Governor's Newsletter, Summer, 2001
Leonard Keilson, MD, MPH, FACP
Governor, Maine Chapter
Notes from the Governor
A new season is arriving. The snow has melted. Cedar Waxwings are fluttering about, enriching the air with their color heralding the black flies that will push everyone for cover. Four weeks ago, a helicopter hovered over home plate in Hadlock Field in order to dry the field for the Sea Dogs, an apt name for a team from Maine, yet this month we are having a serious drought. Opening day was cancelled for the baseball team, the first time since the 'Dogs played in Portland.
A new political season is upon us as well. The son of a part-time Mainer is occupying the White House. He seems familiar and enjoys wearing comfortable clothes, possibly from L.L. Bean or perhaps from a Southern store. We have a hospital in Portland named after his mother. During the opening months of his term of office, he has decided that arsenic is good for us, global warming is not the concern of Americans and the health care of those without insurance not the concern of the beneficiaries of tax cuts. Medicare patients will remain unable to pay for the medications we prescribe and physicians and patients will find the interests of HMOs and Managed Care taking precedence over quality. Vigilance and political pressure will be very important.
The Maine Chapter has a new Governor-elect, Ted Sussman, MD, FACP. Congratulations to Ted. I hope internists will continue to support our Chapter activities as vigorously as in past years.
There are a number of important issues brewing Nationally for internists. The recertification issue is a particularly thorny problem. Even though recertification is presented as a fait accompli by the ABIM, there is much debate about the nature and content of the testing methods. An ABIM group will be visiting Maine Medical Center in Portland in the late summer and I encourage physicians to listen to the ABIM recertification proposal (Aug 8th , Marvin Schlessinger, MD, ABIM representative, 9AM medical grand rounds at MMC). We will keep you posted on the Web under the Maine Chapter newsgroup http://www.acponline.org/chapters/me. Locally, we should support the efforts in Maine to reduce the costs of medication for individuals without insurance. The debate will be very intense and once again, Maine has an opportunity to lead the Nation.
Ted Sussman, MD, FACP, Chosen as Governor-Elect of the Maine Chapter
Dr. Ted Sussman, FACP, from Houlton Maine, will assume the Governorship following the Annual Meeting in Philadelphia in April, 2002. Ted has been member of the Chapter since 1982 and active in a variety of committees, including the Health and Public Policy Committee. Ted and his wife, Iva, have been residents of Maine, since 1979. Born and raised in New York, Ted graduated from SUNY at Stony Brook with a BS in Biology. He then traveled to Tufts University Medical School with the help of the National Health Service and did his Internal Medicine Residency at Case Western's program at Cleveland Metropolitan Hospital under Charles Rammelkamp. In 1980 Ted and his wife, Iva, moved to Houlton, to fulfill his National Health Service Corps obligation and have been there ever since. Ted also took a year off to pursue a Cardiology fellowship in Boston. Ted and Iva have raised three boys, Eric, Michael and Daniel. Ted notes his children are always thankful for ending up in rural Maine. In addition, Ted feels that "...the Maine chapter can continue to show young internists the way 'life should be'..."
Physician's Assisted Suicide: Did Both Sides Win?
Two Chapter members, Betsy Weiss of Bangor and Laurel Coleman of Gardiner, represented opposing positions on the physicians assisted suicide legislation proposed during the November elections. The proposal was defeated. The debate around the terminal care of patients, sparked many discussions state-wide, including the need for better terminal care of patients. The benefit of the debate included clarification of a number of key issues:
- Improved communication between patient and physician, particularly in regards to the end-of-life directives of the patient and family;
- Improved use of palliative, end-of-life medications;
- Improved access to hospice care; and
- Importance of the role of the primary care physician as care-giver and coordinator.
At the recent Annual meeting in Atlanta, much discussion was held about the proposed recertification process by the American Board of Internal Medicine (ABIM). This issue is not resolved as of yet. During the Board of Governors meeting in the Fall, heated debate occurred around this topic. My impression is that further pressure will be needed to move the ABIM away from their proposed recertification plan. I want to call this important issue to your attention. I want you to realize that the ABIM and the ACP-ASIM are separate organizations and have worked jointly over the years with internists representing both organizations. I have extracted some quotes that might help you understand the issues. The first is from an article published by the Annals, the second is a response by our former President of the ACP-ASIM, Sandra Fryhofer, MD, FACP.
1. Recertification in Internal Medicine: A Program of Continuous Professional
Stephen I. Wasserman, MD; Harry R. Kimball, MD; F. Daniel Duffy, MD, for the Task Force on
Recertification, for the ABIM
"In 2000, the American Board of Internal Medicine (ABIM) introduced a second-generation recertification process that builds on the current knowledge-centered program by adding assessments of clinical and communication skills, clinical performance, and medical outcomes. The three-part process, called a program of continuous professional development, includes innovative self-evaluation exercises, documentation of essen- tial knowledge, and confirmation of satisfactory qualifications and professional and community good standing. The program introduces the principles of continuous quality improvement; deemphasizes the summary nature of the traditional secure examination; and is designed to be a more continuous, less saltatory process for main- taining clinical competence. With the continuous professional development program, ABIM believes that it has taken a substantial step toward creating a recertification process that meets its goal of being 'valuable, doable, tolerable, and affordable' while maintaining the high standards expected of an accountable profession."
"....Diplomates with permanent certificates issued before 1990 may enter the CPD program at any time and do not put their original certificates at risk if they do not complete the program."
"A minimum of five modules, covering medical knowledge, clinical and communication skills, medical care and professionalism, and practice performance, will be completed at 1- to 2-year intervals over the 10-year certifi- cation span. Because some diplomates with limited or interrupted patient care responsibilities may not be able to complete some of the patient-centered self-assessment modules, alternate modules are being developed for those who are regularly involved in indirect clinical care activities, such as educators, researchers, and most admin- istrators. To be recertified, however, all diplomates must satisfy all credentialing requirements; pass the secure examination of essential knowledge; and participate in the self-evaluation exercises of expert knowledge, clinical and communication skills, and peer ratings..."
"...Completion of the CPD program will require an estimated 75 to 100 hours over 10 years, excluding prepa- ration for the secure examination. This is approximately the same amount of time that is required for the current recertification program. To minimize the intrusiveness of CPD, new modules will replace older ones instead of being added..."
Ann Intern Med. 2000;133:202-208.
2. Dr. Sandra Fryhofer, MD, FACP, President of the ACP-ASIM responds:
"...Board certification and recertification are critically important issues for internists and our patients. I'd like to take a few moments to address ABIM's proposed recertification program, and clarify a common misunder- standing. First, it is important to note that ACP-ASIM and ABIM are two separate and independent organizations. ACP-ASIM's goals include providing comprehensive education and information resources to internists and subspecialists in order to enhance the quality and effectiveness of health care. ABIM evaluates and certifies the medical knowledge and skills of internists and subspecialists. Maintaining the distinction between our separate organizations is important so that there is no conflict of interest on the part of either organization. Secondly, ACP-ASIM supports the concept of recertification. As internists, we have a responsibility to our patients and to our profession to maintain the highest standards of excellence and professionalism in order to provide our patients the highest quality of care.
However, the College has not endorsed the ABIM's proposed recertification program. The College believes that a recertification process should be relevant, simple, cost-effective, and not duplicative, intrusive or time consuming. The College also believes that once a program has been introduced, research should be conducted to determine its value..."
Sandra Adamson Fryhofer, MD, FACP
ACP-ASIM Goes to Washington
By: Ted Sussman, MD, FACP
On May 8 and 9, Dan Morgenstern and I went to Washington D.C. to lobby our congressional delegation. We focussed on hassle reduction legislation (MERFA), the Bipartisan Patient Protection Act, expanding access (REACH) and prescription drug benefits. We were able to meet with Congressman Baldacci, Senator Collins (briefly) and the staffs of Congressman Allen (his plane never left Portland) and Senator Snowe.
In general we found all our representatives supportive to our concerns. As one might expect there were some philosophical differences between Democrats and Republicans, but much less than you might expect in our delegation. Democrats generally support the ACP-ASIM positions, but felt that the present tax policies will leave no money for MEDICARE expansion. The Republican delegation was also generally supportive but concerned about the effects of some of the provisions upon small business.
At the end of the day, we felt some MEDICARE hassle relief would happen, access would be expanded modestly using a tax credit and expansion of Medicaid and S-chip, patient protection might happen but only after a significant compromise on liability in federal court and prescription benefits would be talked about but there is no idea of how to do it or how to pay for it.
It is always interesting to realize how many people and organizations lobby these folks. It was clear in our visits that we were frequently preceded by other physician groups (the AMA has annoyed a lot of people on some of these issues), pharmacists nurses, drug companies etc. However they appear to like to hear from constituents and it appears to be helpful to develop a relationship with your local reps.
Before leaving we took in some Senate debate and enjoyed listening to Tom Daschle rant and rave against the budget with absolutely no one else in the room.
Feel free to contact Dan or myself for details or use the Maine chapter web site at www.acponline.org/chapters/me/.
Maine Chapter Annual Meeting
Holiday Inn Sunspree Resort in Bar Harbor
October 12-14, 2001
This year's Annual Chapter Meeting will take place in Bar Harbor. For members that have not had the opportunity to spend time in Bar Harbor without summer tourists, an October weekend should be ideal for all types of outdoor activities. This year's program committee includes Doug Couper, Ann Browne and Randy Barr. They have developed a program around the clinical theme of diabetes. A full range of topics will be offered along with an internationally recognized expert and teacher of many of Maine's internists, Dr. Ed Horton. Dr. Horton is presently Director of Clinical Research and Vice President of the Joslin Diabetes Center in Boston.The meeting will also include a series of diabetes workshops on Friday afternoon, a reception on Friday night, the plenary session on Saturday, including a "town meeting." The last day of the meeting will be focused around clinical vignettes presented by the housestaff at MMC for competition at the National ACP-ASIM meeting.
As always, a social program will be available for both spouses and children. Following last years' musical debauchery, it is rumored that a well-known Maine humorist will be in attendance for the evening program.
Supporting Your Chapter Through Chapter Dues
Chapter dues are the backbone of local activities and vital to the success of our chapter. While we are provided some financial support from the national office, the chapter dues collected 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.
What ACP-ASIM is Doing for you Today
"What have you done for me lately?" is a question that ACP-ASIM strives to answer before it is asked, by making membership needs an integral part of its strategic planning process.
As such, the following is a comprehensive list of products and services that ACP-ASIM offers to its members, which was compiled by the Board of Regents. Since the College leadership realizes the needs of it membership are ever-changing, they will continue to re-evaluate this list and add new products and services when appropriate. In addition, the College encourages you, the members, to submit your ideas for changes/additions to Dr. Keilson at KEILSL@mmc.org.
Clinical skills teaching modules
Post-graduate review courses
Programs for community-based teachers
Internal medicine board review course (audio and video versions)
Internal medicine recertification preparation course (audio and video versions)
MKSAP 12 update
Annual session audiocassettes
Best Evidence (CD-ROM)
Bioterrorism resource center online
Clinical practice guidelines
Clinical problem-solving cases
Clinical skills videotapes
Firearm injury prevention resource center
MKSAP for students
MKSAP Prep for Boards
Telemedicine resource center
Virtual Annual Session
Professional liability insurance
Center for a Competitive Advantage
Medical informatics program (Annual Session)
Medical Laboratory Evaluation Proficiency Testing Program
Annals of Internal Medicine
ACP Journal Club
Effective Clinical Practice
Books and expert guides
Advocacy and Professionalism
Online membership directory
Decision 2000 campaign
Doctors for Adults public awareness campaign
Ethics case studies
ACP Ethics Manual
Legislative Action Center
Access to legislative and regulatory information, national and state
"Membership Enhancement" programs
Position and policy papers
For Associates and Medical Student Members
Career counseling information and Web links
Career counseling brochures
Community-based teaching program support
MKSAP for students
Representation through Council of Associates and Council of Student Members
Video and slides about internal medicine careers
Support for internal medicine clubs
Annual Session workshops
Clinical skills teaching modules
Internal medicine overseas
Action in internal medicine
International speakers program
Eurasian Medical Education Project
Annual Session workshops
Representation in the International Society of Internal Medicine
Fellowship credentialing process
Associate and Medical Student competitions
Chapter awards program
Community-based teaching awards
College accessories and gifts
Doctors for Adults accessories and gifts
Affinity credit card
Car rental discounts
Financial planning service
Group insurance plans