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

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Doctor-patient relationship is the key to revitalization

From the June ACP Observer, copyright 2004 by the American College of Physicians.

By Phyllis Maguire

NEW ORLEANS—At an Annual Session press conference, ACP leaders presented an update of the College's ongoing efforts to revitalize the practice of internal medicine.

The revitalization campaign has been "building over the past five years," said the College's Immediate Past President, Munsey S. Wheby, MACP. Those efforts are particularly critical because of increasing practice hassles, growing overhead and declining reimbursement, and slipping student interest in general internal medicine.

At the same time, Dr. Wheby pointed out, the growing demand for better health care quality presents unique opportunities to emphasize the complexity and excellence of care that internists provide. Improving the quality of care and nurturing the physician-patient relationship, he said, are key factors in revitalizing the specialty.

Unifying theme

According to Mary T. Herald, MACP, the Immediate Past Chair of the Board of Regents, a two-day summit convened last fall presented a major step forward in the revitalization campaign. That summit brought together members of all segments of the internal medicine community, including physicians from a variety of practice settings.

Other key organizations involved in both the summit and overall revitalization efforts include the Alliance for Academic Internal Medicine, the American Board of Internal Medicine, the Society of General Internal Medicine and the Society of Hospital Medicine. An important factor in the success of the summit and in ongoing revitalization efforts, she said, is "harnessing the synergy" of bringing different internal medicine factions together.

According to Dr. Herald, attendees at the summit identified four top priorities to revitalize internal medicine. They were:

  • repairing a dysfunctional payment system;

  • reducing the hassles and inefficiencies of medical practice;

  • educating the public and purchasers about the value of internal medicine; and

  • revamping training to give students and residents more experience with new modes and systems of care.

Dr. Herald also identified a common thread that ran through all of the summit discussions: the importance of the physician-patient relationship.

"All of us-academics, generalists, subspecialists and associates-have a different point of view to contribute to revitalization," Dr. Herald said. "What brings all of us together is the ability to apply our scientific knowledge to making a difference in patients' lives."

That relationship has suffered in an era of "10-minute medicine," pointed out panel member Charles K. Francis, FACP, President of the College. "By reforming the payment system and emphasizing quality of care, we can better respond to what patients need."

A social moment

Providing that response is becoming more critical, given the aging population and those patients' potential burden of chronic disease, said Eric B. Larson, FACP, Chair of the Board of Regents.

Last year's Medicare reform legislation included provisions that would establish demonstration projects to give physicians incentives for quality initiatives and disease management. And both patients and payers are increasingly aware of problems in health care quality and the value of high quality care.

"We need to use this social moment, " Dr. Larson said, "to promote the quality that internal medicine provides."

While revitalization has become a key concern for the College and other internal medicine organizations, ACP plans to continue its outreach efforts to reform payment systems and educate the public about the value of internal medicine.

One member of the press attending the conference asked if the College intends to work with organizations like AARP to highlight internists' role in treating older Americans. Said Dr. Herald: "That is definitely part of the game plan."

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