ACP: Physicians around the world face similar non-clinical issues

ACP: Physicians around the world face similar non clinical issuesA guest column by the American College of Physicians, exclusive to

Over the past several years, I have had the honor of representing the American College of Physicians at scientific conferences and professional society meetings. In addition to hearing about the latest advances in internal medicine at these events, I learn what is on the minds of physicians in the various regions to which I travel.

Three “hot topics” at recent meetings were the lack of support for primary care, the effects of medical litigation, and the emergence of non-physician health care providers. That may not seem particularly noteworthy, since physicians raise these issues at just about any gathering. However, the meetings where these three topics were discussed were in Dhaka, Cape Town, and Caracas, respectively.

Of ACP’s 133,000 members, over 10,000 are international members. The College has 15 international chapters in Canada, Latin America, Japan, Saudi Arabia, and Southeast Asia, plus members in more than 125 countries that do not have chapters. ACP’s international membership includes internal medicine specialists and subspecialists in practice as well as residents, fellows, and medical students.

When I became involved with ACP at the national level, I was aware of but not very familiar with the College’s international activities. I certainly did not expect that someday I would be traveling to such far off places as an “ACP Ambassador.” While I knew that the science of medicine was something we all shared, albeit with differences related to disease prevalence and resource availability, I had no idea that we would have so much in common in non-clinical areas.

In Dhaka, I attended the annual scientific meeting of the Bangladesh Society of Medicine. The program featured a discussion titled “The Role of Internist in Patient Management in a Demographically Changing Society in Bangladesh” that reviewed how changes in population growth patterns and economic progress are changing physician practice. A key concept of the discussion was the role of the internist. While Bangladesh is in a different place from the U.S. economically and demographically, this discussion of the role of the internist would have been apropos in the U.S. The speaker covered the challenge of defining internal medicine, the need for the government to support primary care internal medicine, the advantages of patients’ having an internist instead of seeing only multiple subspecialists (“better quality and lower cost”), and the emergence of a team model of practice.

The meeting in Cape Town was an international conference of leaders of medical societies of all specialties to discuss items of common interest. I presented a summary of the state of medical litigation in the U.S. that was followed by a discussion of what was happening in other countries. I was surprised to learn that excessive litigation is not a “uniquely American” phenomenon. Anywhere there are lawyers and doctors there are malpractice lawsuits. In parts of Asia, it’s a growing problem as cultural changes make it more acceptable to sue a physician. Some countries have alternatives to the tort system that seem to be working, for example New Zealand with its “no-fault” system, while most are struggling to find solutions. Another subject of discussion at this meeting was recertification and the need for it to be relevant and not add to the hassles of practice (sound familiar?).

Last month in Caracas, I learned that a major area of concern is the growing number of non-physicians brought in from Cuba or trained in new medical schools established by the government to address the shortage of physicians in some parts of the country. These providers are educated outside the traditional medical education structure. The stated objective of the initiative is to bring medical care to the underserved, but the medical community believes that these providers are not qualified to practice medicine because they are inadequately trained. As I heard about this, I thought about an ongoing debate in the U.S., though the specifics are quite different.

It was eye opening for me to see firsthand that despite cultural, linguistic, political, and economic differences, physicians in other countries struggle with many of the non-clinical issues that we face in the U.S. Just as we exchange knowledge on the science of medicine with our international colleagues, we should broaden that dialogue to include the practice of medicine, medical professionalism, and quality of care. We don’t have all the answers, nor do they, but we have lots to talk about.

Yul Ejnes is an internal medicine physician and immediate past chair, Board of Regents, American College of Physicians. His statements do not necessarily reflect official policies of ACP.

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  • azmd

    Interesting. Did any of those international physicians express concern about having personal educational debt averaging $150,000 per person for their medical training?

    • Yul Ejnes, MD, MACP

      I did not discuss educational debt in any detail during my trips. I suspect that the amounts are much lower compared to the U.S., but still may be significant relative to the local economy. The role of government in keeping tuition down is greater in many other countries than it is in the U.S..

      • J.L. Creighton

        Other countries also don’t have the kind of student grant & loan system we have, without which our universities couldn’t charge as much as they do.

        Does our government have to grant and loan so much money because tuitions are so high, or are tuitions so high because no-one has to pay them up front, loans and grants will take care of that…? Chickens, eggs.

      • azmd

        Our colleagues in most other countries have benefited significantly from government subsidization of their medical educations, but interestingly, no one in medical education governance here in the U.S. seems to be too terribly intrigued by that concept…

        If you’re not looking at the private educational debt we are expecting our medical trainees to assume, you’re not looking honestly at medical education or the challenges faced by our profession in the U.S.

  • azmd

    Ending up behind bars for criticizing one’s government is something that can happen to anyone in a number of countries, regardless of his or her occupation.

    The discussion here relates to unique problems associated with the practice of medicine, of which high educational costs is one, if you are educated in the U.S.

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