With new name, ACP moves ahead with united strength
By Munsey S. Wheby, FACP
What's in a name? Far more than you'd think.
In April, after five years of identifying itself with the hyphenated name, "American College of Physicians-American Society of Internal Medicine," the College changed its name to "American College of Physicians." The change became official just months before the fifth anniversary of the merger, which occurred on July 1, 1998.
Changing the name to American College of Physicians was not easy. It occurred as result of a careful, soul-searching process with broad input from the Board of Governors, the Board of Regents, College staff and—most importantly—members, including many who had belonged to ASIM.
Was this a big deal? You bet it was. To help you understand why and how, I'd like to briefly review the history of the merger.
Seeking common ground
ACP was founded in 1915 to help raise the standards of American medicine. Its founding came on the heels of the 1909 Flexner Report, which brought quality control to American medical education. Recognizing the increasing specialization among U.S. doctors, the College sought to improve health care by fostering the educational and professional development of its physician members.
ASIM emerged in 1956 to address political and socioeconomic issues that its founders thought ACP ignored. While the College often addressed the loftier concerns of internists, including those in academic medicine, ASIM confronted the hard realities of practicing medicine in a changing social, political and corporate environment. Grappling with issues of physician reimbursement, coding and third-party payers, ASIM spoke especially for internists in office-based practices.
While many internists belonged to both organizations, competitiveness and even hostility arose between the two groups over the years. Which issues really mattered to internists? And which organization did a better job representing them?
By the mid-1990s, however, it became increasingly clear that the two groups had become mirror images of each other. Both organizations had internists' best interests at heart—and both were powerful advocates for internal medicine.
Additionally, as internal medicine came under growing pressure from society and from medicine as a whole, the internecine rivalries between ACP and ASIM began to fade. Instead, it made sense for the two to seek common ground.
Mergers between ACP and ASIM had been attempted before and abandoned. This time, however, stalwart leaders of both bodies felt that merging had become a necessity. They were convinced of the ultimate strength of an alliance and were willing to withstand the heat of forging it.
While bringing the two together required hard work from many within both organizations, there was a small group of prime movers. From ASIM, this included Alan R. Nelson, MACP; M. Boyd Shook, FACP; and Bernard M. Rosof, MACP. From ACP, this included Walter J. McDonald, MACP; William A. Reynolds, MACP; and Harold J. Fallon, MACP.
Preliminary talks among the leaders in 1997 set the stage for serious merger discussions. Each organization named a negotiating team. When those teams came together, there were some immediate positive developments. Members of each team seemed pleasantly surprised that their counterparts were "just like us."
But the entire process was not so painless. In early negotiations, the two executive vice presidents, Drs. Nelson and McDonald, prodded the teams past their comfort zones to ferret out issues that could be potential deal-breakers.
They found one: the name.
The teams held individual caucuses, then reassembled to entertain a compromise proposal. One proposed name was not unlike what we see today when two strong individuals marry: a hyphenated moniker. All agreed, and negotiations moved forward.
The teams agreed that no further name change would even be considered for at least three years following the merger. In fact, it took almost four years for murmurings to start, partly in response to comments from the press and others that our merged name was too long and cumbersome. It was a mouthful.
We now call the hybrid organization the American College of Physicians. It's a shorter, simpler name that recalls the College's historical roots, but it's also informed by ASIM's activism and advocacy to improve the practice environment. (For more on the process of choosing the new name, see "College will take on a 'new' name this month, but with a twist.")
And what of the organization that bears the name? As I see it, five years post-merger, the new ACP is far stronger than either of its constituent elements. It embodies the best qualities of both organizations, while creating significant new strengths of its own.
ACP is committed to the College's traditional mission of improving the quality and effectiveness of health care by fostering excellence and professionalism in medical practice. Recent initiatives on this front include the electronic Physicians' Information and Education Resource (PIER), and our work with the American Board of Internal Medicine to help shape a recertification process that is both satisfactory to internists and publicly accountable.
But the new ACP also champions issues that were once ASIM's purview alone—particularly concerns about socioeconomic pressures and the practice environment. The Medical Services Committee, established post-merger to address third-party payer issues, has quickly become one of ACP's most active and effective committees.
The merger took our political advocacy efforts in Washington to another level. We've gained many highly competent, politically astute staff. In addition, the fact that a single organization now speaks for a merged membership of more than 115,000 physicians and students lends greater credence and cachet to our efforts.
Since the merger, we've been able to redouble our advocacy for affordable health insurance for all Americans. By the time this article appears, Sen. Jeff Bingaman of New Mexico will have submitted to the Senate a health insurance bill based largely on ACP's plan to give all Americans access to health care by the end of this decade.
Has the merger been successful? My answer is an unequivocal yes.
At the level of the Boards of Governors and Regents, the merger proved a bit challenging, but also energizing. As internists, whether from ACP or ASIM, we were all dedicated to the same professional goals and ideals.
On a practical level, though, differences in the two organizations' structures required each group to make adjustments. Internists from both organizations dealt with some culture shock, to be sure, but this dissipated rapidly. The merger is now virtually seamless at the board level.
Even at the chapter level, the merger has fostered a more collegial climate among members. The old rivalries and hostilities between ACP chapters and ASIM state societies are no more.
As the fifth anniversary of the merger approaches, we're fortunate to have become the new ACP. The merger came just in time: We need every bit of energy, strength and vision our union has produced to mount a major new initiative to revitalize internal medicine.
Internal medicine is under threat as never before. Practicing internists face serious challenges on reimbursement, practice environment and lifestyle. Academic medicine is experiencing unprecedented fiscal and time constraints.
Increasing subspecialization isolates and endangers general internists. And a major challenge for the profession is in the pipeline, as the number of medical students choosing to become internists continues to wane.
To make the case for internal medicine and reverse the negative trends, we need both the professional and educational influence of the old College as well as the activist, practice advocacy of the former ASIM.
Let's take all the clout we've rolled up in our new name and get to work.
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