Fall 2008



Fall Issue


The Texas Internist is a publication of the Texas Chapter of the ACP. Articles from the chapter membership are welcome. Send to the Newsletter Editor, Texas Chapter of the ACP Business Office, 401 W. 15th St., Austin, TX 78701, or fax to (512) 370-1635.



Mission Statement

The mission of the Texas Chapter of the ACP is to promote quality health care for all Texans by strengthening the practice of internal medicine.



President's Message

Robert E. Jackson, MD, FACP, Houston

"Change alone is eternal, perpetual, immortal."
— Arthur Schopenhauer, 1788-1860

American medicine is about to undergo one of the most dramatic changes in its history. The American Medical Association (AMA) is now embracing universal health care, and our industry will be overwhelmed by 40-50 million more individuals who will have some form of insurance in the next several years.

Robert Jackson

The physician shortage, which is chronic in the rural areas, will suddenly become acute in the urban setting. Cost constraints and unfunded mandates on a runaway $2 trillion-a-year system will be placed on us like so many chains on a prisoner being led to the gibbet. We must act now! Internal medicine must redefine itself. And the vehicle must be the medical home.

In the United States, the concept of the patient-centered medical home has been embraced by organizations representing more than 300,000 physicians. State governments have mandated this model for its Medicaid populations in North Carolina and Louisiana. The model will bring quality care to our patients – and allow us to measure this quality.

Large business consortiums will support these initiatives. The federal government will not be far behind because evidence-based medicine has shown the medical home to be successful and because it just makes sense. This initiative is based on a business model of reimbursement by centering primary care practices around the patient and emphasizing access and quality measurements in a structured process, or the medical home.

This will not be the end of medicine as we know it, but the beginning of medicine as we learned it in our training. The National Committee for Quality Assurance (NCQA) has developed criteria to help us build the home to fit the needs of our practices. Soon these measures will be available for your review on the Chapter Web site. The Texas Chapter of the ACP currently is the facilitator of this initiative in our great state, but the process is “owned” by the primary care doctors, including osteopaths, pediatricians, and family practitioners.

A recent summit at the Texas Medical Foundation Health Quality Institute garnered support of many entities, including the Texas Medical Association (TMA), physician organizations, and insurers. Neil Kirschner, PhD, of ACP in Washington, D.C., energized and guided the medical home discussion. As a result, many groups have pledged to participate in a steering committee to roll out the medical home for Texas.

Our Chapter continues to assume a leadership role, but shared governance of this process is mandatory. We must understand and be able to articulate the medical home concepts to our patients, insurers, legislators, and the public. As long as medicine speaks with one voice, we become an irresistible force for change that is eternal, perpetual and immortal.



Governor's Message

W. Mark Armstrong, MD, FACP, Dallas
Texas Northern Region

With this year’s invoice from the American College of Physicians (ACP), you probably noticed chapter dues now are included. Because of this, I want to highlight some of the Chapter’s activities. Most of you have been chapter members for years, so this information will be old news. But I hope everyone can better appreciate how much work is done by the staff in Austin and members around the state to make this one of the finest chapters in the ACP.

mugshot: W. Mark Armstrong

For medical students, the Chapter offers a variety of annual activities. Student interest groups, typically run by the medical school faculty, are active at each Texas medical school. These activities are supported financially by the Chapter and serve to interest students in internal medicine early in their education.

Students also are invited to submit abstracts for posters and clinical vignettes for presentation at the annual meeting. These posters give students the chance to make scholarly presentations. The students also may participate in the On Being a Doctor creative writing competition. The winner of the contest presents his or her essay at the annual meeting. The winning entries and other On Being a Doctor essays can be found on the Texas Chapter of the ACP Web site (link).

The jewel of the students’ program, of course, is the General Internal Medicine Statewide Preceptorship Program (GIMSPP). Many of you are familiar with this program and have been preceptors for medical students for many years. After their freshman year, students may apply to spend one month with a preceptor observing how internal medicine is practiced in the real world. This is a valuable program for the students and preceptors. Ideally, the student will get a favorable impression early in his or her career and will continue to be interested in internal medicine. If you’re interested in becoming a preceptor, contact Pat Maples at pat-at-gimspp.org.

For residents, or associates, ACP offers opportunities for involvement. Residents in each of the five regions present oral clinical vignettes and posters annually, with the regional winners making a presentation at the annual meeting. The top presenter of these oral presentations at the state meeting is rewarded with an expense-paid trip to the national ACP meeting by the state chapter.

One Associate from each region serves as a member of the Chapter board of directors and his or her expenses are paid to the three yearly meetings. Associates and students also join ACP members in Washington each spring for Leadership Day. Those who attend, at the Chapter‘s expense, find it interesting and informative and make a great impression with the congressmen as they articulate their issues.

For members, the Chapter is active in education and advocacy. Each year the state meeting offers excellent speakers and continuing medical education opportunities. A module for maintenance of certification has become a feature to help those who are recertifying.

The chapter is heavily involved in advocacy on both the state and federal levels. The chapter is fortunate to have Michelle Romero as legislative affairs manager; she keeps up to date on the hot topics in Austin and in Washington. Through our advocacy program, you can become a member of Voter Voice (link). This Web-based network is designed to keep you aware of critical issues and have you actively participate in the legislative process.

Members also are encouraged to become a key contact (link). If you do, you will receive information important to health policy, and this system also makes it easy to contact your congressman or senator. The Chapter is very involved in the state legislative process, and many members sit on various boards at Texas Medical Association. The Chapter assigns one of the board members to sit on the primary care coalition with a group of internists, pediatricians and family practitioners. This committee has developed an impressive position paper, “Mending our Fractured Health Care System.” I encourage you to read this document (PDF file), which has been used to try to influence the Texas legislature.

I also encourage you to visit our Web site — considered one of the best among the state chapters — and go through the menu to see what is offered. You’ll also find links to resources at national, including the practice management center, where you can get practical information about day-to-day practice issues.



On Being a Doctor

A Higher Level of Care

Bobby W. Marek, MD, Brenham

Bobby W. Marek

I love medicine. I have practiced as a general internist in a rural community for 26 years. I have always felt rewarded in helping bring good health care to my small town. Medicine may be an art or a science or some of both, but the practice of helping another person prevent or recover from an illness is a good endeavor.

I will tell any young person who asks that medicine can be a good life. We doctors are lucky in a way. We could not have known as college students, thinking of applying to med school, that we were in for a lifetime of learning. First, we had to learn the basic biology of the human, and then discover those things that can go wrong. Next, we had to practice providing what medicine has to offer those in need. Finally, we had to develop our own ideas and philosophy about how we should use our skill to help our patients.

The privilege of taking care of someone over many years is a reward of medicine. To those of us in primary care in small towns, this aspect of medicine is very important. Combining our clinical skills with familiarity of our patients as human beings to help them is one of the most satisfying things primary care doctors do.

I have become fatigued of having to be in two places at the same time. I practice at a busy multispecialty clinic. Those in primary care at my clinic see patients all day at the office and often have many hospital patients.

In recent years, we learned how primary care physicians in non-rural areas have the advantage of being able to concentrate on their clinic practice. I visited a hospital in a nearby medium-sized city and the primary care doctors are allowed to turn over patients to the hospitalist practice completely at their discretion. Amazingly, if they want, they can hand the patient off to the hospitalist only for weekends.

No one knows better than small town primary care physicians that continuity of care is important to patients and is helpful in diagnosis and care. But, I have come to the conclusion that the collaboration between hospital-based doctors and the patient’s primary care doctor has many advantages that clearly outweigh continuity of care.

I can easily see these advantages in what I do in my practice. Recently, I was up most of Friday night with an intensive care unit (ICU) patient on a ventilator. Then, there were several admissions from the emergency room, and I was faced with challenging diagnostic dilemmas in my Saturday clinic. On Sunday night, I was still running to the hospital to attend the ventilator patient.

I believe a case can be made that my ICU patient and other sick patients could be served well by a hospitalist. I knew some of my weekend patients, but, unlike the hospitalist, I could not be there full time. There is something to be said for the benefits of personal presence of the physician. As I understand, many hospitalists have 12-hour work schedules. My partners and I do a full weekend on call and still go to the hospital on Monday morning before clinic. Maybe, even clinic patients would benefit from a well-rested doctor.

Of course, our patients like continuity in their care. But consider that many patients see a number of specialists in addition to their general internist. I believe patients really want to know their specialists are collaborating with their internist for overall good care. Patients want to know their physicians are communicating for their benefit. My patients always appreciate this. “Doctor, have you talked with my heart doctor?” Is there any difference in this collaboration and the collaboration of a primary care internist and a hospitalist?

The time will come (perhaps it’s here) when young doctors will demand predictable and humane work hours. Emergency physicians and hospitalists already are working shifts of 8 hours or 12 hours. I believe the ACP should start advocating for predicable and humane work hours for internists. Many patients need the talents of general internists. Who is better prepared to take care of a person with multiple chronic diseases than a skilled internist? I want the medical community to continue to provide this service. We, who pride ourselves as patient advocates, should initiate this advocacy.

I know hospitals smaller than mine have a hospitalist service. Perhaps our advocacy could include a recommendation that all but the smallest hospitals have a hospitalist service. Hospitals that are too small for this to be practical could be linked in an administrative way with larger hospitals for safe transfer of patients.

We should encourage the redefinition of the concept of “higher level of care” to mean the availability of a general internist hospitalist, as well as a cardiologist, neurosurgeon, or other specialist. A general internist hospitalist has skills every bit as important and helpful as these specialists. We should advocate that it is not wrong for small town internists to want the same benefits for their patients as their colleagues in the cities. If we are successful, our patients and future generations of internists will benefit.

Call for articles: You are invited to send us your stories about the joy or distress of medical practice, which serve to remind us what is most special about our profession. Send your stories to: Gena Girardeau, Texas Chapter of the ACP executive director, 401 W. 15th St., Austin, TX 78701; fax to (512) 370-1635; or e-mail info-at-taim.org.



On Being a Doctor

The Home of Hope

Rohan Ahluwalia, Texas A&M University Health Science Center studentspot-graf-on-being-doctor

Returning home to Ranchi, India, after 11 years, I saw some things had changed but, sadly, not enough. There was still too much poverty, littered streets, and an underdeveloped town. My grandparents’ house, which was a mainstay of Ranchi for 50 years, had been converted into a four-story apartment building.

Some familiar sights were great to see, such as my grandfather’s shop, Zephyr Studios, which has stood for 60 years and which he still operates at age 85. Most importantly, The Guru Nanak Home for Handicapped Children, which was started in 1969 by my great-grandfather and two of his friends, still stood strong.

The home started as an outreach program to provide free health services and hopefully a better life to impoverished children who had debilitating diseases. My grandfather told me about the home’s early struggles — how he would go door to door asking neighbors to donate food, clothing, and medicines for the home. What started as a one-bed dream has grown into an 80-bed hospital with a fully functional operating room, two physiotherapy rooms, and a playground.

In America, we take much for granted, such as air conditioning, running electricity (which was out when I arrived), and patient hygiene. Seeing the severity of the diseases was a difficult adjustment. People come from all around the state of Jharkand and neighboring states for the free health care here, so the orthopedic pathology is remarkable. Within the first five minutes, I saw several cases of severely neglected club foot, variants of cerebral palsy, polio, and muscular dystrophy. After adjusting to the shock, I started asking questions to the children in my broken Hindi with the help of Rajeev, one of the physiotherapists and a good friend.

The best part of my first week was interacting with the kids. I would go to their wards during their break time and just sit and talk. I would first ask about their illness and its progression and try to take a detailed assessment of their daily life. I then would ask about where they grew up, and I learned some hard truths about life. These children came from tough situations (no parents or no home) and had no form of health care, even during childbirth, and yet always managed to smile.

I heard many stories of neglect, deception, and lack of health care. Children are born at six to seven months of gestation between 3-4 pounds with no neonatal unit or incubation. They suffer major trauma because of lack of oxygen and mismanagement. Families with low incomes cannot pay for doctors’ fees and must settle for fraudulent “healers.”

Unlike in America, even during emergencies, patients must be able to pay to receive health care. Doctors will not proceed until the money is collected in full for a life-threatening operation. This is what makes Guru Nanak Home so unique. Two orthopedic surgeons, Drs. Sureshwar and Panday, donate their time each week to see patients and perform surgery on them. It is no surprise the children look to them as gods and bow their heads and say “Pranam Sir” (a formal hello) when they enter.

Working for the home taught me a lot about appreciation. I saw just how much parents are willing to do for their children. Many of these children suffer from severe debilitating diseases that will leave them bed-ridden and dependent on their parents for life. To complicate things, the parents are extremely poor and uneducated. But love is something that doesn’t need to be taught.

The children also are appreciative of little things. My aunt brought mangoes (36 pounds) for the children one day. It was great seeing them line up with excitement as I helped pass out mangoes with their lunch. Simple things I think are just part of life can mean so much to these children.

Throughout my experience at the home, I noticed some major problems. One of the more disturbing problems is the fluctuating electricity. During the day, the lights can go out anywhere from one to five hours, and in this heat which reaches 105 degrees every day, life can be unbearable. If that is not bad enough, during operations, the lights flicker on and off. Before the home had a back-up generator, Dr. Panday told me they used flashlights during power outages to finish operations.

Another major problem is neglect. For example, a 15-year-old child came in with severe spasticity and club foot associated with cerebral palsy. If this child was brought in as a baby, this condition could have been alleviated much more easily with therapy and minor surgery. Now, this boy will have to endure multiple rounds of operations and physiotherapy with limited success.

During my month-long experience at the Guru Nanak Home, my passion for medicine has grown even stronger. The great children I met and stories I documented will stay with me for my professional and personal life. Important life lessons about appreciation, laughter, and touch have a much greater power than I could have imagined. The trust that patients have in their physicians was clearly visible at the Guru Nanak Home. I hope to emulate my family tradition of service and use my medical knowledge to be a force of change in the world.

Call for articles: You are invited to send us your stories about the joy or distress of medical practice, which serve to remind us what is most special about our profession. Send your stories to: Gena Girardeau, Texas Chapter of the ACP executive director, 401 W. 15th St., Austin, TX 78701; fax to (512) 370-1635; or e-mail info-at-taim.org.



Nominations Slate Announced

Robert E. Jackson, MD, FACP, Houston
Nominations Committee Chair and Texas Chapter of the ACP President

The Texas Chapter of the ACP Nominations Committee is pleased to announce an outstanding slate of candidates for election to the Texas Chapter of the ACP Board of Directors. On behalf of the committee, I would like to express our appreciation to those who submitted nominations. The 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 membership. For candidate bios, visit the Nominations Committee report (link). Directors serve a three-year term. The president-elect advances to president in November 2009.

The slate will be presented to the Chapter membership for a vote during the annual business meeting and awards luncheon Saturday, Nov. 15, in Dallas. In accordance with the bylaws, members may make additional nominations from the floor.

Please congratulate and thank these physicians for their willingness to serve in a leadership capacity for our chapter:

  • President-Elect Steve Urban, MD, FACP, Amarillo
  • Southeast Director Jose A. Perez, MD, FACP, Houston
  • Southwest Director Cecil M. Bourne, MD, FACP, Corpus Christi
  • Northeast Director Allan R. Kelly, MD, Fort Worth
  • Northwest Director Noel O. Santini, MD, Dallas
  • At-large Director Ana I. Rodriguez, MD, San Antonio



Annual Meeting Through a Student’s Eyes

Patrick R. Aguilar, The University of Texas Medical Branch student

mugshot: Patrick R. Aguilar
2008 Annual Scientific Meeting

Having attended last year, I know the annual scientific meeting of the Texas Academy of Internal Medicine promises to once again present medical students of all levels with several interesting opportunities. Last year, at the meeting in Galveston, practicing internists, residents and students from across Texas came to Moody Gardens to attend lectures, present posters, and share experiences from their work around the state.

For medical students interested in internal medicine, this event offers a chance to communicate with other similarly minded students. In Galveston, presentations of cases joined with discussions of clinical and basic science research to give students a way to engage in the clinical and academic productivity of their student colleagues. Further, students were able to attend a breakout session and watch their classmates deliver clinical vignettes and discussions in a competition with others from around the state. These experiences will be made available again this year.

The weekend also will feature numerous members of the Texas Chapter of the ACP sharing information from their area of expertise with conference attendees. Scientific and clinical advances are presented for discussion in large group sessions. The winner of the On Being a Doctor creative writing competition will read the winning essay, which is a useful reminder of the importance of keeping humanism at the forefront of our practice of medicine.

In the end, professional meetings enable people to meet others with similar interests. Medical students attending the Texas Chapter of the ACP Annual Meeting will find an opportunity to meet other medical students and exchange ideas about the common grounds that define the medical school experience. Throughout the weekend, students will find several chances to socialize with, listen to, and learn from each other. This will combine with the academic quality of the conference and make the experience well worth the drive to Dallas. I’m looking forward to this year’s meeting and hope to see you there, too.

For complete details about the annual meeting, visit the Annual Meeting page (link). Also, see the following related stories about Associate and student activities:



Annual Meeting Adds Guest Activities Track

2008 Annual Scientific Meeting

For the first time, guests of annual meeting attendees will have a set of activities designed just for them. A trip to three Dallas entertainment stops will be offered Saturday, Nov. 15, from 10 am to 3:30 pm.

The tour will include:

  • The Dallas Museum of Art Tutankhamun and The Golden Age of The Pharaohs Exhibit
  • Lunch at the Bistro inside the historic Adolphus hotel
  • Shopping at Victory Park or the downtown flagship Neiman Marcus

Dressy casual attire is recommended. Cost is $95 per person (includes private motor coach transportation, admission fee and audio tour guide at the Dallas Museum of Art, and lunch at The Adolphus). The shuttle will pick up participants in front of the Fairmont at 10 am.

The Dallas Museum of Art was established in 1903 and features an outstanding collection of more than 23,000 works of art from around the world, from ancient to modern times. Tour the museum and see the Tutankhamun and the Golden Age of the Pharaohs exhibition that drew nearly 4 million visitors during its two-year, four-city tour that will return to Dallas this fall.

The current exhibition includes more than 130 extraordinary artifacts from the tomb of Tutankhamun and other ancient Egyptian sites. The return of the exhibition to the United States will include a selection of new artifacts never before been seen outside of Egypt.

After visiting the museum, guests will travel to The Adolphus hotel, which critics have labeled as “the most beautiful building west of Venice.” Service, plus architectural splendor, set The Adolphus apart as the finest of Dallas hotels. The group will head to the Bistro for lunch to enjoy continental cuisine in an atmosphere reminiscent of the great European coffee houses.

After lunch, guests can shop at the downtown Flagship Neiman Marcus or Victory Park. Located in the heart of Dallas, Victory Park is one of the country’s most significant master planned urban developments. Stores like Dune Living, Haven, James Perse, Munia and the Twelfth Street by Cynthia Vincent add to the diverse shopping experience of Victory Park.

Neiman Marcus opened its doors in Dallas in September 1907. The company set out to offer ready-to-wear clothing of quality and value in an era when most clothing was still custom-made. Today, the flagship store is still standing and continues to give the level of service and luxury retailing as it did in 1907.

Only 45 spots are available, so reserve your spot now. Contact Claire Hogan at (512) 370-1463 or claire-at-taim.org.




Preceptorship Boosts Students’ Interest in Internal Medicine

“GIMSPP program was fantastic and gave me a great snapshot of what internal medicine holds. It was quite helpful to understand that as a first-year medical student!”

“My preceptorship with Dr. Jones specifically increased my interest in geriatrics and reinforced my interest in primary care. I would love to eventually have a practice similar in structure to hers. Definitely an unforgettable experience!”

“This was a wonderful program and was one of the key points that turned my attention to internal medicine as a rewarding specialty.”

Responses like these on a March 2008 survey of students at Texas’ medical schools illustrate the continuing influence of the General Internal Medicine Statewide Preceptorship Program (GIMSPP). Of 114 students who completed surveys 48 (42.1 percent) said they would study internal medicine their first post-graduate year.

GIMSPP charts, Students'
Interest in Internal Medicine

Six (5 percent) will study family medicine and 10 (9 percent) will do pediatric residencies. Twenty-two students (20 percent) plan to practice in primary care. That figure compares to 8 percent of medical students nationwide who plan to pursue primary care.

When asked how the internal medicine preceptorship affected their specialty choice, 50 students (43.9 percent) said it increased interest in internal medicine. Thirty-one students (27.2 percent) said the preceptorship reinforced existing interest.

Intellectual challenge of the field continued to be the reason the majority of respondents gave to the question, “Why did you choose internal medicine?”

Ninety-eight of the graduating students (86 percent) plan to practice in Texas.

The survey was conducted during the week of the resident match in March to determine the effect of the preceptorship program on their career choice.

Sincere thanks go out to GIMSPP preceptors for their willingness to teach the medical students of Texas year after year. They add a dimension to medical education the schools cannot — exposure to a community-based practice. Your commitment of time, expertise, and knowledge introduces this fulfilling specialty to students early in their professional training at a time when it is most influential. Your devotion has helped many students choose internal medicine as their field of study.



Increased Funding Crucial in Upcoming Legislative Session

The 81st Legislative Session that begins in January will be a crucial one for the three primary care statewide preceptorship programs. Without restoration of funding to the 2002-03 level, GIMSPP will not be able to continue to match even the current number of students. This summer, 123 students benefited from rotations with community-based volunteer preceptors only because the program dramatically drew on its financial reserves. Without the commitment of those funds, no more than 75 students would have been introduced to internal medicine this year.

The preceptorships are especially important so first-years have an opportunity to learn one-on-one from a general internist. Many of them are totally unaware of internal medicine as a career choice.

The plight of primary care seems to have finally gained the spotlight in Texas and nationwide, especially with the discussion of the patient-centered medical home. This legislative session may provide a real opportunity to restore funding to programs that have proven their role in increasing the number of students who choose to practice primary care. Currently, Texas appears to enjoy a healthy budget surplus.

Many Texas Chapter members contacted their legislators during the legislative interim while committees have been meeting in preparation for next year’s session. They communicated the impact of the GIMSPP on students and communities. Contacting your state legislators can add to the momentum needed to keep this request for a funding increase in the foreground.

Michelle Romero, Texas Chapter of the ACP legislative affairs manager, will be happy to help you identify and contact your legislators. Michelle can be reached at (800) 880-1300, ext. 1367, or (512) 370-1367, or at michelle-at-taim.org.


Annual Meeting

Competitions Attract Associates, Students to Annual Meeting

2008 Annual Scientific Meeting

Competition and education are in store for residents and medical students during the Texas Chapter of the ACP Annual Meeting Nov.15-16 at The Fairmont in Dallas. Registration for Associates and medical students is free, but advance registration is required (link).

Students and Associates can attend any of the educational offerings at the meeting. Many also are actively involved in various competitions.

Clinical and research poster competitions will be judged Saturday, Nov. 15. A panel of physician judges will select first- and second-place winners in the research and case reports in the student and resident categories.

The annual statewide clinical vignette competition, featuring students selected by each Texas medical school, will begin Sat., Nov. 15, at
9 am. Winners of the five regional Associates’ clinical vignette competitions will compete for the privilege of representing the Texas Chapter at ACP Internal Medicine 2009 in Philadelphia in April 2009. Vignettes will be presented during the general session on Saturday, Nov. 15.

Baylor Doctor’s Dilemma team

During resident regional competitions, Erica Hightower, MD, explains the rules of Doctor’s Dilemma to the winning team from Baylor with assistance from an Associate member from the Southern Region. Members of the team pictured are (left to right): Drs. Mark Lewis; Greg Honeycutt; Navel Daver; Stephen Harder, and Kevin Finkle, MD (moderator).

The highly competitive, annual statewide Doctors’ Dilemma competition will take place on Sunday afternoon, Nov. 16. The competition is open to all Texas residency programs that respond to the Texas Chapter of the ACP office no later than Oct. 15. To send a three-person team to participate in the exciting “Jeopardy”-style competition, contact Claire Hogan at claire-at-taim.org.

For more information about events planned especially for medical students and residents or to register, visit the annual meeting page (link).




Texas ACP Services Prepares for 81st Texas Legislature

Michelle Romero, MPA, Texas Chapter of the ACP Services Legislative Affairs Manager

Michelle Romero

The 81st Texas Legislature doesn’t convene until January 2009, but Texas Chapter of the ACP Services has been preparing for its arrival for months. Chapter members must be ready to offer comment and input when legislation is filed that could impact your practice and the health of your patients.

Health care is at the forefront of legislative agendas on the state and national levels. In Texas, health care will be a top issue as the state looks to reform the Texas Department of Insurance, which will impact your patients’ insurance coverage. Texans truly believe their health care system is in crisis, and insurance hassles factor into the equation.

Texas’ demographics also are dramatically affecting our health care system. The state’s demographer reports that as Texas grows older, poorer, more overweight, and less educated, the spending on health care services is expected to escalate. Plus, the state will need more primary care physicians at a time when the profession is experiencing a critical workforce shortage.

This session also is critical for the GIMSPP, which exposes students to internal medicine careers and receives funding through Texas Statewide Primary Care Preceptorship Program. Without restoration of funding to fiscal year (FY) 2002-03 levels, GIMSPP may not be able to match the current number of students in the program.

The Texas Higher Education Coordinating Board recently recommended a “base” budget amount at the current level of $904,290 for FY 2010-11. THECB does recommend an “exceptional” level of funding at $1.04 million for FY 2010-11 to account for program growth. This exceptional level is still short of the $2 million the program received for FY 2002-03, which is needed to make an impact on our primary care physician shortage.

Another way to make primary care careers more attractive is parity in payment among public and private payers. Wherever possible, Texas Chapter of the ACP Services is advocating for parity in reimbursement for surgical and E&M CPT codes to compensate primary care physicians for the work they perform to manage illness and prevent disease.

Texas Chapter of the ACP Services’ voice is strengthened through our partnership in the Primary Care Coalition with the Texas Pediatrics Society and Texas Academy of Family Physicians. This group leverages each specialty society’s advocacy strengths to promote or oppose legislation.

Texas Chapter of the ACP Services will reveal its legislative agenda at the annual meeting in November. Meanwhile, feel free to contact me to offer input about issues other than those mentioned in this article that you would like to see as Chapter priorities. I can be reached at (800) 880-1300, ext. 1367, or (512) 370-1367, or at michelle-at-taim.org. I look forward to hearing from you and seeing you in Dallas!



Member Kudos

Alejandro Arroliga, MD, FACP, Temple, has been appointed interim chair of the Department of Internal Medicine at Scott & White and the Texas A&M University System Health Science Center College of Medicine.

Gates Colbert, UT-Houston student, has been selected to represent the Southwestern Region on ACP’s Council of Student Members for 2008-09. Gates served as president of the Association of Internal Medicine Students (AIMS) at The University of Texas Health Science Center at Houston Medical School in 2007-08.

Robert Haley, MD, FACP, Dallas, recently was elected to the Association of American Physicians (AAP). Dr. Haley holds the U.S. Armed Forces Veterans Distinguished Chair for Medical Research, honoring America’s Gulf War Veterans.

David P. Huston, MD, FACP, Houston, has been elected to the American Board of Internal Medicine (ABIM) Board of Directors.

Cynthia D. Mulrow, MD, MACP, MSc, San Antonio, was elected to the Institute of Medicine of the National Academy of Sciences. Membership is considered one of the highest honors in American medicine.

Thomas F. Patterson, MD, FACP, San Antonio, has been elected as a member of the Subspecialty Board on Infectious Disease of the ABIM.

Donald E. Wesson, MD, FACP, Temple, recently was accepted into the AAP.

Send news of your accomplishments, or that of a colleague, to: Gena Girardeau, Texas Chapter of the ACP Executive Director, 401 W. 15th St., Austin, TX 78701; fax to (512) 370-1635; or e-mail to info-at-taim.org.



Congratulations to our Newest Fellows

Fellowship recognizes personal integrity, superior competence in internal medicine, professional accomplishment, and demonstrated scholarship.

Brett A. McFadden, MD, FACP, Lake Jackson
Sophia C. McFadden, MD, FACP, Lake Jackson
Aung Naing, MD, FACP, Houston
Laura A. Petersen, MD, MPH, FACP, Houston
Anil P. Thaker, MD, FACP, Houston
Eric J. Thomas, MD, MPH FACP, Houston
David J. Tweardy, MD, FACP, Houston

Advancement to Fellowship applications are available: