Governor's Newsletter, Summer 2001
David N. Podell, MD, PhD, FACP
Governor, Connecticut Chapter
It is a great pleasure and privilege to address you for the first time as the new Governor of the Connecticut Chapter of ACP. I am extremely excited about my new role in the Chapter and feel very fortunate to represent all of you in the College. As the newly installed Governor, I want to first congratulate Dr. James Bernene, our outgoing Governor. He did a superlative job in bringing the Chapter to where it is today. In addition, I want to thank all of those members of the Council and the wonderful committees who have worked tirelessly during the year to realize many of our goals.
As I begin my term as Governor, I feel it is important to look to see where we are and what accomplishments we have made and where we should put our efforts and energies for the next four years. We have wonderful programs and committee efforts in place already. They will be outlined in this newsletter. Our Associates program is stronger than ever with the fortunate leadership of Dr. Matt Voss and Dr. Joe Lim who have been elected to the national council. In addition, our Health and Public Policy Committee has worked extremely hard in getting the issues that are important to each and every one of us as into the political arena. They have been very effective and the leadership by Dr. Rob McLean is most appreciated. Dr. Barry Wu has continued to excite and encourage medical student participation in the College. His medical student jeopardy event has gained national recognition and we are very proud of receiving the Chapter's Evergreen Award for his efforts.
As I look toward the next four years, I feel that increasing our membership is a very important priority. The membership roles in the College have leveled off. I am eager to put efforts into expanding our membership, especially for women, minorities and those whose medical education occurred outside of the United States. I also feel that efforts to allow us to communicate more easily with one another through the use of an expanded web page, as well as e-mail communication will be important. I hope to create a virtual Chapter when crucial issues regarding health and public policy need to be discussed. I am delighted that Dr. Stephen O'Mahoney has agreed to help us in terms of better communication among ourselves, as well as providing up to date information on our web site which will provide an important source of information and communication.
The Associates meeting which occurred in April was a huge success. We had a record number of abstracts presented and I thank Drs. Andre Sofair, Peru Venkatesh and Matt Voss for their leadership and efforts in putting this together.
Plans for our fall Scientific Meeting are coming to completion. We are extremely excited to have a program that will both re-energize the spirit and the mind. Topics will include recapturing the joy in medicine with an exciting panel discussion led by Dr. Frank Davidoff, former editor of the Annals. There will be updates in geriatric medicine, the use of personal digital associates (PDA's), as well as updates in clinical pulmonary medicine, prostate screening and nephrology. I know it will a most exciting and productive meeting and urge all to attend.
I have recently returned from Atlanta from the national meetings of the Board of Governors. Major issues of the highest priorities for the College on the national level include expansion of membership, the issues of re-certification and the issues of commitment of the College to universal health coverage for all.
In this issue of the newsletter, you will read of the many activities that the Chapter is now involved in, including our Associate and student membership, the health and public policy activities and the important work that the College is doing to reduce medical hassles through the "Medicare Education and Regulatory Fairness Act." In addition, there is an important survey created by Drs. Paul Dolinsky, John D'Avella and Rob McLean regarding the impact of managed care on practice costs and patient accessibility which is extremely important in regarding the hassles and challenges that practicing physicians face every day. Our Chapter has taken an initiative to assess this area and to present data to make it a national agenda issue through the resolution process. This information is extremely important and I urge all of you to take the little bit of time it takes to fill out this very important questionnaire.
In closing, I again want to say what a privilege it is to be your Governor. I will strive to provide ways for us to continue to enjoy our work in this wonderful and very special profession.
I wish you a happy and healthy summer season.
With Warmest Regards,
David Podell, MD, PhD
Governor, ACP CT Chapter
ACP Connecticut Chapter Receives National Award
Efforts to raise interest in the specialty of internal medicine among Connecticut-area medical students have won the Connecticut Chapter a national Evergreen Award for 2001. The Evergreen Award program recognizes outstanding ACP chapter efforts. Connecticut was recognized in the Medical Students award category.
The Connecticut Chapter developed several programs to enhance medical student participation. These included a Medical School Activities Fair; oral and poster presentations during their annul meeting; and the Graduation Award, which is given to select students from Yale University and the University of Connecticut for their academic achievement and community service.
In addition, the Connecticut Chapter offered their second annual Medical School "Jeopardy" Tournament in 2000, with participation from 11 schools in six states. All medical schools in the Northeast were informed of the competition involving third- and fourth-year students. A major source of the questions posed to the students came from the new MKSAP (Medical Knowledge Self-Assessment Program) for Students. Using a computer generated board, students competed in preliminary rounds and a final competition. All students who participated were enrolled in ACP medical student membership.
ACP Connecticut Chapter Fall Annual Meeting
The major theme for the September 2001 Connecticut ACP meeting will be "Reclaiming the Joy in Medicine." The healthcare system continues to experience tumultuous change, with many physicians feeling overburdened by productivity demands, intense external scrutiny and intrusion in their clinical practice, and less time for self-reflection and renewal.
The main plenary session of this meeting will address these current stresses, but more importantly explore the joys and rewards of medicine that led most of us to medicine as a lifelong profession. The Connecticut chapter is delighted to have Dr. Frank Davidoff, former editor of the Annals of Internal Medicine, lead a discussion among a group of physicians who have found continued joy as physicians. The panel will include a woman physician and mother, a community sub-specialist active in academics, and a respected community general internist. This opening session will be highly interactive, allowing all participants to share their own experiences and to explore ways to reinvigorate Internal Medicine and their own self-renewal.
The one-day meeting also has two additional goals. Information technology is revolutionizing medicine, and the personal digital assistant (PDA), or palm top computers, are increasingly being used to help deliver care to patients. Dr. Stuart Lapkoff, an information specialist connected with the ACP, will conduct a hands-on workshop about PDA's and their use in clinical medicine. In addition, internists are increasingly facing challenges in treating depression in their geriatric patients. We are fortunate to have Dr. Carol Kelly conduct a workshop on Depression in Older Adults: Management in Primary Care.
The second goal is to provide targeted clinical updates on topics germane to practicing internists. The three topic areas will include updates in prevention and treatment of diabetic nephropathy, controversies in prostate cancer screening, and an update in pulmonary medicine, particularly issues in the care of asthma.
We hope that you can join us on Friday, September 28, at the Waterbury Sheraton Hotel, in Waterbury, for this exciting event. Come not only to learn the latest on palm top computing and clinical issues important to internists, but also to help re-invigorate the joy and meaning we all find in the practice of this great profession we call medicine.
ACP Connecticut Associates Scientific Session
By Matt Voss, MD,
Associate Representative to the Governor's Council
It behooves those who devote themselves to observation to be impressed by this true [i.e., that many "facts" grow old] and to realize that the best work is only good in relation to its time and that it awaits another, more exact and more complete.
Pierre-Charles-Alexandre Louis, 1829
A fitting verse to remember the recent ACP 2001 Spring Scientific Session, held Wednesday, April 25, at the Waterbury Sheraton Hotel. The event was a great success with over 250 in attendance. Dr. Peter Lurie, Deputy Director of the Public Citizens Health Research Group, presented the keynote address entitled: "The Impact of the Pharmaceutical Industry on Medical Education, Practice, and Research." There were 143 poster presentations and 12 oral presentations. Associate presentations were judged in one of three categories original research, clinical vignette, or oral presentation. Although there were many outstanding projects, three associates in each of the categories were recognized.
First Place:Laura Greci, MD
Vaccinations in Pneumonia (VIP): A Study of Pneumococcal and Influenza Vaccination Patterns Among Patients Hospitalized for Pneumonia
Second Place: Matthew Voss, MD
The Participation of Women, the Elderly, and Minorities in Randomized Controlled Trials of Acute Myocardial Infarction: Evidence of Ongoing DisparitiesThrough the Decades of the 1990's
Third Place: Samir Malkani, MD
The Utility of Glycosylated Hemoglobin for Diagnosis of Diabetes in Hospitalized Patients With Random Hyperglycemia
First Place: Benjamin Doolittle, MD
Correlation Between Spirituality and Depression in a Primary Care Clinic
Yale University School of Medicine: Medicine/Pediatric Residency
Second Place: Asefeh Heiat, MD
Trends in the Patterns of Care and Outcomes of Elderly Patients with Heart Failure, 1992-1999
Third Place: Xinqi Dong, MD
Accidental & Suicidal Organophosphate Use in Urban Zimbabwe
Yale-New Haven Hospital
First Place: Bruno De Bortoli, MD
Propylene Glycol Induced Lactic Acidosis In a 46-Year Old Female Treated for Respiratory Failure
Hospital of St. Raphael
Second Place: Grzegorz Nowakowski, MD
Primary Ewing's Sarcoma (ES) of the Lung in an Adult
Third Place: Javier Pou, MD
Overlap Syndrome in Autoimmune Hepatitis: A Recipte for Confusion
In addition to the Keynote Address and Associate Presentations, Dr. Tom Lane was honored for his commitment to the academic development of Connecticut Associates and his support of the Annual Scientific Session.
On behalf of the Connecticut Associates, I would like to thank Drs. David Podell, Andre Sofair, Peru Venkatesh, all of the Judges, and Nancy Sullivan for their time and efforts in organizing the meeting and making the day a memorable one.
Medical Student Committee
By Barry Wu, MD
Internal Medicine continues to be a popular field among our graduating medical students. This year 24 of 78 graduating students from Yale University and 21 of 71 from the University of Connecticut are entering internal medicine residencies. This is the third year that we have awarded the Connecticut ACP Internal Medicine Award to a graduating senior who is entering an internal medicine residency in Connecticut. The recipient is chosen based on their academic achievement and community service. This year's winners are Harry Yoon from Yale University and Devan Kansagara from the University of Connecticut. Harry will be joining the Categorical Program and Devan the Primary Care Program at Yale.
Jessica Mega, our student council representative, will also be entering an internal medicine residency program. She is traveling north to Brigham and Women's Hospital. We are thankful for all of her time, efforts and service over the past two years and look forward to her continued contributions to medicine and the ACP.
In fact, we hope Jessica will be encouraging Boston students to attend the Third Annual Medical School Jeopardy Tournament. Last year, eleven medical schools from the Northeast region participated. This event is scheduled for September 2001 at the Hospital of St. Raphael in New Haven. We look forward to continuing to support this effort to enhance student participation and exposure to the ACP.
Finally, we are grateful for being awarded an Evergreen Award by the national ACP organization. We were recognized for our efforts to increase student communication and participation in internal medicine and the Connecticut ACP. I am particularly thankful for the support from the Connecticut ACP Council and the Department of Medicine at the Hospital of St. Raphael and the dedicated efforts of Dean Nancy Angoff, Dr. Ellen Nestler, and Dr. Jessica Mega. If you are interested in serving on this committee, please contact me at email@example.com.
The Legacy Fund
By Paul Dolinsky, MD, FACP, Secretary-Treasurer
The Legacy Fund was established from funds saved over years by the Connecticut Chapter of the Connecticut Society of Internal Medicine, before the merger with the American College of Physicians in 1998. The purpose of the Legacy Fund is to support socio-economic activities of the Connecticut Chapter of ACP. One way the money will be used is to support Chapter physicians who take the time from their day to lobby for causes supported by our Chapter, when they would otherwise be performing patient care activities. A limited amount of funds will be available annually to offer members, who primarily derive their income from direct patient care activity, a stipend of $500 for a full day (or pro-rated) of activity, with prior approval of the Governor, David Podell and Robert McLean, Chairman of the Health and Public Policy Committee. Dr. McLean will be lobbying Congress in Washington, D.C. this month with Dr. Podell on behalf of our Chapter. A stipend of $500 will be awarded to Dr. McLean. We encourage other members to become involved in the political process to support causes important to physicians and we hope the Legacy Fund can help defray some of the costs in lost time in the office for those activities.
Health & Public Policy Committee Report
By Robert McLean, MD, FACP
In trying to represent the interests of the physicians of the state at the political level, the Health & Public Policy Committee recognizes the crucial need to have more physician voices heard. We need your help. A major goal we have established is to make it much easier for our ACP colleagues to express our important viewpoints to our politicians on the multiple issues which affect our patients and our medical practices.
At our latest meeting in early April, the H&PP committee hosted Rep. James Maloney and honored him as our "Legislator of the Year" for his diligent efforts in the field of health legislation. He provided the group with his perspective on the current political environment in the Capitol and emphasized the crucial need for our voice to be heard since the "other" loudest and most influential voices on health care, the insurance and HMO industry, do not seem to have similar views or goals as physicians. Maloney has already co-sponsored the ACP-endorsed Bipartisan Patient Protection Act of 2001, and he was not yet familiar with the Medicare Education and Regulatory Fairness Act (MERFA) which he has subsequently signed onto as a co-sponsor. He led an interesting discussion about the complicated funding of Medicare and expressed his concern that the current President's budget moves physician payments from the "general fund" into the Medicare trust fund "lockbox," which will actually cause the trust fund to be exhausted sooner.
At the state level, many issues were either working their way through or being held up in various committees. A major issue which CSMS has been pushing hard is the improvement of funding of Medicaid in the state budget through provider rate increases and funding for dual eligible Medicare/Medicaid patients. Other issues which were important to us as internists included managed care reform especially fairness in contracting, scope of practice for other professionals: pharmacists wanting "collaboration" in some medication monitoring and naturopathic physicians wanting prescription writing authority, and efforts to decrease tobacco use via smoke-free workplace and restaurant legislation. We will try to update you on the ultimate fate of some of these pieces of legislation as the Hartford legislative session draws to a close in June, but you can also get more current updates through the state medical society at www.csms.org.
Please become a regular reader of our ACP Chapter web site www.acponline.org/chapters/ct/ and specifically the Health & Public Policy subsection. Other Chapters have compiled e-mail addresses of concerned physicians who receive e-mail alerts about urgent needs to contact politicians when issues or votes arise. It is a very efficient way to communicate, and we must do this as well. Please send your e-mail address to me at firstname.lastname@example.org.
Politicians respond to their local voters, and so we need ACP physicians to help us send letters or call the offices of their local representatives when necessary. The voice of reason in many of these health-related topics increasingly driven by impact on the bottom line of either a company's profits or of the state's budget is frequently drowned out by the loudest voices. We physicians cannot sit back. If we do not stand up as "Physicians," we will increasingly lose influence and credibility because we let opportunities to make a difference pass us by we will merely be thought of as that other "P" word which I think we all have grown to resent, "Providers."
Connecticut Chapter Lobbies Congress
By Robert McLean, MD, FACP
On May 8-9, Drs. David Podell and Robert McLean participated on behalf of the Connecticut ACP Chapter in the legislative activities designated as "Leadership Day on Capitol Hill 2001." We joined over 130 other physicians from across the country who travelled to D.C. for the opportunity to discuss several important health issues in person with legislators and staff.
The major topics emphasized included: 1) patient protection measures through the Patient Bill of Rights, 2) reducing Medicare regulatory hassles through the Medicare Education and Regulatory Relief Act (MERFA), 3) improving access of uninsured patients to care, 4) support measures to improve patient safety and study how to systematically reduce medical errors, 5) oppose efforts to convert Medicare to a defined contribution program (rather than the current defined benefit program), 6) support to establish a prescription drug benefit under Medicare with predictable and sustainable funding, and 7) support the funding of several health programs, including primary care programs and the Agency for Healthcare Research and Quality, which are significantly under-funded in the President's current budget proposal.
We met with Rep. Rosa DeLauro and Rep. James Maloney personally and found both to support all our positions. We also met Health Policy staffers for Sen. Lieberman, Sen. Dodd, Rep. Johnson, and Rep. Simmons. The political environment in Washington with focus on the passage of tax cuts did not seem ready to truly pass major health legislation like a Patient Bill of Rights. However, as I write this column, there has been a power shift in the Senate to the Democrats, and this will likely bring the Medicare prescription drug coverage and the Patient Bill of Rights back to the top of the agenda.
Connecticut has two of the most influential legislators with the regards to health issues: Senator Chris Dodd is a ranking member of the Senate Committee on Health, Education, Labor and Pension, and Rep. Nancy Johnson chairs the House Ways and Means sub-committee on Health. Hearing from physician constituents on health issues will have an impact on these and other legislators, so please make your voice be heard.
What is the Cost of Managed Care on your Practice and does it Reduce the Quality of Care you are able to Deliver to your Patients?
By Paul Dolinsky, MD, FACP
How many phone calls does your office receive daily regarding the navigation of managed care rules? The calls come in from patients, pharmacies, testing facilities and other doctors' offices. Are the phones and staff tied up with these administrative chores and hence limiting the access to care for your patients trying to reach you with medical problems? Do your patients complain that it is difficult getting through to your office? What is the cost to your medical practice in staffing needs for these managed care tasks?
These frustrations were the basis for creation of the a questionnaire. Dr. John D'Avella was the inspiration for this project, in which we will try and document the depth of the problem. We also plan to propose a resolution at the national level of ACP to study this issue and search for alternative solutions.