SGIM FORUM Society of General Internal Medicine TO PROMOTE IMPROVED PATIENT CARE, RESEARCH, AND EDUCATION IN PRIMARY CARE Volume 24 • Number 7 • July 2001 2001 ANNUAL MEETING: A LOOK BACK DISPARITIES THEME DEFINES ANNUAL MEETING Eileen E. Reynolds, MD, and Carol M. Mangione, MD continued on page 12 Contents 1 Disparities Theme Defines Annual Meeting 2 Members Speak Out About ATRC 2 President Forms External Funding Task Force 3 President’s Column 4 Glaser Award Goes to Bob Fletcher 4 John Eisenberg Receives First National Award for Career Achievement in Research 5 Randy Barker is Recipient of Medical Education Award 5 Rhodes Award Presented to Mark Linzer 6 James R. Gavin Receives Nickens Award 6 Chinazo Cunningham Named First Horn Scholar 7 Health Policy Committee Addresses HCFA Regulations 7 Jane Geraci Named Regional Coordinator 8 2001 Annual Meeting: A Photo Album 16 Classified Ads C ompeting for top honors at the re- cent 2001 Annual Meeting were the dedication and spirit of the membership, the theme of Disparities in Health, the inspirational addresses by Drs. David Satcher and Reed Tuckson, and the great host city of San Diego. A full 60% of SGIM members at- tended the Annual Meeting, held May 2- 5, 2001 (were you there?), coming within about 10 of the landmark number set last year in Boston. With a record number of submissions (over 1,200 for all categories combined), we knew that there would be terrific con- tent presented in all areas—precourses, workshops, abstracts, vignettes, and inno- vations. What we weren’t prepared for was the overwhelming response the member- ship showed to the theme, “Addressing Disparities in Health: Roles for General Internists.” With the theme category ac- counting for large numbers of submissions, it is clear that our membership cares deeply and works actively in this area. The theme was apparent throughout the meeting, from the opening abstract of the plenary session, given by Giselle Corbie-Smith on “Distrust, Race and Research,” through one of the last pre- sentations, the Clinical Crossroads case discussed by Steve McPhee, who sum- marized cultural, structural, and bio- medical disparities and issues in the care of Vietnamese-Americans. Another session, on a different sub- ject, brought out the passion and dedica- tion of SGIM’s membership. A special meeting with Council was held, in re- sponse to controversy around their deci- sion to accept funding from a pharmaceu- tical firm to support a thromboembolism research registry. After a brief introduc- tion by Sankey Williams and position statements by Council members repre- senting both sides of the debate, the mem- bership was invited to the microphone to make comments (which were recorded). Dozens of members spoke up, including senior leaders, past presidents, and rela- tively new members. The statements were thoughtful, articulate, and deeply felt; many have commented that the session renewed the sense of commitment we all feel to the Society. Council has taken the comments, which represented a broad spectrum of opinion, under advisement. Two new awards were inaugurated in 2001: the John M. Eisenberg National Award for Career Achievement in Re- search and the Horn Scholars Program. Named after it’s first recipient, the Eisenberg Award was created to mirror the National Award for Career Achievements in Medical Education, which has been given by the Society for some time. Dr. Eisenberg was honored during the Open- ing Plenary Session for his leadership in research and for his vision and advocacy in the funding of research. He made re- marks that reflected on the “serendipity” and satisfaction of his career, from his days as a medical resident at Penn to his cur-
Transcript
SGIM
FORUMSociety of GeneralInternal MedicineTO PROMOTEIMPROVED PATIENTCARE, RESEARCH,AND EDUCATION INPRIMARY CARE
Volume 24 • Number 7 • July 2001
2001 ANNUAL MEETING: A LOOK BACK
DISPARITIES THEMEDEFINES ANNUAL MEETINGEileen E. Reynolds, MD, and Carol M. Mangione, MD
continued on page 12
Contents1 Disparities Theme Defines
Annual Meeting
2 Members Speak Out About ATRC
2 President Forms External FundingTask Force
3 President’s Column
4 Glaser Award Goes to Bob Fletcher
4 John Eisenberg Receives FirstNational Award for Career Achievementin Research
5 Randy Barker is Recipient of MedicalEducation Award
5 Rhodes Award Presented to Mark Linzer
6 James R. Gavin Receives Nickens Award
6 Chinazo Cunningham Named First HornScholar
7 Health Policy Committee AddressesHCFA Regulations
7 Jane Geraci Named Regional Coordinator
8 2001 Annual Meeting: A Photo Album
16 Classified Ads
Competing for top honors at the re-cent 2001 Annual Meeting werethe dedication and spirit of the
membership, the theme of Disparities inHealth, the inspirational addresses by Drs.David Satcher and Reed Tuckson, and thegreat host city of San Diego.
A full 60% of SGIM members at-tended the Annual Meeting, held May 2-5, 2001 (were you there?), coming withinabout 10 of the landmark number set lastyear in Boston.
With a record number of submissions(over 1,200 for all categories combined),we knew that there would be terrific con-tent presented in all areas—precourses,workshops, abstracts, vignettes, and inno-vations. What we weren’t prepared for wasthe overwhelming response the member-ship showed to the theme, “AddressingDisparities in Health: Roles for GeneralInternists.” With the theme category ac-counting for large numbers of submissions,it is clear that our membership caresdeeply and works actively in this area.The theme was apparent throughout themeeting, from the opening abstract ofthe plenary session, given by GiselleCorbie-Smith on “Distrust, Race andResearch,” through one of the last pre-sentations, the Clinical Crossroads casediscussed by Steve McPhee, who sum-marized cultural, structural, and bio-medical disparities and issues in the careof Vietnamese-Americans.
Another session, on a different sub-ject, brought out the passion and dedica-
tion of SGIM’s membership. A specialmeeting with Council was held, in re-sponse to controversy around their deci-sion to accept funding from a pharmaceu-tical firm to support a thromboembolismresearch registry. After a brief introduc-tion by Sankey Williams and positionstatements by Council members repre-senting both sides of the debate, the mem-bership was invited to the microphone tomake comments (which were recorded).Dozens of members spoke up, includingsenior leaders, past presidents, and rela-tively new members. The statements werethoughtful, articulate, and deeply felt;many have commented that the sessionrenewed the sense of commitment we allfeel to the Society. Council has taken thecomments, which represented a broadspectrum of opinion, under advisement.
Two new awards were inaugurated in2001: the John M. Eisenberg NationalAward for Career Achievement in Re-search and the Horn Scholars Program.Named after it’s first recipient, theEisenberg Award was created to mirror theNational Award for Career Achievementsin Medical Education, which has beengiven by the Society for some time. Dr.Eisenberg was honored during the Open-ing Plenary Session for his leadership inresearch and for his vision and advocacyin the funding of research. He made re-marks that reflected on the “serendipity”and satisfaction of his career, from his daysas a medical resident at Penn to his cur-
Gary E. Rosenthal, MD • Iowa City, [email protected] • (319) 356-4241
Harry P. Selker, MD, MSPH • Boston, [email protected] • (617) 636-5009
EX OFFICIORegional CoordinatorJane M. Geraci, MD, MPH • Houston, [email protected] • (713) 745-3084
Editor, Journal of General Internal MedicineJournal of General Internal MedicineJournal of General Internal MedicineJournal of General Internal MedicineJournal of General Internal MedicineEric B. Bass, MD • Baltimore, [email protected] • (410) 955-9868
The SGIM Council invited mem-bers attending the AnnualMeeting in San Diego to attend a
special, 90-minute session to discuss theCouncil’s decision to form an Antico-agulation-Thromboembolism ResearchConsortium (ATRC) using a grant fromAstraZeneca, a pharmaceutical com-pany. The stated purpose of the sessionwas to “provide SGIM members theopportunity to speak directly withSGIM’s Council about its decision andthe larger issues raised by the decision,including SGIM sponsorship of researchinitiatives and industry support for theseinitiatives.” As a non-voting member ofthe Council, I took notes while eachspeaker spoke. A total of 29 membersaddressed comments to the Council.After the session, I reviewed the notesand tried to identify the issues andconcerns that were raised by eachspeaker. I then grouped related issuesand concerns into specific categoriesthat are summarized below. Thosevoiced by more than one speaker aremarked with an asterisk (*).
Concerns about the decision1. * Diversion of efforts and opportunity
costs (including legal costs)2. * Conflict between the mission of
SGIM and the mission of a pharma-ceutical company
3. * Importance of supporting members’professionalism
4. * Desire for informing members aboutthe issue and conducting a ballot onthe decision
5. * Concern regarding adequatesafeguards and rules
6. * Divisiveness of the issue7. * Message that it sends to trainees8. * Ability to grow without accepting
money from a pharmaceuticalcompany
9. * Credibility of the organization10. * Why couldn’t this be done
through a university (or foundation)instead of a professional society?
11. * Concerns about inadequatedecision making process
12. Competition with members
President FormsExternal Funds TaskForceLorraine Tracton
SGIM’s President, Kurt Kroenke, hasappointed Council Member Michael
Barry to lead a nine-member ExternalFunds Task Force. The task forceincludes three additional Councilmembers (Harry Selker, EileenReynolds, and Brent Petty), the Chairsof the Ethics, Research, Education, andDevelopment Committees (LisaRubenstein, Ken Covinsky, CatherineLucey, and Jack Peirce), and an addi-tional Ethics Committee member (MattWynia). The task force will reviewSGIM’s current policy regardingexternal funding (Policy on Acceptanceand Disclosure of External Funds) andmake recommendations for revisions orclarification if needed.
Council approved the currentpolicy document in December 1999,after considering revisions recom-mended by the Ethics Committee. Thisdocument was the product of extensiveresearch and was built on the purposeand values expressed in a previouspolicy document, dated 1994. Thecurrent policy clarifies ambiguities inthe 1994 document. It also differs bystating that it is intended as both anexternal document, for reference by anywho wish to do business with SGIM, aswell as an internal expression of clear
continued on page 13
3
PRESIDENT’S COLUMN
SGIM
FORUM
Published monthly by the Society of General Internal Medicine as a supplement to the Journal of General Internal Medicine.SGIM Forum seeks to provide a forum for information and opinions of interest to SGIM members and to general internists andthose engaged in the study, teaching, or operation for the practice of general internal medicine. Unless so indicated, articles do notrepresent official positions or endorsement by SGIM. Rather, articles are chosen for their potential to inform, expand, andchallenge readers’ opinions.SGIM Forum welcomes submissions from its readers and others. Communication with the Editorial Coordinator will assist theauthor in directing a piece to the editor to whom its content is most appropriate.The SGIM World-Wide Website is located at http://www.sgim.org
EDITOR
David R. Calkins, MD, MPP • Boston, [email protected] • (617) 432-3666
Ellen F. Yee, MD, MPH • Los Angeles, [email protected] • (818) 891-7711 Ext. 5275
YIN AND YANGKurt Kroenke, MD
continued on page 14
It is common after an AnnualMeeting to reminisce about all thereasons one enjoyed the event and
returned to work rejuvenated. I haveattended regularly since my firstmeeting in 1984, and many of the post-meeting feelings have not changed.There is the renewal of my belief ingeneralism through a support group ofcolleagues who, like me, spend most oftheir year in institutions where special-ization is still the favorite child. Thereis the immersion in abstracts andworkshops on medical education,clinical research, and primary care thatinspires me to continue these endeavorsfor another year. There are the SGIMfriendships, for which the meeting is aonce-a-year reunion. In some cases, wecan only chat for a few minutes betweensessions or say “hi” in the corridors.However, like the Christmas cards Ireceive from old college friends, even abrief booster restores my sense ofconnectedness. San Diego was nodifferent. The tonic I received in Maywill hopefully last me until Atlanta.
It is not the old feelings I want tofocus on, however, but rather my newappreciation for differences. SGIM hasalways had them. The very nature ofgeneralism suggests heterogeneity morethan homogeneity, pluralism ratherthan monism. We are a big tent, amelting pot, a mosaic. There are the leftbrains (medical decision making,clinical epidemiology, the “hardsciences” of health services research)and the right brains (doctor-patientrelationships, qualitative analysis,biomedical ethics). There are theteachers, investigators, clinicians, andadministrators. There is regional,demographic, and institutional diversity.Each of us is characterized in some wayby each of these variables, so that thepermutations in a Society of 3,000members not only encourages multiple
subgroups but, infact, mandatesthem.
In Looking inthe Mirror, aclassic book onthe sociology ofchurches, LyleSchaller writesabout sevendifferent sizes of acongregation. SGIM would qualify asmid-size, at which point a successfulvolunteer or member organizationretains its relevance by providingopportunities for members to aggregatein smaller subgroups linked by commoninterests. As opposed to a smallerorganization, where “the focal point isconcentrated in one place,” the mid-sizeorganization is “marked by diversity and
by many activities occur-ring concurrently inseveral different places.”The organization remainsthe home within whichthere are many rooms.Although many rooms arenot new in SGIM, theirsalience for me this yearwas, surprisingly, anepiphany. I will give two
examples of how differences challengedmy thinking as I departed San Diego.
First, there was the meeting theme,“Addressing Disparities in Health.” Thishas not been an area in which I havebeen particularly knowledgeable nor—Isay this with some sense of embarrass-ment—passionately interested. Likemany, I’ve had my own foci in research
4
SGIM FORUM
Glaser Award Goes to Bob FletcherAnn B. Nattinger, MD, MPH
continued on page 13
The Robert J. Glaser Award is theSociety’s highest award. It is givento an individual who has made
outstanding contributions to research,education, or both in generalism inmedicine. It is supported by grants fromthe Henry J. Kaiser Family Foundationand the Commonwealth Fund, and byindividual contributors. This year’sGlaser Award Committee includedJoAnn Elmore, Gustavo Heudebert,Wendy Levinson, Gene Rich, and BillTierney. I am grateful to each of themfor their assistance in making a difficultchoice from among the outstandingcandidates nominated for this award.
On behalf of the committee andthe Society, I was privileged to presentthe 2001 SGIM Robert J. Glaser Awardto Robert H. Fletcher, MD. BobFletcher received his medical degreefrom Harvard Medical School, did hisresidency training at Stanford and atBaltimore City Hospitals, and was aCarnegie-Commonwealth ClinicalScholar at Johns Hopkins MedicalSchool. He has served on severalmedical faculties, including McGillUniversity and the University of NorthCarolina at Chapel Hill. He is presentlyProfessor of Ambulatory Care andPrevention at Harvard Medical School.
Bob’s contributions to generalismare numerous, and I will touch only onthe highlights. As pointed out by hisnominators, Steven Simon, ThomasInui, and David Sackett, Bob hasdistinguished himself as a pioneer andleader in clinical epidemiology researchand primary care education. He is thelead author of, and internationallyknown for, the textbook ClinicalEpidemiology: the Essentials, now in itsthird edition and published in eightlanguages. He was a leader in thedevelopment of the InternationalClinical Epidemiology Network, aprogram for training medical faculty
from developing countries in clinicalepidemiology. For over a decade, Bobdirected the Robert Wood JohnsonClinical Scholars Program at UNCand, since arriving at Harvard, hasserved as co-director of the HarvardGeneral Internal Medicine FacultyDevelopment and Fellowship Program.Through these programs, his nomina-tors estimate that Bob has overseenthe training of one eighth of theUnited States’ clinical epidemiologistsand one quarter of the clinicalepidemiologists in developing coun-tries internationally. This does not evencount the many additional trainees whohave learned from his book, a master-work in the area.
In addition to the dozens of articles continued on page 13
Bob Fletcher proudly displays his GlaserAward, presented by Secretary AnnNattinger, who chaired the selectioncommittee. PHOTO BY L. SIRMOPOULOS
John Eisenberg Receives First National Awardfor Career Achievement in ResearchSankey V. Williams, MD
he has written with trainees, Bob hasbeen a prolific writer himself, perform-ing cutting-edge investigation integrat-ing epidemiologic methods into the
Last year, I asked Ann Nattingerand a group of colleagues to
review our awards, because selectionprocedures were not uniform andbecause it was uncertain whether wewere giving all the right types ofawards. Ann recommended thecreation of a new award, to be calledthe National Award for CareerAchievement in Research, to balancean existing award called the NationalAward for Career Achievement inEducation. SGIM’s Council agreedto create the award and decidedthat this year’s recipient should beJohn Eisenberg.
John was raised in Memphis,Tennessee. He went to Princeton asan undergraduate to study history, andhe received his MD degree fromWashington University in St. Louis.He then became an intern and
resident at the University of Pennsyl-vania, where he stayed for the next 20years. While at Penn, John started the
President Sankey Williams presents thefirst National Award for Career Achieve-ment in Research to former PresidentJohn Eisenberg, for whom the award isto be named. PHOTO BY L. SIRMOPOULOS
5
RANDY BARKER IS RECIPIENT OF MEDICALEDUCATION AWARDAllan H. Goroll, MD
continued on page 14
At this year’s Annual Meeting I hadthe pleasure of presenting theNational Award for Career
Achievements in Medical Education toLee Randol Barker, MD, of JohnsHopkins University. Randy was born inBaltimore and went to college atHarvard before returning to Baltimorefor medical school at Johns Hopkins.He did his residency training atBellevue Hospital in New York City.Randy then did an infectious diseasefellowship at the National Institutes ofHealth and Johns Hopkins, where hewas also a Robert Wood JohnsonClinical Scholar and MPH student. Hethen served as chief resident at Balti-more City Hospital. Upon completionof training, Randy joined the faculty atHopkins as Director of the MedicalHousestaff Clinic and Director of the
Randy Barker accepts the NationalAward for Career Achievements inMedical Education from Allan Goroll,last year’s winner. PHOTO BY L. SIRMOPOULOS
Medical Clinic at Bayview MedicalCenter, positions he continues to holdto this day. In 1979, he became thefirst Director of the Division ofGeneral Internal Medicine at Bayview.He also established the GeneralInternal Medicine Faculty Develop-ment Program at Hopkins. In 1995,Randy received a Fulbright to serve assenior lecturer in Barcelona, Spain.That same year he was promoted toProfessor of Medicine at Hopkins.
Those whose professional liveshave been touched by Randy knowhim as a model clinician, a teachers’teacher, a selfless and devoted mentor,a serious student of medical education,and a fine textbook editor/author,whose textbook, Principles of AmbulatoryMedicine, is one of the leading books inour field.
Randy’s career story reveals therichness and gratification of a career asa clinician educator. His examplecontinues to inspire all those who cometo study with him. SGIM
This year’s recipient of the Elnora M.Rhodes SGIM Service Award is
Mark Linzer, MD. The Rhodes Awardwas established in 1997 to honor ElnoraRhodes, SGIM’s first Executive Direc-tor. The Award recognizes outstandingservice to SGIM and its mission ofpromoting patient care, research, andeducation in general internal medicine.The Award is supported by contribu-tions from SGIM members and memo-rial donations from friends and family ofElnora Rhodes.
Mark Linzer is the fifth recipient ofthe Rhodes Award. He is a graduate ofOberlin College (BA, 1973) and JohnsHopkins School of Medicine (MD,1977). He was a resident in socialmedicine (internal medicine) atMontefiore Medical Center in theBronx, where he also served as chief
resident and later as a faculty member.His subsequent career has taken him tothree other institutions: Duke (1985-1989), where he was Chief, Division ofGeneral Internal Medicine, andDirector, Residency Program inPrimary Care Internal Medicine; Tufts(1989-1993), where he was Director,Office of Primary Care Education; andthe University of Wisconsin (1993-present), where he is Chief, Section ofGeneral Internal Medicine.
Mark has been a member of SGIMsince 1979. He has made manycontributions to the organization.Most notable has been his leadership ofthe Task Force on Career Choice and,more recently, the Research on Careers(ROC) Interest Group. The Task Forceon Career Choice gave rise to theCareer Satisfaction Study Group
(CSSG) and to the Physician WorklifeStudy, one of SGIM’s first externallyfunded research projects. The PhysicianWorklife Study, supported by a grantfrom the Robert Wood Johnson Foun-
Rhodes Award Presented to Mark LinzerDavid R. Calkins, MD, MPP
Mark Linzer accepts the Rhodes Awardfrom Peter Ubel. PHOTO BY L. SIRMOPOULOS
6
SGIM FORUM
JAMES R. GAVIN RECEIVES NICKENS AWARDLisa A. Cooper, MD, MPH
Chinazo Cunningham Named First Horn ScholarCarole Warde, MD
continued on page 15
Established in 1999, the Herbert W.Nickens Award honors anindividual or representative of an
organization who has demonstratedexceptional commitment to culturaldiversity in medicine. The NickensAward is named in honor of the lateHerbert W. Nickens, MD, formerDirector, Office of Minority Health,Department of Health and HumanServices, and the first Vice President andDirector, Division of Community andMinority Programs, Association ofAmerican Medical Colleges. Dr. Nickensdevoted much of his career to establishingprograms that address the critical need fortraining physicians from underrepresentedethnic minority groups.
This year, the committee selectedJames R. Gavin III, MD, PhD, SeniorScientific Officer, Howard HughesMedical Institute to receive theNickens Award. Among his manyachievements, Dr. Gavin has served asDirector, Minority Medical FacultyDevelopment Program, Robert WoodJohnson Foundation since 1993. Prior
to assuming the role of Director, Dr.Gavin served as a member of theNational Advisory Committee for theProgram since its inception in 1983.The Program’s objective is to increasethe number of minority faculty whocan achieve senior rank in academicmedicine and who will encourage andfoster the development of succeedingclasses of minority medical students.Under Dr. Gavin’s leadership, thenumber of peer-reviewed awards goingto underrepresented minority fellowsand junior faculty in academic medicalcenters increased by 20 percent. TheProgram now offers 12 awards per year.Importantly, the Program has em-braced the general area of health caredelivery, including the fields of clinicalepidemiology and health servicesresearch, applied to all specialties ofmedicine, including general internalmedicine. Several members of SGIMhave received awards.
Dr. Gavin’s leadership has had, andwill continue to have, a tremendousimpact on cultural diversity in academic
James R. Gavin III receives the NickensAward from Lisa Cooper.PHOTO BY L. SIRMOPOULOS
medicine, including general internalmedicine, because the Program providescareer development awards and trainingfor a future generation of diverse facultyin academic medical centers.
The committee thought it was mostfitting that Dr. Gavin’s long-standingcommitment be distinguished with the2001 Herbert W. Nickens Award.Congratulations, Dr. Gavin! SGIM
At the recent Annual Meeting in SanDiego, I had the pleasure of an-
nouncing SGIM’s first Mary O’FlahertyHorn Scholar in General InternalMedicine. The Horn Scholars Programdemonstrates a new career model forclinician educators by funding half of afull-time position. The Horn ScholarsProgram seeks to provide role models andmentors who balance personal, profes-sional, and social responsibilities byworking half time. It is SGIM’s hope thatthe Horn Scholars Program and the workof the Personal-Professional BalanceInterest Group will help clinicianeducators across this country find the
priorities of their heart and the resources,both personal and professional, to be ableto live by those priorities.
The Horn Scholars Program ismodelled after a former SGIM member,
Horn Scholar Chinazo Cunningham (fourth from left) is surrounded by herfamily and family and colleagues of Mary O’Flaherty Horn at this year’s AnnualMeeting. Carole Warde (right) presented the Horn Scholar Award.PHOTO BY L. SIRMOPOULOS
7
Health Policy Committee AddressesHCFA RegulationsRobert Blaser and John D. Goodson, MD
continued on page 15
Since 1995, the Health CareFinancing Administration(HCFA) has been seeking to
establish a single mechanism forassigning value to physician work. Thiseffort has proceeded in fits and starts.The original guidelines for the docu-mentation of evaluation and manage-ment (E&M) services, published in1995, proved to be cumbersome, overlydetailed, and administratively awkward.The physician community objectedvigorously. As a result, revisions werereleased in 1997, but there were fewsubstantial changes. Thus a thirdversion was unveiled in the summer of2000 with the intent of simplifying theguideline process, reducing the adminis-trative burden imposed, and allowingconsistent and equitable review.
Aspen Systems, HCFA’s designatedcontractor for the current revisionprocess, has released for commentsclinical examples of what it believes tobe the appropriate documentation ofE&M services for 16 specialties,including internal medicine, across thefull range of services. Though SGIMwill not be allowed to commentformally on these clinical examples, weare working very closely with ourcolleagues at ACP/ASIM to be sure thatthe perspective of the general internalcommunity is fully articulated.
The Primary Care Cluster ofSGIM’s Health Policy Committee hasgenerated comments that address issuesrelevant to primary care physicians asfollows:� The clinical examples need to be
expanded to include material thatrecognizes the broad range of respon-sibilities of the primary care physician(PCP), such as database managementand care coordination.
� The PCP’s role in the comprehensivereview of multiple and interactingpatient needs to be recognized. PCPs
spend much of their time on preven-tive and disease management activi-ties; the value assigned to the work ofPCPs must recognize the breadth oftheir responsibility.
� The PCP’s role in the psychosocialcare of the patient needs to beaccounted for in a way that acknowl-edges the complexities of these issuesand values them appropriately.
� The content and value of activitiesthat address medical issues withoutdirect patient contact, such asinterval care management betweenoutpatient visits by telephone or e-mail contact, must be recognized.
� Clinical examples should not weighthe documentation narrative toohighly. If longer narratives are theonly way to achieve higher levels ofcoding, it will invite the use ofmeaningless templates.
� Clinical examples should appropri-ately account for the complexity ofoutpatient care, not just inpatientcare.
Comments on the clinical examplesfor E&M documentation guidelineswere due to Aspen Systems by July 3,with actual implementation of theguidelines themselves not expected tooccur for at least another year.
On a separate but related issue,SGIM has joined with other profes-sional organizations to support Congres-sional passage of the Medicare Educa-tion and Regulatory Fairness Act(MERFA). Companion bills wereintroduced on March 6, 2000, in theHouse (H.R. 868) and Senate (S. 452)respectively by Representatives BillToomey (R-PA) and Shelley Berkley(D-NV) and Senators Frank Murkowski(R-AK) and John Kerry (D-MA). Thesebills would:� Offer physicians faced with govern-
ment audits new appeal options,
Jane M. Geraci, MD, MPH, has beennamed to succeed Bruce A. Chernoff,
MD, as Regional Coordinator. In thisrole, Jane will serve as an ex officiomember of the Council and as a liaisonbetween Council and regional leaders.Jane’s goals as Regional Coordinator areto increase member involvement inregional meetings and other regionalactivities, and to standardize theadministration of regional programs.
Jane is a graduate of the Universityof San Francisco (BS, 1982) and theMedical College of Wisconsin (MD,1986). She completed a residency ininternal medicine at the MedicalCollege of Wisconsin and a fellowshipin general internal medicine at BostonUniversity, where she also received anMPH. From 1991 to 2000 Jane was anassistant professor of medicine at BaylorCollege of Medicine. Last year she wasappointed Assistant Professor ofMedicine, Department of GeneralInternal Medicine, The University ofTexas M.D. Anderson Cancer Center,Houston, Texas.
Jane Geraci NamedRegional CoordinatorDavid R. Calkins, MD, MPP
continued on page 15
8
SGIM FORUM
2001 ANNUAL MEETING: A PHOTO ALBUM
Catherine Lucey (right) reviews a videotape with participantsin the precourse “Developing Teaching Skills II: When theBasics Aren’t Enough.” PHOTO BY L. TRACTON Pam Charney demonstrates the use silicone breast models
in the precourse “Breast Health Across the Life Cycle.”PHOTO BY L. TRACTON
Tom Byrne immobilizes a volunteer in the precourse“Primary Care Orthopedics: Basic Splinting.” PHOTO BY L. TRACTON
The Cyber Café was a popular attraction duringbreaks. PHOTO BY L. TRACTON
Bob Centor (gesturing) opens the Management Institute,sponsored by the Association of Chiefs of General InternalMedicine. PHOTO BY L. TRACTON
Angela Jackson, Rich Saitz, and their daughter, Isabella,made the Annual Meeting a family affair. PHOTO BY L. TRACTON
Members Arrive Early for Precourses
9
Meeting Begins with Opening Plenary Session, Research Awards
Eileen Reynolds, Chair, ProgramCommittee, welcomes members to theOpening Plenary Session.PHOTO BY L. SIRMOPOULOS
Eliseo Perez-Stable and Rod Hayward, Chair and Co-Chair, ScientificAbstracts, preside over the Opening Plenary Session. PHOTO BY L. SIRMOPOULOS
Giselle Corbie-Smith presents her abstract, “Distrust,Race and Research,” during the Opening PlenarySession. PHOTO BY L. SIRMOPOULOS
Wendy Levinson receives the award forBest Published Research Paper fromKen Covinsky. PHOTO BY L. SIRMOPOULOS
JudyAnn Bigby meets with Dora Lynn Hughes during theOne-on-One Mentoring Program. PHOTO BY L. TRACTON
Regional leaders gather for dinner during the first day of the Annual Meeting.PHOTO BY L. TRACTON
10
SGIM FORUM
Second Day Opens with Theme Plenary Session, Closes with Peterson Lecture
Eliseo Perez-Stable and Nicole Lurie preside over the ThemePlenary Session. PHOTO BY L. SIRMOPOULOS
Eugene Oddone presents his abstract, “Race,Patient Preferences and Use of Carotid Endarter-ectomy,” during the Theme PlenarySession. PHOTO BY L. SIRMOPOULOS
Surgeon General David Satcher offers a prescription foreliminating disparities in health during his PlenaryAddress. PHOTO BY L. SIRMOPOULOS
Judith Walsh and Karen Freund discuss recent researchfindings during the Update in Women’s Health. NancyDolan (not pictured) also participated. PHOTO BY L. SIRMOPOULOS
The Program Committee gathers during the Friday dinner.PHOTO BY L. SIRMOPOULOS
Reed Tuckson urges members to face thechallenges of disparities in health during hisPeterson Honor Lecture. PHOTO BY L. SIRMOPOULOS
11
Meeting with Council, Awards Luncheon Highlight Final Day
Tony Komaroff offers his opinion on external funding during an open meetingwith the Council. PHOTO BY L. TRACTON
Allan Prochazka describes findings of the2000 Member Needs Assessment duringthe Annual Business Meeting.PHOTO BY L. SIRMOPOULOS
Deborah Kwolek and Michael Greene display their awardsfor Innovation in Medical Education. Deborah Burnet (notpictured) also was honored. PHOTO BY L. SIRMOPOULOS
Stephen Salerno receives the Milton W. Hamolsky Awardfor outstanding scientific presentation by junior facultyfrom Bob Wigton. Peter Kaboll and Steven Simon (notpictured) also were honored. PHOTO BY L. SIRMOPOULOS
Stavroula Chrstopoulos receives the Clinical VignetteAward from Redonda Miller. Amjad Al-Mahameed (notpictured) also was honored. PHOTO BY L. SIRMOPOULOS
Outgoing President Sankey Williams passes the gavel toincoming President Kurt Kroenke. PHOTO BY L. SIRMOPOULOS
12
SGIM FORUM
DISPARITIES THEME DEFINES MEETINGcontinued from page 1
EXTERNAL FUNDS TASK FORCEcontinued from page 2
rent position as Director of AHRQ.The Mary O’Flaherty Horn
Scholars program is a new program topromote scholarship, advocacy, andcreativity in the balance of work, family,and social responsibility. The awardssupport individuals to spend 50% oftheir time away from work in caring fordependents; Chinazo Cunningham wasnamed the first awardee.
Finally, Elnora Rhodes was remem-bered and celebrated in pictures, words,and in spirit, by Steve Fihn, Ollie Fein,
past presidents, by herbrother, nephew, and bythe entire membership.We all miss her pres-ence, but her work liveson in SGIM.
San Diego treated usto beautiful weather, andlater in the weeksunburns could bespotted among themembership. Outings to
the San Diego Zoo, Sea World, andLegoland were most popular, and someserious cultural learning was done at theCinco de Mayo festival on Saturdaynight. Though the two-tower geographyat the hotel was a mild annoyanceoverall, it also provided a great excusefor a stroll through the marina.
Despite our continuing strugglewith the technology of online submis-sions, we did have several major “tech”-related successes. The abstract vendor’sdatabase supported searches by author
The theme was apparentthroughout the meeting, fromthe opening abstract of theplenary session…through…the last presentations.
and by institution, so mentors andfriends could find sessions of interest.We continue to debate the merits andcosts of LCD projectors for abstractsessions, but offered them to allprecourses and workshops. Twelvecomputer terminals supplied e-mail andinternet access, as well as on-linemeeting evaluations. We are lookingforward to seeing the formal meetingevaluations, which give us real dataabout what you thought of the meeting;those results will be summarized in anupcoming issue of the Forum.
Already, the 2002 Program Com-mittee is planning for next year’sAnnual Meeting, SGIM’s 25th, to beheld in Atlanta, May 2–4, 2002. If youwould like to volunteer, contactSarajane Garten at the National Office([email protected]; 1-800-822-3060), orProgram Chair and Co-chair JeffJackson and Ellen Yee. See you inAtlanta! SGIM
rules by which the Society governsitself. In addition, it states specificallywhat donors can and cannot get inreturn for contributions and includes aformal process by which to handleexceptions.
However, as Council beganapplying the current policy to recentfunding proposals, it became apparentthat there were still some unansweredquestions. Thus the new task force hasbeen asked to address the following“core” questions or issues:� What are the respective roles of the
Research, Education, Development,and Ethics Committees in reviewingnew proposals?
� Should different types of fundingsources, such as the pharmaceuticalindustry, other for-profit companies(e.g., producers of educationalproducts), federal agencies, orfoundations, be handled differently?
� Does how the funder is identifiedmake a difference? Possibilitiesinclude: (a) an openly competitiveprocess, such as an RFA generated bya federal agency or a foundation; (b)a funder specifically approachingSGIM as a whole or an SGIMindividual or interest group; (c)SGIM (as a whole or as an individualor interest group) identifying a funder.
� When is competition with membersan issue? How does one define andresolve it? How is SGIM to balancethe benefits to many members versusthe needs of a few?
� How may SGIM respond expedi-tiously to time-sensitive proposals?
� When should SGIM allow its actualname to be used on a proposal? Willthis lead to an excessive number ofrequests for this use?
In addition to the goal of improvingthe policies and processes governing
acceptance of external funds, theCouncil is committed to communicat-ing effectively with members about itsprogress in these efforts. Council willnot finalize the revised policy untilthere has been a period for review andcomment by the entiremembership. SGIM
V I S I TT H E
S G I MW E B S I T E
http://www.sgim.org
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MEMBERS SPEAK OUTcontinued from page 2
Potential reasons to supportthe decision1. * Much to gain in addressing impor-
tant questions that could helppatients
2. * Need to respect differences ofopinion and learn from the experi-ence
3. * Support clinician-investigatormembers and promote collaborativeresearch
4. * Decision made after an extensiveprocess
5. Web registry could be low risk6. Confidence in SGIM’s ability to
uphold its principles7. Increase SGIM resources8. Steering Committee serious about
addressing the concerns raised bymembers
I had some trepidation about tryingto summarize the comments, becausethis is a situation where it is difficult toavoid being influenced by personalopinions. When I shared this summarywith the Council, however, the Councilrecommended publishing it in theForum as soon as possible, so that allmembers could hear about the types ofcomments that were made at themeeting. SGIM
Editor’s Note—A complete transcriptof the meeting with Council will be postedon the SGIM website (www.sgim.org).
Division of General Internal Medicineand was its first Chief.
In 1992 he became the Chair ofMedicine at Georgetown University.Five years later, he was named Directorof what is now the Agency forHealthcare Research and Quality(AHRQ), the source of federal supportfor some of our research and theintellectual home for much more of it, aposition he still holds today.
The Council decided to give Johnthis award for three reasons. One reasonis that his research career has beenextraordinarily productive. He haspublished well over 100 articles in peer-reviewed journals describing originalresearch about how doctors makedecisions and especially about howeconomic issues affect those decisions.Most people recognize him as theworld’s leading authority in these areas.
We also are honoring John for hisrole as a research teacher and careermentor. Through his work in researchprograms at Penn and Georgetown, hisinvolvement with the Robert WoodJohnson Clinical Scholars Program,Generalist Physician Faculty ScholarsProgram, and the International ClinicalEpidemiology Network, and his leader-ship at AHRQ, John has made adifference in the lives of hundreds ofstudents, residents, fellows, and juniorfaculty at critical points in theirresearch careers.
The third reason we chose to honorJohn was for his leadership. John hasbeen an articulate and effective spokes-man for academic General InternalMedicine and its research programs atcritical times. Let me give you twoexamples. He was one of a handful ofpeople who imagined this Society,arranged for foundation support tocreate it, and shepherded it through itsinitial years. Also, when he becameDirector of AHRQ, the Agency wasunder political attack, its budget hadbeen slashed, and many people werepredicting it would soon go out ofbusiness. Under John’s leadership, theAgency’s budget has been restored, new
programs are being started, and thefuture looks bright once again.
SGIM’s Council was so impressedwith John’s accomplishments that theydecided not only to give him this year’saward but also to permanently name theaward for him. Therefore, henceforththis award will be known as the JohnM. Eisenberg National Award forCareer Achievement in Research. Iam very pleased that John is its firstrecipient. SGIM
RESEARCH AWARDcontinued from page 4
conduct and reporting of clinicalresearch. He has examined the metho-dologic flaws of published clinicalresearch and carried out an importantseries of investigations relevant to thepublication process. Indeed, he has beenparticularly influential in the area ofpublication of clinical research throughhis roles as founding Co-Editor of ourown Journal of General Internal Medicineand as Co-Editor of the Annals ofInternal Medicine.
Bob served as this Society’s Presi-dent in 1991–1992. He has received theAbraham Lilienfeld Award from theAmerican Public Health Associationand is a Master in the AmericanCollege of Physicians. Although he hasbeen recognized by other prominentsocieties, Bob has remained very activewith SGIM. He has touched the careersof hundreds of academic generalinternists through his ongoing participa-tion and mentoring roles, and I thinkmust be one of the most accessiblesenior members of our Society. He hasbeen a role model for balancing workand achievement with family andpersonal commitments. He has sharedmany of his accomplishments with hiswife, Suzanne Fletcher, a previousrecipient of this award. As furtherevidence of his commitment to thisSociety, Bob generously donated hismonetary award back to SGIM. SGIM
27th Annual MeetingApril 21–24, 2004Sheraton Chicago Hoteland TowersChicago, Illinois
14
SGIM FORUM
YIN AND YANGcontinued from page 3
RHODES AWARDcontinued from page 5
and teaching, but disparities has notbeen one of them. The nature of thisparticular issue, however—the associ-ated social and moral implications—reminds me this is something I need tobe passionate about. Reed Tuckson gaveone of the most inspirational MalcolmPeterson addresses I have ever heard,and David Satcher’s call to arms wasdelivered in a different style but provedjust as motivating. I know there havebeen many in SGIM who have beenardent about this issue. While I’m surethe San Diego meeting further galva-nized them, it is probably members likeme who experienced the steepestgrowth curve in terms of knowledge aswell as feelings.
A second experience for me was themeeting with members on Saturdaymorning to discuss the Anticoagulation-Thromboembolism Research Consor-tium (ATRC) and the start-up fundingprovided by industry to establish aregistry for collaborative researchamong SGIM members with a commoninterest. This issue stimulated consider-able debate within the Council over asix-month period, which is wellchronicled in the January and February2001 issues of the Forum (available onthe SGIM website [www.sgim.org]).SGIM has explicit policies that allowacceptance of external funds foreducation and research and has receivedmodest amounts of industry funding foractivities (predominantly educational)over the past decade. Nonetheless, thisparticular issue demonstrated a strongdivergence of opinions at the meetingwith members. Many members came tothe microphone to express intensefeelings, referring to SGIM as a homeand concerned we not take actions that
might disrupt thedelicate balance thatmaintains a functionalfamily. The themes thatemerged on both sides ofthe issue were noted byEric Bass and aresummarized elsewhere inthis issue of the Forum.
Some believe that on certain coreissues SGIM should “speak with onevoice,” that actions taken by anorganization invariably reflect on eachindividual within the organization.Others argue that differing voices areinevitable, and even healthy, withinpluralistic societies such as the U.S.government, academic institutions, andprofessional organizations. This viewwould hold that dissidence need not besynonymous with divisiveness. As TomInui said, “let us hold our differences.”
In the next six months, thefollowing will be happening. First, anExternal Funds Task Force (describedelsewhere in this issue) will be revisitingSGIM’s current policies for acceptanceof external funds for research andeducation. Members who are interestedcan find these on the SGIM website.Second, the Council’s “winter” retreatwill be held earlier than usual this year(October 17–19) to deliberate on theseissues in considerable depth. Third,SGIM will be determining the bestmechanism for soliciting input from theentire membership. Fourth, there willbe a monthly update in the Forum asthis process unfolds. Fifth, there will bea follow-up open meeting with membersat the Annual Meeting in Atlanta nextspring to provide an update of where weare at that point. Sixth, the Councilwill spend additional time in dialogueand decision making on this issue inAtlanta and at its June 2002 retreat.
Some readers may be familiar withthe Taoist symbol for yin and yang,which has interwoven white and blackhalf circles completing a full circle, witha small black circle in the midst of thewhite half circle and a white circle inthe midst of the black half circle. In the
words of Huston Smith, this signifiesthat “life finds its fulfillment in thecenter of its opposite, and that life as awhole requires opposites for complete-ness.” Hadrian expressed the sameconcept in his injunction: “When twoideas are in contradiction, be ready toreconcile them rather than cancel oneby the other; regard them as twodifferent facets, or two successive stages,of the same reality; a reality convinc-ingly human just because it is complex.”H.L. Mencken once said, “everycomplicated problem has a simplesolution, which is invariably wrong.” Ibelieve that we require opposites forcompleteness. Diversity is, paradoxi-cally, our Society’s glue. SGIM
dation, brought together generalinternists, family physicians, pediatri-cians, and social scientists to explorecareer satisfaction among practicingphysicians and the implications forcareer choice among medical students.The CSSG conducted a national surveyof practicing physicians to obtain bothquantitative and qualitative databearing on these issues. Their workgenerated more than a dozen publica-tions, including several in the Journal ofGeneral Internal Medicine. Many SGIMmembers participated in the CSSG,including JudyAnn Bigby, MarthaGerrity, and Mark Schwartz. ElnoraRhodes was CSSG’s administrativeleader. According to Mark, “Elnoraenergized us, mentored us, and con-nected us with SGIM all the while.”
The work of the Task Force onCareer Choice, CSSG, and now theROC Interest Group touches on issuesimportant to all SGIM members. Mark’sleadership has been critical to thesuccess of these activities. It is, there-fore, most appropriate that he has beenchosen as the recipient of the 2001Elnora M. Rhodes SGIM ServiceAward. SGIM
I believe that we requireopposites for completeness.Diversity is, paradoxically, ourSociety’s glue.
15
Committee; SGIM’s DevelopmentDirector, Bradley Houseton; SGIM’sExecutive Director, David Karlson; andthe many friends and colleagues whohave contributed their support, wisdom,and encouragement over the two years
that it has taken to getthis program together. Ialso want to acknowl-edge the applicants forthis award. My wish isthat your program chairs,colleagues, and SGIMcan help you make yourdreams of a half-timeposition come true.
Our first MaryO’Flaherty Horn Scholar
in General Internal Medicine isChinazo Cunningham of MontefioreMedical Center and Albert EinsteinCollege of Medicine. Personally,Chinazo is passionate, energetic, andcommitted. She has three childrenunder the age of five, and her husbandis committed to a full-time businesscareer. Chinazo’s whole family was withher in San Diego when she received this
HCFA REGULATIONScontinued from page 7
Mary Horn. Mary, with the help of herfamily, colleagues, and university, wasable to have a productive, happy careeras a clinician educator, working withfull-time commitment half the time.She is a role model for us all.
Many people have helped make theHorn Scholars Program a reality: Mary’sfamily, including her mother, LouiseO’Flaherty; her husband, Darwin Horn;and her brother and sister-in-law,Michael and Tina; Mary’s departmentchief, Peter Barrett; SGIM’s formerPresident, Seth Landefeld; SGIM’sDevelopment Committee Chair, JackPeirce; the Horn Scholars Selection
� Prevent HCFA from collectingoverpayments while appeals arepending,
� Prevent HCFA from suspendingpayments,
� Curtail HCFA’s use of extrapolation(i.e., drawing error rates from a smallsampling of claims, projecting themto a physician’s entire claims volume,and increasing financial penaltiesaccordingly),
� Devote a greater share of HCFA fundsto education about compliance,
� Adjust the sustainable growth rate(SGR) to cover the costs to physi-cians of complying with new regula-tions, and
� Prevent HCFA from implementingnew rules before it has issued a finalregulation.
These bills enjoy bipartisan supportin both chambers, and both shouldmove quickly through the committeeprocess. Passage by the full House andSenate is more difficult to predict. TheHealth Policy Committee and Primary
Jane has been a member of SGIMsince 1990. She was founder of theEvidence-Based Medicine Teachers’Interest Group and has served on theNominations Committee. She iscurrently President, SouthernRegion. SGIM
HORN SCHOLARcontinued from page 6
REGIONAL COORDINATORcontinued from page 7
The Horn Scholars Programdemonstrates a new careermodel for clinician educatorsby funding half of a full-timeposition.
award. Professionally, Chinazo’s studentslove her as she teaches courses inphysical diagnosis, evidence-basedmedicine, and community-orientedprimary care. Her commitment to socialresponsibility is demonstrated by hercaring for homeless AIDS patients inthe Bronx, where she has set up aprogram to meet their health careneeds.
Balancing personal, professional,and social responsibilities is an integralpart of Chinazo Cunningham’s life. It is,therefore, most appropriate that she isSGIM’s first Mary O’Flaherty HornScholar in General InternalMedicine. SGIM
Care Cluster will continue to advanceSGIM’s interests with respect to E&Mdocumentation guidelines project andthe MERFA legislation, and will keepthe membership apprised of develop-ments on these matters. SGIM
Society of General Internal Medicine2501 M Street, NWSuite 575Washington, DC 20037
SGIM
FORUM
CLASSIFIED ADS
Positions Available and Announcementsare $50 per 50 words for SGIM members and$100 per 50 words for nonmembers. Thesefees cover one month’s appearance in theForum and appearance on the SGIM Web-site at http://www.sgim.org. Send your ad,along with the name of the SGIM membersponsor, to SGIM Forum, AdministrativeOffice, 2501 M Street, NW, Suite 575,Washington, DC 20037. It is assumed thatall ads are placed by equal opportunityemployers.
CLINICIAN-INVESTIGATOR, WASHING-TON, DC. Division of GIM at Walter Reed ArmyMedical Center is seeking a fellowship-trained (orexperienced) researcher for full-time position; 50–75% protected time (or more, commensurate withgrant support and research productivity); rich clini-cal and teaching opportunities available for bothinpatient and outpatient resident and student ac-tivities; would also participate with GIM fellow-ship; faculty appointment at the Assistant to Asso-ciate Professor level with the Uniformed ServicesUniversity. Salary and benefits competitive. Posi-tion available July 2001, but willing to wait for qual-ity applicants. Contact: Patrick G. O’Malley, MD,MPH at 202-782-5638 or [email protected].
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