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Downstate Governor's Newsletter - Winter 2001

David E. Steward, MD, FACP
Governor, Illinois Downstate Region

From the Governor

You should be receiving this Newsletter just after the holidays - I hope you, your family, and your loved ones had a joyous holiday season, and I wish you all a happy and prosperous New Year.

My term as Governor will conclude at the Annual Session in Atlanta this coming April. To serve as Governor has been a privilege and a terrific experience, and I thank you all for allowing me the opportunity. A list of all the prior Governors is on the following - and to them, I also say thanks for allowing me to be part of a very distinguished group of internists. I've learned a lot in the past four years, and here are some of the highlights.

First, and foremost, I love the College. The American College of Physicians-American Society of Internal Medicine is a great professional organization.

Second, the merger of the ACP and the ASIM, which consumed and transformed the College/Society during the first three years of my term, has resulted in a more open, representative, and vigorous organization. As with any large organization, there are still some flies in the ointment - for example, the Board of Regents is more open than ever, but still not truly answerable to the membership; the ACP-ASIM holds positions that conflict with those of some of our partner professional organizations, in particular the gastroenterologists; and the College's close relationships with pharmaceutical companies threaten our reputation as the premiere provider of quality CME. But, I am confident that the ACP-ASIM will address and solve these issues and the others that face us, and I will continue to proudly claim the College as my professional home.

Third, we internists are all really the same, and the thing that holds us together is our commitment to our patients. Whenever the Governors, or the State Council, or the committees that I participated in, got into a thorny discussion, we always found common ground in the interests of our patients. We are lucky to have this common bond, and must always hold it sacred.

Fourth, it's great to travel to a lot of great meetings in exciting places, but I like to eat way too much when I go to these things. I did not charge the College for the new larger belts and pants I am now wearing.

Fifth, it may be time for the Illinois Downstate ACP-ASIM Region to become less a part of the State Chapter and more an independent organization. The Downstate Region has 632 fellows and members, plus 299 associate or student members (compared to 2999 and 1825, respectively, in the Northern Region, above I-80), making our region the same size as most "mid-size chapters." Our large geographic area and lack of a single center of medical action, plus the pull of the centers of Chicago and St. Louis, will be challenges that I think we can overcome.

Finally, Steve Goetter is a lucky fellow to be taking on the Governorship - I'll miss this role, but at the same time I'm glad to be turning over the responsibility to him. He's going to do a great job, and will make the Downstate Region better than ever. Please, when he calls or asks for your participation in a College activity, just say "yes" and ask questions later.

That's enough for now. Thanks again for allowing me to serve. I love the College.

Governor-Elect's Column

Steven Goetter, MD, FACP
Governor-Elect, Illinois Downstate Region

"Hey Doc, I had these screening tests done at the Senior Center; can you review them with me?" We all have heard this from our patients, and I have encouraged mine to take advantage of blood pressure screens, blood sugars, occult blood testing and the like. However, I was not ready for what I saw earlier this year. A patient brought to our office the latest in screening tests - "total body" vascular flow studies! It seems some enterprising(?) group had arrived in town with Doppler-flow equipment and set up shop at one of the senior high-rise apartments. For $35 per test, ($90 for all three), you could have your carotids, aorta, or femoral arteries screened for "disease." Results were reported in terms such as "good," "narrowed," or "see your doctor."

I tried my best to determine what these tests really indicated, and to explain what, if anything, needed to be done. I wondered if any of my colleagues outside of Decatur had encountered such traveling test givers, so I asked the question at one of the Board of Governor's meetings. While most had not heard of such testing, one gentleman from Arizona went me one better. He reported that CT and MRI scans were available at the local mall with just the swipe of the patients credit card - no insurance, no doctor's order, just cash and a wondering patient!

There is no College position on such testing, and I raise the issue for further discussion among ourselves. Scam? Help-ful? A liability issue? If you have had similar experiences, or just want to share an opinion, feel free to drop me a line at sgoetter@pol.net. It won't cost you a dime and I will be happy to share the results with you and your physician!

Roster of Governors

Illinois ACP-ASIM Chapter - Downstate Region

1929-41 Samuel E. Munson, Springfield
1941-49 Cecil M. Jack, Decatur
1949-58 Thomas D. Masters, Springfield
1964-70 Edward W. Cannady, East St. Louis
1970-76 Richard Allyn, Springfield
1976-80 Richard Ensrud, Champaign
1980-84 Eli L. Borkon, Carbondale
1984-88 Frank B. Norbury, Jacksonville
1988-92 James T. Dove, Springfield
1992-96 Joseph S. Solovy, Peoria
1996-97 George J. Taylor, Springfield
1997-01 David E. Steward, Springfield
2001-05 Stephen Goetter, Decatur

2000 Illinois Laureate Award

Rajagopal Chadaga, MD, FACP, of Carterville, Illinois, received the 2000 ACP-ASIM Laureate award during a memorable ceremony on October 20, 2000, at the Old State Capitol in Springfield. Dr. Chadaga, a Fellow of the College for many years, was recognized for his commitment to the education of medical students, residents, and practicing physicians; and for his exceptional leadership, as Chief of Staff of the Marion VA Hospital, in reorganizing and dramatically improving the quality of care provided to thousands of veterans in southern Illinois, western Indiana, and northern Kentucky. Congratulations to Dr. Chadaga for receiving this well-deserved award.

Downstate Student and Associates Activities

Student and Resident members of the ACP-ASIM in Downstate Illinois have several opportunities to look forward to in the new year. First, the organizational meeting of the Downstate Associates Council was held during the recent State Scientific Meeting in Springfield, and faculty advisers Lannie Cation, MD and Susan Hingle, MD are ready to help the group sustain and expand its activities in the coming year. Residents at the three residency programs in Downstate Illinois have more in common than they do differences, and the opportunity for trainees in all of these programs to become involved in College activities should bring them even closer together.

Second, plans are underway for the second annual Student-Associates meeting, to be held on yet to be determined dates in May, 2001, in Peoria. The first meeting, in Springfield, was a big success, with over 100 attendees, some excellent and fun activities, and good collegial interactions. The planning committee learned a lot from that initial meeting and promises a great meeting this time around. We are looking forward to it.

Third, the Downstate Region has support available for student ACP-ASIM organizations or clubs at each of the three downstate campuses. A minimum of $500 per campus per year has been budgeted, and additional funds are available for special projects and activities. Please contact the Governor's office to request these funds at Dept. of Medicine, Southern Illinois University School of Medicine, PO Box 19636, Springfield, IL 62794-9636.

Students and Associates who would like to become more involved in ACP-ASIM activities are invited to submit their names to the "Help Wanted" notice on page 6. Regional committee assignments, meeting planning, and nominations for regional or national student and associates groups are just a few of the many opportunities available for you now, and participation in any of these roles will serve as a foundation for your future involvement in the College.

Town Meetings

By: Gail Clifford, MD, FACP
Co-Chair, Programs/Education, ACP-ASIM Downstate Illinois

The ACP-ASIM Town Meetings began in May, 2000, in downstate Illinois to provide a general internal medicine topic of interest with CME; fellowship among primary care physicians, with an emphasis on internists; and to increase the awareness of internists in the activities of the College, especially in the downstate region. They have been quite successful on all three counts, based on the questionnaires submitted by the physicians attending. We have seen an increase in membership, as well as an increase in applications for advancement to Fellowship, from the downstate region since the Town Meetings were initiated.

The CME was offered with the assistance of Sheryl Lloyd (south of Route 64) and Ann Ogden (for all other regions) through the Southern Illinois University School of Medicine which co-sponsored the programs. Their help has been invaluable. The topics have been funded primarily by the College thus far, but with treasury funds becoming increasingly spare, can be funded, with a modest amount of additional paperwork, by pharmaceutical companies.

A few items noted to make the Town Meetings more successful include holding the meeting mid-week in the early evening, incorporating dinner during the speech, having the meeting near a hospital to ensure a higher physician attendance, having speakers from outside the immediate region, and allowing as much advance notice as possible. Many of the physicians polled reported their preference for this format to provide local CME, as well as a broader understanding of the College's goals, discussed at some point during the session.

We look forward to additional town meetings in the Spring. If you have any interest in coordinating one in your area, please contact me at drgm28@midwest.net, or Dr. Steward's assistant, Jo Dierks, at (217) 782-2596.

Proposed New Illinois Resolutions

Resolutions may be initiated at any level of a chapter, including members, committees, councils, officers or Governors. Resolutions may address any topic of interest to the author, and they are to be presented first to the Governor and the Council of the chapter before being forwarded on to the College to be submitted to the Board of Governors and the Board of Regents. Eventually, the aggregate of the resolutions approved by the Board of Governors and the Board of Regents constitutes the framework of the principles that guide the College. Therefore submitting resolutions is one of the most effective ways of influencing College policies and actions. At this time, the Illinois Chapter is planning on submitting the following four resolutions.

If you have any comments, please contact Nikki Keil at (312) 435-0484, or nkeil@dellnet.com.

Title: Physician compensation for limiting patient care is unethical

WHEREAS, Medicine is, at its center, a moral enterprise grounded in a covenant of trust; and

WHEREAS, the medical profession has a primary obligation to the patient through our professional societies and organizations, but especially through personal behavior; and,

WHEREAS, ACP-ASIM endorses the Patient-Physician Covenant which obliges physicians to use their competence in the patient's best interests; and

WHEREAS, many third-party payers offer financial incentives to physicians who limit utilization of services by patients; and,

WHEREAS, this practice constitutes an inherent conflict of interest between physicians' personal financial advantage and their obligation to act as advocates for patients in providing the best available care to them; therefore be it

RESOLVED that ACP-ASIM will publicly and formally condemn as unethical the practice of offering financial bonuses or any other incentive resulting in personal advantage to physicians for limiting services to their patients; and be it further

RESOLVED that ACP-ASIM will stimulate and support legislation to prohibit such practices.

Title: The proliferation of Certification Requirements should be opposed

WHEREAS, the Institute for Clinical Evaluation (I.C.E.) was created to accredit physicians' competence in certain specific areas of medical practice, procedures and specialized knowledge; and

WHEREAS, the American Board of Internal Medicine is already certifying competence in General Internal Medicine and its Subspecialties, as do other Specialty Boards for practitioners in Medicine and other Disciplines; and

WHEREAS, the implications of I.C.E. are that existing certification is inadequate to assure such competencies; and

WHEREAS, such certification by I.C.E. also implies competence of non-physicians and non-internists to perform procedural and cognitive functions in which Internists are trained and already certified; and

WHEREAS, there are financial and reimbursement issues which may require multiple certifications of competence above and beyond the current structures in place which have not been shown to be deficient; therefore, be it

RESOLVED, that the American College of Physicians-American Society of Internal Medicine oppose the formation and proliferation of certification requirements being developed by the Institute for Clinical Evaluation and recommend that these certifications be incorporated under the aegis of the American Board of Internal Medicine.

Title: Chiropractor Scope of Practice

WHEREAS, chiropractors commonly offer medical services, such as electrocardiography; clinical laboratory testing; screening tests such as pap smears, lipid testing, and fecal occult blood testing; and the "prescribing" of vitamin and dietary supplements to patients, despite chiropractors' lack of training and expertise in interpreting the outcomes of these tests or treatments, or providing care for the diagnoses that might result; and,

WHEREAS, regulations in many states regarding the scope of practice of chiropractors may allow them to provide medical services despite their lack of training and expertise; and,

WHEREAS, the ACP-ASIM has no current formal policy on the scope of practice of chiropractors; therefore, be it

RESOLVED, that the Board of Regents direct the appropriate Departments and Committees of the ACP-ASIM to immediately develop clear policy about the scope of practice of chiropractors and, that the ACP-ASIM, through advocacy efforts, work to include this policy in state and federal regulations.

Title: Interactions Between Pharmaceutical Companies and Physicians

WHEREAS, the pharmaceutical industry and other producers of medically-related products are involved in, and invest large sums of money in, all aspects of medical research, practice, education, and administration, sometimes in ways that are hard to understand or even recognize; and

WHEREAS, internists' inviolable obligation to our patients, which defines our commitment to our profession, may be compromised when we interact with the pharmaceutical and other industries; be it

RESOLVED that the ACP-ASIM will address this issue comprehensively through:

1. Evaluating its own relationship and that of its commit-
tees, chapters, and programs, with the industry, and

2. Conducting or commissioning a wide ranging study of
this issue; and

3. Using the study results to develop a policy statement that will give guidance to professional organizations, investigators, practitioners, teachers, and medical managers about how to interact with industry

Transition Information

Effective March 28, 2001, Steven Goetter MD, FACP, of Decatur will become the Governor for the Downstate Region of the Illinois ACP-ASIM Chapter. Here's how you can reach him:

Steven Goetter, MD, FACP
302 West Hay, Suite 110
Decatur, IL 62526
Phone: (217) 876-5670
E-mail: sgoetter@pol.net

BOR Action on Fall 2000 Resolutions

The Board of Regents at their meeting October 27-29, 2000, took the following actions on the eight resolutions that were referred to them by the Board of Governors. The Board of Governors (BOG) had reviewed 11 resolutions and recommended that three of them not be adopted - Resolution 7-F00: Development of a Publication Entitled "Decoding Your Health Benefits"; Resolution 9-F00: Developing a Physician Recruitment Service for ACP-ASIM Members; and Resolution 10-F00: Governors Newsletter Production. Below are the results of the Board of Regents' (BOR) decisions.

Resolution 1-F00: Voting Privileges for Associates. The BOR voted to adopt and refer this resolution to the Bylaws Committee for implementation.

Resolved, that the BOR amend the ACP-ASIM bylaws topermit Associates after two years of Associate membership to have the same voting privileges as afforded Members, Fellows and Masters.

Resolution 2-F00: Medicare Reimbursement for Oximetry. The Board of Regents voted to adopt and refer this resolution to the Washington staff for implementation.

Resolved, that the BOR continue to urge HCFA to reinstate Medicare coverage for portable oxygen saturation testing done in physician offices.

Resolution 3-F00: Internal Medicine Preference for the RBRVS System for Fee-Schedule Reimbursement. The BOR voted to refer this resolution to the Medical Services Committee for study and recommendation to the BOR regarding adoption. This resolution asks the BOR to advocate that private insurers use the Medicare RBRVS in determining payments to physicians; recommend any improvement in HCFA's payment policies as are needed to assure that the RBRVS as utilized by Medicare as well as private payers, is as accurate as possible; and recommend that private payers use a single dollar conversion factor with the RBRVS that is sufficient to assure fair and adequate payments to physicians.

Resolution 4-F00: Board of Governors Resolution Process. The BOR voted to adopt and refer this resolution to the Membership Division Staff for implementation and report due back to the BOG regarding the evaluation of the outcome of this resolution.

Resolved, that the BOR and BOG along with the support of the appropriate College staff continue to reevaluate the current BOG resolution process with the goal of reducing the time from action by the BOG to approval and implementation of resolutions.

Resolution 5-F00: Use of Medical Education Numbers in Continuing Medical Education. The BOR voted to adopt and refer this resolution to the Health and Public Policy Committee as lead committee for implementation with input from the Education Committee.

Resolved, that the BOR oppose the use of Social Security account numbers as file identifiers by providers of continuing medical education, certification boards and similar entities, widely known and recommend that such policy be adopted by other organizations, e.g. AMA, national certification boards and similar entities.

Resolution 6-F00: Tobacco Use Prevention. The BOR voted to adopt as amended and refer this resolution to the Membership Division Staff for implementation.

Resolved that the BOR urge ACP-ASIM Governors to encourage their members to contribute their expertise to community and school programs aimed at preventing tobacco initiation and addiction.

Resolution 8-F00: Streamlining and Simplifying the Fellowship Application Process. The BOR voted to adopt and refer this resolution to the Membership Division Staff for implementation.

Resolved, that the BOR request that the Membership Committee continue to investigate ways to simply and streamline the application process for becoming a Fellow.

Resolution 11-F00: Negative Drug Formularies. The BOR voted to refer this resolution to the Medical Services Committee for study and recommendation to the BOR regarding adoption. This resolution asks the BOR to encourage the deletion of drugs from Negative Drug Formularies for which there exist medically equivalent generic substitutes.

"Help Wanted"

The ACP-ASIM Downstate Region invites you to participate in any or all of our activities, and also to nominate someone (including yourself, if you wish) for consideration for election to the State ACP-ASIM Council. We need good people who want to make a difference in the organization - and by getting involved now you can immediately have an important role in College activities. Dr. Sara Rusch, MD, FACP, is the chair of the Nominations/Awards Committee and will be pleased to hear from as many of you as possible.

Current opportunities could include participation in Regional Committees (1 or 2 meetings per year, such as Programs/Education; Health and Public Policy; Communication; Nominations/Awards); help in planning the Downstate Student/Associates meeting; Hosting a "Town Meeting" for your community; serving on the Governor's Advisory Council; Students/Associates are encouraged to volunteer, as well, and are eligible to participate in any of the Region's activities in addition to Regional or National Student-Associate activities.

We Need Your Opinion

At its October meeting in Springfield, the State ACP-ASIM Council discussed plans and some new ideas for future state meetings, about which your opinion is needed.

Until now, the State Annual Scientific Meeting has alternated between Northern (ie, Chicago) and Downstate Illinois - Downstate in even years, Northern in odd years. In addition, until now, a single state Associates meeting has been held in Chicago, separate and usually about one or two weeks before the Annual Scientific Meeting. In May of 2000, the first Downstate Student-Associate meeting was held in Springfield, and was considered a success; the second such meeting is being planned for May 2001 in Peoria.

The leading new proposal for our meetings would result in two annual meetings for the Illinois ACP-ASIM Chapter - one each fall in Chicago, combined with the Associates meeting; and one each spring in a Downstate location, combined with the Downstate Student-Associates meeting. A Council meeting, and selected Committee meetings, would be held in conjunction with each of the meetings.