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


ACP leaders seek ways to revitalize internal medicine

From the May ACP Observer, copyright 2003 by the American College of Physicians.

By Phyllis Maguire

SAN DIEGO—In the wake of Match results showing a continued six-year decline in the number of U.S. seniors matching to internal medicine programs, College leaders spent much of their pre-Session meetings debating how to revitalize the specialty. (For more on the Match, see "In this year's Match, internal medicine continues to lose U.S. graduates.")

"Revitalization is the overarching concern of internal medicine," said Sara E. Walker, MACP, the College's Immediate Past President. "Attracting more students and alleviating the frustrations of practicing internists are core concerns that will determine the specialty's future."

The issue is complex, she said, because it involves not only the needs of students and residents choosing careers, but also the concerns of practicing internists pressured by financial and regulatory concerns.

In a series of meetings before Annual Session, the College's Regents and Governors discussed measures to address those issues. Here is an overview of some of the discussions, along with actions ACP plans to take.

Fall summit

The Regents approved the concept of a fall summit at which College leaders would try to create a coalition of internal medicine and subspecialty organizations, increase the number of students choosing internal medicine careers and promote career satisfaction among practicing internists. (A workgroup charged with developing details about the proposed summit will report back to the Regents in July.)

As part of the College's "revitalization of internal medicine project," the Regents also approved forming a workgroup to explore ways in which internal medicine might fit into future health care models and educational systems. The group will consider holding a forum at Annual Session 2004 to present the ideas it generates.

The Regents also approved a plan from the Board of Governors to explore ways that physicians can use information technology to reduce overhead and save time.

Chapter activities

The Governors adopted several resolutions recommending that the College design strategies to attract students and residents to internal medicine. They include developing resources to help residents manage education debt and to help limit medical school tuition increases.

They also adopted a resolution recommending that ACP allow Associates who take an active role in Annual Session to attend the meeting for free. And they recommended that College staff analyze data on medical student career choices.

Additionally, the Governors adopted a resolution urging the College to consider partnering with academic health centers to hold regional symposia for physicians and the public to highlight the role of general internists.

In a panel discussion, the Governors shared ideas chapters can use to reinvigorate internal medicine. Several speakers suggested ways that chapters can reach out to students and residents, such as identifying student leaders and providing more sessions at chapter meetings geared to Associates.

Douglas S. Paauw, FACP, Governor for the Washington Chapter, said his chapter has boosted student interest by paying half of residents' College dues for their first year of membership. The chapter also hosts meetings on how to use handhelds in internal medicine.

Both he and Richard W. Carlson, FACP, Governor for the Arizona Chapter, stressed the importance of having chapter members serve as mentors for students and Associates. Karen Hsu, ACP Medical Student Member, Chair of the College's Council of Student Members, said this kind of relationship is vital to encourage more students to choose internal medicine careers.

"Even if you can't mentor students, try letting them 'shadow' you for an afternoon," she said. "Students crave that kind of insight and experience."

Stephen M. Salerno, FACP, past Chair of the College's Young Physicians Subcommittee, pointed out that chapters also need to intensify their efforts to recruit and retain young physician members. Young physicians are particularly interested in tools to improve practice management and office efficiency, he said.

"The key is showing young physicians they have a role to play and taking action instead of passively grumbling," said Dr. Salerno. "Small victories will eventually lead to a resurgence of the profession's popularity."

Opportunity out of chaos

At a combined Regents and Governors meeting, Regent Eric B. Larson, FACP, who will become Chair of the Board of Regents in 2004, presented recommendations from a Society of General Internal Medicine task force on the future of internal medicine.

The task force called for changing reimbursement so physicians get paid for health care team management and for phone and e-mail consults. It also recommended expanding general internal medicine training programs to include training in informatics, management and team leadership.

To accommodate that additional training, residency programs may need to be expanded to four years—a prospect that would be viable, Dr. Larson claimed, only with reimbursement reform.

He also said that while health care in general is facing a host of problems like restricted access to care and rising costs, general internal medicine is particularly vulnerable. Internists feel squeezed by government and insurer cost constraints, he said, as well as by rising malpractice premiums and growing demands to curtail patient visits.

He noted, however, that the need remains constant for general internal medicine's core values: expertise in adult medicine, the ability to deliver comprehensive care to varied patient populations and the commitment to lifelong learning.

"In times of chaos, our impulse is to abandon our core values, when in fact that's the best time to endorse them," Dr. Larson said. "Chaos represents an opportunity for innovation. Instead of waiting to see what happens, we must define an agenda and pursue it."


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