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June 2011 Kenneth E. Olive, MD, FACP, Governor


Letter from the Governor

2011 has been an active year for the Tennessee Chapter. The Annual Scientific Meeting program committee has been active organizing our October meeting. The Council of Young Physicians held a spring social event. The chapter joined with the Society of Hospital Medicine and the St. Thomas Health Services to present a program on Accountable Care Organizations in Nashville. Over 100 members of the Tennessee Chapter attended Internal Medicine 2011. The 2011 Reading Retreat explored the general migrant experience with its theme “Migrations: Crossing the Border.” Seven members of the chapter participated in ACP Leadership Day on Capitol Hill in May. The Tennessee Chapter was part of a coalition supporting the passage of tort reform in Tennessee. The Nominating Committee has initiated the process for election of the next governor-elect. This issue of the Governor’s Newsletter explores those issues and more.

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Tennessee Tort Reform

The Tennessee Chapter was part of a coalition of many organizations which supported the Tennessee Civil Justice Act of 2011 (SB 1522/HB 2008). The bill, which won final approval in the State House of Representatives on Friday, May 20, is scheduled to take effect on October 1, 2011 and will apply to all liability actions for injuries after that date.

This legislation makes a number of changes in the state’s tort laws that include setting limits on non-economic damages in civil lawsuits, including medical liability cases. Awards for non-economic damages, such as subjective damages including "pain and suffering," in Tennessee tort cases will be limited to $750,000. In certain catastrophic cases, including spinal cord injuries leading to paraplegia/quadriplegia; third-degree burns over 40% or more of the body or face; amputation of hand or foot, or wrongful death of a parent of a minor, non-economic damages will be limited to $1 million.

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Young Physician Involvement on the ACP Board of Regents

Ryan D. Mire, MD, FACP

This past year I had the honor to serve as an ex-officio member of the Board of Regents (BOR). I served as the young physician representative being Chair of the national Council of Young Physicians (CYP). I was charged with reflecting on my experience as a member of the Board of Regents.

I have to first comment that of the twenty-six members of the BOR, there were three members representing the Tennessee Chapter: Fred Ralston, MD, MACP (Immediate Past President), Wayne Riley, MD, MACP and myself. In addition to having the honor to serve with our own chapter leaders, there was also the valuable opportunity to be a part of an elite group of the College’s leadership. The BOR provided me the opportunity to witness first-hand, the sincere thought, discussion, and careful decision-making that went into creating College policy. The BOR was diverse in representing the broad demographic of the College membership (i.e., private practice, academic, hospitalist, and subspecialist). I participated by representing and providing perspectives of the young physician membership, but the ultimate fiduciary responsibility of the BOR was to create policy in the best interest of the College as a whole.

I recall my first meeting wondering what my role on this regulatory board of the College would be. Would I be a member of this BOR in name only? Was there a true interest in my thoughts and perspectives as a young physician? I quickly learned that my input, comments, and suggestions were not only heard; but there was interest in the BOR wanting to hear my thoughts. During the middle of my first meeting, the Chair of the BOR (Robin Luke, MD, MACP,) stopped mid-discussion on a topic and said, “Let’s take a step back for moment and see how our young physician members would feel about this issue … Ryan?” This quickly gave me the confidence that I was a valuable contributor to the BOR. Ultimately, I served on the strategic planning task force during my year on the BOR, which involved a complete restructure of the College’s strategic plan by developing new priority areas to address the challenges that we, as internists, face in today’s healthcare environment.

In summary, I had a valuable and humbling experience in serving on the BOR. My term provided a unique perspective regarding the creation of College policy, while being able to meet and work with an outstanding group of College dignitaries.

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Leadership Day

ACP Leadership Day on Capitol Hill was held May 24-25, 2011. Bob Vegors, MD, FACP, Jackson, Gena Kluwe, MD FACP, Paris, Elizabeth Bray, MD, FACP, Murphreesboro, Ryan Mire, MD, FACP, Nashville, Ken Olive, MD, FACP, Johnson City, Ravi Parikh, third year medical student, Vanderbilt University, and Earl Stewart, second year medical student, Meharry Medical College comprised the Tennessee Chapter delegation. Leadership Day is an annual event sponsored by ACP designed to equip members to be more effective advocates. The event features educational presentations on effective advocacy and current policy issues. One of the featured speakers was Congressman Phil Roe of Tennessee’s first congressional district, an OB/GYN physician from Johnson City. At the awards banquet Dr. Bob Vegors was recognized as one of the top 10 Key Contacts of the year. This recognizes his work as an effective advocate on both the state and national levels within the ACP Key Contact program. Perspectives of the two medical students participating in Leadership Day follow:

As a student much of your time is spent studying books and learning how to be a doctor. Attending Leadership Day allowed me to become part of the conversation on health policy and begin shaping my big picture view of healthcare. It allowed me to embark on a path to be part of the solution in the U.S.’s health care system and attempt to improve not just individual lives but that of our communities as a whole. Of course I quickly learned that health policy work is a long and tough road, but it is so important to have a student physician perspective. Not only does Leadership Day allow you to join the conversation with Congressmen, Senators, and Legislative aides, but members of Congress appreciate the opinion and views of students. Members of Congress view students as future physicians who genuinely care about patients and are not lobbyists. My time at Leadership Day was a great learning experience and also a lot of fun. I was able to meet mentors as well as peers with similar interests and add to my understanding of healthcare as a whole. My time at Leadership Day has even inspired me to pursue further education in health policy and management so I can further involve myself in improving the health of future patients. Ravi Parikh MS3, Vanderbilt University

The 2011 ACP Leadership Day was a stellar event where physicians and medical students from around the United States participated in advocating and lobbying congressmen and senators on issues of significance to the American College of Physicians. Most of the May 24 and 25 events took place at the Liaison Hotel on Capitol Hill, where briefings, seminars, and receptions took place on Tuesday in preparation for all Capitol Hill visits on Wednesday. As a medical student participating with my delegation for the first time, to be involved in the event was such a wonderful opportunity, having the chance to understand better how organized medicine works and how the decisions made by the United States Congress affects the everyday practice of internal medicine. While representing the state of Tennessee, I had the distinct pleasure to meet and visit with legislative aides, senators, and representatives themselves during the visit to Washington, D.C., and spoke particularly on the issue relevant to increasing discretionary spending to crucial workforce programs such as the HRSA’s National Health Service Corps Scholarship and Loan-Repayment program, indicating how necessary this program is and why mandatory appropriations to it should be maintained or augmented under the auspices of the recently ratified Affordable Care Act. Other issues discussed include making necessary changes and improvement in the Medicare Sustainable Growth Rate (SGR) formula and Tort and Malpractice Reform legislation. Overall, the experience was what I hope to be one of many to come in the future as all 130,000 members of the ACP work tirelessly and continually to advocate for excellent healthcare resources and improved access to healthcare for all of our patients. Earl Stewart, Jr. MS2, Meharry Medical College

2011 Leadership Day Goetz

Elizabeth Bray, Earl Stewart, John Goetz, Bob Vegors, Ravi Parikh, and Gena Kluwe in Senator Corker’s office. Mr. Goetz is Senator Corker’s legislative assistant

2011 Leadership Day Botanical Gardens

Ravi Parikh, Ken Olive, Earl Stewart, Bob Vegors, Elizabeth Bray, and Gena Kluwe enjoy a break in the U.S. Botanical Garden between congressional visits

2011 Leadership Day Top 10 Key Contacts

Bob Vegors and others being recognized as Top 10 Key Contacts. Dr. David Fleming, at left, Chair, Board of Governors, holding Moon Pie presented to him by Dr. Vegors

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Evidence-Based Legislation

Bob Vegors, MD, FACP

After over a decade of making the annual ACP May migration, I have attended my last ACP Leadership Day – not because I am done with advocacy, but because ACP is finally changing the name to something more appropriate. My personal favorites are the “Congressional Best Practices Convention”, or perhaps the “ACP Evidence-Based Legislative Forum”. As if we have scientific studies about legislation! How silly!

But we do! They are written in the public health statistics of the United States and other industrialized countries as they have tried different healthcare solutions during the last 50 years. They are the basis of ACP position papers for the last decade advocating healthcare reform and universal coverage. And they are written on the worried faces and check book stubs of the patients in my office and yours.

Legislation affects patient outcomes as much as the prescriptions we write. Just as we do risk/benefit analysis for various therapies in the hospital or office, so ACP does risk/benefit analysis on pieces of legislation. Let’s take the recently passed Affordable Care Act as an example. Some risks are failure to fix SGR, no public option, and an oversight board without guaranteed physician representation. Some benefits are an end to onerous pre-existing conditions, improved standardized coverage for every American, and a lower final cost after several years. And to make it more difficult for the Washington ACP office, the legislation was a chameleon-like moving target during the weeks before final passage. No piece of legislation is perfect – certainly not this one. And yet there are numerous strong points in the final legislation that clearly reflect the goals for healthcare reform that ACP has been advocating for the last decade. And so we support it, knowing it is not perfect. Just as every day we write prescriptions for medications, knowing that they too are not perfect.

During his convocation speech at the ACP meeting in San Diego ACP President Ralston spoke of a man in his own practice whose colon cancer was diagnosed too late because of poverty. Fred said the memory of that terrible outcome haunted him. It should haunt all of us. Because if we look closely, people with similar stories are in my waiting room and in yours.

Bad legislation begets bad outcomes, and good begets good. Which is why each of us must be as well-versed in legislative matters as we are in preventive care guidelines. Thomas.gov or a similar search engine should be as familiar to us as Epocrates. And it needs to begin in residency. Knowledge is power, and that power can be used for the good of our patients through a well-timed e-mail to a congressman or senator using the ACP website advocacy section. And in so doing, ACP will continue to be a most powerful advocate for the welfare of our patients – with the help of each of us.

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2011 Reading Retreat

Mark Anderson, MD FACP

The Tennessee-ACP Reading Retreat, 2011 (number XXIV) was held on March 4–6 at beautiful Fall Creek Falls State Park. The topic this year was Migrations, Place and Identity. The topic is a reflection of the fact that more and more of our patients as well as we physicians who take care of them are immigrants. The cultural background of our patients has always been important, especially in Internal Medicine, but has increasingly become crucial to take into account as we see more patients from a different culture from our own – and many more different cultures than ever before.

To focus this discussion, we read the following: the novels Remembering Babylon by David Malouf, and How the Garcia Girls Lost Their Accents; the short story collection Who’s Irish by Gish Jen and an essay by Salmon Rushdie, short stories by Amy Tan and Anita Desai and poems by Alberto Rios. In often beautiful prose, this incredible selection of writers was able to render for us riveting descriptions of the trauma of adjusting to a new and different culture. Our in-depth discussions during the conference enabled us to drill down into this adjustment process much more extensively than we ever could in an office visit with a patient. The discussions were furthered enlivened by some of the participants own family experiences as children of immigrants. There was general agreement that our future patient interactions will be enriched by the insights gained during our discussions.

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Nominating Committee

ACP has a well-designed governance process in which the Board of Governors plays an important role. As such, the selection of Governors is critical to the success of ACP. The selection of new Governors is a well-defined process which begins well in advance of beginning a term of office. My term as Governor ends at the conclusion of the Internal Medicine 2013 meeting and the process of electing the next Governor begins now. A nominating committee consisting of three past Governors (Steve Miller, MD, MACP, Mack Land, MD, MACP, and Fred Ralston, MD, MACP) and one member of the Tennessee Council of Young Physicians (Gena Kluwe, MD, FACP) received ten nominations from the voting membership of the chapter. The two selected as nominees who will be on the ballot are Richard Lane, MD, FACP and Ryan Mire, MD, FACP. These names will be forwarded to the ACP national office which will conduct the actual election process. The election and announcement of results will be in the fall of this year. The individual selected is considered the Governor-elect Designee until the end of Internal Medicine 2012 when they will begin their year as Governor-elect. During this year the Governor-elect participates as a non-voting member of the Board of Governors to understand their responsibilities and works alongside the Governor on a transition list to understand chapter function and management. Fulfilling the responsibilities of Governor requires on average 5-10 hours per week.

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2010 Chapter Excellence Award

Chapter Excellence Award Logo

The Tennessee Chapter is in receipt of the 2010 Chapter Excellence Award! The award recognizes chapters which successfully meet the standards for managing a chapter. In order to achieve the Chapter Excellence Award, chapters must meet all basic criteria and seven optional criteria. Criteria include such activities as formulating an effective Governor’s Council and committees, communicating frequently with membership, providing educational opportunities, recruiting and advancing members and celebrating membership through local awards. I would like to extend a special thanks to those chapter members who assisted me in all of these endeavors! For their hard work and dedication, we received this award.

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Tennessee Council of Young Physicians

Reena Kuriacose, MD, FACP, Chair

The Tennessee Chapter Council of Young Physicians (TCYP) officially began in September 2008. The purpose of this Council is to address the needs and issues that affect the young physicians (defined as within 16 years of graduating medical school) across the state and to enhance their professional development through ACP. The council has two representatives from the four regions of the state and a chairperson.

The Council has four members actively participating in the ACP TN Chapter Planning Committee, with Monique Forskin-Bennerman, MD, FACP, being the Chair of that committee, thus enabling young physicians’ representatives to have an input in the TN chapter meeting. Two of the representatives, Jason Hayes, MD, FACP, and Reena Kuriacose, MD, FACP, received the LEAD (Leadership Enhancement and Development) certificate at the National meeting held in San Diego 2011. This is an excellent leadership development program and details about it are here.

A dinner talk on MD ABC's of Billing by Brad Canada was organized in April of this year and was well attended. A picnic, the “Spring Fling,” was organized in May. Council member Gena Kluwe, MD, FACP, represented the TCYP in the ACP's Leadership on Capitol Hill in May 2011.

We hope that more ACP members will be interested and actively involved with the TCYP activities in future and help us to reach out to more physicians and address young physicians concerns to improve their quality of life and enable them in their professional careers.

The Council’s activities can be followed on Facebook and Twitter.

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2011 Chapter Meeting Program Committee

Monique Forskin-Bennerman, MD, FACP, is serving as program chair for the 2011 Chapter Scientific Meeting to be held October 13-15, 2011 at the Nashville Airport Marriott. The Thursday evening program will focus on medical students and residents including a poster competition and Doctors’ Dilemma (Medical Jeopardy). The Friday and Saturday programs will include on sessions on acute stroke management, resistant hypertension, cancer screening and identifying the distressed physician among others. Robert Doherty, ACP Senior Vice President for Governmental Affairs and Public Policy, will make a presentation on health care reform “The Elephant in the Room.” Breakout sessions will include workshops on ECG interpretation, pain management, and smoking cessation. Saturday afternoon following the meeting two ABIM Self-Evaluation Program (SEP) modules will be presented by Jim Lewis, MD, FACP and Catherine Clarke, MD, FACP. Bob Centor, MD, FACP, a member of the ACP Board of Regents, will present an update from the College. Other members of the program committee include Tracey Doering, MD, FACP, John Fowler, MD, FACP, Jason Hayes, MD, FACP, Victor Kolade, MBBS, FACP, Reena Kuriacose, MD, FACP, Ayodeji Oso, MD, FACP, Mukta Panda, MD, FACP, and Mario Ray, MD.

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ACP/Society of Hospital Medicine Educational Program

A significant number of general internists now practice primarily hospital medicine. About 5% of the members of the Tennessee Chapter identify themselves as hospitalists. This likely underrepresents the actual number as the ACP database allows only one specialty designation and many practicing hospital medicine are likely to identify themselves as general internists or subspecialists. Recognizing the increasing role of internists who practice as hospitalists and believing that the American College of Physicians should serve as the unified voice for all of internal medicine, the Governor’s Council has supported efforts to increase hospitalist involvement in chapter activities. John Fowler, MD, FACP, Memphis has coordinated these efforts. Working with Saint Thomas Health Services and Steve Embry, MD, the chapter cosponsored a program “2011 Collaborative Care: What an ACO Needs to Maintain Stability of the Patient with Advanced Congestive Heart Failure” in Nashville on April 28, 2011. Drs. Steve Embry and Amanda Salanitro were the speakers. The 28 attendees evaluated the program highly and encouraged future such collaborations between the ACP and SHM.

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Internal Medicine 2011

Internal Medicine 2011, ACP’s national meeting, again excelled as the nation’s premier internal medicine educational meeting. Over 100 member of the Tennessee Chapter participated. Our own Fred Ralston, MD, MACP, presided over the meeting as the culmination of his exciting year as ACP President. Dr. Andrew Todd of UT-Chattanooga won the national associates research competition. The Vanderbilt Doctors’ Dilemma team represented the Tennessee Chapter in the competition, defeating teams from Northern California, Ontario, and Panama, before falling to the U.S. Army team in the “elite eight” round of the competition. Reena Kuriacose, MD, FACP and Jason Hayes, MD, FACP received LEAD certificates in recognition of their completion of the ACP Leadership Development program. The convocation was an inspiring event lead by Dr. Ralston. As discussed below Drs. Ralston, Miller, and Overholt were recognized with the awarding of Masterships. New fellows participating in the convocation included: Yasmine S. Ali, MD, FACP, Elizabeth S. Bray, MD, FACP, Renata A. Drabik-Nowak, MD, FACP, Sister Mary Diana D. Dreger, MD, FACP, Hany M. Habashy, MBChB, FACP, Frederick Junard, MBBS, FACP, Gena Kaye Kluwe, MD, FACP, Philip S. Kuo, MD, FACP, Reena Kuriacose, MD FACP, J. Suzanne Moore, MD, FACP, Ann H. Price, MD, FACP, and Russell A. Wilke, MD, FACP. Dr. Gena Kluwe discusses this below in her article, “I think you’re going to need a larger hat…” Bob Vegors, MD, FACP also participated as the recipient of the Tennessee Chapter Laureate Award. Several chapter members participated in judging the medical student and associate posters. Friday evening the Tennessee Chapter joined the Kentucky, North Carolina, and South Carolina Chapters for an enjoyable reception. Internal Medicine 2012 will be held in New Orleans. It is not too early to start planning to attend now.

Ralston Opening

Fred Ralston MD, MACP, ACP President, presiding over the opening ceremony

LEAD Hayes

Jason Hayes, MD, FACP receiving his LEAD certificate from Ryan Mire, MD, FACP, National Chair Council of Young Physicians, and Charles Cutler, MD, FACP, Chair, Board of Governors

LEAD Kuriacose

Reena Kuriacose, MD, FACP receiving her LEAD certificate

Doctors Dilemma Bracket

Doctors’ Dilemma bracket showing the Tennessee team reaching the “Elite Eight”

Convocation

Members of Tennessee Chapter getting ready to march in Convocation

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I Think You’re Going to Need a Larger Hat…

Gena Kay Kluwe, MD, FACP

After the Fellowship application process had been completed and submitted, I was thrilled to learn of my election to Fellowship in ACP September 1, 2010. It was so exciting.

Recalling that day when as an intern my program director passed out to us “gentlemen” applications to the ACP with instructions to complete them so we could enter posters in the University of Rochester’s poster competition and hopefully, go onto the State or higher level, I read, with awe, the levels of membership, noting that my program director was a Master in the College. It was at that point that earning Fellowship in the College became my goal.

After becoming a Fellow, I excitedly placed FACP after my name, causing an immediate flurry of, “What’s that?” in the hospital.

Receiving, via email, the invitation to participate in the Convocation Ceremony in San Diego at the ACP’s Annual Session in April 2011, then immediately accepting, the next step was to order regalia. Not wearing hats on a regular basis, I was stymied by the hat sizes. Speaking with someone in customer service, who guided me through a process wherein one enlists the services of a tape measure to collect data on the exact circumference of one’s head, we decided that my head was larger than I thought, or at least larger than the previous regalia required as faculty in 2000 and ordered what would probably be the correct size for my head.

Arriving in San Diego for the ACP Annual Session there were many things to do and naturally, scientific courses to attend, but ultimately, culminating in a time where at long last I picked up my regalia. “How does it look?” I asked the man distributing the regalia. “I think you’re going to need a larger hat.” Luckily, he promptly provided me with a slightly larger size. Undoubtedly, the pride with which I was so filled by becoming a Fellow had further increased the size of my head.

Suitable regalia in hand, official photographs taken, my name discovered on the “Wall of Fame”, fellow Tennesseans assembled for the processional into the Convocation Ceremony. The Masters took the stage first. Then came the Fellows from all over the world, often with very elaborate regalia from their home countries. All so very proud!

The richness of the experience, the colors, the excitement, cannot be captured in words. It was, to me, more exciting than medical school graduation. To be a Fellow in the most prestigious medical association the world over is quite an honor indeed.

If I ever need to wear a cap again, I may need a larger size.

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Participating in the ACP Associates Research Poster Competition

William Andrew Todd, DO, Chief Resident
University of Tennessee College of Medicine - Chattanooga
Erlanger Medical Center

Todd Pugh's Poster

Andrew Todd, DO, ACP Associate and Matthew Pugh, medical student, with their national award winning research poster.

This year a medical student (Matthew Pugh) and I were afforded the opportunity to attend the national meeting of the American College of Physicians (ACP) in San Diego, California with a generous scholarship provided by our Tennessee chapter of ACP. Matthew and I were also allowed to present and compete in a research poster competition amongst some of the best and brightest internal medicine residents from all over the country. After the judging, we were able to network with future colleagues with similar interests. The remainder of the conference offered so many topics that it was sometimes difficult to choose. Between lectures, the exhibit hall proved invaluable to investigate employment opportunities, office equipment, and practice tools such as several types of electronic medical records. When the exhibit hall was exhausted, the skills lab was an interesting departure from passive didactics and allowed hands on learning in almost all inpatient and outpatient procedures that an internist utilizes. Our Tennessee Chapter welcomed all of its members in a special meet and greet session for networking amongst other Tennesseans. On the final night, the winners of the various poster competitions were announced and I was honored to accept first prize for my research poster. The experience was incredible and I greatly appreciate the generous support of the Tennessee ACP for our attendance.

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Membership Summary as of May 23, 2011

Masters-15
Fellows-484
Members-1013
Associates-298
Medical Students-400
Total: 2210

New Masters

Tennessee was fortunate to have three of its members selected for recognition with Mastership this year. Mastership is one of the highest honors which can be bestowed by the college and recognizes outstanding contributions to the profession over the course of the career. Only about 50 Masterships are awarded by the College per year. This year Dr. Stephen T. Miller, Memphis, former Governor of the Tennessee Chapter, Dr. J. Fred Ralston, Fayetteville, Immediate Past President of ACP, and Dr. Bergein F. Overholt, Knoxville received their Masterships during the convocation at Internal Medicine 2011.

New Fellows
(since November 2011)

Olusegun V. Ategbole, MBBS, FACP, Jackson
Gerry N. Boccarossa, DO, FACP, Blountville
Sister Mary Diana D. Dreger, MD, FACP, Nashville
J. Suzanne Moore, MD, FACP, Memphis
Philip S. Kuo, MD, FACP, Nashville
Igor Puzanov, MD, FACP, Franklin
Mark S. Rasnake, MD, FACP, Knoxville
Russell A. Wilke, MD, FACP, Nashville
Ahmad J. Abu-Halimah, MD, FACP, Murfreesboro
Yasmine S. Ali, MD, FACP, Nashville
Nancy J. Brown, MD, FACP, Nashville
Matthew L. Perkins, MD, FACP, Murfreesboro

New Members
(since November 2010)

Goran Antic, MD, Brentwood
Sydney M. Hester, MD, Nashville
Asha R. Kallianpur, MD, MPH, Nashville
Karen Knowles, MD, Nolensville
Janet Lubas, MD, Jefferson City
Muhammad Mudassir Mirza, MD, Memphis
Madubueze U. Nwozo, MD, Brentwood
Obaidur Rahman, MD, Knoxville
Donna Regina Shell, MD, Hendersonville
William H. Smith, MD, Ooltewah
Gregory A. Szych, DO, Jackson
Lawrence H. Yoo, MD, Nashville

Deceased Members

John B. Breinig, MD, Nashville, 07/19/2010, Vanderbilt University School of Medicine
Robert T. Doster, MD, FACP, Nashville, 10/18/2010, University of Tennessee, Health Sciences Center, College of Medicine
Thomas J .White, Jr., MD, FACP, Memphis, 06/26/2010, University of Tennessee, Health Sciences Center, College of Medicine

Visit the Chapter web site

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Contact Information

Richard G. Lane, MD, FACP,
Governor, Tennessee Chapter

Renee Arnott
Executive Director
Ph: 615-460-1657
E-mail: renee.arnott@tnmed.org