It is an honor to begin my term as your next President of the American College of Physicians. My involvement in the College dates from my days of training to the past 28 years of private practice. Throughout these years, the College has provided the structure, identity, education, and career satisfaction that have made me a better internist. In addition, I hold a clinical appointment at the Alpert Medical School of Brown University in Providence, R.I., and have enjoyed mentoring and learning from students and residents for many years.
I am excited to help lead the College in exploring opportunities and meeting challenges during a time of transition in medicine. I hope to bring the real-world perspective of general internists and subspecialists as they navigate the sea changes of today and the near future.
Leadership requires clarity of mission and vision for the College and for me. Leaders need to recognize self-perceptions and strive to gain a broader and deeper understanding of issues. We are an organization of talented and motivated individuals, and I look forward to hearing your thoughts and ideas as we strive to improve the practice of medicine.
As an ambassador I look forward to representing the College in its principles of science, clinical evidence, and delivery of compassionate care to our patients and to helping guide health policy to provide high-quality and affordable health care for all Americans.
The past year has seen many successes, including the repeal of the sustainable growth rate formula that crippled our ability to manage our practices and care for patients. We have now moved to a period of measurement and payment dependent on “value” or “quality” in care delivery. Maintenance of Certification (MOC) has seen needed revisions and we published the 17th edition of our marquee product, the Medical Knowledge Self-Assessment Program (MKSAP).
Many challenges and opportunities lie ahead over the next several years. I will outline a few priorities.
College leaders have done excellent work in advocating for changes to MOC that better reflect the practice of medicine and will continue to advocate on behalf of members. It has been a hot-button topic that has been a source of great frustration and anxiety for our members. The College is guided by its accountability principles and recognizes the balance between the needs of its members and the trust of our patients.
The College will continue to press for further change in the MOC process. Our advocacy must assure that American Board of Internal Medicine (ABIM) makes a decision soon about the future of the secure exam and seriously considers options recommended in the report of the 2020 Task Force. We will also continue to press ABIM to look at ways to decrease the burden and expense of participating in MOC, so that it is an accessible, valuable process that contributes to lifelong learning. We are internists because we seek knowledge and set high standards for patient care. We are frustrated because the present process does not embrace these needs but engenders questions about relevance, time, and cost.
New models of care delivery will continue to evolve over the next 5 to 10 years. My practice of 8 physicians has been a patient-centered medical home for 8 years. We have participated in stages 1 and 2 of meaningful use and in the Physician Quality Reporting System (PQRS) and now are transitioning to an alternative payment model (APM). The College has been a leader again in this transition and has guided policy and helped members in the process. I look forward to continuing to provide “real-world” input, as new rules, regulations, and standards are developed by the Centers for Medicare and Medicaid Services and private health plans.
The rate of “burnout” remains unacceptably high, with 60% of physicians considering stopping practice or changing careers. We need to nurture and foster young and older internists to make healthy choices, balance work and personal life, decrease administrative burden, and seek appropriate payment for our work. Most important, we need to ask our members to self-reflect on purpose, meaning, and the impact of their work.
The care of patients in the 21st century is quite different from the past 100 years. We have team-based care with a focus on care measurement of individual patients and population health. The traditional office visit will be one of many venues for the delivery of care. We have video visits, patient voice integration into the medical record, software for patients to track their health and coordinate care, and “e-consultation” with our colleagues. A College priority is to guide and set quality and ethical standards for the practice of the concept of “telemedicine.”
The College has dedicated significant resources to the development of clinical guidelines and review of performance measures. The College is playing an integral role in assuring that such measures are meaningful and harmonized and improve patient and population health.
Graduate medical education is at a precipice. The Association of American Medical Colleges recently predicted a shortage of 62,000 to 95,000 physicians nationally by 2025. Much of this shortage is a result of an aging population, an increase in chronic disease, a larger number of insured, and general population growth. As internists and subspecialists, we are at the nexus of care delivery. Yet we have not seen significant increases in training positions and sources of funding for decades. The College continues to lead in finding solutions to this critical problem.
Global climate change and its health consequences are one of the most important societal issues of our time. The College recently published a policy paper on this topic, which is also of particular interest to me. The rate at which the climate is changing has not been seen in hundreds of thousands of years, and the health effects of heat-related illnesses; spread of tickborne, waterborne, and other infectious disease; food insecurity; and mental illness are present today. Our vulnerable patients with chronic disease, the poor, the young, and the aged are most at risk. The College has made several recommendations on mitigation strategies. I hope to speak widely about this issue and how our members can be spokespeople at the community, state, and national level on the health effects of climate change.
It is a privilege to be your President and represent the interests of our patients, members, and the College. I hope to continue the excellent work of our previous leaders, most recently Wayne J. Riley, MD, MPH, MBA, MACP, and Tanveer P. Mir, MD, MACP, along with the staff of the College, led by Steven E. Weinberger, MD, MACP. I look forward to working with Thomas G. Tape, MD, FACP, Chair of the Board of Regents, the Board of Regents, the Board of Governors, members, and staff as we tackle the challenges of an interesting time in medicine. Please reach out to me with your thoughts and ideas through e-mail or in person as I visit your Chapters.