Governor's Newsletter, Fall 2000

Joseph W. Stubbs, MD, FACP
Governor, Georgia Chapter

From the Governor's Corner

With the number of uninsured and underinsured Americans rising everyday, nothing could be more important to the safety net of healthcare than physicians willing to volunteer their time and talents to the service of the disadvantaged. Volunteerism is a very strong professional ethic that prevades throughout our rank. I have not met a physician (including non-internists) who does not, in some way, volunteer his professional services for the healthcare needs of others without any hope or desire of compensation. Here in my community of Albany, Georgia, we had a situation fifteen years ago where a major Firestone plant closed leaving thousands without healthcare on a temporary basis. Without hesitation, the medical community established a mechanism whereby these individuals who were without health insurance were able to access both physicians and hospital services for free. Later, in 1994, when thousands of our citizens were left homeless due to the great flood of Alberto, the medical community once again volunteered literally thousands of hours of service working with pharmaceutical companies, the hospitals, and the health department providing needed healthcare to citizens in Southwest Georgia who were left homeless and without their belongings. I'm proud to say that such stories are common place in every community around this state. As a Chapter, we need to recognize physician members who have provided noteworthy community service. Beginning at our next annual meeting, June 8-10, 2001, we will inaugurate the Georgia Chapter ACP-ASIM Community Service Award.

The Georgia Chapter will recognize one of its members who has demonstrated a significant and sustained commitment in the service of others at a local, state, national, or international level. The merits upon which a recipient is selected for this award is based not only on the significance of the contributions that the individual has made, but also on the degree to which the individual reflects and affirms the quality of selfless devotion to the welfare of others. Nominations for this award may come from any member of our organization and should be accompanied by at least one letter of support. If you would like to nominate someone for this award, please submit their name and a description of their community service accomplishments to: Dr. Ben Okel, 2193 N. Decatur Road, Decatur, GA 30033; fax: (404) 325-0372; e-mail: okel@atl.mindspring.com or submit your nomination to Nancy Brady at 214 White Oak Drive, Newnam, GA 30265; e-mail: nbrady@mail3.newnanutilities.org phone: (770) 252-1858; or fax: (770) 252-1871.

Board of Governor's Meeting

The ACP-ASIM Fall Board of Governor's meeting took place in Seattle, September 14-16, 2000. At this meeting, several resolutions were considered that should be of interest to our Chapter membership. The Board of Governors recommended the adoption of a resolution stating that the College should continue to urge HCFA to reinstate Medicare coverage for portable oximetry in physician offices.

The Board of Governors had a lengthy discussion on a resolution allowing Associates to have voting privileges within the College. Those in support of this resolution pointed out that many Associates, after completing their residency, do not go on to become members. They felt that allowing them voting privileges as Associates would help secure their continued membership and involvement in the College. Those arguing against the resolution raised membership concerns that giving Associates voting privileges could significantly dilute the voting strength of the traditional members. The debate ultimately lead the Board to recommend the adoption of an amended resolution, which offers Associates voting privileges after two years of residency.

Finally, the Georgia Chapter offered two resolutions. One of the resolutions urged the College to reassess and streamline the Fellowship application process, and the Board recommended that it be adopted. Another Georgia Chapter resolution urged the College to develop a physician recruitment service. This resolution was not adopted because the College's Marketing Department is already considering the development of such a service. Please n ote that none of these resolutions will become College policy until they are voted upon by the Board of Regents.

The Board of Governors heard that the College continues to be at the forefront of healthcare organizations addressing the issue of healthcare access. The College has developed a set of eight core principles with regard to healthcare access. These include the following:

1. Proposals to expand access to health insurance coverage should have an explicit goal resulting in all Americans being covered by an adequate health insurance plan by a specified date.

2. Financing should be adequate to eliminate barriers to care.

3. Health reform proposals should address sources of patient and physician dissatisfaction with the current system.

4. Patients should have certain basic consumer protection rights, including the right to appeal denial ofcoverage to an independent external review body, the right to hold a health plan accountable in a court of law, the right to be informed about how health plan policies will affect their ability to obtain necessary and appropriate care, and the right to have confidential health information protected from unauthorized disclosure. Denial of care by insurance companies for a particular problem or perceived problem should be based on evidence of clinical effectiveness and predetermined benefits.

5. Health reform proposals should promote accountability at all levels of the system for quality, cost, access, and patient safety.

6. Incentives should be provided to encourage individuals to take responsibility for their own health,preventive care, and pursue health promotion activity.

7. Health reform should have as a goal elimination of disparity in the medical care of patients based social, ethnic, racial, gender, sexual orientation, and demographic differences.

8. The medical profession must accept this responsibility to participate in the development of reform to improve the U.S. healthcare system.

The College Leadership updated the Board on the Decision 2000 political campaign. This campaign is designed to encourage politicians seeking office in this election year to support the concept of all Americans having access to adequate healthcare and giving an explicit timeframe for achieving this goal. The College has also developed a public relations campaign designed to raise awareness of the need for healthcare insurance using the slogan, "No Health Insurance? It's Enough to Make You Sick." This campaign is targeting various key segments of the American population where there is good evidence-based information showing that lack of healthcare insurance is a significant risk factor for poor healthcare outcomes. The population groups that have been targeted so far include women and Latino's.

Finally, the Finance Committee reported that on July 14, 2000, the ACP-ASIM broke ground on a 204,000 square foot addition to their current headquarters in Philadelphia. With the expansion of services and the merger of the American College of Physicians with the American Society of Internal Medicine, there has been a rapidly growing need for increased space. The Finance Committee and the Board of Regents have made provisions for moving forward with this addition without any increase in membership dues.

Wanted: Future Chapter Leaders

Are you interested in getting more involved with your Chapter and sharpening your leadership skills? Do you aspire to hold an elected office in your Chapter (Governor, member of a National Committee) and/or advance to Fellowship? If you answered yes to these questions, then I need you for our newly created Chapter Leader Network.

Designed to lighten the workload of the Chapter Governor, make operations at the Chapter level more efficient and increase member involvement, the Chapter Leader Network will be composed of local "point people," who will chair the activities/initiatives of various areas, including Associates/Medical Student Activities, State and National Healthcare Legislation, Community-Based Teaching, Membership, Educational Program Planning, Third Party Payer Issues, Public Relations, and Women's Health.

The network members will exchange information with specific College staff and initiate local activity when needed. A Chapter Leader Web site will be developed to facilitate communication between network members and staff.

So, if you want to be instrumental in improving the effectiveness of our Chapter, volunteer to be a member of this exciting new endeavor. For a complete listing of the network areas and responsibilities, please contact me at phone: ( 912) 438-3300; fax (912) 438-3384; or e-mail jstubbs@surfsouth.com

American Board Of Internal Medicine Recertification Program

The American Board of Internal Medicine (ABIM) has embarked on a new program for recertification called Continuous Professional Development (CPD). This recertification process will go into effect for all diplomates who were certified by year ending 2000 and thereafter. The CPD program involves three steps:

1. Self Evaluation

2. Examination

3. Peer Credentialing

The examination will be the typical secure recertification examination similar to the one that has been offered since 1990, only it will also be available to be taken online on a computer. The credentialing aspect is also largely unchanged and does not involve any significant financialoutlay or effort by the applicant. This will simply involve the process whereby the ABIM confirms the diplomate's good standing in terms of hospital privileges and maintaining an unrestricted medical license. The controversial aspect are the self-evaluation modules. Internists seeking recertification will have to complete five self-evaluation modules during a ten-year period. Each self-evaluation module is designed to cover:

1. Medical Knowledge- Multiple choice questions focusing on cutting edge knowledge specific to the domain of the certificate, likely requiring reference sources.

2. Clinical Skills - Utilizing CD-ROM, multimedia questions, standard physical examination, diagnoses communication techniques, and appraisal of the literature requiring clinical reasoning derived from covenant based medicine.

3. Professionalism- An automated phone data system is used by patients and peers was selected by the diplomates to complete short surveys on the aspects of professionalism, communications, and patient care.

4. Practice Performance- Separate modules assess patient care of common "tracer" diseases (for example, diabetes, asthma, and congestive heart failure). Others assess specific clinical ser- vices (for example, preventive services) or selected procedures. Each module guides diplomates in chart of practice reviews to determine compliance with accepted standards or guidelines.

Members of the ABIM Board have heard from the College leadership and the Board of Governors' significant concerns and criticisms of this new program. Specifically, criticisms have been leveled at the ABIM indicating that this program is too self serving for the Board, too time consuming and costly for the applicant, and lacks relevancy to the actual clinical practice of the applicant. Many in the College also expressed the opinion that the self evaluation process should be far more flexible and involve the opportunity for physicians to achieve credit for completing other CME programs offered by other organizations, such as the College itself or various academic healthcare centers. This ABIM recertification program is a very ambitious project that will have a major impact on all physicians. I urge you to become familiar with the ABIM programs for continued professional development by calling 800-441-2246, ext. 3593, or visit the Continuous Professional Development web page on the ABIM website at www.abim.org. Our Chapter will be having at our next annual session a member of the ABIM Board to provide a keynote address explaining the recertification program and time to hear your thoughts and concerns.

Pathway To Fame (Fellowship Advancement Made Easy)

Advancement to Fellowship in the American College of Physicians-American Society of Internal Medicine continues to be a mark of excellence in distinction for internists, both in research and in everyday clinical practice. Under the direction of Membership Chairman, Vince Nicolais, our Chapter has embarked on a campaign urging members to consider seeking advancement to Fellowship. Many of you continue to be confused about the qualifications for advancement to Fellowship. Marc Shabot, Governor of Texas Southern, recently wrote this straightforward explanation:

Prerequisites

  • ABIM, RCPSC, or AOBIM certified*
  • Licensed practitioner
  • Formal training completed, Member at least 2 years, in practice or teaching for at least 2 years
  • Proposed/seconded by 2 Masters/Fellows
  • Commitment to lifelong learning and professional development

* May be waived in extraordinary circumstances

Then, Qualify by 1 of the 4 Pathways*

Pathway 1- Academician

  • Holds academic appointment as teacher, researcher, administrator, writes scientific papers, scholarly reviews, book chapters, etc.

Pathway 2- The Scholar/Teacher/ Multiple Certification

  • Active in community as teacher in Continuing Education and Professional Development activities
  • Re-certified or dual boarded, or MKSAP for score

Pathway 3- The Active ACP-ASIM Member

  • 10 years membership in the ACP-ASIM
  • Active in ACP-ASIM meetings and Committees at local and national level

Pathway 4- The Senior Physician

  • May have been a longstanding Member or have joined ACP-ASIM later in life
  • Has demonstrated longstanding professional activity in the community, in teaching, in patient care
    or in service; acts as a role model for other physicians and health professional

Note: Community service, especially the voluntary provision of medical care, and ACP­ASIM activities significantly enhance the likelihood of advancement, under all four pathways.

*Pathways are not mutually exclusive; "combinations" are permissible.

Announcement

Attention: ACP-ASIM Members Who Enjoy Reading Literature

The Georgia Chapter of the ACP-ASIM will have its first literature retreat weekend at beautiful Amicalola Falls State Park, March 23-25, 2001. This is an opportunity to discuss a curriculum of challenging literary works with a master teacher, earn CME credits, and spend a lovely weekend with your family. Spouses or guests are strongly urged to participate in the sessions which will be held Friday evening, Saturday morning and evening, and Sunday morning.

These literary retreats began in Tennessee ten years ago and have since been adopted by many other ACP-ASIM chapters. Dr. Evan Weisman and his wife attended the Tennessee retreat last year, and the Georgia Chapter is fortunate to have Tennessee's faculty member, Dr. Gregory O'Dea from the English Department of the University of Tennessee at Chattanooga, to serve as our faculty.

Enrollment will be limited to 30 couples and will be on a first come, first serve basis. The registration fee of $120 will cover course materials, faculty, all sessions, and continental breakfast Saturday and Sunday. Other meals and housing (at group rates of $80 plus tax) are not included. Attendees at the Tennessee retreat have tended to return annually, and each year several people have, unfortunately, registered too late to be included. Registration deadline is December 31, 2000.

So complete the registration form below today. I can promise you a stimulating and exciting weekend.

2001 Georgia Chapter Scientific Meeting

The 2001 Georgia Chapter Scientific meeting will be held June 8-10, 2001 in Augusta, Georgia, at the Radisson Riverfront Hotel. The theme of this upcoming scientific meeting will be "Technology in the Future of Internal Medicine." Areas of discussion will include application of informatics to clinical practice, application of informatics to patient education, telemedicine, genomics, tissue engineering, genetic screening, new developments in biotechnology, ethical issues of application of technology, preventive medicine, and application of technology to geriartics. This promises to be a very exciting educational opportunity for all members of the Chapter. Please mark your calendars and plan to attend. Registration information will be coming soon.

The Facts Behind The Rumors About The Medical College Of Georgia

By Ruth-Marie E. Fincher, MD, Vice Dean for Academic Affairs,
Medical College of Georgia School of Medicine

The Medical College of Georgia (MCG) is in the midst of unprecedented changes. Many are common to all academic medical centers, but a few are unique to MCG and impact education, clinical service, and research within MCG and the School of Medicine.

In January 2000, the University System of Georgia Board of Regents approved a one-time early retirement program for faculty and staff who met defined retirement criteria. Approximately 20% of School of Medicine faculty accepted the program and the first participants retired March 31, 2000. The remainder will retire by June 30, 2001. Dr. Francis Tedesco, President of MCG, has announced his retirement in December 2000 and Dr. Stephen Portch, Chancellor, has convened a presidential search committee. New faculty are expected to be hired at approximately the 40% level, resulting in a total faculty reduction of approximately 12%. Dr. Darrell Kirch, Dean of the School of Medicine since 1994, resigned in June 2000 to become Dean and Senior Vice President at the Pennsylvania State University School of Medicine. Dr. Betty Wray, a longstanding member of the MCG faculty and former Chief of the Section of Allergy-Immunology, Department of Pediatrics, is Interim Dean.

Until this year, the MCG Hospital and Clinics was a state-run facility and therefore not allowed to enter into private contracts, making it less competitive in today's managed care market. Therefore, a not-for-profit entity, MCG Health, Inc. (MCGHI) was created to assume administration of the hospital and clinics, and the Board of Regents approved the affiliation agreement in January 2000. The agreement covers the hospital and clinics, the Children's Medical Center, and the Georgia Radiation Therapy Center. The new administration became effective July 1, 2000. MCGHI is expected to provide more effective and efficient clinical management and also may enable expansion into a broader health care system.

The educational program for the 720 students enrolled in the School of Medicine is undergoing changes as well. The most significant curriculum change this year is the implementation of a new course, the Essentials of Clinical Medicine, that combines nine small clinical courses into an integrated unit that spans the first two years. The 2-year sequence provides an integrated clinical foundation for the third year by emphasizing clinical and self-directed learning through lectures, interactive small groups, and direct patient experiences. Learning in the third-year core clinical clerkships (family medicine, internal medicine, neurology, obstetrics/gynecology, pediatrics, psychiatry, and surgery) overall is divided equivalently between in- and outpatient experiences. In aggregate, students spend half of their time at off-campus, community- based teaching sites, working with volunteer clinical faculty in their practice sites. Volunteer faculty are vitally important and valued members of the School of Medicine faculty community. The statewide Area Health Education Center (AHEC) clerkship coordinator, clerkship directors, and associate dean for curriculum collaboratively identify, develop, and support the teaching sites, and the volunteer faculty are offered faculty development programs to help them enhance teaching skills and integrate students into their practices. The Center for Educational Excellence, recently established within the Office of Academic Affairs, helps faculty develop teaching skills, fosters educational innovations, and supports educational scholarship.

Research at MCG was a $26 million enterprise in FY99. The vice president for research, Dr. Matthew Kluger, expects that figure to at least double over the next 5 years. To facilitate research development, MCG recently formed the Biomedical Research Council (BMRC) comprised of representatives from all five MCG schools, to develop a strategic plan. The BMRC designated five areas for research emphasis: cardiovascular diseases, cancer, neurological diseases, infection and inflammation, and biomedical technology. These represent existing strengths and opportunities. Based on the current level of extramural funding, cardiovascular diseases represent the strongest research area on campus. The institution plans to hire 45 additional research-oriented faculty, who also will have teaching responsibilities. Funding has been approved for a new research facility, which will add 90,000 square feet to the existing 144,686 square feet of research space.

This is undoubtedly the period of greatest change and greatest opportunity at MCG during the 16 years I have served on the faculty.

Update: FLU Vaccine Supply

From the CDC (special thanks to Melinda Wharton, MD)

This update provides information on the influenza vaccine supply situation and updated influenza vaccination recommendations by the Advisory Committee on Immunization Practices (ACIP) for the 2000-01 influenza season.

Influenza vaccine supplies that are expected to be distributed this year should be approximately equal to what was distributed last year, but a substantial amount of vaccine will reach providers later than usual. Based on information provided by manufacturers, distribution of approximately 75 million doses is anticipated. This total includes 9 million doses that CDC has contracted with one of the vaccine manufacturers to produce. During last year's influenza season in the United States, approximately 77 million doses of vaccine were distributed, of which 3 million were returned, for a net distribution of 74 million doses. Most vaccine doses usually become available to providers by October, with 99 percent of distributed doses available before December. This year, as many as 18 million doses are expected to be distributed in December. Because of the potential health impact of delayed flu vaccine availability, CDC and ACIP updated recommendations for the 2000-01 season. The overall goal of these recommendations is to minimize the adverse health impact of delays on high risk persons. Persons at high risk from complications from influenza are:

1. Persons aged 65 years and older;

2. Residents of nursing homes and other chronic-care facilities that house persons of any age who have chronic medical conditions;

3. Adults and children who have chronic disorders of the pulmonary or cardiovascular systems,
including asthma;

4. Adults and children who have required regular medical follow-up or hospitalization during the past year because of chronic metabolic disease (including diabetes mellitus), kidney dys- function, blood disorders (hemoglobinopathies), or immunosuppression (e.g., caused by medications or HIV);

5. Children and teenagers (aged 6 months to 18 years) who are receiving long-term aspirin

therapy and therefore might be at risk for developing Reye syndrome after influenza infection;

6. Women who will be in the second or third trimester of pregnancy during the influenza season.

The recommendations are as follows:

1. When influenza vaccine becomes available, vaccination efforts should be focused on persons at high risk of complications associated with influenza disease and on health care workers who care for these persons.

2. Temporary shortages because of delayed or partial shipments may require decisions on how to prioritize use of vaccine available early in the season among high-risk persons and health-care workers; such decisions are best made by those familiar with the local situation.

3. Mass vaccination campaigns should be scheduled later in the season as availability of vaccine is assured. Given projected vaccine distribution, in most areas, campaigns will be scheduled in November or later. Efforts should be made to increase participation by high-risk persons and their household contacts, but other persons should not be turned away.

4. Groups implementing mass vaccination efforts should seek to enhance coverage among those at greatest risk for complications of influenza and their household contacts.

5. Special efforts should be undertaken in December and later to vaccinate persons 50-64 years of age, including those who are not at high risk and are not household contacts of high risk persons. Persons in this age group with high risk conditions should be vaccinated along with other high risk persons. Special efforts to vaccinate healthy persons in this age group should begin in December and continue as long as vaccine is available.

6. Vaccination efforts for all groups should continue into December and later, as long as influenza vaccine is available. Production of influenza vaccine will continue through December, and providers should plan for how vaccine provided late in the season can be used effectively.

7. Pneumococcal vaccines are recommended by ACIP for many of the same high risk persons as for whom influenza vaccine is recommended. Assuring pneumococcal vaccination of high risk persons early in the influenza season, will confer substantial protection from a major complication of influenza (pneumococcal pneumonia). Pneumococcal vaccine should be administered when indicated even if influenza vaccine is not yet available. Providers should emphasize to patients or their caregivers that pneumococcal vaccination is not a sub- stitute for influenza vaccination and that patients need to return for influenza vaccine when it is available. The public and private communities will continue to work closely together to ensure the availability of influenza vaccine for the season and to minimize the adverse impact of delays.

For more information about influenza disease and influenza vaccine, visit CDC at www.cdc.gov

American Heart Association's Physician Of The Year

The Augusta area medical community has many excellent physicians, including several with national renowned reputations. Now there's one more. Dr. Jacqueline Fincher of McDuffie Medical Associates. Dr. Fincher has been named Physician of the Year by the prestigious American Heart Association. She was nominated by the AHA's Southeast affiliate for the passion and commitment she brings to educating patients and the public on how to take care of their cardiovascular system. She learned from her work in internal medicine how important that is to reduce the risk of heart disease. She almost always answers the call to speak on behalf of the AHA, which she eagerly supports because of its commitment to good heart health.

We join Dr. Fincher's colleagues, patients, family and friends in congratulating her on an award well deserved. Keep up the good work!

What's New

Contact Information

Vincent Nicolais, MD, FACP,
Governor, Georgia Chapter

Karen Townsend
Executive Director
Ph: 770-693-9973
Georgia Chapter

Michelle Dietz
Administrative Assistant
Ph: 770-920-6995