May/June 2001
Is the PATIENT in Good Hands?
Doctors MetroDoctors THE JOURNAL OF THE HENNEPIN AND RAMSEY MEDICAL SOCIETIES
Physician Co-editor Thomas B. Dunkel, M.D. Physician Co-editor Richard J. Morris, M.D. Managing Editor Nancy K. Bauer Assistant Editor Doreen M. Hines HMS CEO Jack G. Davis RMS CEO Roger K. Johnson Production Manager Sheila A. Hatcher Advertising Manager Dustin J. Rossow Cover Design by Susan Reed MetroDoctors (ISSN 1526-4262) is published bimonthly by the Hennepin and Ramsey Medical Societies, 3433 Broadway Street NE, Broadway Place East, Suite 325, Minneapolis, MN 554131761. Periodical postage paid at Minneapolis, Minnesota. Postmaster: Send address changes to MetroDoctors, Hennepin and Ramsey Medical Societies, 3433 Broadway Street NE, Broadway Place East, Suite 325, Minneapolis, MN 554131761. To promote their objectives and services, the Hennepin and Ramsey Medical Societies print information in MetroDoctors regarding activities and interests of the societies. Responsibility is not assumed for opinions expressed or implied in signed articles, and because of the freedom given to contributors, opinions may not necessarily reflect the official position of HMS or RMS.
CONTENTS VOLUME 3, NO. 3
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M AY / J U N E 2 0 0 1
LETTER
The University Needs Our Help
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PHYSICIAN’S SO AP BO X
Doctor, Who Will Help Me?
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FEATURE
Two Opposing Views on the Need for a Patient Protection Act
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MPPA Executive Summary: How Contracts Between Health Plans and Doctors Influence the Quality of Medical Care and Patient Privacy
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COLLEA GUE INTERVIEW
Kent Neff, M.D.
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Building New Foundations — Surviving and Thriving Inside Corporate Medicine
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American Medical Association Principles of Medical Ethics
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Fundamental Elements of the Patient-Physician Relationship
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Hospital Bed Capacity Issue Gets Attention of Legislators
Send letters and other materials for consideration to MetroDoctors, Hennepin and Ramsey Medical Societies, 3433 Broadway Street NE, Broadway Place East, Suite 325, Minneapolis, MN 554131761. E-mail: nbauer@mnmed.org.
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Designated a Delegate
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MN PERSPECTIVE
For advertising rates and space reservations, contact Dustin J. Rossow, 4200 Parklawn Ave., #103, Edina, MN 55435; phone: (612) 2377363; fax: (612) 831-3260; e-mail: djrossow@aol.com.
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Another Successful Winter Medical Conference
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HMS/RMS Sponsor Medical Student Lunch ’N Learn Sessions
MetroDoctors reserves the right to reject any article or advertising copy not in accordance with editorial policy. Non-members may subscribe to MetroDoctors at a cost of $15 per year or $3 per issue, if extra copies are available.
Classified Ads Governor’s Budget Refocuses Health Debate
RAMSEY MEDICAL SOCIETY
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President’s Message Community Internship Program Caring Hearts for Homeless People Applicants for Membership/In Memoriam/Resolutions RMS Alliance HENNEPIN MEDICAL SOCIETY
29 30 32 MetroDoctors
President’s Report HMS News/New Members/In Memoriam HMS Alliance
The Journal of the Hennepin and Ramsey Medical Societies
On the cover: This issue looks at the physician-patient relationship. Articles begin on page 3.
May/June 2001
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LETTERS
The University Needs Our Help Dear Editor: Living in this state, we are all affected by the vitality of the University of Minnesota. From research and inventions, to food safety and an educated workforce, the University impacts us all. That’s particularly true for health industries. The Hennepin and Ramsey Medical Society leadership recognizes the important role the University’s Academic Health Center plays in the success of our state. With shortages of pharmacists, nurses, medical technologists, dentists, and even physicians, we rely on a healthy university to meet our future workforce needs. The university is home to the leading edge research and innovations that fuel medical technology
companies, biotech industries, and pharmaceutical firms in Minnesota—and that’s important for our future. In addition, I know each of us wants to maintain access to a transplant clinic and cancer center here if you or someone you love needs it. If each of our members would contact their legislators and the Governor, we can help ensure the future vitality of the state. We’ve long been proud of the quality education and health care provided in Minnesota, and we believe Minnesotans want to maintain that quality. The schools and colleges of the University’s Academic Health Center prepare nearly 70 percent of the health professional workforce. These will be the pharmacists, dentists, physicians, veterinarians, public
health professionals and graduate level nurses who improve the health of our communities as well as discover and deliver new treatments and cures. Without a strong university, the Academic Health Center cannot successfully strengthen the vitality of our health industries. Let your legislators and the Governor know—we want a strong Academic Health Center for the future of our state. ✦ Sincerely, Virginia R. Lupo, M.D. Chair, Hennepin Medical Society, and Robert C. Moravec, M.D. President, Ramsey Medical Society
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Products and Services Offered to RMS Members by RCMS, Inc. For more information call 612-362-3704. 2
May/June 2001
MetroDoctors
The Journal of the Hennepin and Ramsey Medical Societies
PHYSICIAN'S SOAP BOX
Doctor, Who Will Help Me?
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WE PHYSICIANS HEAR THE PLAINTIVE CALLS of our patients to help them—help them face illness, the uncertainties and traumas of life, and often a plea to help them deal with our fragmented healthcare system. As physicians we align ourselves with our patients as victims of a healthcare system in Minnesota now dominated by huge managed care organizations. Paul Ellwood, the Minnesota father of HMOs, called HMOs “accountable health plans” in his 1991 “managed competition” proposal, but today’s behemoth managed care organizations are insufficiently accountable to patients or responsive to physicians. It is very difficult for doctors to advocate effectively for patients when we ourselves have so little power. Power will return to patients when they can make choices about their doctors and treatments. Spokespeople for managed care organizations said they would be accountable to patients, and if not to patients, to employers through the marketplace. Those who promoted managed competition spoke less often about accountability to doctors, but implicit in managed competition theory is the notion that physicians would join those managed care organizations which provide quality of patient care and respect for their professional autonomy. But even as Paul Ellwood now says in recent interviews, the competition fantasy turned out to be a bust. Whatever “competition” exists between Minnesota health plans now involves a race to extend the oligopoly beyond the now 95 percent of patients who are tied up in Minnesota managed care organizations. Minnesota managed care organizations don’t compete for patients and doctors, they own them. When a few sellers rule, they are “price makers” and not “price takers.” They dictate the terms of medical care to patients and the working conditions of their labor supply, physicians. Despite recent claims by Minnesota’s managed care plans that they will now cooperate in defining medical care practice parameters based on scientific evidence, with the adoption of standardized medical practice protocols, it is virtually impossible to measure the quality of one managed care organization compared with another. This means it’s impossible to generate competition for patients based on quality of medical care. Consumers (patients) have been told that managed care organizations could be rated by quality report cards allowing patients to make choices about selecting these plans. But no report cards exist and it is unlikely that the National Commission on Quality Assurance (NCQA), or the Joint Commission on Accreditation of Hospital and
BY LEE BEECHER, M.D.
MetroDoctors
The Journal of the Hennepin and Ramsey Medical Societies
Healthcare Organizations (JCAHO), or the ICSI guidelines will provide patients with information to allow them to make choices about health plans or physicians. Employers who purchase managed care health insurance in today’s market are alarmed about double-digit premium increases and escalating pharmaceutical costs. It seems the way Minnesota managed care has been able to do a measure of cost containment is by reducing access to care. There are three ways to do that: reduce the number of available providers, shift the financial risks for health care to the providers of care, i.e. physicians, and control the definition of what is reimbursable through “medical necessity” utilization review. The Minnesota Physician-Patient Alliance (MPPA), building on the work of Hennepin and Ramsey Medical Societies, recently looked for evidence of the ways in which health plans seek to control physician behavior through provider contracts with doctors. We were stunned by the one-sided language we found in these contracts (see accompanying article on page 9: How Contracts Between Health Plans and Doctors Influence the Quality of Medical Care and Patient Privacy). We, at MPPA, realize that patients and physicians together must work to change the present system to alter the power of relationships between patients, physicians, and managed care organizations. Until this occurs, our ability as physicians to help our patients will be severely limited. Patients should lobby their employers for health care choices that allow them more power. Unfortunately, their choices are severely limited. Many employers offer only one or two health plan choices. Patients are also encouraged to partner with physicians in establishing diagnosis and treatment, with patients assuming more responsibility for preventing illness and implementing plans of care for illness, including pharmaceutical treatment. Moreover, patients and doctors are urged to educate their state and federal representatives about their real worlds of health care. While MPPA physician members write resolutions for the Minnesota Medical Association House of Delegates, MPPA patient members add a reality check and partnership through our efforts. Together we have learned that we can’t trust managed care to improve the quality of medical care in Minnesota, and we shouldn’t expect this in the future. Our goal is to make managing care the task of doctors and patients. Check out our website at www.physician-patient.org. Please join us. ✦ Lee Beecher, M.D., is President of the Minnesota Physician-Patient Alliance. May/June 2001
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FEATURE STORY
Why the Minnesota Legislature Should Enact the
Fairness in Health Care Act: It’s the Right Thing for Patients
Editor’s Note: The articles on these two pages present two opposing views on the need for a Patient Protection Act.
The Fairness in Health Care Act …simply puts into place some straightforward procedural safeguards designed to reduce the disparities in bargaining power that currently exist between the health plans and patients.
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MANY MINNESOTA PATIENTS FACE an uneven playing field when attempting to obtain coverage from their health plan. The Fairness in Health Care Act (S.F. No. 796/ H.F. 868) sponsored by Attorney General Mike Hatch, Senator Don Samuelson (DBrainerd) and Representative Ron Abrams (R-Minnetonka) would help level these disparities by enacting procedural safeguards for the patient. Why is the Fairness in Health Care Act needed?
A July 2000 study by Princeton Survey Research Associates for Henry Kaiser Family Foundation and Consumer Reports revealed that 51 percent of consumers under age 65 experienced a problem with their health plan in the last year, 43 percent had moderate consequences (financial problems or change in health status), and 18 percent had serious consequences. Indeed, these types of concerns are echoed in the Attorney General’s lawsuit against Blue Cross and Blue Shield of Minnesota for denying medically necessary treatment for children and young adults suffering from eating disorders, mental illness and chemical dependency. The procedural safeguards contained in the Fairness in Health Care Act are also needed because of the unique nature of health insurance. Health insurance, unlike tangible goods or even financial products, is simply a promise. Patients pay premiums today with a promise that coverage will be provided sometime down the road — after the premiums are paid and after the patient becomes sick. To make things more complicated, in Minnesota three HMOs control more than 80 percent of the health care market. This type of market concentration has consequences. First, it makes it difficult for patients and employers purchasing health coverage to have meaningful choices or to change health plans if they become unsatisfied. Second, the health plans have considerable clout over physicians, because in many cases one-third or more of a physician’s income is derived from a single health plan. The Fairness in Health Care Act is not a mandated benefit bill. It does not require new coverages. Instead, it simply seeks to put in place some straightforward procedural (Continued on page 6) BY ANN BEIMDIEK KINSELLA
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May/June 2001
MetroDoctors
The Journal of the Hennepin and Ramsey Medical Societies
It’s Time for Congress to
Regulate Health Care
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AS THE MINNESOTA LEGISLATURE CONSIDERS additional regulation of the health care industry in the guise of “patient protection,” it’s necessary to be more informed than ever before. Read the papers or watch the news and you’re convinced managed care companies are looking for ways to deny every single claim. Never mind that in Minnesota disputes about health plan coverage are quite rare. Most claims are paid without question; 86 percent of Minnesotans are satisfied with their health plan, and fewer than a half of a percent of Minnesotans in HMOs file a complaint or appeal challenging a health plan decision. So, what’s behind all these “patient protection” proposals? Unfortunately, the real issues that affect the vast majority of consumers are complicated, technical, impersonal and very unsexy. On the other hand, disputes between patients and health plans, while rare, are much more interesting, personal and emotional, making them great topics for political rhetoric and “investigative” journalism. Because politicians and the media focus on anecdotal exceptions, many people have a distorted picture of reality and are unaware of the real issues behind the headlines. It is hard work to fully understand the real issues because you have to dig for the facts and seek balanced discussions of the issues. So what is the real issue?
The most important fact about health plan regulation is that Minnesota has a two-tiered regulatory system — one federal and one state. The State of Minnesota imposes the strongest, most comprehensive managed care regulations and patient protections in the country. Laws already on the books cover patient access to care, mandated benefits, confidentiality, enrollee disclosures, external medical review, grievances and appeals, management and organization structure, patient’s rights, premiums and rating practices, provider contracting, quality assurance and utilization review, reporting and solvency. The list goes on. Virtually every topic that comes up in state and national “patient protection” discussions is already addressed in Minnesota law. But, the majority of Minnesotans aren’t covered by the state’s health care laws because of federal exemptions. State laws apply only to “fully insured” coverage usually purchased by smaller employers, individuals and state health care programs. Most of the
… every time the Minnesota Legislature adds more “patient protection” laws, they protect fewer Minnesotans. This is why the focus of debate is shifting from state legislatures to the U.S. Congress. Only Congress can establish uniform protections for all patients .
(Continued on page 7) BY MICHAEL SCANDRETT
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The Journal of the Hennepin and Ramsey Medical Societies
May/June 2001
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Kinsella (Continued from page 4)
safeguards designed to reduce the disparities in bargaining power that currently exist between the health plans and patients. A summary of the legislation
Pre-authorizations Must Be Honored. If an HMO gives pre-authorization for treatment, it must honor that decision. Right now, a health plan can pre-approve treatment and then simply change its mind, for no reason, leaving patients on the hook for huge medical bills. No Retaliation. If a physician advocates for a patient’s treatment, or disagrees with a health plan’s treatment decision, health plans can’t retaliate against that physician. Right now, physicians and medical facilities may hesitate to stand up to a health plan for fear of losing their provider contract. This is particularly true in a highly consolidated market such as Minnesota’s. In addition, the bill prohibits retaliation against a physician that discloses concerns to the government or the HMO. Moreover, the bill provides that health plans cannot retaliate against patients who participate in utilization review, obtain a second opinion, or file a claim against the plan. Reviewers Must be Qualified. If a health plan uses a medical reviewer to second-guess a physician, the reviewer must be licensed in Minnesota and be board certified. The reviewer must also practice in the same or a similar specialty as the case they are reviewing. In addition, the medical reviewer must be available by telephone to discuss his or her decisions with the treating doctor or the patient.
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May/June 2001
Specialists Must Be Available. If a patient has a condition that needs a specialist, health plans must allow access to such specialists. If an appropriate specialist is not available in the health plan’s network, the patient must be allowed to go out-of-network at in-network rates. The bill also requires health plans to inform patients they have a right to a standing referral. Patients with long-term conditions do not have to continually go back to a “gatekeeper.” Medical Necessity With Certainty. The definition of “medical necessity” is one of the most important terms in a health policy. Yet, some health insurers define “medically necessary” care as “care that we, in our sole judgment and discretion, determine to be medically necessary based upon our internal standards and guidelines.” The plans then claim these “guidelines” are “trade secret.” It’s impossible for a patient to enforce the health plan’s promise to provide medically necessary care if the plan has the “sole” discretion to decide what that is, and if only the plan knows its “guidelines.” The bill puts an end to the secrecy and requires plans to reveal their guidelines. In addition, the bill adopts a standard definition of medical necessity and applies that definition to all health plans. Formularies Can’t Change Mid-stream. If a health plan establishes a drug formulary, and if it changes that formulary in the middle of the year, it can’t charge patients more for their prescriptions during that contract year. In addition, health plans must, upon request, disclose their formulary before the patient buys the policy. Court Ordered Treatment Must Be Provided. If a court orders mental health treatment, health plans must honor that order. CurMetroDoctors
rently, some health plans routinely deny coverage for court ordered treatment, unfairly shifting the cost to families and taxpayers. Health Plans Accountable. If a health plan is going to practice medicine and make a treatment decision, it should be held accountable when its actions harm a patient. In 39 other states insurance companies can be sued in court for “bad faith” actions. However, under current Minnesota law, health plans cannot be held accountable. The bill provides that, when certain conditions are met, a claim can be filed against a health plan. First, a physician must determine treatment is medically necessary. Second, the health plan must interfere and make its own treatment decision. Third, in making its treatment decision, the health plan must deviate from an ordinary standard of care. Fourth, the patient must prove the health plan’s actions caused them harm. Fifth, the patient must exhaust the external review process available under state law. The health plans seem to want it both ways. On one hand, they claim not to practice medicine. On the other hand, they don’t want to be held accountable if they do practice medicine. This provision simply puts health plans in line with other professions. Doctors, lawyers, architects and others can be sued for negligence or malpractice. Yet, health plans operate with immunity. When a health plan practices medicine, it should be accountable. The health plans are opposed to these measures. They claim patients are satisfied and that Minnesota has plenty of laws that address these problems. Yet, as explained above, patients aren’t satisfied and current law is not adequate. They also claim the changes would not impact consumers in so-called “self-insured” plans. However, a (Continued on page 7)
The Journal of the Hennepin and Ramsey Medical Societies
Kinsella
Scandrett
(Continued from page 6)
(Continued from page 5)
number of the provisions would apply to self-insured plans. And, HMOs oppose accountability proposals on the federal level as well, even though those proposals would clearly apply to all patients. The health plans also erroneously claim the legislation will cost too much. In fact, many changes simply require disclosure — of the right to a standing referral, of the guidelines used to make treatment decisions, or of the drug formulary, for example. Other provisions just require health plans to stick with their original decision — for pre-authorization or to cover certain drugs, for example. Still other provisions just require fairness, like prohibiting retaliation and requiring that a medical reviewer be available to the patient. The bill also requires HMOs to keep up their end of the bargain — they should cover court ordered treatment and they should offer access to specialists. And health plan accountability will still allow health plans to control costs, just not at the expense of the patient. The New York Times reported that the first year Texans had the right to sue, the increase in premiums was just 0.1 percent and there has not been an onslaught of lawsuits in Texas. In short, none of the health plan arguments overcome the serious imbalance of power in the current health care equation. The Fairness in Health Care Act is a common sense way to level the playing field and should be enacted. ✦
people in the state are exempt from these laws under various federal laws, including ERISA law that exempts large, self-insured employers from state insurance regulations. Although many of these people carry a health insurance card from a local HMO or health plan, the company is simply hired by the larger employer or union group to do the administrative work. State patient protections do not apply. To make things even more complicated, the high level of state regulation and mandated benefits (and the higher costs that inevitably go with it) create an incentive for employers to switch to federally exempt health plans. As more state regulations are added, more employers make the switch. The past decade has seen a dramatic shift of the state’s population from stateregulated to federally exempt plans. So, ironically, every time the Minnesota Legislature adds more “patient protection” laws, they protect fewer Minnesotans. This is why the focus of debate is shifting from state legislatures to the U.S. Congress. Only Congress can establish uniform protections for all patients.
Ann Beimdiek Kinsella is an Assistant Attorney General and the manager of the Attorney General’s health division. Prior to managing the health division, Ms. Kinsella was a member of the Attorney General’s antitrust division.
MetroDoctors
A word about health plan denials: what would you do?
In contrast to today’s popular rhetoric, I strongly believe health plans should not cover every request for treatment. Studies have found disturbing problems in American health care. Our country pays more for health care and has poorer outcomes than other countries. Why? We have not held our system accountable for providing high quality care in an efficient manner. This is changing, but we have a long way to go. Sometimes health plans should deny coverage. Sometimes an alternative treatment is of higher quality or an alternative is as effective, but less expensive. Some-
The Journal of the Hennepin and Ramsey Medical Societies
times, the requested treatment is unproven, experimental, or even harmful. Sometimes the patient has chosen to purchase lower cost coverage, which excludes the requested treatment or preferred provider. The truth is, when a health plan denies coverage there is usually a good reason. A recent New York Times article on early stage breast cancer treatment outlined the challenges health plans face. A physician requests approval of a radical mastectomy. The request is contrary to the National Institute of Health best practices guideline of breast conserving surgery rather than radical mastectomy, and this particular physician’s mastectomy rate is ten times the regional average. Across the United States, there is 33-fold regional variation in physicians’ rates of radical mastectomy for early stage breast cancer and more than 60 percent of physicians are not using best medical practices. What is “patient protection” in the case of a patient who may be the victim of an unnecessary radical mastectomy? Of course, we need strong laws to ensure that denials are appropriate and fair. Fully insured patients in Minnesota have four options in challenging denials: • A state mandated internal appeal system; • An appeal to state regulators; • An independent medical review; and • A lawsuit to compel payments for needed services. The first three options ensure patients receive the care they need at the time they need it. The third option, a lawsuit, takes much longer but can be a way of recovering payments after medical services have already been delivered. Only Congress can give the answers
Uniform protections are needed — something only the U. S. Congress can accom(Continued on page 8)
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Scandrett (Continued from page 7)
plish. Minnesota’s health plans are in support of the enactment of national patient protections that: • Hold all players accountable for quality and cost-effectiveness; • Call for qualified physicians to make coverage decisions that require medical judgment; • Give patients several legal options, including an external medical review; • Resolve disputes at the time treatment is needed; • Do not drive up costs; and • Keep all health policy priorities in mind: access, affordability and quality. There is always room for improvement, but Minnesotans are well-served today by a health care system that leads the nation in access to health coverage, quality of care, prevention, and consumer satisfaction. Minnesota’s sophisticated managed care system is an important reason for all of these positive outcomes. Minnesotans should be wary of proposals that could quickly undo the progress Minnesota has made in cost, quality and access. Minnesota already has the strongest patient protections. More state regulations will not benefit consumers but will further drive up premiums, cause some employers to drop coverage altogether, and cause others to switch to ERISA plans. What can you do?
Keep abreast of research and best practices so that health plan review is less of an issue. Learn how managed care works and be an effective advocate for patients. Take a moment to look behind the rhetoric for the facts. And help keep quality health care affordable for all. ✦ Michael Scandrett is the Executive Director for the Minnesota Council of Health Plans. 8
May/June 2001
History of Minnesota’s Major HMO “Patient Protection” Laws 1973 “Health Maintenance Act of 1973.” Authorized formation of HMOs and established regulations governing covered services, disclosures to enrollees, financial solvency, patient confidentiality, consumer complaint procedures. 1984 Health plan patient protections and regulations. Contained amendments to HMO laws and added topics such as maternity and newborn coverage, second opinions for mental health and chemical dependency, consumer disclosures. 1988 HMO enrollee “Bill of Rights” and other regulations. Established a comprehensive “bill of rights.” Also established regulations on referrals to specialists, prior authorizations and second opinions, coverage of emergency care, appeal rights, right to sue. 1990 Health plan patient protections and regulations. Added regulations and required reports, strengthened solvency protections, expanded complaint and appeal rights and time limits, established new penalties and regulatory powers. 1992 “MN Utilization Review Act of 1992.” Imposed requirements on “utilization review” activities of HMOs and other health plans, created new regulations on appeals, confidentiality, quality assessment, financial incentives. 1994 Health plan patient protections and regulations. Required HMOs to submit additional action plans and reports, added regulations for denials of services, mandated expanded access to allied providers, required HMOs to participate in government programs. Also included insurance reforms to improve access and placed limits on premium rates. 1995 Health plan patient protections and regulations. Required health plans to use alternative dispute resolution, required parity for mental health and chemical dependency benefits. 1997 “Patient Protection Act of 1997.” Prohibited “gag clauses” and retaliation, required disclosure of provider reimbursement, required plain language billing and prohibited exclusive contracting. Also established new regulations on coverage of emergency care, continuity of care when a person’s health plan changes, standing referrals to specialists, disclosure of executive compensation. 1998 Health plan patient protections and regulations. Further amended laws relating to gag clauses, disclosure of provider reimbursement, alternative dispute resolution. 1999 Health plan patient protections and regulations. Established tighter standards for geographic access to providers and established new requirements for consumer complaints and appeals, including the creation of an external independent review process. ✦
MetroDoctors
The Journal of the Hennepin and Ramsey Medical Societies
MPPA Executive Summary– How Contracts Between Health Plans and Doctors Influence the Quality of Medical Care and Patient Privacy
Editor’s Note: The Executive Committees of the Hennepin Medical Society and the Ramsey Medical Society reviewed the report, “How Contracts Between Health Plans and Doctors Influence the Quality of Medical Care and Patient Privacy,” and supports the work of the Minnesota Physician-Patient Alliance (MPPA) as the beginning of a dialogue about the issues raised in the report. An Executive Summary of this document is reprinted below for your information. MPPA has developed a number of recommendations in response to their findings. As this edition goes to press, these recommendations have not been endorsed by HMS or RMS. However, the recommendations are printed here for your information and may spur further attention. A copy of the full report can be downloaded from the MPPA web site at www.physicianpatient.org or contact Kathy Dittmer at HMS (612/623-2885) or Stephanie Stanton at RMS (612/362-3706) for a copy to be mailed to you.
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THE MINNESOTA Physician-Patient Alliance
(MPPA), a nonprofit, physician and health care consumer organization, was founded three years ago for the primary purpose of returning to physicians and patients the authority taken from them by the insurance industry. The MPPA Board of Directors includes: Lee Beecher, M.D., President; Al Anderson, M.D., Secretary-Treasurer; Ted Fritsche, M.D.; Robert Geist, M.D.; Robert Milavetz, J.D.; Ed Spenny, M.D.; and Kip Sullivan, J.D. MPPA undertook the compilation of this report, “How Contracts Between Health Plans and Doctors Influence the Quality of Medical Care and Patient Privacy,” to help the public BY LEE BEECHER, M.D. A N D K I P S U L L I VA N , J . D .
MetroDoctors
understand how managed care organizations have usurped physician-patient authority over medical decision making. It examines in great detail Minnesota health plan-physician contracts from Blue Cross and Blue Shield of Minnesota, BluePlus, HealthPartners, Medica, and PreferredOne. The contracts from these five plans were selected because together they have controlled 80 percent of the Minnesota health insurance market since 1994. The report (as opposed to the long appendices) is easy to digest, and we urge every physician practicing in Minnesota to read it. We believe all but the most lawyerly of doctors will find something in the report to be surprised about, and all readers of the report should be concerned by its findings. That was our reaction. We found many provisions in these contracts designed to strengthen the hand of the plans at the expense of the doctors and patients. Because of MPPA’s emphasis on the physician-patient relationship, we focused our examination of the contracts on those provisions that affect quality of medical care and privacy of patient records. We ignored numerous provisions in the contracts that did not clearly and directly affect quality and privacy. The report examined these nine categories of contract clauses which: (1) with little or no regard for the health status of the doctor’s patients, entitle doctors to earn more money if they order fewer medical services and which obligate them to earn less money if they order more medical services; (2) permit health insurance companies to terminate contracts with doctors without having to give an explanation; (3) allow health insurance companies to
The Journal of the Hennepin and Ramsey Medical Societies
(4)
(5)
(6)
(7)
(8)
(9)
•
•
change unilaterally the terms of the contract with doctors in the future after it is signed; obligate doctors to follow rules and policies affecting quality of care promulgated by the insurance company, but defining these rules and policies poorly or not at all; give health insurance companies control or influence over physician referrals, admissions, and prescriptions; limit or eliminate the company’s liability in the event that doctors are alleged to provide inferior medical care in whole or in part because of the financial incentives, rules, policies or behavior of health plan company employees; discourage doctors from discussing relevant matters with their patients or the public at large (gag clauses); offer vague descriptions of the process a doctor may follow in the event the doctor wants to challenge a decision by a health insurance company to deny medical care to a patient or, in some cases, no description at all; obligate the doctor to turn patient medical records over to the health insurance company whether the patient approves or not. We examined these five contracts: Blue Cross and Blue Shield of Minnesota (BCBSM) Aware Agreement, effective July 1, 1999; BluePlus Primary Care Clinic Provider Service Agreement, effective January 1, 2001;
(Continued on page 10)
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MPPA (Continued from page 9)
•
HealthPartners Referral Provider Agreement, effective March 15, 1999; • Medica Self-Insured Associate Clinic Participation Agreement, effective February 1, 1999; • PreferredOne Workers’ Compensation Provider Agreement, effective January 1, 2000. The report does not claim, and we do not claim here, that these five contracts are representative of all contracts issued by these plans. We selected these contracts because they were the most recent of the contracts examined by the HMS and RMS medical societies as part of their ongoing health plan contract analysis project. Each of the nine types of clauses, along with the recommendations of the MPPA Board for dealing with the problems created by these clauses, are discussed in the report (available on the website). The recommendations rely heavily on legislative actions.
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Risk-Sharing Risk-sharing requirements were found in two of the five contracts. Risk-sharing means that physicians benefit financially when less treatment is provided. Virtually all experts agree that risk sharing payment methods that are not adjusted to reflect the health status of patients seen by particular doctors or clinics put great pressure on the physicians who see sick patients to deny services to them. Adjusting payment methods to reflect patient health is known as “risk adjustment.” One study cited in the report found that the value of medical services actually provided to patients by a primary care “group” ranged from $3 per member per month to $27. However, the study found that the doctors in this group were paid $10 to $12 per member per month. Obviously, the doctors seeing the $20 and $25 patients were under great pressure to reduce services to these patients. Neither of the two contracts that required risksharing obligated the plans to risk-adjust those payments. MPPA Recommendation: We believe risk-sharing without risk adjustment poses such a serious threat to quality of care that the Legislature should declare such provisions illegal and, until then, physicians should seek to strike such provisions from their contracts. Contract Termination All five of the contracts examined allow the insurers to terminate physicians with no explanation. This exposes doctors to the risk that they will be unable to explain to other health insurance companies why they were terminated. This fact gives the insurers leverage over doctors that doctors do not have over insurers. MPPA Recommendation: We recommend that the Legislature prohibit clauses that authorize plans to terminate physicians without good cause and without an explanation. Contract Modifications All five contracts contain clauses giving the companies the authority to change the contract after the contract has been signed. Two of these contracts give the physician the right to veto the amendments, but we could not determine whether these “right to veto” clauses take preceMetroDoctors
dence over numerous other clauses authorizing unilateral amendments by the health insurance companies. MPPA Recommendation: We recommend that the Legislature outlaw such clauses, and we urge physicians to insist that all documents cited in the contracts they sign be attached to the contracts. Contract Terminology All five contracts contain vague terminology designed to enhance the power of the health insurance company at the expense of the doctor. For example, the BluePlus contract requires clinics to “comply with all rules and regulations, quality improvement, care management, and utilization review requirements and procedures established by BluePlus from time to time, including but not limited to” a list of five vaguely defined programs. MPPA Recommendation: We recommend that the Legislature pass legislation that: (a) prohibits plans from placing in their contracts clauses that require physicians to treat the contract as a secret; (b) authorizes the Departments of Health and/or Commerce to publish all plan-provider contracts on a regular basis; and (c) requires managed care organizations to file annual reports with a state agency describing in detail the programs most commonly cited in their contracts, notably, “quality assurance” and “utilization review” programs, as well as all practice guidelines relied upon by the plan to make medical necessity decisions. Referrals, Admissions, and Prescriptions All five contracts give the insurance companies considerable influence over admissions and referrals, and some mention drug prescribing as well. MPPA Recommendation: We recommend that legislation be developed and passed that requires all plans to file reports annually with an appropriate state agency describing any guidelines or evidence they rely on to decide whether to allow a referral or an admission, all evidence relevant to a decision not to include a drug in a formulary or in a favored tier formulary, and discounts and rebates to hospitals and drug manufacturers that do business with the plan. The legislation should require that The Journal of the Hennepin and Ramsey Medical Societies
the state agency that receives this information must publish it. We also favor full public internet disclosure of all health plan formulary drugs, patient co-payments, and formulary override rules. Liability All five contracts go to considerable lengths to place all responsibility for the quality of medical care delivered to patients on the doctor and to insulate the insurers from any legal liability. Clauses in some of these contracts even obligate the doctor to concede in advance that nothing the health insurance company might do could possibly influence the doctor’s behavior. MPPA Recommendation: We recommend that such clauses be outlawed by legislation, and that the Legislature should enact SF 414 introduced this year and supported by the MMA which amends the current utilization review statute to require that physicians who conduct UR “must be licensed in the state and must be currently practicing in the same specialty as the physician who is ordering care.”
at all. This is an example of an issue discussed by the AMA in its Model Contract. MPPA Recommendation: We endorse the AMA’s call for clear contractual provisions describing how physicians may appeal any decision the physician believes is adverse to the patient’s interest. We go beyond the AMA’s recommendations and recommend clauses that require the plan to turn over to the physician all guidelines, studies and other evidence the plan relied on in reaching the disputed decision. Because this solution seems so obviously justifiable, we think this solution may be achievable in negotiations between physicians and plans. Release of Medical Records All five contracts contain abundant language authorizing plans to demand patient records from doctors. Only two of the contracts mention patient consent, and these two place the burden of extracting consent on the doctor. Minnesota already has a law on the books that prohibits the release of medical records without patient consent.
“Gag Clauses” All five contracts obligate doctors not to talk about broadly and poorly defined topics. HealthPartners’ contract, for example, states that the doctor may not discuss “all information relating to the operations of HPI (HealthPartners, Inc.).” To take another example, the list of subjects in the PreferredOne contract that physicians may not discuss is long, and includes vague phrases such as “methods, systems, practices or plans.” MPPA Recommendation: We recommend that legislation be created that prohibits “gag clauses” that cover anything except information about patients and plan enrollees. There is simply no public interest served by clauses which prevent physicians from talking about how managed care organizations pay physicians, how they decide what drug will be on a formulary, how they make “medical necessity” decisions, how they develop guidelines, etc. Appeal Process None of the contracts describe in sufficient detail their processes for hearing physician objections to decisions by insurance companies not to authorize a service, and three offer no detail MetroDoctors
The Journal of the Hennepin and Ramsey Medical Societies
MPPA Recommendation: We recommend an investigation by the Legislature to answer the question: Is the current law being honored and, if not, what role do planphysician contracts play in violating the law? The complete report, “How Contracts Between Health Plans and Doctors Influence the Quality of Medical Care and Patient Privacy,” can be downloaded from the MPPA web site at www.physician-patient.org, or, for a hard copy, please contact: Kathy Dittmer, Hennepin Medical Society, (612) 623-2885, email: kdittmer@mnmed.org; or Stephanie Stanton, Ramsey Medical Society, (612) 362-3706, email: sstanton@mnmed.org. ✦ Lee Beecher, M.D. is president of MPPA, a west metro MMA trustee, and a psychiatrist in Saint Louis Park. Kip Sullivan, J.D., is a graduate of Harvard Law School and the author of nearly 100 articles about health policy. He has published in the NEJM, Health Affairs, the Am J. Pub Health, the NY Times, the LA Times, Minnesota Physician, the Pioneer Press, and the Star Tribune.
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May/June 2001
11
COLLEAGUE INTERVIEW
Kent Neff, M.D. Editor’s Note: “Colleague Interview” provides HMS and RMS members with an opportunity to ask questions of their colleagues who are in unique roles. In this issue, interview questions were asked by Drs.: Bruce Adams, William Petersen, Michael Tedford, Deane Manolis, Ann Lowry and Kathy Sweetman.
Q A
How did you become interested in physician stress? My first work after residency was to develop a psychiatric program in a large private urban teaching hospital, and I was the only psychiatrist with an office in the hospital. So many physicians and family members were referred for evaluation and treatment. And I was asked to consult regarding physicians with disruptive behavior, alcoholism, and the like. Eventually the medical association asked me to establish a Physicians Assistance Program, and physician stress became a major interest.
What are common behavior problems you see in physicians? How do you address them? One of the most common behavioral problems currently seen in physicians is a competent, often excellent, highly productive physician with very high standards who strives for perfection but does not treat others kindly in the process. He or she means well, but the behavior is harsh and disrespectful. And the doctor has little realization of the negative effects his behavior has upon others around him. Another common problem is inappropriate outbursts of anger toward nurses and even patients when the doctor is under stress. There are several key aspects to addressing these problems. First, it is important to have a fairly low threshold of tolerance for this kind of behavior. Second, separate the behavior from the person. Be hard on the behavior, but respectful toward the individual. Third, don’t let it continue. Intervene, preferably with several colleagues, and tell the individual that you value him but that his behavior is unacceptable. Fourth, be willing to set limits and apply consequences when the behavior does not change. Finally, provide support to the physician during the rehabilitation process. It is very important to give the physician a reasonable opportunity to change his behavior and allow him to return to work when he makes needed changes.
What are the most effective ways to support staff members (M.D./Non M.D.) who must interact with a disruptive physician? One of the best ways to support those who must deal with these behavioral problems is to adopt a written behavioral standard for workplace 12
May/June 2001
behavior. One I have used is called the “Principles of Partnership,” and describes the rationale for insisting upon respectful behavior in the workplace. This is helpful in alerting physicians to the fact that all our behavior, not just the clinical part, is important.
Given a workplace where endemic abuse is ignored or perpetrated by those in high level positions (often physicians), have you any knowledge of successful initiatives by individuals or groups at the bottom or middle of the hierarchy? Short of leaving, how do you advise people to handle these situations? It has been my experience that these people are at risk of being labeled “disruptive.” There is a lot more that individuals at all levels of the hierarchy can do than is generally appreciated. Empowerment of all workers is one of the keys to success. An empowered worker can set limits much better right on the spot. Physicians will often respond to these limits and improve their behavior. I recall many experienced nurses who were never treated poorly — they simply carried themselves in a manner that commanded respect. We are seeing increasing numbers of workers who, when subjected to behavior they considered abusive, are filing harassment claims with the hospital. There is considerable liability for both hospitals and medical groups when this occurs.
What tactics have you found to be most successful in addressing problems of drug and alcohol abuse in physicians? Alcoholism and drug addiction remain common among physicians. They are highly treatable and have a very good prognosis. The great majority of physicians with these illnesses can be successfully rehabilitated and return to a productive life. Key elements in success include the following: First, ongoing education of physicians and staff about the signs and symptoms MetroDoctors
The Journal of the Hennepin and Ramsey Medical Societies
as well as the good prognosis. It is critical that the organization have a truly rehabilitative orientation, so everyone knows that physicians are valued and every effort will be made to support the physician in his rehabilitation. Second, the process must be fully confidential at all levels. Third, it is important to develop written policies and procedures that reflect these positive attitudes, but set limits on inappropriate behavior. Defining clear limits on the use of alcohol and drugs in the context of practice is helpful. Also, having the right to request a body fluid specimen for cause when the physician shows signs of intoxication is very important. I do not like random drug testing at all, except in a physician who is a known addict and is being monitored. Fourth, prompt intervention by a group of concerned physician colleagues who insist on appropriate evaluation and treatment. Fifth, these physicians must be carefully monitored to insure that they remain safe to practice. Such monitoring is not usually a problem if it is planned for in advance. In addition, setting up a Physicians Assistance Committee (PAC) in your medical group or hospital can have a very positive effect on identifying, intervening with, and monitoring these physicians. Such a committee would consist of respected, experienced physicians representing different specialties who would be expected to develop expertise in dealing with these problems. Having several recovering alcoholic physicians on the committee is critical if they can be identified. These physicians can be powerful motivators for physicians in difficulty.
A violation of professional boundaries is devastating to not only the patient(s), but to the physician and the medical community as well. How do you effectively counsel a physician who has been accused and/or convicted of such activities? The area of professional boundary violations is very important and highly complex. Such violations are much more common than is generally realized. It is often not possible to tell how serious the problem is from the nature of the boundary transgression. Again, a firm, yet rehabilitative approach works best. In terms of counseling the physician accused of such activities, I like to tell him that being honest about what happened and making an open inquiry into what made him vulnerable for the problem behaviors are essential. Not only are the roots of such behavior usually chronic conditions, the same roots lead to increased distress and unhappiness. Often these boundary violations are “red flags,” which indicate other unresolved, painful personal issues. Without appropriate treatment, the problem behaviors may well recur, despite the physician’s best intentions. With good treatment and monitoring, a majority of such physicians, in my experience, can return safely to practice. And, remarkably, these rehabilitated physicians and their spouses often report that their lives have substantially improved, personally, as well as professionally.
How are patients/physicians usually referred to you, and what resources can you recommend for physicians who need evaluation? Physician patients are both self-referred and referred by colleagues in positions of leadership, with the latter being more frequent. Physicians whose
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The Journal of the Hennepin and Ramsey Medical Societies
behavior is problematic are often the last to recognize how serious a problem it has become.There are two programs in the midwest which evaluate physicians with behavior problems: Rush Behavioral in DuPage, Illinois, and the Menninger Clinic, in Topeka, Kansas.
With the JCAHO requirement that hospital medical staffs have a method to determine how to deal with physician health issues, what advice can you give medical staff leaders? Take the long view. Be proactive and positive rather than punitive. Develop a program that will be helpful to physicians in addressing a widerange of behavioral, mental, emotional, stress, and physical issues that are really just part of the human condition. Support them in the rehabilitation process.
Can you give us your thoughts on the basic Hippocratic Oath and how this relates to the impaired physician? This is a significant issue. We often cut way too many corners with colleague physicians when they come for help. It is important to convey a truly nonjudgmental, accepting attitude when colleagues give signals that they might need psychiatric help. Insist that they receive care in an appropriate medical setting, communicating the message that they are too valuable to receive less than optimum care. It is also critical to give the doctor permission to be sick when that is appropriate, and to allow himself to be taken care of. Usually this means being assertive and directive with the physician patient. I have seen numerous physicians who needed a brief medical leave, but who were continuing to try to take care of their patients — when they were just barely able to hang on themselves. It is very difficult, as you know, for many physicians to be in the patient role. Remember that, at some point, patient care may be compromised — the last thing that the physician wants to happen.
Any thoughts on helping physicians accept need for psychiatric consultation/care, rather than “curbstone consults?” We need to pay more attention to the important role of grief in medical practice. We see physicians with extraordinary levels of unresolved grief — some related to professional life, and some, personal. Physicians often tend to continue to move forward without stopping to address their own grief and losses. It piles up and can cause serious problems for the doctor. Some specialties, oncology, for example, are particularly difficult in terms of the cumulative losses they present to the physician.
Please feel free to make any additional comments. These are extraordinarily difficult times for physicians. Distress is rampant. Many physicians are working far beyond sustainable levels and enjoying it less and less. The joy of practice is gone for many of our colleagues. I think it is time that we as a profession begin addressing these problems in a more aggressive and proactive manner. No one else will do it for us. ✦
May/June 2001
13
Building New Foundations — Surviving and Thriving Inside Corporate Medicine Editor’s Note: The following is a follow-up to an article that appeared in the March/April issue of MetroDoctors on physicians leaving large groups for independent practice.
D
DOCTORS CHOOSING independent practices are often seeking personal freedom and professional autonomy. Doctors choosing large health systems and medical groups have other reasons in mind. I recently talked with five doctors who have either joined or sold their practices to large systems and groups.
Decisions are Both Financial and Personal Conventional wisdom in the Twin Cities says that by the mid-1990s independent practices became endangered species. The burden of juggling practice demands, absorbing rent increases and satisfying staff salary demands were more than most doctors could bear. “We sold out when office overhead hit 70 percent and we could not make our base-income,” recounted Doug Godfrey, M.D., Allina Medical Group. Jim Giefer, M.D., HealthEast Internal Medicine, added, “We were concerned that in a few years the value of our practice, the opportunity to be compensated for our equity, would be gone.” By the mid-1990s most practices had negotiated a sale to a health system or large group in exchange for cash and income guarantees. The once hot market for practice purchases went cold just after that. Not all decisions about practice setting are driven by economics. Matt Layman, M.D., Twin Cities Anesthesia, PA, recently moved to St. Paul from Bismarck, North Dakota. “Bismarck is a fine place to live but we wanted to be closer to our families and live in a larger metropolitan area.” For Layman, joining a large anesthesia group opened up new professional opBY BOB THOMPSON
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portunities. Charles Terzian, M.D., United Hospital, talked about personal priorities. “My choice was definitely tied to family. I wanted regular hours and a shorter commute so I could spend more time with our new daughter. My wife is in a sales position at a major corporation and travels frequently, so I needed to be home more.” It is Different and It can be Better No one I spoke to is practicing at a leisurely pace. “We put in the same amount of time but see more patients,” Godfrey noted. “Making your numbers means shorter contact times; a 20-minute level-3 visit is now 15 minutes, a 60minute physical exam is 45 minutes.” Len Parsons, M.D., Park Nicollet Clinic, mentioned “I haven’t personally changed as a physician but there’s no question my practice style has been ‘morphed’ by corporate rules.” Or as Godfrey said, “I make a point of ignoring rules that I don’t believe make sense for good patient care.” But there are subtle pressures on physicians to change their practice profile. “System executives talk to us family practitioners about high volume, high margin services and how obstetrics is not worth our time,” Parson commented. Trying to keep up with a traditional office practice takes its toll in other ways. “Whenever a hospitalized patient took a bad turn I was really torn,” said Terzian. “Did I drop everything or stay at the office and maintain my schedule?” The increasingly “helpless feeling that came from not being able to do it all” pushed Terzian toward his new career as a full-time hospitalist. “I miss office practice, the ongoing contact with patients,” he said, adding, “and I miss small things like talking with pharmaceutical representatives about new medications.” Adjusting to Reality of Corporate Medicine Economics may be a primary reason for giving up an independent practice but, “you have to MetroDoctors
understand,” Godfrey emphasized, “that operating costs in big groups and systems are not lower — you work at a faster pace to make up for higher overhead and you don’t give free services or extras.” The culture of a big group or system can be a shock. “You will be a provider number and your patient will be a chart — be ready to live with that,” Parsons warned. Working as a staff physician is different but as Terzian remarked, “Sure you lose autonomy but you’re not managing daily headaches like regulations, reimbursement and recruiting.” The transition may be toughest for physicians in their peak practice years and who have been accustomed to independence. “They know what they’re giving up and they know they can’t retire soon,” Layman observed. The hierarchy, meetings and memos that seem to define corporate medicine create their own stresses. “Going from running my own show to being an employee was a challenge for me,” admitted Parsons. The relative stability and security of a big system means giving up freedom and authority. “We don’t decide who’s hired or fired, and losing a valued employee is frustrating because we can’t change the conditions that led to their departure,” Godfrey observed. Know What You Want and Care About Negotiate the best possible terms at the front end several stressed. “Don’t assume you can bargain for better terms once you’re hired,” Layman cautioned and then suggested, “Ask yourself what you want from your practice and your career.” A decision to join a system or large group can be a step backward or a step forward. “If you’re a partner, the authority and seniority you’ve built up in your group disappears.” Godfrey looked back on his decision and concluded, “Personally, I’d make the same choice today because conditions haven’t changed.” Giefer echoed that thought saying, “I’m conThe Journal of the Hennepin and Ramsey Medical Societies
tent — it was the right choice for me at that time — maybe I could have hung on but the headaches would have been a huge distraction from my patient care.” Giefer added, “My advice is to stay independent if you’re satisfied with your income and can live with the hassles of practice management.” Recent graduates don’t have to make that emotional and financial adjustment. “They haven’t had the experience of practicing in traditional, independent settings,” Giefer said. The newest generations of physicians may be more idealistic; that is more focused on medical practice and less on medical economics. “Older physicians certainly derive great satisfaction from caring for patients but the considerable financial rewards so prominent 20 and 30 years ago undoubtedly influenced who chose medical careers.” Rebuilding the Practice of Medicine The next 15 years are expected to be about absorbing the changes of the past 15 years and building a foundation for corporate medical care. “I expect to see greater use of extenders,” Godfrey predicted, “with the doctor functioning as team leader and consultant.” Terzian suggested “Segmentation by the type of patient and along the continuum of care will increase while information technology will overcome the fragmentation that we see now.” Yet to develop adequately among corporate medical practices are concepts like professional growth and career tracks. “Primary care today looks like a dead-end profession,” Godfrey said, “when you compare the up-front personal investments with the probable lifetime earnings.” Terzian believes younger physicians are thinking strategically about career plans and have definite professional and personal goals in mind. Some Ominous Prospects “Niches for nimble, independent practices still exist in the Twin Cities but options for primary care practices are dwindling fast,” Parsons believes. Doctors will not come to or stay in a region with a heavy-handed managed care environment. “We’re headed for serious physician shortages in the Twin Cities simply because our practice environment doesn’t attract or keep doctors with better options,” Giefer maintains. Layman asked, “If we lose many of our best senior physicians to early retirement who will mentor younger doctors?” A recent transplant to the Twin Cities, he remains shocked by the cumulative effects of consolidation and cutbacks. In contrast, he said, “Bismarck doctors retain a strong sense of community identity and MetroDoctors
responsibility.” He is surprised at how much he misses the deep sense of mission expressed at St. Alexius Medical Center in Bismarck. “Call me an idealist,” he declares, “but I want to do something about the professional apathy that I sense in the Twin Cities.” Reclaiming a Future with Purpose Can an older generation of doctors rally together to show the younger generation that there is a
better way? Layman believes “we must begin a movement that puts back into medicine a stronger sense of purpose and excitement.” ✦ Bob Thompson is an independent hospital and physician consultant. Bob has worked across the U.S. enabling doctors, hospitals and large systems to improve their performance and regain their sense of purpose. He can be reached at www. rthompson 111@earthlink.net, or 952/929-7270.
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The Journal of the Hennepin and Ramsey Medical Societies
ainerdmedicalcenter
May/June 2001
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American Medical Association Principles of Medical Ethics Editor’s Note: The Principles of Medical Ethics are under consideration and will be reviewed by the AMA House of Delegates, June 2001. Please go the AMA’s web site for details pertaining to the proposed revisions. www.ama-assn.org/ CEJA. Future issues of MetroDoctors will include further decscription of the Code of Medical Ethics.
Preamble: The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility not only to patients, but also to society, to other health professionals, and to self. The following Principles adopted by the American Medical Association are not laws, but stan-
dards of conduct which define the essentials of honorable behavior for the physician. I. A physician shall be dedicated to providing competent medical service with compassion and respect for human dignity. II. A physician shall deal honestly with patients and colleagues, and strive to expose those physicians deficient in character or competence, or who engage in fraud or deception. III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient. IV. A physician shall respect the rights of patients, of colleagues, and of other health professionals, and shall safeguard patient confidences within the constraints of the law. V. A physician shall continue to study, apply and advance scientific knowledge, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated. VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical services. VII. A physician shall recognize a responsibility to participate in activities contributing to an improved community. ✦ Source: Code of Medical Ethics, American Medical Association, © 2000.
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MetroDoctors
The Journal of the Hennepin and Ramsey Medical Societies
Fundamental Elements of the Patient-Physician Relationship
F
FROM ANCIENT TIMES, physicians have rec-
ognized that the health and well-being of patients depends upon a collaborative effort between physician and patient. Patients share with physicians the responsibility for their own health care. The patient-physician relationship is of greatest benefit to patients when they bring medical problems to the attention of their physicians in a timely fashion, provide information about their medical condition to the best of their ability, and work with their physicians in a mutually respectful alliance. Physicians can best contribute to this alliance by serving as their patients’ advocate and by fostering these rights: 1. The patient has the right to receive information from physicians and to discuss the benefits, risks, and costs of appropriate treatment alternatives. Patients should receive guidance from their physicians as to the optimal course of action. Patients are also entitled to obtain copies or summaries of their medical records, to have their questions answered, to be advised of potential conflicts of interest that their physicians might have, and to receive independent professional opinions.
law or by the need to protect the welfare of the individual or the public interest. 5. The patient has the right to continuity of health care. The physician has an obligation to cooperate in the coordination of medically indicated care with other health care providers treating the patient. The physician may not discontinue treatment of a patient as long as further treatment is medically indicated, without giving the patient reasonable assistance and sufficient opportunity to make alternative arrangements for care.
6. The patient has a basic right to have available adequate health care. Physicians, along with the rest of society, should continue to work toward this goal. Fulfillment of this right is dependent on society providing resources so that no patient is deprived of necessary care because of an inability to pay for the care. Physicians should continue their traditional assumption of a part of the responsibility for the medical care of those who cannot afford essential health care. Physicians should advocate for patients in dealing with third parties when appropriate. ✦ Source: Code of Medical Ethics, American Medical Association, © 2000.
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May/June 2001
17
Hospital Bed Capacity Issue Gets Attention of Legislators
U
UNDER THE AUSPICES of the Metropolitan Hospital Physician Leadership Committee, 16 physicians gathered at the State Capitol for a hearing before Senators John Hottinger and Sheila Kiscaiden, and Representatives Jim Abeler and Fran Bradley on February 27. Virginia Lupo, M.D., HMS Chair, and Robert Moravec, M.D., RMS President, framed the purpose of the meeting as an opportunity to present the concerns of the medical community about the loss of 1,200 nursing home beds in the metropolitan area in the past year, the recommended closure of more nursing home beds by the Minnesota Department of Human Services, the increasing length of stays in hospitals caused by the nursing home bed shortage, and the capacity limits of hospitals and nursing homes due to the shortage of nurses and other personnel. The physicians had an opportunity to describe situations of ambulance diversions from a hospital “closed” due to the lack of capacity in the emergency room, which may be as a result of no in-patient beds available in the hospital. No availability of nursing home beds has contributed to this “capacity crunch,” which in addition to providing long-term care for patients in need, also serve as short-term rehabilitative
Representative Fran Bradley and Senator Sheila Kiscaiden.
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institutions. The shortage of nurses and other personnel was additionally credited with the inability to staff licensed beds at both hospitals and nursing homes. Another area of concern expressed was for the possible risk of decreased quality of care when emergency rooms are forced to serve as intensive care units, and for a patient who is delivered to another ER/hospital that may not be equipped to care for the patient’s needs. The legislators acknowledged that the workforce shortage is a significant concern, however, the legislators noted they might not be the body that can solve this problem. Before building new training programs, there is a need to focus on filling current slots. Sen. Kiscaiden and Rep. Abeler both suggested “career laddering” as possible solutions whereby employers, in collaboration with academic centers, would offer on-site training and incentive programs to employees to learn a new skill. The legislators offered two challenges to physicians: • Provide your legislators with the expertise/ information to best address these issues; • Encourage public involvement. The public needs to understand these health care issues and the consequences for not addressing them appropriately. The focus of the public is currently on education, there-
Representative Jim Abeler.
fore, health care is taking a back seat. If health care is to be a priority at the legislature, physicians and the public need to be more vocal. The following physicians participated in this meeting: David Anderson, M.D. Robert Beck, M.D. Arthur A. Beisang, M.D. Mick Belzer, M.D. Ray Gensinger, M.D. Bruce Hyde, M.D. Frank Indihar, M.D. Donald Jacobs, M.D. Peter Kelly, M.D. Virginia Lupo, M.D. Robert Moravec, M.D. Aaron Nathenson, M.D. Michael Popkin, M.D. Shelley Springer, M.D. David Swanson, M.D. T. Michael Tedford, M.D. ✦
HMS and RMS members met with legislators regarding the hospital bed capacity issue.
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The Journal of the Hennepin and Ramsey Medical Societies
Designated a Delegate
A
AS SPRING HAS BARELY sprung, it is difficult to already start thinking about autumn in Minnesota. A time when the spring green leaves turn maroon and gold, crisp wind blows from the north, and Canadian geese fly south in preparation for the winter. It is also a time when physicians, medical residents, and medical students from all over the state of Minnesota gather in one location for an annual event of major importance to the health of Minnesota. It’s the Minnesota Medical Association (MMA) Annual Meeting, an annual event in my life for the last three years as a delegate. This year it will be held in St. Cloud, Minnesota, September 19-21. The MMA Annual Meeting is when the House of Delegates meets to determine the policies and agenda of the MMA each year. The House of Delegates is a legislative body of the MMA and consists of members representing component medical societies, specialty societies, and sections of the MMA such as medical student and resident/fellow sections. The overall membership of a group determines the number of delegates and members of each group choose their delegates and alternate delegates. The role of a delegate is to act as a representative for others in their group. It is, therefore, important that members of the group notify the delegate if they have strong views on issues. It is also important for members of the group to consider volunteering for the role of delegate. I have been designated a delegate for the last three years through my involvement in Ramsey Medical Society as a Family Practice Trustee, and now as secretary. The experience has been incredible and I would highly recommend it to any physician feeling the need to “advocate” for their patients and “to do something” about the profession of medicine. I’ve
BY JAMIE D. SANTILLI, M.D.
MetroDoctors
especially enjoyed the honor of being a Reference Committee member and in 2000, a Reference Committee chair. The experience has given me a deeper understanding of the health issues facing our patients, such as a resolution to investigate the price of prescription drugs, and the professional issues, such as advocating for improved reimbursement and opening discussions to empower physicians to collectively negotiate contracts with health plans. The House of Delegates debates and adopts resolutions put forth by MMA members. Prior to the annual meeting, resolutions are developed and submitted by MMA members, component medical societies, and specialty societies. This allows physicians and medical students to advocate for patients, address important current health related issues and advocate for the profession of medicine. At the annual meeting, the resolutions are sent to reference committees composed of members of the MMA who have agreed to serve as chair or a committee member. The reference committees hear testimony from the resolution sponsor or delegates or other interested individuals in organizations. The reference committees, with the exceptional assistance of the MMA staff, prepare reports to be presented to the House of Delegates for debate, consideration, amendment, and eventual vote for adoption. Adopted resolutions become policy of the MMA and determine the work plan for the MMA each year. Some resolutions are referred to the Board of Trustees for study or action. The Board of Trustees manages the ongoing affairs of the MMA and some of the work is accomplished through the 12 standing committees or task forces designated by the MMA. Reports of the Board, committees, and task forces are presented each year at the annual meeting. I’ve been very impressed by the MMA staff, their knowledge of the issues, and their ability
The Journal of the Hennepin and Ramsey Medical Societies
to be proactive to effectively advocate for physicians and public health issues effecting Minnesotans. MMA lobbyists and policy analysts review and advocate for fair and effective legislation and regulations for physicians and their patients. As a delegate to the MMA Annual Meeting and Reference Committee participant, this allows physicians to have representation in public policy making. Through involvement in our component societies at the local level and as delegates at the state level, physicians will have their voices heard to advocate for their patients and the profession of medicine. I greatly encourage your individual involvement. ✦
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May/June 2001
19
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MN PERSPECTIVE
Governor’s Budget Refocuses Health Debate
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GOVERNOR VENTURA’S BUDGET propos-
als for health this year lay out a path for some fundamental reforms in Minnesota’s health system. This budget is different in some important ways from what we’ve seen in the past. It’s not about insurance or clinical care alone; rather, it’s about trying to refocus the debate on health status outcomes, and that’s an even bigger and more complex picture. Yet, some of the Governor’s proposals are refreshingly straightforward. Here are some of the premises in the budget proposal that will get us on the road to a workable and affordable health system. Engage consumers differently. Improving health, and strengthening the health system, can’t be government’s job alone. Health reform is not just about what the legislature is doing in St. Paul. It’s about what communities, businesses and individuals can do, and it’s about the choices we all make. Here at the Minnesota Department of Health, we’ll continue to work with our local public health agencies, schools, health care providers and plans to establish aggressive community-wide prevention goals — and strategies to reach them. And, we’ll make sure there are ways to engage the public in an ongoing discussion about the future of health care. We must have the public involved in developing a consensus about what we want from our health system and what we’re willing to pay for. Changing consumer demand requires that we engage the public in understanding the role of their own choices, including health risk behaviors. Doctors have a large role in that, but we can’t expect them to educate their patients without attention to the economic incentives in the insurance system, and without supportive public health campaigns BY JAN MALCOLM Minnesota Commissioner of Health
MetroDoctors
to reinforce their efforts, by trying to create healthier norms in the larger community. Give increasing priority to prevention. Public health is about prevention first and foremost. The leading causes of disease, disability and premature death in this country are preventable. We must continue to strengthen our efforts here, or anything else we do in health reform will be beside the point. As a nation, and as a state, we spend far too little on prevention — estimates range from less than 2 percent to no more than 4 percent of all health expenditures. Until this changes, we’ll keep pouring more and more money into increasingly more expensive interventions. The Governor’s proposals to address racial and ethnic health disparities, reduce teen pregnancies, and improve the health of schoolage kids through prevention strategies, are all examples of trying to move “upstream” on health challenges. Address emerging health threats. Globalization, antibiotic resistance, cumulative environmental exposures, changes in wildlife habitats and the potential for chemical or biological terrorism are all new but very real health threats. The Governor’s budget would strengthen the capacity of Minnesota’s world-renowned Public Health Laboratory. Its priorities are in monitoring trends, early and rapid detection of new threats, constant emergency response capability, and “real time” investigation of threats. Focus on quality improvement. We truly need the leadership of the health professions to drive a quality agenda in health care. We propose establishing the Center for Health Quality to improve our measurement and reporting of quality of Minnesota’s health system. If we want to reward providers for improving quality, we need better ways to document it. If we want the public to make better choices about their own behaviors and the demands they put on health
The Journal of the Hennepin and Ramsey Medical Societies
care resources, we need to give them the tools to do so. The Center will help support steps recommended by recent Institute of Medicine reports calling for improved patient safety and quality. Shore up investments in the health care infrastructure. The Governor’s budget recognizes that in addition to trying to increase insurance coverage, we also need to invest in the “safety net” providers who provide care to the uninsured and to geographically isolated populations. And, we need to deal with the state’s growing health workforce needs through investments not only in the academic institutions and training sites, but also through loan forgiveness and scholarship funds to draw individuals into health care fields. Our plan also calls for $141 million in health tax relief. We first eliminated those taxes with the most limited assessment base, and permanently set the provider tax at 1.5 percent. These changes will make health care taxes fairer and more predictable. A different path In recommending his budget, the Governor pointed out that the health of Minnesotans is not determined strictly by the health care delivery system, or whether people are covered by insurance. Our environment influences us, and so do our personal choices. So, too, does getting everyone involved in shaping the future of our health system. Without that kind of dialogue, and leadership from key players, we will continue to pursue “band-aid” solutions that will be increasingly unsuited to the fundamental challenges we face. ✦ Jan Malcolm was appointed Minnesota Commissioner of Health by Governor Jesse Ventura in January 1999. The Minnesota Department of Health is the state’s lead public health agency, responsible for protecting, maintaining and improving the health of all Minnesotans. May/June 2001
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Another Successful Winter Medical Conference
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THE 2001 HMS/RMS Winter Medical Con-
and children enjoyed the opportunities for excursions to the Mayan ruins, snorkeling, fishing, swimming, and relaxation. âœŚ
ference attracted 25 physicians and a group of more than 50 that traveled to the Moon Palace, a four star all inclusive resort on the Mayan Riviera south of Cancun, Mexico February 1724. Sixteen hours of CME jointly sponsored with the MMA were offered on topics ranging from Genetics and Molecular Biology of Colon Cancer to the Approach to Patients with Obesity. The evaluations of the program by the participants were excellent. Warm temperatures in the high 80s and sunny skies were the norm. Physicians, spouses, CME faculty (Back row from left): Thomas Dunkel, M.D.,
Anthony Orecchia, M.D., John Allen, M.D., Tim Diegel, M.D. and Pamela Herder, J.D. (Front row from left): Michael Gonzalez-Campoy, M.D., Ph.D., Ken Nollet, M.D., Ph.D., and Steven Tredal, M.D. (Not pictured): Andrew Portis, M.D.
Physicians attending a lecture.
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May/June 2001
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The Journal of the Hennepin and Ramsey Medical Societies
HMS/RMS Sponsor Medical Student Lunch ’N Learn Sessions
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FIRST AND SECOND YEAR medical students turned out in droves for the February 15 and March 13 Lunch ’n Learn sessions, co-sponsored by the Medical Student Section and the Hennepin and Ramsey Medical Societies. Using dual slides and case examples, Janis Amatuzio, M.D. left an intriguing impression of a career in forensic pathology in February. In March, Patricia Stewart, D.O. delivered an enlightening overview of physical medicine and rehabilitation, and Sheldon Burns, M.D., sports medicine, entertained the students with stories of athletic injuries and his work with the International Olympic Committee. ✦
Sheldon Burns, M.D., discusses sports medicine with the students.
Janis Amatuzio, M.D. discusses forensic pathology.
MetroDoctors
Sheldon Burns, M.D. and Patricia Stewart, D.O. spoke at the March session.
The Journal of the Hennepin and Ramsey Medical Societies
May/June 2001
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PRESIDENT’S MESS AGE ROBERT C. MORAVEC, M.D.
From Where I Sit… The Doctor-Patient Relationship RMS-Officers
President Robert C. Moravec, M.D. President-Elect Peter H. Kelly, M.D. Past President John R. Gates, M.D. Secretary Jamie D. Santilli, M.D. Treasurer Peter J. Daly, M.D. RMS-Board Members
Kimberly A. Anderson, M.D., Specialty Director Victor S. Cox, M.D., Specialty Director Charles E. Crutchfield, III, M.D., At-Large Director Kelley C. du Ford, Medical Student Thomas B. Dunkel, M.D., MMA Trustee Michael Gonzalez-Campoy, M.D., At-Large Director James J. Jordan, M.D., Specialty Director F. Donald Kapps, M.D., Specialty Director Kathryn M. Klingberg, M.D., Resident Physician Charlene E. McEvoy, M.D., At-Large Director Ragnvald Mjanger, M.D., Specialty Director Kenneth E. Nollet, M.D., Ph.D., At-Large Director Thomas F. Rolewicz, M.D., Specialty Director Paul M. Spilseth, M.D., At-Large Director Lyle J. Swenson, M.D., MMA Trustee Jon V. Thomas, M.D., At-Large Director David C. Thorson, M.D., Specialty Director Russell C. Welch, M.D., At-Large Director RMS-Ex-Officio Board Members & Council Chairs
Brent R. Asplin, M.D., AMA Young Physician Section Blanton Bessinger, M.D., MMA President Kenneth W. Crabb, M.D., AMA Alternate Delegate Paul J. Dyrdal, M.D., Sr. Physicians Assoc. President Stephen P. England, M.D., Community Health Council Chair *Michael Gonzalez-Campoy, M.D., Education Resource Council Chair Eleanor Goodall, Alliance President Frank J. Indihar, M.D., AMA Delegate William E. Jacott, M.D., U of MN Representative Matthew D. Layman, M.D., AMA Delegate for American Society of Anesthesiologists *F. Donald Kapps, M.D., Council on Professionalsim & Ethics Chair Melanie Sullivan, Clinic Administrator *Lyle J. Swenson, M.D., Public Policy Council Chair *Russell C. Welch, M.D., Communications Council Chair *Also elected RMS Board Member RMS-Executive Staff
Roger K. Johnson, CAE, Chief Executive Officer Doreen M. Hines, Membership & Web Site Coordinator
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May/June 2001
O
ONE OF THE KEY PRINCIPLES in medical
care is the “doctor-patient relationship.” I’ve had the privilege of reviewing numerous local and state medical society mission statements through my role as a surveyor for continuing medical education. In many of them, this principle is held as the highest principle to be preserved, enhanced, and protected. This principle carries an enormous responsibility for clinicians. In an age of remarkable technical advancement in the acute care arena, the doctor-patient relationship continues to be what patients relate to when they reflect on their overall satisfaction of their care. Patient satisfaction surveys focus on how well the health care team communicated and provided explanation to patients and their families. Patients recall how much comfort they felt before and after procedures or during a medical crisis. If clinicians are berated by the public, it is often focused on our inability to bridge this relationship in a meaningful way. To be sure, the public expects competency in surgical skills, treatment of medical emergencies, delivery of a baby, and office evaluations for an acute illness. Satisfaction of care comes from their perception of the adequacy of communication and understanding of the events surrounding the care delivered. It is a responsibility that can be shared by a medical care team (both in the hospital or office) or handled by the physician, but it cannot be abdicated or ignored. All clinicians should focus their incredible energy and talents when developing and enhancing this relationship. The second Institute of Medicine (IOM) report, Crossing the Quality Chasm: A New Health System for the 21st Century, released in March 2001, discusses our failure as a system to live up to our charge. We (as a system) fail to deliver care for up to 40 million Americans in the United States. We (as providers) take an average of 17 years for new knowledge generated by trials to be incorporated into practice (see the reference, Bates and Boren – Yearbook of MetroDoctors
Medical Informatics, 2000 from the IOM Report.) Our best practice guidelines and evidence-based recommendations are often refuted as “cookbook medicine” which threatens clinical judgment and the “doctor-patient relationship.” I submit to you that the doctor-patient relationship is based on trust – trust that we will deliver up-to-date, competent care in an efficient manner and trust that we will be available to answer questions and concerns about our patient’s issues. This most recent IOM report describes the health-care needs of Americans shifting from acute episodic care to care for chronic conditions. We know that chronic conditions are the leading cause of illness, disability, and death and account for the majority of health care expenditures. This aspect of care is best handled by focusing on trusted, up-to-date, and accessible care – the “doctor-patient relationship.” The IOM Report identifies six aims that we should be striving for. Those aims can be summarized as care that is: • Safe; • Effective; • Patient-centered; • Timely; • Efficient; and • Equitable. Isn’t this what the doctor-patient relationship is all about? Whether through a trusted team approach or through individual communication, this principle will serve as our foundation during the upcoming period of health care transformations. ✦
The Journal of the Hennepin and Ramsey Medical Societies
Community Internship Program Reaches Out to Health Policy Class
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Ryan Abbe (left) learned about occupational medicine from Dr. Joseph Wegner at the Physicians Neck and Back Clinic.
each matched with two physicians in the metropolitan area. The interns shadowed each assigned physician for one-half day. Interns ventured to the emergency room, scrubbed in for surgery, and went to clinics such as the Ramsey Health Center for Women, Clinic 42, Model Cities, and Community University Health Care Clinic. The students found their experiences to be very informative and most of them came away with new concerns. Many are much more concerned with Dr. Naomi Duke (right) reviews some paperwork the availability of care for the low-in- with Brandi Hill at Model Cities. come, uninsured, and immigrant population. As part of the intern prothe year 2001 is to ensure universal access to gram the faculty and interns are invited to opencare for all children, adolescents, and pregnant ing and closing receptions to share their experiwomen. ences. Drs. Peter Bornstein, Brett Gemlo, and The students in Macalester’s Political SciJames Hart attended from the faculty. ence 47 rounded out their experience by trackFollowing the Community Internship Proing legislation on the web and conducting regram and after numerous weeks of engaging in search on the disparities between urban and ruintellectual discourse, the students were well preral health care. pared for a guest lecture on MinnesotaCare preThanks to all the physicians who particisented by Dr. James Hart. pated in this Community Internship Program. In addition to clinic visits, the class atWithout your commitment and sharing of your tended the Minnesota chapter of the American time and expertise, this program could not sucAcademy of Pediatrics “Day at the Capitol.” This ceed. To participate in future programs, please session provided a focused and accessible piccall Doreen Hines at 612/362-3705. The next ture of the law-making process. The group arone is scheduled for May 14-17, 2001. ✦ ticulated that one of its legislative priorities for Thank you to the following physicians for participating in the Community Internship Program.
Students participating as Community Interns included: (from left) Corey Kurtz, Ryan Abbe, Kim Russell, Jennifer Fields, Nicholas Kassebaum, Duchess Harris, Ph.D., Brandi Hill, Wairimu Njoya, Andre Carrington, Maimouna Toliver, Kati Miklik, and Anna McCartney-Melstad.
MetroDoctors
The Journal of the Hennepin and Ramsey Medical Societies
Fozia Abrar, M.D. Brian Amdahl, M.D. Peter Bornstein, M.D. Larry Cohen, M.D. David Current, M.D. Paul Donahue, M.D. Naomi Duke, M.D. Michael England, M.D. Stephen England, M.D. Ralph Frascone, M.D. Brett Gemlo, M.D.
Rich Gray, M.D. Teresa Gunnarson, M.D. James Hart, M.D. Melanie Johnson, M.D. Tina Martin, M.D. David Plummer, M.D. Steven Tredal, M.D. John Wahlstrom, M.D. Joseph Wegner, M.D. Clinic 42
May/June 2001
25
Ramsey Medical Society
PROFESSOR DUCHESS HARRIS of Macalester College (immediate past president of the Ramsey Alliance) had another successful semester with her Health Policy Course. The course has three objectives: 1) to familiarize the students with competing theoretical perspectives about political behavior and policymaking; 2) introduce students to the history of health care organizations in Minnesota and the U.S. from Clinton to the present; and 3) to examine crosscultural issues in health. The Ramsey Medical Society provided a very important addition to this class by offering to coordinate a Mini Community Internship Program March 5-12. Eleven students, who are pre-medical and/or public health hopefuls, were
Caring Hearts for Homeless People 2001 Supply Drive
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THE NINTH ANNUAL “Caring Hearts for Homeless People,” sponsored by Ramsey Medical Society, Ramsey Medical Society Alliance and HealthEast Care System, began on Saturday, February 10 and concluded on Sunday, February 25. This year’s drive was a huge success! Twenty-three medical clinics, 45 churches, HealthEast Care System, and many volunteers from the Ramsey Medical Society Alliance, and many other organizations (4-H clubs, girl scout
troops, high school youth groups, elementary class groups) pitched in to collect and sort over $55,000 worth of hygiene and medical supplies for the Health Care for the Homeless clinics, Listening House, and SafeZone. In addition, more than $1,500 in cash contributions was collected. These organizations rely heavily on donated medications, hygiene supplies, toys, juice and monetary donations to help meet the physical, emotional and mental health needs of their clients. This drive contributes the majority of supplies needed for the entire year. Carole Nimlos coordinated the activities of the RMS Alliance members who worked hard picking up the supplies from 23 participating medical clinRed Cross Medical Services employee Jo Launderville and Amy Gullickson, volunteer, coordinated the packaging of ics. ✦
Some of the many volunteers helping out with the sorting of the numerous donations.
Donna Mowlem, RMS Alliance member and Dr. Al Mowlem, retired physician, are at St. Joseph’s Hospital dropping off the items they collected from some of the participating clinics.
1,500 care packages. Carole Nimlos, RMS Alliance, picked up the donated items at the American Red Cross.
Mark your calendars
Thank you to the clinic managers, staff, and physicians of the following clinics that participated: Advancements in Dermatology Partners Obstetrics and Gynecology, P.A. Allina Medical Clinic – Shoreview Physicians Neck & Back Clinic, P.A. American Red Cross Ramsey Family Physicians Dermatology Consultants, P.A. Ramsey Health Center for Women Hamm Memorial Psychiatric Clinic St. Croix Orthopaedics, P.A. HealthEast Shoreview Clinic St. Paul Internists, P.A. HealthEast Vadnais Heights Clinic St. Paul Surgeons, Ltd. Metropolitan Medical Associates Twin Cities Anesthesia Associates Minnesota Medical Joint Services Organization University Family Physicians – Bethesda Clinic Minnesota Epilepsy Group, P.A. University Family Physicians - Phalen Village Clinic Minnesota Gastroenterology – East Metro University of Minnesota – medical students North Suburban Family Physicians, P.A. - Shoreview
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May/June 2001
MetroDoctors
The 2002 Caring Hearts for Homeless People Supply Drive, will be held February 9 through February 24, 2002. Please call Doreen at 612-362-3705 if you would like to have your clinic added to the 2002 drive. You may even consider beginning to collect items now. One idea would be to focus on collecting one item each month (i.e., June-sunscreen; July-bug lotion; August-socks; etc.) You could also call and we could provide you with some of the items that the recipient organizations never seem to have enough of.
The Journal of the Hennepin and Ramsey Medical Societies
RMS UPD ATE
Applicants for Membership
Active Sophia H. Kim, M.D. St. Louis University Medical School Internal Medicine St. Paul Internists, P.A. Matthew D. Layman, M.D. University of New Mexico Anesthesiology Twin Cities Anesthesia Associates Barbara A. Leone, M.D. Harvard Medical School Family Practice North Memorial Family Practice Clinic Linda Anne Long, M.D. Dartmouth University Occupational Medicine 3M 1st Year Practice Fozia A. Abrar, M.D. Semmelweis Medical University, Budapest Occupational Medicine/International Health Regions Hospital International Health Joseph J. Baraga, M.D. Harvard Medical School Diagnostic Radiology St. Paul Radiology, P.A. Paula S. Mackey, M.D. University of Minnesota Pediatrics HealthEast Woodbury Clinic Medical Student (University of Minnesota)
Kriston A. Hines
MetroDoctors
Transfer into RMS — Active Nancy L. Struthers, M.D. University of Minnesota Family Practice Allina Medical Clinic - Cottage Grove Transfer into RMS — 1st Year Practice Theodore J. Passe, M.D. Neuro Radiology St. Paul Radiology, P.A. Transfer into RMS — Resident Eric M. Brown, M.D. University of Minnesota ✦
In Memoriam ALBERT F. HAYES, M.D., died March 12. He was 88. He graduated from the University of Minnesota Medical School, and completed his internship and a residency in obstetrics and gynecology at the University of Minnesota Hospitals. Following his residency training, he joined the military. Dr. Hayes joined RMS in 1946. PAUL F. JAROSCH, M.D., died April 13 at the age of 52. He graduated from the University of Minnesota and completed an internship at Abbott-Northwestern Hospital and his residency at the University of Minnesota. Dr. Jarosch was board certified in diagnostic radiology and currently a partner at St. Paul Radiology. He transferred from HMS and joined RMS in 1989. IAN MARC SWATEZ, M.D., died March 6 at the age of 53. He graduated from the University of Minnesota Medical School. He completed a transitional internship at Hennepin County Medical Center and his residency at the University of Minnesota. Board certified in diagnostic radiology, Dr. Swatez was Chief of Radiology at Regions Hospital and a partner of St. Paul Radiology. He transferred from HMS and joined RMS in 1997. ✦
The Journal of the Hennepin and Ramsey Medical Societies
The 28 Delegates of the Ramsey Medical Society will be representing you at the Minnesota Medical Association House of Delegates Annual Meeting September 19-21, 2001 in St. Cloud. Over the next several weeks, the Delegation will be identifying issues and developing resolutions to carry to the House of Delegates, where MMA policy is established.
Ramsey Medical Society
We welcome these new applicants for Ramsey Medical Society membership.
Call for Resolutions
The RMS delegation of delegates and alternate delegates, chaired by Dr. John Gates, will caucus on Wednesday, May 23 and again on Thursday, June 7. Both meetings will be held at 7:00 a.m. in the St. Joseph’s Room at St. Joseph’s Hospital in St. Paul. Please help us to assure that your interests are accurately conveyed to the House of Delegates by contacting the RMS staff to submit resolutions: phone: 612/362-3704, fax: 612/623-2888, e-mail: sstanton@mnmed.org.
May/June 2001
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RMS ALLIANCE NEWS ELEANOR M. GOODALL
A Message for Spouses of Physicians: Life Work Planning
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MY YEAR AS PRESIDENT of the Ramsey
Medical Society Alliance draws to a close. And, as one prepares to leave a leadership role, it’s natural to reflect on a few questions, such as: “How did I do over the course of the past year? Were my mistakes small and, hopefully, my accomplishments larger? Did the organization become better, stronger, and more viable during my tenure? Am I leaving it in good shape for those who follow me? The year, however, is now in the past and I want us to look at the future. While it’s important that we learn from the past, the potential in each of our lives lies in our planning for the future — deliberately and thoughtfully planning our life work, however we define it.
There are four important life questions: • Who are you? • Where did you come from? • What are you doing here? • Where are you going? These are important because, when you can answer them, you consciously understand your role in the universe, in your own life, in your work and in your associations with others. Let’s take them one at a time and briefly look at what each is asking. Who are you? Superficially, this may seem like the philosophical pondering of a college student, but we need to have knowledge of self in order to comprehend our capabilities, to realize our potential. You can’t be the best person within you unless you know who that person is to start with. Are you a musician, an artist, a thinker, a motivator, a helper, a visionary, and so on? The point is that by knowing yourself in all the various facets of your life, you can stretch to reach the heights of each, thereby creating for yourself a truly wonderful life. Where did you come from? We need a sense of belonging, of tradition, history, and culture. We all probably have some mix of good and not-so-good experiences in where we come 28
May/June 2001
from and we need to come to terms with our background in order to move forward. What are we doing here? Whether you believe in a specific God, a universal God, a Spiritual Being, a natural Entity, there is an order to life. What I mean is that existence of everything is either in order or chaos. And, clearly atoms, molecules, annual seasons…line up in order. So, where do you fit in this grand scheme of things? Does each of us have a purpose? How do we discover it? Where are you going? Ah, perhaps the toughest of all to grasp. The first three questions deal with the past and the present. And, while not necessarily easy to search out the answers, the material is there for us to work on. This question addresses the future — your future. And recognizing that you have the power to shape it. To do this, we need to be able to learn. I want you to reflect a little. Think of all you know as fitting into three piles: 1. Things I absolutely know are true. 2. No way are these true. Totally false. Wrong. 3. I just don’t know. Could be true. Might be false. For many people life is simply a duality. Things are right or wrong. But — there is a lot in between. Seldom are things or situations black or white, but rather one of many shades of gray. Build that third pile. In order for you to learn, this pile needs to be much larger. The first two piles close off learning to you. The longer you live, the bigger the third pile grows because every time we learn something we become aware of how much we don’t know. Think of your life as a book. The title of the book is “My Life.” Each chapter is a year of your life. So, think about the chapter you are on right now (that would be, of course, how old you are).What would be the title for the chapter of your last twelve months? How do you want to title the next chapter? Where are you going with your life? Where do you want MetroDoctors
to be five or 10 years from now? And, what are you doing to create that reality? How do you create that reality? Being what you want to be means opening up to learning. It means building on that third pile. It means a congruent flow of energy within your life. How do we do this? The “source” of our being is our soul or spirit. Through this we KNOW. Then comes our mind, our emotion, and our body and through these we THINK, FEEL and ACT. If we are the same person at all levels, we are in alignment, we are integrated in our life. Energy flows back and forth, there are no blockages. If we have a mental, emotional, physical, or spiritual problem, there is a break. We cannot be all we are capable of being. When you forget yourself and what you’re here for — you get caught up in stuff. And it becomes harder and harder to get things done that move you along the design process of your life. Be patient. We grow by stages. Do what is important to you to get you where you want to go. Keep yourself integrated, in alignment. Keep body, mind, emotion and soul in sync. The idea is to consciously think about your life, to plan the way you want to live, and to live well. You can’t die well unless you have lived well. As I look over this piece, I see a lot of questions. The answers are within each of you. I urge you to search for them. It has been a splendid year! Thank you for the opportunity to lead this Alliance. You are good people doing good work. Continue to learn, to grow, to be all you can be! ✦
The Journal of the Hennepin and Ramsey Medical Societies
PRESIDENT’S REPORT DAVID L. SWANSON, M.D.
HMS-Officers
HMS-Board Members
Ben Baechler, Medical Student Michael Belzer, M.D. Carl E. Burkland, M.D. Jeffrey Christensen, M.D. William Conroy, M.D. Dianne Fenyk, Alliance Co-President Paul A. Kettler, M.D. James P. LaRoy, M.D. Ronald D. Osborn, D.O. Joseph F. Rinowski, M.D. David F. Ruebeck, M.D. Richard D. Schmidt, M.D. Marc F. Swiontkowski M.D. D. Clark Tungseth, M.D. Trish Vaurio, Alliance Co-President Joan M. Williams, M.D. HMS-Ex-Officio Board Members
Barbara H. Subak M.D., Senior Physicians Association Lee H. Beecher, M.D., MMA-Trustee Karen K. Dickson, M.D., MMA-Trustee John W. Larsen, M.D., MMA-Trustee Robert K. Meiches, M.D., MMA-Trustee Henry T. Smith, M.D., MMA-Trustee David W. Allen, Jr., MMGMA Rep. HMS-Executive Staff
Jack G. Davis, Chief Executive Officer Nancy K. Bauer, Associate Director
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THIS EDITION of MetroDoctors is devoted to the role of physicians as patient advocates. For the past seven years, organized medicine, in alliance with other interested parties, has advocated for our patients by lobbying for a patient protection bill. Last year, success seemed attainable. The House of Representatives passed the NorwoodDingell Patients’ Bill of Rights with an impressive 275-151 vote, with 68 Republicans voting for the passage. In the Senate, unfortunately, the bill stalled. The members of Senate Conference Committee were interested in protection of a different kind, the protection of their continued gluttony at the trough of the drug and health plan lobbyists. The Patients’ Bill of Rights died in committee. That fact remains that our patients need the passage of a patient protection bill. It is the right thing to do, and it needs to be done now. The American Medical Association has outlined what the bill should include: 1) There must be a guarantee that the decisions regarding medical necessity are made by physicians and their patients, not by health plan bureaucrats and staff. 2) There should be a mechanism by which patients can appeal denials of health care. Those appeals should be independent of the plans, binding, and obtained in a timely fashion that does not subject any patient to risks due to a delay. 3) Health plans should be held accountable for their decisions, while employers who do not make medical decisions should be protected from the liability that results from injurious health plan decisions. 4) Patients must be permitted to sue the managed care plans under state law when the plans’ decisions are negligent and result in death or injury. 5) Patients must be allowed to choose a point of service option with appropriate access to specialists, especially when willing to do so at their own added expense. This option must be exercised without penalties resulting from appropriate medical decisions made by those point of service phy-
The Journal of the Hennepin and Ramsey Medical Societies
sicians. Women should be permitted to obtain gynecological/pregnancy care from an ob/gyn physician and children to obtain pediatric care without a referral. 6) There should be a reasonable standard for determining when a plan must cover emergency medical services, and that standard should be based on what a “prudent layperson” would do when faced with a perceived emergency. 7) Health plans should be required to intelligibly disclose to enrollees the basic information about their medical coverage. Gag clauses, or the implementation of gag practices, should be forbidden. 8) The rights of states to govern the health care of its citizens should be respected. As Chief Justice Rehnquist has said, the state courts should be the forums for any personal injury suits arising from the denial of medical care, ERISA oversight notwithstanding. There is now a Compromise Bipartisan Patients’ Bill of Rights before Congress that incorporates most of these ideals—S283/284, HR526. The insurance industry has spent $100 million to derail this legislation. It needs our support. There is a simple way you and I can advocate for our patients today, now, taking only five minutes of our time. Even if you are not a member of the AMA, you can simply go to this website: http://capwiz.com/ama/home/. Enter your zip code and you will automatically be linked to the e-mail addresses of President Bush, Paul Wellstone, Mark Dayton, and your Congressman. Tell them in a few words what the Compromise Bipartisan Patients’ Bill of Rights means to you and your patients. (Be sure to include your home mailing address, or the staff person screening your e-mail will toss it right in the trash. If your address is on the e-mail, it will be read and forwarded.) ✦ May/June 2001
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Hennepin Medical Society
Chair Virginia R. Lupo, M.D. President David L. Swanson, M.D. President-Elect T. Michael Tedford, M.D. Secretary Richard M. Gebhart, M.D. Treasurer Michael B. Ainslie, M.D. Immediate Past Chair David L. Estrin, M.D.
HMS NEWS Benjamin W. Chaska, M.D. Harvard Medical School Family Practice Park Nicollet Clinic
Hyder M. Khan, M.D. Universidad Automona de Cludad Juarez Pediatrics HFA Pediatrics Clinic
New Members
Ivan J. Chavez, M.D. University of Illinois College of Medicine Internal Medicine Minneapolis Cardiology Assoc.
Marcus Kristupaitis, M.D. Kaunasskig Medicinskij Institut Pediatrics Southdale Pediatric Associates
HMS welcomes these new members to the Society as of February 1, 2001. Schools listed indicate the institution where the medical degree was received.
Daniel Steven Cohan, D.O. Univ. of Osteopathic Medical and Health Science Family Practice North Clinic, P.A.
Nicholas P. LaFond, M.D. University of Minnesota Medical School Family Practice Long Lake Family Physicians
Regular Active Gordon M. Aamoth, M.D. Northwestern University Medical School Orthopedic Surgery Minneapolis Orthopaedic & Arthritis Institute
Eileen Crespo, M.D. State University of New York at Buffalo Pediatrics Hennepin County Medical Center
James R. Larson, M.D. University of Minnesota Medical School Orthopedic Surgery Orthopedic Medicine & Surgery, Ltd.
Deborah A. DeMarais, M.D. University of Minnesota Medical School Pediatrics Andover Park Clinic
Brian M. Leonovicz, M.D. University of Wisconsin Medical School Anesthesiology Medical Anesthesia, Ltd.
Dennis D. Dykstra, Ph.D., M.D. University of Cincinnati College of Medicine Physical Medicine & Rehabilitation University of Minnesota-Medical & Rehab
Andrew Yeng Cheng Leung, M.D. University of Minnesota Medical School Internal Medicine Columbia Park Medical Group-Fridley
Eric R. Ernst, M.D. University of Wisconsin Medical School Internal Medicine Minnesota Heart Clinic
Richard O. Lundebrek, M.D. University of Minnesota Medical School Family Practice Camden Physicians, Ltd.
Joel L. Esmay, M.D. University of Minnesota Medical School Family Practice Riverway Andover Clinic
Heather A. MacKay, M.D. Albany Medical College of Union University Obstetrics & Gynecology Southdale OB/GYN Consultants
Yohannes Gebregziabher, M.D. Medical College of South Carolina Family Practice Camden Physicians, Ltd.
Robert P. Maddock, M.D. Indiana University School of Medicine Anesthesiology Anesthesiology, P.A.
Mark Gregerson, M.D. University of North Dakota School of Medicine Hand Surgery/Orthopedic Surgery Orthopedic Surgical Consultants, P.A.
Mary Miley, M.D. University of Minnesota Medical School Internal Medicine Park Nicollet Clinic - Plymouth
Martin Nicholas Burke, M.D. Yale University School of Medicine Cardiology Minneapolis Cardiology Assoc.
B. M. Hightower-Hughes, M.D. Bowman Gray School of Medicine of Wake Forest University Obstetrics & Gynecology Fridley Plaza Clinic
Robert A. Mittra, M.D. University of Pennsylvania School of Medicine Ophthalmology VitreoRetinal Surgery, P.A.
Lyn Palmer Chapman, M.D. University of Minnesota Medical School Pediatrics Partners in Pediatrics, Ltd.
Daniel A. Keeley, M.D. University of Minnesota Medical School Internal Medicine Lakeview Clinic
Emily Parker Chapman, M.D. Dartmouth Medical School Pediatrics Wayzata Children’s Clinic, P.A.
Peter James Kernahan, M.D. Northwestern University Medical School General Surgery HealthPartners – Riverside
Ingrid Abols-Mantyh, M.D. Universite de Paris VII, Paris 5e Neurology Minneapolis Clinic of Neurology Steven O. Anderson, M.D. Northwestern University Medical School Ophthalmology Northwest Eye Clinic Gary D. Berman, M.D. Mayo Medical School Allergy & Immunology Allergy & Asthma Specialists, P.A. Thomas N. Berscheid, M.D. University of Minnesota Medical School Anesthesiology Northwest Anesthesia, P.A. Mark R. Bixby, M.D. University of Illinois College of Medicine Family Practice Univ. Family Physicians - North Memorial Clinic Miriam Bednar Boyer, M.D. Lekarska Fakulta Univerzita Komenskeho, Bratislava Anesthesiology Anesthesiology, P.A.
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May/June 2001
MetroDoctors
Ibrahim Abdul Mujir, M.D. Gandhi Medical College, Omania University, Hyderabad, Andra Pradesh Family Practice North Memorial Clinic - Brooklyn Park Family Physicians Theodore C. Nagel, M.D. Cornell University Medical College Obstetrics & Gynecology Reproductive Medical Center The Journal of the Hennepin and Ramsey Medical Societies
Shellie Schmidtgall, M.D. Rush University Pediatrics Columbia Park Medical Group
Glenn Albert Nickele, M.D. University of Michigan Medical School Cardiology Minnesota Heart Clinic
Eric S. Schned, M.D. Columbia Univ. College of Physicians & Surgeons Rheumatology Park Nicollet Clinic - St. Louis Park
Stephen L. Olmsted, M.D. University of Minnesota Medical School Orthopedic Surgery Orthopaedic Consultants, P.A.
Nicholas J. Schneeman, M.D. University of Minnesota Medical School Family Practice North Clinic, P.A.
Pamela R. Paulsen, M.D. Medical College of Wisconsin Cardiovascular Diseases Cardiovascular Consultants, Ltd. North Heart Center
J. Richard Sheely, M.D. University of Tennessee Center for Health Sciences Family Practice Quello Clinic-Mall of America
Anil K. Poulose, M.D. University of Kansas School of Medicine Cardiovascular Diseases Minneapolis Cardiology Assoc. Minneapolis Heart Institute Jon L. Pryor, M.D. University of Minnesota Medical School Urology/Urological Surgery University of Minnesota Physicians Kayvon S. Riggi M.D. Mayo Medical School Orthopedic Surgery Orthopedic Medicine & Surgery, Ltd. John B. Rogers, M.D. University of Minnesota Medical School Orthopedic Surgery Columbia Park Medical Group Thomas J. Rossini, M.D. University of Minnesota Medical School Emergency Medicine North Memorial Health Care Ilya Rubin, M.D. Byelorussia Medical Institute, Minsk Anesthesiology Twin Cities Anesthesia Associates Paul R. Rust, M.D. University of Wisconsin Medical School Diagnostic Radiology Consulting Radiologists, Ltd. U of MN Hospitals, Dept. of Diagnostic Radiology Paul A. Satterlee, M.D. University of South Dakota School of Medicine Emergency Medicine North Memorial Health Care John D. Schaffhausen, M.D. University of Iowa College of Medicine Family Practice North Clinic, P.A. MetroDoctors
Douglas Alan Smith, M.D. University of Minnesota Medical School Family Practice Long Lake Family Physicians J.R. Smith-Kristensen, M.D. University of Minnesota Medical School Family Practice Camden Physicians, Ltd. Doris N. Tran-Stoebe, M.D. Rush Medical College Family Practice North Memorial Health Care - Golden Valley Gary L. Trummel, M.D. University of Minnesota Medical School Anesthesiology Northwest Anesthesia, P.A. Jeffrey Richard Vespa, M.D. Loyola University Stritch School of Medicine Emergency Medicine North Memorial Health Care Patricia Ann Welsh, M.D. University of Minnesota Medical School Obstetrics & Gynecology Obstetrics & Gynecology - West, P.A. Andrew G. Westbrook, M.D. Vanderbilt University School of Medicine Family Practice Burnsville Family Physicians Jennifer Woodland, M.D. Ohio State University College of Medicine Family Practice Camden Physicians, Ltd. Paul David Yochim, D.O. Kirksville College of Osteopathic Medicine Anesthesiology Twin Cities Anesthesia
The Journal of the Hennepin and Ramsey Medical Societies
(Continued on page 32)
In Memoriam DAVID M. ANDERSON, M.D., died March 17. He was 83. He graduated from the University of Minnesota Medical School and completed his internship in urology in San Francisco. Dr. Anderson was one of the 11 founding physicians of the St Louis Park Medical Center, which is now Park Nicollet Clinic. He practiced at the clinic from 1950 until he retired in 1987. Dr. Anderson was an adjunct professor of surgery at the University of Minnesota, and also taught for many years at the VA Hospital. He joined HMS in 1951. JAMES EDWARD TROW, M.D., a family physician, died in March at the age of 88. He graduated from the University of Minnesota Medical School. He served in Alaska as a Senior Medical Officer during World War II. Dr. Trow retired from practice in 1990. He joined HMS in 1994. JOHN J. HAGLIN, M.D., a transplant specialist, died February 9. He was 81. He graduated from Wayne State University School of Medicine, Detroit. He was a fellow at Minneapolis General Hospital. Dr. Haglin was a vascular surgeon and former assistant chief of surgery at Hennepin County Medical Center. He helped develop the Minneapolis Medical Research Foundation and was on its board. Dr. Haglin joined HMS in 1962. FABIAN J. MCCAFFREY, M.D., died February 11 at the age of 85. He graduated from the University of Minnesota Medical School. Dr. McCaffrey, an obstetrician/ gynecologist, practiced in Minneapolis. After retirement he became a pastoral minister at St. Patrick’s Church in Edina. He joined HMS in 1942. RALPH PAPERMASTER, M.D., died recently at the age of 83. He graduated from the University of Minnesota Medical School. Dr. Papermaster joined HMS in 1947. KARL E. SANDT, M.D., an ophthalmologist, died February 25. He was 92. He graduated from the University of Minnesota Medical School. He completed an internship at Detroit Receiving Hospital and a residency at Manhattan Eye & Ear Hospital in New York City. Dr. Sandt was an associate clinical professor at the U of M. He retired in 1988. Dr. Sandt joined HMS in 1938. âœŚ May/June 2001
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Hennepin Medical Society
Hoang Duc Nguyen, M.D. University of Texas Medical School of Houston Anesthesiology Anesthesiology, P.A.
HMS ALLIANCE NEWS
D
DIANNE FENYK AND I are all too quickly
approaching the end of our year as co-presidents of this organization. I am a weaver, and find that in designing a woven item, one takes into consideration the best properties of the fibers that will be woven into the fabric. Just as in weaving, our Alliance produces a fine fabric of ideas and talents in order to bring about our best. Dianne and I wish to express our appreciation for all the help and support we have received this year from our wonderful loyal members, including the wisdom of those who have led the organization before us and fresh ideas from our newer members. Our thank yous go to Minnesota Medical Association and Hennepin Medical Society for their support and extra help from the staffs of both, especially Jack Davis and Nancy Bauer who have given us so much advice and assistance. Diane Gayes also deserves much appreciation for all her hard work as chair of our children’s health fair, Body Works, her ongoing commitment to the HIV/AIDS folders, and as President of MMAA — her leadership has been terrific. Special thanks to those who opened their homes this year for our programs, beginning with our summer get together at Penny and Cecil Chally’s lovely lake home. We enjoyed a perfect fall day for our opening event at Eleanor and Bill Goodall’s farm. And thank you as well to Peggy and Bruce Johnson for opening their beautiful home for our Holiday Tea and Silent Auction in December. As we look back over the year we feel that we accomplished several of our goals as stated in our mission, to help educate and promote the health and well being of our members and the community. Stepping Stones, the event that was new to us this year, was a celebration of our 90th anniversary as an organization, which we combined with a fund raising event for three teen clinics in the West Hennepin Suburban area. It was our first venture into such an activity, and we felt it was extremely successful. Our Holiday Tea and Silent Auction was great fun
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May/June 2001
and we thank all those who contributed to the food, donated auction items and made purchases to support the Philanthropic Fund. It really was fun to get together just before the busy Holiday Season. Body Works, our children’s health fair, was as much of a success as was possible during a January ice storm; however, we do live in Minnesota and have to be flexible. We promoted our own health with a fitness day at The Marsh Spa in late January, just when we needed a bit of pampering. The fund raiser this year for the AMA Foundation was a “No Show” tea party in honor of Doctors Day, March 30. This was a welcome idea after the busy fall and winter schedule. At our annual meeting in May, Dianne and I will pass the gavel into the capable hands of Kathy Larson, knowing she will carry on the future activities of Hennepin Medical Society Alliance very well. Dianne and I, as well as Diane Gayes, have stressed the benefits of our affiliation with the National AMAA where we can contribute our ideas and receive leadership training and assistance with our projects. We have applied for a HAP (Health Awareness Promotion) award for the use of the “Hands are Not for Hitting” puzzles in Body Works, and also applied for, and received, a grant of 800 puzzles from the AMAA to distribute the puzzles to teachers during Body Works. The future of HMSA will be very secure under the leadership of Kathy Larson, our incoming President. We look forward to combining some fund raising activities with Ramsey Medical Society Alliance, weaving the strengths of both organizations to provide more benefits for the metro area. We also look forward to working with the Medical Student and Resident Partners, to benefit both of our organizations. We especially appreciate their fresh enthusiasm and we hope to perhaps give some longer-term experience to the spouses of medical students and residents in our area. Again, thank you very much to all who have worked so hard this year to support Dianne and me. It has been a wonderful experience beMetroDoctors
Dianne Fenyk Co-President
Trish Vaurio Co-President
cause we have such great members to work with. Our good wishes go to Kathy Larson as she guides HMSA next year. ✦ Fondly, Trish Vaurio and Dianne Fenyk
New Members (Continued from page 31)
Resident Natalie Anne Hayes, M.D. University of Minnesota Medical School Family Practice Hennepin County Medical Center Mark A. Houghland, M.D. University of New Mexico School of Medicine Cardiology University of Minnesota Physicians Susan Ann Leonard, M.D. University of Minnesota Medical School Anesthesiology Abbott-Northwestern Hospital Lorinda F. Parks, M.D. University of Minnesota Medical School Family Practice University of Minnesota Carol Joy Schlueter, M.D. University of Illinois College of Medicine Pathology-Anatomic/Clinical Fairview-University Medical Center
Medical Student (University of Minnesota)
Justin Lann Esterberg Jonathan D. Kirsch Kathleen M. Larson Peter G. Lund Joel Wegener Rochelle Ann Wolfe Irma Teresa Ugalde ✦ The Journal of the Hennepin and Ramsey Medical Societies