and information resource for internists.
Annals of Internal Medicine is the preeminent journal for internal medicine, while MKSAP is the preeminent model for continuing medical education and recertification. The College has also been a leader in developing postgraduate courses and practice guidelines, and is a member of the Cochrane Collaboration.
Despite our best efforts, there are shocking discrepancies between what is recognized as "best practice" and "actual practice." Unacceptable differences between recommended and actual medical practice have been observed in the management of conditions such as congestive heart failure, acute myocardial infarction, diabetes mellitus, asthma and antibiotic usage.
In light of such discrepancies, some may question just how successful the College's educational and information resources have been in improving patient care. Lectures, no matter how dazzling, articles, no mater how brilliant, and interactive programs, no matter how innovative, do not necessarily lead to improved patient management. Outcome studies have reported that specially designed interactive workshops are somewhat more effective. I am haunted by the remarks of Donald M. Berwick, MD, who will speak at this year's Annual Session Opening Ceremony: "Best practices are all around us, and yet, judging by the pace of their spread, you might think that they were kept secret in unbreakable codes."
This past year, College President Harold C. Sox, FACP, and Board of Regents Chair Robert B. Copeland, FACP, challenged the College to improve the health care delivered by its members. After identifying a number of themes, the Board of Governors chose appropriate antibiotic usage as the College's inaugural clinical theme.
Board of Regents Chair-elect David J. Gullen, FACP, and Board of Governors Chair-elect Munsey S. Wheby, FACP, and I have assumed the stewardship of the clinical theme initiative, and we are helping plan a vigorous educational program. We are seeking ways to help College members gain new skills to effect clinical change that goes beyond the traditional mechanisms of professional education. These new skills will narrow the gap between the dissemination of knowledge and clinical management. The American public deserves no less.
This column periodically will return to the challenge of improving clinical management. I welcome comments.
On Jan. 1, 1999, ACP-ASIM had 115,941 members, including 12,882 medical students and 25,434 Associates. That figure represented the largest combined membership in the history of either of the two former organizations. The College is currently the largest medical specialty organization and represents the majority of internists and internal medicine subspecialists in the United States.
The College has successfully recruited new members by extending Associate membership during training and helping members make the transition from Associate to Member status. In addition, the College has made paths to Fellowship more accessible, in part by placing more emphasis on community-based service and teaching.
Despite such efforts, I am convinced that the College needs to discover why many internists are not members, and why Associates and other Members allow their College membership to lapse. (Some of these members do, in fact, rejoin.)
One reason may be that there are so many professional societies, especially among the subspecialties, that membership in multiple societies is a financial burden. This is particularly the case with practice organizations and academic health centers that are watching their incomes fall.
But we must identify—and overcome—the other barriers to joining or to retaining membership if the College is to continue to grow.
One area in which our membership must grow is in the representation of ethnic minorities, particularly African-Americans. As of Jan. 1, 1999, the College had 2,581 African-American members, representing 2.5% of overall membership, and 3,874 Hispanic members, representing 3.8% of the membership. Making the College more attractive to minority internists is a priority, and I intend to do everything I can to advance this agenda. Diversity in an organization leads to increased energy, imagination and more enlightened policy and practice. The College needs diversity in its membership.
Meeting the challenge
Being given the opportunity to serve as President of our newly formed organization is the highest honor and greatest responsibility I can imagine. It is an honor because I profoundly respect the values and accomplishments of ACP-ASIM and I greatly admire the current and previous leaders of both these organizations.
The role of President brings with it tremendous responsibility because of the difficult and compelling issues facing the practice of internal medicine and the health of all Americans. To do this job, I will need the help of every member. My e-mail address is firstname.lastname@example.org.
I pledge you my very best.
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