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Global outlook toward improving America's health care system

From the February ACP Internist, copyright © 2012 by the American College of Physicians

By Virginia L. Hood, MBBS, MPH, FACP

During a recent international visit to represent ACP and speak at a national internal medicine society conference, I was greeted by a member who told me, “I'm very proud to be FACP. The ACP is so respected, and has great educational materials and the right values.”

This was not the first time I had heard this sentiment expressed during visits to other countries. Surveys of our international members indicate great respect for ACP educational programs, products and services as well as for the professional recognitions of Fellowship and Mastership, which are valued all over the world.

ACP has been an international organization since shortly after its foundation in 1915. We now have international chapters in 13 countries and members in 130, and more than half of these 9,600 members are subspecialists.

Many members living in the U.S. also have strong international connections. Some have medical training from elsewhere. I am one of the 30% who are international medical graduates (IMGs), and several other IMGs serve on the Board of Governors, the Board of Regents and policy committees, as well as play influential roles in state chapters. In addition, some members serve in other countries while on military duty or visit for educational exchanges and/or professional opportunities.

Our growth in international activities parallels our growth in membership. This academic year, our International Ambassadors' Program, an extension of the International Speakers program, will support visits to 20 countries by College representatives to speak at conferences hosted by the countries' national or regional medical societies or international bodies. As well as presenting on topics requested by the host, ambassadors meet with leaders of internal medicine, practicing physicians, residents and medical students, as well as our Members, Fellows and Masters.

Each year at ACP's annual Internal Medicine meeting, in addition to the international reception and panels, we host leaders of internal medicine from Europe, Africa, the Americas, Asia and the Pacific region for convocation. We are fortunate that many stay to participate in the international forum initiated by William E. Golden, MACP, and Lynne M. Kirk, MACP, in 2007. Since then, the forum has been an enlightening and productive annual event, with discussions focusing on physician workforce balance, physician migration, quality and internal medicine training issues.

During my 12-year tenure on the Board of Governors, Board of Regents and International Council, I have served as ACP ambassador to 15 countries, four of which have ACP chapters. I am always impressed by the energy and enthusiasm of students, residents and leaders and the evidenced-based, well-referenced quality of the educational programs I encounter. Perhaps most impressive is that despite the daunting challenges many physicians face in their countries, they never fail to provide gracious and generous hospitality to visitors.

The U.S. has an outstanding postgraduate and continuing medical education system that is valued for its consistency, uniformity of standards and emphasis on quality and competency. However, our health care system could learn a lot from those of other countries, where for a fraction of the cost, high-quality care with better overall outcomes is often provided for a much greater proportion of the population. Nevertheless, most countries I've visited are like the U.S., struggling with a lack of effective primary care services and fewer young people choosing careers in internal medicine.

One question we must always address is how our international activities fit with our strategic themes. In each area where we have a focus, our global relationships provide a thread that strengthens the fabric of our mission. The same challenges are present in all countries to ensure that those who are patient-centered specialists get the recognition and rewards needed to ensure a viable workforce.

While the goal of improving the U.S. health care system may not be a priority for international members or other nations' organizations, practice transformation, improved provision of primary care services, payment reforms and promotion of professionalism really are common needs everywhere. In all these areas we can learn from each other.

How can ACP members benefit from the wisdom that is universal among physicians? Join in ACP's activities with our international members at Internal Medicine 2012. Let the international office know that you would consider hosting a student, resident or physician observer. Work with your chapters to develop sister/brother relationships, as have Chile and Indiana and more recently Brazil and New York. The opportunities that these interactions provide bring both expected satisfaction and unexpected delights.

As an organization, ACP can be proud that we have such a well-recognized place in the global health care world. The individual and organizational relationships forged and fostered among national and international internal medicine societies, academies and colleges allow us and our colleagues around the world to lead the effort to promote excellence and professionalism in the practice of medicine for the benefit of patients in the global community.

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