Fall/Winter 1999 Governor's Newsletter
From the Governor's Corner
Dear Colleagues:
The word consistency is no longer a part of today's lexicon. Change is everywhere. We have cloned sheep, sent a 70 year-old into space and have microchips that can compute billions of bits in the blink of an eye. We have hit 10,000 on the Dow, hit 70 home runs and we have almost hit the year 2000. The world is evolving rapidly. Despite all of this, the Michigan Chapter has remained committed to consistency. Kudos to all of the participants in our Fall Meeting, but mainly to the Program Director for the last couple of years, Dr. Ken Fisher, who agreed again to spearhead our meeting in Traverse City, in the year 2000, with Dr. Eric Scher as Co-chair.
Dr. Michael Zaroukian and our colleagues from Michigan State University are hosting our Associates Program on May 12, 2000, at the East Lansing Marriott. Our Council is meeting January 9th and I would encourage any of you with some suggestions on how we can better serve you in 2000, to notify either our office or one of your colleagues who is a member of the Council.
Newly Elected Masters
I would like to take this opportunity to congratulate three new Masters of the College - Raymond H. Murray, MD, previous Governor of the Michigan Chapter (1994-1998) and past Chairman, Department of Medicine, Michigan State University; Ananda S. Prasad, MD, a Professor in the Department of Internal Medicine, and since 1963, Director in the Division of Research, Wayne State University School of Medicine; Edward L. Quinn, MD, Emeritus Chair, Department of Infectious Diseases, Henry Ford Health System. Mastership is awarded to those few individuals who have made major contributions to the field of internal medicine and recognized as "giants" in their field. Dr. Murray recently moved closer to his family in Indiana. He is known to all of us for his tireless work as past Governor of the ACP-ASIM Michigan Chapter. We wish him the best in his new surroundings.
1999 Regional Meeting
Those of you who attended the Michigan Regional Meeting in September know that is was a tremendous success with the participation of over 450 registrants. The theme of our meeting was "Ambulatory Approach to Chronic Diseases" and topics included: Hypercalcemia, Hypertension, Multidimensional Approach to the Management of COPD, Congestive Heart Failure, Rheumatology and Infectious Disease.
Reflections of portions of our Regional Meeting are given by the physicians listed below.
What's Around the Corner for Us? -
Thomas C. Royer, MD, CEO, Christus Health, Dallas, Texas
Compiled by Ruth Hoppe, MD, FACP
I. Strong Voices Will Continue to be Raised
A. Voice of Government - size of GNP to health care demands their voice be raised.
B. Voice of Business - given the way we distribute health care in the US, these are the major purchasers.
C. Voices of Patients - they want quality and personal care.
II. Certain Past Trends Will Continue
A. Continued Increased Costs (due to aging population, rise in technology, increased pharmaceuticals, esp. "lifestyle" drugs) - combined with flat revenues, this spells trouble financially.
B. Continued Demand for Efficiency and Productivity - this is going to require some system re-design to make headway beyond this point.
C. Slowing Growth of Managed Care - only Medicare and Medicaid will grow further and slowly; private sector penetration will peak at 37%.
D. More Informed and Active Patients - they will value and demand access (over continuity), service satisfaction, choice and complimentary medicine.
E. Continued Investment in HC Technology - examples = internet, telemed, electronic medical records, pictureless radiology, new pharmaceuticals (by 2004, 80% of the cost of pharmaceuticals will be in the ambulatory sector.)
F. More Competition Based on Quality Measurement (and the measurement will be conducted in the public arena.)
G. Increased Pressure for "Corporatization" of Medicine - medicine viewed as a commodity.
H. Continued Government Involvement - directed at fraud and abuse, antitrust, plus eroded support for medical education.
I. Shortage of Personnel and Leadership - there will be a need for a new kind of leadership (see Five Temptations of a CEO.)
J. Increased Power of the Purchasers of Health Care - these purchasers will be increasingly connected to each other to increase their leverage.
III. What We Will Need
A. Delivery System Thinking - thinking only about one locus of care, one disease, one illness episode will be totally inadequate. We need to think about the links of all these because that is where the increased costs are.
B. Collaborative Culture in Health Care - we need to move from provider-centered to patient-centered and from competitive to collaborative.
C. Better Measurement of Quality.
D. Increased Evidence-Based Medicine.
E. Increased Ability to Use the New Genomics - including prevention-oriented gene therapy.
IV. What Can Docs Do?
A. Focus on what you can control and achieve the very best.
- Technical quality of care you deliver.
- Service quality of care you deliver.
- Service quality of your team.
Summary of Annual Meeting
Joseph J. Weiss, MD, FACP
The Annual Meeting began with a meeting of the Governor's Council. The Council heard from Regent Dr. Mahendr Kochar, and introduced themselves to him. Items of interest to the membership included a letter from Dr. Sonia Parks of Michigan Blue Cross/Blue Shield. She has requested a meeting with representatives from the ACP-ASIM-Michigan Chapter to discuss problems we have in reimbursements and to gain our support for BSBS programs, such as DRAMS and DENIS. The Governor's Council approved that the Economics Subcommittee of the Health Policy Committee should go forward with arrangements to meet with Dr. Parks.
That evening, Dr. Donald J. DiPette gave the welcoming address on "Hypertension - A Model for Treatment of Chronic Disease." Following his presentation, the audience enjoyed the Laureate Wine and Cheese reception, which was followed by a presentation by the winners of the 1999 Associates Day Awards of their first and second place research papers.
On Friday morning, Dr. Kochar gave an update on the ACP-ASIM's national activities, which was followed by a lively town meeting discussion on the value and present limits of Organized Medicine. Audience participation revealed the memberships' anger over how insurance companies, government and for profit health institutions have used doctors and how much physicians now want to push back.
The morning session concluded with concurrent presentations on evidence-based update in infectious disease and pulmonary medicine.
The highlight of the noon luncheon was a presentation by Dr. Tom Royer, on what physicians should expect in their professional milieu and how they should respond to the national demands that the millennium will put upon the profession.
It was a lively Friday afternoon with "Professors In Action" working through three CPC cases; a summary by Dr. Michael Kleerekoper, bringing the clinical work of Boy Frame to its present molecular biology understanding; and in the late afternoon, four concurrent sessions presenting selected abstracts for oral presentations.
The formal meeting reconvened on Saturday morning with Dr. David Scrase's popular "Thieves Market." More evidence-based update followed with one session on rheumatology and a second session on infectious disease. The James Hall Lecture speaker was Dr. John O'Connell, who discussed, "Ambulatory Management of Congestive Heart Failure."
The Sunday session of "Highly Effective Medical Families," completed this year's program.
The meeting provided practicing doctors with updates and insights that were useful to their practice. The gathering gave many of us the opportunity to renew friendships, and the time away from daily practice, afforded the chance to take a long look at our professional lives.
The residents had fantastic presentations and the winners of the competition are listed on page seven of this newsletter. Not only was the scientific interchange interesting and stimulating, but the social times and ability to discuss old times with old friends was an important aspect of the meeting.
Update in Rheumatology
Joseph J. Weiss, MD, FACP
The panel considered four new drugs in the treatment of rheumatoid arthritis. The first is Enbrel, a tumor necrosis factor (TNF) inhibitor. This medicine needs to be given subcutaneously two times a week and is expensive - between $300/$400/wk. Its role likely will be in patients refractory to treatment with conventional DMARDS such as Gold, Methotexate, Immuran and Azulfadience. As TNF plays a role in fighting infection, particularly tuberculosis, the use of Enbrel is contraindicated in a patient prone to infection, seriously immunosuppressed, or infected with tuberculosis.
The second new medication is Arava, a pyrimidine inhibitor. This medication is taken daily, costs approximately $400/month and like Enbrel, should be considered when conventional DMARDS have proved ineffective. Arava has known hepatic toxicity and should not be used in a person who is a heavy drinker or has known history of hepatitis.
The third drug the panel considered was Celebrex. It is a COX-2 inhibitor that has a better safety record for GI bleed then conventional NSAIDS. The panel favored its use if the patient has a history of GI bleeding or gastric upset. The panel noted that the record of Celebrex in this regard was very good, but not perfect.
The fourth new drug is Vioxx. Panel experience with this medication is limited; its use in rheumatoid arthritis remains to be determined.
Local Council of Associates - ACP-ASIM Michigan Chapter
Cristian E. Sciutto, MD
A Chapter Council of Associates is now in place and we were able to meet during the Scientific Meeting. The Council is an advocate for Associates in issues affecting physicians in training. We addressed the following issues and will continue to strive to address and resolve concerns expressed by residents in training at the local level. Chief residents from Henry Ford Hospital, University of Michigan and Hurley Medical Center were present at this first meeting. An overview of our meeting included the Roles of Chief Residents in each respective program and the significant differences including the amount of patient care responsibilities, which ranged from non-existent of 50% of time. We discussed moonlighting issues and noted that no J1 international graduate at the represented institutions were moonlighting. It was noted that participation of the House Staff in academic activities is most consistent in most of the institutions and reinforced by the Program Director. The National Council of Associates (NCOA) has its own Web site at www.acponline.org/srf/res_coa.htm. Associates are encouraged to get involved with the National Council by communicating through this Web site.
This meeting was a good starting point and this Council will be meeting intermittently in the months ahead with feedback to the Governor of the Chapter.
Program Director's Meeting
Eric J. Scher, MD, FACP, Chair
Our meeting was devoted to a discussion about developing an OSCED (objective structured clinical exam) as an additional evaluation tool for resident competencies. We thought about developing a consortia of programs that would sponsor an OSCED at a single site and we would rotate our residents to that site for formal testing at a prearranged time. Dr. Ernie Yoder was also going to look into getting a grant to cover our startup costs. If monies can be identified than a working group would probably be required to develop specific testing stations based on feedback from all Program Directors. We might also approach the medical schools for help since medical students already have this tool available to them.
Minority Physician's Breakfast
Vanessa L. Robinson, MD, FACP, Co-chair
A thanks is in order for those who attended the breakfast meeting during our Scientific Meeting. Excellent ideas were generated concerning ways to network among the different institutions. We need your help, your support and your ideas. Please contact me at Henry Ford Hospital or via e-mail at <vrobins1@hfhs.org>. Again, thank you.
Resident Competition
lst place, $100 and a plaque; 2nd place, $75 and a plaque; 3rd place, $50 and a certificate.
1st Place Clinical Vignette, Mustafa Hashem, MD, St. John Hospital & Medical Center
2nd Place Clinical Vignette, David H. Nguyen, MD, St. Joseph Mercy, Ann Arbor
3rd Place Clinical Vignette, Yasser Almanaseer, MD, Bon Secour
1st Place Oral Presentation, Krishna Malineni, MD, Henry Ford Health System
2nd Place Oral Presentation, Arti Bhan, MD, St. John Hospital & Medical Center
3rd Place Oral Presentation, Ravi Ravinuthala, MD, Henry Ford Health System
Connect With Members Through ACP-ASIM's New Online Directory
Do you want to correspond with a member of the College, but find that you don't have his/her current mailing address? Use Member Connection, the College's new online membership directory, which is accessible to members - only via ACP-ASIM.
Updated daily, the information in Member Connection is taken directly from the College's main membership database and can be used to search for colleagues by name, state, city, zip or postal code, country, region or specialty,
Members who wish to be excluded from Member Connection must notify the College in writing. Members can obtain a Directory Exclusion Form on ACP-ASIM Online, or by calling Customer Service at (800) 523-1546, ext. 2600, or (215) 351-2600 (9 a.m. to 5 p.m. EST).
Laureate Awards
The Chapter had an impressive and elegant awards banquet where the following physicians were recipients of the 1999 Laureate Award.
Congratulations on an Honor Well Deserved! Newly Elected Fellows - January and July 1999
January
Said Abuhasna, MD - Dearborn
Azmy A. Allam, MD - Owosso
Sante D. Bologna, MD - Troy
Albert M. Brady, MD - Pontiac
Rizwan Danish, MD - Flint
Richard D. Dryer, MD - Dearborn
Manoharan W. Eustace, MBBS - Flint
Bradford C. Gelzayd, MD - Southfield
Eliezer Monge St. Laurent, MD - Farmington
Pablo Reyes, MD - Warren
Marguerite A. Saith, MBBS - Portage
Yvonne T. Sesi, MD - Ann Arbor
July
Amer G. Aboukasm, MD - Grosse Pointe
Raakesh C. Bhan, MD - Battle Creek
William D. Chey, MD - Ann Arbor
Patricia A. Duley, MD - Gaylord
Mohamad A. Hatahet, MD - Wixom
Diane M. Howlin, MD - Chelsea
Lawrence L. MacDonald, MD - Novi
Sheila P. Meftah, MD - Farmington
Marjorie A. Mooney, MD - Muskegon
Prasad V. Podila, MD - Southfield
Steven A. Portney, MD - West Bloomfield
Mohammed A. Razzaque, MBBS - Franklin
Rick J. Schiebinger, MD - Detroit
Barbara M. Segal, MD - Ann Arbor
Gregory S. Stone, MD - Canton
C.J. Subitha, MBBS - Grand Rapids
Larry B. Tankanow, MD - Ann Arbor
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 the beginning of a 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.
Congratulations again and I am sure a number of you will go on to serve on regional/national ACP-ASIM committees and attain leadership positions, including Governor for your Region.
Are You Interested in Being More Involved in ACP-ASIM Activities?
If so, please contact our ACP-ASIM Michigan Chapter office at the number listed below or e-mail me at jrival1@hfhs.org.
As a start, consider these possibilities:
- Member of certain key committees such as Health and Public Policy, Membership, Minorities, Women's Committee, Nominations and Awards, Annual Scientific Program, Legislative, etc.
- Delegate to the Annual Leadership Day on Capital Hill.
- Being our Continuous Quality Improvement "guru."
- Serving on special Task Forces as needs arise.
- Willing to participate as a speaker at our Annual Regional Meeting.
I look forward to seeing you at Annual Session 2000 in April. Please be sure to join your colleagues at the Michigan Chapter's Reception on Friday, April 14, 2000, from 7-9 p.m., at the Philadelphia Marriott Hotel-Salon I, 5th Floor. The Chapter wishes to thank the following institutions for their monetary support of this function at this printing: Henry Ford Hospital, Michigan State University/East Lansing, St. John Hospital & Medical Center, WSU/Detroit Medical Center and William Beaumont/Royal Oak.
I wish you a healthy and peaceful holiday season, an abundance of enjoyment for your family and yourself and a very happy and healthy New Year.
Just a Reminder
It is very easy to get in touch with us. If you would like to include any of your thoughts in a future Governor's Newsletter, give us your fax/e-mail address. We need to hear of your concerns/suggestions/proposals. Our door is open to all.
Beat This
"I've never had major knee surgery on any other part of my body"
--Winston Bennett, University of Kentucky basketball forward
"I love California. I practically grew up in Phoenix."
--Dan Quayle, Former U.S. Vice-President
"Please provide the date of your death."
--from an IRS letter
"Be sure and put some of those neutrons on it."
--Mike Smith, Baseball pitcher, ordering a salad at a restaurant
"The word 'genius' isn't applicable in football. A genius is a guy like 'Norman Einstein'."
--Joe Theisman, NFL football quarterback and sports analyst
"Half this game is ninety percent mental."
--Danny Ozark, Philadelphia Phillies manager
"It isn't pollution that's harming the environment, its the impurities in our air and water that are doing it."
--Dan Quayle, Former U.S. Vice-President
Mark Your Calendar Now
April 13-16, 2000 - ACP-ASIM Annual Session, Philadelphia, PA
May 12, 2000 - Michigan ACP-ASIM Associates Meeting, East Lansing
September 21-24, 2000 - Michigan ACP-ASIM Regional Meeting, Traverse City
Ways to Contact Your Governor
| Write: Michigan Chapter ACP-ASIM c/o Henry Ford Hospital Attn: Room B-1540, K-15 2799 West Grand Blvd. Detroit, MI 48202 |
Call: (800) 247-2482 (MI residents only) or (313) 876-1403 Fax: (313) 916-1409 E-mail: jrival1@hfhs.org |
Please let me know of your ideas, concerns, criticisms.
What's New
Contact Information
Ruth Hoppe
Governor, Michigan Chapter
Marty Muth
Michigan Chapter Staff
Phone: 517-353-9548
Fax: 517-353-9604