When Fayetteville, Tenn. internist J. Fred Ralston, Jr., MD, FACP, recently took the helm of the American College of Physicians, he did it in service to his profession but also for a personal reason. “What I do in the ACP makes me stay sane about the frustrations I have in daily practice,” Ralston acknowledged with a chuckle.

 

The second-largest physician group in the United States behind the American Medical Association, the ACP is comprised of 129,000 internists, related subspecialists and medical students. Ralston’s ACP roles date back to 1998, and in 2000 he was elected governor of the Tennessee chapter. After three years on the ACP Board of Governors, he was elected board chair for 2005-06. Since then, he’s served on many ACP committees and began his one-year presidential term in April at the ACP annual scientific meeting in Toronto. Ralston also has served in several Tennessee Medical Association leadership roles, including board chairman.

 

“I’ve been interested in both political science and medicine from an early age,” Ralston said. Born and raised in Fayetteville, he was handed an extraordinary opportunity as a teenager – a high school scholarship to prestigious Phillips Academy in Andover, Mass. “I was different for them. I was a small-town, Southern kid whose father didn’t go to college. It was good for them, and it was good for me,” Ralston recalled. During high school, he nabbed a semester internship in the office of U.S. Sen. Mark Hatfield (R-Ore.), “not as a page, but in the office … and in the office during the spring when the Hill isn’t flooded with interns,” he said. That experience fueled his love of politics. Upon graduation from Andover, he moved one state south to Connecticut where he graduated from Yale University with a bachelor’s in political science. Yet, the continual fundraising mode of politics and Ralston’s inclination to answer complex questions with more than a yes or a no answer doused any political office ambitions, he admitted.

 

Therefore, with his love of medicine in tact, Ralston returned to the Volunteer State, where he earned his medical degree in 1980 from the University of Tennessee College of Medicine in Memphis. “Little did I know then how intricately related politics and medicine would become,” he said.

 

After his internal medicine residency at Baptist Memorial Hospital in Memphis, Ralston truly went home in 1983 to join the group practice of Fayetteville Medical Associates. “I went home not because I didn’t know any better, but because I love the place,” Ralston said. Of the eight physicians in the group, six are Lincoln County natives. “It really speaks well of the community, and it also is why we don’t have as much of a primary-care shortage in Fayetteville as we do in the rest of the country. We retain more of our own people,” Ralston said. He and his wife, Farris, a native of nearby Pulaski, are raising twin sons, Will and Jim, in Ralston’s hometown. The boys turn 16 this month.

 

Ralston said his involvement with ACP and TMA is a result in large measure of treating his older patients on Medicare. “If we didn’t communicate with our elected leaders, the system would get worse and worse,” he said. “Unfortunately, it still has, but I also do feel like I’ve been able to make a difference at the margins, communicating to some pretty key individuals things that need to be changed.”

 

While Ralston said he’s “humbled by the privilege” of taking care of patients, beyond the exam-room door is a “hostile world” of third-party payers and paperwork. “Part of what I am trying to do now is make the system more attractive so that there’ll be somebody to take care of my generation when we’re older and replace us in practice,” he said.

 

Ralston has been a proponent for the Obama administration’s healthcare reform initiative, but not because he believes the legislation takes care of all of medicine’s problems … not by a long shot. “Right now we have a failed political system trying to correct a failed medical-delivery system,” he said.

 

Here’s what worried Ralston: “Probably the thing that convinced me more that we needed to pass this was that it is considered a third-rail topic in politics,” he said. After the Clintons’ failure in the early 1990s, politicians basically ignored healthcare’s problems. Ralston was worried that if Obama failed “it would have been 10 or 15 years before somebody would have had the guts to try that again.”

 

The result of reform’s passage, Ralston added, is that “right now, we have some options.”

 

The ACP decided to back the legislation, he explained, because it addressed some of the policies most important to the organization – first and foremost, accessibility of affordable health insurance. Ralston noted that, according to the “respected, nonpartisan” Institute of Medicine, America already spends $100 billion annually on the uninsured, and preventive care would drastically diminish that expenditure. The ACP also supported the “first steps” taken by the legislation to support primary care, he added.

 

Where the ACP has a problem is that the legislation does not effectively address the “spiraling cost curve,” Ralston explained, or tort reform, which he described as a partisan issue. “Yet even when Bill Frist was there with the Republican majority in the Senate and a Republican president who would have signed the legislation, he wasn’t able to get substantive national tort reform put through,” said Ralston, who added that perhaps 15 percent of healthcare costs could be eliminated by decreasing defensive medicine. Nonetheless, Ralston said that “it’s not too late to proceed separately” with a tort-reform strategy.

 

Annually, Ralston heads to Meharry Medical College in Nashville to pitch medical students on the merits of internal medicine. He acknowledged that some of those students are born to be a surgeon or a neurologist, and moving them away from their calling would be a mistake.