2007sepoct

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Metro Dr SeptOct.pdf 1Metro Dr SeptOct.pdf 1 9/11/07 1:59:03 PM9/11/07 1:59:03 PM

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MetroDoctors The Journal of the Hennepin and Ramsey Medical Societies September/October 2007 1

C O N T E N T SV O L U M E 9 , N O . 5 S E P T E M B E R / O C T O B E R 2 0 0 7

Physician Co-editor Lee H. Beecher, M.D.Physician Co-editor Thomas B. Dunkel, M.D.Physician Co-editor Peter J. Dehnel, M.D.Physician Co-editor Charles G. Terzian, M.D.Managing Editor Nancy K. BauerAssistant Editor Doreen M. HinesHMS CEO Jack G. DavisRMS CEO Sue A. SchettleProduction Manager Sheila A. HatcherAdvertising Representative Betsy PierreCover Design by Outside Line Studio

MetroDoctors (ISSN 1526-4262) is published bi-monthly by the Hennepin and Ramsey MedicalSocieties, 1300 Godward Street NE, BroadwayPlace West, Suite 2000, Minneapolis, MN55413. Periodical postage paid at Minneapolis,Minnesota. Postmaster: Send address changes toMetroDoctors, Hennepin and Ramsey MedicalSocieties, 1300 Godward Street NE, BroadwayPlace West, Suite 2000, Minneapolis, MN55413.

To promote their objectives and services, theHennepin and Ramsey Medical Societies printinformation in MetroDoctors regarding activitiesand interests of the societies. Responsibility isnot assumed for opinions expressed or implied insigned articles, and because of the freedom givento contributors, opinions may not necessarilyreflect the official position of HMS or RMS.

Send letters and other materials for considerationto MetroDoctors, Hennepin and Ramsey MedicalSocieties, 1300 Godward Street NE, BroadwayPlace West, Suite 2000, Minneapolis, MN55413. E-mail: nbauer@metrodoctors.com.

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2 LETTERS

Index to Advertisers

3 Joint Commission Medical Staff Bylaws Standard Now Final

4 Women in Medicine—a Career of Passion and Balance

12 COLLEAGUE INTERVIEWCarolyn Adair Johnson, M.D., CMD

15 When Physicians and Their OrganizationsFace Difficult Problems: The Case for Adaptive Leadership

17 Community Internship ProgramProvides a Glimpse into the Practice of Medicine

19 YOUR VOICEThe Trouble with Medicaid Managed Care

21 Focused Group: Meet Your Future Colleagues—the U of M Class of 2007

22 Medical Students Connecting With Community Partners

23 Jacott Elected Chair AMA Senior Physician Group Governing Council

24 Law Firm Adds Services, Roger Johnson JoinsGovernment Relations Team

RAMSEY MEDICAL SOCIETY

25 President’s Message

26 Smoke-Free Washington County Coalition Update

27 Sue Schettle as New CEO of RMS/In Memoriam/“Ethical Issues in Pay for Performance” Conference/Winter Medical Conference 2008

28 2007 RMS Annual Community Service Award

HENNEPIN MEDICAL SOCIETY

29 Chair’s Report/New Board Member

30 HMS In Action

31 New Members/Four Weeks Until Smoke-Free Air/In Memoriam

32 HMS Alliance News

On the cover: September hasbeen hailed by the AmericanMedical Association as“Women in Medicine” Month.Article begins on page 4.

MetroDoctorsT H E J O U R N A L O F T H E H E N N E P I N A N D R A M S E Y M E D I C A L S O C I E T I E S

Doctors

2 September/October 2007 MetroDoctors The Journal of the Hennepin and Ramsey Medical Societies

To the editor:The Peter Dehnel commentary in the July/August issue of MetroDoctors was excellent.He points out that there is a big distinctionbetween health insurance and health care. Inrecent years many public officials have con-fused the two, but the distinction is critical.For every person who is uninsured, there areseveral who have health insurance coverage,but who cannot access health care —becauseof exclusions in their coverage, unaffordable co-pays and deductibles, or a shortage of medicalproviders who will accept the low reimburse-ment rates. At a recent hearing in Mankato,the Senate Health Committee heard testimonyfrom people who have health insurance, butwho struggle to obtain medical care becauseof each of those three reasons. I believe thatit is time for Minnesota to ensure access to

health care, not health in-surance and, in doing so, wemust ensure that we avoidthe pitfalls of our currenthealth insurance system.Like a majority of Minne-sota physicians who supporta single-payer plan according to the study citedby Dehnel, I believe that it is the best way toprovide health care for all Minnesotans, savingmoney by eliminating bureaucratic paperworkand focusing on prevention and health promo-tion. But in doing so, we must ensure adequateand timely reimbursement for all medicalproviders— something that is sorely lackingin current programs.

Sincerely,John Marty,Chair, MN Senate Health Committee

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Joint Commission Medical Staff Bylaws Standard Now Final

Editor’s Note: At a recent meeting of the Metro-politan Hospital Physician Leadership Commit-tee, Dr. Bill Jacott discussed a proposed change to the medical staff bylaws being considered by the Joint Commission relating to medical staff governance (MS 1.20). As a result, a letter was crafted by Libby Snelson, JD, to be co-signed by the leadership of HMS and RMS urging the Joint Commission to “retain in MS 1.20, and therefore in our medical staff bylaws, all the elements of medical staff self-governance.”

AFTER YEARS OF REVISIONS and con-troversy, Joint Commission MS 1.20 has been finalized. Overall, the revised standard is favorable to medical staffs and medical staff self-governance. However, even the strongest medical staff bylaws will require amendment to comply with the revised standard’s 33 Ele-ments of Performance.

The revised MS 1.20 imposes new requirements, different from any previously called for by the Joint Commission and most, if not all, states’ laws. Although the standard does not go into effect until July 1, 2009, medical staffs will be undertaking amendments right away, often at the impetus of their hospitals. It is critical that medical staffs proceed with caution to make bylaws amendments that protect and preserve the interests of the medical staff while achieving compliance with the revised MS 1.20.

The revised standard boosts medical staff self-governance by requiring that most elements be addressed in bylaws voted on by the medical staff, rather than by the medical executive committee acting on behalf of the medical staff. While allowing procedural

details to be addressed in rules and regula-tions or policies subject only to approval by the medical executive committee, under the revised MS 1.20, the medical staff must retain the ability to propose not only bylaws, but also rules and regulations and policies and any amendments thereto, directly to the hospi-tal board. Further, in addition to describing what authority the medical staff confers on the medical executive committee, under the revised MS 1.20, medical staff bylaws are to describe how the authority is delegated and removed. These new requirements can protect medical staffs from being controlled by medical executive committees comprised chiefly of hospital-appointed department heads and administrative representatives.

The revised standard MS 1.20 preserves the intent of the original MS 1.20, to pro-vide medical staffs and hospitals with a list of what has to be in medical staff bylaws. Medical staff bylaws that had been divided into separate plans and manuals will require revision to comply with the new MS 1.20.Generally, any medical staff that has a “Fair Hearing Plan,” a “Credentials Manual,” or an “Operations and Functions Manual” will need revisions to comply with the new MS 1.20. The revised MS 1.20 should help to make medical staff bylaws more transparent and responsive to medical staff members.

The final standard is published on the JC Web site at http://www.jointcommission.org/AccreditationPrograms/Hospitals/revisions_std_ms120_approved.htm.

Please contact me with any questions at easesq@snelsonlaw.com.

B Y ELIZABETH A. SNELSON, ESQ.

Women in Medicine—a Career of Passion and Balance

Julia Joseph-DiCaprio, M.D.

Describe your practice environment. What is unique about your practice?I am the Chief of Pediatrics at HCMC, an inner city county teaching hospital. I also practice general pediatrics and adolescent medicine. My clinical practice is unique be-cause of the large percentage of at-risk youth for whom I provide care.

What factors had an impact on your decision to go into medicine and, specifically, the specialty you practice?My mother was a nurse and I was exposed to, and fascinated by, the practice of medicine from a young age. I most enjoyed the com-plexity of pediatrics when I was in medical school. Further, I discovered that I enjoyed the opportunity to provide health care for adoles-cents and interact with them and their families. Thus, after a pediatric residency I completed a fellowship in adolescent medicine. I enjoy leading this department because of HCMC’s tradition of high quality care to all, including the underserved, and our commitment to

training the next generation of health care providers.

According to the University of Minnesota Medical School, females comprise 50 percent or more of their current medical student classes. To what would you attribute the increase in the female gender in medical schools?Increasingly the barriers that made it difficult for women who wanted to have a professional career are falling. This has been very evident in medicine.

Given your experience, would you encourage students to go into medicine? Why or why not?Absolutely. I cannot imagine a more fulfilling, challenging job.

How do you juggle your family/private life with medicine?My mother always worked. She also raised three children. She did much more around the house than I do such as cooking most meals, keeping an absolutely clean house, and even making most of our clothes. I see having a career and a family as normal and joyful.

If there were an opportunity for you to ad-vance in health care management, would you do so? Why or why not? I have very much enjoyed moving into the administrative aspect of health care. I have been helped in this transition by the University of St. Thomas Physician Leadership College. This year and a half cohort learning program trains and mentors current and future physi-cian leaders.

Mumtaz Kazim, M.D.

Describe your practice environment. What is unique about your practice?I feel very fortunate to work with seven other family practice physicians that I can truly call my friends. We are more than partners—we are a family. We all have the same vision of what we feel a quality, patient-oriented medical practice should look like. We try very hard to provide the most up-to-date medical care and technology for our patients. We treat all of our patients as if they were part of our own family giving them the best care we can offer.

What factors had an impact on your decision to go into medicine and, specifically, the specialty you practice?I grew up in Trinidad where both of my parents were physicians and I used them as role models.

Editor’s note: September has been hailed by the American Medical Association as “Women in Medicine” month. MetroDoctors conducted a Q&A interview with seven physicians, each in a unique practice situation. We hope you enjoy their stories.

Describe your greatest accomplishment to date—personal or professional.My greatest accomplishment and joy — my family. I have been married for 16 years and have two adolescent children.

(Continued on page 6)

I became quite aware of the dedication that was required in this profession at a very early age.

According to the University of Minnesota Medi-cal School, females comprise 50 percent or more of their current medical student classes. To what would you attribute the increase in the female gender in medical schools? When I started in medical school the ratio of men to women was swayed the other way. There were many more men when I began than there are today. I think one of the reasons for this is that women of today have many more opportunities than they did years ago. I believe there is a much greater demand for female physicians at present. Many women today choose to see a female physician instead of a male physician. Why this is, I really don’t know, but statistics are proving this.

Given your experience, would you encourage students to go into medicine? Why or why not?I would encourage any person who has a pas-sion and love for medicine. This is a rewarding profession requiring dedication and a lifetime commitment.

How do you juggle your family/private life with medicine?It is truly a challenge. I am fortunate to have grown up in a home where both my parents were physicians so I had a model on how to juggle the two. I am also fortunate in that my husband is a pediatric urologist so he also un-derstands the demands of the profession. We have managed to raise a beautiful, successful daughter and are very happy in our life.

If there were an opportunity for you to ad-vance in health care management, would you do so? Why or why not? There is too much bureaucracy in health care today so I would have to decline. I am a people person. I love my patients and caring for them, and that is what I am good at.

Describe your greatest accomplishment to date—personal or professional.I would have to say that I have been able to create a relationship in my practice where I consider my patients, partners and co-work-ers as my family and friends. What greater accomplishment could there be?

Maureen Reed, M.D.

Describe your practice environment. What is unique about your practice?At present my practice is health care consult-ing at a state policy level. So it’s appropriate to say that right now, the State of Minnesota is my patient. In addition to working on state tobacco control issues, I’m pleased to be serving as a member of the Governor’s Health Care Transformation Task Force. Fortunately for Minnesota, the goals of the Task Force are explicit and aggressive: to develop methods for covering everybody, reducing health care costs by 20 percent, and substantially increas-ing health and health care outcomes—all by 2011. With so many of our citizens, businesses and agencies so deeply (and appropriately) concerned about cost, quality and coverage, it’s extremely important that Minnesota suc-cessfully resolve these issues.

What factors had an impact on your decision to go into medicine and, specifically, the specialty you practice?I actually came across my med school appli-cation a few weeks ago. In some ways it was painful to read—not because it was incorrect, but rather because it tried so hard to be correct. As Bob Dylan said, “I was much older then; I’m younger than that now.” From today’s youthful vantage point, I’d give much more credit to my parents for encouraging independent thinking and hard work, and to my very elderly grand-mother who, in living with us, provided us all with the opportunity to learn the joys and the sadness of care-giving. And whether a cause or an effect (or simply a correlation), I’d have to credit a liberal arts education as the stage on which I learned how wonderful it is to be a generalist in a world of specialization.

According to the University of Minnesota Medical School, females comprise 50 percent or more of their current medical student classes. To what would you attribute the increase in the female gender in medical schools?In my 1979 class, I believe about 18 percent of the graduates were women. I’ve not studied the reasons why enrollment of women has tripled, but I’m sure many smart people have. I’ll let them give the fact-based answer. For myself, I’d just say that whatever the reasons, our profes-sion and our patients are much the richer for this development.

Given your experience, would you encourage students to go into medicine? Why or why not?Ardently, unequivocally, unshakably, yes! There have been two decisions in my life that I have never regretted. One was to go to medical school. (The other was to marry Jim Hart.) The opportunity to serve patients, to serve organizations, and to serve the public is a privilege beyond words. But in addition to the marvelous experiences of health care work itself, a career in medicine actually prepared me for many (most?) of the things I’ve done outside of medicine. I see no reason that the same would not be true for others today. And I am shamelessly optimistic that for those who enter the field for the right reasons, the future opportunities will be boundless.

How do you juggle your family/private life with medicine?Sad to say (or maybe it’s not), I’ve never mas-tered balance—not in medicine and not in most other aspects of life. Having a husband of like disposition and having no children allows the formula to work. But surely I wouldn’t presume to give advice to anyone on this subject.

If there were an opportunity for you to ad-vance in health care management, would you do so? Why or why not? I would take every opportunity that presents itself to expand in any arena for which I had the time and the inclination. Addressing systems issues through health care administration or policy is tremendously invigorating and worthy

of effort. Our patients and our society deserve big, fundamental fixes to the vexing problems of today. And the advantages of tackling them sure beat the alternative of doing nothing.

Describe your greatest accomplishment to date—personal or professional.Isn’t this the toughest question of all? Probably because the quick answers are not the right an-swers. Serving on the University of Minnesota Board of Regents as its Chair, running for Lt. Governor with Peter Hutchinson, and recently writing a play were fabulous experiences, but I think these are outward manifestations of a deeper factor. In all candor, the right answer is that I’ve learned to no longer be afraid of not succeeding. It’s taken me years to learn this. To strive for the right thing, the important thing, the necessary thing is, in fact, the main thing. And it is reward enough.

Sandra Rosenberg, M.D.

Describe your practice environment. What is unique about your practice?I used to work for a major metro health or-ganization. I now am a private practitioner. Though I still practice some general physical medicine and rehabilitation, I mainly concen-trate on the treatment of lymphedema, venous status (non-surgical) and chronic wound care. I see in-house patients as a consulting physi-cian, spending the majority of my time in outpatient clinical care. I work part-time. What makes my practice unique is that I am

a 14-year breast cancer survivor who has dealt with lymphedema myself.

What factors had an impact on your decision to go into medicine and, specifically, the specialty you practice?In truth, my favorite medical student rotations were in the surgical specialties. However, I tend to be very detailed, meticulous and stubborn. Becoming a mother during my second year of medical school made me quickly realize that I could never be happy trying to coordinate be-ing a parent with being a surgeon. I would feel incompetent at both. I had been introduced to Physical Medicine and Rehabilitation by my mother, Pearl Rosenberg Ph.D. The specialty incorporated the neurological, orthopedic and internal medical sciences. It offered me the chance to connect with my patients over longer episodes of care. The residency of four years was reasonable and I knew it was some-thing that I could do and still be a part of the lives of the people I loved most, my husband and my children.

According to the University of Minnesota Medical School, females comprise 50 percent or more of their current medical student classes. To what would you attribute the increase in the female gender in medical schools?Wow, that is a ten-page essay question! A couple of things quickly pop to mind:

Just read the headlines and the data show-ing that overall girls are doing better in school than boys. Boys have a higher high school dropout rate and colleges are having a harder time keeping their male to female ratio up.

Medical incomes have gone down while the cost of giving care has increased. Women tend to be less concerned with the income and, let’s face it, there are easier ways of making money these days with far less hassle.

As of the U.S. census in 2002, I thought women were about 51 percent of the popula-tion, outnumbering men. Doesn’t it seem reasonable that most professions should be 50/50 male to female ratios? Of course, for some reason women still only hold about 16.3percent of the seats in the U.S. Congress * so, I guess I don’t really get it.

*h t tp : / /www.rc i . ru tge r s . edu/~cawp/Facts.html

Given your experience, would you encourage students to go into medicine? Why or why not?As with anything, investigate as carefully as possible what you are getting yourself into. Medicine is a hassle, the paperwork exhausting, the workload unending, the insurance battles frustrating, the training forever and the system is very broken. Medicine is also the chance to give, to care, to change and the chance to be changed by the unique relationships we have with our patients and the profound impact we have on their lives. Medicine is a gift and physicians are a special breed.

Would I do it again? For me, retrospect only confuses this question more. Early in my medical career I was diagnosed with cancer and took care of two parents dying of cancer. It was too much, too soon. Medical training had already taken me away from my young family too much. If I had known what was to follow, I might not have pursued a career in medicine. Still, I was never given the ability to foresee the future. I am not, nor ever was a prophet. So, I probably would have done exactly the same.

How do you juggle your family/private life with medicine?I guess I learned the hard way. I finally learned to say “No.” I am now in private practice, part-time. I am in control of my schedule and my time. It is wonderful.

If there were an opportunity for you to ad-vance in health care management, would you do so? Why or why not? Once my children are on their own (my young-est graduates from high school next June) then I would consider adding work time and look-ing into other opportunities.

Describe your greatest accomplishment to date—personal or professional.My greatest accomplishment is my relation-ship with my best friend, my husband. It is he who has nurtured my most significant growth. Without his help, support, love and infinite patience I could not have become a physician, survived cancer or found a light after the pre-mature deaths of my parents. Without him I would not have had the chance to look into my son’s and daughter’s eyes to see the most awesome wonders of my life.

Women in Medicine

(Continued from page 5)

Martha Sanford, M.D.

Describe your practice environment. What is unique about your practice?I came to Stillwater Clinic in May of 1987 fresh out of an internal medicine residency at Hen-nepin County Medical Center. At that time I was the 10th physician in the group and the second internist. Our group, Stillwater Medical Group, which is part of the Lakeview Health System, has approximately 55 physicians, four PAs and seven NPs. Most of us practice in a beautiful facility on Curve Crest Boulevard in Stillwater with a small (but important) satellite clinic in Somerset, Wisconsin. I am currently one of nine internists.

In addition to the statistics described above, my work environment is, and has al-ways been, supportive, flexible and has valued the quality of life of its members. This culture gives me a sense of independence, self-deter-mination, and a fierce loyalty to my group and those whom we serve.

What factors had an impact on your decision to go into medicine and, specifically, the specialty you practice?The factor that influenced me the most in pur-suing medicine was my parents and especially my mother. Both of my parents, John Sanford, M.D., general surgeon, and Julie Moller, M.D., internal medicine, provided me with the wis-dom that I could do whatever I wanted to do, and that the more education I got, the better.They loved their work and showed me that the service aspects of being a physician are reward-ing beyond what you could have anticipated. I had fully intended to go into family practice, but my clinical rotation on a labor and delivery ward as a third year medical student (pre epi-dural anesthesia) changed my mind. Internal

medicine was an easy second choice and I’ve never looked back.

According to the University of Minnesota Medical School, females comprise 50 percent or more of their current medical student classes. To what would you attribute the increase in the female gender in medical schools?The question should be, why hasn’t it always been over 50 percent of physicians are women? I remember my mother talking about her inter-views to enter medical school. The interviewer from Johns Hopkins told her that he would like to accept her into their entering class but that they had already accepted their two or three female medical students for that class.Need I say more?

Given your experience, would you encourage students to go into medicine? Why or why not?I cannot imagine a better job. It has not been an easy road, though. Twelve years of post sec-ondary education can be grueling and there are sacrifices that all physicians must make.BUT if you love science, problem solving and people with all of their gifts and idiosyncrasies, the joy of this work cannot be matched. I truly believe that being a physician is a calling. Key to having and retaining my enthusiasm has been my self-determination and a significant perception that I am in control of many aspects of my work life. Without these later factors I am sure there would have been much more upheaval and change in my career.

How do you juggle your family/private life with medicine?The short answer to this question is, you don’t.You can’t. The quest for being the best is going to fail and usually on both sides of the teeter-totter. I have made mistakes in my work and with my family, and I have to accept the reality of my own fallibility. Yet, I know that I am doing my best and am acting with compassion toward myself and others.

If there were an opportunity for you to ad-vance in health care management, would you do so? Why or why not? I believe that as a primary care physician “health care management” is not a “them or us” dualism. We are all health care management.

We play a tremendous role in stewardship of the health care dollar and delivering high quality care. The payers, providers, purchasers (employers) and patients need to communicate clearly and honestly at every opportunity in our mutual quest of bringing better health and wellbeing to our communities. I have had the privilege in my group to do quite a bit of quality improvement work in the past and have enjoyed this tremendously. As a part of this I have come to admire and respect ICSI (Institute for Clinical Systems Improvement) for all they do for Minnesota. Their growing role as convener of consensus and alignment of incentive of the many factions in health care cannot be over stated, and we all need to support their continuing work and become involved in this progressive movement.

Describe your greatest accomplishment to date—personal or professional.My greatest accomplishment is more of a bless-ing, and that is to have a very fine husband and three lovely, challenging and bright daughters who all teach me something every day.

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Elisabeth (Betsy) Slattery, M.D.

Describe your practice environment. What is unique about your practice?I am the founder and president of a private in-ternal medicine practice in downtown St. Paul, “St. Peter Street Internal Medicine,” where I practice a combination of clinic and hospital medicine. The practice opened in a humble office on November 1, 2006, while waiting for the new clinic to be built. I moved into the new and permanent space as a solo practitioner on February 1, 2007. A partner, Dr. Sophia Kim, joined the practice May 1, 2007. The practice is showing excellent growth. This is a unique setting because it is privately owned and managed by experienced physicians. This is a different product compared to mega-managed health care clinics. Our challenge is to deliver personable and individualized care that is af-fordable and cost efficient.

What factors had an impact on your decision to go into medicine and, specifically, the specialty you practice?My key guiding force was my husband, Dan, who is also a physician. I was a nurse before becoming a doctor (and much of me is still a nurse). Dan shared in my dream and encour-aged it, to the point where I believed in myself, and knew I could do it. It is the right profession for me. My specialty as an internist was not an accidental choice. I would faint on clinical rotations in the operating room, so this left all forms of surgery and OB out. I love children so much that I couldn’t hurt them, including my inability to even draw blood when they were screaming. Pediatrics was not for me. This left

all of family medicine out as well. I love num-bers and the science of internal medicine and could stick a line in any adult during residency without a problem. It is an honor to work as an internist.

According to the University of Minnesota Medical School, females comprise 50 percent or more of their current medical student classes. To what would you attribute the increase in the female gender in medical schools?I think my graduating class in 1985 from the University of Minnesota was nearly 50 percent women, and the numbers have been approximately that for years. The public desires physicians of both genders. What is bother-some to me is the large numbers of women who graduate and eventually drop out of practicing medicine. Many of my medical school and resi-dency colleagues are not practicing even part-time. This is a tough and demanding job, and difficult to manage along with family life in a managed care climate.

Given your experience, would you encourage students to go into medicine? Why or why not?I definitely encourage students to enter the field of medicine. I am thankful every day that I have had this opportunity. It is an honor to know medicine, to figure out problems, to help people through the troubles of life. In-ternal medicine allows me to follow people and their families for years. There is still an art to medicine, despite the new computers and demands upon doctors today. It is not a field for everyone; it takes much more than an excellent student interested in the sciences. It’s a field where a student must feel a compassion and love for all sorts and parts of human be-ings and life. It also takes an individual with gumption, tenacity, stamina and creativity to get through tough times.

How do you juggle your family/private life with medicine?I am married and have five children…all daughters actually, and to the same guy all these years. Two were born in medical school, one during residency, the fourth was born just after the internal medicine final boards exam, and the fifth came when I was employed at Hen-nepin County Medical Center. “Juggle” is a

good word, and it becomes a way of life. There isn’t a day when my work isn’t modified for my children, and conversely, there isn’t a day in my children’s lives when they are not affected by my occupation — unless we are on vacation without beepers and telephones. Efficiency, multi-tasking, hard work, trouble-shooting and teamwork with my husband have been key to both family and occupational survival.

If there were an opportunity for you to ad-vance in health care management, would you do so? Why or why not? Sure I would, but it would need to be the right situation.

Describe your greatest accomplishment to date—personal or professional.This would have to be my five beautiful daugh-ters and my marriage. They always come first before my occupation. Graduating from medi-cal school was a great accomplishment, and opening this clinic has been a surprising and delightful experience.

Stephanie Stanton, M.D.

Describe your practice environment. What is unique about your practice?The most obvious answer is that United Family Practice Health Center is a Family Medicine Residency clinic, offering a full spectrum of care from birth to end-of-life. Other than family medicine physicians, our clinic staff includes PAs and psychologists and one IM doc. There is a very strong female presence in our staff, community preceptors, and

Women in Medicine

residents, with literally award-winning femalerole models and advisors. The clinic is also anFQHC look-alike clinic and serves a significantunderserved and uninsured population, and wecouldn’t possibly function without the supportof our Patient Advocate team. There are verystrong historical and current ties to the WestSeventh Community with satellite clinicsstretching from the North end Face-to-Faceclinic serving high-risk teen pregnancies tothe homeless at Dorothy Day to immigrantpopulations at Sibley Manor apartments onthe far end of West Seventh. In complement tothis diversity, the clinic support staff, providersand patients are equally multi-cultural with atleast 10 languages spoken in our clinic by staffand patients: English, Somali, Spanish, Rus-sian, Hmong, French, Vietnamese, multipleChinese dialects, Ordu, and Cambodian toname a few. We serve a vast array of patientsfrom the newest immigrants to recent genera-tions of college students and families to well-established citizens whose records date back toAncker Hospital.

From a residency perspective, we enjoy asmall class size with a strong focus on a healthybalance between our professional and personal/family lives. Most of the residents are marriedand about one-half have children. I think wehad over 10 babies born or in gestation justamong the 18 residents in the last year! Ourprogram is good about emphasizing patient-centered care without losing site of the needto care for ourselves too. While not yet partof the practicing physician culture, residencyprograms began working under the 80 hourworkweek restrictions four years ago in theinterest of patient safety, resident safety andeducation. I’m proud of our program’s flex-ibility and ingenuity in implementing thesenew restrictions, as we’ve adopted a night floatsystem in the past year, which again speaksto our program’s dedication to the health andwell-being of both our patients and our resi-dents (and future practicing physicians).

What factors had an impact on your decisionto go into medicine and, specifically, thespecialty you practice?Education and job security were very impor-tant lessons instilled in me early in life by mymother and grandmother. I watched my moth-er struggle to find work in the 70s without a

college education, deeply in debt, despite beinga veteran with educational benefits. I similarlygrew up with my grandmother’s stories aboutstruggling to make ends meet as the daughter ofan Oklahoma Seminole-Irish couple and withonly a sixth grade education. There was nevera question about whether I would be going tocollege—that was assumed, because educationwas the answer to every problem that my familystruggled with. I never knew it might be medi-cine. There are no physicians in my family,although my mother has worked as an autopsyspecialist in the Air Force, grandma workeda bit as a lab tech, auntie is now an RN, andanother aunt became an ambulance driver afterI started medical school. And my stepfathertaught animal science, having served as a largeanimal veterinarian in his earlier years.

I think I ultimately decided to go intomedicine for many reasons: challenge, job se-curity anywhere, chance to use language andculture and develop strong enduring relation-ships with patients and co-workers.

In terms of specialty choice, I stronglyconsidered OB, but realized that I want flex-ibility to practice in underserved and rural

environments. As a student, I visited placeslike Ely and Grand Marais and fantasizedabout being an OB in these locales, only to beinformed that they really don’t have enoughpregnancies to support an OB. I ultimatelydecided on family medicine because it wouldallow me the greatest flexibility in futurepractice types and locations, and would allowme to refine and focus my interests as theydeveloped. Especially in a rural underservedsetting, where there is a great shortage of healthcare and physicians, I could be most useful asa family physician. These decisions were quiteheavily influenced by my participation in theRural Physician Associate Program as a medicalstudent and the overall attitude of the U of MNmission to train primary care physicians.

I’m also attracted to family medicinebecause there is CLEARLY a spirit of team-work at all levels of providers from physiciansto nursing assistants, to front desk staff to thepatients — I’ve not seen this level of respectand cooperation in any other specialty.

And family medicine inherently has astronger priority on family life, which trans-

lates into quality of life for my colleagues and my family. Granted there are other specialties that don’t have call the way FM and OB does—but those specialties don’t necessarily also actually respect women and families. Most of my college friends who went into medicine are already practicing so I got to watch them struggle through choices. Those who studied hard enough in medical school to be AOA and win spots in very competitive specialties weren’t family focused and didn’t have relationships that I admired. And my female friends in surgi-cal specialties ended up divorced —even those with children.

According to the University of Minnesota Medical School, females comprise 50 percent or more of their current medical student classes. To what would you attribute the increase in the female gender in medical schools?The first time that females made up over 50 percent of the U of MN med school class was only a few years back with the class starting just before mine (the class starting in 2000). I think my class, the very next one in 2001,actually barley missed this benchmark just shy of 50 percent, but thereafter there have been >50 percent women again.

The women in college and medical school today are the daughters and granddaughters of women who fought for female equality and women’s rights. We had the benefit of growing up in a society that has seen increasing numbers of women in leadership positions, like current U of M med school Dean Deborah Powell. It never occurred to me growing up that there were any barriers to me just because I was fe-male, and I attribute this COMPLETELY to my mother, who was a leader in her own pro-fession and certainly not about to be stopped from accomplishing something because of her gender. Compared to our grandmothers and the first women in medicine, the newest gen-erations enjoy more girls finishing high school and more young women attending college. So it really should come as no surprise that now women are comprising greater percentages of graduate level training programs, including medicine, law and sciences. What’s interest-ing is to see which professions women choose to go into and for what reasons.

I guess I have to admit that the pessimist in me says that men are looking at other careers these days. I remember growing up, taught by society at large, that a good job was doctor or lawyer or business(wo)man. But in the last couple decades, it has become more difficult to earn a comfortable rewarding life as a physician — and in some ways this can make medicine a less desirable career choice. But this is tempered against the recognition that medicine has matured, and now exists in a more caring preventive environment, benefit-ing greatly from female attitudes, perspectives and sensibilities.

Given your experience, would you encourage students to go into medicine? Why or why not?This is a question I face frequently — one of my friends/advisees is literally packing to go off to Illinois and start medical school next month. It has been a long process for her, and she actually did a good job of considering all options for a career in medicine from nurs-ing, to PA, to MD vs. DO school. I have no reservations at all about encouraging some-one like her from going into medicine, but it needs to be for the right reasons, and I don’t necessarily find myself encouraging someone to become a physician—especially given the drastic changes in health care in recent years and the enormous impact it has on the physi-cian-patient relationship.

Medicine is rapidly evolving, and I doubt that anyone can accurately predict what it will look like in 10 years—and anyone just starting to consider working in health care as a physi-cian, wouldn’t start practicing for at least 10years. So it’s hard to advise such individuals. But I think that potential physicians should be prepared to work in an environment over which they have little control or independence. I’d make sure they are fully aware of the com-mitments for their entire life that they are making. Make sure they shadow physicians while an undergrad or even in high school, like what Dr. Sih does for some local high school students several times a year. Despite the challenges of paperwork and reimburse-ment and government interference, and insurance/pharmaceutical industry indiscre-tions, medicine still is and always will be the noblest profession, a profession of which one will always be proud.

How do you juggle your family/private life with medicine?Only through great sacrifices by me and my family, and remembering to keep one foot squarely planted in each aspect of my profes-sional and personal life. It’s hard — very, very hard; this isn’t really what I had in mind when I thought medicine would be a good “challenge.” I am often envious of my resident classmates who aren’t married or who don’t have children yet because I can’t help but notice that they have much more time and flexibility available to them to study, travel abroad, or spend time in leisure activities. And they aren’t so nega-tively impacted by evening shifts and chaotic schedules.

I’m excited for two of my male classmates who are planning an international rotation together; although married, they don’t have children. In contrast, I notice myself and female classmates planning when I can even think about getting pregnant and how that relates to my current job search and whether I’ll be able to travel when I need to if I am pregnant or have a young baby. And then I find myself equally envious of patients, usu-ally homemakers (men and women!) who are at home full-time. What a joy it would be to dedicate all my time to my husband, child and family. But in truth, I know that I would never be happy in either of those situations —I’ve actually tried them in life in my own way and know that I wouldn’t change things if given the chance. I could have gone through med school and residency without family, but that would mean that I would have jumped into med school right after college. I would have missed out on so many formative years that make me a better communicator and a more empathetic physician today. I know these are invaluable skills for my patients, for me, and for my family. And while I enjoyed an extended maternity leave with my first child, it wasn’t long before I wanted to get out of the home and start being a physician again. Some might call it greedy or unrealistic, but I want to be both a good wife and mother and a good physician. I honestly don’t think I’d be as good at one without the influences of the other.

The real answer to juggling these compet-ing priorities in life is making good choices, sometimes hard choices, and having the cour-age to change course when you find yourself

Women in Medicine

on the wrong path. I couldn’t possibly do anyof this without my most extraordinary andamazing husband and our extended familiesand friends. Heath picks up and drops off ourson more than I do, and gets stuck with morehouse chores than any of his peers —despitethe fact that he is a high level executive in hisown professional world.

The other fortunate choice that allows thisjuggling act to work for me is going into familymedicine and into a program with tremendousflexibility and the utmost priority and respectfor family. I know I’ll be looking for thistype of flexibility as I begin to sort throughpractice opportunities. Realizing that some ofmy peers and potential employers will scoffat my expectations, I believe that medicine isheading in the direction of more humane andfamily-friendly hours and practice styles. Andwhile some will think this is a matter of thenewest physicians just not wanting to workas hard, it can’t be pointed out enough thatit’s really about safety for our patients —butmaybe even more so for the protection andsafety of physicians, their marriages, and theirrelationships with their family and commu-nity. This is becoming imminently truer as agreater number of women and family-orientedphysicians go into medicine. I think it’s onlya matter of time before practicing physiciansstart following safer and more sensible workhours, as currently enjoyed by resident physi-cians. And I think that this will allow moreflexibility in practice styles so that physicianscan be at their best not only for their patientsbut also for themselves and their families andtheir communities.

If there were an opportunity for you to ad-vance in health care management, would youdo so? Why or why not?Not sure. I don’t see myself staying in a largemetro area, where most health care manage-ment is centered. I guess I’d consider beingpart of it in a smaller community, but it’s notsomething that I see myself actively pursuing atthis time. This has nothing to do with being awoman or my perception of how it affects timewith family. It’s just not something that I’mterribly interested in at this time. My interestslie more in patient care and activism withinorganized medicine. Although, now faced withthis question, I realize that I could very well end

up in such a role at some point in my career,because I very much enjoy looking for waysto improve efficiencies and accuracy within asystem, while maximizing satisfaction amongstthose affected by the system.

Describe your greatest accomplishment todate—personal or professional.I suppose all mothers and parents have thesame answer. Our children are our greatestpride and joy, our greatest accomplishment.No day, no call shift, no board exam is ever thatbad once I get home and gather my gigglingtoddler into my arms.

I am yet so young in my career that Ifeel like my greatest professional accomplish-ments are yet to come. But my proudest ac-complishments in medicine are two-fold: (1)when there’s a significant breakthrough witha patient like finally getting control of diabe-tes or cholesterol or back pain or alcoholismafter months or years of hard work; and (2)introducing a colleague to organized medicineand seeing them blossom into amazing partici-pants and leaders within the organization. I’mproudest of helping to revitalize the medical

student section of the MMA and AMA in ourstate from 2001-2005, and watching studentparticipation literally explode. I’m proud andhonored to have served as the Vice Speaker ofthe national AMA-MSS in the era where wehad just begun implementation of residentwork hour restrictions and as we debatedwomen’s rights and accessibility to emergencycontraception on the floor of the AMA Houseof Delegates—an issue brought forth by theMedical Student Section. And much more im-portantly, you have helped bring forth resolu-tions from the student and resident sections tothe AMA House of Delegates, which ultimatelyand successfully changed the priority of theAMA to Cover the Uninsured, which is ofutmost importance to the patient populationat my clinic but with obvious applications toall aspects of health care. As I start my termas the Vice Speaker of the AMA-RFS, I findmyself thankful for having found a residencythat appropriately values active participationin organized medicine and I can’t wait to seewhere the next decades take medicine and whatrole I get to play in it.

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C O L L E A G U E I N T E R V I E W

Carolyn Adair Johnson, M.D., CMD

Carolyn Adair Johnson, M.D., CMD graduated from the University ofMinnesota School of Medicine in 1953 and completed an internship atCharles T. Miller Hospital (United Hospital). She is board certified infamily practice and became a Life-Member of the American Academy ofFamily Physicians in 1997. She is a clinical professor at the Universityof Minnesota. Dr. Johnson is also a Certified Medical Director.

When and why did you decide to go to medical school?How was medical school different in the 1950s than now?How many women were in your class, out of how manystudents? Were you treated respectfully?

When I was seven years old I wrote in my diary every day for threeweeks when I was home quarantined with chicken pox —“I am verylucky I am home with the chicken pox and dreaming about my futureperfession (misspelled).” My father taught me to tie surgical knots at thattime with my right and left hand. “So you can help me when you growup,” he said. So, naturally, my focus from then on was to be a doctorand work with my dad.

When I started at the University of Minnesota Medical School in1948 the ratio of men to women was definitely different. I was one offour women enrolled with 120 men, many of whom were 30-year-oldwar veterans. The medical school professors were leery of us since 10women had enrolled the year before and four dropped out the first weekof school. We were told every morning in lecture “you are here and somemen are not here so we expect you ladies to practice medicine fully andwork long hours your entire career.” I worked 60 hours a week the first 47years and then cut back to part-time the next five years. So, I obeyed!

I was treated respectfully with the exception of two professors thefirst year that liked to call on us a lot, did not like women in class, andwere caustic in their remarks. After that first year I was always treatedrespectfully.

Was there a mentor that you had to rely on during yourmedical school/residency programs, or perhaps after youfinished your training?

My closest mentor was my father, Carl E. Johnson, M.D., who practicedin St. Paul for 50 years doing general practice and surgery. I was his as-sistant in surgery for 10 years after I joined his practice.

The other physicians who were mentors for me in my training atCharles T. Miller Hospital, now United Hospital in St. Paul, were Dr.Jane Hodgson and Dr. Theodore (Ted) Watson (both OB-GYN) andDr. Frank Quattlebaum (surgeon).

After retiring from family practice in 2000 I became the medicaldirector of the three long-term care facilities of HealthEast —BethesdaCare Center, Marian Care Center, and White Bear Lake Care Center,plus Dayton’s Bluff (now Good Shepherd’s). Dr. Thomas Altemeier, geri-atrician and family practitioner and the previous director of these fourhomes, made fast walking rounds with me for several weeks before retiringcompletely from being the director and attending. He was a world-classgeriatrician and it was an honor to be following in his steps.

Will you tell a story that comes to mind about a studentyou have taught? Is there someone who was challenging toteach, or who had a hard time with a patient, and whathelped with that challenge?

For 20 years many fourth year female medical students and a few menrotated on a six-week program through my office in St. Paul. They were allbright, eager and great to work with. No one was challenging to teach.

It is great to see them still practicing here in the Twin Cities and,a few out of the state, happy with their profession. The women whomI remember the most are Ann Barnes, Barbara Leone, Sandra Coffin,Bonnie Hill and Terry Wollan. They were all shining lights and are nowexcellent practicing physicians.

How did you balance your home/family life when youwere practicing medicine?

Since I did obstetrics, family practice and numerous house calls the first10 years, plus surgery weekly with my father, I was very busy. Add tothis six children and a bevy of housekeepers.

However, it would have been impossible to do all this calmly with-out my husband’s support and help. Besides running his Departmentof Educational Psychology at the University of Minnesota, he was themain cook. His hours were more predictable than mine any day, and hewas the best cook.

Will you say a little about the Medical DirectorsAssociation? Who are the members? As medicaldirector, did you do both clinical work and admin-istration? What did you like most and least abouteach role, and about the combination of roles?

The Medical Directors Association is made up ofphysicians who are family physicians, internists, orgeriatricians who see patients in long-term care facili-ties or serve as the medical director in a facility.

I did both for 18 years and the last five years Iworked as a medical director. In that capacity youmake sure that the medical staff ’s bylaws, rules andregulations are followed. This entails meetings forsafety, analyzing falls, checking charts and records,updating administrator’s daily, giving in-services,starting ethics committees to cover patients who haveno family or conservator, meet with families who haveconcerns, overlook care plans, and discuss problemswith attending physicians.

I worked mornings five days a week the last fiveyears and came back for problems if necessary. Thecombination of roles was the most satisfying. However,clinical work or interacting with patients was the mostexciting part of work.

When I retired from family practice in 1992 Dr.James Pattee encouraged me to take his last course atthe University of Minnesota to be well rounded as amedical director. He was a great educator and becauseof him and Dr. Tom Altemeier I added another 15years of practice to my total years of working (1953to November of 2005).

Describe your practice as an ob/gyn—both thechallenges and the rewards.

As a female practitioner who did obstetrics and gy-necology in the 1950s and as one of only five women

doing obstetrics in St. Paul, those first years kept me very busy withhundreds of deliveries every year.

I also did home deliveries from 1953 to 1977 in the Twin Cities, inthe drug communes (houses) in St. Paul and Minneapolis. The womenI helped were good people and cooperative. They were rebellious youngwomen against society. I never lost a baby or mother.

The three obstetricians who were my back up knew me and agreedto do emergency C-sections if necessary, which happened rarely. My

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patients had to agree, in advance, to go to the hospital if I said so. If they refused, the consequences were that I would never help another woman at home. Most of those people eventually saw me regularly the rest of my career. I also did home deliveries for several wives of physicians.

Obstetrics is a most exciting part of practicing and to be sharing in the happiness of a couple for this special event. A plus is to be invited to the graduations and weddings of the children I delivered.

Challenges were great then with no ultrasound to tell us the size of the baby, and with rare blood types never being diagnosed before-hand.

What was your most interesting home delivery, and did you ever regret doing home deliveries?

My most interesting house delivery was in Minneapolis in the 1950son the West Bank in a drug commune. Thirty people lived there. The delivery took place on the third floor in a huge room and a bathroom adjoining.

Throughout the hours before the delivery many of the men came upstairs to use the toilet and slowly sauntered past us observing the woman in labor with her first child. There were no floor lamps, only flashlights.

All went well with the delivery and the baby cried normally. I had my Ambu resuscitator there and an oxygen tank had been delivered one month in advance of the due date per my instructions.

Fortunately, the granddad, a dentist, arrived and helped hold two flashlights for the repairs. He was a great conversationalist also.

At the end they released the 20 Doberman dogs chained around the room (usual in those days —this was a “drug house”) and I was told to throw them the placenta as far away from my back as possible.

I never regretted doing home deliveries. Most of the expecting parents were bright, questioning groups of young adults. Many of them eventually became my regular patients and stayed with me in my fam-ily practice career. I enjoyed watching them pursue their own careers eventually.

If you had a granddaughter who was interested in becom-ing a doctor, would you recommend it to her based on the current climate physicians work in?

If she were as excited about being a doctor as I had been 55 years ago and she loved people and the challenge of medicine, I would say go for it.

However, I would definitely point out what physicians face today, starting with the staggering financial debt after four years plus internship and residency of $400,000 plus. Add to this the increased paperwork plus time consumed entering patient data and prescriptions on a computer. This definitely interferes with valuable patient-doctor dialogue. If she said she planned to share a job with another physician so she could work fewer hours I would try to stop her right then.

Working two and a half to three days a week is not good in my world. If, as a patient, you can never see your physician because of her schedule, that’s a problem. And that woman who only wants to work two to three days a week will never do good research in medicine in that field.

What is the most significant change in health care that you saw/experienced during your career?

During my career from 1952 through 2005 the three most exciting dis-coveries that took place and changed how we practiced better medicine were: (1) Rh blood testing; (2) pap smears; and (3) mammography.

As a female physician who primarily saw women and children, the great number of women I saw in the 1950s and 60s dying of cervical and breast cancer and babies dying of jaundice with undiagnosed Rh problems was overwhelming.

If you could do your career over again, would you still go into medicine? Why or why not?

Yes— a thousand times, yes.Medicine is the most challenging, most exciting and satisfying job

in the world right along with raising your children.

When Physicians and Their Organizations FaceDifficult Problems: The Case for Adaptive Leadership

Editor’s note: This is the first of a three partseries discussing adaptive leadership as a modelfor addressing the difficult problems that healthcare organizations face. The second article uses thecase method approach to leadership education. Inthe third article the principles of transformativeleadership will be described.

Being a physician today is, by definition, aleadership challenge:• In the name of cost containment, health

plans implement administrative require-ments for high tech imaging that createcomplexity and increase cost.

• Under pressure from government andbusiness purchasers, clinic and hospitaladministrators install immature electronicmedical record systems. Doctors must copewith new inefficiencies in exam rooms andat the bedside.

• A prestigious government agency publicizesthe deaths of nearly 100,000 people peryear as a result of errors in our hospitals.

• With ever increasing time constraints,physicians struggle to find adequate timeto assist families in making important deci-sions and resolving disputes.

• Physicians are rated and compensatedbased on quality improvement measure-ments that do not adequately account forseverity of illness or patient behavior.

• State legislatures address the health careworkforce shortage by granting prescrib-ing authority to non-physicians.

Medicine presents unique leadershipchallenges — unfortunately, not in forms thatare most comfortable for us. As doctors, wehave mastered technical work and regularly useour authority to lead teams in solving technical

medical problems: running a code, performingcomplex surgery or delicately balancing mul-tiple medications in a fragile nursing homepatient. We know how to evaluate data anduse our vast knowledge and experience to makeclinical decisions.

As physician administrators we use ourformal and informal authority in administra-tive suites and boardrooms: running meetings,negotiating with multiple stakeholders andspeaking the language of business. Whetherin the clinic or the meeting room we use ourauthority to set direction, shape and maintainnorms, orient others to roles and responsibili-ties, control conflict and protect our organiza-tions from outside threats.

But all of our education, experience andskills do not prepare us for the importantleadership challenges we face in the world ofmedicine today. A multitude of competing in-terests and values now dominate the horizon.Plenty of stakeholders— employers, unions,third party payers, public policy experts andlegislators — offer solutions. Many have theformal authority to execute their plans. Butwe physicians hold our own unique brand ofauthority. If we hope to influence the evolutionof our health care system and make progress oncomplicated issues, we must develop the skillsthat enable us to go beyond the authority andexercise leadership to deal with new challenges.If we become effective leaders we can ensurethat our critical perspectives are reflected inour organizations’ adaptation to change.

Ron Heifetz*, a psychiatrist working atHarvard’s Kennedy School of Government,shatters our understanding of effective leader-ship. Through observation and application ofprinciples in psychology, group dynamics andorganizational behavior, he has developed amodel of leadership that takes into account

the obstacles to significant change that weall encounter. He calls the model “AdaptiveLeadership.” This model acknowledges theorganic nature of human systems, includinghealth care. Adaptive leadership is requiredwhen there is no best response to the externalforces that we cannot control or our own inter-nal pressures to compete and succeed. Adaptiveleadership is required when the application oftechnical expertise will not suffice.

Crisis is the strongest evidence of the needfor adaptive leadership. If no clear technical so-lution can be found, or when problems persist

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Adaptive Leadership

despite efforts to address them, it may be that an adaptive model is needed. According to Heifetz, “Adaptive leadership is required when our deeply held beliefs are challenged, when the values that made us successful become obso-lete and when competing perspectives emerge.” Exercising leadership means bridging the gap between the shared values that people hold and the reality they face. It requires us to open our minds to new attitudes, beliefs and behaviors and to encourage openness in others.

One of the first and most difficult steps in adaptive leadership is simply identifying the problem as adaptive rather than technical. The culture of medicine trains us as physicians to think logically and sequentially. We apply ra-tional standards to evaluate challenges and, as a result, may miss the subtle and not so subtle factors at the root of a problem. Adaptive chal-lenges are disturbing because there is urgency, the stakes are high and there is no clear path. Resistance, avoidance or lack of motivation (our own or others’) may impede progress. Acknowledging the need to understand what

goals; physicians become frustrated when no progress is made. Adaptive leadership is far more dynamic and complex than the technical work we are accustomed to and thus takes time.

While these obstacles may at first seem daunting, physicians are also uniquely posi-tioned to exercise adaptive leadership effec-tively. The challenges in health care come large and small: proposed reductions in Medicare reimbursement, pay-for-performance, same day clinic appointment policies, cross-specialty credentialing/privileging and so on. Every one of these situations is an opportunity for us to exercise leadership. Our frontline experience provides us with particular insights that pay-ers, politicians, patients and even other health professionals lack. Our position within the health care system allows us to experience multiple perspectives. We know how families respond to illness; we understand how financial incentives can be effective or counterproduc-tive; we anticipate unintended consequences of well-intentioned attempts to regulate safety or control costs.

After identifying the challenge, adaptive leadership allows physicians to utilize new tools and techniques to address the problem. We are in an ideal position to make insightful observations, offer new interpretations, to ask the difficult questions that speak to higher values. After deliberation and consideration of diverse perspectives, we are well situated to take action.

Learning adaptive leadership takes ef-fort, but the rewards are great. We can make progress on the tough issues that we face. Our daily work will be increasingly satisfying when our contributions are evident in the outcomes and when change, which is inevitable, can be greeted with confidence instead of fear.

In the next article, we will discuss the adaptive challenges that accompany imple-menting electronic medical records.

*Heifetz, Ronald, Leadership Without Easy Answers (Cambridge, MA: The Belknap Press of Harvard Univer-sity Press, 1994)

Cascade Partners principals include: Kathleen Brooks, M.D., MBA, MPA; Tom Gilliam, R.N., MBA; Mary Jo Lewis, M.D.; Michael Tedford, M.D., MBA; Valerie Ulstad, M.D., MPA, MPH. CascadePartners offers leadership education and coaching to health care professionals and the organizations they serve.

drives action or inaction establishes a starting point for physicians to become agents of change.

The obstacles that physicians face to em-ploying adaptive leadership are formidable. Financial pressures alone have made time a premium. Clinicians must often sacrifice fi-nancially in order to take on leadership roles. Furthermore, as physicians, we are committed to a set of professional values that require us to consider what is fair, just and best for the patient. We cannot place one value, such as reducing cost or collecting data, above our responsibilities to our individual patients. As clinicians, our role is to represent the most human element of health care, a burden and privilege that other stakeholders do not share.

Our lack of formal training and experi-ence with the processes of change also puts us at a disadvantage. We may believe that meeting to talk about a problem is equivalent to doing something. At the conclusion of a discussion, we expect our recommendations to be executed as precisely as the written order for a hospital-ized patient. Without understanding that other members of the team think in totally different constructs and may have competing aims and

Associate Medical Director – Chief Medical Informatics Officer

HFA is a non-profit physician group practicing at Hennepin County Medical Center, one of America’s best hospitals. Our group consists of over 300 physicians representing 37 specialties. Our practitioners consistently rank among the best in the state, as well as nationally, and hold academic appointments at the University of Minnesota. We are committed to excellence in patient care, teaching and research.

We are looking for a physician to provide leadership for the creation of a patient-centered clinical informatics model that will support efficiency and continuity of care as well as patient safety. As the clinical representative, incumbent will consult with and serve as the liaison between the medical staff (attending and residents), nurse and other clinical practitioners and Information Services, and serve as physician champion for the integrated clinical systems at HCMC. Individual will function as a senior member of the Office of the Medical Director and Information Services, be a faculty member of the U of M Medical School, and expected to spend approximately 20% of time in clinical practice. Position reports to both the Chief Medical Officer and Chief Information Officer.

Position requires a current Minnesota MD license with 5 years clinical experience and 3 years experience in health care informatics in a complex healthcare environment, prefer-ably an urban academic teaching hospital. Advanced training in Medical Informatics a must; certificate/degree preferred. Must have a solid understanding of clinical systems workflow, strong technical skills, the ability to communicate effectively in both verbal and written form, and the capability to build supporting relationships. Experience using the EPIC system preferred.

Phys ic ians o f Hennep in County Med ica l Center

Please submit resume to Human Resources at:Hennepin Faculty Associates600 HFA Bldg; 914 So. 8th St. Minneapolis, MN 55404612-347-5306 (ph) • 612-373-1817 (fax)hr@hfa-mn.org • www.hfahealth.com EOE

Community Internship ProgramProvides a Glimpse into the Practice of Medicine

PROVIDING A GLIMPSE into the practice ofmedicine from the physician’s point of view, theHennepin and Ramsey Medical Societies co-sponsored a Community Internship Programon June 6-7, 2007 for public members and staffof the Minnesota Board of Medical Practice.

The Community Internship Program wascreated to provide a first-hand opportunity forleaders in the community, government andbusiness to personally experience the practiceof medicine from a physician’s point of viewand to observe the actual operations of ourhealth care system at the point of delivery.

Each “intern” was assigned to four phy-sicians throughout the program — one fromsurgery, emergency medicine, and two otherspecialties. One-half day was spent with eachphysician, accompanying him or her on dailyrounds and office visits, attending surgery,and observing emergency care at the doctor’sside. Scheduling only one intern per physicianallows plenty of time for questions and discus-sion.

The program evaluations received fromthe community interns, as well as the physi-cians who served as faculty, have been over- (Continued on page 18)

Board of Medical Practice participants inthe Community Internship Program:From left: Bill Marczewski, Paul Luecke, PatHayes, Mary Erickson, Ruth Martinez,Robert Brown, Ph.D., and Kelli Johnson.Not pictured: Helen Patrikus and AllenRasmussen.

Community Internship Program

June 8, 2007

To: Hennepin Medical SocietyRamsey Medical Society

Thank you so much for making the Hennepin and Ramsey Medical Societies CommunityInternship possible for me and the rest of the Minnesota Board of Medical Practice crew.Being a fly on the wall in these amazing health care settings was an unforgettable experience.

Witnessing the physicians’ many interactions with patients, colleagues, and computershas provided me with new insight into the demands of the profession. This insight willundoubtedly serve me well as I continue in my service on the Minnesota Board of MedicalPractice.

Once again, thank you. I feel so lucky to have been able to participate. It was an honor, aprivilege, and a once-in-a-lifetime experience. Thank you so much.

Sincerely,Kelli Johnson, Public MemberMinnesota Board of Medical Practice

whelmingly positive and rate the value of theinternship as a community oriented projectas excellent. Some of the comments received

Thank you to the following physiciansfor taking the time as faculty members toprovide this positive experience for thesecommunity leaders:

Sean Adams, M.D.Jeanne Anderson, M.D.Steven Wade Barhart, M.D.Jeffery Barkmeier, M.D.Arthur Beisang, M.D.Paul Bearmon, M.D.Eric Becken, M.D.Debra Bohn, M.D.Peter Bornstein, M.D.Paul Broadbent, M.D.Eric Christianson, M.D.Nancy Collins, M.D.V. Ross Collins, M.D.Stuart Cox, M.D.Peter Daly, M.D.Laura Dean, M.D.Dale Dobrin, M.D.Daniel Dunn, M.D.Thomas Gilbert, M.D.Walter Gleich, M.D.John Graber, M.D.William Heegaard, M.D.Steven Hommeyer, M.D.Louis Jacques, M.D.Eugene Ollila, M.D.Douglas Pryce, M.D.St. Paul RadiologyCharles Terzian, M.D.Jackson Thatcher, M.D.Chris Tolan, M.D.Benjamin Whitten, M.D.Peter Wilton, M.D.

included: “This was a fascinating experience. Iam so impressed with all the knowledge that justrolls out of their heads as well as all the technol-ogy, robotics!” “I was amazed by the level of un-reimbursable activities, e.g. completion of healthforms for camps and school, and the amount of

time spent with a patient’s family regarding endof life decisions.” “I was especially impressed withthe physician’s ability to analyze the often timeslimited information given by patients and deter-mine the diagnosis/course of treatment.” “A lot ofpatients are seen in a very short period of time.”

Plans are underway for HMS and RMS tooffer another Community Internship Programthis fall, inviting members of the legislature toparticipate as the interns. This program pro-vides an effective opportunity for the publicto understand the challenges and rewards ofbeing a physician.

If you are interested in serving as a facultymember for the next Community InternshipProgram, please contact Nancy Bauer, HMS,(612) 623-2893, nbauer@metrodoctors.comor Katie Snow, RMS, (612) 362-3704,ksnow@metrodoctors.com.

Y O U R V O I C E

The Trouble with Medicaid Managed Care

BY PETER J. NELSON, J .D. (Continued on page 20)

Arenewed push for universal health insurance coverage is un-derway in Minnesota, and many believe expanding the state’sexisting Medicaid program is the answer. But the present

Medicaid program, one of the most expensive (and expansive) in thenation, has serious problems and expanding it would only exacerbatethose problems.

In the mid-1980s Minnesota began shifting Medicaid popula-tions from traditional fee-for-service Medicaid to Medicaid managedcare. Under fee-for-service, the government administered the healthplan: The government fixed the price for medical services, and thegovernment paid the provider’s bill. Today, the state pays a privatemanaged-care health plan a per-person fee, and the health plan, inturn, pays the doctor.

Moving away from government administered fee-for-service wasa step in the right direction. Yet exclusive reliance on private man-aged-care plans has proven to perpetuate in varying degrees the sameproblems that beset traditional fee-for-service Medicaid, withoutrealizing any of the benefits that managed care promised.

Two particularly troublesome fee-for-service traits have carriedforward to managed care: For one, managed care requires little to nocost-sharing in the form of co-pays or deductibles and, two, managedcare pays providers low, often below-cost reimbursement rates.

By providing generous first-dollar coverage that requires littleto no cost-sharing, managed care perversely erodes the incentive forenrollees to take personal responsibility for their health care decisions.With scant out-of-pocket expenses, prudent use deteriorates, givingway to overuse, a connection long ago confirmed by the RANDHealth Insurance Experiment.1

Reining in overuse could result in significant savings. A studycommissioned by the Minnesota Department of Human Services esti-mated $26 million in emergency room overuse by Medicaid enrolleesin 2003, which is about the annual cost to fund 11,000 children inMinnesotaCare.2

Unfortunately, the RAND Experiment also showed that sickpeople with low incomes who were subject to cost-sharing had worsehealth outcomes on some measures. Still, this finding does not suggestthat Medicaid should be free of any and all cost-sharing; rather, it cau-tions states to apply cost-sharing judiciously.

Cost-sharing could be targeted to medical services not linked toworse health outcomes and that tend to be based on patient prefer-

ence versus medical need. Cost-sharing could also be structured sothat enrollees are not forced to spend cash out of pocket. For instance,Oklahoma, South Carolina, Indiana and Idaho are implementingMedicaid reforms that publicly fund special enrollee-controlled medi-cal spending accounts that can be used to pay for medical care.

Additionally, generous Medicaid coverage competes head-to-headwith private insurance coverage for low-income customers, whichcan “crowd out” private coverage. One study estimates that publiccoverage crowds out private coverage by around 60 percent; mean-ing that for every ten people who enroll in Medicaid, six drop privatecoverage.3

If 60 percent of people enrolling in Medicaid already had privatecoverage, they obviously did not need Medicaid. By pulling peoplefrom private coverage, private payers’ influence on the health caremarketplace diminishes and the government’s role grows.

By paying providers lower-than-market rates— often below theoperational cost of procedures —reduced access, cost shifting, and in-centives to deliver second-class care all become issues under Medicaidmanaged care.

In an American Academy of Pediatrics (AAP) survey of Min-nesota pediatricians, 45.1 percent reported Medicaid payments donot cover overhead (47.2 percent reported they didn’t know).4 Thelatest estimates from the Minnesota Hospital Association show thatMedicaid underfunds hospitals by 9.3 percent below cost.5 Conse-quently, doctors sometimes try to avoid serving unprofitable Medicaidpopulations. Some outright refuse to accept them as patients, whileothers avoid them through less overt methods. For instance, olderestablished doctors can refuse to accept any new patient; younger doc-tors can start or relocate clinics away from less mobile, lower-incomepopulations; and medical school students can avoid practice areas, likepediatrics, with higher proportions of patients on Medicaid.

Too-low reimbursement rates also result in a perpetual cost-shift-ing game where health plans, providers and patients parry the costs oflow reimbursement rates to someone else. Cost shifting is a zero-sumgame. All resources devoted to the game are wasted, because they’reexpended to shift, rather than to create, value.

Costs often end up inequitably shifting to people least able toafford it. Residents of lower-income inner-city neighborhoods willfind their nearest hospital charges them a higher rate than suburbanhospitals because they treat more patients on Medicaid. Costs shiftedin the form of higher insurance premiums make health care less

affordable for people at the margins—poor but not poor enough to qualify for Medicaid. Further, higher premiums are essentially a hid-den tax subsidizing Medicaid that operates much like a sales tax and, like any sales tax, it’s regressive.

Not incidentally, the hidden tax inherent in higher premiums hides the true cost of Medicaid and avoids the state budgeting process, which undercuts transparency and accountability within the Medicaid program.

Most troubling, low reimbursement rates can lead to second-class care. No doctor would ever admit to treating Medicaid patients differently than private-pay patients, but any other businessperson instinctively treats more profitable customers better. It’s hard to prove that some doctors deliver second-class care, but the perception exists. Thirty-eight percent of adult Medicaid enrollees surveyed in 2003 believed providers treated them unfairly due to their enrollment in Medicaid.6

If managed care lived up to its promise—to lower costs and improve health by actively coordinating medically appropriate care—then some of the shortcomings just outlined might be for-given. Unfortunately, managed care has not delivered.

The Urban Institute has conducted a number of studies assessing Medicaid managed care. One nationwide study concluded that man-aged care’s expected cost savings “did not materialize, and managed care did not translate into dramatically slower growth in program costs per beneficiary.”7 Two studies of rural Minnesota also suggest switching to managed care did not result in savings. The studies com-pared differences in the use of medical services for people in managed care after switching from fee-for-service Medicaid and uncovered no difference in emergency room or inpatient hospital use, two places prone to overuse and ripe for cost-cutting supervision from managed care.8

Moreover, if managed care were effectively containing costs, one would not expect per-person costs in MinnesotaCare—a Medicaid managed care program for children and families who don’t qualify for traditional Medicaid— to have climbed 289 percent since 1998compared to 212 percent for private insurance premiums.

As for quality, most research reveals that managed-care plans deliver quality no better and no worse than non-managed-care health plans. The two Urban Institute studies of rural Minnesota compared factors related to quality in managed care to fee-for-service Medicaid and found little difference in the location of where care is obtained, unmet health needs, reports of fair or poor health care experiences, or number of doctor visits.

In a free market, health plans compete on many levels, includ-ing price, service, quality, and benefit packages, as well as the plan design. All this competition should lead to lower prices, richer benefit packages, wider provider access, and higher quality service— in short, enhanced value. But most of this value-enhancing competition is absent within Medicaid managed care because the state defines the product. Thus, managed care plans generally have the same co-pays, premiums, benefits package and health maintenance organization plan design. Enrollees are left to choose a plan based almost entirely on the plan’s provider network and subjective perceptions of quality.

Private health plans are constantly evolving and innovating to meet customer needs. Why restrict Medicaid enrollees to a single, almost immutable plan type? For people with incomes above the fed-eral poverty guideline who are more able to share costs and are more capable of navigating the health care marketplace, other plan types might be more fitting.

One way to inject competition would be to provide Medicaid enrollees with the means to shop for their own private-market policies with direct subsidies or tax credits. Medicaid enrollees could then shop among plans with a defined state contribution that they or their employers would supplement to meet the full premium.

More shopping, choice, and competition would deliver more value to the Medicaid program, just as it has for Medicare’s new prescription drug benefit. Since heavily subsidized private prescrip-tion drug plans became available under Medicare Part D, they have consistently offered more benefits at lower prices than ever expected.

On top of enhanced value, subsidizing private health plans offers a number of additional advantages:• By purchasing the same health plans available to anyone in the

private market, Medicaid enrollees would be covered by the same reimbursement rates and eliminate the access, cost-shifting, and quality problems caused by too-low reimbursement.

• Children who qualified for Medicaid when their parents did not could use the subsidy to join their parents’ private policy, unify-ing families into one plan that’s easier to navigate with the same network of providers.

• A private-market Medicaid policy would be more portable at the time enrollees lost or gained eligibility and thus would provide a more continuous and stable source of insurance. Instead of having to leave the plan altogether upon losing Medicaid eligibility, the enrollee or the enrollee’s employer could take over payments.

• Employers, employees and Medicaid would find it much easier to share in the costs.

It bears repeating that Medicaid’s motivating purpose—to assist people without health insurance—remains sound. Yet we could do better, much better, if only we would implement reforms that intro-duce competitive market forces to enhance the value of the health care services funded by Medicaid.

Peter J. Nelson is a Policy Fellow, Center of the American Experiment.1) Joseph Newhouse, Free for All? Lessons from the RAND Health Insurance Experi-

ment, pp. 100 & 339 (1994). 2) Minnesota Department of Human Services, Health Care Services Study: Findings and

Strategies for Savings, (January 2005).3) Jonathan Gruber and Kosali Simon, Crowd-Out Ten Years Later: Have Recent Public

Insurance Expansions Crowded Out Private Health Insurance?, National Bureau of Economic Research Working Paper No. 12858 (Jan. 2007).

4) Beth K. Yudkowsky, Suk-Fong S. Tang, Alicia M. Siston, Pediatrician Participation in Medicaid/SCHIP: Survey of Fellows of the American Academy of Pediatrics, 2000, American Academy of Pediatrics.

5) Joe Schindler, “Minnesota Hospital Association Analysis of Health Care Cost Informa-tion System Data,” May 30, 2007.

6) Minnesota Department of Human Services, Disparities and Barriers to Utilization Among Minnesota Health Care Program Enrollees (Dec. 2003).

7) Robert Hurley and Stephen Zuckerman, Medicaid Managed Care: State Flexibility in Action, Urban Institute Discussion Papers 02-06 (Mar. 2002).

8) Sharon K. Long, Teresa A. Coughlin, and Jennifer King, “Capitated Medicaid Man-aged Care in a Rural Area: The Impact of Minnesota’s PMAP Program,” The Journal of Rural Health Policy, Vol. 21, No. 1, p. 19 (Winter 2005); and Teresa A. Coughlin and Sharon K. Long, “Effects of Medicaid Managed Care on Adults,” Medical Care, Vol. 38, No. 4 pp. 433-446 (Apr. 2000).

Your Voice

BY HELENE M. HORWITZ, Ph.D.

Focused Group Meet Your Future Colleagues—the U of M Class of 2007

FOCUS, A GENEROUS MEASURE of inten-sity, and a knack for letting their hair down, as needed—these are some of the characteristics evident among the 226 new physicians who graduated from the University of Minnesota Medical School in May. The Class of 2007 made a difference near and far, as they insti-tuted a new reflective retreat for themselves as future physicians and also learned around the world.

Before sharing a few of their stories, let’s look at the statistics. Seven of our new physi-cians are American Indian —Minnesota ranks second among medical schools in graduating American Indians. Almost half of the class is women. Ninety-seven new doctors entered pri-mary care specialties. The rest chose among the broad spectrum of surgical, medical, and hospital-based careers. The majority are Min-nesota natives and we expect many, after they complete their residencies, to practice here. More than half of the new graduates matched to residencies in Minnesota.

Their ties are strong. Many in this class also completed their undergraduate education at the University of Minnesota, and refer to themselves as “triple Gophers.” Class Presi-dent Sarah Nakib calls herself a “quadruple Gopher,” having also completed a master’s degree in Public Health at Minnesota.

Nakib, who is now a first year resident in the brand-new combined Internal Medicine and Dermatology Program at the University of Minnesota, considers herself well prepared to begin her graduate medical education. So does the rest of her class, according to results of the 2007 Association of American Medical Colleges Graduation Questionnaire. Minne-sota students are confident they have acquired

the clinical skills required to begin a residency program.

Asked to describe the personality of her class, Nakib says: “Overall, we were a some-what reserved class, we didn’t ‘rock the boat’ too often. Still, that didn’t get in the way of having a great time in med school. We valued having a sense of humor and took our talent shows very seriously.”

The Class of 2007 knows how to balance the lighter side of life with their professional values and their humanism. The co-chairs of the Gold Humanism Honor Society, Tara Frerks, M.D., and Kathryn Berkseth, M.D., spearheaded the first all-day retreat for fourth-year medical students entitled “After the Match: Transitioning to Residency as a Humanistic Physician.” The March 14, 2007, retreat provided an opportunity for the seniors to reflect upon their medical school experiences and how they intersected with humanism, to regroup and refocus in anticipation of the up-coming challenges of internship and residency, and to reflect upon what they wish to take with them on the next part of the journey. Medical School Dean Deborah Powell, M.D., gave a moving address, reflecting upon her encounters with the health care system on behalf of family members.

At the conclusion of the day, the students addressed letters to themselves that will be mailed six months into their residency. This opportunity for the “almost physicians” to re-flect upon the reason they chose medicine, their concern for the well-being of patients and their affirmation of the worth and dignity of each human being under their care, will become a tradition for the medical school classes that follow.

To develop these humanistic physicians, the educational program must be sensitive

to the needs, values and experiences of individual students. From this under-standing, the concept of the Flexible M.D. emerged. Fifteen per-cent of the graduating class chose to diverge from the traditional four-year curriculum and took additional time to pursue a variety of in-terests. These students extended their medical education an average of one additional year. Four percent of the Class of 2007 completed dual degrees, including nine M.D./Ph.D. physician scientist graduates.

A number of the graduates chose to pur-sue extensive international experiences while in medical school. Stephanie Smith, M.D., a Gold Humanism Honoree, spent nine months abroad. First, she conducted research in Cape Town, South Africa, and then worked at a public health clinic in Quito, Ecuador. For Smith, the Flexible M.D. provided her with the opportunity to push boundaries and help to create her own vision of enhancing human well-being.

During a volunteer research experi-ence in his first year of medical school, Rob Schleiffarth, M.D., became fascinated by a heart defect in mice. Deciding to pursue the problem, Rob took a year off after completing the basic science curriculum to work under the direction of Anna Petryk, M.D., with support from the Howard Hughes Medical Institute and the Minnesota Medical Foundation. Hop-ing to combine intricate surgery, patient care, and research in his medical career, Rob is now at the University of Iowa in his first year of a residency in Otolaryngology.

U of M Class of 2007

Another graduate and Gold HumanismHonoree now in Iowa is Harrison Hanson,M.D., training in Family Medicine at MercyMedical Center in Mason City. He is one of 30students from the Class of 2007 who pursuedan interest in rural medicine by participatingin the Rural Physician Associates Program(RPAP), a program begun 35 years ago thathas more than 360 alumni practicing in smalltowns in Minnesota. Harrison completed hisRPAP experience in his hometown of LongPrairie.

Described as a compassionate leader anddedicated champion of family medicine, Har-rison was chosen to receive the Medical StudentAward for Contributions to Family Medicineby the Minnesota Academy of Family Physi-cians. Also an active volunteer, Harrison leda group of high school students on a serviceproject to an orphanage in Mexico, and, ninedays after hurricane Katrina hit the Gulf Coast,flew to Mississippi to volunteer at an outreachclinic. Shortly before graduation, this physi-

cian, who began medical school on the Duluthcampus, completed a one-month externship inGhana.

His fellow Duluth classmate and GoldHumanism Honoree, Ross Perko, M.D.,also traveled to Africa. Ross, who is now aresident in pediatrics at the University ofMinnesota, made a difference in the lives ofchildren in Uganda. As reported in his IronRange hometown newspaper, the Mesabi DailyNews, Perko was moved to help children at theMulago Hospital in Kampala and at the localorphanage. When the chickens belonging tothe orphanage were stolen, and the children nolonger had any eggs, he asked his hometownfriends and neighbors to help. They gave the$7 cost for purchasing a chicken many timesover, helping to pay for food and toys for thechildren.

Ioanna Apostolidou, M.D.Jack Bert, M.D.Iris Wagman Borowsky, M.D.Christopher Callahan, M.D.Lisa Capell, M.D.Gretchen Sandvik Crary, M.D.Timothy Crimmins, M.D.Sean Elliott, M.D.Julia Grigoriev, M.D.Kenneth Holmen, M.D.Christine Hult, M.D.Allan Ingenito, M.D.Michelle Johnson, M.D.Kenneth Kephart, M.D.Natalia Kramarevsky, M.D.Kenneth Liao, M.D.Fei Lu, M.D.Lael Luedtke, M.D.Lisa Lyons, M.D.Toni Magnuson, M.D.Jake Matlock, M.D.Clare McCarthy, M.D.

Robert Moravec, M.D.J. Bart Muldowney, M.D.Juliana O’Laughlin, M.D.Luis Pagan-Carlo, M.D.Christopher Robert, M.D.Kari Roberts, M.D.Anne Rosenberg, M.D.Ashajyothi Siddappa, M.D.Lance Silverman, M.D.Jay Simonson, M.D.Arif Somani, M.D.William Stauffer, M.D.Thomas Stillwell, M.D.Suzette Sutherland, M.D.Robert Sweet, M.D.Joseph Tashjian, M.D.Umeng Thao, M.D.Jeanette Thomas, M.D.Ezgi Tiryaki, M.D.Paul Tuite, M.D.Jennifer Welsh, M.D.Parin Winter, M.D.

As medical students, the Class of 2007 hastraveled to far-flung places around the globe aswell as to the small towns of rural Minnesotawhere they positively impacted the health oflocal communities. They volunteered at in-ner-city clinics, schools, shelters and churchesboth here and abroad. Community service andhumanism are values strongly held by thesenew physicians. Now they are bringing thesevalues to the next phase of their education. AsNakib says, “the way we learn has changed abit. The stakes are higher now…we’re lookedto for leadership and decisions.”

Helene M. Horwitz, Ph.D., is associate dean forstudent affairs at the University of MinnesotaMedical School. For more information about themedical school, go to www.med.umn.edu.

Addendum to Article“Medical Students Connecting with Community Physicians”

The following HMS/RMS physicians also serve as mentors in the Medical StudentsConnecting with Community Physicians program. These physicians are in addi-tion to those reported in the July/August issue of MetroDoctors. Thanks again toall physicians participating in this medical student mentoring program.

We are a thriving, five physicianindependently owned clinic,established in the ‘60s. We arelooking for a physician to assume thepractice of a departing physician andcontinue to develop his/her patientbase. We are conveniently locatednext to Fairview Southdale Hospitalin Edina.

Future partnership opportunity available.

Please contact:Cami or Melissa

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Jacott Elected Chair AMA SeniorPhysician Group Governing Council

WILLIAM JACOTT, M.D., has been electedchair of the seven member AMA Senior Physi-cian Group (SPG) Governing Council. TheAMA SPG includes AMA member physicianswho are 65 and over and retired or semi-retired.The Governing Council has been around forabout 10 years, but has not been visible or in-tegrated into the AMA infrastructure. Recently,the Council has moved to become an impor-tant part of the AMA activities. The charteredpurpose of the SPG is to provide ancillarymembership services to AMA members 65 andover. Up until now it has done this with travelprograms, awards, a senior physicians Web site,a newsletter and a 50-year luncheon. In order

to expand the activity and better participate inmainstream AMA activities, the Council hascarefully considered strategy to move the SPGtoward becoming a Section within the AMA.

The Council has taken a number of keysteps to accomplish that goal. The wintermeeting has been rescheduled from offsite inFebruary to the AMA Interim meeting. Coun-cil members have been active participants inHouse of Delegates reference committee hear-ings. The first Senior Caucus was held duringthis year’s annual meeting in June. Work hasbegun to build a senior physician constituencyby developing a network of senior physiciangroups throughout the country. Two of those

groups already exist here in the Twin Cities. Thisnetwork could be a powerful advocacy group onsuch issues as Medicare, geriatric education, andhealth of the elderly.

The other members of the GoverningCouncil include: Harrison Rogers, Jr., M.D.,Georgia; John Knote, M.D., Indiana; ArthurEberly, M.D., Florida; Virginia Lathum, M.D.,Massachusetts; John Nettles, M.D., Oklahoma;and Irwin Kline, M.D., Pennsylvania. Dr. Jacottis from Minnesota and a former member ofthe AMA Board of Trustees after serving as anAMA delegate. The Council members serve twothree-year terms and are appointed by the AMABOT after an open call for nominations.

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Law Firm Adds Services, Roger Johnson Joins Government Relations Team

Lockridge Grindal Nauen P.L.L.P. (LGN) announces that Roger K. Johnson has

joined the law firm as a lobbyist and consul-tant, part of the Government Relations teams in Minnesota and Washington, D.C., effective July 1, 2007. In his new position, Mr. John-son will provide LGN clients with association management services, grassroots development, lobbying and public relations.

LGN Partner Ted Grindal said, “Roger is an outstanding professional whom I’ve known for 25 years. I look forward to working with him as the firm expands to offer public affairs, public relations and association management

services for clients working with us in Min-nesota and Washington, D.C.”

Johnson will advise, assist and advocate for physicians, physician group practices, prac-tice administrators and specialty societies at the Capitol and in state agencies in St. Paul.

“I am very pleased to be affiliated with Lockridge Grindal Nauen,” Johnson said. “I look forward to working with the LGN ad-vocacy team in Minnesota as well as with the attorneys in the LGN Health Care Practice Area on behalf of physicians and other health care professionals.”

A Minnesota native and graduate of the

University of Minnesota, Johnson has held several positions in organized medicine rang-ing from director of communications at the Minnesota Medical Association to the CEO of the Ramsey Medical Society, a position he held for 13 years until June 1, 2007. He is a Certified Association Executive (CAE).

Founded in 1978, LGN represents a broad base of clients in Minnesota and surrounding states. The firm’s practice focuses on environ-mental, employment, and health care areas of law and state and federal government affairs. LGN is soon to be the only Minnesota-based law firm with offices in Washington, D.C.

Ear, Nose & Throat SpecialtyCaretakes pleasure in announcing

Ilya Perepelitsyn, M.D.IN THE PRACTICE OF

Otolaryngology — Head and Neck Surgery

Minneapolis | St. Paul | Burnsville | Coon Rapids

Edina | Fridley | Golden Valley | Plymouth

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2211 Park Avenue South, Minneapolis, Minnesota 55404

(612) 871-1144

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Gregory L. Barth, M.D.

Merrill A. Biel, M.D., Ph.D.

Carl A. Brown, M.D.

Karin E. Evan, M.D.

Gary E. Garvis, M.D.

William J. Garvis, M.D.

Matthew S. Griebie, M.D.

Michael B. Johnson, M.D.

Nissim Khabie, M.D.

Richard M. Levinson, M.D.

Stephen L. Liston, M.D.

Jeffrey C. Manlove, M.D.

Michael P. Murphy, M.D.

Julie C. Reddan, M.D.

Melvin E. Sigel, M.D.

Benhoor Soumekh, M.D.

Jon V. Thomas, M.D.

Rolf F. Ulvestad, M.D.

Larry A. Zieske, M.D.

PRESIDENT’S MESSAGEV. STUART COX, M.D.

RMS Officers

President V. Stuart Cox, M.D.President-Elect Peter B. Wilton, M.D.Past President James J. Jordan, M.D.Treasurer Ronnell A. Hansen, M.D.

RMS Elected Board Members

Arthur A. Beisang III, M.D., DirectorCharles E. Crutchfield, III, MMB, M.D.,

At-Large DirectorLaura A. Dean, M.D., Specialty Director,

Obstetrics & GynecologyAndrew S. Fink, M.D., At-Large DirectorThomas J. Losasso, M.D., At-Large DirectorNicholas J. Meyer, M.D., DirectorRobert C. Moravec, M.D., At-Large DirectorJane C. Pederson, M.D., Specialty Director,

Internal MedicineJerome J. Perra, M.D., DirectorLon B. Peterson, M.D., DirectorThomas D. Siefferman, M.D., Specialty Director,

PediatricsJacques P. Stassart, M.D., At-Large DirectorChristina J. Templeton, M.D., Specialty Director,

PsychiatryScott A. Uttley, M.D., Director

RMS Appointed Board Members

Stephanie D. Stanton, M.D., Resident PhysicianKimberly C. Viskocil, Medical StudentMarie L. Witte, M.D., Young Physician

MMA Officers and Board Members

Lyle J. Swenson, M.D., MMA Vice Speaker of HouseTodd D. Brandt. M.D., MMA East Metro TrusteeCharles G. Terzian, M.D., MMA East Metro TrusteeDavid C. Thorson, M.D., MMA East Metro Trustee

RMS Ex-Officio Board Members &

Council Chairs

Blanton Bessinger, M.D., AMA Alternate DelegatePeter F. Bornstein, M.D., MPS, Inc. ChairKenneth W. Crabb, M.D., AMA DelegateRobert W. Geist, M.D., Professionalism & Ethics

Council ChairNeal R. Holtan, M.D., Community Health

Council ChairFrank J. Indihar, M.D., AMA Delegate, Chair of

MN DelegationCarolyn A. Johnson, M.D., Sr. Physicians

Association PresidentMark J. Kleinschmidt, Clinic AdministratorAnthony C. Orecchia, M.D.

Education Resource Council Chair

RMS Executive Staff

Sue A. Schettle, Chief Executive OfficerKatie R. Snow, Executive AssistantDoreen M. Hines, Manager, Member Services

SHealth Insurance andMedical Economics

“SICKO” HAS ONCE AGAIN thrust the prob-lem of health insurance and medical economicsto the front of the public eye. It has probablyalso bolstered the resolve of several Minnesotapoliticians to pass a constitutional amend-ment requiring the government to providehealth care for all Minnesota citizens. Withthe yearly increase in medical spending and thecurrent percentage of our GDP spent on healthcare, we certainly appear headed for some sortof dramatic change in how we provide and payfor health care.

“Sicko” at least implies that universalhealth coverage paid for by the national gov-ernment as in Canada, the United Kingdomand Cuba, is superior to our current system.Looking at the cost of health care per capitaand several health measures, the U.S. is notdoing as well as would be expected. However,the problem is endlessly complex. A goodstarting point is comparing how health careis provided and paid for here compared to theuniversal health coverage countries. Dr. BobGeist, in a recent newspaper editorial, pointsout that we currently have an agreement withprivate companies that we pay our premiumsand they will take care of us. Whereas, in theUK and Canada, the deal is made with thegovernment. They pay their taxes so they willprovide health care.

One of the arguments for universalhealth coverage is the number of uninsured.Undoubtedly, some cannot afford health insur-ance. However, many choose to forgo healthinsurance and rely on “free care.” Insuranceis primarily a vehicle to protect our assets inthe face of a health care catastrophe. If an in-dividual family has minimal assets, it doesn’tmake economic sense to spend a large part ofits income to protect its assets. Unfortunately,health insurance in America has morphed intoan agreement that we will take your moneyand then provide you with all the health careyou need. This puts an enormous amount ofmoney (power) in the hands of insurers whowill benefit by rationing care, and also leadsto the assumption by those who pay the pre-

miums that anything that can be done mustbe done regardless of cost or often unprovenoutcome. Demand is the primary driver ofhealth care cost.

The MMA’s proposal for health carereform would require that all individuals haveinsurance coverage. The “basic” insurance willprovide a single standardized set of health ser-vices for the protection of individual and publichealth. The State would also ensure afford-ability through subsidies and tax incentives.There would also be incentives for employersto offer insurance above the “basic” coverage.The MMA plan also calls for strengthening thepublic health system and reforming health caredelivery with incentives for improving value.The health savings account model has puta large part of the decision making on theindividual, who, up to this point, has beenlargely left out of the equation. The model isbuilt on a combination of the HSA and majormedical insurance, which is to protect against ahealth care catastrophe. The HSA is controlledby the individual and can be spent withoutsignificant outside restrictions. This could besupplemented further by a third account sup-plied by the employer to cover expenses afterthe HSA is exhausted but before major medicalkicks in. The advantage of the HSA model isself-rationing, allowing individuals to decidethe best health care value, and more freedom ofproviders to affect pricing. The concern is thatpeople could forgo preventative care and endup choosing “poor quality” health care.

Rationing — a political third rail — isinevitable. The problem with the currentsystem is irrational rationing, where both thepatient and the physician lose. Whether wehave rationing from the government, privatecorporations, individuals, or some amalgama-tion of all three, the escalation of spending onhealth care cannot increase indefinitely.

Smoke-Free Washington County Coalition Update

We are celebrating the passing of the Freedom to Breathe Act! Starting October 1, 2007 all workplaces and public places will be smoke-free. We have already started our implementa-tion work and have been running into the same question, “What is left to be done, the law already passed?” Well, we have a lot of public education to do to prepare Washington County for the new law. Many people are either not aware or do not fully understand all the details of the new smoke-free law. To educate we are attending many community events, presenting to community organizations and also getting in touch with businesses. Let the countdown begin!

Summer EventsDQ EventWe held an event in partnership with the Still-water Dairy Queen where we gave away free Blizzards to those who came out to support the new smoke-free law. It was a huge suc-cess! We gave away 199 Blizzards, and it was a wonderful opportunity to hear what Stillwater citizens have to say about their community go-ing smoke-free.

months. In September, Alecia will be entering her senior year at Gustavus Adolphus College. She is pursuing a degree in Sociology & An-thropology. A strong interest in health care, public policy, and general non-profit work led Alecia to Ramsey Medical Society.

Serving as a community organizing intern, Eliza-beth Frosch joined the Smoke-Free Washington County Coalition in June. Elizabeth works to increase public awareness and edu-cate the community on the statewide smoke- free law. As a 2007 graduate of St. Olaf College, Elizabeth brings her social work degree, public health experience, and strong interest in public policy to the implementation process.

Upcoming EventsGo to www.smokefreewashingtonco.org to check out our event calendar to find an event in your area. Click on the calendar in the bot-tom right corner to find upcoming events.

9/15—Youth Event in WoodburyStudents will get the chance to get in-

volved and educate the public by holding signs on busy Woodbury intersections advertising the coming of the new smoke-free law.

10/1—Implementation Day!Lunch–We encourage everyone to eat out

at their favorite restaurant with co-workers or friends for lunch and thank your host/server/restaurant manager for the Fresh Air!

Progressive Dinner – check out our Web site to find out more information on our Implementation progressive dinner start-ing at Gorman’s restaurant in Lake Elmo www.smokefreewashingtonco.org.

If you are interested in getting involved please contact Cynthia Piette at (651) 439-3096 or cpiette@metrodoctors.com.

RMS UPDATE

Washington County FairSmoke-Free Washington County had a booth at the Washington County Fair August 1-5.We had our new t-shirts on and our PLINKO game was a big hit with the kids. With lots of traffic through the buildings we had a great opportunity to educate Washington County citizens on the new law.

Woodbury DaysWe had a table in the community business section at the Woodbury Days August 24-26 giving us another chance to get materials out to citizens on the new law. Additionally, Wood-winds Hospital passed out Freedom to Breathe information cards at the parade.

Smoke-Free Washington County has a Web site!When you have a minute, check out our Web site: www.smokefreewashingtonco.org. Here you will find information about Freedom to Breathe, secondhand smoke facts, ways to get involved, and an opportunity to tell your story.

Summer InternsPlease welcome our two summer interns: Alecia Gooch and Elizabeth Froch.

Alecia Gooch was a new addition to the Smoke-Free Washington County team as of June 15. She is working on community events through the summer

Washington County residents enjoying Blizzards at the Sillwater Dairy Queen.

Elizabeth Frosch helps two little girls play Smoke-Free PLINKO at the Washington County Fair.

In MemoriamDAVID M. CRAIG, M.D. died in his home inPortland, Oregon on June 13, at the age of 90.He graduated from the University of Minne-sota Medical School and interned at MilwaukeeCounty Hospital. Dr. Craig served as a Majorin the Army Medical Corps in North Africaand Italy. Upon his return to St. Paul he beganpracticing with St. Paul Internists and remainedthere until retirement. Dr. Craig joined RMS in1947 and served as President in 1969 and wasvery active in organized medicine.

MICHAEL LOBELL, M.D. died on May 9 inTucson, Arizona at the age of 70. Dr. Lobell re-ceived his medical degree from the University ofLouisville School of Medicine and his postgradu-ate work and residency were spent at the StateUniversity of New York Hospitals. He completedclinical and research hematology work at the Uni-versity of Utah. He served as a clinical professorof medicine at the University of Minnesota, theUniversity of Kansas Medical Center, and for thepast six years, at the Arizona Cancer Center. Dr.Lobell specialized in Hematology/Oncology andfound his calling in the Arizona desert improvingcancer care for the underserved Native Americanpopulation. He was a member of RMS prior tohis move to Arizona in 1991.

Sue A. Schettle as New CEO of RMS

Iam very excited todig in as the newc h i e f e x e c u t i v e

officer of the RamseyMedical Society. Tryingto fill this role that washeld by my friend, RogerJohnson, will not be aneasy task, but I am up forthe challenge and energized by it.

As I take the reins of Ramsey Medical Soci-ety I realize that I have stepped into a whirlwindof activity. For a relatively small organization, wehave a lot going on and a lot of opportunity forphysicians to get involved. We have an active andengaged board of directors and executive com-mittee who meet frequently and get involved inmany of the activities of the society. Our foun-dation board members are engaged and lookingforward to future fundraising and gifting pos-sibilities. We have a for-profit subsidiary, Min-nesota Physician Services, Inc., that has recentlybroadened its scope to include the entire state ofMinnesota and is focused on entering into newbusiness relationships that will bring additionalnon-dues revenue to the society.

We have three active councils that includethe Education Resource Council focusing onCME, the Professionalism and Ethics Councildealing with the ethical dilemmas physicianssometimes face in the business of health care,and the newly reinvigorated Public Policy Coun-cil which is a joint council with the HennepinMedical Society and focuses on engaging physi-cians in health care legislation at the local level.

We also are the recipients of two grants towork on smoke-free initiatives in WashingtonCounty and Dakota County. The grants helpfund two full-time staff members who workon implementing the statewide law in theirrespective counties. We staff and administer theMinnesota Ambulatory Health Care Consor-tium, which focuses specifically on monitoringlegislation affecting ambulatory surgery andimaging centers. We are active in working withthe Minnesota Medical Group Management As-sociation on many initiatives, and I serve on theirgovernment affairs committee. We work jointlywith the Hennepin Medical Society on the Min-nesota Provider Coalition that is comprised ofa diverse group of health care organizationsworking to pool their resources to affect change

at the legislature. Together with HMS, we staffand manage the Metropolitan Hospital PhysicianLeadership Committee, which is a committeecomprised of medical directors, vice presidentsof medical affairs, and chiefs of staff from metroarea hospitals who come together quarterly totalk about issues specific to hospitals.

RMS has a core, dedicated group of retiredphysicians who meet routinely and discuss issuesthat are sometimes health care related, sometimesnot. It is an opportunity for them to meet withfriends and to socialize.

I am glad to be a part of an organizationlike the Ramsey Medical Society that is very aliveand active. I am also thrilled at the opportunitypresented to me and look forward to workingwith many of you. If you have comments thatyou’d like to share with me please feel free tocontact me at (612) 362-3799, or e-mail me atsschettle@metrodoctors.com.

Please Join Us

“Ethical Issues in Pay for Performance”

Speaker: David Satin, M.D.• Post-Doctoral Fellow, Center for Bioethics,

University of Minnesota• Assistant Professor, Department of Fam-

ily Medicine and Community Health,University of Minnesota

• Family Physician, University of MinnesotaMedical Center (Smiley’s) Residency Pro-gram, Minneapolis

• AMA Geriatric Pay-for-Performance WorkGroup

Friday, November 16, 20077:30 a.m. – 8:30 a.m.

United Hospital John Nasseff Medical Cen-ter (formerly the Heart and Lung Center)Miller and St. Luke’s Conference Rooms255 N. Smith Ave., St. Paul, MN 55102

Lower Level

Sponsored jointly by the Ramsey MedicalSociety and the medical staffs of UnitedHospital and HealthEast Hospitals.

The public is welcome.

CME and CEU credits are available.

Please contact Marge Avoles in PhysiciansServices at (651) 241-8548 with questionsabout this presentation.

Ramsey Medical Society Foundation

WinterMedical Conference 2008

February 23, 2008-March 1, 2008

San Diego, California

Save the Date

This nomination submitted by (Full name): _______________________________________________________Mail nomination form to:

Ramsey Medical Society, P.O. Box 131690, St. Paul, MN 55113-0015Or fax to 612-623-2888/ Email: sschettle@metrodoctors.com. Questions call 612-362-3704.

Nominee must be an active or retired RMS physician member.Service(s) by candidate must be voluntary in nature, performed locally, andshould include one or more of the following elements:(a) leadership and development of special community projects or programs;(b) Participation in civic or service organizations/groups;(c) Participation in educational, charitable, church, or other projects; or(d) Public offices held.RMS presidents are ineligible for the award until two years after thecompletion of his/her term of office.

2007 RMS AnnualCommunity Service AwardIn 1992, Ramsey Medical Society established an annual Community Service

contributions to our local community. The award is now entering its fourteenthyear. Recipient(s) of the 2007 Community Service Award will be recognized atthe RMS Annual meeting in 2008. A commemorative plaque will be presentedto the selected physician(s) and the winner(s) of the annual award will beprominently displayed on a perpetual plaque in the Society office. The RMSBoard of Directors is seeking physician nominees from the membership.

Do you have a colleague who should berecognized for his/her many volunteeractivities in the community?

RMS Physician Nominated (Full Name): _________________________________________________________

Describe why you are nominating this physician for the RMS 2007 Community Service Award, including specific communityactivities above and beyond professional medical work that this person has been involved in. You may also use a separatepage if you need more space. (Please print or type and return by Monday, December 10, 2007.)

AWARD CRITERIA

MHMS-Officers

Chair Paul A. Kettler, M.D.

President Anne M. Murray, M.D.

President-elect Richard D. Schmidt, M.D.

Secretary Edward P. Ehlinger, M.D.

Treasurer Eric G. Christianson, M.D.

Immediate Past Chair James A. Rohde, M.D.

HMS-Board Members

Lauren Baker, M.D.

Alan L. Beal, M.D.

Carl E. Burkland, M.D.

Peter J. Dehnel, M.D.

Laurie Drill-Mellum, M.D.

Kenneth N. Kephart, M.D.

Stephen MacLeod, M.D.

Frank S. Rhame, M.D.

Janette H. Strathy, M.D.

Thomas C. Tunberg, M.D.

David J. Walcher, M.D.

David A. Willey, M.D.

HMS-Ex-Officio Board Members

Michael B. Ainslie, M.D., MMA TrusteeMartha Arneson, Co-Presiding Chair, HMS AllianceBeth A. Baker, M.D., MMA TrusteeChristian L. Ball, M.D., Resident RepresentativeKaren K. Dickson, M.D., MMA TrusteeDavid L. Estrin, M.D., AMA Alternate DelegateMelanie Fearing, Medical Student RepresentativeDonald M. Jacobs, M.D., MMA TrusteeRoger G. Kathol, M.D., MMA TrusteeDawn Lunde, MMGMA RepresentativeRichard E. Streu, M.D., Sr. Physicians Association

RepresentativeKarin M. Tansek, M.D., MMA TrusteeTrish Vaurio, Co-Presiding Chair, HMS AllianceBenjamin H. Whitten, M.D., AMA Alternate Delegate

HMS-Executive Staff

Jack G. Davis, Chief Executive OfficerJennifer Anderson, Smoke-Free Project CoordinatorNancy K. Bauer, Assistant Director, and

Managing Editor, MetroDoctorsKathy R. Dittmer, Executive Assistant

CHAIR’S REPORTPAUL A. KETTLER, M.D.

Reflections of 2007

MY TERM AS CHAIR of Hennepin MedicalSociety is soon ending and this will be my lastcolumn. I would like to take time to reflect onthis past year’s accomplishments.

HMS staff and many of its physicianshave worked hard and championed for asmoke-free workplace. This perseverancehas resulted in the passing of the Freedomto Breathe Act, which protects people fromsecondhand smoke. Without the involvementof physicians, this would not have happened.Thank you to all who have donated your timeand talents in this effort.

The Board also participated in a strategicplanning retreat this year to re-look at the or-ganization of HMS and why it exists. Throughthis process a new mission statement, visionstatement, and name change were crafted.The new mission statement reads “HennepinMedical Society is an organization of physiciansdedicated to improving health care through edu-cation, support and advocacy for patients andphysicians.” The Board also replaced the cur-rent marketing statement with the followingvision statement “Providing medical leadershipto ensure a healthier and safer community.”

HMS is growing and expanding with ourmembership increasing over the past severalyears. The fastest growth is in counties out-side of Hennepin, Carver, Scott, Anoka andWestern Dakota counties. Physicians withinthese counties have expressed a “disconnect”with HMS. In response, the Board has dis-cussed and debated the pros and cons of anorganizational name change. This was nottaken lightly as HMS has a long-standinghistory and tradition. After much discussion,a new name was recommended by the Boardof Directors — West Metro Medical Society(WMMS). This will require approval fromthe House of Delegates at the MMA annualmeeting this September in Mankato. It wasfelt this name would better reflect the truemembership of the society.

The Board also approved a new award, the“First a Physician” award. This award recognizes

a member of HMS who exemplifies the profes-sion of medicine as a result of an outstandingcontribution to community service, work onpublic policy issues or legislative advocacy, orsignificant contribution to the governance andsuccess of the Hennepin Medical Society. Thisaward will be presented at the Annual Boardof Directors meeting in October.

Unfortunately, a lot of work lies ahead.The Medicare reimbursement for 2008 will becut almost 10 percent. The system is brokenand needs to be fixed once and for all. TheAMA and MMA work hard on behalf of physi-cians and patients but rely on your grassrootsefforts to be successful. Please get involved; allit takes is a phone call or an e-mail. In Min-nesota there is also a significant campaign toadvance a constitutional amendment (Marty-DFL) that grants every Minnesotan the rightto affordable health care. If this passes in the2008 session the amendment would appear onthe ballot. Physicians need to be involved andengaged on this issue; otherwise the practiceof medicine will be legislated by politicians.

The future of medicine lies in our handsand physicians can no longer afford to keeptheir heads in the sand. Now is the time to getinvolved. Finally, thank you for allowing methe honor and privilege of being chair of theHennepin Medical Society.

Welcome NewHMS Board Member

Stephen MacLeod, M.D.

HMS in Action highlights activities thatyour leadership and executive office staffhave participated in, or responded to, be-tween MetroDoctors issues. We solicit yourinput on these activities and encourageyour calls regarding issues in which youwould like our involvement.

HMS IN ACTIONJACK G. DAVIS, CEO

The Southdale Pediatrics board meetingwas selected as the venue for the recogni-tion of three Edina legislators supportive ofthe Freedom to Breathe Act. Left to right:Nancy Ott, M.D., Rep. Neil Peterson, Rep.Ron Erhardt, Sen. Geoff Michel, and LoriSkallerud, M.D. are pictured with Freedomto Breathe certificates. Rebecca Thoman,M.D., MMA Tobacco Control AdvocacyCoordinator, and Jack Davis attended andparticipated in this award presentation.

Dianne Fenyk, wife of John Fenyk Jr.,M.D., past President of the Hennepin Medi-cal Society Alliance, was installed as the 83rdPresident of the American Medical Associa-tion Alliance on June 26, 2007. A receptionpartially sponsored by the Minnesota MedicalAssociation, Hennepin Medical Society andRamsey Medical Society took place on June25, 2007 in Chicago.

Hennepin Medical Society Caucustook place on May 23, 2007. Over 20 resolu-tions were presented and approved for sub-mission to the Minnesota Medical AssociationHouse of Delegates, which is scheduled to beheld in Mankato on September 19-21, 2007. Ifyou haven’t yet registered, please contact KathyDittmer at (612) 623-2885. The future focusof the MMA will be determined during thismeeting.

The Partnership for a Smoke-FreeScott County has met several times and isfocused on the local implementation of thestatewide Freedom to Breathe Act. The Actprohibits secondhand smoke exposure in allworkplaces including bars and restaurants andwill become effective on October 1.

June 5 through June 7, 2007 were the dates forthe latest Community Internship Pro-gram. The CIP is designed to offer physicianshadowing opportunities to individuals whoare likely to play a role in setting or imple-menting health policy at a local, statewide ornational level. Legislators, judges, members ofCongress, and human resource executives aresome examples of the public who are targetedfor participation in this program. The Juneoffering focused on the public members and

senior staff of the Minnesota Board of MedicalPractice. See article on page 17.

Sandra Eliason, M.D., HMS memberphysician practicing at the Columbia ParkMedical Group and Executive Director of theCenter for Cross Cultural Health, spoke at theJune meeting of the Senior Physicians Associa-tion. Dr. Eliason’s presentation focused on hermedical travels to Cuba and the Cuban healthcare system. Her interesting talk was attendedby 50 retired physicians and spouses.

Jack Davis and Sue Schettle of the RamseyMedical Society spoke at a recent meeting ofthe Children’s Executive ProfessionalCommittee. They spoke on the importanceof medical professionals being engaged in thepolicy debate regarding health care and publichealth issues. They reminded those attendingthat the 2007 Health Care Omnibus Bill con-tained 555 pages filled with legislation thatmight well affect the delivery and financing ofhealth care. It’s important that physicians andother health care professionals participate inthe debate in support of their patients.

On July 16 Southdale Pediatrics physi-cians presented Sen. Geoff Michel, Rep. RonErhardt and Rep. Neil Peterson with certificatescommemorating the historic passage of theFreedom to Breathe Act. Nancy Ott, M.D. andLori Skallerud, M.D. presented the certificatesof appreciation and thanked the Legislators forsupporting the Freedom to Breathe Act. Ad-ditional discussion took place regarding healthcare reform and the concerns of the pediatriccommunity. Peter Dehnel, M.D. and JackDavis participated in the discussion. Thisevent was organized by Rebecca Thoman,M.D., MMA’s Tobacco Control AdvocacyCoordinator.

In a similar event, which took place at St.Francis Regional Medical Center,Brian Prokosch, M.D. presented a certificateof appreciation to Senator Claire Robling,

during a media training program conductedby Rebecca Thoman, M.D. Senator Roblingwas appreciative of the recognition and feltthat, although conflicted, she had to comedown on the side of the health consequencesof secondhand smoke.

Jack Davis and Nancy Bauer recently met withRobert Stevens, CEO Ridgeview MedicalCenter, to explore opportunities for collabo-ration and outreach.

Senator Claire Robling is presented with acertificate of appreciation by Dr. Brian Pro-kosch and Michael Baumgartner, Presidentof St. Francis Regional Medical Center.

HMS NEWS

Welcome New HMS Members

ActiveGoeffrey Getnick, M.D.The Ear, Nose & Throat Clinic & Hearing CenterOtolaryngology, Head and Neck Surgery

Kapil Gupta, MBBSHennepin County Medical CenterInternal Medicine/Gastroenterology

Abraham K. Jacob, M.D.University of Minnesota PhysiciansInternal Medicine/Pulmonary Disease

Robert J. Loegering, D.O.Hennepin County Medical CenterRadiology

Robert W. McKenna, M.D.University of MinnesotaHematologic Pathology

Margaret I. Rice, M.D.Evercare MinnesotaInternal Medicine/Geriatric Internal Medicine

Aasma Shaukat, MBBSUniversity of MinnesotaGastroenterology

Robert A. Taylor, M.D.University of MinnesotaNeurology

Resident PhysiciansHazmer H. Cassim, D.O.Benjamin H. Crenshaw, M.D.Todd L. Eisenberg, M.D.Elizabeth K. Gross, M.D.Aaron J. McCabe, D.O.Patrick J. Raasch, M.D.Matthew T. Reed, M.D.Kathleen A. Rieke, M.D.Gustavo J. Rodriguez, M.D.Charles J. Snow, M.D.Hassan A. Tetteh, M.D.Sabu Thomas, M.D.Ryan M. Williams, M.D.

In Memoriam

With only four weeks until Minnesota goes smoke-free, the Partnership for a Smoke-Free Scott County is educating local businesses and community members on the ins and outs of the new law, effective October 1, 2007.

The Partnership recently had a booth at the Scott County Fair and received very posi-

Four Weeks Until Smoke-Free Air!

tive feedback from fair-goers who are looking forward to being able to patronize their favorite food and drink establishments without suffer-ing the consequences of secondhand smoke. One fair attendee mentioned now he would be able to join the local bowling league because of the new law!

Also, be sure to check out our new Web site at www.smokefreescottcounty.org. BY JENNIFER ANDERSON

Project Coordinator, Partnership for a Smoke-Free Scott County

ROBERT N. HAMMERSTROM, M.D., FACSdied July 13, 2007 at the age of 84. He graduated from the University of Utah College of Medicine in Salt Lake City. Dr. Hammerstrom practiced general surgery in Minneapolis. He served in the U.S. Army in WWII, and in the U.S. Air Force in the Korean War. Dr. Hammerstrom joined HMS in 1958.

EDWARD A. JOHNSON, M.D., age 81, died on July 14, 2007 after a sudden and acute illness. He graduated from the University of Minnesota Medical School. Dr. Johnson practiced internal medicine at Bloomington Oxboro Clinic for 40 years. He was an active member of the Secular 3rd Order of St. Francis throughout his life. Dr. Johnson joined HMS in 1986.

JEANETTE LOWRY, M.D., died May 17, 2007, after a long illness. She was 86. As a child, she was inspired by her next-door-neighbor, Dr. Nelson, to become a physician. She graduated from the University of Minnesota, and obtained a masters degree in bacteriology from Harvard Medical School. Later, she attended the Uni-versity of Minnesota Medical School, where she

graduated first in her class. Dr. Lowry was one of the first female residents to train in internal medicine at the University of Minnesota. After residency training, she did research with Dr. An-cel Keyes, whose studies in physiology became groundbreaking. She later joined her husband, Paul, to practice internal medicine with him for many years, until her retirement from Lowry Medical Associates in 1992. Dr. Lowry joined HMS in 1960.

DONALD G. MCQUARRIE, M.D., Ph.D.died on June 19, 2007 at the age of 76. He graduated from the University of Utah and the University of Utah Medical School with high-est honors. He did his surgical internship and residency at the University of Minnesota. After serving in the Navy, he joined the surgical staff of the Minneapolis Veteran’s Administration Medical Center as a thoracic surgeon. He was Director of the Surgical Research Laboratory and was a Professor of Surgery at the University of Minnesota for 37 years. He served as Chief of Surgery of the Minneapolis V.A. Dr. McQuarrie joined HMS in1982.

Visit us at www.metrodoctors.com

ELive Each Day as Though it is Your Last

For One Day You’re Sure to be Right

HMS ALLIANCE NEWSELEANOR GOODALL

EACH OF US is the only person alive who hasthe sole custody of our life. There are thousandsof people who have our same education, do thesame work, volunteer for public service in theircommunities, and so on. But our own life, thelife of our mind, of our heart, of our spirit orinner essence, is unique and only ours.

We need to realize that life is the best thingever and that we have no business taking it forgranted. Sure the trappings we accumulate arenice, however, do you think you’d care verymuch about a new car or a larger house if youblew an aneurysm one day, or found a lumpin your breast?

We need to care so deeply about ourlife and its goodness that we want to spreadit around. All of us want to do well. But if wedon’t also do good along the way, then doingwell will not be enough.

It is easy to waste our lives. It’s easy toexist instead of live. There is a tendency notto learn this until something bad happens tous. Perhaps the worst ever, as in when a lovedone is taken from us prematurely. But we don’thave to go through such an event to learn tolove the journey, not the destination, to knowwith certainty that it is not a dress rehearsaland that today is the only guarantee we get.

So, if we are not, at this point, living withour heart and spirit as well as our mind, how dowe get there—without having to go througha life-changing event? I’d like to make a sug-gestion. Join the Hennepin Medical SocietyAlliance and work, play and make a differencein your community with other like-mindedphysician spouses. Through association withthis great group of people, we have an oppor-tunity to look at all the good in our world andto try to give some of it back. It’s a chance toadd dimension to your life, to have a worth-while and joyous connection to other humanbeings. And, when these other human beingsare all part of the family of medicine, there isalready a basic connection, one that eases thesharing of your ups and downs, the joys andthe challenges of a medical marriage.

Think of life as a terminal illness, and ifyou do, you will live it with joy and purpose.Continue to grow and to learn. The classroomis everywhere and the exam comes at the veryend. Living a full life, helping others — onyour own or through your work with a Medi-cal Alliance —will help you get a good gradeon this final exam. Plus, you’ll feel pretty darngood along the journey!

There are no guarantees about the futurebut feeling good about what you do and havingsome fun doing it is a good start. Plan on com-ing to the Hennepin Medical Society AllianceFall event. Mark your calendar for Tuesday,September 25 and further information willfollow. You will gain from personal learning,personal enjoyment, association with friends,plus you’ll be part of making our communitiesbetter places to live.

For further information on the HMSAlliance please contact Martha Arnesonarnesonma@msn.com, or call the HMS officefor a referral to other Alliance members (612)623-2885.

A New AMAAlliance PresidentOn June 26, 2007 DianneFenyk, HMSA and MMAAmember, was inaugurated asPresident of the AMA Al-liance. It’s been 60 yearssince an Alliance memberfrom Minnesota has heldthis prestigious office andall of us who know Dianneare anticipating an awesome year for the cur-rent 22,000 Alliance members nationwideunder her leadership.

In her inaugural address, Dianne relatedthe Aesop’s fable of the wind and sun debatingtheir relative strength, with the ultimate test ofsaid strength causing a man they saw to takeoff his coat. We all know the ending of thisone: The wind blew so hard the man drewhis coat tighter; the sun shone so brightly andwarmly that he, of course, took off his coat,proving that gentleness can be stronger thanforce. Dianne’s theme for her year in officeis gentleness, and the enormous strength andpower it brings to bear. Citing the physiciansof America, our heroes and our spouses, shecalled them the compassionate everyday heroeswho face reality every day with courage, withscience, with gentle-ness.

And, as Alliancemembers, she urgedus all to continue towork with the gentledetermined power ofthe sun.

HMS CEO Jack Davispresents Dianne Fenykwith a congratulatoryproclamation .

WEBERLAW OFFICE

a subsidiary of Ramsey Medical Society

You do not need to be an RMS member to participate

AmeriPride ApparelAmeriPride ApparelAmeriPride ApparelAmeriPride ApparelAmeriPride Appareland Linen Servicesand Linen Servicesand Linen Servicesand Linen Servicesand Linen Servicescontinues to be a terrificbusiness partner for MPS,Inc. and more importantly, forour members and physiciangroups across the state. Theyoffer linen services includinggowns, lab coats, towels ...youname it. Take a few minutesand let them provide you witha competitive bid for yourlinen services. You might bevery surprised at your savings.Contact Steve Severson atAmeriPride to get your free bidat 612-362-0334.

SafeAssureSafeAssureSafeAssureSafeAssureSafeAssureoffers OSHAcompliance trainingfor clinics. Medicalsociety membersreceive 50-60%discount onservices andtraining. Visit ourwebsite to readtestimonials fromclinicadministrators whohave used theirservices (seewebsite addressbelow).

Orbit Systems,Orbit Systems,Orbit Systems,Orbit Systems,Orbit Systems,Inc.Inc.Inc.Inc.Inc. is an Eagan-basedorganization specializingin services ranging fromnetwork connectivity,mail and Web hostingservices, to the completeoutsourcing of hardware,software and support.Discounts are available ifyou mention MPS, Inc.when you connect withthem. They are interestedin talking to you aboutways that they can helpwith your IT needs. To learnmore about them visit theirwebsite at www.orbits.netor call Steve McFarland at651-767-3322.

InforMED Group,InforMED Group,InforMED Group,InforMED Group,InforMED Group,Inc.Inc.Inc.Inc.Inc. is a healthcaretechnology and marketingservices organization thathelps physician practicesto streamline, manageand grow. They helpclinics adopt technologyand identify areas to savemoney, save time,increase revenues, and/orenhance their communityimage through costeffective marketing. Tolearn more visit theirwebsite atwww.informedgroup.com,or call Tom Riester atInforMed at 952-826-6980.

Berry CoffeeBerry CoffeeBerry CoffeeBerry CoffeeBerry Coffee is aMinnesota basedcompany that has areputation for world classservice by providingcoffee and refreshments.They also provide state ofthe art equipment foryour clinics andhospitals. We havenegotiated a grouppurchasing agreementwith Berry Coffee. Besure to mention MPS,Inc. when you call foryour pricing. Contact BobDilly at 952-937-8697.

Longstanding business partners continue to offer greatLongstanding business partners continue to offer greatLongstanding business partners continue to offer greatLongstanding business partners continue to offer greatLongstanding business partners continue to offer greatservices and valueservices and valueservices and valueservices and valueservices and value

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