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Governor's Newsletter - Summer 1999

Warren W. Furey, MD, FACP
Governor, Northern Illinois Chapter

From Our Transitional Governor

By John Schneider, MD, PhD, FACP

Recently there has been increasing distress among physicians about the restrictions placed upon their ability to practice medicine as a result of managed care organizations' efforts to control health care costs. For many physicians there has been a decrease in income, demands to see more patients in a shorter period of time, and restrictions upon their ability to refer patients and/or obtain medically appropriate tests or procedures. As managed care organizations and payers have become larger they offer individual physicians very restrictive contracts with no opportunity to negotiate changes. Physicians feel that their autonomy to function independently has decreased and they are essentially employees of the insurer. New young physicians are commonly employed and housestaff are viewing themselves as functioning more as employees than as students. Thus, the strongest advocates for organized medicine developing a labor organization are housestaff and young physicians. The House of Delegates of the American Medical Association voted on June 23rd to develop an affiliated national labor organization to represent employed physicians and where allowed by state law, residents in order to enable those physicians to advocate more effectively on the behalf of their patients. Likewise, the ACP-ASIM at the April 1999 Board of Regents adopted the position that the ACP-ASIM would support legislation to allow physicians who contract with health plans to negotiate collectively with such plans on issues that affect the quality and access to patient care. The ACP-ASIM presently is drafting a position paper to provide details as to how that organization should be structured.

Antitrust laws have been the major restraints keeping physicians from joining together to negotiate with insurers. Physicians who are not in an employment relationship, i.e., who are self-employed, are viewed as competitors and therefore may not agree on prices or otherwise negotiate jointly with an insurer. Collective bargaining can only be used by self-employed physicians if there is an exemption from present antitrust laws. The labor laws provide an exemption by protecting legitimate activities of labor organizations and their members to engage in collective negotiation over terms and conditions of employment, but is contingent upon an employment relationship. Thus, only a limited number of physicians, who are in an employee status, would be able to form a collective bargaining unit to negotiate with their employer. A labor organization is the specific legal term which is defined by the National Labor Relations Act (NLRA). Any entity, including a medical society or group of physicians, can be certified as a collective bargaining agent without affiliating with a traditional labor union. For staff model HMOs clearly an employer/employee relationship does exist as is also true for physicians who are employees of a hospital or faculty of a medical school. In a number of states, including Illinois, housestaff members at a public hospital may organize either independently or participate in a traditional labor union for purposes of collective bargaining.

The majority of physicians are self-employed and to be able to participate in a labor organization would require changing present antitrust laws. The most significant of these being the Quality Healthcare Coalition Act of 1999 (HR1304), which has been introduced by Congressman Tom Campbell and would enable self-employed physicians to organize. This legislation states that since the insurance industry enjoys an exemption from antitrust laws and possesses significant market power there is an imbalance in the relationship between the insurer and the individual physicians. The Quality Healthcare Coalition Act is designed to level the playing field and place the payers and the providers on a more equal status and would allow health care professionals to join together and negotiate terms and conditions of their contracts with health plans without violating antitrust laws. The bill would not permit doctors to deny services including striking. Physicians could not engage in price fixing or setting of fees. The plan is in the Judiciary Committee and has not been considered by the House as a whole although it has over 100 co-sponsors.

The AMA National Labor Organization would not be a traditional labor union since physicians would not be able to strike or endanger patient care. By being established by the AMA, medical ethics would be protected. Physicians' negotiations would maintain the highest level of professionalism and be consistent with the AMA principles of medical ethics and current opinions of the Council on Ethics and Judicial Affairs. The AMA would continue its private sector advocacy programs working to stop egregious health plan practices and helping physicians level the playing field. Finally, the AMA would educate members, non-members, and the public on the benefits and risks of formation of the national labor organization.

The ACP-ASIM is in the process of developing a position paper on this issue. Support will be based on regulations that would prohibit collective action by physicians that would result in denial or limiting services to patients, price fixing, or other anti-competitive behavior. Unlike the AMA, however, the ACP-ASIM at the present time is not supportive of development of similar programs for residents.

At the time you are reading this, it is quite likely that the AMA will have proceeded further with developing their organization and the ACP-ASIM will have come forward with a more definitive policy statement. What will the future hold? It is uncertain as to how many physicians would be able and/or interested in participating in a collective bargaining labor unit. Would the costs of such a collective bargaining unit be effective in promoting the interests and concerns of physicians and the improvement of patient care? Will the public perception be favorable, unfavorable, or one of disinterest? Finally, can a professional organization maintain the image of physicians as professionals and at the same time engage in negotiation with payers to effect a decrease in the restrictions, administrative hassles that demand so much of physicians' time and cause physicians so much distress? Will it enable physicians to devote more of their time and effort providing effective and efficient care to patients? What are your thoughts? Your Governors and I would very much appreciate your comments. We would especially like input from Associates and young physicians since formation of labor organizations will have a dramatic impact upon their future careers.

ACP-ASIM Northern Illinois Chapter Advisory Council Members

Whitney Addington; John Brill; Marion Brooks; William Cannon; Ray Curry; Anne Dean; Evelyn Diaz; Thelma Evans; Patrick Fahey; James Foody; Nancy Furey; Serafino Garella; Stephanie Gregory; Rolf Gunnar; Ashutosh Gupta; C. Anderson Hedberg; Holly Humphrey; E. Stephen Kurtides; Stuart Levin; Armand Littman; Melvin Lopata; Joan Mullan; Lisa Orelind; Steve Potts; Janet Riddle; John Schneider; John Sheagren; Lori Siegel; Michael Silver; Kevin Simpson; James Sipkins; John Skosey; Vesna Skul; James Webster; Wayne Williamson; and Quentin Young.

Chairs of Medicine: Lewis Landsberg; Patrick Fahey; Stuart Levin; Eric Gall; Harvey Golomb; and Lawrence Frohman.

The Illinois Chapter of the American College of Physicians-American Society of Internal Medicine and The Midwest Chapter of the Society of General Internal Medicine

"New Approaches to Prevention and Health Care"
Friday, October 8th & Saturday, October 9th 1999
The Lodge at McDonald's Office Campus
Oak Brook, Illinois
Program Director: John Butter, MD

The 26th Annual Illinois American College of Physicians-American Society of Internal Medicine Associates Meeting
Wednesday, October 6, 1999
12:00 noon
Illini Union Conference Center
University of Illinois College of Medicine at Chicago

Excellence in Teaching Award

By Karen B. Weinstein, MD, FACP

One of the College's first Community-Based Teaching (CBT) Excellence in Teaching Awards was bestowed on Karen B. Weinstein, MD, FACP in June, 1999. The award is reserved for internal medicine physicians who have been involved in a community-based teaching program for 7 out of 10 years, with at least three years at the same sponsoring institution and an average of 50 hours per year of direct trainee contact. The physician must meet certain measures of teaching excellence and have the recommendations of three professional colleagues.

Dr. Weinstein, Associate Program Director of the Internal Medicine Residency Program at West Suburban Medical Center in Oak Park, Illinois, is described by her colleagues as an outstanding administrator, teacher and role model and for demonstrating excellent teaching abilities, attention to detail, ingenuity and excellent diagnostic and management skills in her art. Her colleagues also cited that Dr. Weinstein's ratings by students and staff are the highest of any teacher in the institution and her clinic is one of the most sought after teaching sites by students assigned to outpatient care.

Community-Based Teaching (CBT)

Speaker's Bureau

The staff at the CBT program is pleased to announce the availability of the CBT Speaker's Bureau. The Speaker's Bureau is a "Clearinghouse" of human resources and the first national list of experts in ambulatory care education. The Bureau is comprised of administrators and physicians who have experience in Community-Based Teaching and are willing to share that experience by speaking at workshops, seminars and conferences. We have members with expertise in the areas of Faculty Development, Teaching Skills, Mentoring, Curriculum and many other areas. Please note that the CBT Program is not responsible for travel arrangements or funding. Because of scheduling conflicts, some speakers may not be available. In this case, the CBT program will attempt to identify an alternative speaker. We are currently designing a searchable database that users may access from the main site to search for a speaker based on topic or geographic area. In the meantime, if you are looking for a speaker for your learning event, please contact Stephanie Woodward at (215) 351-2588. If you are interested in volunteering for the Bureau, please fax your CV and topics of expertise to the attention of the CBT Speaker's Bureau at (215) 351-2594.

Community Services

By Ashutosh Gupta, MD, FACP

The India Medical Association (IMA) is a non-profit professional organization of physicians of Indian origin established in 1979. IMA has been involved in community services on several fronts:

Community Health Fairs: IMA has been conducting community health fairs and health screenings for several years in Chicago metropolitan area and several other locations on a regular basis. Last year Sister Sheila Lynn, Health Commissioner, Chicago Board of Health and the then CMS President, Dr. Joseph Murphy, visited the health fair.

Public Health Seminars: IMA has been presenting free public health seminars on several topics of interest, such as diabetes, hypertension, myocardial infarction, cancer, women's health issues, AIDS awareness, stress management, etc. These seminars are primarily directed towards educating non-medical audiences.

Free Health Clinic: In 1994 IMA established a charitable foundation which operates a free medical clinic with a mission, "To serve the underserved." The clinic is located at Indo-American Center (6328 N. California Avenue) and offers basic health care and limited specialty care. The clinic is staffed by IMA physicians and other allied health professionals who volunteer their time and services. The clinic has served over 1,600 patients so far, irrespective of race or ethnic origin.

Dr. A. Gupta served as Chair of the IMA Charitable Foundation during 1995-96 and is presently Chairman of the IMA Public Relations Committee.

Medical Students (Club Meds)

By Ray Curry MD, rcurry@nwu.edu

Chicago Medical School:
Laurie Broutman - broutmanl@mis.fivch.edu

Loyola:
Kevin Simpson - ksimpso@wpo.it.luc.edu

Northwestern:
Lisa Orelind - lorelind@nmh.org

Rush Medical College:
Janet Riddle - jriddle@rush.edu

U. Chicago:
James Foody - jfoody@medicine.bsd.uchicago.edu

U. Illinois:
Mel Lopata - Mlopata@uic.edu

Awards Program: For internal medicine interest groups at U.S. and Canadian medical schools there will be two types of awards. The first award will go to all schools whose ACP-ASIM Medical Student Membership increases 15 percentage points or more during the time frame beginning July 1, 1999 and ending April 1, 2000. Awardees will receive a Certificate of Merit.

The second award will go to the school having the greatest overall increase in Medical Student Membership during the same time frame. The winner will receive a Certificate of Merit and possibly a monetary prize. Both Awardees will be identified at the Medical Students and Associates Recognition Reception during the 2000 Annual Session.

A Call for Universal Health Coverage

On Saturday, October 9,1999, at 10:30 AM help launch Universal Health Coverage at the Town Meeting following the Illinois Regional Meeting at McDonald University in Oak Brook Illinois. We will discuss specific issues needed to help solve our healthcare crises: (1) The funding dilemma, how to balance revenue and expenditures; (2) How to apply current evidence to maximize quality effectiveness and efficiency of medical interventions; (3) What is the meaning of a basic benefit package; and (4) What are the realistic strategies to implement a form of universal health insurance that will expand coverage to those currently without access or are enrolled in substandard medical care programs. Dr. James Webster, MD, MACP, Chair, would love to have more members, fellows, associates, and medical students work with him. Dr. Webster can be contacted at j-webster@nwu.edu, (312) 503-3087, or fax (312) 503-5868. Information regarding committees, conferences, and legislative activities can be obtained by contacting the Illinois Ad Hoc Committee to Defend Health Care. Website: www.iladhoc.org.

Physicians' Work Group on Universal Coverage

At a press conference on June 14, 1999, Dr. Whitney Addington took the lead in releasing the Physicians' Work Group on Universal Coverage consensus statement to the public. Seven of the largest medical societies are involved. The participating medical societies have pledged to use their organizational resources and collective grassroots membership to support this effort. The group has asked the presidential candidates to promise to create or support a plan to solve the problem of the underinsured and the uninsured. The consensus statement establishes three basic concepts for universal coverage:

  1. All Americans must have health care coverage.
  2. Health care coverage will contain a quality benefit package.
  3. Medical necessity determinations made under the benefit package should reflect generally accepted standards of medical practice, supported by outcomes-based evidence.

Members include:

ACP-ASIM

Whitney Addington, MD - President
Harold Sox, MD - Immediate Past President
Walter J. McDonald, MD - Exec. Vice President

American Medical Association

Nancy W. Dickey, MD - President
Thomas R. Reardon, MD - President-Elect
E. Ratcliffe Anderson, Jr., MD - Exec. Vice President

American Academy of Family Physicians

Lanny Copeland, MD - President
Bruce Bagley, MD - President-Elect
Robert Graham, MD - Exec. Vice President

American Academy of Pediatrics

Joel J. Alpert, MD - President
Donald Cook, MD - Vice President
Joe M. Sanders, MD - Exec. Vice President

American College of Surgeons

George F. Sheldon, MD - President
Samuel Wells, MD - Medical Director

American College of Emergency Physicians

John Moorhead, MD - President
Colin Rorrie, Ph.D. - Exec. Vice President

American College of Obs. and Gyne.

James P. Youngblood, MD - Immediate Past President
Frank C. Miller, MD - President
Ralph W. Hale, MD - Exec. Vice President

The Bernardin Amendment

Health care is an essential safeguard of human life and dignity, and there is an obligation for the State of Illinois to ensure that every resident is able to realize this fundamental right. On or before May 31, 2002, the General Assembly by law shall enact a plan for the universal health care coverage that permits everyone in Illinois to obtain decent health care on a regular basis.

After the overwhelming mandate in Cook County endorsing the Amendment (83%) in Nov. 1998, voters in 17 suburban and rural downstate counties overwhelmingly supported the Amendment by an average of 71% in the elections in April 1999. State Representative Mike Boland from East Moline is spearheading the effort to get bipartisan support this fall.

Group Insurance Administrators (GIA)

By Jack Finnegan, GIA, Vice President of Insurance and Financial Planning

Who are these people? Oh, they are the folks that set up the College Display at Chapter Regional Meetings. Yes they do that, but let's look at Group Insurance Administrators' (GIA) principal responsibilities in providing benefits of membership for ACP-ASIM members.

The appointed administrator of ACP-ASIM sponsored Insurance and Financial Planning Services, GIA has been providing its expertise in these services for over 45 years. Currently over 28,000 ACP-ASIM members benefit through participation in insurance plans, which are designed exclusively for them and administered by GIA. An added benefit is that GIA devotes all of its skills to College members only!

GIA understands your needs for protection in the event of death, disability, medical expense and financial planning. They also recognize that members of the College are preferred risks and this is reflected in the low premium rates charged for benefits selected.

GIA's insurance and financial planning services are monitored by the Board of Regents' Member Insurance and Financial Services Subcommittee. The members of the subcommittee include GIA's Executive Vice President and Treasurer, as well as one member of the Board of Regents and four members of the Board of Governors.

For more information, contact GIA at 1-800-GIA-PLAN. Also, if you wish to set up an Insurance or Financial Planning Seminar in your community, hospital or University, call Jack Finnegan, Vice President of Insurance and Financial Planning, and GIA will take care of the arrangements.

My Experience With Kosova Refugees

By Ayesha Bashir, MD, Associate

My visit to Albania as a physician was to help the Kosovar refugees. I worked with a relief organization (ICNA), that had a clinic set up in Tirana and Kukes and a mobile unit (ambulance) that went to the camps set up in and around the city. There were greater than 100,000 refugees estimated in Tirana alone, while in Albania as a whole, there were believed to be at least half a million refugees. Everybody we met had a story of someone they had lost, of merciless killings and inhumanities by the Serbian forces. Families had been split up not knowing if other members were alive or dead. During my last week there, some of the people had received good news, while others received bad news.

The city did not have enough hospitals or medical facilities. We were advised to treat and manage as best we could with what was available. The relief organization bought a house and turned it into a clinic and pharmacy. The medications were donated by individuals from all over the world. Laboratory access was not possible most of the time so my diagnoses were based on the history and physical examination and treated as such. The most common medical problems that I dealt with were urinary tract infections, upper respiratory tract infections, asthma, infectious diarrhea, gastroenteritis, rashes, depression, insomnia, anemia, headaches, arthritis, sciatica, stress amenorrhea, angina, cuts, sunburn, hypertension and loss of appetite. My youngest patient was one month old and the oldest was 90 years old.

The camps we visited consisted mostly of elderly people, women, children and orphans. Adult men were few in number having been killed in Kosova. In the camps I noticed that the people would try to keep their tents as clean and comfortable as possible. They were very hospitable, letting us use their tents as make shift clinics to treat others. They offered us coffee and food from their rations. Despite all they had suffered I saw great patience and strength among the refugees. Of all that I saw and heard, I will remember their smiles and courage the most. As an American I am thankful for the freedom and liberties that I have compared to others.

Note from Dr. Warren Furey: Dr. Bashir is a third year resident in internal medicine at Mercy Hospital, Chicago. She spent $4,000 of her own money and took her vacation time for the privilege of serving others.

Control Violence

By Kim Meyers, MD, FACP

Ricky Birdsong was a former basketball coach at Northwestern University. He was African-American and as we were to learn unforgettably, after his murder, he was much loved and a beautiful person. He was shot while jogging with his children by a racist, a lunatic who also shot at, with intent to kill, Jews and Asians last fourth of July weekend. Following is a copy of a letter which appeared in the July 13, 1999 Chicago Tribune, by Dr. Kim Meyers.

Ricky Byrdsong was fatally wounded and lay dying on my front lawn. My 11 year old son and his 13 year old baby sitter responded to the frantic calls of Rickey's nine year old son at my front door. These children were exposed to the senseless violence that permeates this society.

The agent of death most commonly used in these situations is clearly the handgun. It is appalling to me that the gun lobby has already made a pre-emptive strike on your editorial page suggesting that concealed weapons could have averted this tragedy. (Chicago Tribune, July 8, 1999). Common sense speaks otherwise.

Even if my children and the neighbors were fully armed, they would not have been able to react in time to stop the shooting. On the other hand, if the most lethal object Mr. Smith could have obtained was a knife or club, he would not have been able to affect as many lives as he has.

Even with the millions of guns in circulation, this country could disarm itself and eventually get to the point where handgun violence would become a rare occurrence. A national vote, even if not binding to the politicians, should be done to check the feelings of the average citizen, not just the lobbying groups.

Our founding fathers were not infallible. They were wrong to allow slavery to continue nearly 100 years after the Declaration of Independence. They were wrong about making gun ownership a basic principle of our country. The latter reflects a time and way of life that is far removed from our current situation.

I know that effective gun control legislation will not come yet. It is tragic that going to school or taking an evening stroll with your children have been added to the list of situations in which you need to be prepared for a lunatic with a gun. It is apparent that we will need to suffer through many more such tragedies before we begin to accept real solutions.

ACP-ASIM Northern Illinois Chapter Committees and Chairs

Health & Public Policy: S. Garella

Public Health: Quentin Young

Domestic Violence: John Scott

Gun Violence: David Leehey

Community Service: S Garella

Resolutions: Warren W. Furey

Associates: Steven Potts

Membership Enhancement: V. Skul

Women: Janet Riddle

IMG: Ashutosh Gupta

African-American: Sonja Boone

Hispanic: P. Lopez, E. Diaz

Health Care Reform: James Webster

Legislative: John Schneider

Medical Students: Ray Curry

Ethics-Professionalism: Rolf Gunnar

Awards: Joan Mullen, Warren W. Furey

Newsletter: Nancy Furey

Finance: Rolf Gunnar