Our challenge to live, thrive through ‘interesting times'

Recently, as I have addressed various ACP committees and groups, I have often referred to the saying, “May you live through interesting times.” These famous words are attributed to a Chinese expression and are often regarded either as a blessing or a curse, reflecting on the dual-edged nature of experiences that can occur during times of transformation, where one can wake up elated one day only to be plunged into despair the next. To live through such times is to witness great upheaval and change, moments that redefine societies and reshape the course of destiny.

As events have unfolded since the U.S. inauguration in January, I could not escape the feeling that the whole world, and in particular the world of medicine, has moved into “interesting times.” It was no secret that the new administration was going to be disruptive in many ways, but the immediate rash of proclamations and presidential orders seems to have taken us all by surprise. The breadth of these actions, which affect health care, equity, immigration, global trade, and international aid and relations, are set to fundamentally reconfigure the U.S. government in unprecedented ways. We are just at the beginning of what will be an “interesting” four years.

As I write this column, many presidential executive orders are already changing or reversing hard-fought health care milestones, especially for vulnerable populations, while others threaten the very foundation of our health care system. A banning and purge of diversity, equity, and inclusion (DEI) programs across the federal landscape, restrictions to gender-affirming care, and changes in reproductive health services, including in vitro fertilization (IVF) and abortion, are impacting millions of patients by limiting culturally competent care and restricting essential reproductive care.

The wholesale dismantling of USAID and restrictions to NIH and CDC programs threaten our disease control preparedness and responses locally and internationally, while the large-scale layoffs in the federal workforce, including workers at vital health agencies, threaten the very foundation of our health system. Other administration actions that are designed to reduce funding to programs such as Medicare and Medicaid, coupled with efforts to reverse Biden-era policies that expanded the reach of the Affordable Care Act, will result in a burgeoning rise in the number of uninsured patients, particularly among the poorest and most vulnerable in our society.

Many of these executive actions are in direct contrast to well-established ACP policy positions. In my view, they weaken rather than strengthen public health infrastructure, create a hostile work environment for federal health care professionals, and increase uncertainty and mistrust in professional and scientific organizations. The limits placed on the activities of the CDC, NIH, and Advisory Committee on Immunization Practices (ACIP) are particularly worrisome, and the barring of federal scientists from information exchange and public discourse through conferences and publications is unprecedented.

Under these circumstances, ACP cannot and must not stand idly by. While we have taken an active role in voicing our concerns, first with the presidential transition team, then with legislators and political leaders, we must rise and push harder for our patients and our colleagues, many of whom are directly impacted by these changes. ACP's engagement with the government through our Department of Governmental Affairs and Public Policy has been quite active, with a strong foundation based on our well-established policy positions. These positions represent the ideals of our membership and our collective desire to constantly improve care for our patients, while ensuring that every internal medicine physician has access to educational opportunities, career advancement, and joy of practice through a collegial professional home.

As I write my last column as President, I cannot help but reflect on how “interesting” these times have become. At the beginning of my tenure, we had just laid out a new set of strategic priorities that aimed to strengthen the College and better serve our patients and membership. At the time, I called upon the house of medicine to tackle external circumstances that impinge on and influence how we care for our patients. As we now confront the challenges brought on by the change in administration, it is even more imperative that we shore up our activities, protect the future of our profession, and live up to our mission: to enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine.

The College is the right agent to do this important work. Our commitment to scientific evidence as the basis of patient-centered care obligates us to be the vanguard pushing back against forces that subvert our mission. We must continue to promote science and high-value care and fight to reduce health care disparities in a world that desires to roll back hard-earned gains for the most vulnerable in our society. We must continue to push for access to equitable and affordable care for every American and continue to insist that our society must have a functional primary and preventive care system. We must also continue to care for each other and ourselves, combat the factors that contribute to burnout and loss of the joy of practice, and promote a healthy, sustainable, and satisfying professional environment for every physician.

As I affirmed in my inaugural address last year, this is our profession, our livelihood, and our business. We see the patients, we conduct the research, and we develop the scientific evidence that is the basis of our clinical decisions. We are the ones at the bedside caring for patients with professionalism and compassion. Despite political winds sweeping across the landscape, and however “interesting” the times may be, we must keep our eye on our North Star: We are a science-based, professional, and antiracist organization. As we set our goals for the future of the College, we must also consider in our plans the future of medicine, and I am confident that despite these “interesting times,” our future is bright.