American College of Physicians: Internal Medicine — Doctors for Adults ®

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ACP membership: United to meet today's challenges

From the April ACP Observer, copyright © 2005 by the American College of Physicians.

By C. Anderson Hedberg, FACP

I am delighted to be writing this column, my first as your College President. As a young internist and gastroenterologist in the late 1960s, I attended my first College meeting, and have rarely missed one since. I have always relied on ACP's principles and ideals during my nearly 40-year tenure as a practicing and teaching physician. Those principles will continue to guide me as I work to serve you over the coming year.

Arguably, those same College principles have never been more sorely needed. There are many complex challenges facing internal medicine today: a payment system that doesn't fairly reimburse us; a rising number of uninsured patients, which threatens the quality of our national health; the need for what everyone agrees will be an expensive information technology network; and emerging new models for providing health care, including pay-for-performance and quality incentives. I believe we are in the midst of revolutionary changes in American medicine—ones that internal medicine and the College will play pivotal roles in directing.

Strength in numbers

To meet those challenges, we need to draw on our strength in numbers. That makes one of ACP's seven goals—"to unify the many voices of internal medicine and its subspecialties for the benefit of our patients, our members, and our profession"—vitally important.

The issue of unity has been a key factor in the growth of internal medicine, going back more than 100 years. The founders of internal medicine, which is a discipline established in late 19th-century Europe, took the revolutionary step of introducing the scientific method to the practice of medicine.

William Osler, MD, and other medical innovators championed this idea in the United States, bringing their own devotion to science and rigorous pedagogy to the task of fundamentally changing medical teaching, research and practice. When the College was established in l915, its founders put in place an organization that could nurture and advance that scientific base, as well as our specialty's code of ethics and professionalism. As the ancients knew, our art is a unique blend of science and the humanities. Dr. Osler and others showed us that patient care must bring together scientific knowledge and experience, along with compassion and a strong sense of social responsibility.

Since those beginnings, internal medicine and the College have been challenged by remarkable developments, including the emergence of academic medical centers, the rise of subspecialties, the medical demands of war and terrorism, the unpredictable emergence of new and deadly diseases, and the constant acceleration of new information in science and technology. Also, the expansion of government programs and regulation, and the emergence of managed care, have brought dramatic changes to the practice of medicine.

And the College has met those challenges. Its successful merger in 1998 with the American Society of Internal Medicine, and its adoption of a resolution process that brings your grassroots ideas to the Boards of Governors and Regents for their deliberation, are just two examples of recent structural changes that have strengthened our organization.

Going forward

The College is continuing to take steps on the national level to strengthen our ability to practice internal medicine. The ACP Revitalization of Internal Medicine Project, inaugurated in 2003 by the specialty's major stakeholders meeting, identified the major themes that the College and the specialty now need to pursue. (More on revitalization is online.) The College has issued the following far-ranging recommendations on those themes to promote our goals of quality, safety and cost-effectiveness:

  • Repair the dysfunctional payment system. College and specialty leaders are working to develop a stronger, fairer and more predictable payment system for all internists.

  • Redesign the practice of medicine. A key component of this goal is to bring information technology to our offices to improve the efficiency and safety of our practice and connect us as a national, interoperative network. The electronic medical record will provide the necessary infrastructure for collecting and analyzing clinical patient information and for collating performance measurement data—part of the rapidly emerging push toward accountability in medicine.

    Another endeavor that is crucial to redesign is to continue advocating for reductions in regulatory and administrative burdens that private and public payers impose on physicians.

    And practice redesign will have to encompass new modalities and systems of care for patients with chronic illnesses, multiple diagnoses and complex medical problems, particularly for our geriatric patients. ACP is at the forefront of participating in demonstration projects that will help refine our role in the care of these patients. At the same time, we're working hard to make sure that rigorous scientific method—our specialty's strength—is applied to emerging redesign trends.

  • Define and articulate the value of internal medicine. We need to increase the awareness on the part of our patients, purchasers, payers and the government of how general and subspecialty internists contribute to the health of our population and the care of the sick. All internists should be engaged in this effort.

  • Educate and train internists for the future practice of internal medicine. Helping educate each successive generation of internists has been a core goal of the College since its founding. Today's medical students and residents are bright, eager and idealistic, and it is unfair to burden them with overwhelming debt.

    The College has issued several proposals to alleviate this problem. Moreover, we are working with leading educators to incorporate more fully into students' and residents' training the skills that they need for clinical practice.

    At the same time, the College is committed to giving practicing internists comprehensive educational support for ongoing professional development, board recertification and the emerging field of performance measurement.

It is an ambitious agenda, but it's one the College and internal medicine need to take on. At the same time, ACP continues to work toward goals we've held for years.

The crisis of uninsured Americans continues to grow. Since 1990, the College has been a strong voice in proposing constructive plans to right this wrong. Our current ACP incremental health plan has received support from medical organizations and legislators, and represents a blueprint to help us attain universal health care. At the same time, ACP continues to apply strong pressure for medical liability reform. Without it, malpractice problems will continue to escalate to a level of intolerable and costly interference in medical practice.

The College offers superb resources: an advocacy group that continues to work for legislative and regulatory change, as well as first-rate educational tools to help us keep up-to-date on clinical developments and practice management.

But our greatest resource is our membership, the internists, residents and students—117,000 strong—whose thoughts and suggestions are always welcome and needed. Your communications with your ACP governors and leaders are essential for helping us set College policy and direction.

As I begin my term as President, I am confident that ACP will continue to exert a powerful influence on the present and future course of medicine. Our field remains intellectually challenging and deeply gratifying. College leaders bring a wide range of knowledge and experience to the organization, and are fully engaged on your behalf. I am honored to be your President, and over the course of the next busy and exciting year, I hope to meet many of you.

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