Transitions don't mean a loss of continuity for ACP's mission

As ACP's outgoing president contemplates the upcoming change of leadership, she realizes that while the people may change, the organization still requires its leaders and its members to continue.

This month the College leadership will transition to the capable hands of David L. Bronson, MD, FACP, President; Phyllis A. Guze, MD, FACP, Chair of the Board of Regents; and Thomas G. Tape, MD, FACP, Chair of the Board of Governors, who will continue to lead the quest in ACP's mission statement to “enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine.”

As I reflect on the past year, I feel immensely grateful to have carried the torch for the College and our profession for one short lap of the 96-year journey we have traveled so far. It has been a privilege to hear the stories, experiences, ideas, concerns and hopes of the physicians, trainees and medical students I have met in the U.S. and other countries, as well as to talk with them about College activities.

I am also very fortunate to have worked with a remarkable team: Yul D. Ejnes, MD, FACP, Chair of the Board of Regents; David Fleming, MD, FACP, Chair of the Board of Governors; and Dennis R. Schaberg, MD, MACP, ACP's treasurer, along with Steven Weinberger, MD, FACP, EVP/CEO; Wayne Bylsma, PhD, Chief Operating Officer; and the rest of ACP's extraordinary staff. Like so much in medicine today, all successful enterprises reflect the quality of the team, and the College has one of the best. I thank them all for their support and for what they taught me, but most importantly for their responsiveness to our members.

At the start of this year, many asked what my focus would be as President. I explained that my job was to be a spokesperson for the College, to promote the mission and help accomplish the strategic priorities. I wanted to ensure, as best I could, that internal medicine specialists and subspecialists and the College provided needed leadership to improve the well-being of our patients and our ability as physicians to offer the quality care they deserve. Embedded in that was my desire to foster the high-value, cost-conscious care initiative, enhance our global and national collaborations and encourage interactions with internal medicine subspecialists.

ACP had clear priorities for 2011-2012 set by our strategic planning process. They were to be the premier synthesizer and distributor of health care education; to be the professional home for all internists (specialists and subspecialists); to define and communicate the unique value of internal medicine; and to support changes in the U.S. health care system that would improve patient care, improve health and promote cost-conscious care.

In the area of advocacy, we have tried to bend the legislative agenda toward responsible reduction in health care spending while preserving programs that protect graduate medical education training to ensure a workforce that meets the most pressing health care needs of the nation, especially the underserved. In addition, we have worked tirelessly to advocate for appropriate funding for, and transitions to, systems of care that reward value, not volume, and thus will ensure the “survival-thrival” of internal medicine specialists and subspecialists.

Unfortunately, success in bringing about meaningful change in national health care policy is all too often left to the whims of lawmakers, who this year have pursued political posturing rather than seeking solutions to pressing problems. However, we have had success in many regulatory areas because of our thoughtful, patient-centered, nonpartisan positions.

ACP continues to be the most respected producer of educational materials for all practicing internal medicine physicians. MKSAP 15 has been used by 58,000 physicians in 86 countries. It is now available on mobile devices, and answers can be directly credited to Maintenance of Certification (MOC) accounts. Annals of Internal Medicine CME use is increasing, and Annals also offers the first journal-based MOC opportunity with the Ethics Manual MOC module. Information from Annals articles has reached an audience of 2.5 billion in the past calendar year.

For me, the most exciting initiative of the College during this year has been the focus on high-value, cost-conscious care. The pertinence and traction of this issue were highlighted by the enthusiastic press coverage it received following the publication of the Sixth Edition of the Ethics Manual as a supplement to the Jan. 2, 2012 issue of Annals.

Although some commentators seemed concerned that ACP would recommend “parsimonious” care—focusing on one definition, “frugal to the point of stinginess”—most realized the key issue is that physicians are responsible for prescribing just the right amount of care rather than following the culture of excess. The latter has led to more than $200 billion of overuse and misuse resulting in real harm as well as contributing to unsustainable increases in health care spending for individuals and society. This is an issue that resonates in all countries with a variety of health care systems, as I discovered when I spoke about it to physicians in Europe, South America and Asia.

It is concerning that some of our patients and the public have been caught up in the “more is better” cult, but it is our responsibility to educate ourselves and them about using only safe and effective practices that make sense. Fortunately, we have great allies in other medical organizations such as the American Board of Internal Medicine Foundation, groups such as the Consumers Union, and many patients who do not want unnecessary tests or treatments that cause them inconvenience, discomfort, harm or additional cost.

We have pursued our mission with diligence and enthusiasm, but there is still much to do. We need to support and enhance an internal medicine workforce that maintains lifelong standards of excellence and professionalism to ensure that our patients with chronic, complex, multisystem disease receive the safe, effective, high-value and coordinated care they deserve in the 21st century.

We need to collaborate with equally dedicated professionals in other health care organizations to reduce disparities in access, quality and patient experiences. Most important, we need to celebrate the power that internal medicine specialists and subspecialists bring to these efforts. The College is an extraordinary organization, but it needs your continued involvement, ideas and support to always be the beacon for our discipline and for the benefit of our patients.