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Governor's Newsletter, January 1999

Governor's Corner

I hope that this newsletter finds you and your families in good health and looking forward with some anticipation to the upcoming last year of the millennium. It is common to announce one's personal resolutions for the coming year, in some ways to set a 'bar' to measure up to in January 2000 (doesn't that still sound a bit odd?). I generally don't announce these publicly, but internalize them and allow my own heightened sense of self-criticism take hold. However, this has been a year of relative stasis within the Chapter as we have accomplished the transition to the newly merged ACP-ASIM. I think it is fair, therefore, for me to discuss some recent changes and the challenges I have set for the Chapter and myself for the 2.33 years that I have remaining as your Governor.

As a consequence of the merger I have made a personal commitment to each of you to maintain the best of both organizations. I have come to believe that I cannot achieve this goal with the traditional infrastructure of either the old Colorado Chapter or the old CSIM. With the help of your leaders, I have been reviewing the Chapter's Committees from the standpoint of leadership, participation, and effectiveness. As we move from what we were to what we can be, I intend to use the Committee structure as the engines for change within our organization. I pretend no prescience in this regard. What I offer are initial suggestions that are likely to be modified as they are tested in practice. I truly welcome the advice, support, criticism, or invective that these initial changes may engender from our membership.

Committee Leadership - The following have accepted positions as Chairs

  • Nominating Committee - Herbert Rothenberg, MD, MACP
  • Finance Committee - Joseph Matthews, MD, FACP
  • Membership Committee - David Albey, MD, FACP
  • Medical Student Committee - Debra Parsons, MD, FACP
  • Associates Committee - William Kaehny MD, FACP and Robert Gibbons, MD, FACP (Alternating every other year)
  • Health and Public Policy Committee - Christopher Unrein, DO, FACP
  • Program Committee - Robert Swaney, MD

Committee Membership

  • Nominating Committee - To be composed of senior Fellows within the Chapter who have the perspective to evaluate the eligibility of their colleagues for major College accolades.
  • Finance Committee - Composed of members from all segments of our Chapter who will be impacted by resource allocations.
  • Membership Committee - Composed of members representing the diversity and geographic distribution of our membership.
  • Medical Student Committee - Composed of members representing the Department of Medicine, Medical Students, as well as Full-time and Community based faculty.
  • Associates Committee - Training directors, members with interests, and Associates.
  • Health and Public Policy Committee - Should have representation from any in our Chapter that want to actively impact the public health and policy environment that effects our membership.
  • Program Committee - All who have an interest in the content and direction of the educational content of our annual meeting.
  • Governor's Advisory Committee - All Committee Chairs ex-officio. Two members elected each year by the membership for 4-year term. All ex-Governors ex-officio. All Regents and ex-Regents ex-officio.

Committee Participation

  • Beginning with this calendar year distance will not be a reason for our membership not to participate. For either purposes of convenience or distance our Chairs will be given the fiscal resources to conduct their business using teleconferencing, FAX, or Internet.

Committee Charge

  • Nominating Committee - (a) to define criteria, and select candidates, for election to the post of Governor. (b) To propose candidates for the advancement of Fellows to Master. (c) To select candidates for statewide and national awards of recognition that are given by the ACP-ASIM. (d) To develop a budget for resource needs that are identified to accomplish goals.
  • Medical Student Committee - (a) To develop programs that encourage medical students at the University of Colorado School of Medicine to enter the specialty of Internal Medicine. (b) To encourage the members of this Chapter throughout the state to be actively involved as mentors and teachers of these medical students, by advancing the goals of the Primary Care Continuity Course and the Summer Practice Preceptorship Program. (c) To seek out resources to help fund the stated goals. (d) To develop a budget for resource needs that are identified to accomplish goals.
  • Finance Committee - (a) to actively seek out resources to allow the Colorado Chapter to achieve its mission. This would include both industry and foundation sources. (b) To evaluate requests for resources by the standing Committees and to make recommendations to the Governor and the Governor's Advisory Council as to feasibility. (c) To evaluate current Chapter dues structure.
  • Associates Committee - (a) to coordinate and organize the annual Associates Meeting. To encourage all Internal Medicine trainees to write up abstracts of research and/or clinical vignettes for submission to the meeting and the national ACP-ASIM meeting. (b) To develop programs that would encourage Internal Medicine trainees to become Associates of the ACP-ASIM. (c) To develop programs that would encourage the broader involvement of Associates in Chapter activities. To solicit educational grants from industry and foundation sources that help to support the missions stated above. (d) To help solicit educational grants from industry and foundation sources that support the missions stated above. (e) To develop a budget for resource needs that are identified to accomplish goals.
  • Health and Public Policy Committee - (a) to develop mechanisms to keep the Committee aware of public policy issues at the regional and national level that may impact our patients or our specialty. This would include monitoring legislation at the state and national level. (b) To identify mechanisms by which the Chapter can become broadly involved in advocacy for the issues we identify as important for our patients and our profession. This would include mechanisms for better and more rapid communication with interested members through the state. (c) To identify an issue that affects our patients or our profession that cuts across specialty/sub-specialty lines that the entire Chapter can mobilize behind on a statewide basis. Central to the choice of an issue is that it has the potential for engaging the interest and involvement of a broad base of our membership. (d) To provide a group to review ACP-ASIM health policy under development. (d) To develop a budget for resource needs that are identified to accomplish these goals.
  • Membership Committee - (a) to develop and initiate strategies by which Associates and Members throughout the state that are eligible for advancement are identified and enabled in this process. (b) To identify the Colorado Internists who are not members of the ACP-ASIM, and consider mechanisms by which they might be recruited into the organization. (c) To develop a budget for resource needs that are identified to accomplish goals.
  • Program Committee - (a) to select the program, and speakers for the Annual Meeting of the Colorado Chapter of the ACP-ASIM. (b) To develop a budget for the resource needs that are identified to accomplish these goals.
  • Governor's Advisory Council - (a) Review all requests for resource allocations forwarded to and evaluated by the Finance Committee, put requests in context of overall mission of the Chapter and the ACP-ASIM, and recommend appropriate allocations to the Governor. (b) To act as primary site for generation and review of potential resolutions to the Board of Governors that will be voted on by the Governor. (c) To serve as an advisory Committee to the Governor for the review and modification of the Chapter's By-laws.

Recognizing the top-down organizational structure that has been traditional in the antecedent organizations, this is an ambitious restructuring of process for the new Chapter. The plan places greater responsibility for action and resource allocation with the membership taking part in the committee structure. The plan reduces the direct control of the Governor over these processes while expanding input from the membership. The plan sets ambitious new goals for the committees and their Chairs, but offers the promise that resource (e.g. dues) will be available for the development of new initiatives. In short, the plan offers the potential for the Chapter to evolve into a busier, more active, more creative, institution that helps our membership succeed in identifying our appropriate role in the health care 'system,' and creating a healing environment for our patients.

Some will immediately recognize the potential 'fatal flaw' in this plan. If the membership is not interested in becoming more involved in the Chapter and its works... if the membership doesn't care enough about the issues that confront them to participate... if the membership wants someone else to do the work... then we cannot change, we cannot evolve. We will remain a centrally controlled (e.g. Governor-directed) organization that will have a limited (by the time that individual can commit to the organization) impact on our practice of medicine.

I hope that the 'fatal flaw' remains potential and unrealized, and that you will join with your colleagues to create something new and different for the specialists in adults in Colorado. I will be calling some of you directly asking for a bit of your time. I solicit inquiries from any members who believe they have an interest or a skill to contribute. I look forward to the coming years with some anticipation.

News From the New ACP-ASIM

New Community Based Teaching (CBT) Award Now Available: The CBT Excellence in Teaching Award

On November 1, 1998, the ACP-ASIM Board of Regents approved the CBT Excellence in Teaching Award. This new award for CBT practitioners is substantially different than the Preceptor Recognition Award. The essential criteria for the Preceptor Recognition Award include participation in CBT for 2 out of 3 years, with at least 2 years at the same sponsoring institution. In contrast to this award, the CBT Excellence in Teaching Award requires involvement in a CBT program for 7 out of 10 years, with at least 3 years at the sponsoring institution, and an average of 50 hours of direct trainee contact during those years. In addition to the time requirement, the practitioner must also meet certain measures of teaching excellence, which are defined in the application document. Both awards are available only once for each individual. That is, an individual CBT physician may be honored with both a Participation Award and a CBT Excellence in Teaching Award, but only once for each. We will be working with our Medical Student Committee and Lorraine Adams of the Department of Medicine to identify eligible clinical faculty.

The ACP-ASIM Annual Session 1999 - April 21-25, New Orleans

Join your colleagues for a mixture of education and fun at the first Annual Session since the merger of the ACP-ASIM. From CME credits to recertification preparation, hands-on clinical skills workshops to computer training sessions, the 1999 Annual Session has something for everyone.

Both generalists and subspecialists will gain invaluable knowledge and insight from the sessions' nationally recognized faculty. Don't forget to register in advance for those sessions that require reservations. There is no additional fee to attend a reserved session, but requests are filled on a first-come, first-served basis.

While ACP-ASIM members are broadening their educational horizons, their guests can discover where to shop and where the locals dine and dance at the guests' "insider's orientation." Planned tours and seminars include: C'est la vie on the Bayou: A Swamp Tour Experience; Southern Living: Plantation Homes; Moonlight and Jazz on the Mississippi; A Cooking Experience with a Great Louisiana Chef; as well as others. The internationally recognized Jazz Festival begins on the weekend of April 23rd, and shouldn't be missed by music lovers.

Annual Session - Council of Associates Plans Workshop on Stress

During their residency training, residents face three types of stress: situational (stresses of the training program); professional (increased responsibilities for patient care and teaching); and personal (marriage, parenthood and financial). Often these stresses overlap and may result in depression, burn out, impairment, and, in some cases, suicide.

Recognizing the importance of coping with stress, the Council of Associates is working on several approaches to the problem. One is to post information on signs of stress, intervention, and resources on the Council's web page. A second is a workshop at the 1999 Annual Session in New Orleans. On April 23rd, from 11 a.m. to 12:30 p.m., Faith T. Fitzgerald, MD, MACP, Governor, Northern California Chapter, will moderate a Council-sponsored workshop on residency and stress. The Council hopes you will attend.

Associates - Local Issues

We would like to have Associates as members of the Health and Public Policy Committee, Governor's Advisory Council, Membership Committee, and Medical Student Committee. Additionally, if there were an interest, I would be happy to create an expanded self-directed charge (and Associate Chair) for the Associates Committee that would go beyond the current focus on abstract writing and presentation. Broader social or political issues could be addressed. Associates who have an interest in learning more about their specialty and the forces that impact it please let me or your program directors know.

Dues Adjustments/Waivers

ACP-ASIM members should know that there are several circumstances under which national dues can be adjusted or waived on a temporary basis or permanently.

Retirement

Members who have reached age 60 can request one of the following options.

  • Dues permanently adjusted to the lowest rate (currently $96) per year, with maintenance of all benefits including the three College publications; or
  • Dues permanently waived, with maintenance of all membership benefits except the three College publications, although either Annals of Internal Medicine or the ACP Journal Club can be purchased at significantly reduced rates contacting Customer Service at one of the numbers shown above.

Requests should be made in writing, addressed to the Customer Service Department, by mail, fax at (215) 351-2799, or e-mail at custserv@acponline.org.

Disability

Members who are permanently disabled can request either one of the two options noted above. Their written request must explain the nature of the disability, and should be addressed to Dr. Joseph E. Johnson III, Senior Vice President for Membership. The request may be sent by mail, by fax at (215) 351-2759, or by e-mail to jjohnson@acponline.org.

Members who are temporarily disabled can request a temporary adjustment or waiver by requesting it in writing, explaining the nature of the disability, to Dr. Joseph E. Johnson III, Senior Vice President for Membership, as noted above. Temporary adjustments or waivers must be requested on a year-to-year basis, and the request should be submitted by May.

Financial Hardship

Dues can be adjusted on a temporary basis if a member is experiencing a serious reduction in income due to a career change, or family leave, etc. The request must be put in writing and sent to the Customer Service Department via mail, fax or e-mail. The adjustment is generally to the lowest dues rate (currently $96 per year) and must be requested on a year-to-year basis by May. It is usually only granted for 2 or 3 years in a row.

Fellowship Training

Members can request a dues adjustment to the Associate rate (currently $96) if they have returned to do additional residency or fellowship training. They must request it in writing, giving the name and address of the fellowship training program, and the start and proposed end dates of training. The request must be in writing on a yearly basis for as long as they are in training; it should be sent to the Customer Service Department.

Couple Dues

Members who are couples may request a reduction in dues for one member of the couple; the request must be in writing and sent to the Customer Service Department. After the adjustment, only one set of publications is sent, to the individual the couple designates.

The adjustment will be in effect on a permanent basis, or until the couple notifies Customer Service that they are no longer a couple. Then both members will be charged the rate at which they normally would be charged, and both will receive sets of publications.

ACP-ASIM's National Council of Student Members

Medical students are important to ACP-ASIM, as they represent the future of medicine. Through membership in ACP-ASIM, medical students can learn about a career in internal medicine or one of its subspecialties. The Medical Student Membership program has been underway for about five years now, and has been very successful, with around 13,000 Medical Student Members currently. In 1998 the College formed the Council of Student Members (CSM). The CSM currently has eight members, who represent medical students throughout the United States. We are privileged that Eric MS II, has been chosen to be one of these eight students.

The CSM had its first official meeting in October 1998 at the Philadelphia headquarters. After an orientation and introduction to ACP-ASIM, the CSM began working on identifying what is important to medical students and what medical students want to know about internal medicine. The CSM prioritized their goals and are developing an action plan to meet those goals. The CSM wants to:

  • add more information for medical students to ACP-ASIM Online;
  • publicize the flexibility of career options in internal medicine;
  • establish relationships with all of the medical schools in the United States;
  • help medical schools develop internal medicine interest groups;
  • assemble a resource package for internal medicine interest group leaders; and
  • establish strong relationships with local ACP-ASIM Chapters and Governors.

Medical Students - Local Issues

Many of the goals of the Council of Student Members are not new to the Colorado Chapter. Our own Medical Student Committee has initiated innovative programs that can serve as models on the national level. We welcome the participation of medical students in the structure of our Chapter. If you have the time and the interest, and wish to participate in our Chapter committees please contact me at the University.

Medical Services Committee

With the establishment of the ACP-ASIM most of the previous functions of the ASIM were incorporated into the ACP committee structure. However, it was obvious that direct advocacy for the many issues that have an impact on Internal Medicine could not be accomplished by the Health and Public Policy Committee of the old ACP. Therefore, the Medical Services Committee (MSC) was created. Regent Cecil Wilson, MD, FACP was selected as the Committee Chair and I was asked to serve as the Vice-Chair. Our first meeting had a very full agenda that covered the full panoply of legislative and regulatory issues confronting our specialty. I was impressed by the Washington staff's action oriented approach to these issues, that allowed the new organization to rapidly mount a very effective advocacy effort that was centrally responsible for the failure of the 'end-of-life' legislation that threatened our ability to provide effective pain control for terminally ill patients. The agenda for the upcoming meeting this month is daunting and includes a face to face discussion with representatives of the Office of Inspector General to air our concerns about their interpretation and prosecution of fraud and abuse legislation. An update on these policy issues will be provided at our Annual Meeting in the Broadmoor Resort on February 18-20, 1999.

Happy New Year