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Governor's Newsletter, Summer 2001

Joseph G. Weigel, MD, FACP
Governor, Kentucky Chapter

From the Governor

As I write the introduction for the 2001 Summer Newsletter, I am on vacation at the beach in the Florida panhandle gazing out at the turquoise Gulf of Mexico in all of its early morning splendor. It is a vision I will try to keep with me later this year when early, cold, dark Kentucky mornings awaken me with thoughts of the workday ahead. It has been a good week, perhaps the last week I will be with my entire family at once for a while, as my oldest son starts college life this fall. It has been a good reminder to me of how important vacation and time off can be. Medicine is hard work, and internal medicine done well is very hard work. If we do not take time off to recharge, then we are not much use to our patients, our loved ones, or to ourselves. So I hope all of you have or will, take a break soon. It can help improve, and alter, your perspective.

It has been a good year so far for our Chapter. The ties between the Chapter and the medicine programs at both universities have never been stronger. Once again, we sent a representative to Washington in May for Leadership Day. We had strong Student and Associate representation at the poster competition at the Annual Session in Atlanta. Perhaps most importantly, we have begun a series of educational meetings organized and conducted by members of the Governor's Council. The first of these was held in late April of this year. In the hope that more members will participate in some way in our Chapter's activities, we are planning regional meetings at times different than our Annual Scientific Meeting. We hope to continue to build on this process, and have a second regional meeting later this year.

I hope to see all of you in Louisville in September.

Joseph G. Weigel, MD, FACP

Annual Session

Annual Session continued the tradition of offering high quality, clinically relevant information in internal medicine, the subspecialties, and a broad range of issues relevant to the medical community. Approximately 5,400 physicians and medical students attended the College's eighty-third Annual Session in Atlanta, surpassing attendance of the 1995 Atlanta meeting. Total registration, which includes physicians and non physician attendees, guest exhibitors, etc., was over 9,300.

Nine pre-session courses provided in-depth coverage of selected topics including office-based dermatology and ECG interpretation. Other pre-session programs took a broader perspective, covering a range of problems in primary care and critical care. The two-day intensive recertification preparation course continued to be the most highly attended pre-session program.

The Scientific Program featured over 350 educational offerings. Once again the Update and Multiple Small Feedings of the Mind sessions drew large audiences. New this year were the Clinical Pearls sessions, featuring a highly interactive format where the attendees use the audience response system to answer challenging case-based questions often seen in day-to-day practice. Patient-management issues in six different clinical problem areas were discussed, and faculty provided "clinical pearls" (teaching points that are evidence-based but not widely known.) The Clinical Pearls sessions were quite popular-requiring the sessions to be moved to a larger room that could seat 1,500 attendees.

The College's Clinical Theme, Emerging Antibiotic Resistance: Appropriate Use of Antibiotics and Immunization, was the focus of a dozen sessions. A number of the offerings were planned and presented in coordination with the Centers for Disease Control and Prevention. The ACP-ASIM patient safety initiative gained exposure, with a variety of sessions offering physicians insight and tools to help them reduce patient errors in the practice setting.

Activities in the Learning Center added another dimension to the program. Attendees had the opportunity to participate in a wide range of hands-on sessions to improve physical examination skills and gain experience with the office-based procedures. Sessions in skin biopsy techniques and arthrocentesis continued to be in high demand. Other popular activities included sessions on sports medicine, casting and splinting, and flexible sigmoidoscopy using computer simulation technology. The medical informatics area was well trafficked, with sessions on hand-held devices attracting large audiences.

Our Chapter had both Associates and Students from the University of Louisville participate in the poster sessions. Two fourth year medical students, (now physicians) David Hasselbacher and Jeffery Groce, were winners in the poster competition. The Chapter continues to support entries of both Associate and Student members in the competition and we hope that our Chapter representatives can continue to do well in such presentations.

The single largest and most discussed issue facing internal medicine and the ACP-ASIM is that of recertification. This issue has dominated conversation and discussion at sessions involving all the Governors over the last year, (see Dr. Waxman's article.)

Recertification: The Dialogue with the ABIM

Dr. Herbert Waxman
Senior Vice President, Education, ACP-ASIM

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 had 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:

  • 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 performance measures and improvement plans.) College members have expressed very strong feelings about this.
  • 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.)
  • There should be a clear articulation of the fact that maintenance of competence requires more than just evaluation periodically. It should also encompass relevant continuing education 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 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 evaluation 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 physician's 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 as 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 peer evaluation module is viewed most 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!

Leadership Day Participants Converge on Washington

Dr. Robert Emslie, of Bowling Green, who has advocated for the Chapter for years, was our representative at Leadership Day in Washington D.C. on May 8th and 9th. Dr. Emslie was able to meet with staff for Senators Bunning and McConnell and with staff for Representatives Ron Lewis and Ernie Fletcher. The meetings were productive, and Dr. Emslie feels it is important for our Chapter to continue to participate, and send representatives.

The following is from the College's web site: Leadership Day 2001 attracted 120 ACP-ASIM Chapter leaders from 35 states to Washington, D.C., to meet with their senators and representatives and to learn how to effectively advocate on behalf of their patients and profession. Attendees participated in a half-day of training including expert panel briefings on the Medicare Education and Regulatory Fairness Act (MERFA) legislation to reduce Medicare hassles and tax credits to increase access to health insurance. The session included workshops on "working the media to influence elected leaders" and "RX for ongoing advocacy."

At dinner, Mahendr S. Kochar, MD, FACP, was presented the Key Contact of the Year Award. Also, Stuart Rothenberg, editor and publisher of the Rothenberg Political Report, and political analyst for CNN, offered his analysis of President George W. Bush and congressional politics and health care in the first 100 days.

On May 9th, Sen. William Frist (R-Tenn.) reported on the status of health legislation in Congress. Rep. Shelley Berkley (D-1-Nev.) presented information regarding MERFA and physician advocacy. Participants visited Capitol Hill to meet with members of Congress. The College's priority issues for Leadership Day were reducing Medicare hassles, patient protections in managed care plans, expanding access to health insurance and patient safety.

The Year in Brief

Earlier this year we began a series of regional CME meetings, created especially for rural physicians in the western, eastern, and northern portions of the state who find it difficult to attend our Annual Scientific Session. The first of these meetings was held in Pikeville, and was organized by Dr. Lela Maynard. Forty-five attendees were present, and 5 Category 1 CME Credits were provided. Many thanks go to Dr. Maynard and to Pikeville Methodist Hospital for their help. I hope this initial meeting can be built upon with a second meeting in Bowling Green later this year.

Speaking of our Annual Scientific meeting, this year it will be held in Louisville in conjunction with the Annual KMA meeting, on Tuesday, September 11. All of you have received several mailings regarding this meeting, and I hope you will attend. We have attempted to put together an excellent session. Our College Representative will be Dr. Munsey Wheby from Virginia.

Finally, we have a new Governor-Elect for our Chapter. Time has flown, and my term as Governor will expire with the Annual Session in Philadelphia in 2002. Dr. David Bybee, who has served as Chapter treasurer for a number of years, is now the Governor-Elect, and will assume office next spring. David has been an ardent supporter of the Chapter and will serve us well.