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And so it begins: The long but not-so-lonely road

From the May ACP Internist, copyright © 2014 by the American College of Physicians

By David A. Fleming, MD, MA, FACP

As I embark on my year as ACP President, discordant feelings sweep over me, knowing what lies ahead. I am naturally apprehensive about the days to come but also elated to be afforded this opportunity.

At the outset let me say that I am deeply grateful to you for allowing me to serve as your president and for the rich and fulfilling year to come. I must also offer my deep gratitude to outgoing ACP President Molly Cooke, MD, MACP; outgoing Board of Regents Chair Charles Cutler, MD, MACP; and outgoing Board of Governors Chair Susan Hingle, MD, FACP, for their consistently strong and precise leadership, unfailing mentorship, and grace this past year. They have set a very high bar and greased the skids quite nicely for incoming Board of Regents Chair Robert Centor, MD, FACP; incoming Board of Governors Chair Darilyn Moyer, MD, FACP; and me as we take our places at the table.

Our collective praise, of course, must ultimately go to the amazing executive team and staff that anchor the heart and soul of our College, under the able leadership of CEO and Executive Vice President Steven Weinberger, MD, FACP, and Chief Operating Officer Wayne Bylsma, PhD. This “A Team” is the foundation on which the College functions and thrives. Our staff are “the rock” and to a large extent the reason that this organization and its leadership are able to function at such a high level. We can’t thank you enough!

To say there are ever-expanding challenges before us would be an understatement, but then when has that ever not been the case when transitioning to new leadership each year? Indeed, we have much to do, not the least of which is reinvigorating a sense of excitement in and commitment to our profession. We need to find a way to recapture a sense of joy in what it is to be an internist, caring for the most complicated, chronically and often critically ill patients, being key leaders and educators in health care in our country, and developing strategies to ensure high-value care.

I must admit to a deep sense of concern in finding a growing number of distrusting and dissatisfied colleagues who tell me that being an internist is no longer fun or professionally fulfilling. For many the sense of purpose and commitment has been displaced by a growing administratively burdensome workload that distracts from actual patient care. One of my goals this year is to work with members and other leaders in the College in an ongoing effort to reinvigorate a sense of pride and fulfillment in choosing internal medicine as a specialty. This means leading by example and by reinvigorating our profession in our own hearts and minds, as well as those of our mentees. This requires some heavy lifting, and I will need your help.

It is important that we stand together, even when it’s hard. In trying times we must remind ourselves that we are grounded by shared principles of professional excellence, a universal commitment to patient welfare, and an understanding of shared trust in the relationship we have with our patients. This is our grounding principle—this is the glue that will hold us together. I also encourage us to recognize that the College is fiercely committed to helping its members do a better job taking care of patients and promoting the public welfare. Not surprisingly, with nearly 140,000 highly trained, intellectually bright, and skilled members, there will be disagreement as to the priorities in meeting our mission and goals. But it is critically important that we remain unified and continue a dialogue dedicated to advocacy and constructive change.

We have enjoyed several victories thanks to the advocacy efforts of the College. The Affordable Care Act is the law of the land and is being implemented, though with a stuttering start at several levels and with many opportunities for improvement. At long last the “elephant in the room” of the Sustainable Growth Rate formula for Medicare reimbursement is being addressed seriously, and in a bicameral, bipartisan way, by policymakers, even if it hasn’t been resolved. Medicaid expansion is starting to occur in some fashion in many states that have been resistant; the insurance exchanges are enrolling millions; and the College is having an increasingly great impact internationally. Our membership is at an all-time high and we continue to grow, in no small part because young physicians, residents, and fellows see the value in being part of a professional enterprise that is making a difference. And as important, they see ACP as their professional home.

Our road map has many directions. In the months to come you will hear from me about the challenges we face with Maintenance of Certification; electronic medical records and other administrative burdens; the Affordable Care Act rollout and Medicaid expansion; adoption of alternative payment models through high-value care; the complexities and accommodations needed for successful team care and the patient-centered medical home; the future of primary care; the influence and growth of ACP in other countries; public health concerns, including the sale and use of firearms; and other issues that may arise that are important to the College, our patients, and our membership.

Looking forward, I so appreciate having very able partners and mentors in Drs. Centor and Moyer. Each in their own way provide an amazing level of intellect and wisdom and I am very lucky to be standing with them. We will be a good team.

I can’t help but glance over my shoulder every now and again to reflect on the history of this amazing organization and the many important changes that have taken place through our collective effort. These are historic times, and we have an opportunity to witness an incredible shift in the culture of health care in this country and beyond. As we move into the centennial year of this, our American College of Physicians, I feel blessed to be part of it. What calms and strengthens me is an awareness that we walk this road together, focused on the singular goal that unites us in spite of our differences of opinion, specialty, and practice: the care and welfare of our patients.

Yes, we have much to do and I have faith that we will get it done. I look forward to the challenge and to your partnership.

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