EB: What was the purpose of the Hess Institute conference at the SGIM Annual Meeting in May?

ME: In recent years, ACLGIM members have been grappling with the decreasing numbers of people pursuing careers in academic general internal medicine (GIM). The problem now represents a serious crisis. After seeing vigorous discussion of the problem on ACLGIM’s portal in GIM Connect over the past year, the leaders of ACLGIM decided to devote the 2023 Hess Institute at the SGIM Annual Meeting in Denver to a day-long discussion of how to develop solutions that ACLGIM can champion to address the crisis.

EB: How did ACLGIM frame the discussion at the conference?

ME: To prepare for the conference, ACLGIM hired a consulting group, The Civic Canopy, to conduct a survey of SGIM members about their views of the problem. Based on responses from 247 members representing a spectrum of professional status, clinical settings, and demographics, the survey indicated that GIM is rewarding, gratifying, and stimulating while also being challenging, stressful, and overwhelming. The conference organizers used the survey results to map barriers to different levels of system change within the medical education system and the overall healthcare system, taking into consideration the conditions for change related to policies, practices, resource flows, relationships, power dynamics, and mental models. After presenting the survey results, the organizers asked the 100 attendees to break into small groups of two, then five, and then 10 to discuss how each barrier was related to the conditions for change. The groups of 10 then selected two top ideas they felt were most pressing to address. The resulting list of possible solutions fell into eight conceptual categories, including:

1. Rebalance academic primary care compensation to align with work;
2. Share the “Proud to be GIM” message;
3. Enhance the focus on team-based care delivery;
4. Increase learner exposure to primary care through time and mentoring;
5. Increase ambulatory training time;
6. Enhance the focus on the business case for primary care;
7. Demonstrate the value of primary care clinicians to institutional leaders;
8. Expand and advocate for fluid roles between inpatient and outpatient to move to a more effective team-based model.

EB: What did the group ultimately select as the solutions that ACLGIM should focus on?

MN: Using an electronic polling system, the conference participants selected three topics for identifying solutions about which they felt most passionate:

1. Enhancing focus on team-based care delivery;
2. Rebalancing primary care compensation to align with work;
3. Increasing learner experience in primary care and increasing training time.

The group then brainstormed about what could be done right away that would not add too much to their commitments. The resulting ideas had six main themes:

1. Organize and advocate;
2. Share our story;
3. Adjust the workflow;
4. Focus on training opportunities;
5. Collect data;
6. Take other actions.

EB: How can SGIM members help to address the issues identified by the conference participants as top priority?

MN: ACLGIM leaders plan to form three work groups to develop and deploy specific tactics for addressing the recommendations that emerged from the conference. We anticipate that the work groups will invite SGIM members to participate, most likely through collaboration with members of SGIM’s Clinical Practice Committee, Education Committee, Health Policy Committee, Research Committee, and Program Directors Interest Group. ACLGIM is committed to devoting substantial energy to further work on addressing the crisis in recruiting and retaining academic general internists.