American College of Physicians: Internal Medicine — Doctors for Adults ®


New College CEO to focus on changing practice climate

Advocacy efforts will target physician fee increases and access to care, along with practice management tools

From the September ACP-ASIM Observer, copyright 2002 by the American College of Physicians-American Society of Internal Medicine.

By Phyllis Maguire

As the College's new Executive Vice President and Chief Executive Officer, John Tooker, FACP, MBA, wants to help internists cope with the rapid pace of change in medical practice, both through advocacy efforts and practical management tools.

Dr. Tooker, who began his new duties on July 1, assumes leadership of ACP- ASIM during a period of shifting political agendas, growing fragmentation in organized medicine and major ongoing practice management changes for physicians. "The challenge for medical organizations," he said, "is to understand both the magnitude and pace of change in the practice environment so we can provide services that address physicians' experiences and needs."

Dr. Tooker has taken the reins at a time of political sea change in organized medicine. In Washington, the policy agenda has shifted away from issues like the patients' bill of rights, which was a focus for College advocacy efforts just a year ago. Dr. Tooker said that the government's new emphasis on fighting terrorism has required the College to modify its political agenda as well.

He cited two encouraging developments that the College continues to support: physician fee increases in the Medicare fee schedule that were part of a prescription drug benefit bill passed by the House earlier this summer, and growing legislative support for the College's ambitious seven-year plan for improving health care access. (For more information on the College's access plan, see Achieving Affordable Health Insurance Coverage for All within Seven Years: A Proposal from America's Internists.)

Dr. Tooker noted that ACP- ASIM is putting more focus on liability insurance problems, which are financially crippling physicians in many parts of the country. While College chapters are actively engaged in ongoing state efforts, the College is working with national coalitions for federal solutions.

ACP-ASIM is also continuing to take a strong advocacy role in educating both physicians and the public about strategies for responding to bioterrorism. For physicians, Dr. Tooker pointed out, that response may hit very close to home.

"HHS recently recommended that health care workers be vaccinated against smallpox, and the implications for physicians aren't clear," he said. "On the face of it, it sounds like the right thing to do, but this is a live vaccine that has some risk associated with it." He said that the College is currently examining how the recommendation would affect individual internists.

The College's shifting political focus is only part of the overall effort to help internists. Dr. Tooker noted that physicians' practice environment is tougher than ever, particularly for the 60% of physicians who work in small practices. Business considerations are leading many physicians to get MBAs—Dr. Tooker among them—and accelerating physicians' need for timely information and quality education. Dr. Tooker said that the College must give internists both business and clinical tools.

He wants to continue to build on the practice management expertise that the ASIM brought to the 1998 merger with ACP and expand the services of the College's Practice Management Center. ACP-ASIM is also developing original patient safety materials with a grant from the Agency for Healthcare Research and Quality to help physicians maintain patient safety practices.

Dr. Tooker also wants the College to take a strong role in the ongoing evolution of continuing medical education (CME). In addition to traditional CME offerings, the College is exploring innovative ways for physicians to earn credits, including giving credits for clinical practice and quality improvement efforts.

He pointed out that ACP-ASIM is considering giving CME credit to physicians who participate in the research-based QNet quality program, which helps physicians implement clinical best practices in office settings. The College is also launching a pilot program with Allscripts Inc. to give physicians CME credit for using PIER, the College's new electronic point-of-care product.

And he explained that the College is considering developing performance measures related to the College's Clinical Efficacy Assessment Project (CEAP) guidelines, and may give CME credits to physicians using those measures. The College is also exploring ways to develop practice improvement measures.

"Physicians are spending more and more time in these types of demanding, time-consuming practice assessment activities," Dr. Tooker said. "At a minimum, they ought to be able to receive CME credit and optimally reimbursement."

While he intends to help the College spearhead new programs, Dr. Tooker also intends to build on strengths forged by his predecessor, Walter J. McDonald, MACP. A big part of that effort includes maintaining the College's strong relationships with internal medicine subspecialty societies.

"One challenge is to address the fragmentation of medicine into smaller and smaller organizations," Dr. Tooker explained. "We have to continue to bring all the internal medicine specialties together to share information and, where possible, find common ground on policies."

He also plans to create new marketing opportunities for College products and address the ongoing slide of primary care in the National Resident Matching Program.

"We want to see that trend reversed," he said. "There is clearly going to be a growing demand for internists to treat increasingly sick patients in the outpatient setting."


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