From the Governor’s Desk- Robert McLean, MD, FACP
“Change is coming, and you can’t fight it.”
The healthcare system is changing, like it or not. Many are frustrated, but many welcome what are felt to be needed reforms. Here are a few questions which have been posed to me during my short tenure as your Chapter Governor:
“Why isn’t the ACP doing more to help physicians in practice maintain the ability to see and treat our patients as we see fit, since we clearly have the necessary training and knowledge to serve our patients well?”
“Why doesn’t the ACP continue to resist the attempts by third-party intermediaries and government bureaucrats to mandate how we practice and document our care?”
“It seems like the ACP has decided that this construct called the “Patient-Centered Medical Home” (PCMH) is the only path to saving primary care internal medicine. Doesn’t the ACP realize this adds technology expense (EMRs), unreasonably requires me to prove I’m a good doctor by outcome/performance measurement, and adds to my personnel overhead since now my practice needs other team members to qualify as a PCMH? All this hassle just takes time away from me delivering good care in the exam room. Why can’t we just practice traditional medicine like the good old days?” “I just want to take care of my patients. That’s why I became a doctor. Can’t we get rid of the administrative hassles?
A simple answer to all these questions is DATA. We are not as reliable as a profession at delivering good health care as we think. Plain and simple. It was not until we had large computer generated data bases that this became evident. And when those paying for the care (employers, insurance companies, and the government) saw skyrocketing costs overall but tremendous geographic variations in health care spending, they started to ask questions. Why does it cost twice as much to take care of a Medicare beneficiary in Miami as in Minnesota? The answer is not better care, since these analyses also demonstrate there is no correlation between dollars spent and outcomes (See highly publicized paper by Atul Gawande “The Cost Conundrum” in The NewYorker June 2009 as well as “A Dartmouth Atlas White Paper- Improving Quality and Curbing Health Care Spending: Opportunities for the Congress and the Obama Administration” in December 2008). Whoops. Can we really blame those paying the bills for asking some logical questions which follow?
*Is that more expensive new medication really more effective that the cheaper old generic one?
*Does that particular expensive test really make a difference in making that diagnosis?
*Does that surgical procedure really help improve the outcome of the condition 1-2 years later?
Sure, these question our clinical judgement (how dare they do that!) as we think we are delivering the best care for our patients. But we must accept the premise that just maybe we are not always practicing in the most clinically effective or cost-effective way with every one of our decisions. Computer technology will allow us to get reminders on care we know we need to deliver but which gets lost or forgotten in the morass of information we handle in our complex medical patients with multiple medical problems. Is all this really “progress” or just a way to denigrate the complexities of our work as physicians? No doubt, these changes are painful.
I have heard the reply, “All the requisite changes are making my life miserable, and I am not delivering any better care”…or are you?
Without the ability to measure many of these outcomes, you cannot know. We are trained as scientists, and we must admit that well-interpreted data must drive our decisionmaking.
The ACP is ready and able to help. More than any other physician organization, the ACP sits at the table giving input with various coalitions and government reformers as our health system is being designed to undergo significant health reform. The dysfunctional nature of our health care delivery system has seemingly reached the point that it will not be tolerated anymore by public opinion, the Congress, and President Obama. “Now, there are some who question the scale of our ambitions, who suggest that our system cannot tolerate too many big plans. What the cynics fail to understand is that the ground has shifted beneath them, that the stale political arguments that have consumed us for so long no longer apply.” President Obama, Inaugural Address, January 20, 2009
In addition to strong advocacy work and policy position papers, the ACP has resources to help your practice face many challenges. Explore the ACP website www.acponline.org . You will be impressed with the Practice Management section and especially the Center for Practice Improvement and Innovation.
In this ever changing and challenging environment of health care delivery, you will find support and encouragement at all levels from the ACP. Please get involved. Our Chapter has several committees, and I encourage you to contact the appropriate chairperson if you have interest in a particular area. My work with the ACP through the years has proven very gratifying, and I expect you will discover the same. I look forward to serving as our chapter’s Governor over the next four years and hope to see you at our annual Chapter meeting in late October.
It’s a very exciting time, and you will not want to just sit on the sidelines and watch. Change is coming, and you can’t fight it. The ACP is doing what it can to ensure that the change will serve our patients well and allow physicians to deliver effective and efficient care.
Governor Eric Mazur welcoming incoming Governor-Elect Robert McLean at Convocation April 2009
Council of Young Physicians - submitted by Jeanette Tetrault, MD
On March 4, we held a very successful networking event at Barcelona’s in West Hartford. We had a great turn out and look forward to our next semi-annual event. Our main priority continues to be recruitment of a core group of young physicians. We invite any interested physician members who qualify (sixteen years or less since graduating medical school) to become involved.
Additionally, since our last update, the Council was represented at Leadership Day on Capitol Hill. Rebecca Andrews, co-chair of the Young Physicians Council, spoke for CT’s young physicians at this annual ACP lobbying event. It is a time of exciting political change in Washington, and we are feeling confident that our voice was heard.
Our next semi-annual event will take place in the fall. We will continue to host events at sites throughout CT in hopes to be accessible to many interested members. If you would like to become a member of the Council or would like to participate in future Young Physician activities, please email either of us (firstname.lastname@example.org; email@example.com) or look for future postings on our Chapter website.
Health & Public Policy Committee-submitted by Keith Vom Eigen, MD
With all the health reform activity going on in Washington this year, you’ll be glad to hear that ACP has been in the forefront promoting policies to expand access to affordable, high quality health care for all Americans, and to make sure we have the workforce available to meet these goals. The Connecticut Chapter has been doing its part to make sure our legislators are aware of ACP policy recommendations, and understand how these policies will help meet the nation’s health care needs. Seven representatives of the Chapter (Robert McLean, Eric Mazur, Keith Vom Eigen, Rob Nardino, Rebecca Andrews, Todd Staub, and Dan Henderson) traveled to Washington for the annual ACP Leadership Day on May 20th. This is the day when ACP representatives from all over the country converge on Capitol Hill to meet with legislators to deliver ACP’s health policy message. In contrast to past years, we found Congress geared up for a major legislative push for health care. We met personally with three Representatives (Murphy, Courtney, Himes), and health policy staffers for the other Representatives (Larson, DeLauro) and two Senators (Dodd, Lieberman) representing Connecticut. In our conversations we were gratified to find our legislators aware of and supportive of the ACP legislative agenda. They recognize the need for reforms to correct our system’s built-in bias against Primary Care, and the need for policies to nurture the health care workforce we will need for our aging population. Be assured that the Chapter will continue to work with our legislators to promote these objectives as the health reform process plays out.
The CT delegation for Leadership Day on the steps of the Capitol, May 20, 2009
On the local front, this year’s state legislative session also produced some major health care policy efforts, most notably the Sustinet Health Care Plan developed by the Universal Health Care Foundation of Connecticut. The Connecticut ACP chapter, with support of the national ACP, and in cooperation with State Medical Society, testified in favor of the Sustinet plan in legislative hearings, because we found it consistent with ACP policies on expanding access to care. We also were impressed by the breadth of support the proposal gained from physicians, nurses, patients, business groups, religious leaders, social service agencies, and community organizers. Although the bill passed in both houses, it is uncertain whether the Governor will support it, especially in this difficult economic environment. The Chapter promoted ACP policies in other state legislative debates as well, such as that regarding the scope of practice of nurse practitioners.
Regardless of where you stand on health care reform, the coming weeks are sure to be one of the most exciting, and hopefully productive, periods in our progress towards a more efficient, equitable, and accessible health care system. If you have any questions about Chapter health policy activities, or would like to become more involved in this regard, feel free to contact Keith vom Eigen at: firstname.lastname@example.org.
Rep. Joe Courtney with our Leadership Day delegation in his office: Rob Nardino, Rebecca Andrews, Robert McLean, Rep. Courtney, Dan Henderson, Eric Mazur, Todd Staub and Keith Vom Eigen
Medical Student Committee - submitted by Barry Wu, MD
We are thrilled that Connecticut students continue to pursue careers in internal medicine. This year 14 of 74 (18%) graduating students from the University of Connecticut and 18 of 96 (18%) from Yale University matched to internal medicine residencies. This was the eleventh year the Connecticut ACP Internal Medicine Award was given at graduation to students entering a Connecticut internal medicine program. The recipients were chosen based on their academic achievement and community service. This year’s winners were Angela Stein, MD from the University of Connecticut and Aviva Romm, MD from Yale University. Angela and Aviva are by now seasoned interns at the University of Connecticut Internal Medicine Program and Yale Primary Care Program, respectively.
We look ahead to a new academic year and opportunities to network between the Scholars of Medicine Group at the University of Connecticut and the Yale Internal Medicine Interest Group. It is spectacular to have a renewed interest in internal medicine at both medical school campuses in Connecticut and we look forward to increasing membership. These efforts will be led by student leaders are Bryan Piccirillo (email@example.com) at the University of Connecticut and Samir Gautam (Samir.firstname.lastname@example.org) and Sameer Sheth (email@example.com) at Yale School of Medicine.
We hope to engage medical students with all that the ACP has to offer: resources to help with third year medical clerkships, with the residency application process, and with updates on health reform and legislative issues. The newsletter for medical students ACP Impact is a wonderful delivery to your e-mail box on a regular basis and will prove a worthwhile read. If you are interested in participating on this committee, please contact Dr. Barry Wu at firstname.lastname@example.org.
Associates Committee Report -submitted by Dr. Luca Paoletti
The Chapter Associates Committee sponsored a spring meeting focusing on different portions of medical liability and what occurs during litigation. We heard from a risk manager at John Dempsey Hospital who described the details of that position. Then the assistant Attorney General spoke about the different laws and regulations regarding medical litigation as well as rules and laws covering residents, tail coverage, and the Department of Public Health.
The final speaker was Rob Silva, a defense attorney for physicians. He walked us through the preparation for trial, from the initial meeting all the way to trial, and then through trials as well. He was a wonderful speaker, at times funny, but also serious. The final portion involved the two lawyers performing a mock deposition on the risk manager, a fascinating process to observe. An excellent 35 minute question and answer session concluded the meeting, which was wonderfully received and appreciated by all the residents attending.
Dr. Adam Silverman deserves kudos for a good job organizing the speakers and making the conference such an educational hit!
Diversity Committee Report - submitted by Naseema Merchant, MD & Joshua San Vicente, MD
The CT chapter ACP recently organized a Diversity Committee to address various issues related to our physicians, many of whom come from diverse clinical, cultural and ethnic backgrounds. The committee was conceived to address and accomplish several goals. Some of these include:
- Learn from our young, diverse group of CT members how the CT ACP Chapter can best serve their interests and be more relevant to their clinical practice and career goals.
- Increase the membership in the National ACP and CT ACP Chapter of internists from diverse backgrounds.
- Provide a forum for interaction and brainstorming for physicians interested in promoting diversity in Medicine.
The committee welcomes any ideas or feedback from members or non-members. For those individuals interested in serving on this committee or those wishing to share any ideas, please contact the committee chairs.
College Forms Collaborative Relationship with Pri-Med
The American College of Physicians (ACP) and Pri-Med Institute (PMI) have joined forces to launch ‘Pri-Med Access with ACP.’ The continuing medical education (CME) program aims to offer internal medicine physicians greater access to leading educators through a nationwide series of local, two-day programs that began this summer.
The CME curriculum covers diabetes, cardiovascular disease, dependency, and immunizations with a special focus on disease risk prevention and risk management. The format includes a combination of case-based lectures, interactive workshops, and “work with the expert” sessions.
“‘Pri-Med Access with ACP.’ will deliver new forums for CME that meet internists’ current needs,” said Steven Weinberger, MD, FACP, ACP’s senior vice president for medical education. “By combining ACP’s understanding of the needs and challenges facing physicians with the rich learning environments that Pri-Med events are known for, we will empower internists to make improvements in their practices.” ACP and PMI designed the CME curriculum after a comprehensive review of the clinical care needs and practice gaps of primary care physicians, leveraging the extensive Pri-Med physician member base for surveys, and supplementing this with other studies on the needs of practicing primary care physicians.
‘Pri-Med Access with ACP.’ will available to internists in 26 U.S. cities with a total of 48 programs in 2009, including one in Hartford in late September. Over time, the ACP chapters will play a pivotal role in adapting the curriculum to address the local or regional issues and challenges. The complete ‘Pri-Med Access with ACP’ schedule is available online.
Newly Elected Fellows:
Peter R. Cimino, MD, FACP
Ivette E. Diaz, MD, FACP
Sunil D’Cunha, MBBS, FACP
Benjamin R. Doolittle, MD, FACP
Marjorie P. Golden, MD, FACP
Steven C. Lieu, MD, FACP
Lionel S. Lim, MBBS, MPH, FACP
Naseema B. Merchant, MBBS, FACP
Elias I. Obeid, MD, FACP
Patrick G. O’Connor, MD, MPH, FACP
George C. Roush, MD, FACP
Frank J. Samperisi, MD, MBA, MPH FACP
Madura Saravanan, MBBS, FACP
Vadim Tikhomirov, MD, FACP
Henry N. Ward, MD, FACP
Housein Wazaz, MD, FACP
J. Francisco L. Yuvienco, MD, FACP
Winners of Medical Jeopardy (held on March 5, 2009)
UCONN (Traditional IM)
Ruchir Trivedi, MD
Vimal Rabdiya, MD
Subramanian Kannan, MD
Abhijit Ghatak, MD
Convocation 2009 in Philadelphia with newly inducted CT Fellows. Front (left to right) R. McLean (Governor-Elect), N. Merchant, M. Golden, H. Ward, E. Obeid, Y. Diaz, F. Yurvienco, and E. Mazur (Governor). Back (left to right) L. Lim, P. Cimino, P. O’Conner, F. Samperisi, S. D’Cunha, and V. Tikhomirov.
When: Friday, October 30, 2009
Where: Aqua Turf Club, Southington
Meeting Brochure and Registration
Don't miss the most exciting medical CME event in Connecticut this year!
Chapter Meeting Topics
We have incorporated successful formats from National ACP meetings:
Multiple Small Feedings of the Mind
-Nutritional Management After Bariatric Surgery - Rosemarie Fisher, MD, FACP
-Fascinating Nail Findings - Henry Schneiderman, MD, FACP
-And Other Topics
- Clinical Pearls:
-Hematology (Eric Mazur, MD, FACP)
-Diet and Nutrition (Lisa Sanders, MD)
- Professor in Action-2008 Thornton Teaching Award Winner (Andre Sofair,MD)
- SEP Modules: 2009 updates in office-based and hospital based internal medicine
- Associate Oral and Poster Abstracts
Please contact Nancy Sullivan with any questions
Page updated: 8/7/09