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


Members nationwide meet practice challenges head-on

From the March ACP Observer, copyright 2006 by the American College of Physicians.

By C. Anderson Hedberg, FACP

This will be my last column as College President. Look in this space next month for the comments of my esteemed colleague and friend Lynne M. Kirk, FACP, as she begins her tenure as ACP President. I confess that I have enjoyed this monthly exercise, even under deadline. As an avid newspaper reader, I've often longed to have my own column—in either sports or current affairs!—so found this an excellent way to indulge my fantasy.

Over the past year, I have had the great privilege of meeting and speaking with many of you as I logged many miles on behalf of the College. I'd like to use this last column to share some of those experiences and how they affected me.

Momentous changes

First, my conversations with many of you made it very clear that we are in an era of momentous changes in the way we practice medicine. The discussions I've had at town hall meetings and in corridors have been lively and informative, filled with the curiosity and probing analysis that mark internists' active minds.

The physicians I met are worried about the flawed payment system, the growing problems facing general internal medicine, the challenges of implementing health information technology and the big unknowns related to pay for performance. Many physicians I spoke with told me they want a more efficient practice with less paperwork, less stress and the ability to lead more balanced lives.

Despite these concerns, I found the mood of ACP members nationwide to be generally upbeat, and physicians themselves to be open-minded and eager to tackle their practice problems. That impression mirrors results of the College's 2005 member survey, which found that fully 77% of respondents were either very or somewhat satisfied with their medical career, as opposed to only 16% who were somewhat or very dissatisfied. (The remaining 7% didn't have strong feelings either way.)

I have particularly enjoyed the chapter meetings I have attended. I found the scientific sessions uniformly excellent, policy discussions informative and council meetings comprehensive. Associates and students deserve special recognition for their eloquence, knowledge and enthusiasm. I've greatly enjoyed their presentations, poster sessions and high-spirited Doctor's Dilemma competitions, and am convinced our specialty has a bright future with such superb young physicians.

I also had the opportunity to represent the College outside the United States, attending meetings of the 39th Singapore-Malaysia Congress of Medicine and the College of Physicians of Singapore. I had a chance to share our views with medical leaders from around the world and to realize the College's extensive international reach.

And I have had several opportunities to visit the halls of Congress and to meet with elected officials, administrators and staff. I can't emphasize enough how important it is to actively present our views—and how well-respected ACP is in Washington. That's due to our ability to deliver timely advice when called upon and to present reasonable, well-informed policies.

New key policies

Seeing firsthand how we're received in Washington has given me a new appreciation for the College's policy-making process.

New ACP policy can originate at the grassroots membership level in resolutions submitted by chapters through the Board of Governors, or from ACP committees. If policy recommendations are approved by the Board of Regents, those recommendations may then be referred to the appropriate College committee to be developed into policy papers.

Once they receive final approval from the Regents, those papers provide a reasoned blueprint for action on the major issues facing internal medicine.

As my term of office comes to a close, I am heartened to see new and upcoming policy papers that address precisely the concerns I've heard physicians voice again and again over the past year. Here are several I'd like to highlight:

  • "Linking Physician Payments to Quality Care." Approved by the Regents last year, this paper presents the College's position on the value of and requirements for a successful pay-for-performance system. It also includes steps that must be taken to ensure a fair and useful pay-for-performance methodology that can improve the quality of care.

  • "The Advanced Medical Home: A Patient-Centered, Physician-Guided Model of Health Care." This new policy was approved by the Regents in January. It calls for far-reaching changes to improve the quality and safety of ambulatory care and to make practices more efficient so physicians can spend more time with patients. The paper focuses on patients' comprehensive medical needs and stresses the value of long-term coordinated case management. It also emphasizes the need for physicians to be reimbursed for these services. And the paper provides recommendations for measuring practice performance and for utilizing electronic records and online communication.

  • "Creating a New National Workforce for Internal Medicine." Scheduled to be completed this spring, this paper will address national medical workforce policy to ensure an adequate supply of internists, both generalists and subspecialists, for the future.

In the meantime, the College continues to use existing policies—on revitalizing internal medicine, reforming the dysfunctional payment system, reducing practice hassles and using information technology to improve care quality—to push for needed reforms. (A full list of ACP position papers is online.)

Such policies are critically important to move the College's strategic plans forward on behalf of our patients, physicians and the public. I have been very fortunate to be so closely allied with these dynamic College processes for many years, and to serve as your President. Thank you for all your help and support, and I hope all of you will continue to help steer the present and future direction of this great organization.


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