By Christopher Guadagnino, Ph.D.

Published January 2001

• React to this article in the Discussion Forum.

Allen Myers, M.D., is president of the College of Physicians of Philadelphia and a professor of medicine at Temple University School of Medicine.

PND: How has the College and its roles changed over its history?

AM: The College has been dedicated to certain principles since its inception in 1787: the continuing education of physicians and the public, community service and, for the past 100 years, the preservation and interpretation of the history of medicine. We act as a neutral site for busy physicians from all the medical schools and hospitals in the area and we are a site for collegiality and fellowship. Our membership numbers 1,800: about 1,200 are in this region and 600 are outside of this region, including overseas. Included in the organization’s history are many of the leaders of American medicine, seven presidents of the American Medical Association, and Nobel Prize laureates. The College has been at the forefront on public health, clinical and ethical issues and has provided lectures since its inception. Originally, it acted as a forum for physicians to discuss clinical problems and the diseases that were affecting Philadelphia in those days and to deal with issues of public health. For example, the College was involved in controlling a typhoid epidemic of 1792. There weren’t medical schools yet, except for the University of Pennsylvania, which had started in 1765 by many of the same doctors who founded the College.

The College was initially limited to education of fellow physicians. Our educational role has now enlarged to community education. For example, about five years ago we established our Community Health Information Center, named after Dr. Koop, former Surgeon General, who is a fellow of the College and a member of its board. The Center provides a source of information for lay people with regard to health issues. One can come into the College and sit down at a computer with a librarian who will help them search out the database for information on any area of health. This is open to the public and is free. It has been reviewed by the Centers for Disease Control in regard to the quality of its information and found to be excellent. We are now in discussions with the Free Library of Philadelphia regarding a partnership that would allow the Free Library to have its main branch and other branches as a disseminating source for our Community Health Information Center. This would provide access to many more people and would be a great service to the community.

We have a school education program. About ten years ago the College was part of the Adopt-a-School program in which we adopted a school in South Philadelphia where we provided some education and career counseling. That program has grown. We’ve expanded it for students from many schools to visit the College, its gallery and museum, and the Community Health Information Center. We are working with the Philadelphia School District to promote scientific education, science literacy and career education. Another community service we are developing is a program in which fellows of the College volunteer their time in community health clinics to deliver health care to the poor. We have a lot of senior physicians who would be anxious to do that. Also, our gallery is addressing current diseases. The present exhibit is Emerging Infectious Diseases: Ancient Scourge and Modern Menace. The gallery is open to the public seven days a week, as is the Mutter Museum, which the College has been very proud of since it opened its building on 22nd Street.

PND: What other public health initiatives has the College been involved in?

AM: Infectious diseases and cancer have been issues we have been involved with for some time. The College has a Section on Public Health which has about 250 members, of which about 20 percent are College Fellows. The rest are people in the field who are interested in discussing topical issues in public health. One of the public health initiatives that I’ve been involved with since I became president this past July is the state’s share of the federal tobacco settlement. I wrote a letter to Governor Ridge in which I offered the services of the College as a neutral site for discussion and implementation of the tobacco settlement relating to Pennsylvania, or at least to Southeastern Pennsylvania. Members of the Section on Public Health are also talking about getting involved in issues of tobacco use, prevention and the like. These are very difficult issues and require very careful thought as to how to approach them. The school system is trying to address the issues in their health classes. We’re looking at other approaches. As part of another initiative, the College sent a letter recently to Tinicum Township in an effort to support the preservation of the Lazaretto public health buildings, which are monuments to the history of public health in Philadelphia. Those buildings are owned by entrepreneurs who are anxious to develop a mall or similar project. Also, we’re presently trying to schedule a lecture program in Spring 2001 to update physicians in the community on what’s known about West Nile fever and what has been done in neighboring states of New York and New Jersey.

PND: What relationship does the College have with the Philadelphia Health Department?

AM: Dr. Walter Tsou, who’s the Commissioner of Health in the City of Philadelphia is a Fellow of our College and a member and former chair of our Section on Public Health. He is a member of a new committee I have formed to try to develop a strategic plan for the College for the next five years.

PND: What are other specific venues for physician activity within the College?

AM: I think that it’s critical to understand the interest in the history of medicine by the College. We are the oldest physician organization in the United States. We have an extraordinary historical library with copies of books that date back to the 14th and 15th centuries. Our building, built and opened in 1908, is a treasure in itself. The way we focus on the history of medicine is through our Section on Medical History and the Wood Institute, an endowed program in which scholars use the College to study aspects of the history of medicine—including clinical, scientific and ethical issues. We have a Section on Medical Ethics which looks at the issues related to medical trials, testing and privacy. We may, from time to time, issue a White Paper. We have done that on succession of the president of the United States—what happens if the president becomes incapacitated or doesn’t recognize he’s incapacitated? How do you make that judgment and how do you move forth? We sent it to Senator Specter and to the Judiciary Committee of the U.S. House of Representatives.

We also have a Section on Arts/Medicine, looking at the relationship between those two realms. There are smaller, independent sections that are more subject-specific: a Section on Dermatology and a Section on Ophthalmology. They meet at the College on a regular basis and have been associated with the College for many years.

PND: The landscape of the medical profession has changed significantly over the past several years. About half of all U.S. and Pennsylvania physicians are now employees, managed care organizations have become dominant financing entities in the marketplace and non-physicians are broadening their scopes of practice. What challenges does the College face in staying relevant in the face of those changes?

AM: That’s exactly why I convened a strategic planning process, which will probably take a year, to outline where we’ll be five or seven years from now. The strategic planning process started in September, so I can’t tell you what the results are yet. We’re wrestling right now with membership and program issues to keep us relevant to present physicians. Younger physicians today have a different mindset about how the practice of medicine is and will be. It’s certainly different from the majority of fellows of the College now. We have to be prepared to accept that and we’re trying to make the College relevant to them so that they will join and stay as Fellows. The criteria for fellowship is honorific. You have to be fairly well-established and have a reputation in the community as a significant practitioner or scientist before you actually become a Fellow.

The College is primarily an organization of physicians, but a few years ago decided to allow community leaders who are non-physicians into the College. People who have had major interests and involvement in health care have become fellows of the College. We’ve recently increased this effort a little bit and are trying to attract major hospital administrators and other business leaders in health and medicine.

In general, we have tried to stay out of the economic issues related to physicians. That, I think, is something more that the county and state medical societies have been involved with, as well as the major physician organizations such as the American College of Physicians and the American College of Surgeons. We are not going to be a lobby organization to increase income to physicians. We are not going to deal with the economic issues of the practice of medicine. We have tried to stick to clinical issues, scientific issues, ethical issues, historical issues of medicine and not to get involved in economic issues. We will continue to deal with issues as to how the public gets its health care delivered and present them in our lectures. We will continue to educate physicians on key topics. Now, some will argue that that happens at their hospital grand rounds, but in fact, those are largely drug company-sponsored. We do not take outside support from pharmaceutical companies for lectures. We have tried to remain steadfastly neutral and I hope we will be able to continue to do that. We’re always developing new activities, but largely along the lines of the basic areas I’ve described. We will not, I can assure you, give up the preservation and history of medicine or our treasures.