Summer 2008



Summer Issue

Texas Internist Summer 2008

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



Mission Statement

The mission of the Texas Academy of Internal Medicine 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

“I desire no other epitaph … than the statement that I taught
medical students in the wards, as I regard this as, by far, the
most useful and important work I have been called upon to do.”
— Sir William Osler

For those of us who feel called to teaching or mentoring medical students, our own General Internal Medicine Statewide Preceptorship Program (GIMSPP) provides that opportunity. Keeping this program alive and growing is critical to meeting the health care needs of Texas.

Robert Jackson

When the Texas Legislature convenes in 2009, it is expected to have a $10.7 billion surplus to parcel out during the budget cycle. This is great news for GIMSPP and the state’s two other primary care preceptorship programs (pediatrics and family medicine), and we must take action! Contact your Texas senators and representatives and ask for reinstatement of the funds that were reduced in 2003.

During that year, GIMSPP funds were cut in half during the state’s budget “crisis.” Please lobby your legislators to reinstate the three statewide primary care preceptorship programs back to the original $2 million level budgeted for the combined programs. Plus, push for an extra $1 million to encourage even more students to enter primary care. Remind your legislators these specialties form the cornerstone of health care delivery in our state.

To locate your representatives, go to our “Who is my legislator?” resource, a part of our Advocacy section (link). By typing in your address (look at both home and business) you are automatically directed to the Web site for information about Texas.

I recommend you also download the “Mending our Fractured Health Care System” document (PDF link), and print it to take with you on your lobbying efforts. Make an appointment with your representatives in the Texas House and Senate and see them before this fall. Show them how internal medicine and primary care is dying on the vine. Without GIMSPP support, we will be unable to attract medical students to internal medicine. Medical students are our life blood; without attracting them into internal medicine, it will be impossible to deliver adequate primary care for Texans.



Governor's Message

Andrew K. Diehl, MD, MSc, FACP, San Antonio
Texas Southern Region

A friend of mine has practiced general internal medicine for more than 20 years. Bill and I have known one another since he was a resident at The University of Texas Medical School at San Antonio. For a time, he served on our faculty. Recently, he and his partner decided to give up their hospital work.

Andrew K. Diehl, MD, FACP


“I put up the good fight for 21 years, but, as of Jan. 1, we are only doing office work,”says Bill. “I was reluctant to do so, but now that we have made the decision, I don’t think I will regret it. It was just too difficult to work hard all day and then go and do an admission at 7 p.m. Financially it was about 10 percent of my income, but I hope I can recoup that with additional office visits now that we are not running back and forth from the hospital ...

“We were beginning to feel a bit like dinosaurs anyway, as our call group was the only internist group at our hospital that did its own rounds. I definitely have mixed feelings, as I always felt the hospital work and the continuity it offered patients was what separated us from the family practitioners.”

I think Bill is right. The momentum for hospital medicine continues to grow, and no one believes we’ll return to the comprehensive internist model as the standard, at least not in urban areas. Newly minted general internists are becoming hospitalists or “officists,” but not both. This is not a bad thing in my opinion. Although some are concerned about the further fragmentation of our specialty, practical issues, such as those highlighted by Bill, are promoting rapid change.

Bill’s concern about the impact of this movement on patient continuity also is appropriate. Although some studies indicate experienced hospitalists are efficient in their use of hospital resources while providing care of equivalent or even superior quality to patients they do not know well, disrupted continuity and haphazard communication remain a threat. We can only hope that, as electronic health records grow more prevalent, information transfer will improve and mishaps will occur less often.

Just as full-time hospital work makes hospitalists more efficient, the officist’s practice will improve with concentrated experience as well. Bill and his partner recently installed an expensive electronic medical records (EMR) system in their practice. It helps them move reports, prescriptions, records, and mail around their office. They still type their progress notes, but the point-and-click features speed the completion of other portions of the patient record. They may not save money, but they’re more efficient.

The practice also is building the framework for a “medical home.” A half-time physician assistant assists with add-on appointments and fills in when they take vacation.

Bill says, “The medical home concept seems promising as long as we’re not burdened with a lot of ‘quality indicators’ [of uncertain validity]. Perhaps with the EMR, generating those reports will be more feasible, and, in fact, this was part of the decision-making process to make the commitment to a new system. If we could get a reasonable case management fee per patient, it sure would help.”

The American College of Physicians (ACP) continues to pursue, with others, its commitment to the patient-centered medical home model. The outcome of this fall’s elections will determine the receptivity for significant reform of our health system. Let’s hope our newly elected leaders provide support for practices like Bill’s.



On Being a Doctor

"Learning to Master a Recipe"

Mitali Banerjee, Baylor College of Medicine studentspot-graf-on-being-doctor

Before Kemah, Texas, got a ferris wheel and boardwalk with upscale restaurants, Betty Arnoldi ran a small Italian place with her husband just past the bridge. Walls painted dark blue with stars and decorated with astronaut memorabilia and pictures from the Hubble telescope, it was a family restaurant where the Arnoldis served you themselves. My parents would take my sister and me for Rocketship Ravioli, named for their shape, and Spaghetti with Nine Meatballs, arranged like the planets around a sun of pasta sauce and mozzarella. At the time, growing up a mile from the Johnson Space Center in the late 1980s, more than anything, I wanted to be an astronaut.

Fifteen years later, I keep tabs on astronomical phenomena like eclipses and meteor showers, eagerly follow reports on shuttle launches and the commercial space industry, and remain awestruck looking at the moon and stars from a Texas field. But I am in my fourth and final year of medical school in Houston, just 20 minutes from my parents’ house. The Arnoldis’ restaurant closed after my senior year of high school, around the time I went to college. We discovered this one evening when I was back home: We drove to it and saw the life gone from the building – no open sign, no tables outside, no light in the windows.

Last year, on a cardiology elective month, I eagerly followed my attending Dr. Kalife on rounds with the residents and fellows. I hoped that somehow being around them, I would develop their superpower to hear murmurs and extra heart sounds. Closing my eyes, holding my breath, pressing my bell against a patient’s chest, I strained to hear something besides the steady lub-dub. At the library, I had downloaded files of heart sounds to my iPod, but I never heard with the stethoscope what I heard through my headphones.

Then gradually, unrelenting effort and Dr. Kalife’s aura gave me the ability to hear even grade I and II murmurs. I think my joy might have been how Neil Armstrong felt taking his giant leap on the moon. As a conscientious student, I had observed what questions to ask in the history and memorized differential diagnoses and basic steps in managing various heart conditions, but actually arriving at an assessment proved a challenge until I mastered a good heart exam.

“Tell me what you hear,” Dr. Kalife said, which was our new game instead of him telling me what I should listen for. We entered a patient’s room and sitting in a blue gown that matched her eyes was Mrs. Arnoldi. Though she looked much older since I had last seen her nearly seven years ago, I recognized her immediately. Dr. Kalife and the team usually gave me the opportunity to start the patient interview, but I did not know what to say, because I was smelling fresh garlic and basil and my whole family was together, laughing and eating -- all of us -- over large plates of pasta.

A resident took over the history-taking. Timidly, I approached Mrs. Arnoldi when motioned to do my physical exam. While counting her pulse, I introduced myself. Unexpectedly, as if I were her own daughter coming home for Christmas, she gave me a strong hug and kissed me on the cheeks, telling me how good it was to see me.

She had pulsus parvus et tardus and she had come for a valve replacement for aortic stenosis. I went to see her several times before and after the procedure, and we learned more about each other. Somehow I got to talking about my meals in medical school, which too often involved the microwave and something from my freezer. She offered me her family recipe for ravioli, and I wrote it down carefully, promising to report the results from my cooking experiment to her the next morning after rounds.

I bought the right ingredients and combined them in the right amounts, and, though it was Mrs. Arnoldi’s recipe, it was not Mrs. Arnoldi’s ravioli. Luckily, however, this story about cuisine and medicine has a happy ending. Mrs. Arnoldi recovered after receiving her mechanical valve, and she can walk her two dogs on the Kemah Boardwalk every day again.

As for me, I am an increasingly better cook and better doctor-to-be. In the end, I learned by experience to feel when a tomato was ripe and ready for the sauce, to smell when the sauce was ready, to know how to make perfect ravioli.

In that way, medicine also is more than following a recipe. The art of medicine requires knowing the subtleties that cannot be learned in a cookbook: how to hear a heart, how to care for a patient. We can observe great chefs and great doctors, but to be like them, we have to remain passionate and cultivate our skills, learning by doing, by tasting, by trying variations, by failing and learning from our mistakes, by practice.



Chapter Executive Director Retires

Edward C. Lynch, MD, MACP, Houston
Texas Southern Region Governor, 1995-99

I was, of course, surprised and disappointed to hear that Catherine Bailey is retiring after 12 years as the chapter’s executive director. The chapter will miss her very much.

Catherine has been a fantastic leader as executive director of TAIM. As members of the ACP, we internists in Texas have been fortunate to have an outstanding chapter, and Catherine played a big part in the development of the range of excellent programs and services of TAIM.

I remember well in the late 1990s when the ACP and the ASIM joined together to become a single organization representing internists. Her efforts were a major reason for the success of this merger in Texas. In fact, we came out of the merger with a much stronger organization in Texas than we had previously. Join me and the other chapter leaders in wishing Catherine the best.

Chapter Executive Director Retires

(Left to right) Drs. Herbert DuPont, Houston; Edward Lynch, Houston; Mark Armstrong, Dallas; Abraham Delgado, Austin; Andy Diehl, San Antonio; Robert Jackson, Houston; and Chris Finnila, Houston, took the opportunity to bid farewell to Catherine Bailey, CAE, CMP, during the Texas Chapter reception at the ACP annual meeting in Washington, D.C.



TAIM Welcomes Executive Director

Gena Girardeau


TAIM is pleased to introduce Gena Girardeau as the new executive director for the Texas Chapter of the ACP. Gena comes to TAIM from the American Cancer Society (ACS), where she was responsible for coordinating 58 local chapters of the ACS spread throughout Texas and six other states, maintaining the large online cancer resource center/database, and much more.

Gena has deep roots in Central Texas and a passion for volunteer work and patient advocacy. She grew up in Seguin and graduated from Texas State University in San Marcos.

The Chapter’s executive director provides administrative support for the board of directors and committees, and manages the chapter’s member communications via the Web site, newsletter and e-mails. The executive director also manages the Chapter’s finances, and oversees arrangements for the annual chapter meeting.

Give Gena a call to personally welcome her to TAIM. She can be reached at (512) 370-1508 or



Mission Statement Amended

The TAIM mission statement was amended by the TAIM Board of Directors on Feb. 16.

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




GIMSPP Adds 25 Preceptors

The General Internal Medicine Statewide Preceptorship Program (GIMSPP) is fortunate to have preceptors who give generously and unselfishly of their time, knowledge and talents to teach the next generation of physicians. Since 2006, GIMSPP has added these 25 mentors and teachers:

  • Shezi Z. Ali-Kirmani, MD, Houston
  • Felicia L. Austin-Tolliver, MD, FACP, Angleton
  • Anand Balasubramanian, MD, Houston
  • Ursula K. Braun, MD, Houston
  • Katherine A.B. Brown, MD, Austin
  • Gopinath C. Chandrahasan, MD, San Antonio
  • Gary A. Croll, MD, Dallas
  • Bryan K. Demarie, MD, Irving
  • Ricardo Diaz, MD, Dallas
  • Donna Sue Dolle, MD, FACP, Nassau Bay
  • Robert Frachtman, MD, Austin
  • Sean E. Garcia, MD, San Antonio
  • Robert W. Israel Jr., MD, FACP, Irving
  • Gauri Gopal Kanhere, MD, Rio Grande City
  • Joel S. Kneitz, MD, Houston
  • Anita Kuruvilla, MD, Livingston
  • Sergio A. Lara, MD, Plainview
  • Adrian Meyer, MD, Richardson
  • Saji Pillai, MD, Irving
  • Paul K. Piper, MD, Dallas
  • Rebecca A. Quiroz, MD, San Antonio
  • Aaron Lee Samsula, MD, Plano
  • M. Keith Schrader, MD, Plano
  • Nicholas Sollenne III, MD, FACP, Houston
  • Robert D. Thompson, MD, FACP, Dallas

Our deepest appreciation goes to these new volunteers and to the active, dedicated preceptors who make time to teach students as often as they can. Their contribution immeasurably enhances the education of medical students.




TMA, Medical Schools Support Program Funding Goals

GIMSPP coordinated a successful presentation to the Texas Medical Association’s Council on Medical Education during TMA’s TexMed 2008 in May. The presentation focused on the state’s three preceptorship programs – internal medicine, family medicine, and pediatrics – and their importance to the future of primary care.

The goal was to educate TMA leaders and medical school deans about the important role the preceptorship programs play in introducing medical students to the rewards of primary care early in their careers. GIMSPP also was soliciting TMA’s support and advocacy for the programs.

Eugene W. Stokes, MD, FACP, San Angelo, immediate past president of TAIM and co-chair of the Medical Students Committee, gave a brief history of the programs, emphasizing the looming crisis for primary care in Texas. He introduced two third-year students from UTHSC-San Antonio who participated in preceptorships as first years.

Jackie Rellas, a GIMSPP student, talked about her preceptorship with an internist in San Antonio. She said she appreciated the opportunity to gain early hands-on experience in patient interaction, which prepared her for her third-year rotations. Jackie said her preceptor continues to be a mentor to her.

Travis Holloway, a Texas Statewide Pediatric Preceptorship Program (TSPPP) student, worked with a community-based pediatrician. In addition to learning patient care, he also was introduced to practice management, coding and billing processes. Ironically, Travis had originally applied to the GIMSPP but was turned away because the funding for 2005-06 had been exhausted before he could be matched with an internist.

Representatives of the other two primary care preceptorships also participated. Robert Nolan, MD, chair of the TSPPP advisory committee, explained that preceptorships teach students something medical schools cannot – how to run an efficient private practice. Lewis Foxhall, MD, director of the Texas Statewide Family Medicine Preceptorship Program, discussed preceptors’ enormous in-kind contribution to the education of medical students through volunteer teaching in their community-based practices.

Two council members spoke extemporaneously about doing family medicine preceptorships several years ago and how much the experience influenced their decision to practice primary care. Both had entered medical school with the intent to specialize.

Stacey Silverman, PhD, director of Medical Education for the Texas Higher Education Coordinating Board (THECB), fielded questions about the funding history of programs administered by the THECB.



GIMSPP By the Numbers


Applications for 2007-08


Students matched


Students dropped because of lack of funds


Preceptors who will teach students


State funding for 2007-08



Students, Associates Call for Abstracts

Residents and medical students are invited to submit entries for several competitions during the TAIM Annual Meeting Nov. 15-16 in Dallas.

Associate and medical student poster competitions: Residents and medical students are invited to submit abstracts of case report and research projects that have clinical relevance to internal medicine via the abstract submission form (link).

Submission deadline is Friday, Aug. 8. Abstracts will be reviewed, and submitters will be notified of the status of their abstract via an announcement on the TAIM Web site by Wednesday, Oct. 1. Those who are accepted to the competition will be invited to present their abstract in poster format at the 2008 TAIM Annual Meeting Nov. 15-16 at The Fairmont Hotel in Dallas.

A panel of physicians will judge the posters. First- and second-place winners will be chosen in both the Case Report and Research categories in the medical student and associate competition.

On Being a Doctor creative writing competition: Residents and medical students are invited to submit original prose or poetry dedicated to the theme, “The Patient as Teacher.” Submissions are limited to 1,000 words or less and must be submitted via the submission form (link) by Aug. 29. Contestants must reside in Texas and be ACP members.

A panel of physicians will review the submissions, and the winner will be announced no later than Oct. 15. The winning author will be invited to present his or her work in a 10-minute oral reading during the TAIM Annual Meeting general session. The author will have all expenses paid to attend the TAIM Annual Meeting.



ACP Annual Meeting

Resident Shares Perspective

Naval G. Daver, MD, ACP Associate Member, Baylor College of Medicine

I want to thank the Texas Chapter of the ACP for providing me and my colleagues the opportunity to represent Texas at the ACP annual meeting in Washington, D.C. Our journey began in November 2007 when we won the statewide Doctor’s Dilemma competition, beating 10 other outstanding teams in this medical “Jeopardy” contest. The competition was fierce, and we were lucky to prevail as winners. But making it to the ACP meet was well worth the effort.

Doctor’s Dilemma team from Baylor College of Medicine in Houston

The Doctor’s Dilemma team from Baylor College of Medicine in Houston accepts congratulations and cash awards at the 2007 TAIM Annual Meeting in Galveston from Gov. Andrew K. Diehl, MD, FACP. Team members are (left to right): Gregory R. Honeycutt, MD; Noman Ashraf, MBBS; and Naval G. Daver, MBBS.

I had the good fortune of attending the 2007 ACP annual meeting in San Diego, Calif., and it seems that every year the ACP seems to get bigger and better, much like Texas. What better place to have the ACP annual meeting than Washington D.C., a city with a vibrant and eclectic mixture of people.

The Washington Convention Center, nestled in the heart of downtown, is an impressive structure. As we entered the main lobby, we were amazed by the crowds of physicians who had convened at the annual meeting, not just from across the United States but from across the globe. Well-renowned and respected speakers, many of them pioneers in their respective fields, discussed topics ranging from the most recent updates in allergy and immunology to the newest policies on resident physicians’ weekly work hour regulations. Hands-on training in medical procedures even was available for those who wished to hone their skills.

The Doctor’s Dilemma competition began on the first day. As we triumphed against teams from three other states, our hopes were raised. However, in the semi-finals, the Texan in us came out as we turned “trigger-happy” and missed the finals by a narrow margin. Our dejection was short-lived, however, as later that evening we attended the Texas Chapter reception to congratulate our newly crowned ACP Masters from Texas.

As we chatted with members and organizers from the Texas ACP and thanked them for their support and confidence in our team, I realized the ACP is not just an organization but a platform for us to interact and learn from physicians all over the world. In so doing, we develop true camaraderie in the field of internal medicine.



Associates Shine in Area Competitions

All across Texas, internal medicine residents are hard at work learning, practicing, and teaching medicine. TAIM has the honor of allowing these young physicians to showcase their hard work locally at one of our five Associates regional competitions.

This year’s meetings followed tradition. Competition was stiff, participation was high, and the work was of exceptional quality. Much energy and commitment also was put into planning each event. Recognition for meeting preparation goes to Drs. Michael J. Morris COL, MC, for the Southwest; Niraj N. Mehta for the Southeast; Steven Urban, FACP, for the Northwest; W. Mark Armstrong for the Northeast; and Lydia Espinoza for the Far Northwest.

The regional programs involved a mix of Doctor’s Dilemma, podium presentations, and research and clinical poster competitions. Congratulations to the regional winners.

Research Podium
Bao Le, DO, Texas A&M

Clinical Poster
Marc Elieson, MD, Texas A&M

Research Poster
Thomas A. Showalter, DO, Texas A&M

Nicolas Melgarejo, MD, UT-Houston

Clinical Poster
Marc Elieson, MD, Texas A&M

Research Poster
Christian Kottner, MD, UTMB

Sobia Ahmad, MD, TTUHSC-Amarillo

Afua Agyarka, MD, Methodist Health System

Clinical Poster
Poorya Fazel, MD, Baylor

Research Poster
Min Xie, MD, UT Southwestern

Far Northwest
Jose Burgos, MD, TTUHSC-El Paso

The Texas Chapter supports the regional Associates’ councils with annual grants of up to $1,500 per council to help fund their programming. Each regional clinical vignette competition winner will receive chapter support to travel to Dallas Nov. 15-16 to represent their region at the TAIM Annual Meeting. Visit the TAIM Web site for a complete list of winners. We hope to see you in Dallas!




TAIMS Prepares for Primary Care Legislative Victories in 2009

Michelle Romero, MPA, TAIMS Legislative Affairs Manager

Physicians have a unique opportunity to make their voices heard to promote significant reforms within the Texas insurance marketplace during the 81st Texas Legislature in 2009. During this interim, the Texas Sunset Commission will review the workings of the Texas Department of Insurance.

Leadership Day

Members of the Texas delegation to ACL Leadership Day visited with Rep. Michael C. Burgess, MD, about his Ensuring the Future Physician Workforce Act of 2008. Physicians (left to right) are: Mark W. Armstrong, MD, FACP; J. Phillip Myatt, MD; Marc S. Elieson, MD; F. David Winter, MD, FACP; Rep. Michael C. Burgess, MD (R-Dist. 26); Marguerite G. Wubker, MD, FACP; Scott W. Yates, MD, FACP; and Clark R. Gregg, MD, FACP.

The 12-member Sunset Commission is a legislative body that reviews the policies and programs of more than 150 government agencies every 12 years. The commission questions the need for each agency, looks for duplication of services, and considers new and innovative changes to improve each agency’s operations and activities.

This means the entire Texas insurance statute will be debated by the Texas Legislature and will, therefore, be subject to amendment. As with everything in the legislative arena, the pros and cons are weighty. Positive reforms TAIMS supports that have the potential for full debate include: promoting health care transparency, preventing inadequate networks, and regulating “silent preferred provider organization” practices.

On the negative side, critical and recently won health insurance victories such as the Patient Protection Act, prompt pay, and physician negotiation also could be subject to renewed debate. The commission will seek public input on the insurance agency at a public hearing on June 24 to consider continuation and modification of the agency.

The Legislature also will have a chance to help reduce our state’s primary care physician shortage. Increasing total funding for the three Texas statewide primary care preceptorship programs, including our own GIMSPP, back to the 2003 funding level of $2 million for the biennium will make a significant impact at growing the number of medical school graduates entering an internal medicine residency program.

Physician loan repayment is another program that has generated interest as a means of attracting primary care physicians to underserved areas. Once again, increased funding levels are required for this program to have a real impact.

In 2007, the current state-funded program provided repayment to 72 physicians at no more than $9,000 annually per physician. Total loan repayment per physician is capped at five years or $45,000, and the program has an overall annual budget of around $1 million. The maximum loan repayment amounts are unchanged from the inception of the program in 1985 and are widely considered to be inadequate to address current needs. The $45,000 total repayment covers only one-third of a physician’s average medical education-related debt.

Offering ascending loan repayment amounts for each year of service to an underserved community, with a defined cap such as five years, could serve as a greater incentive for retaining primary care physicians in physician shortage areas. Research indicates the longer a physician practices in a community, the more likely they are to be retained. At a time when more physicians need assistance with loan repayment, fewer are receiving it.




Resident Gains Advocacy Training at Leadership Day

Amie M. Sun, MD, PhD, ACP Associate Member
Methodist Health System, Dallas

I am a third-year medical resident in internal medicine at Dallas Methodist Hospital. I volunteered to attend Leadership Day primarily to learn the valuable skill of communicating the needs of the medical community to lawmakers on Capitol Hill.

The first day of the conference involved discussions and strategy sessions with the most up-to-date information on key issues affecting primary care, as well as ACP’s position on these issues. For example, one session focused on how physicians can effectively and efficiently convey the needs of the medical community to Capitol Hill. On the second day, members of ACP met with congressmen and senators from their various states to discuss primary care issues and share ACP’s views on those issues.

Physicians are aware of the problems confronting primary care and know what needs to be done to fix the problems. However, doctors do not always have opportunity to convey those solutions to lawmakers. Leadership Day offered me, and members of the ACP, the opportunity to express to these senators and congressmen our positions on the major issues affecting primary care.

As a member of the Texas Delegation, I met with Sens. Hutchison and Cornyn to discuss primary care issues, as well as ACP’s desire to urge Congress to add the 20/220 pathway re-instatement (medical school loan repayment), restoring critical economic hardship deferment pathway when the Higher Education Act is reauthorized. I highly recommend the Leadership Day experience to fellow young physicians and look forward to advocating in the future on behalf of ACP.



ACP Leadership Day

Texas Physicians Share Concerns with Congressmen

F. David Winter Jr., MD, MSc, FACP, Dallas
Chair, HealthTexas Provider Network, and former Texas Northern Region Governor

Texans and Texas physicians have another reason to be proud. They were well-represented by 17 physicians during the American College of Physicians’ Leadership Day in Washington, D.C., May 13. Texas had the second largest state delegation.

Texas physicians also had the most contributors to the prestigious top donor category of the ACP Services Political Action Committee (ACP PAC). Dollars contributed to ACP PAC allow more access to members of Congress in Washington and also to fundraising events throughout the year back in the home territories of the politicians.

Texas physicians met and visited with members of Congress during the annual event to present issues important to our patients and fellow physicians. Medicare topped the list, with the plan to cut physician reimbursement by 10.6 percent on June 30 and another 5.0 percent in January 2009. Fortunately, all Texas Senators and House members are opposed to these cuts and are working to reverse the planned downward trend in physicians’ income.

The patient-centered medical home concept also was well-received. This model would encourage and reward ongoing management of chronic diseases such as diabetes, asthma, and congestive heart failure. Our legislators in Washington understand that patients who are carefully managed by primary care physicians have better, less costly outcomes. The ACP has championed this idea, and many in Washington are moving to enhance reimbursements for this type of care.

Other issues discussed by TAIM representatives with those in Washington included recruitment incentives for primary care education and training, debt forgiveness and scholarships, retention incentives, and improved payment systems. All of these methods are designed to make general internal medicine a more attractive field of medicine in the future.

Please take time to thank these colleagues who took time to represent us: Drs. Mark Armstrong, Felicia Austin-Tolliver, Andrew Diehl, Marc Elieson, Bruno Granwehr, Clark Gregg, Robert Jackson, Lynne Kirk, David Montemayor, James Myatt, Blaine Purcell, Umara Raza, Rene Rodriguez, Victor Simms, Amie Sun, David Winter, Marguerite Wuebker and Scott Yates. We also thank Catherine Bailey, TAIM executive director, and Michelle Romero, TAIMS legislative affairs manager, who helped organize the meetings.

Leadership Day is a wonderful and important opportunity for physicians to meet directly with members of Congress. We must voice our concerns, as others are voicing theirs. As we walked the halls of the Senate and House offices, we saw lawyers, bankers, dentists, farmer.

Please consider attending Leadership Day next year. It will give you a greater understanding of our governmental process. A donation to the American College of Physicians PAC also will facilitate the work of those who represent you.



Member Kudos

Richard Anderson, MD, Tyler, received the Gold-Headed Cane Award from the Smith County Medical Society.

Noman Ashraf, MD, Baylor Associate member, competed in the national Doctor’s Dilemma competition at the ACP Internal Medicine 2008 (IM08) in Washington, D.C., as a member of the winning team from the statewide competition hosted by TAIM in November.

Joseph S. Bailes, MD, FACP, Austin, was appointed by House Speaker Tom Craddick to the Cancer Prevention and Research Institute Oversight Committee created by the Texas Legislature and funded by a constitutional amendment to issue $3 billion in bonds to finance its research and prevention activities.

John D. Bonnet, MD, FACP, Temple, was elected president of the Texas Medical Association (TMA) 50-Year Club, whose members are physicians who graduated from medical school at least 50 years ago.

Carlos Cardenas, MD, Edinburg, was re-elected to the TMA Board of Trustees.

Gates Colbert, UT-Houston student, was elected to represent the Southwestern Region of the ACP Council of Student Members, which includes Alabama, Arizona, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas.

Monica A. Dandona, Baylor student, was selected to present a poster in the national poster competition during ACP IM08.

Naval Daver, MD, Baylor Associate member, competed in the national Doctor’s Dilemma competition at the ACP IM08 meeting as a member of the winning team from the statewide competition hosted by TAIM in November.

Herbert L. DuPont, MD, MACP, Houston, was awarded Mastership in the ACP.

Eugene P. Frenkel, MD, MACP, Dallas, was awarded Mastership in the ACP.

Bruno P. Granwehr, MD, Houston, was elected to the ACP Council of Young Physicians, and appointed chair of the Texas Chapter Council of Young Physicians.

Stephen B. Greenberg, MD, MACP, Houston, was awarded Mastership in the ACP.

Kalpalatha Guntupalli, MD, MACP, Houston, was awarded Mastership in the ACP.

Gregory R. Honeycutt, MD, Baylor Associate member, competed in the national Doctor’s Dilemma competition at the ACP IM08 meeting as a member of the winning team from the statewide competition hosted by TAIM in November.

John Mendelsohn, MD, Houston, received the Dorothy P. Landon-American Association for Cancer Research Prize for Translational Cancer Research.

Robert G. Mennel, MD, FACP, Dallas, received the ACP Outstanding Volunteer Clinical Teacher Award at the ACP IM08.

Sahil Mittal, MD, UTMB Associate member, was invited to present a poster at the ACP IM08 in Washington, D.C., as the winner of the statewide competition hosted by TAIM in November.

Tara P. L. Neubrand, UTMB student, was invited to present a poster at the ACP IM08 in Washington, D.C., as the winner of the statewide competition hosted by TAIM in November.

Paul E. Pepe, MD, MACP, Dallas, was awarded Mastership in the ACP.

Spencer Pruitt, UT-Houston, was elected chair of the AMA Medical Student Section Region 3, and received the MSS 2008 Leadership and Excellence Award at its annual meeting in June.

J. James Rohack, MD, FACP, Temple, was elected president-elect of the American Medical Association at its annual meeting in June.

Robert C. Schutt III, TTUHSC student, was selected to present a poster in the national poster competition during the annual ACP meeting.

J. Marc Shabot, MD, FACP, Galveston, received the Ashbel Smith Distinguished Alumnus Award, which recognizes outstanding service to the medical profession and to humanity. This is the highest honor bestowed by The University of Texas Medical Branch School of Medicine Alumni Association.

Josie R. Williams, MD, College Station, was elected the 143rd president of Texas Medical Association and the fourth female president.

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



Congratulations to our Newest Fellows

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

Ana L. Blackmon, MD, FACP, Houston
Daniel H. Darmadi, MD, FACP, Houston
Richard J. Fetchick, MD, FACP, San Antonio
Utpal Ghosh, MBBS, FACP, Humble
William F. Harper, MD, FACP, Temple
L. David Hillis, MD FACP, San Antonio
Marcia A. Kielhofner, MD, FACP, Houston
Suresh Ratnam, MBBS, FACP, McAllen
Vivyenne Roche, MD, FACP, Dallas
Roger W. Rodgers, MD, FACP, Webster

Advancement to Fellowship applications are available: