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Chapter Newsletter - Summer 2001

Fred J. Schiffman, MD, FACP
Governor, Rhode Island Chapter

From the Governor's Desk

Our ACP-ASIM annual Spring meeting was held at the Radisson Airport Hotel on Tuesday, April 17 and Wednesday, April 18, 2001. It was extraordinarily well attended and our usual format worked especially well this year.

Our resident poster presentations numbered into the 90's and with hors d'oeuvres and refreshments, we had a wonderful viewing opportunity on Tuesday night. The next morning I introduced Dr. Jeannette Mladenovic from the American Board of Internal Medicine (ABIM) who participated in a panel discussion led by Governor-elect Yul Ejnes regarding ABIM recertification. There was lively audience participation.

Our oral presentation by residents from the teaching hospitals in Providence were presented and after a refreshment break, the 2001 Irving Addison Beck Chapter Laureate Award was presented to Dr. Robert Burroughs (more on this later in the newsletter).

"Meet-the-Professor" sessions were held during the luncheon hour. Drs. Joseph Sweeney, Yousaf Ali, Alan Epstein, Alan Shurman and Sharon Rounds presented challenging cases in their respective specialties with group participation.

In the afternoon, there were further presentations by our Associates and Dr. Timothy Flanigan and Dr. Anne Spaulding presented a session on blood-borne diseases and universal precautions. This presentation was not only an excellent update of the topic, but it also met the Department of Health's medical relicensure requirement of two CME hours on blood-borne pathogens.

Attendance was outstanding and preliminary results from participants show that it was a highly rated event by our members.

We have already begun planning for the Fall meeting to be held in Newport at the Hyatt Regency Hotel on October 31, 2001. Our successful format will be followed again this year with a co-sponsorship of the ACP-ASIM event by the Brown University Department of Medicine. We will have updates and symposia in carefully chosen specialties and Bob Doherty from our Washington DC office will tell us what is happening in Washington that will affect our lives.

With best wishes for a healthy and safe summer,
Fred J. Schiffman, MD, FACP
ACP-ASIM Governor for Rhode Island

Odds and Ends

Yul D. Ejnes, MD, FACP
Governor-Elect, Rhode Island Chapter

What's In a Name?-
The merger agreement between ACP and ASIM called for the new organization to be known as ACP-ASIM for at least three years. July 2001 marks the end of the three years. While the agreement doesn't require the College to do anything at the end of that period, many in ACP-ASIM believe that a change is warranted. The name "American College of Physicians-American Society of Internal Medicine" is a mouthful that takes up valuable column space in newspapers and takes long to say on radio and TV. The abbreviation "ACP-ASIM" hasn't yet taken on a life of its own, like the similarly hyphenated AFL-CIO (how long did it take for that name to stick?).

So, we're faced with an important decision. Do we keep the current name or consider alternatives that are easier on the tongue and/or more descriptive of what we do? Already, some have suggested "American College of Adult Medicine" (does that make us "adulterers"?), "American College of Internal Medicine" (a more compact version of the political correctness that gave us the current name?), or the time-honored "American College of Physicians" (which would allow us to keep our current stationery with "FACP" on them).

Whatever the rationale behind the current hyphenated name, it served to preserve the legacies of both predecessor organizations at the time of the merger. Today's activities and achievements of the College perpetuate the best of both ACP and ASIM more than any name will, so a new name doesn't need to serve that function. It must be simple, recognizable, and meaningful.

If you have any thoughts on what our name should be, please let me know. I'm on the College's Marketing and Communications Committee, which is looking at this issue very closely.

Sign 'Em Up!-
According to the 2000 Chapter Profile prepared by the national office, the Rhode Island Chapter saw a decrease of 4.8% in membership between 1999 and 2000. This was primarily in the Associates group, a category of members made up of residents and fellows or recent graduates of training programs. Many of these members leave the area after training, while others eventually become full members. Even if we omit this membership category and the medical students category, growth is flat at best.

Another statistic is that only 46% of Board-certified internists in Rhode Island are ACP-ASIM members. (The College's statistics use ABIM-certified internists as the denominator, a practice that I've criticized as further establishing Board certification as a "must have" at a time that we're battling ABIM over its recertification program.) If one includes all internists in Rhode Island in the denominator, the percentage is surely smaller.

These numbers are disturbing. At a time when we need the clout of a professional society the most, under half of our specialty participates via membership. Of course, to paraphrase an old saying, all internists benefit from what ACP-ASIM does nationally and in Rhode Island whether they pay dues or not. Unfortunately, while we are fortunate to have a large core of active members who are willing to work for you free of charge, it costs money to hold educational meetings, mail announcements and legislative alerts, administer the Chapter, and even recruit new members, not to mention run the national organization. The funds to do all of that comes from the dues that you pay.

There are many reasons for internists' not joining ACP-ASIM and we are trying to address them. One is membership in subspecialty societies, which competes for the same dollars that might otherwise go to ACP-ASIM membership. The College is looking at ways of making membership in both ACP-ASIM and the subspecialty societies financially attractive. The national Council of Associates is looking at ways of maintaining interest in the College after residency and fellowship training are over. Two other initiatives under consideration are marketing to non-ABIM-certified internists and to Doctors of Osteopathy who specialize in internal medicine and meet membership criteria.

What I find most interesting is that many of the non-member internists work side-by-side with many of you. Why these colleagues haven't joined is something that I'd like you to ask them. I'd also like you to share with them these newsletters and ACP-ASIM Observer to show them what this organization is doing for them. I'd really appreciate it if you told them what we've done for them in Rhode Island: blocking mandatory hospitalist programs; providing over a dozen hours of high-quality yet inexpensive CME per year (including the two required blood-borne pathogen CME hours this spring); advocating for their patients and their profession via participation with the Medical Society and through meetings with federal and state legislators, local insurers, and regulators; and demanding that the ABIM modify its recertification process so that it is relevant, cost effective, and improves the quality of care.

After you've done all of this with your practice colleagues, have them call me and I'll gladly send them an application. Or, better yet, call me before you talk to them and I'll send you an application so you can sign them up on the spot. If you want to make it real easy, have your office manager fill it out for them so that all they have to do is sign.

The more members we have, the more effective we'll be. It's as simple as that.

College to Transition to e-Communications-
In an effort to control costs, ACP-ASIM is looking at e-mail and fax as delivery methods for Governor's Newsletters in place of the current paper versions. As you can imagine, the potential savings are significant. The major obstacle to implementing this plan is that the College has working e-mail addresses and fax numbers for a relatively small number of members. A second hurdle is member preference - some prefer paper even if they are equipped to receive e-mail or fax.

This proposal is worth your thoughtful consideration and feedback. Would you mind receiving this newsletter in electronic form only? Would you be willing to pay extra to continue to receive it in paper form? Please let me know so Fred and I can share your opinions with the Board of Governors. Also, as a member of the ACP-ASIM Marketing and Communications Committee, I can relay your views to that group.

ACP-ASIM Studies Individual Ownership of Health Insurance Last year, the Rhode Island Chapter submitted a resolution to the Board of Governors that called for ACP-ASIM to explore individual ownership of health insurance as alternative to employer-based health coverage. This resolution resulted in the development of a policy monograph that was released this spring and is available on ACP-ASIM Online at http://www.acponline.org/hpp/indv_healthins.htm. The gist of the paper is that individual ownership of health insurance has potential, but in order for it to work, several things need to change first. This monograph is an example of the national organization's responding to a grassroots initiative.

If you have ideas for ACP-ASIM policy that you would like forwarded by the Chapter as resolutions for the Board of Governors meetings in the spring and fall, please let me know.

Support our Medical Society-
As many of you know, in September I begin a one year term as President of the Rhode Island Medical Society (RIMS). Our chapter's relationship with RIMS is a good one, notwithstanding my imminent role. For the past several years, the chapter has had representation on the RIMS Executive Council, along with representatives of other specialty societies. We've worked together on state legislative issues and coordinated our efforts on the national front. RIMS has played a major role in trying to improve the practice environment for Rhode Island's physicians through its advocacy efforts with government officials, insurers, and the general public.

In order for a specialty society to participate on the RIMS Council, at least 50% of its members must be RIMS members. Even without that requirement, membership in RIMS is important to every internist in Rhode Island. I strongly encourage you to join. (Note that in order to be a RIMS member, you don't have to join the AMA.)

Calling All Councilors-
One of this chapter's crowning achievements is its Council. Members volunteer their time to attend quarterly meetings and respond to e-mails in order to make our chapter work effectively. As Council members move on to other endeavors, opportunities for new members to join arise. If you're interested in serving on our Council or committees, please e-mail Fred (fschiffman@lifespan.org) or me (Yul_Ejnes@brown.edu).

Leadership Day 2001

Yul D. Ejnes, MD, FACP

On May 9, Scott Hanson and I traveled to Washington DC to participate in ACP-ASIM's annual Leadership Day. We visited our elected officials in the Congress and met with Senator Chafee, Representatives Kennedy and Langevin, and a member of Senator Reed's staff (he was on the Senate floor at the time, but has met with us on earlier visits).

Among the topics that we discussed were the "Patients' Bill of Rights," the Medicare Education and Regulatory Fairness Act (MERFA), and access to health care. As in previous years, we found our elected officials to be interested in what we had to say and willing to spend time listening to our concerns.

We were again reminded that this kind of interaction with our Congressional representatives need not occur just once a year in Washington. Our Senators and Representatives return to Rhode Island frequently and are available to meet with constituents at the district or state office. They are also reachable by phone, e-mail, or fax. Even if you don't contact the elected official, members of their staff keep track of who calls and what his or her position on a given issue is. Numbers do count.

ACP-ASIM has an easy to use service for contacting members of Congress. Visit the Legislative Action Center at http://congress.nw.dc.us/acp/. Summaries of key issues of concern to internists are posted there, along with sample letters for elected officials. Follow the instructions on how to customize and send these messages by e-mail, fax, or paper mail.

Diabetes - A Call to Action

Michael David Hein, MD

[Editor's note: I'm pleased to publish what I hope is the first of many submissions from members. Dr. Hein recently wrote me to express concern over alarming statistics on how Washington DC area physicians did in taking care of their diabetic patients. Is the same true in Rhode Island, and if so, what can be done about it? Read on...]

Diabetes Mellitus. Particularly Type 2 Diabetes Mellitus. Not very sexy. But, the numbers are astronomical. The Pandemic is here. And so is the response - or lack thereof.

Diabetes has increased 300% over the past 40 years, 33 percent just in the year 1998-1999 alone!

Diabetes is sexist - it removes and reverses the natural protection against ASCVD seen in premenopausal women.

Diabetes is ageist. Type 2 Diabetes occurs in the aged, and now is increasing rapidly in adolescents because of severe insulin resistance due to increasing obesity in the population.

Diabetes is racist - Hispanics suffer Diabetes 2 times that of Non-Hispanic Caucasians, African-Americans 3.5 times, and Native Americans from 10 - 20 times the incidence of Type 2 Diabetes Mellitus!

Diabetes costs a lot of Money - over 105 Billion dollars in 1992 in the US alone - BEFORE the 1990's incidence explosion.

While only 1 in 15 people have Diabetes:
1 in 5 health care dollars are spent controlling its complications
1 in 3 patients admitted for any and all forms of ASCVD have Diabetes

While only 50,000 Deaths yearly are attributed directly to Diabetes - 80% of people with Diabetes die of atherosclerotic causes - constituting one-third to one half of all deaths from cardiovascular diseases - increasing the death toll to 600 - 700,000 deaths per year.

A staggeringly under appreciated thought!

What influenza was to the 1910's, tuberculosis to the 30's and 40's and HIV to the 80's and 90's - Diabetes is to the first part of the Third Millennium - the scourge of society.

With all that said, we now have the tools and the proof that aggressive control of blood sugar to a glycohemoglobin of <= 7.0%, lipids to an LDL of 100 mg% and HDL > 45 mg%, and blood pressure to no greater than 130/85 can substantially decrease the morbidity and mortality in Diabetes (in accumulated studies) of from 30 - 90%!

We are, however, not making the impact we should.

In a recent survey of general internists and family practitioners, 90% of respondents could not name glycohemoglobin, Blood Pressure, and Lipids as the three most important numbers to know and manipulate in a patient with Diabetes.

Other studies have shown consistent lack of performance and/or documentation of foot exams, eye exams, lipid profiles, and urinary microalbumin excretion.

HEDIS 2000 and on will not only show what was done or not done, but what the practitioners response to the (bad) numbers was.

Suggested methods to improve attention to the ongoing details of Diabetes management include flow sheets and fill-in sheets (many of which are available - including from Lifespan) for the patient charts, ongoing educational seminars on the evolving importance of different facets of care in Diabetes Mellitus, third-party and governmental sources of free information, and electronic medical records which can organize, present, remember, and prompt attention to different details of care.

Provision of Diabetes Education, Dietary Counseling, podiatric examinations, and home blood glucose monitoring - and their coverage by insurance plans without hassles or hoops to jump through - is necessary, as is unfettered patient access to affordable drugs scientifically proven to be of benefit - from oral diabetes agents, to insulin, to anti-hypertensives and anti-hyperlipidemic agents - without denial by managed care organizations, hindrance by profit driven pharmacy benefit managers, or obscene markup prices from drug manufacturers.

We have the imperative, we have the information, we have the tools, and now we have the onus. It's time that - as in other areas of Medicine in the Third Millennia, we wrest back not just scientific and financial, but also moral control of the care of Diabetes Mellitus.

It is important to the health and welfare of the community, the financial health of the nation, and the reputation of the profession that we do.

Contact information:
Michael David Hein, MD
Endocrine Treatment Centers, Inc.
407 East Avenue, Suite 110
Pawtucket RI 02860
(401) 725-3252

Beck Award Presented to Robert Burroughs, MD, FACP

Yul D. Ejnes, MD, FACP

The recipient of the 2001 Irving Addison Beck Memorial Laureate Award is Robert Burroughs, MD, FACP. Dr. Burroughs is an internist/ cardiologist on staff at Memorial Hospital of Rhode Island. He received his medical degree from Boston University School of Medicine and did his residency training at Rhode Island Hospital. Since 1970, Dr. Burroughs has been in private practice in Pawtucket.

An acclaimed clinician, teacher, leader, and musician, Dr. Burroughs joins the ranks of distinguished practicing internists who have received this award, named after Dr. Beck, who personified the highest professional standards. The award was presented to Dr. Burroughs by RI Chapter Governor Fred J. Schiffman, MD, FACP, at the Annual Regional Meeting in April.

Congratulations New Fellows

The following members were elected to ACP-ASIM Fellowship by the Board of Regents in July 2000:

Thomas A. Bledsoe-Providence
Edward J. Wing-Providence

The following member was elected to Fellowship in January 2001:

Richard F. Lain-Westerly

Dr. Bledsoe along with Robert Crausman, MD, FACP participated in the New Fellows Convocation at the ACP-ASIM Annual Session in Atlanta in March.

Health and Public Policy Committee Report

Paul McKenney, MD

The Health and Public Policy Committee met recently to set an agenda for the coming year. We plan to restart periodic meetings with leaders and policy-makers in health care, beginning in the fall. This will probably include medical directors and administrators for Blue Cross, UnitedHealthcare and Medicare. We may also schedule informational sessions with state legislators, Pharmacy Benefit Managers (such as Pharmacare) and media groups working on health-related issues.

We hope to expand member involvement in the ACP-ASIM lobbying sessions with our RI Senators and Congressional representatives, held in Washington DC each May. Yul Ejnes and Scott Hanson have carried the torch to DC the past two years and strongly recommend the experience. Finally, we will try to work with the Health and Public Policy Committees from other New England chapters on matters which affect all of us.

We plan to meet quarterly, with regular reports to the entire Council and chapter membership by newsletter or e-mail. Current committee members are Paul McKenney (Chair), Scott Hanson, Fred Crisafulli, Mark Schwager, Bob Schwengel, Diane Siedlecki, and (ex-officio) Yul Ejnes and Fred Schiffman but we are open to other interested members. Please contact me by e-mail at mckenneyp@kentri.org., or at (401) 738-6544, with questions or suggestions.

Yellow Pages Correction

James Crowley, MD

Dr. James Crowley would like to inform members that the current Yellow Pages incorrectly lists him as board certified in Oncology. He is correctly listed in the same issue as board certified in Hematology and Immunology. As many of you know, Jim recently moved his practice to Memorial Hospital of Rhode Island.

RI Wins Chapter Management Award

For the second year in a row, the Rhode Island Chapter was recognized for its work by ACP-ASIM, by receiving a Chapter Management Award. This honor is presented to a select number of chapters that fulfill criteria such as the publication of newsletters, establishing committees, and participating in national ACP-ASIM policymaking. The award was presented at the Annual Regional Meeting in Warwick in April.

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.