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Hospitalist issues take hold at Board of Governors meeting

From the June ACP Hospitalist, copyright © 2007 by the American College of Physicians.

By Jessica Berthold

From boosting recruitment to managing infections, hospitalist issues were well represented during the Board of Governors' April business meeting at Internal Medicine 2007 in San Diego.

For starters, the Governors asked the Board of Regents to find ways to recruit and retain physicians who practice hospital medicine. About 7% of the College's young physician members, and 2% of overall members, identify their specialty as hospital medicine, according to a 2006 survey.

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ACP's Board of Governors at Internal Medicine 2007

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In supporting the measure, Kimberly C. Bates, ACP Associate Member, Chair of the Council of Young Physicians, noted the large number of young doctors who are specializing in hospital medicine, while James Foody, FACP, Governor-Elect from Illinois, stated that internal medicine "will fracture" if it doesn’t align itself with hospitalists.

The Governors weren't so keen on the prospect of tailoring certification to those who practice hospital or ambulatory medicine, however. After hearing talks on focused recognition—which would use the American Board of Internal Medicine's (ABIM) Maintenance of Certification program to acknowledge where a doctor practices—more than a dozen Governors and Regents voiced opposition to the idea, saying they feared it would divide the field of internal medicine at a time when it needs more unity.

"Just to be clear, I didn't hear anyone speak in favor of this concept," summarized Virginia Collier, FACP, Governor from Delaware.

Focused recognition is under consideration by the College and the ABIM, each of which had speakers on hand at a combined Governors and Regents meeting to discuss the idea.

Separately, the Governors also asked the Regents to work with the Society of General Internal Medicine and the Association of Program Directors in Internal Medicine to study the impact resident duty hours may have on clinical teaching faculty, and to develop recommendations based on the findings.

Regarding payment issues, the Governors said that the Regents should advocate to private and governmental insurers for adequate reimbursement of oral anticoagulant monitoring in person and by phone. They asked that the College join with other physician organizations in this endeavor and use the ACP Practice Management Center to educate doctors on how to lobby local insurers for coverage.

The Governors also requested that the Regents develop methods to monitor the fairness of pay-for-performance programs and ensure that quality measures, not economic considerations, are the primary factor in evaluating doctors. Such programs should avoid penalizing doctors for patient non-adherence and should use case-mix models that include sample size when assessing a doctor's performance, they said.

Additionally, insurance plans should periodically report to doctors on their performance measures and should allow enough time for appeals and corrections before penalties are instituted, the Governors said.

"The College should be proactive in trying to monitor for problems with pay-for-performance systems," concluded Washington, D.C., Governor Lawrence E. Klein.

Heavily discussed, and ultimately tabled for further study, was a measure to advocate for a streamlined process to obtain J-1 and H1B visas for international medical graduates who are not U.S. citizens. New Hampshire Governor Dana Merrithew, FACP, said he feared that importing doctors diverted the College's energy from improving internal medicine in the U.S. and drained other countries of doctors they may desperately need.

Others, however, noted that international medical graduates help fill positions that don't easily attract U.S. residents. "If we limit the numbers of [international medical graduates] who come in, it will negatively impact underserved areas in communities," Dr. Bates said.

Also referred for further study was a recommendation that the Regents support evidence-based methods for reducing hospital-acquired infection rates and develop a policy statement to make control of such infections a quality improvement measure.

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ACP Hospitalist provides news and information for internists about the practice of medicine and reports on the policies, products and activities of ACP. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated