Governor's Newsletter July 2001
Stephen R. Jones, MD, FACP
Governor, Oregon Chapter
It is an honor to have assumed the Chapter Governorship from Jim Reuler. During the last four years Jim has served the Chapter with integrity, industry, and intelligence. The order and security of the Chapter is at an all time high. A well organized Council, an active Associates' Council, and secure finances have been passed on to me. It will be my goal to maintain these advances. My vision for the Chapter for the next four years is discussed near the end of the Newsletter.
History of the Oregon Chapter of the ACP-ASIM
In order to understand where we may go in the next four years, a brief review of the Chapter history may be useful:
Chapter Founded: September 13, 1983
Governors and Dates of Office:
1927-40 - T. Homer Coffen, Portland
1977-81 - George B. Long, Portland
1940-48 - Homer P. Rush, Portland
1981-85 - Emil J. Bardana, Jr., Lake Oswego
1948-51 - Howard P. Lewis, Portland
1985-89 - William M. Bennett, Portland
1951-60 - Merl L. Margason, Portland
1989-93 - Walter J. McDonald, Sherwood
1960-66 - Daniel H. Labby, Portland
1993-97 - Donald E. Girard, Portland
1966-72 - Franklin J. Underwood, Portland
1997-01 - James B. Reuler, Portland
1972-76 - Wayne R. Rogers, Portland, Andrea M. Kielich, Portland
1976-77 - J. David Bristow, Portland (Transitional Governor until Oct 1999)
Date of First Annual Chapter Meeting: October 21-22, 1983, at the Red Lion Hotel in Springfield, OR. There were 139 registrants.
Chapter Council, 2000-2001
The following are members of the Chapter's Council for 2000-2001. Thanks to all for their work on behalf of the Chapter and the College.
Annual Oregon Chapter Meeting,
November 1-3, 2001
The Program Planning Committee, chaired by Linda Humphrey, is completing work on the line up for this year's meeting, November 1-3, in Eugene. Dr. Norton Greenberger, of The University of Kansas, will be the HP Lewis Visiting Professor, and Dr. Eric Larson, of The University of Washington, a College Regent, and a past president of the Society of General Internal Medicine, will be the College Representative.
Updates will be given on:
- Lung Cancer Screening
- Domestic Violence
- Parkinson's Disease
- Prostrate Cancer
- Sports Medicine
- Cardiology... and more
Mark your calendar and make plans to attend now.
Oregon Internists Teach at the 2001 Annual Session
Oregon teachers of internal medicine again made major contributions at the Annual Session in Atlanta this Spring:
- Emil J. (Bud) Bardana, Jr., MD, FACP
Update in Allergy and Immunology
- Robert M. Bennett, MD, FRCP, FACP
Workshop on the Fibromyalgia Syndrome
- Paul N. Gorman, MD, FACP
Workshop on Computers and the Internet
- William R. Hersh, MD, FACP
Workshop on Computers and the Internet
- Charles M. Kilo, MD, Member
Workshop on Practice Improvement
- Anthony Montanaro, MD
Precourse in Allergy
- Mark T. O'Hollaren, MD, Member
Precourse in Allergy
- Ellen L. Singer, MD, FAAP, FACP
Workshop on Med-Peds Careers
- Jocelyn C. White, MD, FACP
Panel on Culturally Competent Care
Three Oregon Internists Recently Selected for Fellowship
Three ACP-ASIM members from Oregon were selected by the College Membership Committee for advancement to Fellow:
Elizabeth N. Eckstrom, MD, MPH, FACP, Portland
Geoffrey Marx, MD, FACP, Klamath Falls
Daniel E. Stepan, MD, FACP, Portland
Information about the requisite qualifications for Fellowship may be found on the ACP-ASIM Online at
http://www.acponline.org/college/membership/required.htm. I encourage ACP-ASIM members to review the material at this site, and if you qualify request an application from the conveniently listed E-mail address at this site.
Oregon Fellows Inducted at 2001 Convention
With tradition and ceremony, five Oregon internists were inducted as Fellows of the American College of Physicians-American Society of Internal Medicine at the 2001 Annual Session in Atlanta this Spring:
Richard E. Bayer, MD, FACP, Portland
Joji Kappes, MD, FACP, Portland
Geoffrey Marx, MD, FACP, Klamath Falls
Jennifer C. Nearing, MD, FACP, Salem
John T. Nelson, MD, FACP, Astoria
Career Tumult and Physician Well-Being
Jim Reuler, MD, FACP
The topics of career satisfaction and stress and physician well-being are receiving increasing attention by professional organizations, including the College. The ACP-ASIM Environmental Assessment 2002-2007 notes that "career satisfaction among practicing physicians will decrease" and the Joint Commission on Accreditation of Healthcare Organizations has included new guidelines for education of staff regarding well-being and prevention of distress and burnout. It is acknowledged that many 'systemic' issues in U.S. health care (lack of a universal system of care; reimbursement disparities; 'hassle' factors) represent root causes of career dysphoria which demand solutions and collaboration among professional and consumer organizations and legislators.
With a Development Grant from the College, our Chapter commissioned a satisfaction survey of members which was coordinated by investigators at the University of Washington and mailed in July, 2000. Preliminary analysis of 345 surveys from practicing internists (2/3 male - same as total membership):
- 73% of men and 59% of women in practice 10 years are satisfied with their job;
- 61% of all were satisfied with their careers and would go to med school again;
- 30% would change to another medical position; 17% would change to a non-medical job;
- 54.5% were not satisfied with the balance between personal and professional lives;
- Greatest unmet expectations related to lack of control+autonomy at work + less income; and
- 78% of the 345 members exercised at least every two weeks.
Final analysis of, and commentary about, this information about our members will be completed in the coming months by Deborah Kasman, MD, and colleagues.
Here are a few things that you can do to avoid burnout and 'renew' yourself (a compilation of ideas from the March, 2001, Observer; Quill+Williamson's 1990 article; discussions+personal reflection):
- Take care of yourself+loved ones; have fun; seek outlets;
- Talk to your colleagues, avoid isolation;
- Allocate time to clarify values+passions; take a 'snapshot' of yourself;
- Develop (realistic) short-term and long-term goals;
- Exclude low priority commitments/set boundaries;
- Get connected with your community; volunteer; be a mentor to someone;
- Be realistic about what other 'pastures' look like; and
- Do something to help effect change to improve care and sustain doctoring.
The following are some resources related to physician well-being:
- ACP-ASIM Physician Burnout and Renewal Project - catalogued in the Career Resource Center of the College's webpage
- The Foundation for Medical Excellence's NW Center for Physician Well-Being which will sponsor the 3rd annual NW Regional Symposium on Physician Well-Being at Skamania Lodge October 20, 2001 (our Chapter is a sponsor); www.tfme.org, or 503-636-2234.
- Western Journal of Medicine, January, 2001, issue is devoted entirely to the topic of career satisfaction and well-being; many of the papers are authored by Chapter members; text can be accessed via www.ewjm.com/content/vol174/issue1.
- ACP-ASIM Young Physicians Section; many initiatives; presently working on issues related to practice frustrations of young women physicians and position papers on maternity and family leave.
Oregon Chapter Supports Physician Well-Being Conference Sponsored by the Foundation for Medical Excellence
The Chapter has made a major financial contribution in support of The Foundation For Medical Excellence's Physician Well-Being Conference, to be held on Saturday, October 20, 2001, at the Skamania Lodge in Stevenson, WA. This highly regarded conference brings area clinicians together with an outstanding group of regional and national educators to discuss issues of mutual concern that affect physician well-being. This year Daniel Duffy, MD, FACP, Vice President of the American Board of Internal Medicine, Linda Hawes Clever, MD, FACP, former Editor of the Western Journal of Medicine, and Ronald Epstein, MD, of the University of Rochester have been chosen as keynote speakers.
For more information contact:
The Foundation For Medical Excellence
One SW Columbia Street, Suite 800
Portland, OR 97258
Phone: 503-636-2234; Fax: 503-769-0699;
ACP-ASIM Works to Reduce Medicare Hassles
ACP-ASIM is pleased to announce its endorsement of the "Medicare Education and Regulatory Fairness Act" (MERFA), S. 452/H.R. 868, which directly addresses internists' concerns with Medicare red tape and hassles. Medicare's complex regulations have created a heavy paperwork burden that significantly reduces the time doctors spend with patients, according to William Hall, MD, FACP, President-Elect of ACP-ASIM and a practicing geriatrician. Dr. Hall represented the College and announced support for this important legislation at a March 7 press conference with the American Medical Association and the American College of Cardiology, as well as MERFA's Senate and House sponsors.
MERFA directly addresses the Medicare procedures and rules that are the source of much frustration with the program. Under Medicare regulations, physicians must comply with numerous federal rules and local contractor policies to complete claim forms, provide advance beneficiary notices, certify medical necessity, file enrollment forms and comply with code documentation guidelines. Yet, there is no single source that physicians can access to learn Medicare's rules and policies.
Introduced in the Senate by Senators Frank Murkowski (R-AK) and John Kerry (D-MA) and in the House by Representatives Shelley Berkley (D-1-NV) and Pat Toomey (R-15-PA), MERFA would allow physicians and their staff to spend more time treating patients, and less time handling needless paperwork.
It would enact the following reforms:
- Medicare rules and policies and answers to "frequently asked questions" would be made more accessible, and physicians would be given advance notice about changes in rules.
- Medicare would be required to pay 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, while also educating physicians on how to prevent inadvertent billing mistakes that result in overpayments.
Enactment of MERFA is one of the College's highest priorities. The College strongly encourages you to ask your Senators and Representative to co-sponsor this important bill if they have not already. Illustrate for your legislators your experiences with the burden of complying with regulations, and how much time it takes you and your staff to deal with complex, confusing, duplicative and unfair Medicare requirements.
E-mail, fax, or compose a letter to your legislators through the ACP-ASIM Legislative Action Center or call your Senators and Representative toll-free through the ACP-ASIM Grassroots Hotline at 1-888-218-7770 (the Hotline will prompt you for your 8-digit member number, which you can find on the mailing label of ACP-ASIM publications, such as Annals of Internal Medicine). Additional information may be found at the following website, www.acponline.org/lac. Report your contacts to Jean Jenkins in the ACP-ASIM Washington Office at
1-800-338-2746, ext 4536, or by blind copying e-mails to
email@example.com. Thank you.
Martin Jones, MD - Chair, Public Policy
It has been an active year for Public Policy activities by the Oregon chapter of ACP-ASIM.
Safe Gun Legislation
In June, the Chapter mailed out petitions to members asking them to get signatures for the initiative to require background checks at gun shows, in order to prevent criminals, youth and the mentally unstable from purchasing firearms. The response was gratifying, and enough signatures were obtained by the deadline in July to get the initiative on the ballot. As you know, it was approved by voters in November by a 2:1 margin. This common-sense measure has long been advocated by most all health organizations state-wide and nationally (including the OMA, American Academy of Pediatrics, American College of Family Physicians, and ACP-ASIM), yet it is law in only a few states. Hats off to all of you who helped make this possible!
Based on sound scientific evidence of the dangers of second hand smoke and the ineffectiveness of ventilation systems at removing carcinogens, 8 more cities and 1 county (Tillamook) have followed Corvallis' lead and banned smoking in all indoor workplaces, including bars and restaurants. These cities include St. Helens, Scapoose, Philomath, Eugene, Manzanita, Wheeler, Tillamook and Rockaway. In addition, many more jurisdictions have banned smoking in all workplaces, but not yet bars. These include Multnomah and Benton counties, Central Point, Baker City, Grants Pass and Lake Oswego. Many physicians statewide are continuing to work with their local county Tobacco Free Coalitions to make these public health measures a reality.
In addition, Youth Access Prevention ordinances are being passed in many of the same and other cities. These would help prevent minors from purchasing tobacco products, by increased surveillance and fining of retailers who break the law.
If you would like to become involved, call your County Tobacco Free Coalition. Or contact me for more information (see contact information below.) Much remains to be done.
Unfortunately, at the time of this writing, several bills are being considered in Salem that would overturn these local advances, and seriously hamper statewide prevention efforts. These three bills are part of a nationwide tobacco industry strategy to guarantee their profits with flagrant disregard for the public's health. Hopefully, the bills will be defeated in the Senate or vetoed by the Governor. They are:
HB 3953: preempts local tobacco ordinances and allows smoking in bars, bar-restaurant combinations, offices that have closed doors, even if non-smokers must enter during the workday.
HB 3874: prohibits advocacy on anti-smoking ordinances by local County Tobacco Free Coalition members paid by state or local governments.
HB 3542: dismantles the statewide tobacco prevention program.
If you have any suggestions about directions the Committee should go, topics we should pursue, or want your name on the "Activist Alert" mailing list, please call or e-mail:
Martin Jones, MD
Public Policy Chairman
2300 Parkside Lane
Eugene, OR 97403
Sima Desai, MD - Chair, Associates' Council
The Associates' Council has had another wonderful year of events and memories. The Associate Council members who have made all of this happen are:
- Rejan McCaskill, MD, Portland Providence Medical Ctr
- Jenny Silberger, MD, Portland Providence Medical Ctr
- Amy Chaumeton, MD, Legacy Health System
- Heather Hue, MD, Legacy Health System
- Steve Seres, MD, Legacy Health System
- Peck-Houy Ung, MD, Portland St. Vincent Medical Ctr
- Craig Kunz, MD, Portland St. Vincent Medical Ctr
- Karen Englund, MD, Portland St. Vincent Medical Ctr
- James Nachiondo, MD, OHSU
- Rebecca Sunenshine, MD, OHSU
- Judy Zerzan, MD, OHSU
We started off our year with the annual Summer Mixer party in July. The mixer event is a way for everyone from all programs to get the chance to meet and mingle. The event was a success with over 80 in attendance. The Council spent a great deal of time in preparation for the Residents' Poster and Oral Competition at the Chapter Scientific meeting in Eugene in November. We had a tremendous turnout with excellent presentations and posters. Our Career Series started in the fall with the first session as a panel discussion with local internists in various practice settings as well as Dr. James Reuler discussing the finer points of starting and maintaining a curriculum vitae. In December we followed with the next workshop, which was negotiating employment contracts. April brought the last session on medical malpractice. It's been a successful and exciting year for the Council. We will be sadly saying goodbye to some of our graduating members (Jim, Rebecca, Craig and Karen), but looking forward to adding new members and starting another phenomenal year.
Amy Schmitt and Sarah Cassell - Fourth Year Medical Students
Medical students, Amy Schmitt and Sarah Cassell have been heading up our student activities for the Chapter for the last four years. We asked them to put into their own words, some thoughts about being a student in the Oregon Chapter.
When Dr. Reuler, previous Governor, asked me if I was interested in becoming involved in the Chapter nearly four years ago, I really had no idea what the society was all about. Trusting that Dr. Reuler would only be involved in a respected, upstanding organization that undoubtedly served a worthy cause, I was honored to begin attending annual business meetings. I contributed very little the first year but was able to meet several outstanding internists who were tremendously devoted to their community and to the field of internal medicine. By the second year, the Chapter had received a grant to further student involvement and activities. We decided that community service should be our first priority, with the additional goal of providing first and second year medical students an opportunity for hands-on clinical experience. After surveying the community areas for need, we began holding free blood pressure and diabetic screenings at the local Loaves and Fishes Organization. Since that time, the project has taken off, there are now regular screenings coordinated by second year medical students.
It is amazing to think that three years ago the project did not exist, and that with a little organization, faculty leadership, and student interest, we were able to help hundreds of individuals become more aware of their health.
The second priority of the student leaders was to provide a mentorship opportunity between medical students and physicians practicing throughout Oregon. With the faculty direction of Rick Wise, MD, student Sarah Cassell and I, launched this program and have matched nearly thirty student-mentor pairs. The response from physicians wanting to serve as mentors was overwhelming. It has been very encouraging to hear from students who had been seeking ways to build relationships with physicians outside medical school, and were not finally given the opportunity. The program is still in its infancy, however, and will hopefully continue to expand and evolve to meet the needs of it's participants as Alicia Ahn, MS-I, takes over student leadership of this project.
Our next priority was to encourage student attendance at the annual Oregon Scientific meeting in Eugene. By offering assistance with lodging, we increased student attendance dramatically over a two year period. In addition to the meeting in Eugene, financial assistance was provided for four students to attend the national meeting in Atlanta this past spring. Meeting so many amazing individuals, we appreciated the mentoring and were inspired by some of the older students and physicians that we met. The excitement about learning was almost tangible.
As Sarah and I reflect back over our years of involvement in ACP-ASIM, we agreed that it was an incredible honor to work with such extraordinary faculty who are not only devoted to their community and peers, but also to the education of students. We feel extremely fortunate to have had the opportunity to serve our community and peers, in addition to furthering our own education by attending ACP-ASIM sponsored events. We were greatly encouraged by the enthusiasm of other students who have been willing to get involved and take over leadership where Sarah and I have left off.
Finally, Sarah and I would like to say a special thanks to Dr. James Reuler, who is not only responsible for our involvement in ACP-ASIM, but who is also an exceptional role model to hundreds of students with whom he interacts on a daily basis. His genuine concern for the welfare of others, both patients and peers, is an exemplary characteristic that we hope to simulate in our future careers.
Thoughts from the Governor
Stephen R. Jones, MD, FACP
In the view of most reasonable people, the purpose of a local chapter of a national organization such as the ACP-ASIM, must mirror the parent organization's mission. Education and advocacy for internists are fundamental to this organization. In addition, as we hear from our colleagues in health care administration, "if there is no margin, there will be mission." In other words, the chapter must be financially responsible.
It follows from this that as Governor I will focus on these three broad themes:
- Advocacy and Policy
- Financial Management of the Chapter
It is important to continue the excellence of the annual fall Chapter meeting and program. In the last two decades, the "Eugene Meeting" has become a tradition. It is well attended and gets appreciative reviews. I will work to continue its success.
In August 2000, the American Board of Internal Medicine announced what they called a second-generation for Recertification in Internal Medicine: Continuous Professional Development (CPD). Within weeks it became clear that CPD was interpreted by many of the membership of the ACP-ASIM as unremitting or incessant professional development, and the 1960's cry "hell no, we won't go" was heard. Strong and eloquent anti-CPD attitudes were expressed at the fall Board of Governors (BOG) meeting and again this spring in Atlanta. I was surprised at the reaction of the membership as expressed by the Governors. Perhaps I'm surprised because of my own self interests; I'm over 60, inured of standardized teats and I was recertified last year. I assume that most believe CPD sets to be responsible and affordable standards for the process. Because of that, I want to hear your opinion after you have read and considered three important writings:
1. Wasserman SI, Kimball KR, Duffy DF: Recertification in Internal Medicine: A Program for Continuous Professional Development. Ann Int Med 133: (2000) 202-208.
2. Goldman L: Key Challenges Confronting Internal Medicine in the Early Twenty-first Century. Am J Med 110: (2001) 463-470.
3. Kassirer JP: Pseudoaccountability. Ann Int Med 134: (2001) 587-590.
The ideas of these articles build on each other and give a perspective on why CPD is both difficult and necessary. I want to help the ACP-ASIM be respectful of the membership and the profession in the fullest meaning of the words.
According to the Directory of Board Certified Medical Specialists, 33rd Edition, in the year 2001 there are, 1,748 internists in Oregon. That's a lot of people, .05% of the population, and certainly a lot of doctors. Internists are the cornerstone of adult health care in America. We have an important voice in the State, and we need to find it. Here are some encouraging recent developments:
- Martin Jones has agreed to continue to Chair the Public Policy Committee and I encourage our membership to join him in such important issues as gun and tobacco control.
- Robert Gluckman has agreed to represent us to the OMA House of Delegates.
- Past Governor, Don Girard is a member of the Executive Committee of the OMA.
- Past Governor, Walt McDonald, has announced that as of July 2002, he will retire as the ACP-ASIM Executive Vice President, and is returning to Oregon from Philadelphia. Walt's vision for expanded health coverage is well known, and perhaps he will help find a local solution.
At the Annual Session in Atlanta this spring, the Oregon Chapter was selected for a 2000 Chapter Excellence Award. The Chapter, under Jim's direction and with the aid of Mary Olhausen, Chapter Support Staff person, met specific criteria determined by the ACP-ASIM Chapters Subcommittee for excellence in Chapter management. Here's how I plan to maintain the excellence of the Chapter:
- Mary Olhausen has agreed to continue as Chapter Support Staff person.
- Mack Roberts & Company, LLC, Portland, has been engaged to audit the fiscal records and to prepare various tax reports for the Chapter.
- Art Hayward, MD, has accepted appointment by the
Council as Chapter Treasurer. He will work with Mary Olhausen, Mack Roberts & Company, and me to insure that the finances of the Chapter remain strong.
This is a great group of people with whom to work, and I look forward to helping them serve you.
Faculty Development that Targets Ambulatory Preceptors
Elizabeth Eckstrom, MD, MPH, FACP and Judith Bowen, MD, FACP
Many internists have taken on the role of teaching and mentoring young physicians. Some participate by precepting students and residents in their clinics. This is a very rewarding role, and many of us feel ill prepared to balance the pressures of patient care and teaching.
Through a grant from the Federal Health Resources Services Administration, several organizations collaborating to develop and disseminate the most effective teaching techniques:
- Clerkship Directors in Internal Medicine
- Society for General Internal Medicine
- Association of Professors of Medicine
- Association of Program Directors in Internal Medicine
In Oregon, Drs. Judy Bowen and Tom Cooney of OHSU, Elizabeth Eckstrom of Legacy Health System, Chuck Wood of Kaiser Permenanente, and Paul Matson of the Veterans Administration Medical Center, are offering a series of workshops for physicians who are interested in improving their teaching skills in the outpatient setting. The workshops focus on a series of skills:
- Orienting the new learner to the clinic environment;
- Effectively and efficiently teaching in the brief encounter;
- Providing effective feedback; and
- Managing the problem learner.
The goal is to expand the workshops and make them available to all office based physicians in the community who work with students or residents. If you are interested, please contact GIMGEL Project, Division of General Medicine, OHSU, 503-494-6550.
ACP-ASIM Oregon Chapter Communicates Electronically
The purpose of this list is to provide a forum for posting of electronic announcements of important/timely messages from the ACP-ASIM Oregon Chapter. This is not a discussion group, however, you are welcome to submit items for posting to the list by going to the Chapter Web Site and following the instructions there (no attachments please.)
August 21-22, 2001 - ABIM Certifying Exam
October 20, 2001 - Physician Well-Being Conference, Skamania Lodge, WA
November 1, 2001 - 11th Annual IDSO Meeting
November 1-3, 2001 - Oregon Chapter Scientific Meeting, Eugene
November 7, 2001 - Subspecialty Recertification Exams
December 1, 2001 - Fellowship Applications Due
April 11-14, 2002 - ACP-ASIM Annual Session, Philadelphia, PA
- Lynn M. Keenan, Eugene
- Charles Hofmann, Baker City
- James E. Leggett, Portland
- Robin H. Miller, Medford
- Karl D. Ordelheide, Lincoln City
- Mark D. Sternfeld, LaGrande
- Jocelyn C. White, Portland
- Frances Yuhas, The Dalles
- Robert A. Gluckman, Represents Chapter to OMA, Portland
- Sima Desai, Associates' Council Coordinator, Portland
- Martin Jones, Chair, Public Policy Committee, Eugene
- Linda L. Humphrey, Chair, Program Planning Committee, Portland
- Arthur D. Hayward, Chapter Treasurer, Portland
- James B. Reuler, Immediate Past Governor, Portland
- Stephen R. Jones, Governor, Portland
How to Reach Us
Stephen R. Jones, MD, FACP
Legacy Good Samaritan Hospital Department of Medicine
1015 NW 22nd Avenue (R-200)
Portland, OR 97210
Phone: (503) 413-8258
Fax: (503) 413-7361
Oregon Health Sciences University 3181 SW Sam Jackson Park Road (OP-30)
Portland, OR 97201-3098
Phone: (503) 494-8676
Fax: (503) 494-5636