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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.
Jose A. Perez, Jr., MD, FACP
It is my pleasure to communicate with you in this first 2013 edition of The Texas Internist. Texas ACP has honored me as your new President. This past year has been an exciting one. There was never a dull moment in a year where the Sustainable Growth Rate formula (SGR) has not been solved, we have had a hotly-contested presidential election and where, at the time of this writing, the “fiscal cliff” threatens to raise taxes and implement mandatory spending cuts. Many might ask what we have to look forward to. I would argue that we have a lot to look forward to. As physicians, we know that our patients require our service and they are still there. Our patients are the reason we are here. Everything else around them and us, however, is changing. Adaptability and flexibility will the prized attributes in the coming few years and beyond.
Texas ACP has participated to a great extent in preparing the next generation to take care of our patients (and maybe us in a few years). This past year, we were able to continue placing students in the General Internal Medicine Statewide Preceptorship Program (GIMSPP) despite the loss of state funding that had been present for many years. GIMSPP is designed to encourage medical students to pursue a career in Internal Medicine and as part of the program, pairs students early on in medical school with practitioner preceptors. Thanks to many Texas ACP members who have served as preceptors, we have been able to continue placing students in Internists’ offices, exposing them first hand to the practice of medicine. On a side note, as a residency director and General Internist myself, It gives me great joy to see the number of residency applicants who have gone through this program, a testament to its effectiveness.
We have an opportunity to advocate for our patients and ourselves given the beginning of the 83rd Legislative Session in January 2013. At a recent Texas Medical Association Advocacy Retreat, I had the privilege of representing our organization as we try to engage our legislators in restoring funding for the GIMSPP program, restoring the Physician Loan repayment program and expanding Medicaid under the Affordable Care Act. This latter initiative is not only supported by our organization, but was also by the overwhelming majority of the attendees at this meeting, who represented many specialty organizations.
Your participation in Texas ACP can take many forms. There are great opportunities to be active in advocating for our initiatives given the upcoming legislative session. Your participation in yearly meetings, regional Associate’s Day events, attendance at Internal Medicine 2013 in San Francisco, service as a preceptor in the GIMSPP program, or service as a committee or board member are some of the ways you can participate. Not only will the organization benefit from your participation, but hopefully you will come to realize how important the organization is to the practice and policy-making in Internal Medicine. I hope to see during the year at one of our many events and welcome any questions regarding participation or ACP activities in the coming year. Best Wishes for 2013.
Robert E. Jackson, MD, FACP
Governor, TX Southern Region
ALL IS FLUX, NOTHING STAYS STILL
This past year has brought substantial change to the American Health Care System. The Affordable Care Act was deemed constitutional by the Supreme Court. The economy is slowly recovering. President Obama was re-elected. Congress averted the “fiscal cliff” and raised income taxes for the first time in decades. But ideological differences remain enormous .The country is polarized motivating the pundits to declare impending doom as the icing on the cake of gloom. The Republic is threatened!
But is it really? If you want a ray of hope I suggest you see LINCOLN, Spielberg’s masterpiece on the days surrounding passage of the Thirteenth Amendment to the Constitution abolishing slavery and involuntary servitude. It reminded me how much the two parties, Democrats and Republicans, hated each other as entities and despised each other as individuals. Not much has changed! Except that the country is so much bigger, so much more diverse and so much more “connected’.
So where does this position Internal Medicine? In my opinion we are on the brink of re-establishing physicians as the true leaders in the much needed transformation of our “industry”. Internal Medicine and Primary Care are the vanguard in re-designing our health care system based on quality, outcomes and patient satisfaction. The American College of Physicians is at the forefront of this movement and is well respected in Washington D.C. as the non-partisan advocate for quality patient care. I encourage you to visit the ACP website and especially the re-designed Texas ACP website to stay in touch with current events, scientific meetings and advocacy matters.
Please mark your calendars for important dates: April 11-13, 2013, the ACP Annual Scientific Meeting to be held in San Francisco California. Leadership Day is an important venue to meet your congressman and is usually in May (date yet to be set). We have grants for participants to defray travel costs and I encourage you to join the well-respected Texas delegation.
The 2013 TXACP Annual Scientific Meeting will be held in San Antonio at the Westin La Cantera. The dates are November 16-17, 2013 and the program will be outstanding and different this year. Stay tuned! Finally I want to extend congratulations to Dr. Clark Gregg, M.D. as he finishes his term as Governor of the Texas Northern Region. Clark has been a true friend, guide and advocate for Internal Medicine. His dedication to our veterans as Chief of Staff of the Dallas VA Medical Center is to be commended and his five year tenure as our Governor saluted. Best wishes, Clark and congratulations on a job well done!
Robert E. Jackson
Officers and board members for Texas Chapter of the ACP and Texas Chapter of the ACP Services, the Texas Chapter’s advocacy arm, were elected during the annual awards and business meeting luncheon November 3, 2012, in Fort Worth
Jose A. Perez, Jr. MD, FACP
Roger Khetan, MD, FACP, FHM
Maureen Francis, MD, FACP
John D. "Jack" Myers, MD, FACP
LeChauncy Woodard, MD
Robert Goldsteen, DO, FACP
New Regional Directors:
Marguerite Wuebker, MD, FACP, Addison- NE Director
Curtis Mirkes, DO, FACP, Temple - NW Director
Lara Colton, MD, FACP, Houston - SE Director
Lianne Marks, MD, PhD, FACP, Georgetown- SW Director
Christian Maluf, MD, McAllen - SW Director
Three distinguished members were honored with the Texas Chapter highest awards during the November 2012 Annual Chapter Scientific Meeting in Fort Worth.
The Laureate Award honors those Fellows and Masters of the College who have demonstrated a life of commitment to excellence in medical care, education, or research and in service to their community, the Chapter, and the ACP. Drs. Michael Emmett, MD, MACP, Dallas, Mark Feldman, MD, MACP, Dallas, and Herbert L. Fred, MD, MACP, Houston, were the 2012 Laureate awardees.
Drs. Clark Gregg, Mark Feldman, Herbert Fred, Michael Emmett and Robert Jackson after the awards ceremony during the annual meeting business luncheon.
The Volunteerism and Community Service Award honors Texas Chapter members who have demonstrated an abiding commitment to excellence in medical care, education, research, and dedicated service to their community, the Chapter, and the ACP. Darla Lowe, MD, Belton was honored with the Chapter Volunteerism and Community Service Award.
The Texas Chapter of the ACP Services Chumley/Synder Advocate of the Year 2012 award was presented to Eugene W. Stokes, MD, FACP, San Angelo for his outstanding leadership in legislative advocacy and grassroots activism on behalf of medicine and the patients of Texas.
Dr. Gene stokes giving his acceptance speech at the annual business meeting luncheon.
Victor Simms, MD, MPH, FACP, Pearland, TXACP’s first recipient of the Young Physician Leader of the Year Award. He is an active ACP member that demonstrates leadership in community services that has been in practice for at least ten years. The Young Physician Leader of the Year Award is the most prestigious recognition of achievement for young physicians.
Drs. Woodard, Simms, and Felicia Austin Jordan congratulating Dr. Victor Simms on his award.
The General Internal Medicine Statewide Preceptorship Program Decade of Service Award honors highly active and dedicated preceptors who have taught medical students in their practices for the past ten years.
It is with genuine pleasure that this year, the Texas Chapter presents the GIMSPP Decade of Service Award to GIMSPP Decade of Service Award to:
Ramon Aggarwal, MD, Dallas
KP Ganeshappa, MD, FACP, San Antonio
Michelle Ho, MD, FACP, Dallas
Edith Jones, MD, MACP, Houston
Ellen Manzullo, MD, FACP, Houston
Brad Snodgrass, MD, MBA, Lubbock
Joel Walker, MD, FACP, Bedford
Drs. Ellen Manzullo and Michelle Ho after the awards ceremony with Medical Students Committee Co-Chair, Dr. Gene Stokes.
The Awards committee welcomes and accepts nominations from the membership year round. Nominations from the chapter should include a detailed letter of recommendations and curriculum vitae (CV). Additional letters of support are welcome and may strengthen the nomination.
Send nominations, CVs, and letters of support to: Texas Chapter of the American College of Physicians, Awards and Recognitions Committee, 401 W. 15th St., Austin, Texas 78701 or email.
This past November the second annual Texas Council of Young Physicians Annual Breakfast CME event was held. Co-Chairs Pete Yunyongying, MD, FACP and Amy LaViolette, MD, MPH, FACP led the session on “Communication within the Healthcare Team”. We explored the most common characteristics of Emotional Intelligence, specifically exploring which traits were likely common among internists, and how these traits affect our interactions with others in the healthcare team, including our patients. As young physicians learning how to better interact with patients and staff is an important aspect of our professional development. Our attendance was not as high as we would’ve liked, but we had a lively discussion…especially for 7:30AM. We’d love to continue the picking topics that can help young physicians grow in their professional development, so if anyone has any ideas for next year’s topics (even though it’s a year off) please contact Becca Lawson with the TXACP chapter office at Rebecca.Lawson@texmed.org or by phone at (512) 370-1463.
The Associates clinical vignette competition featured five residents who were selected in their regional competitions to compete at the statewide meeting. Outstanding presentations were made by Fahmi Farah, MD, Texas A&M Health Science Center at Scott & White; Elan Gada, MD, University of Texas Southwestern Medical Center, Dallas; Christopher W. Larson, DO, William Beaumont Army Medical Center, El Paso; Arati Rani Chand, MD, Texas Tech University Health Sciences Center Amarillo; and Kaushal Pate, MD, Baylor College of Medicine, Houston.
Elan Gada won first place in the competition with his vignette, “Bowel-Associated Dermatitis-Arthritis Syndrome in a Nonsurgical Patient”. Elan will automatically advance to San Francisco to compete at the national level during the ACP Annual Session in April.
In a dramatic conclusion to the annual Doctor’s Dilemma, the team from UTHSCSA Internal Medicine, San Antonio emerged as champions. Congratulations to UTHSCSA Internal Medicine team members Sahand Rahnama-Moghadam, MD, Raymond Fleisher, MD, and Patrick Griffin, MD. The team will represent the Texas Chapter in the Doctor’s Dilemma competition at the ACP Annual Session in San Francisco this April.
The Doctor’s Dilemma winning team from UTHSCSA, pictured with their Program Director and host of the event, Dr. George Crawford.
Congratulations to the University of Texas Medical School at Texas, Houston team that took second place. This competition would not have been possible without the help of Drs. Suma Pokala, FACP, Temple and George Crawford, MD, FACP, San Antonio, for organizing this event. A special thank you to Drs. Julie Nguyen, MD, FACP and Austin Metting, MD for their assistance with the competition.
Of the 86 abstracts that were submitted for the competition, 13 were chosen to participate in the Associates’ Poster Competition. The submissions came from 9 residency programs.
Thanks to the work of dedicated TXACP volunteers who judges the posters. The competition would not be possible without your help. The following winners were announced during Saturday evening’s reception:
Clinical Poster Winners:
1st place: Scott McCord, from Texas A&M Health Science Center College of Medicine
2nd place: Akanksha Sharma, from UT Southwestern Medical Center
Medical Student poster presenters with one of the Medical Students Committee Co-Chairs, Dr. Gene Stokes.
Clinical Poster Winners:
1st place: Anthony Sidari, MD from SAUSHEC Internal Medicine
2nd place: Harman Kular, MD from Baylor College of Medicine
Clinical Research Poster Winners:
1st place: Karyne Vinales, MD from University of Texas Health Science Center at San Antonio
2nd place: Ragesh Panikkath, MD from Texas Tech University Health Sciences Center
Associate Poster winners with the Associates Committee Chair, Dr. Suma Pokala and Texas Southern Governor, Dr. Clark Gregg.
The annual meeting would not be possible without the help of the companies that continue to support our organization. The Texas Chapter of the ACP would like to thank the Harris Methodist Health Foundation for their generous educational grant at this year’s meeting. The following companies provided financial support as well for the meeting. Our chapter is extremely grateful for all of their assistance and for every company that contributed to this year’s meetings success!
2012 Platinum Level Support
Harris Methodist Health Foundation
Gold Level Support
Silver Level Support
Scott & White
Bronze Level Support
American College of Physicians
Apple Medical Billing
Business Advisors MD
Centers for Medicare & Medicaid Services
Covenant Medical Group
Department of Social and Health Services (DSHS)
FLB Capital Management
Hospital Corporation of American (HCA)
LHP Hospital Group
Office of Injured Employee Counsel
Physician Oncology Education Program
Texas Health Resources
Texas Medicaid Wellness Program
Texas Medical Liability Trust
TX Dept State Health Services - HIV Prevention & Care Branch
2013 Leadership Day
415 New Jersey Avenue, NW
Washington, DC 20001
The 21st annual Leadership Day on Capitol Hill will be held on May 21-22, 2013 at the Liaison Hotel in Washington, D.C.
Leadership Day enables the College to increase its presence on Capitol Hill and bring our issues of concern to U.S. lawmakers.
This two-day event provides ACP members with advocacy and/or media training, an update on the College's priority legislative issues; briefings from Members of Congress, Administration officials, and key Capitol Hill staffers; and an opportunity to meet with your state's elected officials. A special briefing for associate and medical students is also provided.
ACP members interested in participating in Leadership Day 2013 should contact their chapter Governor to let him/her know of your interest and to be included in the chapter delegation congressional meetings.
For more information, please contact Shuan Tomlinson at firstname.lastname@example.org or 800-338-2746 ext. 4547.
Alejandro Moreno, MD, MPH, JD, FACP
TXACP Services Immediate Past President
Dr. Alejandro Moreno, a TXACP Member and an Internist with the University of Texas Southwestern, testified to the House of Representatives Appropriations Subcommittee on Tuesday, February 12, 2013. Dr. Moreno testified in regards to Article III, public and higher education funding, asking the Subcommittee to restore the funding for the General Internal Medicine Statewide Preceptorship Program (GIMSPP). Here is the testimony:
Good morning Mr. Chairman and Committee Members,
My name is Alejandro Moreno. I am an internal medicine physician and a faculty member of the University of Texas Southwestern in Austin. I thank you for the privilege of testifying before you today.
I am here on behalf of the Texas Chapter of the American College of Physicians, which has over 6,700 physician and student members, to discuss restoring the funding of the General Internal Medicine Statewide Preceptorship Program and the Primary Care Residency Training Programs. I am sure you are asking why these programs of the Texas Higher Education Coordinating Board deserve their funding to be restored when there are other important priorities and calls for cost-containment.
According to the State Demographer, the population of Texas is growing fast at a rate of 20% while the rest of the country is doing so at a rate of 9%. It is predicted that Texas would have 45 million people by 2040.1 Although Texas has made some gains in the number of physicians, the State continues to lag behind this critical need.2 Texas has only 68 primary care physicians for every 100,000 people; the national average is 81 per 100,000 people.3 The State has more than 115 counties designated primary care shortage areas of which 19 have only two physicians, 17 have only one physician, and 25 have no physician at all. Seventy-six counties experienced reductions in the number of primary care physicians between 2002 and 2011.4 We need an additional 4,500 primary care physicians by 2015 to care just for the state’s underserved population (roughly 5 million people). To make matters worse, a survey by Merritt Hawkins and Associates found that over half of the physicians ages 50 to 65 are considering retiring or seeking non-clinical jobs.5
The foundation of an efficient and effective healthcare system is the three primary care specialties: internal medicine, family medicine, and pediatrics. Study after study has shown that access to primary care physicians produce better health outcomes for less cost. Small increments, of just 1%, in the primary care physician workforce of a mid-size city have significant impact, reducing 500 preventable hospital admissions, 3,000 unnecessary emergency room visits, and 500 avoidable surgeries. A truly efficient and effective health care system needs to have a workforce balance of 50% primary care specialists and 50% subspecialist.6 In Texas, however, there are far more subspecialists than primary care physicians (24,400 vs. 17,900, respectively).
The benefits of a strong primary care workforce extend well beyond health outcomes. One study has shown that each primary care specialist working in a rural area generates approximately $1.5 million in revenue, $0.9 million in payroll and creates 23 jobs.7
In addition to the State’s population growth, the shortage of primary care physician in Texas has two other aspects. First, only a small fraction of our medical graduates chooses a primary care specialty. According to the National Residency Matching Program, 18% of medical graduates match in an internal medicine program. An AMA survey shows that only 2% of those medical students intend to actually stay in primary care. Second, Texas invests on average $168,000 educating each medical student. However, many medical school graduates are forced to leave the State because there are not enough residency training slots. Once a medical graduate leaves Texas, he or she is unlikely to return back as 60% will settle within 100 miles of the training program.8
The General Internal Medicine Statewide Preceptorship Program or GIMSPP exposes first and second-year medical students to an early clinical curricular experience in primary care. More than 1,400 medical students participated in the GIMSPP between 1996 and 2006. Forty percent of these students enrolled in an internal medicine training program compared to the 18% national average (a 22% difference). Twenty-six percent of the GIMSPP students intended to practice primary care compared to the 2% national average (a 24% difference). Finally, 82% of the GIMSPP students plan to stay in Texas compared to the 60% state average.
GIMSPP lost all State funding in 2011. The Texas Chapter of the ACP continues to run it; however, it had to drastically cut the number of students. The program went from a high of 369 student applications and 240 student placements per year to only 119 student applications and 56 student placements. Similarly, the Texas Higher Education Coordinating Board’s budget for primary care residency training programs was cut by 80% during the last biennium.
The evidence is clear: GIMSPP and the primary care residency training programs are cost-effective and efficient because both increase the number of primary care doctors, a critical need of the State. Furthermore, GIMSPP and primary care residency programs keep our medical school graduates in Texas, so we do not lose the money invested in their education. Furthermore, each dollar invested in GIMSPP and primary care residency training programs returns to the local community as each primary care physician has a dramatic economic effect in the community.
We kindly ask this Committee to restore the funding for GIMSPP to the tune of 2 million dollars per biennium and reinstate the 80% budget cut for the primary care residency training programs.
1 Office of the State Demographer (presentation to the Texas Academy of Family Physicians 2012)
2 THE HEALTH PROFESSIONS RESOURCE CENTER, TEXAS DEPARTMENT OF STATE HEALTH SERVICES
3 The Primary Solution: Mending Texas’ Fractured Health Care System
4 THE HEALTH PROFESSIONS RESOURCE CENTER, TEXAS DEPARTMENT OF STATE HEALTH SERVICES and The Primary Solution: Mending Texas’ Fractured Health Care System
5 The Primary Solution: Mending Texas’ Fractured Health Care System
6 The Primary Solution: Mending Texas’ Fractured Health Care System
7 The Economic Impact of a Rural Primary Care Physician and the Potential Health Dollars Lost to Out-migrating Health Services
8 Texas Higher Education Coordinating Board 2012 GRADUATE MEDICAL EDUCATION REPORT
The Texas Health/Medical Home Summit is the first statewide conference focused specifically on expanding access to a health/medical home for individuals and families in Texas. This summit offers interested parties the opportunity to learn about medical home models and best practices and to interact with program experts at various stages of implementation.
2013 Texas Health Home Summit
April 4-5, 2013
Sheraton Austin Hotel at the Capitol
701 East 11th Street, Austin, Texas, 78701
Summit topics will include:
Care Coordination: A Function, Not A Person;
Team-Based Care: Best Practices;
Engaging Patients and Families: Best Practices;
Information Technology: Health/Medical Home Essentials;
TMHI Practices Present Their Experiences on the Journey to the Health/Medical Home;
The Health/Medical Home: What the Evidence Tells Us; and
Health/Medical Home for Children and Young Adults With Special Health Care Needs.
For more information and to register, visit the summit website.
It’s my privilege to introduce myself to you as your new Executive Director for the Texas Chapter of the American College of Physicians. Thank you for being members of TXACP and for your dedication to providing quality care for your patients, exceptional education for your students and serving as an invaluable resource to this association, your colleagues and Internal Medicine.
Prior to being chosen for this position, I served eight years in membership and events focused roles including working with two educational associations on their fundraising, membership and legislative efforts. I received my Bachelor of Public Relations from Mount Saint Vincent University in Halifax, Nova Scotia. I currently reside in Austin with my husband and our daughter.
I look forward to meeting you at the upcoming ACP Annual Meeting this April and mark your calendars for the 2013 Annual Chapter Meeting to be held November 16th and 17th at The Westin La Cantera Resort in San Antonio!
Phone: 512-370-1528 Email: Nicole.Abbott@texmed.org
Fellowship recognizes personal integrity, superior competence in internal medicine, professional accomplishment, and demonstrated scholarship.
Gaurav Agarwal, MBBS FACP, San Antonio
Oluremi A Aliyu, MD FACP, San Antonio
Rachel D Bishop, MD FACP, Richmond
Bernard J Blumenthal, MD FACP, Odessa
Gregory D Bowling, MD FACP, Odessa
David P Capper, MD FACP, Odessa
Devasmita Choudhury, MD FACP, Houston
Marc S Elieson, MD FACP, Houston
Essam F Elsayed, MD FACP, Pasadena
Susan E Favour, MD FACP, Pasadena
Mary Allison Hendrickson-Quirk, DO FACP, Pasadena
Adarsh Hiremath, MBBS FACP, San Antonio
Nancy L Hughes, MD FACP, San Antonio
Robert L Johnson, MD FACP, Fort Worth
Marjorie R. Jenkins, MD FACP, Amarillo
Rajdeep S Kakar, MD FACP, Fort Worth
Sumeet S Kalra, MD FACP, Dallas
Manasi S Kekan, MBBS FACP, Dallas
Faisal A Khasawneh, MD FACP, Waco
Tresa McNeal, MD FACP, Waco
Deepa Mittal, MBBS FACP, Allen
Carlos Orces, MD FACP, Dallas
Lavi Oud, MD FACP, Dallas
Alejandro Ovalle, MD FACP, Arlington
Peter J Plantes, MD FACP, Arlington
George M Rapier, III MD FACP, Houston
Joseph J Roman, MD FACP, Houston
Sherine E Salib, MD FACP, Galveston
Michael K Schrader, MD FACP, Galveston
Jeffrey M Schussler, MD FACP, Plano
Joshua D Septimus, MD FACP, Plano
Mohamed M Shehata, MD FACP, Plano
Yu-Min P Shen, MD FACP, Plano
Jasvinder S Sidhu, MD FACP, Dallas
Sandeep Singh, MD FACP, Dallas
Samer S Suki, MD FACP, Dallas
James E Sutton, MD FACP, Sugar Land
Salil K Trehan, MD FACP, Sugar Land
George M Viola, MD FACP, Amarillo
Alexis A Wiesenthal, MD FACP, Amarillo
Maurice Willis, MD FACP, Amarillo
Lechauncy D Woodard, MD FACP, Temple
Gordons L Woods, MD FACP, Temple
William A Zoghbi, MD FACP, Austin
Congratulations to the newest CYP Northern Co-Chair Elect, Dr. Maria Gove and the newest CYP Southern Co-Chair Elect, Dr. Gregory Johnson. Please read their bios below to learn more about the newest CYP leaders.
The Texas Northern Co-Chair Elect will serve as Co-Chair Elect for one year. The Texas Southern Co-Chair Elect will serve as Co-Chair Elect for two years. The Co-Chair elects will serve two years as the Co-Chair and one year as the Immediate Past Co-Chair.
Dr. Maria Gove
Dr. Gove currently works in the General Internal Medicine Section at the North Texas VA in Dallas, Texas teaching the internal medicine residents from UT Southwestern. She has been a member of ACP since 2001 and a Fellow of ACP since 2011. She is involved with the local Texas Chapter of the ACP since moving to Texas in late 2009. Prior to that time, she was active in the local chapter in Arizona. Dr. Gove is currently a member of the Communications Committee and has judged Residents’ Posters for the North Texas Associates Day Abstract Poster Competitions and at the ACP national meeting. Dr. Gove is married and has a two year old daughter. She enjoys travelling, outdoor activities and sports.
Dr. Gregory Johnson
Dr. Johnson leads clinical operations for the Central and Southeast region for Sound Physicians. His responsibilities include regional organizational leadership and development and regional operational performance. In his role, Dr. Johnson works directly with the hospital partners and hospitalists along with the regional vice president of operations to ensure the delivery of high-quality patient care and the alignment of performance with partner hospital goals.
Dr. Johnson is a graduate of the University of Texas Health Sciences Center at Houston and completed his residency training in both Internal medicine and family practice at the Ochsner Clinic in New Orleans. He is a Fellow in the American Academy of Family Physicians and a Senior Fellow in the Society of Hospital Medicine. Dr. Johnson is an active member of the Texas Medical Association, where he currently serves on its Board of Councilors and is a past chair of its Young Physicians’ section. He also serves as vice-chair of the Texas Academy of Family Physician’s Leadership Committee and is on the Society of Hospital Medicine’s Public Policy Committee.
By Dr. Young
For Pete’s sake... What do I do with all these loans now that I can no longer defer them? Where can I learn more about how to handle my finances?
- Broke in Bedford
Loan repayment is something a lot of us don’t want to think about when we’re originally taking on our loans, but unfortunately it is something that needs to be done. With the average doctor with over $162,000 in debt at the time of graduation this is pretty important stuff.
Your options really depend on what you can afford. The ideal situation is to put aside money each month and just pay them. If that’s not in the cards, then there are some other options depending on how aggressive you want to be. You could join the military and qualify for the Health Professionals Loan Repayment Program. If you’re working in a medically underserved area or interested in possibly moving to a medically underserved area you could look into the National Health Service Corps Loan Repayment Program (http://nhsc.hrsa.gov/currentmembers/loanrepaymentrecipients/index.html).
If you’re having trouble making your payment and these options aren’t really options for you, you could always speak with your lender to try to adjust the payments (this is better than not paying) or depending on the types of your loans consider loan consolidation, which could make your payments lower. You can gather a lot of information about loans from your lender as well as from government websites.
Learning how to take care of finances is another daunting task that lots of doctors aren’t very good at, especially at the beginning of their career. There are lots of financial planners eager to help you/invest/take your money and you can learn a lot from them. There are also books available commercially and through the AMA. Keep an eye out for seminars hosted by your local CYP group or medical societies where you can ask questions without the one-on-one pressure of meeting with someone individually.
For Pete’s sake…How do I deal with my new partners. They are just driving me up the wall. All their patients say it's impossible to get an appointment with him so they just do walk-ins with me because I am more available. OMG! This has got to stop.
- Fed up in San Antonio.
I wish there was an easy answer to this question, but there’s not. What you need to do is take good care of their acute visits and move on. Some of their patients will appreciate the care you provided to them and transfer over and if your partners recognize that you’re taking good care of their patients they will be more likely to send new patients your way instead of keeping them to further build their already overwhelmed practice. It doesn’t seem like it now, but there will be a time that you’ll appreciate those easy/fast upper respiratory infections and UTIs and wish that you had more of them to see instead of your complicated uncontrolled diabetics/hypertensives. If the walk-ins are becoming more like chronic disease management, then it might be necessary to discuss with your partners how they want you to handle this situation or set some clear guidelines with your office staff as to what you will see as a “walk-in”. For the moment, when you’re seeing your partners’ acute patients, just think to yourself that this is an easy way to make some extra RVUs/money and move on.
If you have questions for the next “For Pete’s Sake…” please email them to Becca Lawson at the TXACP Business office at email@example.com.
"Lessons from My Father "
While he was not a physician, my father taught me the skills I would need to become one. He grew up in a generation that lacked the benefits of modern medical technology, a generation that relied primarily on the art of taking an informative history and conducting a thorough physical examination rather than on MRI’s and laboratory results. My father taught me that while technology aids significantly in the diagnosis and treatment of disease, it is important to remember that each patient has a unique story that cannot be revealed via scans and diagnostic tests. While he passed away unexpectedly during my first year of medical school, the principles he instilled in me guide me as I interact with patients.
Lesson 1: Take Time to Listen
Mrs. Jones (name changed) was an eighty-seven-year-old nursing home patient who was sullen and withdrawn. Although most of the staff believed she was unable to communicate due to dementia, my father, who was working as a nursing home administrator, began to talk to her, and she began to tell him stories about her childhood, the Great Depression, and her lengthy career as a symphony pianist. When he heard this, my father, who loved music, insisted on taking her to the living room where a majestic grand piano stood. At once, Mrs. Jones began to play beautiful classical pieces from memory, to the shock of the other staff members and patients who had not known that such tremendous skill lay dormant in this quiet, diminutive woman. Simply listening to the stories people tell can enable physicians to improve the quality of life and health of patients. Likewise, making assumptions about patients can impede health care delivery.
Lesson 2: Embrace Learning
For most of his career, my father was a clinical microbiologist, and he introduced me to the wonders of science. He would show me specimens with his microscope, and I was fascinated by the unique shapes and strange colors that suddenly became visible, as if by magic, when I looked through the eyepiece. He also loved books, and our home was filled with all kinds – encyclopedias, novels, and textbooks – that I spent much of my childhood perusing. My father instilled in me a thirst for knowledge that has driven me to become a life-long learner.
Lesson 3: Care about Others
My father genuinely cared about people, and he could become friends with a complete stranger in minutes. He sincerely wanted to learn about others’ interests, values, families, and hobbies. Although he enjoyed talking to people of all ages, he had a particular fondness for children, and he would entertain them with magic tricks, making coins, handkerchiefs, and balls disappear and reappear. Watching my father interact with others inspired me to enter a profession where caring for people is paramount.
Lesson 4: Competence and Compassion
At my White Coat Ceremony, a distinguished faculty member named Dr. Foster said, “To be a physician, one must be competent. But when competence fails, one must be compassionate. We teach our students to be both competent and compassionate.”
Although these words were planted firmly in my mind, I finally appreciated their wisdom when I received a phone call that caused my world to implode at 7 A.M. on February 29, 2012. Leap Day. My mother told me that my father had suffered a cardiac arrest while walking our dog. He was resuscitated by a kind neighbor, who happened to be a critical care nurse. When I arrived at the ICU, my father was on a ventilator, an aortic balloon pump, and more drips than I thought possible to attach to a human being.
My family and I waited anxiously for signs of movement, anything that could possibly indicate that my father had some neurological function preserved. As the days wore on, we began to lose hope. Although his brainstem was intact, an EEG showed seizure activity. He began to cough violently, and a tracheostomy was performed to help him breathe more easily. My mother, brother, and I began to discuss when to switch to comfort care. By day 10, we had begun to accept the looming inevitability of death, but my brother was reluctant to allow the doctors to disconnect the ventilator that kept my father alive. My brother is an engineer, and to him, the human body is akin to a machine that can be fixed if reprogrammed properly. Therefore, he could not come to terms with the fact that, at a certain point, even the most competent physician can no longer stall death.
The cardiologist arrived to speak to my family. And that is when I learned the meaning of Dr. Foster’s words – that when a physician has exhausted all scientific options, all he has left to give is compassion. The cardiologist looked my brother in the eyes and said, “This is the medically right thing to do.” And with that, he assumed the burden of responsibility himself so that my brother would not be tormented by guilt. Minutes later, the aortic balloon pump and the ventilator were turned off. In a final act of compassion, the cardiologist, knowing that the hospice would not take over care until the next morning, prescribed my father morphine to ease his suffering. Two days later, my father passed away peacefully.
As physicians, we rely on science to guide our clinical decisions. But often, even though scientific knowledge grows exponentially with each passing generation, science fails. Unlike controlled experiments in test tubes, life is filled with uncertainties and unexpected events that disrupt the orderly realm of medical knowledge. After the multitude of medicines and procedures are exhausted, the physician has only one option left – compassion. And to the patient and family members, what matters most is that compassion remains even when competence has failed to deliver a cure. Although modern physicians have more tools to use than their predecessors, the most important ones are still the kind touch and comforting words employed by countless generations of healers.
Paul L. Foster School of Medicine Students Speed Date with Internal Medicine Subspecialists
On January, 29th, the Internal Medicine Interest Group (IMIG) at the Texas Tech University Health Sciences Center Paul L. Foster School of Medicine (TTUHSC PLFSOM) held their first Internal Medicine Subspecialty Fair, an event geared towards providing medical students with exposure into the various subspecialties available to them within the field of Internal Medicine. During the event called “Meet Your Match- Speed Dating with Internal Medicine Subspecialists”, students were placed in small groups and had the opportunity to meet with various internal medicine subspecialists and learn about their respective fields for a few minutes before rotating to the next subspecialist. The Subspecialty Fair was attended by IMIG faculty advisor, Dr. Harry Davis (General Internal Medicine), Dr. Ogechika Alozie (Infectious Diseases), Dr. Harold Hughes (Critical Care/Pulmonary), Dr. Kanchan Pema (Rheumatology), Dr. Tariq Siddiqui (Interventional Cardiology), and Dr. Stephen Sandroni (Nephrology).
After students had the opportunity to meet with each of the physicians, Dr. Gordon Woods (Associate Professor of Internal Medicine and Medical Education, TTUHSC PLFSOM) instructed a workshop where he showed students how to interpret EKG readings and heart sounds and how to use them to assist in diagnosing various diseases. The event also received excellent media coverage from two of the El Paso area’s major news stations: KFOX News aired coverage of the event in El Paso, TX and Las Cruces, NM, and El Diario aired coverage of the event in El Paso and Juarez, Mexico.
The event exemplified the hard work of IMIG’s student officers, who worked diligently to ensure that the event was a success. The Paul L Foster IMIG is sponsored by the ACP and the Texas ACP chapter. The goal of IMIG is to inform and provide exposure to students to Internal Medicine and the various subspecialties that represent Internal Medicine. Working with Dr. Davis and Dr. Woods, IMIG’s student officers came up with the idea for the event, recruited physicians to come and speak, promoted the event to the student body, and contacted the various businesses and media outlets to participate in the event in order to involve more of the community, outside of the medical school. With its impressive physician involvement, student attendance, and media participation, IMIG did an outstanding job in making the Internal Medicine Subspecialty Fair one of the biggest educational events to take place at TTUHSC PLFSOM, and IMIG hopes to make the event bigger and better in the years to come.
A special thanks goes out to first year medical student, Daniel Varela, for submitting this article as the PLFSOM Internal Medicine Interest Group Representative.
KoKo Aung, MD, MPH, FACP, of Shavano Park, has been named Chief of the Division of General Medicine, Department of Medicine at the University of Texas Health Science Center at San Antonio. He was concurrently appointed to the O. Roger Hollan Professorship.
Send news of your accomplishments, or that of a colleague, to: Becca Lawson, TXACP Staff, 401 W. 15th St., Austin, TX 78701; fax to (512) 370-1635; or e-mail.
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