A look back at seven years of leading internal medicine
From the June ACP-ASIM Observer, copyright © 2002 by the American College of Physicians-American Society of Internal Medicine.
By Phyllis Maguire
Next month, Walter J. McDonald, FACP, will step down as Executive Vice President (EVP) and Chief Executive Officer of ACP-ASIM. His retirement brings to a close a leadership role that helped steer the College into a much more prominent position within organized medicine and national politics.
Since 1995, Dr. McDonald has led the College through dramatic change. He helped engineer the 1998 merger between the American College of Physicians and the American Society of Internal Medicine, a move that resulted in a much larger combined membership, more political clout and more resources to help the College expand its innovative educational programs.
Dr. McDonald says the merger of ACP and ASIM led the joint organization to greater prominence in organized medicine.
He was instrumental in increasing the College's high-profile advocacy efforts for universal coverage and for enhanced professionalism. He helped establish the ACP- ASIM Foundation to fund programs to improve internal medicine practice, and he oversaw the expansion of the College's member services. He also helped foster a closer relationship between the College and subspecialty groups, creating what he called a "big tent" for internal medicine.
An endocrinologist, Dr. McDonald was associate dean for education at Oregon Health Sciences University in Portland, Ore., when he came to Philadelphia to head up the College. He had spent more than 20 years in Portland teaching, doing research and practicing at the university and serving as chief of medicine at the city's Veterans Administration Medical Center. He served on the Board of Regents from 1992 to 1994, as Chair of the Board of Governors from 1992 to 1993 and as Governor for the Oregon Chapter from 1989 to 1993.
While he intends to stay active after he leaves the College, Dr. McDonald said he isn't seeking another full-time job. Instead, he plans to spend more time with family, including four grandchildren under age 5. He recently sat down with ACP-ASIM Observer and spoke about his seven-year tenure.
ACP-ASIM Observer: When you first came to the College as EVP in 1995, what did you see as your biggest challenge?
Dr. McDonald: The biggest challenge was getting the College more into the mainstream of organized medicine without losing its emphasis on professionalism and ethics.
The College had always had a strong ethical tradition, but an organization can't just lay down the rules and say, 'This is how you act in a professional manner.' You have to work to create an environment that allows people to act in a professional fashion, and you can't do that without strong advocacy efforts or without dealing head-on with issues like physician fatigue and remuneration.
We had a good handle on how professionalism and ethics relate to medical practice, but we didn't have the prominent role in organized medicine that allowed us to communicate that. Now I think we do.
Q: What was key to getting that position?
A: The merger was key, no question about it. Before the merger, both organizations spent a lot of time and money either duplicating or denigrating what the other was doing. Now we're not wasting time shooting blanks at our counterparts—and our membership has grown from 80,000 to 115,000, with a big jump in our combined budget as well. That's helped us have a bigger impact and fund several major initiatives.
Q: What has surprised you the most about the merger?
A: I'm surprised by how effective the resulting organization has become. When you look at what the College can legitimately say we've accomplished in Washington every year, you can now point to a number of issues. In the past, it was always, 'We worked with this and that group to get things through,' but rarely efforts that we spearheaded or led.
With more resources, we've also been able to generate much more interesting and up-to-date educational offerings. PIER [Physicians' Information and Education Resource, an electronic point-of-care service launched in April] is a good example. And anyone who went to Annual Session five years ago can tell you that it was a very different operation compared to today. The sessions are now much more effective because we are utilizing principles of adult education, instead of relying on the old lecture series format.
Q: The Board of Governors has assumed a bigger role within the College since you came on board. Has that expanded role evolved because of issues like recertification, or have you consciously sought to give the Governors a stronger voice?
A: It's been some of both, but a lot of it has been conscious. When I was a Governor, I felt very strongly that the Governors needed to have more of a say. It was always a more representative and diverse group than the Regents, and in many cases it has much closer contact with members. It seemed logical to me that for major directional issues, the Governors needed to have a primary voice, so I've looked for ways to promote that.
Q: You've also put a lot of time into strengthening the College's ties with subspecialty groups.
A: The fact that organized medicine needs to be a partnership has been very clear in the years that I've been here. It's easy to find factors that pull specialists and generalists apart, but I think a lot of those factors are artificial. Too often organized groups create divisions in practitioners' minds that alienate them from other organizations. We've tried to strengthen our ties to subspecialty groups like the CSS [Council of Subspecialty Societies], and we plan to give slotted seats on the Board of Regents to subspecialty groups to make sure their voices are heard.
Q: What development within the College over the last seven years has been the most gratifying to you?
A: Probably the growth in the number of young physicians who are now part of the organization. We've seen many more student and associate memberships, while the average age for Annual Session attendees has dropped substantially. To me, that says that the College has become a more inclusive organization than it once was.
When I came to Annual Session for the first time as a resident in 1968, the College seemed a kind of citadel for physicians who'd reached some pinnacle of achievement. It really didn't start to be a welcoming place for young physicians until the 1980s. Now the College has become an organization that every internist can join to pursue excellence, and that's the way it needs to stay.
The College recently announced that John A. Mitas II, FACP, will serve as its next Deputy Executive Vice President and Chief Operating Officer.
Dr. Mitas will fill the role vacated by John Tooker, FACP, who will become the College's EVP and CEO. Drs. Tooker and Mitas will begin their new jobs on July 1.
Dr. Mitas most recently served as medical director of the DynPort Vaccine Company in Frederick, Md. The firm develops vaccines to prevent illness from common biological weapons.
Currently living in Fairfax Station, Va., Dr. Mitas had a 20-year career with the U.S. Navy. He served as commanding officer of several facilities and was on the board of directors of the National Naval Medical Center in Bethesda, Md.
He has been active in the College, serving on the Ethics Committee and as Governor for the Navy Region from 1991 to 1995. Under his leadership, the region increased its number of College Fellows and established an annual meeting.
A board-certified internist, nephrologist and geriatrician, Dr. Mitas received his medical degree from the Medical College of Georgia in Augusta. He completed an internship at the U.S. Naval Hospital in San Diego and a fellowship in nephrology at the University of California of San Diego School of Medicine and the Naval Regional Medical Center.
Dr. Mitas is currently pursuing an MBA in medical services management at Johns Hopkins University.
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