Fall 2012
Mission Statement
The mission of the Texas Chapter of the American College of Physicians is to promote quality health care for all Texans by strengthening the practice of internal medicine.
President's Message
Felicia Austin-Tolliver, MD, FACP
TXACP President
In the last Presidential Message prior to the Scientific Meeting in November in Fort Worth, my plan was to discuss the ramifications of the Supreme Court decision of the ACA, give my thoughts on the recent redistricting ruling, and perhaps discuss the upcoming election and our role as physicians. However a recent article in USA Today discussing the problem of physician burnout as reported in a survey by Mayo Clinic caught my eye and I felt compelled to address this issue. This is not a new phenomenon and has been discussed in multiple journals over the years including JAMA, Archives of Internal Medicine, and ACP Internist. The most recent estimate of physician burnout is 45.8% and the specialties with the highest rates include general internal medicine, family medicine, neurology, and emergency medicine.
Burnout can by multifactorial and includes reasons such as long hours, the demand of seeing more patients in less time, increased paperwork, and the hassle of dealing with pre-authorizations and utilization review committees. With practices becoming more technologically savvy and e-mail communication mainstream, physicians are more accessible than ever to our patients which sometimes leads to unrealistic expectations of response times. Signs of physician burnout include increasing frustration, low sense of personal accomplishment, depersonalization, and decreased enthusiasm for work. Over time, this can lead to decreased productivity, increased mistakes, and in some cases physicians have closed practices, changed careers, and sometimes even indulged in inappropriate use of alcohol or illicit substances. It is also widely known that physicians have a higher rate of suicide than the general public.
So how do we deal with this problem? Physicians tend to have a hard time finding work life balance. We always try to convince our patients on the merits and advantages of exercise, yet how many of us take the time to exercise ourselves. It is a proven stress reliever but yet we give the same excuses that we are given such as “I don’t have time” or “I’m too tired after work”. We must learn how to draw the sometimes blurred line that separates our work from our personal lives. I too am guilty of logging onto the server at home so that I can finish up result notes or respond to e-mail messages that I didn’t get to during the day because I was so busy seeing patients. If we could give our family and loved ones the same time commitment that we give our patients, life would be so much richer. Rediscover an old hobby or interest that you’ve let lapse or better yet try something new that you’ve been wanting to do. The important thing is participating in something that gives you joy and fulfillment. Make sure that laughter is part of your day for its absence is a poor prognostic indicator. I was disturbed by a quote that I read in an old issue of Medical Economics that said "As I learned through hard experience, the practice of medicine is a black hole that can absorb every moment you will give." Matthew D. Foster, MD.
If it gets to the point that you feel that no matter what you are trying to do is not improving your situation, ask for help. The state of Texas has wonderful resources for physicians if only we would utilize them before something drastic happens. One of them is The Texas Physician Health Program which is a self-governing body that accepts both self-referrals and referrals from concerned colleagues. The Texas Medical Association’s Physician Health and Rehabilitation Committee offers a 24 hour hotline and an assistance fund for physicians undergoing treatment for depression and chemical dependency. Physician burnout is a real issue and in the end can affect the care that we give to our patients and the quality attention that we give to our loved ones. As we’ve heard time and time again, “Physician, heal thyself.”
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Governor’s Message
Clark R. Gregg, MD, FACP
Governor, Northern Region
TIMES OF CHANGE
Catching up on my reading, I was reminded yet again that regardless of the outcome of this November’s election, which immediately follows our Texas Chapter Scientific Meeting: Timely Topics in Internal Medicine 2012 in Fort Worth, “the times they are a’changin’”. Several recent articles in the Annals of Internal Medicine are worthy of more attention than just skimming their titles, as they amplify some important vectors of change in internal medicine.
In the face of the reality that United States health care expenditures are predicted to approach 20% of GDP by 2020, which is widely agreed to be unsustainable growth, the Institute of Medicine reported in 2010 that about 30% of these costs ($765 billion) are potentially avoidable. More than half of these avoidable costs are physician-controlled, including unnecessary services, inefficient or uncoordinated care, and missed preventive care opportunities. ACP developed its High-Value, Cost-Conscious Care Initiative to provide a framework physicians could use to do our part to avoid wasted costs. Smith (1) describes the new curriculum developed by ACP and the Alliance for Academic Internal Medicine to teach residents (and ultimately medical students and practicing physicians) empirical skills to use in cost/benefit/harm analysis and shared decision-making in case management with our patients. The curriculum includes faculty development resources and ten 1-hour interactive teaching sessions applicable to current internal medicine residency training venues. All materials are free and publicly available. Metrics will include surveys and scoring of questions to be included in the Internal Medicine In-Training Exam.
Another timely topic in internal medicine is maintenance of licensure (MOL), which was reviewed by Chaudhry, et. al.(2). The coming MOL model agreed upon by the Federation of State Medical Boards, focuses on three domains: reflective self-assessment, assessment of knowledge and skills, and performance in practice. This sounds kind of like recertification, doesn’t it? There are and will be a wide variety of tools and metrics available to satisfy these domains. MOL will ultimately require broad-based evidence of lifelong learning among actively licensed physicians in their own area of practice to renew their state license. The implementation of these MOL processes will be a gradual sequential evolution over several years starting as early as 2014.
A third article, “A Physician Charter: The 10th Anniversary”, by Cassel, et.al.(3), reminds us that in 2002 the ACP Foundation, the American Board of Internal Medicine Foundation, and the European Federation of Internal Medicine created a benchmark for medical professionalism in the 21st century, called A Physician Charter. The Charter emphasized physicians’ responsibilities toward not only their patients but also society as a whole. Three fundamental principles were the Charter’s basis: patient welfare, patient autonomy, and social justice. The current progress report cites the wide acceptance of its principles, including embracing professionalism as a core competency for residency trainees. More recent movements such as ACP’s Patient Centered Medical Home and the High-Value, Cost-Conscious Care Initiative have furthered the influence of these tenets. The Charter and its goals for professionalism will be increasingly challenged in the modern environment of political volatility including distribution of limited health care resources under the Patient Protection and Affordable Care Act. Also, the management systems in which physicians increasingly are aligned tremendously influence professional behaviors. A key message is that, “Physicians should not constantly have to battle perverse incentives to maintain professional values.”
At the Texas Chapter Scientific Meeting: Timely Topics in Internal Medicine 2012, in November, our special guest speaker will be Steven Weinberger, MD, FACP, Executive Vice President and CEO of ACP. Steve has been at the vanguard of ACP’s positions in many of these societal and professional changes and challenges that ACP seeks to influence with the goal of putting our patients’ welfare and internal medicine professionalism at the forefront. Be sure to register and join us in Fort Worth. You may register at www.txacp.org, then select ‘Annual Meeting’. See you there!
References:
- Smith C D. Ann Intern Med. 2012; 157: 284.
- Chaudhry H J, et.al.. Ann Intern Med. 2012; 157: 287.
- Cassel C K, et.al.. Ann Intern Med. 2012; 157: 290.
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On Being a Doctor
The new doctor: The impact of generational shifts and a changing medical educational environment
Pete Yunyonying, MD, FACP
Becoming a doctor takes sacrifice and determination. Like many others, the only reason
I was able to survive medical school and residency was a singular goal: to become a doctor. But now that I am a doctor, what exactly is my goal? What will guide me now as
I try to survive “the real world”?
The Hippocratic Oath says: “for the good of my patients,” it reads, “and first, do no harm.”
These words have been the guiding principles upon which countless generations have shaped their lives after medical school and residency. But as time goes by, the Hippocratic Oath has played an ever smaller role in doctors’ lives. Much of this generation will not recite this oath upon graduation, swearing “by Apollo the healer and Asclepius and Hygieia and Panaceeia” to “apply ... measures for the benefit of the sick according to [their own] ability and judgement [and] keep them from harm and injustice.”
In this current generation, the Hippocratic oath has given way to the driving principles of patient-centered care. But what exactly does this mean to me? Is it placing patient autonomy and their right to decide their own fate above all else? And what role should patient satisfaction play in my decision making? Am I to focus on “hard” outcomes as the evidence-based medicine movement promotes? Or am I, in this increasingly economic environment, to be a cost-conscious and proper steward of health resources?
Whereas previous generations of doctors had a singular mission defined by Hippocrates, the new doctor grapples with a multi-headed beast of competing priorities. While logical in abstraction, each of these principles becomes problematic and even mutually exclusive in the muddy world of life. How do I choose between saying “no” to an unsatisfied patient that doesn’t understand that antibiotics won’t help that cold? How do I deny hydrocodone to a patient that is convinced it is the only path to relief? What do I tell a patient when continuing their hospital stay is not an option? How do I care for a patient that chooses a triple bacon cheeseburger every day over one hour of exercise and an apple?
Moreover, while previous generations of doctors have lived at the nucleus of the decision-making tree, the new doctor is caught in the web of a muddled health care system. Because of the transparency of the information age, we are no longer necessarily the one that knows best, but the one that tells the patient they are wrong. We have become the barriers to patients receiving what they believe to be the cure for their disease. The new doctor, in short, has been stripped of their traditional identity.
The challenge to the new doctor, then, is not to cure the sick, but to survive the many disparate and often contradictory responsibilities of the new health care system. The time is now for the new doctor to make a statement about how we are to be viewed by our patients and colleagues, about what priorities will guide us, and about what impact we will make in the world. I may not have the answers in this new world, but I am sure that the answers are out there, somewhere. I invite you to write to us with your thoughts. From time to time, we will share these statements in future newsletters and on the web.
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Associates, Students Energize Chapter Annual Meeting
Each year the Texas Chapter is fortunate to have large contingents of Associates and medical students attend the annual meeting. These younger members bring energy and excitement to the gathering, and their vignette and poster competitions generate great interest among all attendees. Doctor’s Dilemma™ attracts a large, enthusiastic crowd.
The 2012 annual meeting will be held Saturday and Sunday, Nov. 3-4 at the Omni Fort Worth Hotel in Fort Worth, Texas. Registration for Associates and students is free, but advance registration is required.
Students and Associates may attend any of the educational offerings at the meeting plus the Texas Chapter Annual Business Meeting and Awards Luncheon. The Cocktail Reception and Awards Presentations will take place on Saturday and we encourage you to attend these events to greet old friends and make new ones.
There are four competitions for these members. During the Saturday morning Plenary Session, five regional Associate clinical vignette winners will vie for first place to advance to ACP’s Internal Medicine 2013 poster competition in San Francisco, CA in April.
Also on Saturday morning, medical students chosen at each school will compete with clinical vignettes for cash prizes and an expense-paid trip to ACP’s poster competition in conjunction with IM2013. On Saturday afternoon, Associates will present their research and case-study posters to judges, and medical students will compete in a separate case-study poster event. First- and second-place winners will be selected in each category.
An always-lively, highly competitive Doctor’s Dilemma™ contest wraps up the meeting on Sunday.
For more information, please visit the TXACP Annual Meeting page to learn more about events planned especially for medical students and residents. Are you ready to register? Click here!
We look forward to seeing you in November!
GIMSPP Match Update for 2012
For the 2012 GIMSPP program, students had to turn in their application by Tuesday, February 28th. At the end of the application deadline, the program had a total of 137 applications submitted by February 28th. Of the 137 applications, 59 of those applicants were matched with a preceptorship for the summer. A total of 109 students were not matched, 19 students dropped out of the program before the matching process began and 9 students dropped out of the program once they were notified of their match. Thank you to all of the 47 preceptors that participated in the program this summer.
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GIMSPP Decade of Service Awardees
The distinctive General Internal Medicine Statewide Preceptorship Program (GIMSPP) Decade of Service award will be presented to seven highly dedicated and devoted volunteer preceptors at the Texas Chapter of the ACP annual meeting during the Awards Luncheon on Saturday, Nov. 3, in Fort Worth. These physicians have been in the program for ten years and since that time have taught and mentored young medical students for at least seven of those years. Without the selfless fidelity of our committed preceptors, the preceptorship program could not exist. We owe them enormous gratitude for teaching the future physicians of Texas. GIMSPP is pleased to bestow the Decade of Service Award to the following physicians:
Ramon Aggarwal, MD,
KP Ganeshappa, MD, FACP
Michelle Ho, MD, FACP
Edith Jones, MD, MACP
Ellen Manzullo, MD, FACP
Brad Snodgrass, MD, MBA
Joel Walker, MD, FACP
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Council of Young Physicians Annual Meeting Breakfast 2012
Don't miss the second annual Texas Council of Young Physicians Annual Breakfast CME event at the upcoming regional meeting, November 4th at 7:30 AM in Sundance 3! Don't miss the second annual Texas Council of Young Physicians Annual Breakfast CME event at the upcoming regional meeting, Sunday. This year the discussion will be led by our co-chairs Pete Yunyongying, MD, FACP and Amy LaViolette, MD, MPH, FACP. Last year we discussed the topic of “Building a Better Team” and this year we’re going to get a little more personal with “Communication within the Healthcare Team”. We’ll be exploring the most common characteristics of Emotional Intelligence that are seen in Internists and how these traits affect our interactions with others in the healthcare team, including our patients. As young physicians learning how to better interact with patients and staff is an important aspect of our professional development.
We won’t be doing any personal testing during this session, so if you want to get a more detailed feel for your Emotional Intelligence, feel free to check out some of the commercially available tests including the Myers-Briggs Type Indicator® at http://www.myersbriggs.org/ or the DiSC Personality Inventory® http://www.thediscpersonalitytest.com/ . There are also a variety of free versions of the Kolb Learning Style Indicator® and DiSC Personality Inventory® available online with some minimal searching. We look forward to seeing you there and learning some more about ourselves and our interactions with others! Don’t forget to register today.
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Council of Young Physicians Co-Chairs Needed for Texas Northern and Texas Southern
The Texas Chapter of the CYP is currently looking for candidates for the Texas Northern Co-Chair Elect and the Texas Southern Co-Chair Elect. The Texas Northern Co-Chair Elect will serve as Co-Chair Elect for one year. The Texas Southern Co-Chair Elect will serve as Co-Chair Elect for two years. As the Co-Chair Elect, you will participate on monthly conference calls, contribute to newsletter articles and observe the current Co-Chair. Once the Co-Chair’s term has ended, you will attend the three Texas Chapter of the ACP Board meetings held throughout the year. The Co-Chair elect will serve two years as the Co-Chair and one year as the Immediate Past Co-Chair. If you are interested in either of these leadership opportunities, please submit your CV and a brief summary of why you would be a good Co-Chair Elect to our chapter office contact, Claire Foster, Claire.foster@texmed.org or call (512) 370-1523.
The mission of the Council of Young Physicians is to enhance the professional development and quality of life of young physicians and to foster their involvement in College activities. Throughout the year, CYP members host physician networking and mentoring events. For 2011, the Texas CYP hosted a Houston dinner gathering, a Dallas museum tour, a regional BBQ and a CME interactive workshop on maximizing team performance at the chapter’s annual meeting. For 2012, the Texas CYP hosted a private concert in Dallas featuring Steinway Artist Jeffrey Siegel that included wine and hors d'oeuvres.
Please join the CYP members in Ft. Worth, TX for the 2012 Annual Meeting of the Texas Chapter of the American College of Physicians on November 3-4th. The CYP will be hosting a networking breakfast at the TXACP Annual Scientific Meeting on Sunday, November 4th at 7:30 am, in Sundance 3, at the Omni hotel. All interested members are encouraged to attend this exciting event.
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The New Physician Leader
Julie C. Nguyen, MD, MBA, FACP
Immediate Past-Southern Co-Chair CYP
Amidst the changes in the healthcare system, various care delivery models have been introduced, such as Accountable Care Organization and Patient-Centered Medical Home. Almost all of the care delivery models emphasize on teamwork in an effort to improve performance. Performance is no longer measured in terms of the amount of patients or procedures a physician can see or perform in a day. It is determined by the overall quality of care – whether the care improves the patients’ illness or meet their needs. Hospital administrators also focus on quality of care delivered by the physician to determine hospital privileges or even financial compensation.
Regardless of the level of intelligence or experience, a physician cannot control every step of the care process. Furthermore, the new generation of physicians value work along with a balanced life – and who is to question the validity of this way of thinking. All this signifies is that in order to positively affect the care delivery process, a healthcare team comprising of members from multiple disciplines is necessary for information sharing and coordination of care.
The change towards multidisciplinary healthcare team often forces the physician, most of the time a primary care specialist, to the top of the team acting as the leader. The leader’s role is to bring everyone together and motivate them to collaborate for the purpose of performance improvement. This person needs to possess great leadership skills as well as a strong passion for performance improvement in this chaotic healthcare system.
Are physicians ready to become good leaders? Leadership is a skill that is often overlooked all through the educational journey. The medical curriculum, especially, has been focused on individual thinking and independent performance. Physicians are used to doing things on their own or faced being labeled as incompetent when seeking for help. The reality of the chaotic system has stimulated a few young physicians to get more involved in improving the system. The improvement is all for the sake of providing good patient care.
Many universities realized a need in developing physician leaders and started to offer numerous training courses in leadership. The cost of some of these programs can be very steep and require many hours to attend the formal lectures. The American College of Physicians (ACP) is cognizant of young physicians’ needs for training in leadership but lack in both money and time. In 2010, ACP introduced the Leadership Enhancement and Development (LEAD) Program at no additional cost to its members. The program allows for work and community leadership activities to count towards the requirements. Furthermore, specific sessions on leadership are available at both the state and national conferences. The sessions are being conducted by current leaders in healthcare on topics ranging from conflict resolution to strategic planning.
According to the ACP website, “The program targets internists early in their careers and offers a variety of activities designed to provide participants with the skills, resources, and experiences necessary to become effective leaders in any setting.” Since its inception, the Texas chapter has three LEAD certificate recipients: Dr. Roger Khetan, Dr. Pete Yunyongying, and myself. By having participated in the program, I can verify that it is an extremely valuable process to prepare physicians as leaders in the new age of healthcare. It is an experience that I encourage every young physician to take.
Young physicians with a desire in leading changes in medicine are encouraged to apply to the LEAD Program by contacting LEAD@acponline.org for further details. More information on the program can be found at http://www.acponline.org/education_recertification/resources/leadership_development/
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Keeping Up With the Guidelines
Pete Yunyongying, MD, FACP
Northern CYP Co-Chair
One of the most difficult aspects of continuing medical education is keeping up to date with clinical practice guidelines. This seemingly never ending task is made even more perplexing with multiple different societies and groups issuing potentially conflicting recommendations. In an effort to help the readers of this newsletter, we will pick a selection of new or emerging guidelines or notable emerging issues related to current guidelines to discuss in this ongoing column.
Has the time arrived for Lung Cancer Screening?
With lung cancer still leading the statistics in most incident and most deadly cancers, there have been many attempts at developing successful screening strategies for lung cancer in the recent past: chest radiography and sputum cytology to name two. These strategies have failed to produce desirable results. But things may be changing. Based largely on a single trial, the National Lung Screening Trial (NLST), many organizations have updated their recommendations to include screening to some degree with Low Dose CT (LDCT). While some of these recommendations have been more measured, others have strongly advocated for screening high risk individuals along the inclusion criteria for NLST. The National Comprehensive Cancer Network (NCCN) guidelines describe two such groups: those aged 55-74 years with > 30 pack years of smoking history and smoking cessation < 15 years and those aged > 50 years with > 20 pack years and additional risk factors.
Organizations that have supported screening to some degree include the American College of Chest Physicians (ACCP), the American Society of Clinical Oncology (ASCO), the American Cancer Society (ACS), the NCCN, the American Thoracic Society (ATS) and the American Association of Thoracic Surgery (AATS). The United States Preventive Services Task Force (USPSTF), traditionally late adopters of new screening changes, has yet to publish their guidelines for lung cancer screening at this time.
But let us look at the basis for these recommendations in more detail. The NLST was a large study conducted by the National Institutes of Health (NIH) and stopped early for efficacy in November of 2010. It included over 53,000 patients and showed a 20% reduction in relative risk of death (95% CI, 6.8–26.7; P = .004) and a 7% decrease in all-cause mortality largely driven by the reduction in lung cancer mortality. The number needed to screen to prevent one lung cancer death was 320 patients. While there was no reported increase in harm, this was not the primary endpoint studied.
LDCT offers several advantages over past CT screening methods, including a lower radiation dose and the ability to use existing equipment with a simple recalibration or added computer-aided diagnosis (CAD) software.
Tempering these results is a 96% false-positive rate among the 27% of study participants with an abnormal finding. Further caveats include a concern for overdiagnosis, particularly length-time bias in a disease that has a very short median survival in advanced stages and a relatively long survival in very early stages. 63% of cancers identified by LDCT were stage I compared with 47.6% in stage I in the control arm. Moreover, there is a concern for an exaggerated effect size with the early stopping of the trial as evidenced by the wide confidence interval: 6% to 27% mortality decrease. In a systematic review by Bach et al. that included other smaller studies, only NLST showed any positive results, questioning the reproducibility of the results.
So, is this an over-exuberant enthusiasm for a long awaited holy grail based on a single study result, or the real deal? While the best available evidence suggests rapid adoption of the guidelines, I’m not sure if the best available evidence is good enough to reach a clear conclusion.
References:
1. Bach et al. Benefits and Harms of CT Screening for Lung Cancer: A Systematic
Review JAMA. 2012;307(22):2418-2429.
2. Fearnow, E Lung Cancer Screening with low-dose CT imaging The Journal of
Lancaster General Hospital. Summer 2012 ; 7(2).
3. The International Early Lung Cancer Action Program Investigators. Survival of
Patients with Stage I Lung Cancer Detected on CT Screening. N Engl J Med 2006; 355:1763-177.
4. Jaklitsch, et al. The American Association for Thoracic Surgery guidelines for lung
cancer screening using low-dose computed tomography scans for lung cancer
survivors and other high-risk groups J Thorac Cardiovasc Surg 2012;144:33-8.
5. The National Lung Screening Trial Research Team. Reduced Lung- Cancer Mortality
with Low-Dose Computed Tomographic Screening. N Engl J Med 2011; 365:395-409.
6. nccn guideines ver 1.2013 http://www.nccn.org/professionals/physician_gls/pdf/
lung_screening.pdf last accessed August 28, 2012.
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For Pete's Sake
Amy LaViolette, MD, FACP
Southern CYP Co-Chair
For Pete’s sake... Sometimes it’s really awkward asking my older patients a sexual history, and I consider leaving it out. Do you have any advice about how to make this more comfortable?
-Awkward in Texarkana
For Pete’s Sake…
Sometimes sexual histories can feel as awkward as “the talk” you had with your parents as an adolescent. The reason these conversations feel awkward is because we let them be that way, but they are an important and relevant part of your patient’s medical history. If we build the questions up and appear anxious about them, they will be awkward. Including questions about sexual history, including sexual preference, abuse history, and review of system questions that also address sexual function in the initial patient questionnaire is helpful for creating the expectation that you are interested in that part of their life. It’s also useful to include a review of the sexual history at your yearly preventative visits so that it won’t be forgotten as new issues that are not “acute” arise. In addition to these more directed interventions, make sure that all of you create a safe and confidential environment in all of your visits so that if a new concern arises they will be comfortable telling you about it and won’t wait until their annual exam if it’s something that’s really bothering them. This is particularly important if you also see a patient’s family members or spouse.
In addition to taking the history it’s important to make sure that your patients are appropriately screened for sexually transmitted diseases. The rate of STDs among older adults is rising rapidly, which makes this particularly important to not ignore this part of screening. I usually try to make a point to ask all of my patients (regardless of age or marital status) if they would like me to check them for sexually transmitted diseases when I do their annual blood work. I’ve had a few patients act offended, but it hasn’t affected our relationship, but the vast majority either take me up on the offer, politely refuse or find it amusing that I would ask them. If a patient really seems disinterested or offended by the question I put a note in their chart to not ask them the next year.
For Pete’s sake…Sometimes I feel like I have a hard time finding people to spend my free time with. My partners are older than I am and pretty busy with their families, and while I’m closer in age to my staff forming a more social relationship with them does not seem appropriate. How can I meet other people and physicians that are closer to my age/stage in life?
-Lonely in Houston
Finding people at a similar place in life as you can sometimes be hard, but there are several places that you can start. Your local county Medical Society is a good place to look. Some societies are more active than others, but they may have networking events that make it easy to meet other doctors and serving on committees that you have an interest in can help you meet people with similar interests. Other places to meet other physicians are state professional societies, such as Texas ACP (who knows there might be a CYP event in the area) or TMA. Becoming involved in these groups is a good way to both help further our profession and meet people that understand where you’re at.
If meeting other physicians isn’t as big of a concern, you could always try to find people with similar hobbies to spend time with by using web-sites such as meetup.com. Many larger cities, such as Houston, have young professional groups, which are also a good resource. If you want to be more involved in CYP to meet young physicians in the area or to find out what we have to offer, please email us and we can try to find ways to get you more involved.
If you have questions for the next “For Pete’s Sake…” please either post them on our Facebook site or email them to Becca Lawson, at rebecca.lawson@texmed.org
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Texas Medical Home Initiative Update
Sue S. Bornstein, MD, FACP
Immediate Past President & Governor-Elect
The American College of Physicians has been a driving force in the movement to revitalize and strengthen primary care in the United States through adoption of the patient-centered medical home (PCMH) model of care.
The ACP’s seminal white paper entitled “"The Advanced Medical Home: A Patient-Centered, Physician-Guided Model of Health Care," was written in 2006 and in 2007, the ACP was one of the authors of the Joint Principles of the PCMH. The development of the Medical Home Builder tool demonstrates the ACP’s ongoing commitment and leadership in this field.
The PCMH model emphasizes increased access to care through various means including e-visits, extended hours and group visits; improved coordination of care across the “medical neighborhood”; continuous quality improvement and use of clinical guidelines; and payment reform that addresses the critical role that internists, family physicians and pediatricians play in their patients’ health care.
Your Texas ACP Chapter has been a trailblazer in the PCMH movement. In 2008, the Texas ACP Board agreed to serve as the convening organization of a medical home pilot in North Texas. The Texas Medical Home Initiative, a 501 (c)(3) organization was developed in 2009. The pilot, which includes 7 adult medicine practices in North and East Texas, has been underway since 2009.
The practices have received intensive practice coaching to assist with the transformation to the PCMH model. They have achieved Level 3 recognition (the highest level available) as medical homes by the NCQA. The practices are reporting on a set of quality metrics that includes diabetes, blood pressure and lipid measures, immunizations and other preventive service utilization and tobacco use and cessation efforts. At Internal Medicine 2012 in New Orleans, the Texas chapter of the ACP was awarded the John Tooker Evergreen Award in Patient Safety and Quality in 2012 for the Texas Medical Home Initiative.
In cooperation with the Texas Health Institute, the Texas Medical Home Initiative is planning the first statewide conference in Texas on the medical home. The conference will be held April 4th and 5th in Austin. The title of the conference is the Texas Health Home Summit. The use of the term “health home” builds on the model of the medical home and extends the concept to include a broader range of services including mental health and linkage with community-based organizations.
The agenda and speakers for the Summit are being developed now and will include state and national thought leaders and will feature practical sessions with Texas practices that have successfully implemented this model.
Please mark your calendars to save the date for this inaugural event!
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Nominations Slate Announced
The Nominations Committee of the Texas Chapter of the ACP is pleased to announce an outstanding slate of nominees for election to the Board of Directors, selected from among the nominations received from the membership. The committee would like to express their appreciation to those who submitted nominations. Our Chapter is fortunate to have members who are willing to devote time and energy in a volunteer leadership role on behalf of our profession and our patients.
The committee worked diligently to select members and Fellows of the ACP who represent the diversity of our Chapter membership. Directors serve a three-year term. The president-elect advances to president in November 2012.
The slate will be presented to the Chapter membership for a vote at the annual business meeting and awards luncheon on Saturday, Nov. 3, in Ft. Worth. To find out more about the meeting, visit the annual meeting page.
Following are the names and bios of the candidates for election to the Board of Directors. Please congratulate and thank these physicians for their willingness to serve in a leadership capacity for our chapter.
For complete bios and pictures please click here.
- Roger Khetan, MD, FACP, FHM, Dallas - President-elect
- Maureen Francis, MD, FACP, El Paso - Secretary- Treasurer
- Marguerite Wuebker, MD, FACP, Addison- NE Director
- Curtis Mirkes, DO, FACP, Temple - NW Director
- Lara Colton, MD, FACP, Houston - SE Director
- Lianne Marks, MD, PhD, FACP, Georgetown- SW Director
- Christian Maluf, MD, McAllen- At-large Director
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Member Kudos
Karen Szauter, MD, FACP, was awarded one of the University of Texas System Regents' Outstanding Teaching Awards/ Health Award.
Felicia Austin-Tolliver, MD, FACP, got engaged this September while on vacation with her now fiancé, Perry.
Gene Stokes, MD, FACP, became the proud grandfather of a second grandbaby, Adley Lynn Wall, born in July.
Julie Nguyen, MD, FACP was one of the twenty applicants accepted into the Texas Medical Associations Leadership College Class of 2013 and will graduate in May.
Send news of your accomplishments or milestones, both professionally and personally, or that of a colleague, to: Becca Lawson, TXACP Staff, 401 W. 15th St., Austin, TX 78701; fax to (512) 370-1635; or e-mail to Becca Lawson.
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Congratulations to Our Newest Fellows
Fellowship recognizes personal integrity, superior competence in internal medicine, professional accomplishment, and demonstrated scholarship.
Gaurav Agarwal, MBBS FACP, San Antonio
Ahsan Azhar, MD FACP, Houston
Rachel D Bishop, MD FACP, Houston
Bernard J Blumenthal, MD FACP, Pasadena
David P Capper, MD FACP, Fort Worth
Devasmita Choudhury, MD FACP, Dallas
Essam F Elsayed, MD FACP, Allen
Susan E Favour, MD FACP, Dallas
Mary Allison Hendrickson-Quirk, DO FACP, Arlington
Nancy L Hughes, MD FACP, Galveston
Rajdeep S Kakar, MD FACP, Plano
Sumeet S Kalra, MD FACP, Dallas
Faisal A Khasawneh, MD FACP, Amarillo
Tresa McNeal, MD FACP, Temple
Deepa Mittal, MBBS FACP, Austin
Carlos Orces, MD FACP, Laredo
Lavi Oud, MD FACP, Odessa
Alejandro Ovalle, MD FACP, El Paso
Peter J Plantes, MD FACP, Irving
Sherine E Salib, MD FACP, Austin
Joshua D Septimus, MD FACP, Houston
Mohamed M Shehata, MD FACP, Katy
Yu-Min P Shen, MD FACP, Plano
Jasvinder S Sidhu, MD FACP, Bellaire
Samer S Suki, MD FACP, Houston
James E Sutton, MD FACP, Royse City
Salil K Trehan, MD FACP, Amarillo
Alexis A Wiesenthal, MD FACP, San Antonio
Maurice Willis, MD FACP, Galveston
William A Zoghbi, MD FACP, Houston
Advancement to Fellowship applications are available:
• At the ACP Web site
• From the ACP Customer Service Department at (800) 523-1546, ext. 2600
• By e-mail at custserve-at-mail.acponline.org
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ACP Recruit-a-Resident Rewards Program
December 31, 2012
ACP's Recruit-a-Resident Rewards Program provides education resources to residency programs that recruit residents to become ACP Associate Members.
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ACP Internist
ACP Internist Weekly is an update for internists published every Tuesday by the American College of Physicians
For more information and to Sign up to receive ACP Internist Weekly, please click here
2013 ACP Internal Medicine Meeting
April 11-13, 2013
San Francisco, CA
For more information and to register, please click here.
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