Tuesday, April 06, 2010

Should I cut the ACP some slack?

It’s no secret to regular readers that I’ve been critical of the American College of Physicians. Dr. Robert Centor, a blogging colleague who writes Medical Rants, took me to task about one of my recent posts. In my comment thread I characterized the ACP as elitist because of their hierarchical membership structure, to which he replied:

I must take umbrage in your characterization of ACP as an elitist organization. ACP really has a wonderful mixture of academicians and private practice physicians in its leadership. ACP has changed dramatically over the past decade. No other organization even tries to consider the breadth of internal medicine in its mission.

You really should reconsider ACP as an incredibly important society.

OK, let's be clear that I consider ACP an important professional society. They offer excellent educational resources for internists which I have taken advantage of many times over the years. Maybe elitist is too strong a word, but early on it struck me that in their two-tiered membership the ordinary members were like second class citizens. Advancement to fellowship in the organization was next to impossible unless you were in academic medicine. When they made fellowship attainable to community internists they changed to a three-tiered system with the new and more elite rank of Mastership. I understand the organization wanting to recognize different levels of achievement, but it rubbed me the wrong way.

In that same post I also said the ACP no longer supports general IM as a unique specialty. DB responded to that assertion with an entire post of his own, but he didn't directly address my criticism. I agree with every word of that post. He said that the hospitalist movement has contributed to the decline of general IM (my italics):

What happened? We have two problems: (1) the growth of hospital medicine and (2) the lack of payment growth for outpatient medicine. Hospital medicine has grown because hospitals willingly pay reasonable salaries for hospitalists. Hospitalist programs grow dramatically for several factors that I have previously enumerated. Residents are attracted to these programs because they understand the job very well, they are paid reasonably, and the schedule provides significant non-working days.

The growth of hospital medicine has made the dualists a dying breed.

At SHM 2008 one of the keynote speakers said words to the effect that the hospitalist movement was poised to be the grand integrator of health care. Instead the movement contributed to the disintegration of health care by removing the dualist's niche. We became the grand enablers of a fragmented system.

While DB didn't address my criticism directly he cited factors in the decline of traditional IM that are no fault of the ACP. Don't blame the organization, he said.

Fair enough. I don't blame the ACP for all of Internal Medicine's problems. I am saying that the ACP is powerfully positioned to help general Internal Medicine regain its identity yet chooses to do nothing to further that end. I have cited evidence here, here, here, here and here.

Finally, though a little less relevant since Pharma cut off many of its gifts to physicians, I was disturbed a few years ago by the ACP's hypocritical stance on physician-Pharma relations, which you can read about in this press release.

So: Yes the ACP is an important organization. Yes they have produced some incredibly valuable educational resources for physicians. No they are not to blame for Intermal Medicine's problems. And yes they have irritated me just enough times to dissuade me from joining.

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