Carrie A. Horwitch MD, MPH, FACP
2033 6th Ave Ste 1100
Seattle, WA 98121
Carrie A. Horwitch, MD, MPH, FACP
"Medicine forms a remarkable world unit for hope." Sir William Osler
I recently returned from the National ACP Internal Medicine meeting in New Orleans. The meeting was packed full of fabulous lectures and hands-on venues to increase and improve our skills as physicians. The key note speaker was Dr. Wayne Riley, President and CEO of Meharry Medical College who gave a wonderful and inspirational talk on health disparities in the United States. He challenged us in Internal Medicine to be the leaders of change and reduction of disparities in our own communities. To help us achieve that goal please see the article in this newsletter on what is happening in Washington State. Another highlight was Dr. T.J. Murray, Professor Emeritus Dalhousie University who presented the views of medicine and doctors as seen through the eyes of artists. It was a reminder that our patients do not always view what we do as kindly and benevolent and was an eye opener as to how we might look to a patient in our care. We should continue to be mindful that our patients need our compassion and understanding as much or more than they need our "medicine".
These national meetings always bring new ideas and energy to the work we do as physicians. And they bring new ideas to me of what we might accomplish in our own ACP chapter and community. I hope you will take the time to read about our wonderful committees and the upcoming events we will be having. I also would again like to invite you to be involved." Many hands make light work". We can do activities that advocate for our patients and profession, that can help reduce health disparities in our community, and can foster mentoring for our medical students, residents, and early career physicians. If you want to be more involved or have ideas for an event please contact myself or any of the committee chairs.
In a few weeks we will have Leadership Day in Washington DC where we have the opportunity to speak with our congresspersons and senators about issues that are important for our nation's health. This year may be particularly challenging given the unknown about the Supreme Court ruling on the ACA and the ongoing fate of the Medicare SGR. One of the important factors is that our voices, our stories and our patient's stories need to be heard.
Remember to mark your calendars for our Washington State annual meeting in November 1-3, 2012 at Bell Harbor Conference Center. I look forward to seeing you there. If you have any questions, please email me at firstname.lastname@example.org.
Save the Date - Annual Chapter Meeting, Nov 1-3
**New This Year - MOC Modules
Be sure to mark your calendars for the 2012 Washington State ACP conference. The conference, held at the Bell Harbor Conference Center in Seattle on November 2-3, will cover both inpatient and outpatient topics in a high-yield, case-based format.
Highlights this year include updates in cardiology and pulmonary/critical care, discussions on the legal ramifications of electronic medical records and medical marijuana, and break-out sessions on wound care and diabetes management. The featured talk will be a discussion on health care reform by Dr. Bob Doherty, Senior Vice President of ACP Governmental Affairs and Public Policy. Also, back by popular demand, Dr. Moe Hagman returns to lead associates in Medical Jeopardy.
For the first time, this year we are offering ABIM Maintenance of Certification (MOC) modules on the morning of Thursday, November 1. Faculty will teach the modules by presenting and analyzing each question, reviewing current evidence, and highlighting clinical pearls and key points. This format will be highly interactive with use of an audience-response system. The scheduled modules are the 2011 Update in Internal Medicine (Module C0-L) and 2011 Update in Hospital Medicine (Module 83-L). Participants will leave the session ready to submit completed modules to ABIM for 10 MOC points each.
On the afternoon of November 1, we are offering pre-courses in hospital medicine and musculoskeletal/sports medicine. Each of these pre-courses will provide in-depth, high-yield clinical information for both the inpatient and outpatient internist.
There will be an additional fee to register for pre-courses and MOC modules. More information about the conference will be coming soon from Washington ACP. If you have any questions, please email Chapter Executive Amanda Watne at email@example.com.
Call for Internist Award Nominations
To recognize the outstanding efforts of internists in our state, we need your nominations for the following awards:
* Washington ACP Internist of the Year
* ACP Community Service Award
* ACP Golden Apple Award
Please take a few minutes to tell who is deserving of a recognition award from their colleagues. Click here to write in the name of your nominee(s), along with a brief statement why this person should be considered for the chosen award. Or send your nominations and comments to Paul Smith at firstname.lastname@example.org. The deadline for submitting your nomination is August 31, 2012. Awards will be presented at the Washington Chapter ACP Annual Meeting, November 1-3, 2012 in Seattle, Washington.
Membership Committee Report
by Kemi Nakabayashi MD FACP, Membership Chair
Spring for ACP means annual meeting and the next membership cycle! This year is a great time to encourage new membership as Internal Medicine 2013 returns to the west coast-San Francisco next April. Please renew your membership, if you have not taken the time to do so already. Also check out the ACP membership page online for the Rewards and Recognition programs:
Applying for fellowship is streamlined by the online application option. Recruit-A-Colleague again allows for credit for each new member recruited towards your following year's membership dues. Our chapter is also rewarded for each new member recruited through the Recruit-A-Colleague program. Particularly useful ACP benefits include IM board recertification preparation and free patient education materials ordered through the ACP Foundation. In addition, ARNPs are now eligible in addition to PA-Cs for affiliate membership in ACP. Please direct your mid-level colleagues to the non-physician healthcare professionals membership page.
The WA chapter executive council is working toward more grassroots involvement across the state to have informal gatherings, ACP-sponsored CME activities, and representation for advocacy efforts. Please feel free to email your suggested topics, venues or any other ideas to email@example.com and check out the WA chapter page of the ACP website also.
Council of Young Physicians
by Lili Yao MD, CYP Chair
Your Council organized an event in March. Dr. Viral Shah spoke about "Wealth-building For Young Physicians". Here is what I heard from this talk - Most, if not all, physicians earn an income that puts them in the top 10% of income earners, and more than 25% of physicians earn an income that puts them in top the 1% of income earners. Surprisingly, this high income does not translate into being wealthy - as physicians and dentists combined make only 4% of millionaire investors. One can think of many reasons why such a discrepancy exists.
A simple principle is more important than investing in complicated investment structures or tax saving vehicles - "Save more and spend less". As physicians, we ask our patients to live a healthy lifestyle, exercise more and eat less salt. Personally, I tend to believe that lifestyle choices make more impact on my patients. The same principle applies to wealth-building. The road to riches starts with us changing our personal choices and habits.
I thank you for your attendance and a vibrant Q&A session.
I welcome your comments and suggestions for future events at a venue near you. Please email me at firstname.lastname@example.org.
Osler Club News
The Osler Club Continues to Grow in 2012! As we expand our membership, we're also working to expand our scope of activities.
The 2011-2012 school year has brought with it a lot of new energy and new faces to the Osler Club. We are very pleased to welcome new first- and second-year medical students to our board, including Amy Chang, Alexandra Graham, Steven Levitte, Amy Kennedy, Sarah McGuffin, Sheridan Reiger, and Greta Tubbesing.
Read the Osler Club Newsletter
Women in Medicine News
by Linda Bavisotto MD FACP, WIM Committee Chair
One last event in the continuing "Dim Sum Around the Sound" series is planned as an opportunity for informal gathering before summer arrives, open to all women physicians. These events are no-host, drop-in, informal conversation cafes, which have been taking place every other month (even numbered months) on the first Saturday of the month. We've diversified the locations each time, to make it as convenient as possible to a wider number of women physicians living around the Puget Sound region. We generally reserve a table or two in advance (please RSVP to the contact number below if you know you can join us, but do come even if you haven't had an opportunity to RSVP.) Please mark your calendars for the next event in June which will take place in Issaquah:
Saturday, JUN 2 at 10 AM: MACKY'S DIM SUM RESTAURANT
317 Gilman Blvd, Ste 43, Issaquah, WA.
Restaurant phone: 425-391-7200Particular specialties are their dumplings and barbecue items. The owners of Macky's previously ran China Gate Restaurant in Seattle's International District. A map and driving directions will be posted to the ACP chapter website. Please RSVP to Kemi Nakabayashi at email@example.com
Note also that the City of Issaquah Farmer's Market will be running that day, from 9 am-2 pm, in the Pickering Barn: 1730 10th Ave. N.W., Issaquah, WA 98027, across the street from Costco - You might want to take in both events while visiting Issaquah! The City of Issaquah Farmer's Market features live music, a description can be found at: http://www.ci.issaquah.wa.us/page.asp?navid=2394
A small but lively group attended the April dim sum event at Zen Garden in Mill Creek, WA. We are grateful to Kemi Nakabayashi, MD FACP, who has been organizing and coordinating these events.
The WIM Organizing Committee is adding a few new members from eastern Washington, and will be meeting soon to plan our next presentation event. There is interest in having a forum concerning mid-career transitions, as well as career re-entry for internists who have taken short or long leaves from work for various reasons, to include stories, experiences, and suggestions from physicians who have navigated these waters successfully. Please email me if you have any questions or suggestions at Bavisotto@comcast.net
Welcome New Members
We are pleased to welcome the following new members since January 2012.
Mary S Badger, DO - Spokane
Vishal Chaudhary, MD - Bellingham
Ranu Choudhary, MD - Bellevue
Catherine A Ehlen, MD - Seattle
Margaret Lynn Green, MD - Seattle
Emily Hanson, MD - Seattle
Grace Hercl, DO - Richland
Eric C Hisken, MD - Mercer Island
Xuewei Huang, MD - Seattle
Ken P Lee, MD - Olympia
Rebecca Kathryn Over, DO - Seattle
Catherine A Parkman, MD - Port Townsend
Culbert Serrano, MD - Seattle
Leslianne Yen, MD - Seattle
Jeanie C Yoon, MD - Seattle
Congratulations New Fellows
We are pleased to announce the new Fellows in Washington Chapter since January 2012.
Maqsood A Bhatti, MD FACP - Aberdeen
C Jeffrey Bulva, MD MS FACP - Rosemount
Lisa A Chiou, MD FACP - Seattle
Tinsley Coble, MD FACP - Seattle
MAJ Paul M Faestel, MC USA FACP - Steilacoom
Sean D Fennessy, MD FACP - Seattle
John N Klim, MD FACP - Spokane
Johannes Koch, MD FACP - Seattle
Joyce K Lammert, MD FACP - Seattle
Edward E Leonard, II MD FACP - Kirkland
Leo S Morales, MD FACP - Seattle
Murali K Nair, MBBS FACP - Bellevue
Galen R Sorom, MD FACP - Wenatchee
Jude Gerard D Verzosa, MD FACP - Auburn
Zhimin Zhai, MD FACP - Mercer Island
Vaccine Advisory Committee News
by Justin R. Ortiz MD, Vaccine Advisory Committee
The Washington State Department of Health received an Affordable Care Act Adult (ACA) Immunization Grant to focus on adult immunization. One of the goals of this grant is to improve healthcare worker immunization rates and learn more about healthcare worker vaccination policies and practices in clinic settings.
We need your input. We want to learn more about any policies or practices your office/clinic has in place regarding healthcare worker immunization. We are also interested in any offices/clinics that are using evidence based interventions to increase adult immunization rates, such as reminder recalls, standing orders, provider assessment & feedback on vaccination coverage.
If you would like to share your work please email firstname.lastname@example.org
Thank you so much for your time.
Update in Internal Medicine in Spokane a Success!
by Matt Hollon MD MPH FACP
With support from our Washington ACP chapter, the Spokane Society of Internal Medicine held it's 63rd annual Update in Internal Medicine at the Spokane Convention Center on February 24-25, 2012.
Our ACP Chapter's support contributed to the success of the meeting. Nearly 200 attendees and over 30 ACP members heard outstanding talks across a breadth of topics.
With a special meeting focus on managing diabetes and obesity in the face of the current epidemic, attendees heard from regionally and nationally renowned speakers including Dr. Carol Wysham, Dr. Paul Ciechanowski, Dr. Irl Hirsch, and Dr. Ken Fujioka.
In a special session sponsored by the Stier Foundation, Dr. Karen Lee, New York City's Director of The Built Environment discussed important public health approaches to tackling the obesity epidemic. In another special session sponsored by the Shikany Foundation, we welcomed Dr. Steve Schroeder, Past President of The Robert Wood Johnson Foundation and currently the director of The Smoking Cessation Leadership Center at University of California, San Francisco.
On Saturday, ACP governor Carrie Horwitch, MD MPH gave a provocative and well received talk on ACP's initiative, "High Value Cost Conscious Care". This year's meeting also featured updates in pain medicine, critical care medicine, endocrinology, and cardiology as well as general internal medicine sessions for both hospitalists and primary care physicians.
All in all, the meeting proved to be an outstanding opportunity for both hospital-based and office-based internists to update their medical knowledge and earn 12.5 Category I AMA PRA CME credits. Most notably, ACP members received discounted registration so the value of the meeting (cost per credit of CME) was exceptional.
MARK YOUR CALENDARS - Next year's Update in Internal Medicine will be held on Friday, February 22, 2013 at the Spokane Convention Center. Next year will see the meeting move to just one day of exceptional learning so plan ahead and stay the weekend to take advantage of Inland Northwest skiing at one of the 5 major resorts within two hours of downtown Spokane!
If you have ideas about other ACP activities you would like to see in Eastern Washington don't hesitate to contact Governor Horwitch email@example.com or Executive Council members Jeff Clarke firstname.lastname@example.org (Wenatchee) and Matt Hollon email@example.com (Spokane).
Health Care Disparities in Medicine
by Ali Thomas MD MPH, Group Health
Several years ago, a subtle, yet unforgettable experience reminded me we physicians are not truly color blind. Walking into the hospitalist work room, I saw two patients who arrived the prior night with acute coronary syndrome. Coincidentally, one turned out to be a white man, and the other an African-American woman.
I discharged the white patient the very next morning. He was in his early 50s, active, and besides the fact he had a worrisome family history, he had no other risk factors. He had normal coronaries on catheterization the day of admission. Both he and his wife were effusively grateful.
My other patient, a very pleasant woman in her late 40s, strived to conceal her anxiety from ongoing chest discomfort the prior night, as she waited for a pharmacologic stress test. She had five risk factors and a CABG at age 34. Late that night, after her pain grew relentless, her nurses summoned the cardiologist from bed. Thirty hours after the catheterization, her study showed three-vessel disease requiring a repeat bypass.
Two people, both insured, arrived at the same time, to the same hospital, with the same complaint, and were seen by the same physicians but received completely different care, diametrically opposite their medical indications. Although we recognize gender differences in cardiac care, this was also a case of racial heath inequity.
Race does matter in American medicine.
We know inequities exist. In 2001, the Institute of Medicine noted that racial differences in health outcomes are consistent across the entire range of diseases and healthcare services. By definition, this means differences in care despite insurance status, income and education, severity of illness, and other known causes.
We're learning why inequities arise. In videotaped vignettes, physicians were less likely to refer black women for cardiac catheterization than whites or black men (1)
. The difference was certainly unconscious: residents referred fewer hypothetical black patients with acute MIs for thrombolysis, in proportion to measures of subconscious bias (2).
Despite our competence, and despite our compassion, we somehow treat minority patients differently than whites. We've allowed "colorblindness" to blind us.
What can we do about this?
Nationally, twin Federal initiatives, the Accountable Care Act and the National Partnership for Action to Reduce Racial and Ethnic Disparities, might provide the greatest answer to disparities in a generation.
Within Internal Medicine, our challenge-rather, our opportunity-is admitting, identifying, and solving racial and ethnic differences in patient care. But ignoring inequities based wholly on race and ethnicity jeopardizes the health of the millions we collectively serve.
We want to make a difference. Let's start the conversation.
If you are interested in joining ACP efforts to address health inequities please contact Amanda Watne at firstname.lastname@example.org
or Dr. Carrie Horwitch at email@example.com Ali Thomas, MD, MPH, currently at Group Health Cooperative, was a 2010-2011 Mongan/Commonwealth Fund Fellow in Health Policy at Harvard (formally, the Harvard University/Commonwealth Fund Fellowship in Minority Health Policy).
1. Shuman KA, Berlin JA, Harless W t al.The effect of race and sex on physicians' recommendations for cardiac catheterization. N Engl J Med 1999; 340:618-626.
2. Green AR, Carney Dr, Pallin DT et al. Implicit bias among physicians and is prediction of thrombylysis decisions for black and white patients. J Gen Intern Med 2007; 22:1231-1238.
Washington State Public Health Update
by Maxine Hayes MD MPH, Washington State Department of Health
The pertussis epidemic continues to increase quickly in our state. As of May 12, reported cases jumped by 200 in a week for a total of 1,484 reported pertussis cases this year, compared to 134 last year during this same time. It's the highest number of reported cases in more than six decades. We expect this epidemic to continue for several months.
In early April I shared information on recommendations for vaccination, testing, and treatment. The Department of Health continues public outreach and education to encourage vaccination and raise awareness about the seriousness of this disease.
We need your help!
Here's what we're asking you to do:
* Offer pertussis vaccine to everyone who lives with or cares for an infant. Women are now recommended to get the Tdap vaccine while pregnant (after 20 weeks gestation).
* Make sure you and everyone who works in your clinics is vaccinated against pertussis.
* Use the state immunization registry to check the status of your patients and vaccinate them if they are not up-to-date.
* Recall patients who need a Tdap shot - the immunization registry can help you do this.
* Continue to test and treat suspected pertussis cases.
Information for health care providers and the public are on our new 2012 Pertussis Epidemic web page. Materials like posters and parent fact sheets about the disease are available in English and Spanish. Weekly updates on reported cases are posted to our agency website on Tuesday afternoons around three o'clock.
If you have questions, call your local health agency or contact our Office of Immunization and Child Profile (OICP@doh.wa.gov), 360-236-3595.
Thank you for your continued help in reducing the spread of this disease.
Important News from National ACP
e-Prescribing Program Update
In late February, ACP began hearing concerns from members regarding the e-prescribing penalty:
- Members who believed they met the criteria for a hardship exemption and applied for it were having the 1% penalty deducted from their Medicare payments
- Members who completed the required number of successful eRx transactions to avoid the penalty and had the necessary documentation (EOBs) were having the 1% penalty deducted from their Medicare payments
CMS has created a "QualityNet Help Desk" to address these problems, but some members were reporting difficulty contacting this site, while others were not satisfied with the outcome produced from contacting this site. In response, ACP has developed an eRx Complaint Center where members can report their problems regarding the eRx penalty implementation if they were unable to satisfactorily resolve them through the CMS QualityNet Desk. Members are advised to submit the "E-Prescribing Complaint Form" to the eRx Complaint Center at ACP. ACP staff will review the complaints received and contact CMS regarding those complaints that appear valid based upon the evidence provided.
ACP also developed an overview of the 2012 Medicare eRx program, including details regarding the CMS e-Prescribing Program exceptions and the hardship exemptions.
"Choosing Wisely" Campaign"
The ABIM Foundation in cooperation with nine specialty societies including the ACP has developed the "Choosing Wisely" campaign. This has resulted in each of the nine specialty societies creating a 'Top 5' list. These lists include the top five things in each of these specialty areas that physicians and patients should question. This is a list all primary care physicians should familiarize themselves with. The list is on the ABIM Foundation website and can be accessed here.
2012 Calendar of Events
June 6 & 7 ACP Leadership Day, Washington D.C.
Sept 7 & 8 What's New in Medicine, Tri-Cities
Nov 1 Inpatient and Outpatient MOC Modules, Seattle
Nov 1 Sports/Musculoskeletal Medicine &
Hospital Medicine Precourses, Seattle
Nov 2 & 3 WA-ACP 2012 Scientific Meeting, Seattle