Governor's Newsletter—Summer 2000
David C. Dale, MD, FACP
Governor, Washington Chapter
Our Scientific Program Committee for the Annual Meeting of our chapter of the ACP-ASIM, led by Dr. Linda Pinsky, has been very busy over the last few weeks organizing the program for our Annual Meeting to be held at the Seattle Sheraton, October 27-28, 2000. The program will emphasize an evidence-based approach to diagnosis, treatment and prevention of a number of diseases and common problems in internal medicine. Assisting Dr. Pinsky in organizing the program are: Drs. Jan Bridge, Rebecca Ruud, Richard Simon and Paul Sutton. Again this year, we will have our Associates' Competition for the best clinical vignette by residents from the Madigan, Spokane, University of Washington and Virginia Mason programs on Saturday afternoon. This is an exciting finish to the program. I do hope you will come and stay until the winner is announced.
I just returned from four days at our ACP-ASIM headquarters in Philadelphia. I was there for the meetings of the Clinical Efficacy Assessment Sub-committee the Guidelines Committee, the Education Committee and the Executive Committee of the Board of Governors. The College headquarters is growing with a handsome addition under construction now. Philadelphia has become quite an attractive city in recent years, and a new home for the Liberty Bell is being built just in front of the ACP-ASIM headquarters. Spirits at the College are very good under the able leadership of Dr. Walter McDonald. My impression is that the College is currently doing very well and the merger of ACP and ASIM has been consummated without a glitch or a hitch.
Inside the College, a lot is going on. Very recently, Dr. Frank Davidoff, resigned from his position as Editor of the Annals of Internal Medicine. A search for his replacement is underway. At the Education Committee, there was considerable discussion about re-certification. and how it is now required for those passing the ABIM exam, during the last decade. Very active discussions are ongoing with the ABIM toward aking this a satisfying and efficient process.
Patient safety is also being very actively discussed within the College. A number of responses to the report from the Institute of Medicine are being made. There are a number of other interesting and important topics on ACP-ASIM Online (http://www.acponline.org). For example, you will find there the Virtual Annual Session, which allows you to click and get the key points from many presentations at the 2000 Annual Meeting in Philadelphia. It is also an easy place to send a message to your congressional representative. There is now also a useful member directory.
We will be electing the next Governor of our chapter this Fall. A slate is being prepared now by our nominating committee chaired by former Governor, Tom Reis. The other committee members are Drs. Findlay Wallace and Bruce Smith. If you have not done so, please make your recommendations right away. We are also requesting nominations for the Laureate Award to be given at our Annual Meeting to an outstanding member of our chapter. Please send your recommendations to me (see contact information on page 5), or forward to Dr. Neil Elgee at 3621 72nd Pl. SE, Mercer Island, WA 98040.
I do hope that you are having a good Summer, with at least a little time away from the hurry and hassles which fill our days.
Virginia Mason Internal Medicine Residency
Our program graduated 10 excellent internists last week, all of whom are entering clinical practice as generalists. Michael Longo, MD, of our Cardiology Section, was voted "Teacher of the Year" by the entire residency. James Banta, MD, Preliminary Medicine PGY-1 resident, was voted "Intern of the Year" by interns from all programs.
Alumni note:Gary Kaplan, MD, a 1981 graduate of our program, and a practicing General Internist at VM Kirkland, has been selected as CEO of Virginia Mason Medical Center.
On March 20-21, all IM residents with key faculty members attended a second annual overnight retreat at Rainbow Lodge in North Bend. Speakers included John Wynn, MD, on "Physician Burnout," and Todd Pearson, MD, on "The Renewal Cycle." Residents provided entertainment in the form of "Virginia Mason Family Feud" (a genuine hoot!) Evaluations documented the value of refreshing the professional lives of residents. In the residents absence, General Medicine and Pulmonary-Critical Care faculty took great care of inpatients and developed an acute appreciation for the care residents provide our patients.
On June 2, our Continuity Clinic and Ambulatory Block faculty attended the Ambulatory Teaching Skills and Primary Care Procedures CME course at Mt. Baker Community Club. Faculty shared educational workshops with our residents, who were holding their Teaching and Transitions retreat at the same time and location. Faculty representing Country Doctor, Rainier Park, International District and Carolyn Downs Community Clinics, as well as Virginia Mason sites at First Hill, Sequim, Lynnwood, Kirkland, Federal Way, Mercer Island and Winslow, enjoyed the opportunity to meet with other community-based clinical teachers, mix with residents and hone our teaching skills. Similar programs are planned for Inpatient and subspecialty faculty later this year. This program has been facilitated by VM's participation in the national "General Internal Medicine Faculty Development Project," which is cosponsored by your ACP-ASIM.
A fresh group of aspiring internists will appear for orientation this week. After several years of overwhelming interest in primary care, current and incoming residents are increasingly pursuing careers in subspecialty and hospital medicine. We are delighted that our residency carries a full complement of wonderful residents. Nationally however, there is cause for concern that the proportion of excellent US medical students interested in Internal Medicine, and more particularly in Primary Care Medicine, is shrinking.
Roger W. Bush, MD, FACP
Director, Internal Medicine Program
Virginia Mason Medical Center, C8GIM
1100 Ninth Avenue; Seattle, WA 98111
(206) 625-7373, 63380#
Childhood Immunization Rates Top 80%
Provider Survey Examines Missed Opportunities
Collaborative efforts by health care providers and immunization advocates to raise childhood immunization levels in Washington state are paying off. Immunization protection for infants and children less than two years of age reached an all-time high of 81% in 1998, according to the latest CDC data.
State and local public health officials credit health care providers for much of the gains, citing work to raise patient awareness and promote recommended immunization guidelines in their practices.
"Individual provider and practice-setting behaviors are the most important determinant of a child's immunization status," said Maxine Hayes, MD, MPH, state health officer. "The Department of Health (DOH) Immunization Program and Local Health Jurisdictions (LHJs) are working to make vaccines more accessible to the health care provider community, and practitioners, in turn, are taking advantage of opportunities to administer vaccines at the point of patient contact."
Dr. Hayes reported that private providers give approximately 80% of all childhood immunizations.
Providers Are Involved
To learn more about current immunization practices and the use of computerized immunization tracking systems, DOH surveyed members of the Washington Chapters of the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP). Over 75% of their combined 2,472 members responded.
The study found that 99.5% of state pediatricians and family practice physicians would almost always immunize during well-child visits. In more than 90% of these cases, providers are administering multiple vaccines, and the percentage is even higher when the child is overdue for a needed immunization.
The Contraindications Challenge
Still, public health officials and providers agree, there is room for improvement. The study suggests that the number of vaccinations administered falls sharply during chronic and acute medical treatment interactions, with most providers unlikely to immunize if a child comes in sick, even with a minor illness.
Of providers surveyed, 62.8% said they would administer multiple vaccines during a chronic care visit, and still fewer, 39.5%, would immunize when treating a child with an acute condition.
However, the Standards for Pediatric Immunization Practice USHHS (February 1996), which reflect the unified practice guidelines endorsed by AAP, AAFP and ACIP, recommend that only true contraindications be used as a reason not to immunize. These guidelines recommend immunizing during most mild illnesses, including if illness is accompanied by a mild fever.
"Providers often face major barriers to immunization when they see these patients," said Dr. Hayes, acknowledging the medical considerations, patient comfort and parental influences that exist. "Not having accessible vaccine status information about each child and what vaccines they need can be a barrier for busy providers. However, there also appear to be missed opportunities where children could safely receive their needed vaccinations. This is why we need to focus more effort on provider and parent education."
DOH and LHJs statewide are working with provider groups, managed care organizations and health plans to develop such education programs. Currently, DOH offers a number of tools which are available to health care providers to assist in tracking immunizations to avoid missed opportunities and provides materials for educating parents. They include CASA Assessments, the CHILD Profile Registry System and CHILD Profile Health Promotion Materials sent to parents of all newborns born in Washington state.
The AAP/AAFP survey found that the majority of physician immunization providers agreed that computerized immunization systems are, or would be useful, but that few (30.4%) physicians have used, or were using them, at the time of the survey and even fewer (6%) were using CHILD Profile.
Automated immunization registries can assess what vaccines a child needs based on what vaccines have been previously administered. They can also assist providers with reminder and recall notices when vaccines are missed during a visit.
You are invited to get involved. If you would like to receive the DOH Immunization Program newsletter, would like additional information on survey methodology or more detailed survey results, or would like to know more about statewide efforts to increase childhood immunization rates, please call Pat deHart, Epidemiologist, DOH Immunization Program at (360) 236-3537 or contact your LHJ.
Calendar of Events
August 22-23, 2000 ABIM Certification Examination in Internal Medicine
Sept. 21-24, 2000 WSMA Annual Meeting
October 27-28, 2000 Washington Chapter ACP-ASIM Annual Mtg Sheraton Seattle Hotel & Towers, Seattle, WA
December 1, 2000 Fellowship Applications due at ACP-ASIM
March 29-April 1, 2001 ACP-ASIM Annual Session, Atlanta, GA
April 11-14, 2002 ACP-ASIM Annual Session, Philadelphia, PA
Exercise Your Right to Vote
Your vote counts! Exercise your right to vote and have your voice heard this fall when the ballots are mailed to elect the next Governor for your chapter. Candidates willing to serve your interests, represent your thoughts and positions on nationwide issues, and support local activities that will expand and enhance the chapter are running for office.
You are empowered to guide the College's leadership into the new century. It all starts with one little checkmark. Ballots will arrive in November to all eligible voters (Masters, Fellows and Members), including brief biographical information on the candidates as well as vision statements from them. If you don't receive your ballot by the end of November, look in the
Member Connection section of ACP-ASIM Online http://www.acponline.org/private/mbrconn/, to check that the mailing address listed for you is correct. If you did not receive a ballot, you can request that one be sent to you by contacting Joy Crist at 800-523-1546, ext. 2722.
Support the best your chapter has to offer and take a few moments to review the ballot. It's easy. When the ballot arrives, just check off one name and return it in the envelope provided. It's that simple. And you can make a difference.
How To Reach Us
David C. Dale, MD, FACP
U/W, Dept. of Medicine; Box 356422
Seattle, WA 98105-6422
Phone: (206) 543-7215; Fax: (206) 685-4458
2033 Sixth Avenue, Suite 1100
Seattle, WA 98121
Phone: (206) 956-3646; Fax: (206) 441-5863