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Posts by Skip Radwany MD FACP FAAHPM

Lessons Learned at the ACP Meeting: Where do we go from here?

Steven (Skip) Radwany, MD, FACP, FAAHPM, is the Medical Director of Summa Health System’s Palliative Care and Hospice Services, and Professor of Medicine, Northeastern Ohio Universities Colleges of Medicine and Pharmacy. Dr. Radwany is the AAHPM Ethics, Advocacy and External Awareness Strategic Coordinating Committee Chair.

This comes in follow-up to my post a couple of months ago regarding our relationships within organized medicine and academic medicine via the Academy. I recently attended the American College of Physicians (ACP) Annual Meeting in San Diego, California, from April 5-10, 2011. I was able to obtain some of those valuable Maintenance of Certification Points during a pre-course in order to finalize preparations for my Geriatrics re-certification.

As always, this ACP sponsored meeting offered hundreds of excellent presentation from which to choose. The schedule exhibited great depth and breadth in with one significant exception:

Out of the hundreds of subspecialty and generalists offerings, including a complete track for hospital medicine, there were only 2 explicit Hospice and Palliative Medicine offerings on the schedule. These were provided by Jean Kutner, AHHPM Board Member and Keith Swetz, AAHPM Member.

Under listing of topical areas on the schedule included all of usual suspects: Cardiology, Dermatology, Endocrine, Geriatric Medicine, Gastroenterology, etc., yet Hospice and Palliative Medicine did not appear to be recognized as a distinctive or important specialty.

Nonetheless, the largest proportion of certified Hospice and Palliative Medicine specialists are internists. Additionally, the largest proportion of Hospice and Palliative Medicine Fellowship Programs are housed in or attached to Internal Medicine Programs. Thus Internal Medicine and Hospice and Palliative Medicine are clearly joined at the hip. Yet the relative absence both in name and person from Internal Medicine’s largest annual meeting suggests a bit of a disconnect.

We must collaborate extensively with Internal Medicine generalists and subspecialists in order to provide the highest quality care to our patients. We certainly need to be fully recognized and able to stand tall amongst our fellow Internal Medicine subspecialties. Some of the disconnect could reflect the integrative character of out specialty, yet General Internal Medicine, Geriatric Medicine, and Hospital Medicine all have prominent roles in this annual meeting.

Another barrier or concern might be the large number of sponsoring general specialties from which one can enter the field of Hospice and Palliative Medicine including Radiology, Pediatrics, Neurology, etc. This broad “ownership” of Hospice and Palliative Medicine may dilute the attention of organized Internal Medicine to our field though dual sponsorship of Geriatrics by Family Medicine and Internal Medicine has had no such effect.

So, where do we go from here? The concern I express above comes attached to the concern I expressed previously about HPM’s lack of recognition within the Alliance for Academic Internal Medicine. We must be visible and proactive, and we must communicate with our own Academy about existing or potential external relationships or roles we might have in other areas of organized medicine. Also, we should accept any invitations to speak at meetings such as the ACP’s and participate in leadership roles whenever possible. Sometimes to get a seat at the table you need to bring your own chair and politely elbow your way in.

And for those ACP members out there, the site below would allow you to submit a clinical skills workshop for the 2012 meeting or a presentation for the 2013 meeting:

Entrenching Hospice and Palliative Medicine in the Firmament of Organized Medicine

Some general questions arose in my own mind during my participation in the Association of Specialty Professors Council recently. First, by way of background, the Alliance for Academic Internal Medicine (AAIM) is a consortium of five specialty organizations representing departments of internal medicine at medical schools and teaching hospitals throughout the US and Canada. One of those five is the Association of Specialty Professors (ASP) which is the organization of the internal medicine divisions at medical schools and community teaching hospitals in the US and Canada. The ASP is compromised over 1000 members with 89 medical educational institutions represented. Its focus is on fellowship education, leadership development, and research. I currently serve on the Council of the ASP as the “Community Hospital Representative” (though I informally advocate for HPM as best I can). I was nominated and appointed to this position after participating in some of AAIM and ASP’s education and development programs.

This national council meets by conference call monthly and face to face twice a year. Looking at the membership, all of the typical subspecialties of internal medicine are represented: nephrology, cardiology, rheumatology, etc. Hospital medicine is now officially recognized as a specialty on this council though Hospice and Palliative Medicine is not. This struck me as unusual given that Hospital Medicine does not have an ABMS certification process nor are there specific accredited training programs in Hospital Medicine. This is not to demean Hospital Medicine in any way as its value to patients, health systems and medical education has become abundantly clear in recent years. Nonetheless looking also to the American College of Physicians formal representation or involvement from Hospice and Palliative Medicine does not exist within that largest specialty society of internal medicine. With the greatest proportion of HPM specialist being internists this will hopefully change over time.

In general our relationships within academic and organized medicine from Hospice and Palliative Medicine have grown organically over time. We clearly have a growing relationship with the AMA and strong representation within its governing bodies. How AAHPM relates to other organizations such as ACP, ACS, AAFP, AAN and AAP is something our members and leadership will further address over time. AAHPM staff have created a grid for the External Awareness Task Force of the external relationships that already exist and the nature of those relationships. Again, our members and leadership will decide how these relationships should be prioritized over time and what the nature of these relationships should be. Should there be liaison representation on the boards of some of the large organizations? Is that an appropriate way for hospice and palliative medicine to become more entrenched in the firmament of organized medicine? What will be the most efficient and effective way for AHHPM to utilize its limited resources in developing these relationships? Where do we get the most bang for the buck so to speak? At a minimum it seems that we need to continue to identify AAHPM members who hold leadership positions or are potential candidates for leadership positions in some of the important organizations which interface with hospice and palliative medicine in both education and practice. As individual members we can greatly further this process by seeking involvement in the professional societies representing our primary specialties whenever such opportunities arise. At a minimum we can informally advocate and educate for our field from those positions especially given our accustomed roles as patient and family advocates. Over time these roles may evolve from informal to formal. Keeping AAHPM aware of any such activity should offer all of us greater opportunity to help our patients and promote our specialty.