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Governor's Newsletter - May 2000

From the Governor

Greetings to Illinois Downstate ACP-ASIM members, fellows, students, associates and masters! I write this just after returning from the ACP-ASIM Annual Session in Philadelphia. After seeing many of you there, attending some outstanding sessions, and getting the resulting "recharge" of my batteries, I have renewed enthusiasm about the privilege of being an internist and belonging to a great organization like the ACP-ASIM. I hope all of you will consider attending the Annual Session in Atlanta next spring - the investment of time, travel, tuition and other expenses, seems like a lot at the beginning, but the value of what we receive is impossible to measure.

Congratulations to a student and two residents who presented posters at the Annual Session. James Hancock, a student and Malik Ali, MD, a resident from Peoria and Nancy Wozniak, MD, a resident from Champaign, all attended the meeting and did us proud with outstanding posters. Congratulations to these future leaders of the ACP-ASIM!

Important and positive news from the Downstate Region starts with the recent election of Stephen Goetter, MD, FACP, as our Governor-Elect (and, beginning in the year 2001, Governor for the next four years.) Dr. Goetter is a general internist in Decatur, who has a long history of leadership in internal medicine, including a previous stint as the President of the Illinois Society of Internal Medicine, a record of activity in the state and national Society of Internal Medicine organizations and leadership in his local community. We are fortunate that Steve is willing to make this commitment, as it predicts only good things for the Downstate Region for the next few years.

Other recent organization activity includes the successful "Committee Day," held in Springfield, on February 12, 2000, at the Springfield Hilton Hotel. The following people attended:

  • Solomon Apostol, Mt. Vernon
  • Craig Backs, Springfield
  • Lanie Cation, Peoria
  • Gail Mullen, Mt. Vernon
  • Kevin Dorsey, Carbondale
  • Jim Graumlich, Peoria
  • Susan Hingle, Springfield
  • Larry Jennings, Mt. Carmel
  • Sara L. Rusch, Peoria
  • David Stricklin, Carmi
  • John Scott, Quincy
  • Sunil Sinha, Marion
  • Kathleen Treanor-Armich, Springfield

A number of notes in this newsletter outline some of the accomplishments of that day and we thank all of those who participated for their effort. Others in the region who are interested in participating are welcome to join committees. You can qualify to join a committee by being interested, making sure your membership in the ACP-ASIM is up-to-date and contacting me at the e-mail, telephone, or mail information included in this newsletter.

The Illinois ACP-ASIM Council met in Chicago, on March 18, 2000 and the Downstate Region was well represented with its Council members - Larry Jennings, Sunil Sinha and Craig Backs, along with Sara Rusch, the secretary of the State Council. Steve Goetter also attended, along with about fifteen representatives of the Northern Region. This Council meeting was intended to be the first official meeting of the "new" Council of the merged ACP-ASIM organization, but was generally conducted in the style of the old Governor's Advisory Council meetings.

In addition to some general discussions about local chapter activities, the group spent most of its time discussing the resolutions to be considered at the next Board of Governors' Meeting. The next official Council meeting will be in October, at the time of the State Scientific Meeting in Springfield - by that time the organization should have a much more structured approach to its Council meetings. In the interim, an Executive Committee Meeting consisting of the officers of the Council (President, Vice President, Secretary and Treasurer), our Governor-Elect and three other Council members (two from Northern and one from Downstate), will meet to establish structure and begin to make budget plans for the new organization. In my view, the Council should conduct business in a manner that makes it accountable, while still inviting broad input from committees, members in general and especially those people who have long records of participation and contribution to the ACP and/or ASIM. It will take some time to develop the exact right formula for the Council's operation.

The ACP-ASIM's educational efforts are particularly exciting. By the time you read this, the first Downstate Associates' Meeting will have taken place in Springfield, on May 18. We expect a large crowd and a great program, organized by Susan Hingle, Lanie Cation and numerous residents and students. In addition, a number of "Town Meetings" are planned in the Southern Illinois area, with the first set for Wednesday, May 3, at Mary's, in Herrin. While these meetings officially have a tuition cost, this fee will be waived for all ACP-ASIM members. I hope all of you in the Marion-Herrin-Carbondale area will plan to attend.

In cooperation with IDPH, we are co-sponsoring a communicable diseases program in Springfield in early June and again in October. And, finally, the State Scientific Meeting will be held on October 20-21, 2000, in Springfield. This two-day meeting will be packed full of updates, lectures, small group sessions, clinical skills activities and news from the College. It will be great to see you all there.

I hope this note and the rest of the newsletter provide the kind of information you are looking for from your College. Please be in touch whenever you feel that the College can be of any assistance to you.

Message from the Governor-Elect

I would like to thank Dr. Steward for giving me this opportunity to introduce myself to those of you who do not know me personally. I am proud and excited to be your Governor-Elect for Downstate Illinois and look forward to getting to know as many of you as possible in the next four years.

I am a lifelong resident of Illinois, growing up in Collinsville and doing my undergraduate work at the University of Illinois and my medical school training and internal medicine residency at SIU School of Medicine in Springfield. I came to Decatur, Illinois after completing my residency in 1979 and have lived in Decatur with my wife, Jackie, and our three sons since that time.

This is my first exposure to a leadership position within the ACP-ASIM. However, I have been active at the local level for sometime in various capacities at both Decatur hospitals. I also served as a counselor in the Illinois Society of Internal Medicine for some nine years, as well as serving as president for one term. I had the opportunity to serve on the ASIM National Liability Committee for ten years, including four years as Chairman. Obviously, my background is not in academics and my interests as Governor will tend to be focused on the everyday practice of medicine by those of us outside the academic community.

The term "hassle factor," popularized by ASIM several years ago, is being revived by the ACP-ASIM and it is as appropriate today as ever before. The problems that practicing physicians have in dealing with Medicare, insurance companies, hospital rules and regulations and the variety of healthcare plans, can consume more of our time than the actual patient care. I would hope that in the years ahead, you would look to ACP-ASIM as a primary source for any concerns that you have regarding the practice of medicine. You already recognize ACP-ASIM as THE source for continuing medical education and quality publications; I hope you will also think of us if we can be of any service to you regarding the economic issues we face each day.

Again, I look forward to seeing you at Chapter meetings and hearing from you whenever we can be of service. I can be reached via e-mail at sgoetter@pol.net or at my office (217) 876-5622.

Report from the Spring Board of Governors' Meeting

By David E. Steward

The Board of Governors (BOG) of the ACP-ASIM meets twice a year, once in conjunction with the Annual Session and once separately in the Fall. On April 11-12, 2000, the Governors met at the Pennsylvania Convention Center in Philadelphia, for this year's Spring meeting. Following is a brief review of those events.

The meeting opened with breakfast discussions of important topics among groups of Governors from around the country, who have the same terms - my term ends in 2001, so I met with the twenty or so Governors whose terms all end in 2001. Our discussions focused on the importance of the College communicating with its members and how these efforts could be enhanced. The Downstate Illinois Region was fortunate that Stephen Goetter, MD, FACP, the Governor-Elect designee for our region, was able to attend the meeting and participated in the breakfast.

Thereafter, the general meeting convened. The highlights of the morning of April 11 were a brief presentation from Dan Klein, MD, Governor of Wyoming, who cared for some of the people involved in the nationally-publicized hate crime murder of a gay college student in his town of Laramie. He published a note about this in the February 1999 edition of the Annals of Internal Medicine and this is recommended for your review. We also heard reports from all of the College's committees. Of particular interest were the deliberations of the Education Committee about the recertification process at the American Board of Internal Medicine - with the hope of streamlining and simplifying this currently somewhat cumbersome process - and of the Medical Services Committee, which is concerned with the frequent and increasing hassles that physicians face in all aspects of their practice. Later in the morning, Reference Committee hearings were held to hear testimony from the BOG on seventeen resolutions.

On the afternoon of the first day, we heard a report from John Eisenberg, MD, MACP, the director of the federal Agency for Health Research and Quality (AHRQ). His presentation addressed medical errors and patient safety and provided interesting insights into the approach that the AHRQ is taking in conducting research, which should help reduce medical errors. Perhaps his most important point was the misunderstanding that the public, and even physicians, have about the nature of medical errors, most of which occur because of system problems, rather than the individual mistake of a doctor, nurse, or other healthcare worker.

We finished the afternoon with a series of reports, the first of which was from Bob Doherty, from the ACP-ASIM Washington Office, who discussed the advocacy efforts that the College is currently managing. Our advocacy approach to the medical errors and safety issue was of special interest and included careful analysis of how medical errors should be reported, what is discoverable and what risk physicians might incur if they report an error.

We also heard about the College's efforts in supporting Medicare prescription drug benefits and other aspects of Medicare reform and patient rights legislation. Finally, the issue of access remains one of the highest priorities of the College's advocacy groups and we hope that progress can be made in this area soon, with recent specific support for proposals that would provide tax credits for acquiring and paying for health care.

On April 12, the second day of the meeting, Walt McDonald, the CEO and Executive Vice President of the College, provided an overview of the strategic directions taken by the College for the coming year. He identified four themes: 1) patients, including vulnerable patients with specific mention of those in rural areas, who are aging and may lack insurance; along with the growing use by patients of the Internet to seek health information; 2) physicians with specific attention to the competition for the primary care role by allied health personnel, and the declining incomes of internists with the conflict this causes within the profession; 3) the College, with special emphasis on the advocacy role of the College, the educational needs of our members and how the College balances its business and professional values; and, 4) academic heath centers, with special attention to helping these centers sustain their social contract for care of the poor and disadvantaged, while at the same time maintaining educational programs in the face of declining resources.

We then heard a terrific presentation by Alan E. Guttmacher, MD, the senior clinical advisor to the director of the National Human Genome Research Institute at the NIH. Dr. Guttmacher first reviewed "old genetics," which were the things that all of us learned in medical school as classical Mendelian inheritance and the occasional genetically-related illness. He then discussed the implications of the "new genetics," in which almost all diseases and conditions may have a genetic basis because of increased or decreased predisposition (such as heart disease or HIV infection.) Dr. Guttmacher provided a very relevant and thought-provoking perspective on the potential social, personal and medical implications of our increasing knowledge of the human genome. We hope that Dr. Guttmacher or one of his colleagues will attend our fall Annual Session in Springfield, on October 20-21, 2000, to make a similar presentation.

The meeting ended with an awards ceremony at which Warren Furey, MD, FACP, distinguished Governor of the Northern Region of the Illinois Chapter, completed his term, along with other Governors in the "Class of 2000." Warren has done a spectacular job as an organizer and manager of the Northern Illinois Region and even more importantly, has provided tremendous professional and spiritual guidance to our Chapter and physicians in general. His successor is Serafino Garella, MD, FACP, who immediately assumes the position of Governor for the Northern Region. Congratulations to Warren and welcome to Serafino - we look forward to working with you in the future.

The next Board of Governors' Meeting will be held in Seattle, September 14-16, 2000, at which time our Governor-Elect, Stephen Goetter, MD, FACP, will begin his official duties in picking up the "reins" of the Downstate Region leadership. Welcome aboard, Steve.

Committee Reports

Nominations and Awards Committee

By Sara L. Rusch, MD

The Nominations and Awards Committee is developing a way to identify and acknowledge internists committed to the ideals of the ACP-ASIM. These internists need to be recruited into leadership opportunities within the organization. Their successes should be rewarded with nominations for State and National Awards and promotion to Fellow or Master status.

The diffuse and diverse nature of Downstate Illinois ACP-ASIM members makes it difficult to identify those interested, or deserving of nominations/awards. The committee proposes building a network of ACP-ASIM members who represent smaller areas, or districts of the State. These unofficial district representatives would serve as a point of contact for members in their district. The district representatives responsibilities would include identifying members who should be nominated for awards/promotion, or who may be interested in leadership. They would relay these names to the Chair of the Nominations and Awards Committee via mail or e-mail.

The district representative would also be a potential contact point for ACP-ASIM-sponsored town meetings, where local ACP-ASIM members can obtain CME credit and gather with other local ACP-ASIM members without having to leave their community.

If you are interested in participating in your organization in this way, please contact me:

Sara L. Rusch, MD
Department of Medicine
Saint Francis Medical Center
530 NE Glen Oak Avenue
Peoria, IL 61637
E-mail: Rusch@uic.edu

After reviewing areas of the state that are represented by volunteers, we will attempt to expand representation by asking members in unserved areas to "volunteer."

It is important for the ACP-ASIM to utilize the skills of all of its members and to acknowledge and reward all those who contribute. Only by getting broader involvement can this be accomplished.

Health and Public Policy Committee Report

By Craig Backs, MD

The members of the Downstate Illinois ACP-ASIM Health and Public Policy Committee met during a series of committee meetings arranged by Governor David Steward in February. We discussed several issues of importance to Illinois ACP-ASIM as we move forward. The members of the committee are Kathleen Treanor-Armich, MD (Springfield), Sunil Sinha, MD, (Marion) and Craig Backs, MD, FACP (Springfield), Chairman.

First, we discussed the need for Illinois ACP-ASIM to be involved in the development of public policy as it affects the health care services delivered by internists and internal medicine subspecialists to our patients. This would include reviewing and commenting upon current policies, developing guidelines and criteria for policies that are friendly to internists and the patients we serve and proposing model legislation. There was consensus that this is a proper role for Illinois ACP-ASIM.

We next discussed our relationship with the Illinois State Medical Society (ISMS). We recognized that historically, the Illinois ACP-ASIM and the ISMS have disagreed on many issues and practices. We recognized the differences in culture and focus, particularly in the area of advocacy for universal coverage. Nevertheless, we discussed the reality of the political strength and credibility of ISMS and the need to work with and within ISMS to affect policy that is more consistent with Illinois ACP-ASIM policy. There was consensus that existing barriers to communication and interaction with ISMS must be overcome in order to promote Illinois ACP-ASIM policy within the Illinois State legislature, by involvement of Illinois ACP-ASIM members and leaders in the ISMS House of Delegates, committees and the Board.

We then spent considerable time discussing a proposal for universal health insurance coverage for all Americans. The chairman presented a draft outline to the committee that calls for development of a National health insurance program, which could cover all Americans at lower overall costs than our current model of overlapping and gapping coverage. The committee is currently in the process of reviewing and reflecting on the proposal and hopes to present it to a wider representation of the Illinois ACP-ASIM soon.

Programs and Education Committee

By Sue Hingle, MD

The Programs and Education Committee discussed a number of upcoming educational offerings by our chapter.

State Scientific Meeting

Some of the ideas the group discussed involved findings ways to make the meeting more accessible. We thought that the availability of pre-arranged transportation and housing might improve attendance and participation. We also thought that having entertainment (e.g., receptions, museum tours, sporting event outings) for both the participants and their spouses and families would be a nice addition. Continuing to give CME credit and making the meeting as inexpensive as possible are also positive draws.

As far as content of the program goes, we discussed having three areas of focus: 1) health of the patient; 2) health of the community; and 3) health of the physician. Health of the patient topics included hepatitis, atrial fibrillation and anticoagulation, Helicobacter pylori, and integrative/alternative medicine. We thought that using the format of "multiple small feedings of the mind" would be useful. Also, the utilization of "specialoids" such as rheumatologists, endocrinologists, etc., who are specialists, but who also do a lot of primary care, would be more beneficial than using specialists and subspecialists, as the "specialoids" would make the information more applicable to the internist. Health of the community topics included smoking cessation, access to health care and domestic violence. Health of the physician topics included stress management, time management, money management, and spirituality.

We also came up with the idea of pursuing "Town Meetings," which would be CME activities occurring monthly or every other month in smaller towns such as Belleville, Carbondale, Marion, Mt. Vernon, Effingham, Champaign, Quincy, Heron, Frankfurt and Champaign. The sites and topics would alternate. They could involve panel discussions, community leaders, etc. We could survey our membership for topic ideas.

Associates/Students Meeting

This year, the first-ever Downstate Associates/Student Meeting will take place at SIU in Springfield. We will have a panel discussion regarding insurance issues, including some emphasis on the Patient Bill of Rights. We will have small hands-on skills workshops, including joint aspirations and skin biopsies and a medical jeopardy-like competition between the various residency programs and medical schools. Included, too, will be clinical vignettes from each of the residency programs. Our keynote address will be by Whitney Addington, MD, MACP, who will focus on the topic of improving health care access for the uninsured. The Associates/Student Meeting will become an annual event and will rotate sites.

Other

We also discussed developing a mentoring project for medical students and residents. Details not yet elucidated.

Upcoming Events

Town Hall Meetings
Dates and locations TBA

Geriatrics/Primary Care Symposium
August 24, 2000
Carterville, IL

Illinois ACP-ASIM Annual Scientific Meeting
October 20-21, 2000
Springfield, IL (Hilton Hotel)

ACP-ASIM Annual Session
March 29 - April 1, 2001
Atlanta, GA

New Products for Young Physicians

The Young Physicians Subcommittee (YPS) of the ACP-ASIM was formed just over a year ago to meet the needs of young physicians under the age of 40 and to facilitate their passage from Associateship to Membership. The YPS has developed two new products for young physicians - the Young Physician Practice Management Survival Packet and the "Evaluation and Management Coding Card."

Aimed at the young physician who is beginning his/her practice, the Young Physician Practice Management Survival Packet provides information about the resources that the College has to offer the young physician in the early stage of his/her career. In addition, the booklet contains information from a variety of sources that can help you successfully launch a career. The information provided contains references to Internet sites and telephone numbers. It also contains a checklist for getting started.

The "Evaluation and Management Coding Card" is a laminated, pocket sized sheet designed to help the young physician select appropriate levels of service for history, exam and medical decision making. It presents a great deal of information from a variety of sources in one easy to read card.

If you would like copies of the survival packet and/or coding card, please contact Jean Elliott, Staff Liaison, Young Physicians Subcommittee, at (800) 523-1546, ext. 2692.

ACP-ASIM Teaching in the Ambulatory Setting

Patrick C. Alguire, MD, FACP
Director, Education and Career Development

The College's Community-Based Teaching Program has just released ACP-ASIM Teaching in the Ambulatory Setting. This 20 minutes videotape is intended to help office-based physicians responsible for precepting medical students and residents improve their teaching skills. The videotape presents nine different teaching scenes, each illustrating a different teaching strategy or problem. Illustrated in the videotape are examples of setting goals and expectations, modeling problem-solving, use of the precepting "microskills," priming and focusing, and providing feedback, as well as examples of common teaching errors. The videotape is accompanied by an eight-page companion text that briefly describes the teaching skill or error being demonstrated.

The videotape was produced by Gary S. Ferenchick, MD, a general internist, who has authored many articles on teaching and teaching improvement, and has designed and directed faculty development workshops for ambulatory-based teachers. Dr Ferenchick is currently an associate professor of medicine at Michigan State University, the internal medicine clerkship director, and a faculty member in the Michigan State University Primary Care Faculty Development Fellowship Program.

This videotape program can be used by individual physicians or as part of a faculty development program. To order, call Customer Service at (800) 523-1546, ext. 2600 and ask for product number 190400100 ($24.95. plus shipping and handling.)

How to Contact Us

David E. Steward, MD, FACP
Southern Illinois University School of Medicine
PO Box 19230
Springfield, IL 62794-1311
Phone: (217) 782-2596; Fax: (217) 524-8156
E-mail: dsteward@siumed.edu