Letters
From the July-August ACP Observer, copyright © 2003 by the American College of Physicians.
Name change
A golden opportunity was lost when the Board of Regents decided to revert to the not-so-new name of American College of Physicians nearly five years after the ACP-ASIM merger. ("College will take on 'new' name this month, but with a twist," March ACP-ASIM Observer, page 1.)
Various supporters gave reasons for deciding to choose the ACP name, including practical concerns such as not altering the honorary titles for Fellowship and Mastership. Frankly, I think legislators, the media and physicians would have all adjusted perfectly well to any change in the initials that follow our members' names.
Others cited research showing that the name ACP "resonated strongly" with various groups. There was a general consensus on the value of an established name such as ACP, which enjoys name recognition among internists, physicians and other medical groups.
However, no one commented on the fact that a group's name recognition matters little if the public doesn't understand who that group represents. The generic name American College of Physicians does not even begin to hint at the specialty of its members.
A great majority of the public remains confused about the term "internal medicine," despite our efforts to educate them about our specialty. How can the public have widespread recognition of ACP if it has little grasp of our specialty's role?
The merger of ACP and ASIM offered a perfect opportunity to create a new name that could have enhanced public awareness of internal medicine. One good choice would have been the American College of Internal Medicine, one of the three finalists leaders considered. It would have combined the names of both organizations and honored their prior efforts and combined strengths while enhancing awareness of internal medicine.
Some are optimistic that the use of a new logo and graphics, along with a "tag line" that few people will read or remember, will help solve this identity crisis. I'm skeptical of such conclusions and remain convinced that ACP will forever wallow in confusion and near anonymity among the general public.
Daniel K. Mangum, FACP
Portland, Ore.
Diuretics
I was very disappointed that your article on the ALLHAT study failed to mention that a major side effect of thiazide diuretics is impotence in sexually active men. ("Diuretics for hypertension get a big boost, but will data change prescribing patterns?" April ACP Observer, page 1.) Young physicians reading your publication should know that this fact greatly influences many physicians' treatment of hypertensive patients.
Roland K. Molinet, ACP Member
Fort Lauderdale, Fla.
The Match
Those of us who have been practicing general internal medicine over the last 20 years do not find it surprising that new physicians do not wish to enter this field. ("In this year's Match, internal medicine continues to lose U.S. graduates," May ACP Observer, page 1.)
Among the physicians who are at the hospital early in the morning and late at night, general internists are at the bottom of the reimbursement pole. Certainly all of medicine demands much from its physicians, but neurosurgeons, invasive cardiologists and orthopedists are compensated quite well for their difficult hours. Internists simply are not.
General internal medicine is tough, time-consuming and often deals with end-of-life issues that others do not wish to confront. Those of us who work in the specialty day in and day out truly love it, or we would find easier ways to support our families.
The College must understand that because there is no way to make what we do pretty, easy or glamorous, we must be compensated justly. If not, I don't know who will serve as the "sick people" doctors in the future.
Joseph G. Weigel, FACP
Somerset, Ky.
The decline in internal medicine's Match performance will continue until internists' intellectual work is valued commensurately with other specialties' procedural work. Internists provide a labor-intensive service that is difficult to quantify, resulting in systematic undercompensation.
This problem is not unique to internal medicine. Pediatricians, family practitioners, neurologists and psychiatrists are similarly undervalued. In contrast, student interest in procedurally-oriented subspecialties hasn't decreased.
Reducing tuition will not do enough to alter the present trend. It would provide only a small incentive relative to lifetime income disparities. Those who choose internal medicine are the few who remain undeterred by the too-true observation that no good deed goes unpunished.
Robert D. Blank, FACP
Madison, Wis.
While we cannot control internal medicine's lifestyle, hours or patient types, we can fight for fair pay without the extra hassles Medicare imposes on cognitive services. Unless ACP more aggressively deals with pay disparities between internal medicine and other branches of medicine and surgery, America's best medical students will pursue higher paying specialties and American primary care will shift progressively to foreigners.
The AMA, HHS and the Centers for Medicare and Medicaid Services seem unaware of the potential harm of continuing such pay discrepancies or the prospect of nearly all generalists (especially in small communities) coming from overseas. A two-tier system, with foreigners less able to protest inequalities, will likely result.
Andrew L. Taylor, FACP
Miami
Over the last five years, I have mentored about 15 students in a community-based teaching program. Not one of them has expressed serious interest in internal medicine as a career, despite consistently excellent student evaluations of both the site (my practice) and the teachers (my partner and me).
Does anyone really need to question why? Relatively low income, long hours, difficult call and low prestige have long been disincentives. Add onerous recertification requirements that embitter potential mentors, and it's amazing that any students choose internal medicine.
From my vantage point, the entire question of recertification could soon be moot as demand for internists (certified or not) greatly outstrips the supply. When I look at statistics on recertification from the American Board of Internal Medicine, it seems clear that a large number of internists are choosing not to recertify when their certificates expire. I feel that even a significant minority choosing not to recertify could make the process irrelevant.
William J. Baker, ACP Member
Abingdon, Va.
E-mail consults
I disagree with the College's attempt to convince Medicare to pay for e-mail correspondence with patients. ("Two new ACP papers explore time pressures, e-consults," May ACP Observer, page 9.)
We already have enough problems with access to care and Medicare reimbursement. Why complicate matters with government and third party e-commerce?
Besides, e-mail care is a higher liability form of care and essentially a luxury service. If physicians want to open this can of worms, I think they should treat it as an additional service or ancillary business.
Raymond W. Kordonowy, ACP Member
Fort Myers, Fla.
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