“I practice medicine.”
I remember someone making a joke of that and saying with a wry smile, “I practice medicine …. Someday, I'll get it right.” I practice medicine. Like practicing piano or playing a sport, it is a discipline, and the first step is being present in the clinic, in the hospital, with the patient, with the family. Wherever we are called to be, we are there for our patients to provide care and clinical expertise.
If only our work began and ended with the care of the patient. As complex as that can be, most of us would sigh with relief if it were the sole focus of our work.
The practice of medicine takes place within a multilayered institutional structure that requires multiple people to keep it afloat. The practice of medicine is linked with the complex structure of billing. Billing, insurance, and related documentation and practice guideline requirements result in multiple layers of work and processes that overlay, complicate, and may even interfere with the care of the patient.
I remember, early in my student days, thinking that I would do rural medicine and I would barter. My practice would be a simple exchange of needs. I later realized how much I am an urban child and how medical oncology would not really be feasible in a solo rural setting. And even if it were feasible, I might barter with my patient, but the pharmaceutical company would only want a monetary exchange.
And there is billing, along with the complex and ever-changing link between documentation and billing. There are guidelines and regulations and levels of reimbursement, all linked to our bottom line, to how we are compensated. We rank the specialties by level of compensation. We observe that medical students are disincentivized to pursue general internal medicine because of the level of compensation and the level of student debt. We are very aware of the differences in compensation among the specialties and, although these are generally accepted, we are becoming aware of other differences in compensation such as those of gender, international medical graduate status, and ethnicity, among others. Aware of the importance of equity for all of us, ACP has come forward with a statement supporting equitable compensation for comparable work.
Acknowledging the multitude of factors that impact our practice of medicine, ACP has developed a multitude of resources to support your ability to care for patients on a daily basis. These include resources to help you address regulatory and quality factors that impact your practice. I want to share some of these with you, along with links to facilitate your access. The best place to start is with the dashboard of resources at ACP's Practice Resource page.
- Medical coding resources, videos, and fact sheets that can be used by office staff as well as physicians.
- Resources to address payment hurdles related to Medicare, Medicaid, private insurance, and alternative delivery and payment models.
- Tools and resources to move toward value-based care, including access to ACP's Practice Advisor, referrals to Practice Transformation Networks, and free CME/MOC through High Value Care cases.
- Practice transformation tools to assist with navigating value-based payment, high-value care implementation, practice redesign support, quality improvement and registries, and patient and family engagement.
- Health information technology resources for electronic health record implementation and Meaningful Use approaches, transitions of care, and ACP positions.
- Office management resources, such as patient care and office forms, a chart abstraction tool, office financial tools, human resources information, group or liability insurance options, practice ownership tools, and an audio and video instructional series.
- Because we know that inclusion leads to wellness and wellness leads to quality, ACP's wellness resources may also be of interest to you.
As you review these resources, consider opportunities that may assist you in your goals. These modules are updated regularly. Recent additions include a diabetes module in the ACP Practice Advisor and an evaluation and management coding utilization tool that allows for benchmarking. If you have thoughts on topics that are missing or could be improved, or new approaches for the information, please do forward thoughts and comments to us. Your insights are deeply valued and will improve the work the College does for you.
You have on-the-ground experience, and your efficacy may be enhanced with skill-building. Think of the College, your professional home, as being there, by your side, ready to assist you. If you are a champion for these issues in your practice, you may consider more formal leadership training at the ACP Leadership Academy. You may also consider joining colleagues for ACP's annual Leadership Day and addressing health policy practice issues on Capitol Hill. Many of the topics that are discussed with legislators relate to practice.
Consider working with your Chapter Governor on health policy issues as they relate to practice in your state. ACP's State Health Policy program can help you take action at the state level. Join the virtual Advocates for Internal Medicine Network and subscribe to the e-newsletter ACP Advocate, where every other week you can receive the latest information on health policy topics that may impact your practice. Invite staff who are doing this work for you to your state meetings and help inform the College on practice issues that are of greatest interest to you.
As always, we are living in interesting times regarding the rules around the practice of medicine. ACP is regularly working for you to monitor the pulse of this topic and to protect your practice options. Please visit the “Where We Stand” page on our website to learn about the latest hot topics.
Thank you for the opportunity to work with you on these issues. Thank you for what you do every day to care for patients. Thank you for making a difference in your “practice of medicine.” I hope these resources make your life easier.