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Governor's Newsletter Winter 2001

Serafino Garella, MD, FACP
Governor, Northern Illinois Region

From the Governor

The following is an update on all the Chapter activities that have taken place since the "Fall 2000" newsletter.

  • The Uninsured Latinos: Community at Risk Forum and Press Conference was held Thursday, September 7, 2000. It was the first such event nationally (the others were held in Miami, FL, and in Austin, TX.) The meeting was a big success and received widespread media coverage in the Chicago area. The symposium was co-sponsored by the ACP-ASIM, the Commonwealth Fund and the National Hispanic Medical Association. It included presentations from Dr. Sandra Adamson Fryhofer, ACP-ASIM President; Dr. Whitney Addington, Immediate Past President of ACP- ASIM; Dr. Elena Rios, President of the National Hispanic Medical Association; Melinda Schriver, Health Policy Associate of the College; Sister Sheila Lyne, Commissioner, Chicago Department of Health; and me. An audience of approximately 175 physicians, public health advocates, nurses, ministers, community activists, and business leaders heard the presentations and then engaged in a lively discussion of possible solutions. Following the symposium, a Press conference was held at the CommunityHealth free clinic.
  • The "All For Health" Illinois Coalition of Health Care Organizations has been formed as a result of the initial meeting sponsored by the Illinois Chapter of the ACP-ASIM. The intent of the coalition is to push for the correction of the misallocation of tobacco settlement monies. The coalition is an umbrella organization representing the common interests of health-related societies or groups. The intent of the Chapter in sponsoring this coalition is to present a unified and powerful voice to the State legislature, requesting that all future tobacco settlement funds be allocated to the improvement of health, including anti-smoking and tobacco cessation programs. A resolution to this effect has been adopted by 16 health-related organizations in Illinois. A Working Group of this Coalition, chaired by our rep- representative David Ansell, MD, FACP, has been formed and is moving forward in contacting all legislators to get them to publicly state their stand on this important issue. Future undertakings of this Coalition may include fostering the passage of the Bernardin Amendment to change the Constitution of the State of Illinois to guarantee universal health coverage for all citizens.
  • Wednesday, October 4, 2000, was a red-letter day for our Associates and for those Members who were fortunate enough to be able to attend. It was the 27th Annual Illinois Associates Day held at Rush Medical College.
  • The 2000 Annual Illinois Chapter Scientific Meeting, held on Friday and Saturday, October 20 and 21, 2000, in Springfield, was educational, informative and above all a great deal of fun! The presentations on Antibiotic Resistance (Drs. John P. Quinn, Gary Noskin, Janet Jokela and Jose Fernandez) and the updates on What's New for the Practicing Internist (Drs. Susan T. Hingle, Vesna V. Skul, Carmel Fratianni, Adam Cifu and James T. Dove) were very well done and gave us all much timely information and food for thought. Edward Shortliffe, MD, PhD, FACP, the College Representative, spoke on The Future of Medical Records in the Era of the Internet, as well as the National College Update. There were programs on Understanding Medical Accidents (Drs. Michael O'Connor and Michael Zia), Diversity in Medicine (Dr. Hugo Alvarez) and a Legislative Update from Robert Doherty of the College's Washington Office. On Friday evening there was a wonderful dinner in the inspiring surroundings of the Old State Capitol. Following the dinner there was an Awards Presentation Program in the Hall of Representatives. The 2000 Laureate Awardees were Rajagopal Chadaga, MD, FACP and Margaret Telfer, MD, FACP. You can read their bio-sketches on our Chapter website www.acponline.org/chapters/il/. Farr Curlin, MD, an Associate from the University of Chicago, was the recipient of the Norris L. Brookens Award. In addition, Dr. Shortliffe presented the Northern Illinois Region with the College Chapter Excellence Award for excellence in chapter management. This is indeed, a great honor and due to the hard work, leadership and guidance of Warren W. Furey, MD, FACP, the Immediate Past Governor of the Northern Illinois Region.
  • At the Town Meeting on Saturday we discussed the resolutions that the Chapter plans to send on to the Board of Governors. Recommendations were made to go forward with four of the resolutions (Physician Compensation for Limiting Patient Care is Unethical; Proliferation of Certification Requirements Should be Opposed; Chiropractor Scope of Practice; and Pharmaceutical and Medical Products Industries). The text of all these resolutions can be found on our Chapter website. If you have any suggestions, or additional resolutions you would like to have considered, please contact the Regional Office at (312) 435-0484. The one resolution that will not be forwarded to the Board of Governors was on the Coverage of Appropriate Preventive Measures and/or Screening Tests. Although the membership agreed with the substance of the resolution, after discussion at the Town Hall Meeting and with input from Bob Doherty, it was decided not to submit it because various College committees are already at work on this issue. The All For Health tobacco resolution was also discussed. As this is solely related to the State of Illinois, it will not be sent to the Board of Governors. However, the Chapter (represented by David Ansell, MD, FACP) will continue to work on the issue.
  • The Illinois Chapter Council also met in Springfield. Council elections and membership were discussed. Lots were drawn to determine which Council members would have a one-year term and which would have a two-year term. In the Downstate Region, Drs. Craig Backs and Sunil Sinha will serve two-year terms and Drs. Gail Clifford-Mullen and Lawrence Jennings will serve one-year terms. In the Northern Region, Drs. Raymond Curry, James Foody, Vesna Skul and Wayne Williamson will serve one-year terms and Drs. Patrick Fahey, Ashutosh Gupta, Patricia Russell and Michael Silver will serve two-year terms. Election of new Council members will take place at the 2001 Spring Council meeting. Therefore, we are soliciting the names of individuals who are interested in serving on the Illinois Council. There will be two positions available in the Northern Region and one in the Downstate Region. There are at least two Council Meeting annually and special meetings of the Council may be called. The term for a Council Member is two years. There is no compensation for services as a Council Member; however, bona fide expenses incurred arising out of service will be reimbursed. This is an opportunity to really get involved in the decision-making policies of the Chapter. If you or someone you know is interested in running for one of the positions on the Illinois Council please contact the Regional Office indicating the name and contact information of the individual you are recommending (see back panel for contact information), or fill out the enclosed Request for Nominations form (see page 4.) We will need this information by 2/01/01.
  • In addition to the above activities three of our Internal Medicine Interest Groups at the medical schools have held Club Med meetings for medical students. These Club Meds introduce the student to the field of Internal Medicine, as well as to the activities of the College. Northwestern University Medical School held a Club Med on September 19, 2000; the University of Chicago held one on September 21; and the University of Illinois at Chicago held one on November 1. Northwestern University Medical School also selected Ripal Gandhi to receive the ACP-ASIM Certificate of Merit in recognition of an outstanding performance in the junior medicine clerkship. A certificate and honorarium were awarded from the College.

As you can see, the Chapter has been very busy this fall. I hope we can continue these activities and even increase our visibility to the public as the organization of physicians whose mission is to enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine.

I cannot close this note to the College membership without pointing out my great personal dismay and disappointment regarding the contents of the article that appeared in the October 23, 2000 issue of the Archives of Internal Medicine, titled "Physicians' Attitudes About Involvement in Lethal Injections for Capital Punishment." It should be recalled that the World Medical Association, the American Medical Association, and the ACP-ASIM deem that it is unethical for physicians, regardless of their personal views on capital punishment, to participate in legally authorized executions except to determine or certify death. The College's 1999-2000 Policy Compendium states that active involvement by physicians in carrying out the death penalty constitutes a threat ...to the moral standing of physicians [which] warrants immediate and decisive action to assure the public, and each patient, that physicians will not use their skills to cause immediate and irreparable harm. The policy calls for several actions, including the following recommendation: State medical boards...should define physician participation as unethical conduct, and take appropriate action against physicians who violate ethical standards.

Despite these statements and recommendations, the Archives survey indicated that a substantial minority (43%) of respondents was in favor of physicians actually administering lethal drugs, and that higher percentages were in favor of physicians participating in other aspects of capital punishment. I do hope that none of these were members of ACP-ASIM. My question to you is: What can we do to eliminate this stain on our profession? Can the various State Medical organizations act together to influence the medical board to impose serious penalties on those (few) physicians who participate in lethal executions? How can we ensure that Illinois no longer requires physician participation in capital punishment?

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 to permit 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.

Young Physicians Subcommittee

The Young Physicians Subcommittee (YPS) wants to hear from young physician members of the College about the practice environment today. Your frank comments will, through the Subcommittee, have a direct impact on you and your colleagues.

We'd like to know how you feel about recertification, establishing a practice, coping with stress, and time constraints. Would you like a copy of the YPS Practice Management Survival Booklet? An E/M coding card? A curbside consultation about and evaluating and improving a practice via the College's Center for a Competitive Advantage? If you answered "yes" to any of these questions, the web site can also be used to request this information. ALL e-mails will be answered.

Visit http://www.acponline.org/private/committees/yps/ and let us know what's on your mind.

If you have any questions, please contact Jean Elliott, YPS Staff Liaison at (800) 523-1546, ext. 2692

Community Service Committee

Volunteering As A Physician

The ACP-ASIM encourages volunteerism and community service amongst its members, as a way to enhance access to health care for the uninsured and underinsured. Besides the unique experiences provided by volunteering, physicians involved in community service report satisfaction from making a difference in the health and well being of members of the community. Illinois is blessed with several free clinics that need volunteer physicians. The Free Clinics Foundation of America Directory on the Internet www.freeclinic.net is one good source for such opportunities. A link to this and other volunteer (national/overseas) and community service (including non-medical) opportunities is available at the College's web site, www.acponline.org. Such activities are also recognized as an important piece, in support of candidacy for Fellowship in the ACP-ASIM. For questions about volunteering, or to nominate an ACP-ASIM member for volunteerism awards, please contact Nkem Iroegbu, MD, FACP Kemix@aol.com or Bill Cannon, MD, FACP wcannon@wpo.it.luc.edu.

The ACP-ASIM 27th Annual Illinois Associates' Meeting held on Wednesday, October 4, 2000, at Rush Medical College, was a huge success! We had over 500 people attending and participating. The meeting started off with a welcome from Alan Harris, MD, FACP, Professor of Internal Medicine and Preventive Medicine and Senior Assistant Chairman and Program Director at Rush. This was followed immediately by an "Infectious Disease Case Debate" with Dr. Harris serving as moderator for the discussion held by Gordon Trenholme, MD, FACP, Harold Kessler MD, FACP and Mary Hayden, MD. Clinical Case Vignettes followed. All of the vignettes appear on our Chapter website www.aponline.org/chapters/il/. Below is a listing of presenters, their vignettes and winners:

Clinical Skills Program Wins National Award

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

The American College of Physicians-American Society of Internal Medicine is pleased to announce that Linda Casey, MS, MPH, Senior Associate, Educational Development, is the recipient of the Alliance for Continuing Medical Education 2001 Award for the Most Outstanding Certified Live CME Activity. The Alliance for Continuing Medical Education is a major international society for continuing medical education professionals. Ms. Casey won the award for leading the design of the pre-session course "Clinical Skills" presented at the 2000 Annual Session in Philadelphia. The Clinical Skills Course is an opportunity for internal medicine physicians to learn or enhance physical examination and procedural skills using the techniques of lecture, demonstration, practice, and feedback. The participants rotated through five learning stations.

In this program, the learning stations were designed to teach the following clinical skills: (1) skin biopsy and cryosurgery, (2) arthrocentesis and joint injection, (3) pelvic and breast examination, (4) joint examination, and (5) male genitourinary examination. Prior to the skin biopsy, arthrocentesis, and pelvic and breast examination the participants watched a 20 minute demonstration videotape that demonstrated the skill to be learned. Expert faculty provided additional content information for the skin biopsy and arthrocentesis stations. At the remaining stations, teaching associates (professional teaching patients) provided instruction. At each station, the faculty to participant ratio ranged from 1 to 2 for teaching associates to 1 to 5 for skin biopsy. The overall satisfaction rating for the course was 4.5 on a five-point satisfaction scale, making it the highest rated ACP-ASIM pre-session course in six years.

Ms Casey will present at poster presentation at the Alliance's Annual Conference this January, and a description of the "Clinical Skills" program will be published in the Alliance's Almanac. The award winning "Clinical Skills" program will be presented at the 2001 Annual Session in Atlanta as a pre-session course on Wednesday, March 28, 2001. Registration for this pre-session course is required and can be accomplished either online http://www.acponline.org or by calling Customer Service at (800) 523-1546, ext. 2600, or (215) 351-2600, Monday through Friday, 9:00 a.m.-5:00 p.m., EST.

Benefits of ACP-ASIM Membership

In an effort to encourage current Associates, Members, Fellows and Masters to actively promote College membership among non-member friends and associates, I thought it might be helpful to give you a little history about the formation of the American College of Physicians-American Society of Internal Medicine as well as a listing of the many benefits available to individual physicians upon joining the College.

The American College of Physicians (ACP) was founded in 1915 to uphold the highest standards in medical education, practice, and research. The American Society of Internal Medicine (ASIM) was established in 1956 to explore and influence socio-economic and political questions that affect the practice of medicine. In March 1998, the two organizations approved a formal merger agreement. The new organization, ACP-ASIM, continues its mission that emphasizes the enhancement of the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine. Some of the benefits available to Associates, Members, Fellows and Masters of the College include:

Subscriptions to the Annals of Internal Medicine, the most widely cited specialty medical journal in the world. Published twice monthly it is also available to members online at www.annals.org. This electronic version offers cross-referencing and is the perfect way to build a living archive of the latest clinical research. Subscription to the ACP Journal Club, provides a literature review as well as brief commentary from leading clinical experts. Subscription to the ACP-ASIM Observer, provides monthly coverage of news, legislation and economics of internists Subscription to Effective Clinical Practice, a bimonthly journal focusing on improving clinical practice and health outcomes by publishing high-quality, peer-reviewed clinical articles.

The Annual Session and Illinois Chapter Scientific Meetings are offered each year. The 2001 Annual Session will be held in Atlanta, Georgia March 29-April, 2001. The Illinois Chapter Scientific Meeting will be held in Chicago, Illinois November 9-10, 2001. These meetings offer distinguished faculty presenting educational sessions. Continuing medical education credit is given. Discounted registration rates are available to ACP-ASIM members.

The Center for a Competitive Advantage (CCA) Practice Management Assistance provides personalized advice, 40 practical written guides and three "Check Up" management tools.

In addition, Electronic Information Resources offer a wide array of internal medicine resources in electronic formats. ACP-ASIM Online www.acponline.org offers information and services for members and the general public. Features include public policy positions, a "Legislation Action Center" to contact members of Congress, etc. ACP-ASIM Online also offers a private discussion forum, which allows members to communicate with colleagues about practice issues. The Illinois Chapter Website www.acponline.org/chapters/il/ offers specific information about College activities in Illinois as well as current legislative actions by the Chapter. The ACP-ASIM has an active Book Publishing Program, which includes books published in several series. Audio Cassettes provide presentations from the Annual Session as well as programs to prepare for the ABIM certification and recertification exams. QNet, the Continuous Quality Improvement Network Project, is a practice-based research network available only to ACP-ASIM members. Physicians can compare their everyday practice to that of their peers and evidence-based "best practices" through individual reports created by Scientific Policy for each participant. Medical Knowledge Self-Assessment Program (MKSAP) and Subspecialty MKSAPs provide up-to-date theoretical and practical information and aids in preparation for recertification. Discounts are available to members. Clinical Practice Guidelines/Clinical Efficacy Assessment Project (CEAP) provides clinical practice guidelines, products and information services. All ACP-ASIM Clinical Practice Guidelines are evidence-based and developed through a rigorous development process. Clinical Skills Program offers a variety of "hands-on" training programs providing the opportunity for internists to learn clinical skills in the areas of medical interviewing, physical examination and procedures. Practice Management Tools- discounts are available to members on the following assessment tools: Practice Management Check Up (examining the business health of your practice); Patient Satisfaction Check Up (assessing patient perceptions) and Office Lab Check Up (is your lab financially fit?) Through the Insurance Program, the ACP-ASIM offers competitively priced insurance programs as well as financial planning services. Discounts are available to members on Car Rentals at Hertz, National, Alamo and Avis. Affinity Credit Cards (Platinum Plus, Gold and Preferred MasterCard) featuring competitive annual percentage rates are available to members.

These are some of the individual benefits available to members of the American College of Physicians-American Society of Internal Medicine. In addition of course, are the general professional benefits of belonging to the largest medical specialty society in the world with approximately 115, 000 members. The ACP-ASIM is the only society of internists dedicated to establishing standards; providing information and education; advocating for the public, patients and members; promoting research; and recognizing excellence in the field.

I hope you have found this information useful and will be able to use it yourself or use it to attract non-member colleagues to membership in the College. If you have any questions or wish to have a Membership or Advancement to Fellowship application sent to you or a colleague, please call the Regional office at (312) 435-0484.

Associates' Corner

Satyavardhan Pulukurthy MD
(5th Place)
UIC, Champaign-Urbana
To B or Not To Be

Vineet Arora, MD
University of Chicago
"Nail"ing the Diagnosis

Darien Heap, MD
University of Illinois @Chicago&
Hypereosinophilia Neighborhood

A. Nasser Khan, MD
Louis A. Weiss Memorial Hospital
The Patient Who Did Not Read the Book

Hesham Hassaballa, MD
Rush-Presbyterian-St. Luke's
Dr. Moschowitz, I Presume?

Pushpalatha Arakere, MD
Christ Hospital
A Janitor's Cry for Air

John Maks, MD (2nd Place)
Evanston-Northwestern
A Mercury Saga from the Mad Hatter

Anne T. Parappuram, MD
Chicago Medical School
Beyond the Obvious

M. Firas Joudeh, MD
Westlake Hospital
When the ECHO is not Enough

Bindu Ravindranathan, MD
(4th Place)
West Suburban Hospital
Altered Mental Status

J.E. Morales, MD
Southern Illinois University
Breathing Ain't So Easy

Tushar V. Shah, MD
Ravenswood Hospital
Blue Man

Danielle Shafer, DO
Loyola University Medical Center
The Boilermaker

Ziad William Sara, MD (1st Place)
Mercy Hospital
The Italian Mystery

Arturo Segismundo, MD
(3rd Place)
St. Joseph Hospital
To Be Or Not To Be: A Soliloquy

The judges (Warren W. Furey, MD, FACP, Immediate Past Governor, Northern Illinois; Serafino Garella, MD, FACP, Governor, Northern Illinois; David Steward, MD, FACP, Downstate Illinois) had a very tough time selecting the winners. Award presentations were made at the cocktail reception which followed the Jeopardy Finals. Dr. Sara will be entered in the national competition and will be going to the Annual Session in Atlanta at the end of March to present his vignette orally or as a poster.

Twelve teams entered the "Medical Jeopardy Trials." This was a new event at the Associates Day and it was a big success. The three finalist teams were: Cook County Hospital, Northwestern Memorial Hospital and St. Joseph Hospital. The winning team, who will go to Atlanta, Georgia for the Annual Session and compete in the National Doctors' Dilemma Competition was Northwestern Memorial Hospital. The Northwestern Team was made up of: Jesse Jorgensen, MD, Punit Chadha, MD, and John Eklund, MD. Congratulations to all the participants in both the Jeopardy Rounds and the Vignette Presentations for a job well done! The success of this conference was due to the hard work of the Rush Chief Residents: Suchita Kishore, MD, Maureen McMahon, MD, Michelle Milic, MD, DeeAnn Rivera, MD, Elizabeth Teperov, MD

Negotiating a Contract Seminar

The Illinois Council of Associates is planning a luncheon meeting on "Negotiating a Contract" sometime in December or January. Flyers will be going out with the details, so look for them or call the Regional office at (312) 435-0484 for more details.

Don't forget to check our Chapter web site for the latest information: www.acponline.org/chapters/il/

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:

ACP-ASIM
332 South Michigan Ave. #525
Chicago, IL 60604 E-mail: nkeil@dellnet.com
Phone: (312) 435-0484
l Fax: (312) 435-0487

E. Stephen Kurtides, MD, MACP

We are saddened to note the death of Dr. E. Stephen Kurtides, a Master of the ACP-ASIM, on Friday, October 13, 2000. Dr. Kurtides was a frequent and thoughtful par-ticipant in the activities of the College as a whole and of the Illinois Chapter in particular. As one of only eight Masters of the College from Illinois, Dr. Kurtides epitomized the true meaning of the title. His longstanding mentorship of residents, his leadership roles in the medical community and his strong personal character are all attributes the College admired and respected. Dr. Kurtides was an active participant in Chapter activities as a member of our Advisory Committee and Awards Committee. We will all miss his wise guidance and kind demeanor in our future deliberations.