Fall 2011



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.


Governor’s Message

Robert E. Jackson, MD, FACP
Governor, TX Southern Region

“If you don’t go to somebody’s funeral, they won’t come to yours.” - Yogi Berra
Over the last several months I have been privileged to represent Texas at several national ACP functions.  I am indebted to Drs. Clark Gregg and Andy Diehl for “showing me the ropes“ while I was Governor-Elect. It has been a splendid opportunity to network and meet new friends who are concerned about the same issues we have in our State. Uncertainty reigns in these conversations about SGR, falling reimbursement, rising costs and the “unsustainable” growth in expenditures of our health care system.

So, if all of these problems seem insurmountable why are we not rallying together as internists and supporting our national organization by increasing membership and contributing to our Political Action Committees? Why are more internists and Texas ACP members not becoming involved in the Texas Medical Association (TMA) which certainly has the ear of our Texas legislature? The majority of internists in the United States do not belong to the ACP and the same may be said for the TMA here in Texas. Why is this case?

I am reminded of the parable of the boiled frog which says that if you toss a frog in a boiling pot of water it will do everything to get out quickly and urgently. But if you place a frog in a pot of cool water and slowly turn up the heat it will not sense the danger and by the time it is boiled and dead it is too late. My theory is that the heat is turning up so slowly that we internists do not recognize we are slowly being boiled alive.

What to do? Most physicians do not have the time to go to Washington or Austin to lobby for our issues. But that does not mean you cannot continue to pay ACP dues, contribute to the PAC and join the TMA! The leadership of both organizations realizes that your time is “the coin of the realm.” If you cannot commit time at least join and commit money! We need your support and we need for you to help us increase membership.  As individuals we can do very little to affect change but as a cohesive group we can do much! The ACP is a major player now in Washington D.C. and we strive to increase our influence in Texas. The TMA works diligently on our behalf and while we have not had much influence in this organization it is imperative to get involved now beginning with your local County Medical Societies. I encourage you to join the TMA. Be an active member of the Recruit-a-Colleague initiative for the ACP. Recruiting members, as my friend Andy Diehl says, is a contact sport and you need to personally use your influence on your “non-member” internist colleagues to enhance recruitment.  Do not become a member of the “Boiled Frog Club” and remember what Yogi said…show up or nobody will come to yours!


President's Message

Sue S. Bornstein, MD, FACP
TXACP President

Internal Medicine - Too Important to Fail?

We are living in an age of unprecedented uncertainty with respect to the future of our health care system. Chronic lack of resolution on the Medicare Sustainable Growth Rate (SGR), the implications of the move toward meaningful debt reduction and the on-again, off-again status of the Affordable Care Act do little to strengthen our faith in a bright future for our specialty. 

Texas will begin to experience the effects of draconian cuts in GME funding, preceptorship programs and physician loan repayment programs in the very near future. We have already seen some Family Medicine residencies eliminated due to lack of funding.  These cuts are even more harmful in a state that ranks 42nd out of 50 states in the number of physicians per capita. Coupled with a rapidly growing population, a disproportionate percentage of residents with obesity and its complications and the largest number of uninsured residents, we are facing a “perfect storm.” Add to this the ever-declining numbers of young people choosing internal medicine as a career and the picture is grim.

Despite the gloomy picture there is ample room for hope! The late Barbara Starfield and her colleagues demonstrated that when health systems emphasize primary care, patients achieve better outcomes at lower costs.  However, it is unlikely that our country can fully realize the salutary effects of primary care in our current system.

In a 2008 JAMA editorial, Christine Cassel and Richard Baron wrote “If physicians in primary care are expected or needed to coordinate it all, it is important to think differently about the competencies required of them, weighing less heavily toward well-patient or acute care and more heavily toward complexity and continuity where the physician’s extensive medical training is put to best use.”

Drs. Baron and Cassel presaged the importance of team-based care. I am struck by the paradox that when physicians are trained in a hospital setting, collaboration with a multidisciplinary team is an indispensable part of caring for patients. However, when we cross the threshold into our offices, team-based care is not yet the norm. Why has this occurred?

It is clear to me that in order to meet the needs of an increasing number of patients, many of whom are elderly and have multiple co-morbid conditions; our specialty must embrace new models of care.

Former ACP President Fred Ralston, Jr. recently wrote a guest editorial on KevinMD.com in which he shared some observations he gleaned throughout the last 7 years in leadership roles at the ACP.  Dr. Ralston stated that he would encourage his practice and other practices to institute the following:

  • Easy patient access to avoid unnecessary ER visits and hospitalizations (24/7 phone access enhanced by an electronic record and same day appointments where practical)
  • Better communication (Between patients and caregivers, among various physicians, and between inpatient and outpatient settings)
  • Better understanding of cost-effective care both within my practice and in those we refer to
  • Continuous quality improvement to allow physicians to improve the care we provide

By embracing change and adapting new models of care we will not only improve the health of our patients; we will also find ourselves much more satisfied with the noble work we do. And in the process, I wouldn’t be surprised if we find more young people drawn to internal medicine!

[1] Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Quarterly. 2005; 83 (3); 457-502.
[1] Baron R, Cassel C. 21st century primary care: new physician roles need new payment models. JAMA, April 2, 2008 - Vol. 299, No. 13; 1595-1597.


On Being a Doctor

Pete Yunyonying, MD, FACP

On this, the tenth anniversary of 9/11, I reflect on the numerous tributes and specials.  Beyond simply being a moment in time to be remembered, 9/11 should be a touchstone on which we may reflect so that we may learn and grow. Nowhere has this reflection more evident than on the television show "Rescue Me" starring Dennis Leary. Beyond the superficial exterior of a tribute to the firefighters who gave their lives the show is about the emotional toll of being a firefighter, of being a first responder, of dedicating your life to the salvation of others. This is not unlike the core of being a doctor. While not nearly as dramatic as racing into a burning building, physicians are asked to do many of the same things - to place ourselves and our needs aside as we deal with people who need saving, sometimes from unfortunate circumstances and sometimes from themselves. And while "Rescue Me" illustrates the quick death of being trapped in a collapsing building, it also shows the slow death of firefighters ignoring themselves and their needs to concentrate solely on the needs of others. The show starts and ends with almost the same monologue by the main character, Tommy Gavin, to new firefighter recruits.

"This ain’t a job. It ain’t an occupation. It’s a calling, a need, a desire that you feel in your bones and your brains.”

But the meaning behind the words has changed. What Tommy Gavin has learned in the interim is that the calling should not strip someone of their identity, of their individuality, and of their soul. Dedication is not about sacrifice, not about saving others at all costs including your own life. Rather, dedication to a calling is about defining yourself, your whole self, around an ideal. A calling should be a foundation on which you build your identity, and around which you place the pieces of your lives. It is the centerpiece around which you decorate yourself with the richness of everyday life. It should not a razor blade that strips your identity away. To do so leaves only an empty shell, a slow death. For Tommy Gavin, such a slow death led to a path of destruction over seven marvelous seasons.

As I listen to our new recruits in residency, I cannot help but hear phrases like "work-life balance," and "my time versus work time.” They ask the central the question of this generation: Where does being a doctor end and being me begin? To me, these are all signs of the slow death of Tommy Gavin. But perhaps on this 10th anniversary of 9/11, we can learn a little from the brave firefighters and the tribute to their lives in the form of "Rescue Me". Perhaps the solution to the emotional toll of being a doctor isn't in separating our needs from those of our patients, as calls for duty hours proliferate. Perhaps instead we need to heed the calling, and make it part of ourselves, the calling is the beginning of who we are, not the end. Being a doctor for me is being a person, a whole person. I am not limited to medicine and its vast technical skills and fund of knowledge. I am more than that with all of the richness and texture of that art, and music and friends, brings to my life. To survive bring a doctor, you must first understand that you cannot turn it on and off like a switch. To be a good doctor, you first have to be a good person, a whole person.

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 2011 annual meeting will be held Saturday and Sunday, Nov. 12-13 at the AT&T Executive Education and Conference Center in Austin. 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 2012 poster competition in New Orleans, LA 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. 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!

Thank You to All of Our Summer 2011 Preceptors

The General Internal Medicine Statewide Preceptorship Program would like to thank all of the physicians that served as preceptors for medical students this summer. Their dedication to the program, the students and to internal medicine is greatly appreciated. 

Alan Kaye, MD, FACP
Alan Keister, MD
Alejandro Moreno, MD, MPH, JD, FACP
Ali Bagheri, MD
Allan Kelly, MD, FACP
Ben Barnett, MD, FACP
Brook Jimma, MD
Carmen Escalante, MD, FACP
Craig Berent, MD
Edward Sargent, MD, FACP
Ellen Manzullo, MD, FACP
Enrigue Rodriguez, MD
Errol Bryce, MD, FACP
Fay Simon, MD
Felicia Austin-Tolliver, MD, FACP
George Burnazian, MD
Gopinath Chandrahasan, MD
Gordon Strom, Jr., MD, FACP
Hafiza Docrat, MD
Ildefonzo Flores, MD
Jeffrey Lee, MD
Joel Kneitz, MD
Joel Walker, MD, FACP
John Crommett, MD
John Dickson, MD
Julie Nguyen, MD
Kathleen Smalky, MD
Khanh Diem Vu, MD, FACP
Koko Aung, MD, FACP
Lynn Lester, MD
M. Keith Schrader, MD
Mark Armstrong, MD, MACP
Mark Farnie, MD
Mark Ginnings, MD, FACP
Mark Johnston, MD, FACP
Michelle Ho, MD, FACP
Michelle Mercatante, MD
Mike Neff, MD, FACP
Oladayo Sanusi, MBBS, FACP
Pariac Mulgrew, MD, FACP
Patrice Alves, MD
Patricia Salvato, MD
Pedro Arrazola, MD
Philip Johnson, MD, FACP
Randlow Smith, Jr., MD, FACP
Raymon Aggarwal, MD
Robert Thompson, MD, FACP
Roxana Rhodes, MD
Sarah Smiley, DO
Scott Yates, MD, MBA, FACP
Stephanie Mundy, MD, FACP
Steve Rosenbaum, MD
Suresh Antony, MD, FACP
Susan Andrew, MD
Thwe Htay, MD, FACP
Tom Baxter, MD
Uyen-Thi Cao, MD
Wenli Liu, MD
William Mania, MD, FACP
William Mitch, MD
William Robinson, MD, FACC
Zafer Hassan Haydar, MD

GIMSPP Match Update for 2011

For the 2011 GIMSPP program, students had to turn in their application by Tuesday, March 1st. At the end of the application deadline, the program had a total of 208 applications submitted by March 1st.  Of the 208 applications, 68 of those applicants were matched with a paid preceptorship for the summer.  A total of 97 students were not matched, 23 students dropped out of the program before the matching process began and 20 students dropped out of the program once they were notified of their match.  Thank you to all of the 62 preceptors that participated in the program this summer. 

Nominations Slate Announced

Felicia Austin-Tolliver, MD, FACP, TXACP President-elect of the TXACP Nominations Committee is pleased to announce an outstanding slate of candidates for election to the TXACP Board of Directors. On behalf of the committee, I would like to express our 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 during the annual business meeting and awards luncheon on Saturday, Nov. 12, in Austin. 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:

For complete bios and pictures please click here.   

     President-Elect           Jose A. Perez, Jr., MD, MSEd, MBA, FACP, Houston
     Secretary-Treasurer   Stephen J. Sibbitt, MD, FACP, Temple
     Northeast Director      Daniel M. Goodenberger, MD, MACP, Dallas
     Northwest Director     Jose D. Burgos, MD, El Paso
     Southeast Director     Julie C. Nguyen, MD, Houston
     Southwest Director    KoKo Aung, MD, MPH, CPH, FACP, San Antonio
     At-Large Director       Randy A. Fuentes, MD, Corpus Christi

Member Kudos

Neha Gupta Mittal, MBBS, Lubbock has been elected to the Texas Medical Association Leadership College, Class of 2012.

Riva Rahl, MD, Dallas, has been elected to the Texas Medical Association Leadership College, Class of 2012.

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


Congratulations to Our Newest Fellows

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

Amanda K LaViolette, MD, FACP, Austin
Chirayu J Shah, MD, FACP, Houston
Eric H Bernicker, MD, FACP, Houston
Gnana S Naini, MD, FACP, Plano
Harrys A Torres, MD, FACP, Houston
Imran R Khawaja, MD, FACP, Coppell
Jennifer K Zimmer, MD, FACP, Frisco-
Kalpana J Gupta, MD, FACP, League City
Liam M Fry, MD, FACP, Austin
Melinda C McMichael, MD, FACP, Austin
Munir Loya, MD, FACP, Houston
Nolan E Perez, MD, FACP, Harlingen
Rahul K Patel, MD, FACP, Irving
Shah Nawaz Afridi, MD, FACP, Victoria Rancho
Shubhada Mithilesh, MBBS, FACP, Dallas
Steven Roderick Bailey, MD, FACP, San Antonio
Stuart C Pickell, MD, FACP, Fort Worth
Subramaniam Anandasivam, MD, FACP, Viejo

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


2011 TXACP Northern Governor-elect Election

Biographical Sketches and Vision Statements

Texas Northern

Sue S. Bornstein

DATE/PLACE OF BIRTH 11/12/1953; Dallas, Texas; EDUCATION: MD – Texas Tech School of Medicine (1992); MA – University of North Texas (1976); BA – University of Texas at Austin (1974).; POST DOCTORAL TRAINING: Internship and residency in internal medicine, Baylor University Medical Center, Dallas, Texas (1992-1995); CERTIFICATION: American Board of Internal Medicine 1995; recertified 2005; PRESENT POSITION: Executive Director – Texas Medical Home Initiative (a multi-stakeholder medical home pilot project of which the Texas ACP is the convening organization); ACP ACTIVITIES: Fellowship – 2003; Medical Practice and Quality Committee – member; 2010-2012; faculty at Internal Medicine 2010; CHAPTER INVOLVEMENT/LEADERSHIP ACTIVITIES: Board of Directors  2005-2006; Secretary/Treasurer 2007-2008; President-elect 2010; President 2011; HOSPITAL/COMMUNITY SERVICE: (all at Baylor University Medical Center – Dallas) Secretary (1998);  President (2005) and Chair, Executive Committee (2006) of the Medical Staff ; Chair – Multidisciplinary Quality Committee on Peripheral Angiography (2000-2006); Organizer and Chair, Women Physicians’ Forum  (1998-2005).; OTHER APPOINTMENTS: Dallas County Medical Society – Secretary/Treasurer and Executive Committee member 2007; Dallas County Medical Society delegate to the Texas Medical Association 2008-2011; Texas Medical Association – Select Committee on Medicaid and CHIP 2010-2011, Teaching attending and Internal Medicine Clinic Attending 1996-2006 (Baylor University Medical Center); AREAS OF PROFESSIONAL INTEREST/EXPERTISE:  Disease prevention; patient-centered medical home; palliative care and clinical ethics; governance of non-profit healthcare organizations

Vision Statement

It is a singular honor to be nominated to the position of Governor-elect of the Texas Northern Region of the American College of Physicians.  The Texas Chapter of the ACP is a remarkably diverse organization. Our members are general internists, hospitalists and specialists who practice in settings ranging from solo practices to academic institutions. Their practice locations range from rural Texas towns to large urban centers. They are US and international medical graduates. This diversity contributes greatly to our strength as a chapter.  To the Texas ACP I bring the ability to lead by developing consensus even around the most challenging of issues.  My work on the Texas Medical Home Initiative is evidence of my ability to successfully create coalitions of seemingly disparate factions.  If elected, I will tirelessly and passionately advocate for the needs of Texas’ internists and internal medicine specialists and the patients for whom we care. 

Stephen J. Sibbitt

DATE/PLACE OF BIRTH: St. Catharines, Ontario, Canada. November 10, 1963; EDUCATION: Honors Bachelor of Science, McMaster University, Hamilton, Ontario, Canada (5/1990), Master of Science, American University of the Caribbean, Plymouth, Montserrat, British West Indies (1992), Doctor of Medicine, American University of the Caribbean, Plymouth, Montserrat, British West Indies (5/1994); POST DOCTORAL TRAINING: 07/94 – 05/95 Internship, Internal Medicine, St. John Hospital and Medical Center, Detroit, Michigan, 06/95 – 08/97  Residency, Internal Medicine, The University of Texas Medical Branch, Galveston, TX, 07/97 – 06/98  Chief Resident, The University of Texas Medical Branch, Galveston, TX; CERTIFICATION: ABIM, Initial Certification 1998, Recertification 2008; PRESENT POSITION (all current): Chief Medical Officer, Scott & White Memorial Hospital, Temple, Texas, Assistant System Chief Medical Officer, Scott & White Healthcare, Temple, Texas, Member, Board of Directors/Board of Trustees, Scott & White Healthcare, Temple, Texas, Chairman, Board of Directors, Scott & White Continuing Care Hospital, Temple, Texas, Member, Board of Directors, Scott & White Llano Hospital, Llano, Texas, Member, Corporate and Community Board of Directors, Metroplex Adventist Hospital, Killeen, Texas; ACP ACTIVITIES: Fellow, American College of Physicians (January 2009); CHAPTER INVOLVEMENT/LEADERSHIP ACTIVITIES: Texas Chapter of the American College of Physicians, Secretary/Treasurer (term began 12/09), Texas Chapter of the American College of Physicians, Board of Directors (term 11/06 – 11/09), Texas Chapter of the American College of Physicians, Associates Committee (July 2007 – present), Nov 2010: Judge and Abstract Reviewer for Student and Associate Competitions, Annual Texas ACP Meeting, Houston, Texas, Nov 2009: Judge and Abstract Reviewer for Student and Associate Competitions, Annual Texas ACP Meeting, San Antonio, TX, Nov. 2008: Judge and Abstract Reviewer for Student and Associate Competitions, Annual Texas ACP Meeting, Dallas, Texas, May 2006: Program Chair, 13th Annual South Texas ACP Associates’ Meeting, May 2005: Judge, 12th Annual South Texas ACP Associates’ Meeting, March 2003: Abstract Reviewer, 10th Annual South Texas ACP Associates’ Meeting; HOSPITAL/COMMUNITY SERVICE: Numerous activities related to Board positions; OTHER APPOINTMENTS: Southwest Transplant Alliance (Texas) – Board of Directors (term began 4/2011), Healthcare Coalition of Texas - Physician Leadership Network (Chairman effective Jan. 2011), Healthcare Coalition of Texas – Physician Leadership Network (Member since 2007), Healthcare Coalition of Texas – Standardized Order Set Task Force - Chairman; Texas Hospital Association – Hospital Physician Executives (2010), Texas Hospital Association – Council on Policy Development (term begins 1/1/11 and ends 12/31/11), Texas Hospital Association - Board of Trustee Nominee (one of two physician nominees for the two open seats. Electronic election fall 2011, term would begin Jan 2012); Alpha Omega Alpha Medical Honor Society, Texas Chapter, Inducted February 2011; AREAS OF PROFESSIONAL INTEREST/EXPERTISE: Hospital Administration, Quality and Patient Safety, Residency Education

Vision Statement

My interest in running for a ‘Governor’ position with the Texas Chapter of the ACP stems from my firm commitment to our organization, its’ members, and the patients we serve. My vision for the Texas Chapter of the ACP is to be seen as the role model chapter within the national organization.   We will establish the bar of performance in promoting the highest quality of care for our patients, in growing and engaging our membership, in leading patient advocacy, in fostering excellence in medical education, and in role modeling professionalism within Internal Medicine and its’ specialties.

As Governor/Governor-elect, I will hold myself accountable and responsible to every chapter member.  Furthermore, I will hold our national organization’s leaders accountable to the mission of the ACP.  Regardless of this election’s outcome, I pledge my continued support to the Texas Chapter of the ACP.  Thank you for your consideration.