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Governor's Newsletter - Summer 2002

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

(The Summer 2002 Governor's newsletter is also available as an Adobe Acrobat PDF file.)

From the Governor's Desk...

One of the many strengths of the Rhode Island Chapter of ACP-ASIM is the ease of the transition of the governorship. This is due, in no small part, to the close working relationship between the outgoing Governor and his or her successor. Once again, the members of the chapter benefit from this collaboration as I begin my four-year term as Governor, inheriting a strong, effective, and award-winning chapter from my predecessor, Fred Schiffman. I'm thrilled to begin my term, albeit a little stressed because of the brief overlap with my year as RIMS President (fortunately we're on the same page on the big issues, and the structure of the Medical Society, with the Council made up of representatives of the specialty societies, makes this work well).

Four years seems like a long time, though if you ask some former ACP-ASIM Governors it sometimes isn't enough. Here are a few things that I would like to accomplish, with your help, during my term:

  • Strengthen the medical student section of the chapter. We were one of the first chapters to include automatically a medical student on the Council, and under Mark Fagan's leadership, we have a medical student subcommittee. But we need to do more to attract students not only to ACP-ASIM but to internal medicine itself.

  • Expand Associate activities beyond the poster and abstract presentation in the Spring meeting. It has been said repeatedly that the Associates are the future of this organization. ACP-ASIM recently reconfigured its dues structure to make Associate dues more affordable. Locally, our chapter has had an innovative program of one years' free membership for residents who present posters or abstracts at the spring meeting. Yet nationally, after completion of their training, many associates drop out of the College in favor of subspecialty society membership. We must look at ways to make ACP-ASIM membership appealing enough to maintain after residency training ends.

  • Improve communication with the internal medicine subspecialty societies. This is a major priority nationally, and should be locally. The state's small size and existing affiliations make this task somewhat easier for us than it is for ACP-ASIM. There are active chapters of the American College of Cardiology, the American College of Gastroenterology in Rhode Island, and others. I would like to begin this process by borrowing an idea from the national Board of Regents and other state chapters and invite the internal medicine subspecialties to send a representative to our Council. At the same time, the Rhode Island Chapter should develop closer relationships with the other primary care specialties. The impact of such an alliance was very apparent a few years ago when we joined the Rhode Island Academy of Family Physicians in opposing mandatory hospitalist programs.

  • Move us to electronic communications. This is not just a financial move, but also one of efficiency. It will take about four weeks for this newsletter to go from writing to your mailbox. By the time you receive it, some of what you read will no longer be current. Then there is the matter of printing, folding, and postage (which just became more expensive). For the past several months, we've experimented with sending this newsletter out in PDF format, allowing you to view it on your screen in the original formatting or print it out for reading the old-fashioned way. In addition, using software provided by ACP-ASIM, we are sending occasional mass e-mails to members (and will soon begin sending blast faxes). This migration to electronic communications must continue if we want to be better able to respond rapidly to changes in the healthcare environment and make your dues dollars go further.

  • Grow the chapter's infrastructure, specifically its committees. As is the case in most professional organizations, a tiny minority of the members does the vast majority of the work. It has always been my opinion that paying dues is itself a contribution to the health of the chapter, since there are many internists who benefit from ACP-ASIM yet don't ever join. But I know that there are many members out there with talents and interests that could be put to good use on one of our committees. For the relatively small price of a couple of hours a few times per year (less if we use electronic communications), you can help the chapter by writing for the newsletter and web site, meeting with insurers and regulators, helping develop creative ways to increase membership, and planning our scientific meetings.

I look forward to hearing from you with additional suggestions for this list. Better yet, I hope to hear from members who would like to help the chapter achieve these goals. I am easiest to reach by e-mail at Yul_Ejnes@brown.edu, or if you prefer by phone, at 401-275-1991.

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

Fall Update in Internal Medicine: October 30

This year's annual "Update in Internal Medicine," held in conjunction with the Brown Medical School Department of Medicine, will take place on Wednesday, October 30 from 8:00 am until 4:00 pm in Newport at the Hyatt Regency. Among the topics that will be covered in this year's Update are hormone replacement therapy, depression, management of diabetes, a mini-symposium on screening, and management of abnormal pap smears. As has become tradition for the fall meeting, Bob Doherty, ACP-ASIM Senior Vice President for Governmental Affairs and Public Policy, will be our lunch speaker.

You will receive additional information and registration materials in the mail later this summer, but save the date now, since this meeting is usually well attended and may sell out.

Leadership Day 2002

On May 22, Scott Hanson and I took our annual trip to Washington DC to learn about legislation affecting internists and their patients and to visit members of our congressional delegation. This year we were again fortunate to meet with Senators Reed and Chafee and Representatives Kennedy and Langevin. Among the many issues that we discussed with them was declining Medicare payments and the effect that they will have on patient care. We asked the legislators to support proposals to fix the formula that resulted in this year's 5.4% payment decrease and will result in additional reductions if something is not done. Another topic of discussion was tort reform. With a professional liability insurance crisis in many states, and other states approaching crisis, the time is past for change that will protect the rights of patients to be compensated for their injuries resulting from malpractice, while curbing the excesses that drive up costs, strain patient-physician relationships, and take the joy away from the practice of medicine.

This day is always educational and energizing, especially given the warm reception that we always receive from our legislators. With the low cost of travel from Providence to BWI, the chapter can afford to send more than two representatives to Leadership Day, so if you are interested in participating in 2003, please let me know. As I always write at the end of the yearly Leadership Day report, physicians need to interact with their federal and state legislators more than one day a year. ACP-ASIM makes it easy to contact members of Congress via the Legislative Action Center. The RI Secretary of State's web site is an easy way to find and communicate with your state legislator. A phone call, e-mail, or letter from a constituent lets a legislator know not only how you feel about an issue, but how others must also feel. If you're not already an ACP-ASIM Key Contact, become one and receive regular communication on matters before the Congress that affect you and your patients. On the state level, the chapter's Health and Public Policy subcommittee and the Rhode Island Medical Society's Public Laws Committee are great ways to participate in local issues.

PIER is Here... The Physicians' Information and Education Resource

PIER, The Physicians' Information and Education Resource, is now available for exclusive preview by ACP-ASIM members

What PIER is - Integrated with the College's other medical information and education resources, PIER is ACP-ASIM's new, electronic, Web-based, decision support tool designed for rapid point-of-care delivery of up-to-date, evidence-based guidance for physicians. PIER contains modules focusing on the diagnosis and treatment of diseases, and will eventually include sections on prevention and screening, procedures, ethical and legal issues, complementary and alternative medicine, and patient education. ACP-ASIM members can visit the PIER web site by going to http://pier.acponline.org.

Why PIER is the Best Choice - All information in PIER has gone through a rigorous review process, so you can be sure that the information found in PIER is credible, up to date, and accurate.

How PIER Can Help You -

  • Get answers to clinical questions fast.
  • Rapidly review diagnostic and therapeutic strategies.
  • Find focused drug information.
  • Provide clear information to patients in print or electronic format.
  • Have ready access to the evidence and related literature.
  • Be up to date on the newest data.

What to Expect From PIER in the Future -

  • Ongoing coverage of the newest data
  • Integrated links to electronic medical records
  • Customizable patient information
  • Clinical question archiving

Visit http://pier.acponline.org today and see how PIER can work for you!

AMA House of Delegates Meets

AMA meetings are not usually reported in this newsletter, but in June I had the opportunity to attend the AMA House of Delegates meeting as an alternate delegate. The AMA is an organization that is not embraced by many ACP-ASIM members, for reasons that I will not recount here. While I am a member (with a gap of a few years where I let my membership lapse), I haven't been very active.

What I found most interesting about the meeting, which is mainly a policy-making session, was the dedication of the delegates to the AMA ("our AMA"). At the same time, they were not shy about disagreeing with some of its policies.

The most significant decision made by the House was acceptance of a resolution calling for a committee made up of representatives of the specialty societies and state medical societies to develop a business plan for restructuring the AMA into an "organization of organizations." As envisioned, under this model, members of the component societies would automatically be members of an AMA that would function more like an umbrella organization.

Two other major issues covered at the meeting were the AMA's adopting a series of resident work hour restrictions and the medical liability crisis. The work hour issue is not a new one, and the specific limits approved by the AMA are not unlike what our internal medicine programs are already following, but it does represent the first time that the AMA adopted policy on this matter and follows by a week or two the ACGME's adopting similar work limits. Medical liability evoked the most emotional responses from the delegates, who heard physicians from states where liability coverage is unavailable or outrageously expensive, as well as other speakers who discussed the impact of the current liability climate on the cost of care, access, and the attractiveness of medicine as a career.

I was pleased to see many ACP-ASIM leaders at the meeting, some of whom were elected to top leadership positions at the AMA. One of them was Cecil Wilson, who is our current Chair of the Board of Regents but will familiar to some of you as our Assigned Trustee in the final years of the Rhode Island Society of Internal Medicine. Another internist from Florida, Yank Coble, became AMA President at this meeting. It is difficult to decide which organizations to join, but each has a role to play in our professional lives. Perhaps the reorganization of the AMA will simplify those decisions. For those of you who swore off the AMA because of its past decisions or the Sunbeam scandal, it may be time to become reacquainted.

New Member Benefit: Online CME Transcripts

The College is pleased to announce a new member benefit - online CME transcripts. ACP-ASIM members may view and print a transcript of their CME credit earned for participation in activities sponsored by the College. The transcript provides a six-year listing and includes credit earned for:

  • Annual Session
  • Postgraduate Courses
  • Chapter/Regional Meetings Accredited by the College (Starting November 1999)
  • MKSAP and Related MKSAP Enhancements
  • MKSAP Audio Companion
  • Clinical Problem Solving Cases
  • Audio and Video Products

Work is underway to include credit earned for The Medical Laboratory Evaluation Program and the educational component of the ABIM recertification program.

Members can also print documentation of their participation in sessions related to state specific CME requirements. If you have any questions, please contact ACP-ASIM's Customer Service Department at (800) 523-1546, ext. 2600, or custserv@acponline.org.

Board of Governors Meeting Highlights

By now, you have read about the spring Board of Governors meeting and its resolutions, adopted by the Board of Regents, on recertification. If not, check the June ACP-ASIM Observer. You should be aware of the significant role that the RI Chapter played in developing College policy on this issue. The RI Chapter cosponsored three of the resolutions that were incorporated into the final document. In addition, the College's position on the secure exam was modified based on testimony submitted on your behalf. In fact, during the hearing on recertification, I quoted one of our members, whose e-mail to me literally arrived minutes earlier.

The process of change is a slow one, especially for physicians, who are accustomed to making decisions and seeing results right away. However, the system does work if you give it time. If you have an issue that you want brought to the College's policymaking apparatus, let me know.

RI Spring Meeting Report

The 2002 Regional Meeting was held on May 2-3. Those of you who did not attend (and there were many of you) missed several interesting and provocative presentations. We were honored to have Rowen Zetterman, MACP, a former chair of the Board of Regents, as our College representative. The Irving A. Beck Award and the first-ever Governor's Award were presented (see below). Two panel discussions, one an update on bioterrorism preparedness featuring Drs. Andrew Artenstein, Leonard Mermel, and RI Department of Health Director Patricia Nolan, the other an overview of the controversies over MRI and CT scan screening, presented by Drs. Tom Wachtel, Gary Strauss, and John Pezzullo highlighted the meeting.

Our associates were featured at the evening reception on May 2, which was devoted to their posters, and at the full-day session, where several presented research or clinical vignettes. Meet-the-Professor lunch breakouts and a tribute to outgoing Governor Fred Schiffman rounded out the meeting.

Attendance at the 2002 Regional Meeting was not as good as at previous spring meetings. The Education Subcommittee, chaired by Jim Hennessey, would like to hear from members who attended and those who did not as it begins planning the 2003 spring meeting. All aspects of the meeting-format, location, and day of week-are on the table. Please use the fax response form or e-mail us at riacpasim@worldnet.att.net.

Awards Presented to Two Chapter Members

At the Spring Regional Meeting on May 3, Chapter Governor Fred Schiffman, MD, FACP presented the Irving A. Beck Laureate Award to Kenneth Nanian, MD. FACP, and the Governor's Award to Joseph Chazan, MD, FACP. Dr. Nanian is a cardiologist in private practice in Providence who has served on the staff of Rhode Island Hospital for decades. In addition to his full-time practice, he was involved in the training of internal medicine residents and cardiology fellows over the years, and helped to establish the Rhode Island component of the American Society of Internal Medicine.

Dr. Chazan was presented with the first-ever Governor's Award for his years of service to the College and to the Rhode Island medical community. A former Governor of this Chapter, Dr. Chazan was also responsible for establishing the first hemodialysis facility in this state and played key roles in the development of the Department of Medicine at Rhode Island Hospital and in the teaching of hundreds of renal fellows, medical residents, and students.

Imaging Studies - Major Educational Initiative Planned

Blue CHiP, RIMS, and the specialty societies are working together to address Blue CHiP's concern that the cost of radiology services in its Blue CHiP for Medicare product is rising excessively. The insurer initially planned to implement a preauthorization requirement for all CT, MRI, and nuclear studies, but at the request of the physician organizations, they agreed to delay that program and discuss alternatives.

At the time of this writing, a working group of specialty society representatives, RIMS leadership, and CHiP administrators is reviewing data and considering educational initiatives that will support the appropriate use of imaging studies. Among the options being considered is the distribution of widely accepted guidelines that address diagnoses for which imaging studies may be ordered, the addition of topics that cover this area to CME programs that the specialty societies are presenting, or the development of CME programs specifically designed to address this issue.

While the insurer is motivated by the need to control costs, the physician community views this dialogue as an opportunity to improve care by educating physicians on the proper use of imaging procedures and as a new way of problem solving with a major insurer that may be applicable to other issues.

Scott Hanson, MD represents the Rhode Island Chapter of ACP-ASIM in this process. As RIMS President (until September 20), I am also involved in this discussion and will likely continue to play a role after my term ends. If you have any suggestions for how we can best reach physicians and have an impact on how they use imaging procedures, please let us know.

Save the Date

RI ACP-ASIM/Brown Department of Medicine

Update in Internal Medicine

Wednesday, October 30, 2002
8:00 am - 3:30 pm
Hyatt Regency, Newport

Topics to be covered include:

  • Hormone Replacement Therapy
  • Management of Diabetes
  • Screening for colon and prostate cancer
  • What to do with an abnormal pap smear
  • Management of Depression
  • ... and more

Registration materials will be mailed to you soon.

RI Chapter Wins Two Awards

The Rhode Island Chapter received the 2002 Evergreen Award for its Practice Management Issues and Resource Page. The Chapter, in conjunction with the College's Practice Management Center, developed a Practice Management Resources page on the Rhode Island Chapter Web site. The Web page contains links to online information on state regulations and offers online provider enrollment materials for the Medicare and Medicaid programs. The Chapter researched and collected all of the local and state information included on the Web site. Links to features on the national Practice Management Center, and a directory of Web sites and phone numbers for the provider relations departments of health insurers who have done business in Rhode Island are also included. Physicians have the opportunity to submit an online form to the Chapter to report their practice management issues and to ask questions. A template was created from the Rhode Island Chapter page, which allows other chapters to create a similar Web page on their Web sites. The new information offers physicians in Rhode Island valuable information and the ability to communicate with the chapter on practice management issues.

Also, the Rhode Island Chapter received a Chapter Management Award this spring for fulfilling requirements in the areas of chapter organization, member service, advocacy, and communications.

Summer 2002 Member Response Form

Please Send Us Your E-mail Addresses and/or Fax Numbers

By e-mail: riacpasim@worldnet.att.net

By fax: (401) 793-7402

By paper mail: Nancy Baker-Hobinc/o Amb. & Resp. Care Svcs (Fain-281)
The Miriam Hospital
164 Summit Ave.
Providence, RI 02906

Please let us know how the chapter can better serve you and your patients, or if you would like to play a more active role in the chapter. Also, if you have any suggestions for award recipients or for the format and location of the spring Regional meeting, please write them in the space below. Thank you

Rhode Island Chapter of ACP-ASIM Executive Council

Yul D. Ejnes, MD, FACP - Governor (401-275-1991)
Fred J. Schiffman, MD, FACP - Immediate Past Governor (401-793-4035)
Mitchell A. Pressman, MD, FACP - Treasurer (401-435-5533)
John R. Audett III, MD, Member
Munawar Azam, MD, Member - Chair, IMG Subcommittee (401-456-3000)
James Burrill, MD, FACP
J. Russell Corcoran, MD, FACP
Robert S. Crausman, MD, FACP
Frederick S. Crisafulli, MD, FACP
Michele G. Cyr, MD, FACP
Mark Fagan, MD, Member - Chair, Associates Subcommittee (401-444-5344)
Edward Feller, MD, Member
Neal Galinko, MD, FACP
Reginald Y. Gohh, MD, Member
R. Scott Hanson, MD, Member
Pamela Harrop, MD, Member - Chair, Membership Subcommittee (401-253-8900)
James V. Hennessey, MD, FACP - Chair, Education Subcommittee
Harold M. Horwitz, MD, Member
Janice M. Kizirian, MD, FACP
Dennis S. Krauss, MD, FACP
Paul F. McKenney, MD, Member - Chair, Health and Public Policy Subcommittee
Anthony Mega, MD, Member
Harold Sanders, MD, FACP
Mark Schwager, MD, Member
Diane Siedlicki, MD, Member
Karen Stevenson, MD, Member
Dominick Tammaro, MD, FACP
Alan Weitberg, MD, FACP

Administrative Assistant
Nancy Baker-Hobin
c/o Amb. & Resp. Care Svcs (Fain-281)
The Miriam Hospital
164 Summit Ave.
Providence, RI 02906
Tel. 401-793-2995
Fax 401-793-7402
E-mail: NBaker4@cox.net

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