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Governor's Newsletter, Winter 2002

David N. Podell, MD, PhD, FACP
Governor, Connecticut Chapter

Governor's Column

The events of September 11, 2001 have touched and in some ways transformed each and every one of us. For many of us the way we act and think about the world has changed. We must all remember that as physicians we are in essence healers and already many of us have tried to aid and support our patients, our students, our residents and our country by offering consolation, emotional support, financial contributions and simply being there as a respected member of the world community.

I felt it was most fortunate to be able to come together soon after the September 11th tragedy at our Connecticut meeting on September 28th in Waterbury, Connecticut. Coming together at that meeting reminded me of how much we need to be with our colleagues, young and old, who share common values and problems. The College also has broader issues regarding this "new world" that we have entered. Issues such as bioterroism and chemical warfare are ever present. We as physicians will need to be a source of knowledge for our patients and community. Finally, we are fortunate to have the ACP, which is blessed with tremendous ethnic and cultural diversity. We must therefore be a force of reason and understanding in our communities that may become polarized. We have enormous influence and offer much to the world.

I wanted to let you know "what your Governor has been up to" since the last newsletter. It has been a busy summer and fall highlighted by the very successful fall meeting entitled, "Recapturing the Joy in Medicine". I have begun an initiative to visit all Departments of Medicine within the state during my four years as Governor. I had the pleasure and privilege of beginning my tour by visiting Day Kimble Hospital in Putnam, Connecticut. I found it to be most informative and a pleasant experience. It confirmed my thoughts that our membership needs to be heard and important issues need to be discussed at the national level. I look forward to meeting all of you during my four-year tour of the departments in Connecticut.

I also had the opportunity to attend a Centers for Medicare and Medicaid Services (CMS First Physicians Listening Session) in New York City on September 10, 2001 at the Jacob Javits Federal Building. This meeting was extremely important and consisted of state medical societies and representatives from other physician organizations across the Northeast consortium. I left the meeting with cautious optimism that the new CMS is listening to physician needs and hopeful that progress will be made to understand the barriers that exist in our attempts to take care of our patients. Please read the article in this newsletter regarding the results of this meeting.

In this newsletter, Dr. Paul Dolinsky reports on the results of his very important questionnaire regarding the impact of managed care on practice cost and patient accessibility. This resolution will be presented at the spring meeting in Philadelphia in 2002. Also, Dr. Ann Reiseman, faculty member at the Yale University School of Medicine, has developed and included an important questionnaire regarding internist's knowledge of bioterroism and attitudes towards this issue. I urge all of you to take a short bit of time to complete this questionnaire, which will be very important to our constituents and to our membership at large.

Dr. Stephen O'Mahoney has been busy working on our web site and making contacts with the national office to improve distribution of information. As part of that initiative, we are requesting that all of you please send us your e-mail address so that we may be able to contact you quickly and easily when important medical and health policy issues become important and crucial.

In this newsletter, I have provided bittersweet news about our chapter. We were saddened by the loss of Dr. Alvan Feinstein, a master in the College and a recipient of the College's Richard and Hinda Rosenthal Award. In addition, I am delighted to report on the mastership received by Dr. Frank Davidoff. We are all delighted and congratulate him on this great accomplishment. If any of you have information about accomplishments of yourself or your colleagues, please send them to me so that I can share important information with our membership.

In the newsletter, there are other important activities in our Chapter, including the medical student work by Dr. Barry Wu, Health and Public Policy initiatives by Dr. Rob McLean, and the Associates Committee work by Dr. Matt Voss.

In this very tumultuous and challenging time in the world and in medicine, I hope that all of you and your family are well and safe and that together we all continue to enjoy and sustain ourselves in what I feel is a most wonderful profession.

Connecticut Chapter-Fall Annual Meeting

The 2001 Connecticut Chapter Scientific Meeting was held on Friday, September 28, 2001 at the Waterbury Sheraton Hotel in Waterbury, Connecticut. The theme of the meeting, "Reclaiming the Joy of Medicine" provided a wonderful program moderated by Dr. Frank Davidoff, former Editor of the Annals of Internal Medicine. Narratives by Drs. Margaret Bia, Fred Finkelstein and Joseph Andrews highlighted ways in which physicians find happiness and joy in their daily task of being a physician. We were delighted to hear the winners of the Associates Meeting presentation, which were moderated well by Dr. André Sofair. Drs. Benjamin Doolittle and Asefeh Heiat provided superb discussions about their original research. Simultaneous workshops regarding updating on personal digital assistance, PDA's in Medicine, and Depression in Older Adults, Management in Primary Care by Dr. Stephen Lapkoff and Carol Kelly were very well received and attended. Our lunch time events were highlighted by awarding Dr. James L. Bernene, former Governor of the Connecticut Chapter, and Dr. Barry J. Wu, the Laureate Awards. The George F. Thornton Award was awarded to Dr. Lawrence G. Reis. For the first time, the College presented a Chapter Volunteerism and Community Service Award to Dr. Robert H. Gifford, Professor of Medicine Emeritus and former Deputy Dean for Education at the Yale University School of Medicine. An active town meeting and College update was provided by our College rep, Dr. Robert Gibbons, Regent of ACP. Mr. Robert Dougherty, SVP of Governmental Affairs and Public Policy, provided a superb summary of the current health policy issues affecting internal medicine in Washington. The afternoon provided a comprehensive and very meaningful update in clinical medicine moderated by Robert Nardino, MD. Issues in Pulmonary Medicine and Asthma Care by Dr. Lynn Tanoue, Prevention and Treatment of Diabetic Nephropathy by Dr. Susan Crowley, and Controversies in Prostrate Screening by Dr. John Concato were very well received by the membership. I thank the Planning Committee for their hard work in putting this wonderful meeting together. The Program Committee members included: Nancy Angoff, Pamela Charney, Bruce Gould, Eric Holmboe, Eric Mazur, Robert McLean, Todd Staub, Matt Voss and Barry Wu. I also want to thank Nancy Sullivan for her wonderful organization and hard work in putting all of the behind the scene details together.

Impact Of Managed Care On Practice Costs And Patient Accessibility

Paul Dolinsky, MD, FACP

The results are in from the Questionnaire on the impact of managed care on patient accessibility presented in our last newsletter and the results are resounding. 71% of the respondents noted a substantial impact produced by compliance of managed care tasks resulting in reduced patient accessibility to medical care. Unfortunately, the total number of respondents was small (27), and not statistically significant, but the trend is clear from those who did take the time to complete the form.

Almost half (49%) of the doctors responding spend 4 hours or more per week of uncompensated time in order to fulfill managed care requirements, and another 30% spend 3 to 4 hours per week on those tasks. 46% of the staff responding to the Questionnaire had estimated that 11 to 20% of all the telephone calls received are related to managed care inquiries (23% of the respondents noted over 20% of the call related to managed care and 31% noted 6 to 10% of the call related to managed care). 37% of the respondents noted that for each full time physician (or nurse practitioner or physician associate) that 10 to 20 hours per week of staff time are required to perform managed care tasks. (29% noted 4 to 10 hours per week per clinician and 22% noted 20 to 30 hours per week per clinician).

The respondents who exclusively derived their income from direct patient care represented 71% of the group. The others who had a mixture of responsibilities, included 58% from direct patient care, 12% administration, 16% academic teaching and 2% research activities.

Although not a statistically valid study, those who did respond to the Questionnaire noted a substantial cost to their practices in staff time and uncompensated physician time complying with managed care activities. Also noted was the burden of telephone calls from patients related to managed care activities and reduced accessibility to medical care. Dr. Podell has brought these issues to the national level at the Board of Governors meetings in the form of a resolution form Connecticut physicians. The results of this Questionnaire will emphasis our concerns. We thank all the physicians who responded to the Questionnaire.

Associate Report

Matthew R. Voss, MD, Northeast Representative of the COA, Associate Member of the CT Governor's Council

Annual Scientific Meeting for Associates-This year is a year of change in planned activities for Connecticut (CT) Associates. CT ACP Governor David Podell is working with Associates and local ACP leaders to organize a combined meeting to take place in the Fall of 2002. This meeting will be similar in format to the National Annual Session and allow Associates and Members to interact and discuss pertinent local and national issues related to the College and practice of medicine. The Associate Poster and Oral Presentations will take place at this meeting. Potential workshops would focus on mentoring, career counseling, and getting involved with research ("From Poster to Paper" Workshop). Having the Associate Poster and Oral Presentations in the fall will allow timely submission of projects to be represented at the National Annual Session (Spring 2003). Final details for the meeting will be discussed at the fall Governor's council meeting on December 5.

2002 Associate Jeopardy Tournament - The 2002 Associate Jeopardy Tournament will take place on Friday, March 1, 2002 at the Hospital of St. Raphael. Information about the tournament can be obtained from Robert Nardino, MD at the Hospital of St. Raphael.

Spring Educational Day for Associates -A committee including David Podell, MD, Connie Vergara, MD, Scott Wolf, MD, Paul Tabereaux, MD and Matthew Voss, MD, has been formed to discuss an Education Day for Associates to take place in the Spring of 2002. A similar event took place two years ago at Hartford Hospital and focused on critical analysis of the literature and preparation for interviews and public speaking. The organizing meeting will take place at 3pm, Friday, November 30, 2001, at Waterbury Hospital.

Resident Research Consortium -Joseph Lim, MD, an Associate from Yale and the Northeast Representative to the Council of Associates is organizing a communication network of residents from around the country to participate in collaborative research. This project aims to promote involvement of internal medicine residents in research, encourage communication and collaboration between internal medicine residency programs, support education-oriented research investigation, provide a valuable tool for residents in strengthening research studies, and demonstrate the ACP's commitment to addressing needs of residents and fellows Question regarding the Resident Research Consortium can be addressed to (limjoseph@yahoo.com).

National Council of Associate (COA) Activities -The National Council of Associates met from November 9-12, 2001.

Resident Work Hours - Many medical organizations including the AAMC, AMSA, AMA-RFS, ACP and ACGME are evaluating work hours and sleep hours for physicians in training. Several position statements and legislation regarding resident work hours have been proposed or are being drafted. On November 6, 2001, Representative John Conyers (Democrat from Michigan) introduced the "Patient and Physician Safety and Protection Act of 2001" (HR 3236) which establishes limits on housestaff work hours, permits residents and fellows to file anonymous complaints regarding violations, and includes financial penalties for noncompliance. The Council of Associates has developed a position statement addressing resident work hours which should be available on the ACP website shortly. In collaboration with the COA, the College is preparing a survey to be administered to Associates in the late fall addressing resident work hours. Please encourage all Associates to fill out the questionnaire that will be distributed by an email electronic link to the College website. Data should be filed by February 2002 and discussed at the Annual Session in April 2002.

ABIM Continued Professional Development (CPD) - At this point the College does not support the present process. The College feels that this process is redundant, burdensome, intrusive, and not validated. This issue will be further discussed by the BOR at the Annual Session in April 2002.

PIER (Physicians Information Education Resource) Project - This is an electronic medical resource and patient management tool to be debuted at the Spring 2002 Annual Session and available to all members soon. This will be not only a tool for access to high quality medical information but also have capabilities as an electronic medical record.

Reduced Membership Dues for Latin American Associates - The COA has submitted a resolution regarding reduced membership dues for Latin American Associates. The BOR is to address this resolution in the spring.

Publication of Winning Abstracts as Annals Supplement - The COA has submitted a resolution that the winning abstracts from the ACP Annual Session Associate Abstract Competition be published as a supplement to the Annals of Internal Medicine. The BOR will address this resolution in the spring.

Fair Treatment of International Medical Graduates - The COA is drafting a position statement reaffirming the College's position the no physician in training, regardless of where they received their medical education, should be discriminated against based on their sex, race, ethnicity, religion, or country of origin. The full statement will be available on the ACP website shortly.

Annual Session April 11-14, 2002, Philadelphia, PA - The 2002 Annual Session has many activities geared specifically towards Associates. There are five breakout sessions and a luncheon (Associate Forum 2002) sponsored by the COA. The Associate Forum 2002 is an opportunity for Associates from around the nation to get together and discuss a particular issue. The focus of this year's Associate Forum is Resident Work Hours. Leaders from around the country will be available to address questions and brainstorm solutions.

The five breakout sessions for Associates include:

  • Preparing for the ABIM Boards
  • Heart and Lung Sounds
  • EKG's Interns Should Know
  • Applying for Fellowships
  • Illicit Drugs/Raves

I encourage all Associates to attend the Annual Sessions which is packed full of high yield information and activities For more information or questions, please feel free to contact me by email (mvoss@javanet.com).

In Memorium - Alvan Feinstein, MD

I write with great sadness the passing of Dr. Alvan Feinstein. The Feinstein was the Sterling Professor of Medicine in Epidemiology and Director Emeritus of the Robert Wood Johnson Clinical Scholars Program at Yale. Dr. Feinstein who was born in Philadelphia attended the University of Chicago where he received his Bachelor's Degree, a Master's Degree in Mathematics and his Doctor of Medicine Degree. He completed his clinical training in internal medicine at Yale and research training at the Rockefeller Institute. In 1962 Dr. Feinstein became a member of the Yale faculty and in 1974 became the founding Director of the Robert Wood Johnson's Clinical Scholars Program at Yale. Trained as an internist, Dr. Feinstein had a reputation of a master clinician and was awarded mastership in the American College of Physicians. He also received the Richard and Hinda Rosenthal Foundation Award from the College in 1982. Dr. Feinstein was a major influence in the careers in many fellows, residents and faculty at Yale. He will be deeply missed. On behalf of the ACP, Connecticut Chapter, we extend our deepest condolences to his family, colleagues and friends.

Help - We Need Your Email!

The Connecticut Chapter would like to email important issues, meeting notifications, announcements and legislative updates to you. We don't have email addresses for a majority of the membership. If you would like to receive these updates, please notify Nancy Sullivan, Exec. Secy. at (76032.660@compuserve.com). Questions??? - Please contact Nancy at the Chapter Office:(860-349-8995).

Assessing Internists' Knowledge - Biological Warfare

David N. Podell, MD, PhD, FACP, Governor, ACP CT Chapter; Anna B. Reisman, MD, Assistant Professor, Yale UniversitySchool of Medicine; Cary P. Gross, MD, Assistant Professor, Yale UniversitySchool of Medicine

Although recent events have demonstrated to us all that biological warfare is now a disturbing reality, the degree to which internists are prepared to recognize and manage diseases related to biological warfare is unknown. The Connecticut Chapter has created a questionnaire that attempts to assess internists' knowledge of the subject in order to design efficient training sessions.

This is an anonymous questionnaire. We ask that you include your name either on the return fax cover page or on an envelope so that we can keep track of who has responded. The identifying fax cover page or envelope will then be discarded immediately. Under no circumstance will an individual's responses be reported, and no data at the individual level will be analyzed. The questionnaire takes approximately 5 minutes to complete.

We will make an information sheet with the answers to the clinical questions as well as a list of important contact numbers available when we receive your questionnaire. Thank you for taking the time to fill out what we believe is a vitally important survey. Please send the completed survey to Nancy Sullivan, 30 Dwight Drive, Middlefield, CT 06455, or fax to Nancy at 860-349-3004.

Medical Student Committee

Barry J. Wu, MD,FACP

The medical student committee started the new academic year by participating in the Special Olympics, in New Haven on June 8-10. Rina Reyes, a third year Yale medical student, helped organize participation in the event. We are grateful also to have Rina as the student representative on the Governor's council this year. Student membership to the ACP continues to be enhanced bystudents from Connecticut. Nearly a quarter of the incoming first year students signed up for membership at the Yale medical student activities fair held on September 6. The 3rd Annual Medical Student Jeopardy Tournament was held at the Hospital of Saint Raphael on September 22. After a welcome from our Governor, Dr. David Podell, students from six different schools; New Jersey Medical College, New York Medical College, Mount Sinai, SUNY Downstate, Univ. of Connecticut and Yale participated in two preliminary rounds. The final round included teams from New York Medical College, SUNY Downstate,Univ. of Connecticut and Yale. SUNY Downstate emerged as the 2001 winners. All participants received a Washington Manuel and the SUNY Downstate team received 2001 Harrison's textbooks. SUNY Downstate joins previous winners, New Jersey Medical College (1999) and New York Medical College (2000). Finally, we were delighted to be recognized at the Annual Meeting with a National Evergreen Award and $500, presented by Regent Robert Gibbons, MD, FACP to the Connecticut Chapter. Many thanks for the support from the Governor's Council, the Hospital of Saint Raphael Dept. of Medicine, and all who have contributed to the committee including Nancy Angoff, MD, MPH, Stephen Atlas, MD, Kathy Contois, Karen McCausland, Jessica Mega, MD, Robert Nardino, MD, Ellen Nestler, MD, Nikolai Podoltsev, MD, Rina Reyes, Tony Sreih,MD, and Pat Wales. If you are interested in serving on this committee, please contact me at (bwu@srhs.org).

Health & Public Policy Committee Report

Robert McLean, MD, FACP

Meeting with Rep. Nancy Johnson-The HPP Committee hosted Rep. Nancy Johnson in late August for a dinnermeeting which allowed us to discuss various health legislative issues for several hours. While the ACP's approach on details of many of the existing legislative proposals were different from those held by Rep. Johnson, she seemed to come away from our meeting with a greater sense of our physician perspective. In late September, Rep. Johnson as Chair of the Health sub-committee of the House Ways and Means Committee invited ACP as the only physician group to testify on pending Medicare regulatory reform legislation. The subsequent mark-up session made several substantial modifications to the bill that seemed to correspond to some concerns detailed by ACP President William Hall, MD, and the Johnson-Stark bill known as the "Medicare Regulatory and Contracting Reform Act of 2001" will clearly help physicians in the everyday practice of medicine if it moves through Congress as expected. Those attending our state Chapter meeting in late September enjoyed a review of the current legislative landscape given by Robert Doherty, the College's SVP, Gov. Affairs and Public Policy. He explained the change in legislative priorities since September 11 and subsequent desire to avoid divisive issues. Unfortunately, it would appear unlikely that a patient bill of rights will be a major topic this year.

State Activity - At the state level, we maintain a presence on the CSMS Legislative Committee that met in early October to establish an agenda for the state's legislative session in early 2002. While the State Budget passed in June did include a $3.9 million appropriation for reinstatement of dual eligible crossover payments to begin in July 2002, there was concern that expected state budget shortfalls now being recognized will allow the Governor and the Legislature to back out. Other legislative topics will likely include a push from large chain pharmacies to allow pharmacists to "collaborate" with physicians in management of several outpatient medications and be able to bill for these services (grave concern over this), possible medical liability reform due to concern over increasing malpractice jury awards and rapidly increasing malpractice insurance premiums, and, as always, efforts to regulate managed care regarding bundling, downcoding, and fairness in contracting. CSMS maintains an effective political presence in Hartford. I encourage our members to join CSMS for this important reason. I was made aware that only 11% of CSMS's total membership contributes to the Political Action Committee (PAC), a crucial arm of CSMS allowing it to be effective in representing the interests physicians throughout the state. Through CSMS, our Chapter is able to be better connected to the political process than we could otherwise afford. CSMS-PAC deserves your support. Our Chapter will try to establish more personal relationships with several key legislators from Hartford over the next few months at breakfasts being organized in different locations. Politicians respond to their local voters, and so we need more ACP physicians to help us. If you would like to join us for breakfast, please contact me (rmmclean@optonline.net).

Current Legislative Concerns - Most recently, the Center for Medicare and Medicaid Services (CMS, formerly known as HCFA) decided to cut Medicare physician payments 5.4% (while hospitals and home health are not facing across-the-board payment reductions) due to a flawed formula that ties physician payments to general economic indicators. There is legislation just introduced in the Senate in mid-November "The Medicare Physician Payment Fairness Act of 2001" (S. 1660) which would replace the 5.4% payment decrease with a 0.9% reduction. We need our legislators in Washington to hear that the 5.4% cut would be disastrous to many of our practices. A "Legislative Alert" on the topic is available at acponline.org, and I encourage everyone to look at the key points and fax a letter or e-mail to your representatives. I have made previous requests with minimal response. 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.

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Robert Nardino, MD, FACP
ACP Governor, Connecticut Chapter

Nancy Sullivan
30 Dwight Drive, Middlefield, CT 06455
Phone: (860) 349-8995
Fax: (860) 349-3004 or
E-mail: ctacp@comcast.net

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