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.
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.
Scott W. Yates, MD, FACP
Medicine is fun!
Yes, I said it. Fun! Practicing medicine can be, should be and really must be fun. We all know that people who enjoy their work tend to do a better job than those who do not. And they live longer.
“Life is uncertain, eat dessert first.”
— Ernestine Ulmer
We hear this from our 90-year-old patients and relatives. Turns out, they ought to know. The link between stress and Type A behavior was established by studies in the 1960’s. Researchers at Yale described “living a life-style of chronic struggle” as the problem. That makes sense — it may not be how “busy” we are. Rather, it may be the degree to which activity in our lives causes us to “struggle.”
Medicine has become a contact sport and “struggle” can describe much of the internist’s day. We doctors spend a large portion of our time learning and practicing our profession. I don’t know about my banker, but I don’t know many people who spend as much time working as do physicians. If work presents a “struggle” then we’re in big trouble. But, we can decide to have less “struggle” and more fun.
Medical practice can be trying. Most of us did not envision running a small business, deciphering ballooning government regulations, managing employees and trying to negotiate with monopolistic insurance carriers while watching overhead rise and collections decline. So, what to do? At least find some relaxation every day and choose to have some fun.
Most physicians have “crazy busy” days. But, we can all find a couple of minutes somewhere to do something that benefits both us and our patients. Take a deep breath. Spend three minutes with the Wall Street Journal. Run across the street to Starbucks. Or, call a patient who has been ill and check on them.
Have Some Fun
Pick one of the top “rocks in your shoe” and start there. I’ve a colleague who decided that a technician, pharmacist, nurse or physician in another city who had never seen his patient should not decide which medication or imaging study was most appropriate. Of course, this is a common sentiment among physicians. However, this doctor (I’ll call him “Dr. Local”) decided to take action and also have some fun. He found that his office phone system could record calls, so when forced to call for approval for a medication or CT or MRI, he’d begin the conversation with the medical director as follows ...
“Dr. Distant, this is Dr. Local calling about Mrs. Smith’s MRI. Mrs. Smith wants to know about her care, so I’ll be recording our conversation to send to her. And, I’ll add it to her medical record.”
You’d be amazed at the responses he gets. He tells me that the most frequent is something like, “Well, Dr. Local, I’m not sure why you had such trouble with this request, it seems very reasonable so there must have been some mistake. Here’s the approval number ...”
Once, he had a long and heated conversation that ended with, “Well, Dr. Local, you know the patient better than I do, so I guess it’s okay to get the MRI.” Dr. Local responded, “Yes, I do.”
Clark R. Gregg, MD, FACP
Fort Worth, Texas Northern Region
I’m honored to have been elected as your new Governor for the Northern District of the Texas Chapter of ACP. I succeed Mark Armstrong, M.D., in this office, and he has been continuously instructive and helpful to me in this transition.
My principal goals as Governor are to:
- strengthen our Chapter’s real and perceived value to its members, as well as,
- strive to build recruitment of not only medical students toward choosing Internal Medicine as a profession, but also Internal Medicine Residents toward pursuing General Internal Medicine as a career.
We all know the need is great, and the challenges are apparent.
I attended the Board of Governors Meeting followed by the ACP Annual Meeting “Internal Medicine 2009", April 20-25, in Philadelphia. At the Awards Luncheon, Mark Armstrong was recognized for the Texas Chapter’s winning a 2008 Chapter Excellence Award. We were also notified that the Texas Chapter will receive ACP’s Evergreen Award for the project, “Collaborating with other Physician Organizations to Promote Primary Care,” acknowledging our work with the Primary Care Coalition in Texas.
At the Convocation Ceremony we honored the new Fellows and Masters of ACP. Texas had 144 new Fellows, a number of whom marched with Drs. Armstrong, Andrew Diehl and me in the Convocation, and two new Masters, Dr. Rody Cox and Dr. Clyde Yancy, both of Dallas. These are signal achievements for members of ACP and confer some of the highest honors the College can bestow on physicians for their clinical, ethical, leadership, teaching, public policy advocacy, volunteerism, and research prominence in the eyes of their colleagues.
None will be surprised to hear that the scientific meetings met or exceeded their consistently high standard of reviews of current knowledge and recent practical advances in clinical care. A broad array of topics which included humanities sessions on medical history and literature satisfied a range of interests. Please plan to join us next year in Toronto at the national ACP meeting.
Mr. Robert Doherty, Senior Vice President for Governmental Affairs and Public Policy for ACP, spoke to the Board of Governors on the ACP and President Obama’s First 100 Days in Office. Extensive polling shows that over two-thirds of voters today want major reform or complete overhaul of our health care system to address the key concerns of rising costs, lack of access to care, and prevention of medical errors. They strongly favor incentivizing doctors for high quality and preventive care. This prevailing sentiment encourages the reform movement we are witnessing now in Washington, D.C. ACP is a key advisor to our legislators on the health policy agenda and at the recent White House Health Care Summit. Our striving for dynamic workforce planning including payment reform and medical school debt reform, as well as support for the Patient-Centered Medical Home, is recognized and respected as sound counsel.
We live in interesting times. Your ACP has its best opportunity ever to influence reform and accomplish our principal priorities
On Being a Doctor
Love’s Brighter Face: Lessons from Last Winter
Bielose Konwe, TXACP Resident Member, RAHC/UTHSCSA, Harlingen
It was the last day of spring. I was home alone trying to unwind after a grueling day at work. I was in one of those states of profound and unyielding inertia that we occasionally find ourselves, especially after a demanding and emotionally draining experience. I lay there on my bed trying to overcome this pervading sense of inertia. The more I tried, the more it seemed like I was wading through a pool of molasses.
My mind continued to mutiny against me and deny me that serenity that I so much desired at a time like this. Several imageries from my month-long ICU rotation, last winter, began to intrude into my already chaotic state of mind. Some of the imagery was sharp and crisp, yet some have been distorted by the steady hands of time.
It was only three months since I completed my ICU rotation, but it seemed like many years had come and gone. I could still, with some effort, attach names to some of the faces. However, there was one face that came to me with untainted clarity. I could still see his face as he fought so hard to hold back the tears that so threatened to drown him.
Timothy Aldair was in his late fifties; he was a man of slight build, a man of few words and mild manners with a slow, deliberate southern accent. Jane, his wife of thirty years, was my patient. She had been in the ICU for four weeks with no clear diagnosis as to what her illness might be. She had a lung process which had progressed rather rapidly, and after two lung biopsies her diagnosis continued to elude and befuddle the medical staff who worked tirelessly to proffer a remedy for her malady.
Jane Aldair was forty eight years old and had been in good health until this debilitating illness. She had a serene and optimistic disposition despite the graveness of her illness. I was always taken by her efforts at trying to keep up communication with Tim despite the encumbrance imposed upon her by the tube down her windpipe and the ventilator, which though were life sustaining in a sense, were a nuisance in every other sense. She never appeared to me to be drowning in self pity, neither did she betray any show of anger.
Of the two, she seemed the braver. Tim would take a look at his wife in her almost lifeless state and shake his head in despair, tears coursing down his somber face as he sobbed inaudibly by her bedside. She would muster all the strength left in her frail body to give Tim a reassuring squeeze.
Tim was suffering as much as Jane, by just having to watch helplessly as his wife withered slowly and steadily to her demise. He wished he could do something to help her, he wished the doctors could find a cure for her. He was willing to continue to endure the suffering if only the doctors will assure him that somehow, somewhere there was a cure.
We had no answers for Tim. His wife’s prognosis was grim. She had remained ventilator dependent and had been on empirical steroid therapy for two weeks with no signs of improvement.
For me, it was emotionally exhausting to watch this young woman continue the battle against her disease with no clear answers to her questions. Up till that moment, nothing I had encountered in my entire career had such an impact on me.
Jane finally decided it was time to let go by the fifth week of her ICU stay. She had put up a brave fight, but on this fateful day she had come to terms with the futility of the collective efforts of the medical staff on one hand and Tim’s desire to continue the fight on the other. She had decided that she and Tim were both suffering in ways that she could no longer endure.
On that winter morning, just as I was finishing my rounds and getting ready to leave her bedside, she tugged gently at my lab coat, and signaled that she wanted something to write on, since the tube in her windpipe was hindering her from speaking. I watched with some trepidation as she scribbled on the piece of paper, in almost child-like scrawl: It’s time to let go!
I nodded my head to her wishes, patted her warmly on the shoulder and settled my gaze on Tim who was by her bedside. He broke down in loud audible and heart wrenching sobs as he assimilated the irreversibility of their decision. “Yes, we’ve decided to let go,” he struggled to say in between sobs. “I can’t continue to watch her die painfully and slowly before my eyes. I love her too much to put her through this.”
“I totally understand and respect your wishes.” I struggled to keep my voice from succumbing to the emotional dictates of the moment.
After all life supporting devices had been discontinued, I thought I could make out a total look of peace and equanimity on her face. She summoned up all her strength and courage and whispered, “I love you the most Tim. I’ll always love you.”
Tim held onto her hands; “I’m a coward Jane. I can’t stand you suffering this way,” he sobbed. “God be with you.” He kissed her on the forehead and clung on to her as she continued to drift in and out of consciousness.
And in those final moments, as Jane approached the threshold, I could discern the faintest trace of a smile around the corners of her mouth. Her smile, austere as it was ephemeral, held a brighter face of love. It was love in its purest form, strong enough to transcend the bounds of pain and hopelessness, giving hope to the one she was about to leave behind.
Program Meets Summer Match Goals
With sponsorships from UTHSCSA, TAMUHSC and TTUHSC in addition to state funding, the GIMSPP was able to meet and exceed the goal set by the Medical Students Committee and match 125 students for summer preceptorships. Two hundred twelve applications were received, and sadly, fifteen students who maintained their applications had to be turned away because of lack of funds.
Cooperation among the three primary care preceptorship programs remained strong as staff worked to meet placement goals of their programs and to ensure each student interested in a preceptorship was matched.
Some students were not able to secure rotations in their first choice of location. The need for preceptors is especially great in Houston and San Antonio.
If your practice is at least 50 percent general internal medicine and you enjoy teaching eager young people, call GIMSPP toll free at (866) 244-6777 to apply for 2010.
UTHSCSA Gives $2,000 for GIMSPP
L. David Hillis, MD, FACP, Chair of University of Texas Health Science Center at San Antonio’s Department of Internal Medicine, has again provided the GIMSPP with a sponsorship of $2,000. The additional funding allowed two more students from his school to participate in four-week rotations this summer.
Interest among UTHSCSA students remained high, with 39 students applying for preceptorships.
Eugene W. Stokes, MD, FACP and Karen Szauter, MD, FACP, Co-Chairs of the Medical Students Committee, Govs. Diehl and Gregg and the GIMSPP staff thank Dr. Hillis and University of Texas Health Science Center at San Antonio for the sponsorship.
Primary Care Preceptorship Program Retains State Funding
The Preceptorship Program, that encompasses the General Internal Medicine Statewide Preceptorship Program, the Texas Statewide Family Medicine Preceptorship Program and the Texas Statewide Pediatric Preceptorship Program, was able to maintain its current level of funding from the 81st Legislative Session. With the decreased state revenue and increased demand in expenses, it was a triumph to remain in the state budget without suffering budget cuts.
Success could not have occurred without the time and energy expended on behalf of the program by many Texas Chapter of the ACP members. Drs. Robert E. Jackson, FACP, Houston, Rene M. Rodriguez, FACP, Corpus Christi, and Rajat Maheshwari traveled to meet with Rep. Warren Chisum and Sen. Carlos Uresti in September. Dr. Scott W. Yates, FACP, Plano, President of the Texas Chapter, provided testimony before the House Article III – Education Subcommittee regarding the effectiveness of the preceptorship program. Dr. Felicia L. Austin-Tolliver, FACP, Katy, President of Texas Chapter Services, attended TMA’s First Tuesday and talked with lawmakers on behalf of the program. Also advocating on behalf of the GIMSPP and other programs on First Tuesdays were Drs. Eugene W. Stokes, FACP, San Angelo, Co-chair of the Medical Students Committee, Sue S. Bornstein, FACP, Dallas, consultant for the Texas Medical Home Initiative, and preceptors Drs. Keith Robinson, Abilene, Peggy Russell, Austin, Robert D. Thompson, FACP, Dallas, E. Linda Villarreal, Edinburg, John Flores, Little Elm, and Danette Elliott-Mullens, New Braunfels.
Countless members responded to the legislative alerts through Voter Voice and contacted their senators and representatives to encourage future funding. A big thank you to everyone who took the time to ensure that statewide preceptorships remain an opportunity for Texas medical students to experience clinical primary care in a community-based environment early in their training.
Regional Competitions Associate Winners
All across the state of Texas, internal medicine residents are hard at work learning, practicing, and teaching medicine. The Texas Chapter of the ACP 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 in the successful tradition of those of the past. Competition was stiff, participation was high and all of the work was exceptional quality. An enormous amount of time and energy went into the planning of each event. Recognition for the extensive meeting preparation goes to Drs. Michael J. Morris for the Southwest region, Niraj Mehta for the Southeast region, Kenneth Nugent for the Northwest region, W. Mark Armstrong and Clark Gregg for the Northeast region, and German Hernandez for the Far Northwest region. Thank you all for your diligence and hard work.
The regional programs involved a mix of Doctor’s Dilemma, podium presentations, and research and clinical poster competitions. Congratulations go to the following regional competition winners!
Oral Vignette Presenters:
First Place: Stephen Harder, MD (BCM),
Second Place: Lenny Chow, MD (UTMB),
First Place: Shivang Mehta, MD (UTHSC-Houston),
Hypereosinophilia in a Hispanic Immigrant: Not Always a Parasitic Infection
Second Place: Miguel Ordonez, MD (Methodist),
Chronic Diarrhea as a Presenting Feature of Clostridium difficile colitis
Third Place: Reeti Joshi, MD (UTHSC-Houston),
Is it Really CHF?
First Place: Christian Assad-Kottner, MD (UTMB),
Evaluation of Humoral Immunity in Heart Failure: Plasmapheresis Potential Therapeutic Strategy
Second Place: Praveen Guturu, MD (UTMB),
A Low Risk Index for the Estimate of Fibrosis in Non Alcoholic Fatty Liver Disease (NAFLD): Comparison with the Mayo score & the AST Platelet Radio Index (APRI)
Third Place: Preethi Nambi, MD (BCM),
Volumetric Analysis by Non Contrast Computed Tomography is Comparable to Contrast Enhanced Computed Tomography in the Follow-Up of Patients with
Endovascular Abdominal Aortic Aneurysm Repair
UTHSC-Houston: Rajeev Fernando, MD; Reeti Joshi, MD; Evren Kaynak, MD; and Amit Verma, MD
Oral Vignette Presenters:
First place: Bryant McNeil, Capt. USAF, MC (SAUSHEC),
Stress Fractures and Impotence Heralding a Case of Men 1 with Rare Associated Spinal Tumor
Second place: Divya Ratan Verma, MD (UTMB-Austin),
Third place: Anisha Arora, MD (TAMHSC-S&W),
Anabolic Steroids: A Paradoxical Breakdown
First place: Juan Echavarria, MD (UTHSCSA),
Dyserytrhopoiessis and Severe Malarial Anemia in Aotus Monkeys
Second place: Bermily Maldonado, MD (UTHSCSA),
Omniscan Induces Cell Proliferation in Cultured Human Foreskin Fibroblasts
Third place: Nathan Smith, MD (SAUSHEC),
Initial Use of Fluticasone/Salmeterol Adherence to National Guidelines, Persistance and Clinical Outcomes
Oral Vignette Presenters:
First place: Jenny Duewall, MD (BUMC),
“Beer” Belly: Uroperitoneum and Pseudo-Renal Failure
Second place: Rahel Alemu, MD (Texas Health Presybertian Hospital Dallas),
An Unusual Acquired Coagulapthy
Third place: Deepa Moparty, MD (Methodist-Dallas),
Dry Eye Disease as a Cause of the Deep Freeze
First Place: Poonam S. Sharma, MD (BUMC),
A Polyuric Pregnancy
Yanjun Ma, MD (BUMC),
Iatrogenic Hypermagnesemia: A System Failure and Improvement
Qurat-ul-ain Rashid, MD (Methodist-Dallas),
“Budding” Clot and the JAK2 Mutation
Oral Vignette Presenters:
First Place: Saba Rahdi, MD (TTUHSC-Lubbock),
An Uncommon Presentation of a Rare Condition
Second Place: Aabu Thomas, MD (TTUHSC-Amarillo),
Skipped lesions a diagnostic challenge
Third Place: Ming Chen, MD (TTUHSC-Amarillo),
A Feverish Pastor
Oral Vignette Presenters:
First place: Tarek Alhamad, MD (TTUHSC-El Paso),
The Silver Bean
Second place: Jennifer Pena, MD (WBAMC),
Puzzling Pee Pee
Third place: Ahmed Elsayed, MD (TTUHSC-El Paso),
Passenger X in the Subway-Lymph
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 allow them to travel to San Antonio, November 14-15, 2009, to represent their region at the Annual Meeting. Visit the Texas chapter’s site for a complete list of winners. We hope to see you in San Antonio this November!
Students, Associates Call for Abstracts
Residents and medical students are invited to submit new entries that have never been submitted in the past for several competitions during the Texas Chapter of the ACP Annual Meeting Nov. 14-15 in San Antonio.
Associate and medical student poster competitions: Residents are invited to submit abstracts of clinical vignettes and clinical research (not basic science research) projects that have clinical relevance to internal medicine. Medical students are invited to submit clinical case reports that have clinical relevance to internal medicine. These abstracts will be submitted to the 2009 Texas Chapter of the ACP Associates and Medical Students Poster Competitions via the abstract submission form on the Texas Chapter’s web site. Submission deadline is Friday, August 7, 2009. Abstracts will be reviewed and submitters will be notified of the status of their abstract via an announcement on the Texas Chapter’s website by Friday, October 2, 2009. Those who are accepted to the competition will be invited to present their abstract in poster format at the 2009 Annual Meeting, November 14-15, 2009 at the Hyatt Hill Country Resort in San Antonio, TX.
A panel of physicians will judge the posters and first and second-place prizes will be awarded 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, “Caring for the Sick: The Human Side of Medicine.” Submissions are limited to 1,000 words or less and must be submitted via the submission form on the Texas Chapter of the ACP web site. Contestants must reside in Texas and be members of the ACP.
A panel of physicians will review the submissions, and the winner will be announced no later than October 2, 2009. The winning author will be invited to present his or her work in a 10-minute oral reading during the general session at the Annual Meeting. The author will win an all expense paid trip to attend the Texas Chapter of the ACP Annual Meeting.
Texas ACP Services
Focusing on Improving Primary Care
From the Texas Capitol to the United States Capitol, Texas ACP Services has been very active working to improve primary care. On the state level, the Texas chapter worked diligently to increase funding for the Texas Statewide Primary Care Preceptorship Program, which provides funding for our GIMSPP, so that more medical students would be encouraged to pursue primary care careers. Nationally, the Texas ACP participated in the ACP Leadership Day on Capitol Hill and sent a 13-member delegation to Washington, DC on May 20, 2009 and lobbied our Texas Congressional delegation to promote the ACP’s top priorities on health care reform, concentrating on strengthening primary care. Texas ACP Services knows the need to confront the challenges facing primary care could not be more critical.
The 81st Texas Legislature convened in Austin on January 13, 2009 amid grim budget news from State Comptroller Susan Combs that the national recession had indeed come to Texas.The state would have about $9.1 million less to spend in the current biennium than in the last. Making things even more bleak, the Legislative Budget Board filed its proposed budget for 2010-2011, which revealed that the state would need $3.7 billion more than Comb’s projections just to maintain state services at the current level. Even with an infusion of approximately $16 billion of federal stimulus dollars into the Texas state budget, increasing funding for the Primary Care Preceptorship Program would be an uphill climb.
Texas ACP leaders contacted their state representatives and senators by phone, email and personal visits to educate them about GIMSPP and the need to restore funding to $2 million for the Preceptorship Program. The Texas ACP Services also participated as a group during the first TMA First Tuesday physician lobby event on February 3, 2009 to ask their legislators to support increased funding in Senate Bill 1, the state budget. Scott Yates, MD, FACP, MBA, President of Texas ACP, testified in March before the House Appropriations workgroup deliberating GIMSPP funding.
The Preceptorship Program received significant support from leaders in the Texas House of Representatives such as Rep. Richard Raymond of Laredo, Rep. Mike Villarreal of San Antonio, and Rep. Susan King of Abilene. It was the House that decided to bring Preceptorship funding up to $2 million for the 2010-2011 biennium, and those leaders consistently voiced their support throughout the budget process. The story was different in the Texas Senate, which did not recommended additional funding. Eventually, the Primary Care Preceptorship Program received $904,289 for the next biennium.
Nationally, Texas ACP Services will work with our Texas Congressional representatives throughout the remainder of 2009 to promote ACP’s top priorities on health care reform.
The key issues are:
- Ensure that all Americans will have access to affordable coverage;
- Pilot test new Medicare payment models that realign incentives to support effective, efficient, patient-centered, coordinated care;
- Improve Medicare fee-for-service system payments to make primary care competitive with other specialties; and
- Establish a national workforce policy to ensure sufficient numbers of primary care and other physicians.
The Texas chapter will do its part to encourage its Congressional leaders to support comprehensive federal legislation to tackle the primary care crisis.
Please contact the chapter if you would like more detailed information on the 81st Texas Legislature or on Texas ACP Services participation on national health care reform.
Anu Tandon, MD, Baylor UHC Associate member, competed in the national Doctor’s Dilemma competition at the ACP Internal Medicine 2009 (IM09) in Philadelphia, PA., as a member of the winning team from the statewide competition hosted by TXACP in November.
Cheves McCord Smythe, MD, Houston, was honored with a President’s scholar award for excellence in teaching and research.
Clyde W. Yancy, Jr., MD, MACP, Houston, was awarded Mastership in the ACP.
Dan Richey, MD, Baylor UHC Associate member, competed in the national Doctor’s Dilemma competition at the ACP Internal Medicine 2009 (IM09) in Philadelphia, PA., as a member of the winning team from the statewide competition hosted by TXACP in November.
Evan Hardegree, Texas A&M Health Science Center College of Medicine student, was invited to present a poster at the ACP IM09 in Philadelphia, PA, as the winner of the statewide clinical vignette competition hosted by TXACP in November. At the national level, Evan was chosen as one of the top 5 winners out of all the posters submitted.
Frank Arnett, Jr., MD, FACP, Houston, was honored with a President’s scholar award for excellence in teaching and research.
Herbert DuPont, MD, MACP, Houston, was honored with a President’s scholar award for excellence in teaching and research.
Jose D. Burgos, MD, Texas Tech – El Paso Associate member, was invited to present a poster at the ACP IM09 in Philadelphia, PA, as the winner of the statewide associates vignette competition hosted by TXACP in November.
Ralph A. DeFronzo, MD, FACP, San Antonio, Professor and Chief of the Division of Diabetes, received the American Diabetes Association’s most prestigious honor: The Banting Medal for Scientific Achievement award.
Robert Kimbrough, MD, FACP, Lubbock, was named Professor in Outstanding Medical Education at the Texas Tech University Health Sciences Center, in recognition of his dedicated service to the School of Medicine as one of its exceptional teachers.
Rody P. Cox, MD, MACP, Houston, was awarded Mastership in the ACP.
Thomas J. Purgason, MD, Arlington, was honored as the 2008 Arlington Physician of the Year.
Troy Neal, MD, Baylor UHC Associate member, competed in the national Doctor’s Dilemma competition at the ACP Internal Medicine 2009 (IM09) in Philadelphia, PA., as a member of the winning team from the statewide competition hosted by TXACP in November.
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 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.
Phillip M Aronoff, MD, FACP, Dallas
Eugene V Boisaubin, MD, FACP, Houston
Ako D Bradford, MD, FACP, Amarillo
Katherine B Brown, MD, FACP, Austin
Christian T Cable, MD, FACP, Temple
Jadranko Corak, MD, FACP, Austin
Ksenija Corak, MD, FACP, Austin
Andrea Duchini, MD, FACP, Houston
Cathy Eng, MD, FACP, Houston
Barbara M Fishman, MD, FACP, San Antonio
Chris R Garrett, MD, FACP, Houston
Stephen Hines, MD, FACP, Dallas
Kevin B Horton, MD, FACP, San Antonio
Alan G Kaye, MD, FACP, Dallas
Anita Khetan, MD, FACP, Dallas
Rainer A Khetan, MD, FACP, Dallas
Roger S Khetan, MD, FACP, Dallas
Wen S Lai, MD, FACP, Irving
Bobby W Marek, MD, FACP, Brenham
Tai N Nguyen, MD, FACP, Houston
Marty M Perez, MD, FACP, Corpus Christi
Carmen Perez-Masuelli, MD, FACP, The Woodlands
Anjana Rastogi, MBBS, FACP, Odessa
Edgardo Rivera, MD, FACP, Houston
Ian L Sachs, MD, FACP, Houston
Zeenat Safdar, MD, FACP, Houston
Ibrahim Shalaby, MBBCh, FACP, Lubbock
Stephen J Sibbitt, MD, FACP, Temple
Robert Kent Smitherman, MD, FACP, Fort Worth
Robert F Todd III, MD, FACP, Houston
Advancement to Fellowship applications are available: