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June 2011 CDR Mark L. Dick, MD, FACP

Dr. Dick

Governor's Desk

Welcome to the Spring/Summer 2011 re-designed newsletter. I have several tremendous announcements to share with the Chapter. The Navy Chapter has received the John Tooker Evergreen award for Resident to Staff Transition Symposium in the category of Associate activities. The award will be formally presented at the chapter meeting in San Diego. The chapter was last presented with an Evergreen award in 2004. This year, the Chapter committee reviewed 19 nominations from 16 of the 71 chapters. The Navy and New York chapters were the only chapters that did 2 award packages. LT Brent Lacey from Naval Medical Center San Diego was selected to be the Uniformed Services representative to the Council of Associates. The Navy chapter’s excellence continued at Internal Medicine 2011 with LT Michael Wagner’s clinical vignette poster being recognized as a Top Ten vignette.

I would like to thank CAPT Jeff Cole for his leadership of the Chapter over the past 4 years. A partial list of the Chapter’s and Jeff’s achievements include: 4 Chapter Excellence awards (for a current string of 10 consecutive awards), the recent John Tooker Evergreen award, 3 members advanced to Masters (RADM Brian Monahan, CAPT(ret) Angeline Lazaraus, and CAPT(ret) John Mitas), 53 chapter members advanced to FACP and a growth in chapter membership. Although he has stepped down as Governor, Dr. Cole will continue to serve as the chairman of the College’s Credentials Committee. Back at his duty station Naval Medical Center Portsmouth, CAPT Cole has been fleeted up to become the Director for Quality Management and CDR Jeffrey Winebrenner has succeeded him as the Chairman of Medicine.

I realize that I have big shoes to fill, but fortunately I have a great group of past Governors and the Governor’s Council to ask for advice. I have been involved with the American College of Physicians since 1992 when I attended the Missouri Chapter meeting. Ever since, I have been hooked with numerous Chapter meetings, national meetings, and MKSAPs. My term goal is to make and keep the Chapter your professional home. About 55 % our members and Fellows are ex-Navy physicians. Sixty-five percent of the active duty internists and about 40 percent of the reserve internists belong to the American College of physicians. These statistics help to remind me that my constituency is very broad. I would like to better involve our members’ talents who have had tremendous achievements, including Professors of Medicine, extensively published academicians and a Chief Medical Officer of 1,171-bed, tertiary-care teaching facility. I am looking at mentorship opportunities to involve our membership. The chapter is looking at establishing a Council of Young Physicians. I have sent out a survey to gauge out young physician’s interests.

The Spring Board of Governors Meeting occurred in San Diego just prior to Internal Medicine 2011. Executive Vice President & Chief Executive Officer of American College of Physicians Steven E. Weinberger, MD, FACP, presented the College’s fiscal year 2011-2012 strategic plan. The priorities include:

  • To be the premier synthesizer and distributor of education and information
  • To be the professional home for all internists (specialists, subspecialists and hospitalists) through focused and customized membership development
  • To define and communicate the unique value of internal medicine
  • To support changes in the U.S. health care system that improve patient care, improve health and promote cost conscious care.

Toward these goals is the on-going College initiative High-Value Cost-Conscious Care (HVCCC). In the February 1 issue of Annals of Internal Medicine, “Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care from the American College of Physicians” is the first article in this series. Some of your facilities have used ACP’s Medical Home Builder to evaluate your practices. The College is updating this program to Medical Home Builder 2.0. There is also an on-going critical analysis and re-working of Physicians' Information and Education Resource (PIER).

Deputy Assistant Secretary of Defense for Clinical and Program, Warren Lockette, MD addressed the Board of Governors to discuss the Military Health System and TRICARE. He highlighted National Naval Medical Center’s Internal Medicine Medical Home’s achievements; including a 39.5% reduction in emergency room visits and improvement of continuity from 56.6 to 75.3%. He discussed areas of collaboration between the 9.6 million TRICARE beneficiaries and the College including: patient safety and quality, primary care, physician training, research and global and rural medicine. The College’s Leadership recently met with the Deputy Director of TRICARE Management Activity, RADM Christine S. Hunter, MC USN FACP to discuss collaboration opportunities.

One approved resolution is of particular interest to our chapter. The BOG recommended that Regents allow members of ACP military chapters to maintain membership in both a military and a state chapter, with the understanding that the member will pay chapter dues to both chapters and choose one chapter as primary for the purpose of membership accountability. No action has yet been taken by the Board of Regents.

Internal Medicine 2011 had many highlights for me. I would like to share some tidbits from the keynote speech. Dr. Richard J. Baron, MD, MACP, former Chair of the American Board of Internal Medicine Board of Directors, delivered the keynote address "Medicine as Practice: What Do We Need to Keep and What Do We Need to Leave Behind?”. During his presentation he compared his modern practice to that of a 19th century physician, Dr. Wister, who practiced in his same area. The types of treatment may be vastly different, but there are striking similarities in professional demands.

He referenced a study done jointly by ACP and ABIM which showed “21% of internists with an internal medicine-only certificate were not practicing clinical medicine ten years after completing their training. That’s a 21% ten-year professional mortality rate for general internists! The aging population and the decline of those going into general internal medicine means that over the next 20 years the ratio of folks over 65 per general internist will go from about 500 today, up to 1,242

He compared Dr. Wister’s 30 house visits a day to the modern physician’s practice demands from his publish work derived from his looking at an average day’s workload in his office practice.

type of service

He also talked about practice re-design from the aspect of quality of care. He discussed “The Break Even Point: When medical advances are less important than improving the fidelity with which they are delivered.” Again asking the rhetorical question posed by the authors Woolf and Johnson, “how much better a new drug would have to be to help more people than improving the rate at which the existing drug is delivered? Internists argue over the benefits of rosuvastatin over simvastatin, but are we reliably getting any statin to patients who need it?”

Congratulations to the following Navy internists who were selected for Captain:

CDR Adam Armstrong, MC, USN, FACP, NNMC Infectious Disease
CDR Timothy Burgess, MC, USN, Naval Research Center
CDR Patrick Clyde, MC, USN, FACP, NNMC Endocrinology
CDR Nancy Delaney, MC, USN, FACP , NMCP Rheumatology
CDR Kathyrn Elliott, MC, USN, FACP, Amphibious Squadron ONE
CDR Jonathan Groh, MC, USN, FACP, NAS Jacksonville/VP-30
CDR Christopher Lewis, MC, USN, NH Pensacola Pulmonary
CDR Matthew Lim, MC, USN, FACP, World Health Organization Geneva
CDR Kyle Petersen, MC, USN, FACP, NAMRU-6 Lima
CDR William Shimeall, MC, USN, FACP, NNMC Internal Medicine
CDR Alfred Shwayhat, MC, USN, FACP, USS CARL VINSON (CVN-70)
CDR Theron Toole, MC, USN, NH Camp Pendleton
CDR Jeffrey Winebrenner, MC, USN, FACP, NMC Portsmouth Internal Medicine
CDR Kimberly Wyatt, MC, USN, NNMC Gastroenterology

I have one historical note to share. I am not sure that many of the younger members of our chapter know that not too long ago there were four Navy Internal Medicine residency programs. There are not too many alumni of Naval Hospital Oakland or Oak Knoll still on active duty as it closed in April 1996. The building was eventually sold and fell into neglect. The hospital building was imploded this April.

It is my pleasure to serve as your Governor. I am always happy to hear from you. My email is: mark_dick@yahoo.com.

I look forward to seeing you at the Chapter Meeting in San Diego October 6th-8th, 2011.


2011 Navy Chapter Scientific Meeting

The meeting planning committee has planned another exceptional meeting. The 2011 Navy Chapter meeting will be held at the Westin San Diego in downtown San Diego, California from October 6-8. This year’s meeting theme is: “Navy Internal Medicine 2011: Navigating the Course”.

Meeting highlights:

  • Updates from experts in the latest developments in hepatitis C, antibiotic resistance, advanced cardiac imaging, hypertension, rheumatic disease, bariatric surgery, and sleep-related disorders
  • A pre-course procedural workshop for general internists including skills stations for shoulder and knee arthrocentesis, central line placement, and lumbar puncture
  • One on one meetings with the non-surgical specialties detailer
  • Presentation by College Regent Robert Gluckman, MD, FACP of the John Tooker Evergreen Award.

The full program [PDF] is available on the chapter website.

Meeting registration is online.

The Chapter Awards Dinner will be held on Saturday evening, October 8 at the US Grant Hotel in San Diego’s historic Gaslamp Quarter. Attendees can indicate their plan for attending the dinner when registering at the Henry M. Jackson Foundation at www.hjf.org/events. Electronic payment for the awards dinner can be made through PayPal to nicole.gunn@med.navy.mil.

The military uniform of the day is Summer Whites at the meeting and Dinner Dress Blues or Service Dress Blues for lieutenants and below at the Awards Dinner. For non-military members, the dress code is business casual.


Update from National Naval Medical Center

Academic year 2010-2011 at NNMC Bethesda has flown by. We started off on one side of campus and ended up on the other. We began with 2 parking garages and ended up with 5. We began as NNMC and will end up as WRNMMCB (Walter Reed National Military Medical Center Bethesda). We started off with fresh faces and ended up with great friends!

The NNMC Internal Medicine Residency Program continues to excel through the final stages of integration with Walter Reed. Current Program Director, CAPT(sel) William Shimeall, will lead the new program into the future as the new program director for the combined WRNMMCB’s Internal Medicine Residency Program. CAPT(sel) Shimeall’s new team of Associate Program Directors (CDR Colleen Dorrance, MAJ Josh Hartzell, MAJ Jeff LaRochelle, LTC William Kelley, LTC Travis Richardson) and upcoming chief of residents, LT Scott Hopkins and Army CPT Brian Cohee, have been hard at work designing a new training program from the ground up which will be one of the largest training programs in the military.

We participated in the National ACP Scientific Meeting this April in San Diego, CA where our housestaff were well represented at the meeting as attendees and as poster presenters. Posters were accepted for presentation by: LT Jeff Levine (PGY3), LT Joseph Lopreiato, Jr. (PGY1), LT Brandon Peterson (PGY1), LT Mike Kavanaugh (PGY3), and LT Kerry Meagher (PGY2). In addition, six housestaff will be presenting at the District of Columbia’s ACP meeting in June. As you can see, housestaff at NNMC continue to be active in medical education and research - our dedicated staff and program leadership make all of this possible.

Congrats are in order for new members of our military family since the last newsletter. LT Cicely Dye’s baby boy Vincent, LT Stacy Chronister’s baby boy Cade, LT Jace Mattingly’s baby girl Caelis, and my wife, Michaela and I welcomed our baby girl Alivia!

We have continued to incorporate operational experiences into our training program. Earlier in the academic year LT Jeff Levine (PGY3) was onboard USS IWO JIMA (LHD-7) where he cared for hundreds of patients in Guyana and Surinam. He later spent a month doing epidemiologic research at Naval Medical Research Unit #6 in Lima, Peru. This summer LT Vernon Mackie (PGY2), LT Hampton Crimm (PGY2), and LCDR Lynn Byars (class of 2010) will be deployed onboard the USNS Comfort for Operation Continuing Promise 2011.

As this year comes to an end we say goodbye to our graduating senior residents and our interns going to serve the Navy on GMO, FS, or UMO duty.

NNMC Interns: LTs Wesley Campbell, Geoffrey Cole, Joseph Lopreiato Jr., Michael Monson, and Daniel Seeger will be a part of the new WRNMMCB PGY2 class. LTs Nikunj Bhatt and Olamide Oladipo will be a part of NMCP’s PGY2 class. Graduates going into residency include LT Regine Reimers (Neurology at WRNMMCB), LT Brandon Peterson (Pathology at NMCSD), and CPT Jameson Voss (Preventive Medicine at USUHS). LT Steven Elek will serve as a GMO at Fallon NAS, Nevada. LTs John Evans, Marshall Hoffman, Patricia (Pitter) Hogan, John (Jace) Mattingly, and Brian Toupin will be joining the Flight Surgery community at NAMI Pensacola, FL. LT Colin Young is headed north to Groton, CT for UMO training.

NNMC Senior Residents - A number of residents will be serving as staff internists around the world: LT Melissa Butts NH Pensacola, LT Stacy Chronister NHCL Corpus Christi, LT Jeffrey Levine NH Yokosuka, Japan, LT Steven Shelden USS Pearl Harbor San Diego, CA, LT James Stanton NH Jacksonville and LT Joseph Zeman NH Guam. Graduates going into fellowship include LT Ashley Jackson (Infectious Diseases), LT Peter McIntyre (Endocrinology), and LCDR Lou Moyer (Pulm-Crit Care) – all at WRNMMCB. LT Scott Hopkins will serve as Chief of Residents (Navy) for the new WRNMMCB Internal Medicine program.

We also say goodbye to our Associate Program Director LCDR Mark Corriere who will be starting Endocrinology fellowship at Johns Hopkins University in Baltimore, MD. LCDR Corriere’s outstanding clinical acumen, bed side manner and teaching abilities will forever be instilled in the heart and minds of the future of Navy medicine.

We bid them all farewell and best of luck in their future endeavors.

It has truly been an experience of a lifetime serving as your NNMC Internal Medicine Chief of Residents for the past academic year. Because of all of you, I feel that I am a stronger clinician, academician, counselor, and most importantly – shipmate. I will carry all of this into my new duty assignment at the Office of the Attending Physician, US Capitol.

Go Navy!

LT Rahim Remtulla, MC, USN, ACP Associate
The last NNMC Internal Medicine Chief of Residents!


Council of Young Physicians Survey

The chapter would like to have our young physicians’ input regarding how our activities suit their needs. Specifically, we would like to know is there interest in establishing a Navy Council of Young Physicians. The Army and Air Force chapters have a Council of Young Physicians. The ACP defines a Young Physician as within sixteen (16) years of their medical school graduation. However, this definition would cover most of our Navy active duty physicians. Instead, Army and Air Force chapters have used an alternative definition of physicians 5 years out of training as a group with special needs.

Navy physicians are generally in more remote locations and face the decision on whether to reenlisted or to leave the service. We think that a council might fill a professional gap and offer mentoring opportunities. I have sent an email to those physicians in the first 5 years as a member. Review and complete the survey.


Internal Medicine 2011

Forty-four chapter members joined over 9,200 others in attending Internal Medicine 2011 which was held at the San Diego Convention Center from April 7-9th, 2011. During the Convocation Ceremony, over 650 fellows were inducted into the College. As Chair of the Credentials Committee, CAPT Jeff Cole introduced the fellows and led them in the ACP Pledge. Our colleagues, Christina Malekiani, Ryan Maves, and Arthur Pemberton were advanced to Fellows of the American College of Physicians. RADM Brian P. Monahan, MC USN was awarded Mastership in the College.

Our Associates and all 3 residency programs had a strong presence at the meeting. The following associates presented their posters:

Associates and Posters

The Navy’s Doctor’s Dilemma team--LTs Michael Wagner, Jennifer Cunningham and Sarah Wied—from Naval Medical Center San Diego took it down to the wire in final jeopardy losing to the New Mexico chapter in their first round elimination. LT Brent Lacey was quickly put to work helping the Council of Associates run the Doctor’s Dilemma competition.

Not only did our chapter members attend the conference, but one of our own presented. CAPT Eric Holmboe, Chief Medical Officer and Senior Vice President for Quality Research and Academic Affairs, American Board of Internal Medicine, participated in a panel discussion entitled, “Misconceptions about Maintenance of Certification”.

The College returns to the Big Easy for Internal Medicine 2012. The session will run April 19-21, 2012.


Medical Student Activities

The District of Columbia, Maryland, Army, Air Force and Navy chapters recently sponsored the 8th Annual “Medical Students' Steps to Success” meeting hosted by USUHS. This meeting encourages medical students to choose Internal Medicine. This forum consisted of lectures, poster competitions, and hands-on workshops which were attended by approximately 130 students.

Twenty percent more students participated in this April’s meeting compared with last year’s meeting. Forty-four students competed in the poster competition. Congratulations to the following students for their winning posters:

Nathan Bennion, Virginia Commonwealth University -- First Place, Clinical Vignette
Andrea Levine, University of Maryland -- Second Place, Clinical Vignette

Minghao Liu, Johns Hopkins -- First Place, Clinical Research

The Navy Chapter would like to thank MAJ Jeff LaRochelle for coordinating this highly successful meeting!


Update from Naval Medical Center Portsmouth

The residents at NMCP have continued to “ride the wave” of their successful start of AY 2010-2011 and are now reaping the rewards of all their hard work.

Our Doctor’s Dilemma team comprised of LT Michael Wagner (R3), LT Jen Cunningham (R2), and LT Sarah Wied (R1) enjoyed the opportunity to travel to the National ACP meeting and represent the Navy in San Diego…and we only missed progressing out of the first round by a single question. That competition was just a warm up for LT Michael Wagner who also presented his clinical vignette, “When Cultures Fail - PCR Gets to the Heart of the Matter,” which was recognized as one of the TOP TEN vignettes in the country!

Not to be outdone at the National ACP meeting, LT Stacy Coulthard (R3) and LT Patrick Daly (R2) presented their clinical vignettes at the National Society of General Internal Medicine meeting in Phoenix and LT Laura Habelow (R3) presented her vignette at the National Kidney Foundation meeting in Las Vegas. LT Adrienne Lopata and LT Susanne Francis also attended the meeting for moral support.

Our program innovations continue with the successful creation of a Night Float team earlier this year. We recently initiated a new system of admitting patients to our general ward teams; each of our three ward teams are now taking admissions every day of the week. Known affectionately as “Dan’s Drip” (ceftriaxone not included), after our rising Chief of Residents, LT Dan Bowers, it creates a more continuous workflow on each of the ward teams, while also allowing continuity of care between the patient and admitting intern in spite of the upcoming work hour restrictions. LT Bowers is also capitalizing on the TEAM-based approach instituted this year by reorganizing the residents into “squads”, with a plan to allow for more resident ownership and responsibility over scheduling of inpatient rotations, outpatient clinics and leave requests. We’re enthusiastic that his plans will be very successful and create a tight-knit group of teammates.

I have no doubt that as our graduating residents move on to do great things, whether in fellowship training, as practicing general internists, or as operational physicians in the Fleet, they will all continue to represent this program with the same level of professionalism, clinical acumen and adaptability that they have displayed here at NMCP over this last “year of change”. As I move on to the next phase of my career, I look back on my time with them with (mostly) fond memories and wish them all the best of luck in their upcoming endeavors.

LCDR (sel) Justin P. Lafreniere
NMCP Chief of Residents


Update from Naval Medical Center San Diego

It’s hard to believe the year is almost over here at Naval Medical Center San Diego. Our graduating residents are beginning to prepare for some very exciting new challenges as the year comes to a close. LT Jami Peterson will be taking the reins as chief of residents while two of our graduating R-3’s will be staying on for fellowship (LT Antony Choi cardiology and LT Nehkonti Adams Infectious disease). We are going to truly miss all of our graduates who will be spreading out around the world. LT Marc Calestini will be moving up the road to Camp Pendleton and LT Michelle Olson will be enjoying the warmth and sunshine in Great Lakes (JK). Three of our graduating residents are preparing for staff tours abroad. LT Ashley Smith and LT Rachel Harter will both be heading to Guam while LT Grace Lee will earn over 6,000 frequent flyer miles en route to her post at Naval Hospital Okinawa.

This year we have made our presence known throughout San Diego and around the world. We were fortunate to have two residents (LT Grace Lee and LT Brent Lacey) present posters at the National ACP meeting here in San Diego. LT Justin Stocks took home first place hardware for his poster at the NMCSD Academic Research Competition. LT Nehkonti Adams and LT Michelle Olson both recently returned from month long research rotations in Kenya and Peru respectively.

Although our graduating residents are irreplaceable, we are very lucky to have a fantastic group of interns making the transition to residency. LT Katherine Berjohn, LT Luke Oakley, LT Michael Powers, LT Sarah Rice and LT Daniel Dean are without a doubt, ready for the challenges.

I want to personally thank all of our house staff for their hard work and dedication which made this an extremely successful academic yea. I’ll miss you guys!!!

LT Russell Miller
Chief of Residents NMCSD


New Fellows


2011 FACP Convocation attendees: Drs. Mark Dick, Ryan Maves, Arthur Pemberton, and Christina Malekiani (left to right)

I would like to congratulate the following member on their advancement to Fellowship within the past 6 months:

LCDR Mark N. Damiano, MC, USN, FACP, Bethesda
-Sponsored by CDR Patrick E. Young and CAPT Brooks F. Cash

LCDR Christina L. Malekiani, MC, USN, FACP, Office of Attending Physician to Congress
-Sponsored by CAPT(ret) Angeline A. Lazarus and LCDR Mark D. Corriere

LCDR Tuong N. Vu, MC, USN, FACP, NH Camp Pendleton
-Sponsored by CAPT James K. Radike and CAPT(ret) Angeline A. Lazarus

CDR Timothy M Quast, MC, USN, FACP, Bethesda - Sponsored by CAPT(ret) Angeline A. Lazarus and CAPT Catherine F. Decker

The Credentials Committee has streamlined the application process for Fellowship. A prepopulated application can be found online. The sponsors can now complete a sponsor’s form or the alternative sponsoring letter [PDF]. I realized that there are a lot of ex-Navy internists in the chapter who are equally deserving of Fellowship. I am happy to discuss this honor with anyone.


Photo Gallery


NNMC LT Joseph Lopreiato, Jr., presenting a case of an active duty member with transient hip osteoporosis


NNMC LT Michael Kavanaugh presenting his poster on hemophagocytic lymphohistiocytosis


Eager NMCP's Doctor's Dilemma team read for competition LTs Sarah Wied, Jennifer Cunningham, and Michael Wagner


NMCSD LT Grace Shou-Chian Lee displaying her poster on ventricular septal aneuryism and hicuspid aortic valve presenting as a right bundle branch block


NNMC's LT Brandon Peterson treatment of SLE-associated hemophagocytic lymphohistiocytosis


Chapter Award winner LT Jeffrey Levine from NNMC presenting his poster on case series of OIF/OEF veterans with head trauma who acquired meningitis


NMCP's LT Michael Wagner winning poster on the use of PCR in the Diagnosis of Culture-Negative Endocarditis


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Contact Information

Navy Chapter Governor:
CDR Michael P Keith, MC USN FACP