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Governor's Newsletter Summer 2001

Serafino Garella, MD, FACP
Governor, Northern Illinois Region

From the Governor

I am very pleased to report to you the results of the recent election we held for members of the Illinois Council. As you are aware, the Council is made up of the two Governors, the Secretary (Sara Rusch, MD, FACP), the Treasurer (John Schneider, MD, FACP) and twelve Council members (eight from the Northern Region and four from the Downstate Region). The election, which we held in March, was for two positions from the Northern Region and one position from the Downstate Region. Ray Curry, MD, FACP and Joan Mullan, MD, FACP were elected from the Northern Region. Tad Yetter, MD, FACP was elected from the Downstate Region. We welcome Drs. Curry, Mullan, and Yetter to their two-year terms on the Illinois Council. They are joining the other Council members who are presently in the second year of their term: Patrick Fahey, MD, FACP; James Foody, MD, FACP; Ashutosh Gupta, MD, FACP; Patricia Russell, MD; Michael Silver, MD, FACP; Vesna Skul, MD, FACP (from the Northern Region); Craig Backs, MD, FACP; Lawrence Jennings, MD, FACP; and Sunil Sinha, MD, FACP.

New Members and Associates. The Northern Illinois Region welcomed 16 new Members and 95 new Associates for the first quarter of 2001. We hope all our new Members and Associates will be able to attend the Chapter Scientific and Associates Meeting in November (more about that later.) Remember, if you know someone who is interested in joining the ACP-ASIM as an Associate or Member (or someone who is interested in advancing to Fellowship), please call (312/435-0484), e-mail (nikkikeil@msn.com), or write (332 S. Michigan Ave., #525, Chicago, IL 60604) and request an application be sent. We just need a name and address.

Leadership Day. The Illinois Chapter of the ACP-ASIM was well represented in Washington for Leadership Day, May 9, 2001. The Illinois delegation included three Fellows (Drs. Hedberg, Schneider, and Garella) one Associate (Dr. Dilling) from the Northern Region; and two Medical Students (Ms. Deye and Mr. Fillmore) from the Downstate Region. The group was able to visit the offices of seven members of Congress from Illinois. We met with the Legislative Health Aides for Senators Durbin and Fitzgerald; and with Representatives for Senators Rush, Jackson, Blagojevich, and Kirk. We met personally with Representative Jan Shakowsky and her Chief of Staff, Ms. Cathy Hurwit. In our conversations we urged support of the Medicare Education and Regulatory Fairness Act (MERFA), S452/HR868, which will allow physicians to spend more time caring for patients and abolish some onerous and unjustifiable practices that imply physicians are guilty until proven innocent. We encouraged prompt and favorable consideration of the Bipartisan Patient Protection Act of 2001 (BPPA) S283/HR526. We recommended support of the Relief, Equity, Access and Coverage for Health (REACH) S590, that calls for refundable and targeted tax credits for those uninsured people who, while working, cannot afford health insurance. We advocated increased funding to the Agency for Healthcare Research and Quality (AHRQ) with the objective of enhancing patient safety. Finally, we asked the Congress members to join the ACP-ASIM in opposing all "defined contribution programs" and to support offering prescription benefits to the elderly who cannot afford these medications. Overall, the Illinois delegation came away feeling we had fostered the goals of the ACP-ASIM to establish and promote the highest clinical standards and ethical ideals; to be the foremost comprehensive education and information resource for all internists; to advocate responsible positions on individual health and on public policy relating to health care for the benefit of the public, our patients, the medical profession and our members; and to serve the professional needs of the membership and advance internal medicine as a career.

On the Local Political Front we have contacted all the State Senators and Representatives urging support of HB0376, which if passed would reverse the State requirement that physicians participate in executions by lethal injection. Also, on the local front, the ACP-ASIM-sponsored Coalition "All For Health" has continued its efforts to have the tobacco settlement monies used for health related issues (see the article on pages 4-5 by Dr. David Ansell.)

Now for the most important news of all - details about our Chapter Scientific and Associates Meeting. The meeting will be held Friday and Saturday, November 9th and 10th, 2001 on the Northwestern University Campus in Chicago. You can see the preliminary program for the meeting on page 6. This should be a really exciting meeting with Masters, Fellows, Members, Associates and Medical Students all interacting throughout the meeting. The main theme of the Friday morning session of the meeting will be "The Medical Implications of the New Genetics". In addition, we will have talks on Hepatitis C, Coronary Angioplasty and Transplant Approaches to Diabetes Treatment. Dr. Bernard Rosof, Chairman of the Board of Regents, ACP-ASIM will be our College Representative and will moderate our Town Meeting on "Certification and the Recertification Process". Mr. Richard Tractman, ACP-ASIM Director, Congressional Affairs, will bring us up-to-date information on legislative activities from the Washington Office. Perhaps, most exciting of all will be Friday afternoon when the Associates will be handling the program. We will have Vignette Presentations, a Medical Jeopardy Competition and an adventure into the new reality-based media with "Who Wants to be An Internist and Not the Weakest Link?" You will receive additional mailings in the early fall with the final program, registration forms, directions, etc. You can keep checking our Chapter website (http://www.acponline.org/chapters/il/northern/) where we will keep posting the latest information on the meeting. Alternatively, you can always call the office at 312/435-0484 for information. I hope that you will all be able to attend this meeting as it promises to be informative, interesting, exciting and fun!

Supporting Your Chapter through Chapter Dues

Chapter dues are the backbone of local activities and vital to the success of our chapter. While some financial support is given by the National Office, the chapter dues provide the majority of financial support for local activities. Educational meetings, mentoring programs for medical students, local Associates' research competitions, advocacy with State Legislators, and participation by Chapter Leaders in Leadership Day on Capitol Hill are just some of the activities supported by your chapter dues. Many of these activities are orchestrated by unpaid volunteer leaders in our Chapter. However, the increase in activities at the local level has created the need for additional staff support to help manage the day-to-day operation of the Chapter. Your chapter dues help support the cost of local staff and provide funding for new and existing Chapter Initiatives. When you receive your dues notice, please remember to include the chapter dues in your payment. You will be contributing to the success of many grass roots activities happening right here at home.

From The Governor-Downstate Region

Stephen R. Goetter, MD, FACP
Governor, Downstate Region

Greetings from south of Interstate 80! I want to outline very briefly the current and recent events in the Illinois Downstate Region of the ACP-ASIM.

The Second Annual Illinois Associates Meeting was held in Peoria, Illinois on May 23rd, 2001. It was a very successful meeting with some 75 Residents attending. We heard 10 clinical vignettes and had the opportunity to review approximately 12 posters all put together by Residents from SIU Springfield, U of I Peoria and U of I Champaign-Urbana. Also, available for the Residents were workshops on various procedures including injections of knees, shoulders and soft tissues; as well as, improving cardiac diagnostic skills. The highlight of the day was a spirited Challenge Bowl contest among U of I Peoria, U of I Champaign-Urbana and SIU Springfield. The Challenge Bowl was won for the second consecutive year by U of I Peoria, narrowly defeating the team from SIU Springfield.

Leadership Day participants from the Downstate Region were Medical Students, Cinthia Deye and Parley Fillmore. Fortunately, both students were able to attend all aspects of the program and were favorably impressed by the quality of the program, the quality of presentation and the opportunity to speak with Members of Congress. Space does not permit me the opportunity to relay all the comments from the students involved, but, Cinthia described it as, "A fantastic experience that I will definitely recommend to other medical students." Parley was equally impressed, describing the day as, "Well organized and an effective opportunity to bring some of our concerns before Congress." We hope to have further Downstate Members, both Students and Members, be available for next year's Leadership Day.

Discussion continues in regard to expanding the Downstate Annual Associates Meeting to an Annual Meeting for both the Associates and Members of the ACP-ASIM. We are looking towards a meeting next March, which will encompass a weekend beginning on Friday afternoon for the Residents and continuing into and through Saturday afternoon for Residents and Members. We have already talked with ACP-ASIM regarding speakers and representation from the National Organization and this does not seem to be a problem. The location of the meeting will be somewhere in central Illinois either Springfield, Decatur or Champaign-Urbana and hopefully will be scheduled at a time when Members of the Northern Region can also attend. More information will be available on this topic as our plans finalize.

I look forward to seeing many of you at the meeting in Chicago in early November. I believe Dr. Garella and his Committee have done an excellent job in finding speakers and topics that seem to be interesting and applicable to our current practice of medicine. I hope all of you will be able to attend this meeting and make it a big success.

E-Mail/Fax Alert!

We are in the process of establishing an e-mail and fax database for faster and more efficient communication with Members. Please let us know your e-mail address, your fax number, and your preferred method of communication. You can e-mail the information (nikkikeil@msn.com), fax the CLEARLY PRINTED information to 312/435-0487 or mail the CLEARLY PRINTED information to: ACP-ASIM, 332 S. Michigan, Suite 525, Chicago, IL 60604. Please don't forget to include your name so we can match the e-mail or fax with the right person!

Associate's Corner

Last February the Northern Illinois ACP-ASIM Council of Associates had their annual election of Executive Officers. Here are our new officers:

Azhar Majeed, MD, President
Mercy Hospital & Medical Center

Jennifer Coican, DO, Vice President
Lutheran General Hospital

Reed Berger, MD, Secretary
Lutheran General Hospital

The Council of Associates is made up of Residents from Internal Medicine training programs throughout Northern Illinois. The Council meets on the third Tuesday evening of each month and plans activities of interest to medicine Residents. Once again, we are planning several activities throughout the year, including our very successful Fellowship Day Program, Associate's Day (November 9, 2001) and later in the winter a Job Fair for graduating Residents. If the Council sounds like something you would like to participate, please contact your Program Director or Chief Resident and find out who your Program Representative is. If your program is not represented on the Council, please contact Dr. Majeed at (amajeedmd@hotmail.com) with the names of at least two representatives from your program and an address. The Council is striving to have every program represented.

Coming Soon: The Second Annual Fellowship Day Program is scheduled for Saturday, August 11, 2001. This will be a program for Residents interested in obtaining Fellowships. Last year's program was a big success with lots of information on the process. Stay tuned for more details.

Recertification: The Dialogue with the ABIM

Given the many concerns expressed by our members about the ABIM Recertification Process, we have asked Dr. Herbert Waxman, FACP, Senior Vice President, Education, ACP-ASIM, to give us a status report on the ACP-ASIM position. Here is his statement:

It's about a year since there began a serious dialogue between the College and the American Board of Internal Medicine (ABIM) about the many concerns the College has with the ABIM's plan to implement the proposed Continuous Professional Development (CPD) process for recertification. The core concerns of the College are as follows:

1. The process of recertification should be clinically relevant, not excessively burdensome, and not redundant of things that are already being done in physicians' practice environments (e.g. patient and peer evaluation, practice per formance measures and improvement plans.) College members have expressed very strong feelings about this!

2. There should be a clear delineation of the responsibility for high stakes evaluation (ABIM) and education, including self-assessment (ACP-ASIM and other professional societies.)

3. There should be a clear articulation of the fact that maintenance of competence requires more than just evaluation periodically. It should also encompass rrelevant continuing education, taking into account learning preferences of the individual physician.

A Joint ABIM-College Committee on Recertification was set up, with three high-level Governance Members and a Staff Person representing each party. The College sought resolution of the above concerns; the ABIM sought endorsement by the College of the proposed CPD recertification process.

Thus far, the dialogue has resulted in agreement in principle by the ABIM of the need to resolve the College's concerns. However, the devil is in the details, and there haven't yet been proposed details that have been perceived to satisfy the needs of the College and its Members.

At the meeting of the Board of Regents at the Annual Session in Atlanta, five resolutions pertaining to recertification were communicated to the ABIM, addressing the need to respond to the College's concerns and including a deadline for meaningful progress to have taken place. The Board has instructed its Members of the Joint Committee to recommend in July whether the College should endorse CPD or refuse to endorse the process.

In response, the ABIM requested detailed information about what we want specifically. In a letter from Drs. Bernard Rosof and William Hall (our Board of Regents Chair and our President, respectively) to the ABIM leadership, we presented our requirements. In short, we are insisting that a physician's participation in a self-assessment program (such as MKSAP) or in patient or peer evaluations or in practice performance measures in his or her own hospital or health system be allowed to satisfy the corresponding requirements of the self-evaluation modules of the recertification process. Recertification should not impose on the physician requirements of what is already being done well in many physicians' practices.

ACP-ASIM has not taken a position opposing the formal examination of medical knowledge. The College believes that such an evaluation is appropriate for documentation of maintenance of certification and is something the ABIM is skilled and experienced in doing. Meanwhile, our Research Center has carried out a telephone survey of over 600 College Members, most with time-limited certificates. The results confirm what we have been hearing strongly expressed individual opinions: the concept of recertification is supported, but the support for CPD is much weaker. Of the self-evaluation components of CPD, the patient and peer evaluation module is viewed most negatively, the knowledge module least negatively. There is a clear sense that the costs of recertification and of the educational programs to prepare for recertification are much greater than the perceived benefit.

Supporting anecdotal reports, a high proportion of respondents are carrying out in their practice environments most of the functions embodied in CPD. For these physicians, the CPD modules would be redundant and therefore represent an excessive burden. We're now waiting to hear how the ABIM responds to the demands outlined in our letter. Based on that response, there will be a final decision made by the College on whether or not to support the ABIM's proposed CPD process. Of paramount importance to the College is that, one way or another, the strongly felt and legitimate concerns of our members be satisfactorily responded to. Stay tuned!

Partial Victory for All for Health Coalition-More Work Ahead

David Ansell, MD, FACP,
Chair, All for Health Coalition

The All for Health Coalition was convened last fall by the ACP-ASIM to attempt to influence the Illinois State Legislature to appropriate the over $ 350 million annual tobacco settlement dollars to health related causes. This historic settlement which will bring an estimated nine billion in unanticipated revenue to the State over a 25-year period was hailed as a major opportunity to improve public health of the citizens of Illinois especially as it relates to tobacco control and prevention.

The All for Health Coalition is comprised of over 80 health and public health organizations in Illinois, including the Illinois State Medical Society, the Council of Deans for the Illinois Medical Schools, the Illinois Public Health Association, Health and Medicine and Policy Research Group, American Lung Association and the Half for Tobacco Coalition, among others.

A Bill was written by the Coalition and passed unanimously by the State House. The Bill included substantial funding for tobacco prevention and control, biomedical research, public health infrastructure, a pharmaceutical assistance program for the elderly, and funding for free clinics in Illinois. However, after introduction into the State Senate, the Bill died in the rules committee. The Coalition conducted a lobbying and public information campaign including meetings with the editorial boards of the major newspapers, meetings with key legislators and civic groups.

Despite these efforts, the Coalition only had modest success. The dollars appropriated for tobacco prevention were significantly raised from about $30 million last year to $50 million this coming fiscal year. This was a victory though it fell short of the $65 million plus in request. The Coalition also asked that there be an advisory board through the Illinois Department of Public Health (IDPH) to advise on the spending and evaluation of tobacco dollars. While the current legislation seems to provide more oversight of tobacco prevention dollars by IDPH there is no expert advisory board and no statewide coordination of prevention efforts. Much of the target tobacco prevention dollars are directed towards women and children. The State lacks a comprehensive approach to tobacco control. The literature on tobacco control suggests that only comprehensive programs have significant effects on statewide smoking rates.

The other victory was the inclusion of over $107 million in funding for prescription assistance for the elderly and disabled. This was a popular program at the state level and supported by the Governor. There were no dollars for free clinics, and while there were no dollars included for the new Biomedical Research Program recommended by the Coalition, there were $93 million dollars in University Medical Facility Funding. Many of the specifics of this are not known but include a new Cancer Center for Southern Illinois University Medical School. Of all the health related expenditures passed with the tobacco settlement dollars, $250 million could be considered directly or indirectly health related, though there is much in the way of brick and mortar for medical schools. There were other health related dollars allocated from tobacco funds. They are listed in the Table below.

On July 17, 2001 there will be a meeting of the All for Health Coalition to review the legislation and plan for next year. The reluctance of the State legislature to fund a substantial, comprehensive, coordinated and evidence based tobacco prevention program in the State is unfortunate. The best evidence from other states is that a comprehensive statewide tobacco prevention program can reduce smoking and save lives. The ACP-ASIM will continue to participate in this coalition until a rational tobacco prevention program is in place in Illinois.

Appropriation Total All For Health
Senior Health/Circuit Breaker $ 107,700,000 $107,700,000
Children's Health Programs $ 2,000,000 $ 2,000,000
IDPA Hospitals $ 13,800,000  
Liquor Control Commission $ 1,150,000 $ 1,150,000
IDPH - Smoking Initiatives $ 46,950,000 $ 46,950,000
IDPH - Other Health Programs $ 10,350,000  
University Medical Facility Funding $ 93,500,000 $ 93,500,000
University Funding - Other $ 41,500,000  
DCCA $ 6,000,000  
Other Research $ 6,000,000  
AG - MSA Enforcement $ 800,000  
Other Building Projects $ 7,656,000
  $337,406,000 $251,300,000

ACP-ASIM Membership And Fellowship

Becoming a Member or advancing to Fellowship is easier than you think! Simply request the appropriate application from the ACP-ASIM Office by

Nikki Keil
E-mail: nikkikeil@msn.com
Phone: 312/435-0484

332 South Michigan Ave. #525
Chicago, IL 60604
Fax: 312/435-0487

Don't forget to check our Chapter website for the latest information at: http://www.acponline.org/chapters/il/northern/

Illinois Chapter Scientific and Associates Meeting

November 9 and 10, 2001

Friday November 9, 2001 - Members Meeting Northwestern Memorial Hospital (251 East Huron) Feinberg Pavilion, 3rd Flr

7:00 - 8 AM Council Meeting
7:00 - 10:00 Registration and Continental Breakfast
8:30 - 8:45 Welcome and Introductory Remarks
Serafino Garella, MD, FACP and Stephen Goetter, MD, FACP
8:45 - 9:30 The New Genetics: Prospects and Expectations
J. Larry Jameson, MD, PhD
9:30 - 10:00 Implications of Pharmacogenomics for Clinical Practice of Medicine
William T. Beck, PhD
10:00 - 10:15 Coffee Break
10:15 - 10:45 Cancer Genetics
Olufunmilayo I. Olopade, MD
10:45 - 11:15 Are Genetic Test Results Different Than Other Clinical Tests?
Priscilla Short, MD
11:15 - 12 PM Panel Discussion of Medical Implications of the New Genetics
Moderator: Priscilla Short, MD
Discussants: J. Larry Jameson, MD, Olufunmilayo Olopade, MD, William T. Beck, PhD
12:00 - 1:00 Lunch and Presentation by Bernard M. Rosof, MD, FACP
1:00 - 1:15 Move to Thorne Auditorium (375 East Chicago Avenue) for the Members and Associates Meeting
1:15 - 1:30 Welcome and Introduction
Serafino Garella, MD, FACP and Stephen Goetter, MD, FACP
1:30 - 2:15 Presentation of Clinical Vignettes
2:15 - 3:15 Who Wants to be an Internist (and Not the Weakest Link)?
3:15 - 3:30 Break
3:30 - 4:15 Presentation of Clinical Vignettes
4:15 - 5:15 Medical Jeopardy Finals
5:15 - 5:30 Walk to third floor of Feinberg Pavilion
5:30 - 6:30 Awards Reception
7:00 - 9:30 Awards Dinner at The Arts Club, 201 East Ontario Street

Saturday November 10, 2001 - Members Meeting

7:00 - 8:30 Continental Breakfast
8:30 - 9:15 Update on Hepatitis C
Kenneth O'Riordan, MD
9:15 - 10:00 Update on Coronary Angioplasty and Brachytherapy
Mark Ricciardi, MD
10:00 - 10:15 Coffee break
10:15 - 11:00 Transplant Approaches for the Treatment of Diabetes
Cristiana Rastellini, MD
11:00 - 11:30 The ACP in Washington
Mr. Richard L. Trachtman , Director, Congressional Affairs, ACP-ASIM
11:30 - 1:00 PM Town Meeting and Lunch Certification and Recertification Process
Moderator: Bernard M. Rosof, MD, FACP
Review of Resolutions
1:00 Adjournment