So many things are possible when you don’t know that they are impossible! — Norton Juster, The Phantom Tollbooth
As we, as an organization and as individuals, seek to achieve the SGIM vision of “A just system of care in which all people can achieve optimal health”,1 it can at times be easy to become discouraged and frustrated regarding the pace of change. While we have made significant gains that should be celebrated, much work remains. We must maintain constant vigilance to avoid regressing.
Some recent personal experiences have reinforced this for me. For example, I celebrate the following observations:
- Primary care, hospital medicine, palliative care, women’s health and geriatrics—core GIM content areas—have come to be seen as essential components of healthcare delivery by many healthcare systems and payers;
- We are paying attention to and acting in meaningful ways to address harassment in clinical settings;
- We are moving beyond giving lip service to healthcare disparities and equity, taking significant steps to collaborate with underserved communities to truly address identified health needs; and
- SGIM is has become a key partner and voice in national conversations and initiatives
At the same time, I have been distressed over the following:
- Persistence of use of wRVUs instead of patient outcomes to determine financial support for primary care and hospital medicine;
- There have been recent increases in situations in our clinical settings in which trainees, faculty, and staff were disrespected by patients due to the color of their skin or gender, despite policies outlining an institutional environment of mutual respect; and
- Significant health disparities persist in our communities, despite substantial efforts in outreach and community engagement.
These examples and experiences reinforce the importance of ongoing advocacy—individually, locally, and nationally. They also underscore the important role that SGIM plays in advocating for our field and for our core principles.
While SGIM has been active and visible in advocacy for some time, our advocacy activities have greatly accelerated this year. The unprecedented volume reflects both the opportunities that have emerged in the face of the pandemic, as well as ongoing issues relevant to SGIM in the clinical, educational, and research arenas. A complete list of SGIM endorsements is available in the Advocacy section of the SGIM website.2 Some notable examples of advocacy actions undertaken by the Society of General Internal Medicine, its Health Policy Committee, and the three subcommittees during Spring and Summer 2020 include the following:
- SGIM provided an extensive comment letter to the Centers for Medicare and Medicaid Services (CMS) with regard to the Graduate Medical Education (GME) proposals that were included in the Inpatient Prospective Payment System (IPPS) proposed rule.
- In support of the patient and provider flexibilities implemented by the Department of Health and Human Services (HHS) and CMS during the public health emergency, SGIM sent a letter to HHS Secretary Alex Azar and CMS Administrator Seema Verma with recommendations on which of these policies could support the delivery of high-quality care, as well as economic recovery, once the public health emergency concludes.
- SGIM organized and led a sign-on letter addressed to Congressional Leadership requesting that Congress include $50 million in the fourth COVID-19 relief legislation for the Agency for Healthcare Research and Quality (AHRQ) to generate the data needed to make an informed decision about which telehealth flexibilities Congress and the administration should make permanent.
- SGIM signed on to a letter in support of legislation introduced by Senate Finance Committee Chairman Charles Grassley to provide emergency support to nursing homes and other elder care facilities to address COVID-19 related impact.
- To ensure that patients have access to care through a robust physician workforce, and prepare for the next public health emergency, SGIM signed on to a letter asking Congressional Leadership to include the Resident Physician Shortage Reduction Act of 2019 in the fourth COVID-19 supplemental relief package.
- SGIM, through its Clinical Practice Subcommittee, is engaged in the 2020 Field Testing related to the Merit-based Incentive Payment System (MIPS).
The Health Policy Committee and its subcommittees have been essential voices in identifying, vetting, crafting, and speaking for SGIM and its members. The Committee has created an ambitious 2020-2021 Health Policy Agenda in the areas of Clinical Practice, Education and Research available on the SGIM website.3 It is also exciting to see the engagement and leadership of the other SGIM Committees and Commissions in bringing forth important perspectives on many topical issues, through direct advocacy, position statements, publications, and presentations. We have encouraged collaboration across Committees and Commissions in these efforts to assure that all relevant perspectives are being included, and to further amplify the voice of our members. The “Communities” section of the SGIM webpage provides information about the various SGIM Committees and Commissions as well as how to get involved.5
The importance of assuring that our voices are heard is especially timely. The Advocacy section of the SGIM website includes detailed information about SGIM’s advocacy efforts as well as many valuable resources to inform advocacy efforts.4 If you haven’t reviewed these materials recently, I encourage you to familiarize yourself and leverage these resources to amplify your voice, and that of GIM as a field. Whether you express your voice by exercising your right to vote, by contacting your local, state, and Congressional representatives, by publishing in the peer-reviewed literature and other venues, or by advancing issues or positions through SGIM and supporting SGIM’s advocacy efforts, we must continue to transform our values into action (to paraphrase the 2021 Annual Meeting theme) to effect important change, even if it may feel daunting at times, jointly striving for our envisioned future and achieving these possibilities even when others may say that they are impossible.