Unresolved health care reform issues mask real progress

ACP's outgoing president reflects on the past year with confidence that within the turbulent environment of primary care lies great opportunity.

In my first President's Message, I remarked how I looked forward to having the opportunity to address many of the issues facing our members and our specialty. Indeed, speaking to these issues in a variety of venues as ACP President this past year has been an honor and a remarkable experience. In this final column, I would like to share some thoughts.

Not surprisingly, many of the questions posed in the first column—all part of the College's vision for reform—remain unresolved. At the beginning of my term in the spring of 2008, frankly, I was concerned about how much progress we would make with our vision for health care reform. We were facing the largest Medicare physician payment cut we've ever seen and other areas of our system were, and remain, in need of critical attention: access to care for the uninsured, the role of health information technology, administrative expenses and an adequate workforce of primary care physicians.

Today, I'd like to talk more about what is going right rather than what has gone wrong, and how ACP has contributed to the successes. What I have observed and taken part in over this last year gives me confidence that within the turbulent environment of primary care lies great opportunity. We have the ability to make internal medicine stronger, so that many more of today's medical students will select it as a career. I see that change already underway.

First, there is the new administration. Regardless of political leanings, I think we can all agree that President Barack Obama has the best opportunity in decades to reform U.S. health care. The budget deficit is commanding most of his attention now but survey data indicate that the public remains eager for major health care reform.

Second, our argument for reform and the advancement of the patient-centered medical home (PCMH) model has begun to resonate. All across the nation, from employers to health plans, physician membership organizations to advocacy groups, support for the PCMH is gaining momentum. Decision makers are listening and taking action to correct what isn't working and advance what is working, or test what might work better.

ACP is a founding member of the Patient-Centered Primary Care Collaborative (PCPCC), a growing national coalition of the largest and most influential companies in the U.S., consumer organizations, labor unions and major health plans. This diverse group is unified in the belief that the medical home holds promise for improving the quality of care and reducing its cost. Twenty-two medical organizations, including each of the four primary groups and the American Medical Association, have endorsed its principles. This is certainly a positive step.

The public is becoming engaged and educated as well. A survey conducted just before the recent Presidential election, by Harris Interactive on behalf of the PCPCC, found that support for candidates' health care plans grew when the PCMH model was included. In fact, more than 75% of those surveyed said they would increase their support of a health care reform plan if it included a PCMH. This growing trend of public awareness and support is important and something we should cultivate in light of our objective to achieve better patient care through a model of care which patients will welcome.

In my tenure as president of ACP, I had the good fortune of meeting with many colleagues while I traveled in the U.S. and abroad. It was a great pleasure for me, as those I met were eager to share their experiences and warm hospitality was extended wherever I went. My travels abroad were informative. I welcomed invitations to countries which were predominantly Islamic, such as Bangladesh and Morocco, so I might learn how cultural or religious differences affected health care delivery. What I found was that we have more in common than we do not and that those countries face many of the same challenges we do, among them a need to expand the ranks of internal medicine specialists.

Serving as ACP president has been a wonderful experience. The rewards were the people I met and the issues encountered. As the strength of an organization is its members, we are strongly positioned. I am confident we can reach our goals by working together with the collective voice of all internists including generalists, subspecialists and hospitalists. If we continue to reach decision makers through our evidence-based policy and make a concerted effort to affect public opinion, a better health care system will come.

It is the College's good fortune to have Joseph W. Stubbs, FACP of Albany, Ga. as its next President. My hope is that he will have as enriching and rewarding a year as I have enjoyed.