The biggest health care news of the past decade was hard to miss: the Affordable Care Act (ACA) launched an effort to provide health care coverage and access for all Americans. The College had been calling for such a policy for years and in 2007 issued another paper on the topic, recommending that the U.S. consider either a pluralistic guaranteed coverage system or single-payer health care.
Thus, when Congress began considering health care reform in 2009, ACP actively lobbied for passage, which finally occurred in March 2010. Two years later, the Supreme Court upheld most of the ACA. However, the Court made expansion of the Medicaid program voluntary for states, giving the College and especially its state chapters another political task. Many ACP members pushed their representatives to expand Medicaid, often successfully. At least 25 states have done so, with an additional 5 expanding the program under alternative models.
The College also pursued other political goals during the decade. In just 2013 and 2014, ACP released position papers on prevention of firearm-related injuries and deaths, innovative approaches to medical liability reform, and clinical care teams, stirring up controversy with gun supporters, lawyers, and nurse practitioners, respectively.
The question of how nurse practitioners and physicians should collaborate to meet the country's primary care needs was a big one during the decade. The College helped develop and promote the concept of a patient-centered medical home starting in 2006, and, while everyone agreed on the central importance of the patient, there was some debate about the roles of the other participants.
In 2008, College leaders and nurse practitioner representatives held a meeting to discuss their ideas. Based in part on this discussion, ACP produced a policy monograph in 2009 titled “Nurse Practitioners in Primary Care.” The paper included a position statement that proved particularly controversial:
“In the patient-centered medical home (PCMH) model, care for patients is best served by a multidisciplinary team where the clinical team is led by a physician. However, given the call for testing different models of the PCMH, ACP believes that PCMH demonstration projects that include evaluation of physician-led PCMHs could also test the effectiveness of nurse-practitioner led PCMH practices in accord with existing state practice acts.”
The debate was still raging in 2013, when the College released principles encouraging clinicians to collaborate as care teams in Annals of Internal Medicine, accompanied by editorials from other concerned parties, including nurse practitioners, which criticized aspects of the College's position.
In addition to defining teams, the College worked to define internal medicine in collaboration with the American Board of Internal Medicine, the Alliance for Academic Internal Medicine, and the Society of General Internal Medicine. In 2012, they defined internists as “specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness.”
At the same time, ACP developed posters, T-shirts, and coffee mugs to encourage internists' pride in their specialty: “I think, therefore I.M.” read one example. ACP members were interviewed about “What Internal Medicine Means to Me” for a promotional video posted online. YouTube, Facebook, and Twitter were also used to raise public awareness of internal medicine.
ACP products changed to make use of the latest technology during the decade, too. Annals launched an iPad edition and moved to a weekly publication schedule, with print issues coming out on the first and third Tuesdays of the month and online-first articles on the others. MKSAP began offering a Web version, in addition to print and CD options, and the digital version began to offer new technological features, including custom quizzes and mobile applications.
To keep up with changes in internist practice models, the College launched a hospitalist-specific news publication in 2006. In January 2007, ACP Hospitalist became a monthly magazine, aimed at hospital-based internists, hospital-based internal medicine subspecialists, third-year internal medicine residents, and residency program directors.
The next year, this very publication underwent significant changes—renamed from ACP Observer to ACP Internist and redesigned, including the addition of the FDA update and the cartoon caption contest.
There have been a lot of changes to the College and to internal medicine since Heinrich Stern and a few friends gathered in 1915, and many more are likely to come. But certain aspects should remain constant, according to Robert M. Centor, MD, MACP, and Steven E. Weinberger, MD, FACP, writing in “Serving Our Patients and Profession: A Centennial History of the American College of Physicians (1915-2015)”: the strong dependence on evidence-based science; the individualized, compassionate approach to care; and the breadth of patients, clinical problems, and settings of care.
“In all we do, we must keep the patient's interests foremost, matching our diagnostic processes and treatment with our patients' needs, goals, and desires,” they wrote.