Looking back: Some constants amid change

Looking back at the history of health care reform to gain insight on the future of primary care medicine.

As my tenure as editor of ACP Internist draws to a close, I'm struck by how much has changed over the past five and a half years and how certain things seem to resist change.

Since I joined the College in January 2004 as senior writer, ACP Internist has been renamed and redesigned, both in print and online. We've revamped our Web site, expanded the editorial staff from one to five, and grown ACP Hospitalist from a classified advertising vehicle into one of the industry's best-read magazines for hospitalists. We've brought expert columnists on board to write Mindful Medicine, Practical Genomics and Ethical Dilemmas and increased our coverage of clinical conferences. And we've discovered, judging by the response to our Cartoon Caption Contest and our regular blog feature, Medical News of the Obvious, that physicians appreciate a little humor in the mix.

Of course, the past five-plus years also have been marked by changes in the practice of medicine, such as the move toward performance measurement and electronic health records, the explosive growth of hospital medicine, and an increasingly evidence-based approach to managing disease, to name only a few of the topics we've covered in these pages.

Browsing thorough our archives, however, I can't help but notice how little things have changed on the advocacy beat. Payment reform was the lead item on the agenda when I first covered Leadership Day on Capitol Hill in 2004, and it was still front and center at the most recent event in May. Staff in ACP's Washington office have been effective advocates for internal medicine priorities, successfully pushing for important changes such as the updated 2007 Physician Fee Schedule, which increased payments for office visits and evaluation and management services. But the Sustained Growth Rate a term I've become only too familiar with remains in place as legislators go back and forth on how to implement a permanent fix for the flawed payment system.

The legislative stalemate prompted ACP's Senior Vice President for Government Affairs and Public Policy, Robert B. Doherty, in his January 2008 Washington Perspective column, to draw an analogy with the film “Groundhog Day,” in which the lead character is forced to relive the same day over and over again until he gets it right. The movie ends happily, but the plot thickens in Washington. The situation is far from hopeless, however, as a new administration takes charge with health reform near the top of its priority list.

I've enjoyed my time as editor, especially the opportunity to work with such a talented group of editors and writers. I'm certain that ACP Internist and ACP Hospitalist will undergo many more positive changes over the next five years but I won't hazard a prediction on advocacy. Let's just hope that by Leadership Day 2014, the headlines have changed.


Janet Colwell