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During the third week of May 2015, I joined a legion of medical students, residents, primary care physicians, and internal medicine subspecialists on Capitol Hill to advocate for the "House of Medicine". I was particularly buoyed by the presence of several students and residents who were taking early steps through participating in the democratic process to enhance patient care by visiting lawmakers. I would like to briefly highlight some of the initiatives, which were the focus of our visit.
First, we commended Congress for enactment of bipartisan legislation that finally eliminated the flawed SGR formula and moved us toward a new value-based payment and delivery system.
Second, we asked Congress to introduce and pass legislation to continue the current Medicare 10 percent primary care incentive program that is set to expire at the end of this year. This program, which began in 2011, pays eligible internal medicine specialists, family physicians, and geriatricians a 10 percent bonus on designated office visits and other primary care services. It will sunset on January 1, 2016.
Third, we asked Congress to help improve access to primary care for patients enrolled in Medicaid by enacting legislation to ensure that Medicaid payments for primary care and immunization services are reimbursed at no less than what Medicare pays by requesting they cosponsor Senate Bill "Ensuring Access to Primary Care for Women & Children Ac" (S. 737) or House Bill (H.R. 2253).
Fourth, in the area of Graduate Medical Education, we requested that Congress ensure that overall GME funding for FY2016 is sufficient to train enough physicians and urged a GME financing plan though an all-payer system where Medicare, Medicaid and private payers would contribute to GME funding as a public good. We also advocated for passing legislation that will increase the number of GME training positions in primary care specialties (including internal medicine) and others facing shortages, such as in the Resident Physician Shortage Reduction Act (S.1148 and H.R. 2124), the Creating Access to Residency Education (CARE) Act (H.R. 1117).
Finally, you may have heard about the emerging 21st Century Cures legislation by the House Energy & Commerce Committee. This bill would reauthorize funding for the National Institutes of Health (NIH) research and establish an NIH innovation fund, as well as new programs to support young, emerging scientists. It will also support telemedicine as a method of health care delivery and the movement toward true interoperability of health records. We encouraged the House Energy and Commerce Committee to take bold action to address the critical scientific pipeline by increasing funding to the NIH and restoring our global leadership in biomedical research.
All the best in ACP,
Greg Kane, MD, FACP
The Pennsylvania Chapter has announced the retirement of John Derrickson, effective July 1, 2015. Derrickson has served as Executive Director for the past 14 years.
The Governors' decided it would benefit the membership to separate administrative, educational and membership services (our C-3 corporation) from policy and advocacy services (our C-6 corporation.) Beginning July 1, 2015, Specialty Society Management Services (SMSS), a division of the PA Medical Society in Harrisburg, will staff the Chapter's educational and membership and recruitment/retention components. Cicely Elliott will lead the new PA-ACP team.
ERG Partners of Harrisburg, led by John Nikoloff, will administer the management of policy, advocacy and government relations that our PA-ACP Services, Inc. provides for its members. Nikoloff has worked with the Pennsylvania Chapter and led PA internists' advocacy efforts for 28 years.
"PA-ACP is in a position of leadership in Harrisburg on critical issues such as patient safety, GME funding, scope of practice, and quality of care," said Nikoloff. "Along with my partner, Tracy Wingenroth, and Sarah Gulick, ERG's Manager of Public Affairs, we will play key roles on your behalf, working with state and federal officials. ERG Partners looks forward to helping you further strengthen ACP's grassroots advocacy."
If you have any questions about PA-ACP's policies or advocacy activities, contact ERG Partners by email or by calling (717) 233-8606.
PA-ACP Governors selected Specialty Society Management Services (SSMS) a department of the Pennsylvania Medical Society (PAMED) to provide to our C-3 Corporation the needed membership, recruitment, management oversight and meeting planning services, starting July 1.
The SSMS staff will be led by Cicely Elliott, Executive Director and a team that includes Kelley Richwine. Other team members will support them in PA-ACP's governance, communications, meeting planning, membership outreach and retention, and coordination activities.
Please note: as of July 1, 2015, the official PA-ACP email address will be changed to email@example.com and the administrative office phone number will be 888-817-3813.
Elliott introduced her team, saying, "We look forward to collaborating with you all to ensure that the mission, direction, and goals of the Chapter's members and leaders continue to be met, that you are all provided with the continued and proven benefits of ACP membership, including the CME and MOC opportunities, and that the stature of the Chapter continues to grow and develop. While you will mainly see me and/or your meeting manager at Chapter events, remember that you have a dedicated team working on your behalf." "We look forward to hearing from you! Feel free to contact us."
Cicely Elliott, Executive Director
Kelley Richwine, Assistant Executive Director
The General Assembly and Wolf Administration are currently in the annual budget dance, where each excoriates the other while negotiating a final solution, but this year's samba looks different than most. A new Governor who made a novel budget proposal and asked for multiple tax increases is facing a General Assembly controlled by the other party but split in its priorities. This has made the discussions more difficult, and at times quite heated. Republicans are opposing the widespread increases and offering their own plans for reducing property taxes in the state. The likelihood of an on-time budget in 2015 is minimal.
The State Senate has finally begun to confirm Governor Wolf's cabinet nominees, and in mid-May approved Secretary of Health Dr. Karen Murphy, Secretary of Aging Teresa Osborne, and Secretary of Drug and Alcohol Programs, Gary Tennis by unanimous votes. The Senate has yet to vote on Ted Dallas for Secretary of the Department of Human Services or Rachel Levine, MD for Physician General.
The Senate surprised many by passing legislation to legalize medical marijuana for patients with more than a dozen diseases and conditions, and Governor Wolf has said he would sign the bill. But the House has no plans to move the bill at this time. Medical professional organizations have been urging removal of marijuana as a Class I drug, and calling for additional independent studies of marijuana variants for treatment and pain management.
Legislation (SB 717) that would allow certified registered nurse practitioners (CRNPs) to practice as independent practitioners without direction or supervision by a physician has been introduced by Sen. Pat Vance (R, Cumberland). CRNPs have been to the capitol on several occasions pushing for elimination of the current requirement for collaborative agreements. They are focusing on the need for expanded access to care, the lack of primary care physicians, and financial claims to push their agenda forward. PA-ACP supports continuation of collaboration and the agreements within the Patient Centered Medical Home. Look for more information as the bill gets further consideration.
After passage of the SGR fix, a major win for the ACP, priority federal issues include Medicare incentive payments for primary care, Medicaid/Medicare parity, GME funding, support of funding for vital federal health care programs, and 21st Century CURES legislation.
Sixteen PA-ACP members, residents, fellows and students attended Leadership Day in Washington this month, giving PA the largest delegation on hand. We enjoyed a series of good meetings with staff or members in every Pennsylvania Senate and Congressional office and helped move these issues forward. Several Pennsylvania Congressmen have agreed to co-sponsor the legislation.
Kudos to the members who took the time to participate and help educate these public officials! We encourage all members to consider becoming Advocates for Internal Medicine. You can do that online.
PA-ACP's delegation represents Pennsylvania patients and internists on Capitol Hill in Washington during the ACP's Leadership Day, May 20-21, 2015. Delegates urged support of legislation that would improve quality and access to medical care, workforce development.
Pictured above, left to right, are internists Gela Mchedlishvili, Ralph Schmeltz, Amy Davis, John Nikoloff, Arnie Eiser, Larry Jones, Wayne Riley (President, ACP), Christine Prifti, Katherine Clark, Graeme Williams, Greg Kane, Zola Mate, Danielle Krol, and Jonathan Gotfried. Christine Prifti is a fourth year student at Drexel and Katherine Clark is a fourth year resident at Penn. Not pictured are Dan Kimball, Darilyn Moyer and Michelle Matzko.
Dr. Charles Cutler of Norristown, a former Governor of the Pennsylvania Chapter, is presented with the Centennial Legacy award from the American College of Physicians. Presenting the award is PA-ACP East Governor Dan Kimball, MD.
The award is an honor and celebrates ACP's centennial by recognizing one seminal chapter member whose service to the chapter had a significant impact on the chapter's viability. This individual exemplifies ACP's core values including leadership, excellence, respect, compassion, professionalism, and responsibility. Dr. Cutler served as SE Governor from 2006 - 2010. He subsequently served as Chairman of the ACP's Board of Governors and then Chairman of the ACP's Board of Regents.
Clinical Vignette: Beth A Foreman, DO, Penn State Milton S. Hershey Medical Center Novel use of total artificial heart: Terminating refractory arrhythmias in hypertrophic cardiomyopathy
Medical Student: Clinical Vignette Abdul-Razaq Adeniyi, Jefferson Medical College Diffuse lymphadenopathy and weight loss of unknown etiology: A case of HLH in the outpatient setting
Medical Student Clinical Research: Joy Siting Trybula, University of Pittsburgh School of Medicine Autotaxin is an Independent Predictor of Insulin Resistance in Overweight and Obese Females.
I am a third year medicine resident at Temple University Hospital and this year I attended for the first time to the ACP National meeting in Boston. It was a wonderful professional and personal experience, which certainly surpassed all my expectations.
It was exciting to join other colleagues from my program and the region in this national poster competition. This event brings together the great work of hundreds of residents, fellows and medical students from all around the country and even the international medical community. I had the opportunity to share with many of them and learn a little about the most diverse research topics, fascinating cases and various technological advancements in the field from each corner of the country. There were also many opportunities for networking and socializing with other members of the chapter, including the Medical Jeopardy winning team from Einstein Medical Center, other women in medicine and residents.
One of my favorite parts of the event was with no doubt the clinical skills center (Herbert S. Waxman Learning Center). It consisted on a variety of workshops and hands-on sessions ranging from physical exam to procedural skills including lumbar puncture, skin biopsy, central line placement and more. I felt like a kid in a toy store there. Workshops were extremely useful and I learned a lot of physical exam tips: I believe you can never get too good at this.
The educational program of the meeting was extremely rich and I found myself having to choose among the several great presentations that were happening often at the same time. I remember one called "Thieves' market - Fascinating cases" which was excellent. With a non-orthodox presentation, the speaker (Dr. David Scrase) engaged the audience in a journey and a contest to learn about some of the "Zebras" in medicine. I felt lucky learning from the experts. I was particularly interested in the curriculum related to hospital medicine; I found the topics and quality of the presentations to be so good, updated and relevant to my future career that I ended up buying the playback sessions on Hospital Medicine in order listen to the conferences and the pre-courses that I missed. I highly recommend residents and fellows who have the opportunity, plan to experience the ACP National meeting. It was fun, educational and refreshing. I am looking forward to next year's meeting.
Jeydith Gutierrez Perez, MD, is moving to The University of Iowa, where she will be a Hospitalist and Clinical Assistant Professor in the Department of Medicine.
Einstein's unconquerable team celebrated their fourth consecutive national victory and their seventh overall national win at ACP Internal Medicine Meeting 2015 in Boston. Pictured (L to R) team members Jean Bustamante, Chitra Punjabi, and, holding the coveted Osler Cup, Apostolos Perelas. Team alternates, Kene Mezue and Nellowe Candelario are missing from the photo.
A sincere thank you to Team Coaches Guillermo Garrido Rosa and Jedrzej Wykretowicz who led the team to an unprecedented fourth victory. See the separate story of Einstein's climb to the top by Coach Guillermo Garrido Rosa.
The top four teams in the 2015 tournament were: Albert Einstein Medical Center, Walter Reed National Military Medical Center, the Cleveland Clinic, and the University of Washington. The Einstein team won by one point by answering this final question, "Migraines that occur with every menstrual period." The answer was catamenial migraine.
Congratulations to the Einstein Team and all their supporters!!
Doctor's Dilemma, also called Medical Jeopardy, is the ultimate medical trivia contest. This is our trade, skill and craft. After five years on the team, it is quite bittersweet for me to leave. Einstein has a strong Medical Jeopardy tradition: we have accomplished the most trophies in the history of the sport with seven cups, and we are the only team that has won four times in a row. For us, this is a source of pride, joy but also a humbling honor to represent our residency program.
I was initially recruited as a team player and we were runner-ups at the regionals. During my second year, we managed to get our fourth national trophy, and first of this shining stretch, thanks to the addition of two great new players and friends, Drs. Jedrzej Wykretowicz and Praveen Ramkrishnan, but also due to the wonderful coaching of Dr. Riyaj Kasekar. After he left, I had the privilege to use Riyaj's method to coach the team to three more victories, along with Jedrzej. We were also proud to welcome new star players such as Chitra Punjabi, Apostolos Perelas and Jean Bustamante.
We always get approached by many people, inside and out of the competition, asking what our secret is, how do we "do it". Of course we will never reveal our formulas and recipes. However, I am proud to say that our key to success is a mixture of passion, dedication, hard work and support from our peers. We are competitive, we are zealous knowledge seekers, we have fast minds, good memories and fast buzzers. We practice consistently, we mock each other, we challenge each other. We rely on many residents and attendings of all ranks that make questions for us, spar with us, take our pictures, cheer for us and support us in every possible way with tribal loyalty. We never underestimate any opponent and we always go out to do our best. We strategize, anticipate and adapt to the changes of the game format.
Frequently people ask us: "Do you think being Jeopardy elite makes you better doctors?" Although we have differing views on this, I believe undoubtedly it makes us better people. It makes us more humble as we realize how much we have yet to know, it makes us more driven and selfless as we play for glory and not personal gain. We have bonded not only as a team, but with our peers and supervisors in the program in a way we wouldn't have otherwise. The experiences and memories of our travels and outings while at the ACP nationals will be cherished and prized by us forever. It also makes us grateful, as we see and feel the group that is standing by us from high leadership to rank and file, to non-medical staff who stop us in the hallways to congratulate us with a warm smile. We have had the fortune to count on spouses, family and friends who are along for the ride just to be a part of something special. Who knows, maybe we have been made better as doctors as well.
This year, Boston was the latest chapter in a familiar saga. We wrestled through regionals and the Pennsylvania state competitions only to qualify for the grueling Nationals affair. In an almost masochistic fashion, we participate in a face-off with 40 plus teams, where natural selection gets vividly displayed at high speed. The ritual is the same. We fly into town, check in, and then search the hotel for a place to study as a group. Sometimes we sneak into an empty conference room, sometimes we lay siege in the lobby, ignoring probing and reproaching glares from the other guests. We send a scout to figure out our draw for the tournament and locate the time and venue. Morning practice, nerves. Lunch, more nerves, go to the venue. Utter our war cry: "No Retreat, No Surrender", Warm up, play, fight, win. Brief bliss, check out the night life, oh wait, second round tomorrow… more nerves. Rinse, Repeat.
This experience has enhanced our academic life, and these fond memories and relationships have complemented our professional and personal lives in a marvelous way. We have expanded our horizons in many areas and have visited wonderful cities and places. I can't overstate the gratitude we feel toward our leaders, families and spouses, colleagues and friends, and the Pennsylvania chapter of the ACP for all the support we have received. I leave now, knowing the team is in good hands and with strong new blood to carry on the torch.
You get joy, you get pride, you get friends, you have fun: What is Medical Jeopardy?
(Guillermo A. Garrido Rosa, MD, now starts a Pulmonary/Critical Care fellowship at Stanford.)
My journey to the national ACP poster competition in Boston began quite unexpectedly several months earlier, on a quiet Saturday in a hospital nestled in the heart of Harrisburg. The morning was a blur of poster presentations and lively discussions with judges and fellow competitors. As the poster competition winded down, we shuffled to an adjoining lecture hall for concluding speeches and announcements. I was awakened from my reverie by my name being announced as the winner. Winner of the Quality Improvement portion of the poster competition! "Congrats on going to Boston!" I heard as the announcer shook my hand vigorously, and clamorous applause filled the air.
On a cool Boston morning the following April, I hurried to the hotel curb and boarded the ACP conference bus. As it slowly crawled through the morning traffic, I admired the charm of this historic but vibrant city. As I stepped in the convention center, it was abuzz with activity. A throng of attendees had converged on the registration booth, and were attempting to wrestle a spot close to the front to secure a signature canvas conference tote bag and identification badge. I made my way to the elevators and the musical sound of numerous world languages coming together reached my ears. I was able to decipher snippets of French, Spanish, Hindi, maybe? As I began the long trek to the far end of the conference hall to the poster section, I could pick out my fellow poster presenters easily. The long cardboard tubes under the crook of their arms, neat black suit, and their slightly bewildered expression mirrored mine.
I walked through the rows of neatly arranged poster boards and arrived at mine: Number 115. I pinned my poster, and stepped back to admire the colorful display. For a moment, I recounted the months of painstaking data collection and careful analysis. As I glanced over my charts and tables, the final product made me proud. Before long, fellow poster presenters, conference attendees and judges began strolling through the maze of posters. The questions posed by the judges were thought-provoking and insightful. I grabbed free moments to review the work of others, and the scope of research performed by colleagues exceeded my expectations.
That evening as the last rays of sun began to fade, I strolled through the streets of Boston and reflected on my experience. I caught a glimpse of Faneuil Hall in the distance. The dichotomy of a city which played such a pivotal role in American history yet has morphed to a place renowned for advances in innovation, development and scholarship intrigued me. It seemed to be a fitting place to hold a conference which embraced new research, and sought to keep physicians abreast on advances in medicine. I was humbled by the opportunity to represent the Pennsylvania Eastern chapter, and use the results and recommendations of my research to facilitate positive change in the care delivered to Pennsylvania residents.
(Dr. Sooklal just completed her internal residency at Easton, and will be starting a Gastroenterology Fellowship at Drexel University/Hahnemann Hospital in Philadelphia in June 2015. She won first place in the PA poster competition held last November at PinnacleHealth, and presented her work at the ACP's national competition recently in Boston.)
Medical students from Temple and Jefferson coordinated this year's ACP Health Policy Symposium. (L-R) Heidi Mock, Graeme Williams, Adrianna Hitchens, Dani Baurer and Diana Huang. Missing is Gregory Snyder.
We are happy to welcome the following new Southeast members to our Chapter. Please try to attend some of our activities this year. We are looking forward to meeting you.
Jennifer Aldrich, MD, Philadelphia
Deena M. Athas, MD, Philadelphia
Adrianne L Cantor, MD, Gladwyne
Julie Cherian, MD, Philadelphia
Antonette Climaco, Philadelphia
Bevin L. Dolan, MD, Wynnewood
Nancy Finnigan, DO, East Norriton
Gary R. Gilman, MD, Wynnewood
Dan Hoffmanntest, MD, Philadelphia
Faisal Javed, MD, Feasterville
Deborah Ann Fromstein Kahal, MD, Media
Marc J. Kim, MD, Philadelphia
Yu Kuang Lai, MD, Philadelphia
Huiqiu Liu, Bryn Mawr
Ryan McAuley, MD, Philadelphia
Jennifer Nansteel, MD, Villanova
Justyna A. Obara, MD, Broomall
Onyeka W. Okonkwo, MD, Philadelphia
Simona M. Opris, MD, Philadelphia
Shailja Patel, MD, Philadelphia
Amy E. Penza, DO, Philadelphia
Muhammad Ahsan Pervez, MBBS, Feasterville
Nina R. Prabhu, MD, Philadelphia
Sara Peterson, MD, Philadelphia
Nicholas Scharff, MD, Wynnewood
Manjari Sharma, MBBS, Philadelphia
Raya D. Terry, MD, Philadelphia
Sara Van Calcar, MD, Philadelphia
Barbara Westerhaus, MD, Philadelphia
Kai T. Xu, MD, Philadelphia
Thank you to the following members for recruiting their colleagues as part of ACP's Recruit a Colleague Campaign.
Adam J. Albert, MD
Elmer J. Holzinger, MD, MACP
Gregory C. Kane, MD, FACP
Leo J. Motter, MD
Nina Mingioni, MD, FACP
Seth M. Quartey, MD, FACP
Sunjeet Kaur, MBBS
As many of you know, I am retiring on June 30 after 14 very enjoyable years as your executive director. Together with Jackie Franco, my assistant for the past nine years and Joy Crist, our invaluable chapter liaison, we worked with the greatest group of volunteers in the entire American College of Physicians. We continue to be amazed at how many of you volunteer to lead and take part in dozens of activities offered by our Pennsylvania Chapter. We fully appreciate how busy your lives are. Still you find the time to work with our Chapter!
There are too many volunteers to thank here individually. Dozens have chaired our three regional abstract and poster competitions and our regional Medical Jeopardy competitions. Hundreds of volunteers mentor at our many student dinners. But one group of volunteers is very special: the Governors! Being a Governor for the ACP is a demanding, time-consuming and potentially very rewarding four year commitment. During my tenure, I have had the pleasure to work with fifteen Governors. Each represented one of our three regions. Our chapter is very indebted to each of them and I would like to recognize them here: Serving from the Western Region: Ralph Schmeltz, Herb Diamond, Alex Gonzalez, Alan Yeasted and Tom Grau (Tom is Governor-elect until next April, but is already very involved.) Serving from the Eastern Region: Herb Reynolds, Bob Aber, Jack Fitzgibbons, Rich Simons, Dan Kimball, and David George. Serving from the Southeastern Region: Paul Epstein, Chuck Cutler, Darilyn Moyer, and Greg Kane. I have learned so much from these talented and generous internists.
Since I began in 2001, I have had a front row seat to the sea-change in America's healthcare system, and I wonder when we will see the next wave. Many think additional change is needed if we are to match the healthcare results found in other comparable countries. Patients' access to care may have improved, but there are still major hurdles to address. Two worth mentioning are patient outcomes and affordability.
With the passage of time, there often comes a need for new ideas and energy. I know you will have positive change with my successors, SSMS, led by Cicely Elliott and ERG Partners, led by John Nikoloff. Cicely will administer the educational, membership, recruitment and retention, and general administrative activities. John's duties will be enlarged to include all advocacy and legislative activities. He will continue to serve as our lobbyist, a position he has held for most of the last 28 years. I know the Chapter will continue to expand, add value to our 7,500 members, and attract new members.
Farewell and thank you,
September 12, 2015 - Council, Saturday in Harrisburg.
Sept. 30, 2015- WPMS student dinner, Phila.
IMIG dinners - Jefferson and Temple/PCOM in Sept, Oct. Oct. 24, 2015 - PAE regional competition, at Penn State in Hershey, Nicole Swallow is program chair, Simon Mucha is Abstract and Poster Chair, and Brian McAllister is Medical Jeopardy Chair.
Nov. 7, 2015 - PAW regional competition, at UPMC McKeesport in Pittsburgh. Ibrahim Ghobrial is Abstract and Poster Chair, Jen McComb is Medical Jeopardy Chair and Tom Grau is Program Chair.
Nov. 14, 2015 - PAS regional abstract competition at Drexel.in Philadelphia. Allison Ferris is Program and Poster Chair, and David Bernstein is Medical Jeopardy Chair.
December 5, 2015 Saturday, in Hershey, Council, Awards and Jeopardy