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Chapter Newsletter - Winter, 1998-99

From the Governor's Desk

Our primary chapter activities over the past several months have revolved around meetings of the Executive Council and its subcommittees, and with planning for the spring '99 regional conference. The Executive Council met for the second time on December 9, 1998. Discussion was wide-ranging and included development of chapter newsletters, plans for the spring '99 regional conference, and a report on the fall '98 Internal Medicine Update in Newport. Subcommittee chairs discussed their short-term objectives:

  • IMG Subcommittee - Munawar Azam, MD, Chair. IMGs constitute 25% of licensed Rhode Island physicians. Dr. Azam will secure a list of registered IMGs from the RI Department of Health. He will encourage their membership and involvement in chapter activities.
  • Education Subcommittee - J. Russell Corcoran, MD, FACP, and Michele G. Cyr, MD, FACP, Co-Chairs. Neither member could be present. This subcommittee's report was tabled.
  • Membership Subcommittee - Pamela Harrop, MD, Chair. There is a perception that chapter events are too Providence-centered. Therefore, the feasibility of offering scientific conferences in more varied locations throughout the state is under consideration. With an eye turned toward attracting a broader based constituency, Drs. Schiffman and Ejnes will promote chapter activities through personal contacts with leaders in hospital departments of medicine throughout the state.
  • Health and Public Policy Subcommittee - Frederick Crisafulli, MD, FACP, Chair. This subcommittee will examine the ramifications of PAC contributions, concentrate on reinforcing contacts previously initiated by the RISIM, and focus on forging stronger alliances with health-oriented organizations, including the Rhode Island Department of Health, BC/BS, UHCNE, etc.
  • Associates Subcommittee - Mark J. Fagan, MD, Chair. The Associates Subcommittee will partner with Brown's department of medicine to promote student membership in the ACP-ASIM. It is hoped that early exposure of medical students to practicing internists will help direct more students toward internal medicine as a profession. Collaboration between medical students and house staff on scholarly projects will also be encouraged.
  • Communications Subcommittee - Yul Ejnes, MD, FACP, Chair. Our quarterly newsletter's principal function will be to disseminate information of general interest. E-mail and fax communication will be reserved for events warranting rapid member mobilization. To assist Dr. Ejnes with the amassing of an e-mail/fax database, a convenient member response form will continue to be carried in chapter newsletters.

The College web site, merger update, and resolutions for the 1999 ACP-ASIM Board of Governors spring meeting in New Orleans were also discussed at December's Council meeting. This was followed by a report of the chapter's financial health. A financial contribution in support of Medicine-Health Rhode Island - a publication of the Rhode Island Medical Society - was discussed; a motion to support the journal was made, seconded and carried.

The following preliminary agenda was developed for our regional meeting on Tuesday, April 6 and Wednesday, April 7, 1999 at the Radisson Airport Hotel in Warwick:

  • From 6 to 8 p.m. on Tuesday, April 6, there will be a welcoming reception and poster exhibition by medical house staff representing Rhode Island's teaching hospitals. Again this year, the number and quality of abstract submissions are exceptional.
  • On the following morning, April 7, registrants will enjoy a continental breakfast. After opening remarks, in Part I of the Associates program, residents and interns whose abstracts have been selected for oral presentation will address the group. A business meeting will follow at 9:30 a.m. We are fortunate to have Dr. Harold C. Sox, ACP-ASIM president, as our College Representative. He will give the College update and touch on issues of importance to members. Dr. Sox will also provide opening commentary on quality and outcome in the clinical practice of medicine, preceding a panel discussion on the topic, which he will moderate. Panelists will be Edward Westrick, MD, clinical coordinator for Rhode Island Quality Partners; Patricia Nolan, MD, Rhode Island's director of health; Anthony J. Kazlauskas, MD, senior medical director for United Health Care of New England; Peter A. Hollmann, MD, medical director of Blue Chip; and Peter R. Hoffmann, MD, deputy medical director of Harvard Pilgrim Health Plan of New England. They will offer their views on this topic; lively audience participation is expected. The panel discussion will be followed by announcement of the Chapter's 1999 laureate, who will be presented with the Irving Addison Beck Memorial Award. During luncheon, meet-the-professor sessions will feature Marilyn Weigner, MD, (outpatient congestive heart failure and arrhythmia management); Timothy Flanigan, MD, FACP (HIV update); Lance D. Dworkin, MD (hypertension update); and Charles Kahn, MD, FACP (diabetes management). A special meet-the-expert session will be conducted during luncheon by Elaine Narducci, RN, who will work with participants to solve interesting ICD-9 coding and reimbursement problems. In the afternoon, there will be a joint presentation and discussion by Drs. Joseph Sweeney, FACP, and Anthony Mega, MD on the risks and benefits of newer anticoagulants in the treatment of selected illnesses. Registrants are encouraged to bring problem cases to the conference. Plenty of time has been built into the program to allow for audience participation and questions. Part II of the Associates presentations will begin at 3:15. Following closing remarks at 4:30, the conference will adjourn.

The next Executive Council meeting will take place in March, 1999.

Watch your mail for detailed conference and pre-registration information. We urge each of you to attend this, our first combined ACP-ASIM regional meeting...and please, spread the word.

With kindest personal regards,

Fred J. Schiffman, MD, FACP
Governor, RI Chapter, ACP-ASIM

ACP-ASIM Annual Session 1999


Join your colleagues for a mixture of education and fun at the first Annual Session since the merger of the American College of Physicians and the American Society of Internal Medicine. From CME credits to recertification preparation, hands-on clinical skills workshops to computer training sessions, the 1999 Annual Session is one that you don't want to miss.

With over 250 educational Scientific Program Sessions from which to choose, both generalists and subspecialists are guaranteed to gain invaluable knowledge and insight from the sessions' nationally recognized faculty. Don't forget to register in advance for those sessions that require reservations. There is no additional fee to attend a reserved session, but requests are filled on a first-come, first-served basis.

In addition to keeping abreast of the latest developments in internal medicine, attendees can network with colleagues or simply unwind at one of the social/alumni events, including special luncheons and receptions. Please check your programs for a complete listing of the dates and times of these events. Also, be sure to visit the Exhibit Hall and learn about the latest pharmaceutical products, medical equipment and professional services.

While ACP-ASIM members are broadening their educational horizons, their guests can discover where to shop for souvenirs and where the locals dine and dance at the guests' "insider's orientation." Planned guest tours and seminars include: C'est la vie on the Bayou: A Swamp Tour Experience; Southern Living: Plantation Homes; Moonlight and Jazz on the Mississippi; A Cooking Experience with a Great Louisiana Chef, as well as others.

The Community-Based Teaching "Excellence in Teaching Award"

Patrick C. Alguire, MD, FACP

On November 1, 1998, the ACP-ASIM Board of Regents approved the Community Based Teaching (CBT) Excellence in Teaching Award. This new award for CBT practitioners is substantially different than the Preceptor Recognition Award in a number of important ways. The essential criteria for the Preceptor Recognition Award includes participation in CBT for 2 out of 3 years, with at least 2 years at the same sponsoring institution. In contrast to this award, the CBT Excellence in Teaching Award requires involvement in a CBT program for 7 out of 10 years, with at least 3 years at the same sponsoring institution, and an average of 50 hours of direct trainee contact during those years.

In addition to the time requirement, the practitioner must also meet certain measures of teaching excellence, which are defined in the application document. A number of measures of teaching excellence are outlined in the award criteria in order to accommodate the many different ways sponsoring institutions recognize teaching excellence. Like the CBT Participation award, the Excellence in Teaching Award is reserved for internal medicine physicians, and both awards are available only once for each individual. That is, an individual CBT physician may be honored with both a Participation Award and a CBT Excellence in Teaching Award, but will not be eligible for more than one of these awards. The criteria and application form for the Excellence in Teaching award are available on the CBT web page or by calling (800) 523-1546 ext. 2588. Applications will also be published in the quarterly CBT News.

CBT Awardees

Below are members of the Rhode Island Chapter who received ACP-ASIM Community-Based Teaching Participation Awards for the previous quarter:

James D. Burrill, FACP
David B. Ettensohn, FACP
Suhdong Hahn, MD
David C. Yoburn, FACP

Committee Spotlight: Health and Public Policy

Yul Ejnes, MD, FACP

The Health and Public Policy Subcommittee, chaired by Fred Crisafulli, is taking an innovative approach to committee work. It meets all the time, in a "virtual meeting" held by e-mail. Members Steve Schoenbaum, Scott Hanson, Mitch Pressman, Robert Schwengel, Fred Schiffman, and Yul Ejnes exchange messages and develop policy positions "on the fly." Among the issues under discussion is the settlement reached between the tobacco companies and the state attorneys general. While the HPPC's position on this is not yet finalized, there is agreement that all of the proceeds of the settlement should be spent on health care, and a large portion of that on tobacco-related health care.

Using the tobacco settlement as a catalyst, the HPPC is developing relationships with other specialty societies that will prove beneficial for other issues, and continues to coordinate its work with the Medical Society. Additionally, the Committee will meet "live" from time to time to continue the dialogue with Rhode Island's major insurers and other key players in health care. As part of a network of state ACP-ASIM HPPC's, our Committee is frequently in touch with ACP-ASIM headquarters in Philadelphia and coordinates its efforts with those of other chapters and the national organization. Finally, the HPPC is using electronic means to communicate with members, issuing alerts by e-mail and fax (if you haven't yet given the chapter your e-mail or fax information, please do so by completing the form at the end of this newsletter).

The Committee encourages member participation, either by joining the committee or by making it aware of any issue of concern, such as insurance "hassles," legislative matters, or anything else that affects the way that we take care of our patients. Contact Fred Crisafulli (BPCFSC@aol.com, phone 401-331-8555) for more information.

Advancement from Membership to Fellowship


"How do I advance from Membership to Fellowship?" is a question frequently asked by you, the ACP-ASIM members. Below, is a summary of the requirements and pathways that a candidate must fulfill and/or meet in order to become a Fellow of the College.


  • be certified by the American Board of Internal Medicine, the Royal College of Physicians and Surgeons of Canada or the American Osteopathic Board of Internal Medicine;
  • have been a member in good standing for two years in either ACP or ASIM and have held a position in practice or in academia for at least two years since completion of training;
  • have an active medical license in good standing (if in clinical practice);
  • have confined professional activity to internal medicine or a subspecialty of internal medicine;
  • be proposed and seconded with detailed letters of support from two current Masters or Fellows with reference to character, ethics and medical activities, and outlining professional contributions and accomplishments;
  • be endorsed by the appropriate ACP-ASIM Governor;
  • have shown continuing scholarship and professional accomplishments; and
  • document continuing professional activities, including teaching (both institutional and community-based); hospital committee work; public service and community activities; and participation in continuing medical education activities as both a student and teacher.


The College has established four Pathways that serve as guidelines to qualify for Fellowship. For each of the following pathways, the candidates must meet the basic requirements listed above.

Pathway 1: Members must have demonstrated skill in written medical communication.

Pathway 2: Members must have significant and continuing certification activities and/or teaching (both institutional and community-based), and/or community activities that indicate professional achievement and scholarship; they must have undergone recertification, or they must have participated in the Medical Knowledge Self-Assessment Program (MKSAP) with a passing score. In addition, subspecialty certification or certificates of special competence in adolescent medicine, critical care medicine, clinical cardiac electrophysiology, geriatrics, or sports medicine can qualify a candidate for this pathway, but are not adequate by themselves.

Pathway 3: Members must have been active members in ACP or ASIM for at least 10 years, with substantial participation in programs and activities, as well as demonstration of other professional accomplishments.

Note: Outstanding candidates who have been active Members for fewer than 10 years may qualify by combining Pathways 1 and/or 2 with Pathway 3.

Pathway 4: Members must have distinguished professional activity in teaching, patient care or professional service over many years.

Candidates must document each pathway; however, a candidate may be accepted without fulfilling one pathway if his/her work in other pathways is deemed outstanding by the Credentials Committee. For a complete copy of the "Requirements for Advancement from Membership to Fellowship" and/or an advancement to Fellowship proposal, contact your local College Governor or call ACP-ASIM Customer Service at (800) 523-1546, ext. 2600. The "Requirements for Advancement from Membership to Fellowship" can also be found on the College's web site at www.acponline.org/college/membership/required.htm.

[Editor's Note: The deadline for applications for fellowship to be considered by the Credentials Committee at its next meeting is June 1, 1999.]

New ACP-ASIM Fellows

The Rhode Island Chapter recognizes the following members who were elected to fellowship in ACP-ASIM in 1998:

Vincent A. Armenio - East Providence
Richard A. Cottiero - Cumberland
R. Bruce Gillie - Westerly
Kathleen O. Morton - Barrington
Marguerite A. Neill - Pawtucket
Louis J. Rubenstein - Wakefield
Charles B. Sherman - Providence
Gail Skowron - West Greenwich

Political Action Committees: What's Your Opinion?

The ACP-ASIM Board of Regents recently postponed a decision on whether the College should form a political action committee (PAC), in order to provide members an opportunity to express their views on this issue to their chapter governors. At the end of this newsletter is our Member Response Form with a question on this important topic. Please take a moment to complete the form and mail or fax it back to us. If you prefer e-mail, send your opinion to Yul_Ejnes@brown.edu.

Health Care Quality Improvement In Rhode Island

Edward Westrick, MD, MS
Principal Clinical Coordinator
Rhode Island Quality Partners

Let me take this opportunity to introduce you to a new column brought to you by Rhode Island Quality Partners (RIQP). RIQP is contracted by the Health Care Financing Administration (HCFA) to serve as the Peer Review Organization (PRO) in this state. The first edition of this column will provide a brief history of RIQP, its primary purpose, HCFA's Health Care Quality Improvement Program (HCQIP), and some recent activities. Future editions of the newsletter will include results of completed projects, progress on current projects, and plans for future projects.

RIQP was incorporated in 1995 as a joint venture between the Rhode Island Medical Society (RIMS) and Qualidigm (formerly known as CPRO) to seek the Rhode Island PRO contract with HCFA. It was awarded to RIQP in 1996. You may remember the days when the role of the PRO was largely adversarial. Since HCFA established HCQIP in 1992, the role of the PROs has changed dramatically. Today, most of RIQP's work involves collaborating with physicians and others to improve the health of and health care services provided to seniors in Rhode Island. These initiatives are called quality improvement projects and include three key steps: performance measurement in important clinical topic areas; interventions designed to improve performance; and evaluation of the effectiveness of the interventions. Our project methodology has recently been summarized in Health and Medicine/Rhode Island (Part 1: Vol. 81 No. 4 April 1998; Part 2: Vol. 81 No. 5 May 1998).

We are working on projects in hospital care of acute myocardial infarction (AMI), community-acquired pneumonia (CAP) and diabetes mellitus, congestive heart failure, adult immunization, mammography screening, stroke prevention, and pressure ulcers. You may have participated in one of the CME activities jointly sponsored by Brown University for pneumonia and diabetes care.

We recently remeasured performance in pneumonia and acute MI and are very pleased to report significant impact in the timeliness of antibiotic administration in pneumonia and in beta blocker, aspirin, and ACE inhibitor use in acute MI. The details are reported in Health and Medicine/Rhode Island (CAP: Vol. 81 No. 12 December 1998; AMI: Vol. 82 No. 1 January 1999).

Feedback on projects and your participation in this monthly column are welcome.

The author may be contacted at:

Rhode Island Quality Partners
9 Hayes Street
Providence, RI 02908
(401) 528-3250 voice / (401) 528-3210 fax

Rhode Island Chapter of ACP-ASIM Executive Council

Fred J. Schiffman, MD, FACP - Governor (1998-2002) (401-793-4035)
Yul D. Ejnes, MD, FACP - Transitional Governor (1998-2000); Chair, Communications Subcommittee (401-275-1991)
Michele G. Cyr, MD, FACP - Immediate Past Governor, Co-Chair, Education Subcommittee (401-444-4765)
Mitchell A. Pressman, MD, Member - 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 - Co-Chair, Education Subcommittee (401-783-0084)
Robert S. Crausman, MD
Frederick S. Crisafulli, MD, FACP - Chair, Health and Public Policy Subcommittee (401-331-8555)
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 - Co-Chair, Membership Subcommittee (401-253-8900)
James V. Hennessey, MD, FACP
Harold M. Horwitz, MD, Member
Sewell I. Kahn, MD, FACP
Janice Kizirian, MD, FACP
Dennis S. Krauss, MD, FACP
Edward Lally, MD, FACP
Paul F. McKenney, MD, Member
Anthony Mega, MD, Member
Harold Sanders, MD, FACP
Karen Stevenson, MD, Member
Dominick Tammaro, MD, FACP
Alan Weitberg, MD, FACP

Administrative Assistant

Nancy Baker-Hobin
Division of General Internal Medicine
Rhode Island Hospital
593 Eddy St.
Providence, RI 02903
401-444-8537 (voice)401-444-4730 (fax)