My Kind of Medicine: Real Lives of Practicing Internists: Cynthia D. Smith, MD, FACP
Dr. Cynthia D. Smith jokes that she was born to be an internist. Dr. Smith's parents were both in the medical field; her father was an internist and her mother was an intensive care unit nurse. Growing up, she recalls spending time in the hospital while her father completed his rounds on weekends. She believed that she grew up so immersed in the medical world, that she hesitated before choosing medicine because of the exposure that she had growing up. Dr. Smith decided to spend her summers in college working in a variety of different fields to explore career options, other than medicine, including publishing, politics, and research all before finally deciding that medicine was in fact the right career for her. She earned her Bachelor's degree in Chinese History from Yale University and her M.D. from Colombia College of Physicians and Surgeons in New York, NY.
Dr. Smith was drawn to internal medicine through her exposure in medical school. "I remember growing up and asking my dad why he choose to be an internist. Whenever I would tell my friends that my dad was an internist, no one understood what that meant. But when I was in medical school and discovered what being an internist entailed, I knew that was what I wanted to do."
Dr. Smith enjoys the combination of the breadth and depth of content that internal medicine offers. "I feel as an internist that there is no problem that an adult patient can walk in with that you wouldn't feel comfortable addressing. I love the feeling of being able to offer comprehensive care to all adult patients."
A Career in Medical Education
After medical school, Dr. Smith knew that she wanted to teach. "If I had not gone into medicine, I would have gone into teaching, and working in academic medicine allows me to do both." She completed her internal medicine residency at the Massachusetts General Hospital (MGH) and joined the medical staff at MGH and the faculty of Harvard Medical School. She practiced and taught at Massachusetts General Revere, a community health center outside Boston where she was in charge of all of the Harvard medical students who rotated through the center and continued to teach internal medicine residents in the office and the hospital.
In 2000, Dr. Smith and her family relocated to the Philadelphia area where she continued her career in medical education. She joined the medical staff of Lankenau Medical Center, a community based academic medicine center in Wynnewood, PA and eventually became the program director of the internal medicine residency program. She founded the Academic Hospitalist Program there which is still thriving today.
In 2011, Dr. Smith joined the Education Division of the American College of Physicians as a Senior Medical Associate for Content Development. Dr. Smith was drawn to working at ACP because of her interest and experience in education redesign - helping make changes to the medical education process to keep it relevant and thriving in the current healthcare environment. She had previous experience working on educational redesign on a national level with her involvement with the Alliance for Academic Internal Medicine (AAIM) and the American Board of Internal Medicine (ABIM). She also became directly involved with ACP while serving as the AAIM representative on ACP's Education Committee.
In addition to her role in the Education Division at the ACP, Dr. Smith is an Adjunct Associate Professor of Medicine at Pearlman School of Medicine at the University of Pennsylvania. "I feel that I am the luckiest person in the world because I get paid to do things that I love - teach and care for patients." Dr. Smith sees patients one afternoon a week while teaching the internal medicine students and residents at Penn.
Developing High Value Care Curriculum for Medical Students and Residents
Currently in her role at ACP, Dr. Smith collaborated with the AAIM to develop ACP's High Value, Cost-Conscious Care curriculum for residents. The curriculum is part of the College's High Value Care initiative, a comprehensive program that connects two important priorities - helping physicians provide the best possible care to their patients and reducing unnecessary costs to the health care system.
The demand for the High Value, Cost-Conscious Care curriculum for residents was driven by the rising costs in health care expenditures and the need to eliminate the estimated $250-325 billion dollars annually of unwarranted use of health care services. "We have a belief that as physicians, it is part of your professional responsibility to use health care resources judiciously. Residents and students receive little or no training on appropriate resource utilization and they rarely get feedback on their personal resource utilization and its impact on the cost of care."
Dr. Smith and her colleagues working on the High Value, Cost-Conscious Care curriculum chose to focus on residents since they believe that residents are primed to be a large part of the solution and can be viewed as change agents. The High Value Care curriculum launched in July 2012 and since its launch, more than 1200 individuals have downloaded the publically available content; of those, 16 percent have been residents and students.
"A major component of the curriculum is creating a paradigm shift from the belief that more care is better care to a belief that high value care is better care. We can't just give our patients a list of recommendations. Instead we need to prioritize the list to reflect things that are most effective and are a health priority for each individual patient." Currently, Dr. Smith and her colleagues are in the in the process of broadening the High Value, Cost-Conscious Care curriculum audience from internal medicine residents to medical students, non-internal medicine residency training programs, and practicing physicians.
Dr. Smith enjoys the intellectual challenge that her job offers and the opportunity it affords her to be creative. "I love that the products that I develop have such a broad reach and allow me to have an impact on a larger scale. I come to work every day and think what is my contribution going to be today?"
In between balancing her role at ACP and teaching Penn residents, Dr. Smith enjoys family time with her husband and three sons.