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A look at ACP's summit to rejuvenate the specialty

Board of Regents Chair Mary T. Herald talks about what internal medicine must do to save itself

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

By Deborah Gesensway

Ask Mary T. Herald, FACP, Chair of the College's Board of Regents, to identify the most crucial issue facing ACP leadership, and she has a ready answer: the knotty problem of how to revitalize internal medicine and reinvigorate its practitioners. Because that concern is so far-reaching, the Regents, with the support of the Board of Governors, have taken the unprecedented step of convening a summit of the entire internal medicine community to address it.

For six straight years, the number of U.S. medical school seniors applying for internal medicine residency positions has declined. Much of the discussion on revitalization has so far focused—and rightly so, Dr. Herald said—on medical students and the level of debt that pushes them toward higher-paying specialties.

But as she explained, internal medicine's core problem is not the Match. Instead, she said, "it's a problem of us as practicing internists turning students off."

Medical students, she explained, see practicing internists frustrated by the realities of their practice lives. "If the people doing the work are in distress, why would anybody want to go into that coal mine?" she asked. "If internists are moaning and groaning, students are going to think that radiology seems like more fun."

To counter that trend, she said, the College has mapped out a multiyear effort to improve the working conditions and job satisfaction of practicing internists. As one of the first steps in the College's "revitalization" initiative, the Regents this year approved a series of position papers that address compensation for telephone and e-mail care, as well as administrative hassles that slow down or reduce reimbursement. (See "Regents discuss revitalizing internal medicine, more.")

The summit will bring together all the different members of the specialty: community and academic, primary care and subspecialty, and hospital-based and ambulatory physicians. On the first weekend in November, summit participants will identify ways to devise short- and long-term solutions to chronic practice problems.

In the first of an occasional series of conversations with the Board of Regents Chair, Dr. Herald talked to ACP Observer about the upcoming revitalization summit and the kinds of issues it will address.

Q: Why did ACP decide to hold this summit, and what different groups will be involved?

A: The main push for this came out of the Board of Governors. The Governors were adamant that the College has to do something to help us survive right now, as well as in the future. They called on the College to convene a summit that would include the views of practicing doctors.

The summit is being funded by the College's Foundation and will be held in Philadelphia. It will be a think tank of people from the College; the Alliance for Academic Internal Medicine, which includes program directors, professors, clerkship directors and administrators; the Society of General Internal Medicine; the Society of Hospital Medicine; the American Board of Internal Medicine; and the Council of Subspecialty Societies, which includes all the subspecialties of internal medicine.

Q: Why is the College convening such a broad group?

A: The point of getting all the internal medicine organizations together is that none of us has a grasp of the entire problem.

People in academic medicine, for example, have their own current challenges. I'm a subspecialist in endocrinology with a small group practice. We have our set of problems, and I know those pretty well.

The summit workgroups are going to be made up of a mixture of people from all sorts of different venues. We need that broad perspective in order to develop viable solutions.

Q: What issues will the participants look at?

A: We will focus on four areas: innovations in education and training; new medical practice models; changing practice by leveraging technology and evidence-based medicine; and a shared advocacy agenda for improving the system.

Participants will be charged with identifying some immediate changes that we can recommend right now. They will also be asked to come up with some long-term projects that we can roll out in the near future.

We will follow up on these recommendations, and I have a commitment from all the other organizations that the summit will be only one in a series of steps. The College, for example, will offer a revitalization presentation at Annual Session in the spring.

Q: What do you hope the summit will accomplish?

A: While we aren't going to see reimbursement change overnight, it's a goal that we can push for. For now, however, we can give internists tools to make their daily lives better.

If we reduce practice hassles and improve the models through which physicians deliver care, the compensation questions will be less of a problem. We should be able to relieve a lot of the frustration physicians are feeling.

I hope we will identify some specific small steps we can take initially. I'm particularly interested in steps that the internal medicine community will be able to implement on its own.

Along those lines, we may recommend tools that the College can develop. For instance, it could be very helpful to mail every ACP member a computer disk containing templates and consent forms that would make life easier for practicing internists.

What we won't do at the summit is whine about the problem and redefine the issues. This summit is where the rubber hits the road, and the whole thrust of the weekend is going to be positive.

Q: Why not focus the effort on medical students?

A: If we improve the lot of practicing internists—or at least give them the tools to improve their everyday lives—we will help turn the tide.

What we hear from students is that internal medicine is intrinsically an interesting field, one that is unique and complex, but that internists don't seem to be happy. If we can make internists happier in their careers, students will notice, and the Match issue will get resolved.

We don't want to give up on this generation of doctors. These physicians have a lot of experience and talent and commitment. Instead, we want to equip them and advocate for them in the different arenas where we have some reach.

Deborah Gesensway is a freelance writer in Glenside, Pa.

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