Governor's Newsletter, Summer 1999

What We Hope to Accomplish

I look forward to the next four years with eagerness over what we might accomplish and a bit of trepidation over what it will entail. The merger with the American Society of Internal Medicine has brought the American College of Physicians into a more conspicuous role with the socio-economic issues that affect internists and our patients. In Virginia we will strive to ensure that the College remains an influential and respected voice in Washington and in Richmond. We will also remain attentive to the College's traditional role in the continuing education of physicians. Hopefully, on both fronts we will have energy and innovation. Ideally, you and your patients will come to feel that we have accomplished something worthwhile.

Periodically, this publication will be used to inform you of our endeavors and their progress; to solicit your ideas and opinions; and to strongly encourage your active involvement in the College in any one of a host of different venues.

For this first issue, a look at what the College is striving to do amid a rapidly evolving healthcare system is a timely topic:

  • The College supports the intent of the Quality Healthcare Coalition Act of 1999, HR 1304, sponsored by Reps. Campbell (R-CA) and Conyers (D-MI) which would create an antitrust exemption to allow physicians to collectively negotiate with a health plan or insurer. The ACP-ASIM support is predicated on language in the bill to prohibit collective action by physicians that would deny or limit services to patients and/or result in price fixing.
  • The College has recommended that 12.6% of the projected federal budget surplus be used over the next five years to expand access to healthcare coverage. These funds will be used for:

    a. A refundable tax credit for uninsured Americans whose incomes fall between 100-150% of the poverty level;

    b. Extending Medicaid to provide coverage to all Americans with incomes up to 100% of poverty;

    c. Expanding funding for Medicaid enrollment outreach programs to make already- eligible individuals aware of their eligibility for coverage under Medicaid; and

    d. Provide federal subsidies for temporarily unemployed and uninsured persons to obtain coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA) program.

  • The ACP-ASIM supports legislation that provides protections for individuals in all types of health plans, that physicians make medical necessity determinations and that health plans are accountable in a court of law for medical decisions that may result in death of injury to a patient. The ACP-ASIM supports legislation that:

    a. increases patient's choice to ensure all managed care enrollees a point-of-service option;

    b. prohibition of "gag clauses" that restrict communications between patients and physicians;

    c. mandatory timely internal review processes and opportunities for independent external review by qualified physicians when patients are denied services by their health plans; and

    d. coverage of emergency room services by health plans if a "prudent layperson" would reasonably believe that an emergency medical condition existed.

  • In anticipation of Medicare restructuring, the College opposes any "premium support" programs that would provide beneficiaries with a fixed number of dollars in the form of a voucher with which to purchase private health insurance coverage. The College feels that many beneficiaries would not be able to afford the difference between the sum provided to them and the actual cost of insurance. The College feels that the elderly and disabled should be guaranteed coverage regardless of health status or income. A "premium support" program would adversely effect lower income beneficiaries. The College also opposes advancing the age of Medicare eligibility, as such legislation would simply increase the number of uninsured Americans. The ACP-ASIM does support a requirement that higher income beneficiaries contribute more to the program through higher premiums in an effort to help preserve the overall solvency. Lastly, the College also believes that with the expansion of the Medicare-eligible ranks with the arrival of the "baby boomers," Medicare's solvency cannot be preserved simply by cutting costs. The ACP-ASIM supports the administration's proposal to devote 15% of the budget surplus to Medicare. Congress may also need to consider increasing Medicare payroll tax and/or increasing the annual contribution out of general revenue to Part B.
  • The College opposes removing funding for direct costs of graduate medical education from the Medicare Trust Fund. Replacing the currently stable source of funding for residency education and training with a process that would subject it to political pressures and the vicissitudes of the appropriations process would potentially do irreparable harm to medical education. Americans of all ages, not simply Medicare recipients, are dependent upon well-trained physicians for their healthcare. Thus, the ACP-ASIM supports an All Payor System for funding of GME. Included in proposed legislation in the House of Representatives is a 1% fee on all health plan premiums and self-insured plan funds to provide a portion of the funding for graduate medical education. Similar legislation has been proposed in the Senate.

To emphasize the College's stand on these issues, approximately 115 members of the ACP-ASIM from 38 states met with elected representatives in Washington on May 26. Representing Virginia were: Munsey S. Wheby, MD, FACP (Charlottesville), Paul Dallas, MD, FACP (Roanoke), Philip T. Rodilosso, MD, FACP (Arlington), Michael Hattwick, MD, FACP (Annandale), Sarah T. Corley, MD, FACP (Arlington), John F. Cary, MD, FACP (Manassas), John Daniel, III, MD, FACP (Richmond), C. Delp Givens, MD, FACP (Newport News), Thomas J. Manser, MD, FACP (Norfolk), William T. Powers, MD, FACP (Marion), and Jeffrey P. Harris, MD, FACP (Winchester). Meetings were held with Senator Charles Robb, Senator John Warner's legislative staff and the Congressmen or their legislative staffs from 10 of Virginia's 11 legislative districts.

The College enjoys enormous political capital in Washington and is served admirably by a full time Washington staff headed by Alan Nelson, MD, FACP, former Executive Director of the American Society of Internal Medicine and President of the American Medical Association. The staff prepares summaries on these complex issues to help Governors assimilate a working knowledge of them. Much of the above material was garnered from their work. Over the next four years we hope to develop additional means of adding Virginia's voice to the College's efforts in Washington. Similarly, we will try to become more instrumental in Richmond with legislation and regulations that affect the quality of your practice life and affect the healthcare of your patients.

Jeffrey P. Harris, MD, FACP
Governor, Virginia Chapter

Virginian's on a National Stage

  • Munsey S. Wheby, MD, FACP ­ former Governor of the College for Virginia was elected Chair of the Board of Governor's of the ACP-ASIM.
  • Oscar E. Edwards, MD, MACP ­ Mastership was awarded by the College to Oz posthumously. Oz had served as Governor, Chair of the Board of Governors, and Regent of the College. Accepting the award was his wife, Betty.
  • Michael Thorner, MB, DSc, FACP ­ Chair of the Department of Internal Medicine at UVA received the John Phillips Memorial Award for Outstanding Work in Clinical Medicine.
  • Richard Wenzel, MD, FACP ­ Chair of the Department of Internal Medicine at MCV received the James D. Bruce Memorial Award for Distinguished Contributions in Preventive Medicine.
  • Ryan D. Mire, MD ­ a medical resident at MCV, won the Clinical Vignette Poster Competition at the ACP-ASIM's Annual Session in New Orleans. His presentation was "Methemoglobinemia In An AIDS Patient: A Common Presentation With An Uncommon Diagnosis."
  • Andrew Magnet PhD ­ Medical student from MCV was elected as Chair of the Council of Student Members.
  • The Evergreen Award was made to the Virginia Chapter of the ACP-ASIM for the educational format "Multiple Small Feedings Of The Mind," which was developed in Virginia and has become for the last two years, a mini-course at the College's Annual Session featuring faculty from Virginia's medical schools. The program directors for "MSFOTM" program for the 2000 Annual Session in Philadelphia will be Kathleen A. Stewart, MD, Mark D. Schroeder, MD, FACP, and Douglas B. Kiem, MD from Winchester.

Resident and Fellow Career Counseling Program

In a recent survey conducted by the American Medical Association, 22% of graduating internal medicine residents reported significant difficulty in finding a practice position, 12% received only one job offer and 21% reported that the offered salary was lower than expected. While this study has been criticized for methodological flaws, including low response rates and reporting bias, the fact remains that physician career counseling has been neglected in an era of increasing need.

ACP-ASIM is stepping up to fill this need. The Departments of Education and Career development and Advertising Services have collaborated to create an online resident and fellow career counseling program. This program will be valuable to individual residents and fellows as they prepare to enter the job market during their last year of training, and to program directors and department heads wishing to create a career counseling curriculum for their trainees.

The Career Counseling web page consists of a series of articles that addresses tasks that need to be completed during the last training year, or presents data critical to making informed career decisions. The informational articles are organized along a time line, representing the last twelve months of training. The articles are presented on the time line at those points when the resident should be performing the task, or when the information is most likely to be useful in making career decisions. Regardless of when the article is presented on the time line, residents and fellows may select any article for review that catches their interest or fulfills a given need. Examples of available articles include "Planning a Career Strategy"; "Types of Practices"; "Workforce Issues"; "Practice Data"; "Writing a Resume or Curriculum Vitae"; "Soliciting Letters of Recommendation"; "Tips for the First Interview"; "Malpractice Insurance"; and others. Each month, a new task oriented or informational article is added to the time line, enriching the resource.

As an additional service, an e-mail contact form will be available to residents and fellows who have additional questions. The ACP-ASIM staff will answer the questions, or refer them on to other experts.

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.

Requirements

  • 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.

Pathways

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" are also available online.

Council Members for the Virginia Chapter

Awards Committee

William T. Powers, MD, FACP (Marion)
Russell D. Evett, MD, FACP (Norfolk)
A. Ashley Futral, MD, FACP (Winchester)

Bylaws Committee

Philip T. Rodilosso, MD, FACP (Arlington)
H. Verdain Barnes, MD, FACP (Norfolk)
Kathleen A. Stewart, MD (Winchester)

Communication Committee

Sarah T. Corley, MD, FACP (Arlington)
John F. Cary, MD, FACP (Manassas)

Educational Committee

A. Paul Dallas, MD FACP (Roanoke)
Michael F. Rein, MD, FACP (Charlottesville)
W. Hal Cragun, MD, FACP (Roanoke)
Cynthia M. Yoshida, MD (Charlottesville)
Capt. Stephen C. Beuttel, MD, FACP (Portsmouth)
Thomas J. Manser, MD, FACP (Norfolk)
Michael B. Edmond, MD, MPH, FACP (Richmond)
Frederick Kozlowski, MD (Winchester)

Finance Committee

W. Benton Lewis, MD, FACP (Martinsville)
Michael F. Rein, MD, FACP (Charlottesville)
Mark D. Schroeder, MD, FACP (Winchester)

Health and Public Policy

A. Paul Dallas, MD, FACP (Roanoke) ­ Chair
William D. Atchley, MD, FACP (Norfolk)
John M. Daniel, III, MD, FACP (Richmond)
Michael A. W. Hattwick, MD, FACP (Annandale)
Laurie J. Lyckholm, MD (Richmond)
Lawrence K. Monahan, MD, FACP (Roanoke)
Mohan M. Nadkarni, MD, FACP (Charlottesville)
Philip T. Rodilosso, MD, FACP (Arlington)
Lawrence M. Stein, MD, FACP (Arlington)
James K. VanKirk, MD, FACP (Lexington)
Stephen M. Zimmet, MD, FACP (Arlington)

Two subcommittees reporting to HPPC:

1. Managed Care

John M. Daniel, III, MD, FACP (Richmond) ­ Chair
Geoffrey W. Viol, MD, FACP (Richmond)
Cyril A. Barch, MD (Winchester)

2. Coding, Payments and Third Party Relations

Steven M. Zimmet, M.D, FACP (Arlington) ­ Chair
Nelson Richards, MD, FACP (Richmond)
Mark D. Schroeder, M.D, FACP (Winchester)

Nominating Committee

K. Kellogg Hunt, MD, FACP (Roanoke)
Michael F. Rein, MD, FACP (Charlottesville)
Philip T. Rodilosso, MD, FACP (Arlington)
T. Eugene Temple, Jr., MD FACP (Newport News)
William Atchley, MD, FACP (Norfolk)
Capt. Stephen Beuttel, MD, FACP (Portsmouth)
John F. Cary, MD, FACP (Manassas)
R. Ron Clark, MD, FACP (Richmond)
Sarah T. Corley, MD, FACP (Arlington)
W. Hal Cragun, MD, FACP (Roanoke)
A. Paul Dallas, MD, FACP (Roanoke)
John M. Daniel, III, MD, FACP (Richmond)
Michael B. Edmond, MD, MPH, FACP (Richmond)
Leon P. Georges, MD, FACP (Norfolk)
C. Delp Givens, MD, FACP (Newport News)
Jeffrey P. Harris, MD, FACP (Winchester)
Michael A. W. Hattwick, MD, FACP (Annandale)
K. Kellogg Hunt, MD, FACP (Roanoke)
Mark A. Kasari, MD (Roanoke)
W. Benton Lewis, MD, FACP (Martinsville)
Andrew Magnet, PhD, (Medical Student, Richmond)
Thomas J. Manser, MD, FACP (Norfolk)
Mohan M. Nadkarni, MD, FACP (Charlottesville)
William T. Powers, MD, FACP (Marion)
Michael F. Rein, MD, FACP (Charlottesville)
Philip T. Rodilosso, MD, FACP (Arlington)
Mark D. Schroeder, MD, FACP (Winchester)
Thomas H. Scott, Jr., MD, FACP (Virginia Beach)
Lawrence M. Stein, MD, FACP (Arlington)
Kathleen A. Stewart, MD (Winchester)
Michael O. Thorner, MB, DSc, FACP (Charlottesville)
Geoffrey W. Viol, MD, FACP (Richmond)
Richard P. Wenzel, MD, FACP (Richmond)
Munsey S. Wheby, MD, FACP (Charlottesville)
Cynthia M. Yoshida, MD (Charlottesville)