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October 2012 Banu E. Symington, MD, FACP, ACP Governor



Message From Your Governor

Dr. Symington

Are you burned out?

Greetings my fellow Idaho ACP members. I have thought for a while about what my first official communication should focus on-- the virtues of the ACP, High Value Cost Conscious Care, or the Accountable Care Act? But I decided to make this, my first column, a rather personal one. Physician Burnout has been getting a lot of airtime. A recent lead article in the Archives of Internal Medicine by Shanafelt et al (10-8-12), which Netscape later picked up and publicized, underscores the fact that American physicians suffer from burnout at a higher rate than any other profession!!! I “get” this for I have felt it. But if we simply observe it and report on it instead of trying to understand and fix the root causes, I fear there will be no compassionate physicians available for future generations. So, what has happened to our noble calling?

My personal descent into “burnout” was a gradual one. It began a decade ago, when stagnant to declining Medicare reimbursements made me face a tough choice. Close my practice to Medicare patients or find another way to maintain my income. I felt it was important to continue to see patients of my parents age. I did not think doing Botox injections to supplement my income was right for me. So, like all type A personalities, I decided to see more patients daily and forgo the occasional four-day weekend. By the end of two years, I knew this strategy would not work for an internist in an underserved area. Even working harder and longer, I still could not offer staff COLA raises, was cutting my own salary, and had lost any semblance of work-life balance. And of course, that most precious thing, unhurried time during the patient encounter had been sacrificed. Meanwhile, subtle outside pressures reshaped my relationship with dear patients who had been like family. For example, I was no longer a physician taking care of my patients. I was now a “provider” taking care of “clients”, “consumers”, or “customers”. The very intimate healing relationship was now equated with every other “business” relationship. (I have my own beliefs about why this terminology change is being inflicted upon us.) Normally a very “touchy-feely” doc, it became very hard for me to look at my patients, let alone touch them except as I palpated their organs. The almighty computer now sat between us, forming a very effective barrier to touch and even sight. As Abraham Varghese opined so eloquently, touch alone is healing. Yet all the forces of modern medicine are driving us to minimize touch (and time) in the patient encounter. No wonder outcomes and patient satisfaction might be suffering. Another force contributing to my sense of burnout was the entry of the dreaded electronic medical record (EMR) into my practice. The EMR mandate started with the best of intentions-- to allow patients to have portable medical records. Unfortunately, and ironically, no one thought to mandate a universal EMR or at least compatibility between EMRs. So in my own hospital the EMRs of one medical practice could not communicate with another or even with our inpatient EMR!!! So the chaos of Xeroxing and scanning interim records continued at each patient encounter…but now reviewing the record became more difficult. You could not keep your thumb on one lab sheet as you tried to compare how the patient’s creatinine or protime changed with their new heart medications. And of course, then came the pervasive exit patient satisfaction surveys. They frequently reported “not enough time” or “the doctor was distracted by a computer glitch”. So the most gratifying and pleasant part of my daily encounters had been sabotaged, and patients could feel that change. For a long time, I wished to retire…but with two young kids this seemed impossible.

So enough analysis about what happened to our noble profession, how can we fix it? For each of us, there is probably a unique solution. But when you are drowning…overwhelmed with your day-to-day work…. it is sometimes hard to recognize a life-ring let alone think about how to turn nearby floating debris into a life-preserver. Especially when the solution may involve taking on more work! In my simple-minded view of things, I thought I could either become involved in changing the status quo or seek some other outlet for professional satisfaction. Two years ago, I decided to hedge my bets by doing both. I have gotten involved with a pet project, aiming for universal HPV immunization of teens in hopes of eradicating several virally-mediated cancers. I have also gotten involved with a potentially practice changing organization, the ACP. Yes, this extra work eats into my limited free time. But the invigoration and intellectual stimulation these volunteer activities give me made me feel like I had more energy for my day job. (Kind of like the advice we give our fatigued patients. Start a daily exercise routine. It seems counterintuitive but it can work!). I seem to be working more purposefully and efficiently. I feel I am working towards public health improvement with my HPV project. And I feel like I can help change the future of medicine with my ACP involvement. So I feel more empowered and less like a victim. I feel like I am making some headway and feel daily satisfaction in my work life even though computer problems, reimbursement issues, etc have not improved. I want to encourage and invite readers to share how they have been grappling with burnout.

Looking forward to your calls, emails, posts……the “guv”.

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Guest Message from David A. Fleming, MD, MA, FACP

It is an honor for me to contribute as a guest to this, the first newsletter of the Idaho Chapter of ACP! First let me congratulate you on achieving this as another milestone in developing this critically important communication tool. You are on a fast track in growth in development, thanks to the energetic and capable leadership of your Governor, Dr. Banu Symington, in partnership with Idaho Chapter’s staff leadership, Kerrie Dschaak. As Regent and immediate past Chair of the Board of Governors I have had the opportunity to closely work with and observe Banu first hand. From the start she has been enthusiastic, articulate, and in the mix, making her case and ably representing you at BOG meetings and in other venues. At a time when sound leadership is critically important for our profession you chose well, it appears.

These are indeed interesting and historic times for the College. Major areas of focus these days are membership growth, ongoing enhancement of products and services to better serve you and your patients, the work force crisis in primary care, and of course the target rich environment of advocacy. The policy crisis du jour is the looming across-the-board federal spending cuts that are expected the first of the year due to sequestration unless the U.S. Congress can agree on a deficit reduction package. The estimated $11 billion cut under Medicare as a result of sequestration, coupled with the 27% Medicare physician payment cut intended by the SGR, would strike a devastating blow to health care in this country, selectively impacting many of our most vulnerable patients, namely the elderly and chronically infirm. Everyone is hoping that reason will prevail in this situation but the sequestration train keeps rolling down the track and gaining momentum—one can only hope that wiser hands control the break. Visit Bob Doherty’s Blog for a consistently succinct and accurate discussion on these and other health policy issues being addressed by the College.

Other important initiatives address the alarming rise in health care costs. ACP’s High Value Care (HVC) initiative is a comprehensive program that fosters the highest possible quality of care along with reductions in unnecessary costs in the health care system. HVC offers clinical recommendations, patient and physician resources and public policy recommendations. Championing this effort is our own Steve Weinberger, ACP's EVP and CEO who states that high value care is being "undermined by the increasing availability of direct-to-consumer screening tests." The ethics argument is that we should respect patients' right to make their own medical decisions; however, their choices should be informed by evidence of benefits and risks, not advertising or sales pitches. ACP is also joining other professional organizations to partner with ABIM in the Choosing Wisely campaign. This is a multi-year effort of the ABIM Foundation to help physicians be better stewards of finite health care resources.

And there’s much more. Implementation of the Affordable Care Act, development of the Medical Home concept, expanding our primary care workforce, enhancing graduate and continuing education of America’s internists, fostering membership through the mentoring and professional development of our young colleagues, developing products that enhance the quality and efficiency of care….these efforts and more are available to you through membership in ACP. There has never been a better or more critical time to be part of this organization, my friends – as Member, Fellow, or Master - your voice is heard and your professional presence felt through the efforts of both leadership and membership. These challenging times require a concerted effort by ACP’s 135,000 members who speak loudly with one voice representing the needs of our patients and the welfare of our society. Our College gives you that voice. Please use it. Join Banu and me by staying involved and being heard. Recruit more members and advocate. You are an increasingly strong chapter with strong leadership and your ongoing investment will pay off - I look forward to investing with you. These are indeed interesting times but we will prevail—the good of our patients demands it.

Again, I thank you for allowing me to participate in this historic moment for your chapter. Your days forward are bright and the rewards great. Please take care and be well.

DAF
David A. Fleming, M.D., MA, FACP
Professor of Medicine
Chairman, Department of Internal Medicine
Director, MU Center for Health Ethics
University of Missouri School of Medicine

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Idaho Receives 2012 Chapter Excellence Award – 1st time in 11 Years!

Chapter Excellence Logo

I am pleased to announce that our chapter is in receipt of the 2012 Chapter Excellence Award! The award recognizes chapters which successfully meet the standards for managing a chapter. In order to achieve the Chapter Excellence Award, chapters must meet all basic criteria and seven optional criteria. Criteria include such activities as formulating an effective Governor’s Council and committees, communicating frequently with membership, providing educational opportunities, recruiting and advancing members and celebrating membership through local awards. I would like to extend a special thanks to those chapter members who assisted me in all of these endeavors! For their hard work and dedication, we received this award.

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Save the Date!

Hindson Winter Conference Update in Internal Medicine

The Idaho ACP, the Boise VAMC and the David Hindson Foundation are happy to announce the 36th annual Hindson Winter Conference Update in Internal Medicine. Speakers will include internationally known physicians, in addition to our outstanding local clinicians.

January 17 – 20, 2013
The Hunt Lodge
McCall, Idaho

For more information and to register, visit our News & Meetings page.

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Chapter Council/Committee Chairs

Melissa (Moe) Hagman, MD FACP

Dr. Hagman

Executive Council/Young Physicians/Associates

Moe grew up in Boise, attended the College of Idaho in Caldwell, WWAMI’ed to the University of Washington for medical school. She completed a chief resident year at the University of Washington Medical Center, worked as a hospitalist, palliative care consultant and Associate Director for the UW Internal Medicine Residency program until 2011, when she finally came to her senses and returned to Idaho. She now works at the Boise VA Medical Center as a hospitalist, palliative care consultant and Associate Program Director for the University of Washington Boise Internal Medicine three-year Residency program.

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William G. Weppner, MD FACP
Executive Council/Awards/Chapter Meeting Program

Dr. William G. Weppner serves as a Primary Care Physician and Silver Team Lead at the Boise VAMC. He did his undergraduate work at University of Idaho and received his medical degree at the University of Washington School of Medicine, going on to complete both his internal medicine training and a Masters in Public Health at the University of Washington, as well. Dr. Weppner is currently an Acting Assistant Professor of Medicine with the University of Washington, Core Faculty with the University of Washington-Boise Internal Medicine Residency and the Co-director of the Boise VAMC Center of Excellence in Primary Care Education. He has an interest in medical education, particularly in regards to primary care. In his short career as a researcher in health services, Dr. Weppner has published book chapters and manuscripts on primary care appearing in journals such as JAMA, Archives of Internal Medicine and Diabetes Care. Raised in Idaho, he enjoys living in Beautiful Boise with his wife and two children, and is lucky enough to be able to mountain bike to and from work (when he has time)!

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C. Scott Smith, MD FACP, Past Governor

Dr. Smith

Executive Council

Dr. C. Scott Smith graduated from MIT in 1976 then received his M.D. from the University of Washington in 1980. He completed an internship at Mary Imogene Basset Hospital and residency at the University of Washington. He has been an Internist at the Boise VA Medical Center since 1990. He is a Professor of Medicine, Biomedical Informatics and Medical Education at the University of Washington, director of the VA Center of Excellence in Primary Care Education and the Program Director at the UW Boise Internal Medicine Residency. He is currently principal investigator or co-investigator in three studies and has received over $1M in funding since 1990. He has over 50 published peer-reviewed abstracts, papers and book chapters dealing mostly with clinic improvements and medical education. Dr. Smith also has over 30 national and international presentations on clinic improvements and medical education.

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Kevin Owens, MD
Executive Council/Finance

Dr. Owens

Dr. Kevin Owens is an internist at Cassia Regional Medical Center in Burley, Idaho. He received his undergraduate degree from Idaho State University and a medical degree at Ross University School of Medicine. He completed his residency at the Marshfield Clinic/Saint Joseph’s Hospital in Marshfield, Wisconsin. He is currently serving as the Vice-Chief of the medical staff, chairman of the by-laws committee, ICU quality committee and vice-chairman of the ER quality committees at CRMC. He is also the medical director over the critical care unit and respiratory department. Dr. Owens has developed the first Mechanical Ventilator Protocol at CRMC and also created Admission Order Sets to ensure patient safety. He is currently involved with the ongoing development of multiple quality-driven guidelines and protocols.

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Associates
Danielle Orchard, MD
2nd year Internal Medicine Resident at University of Washington, Boise

Dr. Orchard is currently working on a hospital readmission project with Drs. Wilper, Schamber, Thirumali, and Le, at the Boise VAMC. They are interested in this topic because readmission rates are high (about 12-19% among Medicare patients in 30 days) which results in a significant cost burden ($12-44 billion annually). The Patient Protection and Affordable Care Act has designated a reduction of avoidable readmissions as a target for healthcare cost savings. This will result in lower reimbursement rates to hospitals with high rates of readmissions. They are also looking at various variables and risk stratification models to identify persons at high risk of readmission.

Hobbies & Interests

H.S. jersey displayed at the Women’s Basketball Hall of Fame
Full-ride athletic scholarship to BSU
Backpacking: This summer she backpacked through the Seven Devils and summated the Devil peak.
She is an amateur oil painter.
She states “my love of primary care stems from my father, Dr. Doug Orchard, who is a retired family practice doctor.

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Kris Schamber, MD

Dr. Schamber

My name is Kris Schamber, and I am a 2nd year resident in the new, three-year, University of Washington-Boise Internal Medicine Residency program. I was born-and-raised in the high desert of Southern Wyoming, and grew up exploring much of the state with a rifle or fishing rod in my hand. After graduating high school, I attended community college before attending the University of Wyoming to finish my Bachelor’s degree in medical microbiology. I then continued my undergraduate research work and completed a Master’s Degree and Neuroscience. Having always wanted to be physician growing up, and preparing for it my whole academic life I applied to medical school and was thankfully accepted into the Wwami medical program in the fall of 2007, graduating in 2011. After graduation I headed straight to Boise for my top choice in residency programs in the program above.

From the beginning, even before medical school, I had known I wanted to do primary care medicine, though I didn’t know at the time what that term was. During medical school my idea of what medicine was developed into an interest and then a passion for a career in general internal medicine, and by the time residency application season came around I knew I wanted to practice a mixture of inpatient and outpatient medicine in a rural community. To that end I chose a residency program that I felt most clearly prepared me to serve that role, and here I am.

On a personal note, I have a 10 year old daughter who keeps me on my toes, and I am recently married to a wonderful woman. Idaho has been a perfect fit for me socially as well. After growing up in rural Wyoming, I have come to love the outdoors - camping, hunting, and fishing in my spare time – and Idaho provides seemingly endless opportunities for these activities.

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Ben Widener, MD

I was born and raised in Sheridan, WY, where I grew up on a cattle ranch. I later received my undergraduate education and degree from MSU Bozeman. I earned a B.S. in Biotechnology with minors in chemistry and biochemistry. After college I had an interim job/education as a research assistant in a virology laboratory at MSU and spent the winter ski instructing at Bridger Bowl in Bozeman. I later attended the University of Washington for medical school and graduated in 2011. My personal interests include music, fly fishing, hunting, camping and skiing. My professional interests include rural primary care internal medicine and are interested in modern hybrid models of practice structure. My particular areas of interest and fascination are in infectious disease and rheumatology. I plan on eventually practicing primary care internal medicine

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Meet the Executive Director

Dr. Dschaak

My name is Kerrie Dschaak, clinic manager at Cassia Regional Internal Medicine in Burley. I have enjoyed working with Dr. Jeffers, past-Governor for the past four years and look forward to working with Dr. Symington in promoting growth and activity in the Idaho Chapter. I have three children – a son in an emergency medicine residency program in Peoria, IL, a son in the PharmD program at ISU and a daughter, a junior at Burley HS. My hobbies include spoiling my grandchildren, running, water skiing, snow skiing and volunteering for the Pomerelle ski patrol.

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UW-Boise IM Residency Recruitment Season Kicks Off!

The University of Washington-Boise Internal Medicine Residency Program will be hosting their Internal Medicine Recruitment Season from Nov 5th 2012 to Jan 15th 2013 at the Boise Veteran’s Affairs Medical Center in Boise Idaho. This may explain the groups of eager applicants in dark suits you see touring the halls of local Boise facilities!

The Boise program will be interviewing applicants for the recently expanded 3-year residency program affiliated with the University of Washington. There are a total of 12 Internal Medicine Intern positions available – 8 categorical slots and 4 preliminary slots. The program offers an excellent training opportunity for medical school graduates interested in office-based internal medicine, hospital medicine, or further subspecialty training.

The UW-Boise program provides a unique opportunity for growth and development in a close-knit, collaborative setting that is highly tailored to individual interests. Throughout each academic year the trainees in the program rotate through clinical services at the Boise VAMC (also the main residency site), St. Luke’s RMC, St. Alphonsus RMC, West Valley MC, Mountain States Tumor Institute, Planned Parenthood, University of Washington sites in Seattle as well as various rural clinical sites in Idaho (currently including Sandpoint, Twin Falls, Grangeville and McCall). The trainees in the program are exposed to a diverse population of patients in almost every clinical setting; from inpatient medicine, critical care, primary care, women’s health, radiology, surgery, neurology, geriatrics, emergency medicine, and a wide range of consultative and ambulatory specialties.

Building off the success of 30 years as a University of Washington Internal Medicine Residency track, the full 3-year residency offers opportunities and experiences that are shaped by the trainees, enthusiastic attendings and a dedicated residency leadership. With their help, the program will continue to flourish and expand each academic year!

The Boise program looks forward the upcoming Academic Year 2013-2014 recruiting season!

For questions please contact: Program Coordinator: Angela Harris Program Assistant: Sandi Denson Visit our website

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Welcome to ACP - Idaho's Newest Masters!

David A. Hindson, MD, MACP
C. Scott Smith, MD, MACP

Masters comprise a small group of highly distinguished physicians, selected from among Fellows, who have achieved recognition in medicine by exhibiting preeminence in practice or medical research, holding positions of high honor, or making significant contributions to medical science or the art of medicine. Masters must be highly accomplished individuals. Evidence of their achievements can come from many types of endeavors, such as research, education, health care initiatives, volunteerism and administrative positions. The Master must be distinguished by the excellence and significance of his or her contributions to the field of medicine.

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Congratulations to Our New Fellows!

One of the benefits of ACP membership is progressing within the organization and having your expertise validated and recognized by advancing to Fellowship. If you are interested in becoming a Fellow or in nominating a colleague, please refer to the ACP website for further information, or email me or Kerrie Dschaak. The Chapter recognizes and congratulates the following Idaho Chapter physicians who were elected to Fellowship in the College since January 2012.

Donna Beeson, MD, FACP

Lisa Burgette, MD, FACP

Andrew P. Wilper, MD, FACP

Dr. Beeson
Donna Beeson, MD, FACP

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Welcome New ACP Members!

Nathan B. Adams, MD – Idaho Falls
Judith E. Csanky, MD – Twin Falls
Daryl Fickin, DO – Twin Falls
Malatesha Gangappa, MD - Meridian
Manisha Mittal - Eagle
Roger T. Turcoctte, Jr., MD - Boise
Harry VanderWal Jr., MD - Sagle
Jeffrey D. Wilson, DO – Coeur D Alene

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Internal Medicine 2013

Internal Medicine 2013 will be held April 11-13 in San Francisco, CA. Choose from more than 200 CME courses in internal medicine and the subspecialties presented by distinguished faculty.

Information from Internal Medicine 2012 including course handouts and webcasts can also be found here. Submit for CME and MOC now.

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Strengthen Our Chapter: Participate in ACP’s Recruit-a-Colleague Chapter Rewards Program!

The American College of Physicians and the Idaho Chapter encourages all members to help strengthen the voice of internal medicine by recommending ACP Membership to colleagues. By joining the College, your colleagues will enrich their clinical knowledge and skills and have access to all of the ACP member benefits that you enjoy.

To thank you for your dedication to our organization, ACP offers incentives to members and their chapters that recruit new members through the Recruit-a-Colleague Chapter (RACC) Rewards Program.

As with the national Recruit-a-Colleague Program, the RACC Program rewards successful individual recruiters with dues credits for each new full Member recruited and a chance to win a trip to the annual Internal Medicine meeting. In addition, the RACC Program also provides rewards to the recruiters’ chapters. The Recruit-a-Colleague Chapter Rewards Program runs annually from April 1 through March 15.

To participate, simply forward to your colleagues the Membership application . To qualify for the program, your name must be listed on the recruiter line of this specially coded application.

Thank you for your help in strengthening our chapter!

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ACP Annual Report

2011-2012 ACP Annual Report of the Executive Vice President

The annual ACP Report of the Executive Vice President is now available on ACP's website .

The report reviews the College's accomplishments and activities during 2011 and to date in 2012. As part of ACP's ongoing effort to reduce paper and be environmentally responsible, the report has been produced in digital format. You can use the interactive table of contents to jump to specific sections, scroll forward and back through the report with ease, and access detailed content and video.

A video message from ACP CEO and EVP Steven Weinberger, MD, FACP, is available here .

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Contact Information

Banu E. Symington, MD, FACP
Governor, Idaho Chapter
Twin Falls, Idaho
Phone:209-814-1600

Kelly Hess
Executive Director, ACP Idaho Chapter
Phone:208-490-3329