Now the American College of Physicians Wants to Fix Healthcare, Too

This is the intro to a series. See Part 1 here, the context to Part 2 here, Part 2 here, and Part 3 here.

Every medical specialty has its own organization (or sometimes a few competing organizations), and the main organization for internal medicine physicians is called the American College of Physicians (ACP). I think it has such a general name because it wants to be representative of internists AND also all the people who did internal medicine on their way to sub-specializing (e.g., cardiology, infectious disease, rheumatology, gastroenterology, pulmonology, . . .). Yes I know most of them consider themselves internists as well, as they should!

After the AMA (which seeks to include all physicians of every specialty), the ACP is the second-largest physician group in the U.S., which makes sense because internal medicine is the most common residency program for medical school graduates to do. I just checked the data on residency positions, and there were 8,697 internal medicine positions for 2020. The second most common one was family medicine, with 4,662 positions.

Random fact: What’s the smallest specialty in terms of residency spots? Apparently it’s preventive medicine. It had one spot available in 2020. I didn’t even know you could do a preventive medicine residency.

As a large medical specialty organization, the ACP has some significant power to wield, and that’s important because one of its main purposes for existing is to promote the interests of internal medicine physicians in the political arena. I’ve seen this in action twice in D.C., when I joined ACP members from all 50 states to meet with quite a few members of congress to advocate for specific issues.

And now the ACP has entered the realm of my primary interest by releasing a new set of policy proposals specifically talking about how to fix our healthcare system.

I haven’t read all their proposals yet–I’ll be doing that over the coming weeks–but I can guess the general approach they will take because I’ve met with enough physicians who are active in the ACP to know the general type of person who gets involved in this flavor of organized medicine and would be the ones influencing these proposals. At the risk of being accused of overgeneralizing, I will describe them as passionate and caring individuals whose morals drive them to push for social justice and to advocate for system changes especially to improve care for the underserved. Of course there are many involved in the ACP who have totally different priorities, but I would venture to say that that description applies to the most prevalent motivation to be involved.

Another reason I can guess how these proposals turned out is because I’ve heard ACP’s Senior VP over Government Affairs and Public Policy, Bob Doherty, speak a number of times, so I have a sense for what he is all about. Bob is not a physician–he’s a policy guy–and he’s articulate and impressively comprehensible when speaking on health policy issues, which tells me he knows his stuff super thoroughly. He’s been with the ACP for a long time, and I am willing to bet that, intentional or not, he had a significant influence on the shape these proposals took, if even only indirectly by being the primary person teaching ACP leadership about the issues.

My point in talking about Bob Doherty and about what kind of person gets involved in ACP leadership is to say that these proposals are going to reflect the minds of those individuals, and that they would probably have ended up looking very different if I and a randomly sampled group of regular ACP members came up with them.

It’s just interesting that now we have the second-largest physician organization essentially saying, “This is what physicians believe about how to fix healthcare.” And the rest of the country will not have any reason to question that.

So, I guess it’s time to learn what I, an internal medicine physician, believe about how to fix healthcare! There are three main papers that lay out the ACP’s proposals, so over the next few weeks I’ll take each one in turn and see what they have to offer.