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Alaska Chapter Governor's Newsletter
Spring 2002

Richard Neubauer MD, FACP
Governor, Alaska Chapter

Governor's Message

Wow! In a dramatic series of meetings, April 7-9 in Philadelphia, the ACP Board of Governors and Board of Regents articulated a set of specific negotiating points to be relayed to the American Board of Internal Medicine (ABIM) with respect to internal medicine and subspecialty recertification.

Of equal importance, the ABIM has signaled back to the ACP leadership a new willingness to negotiate and change the basic structure of recertification for internal medicine, and internal medicine subspecialties. Prior to this, ABIM has taken a very firm stance that while some modifications to their Continuous Professional Development (CPD) process would be considered, the basic structure was not open to discussion.

As a close observer of the negotiations over the past two years, I believe that these new developments represent a breakthrough for ACP with respect to the issue of recertification. It has always been the ACP position to support a well designed and executed recertification process. Using the negotiating points in an atmosphere of cooperation with the ABIM, internists and sub-specialists will hopefully see substantive improvement in the recertification process, hopefully in the near future.

I've outlined more about the ABIM CPD recertification process in a previous column and won't repeat that here, but the major points in the resolutions passed by the ACP governing boards include:

Internal Medicine, because of the diversity of our physicians and the diversity of their learning styles and needs, would be best suited to recertification via a choice between several separate and distinctly different pathways to be chosen at the discretion of the candidate. Examples of possible pathways besides CPD as currently envisioned by ABIM include a literature based self study program modeled after the American College of Obstetrics and Gynecology (ACOG) program that I also outlined in my previous column, or the completion of MKSAP or other learning resources. It might not be necessary to include a "secure" examination in all these pathways. While ACP governance did not limit itself to specifics as negotiations continue, it was emphasized that real alternatives to CPD should be a key feature of an acceptable recertification process.

Time and monetary costs of recertification need to be a major focus of concern, and "value" for these expenditures needs to be optimized. In the frenetic life of an internist, the issues of time and money are extremely important so these costs need to translate into appropriate benefit for the candidate.

Streamlining the recertification process is also of paramount importance. One criticism of the CPD process has been that it is overly complex, particularly for sub-specialists who want to recertify in both internal medicine and their subspecialty. An ACP priority is to make it as simple as possible for sub-specialist internists to recertify in general internal medicine as well as their sub-specialty.

Why is all this so important? While older physicians are "grand fathered" with time unlimited certification, younger physicians are not. Even though some of us may therefore not be required to recertify, we all need to be concerned about this issue since it could have profound effects on internal medicine as a career choice for young physicians, and could contribute to a further splintering of internal medicine if sub-specialists choose not to recertify in general internal medicine.

One personal perspective of mine on the issue of specific pathways to recertification is related to the literature based self study program administered by the ABOG for OB-GYN recertification. The more I have studied this program the more I like it. By drawing candidates directly to the medical literature, and recertifying on a year-to-year basis, I think this type of program would have broad appeal to internists from many different perspectives. It is my hope that something like this program is chosen as a pathway for internal medicine recertification.

Finally, the ACP Education Committee presented a series of draft documents that enunciated principles guiding the relationship of education and evaluation to development and maintenance of competence, as well as working definitions of medical education, evaluation, and practice performance measurement. Clear definition of principles and terms should also help as discussions continue with the ABIM.

The new negotiating points espoused by the ACP governing boards go a long way toward moving us forward with solutions to these thorny problems. There remains a long path ahead, and perhaps other stumbling blocks that may arise as negotiations with ABIM continue. It is my hope that ACP and ABIM will work rapidly to make substantive modifications to recertification based on the ideas noted above. If this happens, then the efforts by ACP leadership will have helped individual internists to work in a better environment, and internal medicine to grow and to thrive in the twenty first century.

Bringing Home the Bacon

The Alaska Chapter ACP received the Chapter Management Award and also an Evergreen Award at the April 2002 Board of Governors meeting.

I've lost count of how many years in a row that we have been awarded the Chapter Management Award, but it is a lot. This award signifies that our Alaska ACP Chapter has met all the fiduciary criteria, but also recognizes the many activities that our chapter organizes and promotes. We'll receive our certificate at the Chapter Meeting June 27-29, 2002 in Anchorage.

We also received an Evergreen Award. Evergreen Awards are presented to chapters for specific activities that further the growth and development of ACP at the grass roots level. This year, we received an award for our grand rounds program in Anchorage. This program was developed in conjunction with Providence Alaska Medical Center, Alaska Regional Hospital, and the Alaska Native Medical Center to promote a curriculum driven, bias-free grand rounds program. The program has been successful both financially and intellectually, and would not have been possible without the participation of the Alaska Chapter ACP.

It is gratifying to have our chapter recognized at the national level for our activities.

ACP Name Change

It was agreed upon when ACP and ASIM merged some years ago, that after a specified period of time the name of the organization might be shortened. That time is upon us now, and the ACP governing boards have been studying how best to proceed. At this point, it looks like we may soon be once again the American College of Physicians.

As part of the discussion, it was clear that there is broad agreement that the merger between ACP and ASIM has been very successful. ACP has been a very capable and powerful advocacy organization for our membership while at the same time preserving a set of professional values based on the primacy of the patient and the value of life long professional development and learning.

There has been some concern about omitting reference to internal medicine in the name, but the long tradition of the American College of Physicians and the respect the organization has garnered were felt to be overriding considerations when this was discussed in the Board of Governors meeting.

Alaskans at the ACP Annual Session

At the annual session convocation, April 11, 2002, Dr. Norman Wilder was officially recognized as an ACP Master and he can now use the designation MACP in his credentials. He joins Dr. Rod Wilson who became a master in the college several years ago.

The college appoints very few masters, and this honor is bestowed on Dr. Wilder for his contributions to the profession both on a local level and also within the ACP national organization. Congratulations Norm on a great career and your wonderful contributions to internal medicine.

Norm got to celebrate after the convocation, and is pictured with his wife Cathy, Walt McDonald, retiring EVP of the ACP, and his wife Barbara, Keith Brownsberger, and Julie Ake who serves on the national ACP student council and on the Alaska Chapter ACP council.

Keith Brownsberger also marched in the convocation in recognition of receiving the Alaska Chapter laureate award in June 2001. Keith served as governor of our chapter in the late 1980's and has probably attended more ACP annual sessions than any other Alaskan. He continues to contribute to the success of our chapter.

Our Alaska Chapter helped to sponsor two medical students to attend the annual session. Ben Westley and Jon Anderson each received a $300 stipend to help defray the costs of attending the meeting. Through its activities, the Alaska Chapter is committed to promoting careers in internal medicine for young physicians and we were excited to help Ben and Jon attend the meeting. They tell me that the sessions on ethics and professionalism that they attended were particularly provocative for them as students starting to contemplate some of the dilemmas that confront the profession.

Journal Club—mark Your Calendar

The next Alaska Chapter ACP Journal Club meeting will be May 16, 2002, 6:30 pm at my house, 9681 Midden Way (up in Stuckagain Heights). We'll have dinner ready for you and David Hellmann MD, FACP will be reviewing recent literature in rheumatology. Dr. Hellmann is ACP Governor from Maryland. He will also be doing grand rounds presentations at the Alaska Native Medical Center on Thursday May 16 at noon, at Providence Hospital on Friday May 17 at 8:00 AM and at Alaska Regional Hospital on Friday at 12:15 PM.

We'll continue to have Journal Club three to four times a year, picking speakers from our grand rounds schedule to do these more informal evening gatherings. Recent attendance has been excellent, and this affords us all a great opportunity to kibbutz with some of the best clinicians and scientists around.

Alaska Chapter Meeting June 27-29, 2002

2002 Alaska Chapter ACP
Annual Meeting
June 27-29, 2002

History of Medicine: A Look Back and a Look Ahead

The time nears for our Alaska Chapter ACP Annual Meeting June 27-29, 2002.

We have a great topic, History of Medicine, and a great line up of speakers. Where else could you hear physicians like Faith Fitzgerald, Lynn Loriaux, and Jock Murray all in the small forum of our Chapter Meeting?

Dr. Mary Herald, chair-elect of the ACP Board of Regents will be the college representative, and will also talk about the history and the future of diabetes care. Her husband Joe d'Oronzio PhD, MPH will be a speaker at the meeting as well.

Finally, Robert Doherty, ACP Senior Vice President for Governmental Affairs will be there to give you the Washington Update, and to discuss the history of politics in medicine.

You should not miss this meeting! You can view the brochure for the meeting, which includes the full schedule of events, at www.alaska.net/~stuckrik/index.html