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Governor's Newsletter, Spring/Summer 2001

Jan Rival, MD, FACP
Governor, Michigan Chapter

From the Governor's Corner...

Dear Colleagues:

I would like to report the activities and actions taken by the Board of Governors at its meeting in Atlanta in March of this year.

The hottest issue, as you can imagine was the problem and new approach to recertification. As you probably know, the first time limited certificates in internal medicine and its subspecialties awarded by the American Board of Internal Medicine expired in 2000. Therefore, recertification is much on the minds of some ACP-ASIM members. I would like to bring you up to date on the College's involvement in responding to the concerns that many of you expressed.

First, we must make an important disclaimer. The ABIM and the ACP-ASIM are entirely separate organizations and the College neither appoints members to the Board, nor has any say about policies developed by the ABIM. Also, there has been communication between the leaders of the two organizations over the years, the concerns that arose from the College membership about recertification called for a more specific dialogue focused on this most important issue.

As you may know, the current ABIM recertification program introduced in 1995 currently requires passing a number of self-evaluation modules of multiple choice questions followed by passing a secured examination. We heard that the self-evaluation modules have been at times ambiguous and clinically not relevant and not of the quality of the multiple-choice questions in the certifying examination. Some of you are also being greatly inconvenienced by the necessity to travel a considerable distance to reach a test center for the final examination.

The three broad goals of the College as it entered this dialogue with the ABIM were as follows:

  • The recertification process should be clinically relevant, cost and time effective and not redundant on the quality measures that are already being done well in the practice environment of many physicians. The world of practice has changed greatly during the past ten years. Many quality improvement measures and initiatives are now required by hospitals and health care systems which was not the case a decade ago.
  • The responsibility of the ABIM in the recertification should be limited to evaluation. The education that is a necessary part of every physician's maintenance of competence should be left to those organizations that are skilled in educational program development and delivery.
  • There should be requirements for continuing medical education to insure maintenance of competence, however there must be flexibility in how this requirement can be met recognizing the physician's as adult learners may have varying but equally effective learning styles.

I am referring you also to the August 1, 2000 issue of Annals of Internal Medicine (1:33 column 202-208) announcing the revised recertification process called the Program for Continuous Professional Development. This should be fully implemented by 2004.

Based on the above, the Board of Regents approved a College policy in the recertification and relations with the American Board of Internal Medicine. The policy is designed to provide guidance to the College members of the joint ABIM, ACP-ASIM Recertification Committee as they work with ABIM representatives to address College members' concerns about the process. The approved five-point policy states that the Board of Regents:

  • Supports a recertification process that includes an assessment of professional knowledge.
  • Supports a process of recertification that provides a maximum of choices by which physicians can choose how best to further the continuing medical education in preparation for the assessment.
  • Supports a policy which states that education and certification are separate processes which should be overseen by separate non-profit organizations.
  • Has authorized its representatives to continue discussion with ABIM to achieve changes in the ABIM's program of continuous professional development in conformance with the College's policy as stated.
  • Has directed the College representatives of the Joint Recertification Committee to report to the Board of Regents at its July meeting on the results of negotiations and to present a recommendation regarding endorsement or non-endorsement of the ABIM Recertification Program.

Member Survey on Recertification: An Overview

During May 2001, a telephone survey on recertification was carried out. To achieve statistically meaningful results, the number of physicians sought was 600 622 interviews were actually carried out. The sample was reflective of the overall composition of College membership, except the study group was weighted towards younger physicians with time-limited certification those likely to be most affected by mandatory recertification (or continuous professional development {CPD}, as the ABIM has named its proposed new recertification process).

The information collected in the survey included the following elements:

1. Demographic information (nature and scope of practice).

2. Current recertification status and requirement for certification and recertification in the physician's own practice environment.

3. Evaluation activities currently taking place in the physician's own practice environment, including patient evaluation, peer evaluation, and/or practice performance measures.

4. Knowledge about the details of the proposed CPD recertification process.

5. Attitudes about recertification in general and the CPD process in particular..

Here are the highlights from the compilation of survey data:

  • 62% of respondents practice general internal medicine (GIM) exclusively or primarily GIM with some subspecialty practice. 38% are exclusively or primarily subspecialists. 7-8% in both groups have already been recertified; most of the remainder plan to do so. For most (just over 2/3), recertification is a require- ment for privileges in their practice environments.
  • On average, about 75% of their time is spent in direct patient care; only 25% spend less than half their time in direct patient care. They practice primarily in groups, with more than 2/3 in groups of 5 or more physicians.
  • Many of those surveyed are already being extensively evaluated in their own practice environments: 39% by patients, 61% by peers, and 50% by measures of practice performance. Of the last group, about half are provided with information comparing their performance to that of their peers, and about half are required to develop a plan for performance improvement.
  • 40-60% of those surveyed indicated that their understanding of the details of CPD was limited, reflecting what we have heard anecdotally from members about how difficult it is to understand all the details about the complex CPD process and how it relates to their individual circumstances.
  • Among those surveyed, there was little confidence that the ABIM's recertification process would improve the practice of internists in general or of themselves specifically.
  • The most negative responses were seen in questions relating to the balance between cost and value of either the recertification process itself or the study products needed to prepare for recertification: too much cost for the value!
  • Similarly, there were strong negative feelings expressed in response to questions about the relative value of effort compared to benefit from preparing for and participating in ABIM's recertification process; too much effort for the value!
  • However, a large proportion of those surveyed felt positively about the desirability of periodically measuring competence, reinforcing the official position of the College in favoring the concept of periodic recertification.
  • A large proportion of those surveyed felt positively about the periodic assessment of knowledge, both by thee ABIM and by the self-evaluation of medical knowledge.
  • A substantial proportion of those surveyed felt positively about the self-evaluation of clinical skills and clinical performance.
  • However, a much smaller proportion of those surveyed had positive feelings about the inclusion of patient or peer evaluation in the recertification process.

Thus, one might conclude from the data that the average respondent is a young internist with time-limited certification who has either been recertified or plans to be recertified. He/she has limited understanding of the details of the ABIM's planned CPOD process.

The average respondent feels strongly that the ABIM's recertification process will not improve the practice of medicine by internists in general or by him/her in particular. He/she feels very strongly that the process is not worth the direct cost set by the ABIM or the cost of study products to prepare for recertification. He/she feels very strongly that there is little value gained from the effort of preparing for or participating in the ABIM's recertification process.

He/she supports the periodic assessment of competence and feels positively about testing medical knowledge, by both a secure examination and a self-evaluation process. There is a fair chance that he/she is already undergoing evaluation by peers and patients and assessment of practice performance is his/her own environment, with a high likelihood of feedback to him/her.

He/she has mixed but somewhat positive feelings about self-evaluation of practice performance and clinical skills by the CPD process and negative feelings about peer or patient evaluation as part of the ABIM process.

As a membership organization, the College has engaged in the current dialogue with the ABIM, because it was clear that many of our members were unhappy about what they were hearing about the ABIM's planned CPD process. The position taken thus far by the Board of Regents and the College members of the Joint Committee is clearly reflective of what a valid representation of College membership has expressed in the survey.

In a May 14 letter, the College communicated its position to the ABIM. We indicated our opposition to putting internists and subspecialists through a redundant ABIM process, if there are already taking place in the physician's practice environment valid measures of peer and patient opinion and practice performance. The College does not oppose the inclusion in the recertification process of a secure examination of medical knowledge. However, for the self-evaluation of medical knowledge, candidates who wish to do so should be able to substitute for the ABIM module participation in a self-assessment program of the College or of one of the internal medicine subspecialty societies. The College is awaiting a response to this letter as of June 05, 2001.

ACP-ASIM Annual Session 2001

The Board of Governors and Board of Regents meetings were followed by Annual Session with its usual excellent learning and teaching opportunities.

During Annual Session's Convocation, I was proud to walk down the aisle with 21 of my colleagues to be inducted and promoted to Fellowship in ACP-ASIM (see list below.) We are also proud to present three Masters from Michigan, Mastership was awarded to the following:

  • A. Martin Lerner who is a Clinical Professor of Internal Medicine at Wayne State School of Medicine in Detroit and a role model to hundreds of students and trainees. He is a distinguished scientist in the field of infectious diseases and virology. He was Governor of the Michigan Chapter of the College (1990- 1994) and received its Laureate Award in 1995.
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  • Vainutis K. Vaitkevicius has devoted his career to Wayne State University. He is an outstanding teacher. He is a four-time "Best Clinical Teacher of the Year" awardee. He is one of the leading oncologists in Michigan and is known for his work in gastrointestinal cancers and pioneer work in cancer chemotherapy. He has made numerous contributions to local, state, national, and international boards and committees. Dr. Vaitkevicius has been an active member of the Michigan Chapter of the ACP-ASIM and received its Laureate Award in 1992.
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  • Fred Waite Whitehouse is Division Head Emeritus of the Division of Endocrinology at the Henry Ford Hospital in Detroit. He is also Clinical Professor of Medicine at Case Western Reserve University Medical School. Dr. Whitehouse established and directed a diabetes treatment and education center at Henry Ford Hospital that is a model for diabetes treatment centers in the United States and in other parts of the world. He is past president of the American Diabetes Association and a recipient of the Banting Medal. Dr. Whitehouse received the Laureate Award of the Michigan Chapter of the ACP-ASIM in 1995.

Chapter Award

It is my pleasure to express my gratitude to all of you who helped the Michigan Chapter achieve for the fourth time the high distinction of the Chapter Excellence Award. This is granted to a Chapter for meeting the standards determined by ACP-ASIM's National Chapters Subcommittee for excellence in chapter management.

The Chapter was also presented a Certification of Recognition for creating and implementing an Online Abstract Application Form. The Chapter recognizes the efforts to that end to Drs. Scott Kaatz from Henry Ford Hospital and Michael Zaroukian from Michigan State University, our webmasters who spearheaded this project, which is a model for other chapters to follow.

Associates Day

The Michigan Chapter's Associates Day took place May 11, 2001 in Flint. The Planning Committee under the leadership of Drs. Susan Smith and Barbara McIntosh did an outstanding job in attracting associates from our state. The program was developed also with the help of Asadulla Mohammed, Chief Medical Resident, McLaren Regional Medical Center; Nasir Ali, Chief Medical Resident, Hurley Medical Center; and Hamid Okhravi, Chief Medical Resident, Hurley Medical Center; and Susan Petrosky and Dawn Coon, who were co-meeting coordinators I believe this was the best Associates meeting in the last decade and we had an attendance of 218. Certainly this is outstanding preparation for our Chapter Scientific Meeting in Traverse City, September 20-23

Poster Presentations

First Place Case: Harini Jalagani, Sinai/Grace
Second Place Case: Kseniya Filippova, Detroit Medical Center
First Place Research: David Zink, William Beaumont
Second Place Research: Naveed Aslam, Sinai/Grace

Paper Presentations

First Place Case: Rafia Khalil, St.John Hospital & Medical Center
Second Place Case: Shanthi Marue, Sinai/Grace
First Place Research: Wisam Al-Badr, St. Joseph Mercy
Second Place Research: Priya Vishhnubhotla, Sinai/Grace

The above winners are automatically invited to the Chapter's Scientific Meeting held in September with their registration waived and eligible for competition in their respective category.

Leadership Day

May was the month where we participated in ACP-ASIM Leadership Day on Capitol Hill.

At the present time, advocacy efforts are more important than ever because the unprecedented political environment:

  • An equally split Senate which is equally dividing committee memberships and resources.
  • A divided House in which Republicans hold the narrowest of majorities
  • New chairs for the three of the four major health committees of the Congress
  • New President elected to office despite losing the popular vote
  • New heads of Department of Health and Human Services, Health Care Financing Administration and other health agencies.

The Colleges' effectiveness depends on grass-root support of the national policy agenda all year long. It is important to maintain our relationship and develop a new relationship with members of Congress.

The priority issues this year were:

Reducing Medicare Hassles - We asked the lawmakers to:

1. Co-sponsor the Medicare Education and Regulatory Fairness Act (MERFA), S.452 H.R. 868.

2. Urge House and Senate leadership to give MERFA prompt and favorable consideration (Medicare rules, policies and answers to "frequently asked questions" would be more accessible and physicians would be given advance notice about changes in rules. Medicare would be required to pay its claims without demanding more paperwork unless there is evidence that the bill is incorrect. Medicare would be required to actually examine the records rather than using a statistical sample to determine that some claims were billed incorrectly. Medicare's ability to investigate fraudulent claims would be preserved as well as its role in educating physicians on how to prevent inadvertent billing mistakes that result in overpayments.

Patient Protection Legislation - We asked the lawmakers to co-sponsor the Bipartisan Patient Protection Act of 2001 and urged House and Senate leadership to give prompt and favorable consideration.

Regarding patient safety, the College concurs with the IOM's conclusion that the focus must be reform of the system not the punishment of individuals. The College supports establishing a national program within a set number of years that will accurately report the number of errors occurring annually in the health care system. Once more is known about the number of errors occurring, a meaningful national goal can be set for the reduction and eventual complete elimination.

We asked the lawmakers to support adequate and secure funding at the level of $400 million, $100 million for Center of Quality Improvement and Patient Safety, support further examination of how best to report and analyze data on patient errors and support voluntary reporting of "close calls" and injuries with confidentiality protections including a prohibition on disclosing the names of individual practitioners who are involved in an error and limits on "discoverability" in liability lawsuits.

The Michigan delegation comprising of Drs. Jan Rival, Kenneth Fisher and Joseph Weiss visited the offices of Congressman Sander Levin, Joseph Knollenberg and Senators Debbie Stabenow and Carl Levin. As Dr. Weiss viewed this opportunity, "The facts do not describe the experience in the democratic process."

Consider joining the Michigan delegation next year not only to help ACP-ASIM, but for your own enlightenment.

Governor-elect

The Nomination Committee chaired by Park Willis, MD, MACP, reviewed the slate of fourteen (14) candidates for your consideration and election for the office of Governor for the Michigan Chapter. Based on your votes, the new Governor-Elect is John Papp, MD, FACP, starting his tenure after the National meeting in 2002.

John is an outstanding individual with a known track record and a leader who will continue the tradition of excellence and represent the Michigan Chapter well. Congratulations and best wishes from all of us.

Newly Elected Fellows - January 2001

Thomas F. Alguire, MD
Michael G. Kizy, MD
Manveen K. Saluja, MBBS
Frederick K. Askari, MD
Karl F. Kolbe, MD
Breton M. Weintraub, MD
John D. Bisognano, MD
Sohail Qadir, MBBS
Wilhelmine Wiese, MD
Annmarie L, Daly, MD
Ketan G. Rana, MD
Khalid Zafar, MD
Prem C. Ghai, MD
Michael F. Romanelli, MD

By the confirming of Fellowship, you have been recognized by your peers for your outstanding accomplishments, achievements and expertise in medicine and most importantly, for your contributions to your patients, communities, the College and to those students and physicians who have benefited from your teaching. Fellowship of course does not delineate an end, but is a beginning of new period of your professional life and offers an opportunity for you to become involved in the leadership of the College, both on the chapter and national level.

Do You Know Where You Will Be September 20-23, 2001?

Mark your calendar for the upcoming Chapter Scientific Meeting September 20-23, 2001 in Traverse City. You should have a copy of the preliminary program including the hotel and registration form. Due to demand and popularity, we will again offer early sessions in Chest x-ray and EKG reading, as well as hands-on experience in Skin Biopsies.

  • The sessions begin at 3:00 p.m. on September 20. Please work with your Program Director/Chairman in order to participate in these sessions.
  • The Chapter received a record of over 450 abstracts for consideration for either poster or oral presentation via the chapter website. This is the largest number of abstracts the Chapter has ever received for review.
  • Several awards will be presented for both poster and oral presentations.
  • We anticipate a large number of medical students again this year. Please address your suggestions and concerns in this matter to Dr. Joel Appel, who is responsible for student activities.
  • You don't want to miss the Associate Career Workshop planned for Friday morning.
  • "The Boy Frame Lecture" will be presented by Dr. Harold Sox, the newly appointed Editor of the Annals of Internal Medicine.
  • We are pleased to have Munsey Wheby, MD, FACP, Senior Associate Dean, University of Virginia School of Medicine attend as our College Representative.

Its not too late to register or obtain hotel reservations. Please call Darlene at the Chapter Office at 1-800-247-2485 (Michigan Only), or 313-916-1403 with any questions or view/copy the preliminary program/necessary forms on the Chapter web site www.acponline.org/chapters/mi.

Don't miss this great opportunity to participate in our Chapter meeting; an opportunity to learn, teach and socialize with your colleagues. Dr. Eric Scher, as in the past, was responsible for the program and the Chapter is appreciative for his work. See You in Traverse City!

New Fellows Inducted at Annual Session 2001

Thomas F. Alguire, MD
Craig L. Neuner, MD
Joel L. Appel, DO
Robert M. Poole, MD
John D.Bisognano, MD
Steven A. Portney, MD
Sante D. Bologna, MD
Ketan G. Rana, MD
Marc A . Feldman, MD
Elmahdi M. Saeed, MBBS
Tosan A. Fregene, MBBS
Thomas L. Simmer, MD
Prem C. Ghai, MD
Herbert C. Smitherman Jr, MD
Michael G. Kizy, MD
Breton M. Weintraub, MD
Karl F. Kolbe, MD
Wilhelmine Wiese, MD
Barry S. Meyer, DO
Khalid Zafar, MD
Timothy R. Murray, MD

Congratulations to each of you!

*** During the current Governor's "reign," our office was pleased and proud to endorse and promote 128 members to Fellows in the Michigan Chapter ACP-ASIM

Contact Information

Carl B. Lauter MD, FACP
Governor, Michigan Chapter

Thea Lockard
Michigan Chapter Staff
Phone: 248-551-7320
Fax: 248-551-7493