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Tuesday, April 16, 2013

Attending the Annual Meeting of the American College of Physicians in San Francisco 2013: becoming a fellow


The American College of Physicians is an organization of internal medicine doctors, about 133,000 of us, which had its inception in 1915 with the aim of promoting the science and practice of medicine. It is the second largest doctors’ group in the United States, and has members and chapters  throughout the world.  The college has representation in the American Medical Association and influences government health policy.  

The ACP had its annual meeting this year in San Francisco, which is a wonderful place. It was located at the Moscone Center, a big convention hall with gorgeous architecture, and the weather was spectacular. It was right near Chinatown, so I didn't have to eat the overpriced pastries and coffee from the convention vendors, or sell my soul to the devil by eating what the industry sponsors supplied in the hall of evil advertisers. 

I went this year because I was receiving my fellowship in the college. If an internist has been doing medicine for long enough and has distinguished him or herself in some way, in my case by learning and teaching, he or she can be awarded a fellowship in the American College of Physicians. It is necessary that the physician in question be a member of the college, which is a yearly commitment of $525 for me, since I am out of school more than 8 years. It is then necessary to pay an additional $150 for fellowship initiation and have two present fellows write letters of recommendation. There are various categories of being distinguished that one can fall into, which are outlined in the Advancing to Fellowship section of the ACP site. I'm not entirely sure that it means anything, really, but I thought that it would help me to express to people who I wanted to work with in the medical world that I am not a bozo. After being advanced to fellowship, I now can put four more letters after my name: after MD comes FACP, which does look kind of nice.

There were 3000 new fellows this year, 500 of whom went to the ACP meeting, wore graduation gowns and caps and were recognized at the convocation ceremony. Also a much smaller group of doctors received Masters recognition, and quite a few received specific awards for things like research and teaching and service. I usually prefer not to go to ceremonies because they are tedious, and this was a little tedious but also wonderful in some ways. I realized as I watched the folks getting the Masters recognition that these were the grand old men and women of medicine and that their life stories were probably fascinating and filled with sacrifice and dedication and hard work. Also the president of the college, who struck me as a person who would not give a good talk, gave a very good talk. Dr. David Bronson has been involved in all of this ACP business for years, but distinguished himself in preventive medicine at the Cleveland Clinic as an internist. He pulled no punches in his speech, which I will not paraphrase since I would certainly not say it as well. What I heard, though, was that we, as part of the American healthcare system, are responsible for how expensive and ineffective it has become and we need to pull together and fix it, and it will take a long time and a lot of work. He also recognized that many of us are already doing that work and that it is important. He gave lots of details, which I probably have deep in my gray matter somewhere and showed a brief film which reminded me to be as empathic as humanly possible, and we filed out. We returned our regalia and were then done. 

But that wasn't the most interesting part of the annual meeting. The "Scientific Sessions" (actually just lectures by experts) were excellent, covering all of the major high points in internal medicine practice. Some of the talks dealt with things like giving a talk that isn't boring and providing effective leadership, not being wasteful of our patients resources and avoiding errors of miscommunication. It was possible to attend only a small fraction of these, and then, if one was really motivated, shell out more money (the conference itself was pretty expensive) for recordings of all of the sessions. I was impressed with most of the speakers who had really prepared and presented subjects that they appeared to find fascinating in a way that was engaging. I learned a great deal and expect to learn more when my CDs of the rest of the meeting arrive. 

Naturally I was disappointed in the fact that bedside ultrasound, which is clearly transformative for internists, had very little air time in the meeting. There was one workshop in bedside ultrasound of the heart and abdomen, and that was so popular that the waiting list had over 100 people on it. I didn't go, since I have now had enough bedside ultrasound training that I could probably teach it, but it is clear to me that internists are aware of the importance of this and only lack time and teachers at this point. In talks about things like assessing patients with chest pain or sepsis, bedside ultrasound was not even mentioned, which didn't surprise me, but it would have been good to see that these influential folks were moving in the right direction. General Electric, which makes the pocket ultrasound machine that I use, and that internists would find most convenient in their practice, exhibited only one product, a radio tracer, analog of cocaine, which deposits itself in the brain in such a way as to differentiate benign essential tremor from Parkinson's disease, which is hardly transformative, and probably mostly superfluous. 

I probably won't go to the ACP meeting next year, since it is in Orlando, Florida, which is pretty far off of my usual stomping grounds. Still, I am happy about the general direction that the ACP is taking, with real leadership in turning medicine into a leaner and more effective service. 

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