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:

http://www.acponline.org/meetings/internal_medicine/2011/meeting_proposals.htm