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Challenges for Internal Medicine as the American College of Physicians Celebrates Its 100th AnniversaryChallenges for Internal Medicine

Steven E. Weinberger, MD
[+] Article, Author, and Disclosure Information

This article was published online first at www.annals.org on 27 January 2015.

From the American College of Physicians, Philadelphia, Pennsylvania.

Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-2905.

Requests for Single Reprints: Steven E. Weinberger, MD, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.

Author Contributions: Conception and design: S.E. Weinberger.

Drafting of the article: S.E. Weinberger.

Critical revision of the article for important intellectual content: S.E. Weinberger.

Final approval of the article: S.E. Weinberger.

Ann Intern Med. 2015;162(8):585-586. doi:10.7326/M14-2905
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The American College of Physicians celebrates its 100th anniversary in 2015. This commentary highlights 3 leading issues for internal medicine and for the College as it enters its second century and strives to continue to meet the needs of internists and their patients.

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Publish physician satisfaction data
Posted on February 10, 2015
Justin B. Moore, Robert G. Badgett, Jon Rosell
University of Kansas School of Medicine-Wichita (Moore and Badgett), Medical Society of Sedgwick County (Rosell)
Conflict of Interest: None Declared
We are grateful that the ACP has chosen professional satisfaction as one of its three priorities as the College marks its 100th anniversary (PMID: 25621813). While time pressures, as emphasized by Dr. Weinberger, are important, other causes of professional dissatisfaction lurk (PMID: 14702431; http://www.rand.org/pubs/research_reports/RR439.html, accessed 2/9/15). Physician dissatisfaction has consequences beyond retention of the physician workforce; it may lead to lower patient satisfaction, poorer health outcomes, and increased costs. Thus, Bodenheimer and Sinsky have suggested physician satisfaction as a “fourth aim” for the Institute for Healthcare Improvement’s Triple Aim (PMID: 25384822).

We propose that the Practice Enjoyment Initiative prospectively measure the professional satisfaction of ACP members with a goal to disclose back to members the results stratified by employer, specialty, and practice type. Our rationale is simple: an ACP member looking for a job could compare cities’ or institutions’ physician satisfaction scores and use the data to decide whether or not to accept a job offer. If members' professional choices are affected by this information, the transparency may encourage institutions to create sustainable professional experiences. This data is sensitive, and we understand that this may require a period (one or two years) of reporting non-attributed data, after which the data could be de-anonymized at the institutional level to increase transparency of workforce conditions. As this project evolves, disclosure of results to the general public may be appropriate. This is analogous to theoretical patient use of satisfaction data (http://www.medicare.gov/hospitalcompare/search.html, accessed 2/9/15).

Beyond the immediate effect of guiding job-seeking physicians, the reporting would surely prompt health care institutions to better support providers if an institution's inferior scores led to difficulty recruiting and retaining physicians.

We pose that this intervention is precise by providing information only. We are only increasing the quality of the information at the exchange of services. We do not propose encumbrances such as policy development, unionization, or collective bargaining that have been part of prior responses (PMID: 14702431).
Internal Medicine: Managers only?
Posted on May 13, 2015
Katherine Hoekstra
Conflict of Interest: None Declared
The article by dr Weinberger on challenges in Internal Medicine, especially scope of practice in the new health care era, was well written. However, I wish it would have been published 5 years ago.... trends have been developing over the last 8 years, that were clear to see for those of us who actively practice outside of large university hospitals. I hope ACP finds engaged members and is able to come up quickly with a focused strategy to find a meaningful future for Internal Medicine. After 15 years in practice, I find myself at crossroads: the field I choose my career in, no longer exists and has not been replaced by anything that embraces research, new patient care strategies, or conversely acknowledging intra invididual barriers. Instead Internal medicine has become a managing field: managing patients and their health problems, managing specialists if patient in hospital), managing the case managers.
Improving Physician (and Patient) Satisfaction
Posted on May 18, 2015
Andrea Klemes DO, Stephen Glasser MD
Conflict of Interest: Andrea Klemes DO - Chief Medical Officer, MDVIP
We read with interest “Challenges for Internal Medicine…” and “The Return of the House Call” in the April 21st issue. Both articles reference disruptive innovation being used to help solve the ills of today’s healthcare system. We believe MDVIP is one of those innovations that enables a deep primary care physician – patient relationship, improves outcomes and saves the system money.

The MDVIP model was developed 15 years ago by doctors, for doctors. It empowers primary care physicians with the time, tools and technology to take better care of patients and improve lives. Physicians and patients are over 90% satisfied and this is reflected in yearly renewal rates of over 90% (1). Studies show that patients have high compliance rates with preventive services (example colonoscopy rates of 85%) and better control of their diabetes and cardiovascular issues (2). This model has identified thousands more patients at risk for cardiovascular disease (3). And with 79% less Medicare patients in the hospital, the network has saved Medicare over $300 million annually (4).

MDVIP doctors partner with patients to keep them healthy and spend time discussing prevention and wellness. For an annual fee ($1,500 to $2,200), patients receive a set of non-covered services and screenings designed to identify risk, prevent events and improve quality of life. To be able to do this, the panel size is limited to a maximum of 600 patients. Each patient receives a 90- to 120-minute annual wellness visit similar to an executive-style physical. This includes review of test results, coaching and a customized wellness plan. Follow-up visits last 30 minutes. This is in contrast to conventional practices where physicians only have time to focus on preventing complications of disease, rather than preventing the onset of disease (5).

With more time comes the ability to attest for MU as well as make house calls. And it allows them to balance personal time with work. Being part of a network of over 800 physicians makes affiliates part of something bigger, affording them intellectual stimulation, support and interaction with like-minded peers, all of which improves overall satisfaction.

Focusing on the three P's - preventive, proactive and personalized care - keeps MDVIP-affiliated physicians at the forefront of prevention with the newest and best medical advances benefiting our 240,000 patients. Happier physicians, healthier patients, proven outcomes and documented savings – the MDVIP approach to primary care is part of the solution to a broken healthcare system.

(1) Klemes A, Solomon H. The Impact of a Personalized Preventive Care Model vs. the Conventional Healthcare Model on Patient Satisfaction. TOPHJ. 2015; 8: 1-9.
(2) Seligman RE, Gassner LP, Stolzberg ND, Samarasekera NK, Warth K, Klemes A. A personalized preventive care model versus a traditional practice: comparison of HEDIS measures. IJPMC. 2012; 2(4): 775-779.
(3) Penn MS, Klemes AB. Multimarker approach for identifying and documenting mitigation of cardiovascular risk. Future Cardiol. 2013; 9(4):497–506.
(4) Klemes A, Seligman RE, Allen L, Kubica MA, Warth K, Kaminetsky B. Personalized Preventive Care Leads to Significant Reductions in Hospital Utilization. AMJC. 2012; 18(12):e453-e460
(5) Klemes A. How engaging patients improves health outcomes. Medical Economics. 2014 12/25; 30-31.
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