New Mexico Chapter Governor's Newsletter

Well Done, Yet Juicy

Dr. Rowen Zetterman, ACP-ASIM Regent and Professor of Internal Medicine at the University of Nebraska, attended our meeting as the College Representative. He provided an update on chronic hepatitis and fielded questions on College positions and policies. Resident-focused seminars on Debt Management and Job Finding Skills capped Friday afternoon.

The Awards and Associates Dinner was quite lively as well. Attendees congratulated winners of the Abstract, Clinical Vignette and Poster competitions. The 1999 NM Chapter Laureate Award was conferred on William P. Reed, MD, FACP (see page 3.) Later, Flamenco dancer Lili Del Castillo and her guitarist-husband, Luis Campos, aerobically entertained an enchanted audience.

Just when everyone seemed sated, "dessert" arrived in the form of Saturday morning talks by Drs. Dorin and Ross, as well as an interactive computer presentation wherein physicians could instantly and graphically communicate responses to speakers' questions. Over 230 ACP-ASIM members and guest physicians attended, making this one of the best, most intellectually stimulating Annual Scientific Sessions yet.

Residents' Scientific Efforts Rewarded

The following winners were selected by meeting attendee votes:

• Abstracts —Dr. Samer Bahlool
• Clinical Vignettes— Dr. Holly Fleming
• Posters—(1st) Dr. Dave Jessup for "Factor V Inhibitor Associated with Pituitary Microadenoma Hemorrhage";

  —(2nd) Dr. Patricia Carbajo for "Acute Myocardial Infarction in a 24 Year Old Man with Elevated Homocysteine Levels"; and

  — (3rd) Dr. John Massone for a case of "Profound Chest Pain and Hypoxia after Embolization of an A-V Malformation".

Thanks to all who submitted a project or voted for the participants and congratulations to the winners. We all benefited from their efforts!

The Resident Attendance Door Prize was awarded to Dr. Les Donaldson. Drs. Marion Jordan, Scott Smith and Jim Ziomek were rewarded for visiting every display booth and correctly answering all items on the Pharmaceutical and Industrial Conference Supporter Questionnaire. The Annual Session is free of charge to ACP-ASIM members due to the generous contributions of pharmaceutical and industrial companies.

Warm Congratulations To Our Laureate

The Laureate Award is designed to honor those Fellows and Masters in the College who have demonstrated, by their example and conduct, an abiding commitment to excellence in patient care, education or research and service to their community and to the College. Though we Internists in New Mexico are fortunate to have many dedicated, enthusiastic, senior physicians among our membership, Dr. Reed was chosen as our Chapter Laureate for many reasons. As a newly trained Infectious Disease specialist, Dr. Reed joined the faculty of the University of New Mexico in 1969. He was subsequently appointed as a research investigator at the Albuquerque Veterans Affairs Medical Center and was promoted to Associate Chief of Staff for Research by 1974. His work has centered on host defenses to bacterial infections, especially involving shigella, pneumococcus and streptococcus.

Though he retired from the VAH in July of this past year, Dr. Reed continues to serve as Interim Associate Dean of Research at the University of New Mexico School of Medicine. During his career, he has authored nearly 100 scientific publications and textbook chapters. He has been an exemplary Member and Fellow of NM ACP-ASIM since 1969. He has chaired the Scientific Program twice (1975 and 1995) and led the Chapter as President in 1996.

Bill and his wife, are also life scientists in their private lives, travelling the world studying mushrooms and collecting and crafting fine works of art in wood.

Washington Update

• A stronger ERISA/Patient Protection Act (Norwood-Dingell Bill), closing loopholes in earlier legislation, was passed.
• The Balanced Budget Relief Act, which included a moratorium on reductions in the funding of Graduate Medical Education, was passed. And $12 million in previously cut funds was restored.
• NM Hospitals will see a $4 million increase in funding (Disproportionate Share Payments) for care of indigent patients.
• The inflammatory anti-physician Fraud and Abuse Campaign ("Who Pays, You Pay") by the Office of the Investigator General (OIG), was markedly modified after the ACP-ASIM met with the OIG and forced a "touch of reality." By examining data from the 170,000 Patient Hotline phone calls, wherein only 1% truly involved physician fraud complaints of merit, our staff negotiated a fairer, less accusatory revision of governmental guidelines and OIG literature.
• The Agency for Health Care Policy and Research (AHCPR) was re-authorized and revamped, making the agency the focal point of all federal efforts to improve the quality of medical care.
• The study establishing the lack of health insurance as a bona fide health risk was released in a recent press conference as a part of the ACP-ASIM's Decision 2000 Campaign. The College is urging candidates for Congress and the Presidency in the 2000 elections to make a commitment to work for accessible and affordable health care for all Americans.

A portion of our annual dues goes to support these laudable efforts on our behalf in the Capitol. You are invited to express your concerns and opinions to our Washington, DC staff and Mr. Doherty at 800-338-2746, ext. 4536, or: bdoherty@mail.acponline.org.

Become An Acp-Asim Key Legislative Contact

With over 110,000 members, the American College of Physicians-American Society of Internal Medicine is the largest medical specialty society in the U.S. Many of our members are the leaders in their communities. Many of our members are politically active.

We need to remain politically active to influence the direction of access to care, government-sponsored insurance programs, graduate medical education, medical research and the government regulation of our profession.

The Washington office of ACP-ASIM has over 50 people. They keep their fingers on the pulse of what is happening in Washington. Often contacts to key legislators can swing a vote and influence legislation. If you are willing to be part of this process of American democracy, please volunteer as a "KEY CONTACT."

If you know a legislator personally, if you know someone who works in your congressperson's or senator's office, if you provide medical care to a congressman or senator or their families, if you have supported the campaign of a legislator, or if you just want to become politically active, YOUR SERVICES ARE NEEDED.

As a key contact, you will receive periodic congressional updates on legislation that affects you and your patients. When our Washington watchdogs believe that your contact can make a difference in national legislation, you will receive a fax guiding you through that contact. You will be asked to contact your congressman by letter, telephone, or e-mail. The easiest way is to use the ACP-ASIM interactive phone system. Dialing a toll-free phone number (888-218-7770) and entering your 8-digit member number and home zip code will put you in direct contact (or you may leave a recorded message) with your senator or representative. A FEW MINUTES OF YOUR TIME MAY HAVE AN IMMENSE IMPACT.

You may wish to attend Leadership Day in Washington, DC. This is a one and a half day session held on Capitol Hill; after a briefing by congressional staffers you are turned loose to call on our New Mexico congressmen and senators. Several of your colleagues and I have been active in this program over the last seven years. When we started, most congressmen did not know what an internist was. They now know us as ethical physicians who support access to care, medical education and fairness in medicine. Leadership Day on Capital Hill is held in late spring (usually May), when we can have the most influence on legislation.

If you would like to be a key contact, call the Washington office at 800-338-2746, or speak to Barbara McGuire or Dick Honsinger.

Thanks to the Outgoing Council Members And Welcome to the New

The elected Council Officers for the coming year are President ­ Allen Adolphe, MD, FACP; President-Elect and Program Chair ­ Antonios Tzamaloukas, MD, FACP; Treasurer ­ James Sussman, DO, FACP (volunteered to serve another two-year term); and Secretary ­ Clare Castiglia, DO. New Chapter Council Members are Drs. Mike Leweicki (re-elected), Diane Klepper, Mike Randle, Charles Riley and Bruce Tempest. We thank everyone who agreed to be nominated for an office or Council seat and welcome those newly elected. Please contact any Council member to voice your concerns, offer a resolution for action, or bring forward a matter for discussion. The Council meets 4-6 times per year and communicates more frequently by e-mail. We aim to represent you as members.

Board Review Strategies

The American Board of Internal Medicine certifying examination differs from most traditional examinations in that it tests overall knowledge and the application of that knowledge to solve problems, rather than simply recalling facts. To be successful, you may need to view the examination differently and prepare in new ways. The following suggestions were gleaned from the article " Taking the boards? Try these strategies for success," published in the May 1999 ACP-ASIM Observer by Christine Kelly, and the collected experiences of selected program directors.

The Format: Nearly 85% of the test questions are presented as clinical scenarios that take place in ambulatory settings. The test emphases general knowledge; if you haven't seen or heard about it during your residency training, chances are slim that it will be on the board exam. Don't worry about recent studies in medical literature. Examinations are created over a year in advance of their use, so recent material will not be tested. For a breakdown of what is covered on the examination, see the ABIM's web site (www.abim.org/info/blueprnt.htm).

Pace Yourself: Last minute cramming for the exam is not likely to help and may hurt your chances. Despite the difficulty in motivating yourself, most residents need to begin a study program at the beginning of their second year; starting at the beginning of the third year is cutting it pretty close and halfway through the last year is too late. Most experts recommend reading about your own patients as the basis for your study plan. In general, the frequency that you encounter certain problems during the residency program will reflect the importance they receive on the examination.

Assess Yourself: Review courses and practice examinations can help you prepare by identifying your weak areas. One of the most popular and most accurate at predicting your performance on the board examination, is the in-training examination. Residents with scores falling below the 50th percentile on the in-training examination will have the greatest probability of failing the board examination. Remediation, usually in the form of changing reading habits, can improve the likelihood of passing the board exam. In fact, and not surprisingly, there is a direct correlation on the amount of time spent reading and the ability to pass the board examination; about 5 to 7 hours per week appears to be the bottom line for success.

Study Groups: Study groups are a good method to ensure compliance with your study program. Limit the number to three or four individuals, and meet consistently ­ weekly or every other week. The groups can be organized by problem, organ system, or chapters in the textbook. A tried and true strategy is to have each member prepare questions based on their reading and use them to test the group's knowledge. It's not unusual to accurately guess the content areas and types of questions that will appear on the board exam.

Review Sample Questions: Trying out sample questions can help you become a better test-taker by learning strategies to increase your odds of selecting the correct answer. About 80% of residents taking the board examination use the College's Medical Knowledge Self-Assessment Program (MKSAP) as a study tool (www.acponline.org/catalog/mksap/). In addition to the questions, the accompanying syllabus presents key advances in the subspecialty and general internal medicine areas for the past three years.

Review Courses: Near the end of residency training, review courses can help solidify what you have learned during training. Do not deceive yourself into believing that a review course will make up for the lack of consistent and steady study habits, but rather they tend to "tie things together" and give a sense of confidence regarding preparedness for the examination. The College offers a number of board review courses and information about them is available on line (www.acponline.org/cme/acpcours.htm).

Other Tips:

• When starting the exam, determine the number of questions and the amount of time available. Calculate how many should be answered by halfway through the allotted time. Typically, you will need to answer a question every one or two minutes.
• Read the stem (the clinical vignette) carefully. Pick out the pertinent parts of the stem that will help you select the correct diagnosis.
• Pick the obviously correct answer. There are no trick questions.
• Consider race, sex and age when selecting the answer.
• If you don't know the answer to a question, make your best guess and move on.
• Don't change the answers to questions unless you have made an obvious mistake; first impressions are generally the correct impressions.

Planning Begun for the 2000 New Mexico Annual Scientific Meeting

The meeting will be at the Marriott Hotel in Albuquerque (Louisiana Boulevard and I-40), November 16-18, 2000. Any ACP-ASIM member may submit a case or study for review by the Program Committee. Forms can be obtained from Ms. Little or online at our Chapter Web Site www.acponline.org/chapters/nm.

If you wish to volunteer for the Program Committee, donate prizes or awards, or support the Annual Scientific Meeting in some other way, please contact Ms. Little at 505-828-0237, or KLITTLE@NMMS.ORG.

Annual Session 2000 ­ Philadelphia Style

For the first time ever, the College's governing Boards have chosen a Clinical Theme for special emphasis in ACP-ASIM educational programs ­ Emerging Antibiotic Resistance. Since antibiotic resistance is now a major threat to the health of people worldwide, numerous sessions will provide up-to-date information on this topic, strategies on how to reduce this threat and skills to enable physicians to resist the importuning of patients for inappropriate antibiotics for self-limited non-bacterial infections.

With the first set of time-limited internal medicine certificates due to expire in 2000, recertification will be the theme of a two-day Pre-Session Course. By providing an intensive review of core topics in internal medicine, this session will allow you to tailor your own curriculum to meet the upcoming examinations.

Other Annual Session highlights include a four-part series on the history of medicine, the ever-popular "Multiple Small Feedings of the Mind," Clinical Skills workshops and the Learning Center, as well as over 250 educational sessions.

Members are encouraged to register now for Annual Session 2000 to have the best selection of sessions requiring advance reservations, including workshops and the new "Meet and Eat with the Professor" sessions (informal breakfast and lunch sessions with distinguished faculty that provide opportunities to discuss recent advances and new developments in selected topics.) Requests are filled on a first-come, first-serve basis. For more information on Annual Session 2000, or to register, visit ACP-ASIM Online at www.acponline.org or contact Customer Service at 800-523-1546, ext. 2600. Register by January 31, 2000 and save money.

ACP-ASIM's Decision 2000 Campaign Seeks Member Involvement

To date, the College has placed advertisements in the Washington Post and other publications highlighting the evidence that the uninsured have worse health outcomes. Each ad featured the tag line "No Health Insurance? It's Enough to Make You Sick." In late October, ACP-ASIM sponsored a briefing for Capitol Hill staff on universal access with House Majority Leader Dick Armey (R-26-TX). In November, the College held a press conference to release a new white paper that demonstrates the link between a lack of health insurance and poor health. The white paper, "No Health Insurance? It's Enough to Make You Sick ­ Scientific Research Linking the Lack of Health Coverage to Poor Health," summarizes available literature published within the last ten years that confirms the health hazards faced by the uninsured.

The College has also partnered with the Catholic Health Association (CHA) in a petition drive to highlight the need to make accessible and affordable healthcare a national priority. CHA and ACP-ASIM are working to get citizens across the country to sign these petitions, and will be submitting them to presidential and congressional candidates as a mandate on healthcare. A brochure featuring this petition is included in the November issue of the Observer. To request single or bulk copies of the brochure, contact ACP-ASIM Customer Service at 1-800-523-1546, ext. 2600 and ask for product number 510100190. ACP-ASIM encourages all physicians to sign the petition and make it available to their patients, civic groups, hospitals and any other organizations that are concerned about the uninsured.

As the state presidential primaries are held early next year, ACP-ASIM will work to elevate the issue of universal coverage with candidates and voters. The College will call on its leadership and members to write op-eds and letters-to-the-editor, and to attend candidate forums in support of accessible and affordable healthcare for all Americans. ACP-ASIM members will be asked to participate in similar activities during the congressional primaries later next year.

The success of ACP-ASIM's Decision 2000 campaign depends on the participation of Governors and chapter members. Chapter involvement will be especially important during the 2000 congressional elections. Washington staff will be contacting chapters and asking them to participate in grassroots activities throughout the primary season. For more information on the campaign or what you can do to help, contact Jenn Jenkins, Associate for Grassroots Advocacy, in the Washington Office.

You can reach her at 800-338-2746, ext. 4536.

What's Up With ACP-ASIM and Your New Mexico Colleagues?

You can also look up and locate Internal Medicine colleagues locally, across the country and internationally by using "Member Connection," the College's new online membership directory, which is accessible to members-only via ACP-ASIM Online. Updated daily, the information in "Member Connection" is taken directly from the College's main membership database and can be used to search for colleagues by name, state, city, zip or postal code, country, region or specialty.

Also, New Mexico specific data can be obtained via the Chapter Web Page at www.acponline.org/chapters/nm.

This newsletter was compiled by Barbara J. McGuire MD, FACP, Governor, NM Chapter of ACP-ASIM.

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