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

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Off-service note from ACP’s outgoing president

From the April ACP Internist, copyright © 2011 by the American College of Physicians

By J. Fred Ralston, FACP

It has been a true honor and privilege to serve as your president for the past year. Transitions are an important part of medicine. During the year, ACP had some very important transitions at the senior staff level. From day one Steven Weinberger, FACP, has done a marvelous job succeeding John Tooker, MACP, as EVP/CEO. Notice that I do not use the word “replace” because John Tooker is still with us and continuing to make contributions to the College in his unique and thoughtful way.

Michael Barr, FACP, was promoted to senior vice president for a newly created Division of Medical Practice, Professionalism & Quality. Both Michael and the division are going to be great resources in helping our members face the challenges in a changing medical world. Patrick Alguire, FACP, succeeds Steve Weinberger as senior vice president for Medical Education. We look forward to using Patrick’s many talents in maintaining all that is great about ACP’s educational products while we make them available in a variety of new formats that meet the needs of our members. Wayne Bylsma now serves as senior vice president, Executive Office and chief of staff. His perspectives and attention to detail keep the College running smoothly.

Officer roles are refreshed with new energy and talent each year. It has been wonderful to work closely with Robin Luke, MACP (Chair, Board of Regents), and Charles Cutler, FACP (Chair, Board of Governors), this year. Next year there will be a great team of dedicated ACP leaders. You will be well served by Yul Ejnes, FACP, an internist in private practice in Cranston, R.I., who takes over as chair of the Board of Regents. Virginia Hood, FACP, a nephrologist at the University of Vermont, will bring her special touch to her new job as president. The Board of Governors will be under the capable leadership of David Fleming, FACP, chair of internal medicine at the University of Missouri School of Medicine. My good friend and long-time mentor Dennis Schaberg, MACP, will continue to provide strong leadership as treasurer.

To say that we live in a challenging political environment is of course a massive understatement. We continue to work with all who will listen to advance carefully crafted evidence-based ACP policy. We have launched the High-Value, Cost-Conscious Care Initiative in an effort to encourage doctors and patients alike to use our resources wisely.

I try to simply say to both patients and reporters that sometimes less is more and that more is not necessarily helpful but may actually be harmful. If we can change behavior and reduce the 30% or so of medical activities felt to be unhelpful, it would be a huge benefit to our society in so many ways. We continue to push to advance the practice of medicine for the benefit of our patients. Our educational and advocacy efforts aim toward the same goal.

ACP continues to promote the patient-centered medical home as a major element in restructuring the delivery of medical care in a way that works best for patients, doctors, staff and those who pay the bills. It is an opportunity to change incentives so that payment matches value received. In my opinion, this model comes closest to moving away from a system that overvalues procedures and undervalues prevention and care coordination toward one where the payment system and practice resources can retain and attract the doctors and other health professionals we need in the right specialty mix.

Many things need to happen to move toward our goal of allowing everyone to get the right care at the right time. Obviously that remains a goal, but we have taken steps recently toward another long-time goal of ACP: universal coverage. Recent ACP efforts like the High-Value Cost-Conscious Care Initiative should appeal to everyone regardless of their place on the political spectrum.

Frugal is good. As internists we want and need to know what the best options are for our patients based on solid evidence. The more frugal we are when that is best, the more we can pay for cutting-edge innovations that make American medicine great. As I’ve said before in this column, the U.S. is the best place in the world to have a heart attack because no one surpasses our quality and quantity of new interventions. We may also be the most likely place to have that heart attack because of unhealthy lifestyles, lack of medical coverage and lack of focus toward prevention by those who have coverage.

Let’s keep that cutting-edge technology, but use it a bit less, both because we know when it doesn’t help and perhaps because, by better lifestyles and preventions, we will develop fewer of the acute syndromes that require it. ACP is poised to take a leading role in this transformation.

ACP will continue to work with members of both political parties to advance our patient-centered goals. Unfortunately, the long-term need to restructure many aspects of education, training, and delivery do not match well with relatively short congressional timelines and with Congressional Budget Office scoring. We will continue to work with patient advocacy groups, insurers, the business community and others to move toward a true system of cost-effective care.

ACP will celebrate its 100th Anniversary in 2015, with the annual meeting in Boston holding special significance. I have been honored to serve as chair of the task force doing the initial planning for this celebration. ACP’s first 100 years came in the heady times of the Flexner Report, which placed American medicine firmly on a scientific basis. ACP was founded for a very similar purpose.

I feel that American medicine is again at a significant crossroads. As we honor our first 100 years at ACP, let’s all work together to make the start of our second 100 years a true turning point in American medicine with a push toward evidence-based care with coverage for all. We don’t want rationed care in the United States, but rather rational care centered in the team-based patient-centered medical home.

In this system I envision, internists, with our specific talents for diagnosis and management of complex patients, will again be part of one of the most honored and desired specialties in medicine.

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