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3rd Edition

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Chapter 13 : Understanding, Navigating and Leveraging American Medicine

Co-Lead Authors:
Tod Ibrahim and Bruce Z. Morgenstern, MD

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Sections on this page:
  • TABLE 1: American Board of Medical Specialty's 24 Boards and the Accreditation Council for Graduate Education's 27 Residency Review Committees
  • GLOSSARY: Limited Glossary of Organizations and Terms in American Medicine

<Chapter 12: Career Development for Medical Student Clinical Educators

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Introduction

Shortly before his death in 1321, Dante Alighieri completed Divine Comedy. One of the most important works in literature, Comedy consists of three parts: The Inferno, The Purgatorio, and The Paradiso. To describe his journey through The Inferno, Dante divides Hell into nine circles, from “virtuous pagans” (Circle I) to “compound fraud” (Circle IX).1 To explain the chaotic environment that is medicine in the United States at the beginning of the 21st century, this chapter is organized similarly to Dante’s Inferno.

As academic leaders, clerkship directors are expected to understand the organizational structure of American medicine. To ensure their professional development, clerkship directors should navigate many organizations, particularly those bodies that evaluate educational programs and physicians. Clerkship directors should also use resources offered by organizations that represent academic medicine or their specialty. And, clerkship directors should take advantage of opportunities to participate in national organizations, which will increase their academic recognition.

Like Dante’s Inferno, this chapter uses nine circles to explain American medicine and to introduce clerkship directors to the “alphabet soup” that accompanies these circles:

  • Circle I:  Physician Organizations.
  • Circle II:  Academic Medicine.
  • Circle III:  Academic Specialty Organizations.
  • Circle IV:  Evaluation of Physicians.
  • Circle V:  Evaluation of Educational Programs.
  • Circle VI:  Evaluation of Research Programs.
  • Circle VII:  Evaluation of Clinical Programs.
  • Circle VIII:  Hospital Organizations.
  • Circle IX:  Federal Government.

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Circle I:  Physician Organizations

With 250,000 members (including medical students, residents, fellows, and physicians), the American Medical Association (AMA) is the largest physician organization in the world. During the past decade, however, fewer physicians joined AMA. In the mid-1990s, more than 40 percent of all physicians were AMA members, compared to 26 percent today; only 17 percent of practicing physicians under the age of 40 are currently AMA members.2 This decline, In part, is a result of the greater specialization of physicians and the increased prominence of specialty-specific societies, which are outlined later in this circle and in Circle III.

AMA’s loss of members raises several important issues. From an educational perspective, AMA sponsors several oversight entities, such as the Liaison Committee for Medical Education (LCME), the Accreditation Council for Graduate Medical Education (ACGME) and each of the 26 specialty-specific Residency Review Committees (RRCs), and the Accreditation Council for Continuing Medical Education (ACCME). Will another organization administer ACGME if AMA cannot? The AMA also plays a key role in representing physicians to the federal government in terms of reimbursement, especially related to the payment mechanisms under the Medicare and Medicaid programs. Which organization will assume this responsibility if AMA cannot?  The AMA also leads efforts to develop Current Procedural Terminology (CPT) codes, which are the language of billing, documentation, and coding for health care in the United States. How can physicians keep ownership of this critical aspect of the business of medicine without a multi-specialty organization as the final arbiter?  And finally, AMA attempts to coordinate efforts by physicians to lobby Congress. Which organization has the clout to represent physicians before government if AMA cannot?

One possibility is the Council of Medical Specialty Societies (CMSS). “Founded in 1965 as the Tri-College Council, CMSS was created to provide an independent forum for the discussion by medical specialists of issues of national interest and mutual concern” (3).  Membership in CMSS “is limited to those US medical specialty societies that represent diplomates certified” by one of the American Board of Medical Specialties’ (ABMS) 24 specialty-specific boards.3 Currently, CMSS consists of 19 national specialty organizations representing more than 412,000 physicians nationwide. As opposed to AMA, CMSS is not as well known, and many of the nearly 500,000 physicians may not be aware that they are “represented” by the council.

In addition to AMA and CMSS, seven organizations attempt to represent the entirety of each of the major physician disciplines:

  • Family Medicine:  American Academy of Family Physicians (AAFP)
  • Gynecology and Obstetrics:  American College of Obstetrics and Gynecology (ACOG)
  • Internal Medicine:  American College of Physicians (ACP)
  • Neurology:  American Academy of Neurology (AAN)
  • Pediatrics:  American Academy of Pediatrics (AAP)
  • Psychiatry:  American Psychiatric Association (APA)
  • Surgery:  American College of Surgeons (ACS)

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Circle II:  Academic Medicine

The Association of American Medical Colleges (AAMC) is the leading organization in the academic medical community. The community also includes the Association of Academic Health Centers (AAHC), the University Health System Consortium (UHC), and the Alliance of Independent Academic Medical Centers (AIAMC).

Founded in 1876, AAMC originally represented only medical schools. Today, AAMC represents the 125 accredited medical schools in the United States; 17 accredited Canadian medical schools, nearly 400 teaching hospitals, 94 academic societies representing 109,000 faculty members, and 67,000 medical students and 104,000 residents.4 To represent this broad constituency, AAMC consists of the Council of Deans (COD), the Council of Teaching Hospitals and Health Systems (COTH), the Council of Academic Societies (CAS), the Organization of Student Representatives (OSR), and the Organization of Resident Representatives (ORR).

The AAMC also includes nearly 15 professional development groups:

  • Government Relations Representatives (GRR).
  • Graduate Research, Education, and Training Group (GREAT).
  • Group on Business Affairs (GBA).
  • Group on Educational Affairs (GEA). GEA has regions (Southern, Central, Northeast, and Western) and sections; the sections are Undergraduate Medical Education (UME), Graduate Medical Education (GME), Continuing Medical Education (CME), and Research in Medical Education (RIME). It is through the GEA that clerkship directors maximize their interactions in multi-school, multi-discipline settings.
  • Group on Faculty Practice (GFP).
  • Group on Information Resources (GIR).
  • Group on Institutional Advancement (GIA).
  • Group on Institutional Planning (GIP).
  • Group on Regional Medical Campuses (GRMC).
  • Group on Research Advancement and Development (GRAND).
  • Group on Resident Affairs (GRA).
  • Group on Student Affairs (GSA) and Minority Affairs Section (MAS).
  • Women in Medicine (WIM) and Women Liaison Officers (WLO).

AAHC has more than 100 members. To belong to AAHC, an institution must include “an allopathic or osteopathic school of medicine, at least one other health professions school or program, and one or more teaching hospitals at major universities throughout the United States.”5  In contrast, UHC “is an alliance of the clinical enterprises of 88 academic health centers.”6 Therefore, UHC concentrates on the clinical mission, AAHC addresses the education and research missions, and AAMC tackles the tripartite mission.

Unlike AAMC, AAHC, and UHC—which revolve around medical schools—AIAMC members “are affiliated with medical schools but are independent of medical school ownership or governance” (7). As a result, the alliance is “a national network of large academic medical centers and health systems,” particularly teaching hospitals with residency programs accredited by ACGME.7

Interestingly, AAMC, AAHC, UHC, and AIAMC use different definitions for academic health center (AHC). In fact, the organizations use AHC and academic medical center (AMC) interchangeably. Clerkship directors should understand three points about this issue. First, AHC is considered a more appropriate term than AMC because it includes health professionals beyond physicians, such as nurses. Second, there is considerable sensitivity about what constitutes an AHC. Some experts (such as AAHC) believe an AHC includes a medical school, another health professions school or program, and a teaching hospital. Other authorities (such as AIAMC) assert that a major teaching hospital constitutes an AHC. Third, and not surprisingly, AAMC has survey data that indicate the majority of Americans do not know what an AHC is; the public understands the meaning of medical school and teaching hospital.8

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Circle III:  Academic Specialty Organizations

The organizations in Circle I (AMA, CMSS, and the specialty societies) tend to consist of practicing physicians, while the organizations in Circle II represent academic medicine across specialties. Circle III includes organizations that represent faculty leaders (clerkship, program, and fellowship directors as well as chairs) by department. Because each specialty is unique, the easiest way to understand these organizations is by examining the seven major specialties and the associated faculty groups:

  • Family Medicine:  Association of Departments of Family Medicine, Association of Family Practice Residency Directors, and Society of Teachers of Family Medicine (STFM).
  • Gynecology and Obstetrics:  Association of Professors in Gynecology and Obstetrics (APGO) and Council of University Chairs of Gynecology and Obstetrics.
  • Internal Medicine:  The Alliance for Academic Internal Medicine (AAIM) consists of the Association of Professors of Medicine (APM), Association of Program Directors in Internal Medicine (APDIM), Association of Subspecialty Professors (ASP), Clerkship Directors in Internal Medicine (CDIM), and Administrators of Internal Medicine (AIM).
  • Neurology:  Association of University Professors in Neurology and Consortium of Neurology Clerkship Directors (CNCD).
  • Pediatrics:  Association of Academic Administrators in Pediatrics (AAAP), Association of Medical School Pediatric Department Chairs (AMSPDC), Association of Pediatric Program Directors (APPD), and Council on Medical Student Education in Pediatrics (COMSEP).
  • Psychiatry:  American Association of Chairs of Departments of Psychiatry, American Association of Directors of Psychiatric Residency Training, Association of Directors of Medical Student Education in Psychiatry (ADMSEP).
  • Surgery:  Association for Academic Surgery, Association for Surgical Education (ASE), Society of Surgical Chairmen, and Society of University Surgeons.

Most specialties include umbrella organizations. In internal medicine, for example, AAIM includes the academically focused internal medicine organizations, while the Federated Council for Internal Medicine consists of the American Board of Internal Medicine (ABIM), ACP, APDIM, ASP, and Society of General Internal Medicine. In Pediatrics, the Council on Pediatric Education (COPE) includes members from AAP, Ambulatory Pediatric Association (APA), American Board of Pediatrics (ABP), American Pediatric Society (APS), AMSPDC, APPD, COMSEP, Canadian Paediatric Society (CPS), Medicine-Pediatrics Program Directors Association (MPPDA), National Association of Children’s Hospitals and Related Institutions (NACHRI), Society for Adolescent Medicine (SAM), Society for Developmental & Behavioral Pediatrics (SDBP), and Society for Pediatric Research (SPR).

In addition to these academic specialty organizations, two coalitions attempt to unify clerkship and program directors. First, the Alliance for Clinical Education (ACE)—which produces this manual—attempts to “foster collaboration across specialties to promote excellence in clinical education of medical students.”9 Created in 1992, ACE consists of:

  • Family Medicine:  STFM
  • Gynecology and Obstetrics:  APGO
  • Internal Medicine:  CDIM
  • Neurology:  CNCD
  • Pediatrics:  COMSEP
  • Psychiatry:  ADMSEP
  • Surgery:  ASE

Second, the Organization of Program Director Associations (OPDA) attempts to “promote the role of the residency director and residency program director societies in achieving excellence in graduate medical education.”10 Established in 2000, OPDA is a consortium of residency program director societies in each of the medical and surgical specialties that correspond to 27 residency review committees within the ACGME (26 specialties and one for transitional year programs).

Analogous to ACE and OPDA, the International Association of Medical Science Educators represents the teachers of basic sciences.

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Circle IV:  Evaluation of Individual Physicians

Four major organizations oversee the evaluation of individual physicians: the Federation of State Medical Boards (FSMB), through medical boards; the National Board of Medical Examiners (NBME), through a three-step examination; the Educational Commission for Foreign Medical Graduates (ECFMG), through a certificate program; and ABMS, through specialty-specific boards.

Founded in 1912, FSMB consists of “the medical boards of the United States, the District of Columbia, Puerto Rico, Guam, the Virgin Islands and 13 state boards of osteopathic medicine.”11 These boards are responsible for licensing physicians to practice in each state, district, or territory. NBME was founded in 1915 “because of the need for a voluntary, nationwide examination that medical licensing authorities could accept as the standard by which to judge candidates for medical licensure.”12

Together, NBME and FSMB administer the United States Medical Licensing Examination (USMLE), which consists of three steps. Step 1 “assesses whether medical school students or graduates can understand and apply important concepts of the sciences basic to the practice of medicine.”12 Step 2 “assesses whether medical school students or graduates can apply the medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision.”12 To meet these goals, Step 2 consists of two parts; the first measures clinical knowledge, while the second assesses clinical skills. The clinical skills assessment is a recent addition to the certifying examination process, so its impact is unknown. Step 3 “assesses whether medical school graduates can apply the medical knowledge and understanding of biomedical and clinical science considered essential for the unsupervised practice of medicine.”12 Usually, physicians-in-training take Steps 1 and 2 of USMLE during medical school and Step 3 after they complete the first year of residency training.

In most cases, graduates of US medical schools (USMGs) use the National Resident Matching Program (NRMP) and the Electronic Residency Application Service (ERAS) to match into residency programs in the United States. NRMP is an independent organization sponsored by AAMC, ABMS, American Hospital Association (AHA), AMA, and CMSS; AAMC sponsors ERAS. Through its certification program, ECFMG “assesses the readiness of international medical graduates (IMGs) to enter accredited residency or fellowship programs in the United States.”13

After successfully completing medical school, USMLE, and residency training, physicians can pursue certification. ABMS consists of 24 specialty-specific boards “to provide assurance to the public that those certified by an ABMS Member Board have successfully completed an approved training program and an evaluation process assessing their ability to provide quality patient care in the specialty.”14 In 2000, ABMS limited the validity of its certificates to 7 to 10 years. To recertify diplomates, the 24 specialty-specific boards use maintenance of certification (MOC), which is a program “to develop a continuous and credible evaluation process that is valuable to physicians, patients, and the healthcare system.”14

The specialty-specific boards within ABMS have twin responsibilities for evaluating physicians. First, the boards evaluate physicians after they complete residency and, if applicable, fellowship training. Second, the boards evaluate certified physicians every 7 to 10 years during their careers. In the United States, certification and MOC are voluntary processes for physicians.

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Circle V:  Evaluation of Educational Programs

Through various mechanisms, FSMB (and state medical boards), NBME, ECFMG, and ABMS (and its 24 specialty-specific boards) evaluate individual physicians. Several other organizations are responsible for assessing educational programs, including LCME, ACGME, and ACCME.

Sponsored by AAMC and AMA, LCME “is the nationally authorized accrediting authority for medical education programs leading to the MD degree in US and Canadian medical schools.”15 The American Osteopathic Association accredits osteopathic medical schools. The LCME certification process involves an extensive self-study component that generates a sizeable manuscript. This manuscript describes the medical school from the perspectives of the students, faculty, and administrators. LCME conducts an extensive site visit of the school that relies on defined assessment standards. These standards are available on the web at www.lcme.org/standard.htm.

ACGME is responsible for accrediting nearly 8,000 residency and fellowship programs in the United States. “To develop and refine its accreditation standards and to review accredited programs for compliance with the standards,” ACGME relies on 27 RRCs, one for each specialty and “one for a special one-year transitional year general clinical program.”16

Each RRC includes six to 15 volunteer physicians appointed by ACGME member organizations (AAMC, ABMS, the American Hospital Association, AMA, and CMSS) and the appropriate medical specialty boards and organizations (such as the American Board of Surgery and ACS, respectively, for surgery). Each RRC establishes and enforces requirements for training. Every one to five years, the appropriate RRC reviews training programs to ensure they are in compliance with ACGME’s rules.

The table 1 compares ABMS’s 24 Boards to ACGME’s 27 RRCs. The three differences between ABMS and ACGME are diagnostic radiology (which ABMS includes with radiation oncology), neurology (which ABMS combines with psychiatry), and transitional year (which is not relevant to ABMS).

To remain licensed, physicians must pursue continuing medical education (CME) throughout their careers. Often, CME is administered by specialty-specific societies (such as ACOG for gynecology and obstetrics). ACCME oversees this process by using “a voluntary self-regulated system for accrediting CME providers and a peer-review process responsive to changes in medical education and the health care delivery system.”17 ACCME standards are exacting and serve to try to ensure that education takes precedence at medical meetings that offer CME credits to physicians.

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Circle VI:  Evaluation of Research Programs

Concerns about patient safety during clinical trials in the late 1990s led to the creation of at least three organizations that attempt to evaluate the quality of research programs. Created in 2001, the Association for the Accreditation of Human Research Protection Programs (AAHRPP) “offers accreditation to institutions engaged in research involving human participants.”18 To accredit programs, the association “uses a voluntary, peer-driven educational model” that focuses on the “five domains of a highly developed human research program”: organization; research review unit, including institutional review boards; investigator; sponsor; and participant.18

The Department of Veterans Affairs (VA) in 2001 awarded a contract to the National Committee for Quality Assurance (NCQA) to “operate an accreditation program to ensure that VA medical centers are complying with VA and other relevant federal regulations designed to protect human subjects of research.”19 The VA Human Research Protection Accreditation Program (VAHRPAP) includes developing “standards for protecting human subjects of research” and assessing the extent to which VA medical centers “meet these standards through site surveys conducted by clinical researchers and research administrators.”19

In 2003, NCQA and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) formed the Partnership for Human Research Protection (PHRP) to “offer a new accreditation program that will seek to protect the safety and rights of participants in clinical trials and research programs in public and private hospitals, academic medical centers, and other research facilities in the United States and abroad.”20 PHRP standards address “institution responsibilities, institutional review board structure and operations, consideration of risks and benefits, and informed consent.”20

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Circle VII:  Evaluation of Clinical Programs

Although several organizations attempt to evaluate clinical programs, JCAHO is the most dominant for health care settings, particularly hospitals. JCAHO “evaluates the quality and safety of care for more than 16,000 health care organizations”—such as health care networks, ambulatory centers, home health services, and laboratories—in the United States.21 To earn or maintain accreditation, a health care organization “must have an extensive on-site review by a team of JCAHO health care professionals at least once every three years.”21

Frequently referred to as a “watchdog for the managed care industry,” NCQA also evaluates the quality of “individual physicians and medical groups.”22 To meet its mission of improving “the quality of health care,” NCQA attempts to generate “useful, understandable information about health care quality to help inform consumer and employer choice” as well as provide feedback that helps “physicians, health plans, and others to identify opportunities for improvement and make changes that enhance the quality of health care.”22

Seeking to reduce medical errors by 50 percent in five years, the Institute of Medicine (IOM) published To Err Is Human:  Building a Safer Health System in September 1999. This seminal report galvanized two organizations that were created the previous year.  First, the Leapfrog Group “is an initiative driven by organizations that buy health care” that are working “to initiate breakthrough improvements in the safety, quality and affordability of healthcare for Americans.”23 A “voluntary program aimed at mobilizing employer purchasing power to alert America’s health industry that big leaps in health care safety, quality and customer value will be recognized and rewarded,” the Leapfrog Group consists of  a 160-member organization that spend an estimated $64 billion annually on health care.23

Second, the National Quality Forum (NQF) “is a private, not-for-profit membership organization established to develop and implement a national strategy for health care quality measurement and reporting.”24 With more than 200 members, NQF seeks “to improve American health care through endorsement of consensus-based national standards for measurement and public reporting of healthcare performance data that provide meaningful information about whether care is safe, timely, beneficial, patient-centered, equitable and efficient.”24

In addition to these and other private efforts, the federal government—through the Centers for Medicare and Medicaid Services (CMS)—is pursuing several initiatives to improve health care. CMS “administers the Medicare program and works in partnership with the states to administer Medicaid, the State Children’s Health Insurance Program (SCHIP), and health insurance portability standards.”25

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Circle VIII:  Hospital Organizations

AHA is the major hospital organization in the United States. Founded in 1898, AHA includes nearly 5,000 health care systems, networks, and hospitals. Although AHA attempts to represent the entire community, other organizations represent specialized facilities. For example, the National Association of Public Hospitals and Health Systems (NAPH) includes public entities; the Federation of American Hospitals (FAH) represents privately owned facilities; NACHRI and its public policy affiliate (National Association of Children’s Hospitals) represents “children’s hospitals, large pediatric units of medical centers and related health systems, including those that specialize in rehabilitative care of children with serious chronic or congenital illnesses;”26 and the American Association of Eye and Ear Hospitals—which consists of “the premier centers for specialized eye and ear procedures in the world”—is an example of an organization that represents the interests of specialty hospitals.27

Therefore, the hospital community in the United States is as fragmented as the physician community. This partition is not limited to physicians and hospitals, but applies to every aspect of American medicine—providers, facilities, and patients—and even the federal government.

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Circle IX:  Federal Government

In the United States, the federal government has a major responsibility for every aspect of health care. Because each state is different, this circle focuses on the federal government. To understand the federal government’s role in medicine, it is important to “follow the money.”28

The federal government consists of the executive (the White House and federal agencies), legislative (Congress), and judicial (the courts) branches. Congress is separated into the House of Representatives and the Senate; each chamber relies on a similar structure of committees and subcommittees to consider, improve, and approve legislation; in general, these panels are organized around the executive branch’s agencies.

From a financial perspective, congressional committees and subcommittees fall into two categories: those that provide entitlement funding (by statute, Congress must fund these programs) and those that provide discretionary funding (each year, Congress may or may not choose to appropriate money for these programs). In health care, the major entitlement programs are Medicare and Medicaid, which are run by CMS (which was previously the Health Care Financing Administration or HCFA). CMS is located in the Department of Health and Human Services (HHS).

In particular, Medicare supports graduate medical education (GME) through the direct graduate medical education (DGME) payment and the indirect medical education (IME) adjustment. The DGME payment covers the direct costs of medical education, such as salaries, stipends, educational facilities, and tools. The IME adjustment covers indirect costs, which includes allowances for the involvement of residents and supervising physicians in patient care as well as the severity of illnesses of patients requiring specialized services available only in teaching hospitals. In addition, disproportionate share hospital (DSH) payments are additional Medicare and Medicaid funding to help hospitals provide care for uninsured and low-income patients. Because physicians in teaching hospitals treat 72 percent of the uninsured, academic medicine is disproportionately affected as the number of people who lack health insurance or are underinsured increases.29

HHS also administers the majority of health-related discretionary programs, such as the National Institutes of Health (NIH), the Agency for Healthcare Research and Quality (AHRQ, formerly the Agency for Health Care Policy and Research or AHCPR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the Health Resources and Services Administration (HRSA). HRSA has traditionally offered grants and contracts that address issues of undergraduate medical education (www.hrsa.gov/grants/default.htm). Outside HHS, VA receives discretionary funding to operate health-related programs and conduct research through the Veterans Health Administration (VHA).

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Conclusion

After completing his journey through The Inferno, Dante ventured from The Purgatorio to The Paradiso. While challenging, your tenure as a clerkship director will prepare you for continued success in medicine, where you—like Dante—can achieve professional and personal paradise.

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Table 1

American Board of Medical Specialty's 24 Boards and the Accreditation Council for Graduate Education's 27 Residency Review Committees

24 ABMS Boards
27 ACGME RRC's

Allergy and Immunology

Anesthesiology

Colon and Rectal Surgery

Dermatology

 

Emergency Medicine

Family Medicine

Medical Genetics

Internal Medicine

Neurological Surgery

 

Nuclear Medicine

Obstetrics and Gynecology

Ophthalmology

Orthopaedic Surgery

Otolaryngology

Pathology

Pediatrics

Physical Medicine and Rehabilitation

Plastic Surgery

Preventive Medicine

 

Psychiatry and Neurology

Radiation Oncology

Surgery

Thoracic Surgery

 

Urology

Allergy and Immunology

Anesthesiology

Colon and Rectal Surgery

Dermatology

Diagnostic Radiology

Emergency Medicine

Family Medicine

Medical Genetics

Internal Medicine

Neurological Surgery

Neurology

Nuclear Medicine

Obstetrics and Gynecology

Ophthalmology

Orthopaedic Surgery

Otolaryngology

Pathology

Pediatrics

Physical Medicine and Rehabilitation

Plastic Surgery

Preventive Medicine

Psychiatry

 

Radiation Oncology

Surgery

Thoracic Surgery

Transitional Year

Urology

 

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GLOSSARY

Limited Glossary of Organizations and Terms in American Medicine

Acronym

Full Name

 

 

AAAAI

American Academy of Allergy, Asthma, and Immunology

AAAP

Association of Academic Administrators in Pediatrics

AACE

American Association of Clinical Endocrinologists

AACDP

American Association of Chairs of Departments of Psychiatry

AAD

American Academy of Dermatology

AADPRT

American Association of Directors of Psychiatric Residency Training

AAFP

American Academy of Family Physicians

AAHC

Association of Academic Health Centers

AAHP

American Association of Health Plans

AAHRPP

Association for the Accreditation of Human Research Protection Programs

AAIM

Alliance for Academic Internal Medicine

AAMC

Association of American Medical Colleges

AAMP

Association for Academic Minority Physicians

AAN

American Academy of Neurology

AAP

American Academy of Pediatrics

AAP

Association of American Physicians

AAS

Association for Academic Surgery

AASLD

American Association for the Study of Liver Diseases

AAU

Association of American Universities

ABAI

American Board of Allergy and Immunology

ABEM

American Board of Emergency Medicine

ABFP

American Board of Family Practice

ABIM

American Board of Internal Medicine

ABIMF

American Board of Internal Medicine Foundation

ABMS

American Board of Medical Specialties

ABP

American Board of Pediatrics

ACAAI

American College of Allergy, Asthma, and Immunology

ACC

American College of Cardiology

ACCME

Accreditation Council for Continuing Medical Education

ACCP

American College of Chest Physicians

ACE

Alliance for Clinical Education

ACE

American Council on Education

ACG

American College of Gastroenterology

ACGIM

Association of Chiefs of General Internal Medicine

ACGME

Accreditation Council for Graduate Medical Education

ACNP

American College of Nuclear Physicians

ACOG

American College of Obstetrics and Gynecology

ACP

American College of Physicians (formerly ACP-ASIM)

ACR

American College of Rheumatology

ACS

American College of Surgeons

ADA

American Diabetes Association

ADA

Americans with Disabilities Act

ADFM

Association of Departments of Family Medicine

ADGAP

Association of Directors of Geriatric Academic Programs

ADMSEP

Association of Directors of Medical Student Education in Psychiatry

AFCR

American Federation for Clinical Research (now AFMR)

AFMC

Association of Faculties of Medicine of Canada

AFMR

American Federation for Medical Research (formerly AFCR)

AFPRD

Association of Family Medicine Residency Directors

AGA

American Gastroenterological Association

AGS

American Geriatrics Society

AHA

American Heart Association

AHA

American Hospital Association

AHC

Academic Health Center

AHCPR

Agency for Health Care Policy and Research (now AHRQ)

AHME

Association for Hospital Medical Education

AHRQ

Agency for Healthcare Research and Quality (formerly AHCPR)

AHSR

Association for Health Services Research (now AcademyHealth)

AIAMC

Alliance of Independent Academic Medical Centers

AIM

Administrators of Internal Medicine

AMA

American Medical Association

AMC

Academic Medical Center

AMS

Associated Medical Services (Canadian)

AMSA

American Medical Student Association

AMSPDC

Association of Medical School Pediatric Department Chairs

ANA

American Neurological Association

ANA

American Nurses Association

ANAMS

Association of Native American Medical Students

AOA

American Osteopathic Association

APA

Academic Practice Assembly

APA

Ambulatory Pediatric Association

APA

American Psychiatric Association

APC

Association of Professors of Cardiology

APDIM

Association of Program Directors in Internal Medicine

APGO

Association of Professors in Gynecology and Obstetrics

APM

Association of Professors of Medicine

APPD

Association of Pediatric Program Directors

APS

American Pediatric Society

ASBMR

American Society for Bone and Mineral Research

ASCI

American Society of Clinical Investigation

ASCO

American Society of Clinical Oncology

ASGE

American Society for Gastrointestinal Endoscopy

ASE

Association for Surgical Education

ASH

American Society of Hematology

ASIM

American Society of Internal Medicine (now ACP)

ASM

American Society of Microbiology

ASN

American Society of Nephrology

ASP

Association of Subspecialty Professors

ATA

American Thyroid Association

ATPM

Association of Teachers of Preventive Medicine

ATS

American Thoracic Society

AUPN

Association of University Professors in Neurology

AVACOM

Association of VA Chiefs of Medicine (return to top)

BBA

Balanced Budget Act of 1997

BBRA

Balanced Budget Refinement Act of 1999

BHPr

Bureau of Health Professions

BIPA

Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (PL 106-554)

BIO

Biotechnologies Industry Organization

BRDPI

Biomedical Research and Development Price Index

CAAR

Computer Assisted Accreditation Review

CACMS

Committee on Accreditation of Canadian Medical Schools

CAME

Canadian Association for Medical Education

CAP

Clinical Associates Program

CAPER

Canadian Post-MD Education Registry

CAQ

Certificate of Added Qualifications

CARES

Capital Asset Realignment for Enhanced Services

CaRMS

Canadian Resident Matching Service

CAS

Council of Academic Societies

CBO

Congressional Budget Office

CC

Warren Grant Magnuson Clinical Center

CCEP

Clinical Cardiac Electrophysiology

CCM

Critical Care Medicine

CDC

Centers for Disease Control and Prevention

CDIM

Clerkship Directors in Internal Medicine

CECC

Committee on Evaluation of Clinical Competence

CEX

Clinical Evaluation Exercise

CEX

Consultation Evaluation Exercise

CFMS

Canadian Federation of Medical Students

CFPC

College of Family Physicians of Canada

CGIM

Committee on General Internal Medicine

CHAMPUS

Civilian Health and Medical Program of the Uniformed Services

CIS

Clinical Immunology Society

CIT

NIH Center for Information Technology (formerly DCRT, OIRM, and TCM)

CLI

Clinical and Laboratory Immunology (formerly DLI)

CME

Council on Medical Education

CME

Continuing Medical Education

CMS

Centers for Medicare & Medicaid Services (formerly HCFA)

CMSS

Council of Medical Specialty Societies

CNCD

Consortium of Neurology Clerkship Directors

COBRA

Consolidated Omnibus Budget Reconciliation Act of 1985 (PL 99-272)

COC

Committee on Credentials

COD

Council of Deans

COGME

Council on Graduate Medical Education

COMLEX

Comprehensive Osteopathic Medical Licensing Examination

COMSEP

Council on Medical Student Education in Pediatrics

COPE

Council on Pediatric Education

COTH

Council of Teaching Hospitals

CPS

Canadian Paediatric Society

CQI

Continuous Quality Improvement

CRS

Congressional Research Service

CSA

Clinical Skills Assessment (return to top)

CSCR

Central Society for Clinical Research

CSERD

Criteria for selection, evaluation, remediation, and dismissal (of residents)

CSIM

Committee on Subspecialty Internal Medicine

CSQ

Certificate of Special Qualifications

CSR

Center for Scientific Review

CSS

Council of Subspecialty Societies (ACP)

CUCGO

Council of University Chairs of Gynecology and Obstetrics

DGI

Diplomate Generated Item

DGME

Direct Graduate Medical Education Payment

DHHS

Department of Health and Human Services (more commonly HHS)

DLI

Diagnostic Laboratory Immunology (now CLI)

DRG

Division of Research Grants

DSH

Disproportionate Share Hospital Payment

EBM

Evidence-Based Medicine

E/M

Evaluation and Management

ECFMG

Educational Commission for Foreign Medical Graduates

EDI

Electronic Data Interchange

ERAS

Electronic Residency Application Service

FASEB

Federated American Societies for Experimental Biology

FCIM

Federated Council for Internal Medicine

FDA

Food and Drug Administration

FIC

John E. Fogarty International Center

FMG

Foreign Medical Graduate

FMGEMS

Foreign Medical Graduate Examination in Medical Science

FOVA

Friends of VA Medical Care and Health Research

FPO

Federation of Pediatric Organizations

FSMB

Federation of State Medical Boards

FY

Fiscal Year

GAO

General Accounting Office

GBA

Group on Business Affairs (AAMC)

GCRC

General Clinical Research Center

GEA

Group on Educational Affairs (AAMC)

GFP

Group on Faculty Practice (AAMC)

GIA

Group on Institutional Advancement (AAMC)

GIP

Group on Institutional Planning (AAMC)

GIR

Group on Information Resources (AAMC)

GME

Graduate Medical Education

GPO

Government Printing Office

GRA

Group on Resident Affairs (AAMC)

GRAND

Group on Research Advancement and Development (AAMC)

GREAT

Graduate Research, Education, and Training Group (AAMC)

GRMC

Group on Regional Medical Campuses (AAMC)

GRR

Government Relations Representatives (AAMC)

GSA and MAS

Group on Student Affairs and Minority Affairs Section (AAMC)

H&P

History and Physical

HCFA

Health Care Financing Administration (now CMS)

HHS

Department of Health and Human Services

HIPAA

Health Insurance Portability and Accountability Act (PL 104-191)

HPSA

Health Professional Shortage Areas

HPSP

Health Professional Scholarship Program

HRSA

Health Resources and Services Administration

IAMSE

International Association of Medical Science Educators

ICD

International Classification of Disease

IDS

Integrated Delivery System

IDSA

Infectious Diseases Society of America

IHS

Indian Health Service

IME

Indirect Medical Education Adjustment

IMEA

Indirect Medical Education Adjustment

IMG

International Medical Graduate

IOM

Institute of Medicine (return to top)

IRB

Institutional Review Board

ISPE

International Society of Pharmacoepidemiology

ITE

In-Training Examination

JAHF

The John A. Hartford Foundation

JAMA

The Journal of the American Medical Association

JCAHO

Joint Commission for Accreditation of Healthcare Organizations

JDF

Juvenile Diabetes Foundation (now JDRF)

JDRF

Juvenile Diabetes Research Foundation (formerly JDF)

LCME

Liaison Committee on Medical Education

LCSB

Liaison Committee for Specialty Boards

MCC

Medical Council of Canada

MCQ

Multiple Choice Question

MedPAC

Medicare Payment Advisory Commission (formerly PPRC and ProPAC)

MGMA

Medical Group Management Association

MKSAP

Medical Knowledge Self-Assessment Program

MPPDA

Medicine-Pediatrics Program Directors Association

MSPE

Medical Student Performance Evaluation

MSTP

Medical Scientist Training Program

NABR

National Association for Biomedical Research

NACHRI

National Association of Children’s Hospitals and Related Institutions

NAIP

National Association of Inpatient Physicians (now SHM)

NAPCRG

North American Primary Care Research Group

NAPH

National Association of Public Hospitals

NAS

National Academy of Sciences

NaSGIM

National Study of Graduate Education in Internal Medicine

NaSIMM

National Study of Internal Medicine Manpower (now NaSGIM)

NASO

National Association for the Study of Obesity

NASULGC

National Association of State Universities and Land Grant Colleges

NBME

National Board of Medical Examiners

NCCAM

National Center for Complementary and Alternative Medicine

NCHS

National Center for Health Statistics

NCI

National Cancer Institute

NCMHD

National Center on Minority Health and Health Disparities

NCQA

National Committee for Quality Assurance

NCRR

National Center for Research Resources

NEI

National Eye Institute

NHGRI

National Human Genome Research Institute

NHLBI

National Heart, Lung, and Blood Institute

NHPF

National Health Policy Forum

NIA

National Institute on Aging

NIAAA

National Institute on Alcohol Abuse and Alcoholism

NIAID

National Institute of Allergy and Infectious Disease

NIAMS

National Institute of Arthritis and Musculoskeletal and Skin Diseases

NIBIB

National Institute of Biomedical Imaging and Bioengineering

NICHD

National Institute of Child Health and Human Development

NIDA

National Institute on Drug Abuse

NIDCD

National Institute on Deafness and Other Communication Disorders

NIDCR

National Institute of Dental and Craniofacial Research

NIDDK

National Institute of Diabetes and Digestive and Kidney Diseases

NIEHS

National Institute of Environmental Health Sciences

NIGMS

National Institute of General Medical Sciences

NIH

National Institutes of Health

NIMH

National Institute of Mental Health

NINDS

National Institute of Neurological Disorders and Stroke

NINR

National Institute of Nursing Research

NKF

National Kidney Foundation

NLM

National Library of Medicine

NMA

National Medical Association

NMSA

National Medical Student Association

NOF

National Osteoporosis Foundation

NQF

National Quality Forum

NRC

National Research Council

NRMP

National Resident Matching Program

NRSA

Ruth L. Kirschstein National Research Service Awards (return to top)

NSF

National Science Foundation

OAFM

Organization of Academic Family Medicine

OAR

Office of AIDS Research

OASH

Office of the Assistant Secretary for Health

OD

Office of the Director

OER

Office of Extramural Research

OGPP

Office of Generalist Physician Programs

OIG

Office of the Inspector General

OMB

Office of Management and Budget

OPDA

Organization of Program Director Associations

ORR

Organization of Resident Representatives (AAMC)

ORWH

Office of Research on Women’s Health

OSHA

Occupational Safety and Health Administration

OSP

Office of Science Policy

OSR

Organization of Student Representatives (AAMC)

OTA

Office of Technology Assessment

PCOC

Primary Care Organizations Consortium

PCP

Primary Care Physician

PhRMA

Pharmaceutical Research and Manufacturers Association

PHRP

Partnership for Human Research Protection

PHS

Public Health Service

PORT

Patient Outcomes Research Teams

PPAC

Practicing Physicians Advisory Council

PPRC

Physician Payment Review Commission (now MedPAC)

PPS

Prospective Payment System

PRIT

Physicians Regulatory Issues Team

ProPAC

Prospective Payment Assessment Commission (now MedPAC)

QI

Quality Improvement

RBRVS

Resource-Based Relative Value Scale

RCPSC

Royal College of Physicians and Surgeons of Canada

REF

Research and Education Foundation

RO1

Traditional NIH Research Project Grant

RPG

Research Project Grant

RRC

Residency Review Committee

RRC-IM

Residency Review Committee for Internal Medicine

RVS

Relative Value Scale

RWJ

Robert Wood Johnson Foundation

SAM

Society for Adolescent Medicine

SAMHSA

Substance Abuse and Mental Health Administration

SCCM

Society of Critical Care Medicine

SCOR

Specialized Centers of Research

SDBP

Society for Developmental & Behavioral Pediatrics

SEP

Self-Evaluation Process

SGC

Society for Geriatric Cardiology

SGIM

Society of General Internal Medicine

SHM

Society of Hospital Medicine (formerly NAIP)

SMDM

Society of Medical Decision Making

SNM

Society of Nuclear Medicine

SPORE

Specialized Programs of Research Excellence

SPR

Society for Pediatric Research

SSA

Social Security Administration

SSC

Society of Surgical Chairmen

SSCI

Southern Society for Clinical Research

STFM

Society of Teachers of Family Medicine

SUS

Society of University Surgeons

TES

The Endocrine Society

UHC

University HealthSystem Consortium

UME-21

Undergraduate Medical Education for the 21st Century

USIMG

United States Citizen International Medical Graduate

USMG

United States Medical Graduate

USMLE

United States Medical Licensing Examination

VA

Department of Veterans Affairs

VAHRPAP

VA Human Research Protection Accreditation Program

VAMC

Department of Veterans Affairs Medical Center

VERA

Veterans Equitable Resource Allocation

VHA

Veterans Health Administration

VHA

Voluntary Health Agencies

VHO

Voluntary Health Organization

VISN

Veterans Integrated Service Network

VSO

Veterans’ Service Organization

WHO

World Health Organization

WIM and WLO

Women in Medicine and Women Liaison Officers (AAMC)

 

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References

  1. Dante. The Inferno: Dante’s immortal drama of a journey through hell. (trans. Ciardi J.) New York, NY: Penguin Group, 1982.
  2. Page L. AMA membership drop accelerating. Modern Physician. Online. www.modernphysician.com/printwindow.cms?newsId=1580&pageType=news. Accessed 12/16/2003.
  3. Council of Medical Subspecialty Societies. About CMSS. Online. www.cmss.org/index.cfm?p=display&detail=About%20CMSS. Accessed 1/3/04.
  4. Association of American Medical Colleges. About the AAMC. Online. www.aamc.og/about/start.htm. Accessed 1/3/04.
  5. Association of Academic Health Centers. About AHC. Online. www.achcnet.org/about/index.php. Accessed 1/3/04.
  6. University HealthSystem Consortium. About UHC. Online. www.uhc.edu/results_list.asp?folder=WEB/About_UHC/. Accessed 1/3/04.
  7. Alliance of Independent Academic Medical Centers. About the Alliance. Online. www.aiamc.org/brochure.html. Accessed 1/3/04.
  8. What Americans say about the nation’s medical schools and teaching hospitals: Report on public opinion research. Association of American Medical Colleges, October 1996.
  9. Alliance for Clinical Education. Mission, Vision, and Values. Online. www.allianceforclinicaleducation.org/Mission.htm. Accessed 4/22/05.
  10. Council of Medical Specialties. Organization of Program Directors. Online. www.cmss.org/index.cfm?p=display&detail=Organization%20of%20Program%20Directors. Accessed 4/22/05
  11. Federation of State Medical Boards of the United States, Inc. FSMB Facts. Online. www.fsmb.org/aboutsus.htm. Accessed 2/21/04.
  12. The National Board of Medical Examiners. About the NBME. Online. www.nbme.org/about/about/asp. Accessed 1/3/04.
  13. Educational Commission for Foreign Medical Graduates. ECFMG Welcome Page. Online. http://www.ecfmg.org. Accessed 1/9/04.
  14. The American Board of Medical Specialties. ABMS Home Page. Online. http://www.abms.org. Accessed 1/3/04.
  15. Liaison Committee on Medical Education. Frequently Asked Questions. Online. www.lcme.org/faqlcme.htm. Accessed 1/18/04.
  16. Accreditation Council for Graduate Medical Education. The Role of the ACGME. Online. www.acgme.org/About/roleAcgme.asp. Accessed 1/3/04.
  17. Accreditation Council for Continuing Medical Education. ACCME Welcome. Online. www.accme.org. Accessed 1/3/04.
  18. Association for the Accreditation of Human Research Protection Programs, Inc. About us. Online. www.aahrpp.org/about.htm. Accessed 1/3/04.
  19. National Commission for Quality Assurance. VA Human Research Protection Accreditation Program. Online. www.ncqa.org/Programs/QSG/VAHRPAP.vahrpap.htm. Accessed 4/22/05.
  20. National Commission for Quality Assurance. Partnership for Human Research Protection, Inc., Accreditation Program. Online. www.ncqa.org/Programs/Accreditation/PHRP/phrp.htm. Accessed 4/22/05.
  21. Joint Commission on Accreditation of Healthcare Organizations. What is the Joint Commission on Accreditation of Healthcare Organizations. Online. www.jcaho.org/general+public/who+jc/index.htm. Accessed 1/3/04.
  22. National Commission for Quality Assurance. About NCQA. Online. www.ncqa.org/about/about.htm. Accessed 4/22/05.
  23. The Leapfrog Group for Patient Safety. About Us. Online www.leapfroggroup.org/about_us. Accessed 4/22/05.
  24. National Quality Forum. About the National Quality Forum. Online. www.qualityforum.org/about/home.htm. Accessed 4/22/05.
  25. Centers for Medicare & Medicaid Services. About the Centers for Medicare & Medicaid Services. Online. www.cms.hhs.gov/about/default.asp. Accessed 4/22/05.
  26. National Association of Children’s Hospitals and Related Institutions / National Association of Children’s Hospitals. About Us, About NACHRI, About NACH. Online www.childrenshospitals.net/Template.cfm?Section=About_Us1&Template=/
    ContentManagement/HTMLDisplay.cfm&ContentID=16188
    . Accessed 4/22/05.
  27. American Association of Eye and Ear Hospitals. Welcome. Online. www.aaeeh.org. Accessed 7/19/05.
  28. Green K. Follow the Money. Syllabus Magazine. Online. www.syllabus.com/article.asp?id=8286. Accessed 1/3/04.
  29. Association of American Medical Colleges. Teaching hospitals’ contributions to the care of the uninsured. www.aamc.org/uninsured/charts.htm. Accessed 8/23/04.

 

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