Governor's Newsletter, Summer 2002

Eugene P. Libre, MD, FACP
Governor, District of Columbia Chapter

Governor's Message

Since my last newsletter to you in August 2001, some events have occurred which will long be remembered. The events of September 11, 2001 coupled with the bioterrorism anthrax attacks have caused all of us to pause and think about things we have paid little heed to in the past. The Fall Board of Governors (BOG) meeting scheduled to begin on September 12, 2001 in Tucson, Arizona, was canceled. Eighty Governors from the USA, Canada, Central and South America were planning to fly to Tucson on that fateful day in September, which will forever be imprinted on our minds. Immediately following the attack very strict security was in place at all Federal agencies, military installations, airport and sports venues. During the late Fall many conferences on bioterrorism were held in the Washington area and across the country in an effort to bring physicians up to speed in this area of rarely encountered medical problems.

Sara E. Walker, MD, MACP, was the College Representative at our Regional Meeting, November 9-10, 2001. Dr. Walker, President of ACP-ASIM, took part in the Governor's Council Meeting at the Congressional Country Club on November 8, 2001. She interacted with all the members of the Council and had many important things to tell us about the College. Also present at the meeting was Peter Matthews from Georgetown, the newly appointed medical student representative. Eric Rupard, MD from Walter Reed is the new Associates' representative on the Council. Sharyn Horwitz, MD, is the new Chair of the Women in Medicine Committee. Dr. Walker listened attentively to the many concerns voiced by the members of the Council regarding the plight of practicing physicians, and in particular, internists. The question of Board recertification was discussed at length. Dr. Walker described and handed out literature on the Peer-to-Peer Program - a plan to augment membership in the College.

The meeting on Friday featured many interesting topics, including current concepts of viral hepatitis, new treatments for rheumatoid arthritis and update in the management of hypertension and several Associates' podium presentations.

On Friday evening, the Governor's Award Dinner took place at Congressional Country Club. Jeffrey P. Harris, MD, FACP, was the special guest of our Chapter. Dr. Harris, the Governor of the Virginia Chapter, is credited with helping to develop "Multiple Small Feedings for the Mind," which is now standard fare at most Regional meetings and all the Annual Sessions. Lawrence E. Klein, MD, FACP and Stephen Ray Mitchell, MD, FACP, received Laureate Awards. This represents the highest award that a local chapter can bestow on any of its members. Masterships were awarded to Martin Dillard, MD, MACP and Robert E. Goldstein, MD, MACP. The official, formal award took place in Philadelphia at Annual Session 2002. Community Based Teaching Awards were presented to Karen R. Myers, MD, and Paul Schlein, MD, FACP.

The following day the "Update on College Activities," was presented by Dr. Walker. During the time scheduled for the Town Meeting a seminar was presented on bioterrorism. This was followed by a lecture on Management of Headaches. Later in the morning, Dr. Harris moderated the "Multiple Small Feedings for the Mind," which included management of the recently converted PPD, pulmonary embolism, when to convert atrial fibrillation and best drugs for treating congestive heart failure. A very well received talk by Barnett S. Kramer on cancer screening followed these presentations. The final presentation was by Colonel Robert J. T. Joy, MD, FACP, on post-traumatic stress syndrome. Dr. Joy, who is Emeritus Professor in the History of Medicine Department at USUHS, received the Nicholas E. Davies Memorial Scholar Award, which was formally presented to him during Annual Session.

On Saturday morning, following the poster judging, Dr. Walker selected two winning tickets from the group submitted with the correct answers to the five questions in the true/false quiz. Of the 25 people who submitted responses, 19 answered them all correctly. The winners of the random drawing were Kalpana R. Prakasa, MD, and Reverly John, MD, both of whom are residents at Howard University.

Annual Session 2002 Philadelphia, PA - April 11 -14, 2002

In an effort to make up in part for the loss of the Fall meeting in Tucson, an extra day was added to the Board of Governors Meeting in Philadelphia, April 8-10, 2002, which preceded the Annual Meeting on April 11-14, 2002.

The Keynote Address was given by Walter J. McDonald, MD, FACP, ACP-ASIM Executive Vice President and CEO. His main message was that the effects of the events of September 11, 2001 on medicine were both immediate and long. Recognizing and treating unfamiliar agents of bioterrorism while keeping patients calm as well as informed was successfully accomplished. The CDC and the military branches of medicine provided remarkable leadership. The long-term effects will materialize as American, (U.S., Canada, Latin America) and worldwide physicians consider the conditions that gave rise to terrorism. These include poverty, the lack of education and the inequitable distribution of healthcare resources. Although not mentioned by Dr. McDonald it also includes an honest reassessment of the effects of religions worldwide when fueled by zealotry and hatred. This last problem, while difficult to solve, need not be considered impossible. Dr. McDonald, who has retired from the College effective July 1, 2002, will be remembered for his leadership which benefited the College in many tangible ways.

A tribute to Joseph E. Johnson III, MD, FACP, who has retired effective July 5, 2002, was held on April 9, 2002 at a special formal reception. Dr. Johnson has held numerous positions of responsibility in the College as a former Governor, Regent and more recently as a special advisor to the Executive Vice President. He has been a major force in American medicine. This tribute was to recognize and appreciate his contributions. He will be missed, but not forgotten.

The Nicholas E. Davies Memorial Scholar Award for scholarly activities in the Humanities and History of Medicine was bestowed on Robert J. T. Joy MD, FACP. Dr. Joy gave a beautifully illustrated lecture on Friday, April 12. He reviewed the relationship between American medicine and the U.S. Army over the last two hundred years. The development of medicine in the U.S. Army sometimes paralleled, sometimes led and sometimes lagged behind its civilian counterpart. However, the main theme was that both American medicine and military medicine provided mutual benefits. This cooperation was evidenced throughout the several wars in which our Country has been involved, as well as during times of peace. Dr. Joy was nominated for this award by the DC Chapter and was introduced to the audience by myself and Col. Charles E. Bolan, Immediate Past Governor of the Army Chapter. The three previous winners of this special award are, T. Jock Murray of Halifax, NS, Abraham C. Verghese of El Paso, TX, and Cliff R. Cleaveland of Chattanooga TN.

The District of Columbia Chapter received the "2001 Chapter Excellence Award" at the Awards Luncheon. This special award raises the level of achievement above the chapter management award and is based on activities that took place in our Chapter during the 2000-2001 fiscal year. My thanks to all who made this possible.

Catherine R. Lucey, MD, FACP and Carmella A. Cole, MD, presented an excellent update on General Internal Medicine. They reviewed secondary prevention of cardiovascular events, treatment of congestive heart failure, hypertension, helicobacter pylori infection, thromboembolic disease, use of low molecular weight heparin, subcutaneous, compared with intravenous unfractionated heparin for treatment of venous thromboembolic disease. Hormone replacement therapy a number of very useful clinical pearls relative to internal medicine.

The program book for the educational activities contained a number of update sessions as well as numerous sessions on "Multiple Small Feedings of the Mind." If you are interested in finding out more about this session as well as the other sessions that are included, please contact headquarters in Philadelphia and they will help you access this information.

Board of Governors' Resolutions

There were 34 resolutions submitted by the various chapters. Our Chapter submitted three resolutions and the Committee that formulated these resolutions was once again chaired by N. Thomas Connolly, MD, FACP. The other members of the Committee included Lawrence Klein, MD, FACP, Jerry F. Meyer, MD, FACP, Andrew M. Umhau, MD, FACP and John A. Saia, MD, FACP.

  • The first resolution regarding patient confidentiality and common sense was adopted by the Board of Governors with only minimal changes.
  • The second resolution regarding the creation of a promotional insert on a quarterly basis in the Observer prompted the development of a substitute resolution by the Reference Committee which read: Resolved, that the Board of Regents support the inclusion of a feature to the Observer modeled after the ASIM's Intercom publication. The substitute resolution was adopted by the BOG.
  • The third resolution regarding the establishment of a Practice Committee, was not adopted, since the Medical Service Community currently deals with issues relative to practicing physicians.

Since I have been Governor, our success rate for resolutions has been 80 percent - 4 of 5 have been approved. This most important process enables any member of our Chapter to provide grass-roots input in order to effect changes regarding the many issues that affect the practice of medicine and internists in particular. More importantly, it provides a vehicle for new ideas to be disseminated nationwide. If you have an idea, or would like to see something changed that would benefit the practice of internal medicine, please give Tom Connolly a call at 703-536-6034.

Recertification - In a plenary session, approximately two hours were devoted to the discussion of recertification. Four separate resolutions were adopted by the BOG and forwarded to the Board of Regents (BOR). The full text of these resolutions can be found on ACP-ASIM Online. I suggest that you read these carefully, especially if you were certified after 1990. These resolutions reflect the ongoing progress that is being made between the ACP-ASIM and ABIM. The College will work with ABIM to establish multiple pathways to recertification, one of which will include a secure examination.

  • ACP-ASIM will encourage those specialists both in their subspecialty and in General Internal Medicine and work to remove costs and time barriers to multiple recertification.
  • The College will advocate that internists be allowed to substitute other educational resources; MKSAP with materials prepared by subspecialty societies for all ABIM self evaluation models.
  • ACP-ASIM will also work to make ABIM's proposed continuous professional development program (CPD) and patient evaluation module optional.

New Name for ACP-ASIM - One of the resolutions concerned changing the name or finding a new name for ACP-ASIM. After much discussion, the BOG voted that the new name should revert back to the American College of Physicians (ACP).

2002 Convocation

This year's ceremony represented the largest turnout for Fellows elected during the past few years. Seventeen individuals marched with me in the Convocation procession. Harvey Alter, MD, Rasham M. Bashir, MD, Mohammad H. Chaudhry, MBBS, Carmella A. Cole, MD, George C. Ego-Osuala, MD, Norton L. Fishman, MD, James Blaine Fitzgerald, MD, Gertrude Kenney, MD, Michael E. Leibowitz, MD, Azhar M. Z. Manipady, MBBS, Shelly R. McDonald-Pinkett, MD, Melissa Means-Markwell, MD, Brian H. Powers, MD and Carlos M. Vasquez, MD.

There were 45 Fellows who were eligible to march in the Convocation ceremony. For those of you who are eligible to march, but have not yet done so, please make an effort to take part in one of these events during the next year or two - it is a very enriching experience.

Leadership Day 2002

Over 125 members of ACP-ASIM from the 50 States, met at the Mayflower Hotel, May 21-22, 2002, for strategy planning sessions and to help us meet effectively with our Congressional representatives.

Representatives from the DC Chapter included Jerry Meyer, Ira Krefting and myself. We joined forces with the Maryland Chapter represented by Philip A. Mackowiak, Governor, Mary M. Newman and Haya Rubin

On Tuesday afternoon members of the Washington office's Government Affairs Department provided us with useful information outlining the various positions of the ACP-ASIM on the issues concerning internists.

The dinner meeting on Tuesday evening was highlighted by William D. Novelli, Executive Director and CEO of AARP. He gave a very interesting talk answered numerous questions from the audience.

The next day we met with representative Constance Morella. Six of us spent 30 minutes with her in her office for a very fruitful discussion. Legislative assistants to Paul Sarbanes, Eleanor Holmes-Norton, Barbara Mikulski and Benjamin Cardin met with us, as did assistants for Tom Davis of Northern Virginia. They were very knowledgeable and provided us with specific information and specially prepared handouts provided by the Washington ACP-ASIM office. Thanks to all of those who participated. To all of those who were unable to attend this year, please make every effort to do so next year.

Associates' Meeting

A very successful meeting of the Associate Members of the DC Chapter, was held at Walter Reed Army Medical Center, May 11, 2002, under the direction of Col. Greg Argyros, Maj. Eric Rupard and Col. William E. Duncan. There were approximately 100 people in attendance. There were 10 podium presentations and 75 poster presentations. There were two poster winners - Russell Peckham, WRAMC and Letha Seraphin from George Washington University Medical Center. Poster Award winners included John Boger, WRAMC, Yvonne Rudder, Howard University Medical Center, L. Oke, Bo Xu, PGMC, Sayran Abdulrahman, A. Hurley,WHC, R. Shafer, J. Hayashi, Connie Le, GWUMC Kavitha Prakash, Vincent Barthal, NNMC, and Shirin Haddady, GUMC.

A very spirited Jeopardy competition which involved most of the teaching programs in the Washington area was won by the Washington Hospital Center.

A Note From the Vice President

Jerry F. Meyer, MD, FACP

As the end of May rolled around, we were once again presented with our annual opportunity to lobby Congress concerning points related to medicine in general and internal medicine specifically. Leadership Day 2002 consisted of one day of presentations by Congressmen and their staff to all ACP-ASIM representatives from most of the chapters, with time for interaction. The next day was spent taking this information and attempting to influence our Congressman and Senators.

Some topics covered in the lobbying effort were Medicare fee schedules, modernization of Medicare, regulation relief, liability and antitrust legislation. The topic I saw as most emergent was the reduction in the Medicare fee schedule of 5.4% and further reductions to be done later. This apparently has come about as a result of projecting increases in services and attempting to conform to a total budget.

The most astounding information that came out of the discussion by a Congressional staff member was that the Congressional Budget Office (an entity charged with calculating the cost of proposed legislation using prediction of behavior) was of the opinion that if doctors' fees were cut, the doctors would see more patients to make up for it. I commented during the discussion that the concept would hold true if doctors were frozen in their positions, but recently we have seen: 1) in the last four years, there are fewer applicants to primary care residency programs; 2) practicing internists are finding other work such as Federal Government work and businesses; 3) physicians are retiring earlier and on disability - disability insurance companies no longer want to insure doctors because they recognize this problem; and 4) physicians are refusing to see Medicare patients. One staff person said the statistics had not supported that. The front page of the New York Times, however, did substantiate this trend.

We took this issue to Congress. Eugene Libre, Tom Connelly and I visited Congresswoman Connie Morella and the staffs of Congresspersons Eleanor Holmes-Norton, Tom Davis Jr., and Ben Carden. I later talked to Congressman Davis myself. This is a mixture of Democrats and Republicans. My overall opinion was that they know the cuts are unfair and will probably be detrimental to patient care and access, but they don't seem to feel any urgency and cannot see where they may find the funds. Medicine appears to be a low priority item and any effort in medicine appears to be turning towards prescription drug benefits.

It is my opinion that Congress will never adequately fund Medicare. It is ACP-ASIM's position to oppose a defined contribution program for Medicine. I believe, however, it is the only way that we will be able to get the Federal Government out of the business of price controls. Price controls have been known since the Nixon administration to be a faulty concept leading to shortages and poor products. The concept of a defined contribution program does have some bipartisan support.

I am sure Congress will make a minor fix in the payments for Medicare, but as long as the Feds control payments for everyone over 65, access to care will continue to worsen even for the well-to-do patients because they are not allowed to be anything but a low paying patient. I have voiced this opinion at the Leadership Day and intent to pursue it further with ACP-ASIM. Please fax your comments to 202-832-9475.

Mark Your Calendars Now for the 2002 DC Chapter Regional Meeting

November 15-16, 2002
USUHS, Bethesda, Maryland

Munsey S. Wheby, M.D, FACP, ACP-ASIM President-elect, will be our College Representative.