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Governor's Newsletter, October 1997

The Governor's Corner - The Good News and ...

Since my last newsletter there is some great news for the members of this chapter, but unfortunately some that is not good for our patients.

First the great news. In September, after a full day's discussion at the fall Board of Governor's meeting, the Board of Governors voted overwhelmingly to support the principles of the merger of the ACP with the ASIM. I want to thank the dozen or so of you who took the time to let me know your thoughts on this issue. All supported proceeding with merger, as have been all of my informal discussions with members over the past years. It was helpful to have that non-statistically significant sampling when I voted to support merger. We still must wait the vote of the ASIM's House of Delegates at the end of October before initiating the due diligence process that will lead to a formal joining of the two organizations that have represented the specialty and sub-specialties of Internal Medicine.

I want to emphasize the word 'principles.' The details (as in the 'devil's in the ...') of the merger will need to be thrashed out over the next months, and I fully expect these discussions to raise controversial issues, particularly in states where the local relationship between ACP and ASIM has been less cordial than in Colorado. Both sides, I believe, are committed to equitably work through solutions with the goal of having one organization by July 1998. Once the House of Delegates has favorably (I hope) voted in support of these principles I can describe them to you in greater detail, and begin the process of having members of the CSIM formally (as opposed to the current 'informal' participation of joint members) become part of our governance and Committee structure.

Now for the bad news. Despite a strong economy that has created millions of jobs. Despite an almost negligible unemployment rate. Despite increased affordability of health insurance. The number of uninsured in the United States continues to grow. The most recent figures show we have gone from 40.4 to 41.4 uninsured non-elderly Americans in the past year. As some of us predicted, the market-driven health care 'reform' has not led to some 'trickle-down' phenomenon. Access for the indigent remains a central aberration of our health care system. There will not be some 'big bang' that takes care of this problem, but much can be done to see a reduction in this tragedy over the next decade. Clearly, waiting for the 'market' will be as productive as waiting for Godot.

Those unwilling to wait deserve our admiration and support.

For those needing one more reason to maintain active membership in the College, I will remind you that we have been, continue to be, and will remain the SINGLE LARGEST, MOST RESPECTED, AND EFFECTIVE ADVOCATE FOR THE POSITION THAT OUR SOCIETY HAS AN OBLIGATION TO PROVIDE ADEQUATE HEALTH CARE FOR ALL ITS CITIZENS. I am proud of this, I expect you are as well. The national Health and Public Policy Committee is working on specific legislative policies that can incrementally reduce the number of uninsured. But we are not alone.

Under the leadership of the American Academy of Pediatrics the recent Budget legislation provides for new resources to help reduce the number of uninsured children. The College provided full advocacy support for this bill. Advocacy that was completely detached from any possible remuneration for its members.

The American Board of Internal Medicine and the ACP Council of Associates have a stated commitment to support and expand opportunities for Internists to volunteer time for their communities.

The Colorado Medical Society, under the leadership of Dr. Gary VanderArk, has committed this year to formulate new approaches to the problem of medical indigency.

Our Chapter needs to be involved in these initiatives.

Our Chapter will be involved in these initiatives.

I will be charging our Chapter's Health and Public Policy Committee with formulating explicit approaches for our local involvement and advocacy of these issues. We will then bring these suggestions back to the membership, with the expectation that we will see our Chapter become an integral part of the evolving solution to medical indigency.

A Report on the Resolutions Hearing at the Board of Governor's Meeting

Resolution 109: BE IT RESOLVED that the ACP invite its sister organizations in internal medicine to explore the feasibility of drafting and implementing global principles for internal medicine, consistent with regional needs and resources. PASSED. Intent is to coordinate with the IM societies of other countries.

Resolution 110: BE IT RESOLVED that the ACP work with the ACP Research Advisory Group, the Association of American Medical Colleges, and other interested organizations and individuals to sponsor a survey of the status of women within departments of medicine in both academic and private sector settings. PASSED.

Resolution 111: BE IT RESOLVED that a current ACP governor be provided the ballot results of an election for Governor held within that Governor's Chapter. PASSED. I'm not sure what the need for this is and feel it is unlikely that we would care to see the results in Colorado.

Resolution 112: BE IT RESOLVED that the ACP reaffirm its position that it is the obligation of society and physicians to assure that all people receive needed health care. PASSED. Reiterative of current policy.

Resolution 113: BE IT RESOLVED that the ACP take an active role in educating its membership about the various modalities of complimentary and alternative medicine in order to better care for our patients who may be considering and/or participating in such care. PASSED. Forwarded to Education Committee for follow-up.

Resolution 114: Internal Medicine Name Change to Adult Medicine. WITHDRAWN.

Resolution 115: BE IT RESOLVED that the ACP educate its members in the appropriate use of telemedicine, as well as the legal and privacy considerations accompanying the use of such technology. PASSED. Forwarded to Education Committee.

Resolution 116: BE IT RESOLVED that the ACP acknowledge the strong sentiment of the Board of Governors that graduate medical education and employment opportunities be based on merit, and that it re-examine its physician workforce and graduate medical education policies/positions. PASSED. (This referred to International Medical Graduates - IMGs)

I need to let you know I voted against this one. I agree that once trained IMGs (or any qualified physician for that matter) should have equal access to jobs. I could not support the training part of the resolution because I believe there is going to be a large oversupply of physicians in the U.S., and we need to reduce the number of trained physicians entering the workforce. The options aren't pretty. We can cut down on the number of medical student positions (already hard to get into for American students) or dramatically reduce the number of GME slots (currently at 145% of the American graduating school class). If GME is limited, I couldn't rationalize a system that allows IMGs to take limited training spots from American medical school graduates. What are your thoughts?

Resolution 117: 'Consolidation of Internal Medicine Organizations' DEFEATED. In light of proposed merger of ACP/ASIM this was felt to be unnecessary.

Resolution 118: 'Physician workforce: Distribution of Residency Positions on Basis of Local Needs' DEFEATED.

The Colorado Chapter RESOLUTION 119: BE IT RESOLVED that the Executive Committee of the Board of Governors, in concert with the Health and Public Policy and Membership Committees, develop a plan to evaluate and improve the College's grassroots advocacy activities. PASSED UNANINMOUSLY. This will become a formal part of the 'details' of ACP/ASIM merger.

Resolution 120: BE IT RESOLVED that the ACP waive the registration fees for Governors to attend the Annual Meeting. PASSED. Based largely on the fact that College business keeps us from attending 80% of the meeting.

Resolution 121: BE IT RESOLVED that the ACP support initiatives that require insurance plans to offer point of service options that allow patients to receive out of network health care services. PASSED.

Resolution 122: BE IT RESOLVED that the final proposals for merger between the ACP and the ASIM be ratified by the Board of Governors as representatives of the general membership. PASSED. To assure a broader input into the 'details.'

Resolution 123: BE IT RESOLVED that the ACP investigate alternative levels of membership, with lower costs, and fewer benefits, such as eliminating journal subscriptions. PASSED. Forwarded to the Membership Committee.

The number of resolutions keeps increasing each year, suggesting that the Chapters are beginning to view the process as more democratic. I would only note in passing that we are 1 for 1 in acceptance of resolutions.

The Annual Chapter Meeting - February 2-5, 1998 - The Broadmoor

Shortly you will be receiving the brochure and registration form for our annual Chapter meeting. I think you will agree that the Program Committee has put together an interesting, informative, and practical group of talks on the treatment of common disorders. Representatives of the ACP Board of Regents and the ASIM Board of Trustees will be joining our meeting, allowing for an update on the merger.

With our attempts to slowly increase our membership's understanding of the workings of this Chapter (and hopefully your sense of ownership and involvement) an aspect of the meeting costs needs to be clarified. You will note that a new payment policy has been created that differentiates on one basis only - it will cost $15 more for any non-trainee who does not pay Colorado ACP Chapter dues. The reason for this is simple: the meeting costs the Chapter some $8-10,000 more than we receive in fees. This difference, in large part, is paid for by Colorado Chapter dues. It would not be fair for attendees who do not pay Chapter dues to effectively have their fees subsidized by those who do pay dues. Thus, the change in policy. Please call me if you have questions or concerns.

Also I want to emphasize that the Banquet is 'Black Tie Optional.' This allows those of you who want to get out the glad rags and fit into the historical opulence of the Broadmoor to do so; while allowing everyone else to feel comfortable with business attire. Enough said.

Activities of the Medical Student Committee

Over the past four years our Medical Student Committee has had a very productive and collaborative relationship with the Office of Student Affairs of the Department of Medicine of the University of Colorado School of Medicine. Robert Schrier, M.D., MACP has been most generous in his creation and support of a unique educational resource. Lorraine Adams, MSW is the full time Director of the Office and is assisted by Linda Sipos and Jennifer Weber. In addition to monitoring and managing the 3rd and 4th year clinical rotations, the Office has worked with the Colorado Chapter to create activities that will interest more medical students in a career in Internal Medicine (Doctors for Adults - remember?).

The Colorado Chapter's Medical Student Committee under the leadership of Deb Parsons, M.D., FACP (Members = Brian Dwinnell, M.D, Barabara Whitcomb, M.D., Jeannette Mladenovic, M.D., FACP, and Patricia Byrnes, M.D., FACP)has worked with Ms. Adams to develop a wide variety of activities that help students to understand the full scope, challenge, and enjoyment that comes from practicing internal medicine or one of its sub-specialties. I would like to take the remainder of the newsletter to let all of our members see what an effective committee within the Chapter has been able to accomplish within a short period of time.

  • Arranging Clinical Preceptors for Primary Care 1,2,3 Course - A very successful and innovative course at our Medical School. Many of our members, and clinical faculty in the Department of Medicine, have contributed invaluable time to mentor young students 1/2 day per week.
  • Summer Preceptorships - developed by combining resources from this Chapter and foundation money, 21 students experienced office-based internal medicine first hand this past summer.
  • Internal Medicine Club - Free lunch and information. Supported by our Chapter, this monthly event brings interested students together with practitioners. Lisa Winslow, M.D. is talking about Alternative Medicine this coming month.
  • Student Journal Club - Allan Prochazka, M.D. teaches students how to be life-long learners by critically evaluating the medical literature.
  • Salvation Army Globeville Clinic - Helps our students volunteer time for the medically indigent.
  • ACP Medical Student Abstract Competition - Research or clinical vignettes. The winners go to San Diego!
  • National Primary Care Day - Our chapter provided $250 for the support of this 2 hour celebration on September 26th. The internal medicine informational table was staffed by Lorraine; Drs. Peter Nutson, Jeff Glashen, and Kristin Burkhart of the University's housestaff; Nora Morgenstern, M.D. of the Division of Geriatrics; and yours truly.

This Chapter can take great pride in these accomplishments.