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Doctors MetroDoctors THE JOURNAL OF THE HENNEPIN AND RAMSEY MEDICAL SOCIETIES

Physician Co-editor Lee H. Beecher, M.D. Physician Co-editor Thomas B. Dunkel, M.D. Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Charles G. Terzian, M.D. Managing Editor Nancy K. Bauer Assistant Editor Doreen M. Hines HMS CEO Jack G. Davis RMS CEO Sue A. Schettle Production Manager Sheila A. Hatcher Advertising Representative Betsy Pierre Cover Design by Outside Line Studio MetroDoctors (ISSN 1526-4262) is published bimonthly by the Hennepin and Ramsey Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. Periodical postage paid at Minneapolis, Minnesota. Postmaster: Send address changes to MetroDoctors, Hennepin and Ramsey Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413.

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. Send letters and other materials for consideration to MetroDoctors, Hennepin and Ramsey Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. E-mail: nbauer@metrodoctors.com.

For advertising rates and space reservations, contact: Betsy Pierre 2318 Eastwood Circle Monticello, MN 55362 phone: (952) 903-0505 fax: (763) 295-2550 e-mail: betsy@pierreproductions.com.

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. For subscription information, contact Doreen Hines at (612) 362-3705.

MetroDoctors

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CONTENTS VOLUME 9, NO. 5

2

SEPTEMBER/OCTOBER 2007

LETTERS

Index to Advertisers

3

Joint Commission Medical Staff Bylaws Standard Now Final

4

Women in Medicine—a Career of Passion and Balance

12

COLLEAGUE INTERVIEW

Carolyn Adair Johnson, M.D., CMD

15

When Physicians and Their Organizations Face Difficult Problems: The Case for Adaptive Leadership

17

Community Internship Program Provides a Glimpse into the Practice of Medicine

19

YOUR VOICE

The Trouble with Medicaid Managed Care

21

Focused Group: Meet Your Future Colleagues— the U of M Class of 2007

22

Medical Students Connecting With Community Partners

23

Jacott Elected Chair AMA Senior Physician Group Governing Council

24

Law Firm Adds Services, Roger Johnson Joins Government Relations Team RAMSEY MEDICAL SOCIETY

25 26 27

President’s Message

28

2007 RMS Annual Community Service Award

Smoke-Free Washington County Coalition Update Sue Schettle as New CEO of RMS/In Memoriam/ “Ethical Issues in Pay for Performance” Conference/ Winter Medical Conference 2008

HENNEPIN MEDICAL SOCIETY

29 30 31

Chair’s Report/New Board Member

32

HMS Alliance News

HMS In Action New Members/Four Weeks Until Smoke-Free Air/ In Memoriam

The Journal of the Hennepin and Ramsey Medical Societies

On the cover: September has been hailed by the American Medical Association as “Women in Medicine” Month.

Article begins on page 4.

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1

LETTERS

September/October Index to Advertisers AmeriPride................................................................ 3 Burnet Birkeland Group .......................................

Inside Back Cover Classified Ads........................................................... 7 Crutchfield Dermatology...................................11 Ear, Nose & Throat SpecialtyCare..................24 Hennepin Faculty Associates ............................16 LaMettry’s Collision ............................................14 Medical Billing Professionals .............................. 9 The MMIC Group ................................................ 2 Minnesota Oncology Hematology, P.A. .............

Inside Front Cover MinnHealth Family Physicians, P.A. ............. 23 mPay Gateway .......................................................17 Minnesota Physician Services, Inc. ......................

Inside Back Cover Neurosurgical Associates, Ltd...........................13 Red Pine Realty.....................................................15 Southdale Internal Medicine, P. A. .................22 University of Minnesota CME .............................

Outside Back Cover Uptown Dermatology & Skin Spa, P.A. .......18 Weber Law Office ................................................32

To the editor: The Peter Dehnel commentary in the July/ August issue of MetroDoctors was excellent.

He points out that there is a big distinction between health insurance and health care. In recent years many public officials have confused the two, but the distinction is critical.

For every person who is uninsured, there are several who have health insurance coverage, but who cannot access health care — because of exclusions in their coverage, unaffordable copays and deductibles, or a shortage of medical providers who will accept the low reimbursement rates. At a recent hearing in Mankato, the Senate Health Committee heard testimony from people who have health insurance, but who struggle to obtain medical care because of each of those three reasons. I believe that it is time for Minnesota to ensure access to

health care, not health insurance and, in doing so, we must ensure that we avoid the pitfalls of our current health insurance system.

Like a majority of Minnesota physicians who support a single-payer plan according to the study cited

by Dehnel, I believe that it is the best way to provide health care for all Minnesotans, saving money by eliminating bureaucratic paperwork and focusing on prevention and health promotion. But in doing so, we must ensure adequate and timely reimbursement for all medical providers — something that is sorely lacking in current programs.

Sincerely, John Marty, Chair, MN Senate Health Committee

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We design our insurance, technology and technology-related products and services to provide custom solutions to healthcare providers.

To learn how the MMIC Group can help protect you in this ever-changing healthcare environment, call 952.838.6700 or 1.800.328.5532.

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MetroDoctors

to help your practice thrive

that puts you first

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Joint Commission Medical Staff Bylaws Standard Now Final Editor’s Note: At a recent meeting of the Metropolitan Hospital Physician Leadership Committee, Dr. Bill Jacott discussed a proposed change to the medical staff bylaws being considered by the Joint Commission relating to medical staff governance (MS 1.20). As a result, a letter was crafted by Libby Snelson, JD, to be co-signed by the leadership of HMS and RMS urging the Joint Commission to “retain in MS 1.20, and therefore in our medical staff bylaws, all the elements of medical staff self-governance.”

A

AFTER YEARS OF REVISIONS and controversy, Joint Commission MS 1.20 has been finalized. Overall, the revised standard is favorable to medical staffs and medical staff self-governance. However, even the strongest medical staff bylaws will require amendment to comply with the revised standard’s 33 Elements of Performance.

The revised MS 1.20 imposes new requirements, different from any previously called for by the Joint Commission and most, if not all, states’ laws. Although the standard does not go into effect until July 1, 2009, medical staffs will be undertaking amendments right away, often at the impetus of their hospitals. It is critical that medical staffs proceed with caution to make bylaws amendments that protect and preserve the interests of the medical staff while achieving compliance with the revised MS 1.20.

The revised standard boosts medical staff self-governance by requiring that most elements be addressed in bylaws voted on by the medical staff, rather than by the medical executive committee acting on behalf of the medical staff. While allowing procedural

details to be addressed in rules and regulations or policies subject only to approval by the medical executive committee, under the revised MS 1.20, the medical staff must retain the ability to propose not only bylaws, but also rules and regulations and policies and any amendments thereto, directly to the hospital board. Further, in addition to describing what authority the medical staff confers on the medical executive committee, under the revised MS 1.20, medical staff bylaws are to describe how the authority is delegated and removed. These new requirements can protect medical staffs from being controlled by medical executive committees comprised chiefly of hospital-appointed department heads and administrative representatives.

The revised standard MS 1.20 preserves the intent of the original MS 1.20, to provide medical staffs and hospitals with a list of what has to be in medical staff bylaws.

Medical staff bylaws that had been divided into separate plans and manuals will require revision to comply with the new MS 1.20.

Generally, any medical staff that has a “Fair Hearing Plan,” a “Credentials Manual,” or an “Operations and Functions Manual” will need revisions to comply with the new MS 1.20. The revised MS 1.20 should help to make medical staff bylaws more transparent and responsive to medical staff members.

The final standard is published on the JC Web site at http://www.jointcommission.org/ AccreditationPrograms/Hospitals/revisions_ std_ms120_approved.htm.

Please contact me with any questions at easesq@snelsonlaw.com.

B Y ELIZABETH A. SNELSON, ESQ.

MetroDoctors

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The Journal of the Hennepin and Ramsey Medical Societies

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Women in Medicine— a Career of Passion and Balance Editor’s note: September has been hailed by the American Medical Association as “Women in Medicine” month. MetroDoctors conducted a Q&A interview with seven physicians, each in a unique practice situation. We hope you enjoy their stories. training the next generation of health care providers.

Julia Joseph-DiCaprio, M.D. Describe your practice environment. What is unique about your practice?

I am the Chief of Pediatrics at HCMC, an inner city county teaching hospital. I also practice general pediatrics and adolescent medicine. My clinical practice is unique because of the large percentage of at-risk youth for whom I provide care.

What factors had an impact on your decision to go into medicine and, specifically, the specialty you practice?

My mother was a nurse and I was exposed to, and fascinated by, the practice of medicine from a young age. I most enjoyed the complexity of pediatrics when I was in medical school. Further, I discovered that I enjoyed the opportunity to provide health care for adolescents and interact with them and their families.

Thus, after a pediatric residency I completed a fellowship in adolescent medicine. I enjoy leading this department because of HCMC’s tradition of high quality care to all, including the underserved, and our commitment to

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According to the University of Minnesota Medical School, females comprise 50 percent or more of their current medical student classes. To what would you attribute the increase in the female gender in medical schools?

Increasingly the barriers that made it difficult for women who wanted to have a professional career are falling. This has been very evident in medicine.

Describe your greatest accomplishment to date — personal or professional.

My greatest accomplishment and joy — my family. I have been married for 16 years and have two adolescent children.

Given your experience, would you encourage students to go into medicine?

Why or why not?

Absolutely. I cannot imagine a more fulfilling, challenging job.

How do you juggle your family/private life with medicine?

My mother always worked. She also raised three children. She did much more around the house than I do such as cooking most meals, keeping an absolutely clean house, and even making most of our clothes. I see having a career and a family as normal and joyful.

If there were an opportunity for you to advance in health care management, would you do so? Why or why not?

I have very much enjoyed moving into the administrative aspect of health care. I have been helped in this transition by the University of St. Thomas Physician Leadership College.

This year and a half cohort learning program trains and mentors current and future physician leaders.

MetroDoctors

Mumtaz Kazim, M.D. Describe your practice environment. What is unique about your practice?

I feel very fortunate to work with seven other family practice physicians that I can truly call my friends. We are more than partners — we are a family. We all have the same vision of what we feel a quality, patient-oriented medical practice should look like. We try very hard to provide the most up-to-date medical care and technology for our patients. We treat all of our patients as if they were part of our own family giving them the best care we can offer.

What factors had an impact on your decision to go into medicine and, specifically, the specialty you practice?

I grew up in Trinidad where both of my parents were physicians and I used them as role models.

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I became quite aware of the dedication that was required in this profession at a very early age.

According to the University of Minnesota Medical School, females comprise 50 percent or more of their current medical student classes. To what would you attribute the increase in the female gender in medical schools?

When I started in medical school the ratio of men to women was swayed the other way. There were many more men when I began than there are today. I think one of the reasons for this is that women of today have many more opportunities than they did years ago. I believe there is a much greater demand for female physicians at present. Many women today choose to see a female physician instead of a male physician. Why this is, I really don’t know, but statistics are proving this.

Given your experience, would you encourage students to go into medicine?

Why or why not?

I would encourage any person who has a passion and love for medicine. This is a rewarding profession requiring dedication and a lifetime commitment.

How do you juggle your family/private life with medicine?

It is truly a challenge. I am fortunate to have grown up in a home where both my parents were physicians so I had a model on how to juggle the two. I am also fortunate in that my husband is a pediatric urologist so he also understands the demands of the profession. We have managed to raise a beautiful, successful daughter and are very happy in our life.

If there were an opportunity for you to advance in health care management, would you do so? Why or why not?

There is too much bureaucracy in health care today so I would have to decline. I am a people person. I love my patients and caring for them, and that is what I am good at.

Describe your greatest accomplishment to date — personal or professional.

I would have to say that I have been able to create a relationship in my practice where I consider my patients, partners and co-workers as my family and friends. What greater accomplishment could there be?

MetroDoctors

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Maureen Reed, M.D. Describe your practice environment. What is unique about your practice?

At present my practice is health care consulting at a state policy level. So it’s appropriate to say that right now, the State of Minnesota is my patient. In addition to working on state tobacco control issues, I’m pleased to be serving as a member of the Governor’s Health Care Transformation Task Force. Fortunately for Minnesota, the goals of the Task Force are explicit and aggressive: to develop methods for covering everybody, reducing health care costs by 20 percent, and substantially increasing health and health care outcomes — all by 2011. With so many of our citizens, businesses and agencies so deeply (and appropriately) concerned about cost, quality and coverage, it’s extremely important that Minnesota successfully resolve these issues.

What factors had an impact on your decision to go into medicine and, specifically, the specialty you practice?

I actually came across my med school application a few weeks ago. In some ways it was painful to read — not because it was incorrect, but rather because it tried so hard to be correct.

As Bob Dylan said, “I was much older then; I’m younger than that now.” From today’s youthful vantage point, I’d give much more credit to my parents for encouraging independent thinking and hard work, and to my very elderly grandmother who, in living with us, provided us all with the opportunity to learn the joys and the sadness of care-giving. And whether a cause or an effect (or simply a correlation), I’d have to credit a liberal arts education as the stage on which I learned how wonderful it is to be a generalist in a world of specialization.

The Journal of the Hennepin and Ramsey Medical Societies

According to the University of Minnesota Medical School, females comprise 50 percent or more of their current medical student classes. To what would you attribute the increase in the female gender in medical schools?

In my 1979 class, I believe about 18 percent of the graduates were women. I’ve not studied the reasons why enrollment of women has tripled, but I’m sure many smart people have. I’ll let them give the fact-based answer. For myself, I’d just say that whatever the reasons, our profession and our patients are much the richer for this development.

Given your experience, would you encourage students to go into medicine?

Why or why not?

Ardently, unequivocally, unshakably, yes!

There have been two decisions in my life that I have never regretted. One was to go to medical school. (The other was to marry Jim Hart.) The opportunity to serve patients, to serve organizations, and to serve the public is a privilege beyond words. But in addition to the marvelous experiences of health care work itself, a career in medicine actually prepared me for many (most?) of the things I’ve done outside of medicine. I see no reason that the same would not be true for others today. And I am shamelessly optimistic that for those who enter the field for the right reasons, the future opportunities will be boundless.

How do you juggle your family/private life with medicine?

Sad to say (or maybe it’s not), I’ve never mastered balance — not in medicine and not in most other aspects of life. Having a husband of like disposition and having no children allows the formula to work. But surely I wouldn’t presume to give advice to anyone on this subject.

If there were an opportunity for you to advance in health care management, would you do so? Why or why not?

I would take every opportunity that presents itself to expand in any arena for which I had the time and the inclination. Addressing systems issues through health care administration or policy is tremendously invigorating and worthy (Continued on page 6)

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Women in Medicine (Continued from page 5)

of effort. Our patients and our society deserve big, fundamental fixes to the vexing problems of today. And the advantages of tackling them sure beat the alternative of doing nothing.

Describe your greatest accomplishment to date — personal or professional.

Isn’t this the toughest question of all? Probably because the quick answers are not the right answers. Serving on the University of Minnesota Board of Regents as its Chair, running for Lt. Governor with Peter Hutchinson, and recently writing a play were fabulous experiences, but I think these are outward manifestations of a deeper factor. In all candor, the right answer is that I’ve learned to no longer be afraid of not succeeding. It’s taken me years to learn this. To strive for the right thing, the important thing, the necessary thing is, in fact, the main thing.

And it is reward enough.

Sandra Rosenberg, M.D. Describe your practice environment. What is unique about your practice?

I used to work for a major metro health organization. I now am a private practitioner.

Though I still practice some general physical medicine and rehabilitation, I mainly concentrate on the treatment of lymphedema, venous status (non-surgical) and chronic wound care.

I see in-house patients as a consulting physician, spending the majority of my time in outpatient clinical care. I work part-time.

What makes my practice unique is that I am 6

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a 14-year breast cancer survivor who has dealt with lymphedema myself.

What factors had an impact on your decision to go into medicine and, specifically, the specialty you practice?

In truth, my favorite medical student rotations were in the surgical specialties. However, I tend to be very detailed, meticulous and stubborn.

Becoming a mother during my second year of medical school made me quickly realize that I could never be happy trying to coordinate being a parent with being a surgeon. I would feel incompetent at both. I had been introduced to Physical Medicine and Rehabilitation by my mother, Pearl Rosenberg Ph.D. The specialty incorporated the neurological, orthopedic and internal medical sciences. It offered me the chance to connect with my patients over longer episodes of care. The residency of four years was reasonable and I knew it was something that I could do and still be a part of the lives of the people I loved most, my husband and my children.

According to the University of Minnesota Medical School, females comprise 50 percent or more of their current medical student classes. To what would you attribute the increase in the female gender in medical schools?

Wow, that is a ten-page essay question! A couple of things quickly pop to mind: Just read the headlines and the data showing that overall girls are doing better in school than boys. Boys have a higher high school dropout rate and colleges are having a harder time keeping their male to female ratio up.

Medical incomes have gone down while the cost of giving care has increased. Women tend to be less concerned with the income and, let’s face it, there are easier ways of making money these days with far less hassle.

As of the U.S. census in 2002, I thought women were about 51 percent of the population, outnumbering men. Doesn’t it seem reasonable that most professions should be 50/50 male to female ratios? Of course, for some reason women still only hold about 16.3 percent of the seats in the U.S. Congress * so, I guess I don’t really get it. * h t t p : / / w w w. rc i . r u t g e r s . e d u / ~ c a w p / Facts.html

MetroDoctors

Given your experience, would you encourage students to go into medicine?

Why or why not?

As with anything, investigate as carefully as possible what you are getting yourself into.

Medicine is a hassle, the paperwork exhausting, the workload unending, the insurance battles frustrating, the training forever and the system is very broken. Medicine is also the chance to give, to care, to change and the chance to be changed by the unique relationships we have with our patients and the profound impact we have on their lives. Medicine is a gift and physicians are a special breed.

Would I do it again? For me, retrospect only confuses this question more. Early in my medical career I was diagnosed with cancer and took care of two parents dying of cancer. It was too much, too soon. Medical training had already taken me away from my young family too much. If I had known what was to follow, I might not have pursued a career in medicine.

Still, I was never given the ability to foresee the future. I am not, nor ever was a prophet. So, I probably would have done exactly the same.

How do you juggle your family/private life with medicine?

I guess I learned the hard way. I finally learned to say “No.” I am now in private practice, parttime. I am in control of my schedule and my time. It is wonderful.

If there were an opportunity for you to advance in health care management, would you do so? Why or why not?

Once my children are on their own (my youngest graduates from high school next June) then I would consider adding work time and looking into other opportunities.

Describe your greatest accomplishment to date — personal or professional.

My greatest accomplishment is my relationship with my best friend, my husband. It is he who has nurtured my most significant growth.

Without his help, support, love and infinite patience I could not have become a physician, survived cancer or found a light after the premature deaths of my parents. Without him I would not have had the chance to look into my son’s and daughter’s eyes to see the most awesome wonders of my life.

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medicine was an easy second choice and I’ve never looked back.

Martha Sanford, M.D. Describe your practice environment. What is unique about your practice?

I came to Stillwater Clinic in May of 1987 fresh out of an internal medicine residency at Hennepin County Medical Center. At that time I was the 10th physician in the group and the second internist. Our group, Stillwater Medical Group, which is part of the Lakeview Health System, has approximately 55 physicians, four PAs and seven NPs. Most of us practice in a beautiful facility on Curve Crest Boulevard in Stillwater with a small (but important) satellite clinic in Somerset, Wisconsin. I am currently one of nine internists.

In addition to the statistics described above, my work environment is, and has always been, supportive, flexible and has valued the quality of life of its members. This culture gives me a sense of independence, self-determination, and a fierce loyalty to my group and those whom we serve.

What factors had an impact on your decision to go into medicine and, specifically, the specialty you practice?

The factor that influenced me the most in pursuing medicine was my parents and especially my mother. Both of my parents, John Sanford, M.D., general surgeon, and Julie Moller, M.D., internal medicine, provided me with the wisdom that I could do whatever I wanted to do, and that the more education I got, the better.

They loved their work and showed me that the service aspects of being a physician are rewarding beyond what you could have anticipated. I had fully intended to go into family practice, but my clinical rotation on a labor and delivery ward as a third year medical student (pre epidural anesthesia) changed my mind. Internal

MetroDoctors

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According to the University of Minnesota Medical School, females comprise 50 percent or more of their current medical student classes. To what would you attribute the increase in the female gender in medical schools?

The question should be, why hasn’t it always been over 50 percent of physicians are women?

I remember my mother talking about her interviews to enter medical school. The interviewer from Johns Hopkins told her that he would like to accept her into their entering class but that they had already accepted their two or three female medical students for that class.

Need I say more?

Given your experience, would you encourage students to go into medicine?

Why or why not?

I cannot imagine a better job. It has not been an easy road, though. Twelve years of post secondary education can be grueling and there are sacrifices that all physicians must make.

BUT if you love science, problem solving and people with all of their gifts and idiosyncrasies, the joy of this work cannot be matched. I truly believe that being a physician is a calling. Key to having and retaining my enthusiasm has been my self-determination and a significant perception that I am in control of many aspects of my work life. Without these later factors I am sure there would have been much more upheaval and change in my career.

How do you juggle your family/private life with medicine?

The short answer to this question is, you don’t.

You can’t. The quest for being the best is going to fail and usually on both sides of the teetertotter. I have made mistakes in my work and with my family, and I have to accept the reality of my own fallibility. Yet, I know that I am doing my best and am acting with compassion toward myself and others.

If there were an opportunity for you to advance in health care management, would you do so? Why or why not?

I believe that as a primary care physician “health care management” is not a “them or us” dualism. We are all health care management.

The Journal of the Hennepin and Ramsey Medical Societies

We play a tremendous role in stewardship of the health care dollar and delivering high quality care. The payers, providers, purchasers (employers) and patients need to communicate clearly and honestly at every opportunity in our mutual quest of bringing better health and wellbeing to our communities. I have had the privilege in my group to do quite a bit of quality improvement work in the past and have enjoyed this tremendously. As a part of this I have come to admire and respect ICSI (Institute for Clinical Systems Improvement) for all they do for Minnesota. Their growing role as convener of consensus and alignment of incentive of the many factions in health care cannot be over stated, and we all need to support their continuing work and become involved in this progressive movement.

Describe your greatest accomplishment to date — personal or professional.

My greatest accomplishment is more of a blessing, and that is to have a very fine husband and three lovely, challenging and bright daughters who all teach me something every day.

(Continued on page 8)

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Women in Medicine (Continued from page 7)

Elisabeth (Betsy) Slattery, M.D. Describe your practice environment. What is unique about your practice?

I am the founder and president of a private internal medicine practice in downtown St. Paul, “St. Peter Street Internal Medicine,” where I practice a combination of clinic and hospital medicine. The practice opened in a humble office on November 1, 2006, while waiting for the new clinic to be built. I moved into the new and permanent space as a solo practitioner on February 1, 2007. A partner, Dr. Sophia Kim, joined the practice May 1, 2007. The practice is showing excellent growth. This is a unique setting because it is privately owned and managed by experienced physicians. This is a different product compared to mega-managed health care clinics. Our challenge is to deliver personable and individualized care that is affordable and cost efficient.

What factors had an impact on your decision to go into medicine and, specifically, the specialty you practice?

My key guiding force was my husband, Dan, who is also a physician. I was a nurse before becoming a doctor (and much of me is still a nurse). Dan shared in my dream and encouraged it, to the point where I believed in myself, and knew I could do it. It is the right profession for me. My specialty as an internist was not an accidental choice. I would faint on clinical rotations in the operating room, so this left all forms of surgery and OB out. I love children so much that I couldn’t hurt them, including my inability to even draw blood when they were screaming. Pediatrics was not for me. This left 8

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all of family medicine out as well. I love numbers and the science of internal medicine and could stick a line in any adult during residency without a problem. It is an honor to work as an internist.

According to the University of Minnesota Medical School, females comprise 50 percent or more of their current medical student classes. To what would you attribute the increase in the female gender in medical schools?

I think my graduating class in 1985 from the University of Minnesota was nearly 50 percent women, and the numbers have been approximately that for years. The public desires physicians of both genders. What is bothersome to me is the large numbers of women who graduate and eventually drop out of practicing medicine. Many of my medical school and residency colleagues are not practicing even parttime. This is a tough and demanding job, and difficult to manage along with family life in a managed care climate.

Given your experience, would you encourage students to go into medicine?

Why or why not?

I definitely encourage students to enter the field of medicine. I am thankful every day that I have had this opportunity. It is an honor to know medicine, to figure out problems, to help people through the troubles of life. Internal medicine allows me to follow people and their families for years. There is still an art to medicine, despite the new computers and demands upon doctors today. It is not a field for everyone; it takes much more than an excellent student interested in the sciences. It’s a field where a student must feel a compassion and love for all sorts and parts of human beings and life. It also takes an individual with gumption, tenacity, stamina and creativity to get through tough times.

How do you juggle your family/private life with medicine?

I am married and have five children…all daughters actually, and to the same guy all these years. Two were born in medical school, one during residency, the fourth was born just after the internal medicine final boards exam, and the fifth came when I was employed at Hennepin County Medical Center. “Juggle” is a MetroDoctors

good word, and it becomes a way of life. There isn’t a day when my work isn’t modified for my children, and conversely, there isn’t a day in my children’s lives when they are not affected by my occupation — unless we are on vacation without beepers and telephones. Efficiency, multi-tasking, hard work, trouble-shooting and teamwork with my husband have been key to both family and occupational survival.

If there were an opportunity for you to advance in health care management, would you do so? Why or why not?

Sure I would, but it would need to be the right situation.

Describe your greatest accomplishment to date — personal or professional.

This would have to be my five beautiful daughters and my marriage. They always come first before my occupation. Graduating from medical school was a great accomplishment, and opening this clinic has been a surprising and delightful experience.

Stephanie Stanton, M.D. Describe your practice environment. What is unique about your practice?

The most obvious answer is that United Family Practice Health Center is a Family Medicine Residency clinic, offering a full spectrum of care from birth to end-of-life. Other than family medicine physicians, our clinic staff includes PAs and psychologists and one IM doc. There is a very strong female presence in our staff, community preceptors, and The Journal of the Hennepin and Ramsey Medical Societies

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What factors had an impact on your decision to go into medicine and, speciďŹ cally, the specialty you practice?

Education and job security were very important lessons instilled in me early in life by my mother and grandmother. I watched my mother struggle to ďŹ nd work in the 70s without a

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college education, deeply in debt, despite being a veteran with educational beneďŹ ts. I similarly grew up with my grandmother’s stories about struggling to make ends meet as the daughter of an Oklahoma Seminole-Irish couple and with only a sixth grade education. There was never a question about whether I would be going to college — that was assumed, because education was the answer to every problem that my family struggled with. I never knew it might be medicine. There are no physicians in my family, although my mother has worked as an autopsy specialist in the Air Force, grandma worked a bit as a lab tech, auntie is now an RN, and another aunt became an ambulance driver after I started medical school. And my stepfather taught animal science, having served as a large animal veterinarian in his earlier years.

I think I ultimately decided to go into medicine for many reasons: challenge, job security anywhere, chance to use language and culture and develop strong enduring relationships with patients and co-workers.

In terms of specialty choice, I strongly considered OB, but realized that I want exibility to practice in underserved and rural

environments. As a student, I visited places like Ely and Grand Marais and fantasized about being an OB in these locales, only to be informed that they really don’t have enough pregnancies to support an OB. I ultimately decided on family medicine because it would allow me the greatest flexibility in future practice types and locations, and would allow me to reďŹ ne and focus my interests as they developed. Especially in a rural underserved setting, where there is a great shortage of health care and physicians, I could be most useful as a family physician. These decisions were quite heavily inuenced by my participation in the Rural Physician Associate Program as a medical student and the overall attitude of the U of MN mission to train primary care physicians.

I’m also attracted to family medicine because there is CLEARLY a spirit of teamwork at all levels of providers from physicians to nursing assistants, to front desk staff to the patients — I’ve not seen this level of respect and cooperation in any other specialty.

And family medicine inherently has a stronger priority on family life, which trans(Continued on page 10)

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The Journal of the Hennepin and Ramsey Medical Societies

residents, with literally award-winning female role models and advisors. The clinic is also an FQHC look-alike clinic and serves a signiďŹ cant underserved and uninsured population, and we couldn’t possibly function without the support of our Patient Advocate team. There are very strong historical and current ties to the West Seventh Community with satellite clinics stretching from the North end Face-to-Face clinic serving high-risk teen pregnancies to the homeless at Dorothy Day to immigrant populations at Sibley Manor apartments on the far end of West Seventh. In complement to this diversity, the clinic support staff, providers and patients are equally multi-cultural with at least 10 languages spoken in our clinic by staff and patients: English, Somali, Spanish, Russian, Hmong, French, Vietnamese, multiple Chinese dialects, Ordu, and Cambodian to name a few. We serve a vast array of patients from the newest immigrants to recent generations of college students and families to wellestablished citizens whose records date back to Ancker Hospital.

From a residency perspective, we enjoy a small class size with a strong focus on a healthy balance between our professional and personal/ family lives. Most of the residents are married and about one-half have children. I think we had over 10 babies born or in gestation just among the 18 residents in the last year! Our program is good about emphasizing patientcentered care without losing site of the need to care for ourselves too. While not yet part of the practicing physician culture, residency programs began working under the 80 hour workweek restrictions four years ago in the interest of patient safety, resident safety and education. I’m proud of our program’s exibility and ingenuity in implementing these new restrictions, as we’ve adopted a night oat system in the past year, which again speaks to our program’s dedication to the health and well-being of both our patients and our residents (and future practicing physicians).

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Women in Medicine (Continued from page 9)

lates into quality of life for my colleagues and my family. Granted there are other specialties that don’t have call the way FM and OB does — but those specialties don’t necessarily also actually respect women and families. Most of my college friends who went into medicine are already practicing so I got to watch them struggle through choices. Those who studied hard enough in medical school to be AOA and win spots in very competitive specialties weren’t family focused and didn’t have relationships that I admired. And my female friends in surgical specialties ended up divorced — even those with children.

According to the University of Minnesota Medical School, females comprise 50 percent or more of their current medical student classes. To what would you attribute the increase in the female gender in medical schools?

The first time that females made up over 50 percent of the U of MN med school class was only a few years back with the class starting just before mine (the class starting in 2000).

I think my class, the very next one in 2001, actually barley missed this benchmark just shy of 50 percent, but thereafter there have been >50 percent women again.

The women in college and medical school today are the daughters and granddaughters of women who fought for female equality and women’s rights. We had the benefit of growing up in a society that has seen increasing numbers of women in leadership positions, like current U of M med school Dean Deborah Powell. It never occurred to me growing up that there were any barriers to me just because I was female, and I attribute this COMPLETELY to my mother, who was a leader in her own profession and certainly not about to be stopped from accomplishing something because of her gender. Compared to our grandmothers and the first women in medicine, the newest generations enjoy more girls finishing high school and more young women attending college. So it really should come as no surprise that now women are comprising greater percentages of graduate level training programs, including medicine, law and sciences. What’s interesting is to see which professions women choose to go into and for what reasons.

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I guess I have to admit that the pessimist in me says that men are looking at other careers these days. I remember growing up, taught by society at large, that a good job was doctor or lawyer or business(wo)man. But in the last couple decades, it has become more difficult to earn a comfortable rewarding life as a physician — and in some ways this can make medicine a less desirable career choice.

But this is tempered against the recognition that medicine has matured, and now exists in a more caring preventive environment, benefiting greatly from female attitudes, perspectives and sensibilities.

Given your experience, would you encourage students to go into medicine?

Why or why not?

This is a question I face frequently — one of my friends/advisees is literally packing to go off to Illinois and start medical school next month. It has been a long process for her, and she actually did a good job of considering all options for a career in medicine from nursing, to PA, to MD vs. DO school. I have no reservations at all about encouraging someone like her from going into medicine, but it needs to be for the right reasons, and I don’t necessarily find myself encouraging someone to become a physician — especially given the drastic changes in health care in recent years and the enormous impact it has on the physician-patient relationship.

Medicine is rapidly evolving, and I doubt that anyone can accurately predict what it will look like in 10 years — and anyone just starting to consider working in health care as a physician, wouldn’t start practicing for at least 10 years. So it’s hard to advise such individuals.

But I think that potential physicians should be prepared to work in an environment over which they have little control or independence.

I’d make sure they are fully aware of the commitments for their entire life that they are making. Make sure they shadow physicians while an undergrad or even in high school, like what Dr. Sih does for some local high school students several times a year. Despite the challenges of paperwork and reimbursement and government interference, and insurance/pharmaceutical industry indiscretions, medicine still is and always will be the noblest profession, a profession of which one will always be proud.

MetroDoctors

How do you juggle your family/private life with medicine?

Only through great sacrifices by me and my family, and remembering to keep one foot squarely planted in each aspect of my professional and personal life. It’s hard — very, very hard; this isn’t really what I had in mind when I thought medicine would be a good “challenge.”

I am often envious of my resident classmates who aren’t married or who don’t have children yet because I can’t help but notice that they have much more time and flexibility available to them to study, travel abroad, or spend time in leisure activities. And they aren’t so negatively impacted by evening shifts and chaotic schedules.

I’m excited for two of my male classmates who are planning an international rotation together; although married, they don’t have children. In contrast, I notice myself and female classmates planning when I can even think about getting pregnant and how that relates to my current job search and whether I’ll be able to travel when I need to if I am pregnant or have a young baby. And then I find myself equally envious of patients, usually homemakers (men and women!) who are at home full-time. What a joy it would be to dedicate all my time to my husband, child and family. But in truth, I know that I would never be happy in either of those situations — I’ve actually tried them in life in my own way and know that I wouldn’t change things if given the chance. I could have gone through med school and residency without family, but that would mean that I would have jumped into med school right after college. I would have missed out on so many formative years that make me a better communicator and a more empathetic physician today. I know these are invaluable skills for my patients, for me, and for my family. And while I enjoyed an extended maternity leave with my first child, it wasn’t long before I wanted to get out of the home and start being a physician again. Some might call it greedy or unrealistic, but I want to be both a good wife and mother and a good physician.

I honestly don’t think I’d be as good at one without the influences of the other.

The real answer to juggling these competing priorities in life is making good choices, sometimes hard choices, and having the courage to change course when you find yourself

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on the wrong path. I couldn’t possibly do any of this without my most extraordinary and amazing husband and our extended families and friends. Heath picks up and drops off our son more than I do, and gets stuck with more house chores than any of his peers — despite the fact that he is a high level executive in his own professional world.

The other fortunate choice that allows this juggling act to work for me is going into family medicine and into a program with tremendous flexibility and the utmost priority and respect for family. I know I’ll be looking for this type of flexibility as I begin to sort through practice opportunities. Realizing that some of my peers and potential employers will scoff at my expectations, I believe that medicine is heading in the direction of more humane and family-friendly hours and practice styles. And while some will think this is a matter of the newest physicians just not wanting to work as hard, it can’t be pointed out enough that it’s really about safety for our patients — but maybe even more so for the protection and safety of physicians, their marriages, and their relationships with their family and community. This is becoming imminently truer as a greater number of women and family-oriented physicians go into medicine. I think it’s only a matter of time before practicing physicians start following safer and more sensible work hours, as currently enjoyed by resident physicians. And I think that this will allow more flexibility in practice styles so that physicians can be at their best not only for their patients but also for themselves and their families and their communities.

If there were an opportunity for you to advance in health care management, would you do so? Why or why not?

Not sure. I don’t see myself staying in a large metro area, where most health care management is centered. I guess I’d consider being part of it in a smaller community, but it’s not something that I see myself actively pursuing at this time. This has nothing to do with being a woman or my perception of how it affects time with family. It’s just not something that I’m terribly interested in at this time. My interests lie more in patient care and activism within organized medicine. Although, now faced with this question, I realize that I could very well end

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up in such a role at some point in my career, because I very much enjoy looking for ways to improve efficiencies and accuracy within a system, while maximizing satisfaction amongst those affected by the system.

Describe your greatest accomplishment to date — personal or professional.

I suppose all mothers and parents have the same answer. Our children are our greatest pride and joy, our greatest accomplishment.

No day, no call shift, no board exam is ever that bad once I get home and gather my giggling toddler into my arms.

I am yet so young in my career that I feel like my greatest professional accomplishments are yet to come. But my proudest accomplishments in medicine are two-fold: (1) when there’s a significant breakthrough with a patient like finally getting control of diabetes or cholesterol or back pain or alcoholism after months or years of hard work; and (2) introducing a colleague to organized medicine and seeing them blossom into amazing participants and leaders within the organization. I’m proudest of helping to revitalize the medical

student section of the MMA and AMA in our state from 2001-2005, and watching student participation literally explode. I’m proud and honored to have served as the Vice Speaker of the national AMA-MSS in the era where we had just begun implementation of resident work hour restrictions and as we debated women’s rights and accessibility to emergency contraception on the floor of the AMA House of Delegates — an issue brought forth by the Medical Student Section. And much more importantly, you have helped bring forth resolutions from the student and resident sections to the AMA House of Delegates, which ultimately and successfully changed the priority of the AMA to Cover the Uninsured, which is of utmost importance to the patient population at my clinic but with obvious applications to all aspects of health care. As I start my term as the Vice Speaker of the AMA-RFS, I find myself thankful for having found a residency that appropriately values active participation in organized medicine and I can’t wait to see where the next decades take medicine and what role I get to play in it.

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11

COLLEAGUE INTERVIEW

Carolyn Adair Johnson, M.D., CMD

Carolyn Adair Johnson, M.D., CMD graduated from the University of Minnesota School of Medicine in 1953 and completed an internship at Charles T. Miller Hospital (United Hospital). She is board certified in family practice and became a Life-Member of the American Academy of Family Physicians in 1997. She is a clinical professor at the University of Minnesota. Dr. Johnson is also a Certified Medical Director.

Q

When and why did you decide to go to medical school?

How was medical school different in the 1950s than now?

How many women were in your class, out of how many students? Were you treated respectfully?

A

When I was seven years old I wrote in my diary every day for three weeks when I was home quarantined with chicken pox — “I am very lucky I am home with the chicken pox and dreaming about my future perfession (misspelled).” My father taught me to tie surgical knots at that time with my right and left hand. “So you can help me when you grow up,” he said. So, naturally, my focus from then on was to be a doctor and work with my dad.

When I started at the University of Minnesota Medical School in 1948 the ratio of men to women was definitely different. I was one of four women enrolled with 120 men, many of whom were 30-year-old war veterans. The medical school professors were leery of us since 10 women had enrolled the year before and four dropped out the first week of school. We were told every morning in lecture “you are here and some men are not here so we expect you ladies to practice medicine fully and work long hours your entire career.” I worked 60 hours a week the first 47 years and then cut back to part-time the next five years. So, I obeyed!

I was treated respectfully with the exception of two professors the first year that liked to call on us a lot, did not like women in class, and were caustic in their remarks. After that first year I was always treated respectfully.

Was there a mentor that you had to rely on during your medical school/residency programs, or perhaps after you finished your training?

My closest mentor was my father, Carl E. Johnson, M.D., who practiced in St. Paul for 50 years doing general practice and surgery. I was his assistant in surgery for 10 years after I joined his practice.

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The other physicians who were mentors for me in my training at Charles T. Miller Hospital, now United Hospital in St. Paul, were Dr. Jane Hodgson and Dr. Theodore (Ted) Watson (both OB-GYN) and Dr. Frank Quattlebaum (surgeon).

After retiring from family practice in 2000 I became the medical director of the three long-term care facilities of HealthEast — Bethesda Care Center, Marian Care Center, and White Bear Lake Care Center, plus Dayton’s Bluff (now Good Shepherd’s). Dr. Thomas Altemeier, geriatrician and family practitioner and the previous director of these four homes, made fast walking rounds with me for several weeks before retiring completely from being the director and attending. He was a world-class geriatrician and it was an honor to be following in his steps.

Will you tell a story that comes to mind about a student you have taught? Is there someone who was challenging to teach, or who had a hard time with a patient, and what helped with that challenge?

For 20 years many fourth year female medical students and a few men rotated on a six-week program through my office in St. Paul. They were all bright, eager and great to work with. No one was challenging to teach.

It is great to see them still practicing here in the Twin Cities and, a few out of the state, happy with their profession. The women whom I remember the most are Ann Barnes, Barbara Leone, Sandra Coffin, Bonnie Hill and Terry Wollan. They were all shining lights and are now excellent practicing physicians.

MetroDoctors

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How did you balance your home/family life when you were practicing medicine?

Since I did obstetrics, family practice and numerous house calls the first 10 years, plus surgery weekly with my father, I was very busy. Add to this six children and a bevy of housekeepers.

However, it would have been impossible to do all this calmly without my husband’s support and help. Besides running his Department of Educational Psychology at the University of Minnesota, he was the main cook. His hours were more predictable than mine any day, and he was the best cook.

doing obstetrics in St. Paul, those first years kept me very busy with hundreds of deliveries every year.

I also did home deliveries from 1953 to 1977 in the Twin Cities, in the drug communes (houses) in St. Paul and Minneapolis. The women I helped were good people and cooperative. They were rebellious young women against society. I never lost a baby or mother.

The three obstetricians who were my back up knew me and agreed to do emergency C-sections if necessary, which happened rarely. My (Continued on page 14)

Will you say a little about the Medical Directors Association? Who are the members? As medical director, did you do both clinical work and administration? What did you like most and least about each role, and about the combination of roles?

The Medical Directors Association is made up of physicians who are family physicians, internists, or geriatricians who see patients in long-term care facilities or serve as the medical director in a facility.

I did both for 18 years and the last five years I worked as a medical director. In that capacity you make sure that the medical staff’s bylaws, rules and regulations are followed. This entails meetings for safety, analyzing falls, checking charts and records, updating administrator’s daily, giving in-services, starting ethics committees to cover patients who have no family or conservator, meet with families who have concerns, overlook care plans, and discuss problems with attending physicians.

I worked mornings five days a week the last five years and came back for problems if necessary. The combination of roles was the most satisfying. However, clinical work or interacting with patients was the most exciting part of work.

When I retired from family practice in 1992 Dr. James Pattee encouraged me to take his last course at the University of Minnesota to be well rounded as a medical director. He was a great educator and because of him and Dr. Tom Altemeier I added another 15 years of practice to my total years of working (1953 to November of 2005).

Describe your practice as an ob/gyn — both the challenges and the rewards.

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13

Colleague Interview (Continued from page 13)

patients had to agree, in advance, to go to the hospital if I said so. If they refused, the consequences were that I would never help another woman at home. Most of those people eventually saw me regularly the rest of my career. I also did home deliveries for several wives of physicians.

Obstetrics is a most exciting part of practicing and to be sharing in the happiness of a couple for this special event. A plus is to be invited to the graduations and weddings of the children I delivered.

Challenges were great then with no ultrasound to tell us the size of the baby, and with rare blood types never being diagnosed beforehand.

What was your most interesting home delivery, and did you ever regret doing home deliveries?

My most interesting house delivery was in Minneapolis in the 1950s on the West Bank in a drug commune. Thirty people lived there. The delivery took place on the third oor in a huge room and a bathroom adjoining.

Throughout the hours before the delivery many of the men came upstairs to use the toilet and slowly sauntered past us observing the woman in labor with her ďŹ rst child. There were no oor lamps, only ashlights.

All went well with the delivery and the baby cried normally. I had my Ambu resuscitator there and an oxygen tank had been delivered one month in advance of the due date per my instructions.

Fortunately, the granddad, a dentist, arrived and helped hold two ashlights for the repairs. He was a great conversationalist also.

At the end they released the 20 Doberman dogs chained around the room (usual in those days — this was a “drug house�) and I was told to throw them the placenta as far away from my back as possible.

I never regretted doing home deliveries. Most of the expecting parents were bright, questioning groups of young adults. Many of them eventually became my regular patients and stayed with me in my family practice career. I enjoyed watching them pursue their own careers eventually.

If you had a granddaughter who was interested in becoming a doctor, would you recommend it to her based on the current climate physicians work in?

If she were as excited about being a doctor as I had been 55 years ago and she loved people and the challenge of medicine, I would say go for it.

However, I would deďŹ nitely point out what physicians face today, starting with the staggering ďŹ nancial debt after four years plus internship and residency of $400,000 plus. Add to this the increased paperwork plus time consumed entering patient data and prescriptions on a computer.

This deďŹ nitely interferes with valuable patient-doctor dialogue. If she said she planned to share a job with another physician so she could work fewer hours I would try to stop her right then.

Working two and a half to three days a week is not good in my world. If, as a patient, you can never see your physician because of her schedule, that’s a problem. And that woman who only wants to work two to three days a week will never do good research in medicine in that ďŹ eld.

What is the most signiďŹ cant change in health care that you saw/experienced during your career?

During my career from 1952 through 2005 the three most exciting discoveries that took place and changed how we practiced better medicine were: (1) Rh blood testing; (2) pap smears; and (3) mammography.

As a female physician who primarily saw women and children, the great number of women I saw in the 1950s and 60s dying of cervical and breast cancer and babies dying of jaundice with undiagnosed Rh problems was overwhelming.

If you could do your career over again, would you still go into medicine? Why or why not?

Yes — a thousand times, yes.

Medicine is the most challenging, most exciting and satisfying job in the world right along with raising your children.

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MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

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When Physicians and Their Organizations Face DifďŹ cult Problems: The Case for Adaptive Leadership Editor’s note: This is the ďŹ rst of a three part series discussing adaptive leadership as a model for addressing the difďŹ cult problems that health care organizations face. The second article uses the case method approach to leadership education. In the third article the principles of transformative leadership will be described.

Being a physician today is, by deďŹ nition, a leadership challenge: • In the name of cost containment, health plans implement administrative requirements for high tech imaging that create complexity and increase cost. • Under pressure from government and business purchasers, clinic and hospital administrators install immature electronic medical record systems. Doctors must cope with new inefďŹ ciencies in exam rooms and at the bedside. • A prestigious government agency publicizes the deaths of nearly 100,000 people per year as a result of errors in our hospitals. • With ever increasing time constraints, physicians struggle to ďŹ nd adequate time to assist families in making important decisions and resolving disputes. • Physicians are rated and compensated based on quality improvement measurements that do not adequately account for severity of illness or patient behavior. • State legislatures address the health care workforce shortage by granting prescribing authority to non-physicians.

Medicine presents unique leadership challenges — unfortunately, not in forms that are most comfortable for us. As doctors, we have mastered technical work and regularly use our authority to lead teams in solving technical

BY

C A S C A D E PA R T N E R S

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medical problems: running a code, performing complex surgery or delicately balancing multiple medications in a fragile nursing home patient. We know how to evaluate data and use our vast knowledge and experience to make clinical decisions.

As physician administrators we use our formal and informal authority in administrative suites and boardrooms: running meetings, negotiating with multiple stakeholders and speaking the language of business. Whether in the clinic or the meeting room we use our authority to set direction, shape and maintain norms, orient others to roles and responsibilities, control conict and protect our organizations from outside threats.

But all of our education, experience and skills do not prepare us for the important leadership challenges we face in the world of medicine today. A multitude of competing interests and values now dominate the horizon.

Plenty of stakeholders — employers, unions, third party payers, public policy experts and legislators — offer solutions. Many have the formal authority to execute their plans. But we physicians hold our own unique brand of authority. If we hope to inuence the evolution of our health care system and make progress on complicated issues, we must develop the skills that enable us to go beyond the authority and exercise leadership to deal with new challenges.

If we become effective leaders we can ensure that our critical perspectives are reected in our organizations’ adaptation to change.

Ron Heifetz*, a psychiatrist working at Harvard’s Kennedy School of Government, shatters our understanding of effective leadership. Through observation and application of principles in psychology, group dynamics and organizational behavior, he has developed a model of leadership that takes into account

The Journal of the Hennepin and Ramsey Medical Societies

the obstacles to signiďŹ cant change that we all encounter. He calls the model “Adaptive Leadership.â€? This model acknowledges the organic nature of human systems, including health care. Adaptive leadership is required when there is no best response to the external forces that we cannot control or our own internal pressures to compete and succeed. Adaptive leadership is required when the application of technical expertise will not sufďŹ ce.

Crisis is the strongest evidence of the need for adaptive leadership. If no clear technical solution can be found, or when problems persist (Continued on page 16)

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Adaptive Leadership (Continued from page 15)

despite efforts to address them, it may be that an adaptive model is needed. According to Heifetz, “Adaptive leadership is required when our deeply held beliefs are challenged, when the values that made us successful become obsolete and when competing perspectives emerge.”

Exercising leadership means bridging the gap between the shared values that people hold and the reality they face. It requires us to open our minds to new attitudes, beliefs and behaviors and to encourage openness in others.

One of the first and most difficult steps in adaptive leadership is simply identifying the problem as adaptive rather than technical. The culture of medicine trains us as physicians to think logically and sequentially. We apply rational standards to evaluate challenges and, as a result, may miss the subtle and not so subtle factors at the root of a problem. Adaptive challenges are disturbing because there is urgency, the stakes are high and there is no clear path.

Resistance, avoidance or lack of motivation (our own or others’) may impede progress.

Acknowledging the need to understand what

drives action or inaction establishes a starting point for physicians to become agents of change.

The obstacles that physicians face to employing adaptive leadership are formidable.

Financial pressures alone have made time a premium. Clinicians must often sacrifice financially in order to take on leadership roles.

Furthermore, as physicians, we are committed to a set of professional values that require us to consider what is fair, just and best for the patient. We cannot place one value, such as reducing cost or collecting data, above our responsibilities to our individual patients.

As clinicians, our role is to represent the most human element of health care, a burden and privilege that other stakeholders do not share.

Our lack of formal training and experience with the processes of change also puts us at a disadvantage. We may believe that meeting to talk about a problem is equivalent to doing something. At the conclusion of a discussion, we expect our recommendations to be executed as precisely as the written order for a hospitalized patient. Without understanding that other members of the team think in totally different constructs and may have competing aims and

Associate Medical Director – Chief Medical Informatics Officer HFA is a non-profit physician group practicing at Hennepin County Medical Center, one of America’s best hospitals. Our group consists of over 300 physicians representing 37 specialties. Our practitioners consistently rank among the best in the state, as well as nationally, and hold academic appointments at the University of Minnesota. We are committed to excellence in patient care, teaching and research.

We are looking for a physician to provide leadership for the creation of a patient-centered clinical informatics model that will support efficiency and continuity of care as well as patient safety. As the clinical representative, incumbent will consult with and serve as the liaison between the medical staff (attending and residents), nurse and other clinical practitioners and Information Services, and serve as physician champion for the integrated clinical systems at HCMC. Individual will function as a senior member of the Office of the Medical Director and Information Services, be a faculty member of the U of M Medical School, and expected to spend approximately 20% of time in clinical practice. Position reports to both the Chief Medical Officer and Chief Information Officer.

Position requires a current Minnesota MD license with 5 years clinical experience and 3 years experience in health care informatics in a complex healthcare environment, preferably an urban academic teaching hospital. Advanced training in Medical Informatics a must; certificate/degree preferred. Must have a solid understanding of clinical systems workflow, strong technical skills, the ability to communicate effectively in both verbal and written form, and the capability to build supporting relationships. Experience using the EPIC system preferred.

Please submit resume to Human Resources at: Hennepin Faculty Associates 600 HFA Bldg; 914 So. 8th St. Minneapolis, MN 55404 612-347-5306 (ph) • 612-373-1817 (fax) hr@hfa-mn.org • www.hfahealth.com EOE

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P hy s i c i a n s o f H e n n e p i n C o u n t y M e d i c a l C e n t e r

MetroDoctors

goals; physicians become frustrated when no progress is made. Adaptive leadership is far more dynamic and complex than the technical work we are accustomed to and thus takes time.

While these obstacles may at first seem daunting, physicians are also uniquely positioned to exercise adaptive leadership effectively. The challenges in health care come large and small: proposed reductions in Medicare reimbursement, pay-for-performance, same day clinic appointment policies, cross-specialty credentialing/privileging and so on. Every one of these situations is an opportunity for us to exercise leadership. Our frontline experience provides us with particular insights that payers, politicians, patients and even other health professionals lack. Our position within the health care system allows us to experience multiple perspectives. We know how families respond to illness; we understand how financial incentives can be effective or counterproductive; we anticipate unintended consequences of well-intentioned attempts to regulate safety or control costs.

After identifying the challenge, adaptive leadership allows physicians to utilize new tools and techniques to address the problem.

We are in an ideal position to make insightful observations, offer new interpretations, to ask the difficult questions that speak to higher values. After deliberation and consideration of diverse perspectives, we are well situated to take action.

Learning adaptive leadership takes effort, but the rewards are great. We can make progress on the tough issues that we face. Our daily work will be increasingly satisfying when our contributions are evident in the outcomes and when change, which is inevitable, can be greeted with confidence instead of fear.

In the next article, we will discuss the adaptive challenges that accompany implementing electronic medical records. *Heifetz, Ronald, Leadership Without Easy Answers (Cambridge, MA: The Belknap Press of Harvard University Press, 1994)

Cascade Partners principals include: Kathleen Brooks, M.D., MBA, MPA; Tom Gilliam, R.N., MBA; Mary Jo Lewis, M.D.; Michael Tedford, M.D., MBA; Valerie Ulstad, M.D., MPA, MPH. CascadePartners offers leadership education and coaching to health care professionals and the organizations they serve.

The Journal of the Hennepin and Ramsey Medical Societies

9/11/07 1:59:12 PM

Community Internship Program Provides a Glimpse into the Practice of Medicine

P

PROVIDING A GLIMPSE into the practice of medicine from the physician’s point of view, the Hennepin and Ramsey Medical Societies cosponsored a Community Internship Program on June 6-7, 2007 for public members and staff of the Minnesota Board of Medical Practice.

The Community Internship Program was created to provide a ďŹ rst-hand opportunity for leaders in the community, government and business to personally experience the practice of medicine from a physician’s point of view and to observe the actual operations of our health care system at the point of delivery.

Each “internâ€? was assigned to four physicians throughout the program — one from surgery, emergency medicine, and two other specialties. One-half day was spent with each physician, accompanying him or her on daily rounds and ofďŹ ce visits, attending surgery, and observing emergency care at the doctor’s side. Scheduling only one intern per physician allows plenty of time for questions and discussion.

The program evaluations received from the community interns, as well as the physicians who served as faculty, have been over-

Board of Medical Practice participants in the Community Internship Program: From left: Bill Marczewski, Paul Luecke, Pat Hayes, Mary Erickson, Ruth Martinez, Robert Brown, Ph.D., and Kelli Johnson.

Not pictured: Helen Patrikus and Allen Rasmussen.

(Continued on page 18)

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9/11/07 1:59:12 PM

17

Community Internship Program (Continued from page 17)

whelmingly positive and rate the value of the internship as a community oriented project as excellent. Some of the comments received

included: “This was a fascinating experience. I am so impressed with all the knowledge that just rolls out of their heads as well as all the technology, robotics!� “I was amazed by the level of unreimbursable activities, e.g. completion of health forms for camps and school, and the amount of

June 8, 2007 To: Hennepin Medical Society Ramsey Medical Society Thank you so much for making the Hennepin and Ramsey Medical Societies Community Internship possible for me and the rest of the Minnesota Board of Medical Practice crew.

Being a y on the wall in these amazing health care settings was an unforgettable experience.

Witnessing the physicians’ many interactions with patients, colleagues, and computers has provided me with new insight into the demands of the profession. This insight will undoubtedly serve me well as I continue in my service on the Minnesota Board of Medical Practice.

Once again, thank you. I feel so lucky to have been able to participate. It was an honor, a privilege, and a once-in-a-lifetime experience. Thank you so much.

Sincerely, Kelli Johnson, Public Member Minnesota Board of Medical Practice

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September/October 2007

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MetroDoctors

time spent with a patient’s family regarding end of life decisions.� “I was especially impressed with the physician’s ability to analyze the often times limited information given by patients and determine the diagnosis/course of treatment.� “A lot of patients are seen in a very short period of time.�

Plans are underway for HMS and RMS to offer another Community Internship Program this fall, inviting members of the legislature to participate as the interns. This program provides an effective opportunity for the public to understand the challenges and rewards of being a physician.

If you are interested in serving as a faculty member for the next Community Internship Program, please contact Nancy Bauer, HMS, (612) 623-2893, nbauer@metrodoctors.com or Katie Snow, RMS, (612) 362-3704, ksnow@metrodoctors.com.

Thank you to the following physicians for taking the time as faculty members to provide this positive experience for these community leaders: Sean Adams, M.D. Jeanne Anderson, M.D. Steven Wade Barhart, M.D. Jeffery Barkmeier, M.D. Arthur Beisang, M.D. Paul Bearmon, M.D. Eric Becken, M.D. Debra Bohn, M.D. Peter Bornstein, M.D. Paul Broadbent, M.D. Eric Christianson, M.D. Nancy Collins, M.D. V. Ross Collins, M.D. Stuart Cox, M.D. Peter Daly, M.D. Laura Dean, M.D. Dale Dobrin, M.D. Daniel Dunn, M.D. Thomas Gilbert, M.D. Walter Gleich, M.D. John Graber, M.D. William Heegaard, M.D. Steven Hommeyer, M.D. Louis Jacques, M.D. Eugene Ollila, M.D. Douglas Pryce, M.D. St. Paul Radiology Charles Terzian, M.D. Jackson Thatcher, M.D. Chris Tolan, M.D. Benjamin Whitten, M.D. Peter Wilton, M.D.

The Journal of the Hennepin and Ramsey Medical Societies

9/11/07 1:59:13 PM

YOUR VOICE

The Trouble with Medicaid Managed Care

A

renewed push for universal health insurance coverage is underway in Minnesota, and many believe expanding the state’s existing Medicaid program is the answer. But the present Medicaid program, one of the most expensive (and expansive) in the nation, has serious problems and expanding it would only exacerbate those problems.

In the mid-1980s Minnesota began shifting Medicaid populations from traditional fee-for-service Medicaid to Medicaid managed care. Under fee-for-service, the government administered the health plan: The government fixed the price for medical services, and the government paid the provider’s bill. Today, the state pays a private managed-care health plan a per-person fee, and the health plan, in turn, pays the doctor.

Moving away from government administered fee-for-service was a step in the right direction. Yet exclusive reliance on private managed-care plans has proven to perpetuate in varying degrees the same problems that beset traditional fee-for-service Medicaid, without realizing any of the benefits that managed care promised.

Two particularly troublesome fee-for-service traits have carried forward to managed care: For one, managed care requires little to no cost-sharing in the form of co-pays or deductibles and, two, managed care pays providers low, often below-cost reimbursement rates.

By providing generous first-dollar coverage that requires little to no cost-sharing, managed care perversely erodes the incentive for enrollees to take personal responsibility for their health care decisions.

With scant out-of-pocket expenses, prudent use deteriorates, giving way to overuse, a connection long ago confirmed by the RAND Health Insurance Experiment.1 Reining in overuse could result in significant savings. A study commissioned by the Minnesota Department of Human Services estimated $26 million in emergency room overuse by Medicaid enrollees in 2003, which is about the annual cost to fund 11,000 children in MinnesotaCare.2 Unfortunately, the RAND Experiment also showed that sick people with low incomes who were subject to cost-sharing had worse health outcomes on some measures. Still, this finding does not suggest that Medicaid should be free of any and all cost-sharing; rather, it cautions states to apply cost-sharing judiciously.

Cost-sharing could be targeted to medical services not linked to worse health outcomes and that tend to be based on patient preferBY PETER J. NELSON, J.D.

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The Journal of the Hennepin and Ramsey Medical Societies

ence versus medical need. Cost-sharing could also be structured so that enrollees are not forced to spend cash out of pocket. For instance, Oklahoma, South Carolina, Indiana and Idaho are implementing Medicaid reforms that publicly fund special enrollee-controlled medical spending accounts that can be used to pay for medical care.

Additionally, generous Medicaid coverage competes head-to-head with private insurance coverage for low-income customers, which can “crowd out” private coverage. One study estimates that public coverage crowds out private coverage by around 60 percent; meaning that for every ten people who enroll in Medicaid, six drop private coverage.3 If 60 percent of people enrolling in Medicaid already had private coverage, they obviously did not need Medicaid. By pulling people from private coverage, private payers’ influence on the health care marketplace diminishes and the government’s role grows.

By paying providers lower-than-market rates — often below the operational cost of procedures — reduced access, cost shifting, and incentives to deliver second-class care all become issues under Medicaid managed care.

In an American Academy of Pediatrics (AAP) survey of Minnesota pediatricians, 45.1 percent reported Medicaid payments do not cover overhead (47.2 percent reported they didn’t know).4 The latest estimates from the Minnesota Hospital Association show that Medicaid underfunds hospitals by 9.3 percent below cost.5 Consequently, doctors sometimes try to avoid serving unprofitable Medicaid populations. Some outright refuse to accept them as patients, while others avoid them through less overt methods. For instance, older established doctors can refuse to accept any new patient; younger doctors can start or relocate clinics away from less mobile, lower-income populations; and medical school students can avoid practice areas, like pediatrics, with higher proportions of patients on Medicaid.

Too-low reimbursement rates also result in a perpetual cost-shifting game where health plans, providers and patients parry the costs of low reimbursement rates to someone else. Cost shifting is a zero-sum game. All resources devoted to the game are wasted, because they’re expended to shift, rather than to create, value.

Costs often end up inequitably shifting to people least able to afford it. Residents of lower-income inner-city neighborhoods will find their nearest hospital charges them a higher rate than suburban hospitals because they treat more patients on Medicaid. Costs shifted in the form of higher insurance premiums make health care less (Continued on page 20)

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19

Your Voice (Continued from page 19)

affordable for people at the margins — poor but not poor enough to qualify for Medicaid. Further, higher premiums are essentially a hidden tax subsidizing Medicaid that operates much like a sales tax and, like any sales tax, it’s regressive.

Not incidentally, the hidden tax inherent in higher premiums hides the true cost of Medicaid and avoids the state budgeting process, which undercuts transparency and accountability within the Medicaid program.

Most troubling, low reimbursement rates can lead to secondclass care. No doctor would ever admit to treating Medicaid patients differently than private-pay patients, but any other businessperson instinctively treats more profitable customers better. It’s hard to prove that some doctors deliver second-class care, but the perception exists.

Thirty-eight percent of adult Medicaid enrollees surveyed in 2003 believed providers treated them unfairly due to their enrollment in Medicaid.6 If managed care lived up to its promise — to lower costs and improve health by actively coordinating medically appropriate care — then some of the shortcomings just outlined might be forgiven. Unfortunately, managed care has not delivered.

The Urban Institute has conducted a number of studies assessing Medicaid managed care. One nationwide study concluded that managed care’s expected cost savings “did not materialize, and managed care did not translate into dramatically slower growth in program costs per beneficiary.”7 Two studies of rural Minnesota also suggest switching to managed care did not result in savings. The studies compared differences in the use of medical services for people in managed care after switching from fee-for-service Medicaid and uncovered no difference in emergency room or inpatient hospital use, two places prone to overuse and ripe for cost-cutting supervision from managed care.8 Moreover, if managed care were effectively containing costs, one would not expect per-person costs in MinnesotaCare — a Medicaid managed care program for children and families who don’t qualify for traditional Medicaid — to have climbed 289 percent since 1998 compared to 212 percent for private insurance premiums.

As for quality, most research reveals that managed-care plans deliver quality no better and no worse than non-managed-care health plans. The two Urban Institute studies of rural Minnesota compared factors related to quality in managed care to fee-for-service Medicaid and found little difference in the location of where care is obtained, unmet health needs, reports of fair or poor health care experiences, or number of doctor visits.

In a free market, health plans compete on many levels, including price, service, quality, and benefit packages, as well as the plan design. All this competition should lead to lower prices, richer benefit packages, wider provider access, and higher quality service — in short, enhanced value. But most of this value-enhancing competition is absent within Medicaid managed care because the state defines the product. Thus, managed care plans generally have the same co-pays, premiums, benefits package and health maintenance organization plan design. Enrollees are left to choose a plan based almost entirely on the plan’s provider network and subjective perceptions of quality.

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Private health plans are constantly evolving and innovating to meet customer needs. Why restrict Medicaid enrollees to a single, almost immutable plan type? For people with incomes above the federal poverty guideline who are more able to share costs and are more capable of navigating the health care marketplace, other plan types might be more fitting.

One way to inject competition would be to provide Medicaid enrollees with the means to shop for their own private-market policies with direct subsidies or tax credits. Medicaid enrollees could then shop among plans with a defined state contribution that they or their employers would supplement to meet the full premium.

More shopping, choice, and competition would deliver more value to the Medicaid program, just as it has for Medicare’s new prescription drug benefit. Since heavily subsidized private prescription drug plans became available under Medicare Part D, they have consistently offered more benefits at lower prices than ever expected.

On top of enhanced value, subsidizing private health plans offers a number of additional advantages: • By purchasing the same health plans available to anyone in the private market, Medicaid enrollees would be covered by the same reimbursement rates and eliminate the access, cost-shifting, and quality problems caused by too-low reimbursement.

• Children who qualified for Medicaid when their parents did not could use the subsidy to join their parents’ private policy, unifying families into one plan that’s easier to navigate with the same network of providers.

• A private-market Medicaid policy would be more portable at the time enrollees lost or gained eligibility and thus would provide a more continuous and stable source of insurance. Instead of having to leave the plan altogether upon losing Medicaid eligibility, the enrollee or the enrollee’s employer could take over payments.

• Employers, employees and Medicaid would find it much easier to share in the costs.

It bears repeating that Medicaid’s motivating purpose — to assist people without health insurance — remains sound. Yet we could do better, much better, if only we would implement reforms that introduce competitive market forces to enhance the value of the health care services funded by Medicaid.

Peter J. Nelson is a Policy Fellow, Center of the American Experiment.

1) Joseph Newhouse, Free for All? Lessons from the RAND Health Insurance Experiment, pp. 100 & 339 (1994).

2) Minnesota Department of Human Services, Health Care Services Study: Findings and Strategies for Savings, (January 2005).

3) Jonathan Gruber and Kosali Simon, Crowd-Out Ten Years Later: Have Recent Public Insurance Expansions Crowded Out Private Health Insurance?, National Bureau of Economic Research Working Paper No. 12858 (Jan. 2007).

4) Beth K. Yudkowsky, Suk-Fong S. Tang, Alicia M. Siston, Pediatrician Participation in Medicaid/SCHIP: Survey of Fellows of the American Academy of Pediatrics, 2000, American Academy of Pediatrics.

5) Joe Schindler, “Minnesota Hospital Association Analysis of Health Care Cost Information System Data,” May 30, 2007.

6) Minnesota Department of Human Services, Disparities and Barriers to Utilization Among Minnesota Health Care Program Enrollees (Dec. 2003).

7) Robert Hurley and Stephen Zuckerman, Medicaid Managed Care: State Flexibility in Action, Urban Institute Discussion Papers 02-06 (Mar. 2002).

8) Sharon K. Long, Teresa A. Coughlin, and Jennifer King, “Capitated Medicaid Managed Care in a Rural Area: The Impact of Minnesota’s PMAP Program,” The Journal of Rural Health Policy, Vol. 21, No. 1, p. 19 (Winter 2005); and Teresa A. Coughlin and Sharon K. Long, “Effects of Medicaid Managed Care on Adults,” Medical Care, Vol. 38, No. 4 pp. 433-446 (Apr. 2000).

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

9/11/07 1:59:14 PM

Focused Group Meet Your Future Colleagues—the U of M Class of 2007

F

FOCUS, A GENEROUS MEASURE of inten-

sity, and a knack for letting their hair down, as needed — these are some of the characteristics evident among the 226 new physicians who graduated from the University of Minnesota Medical School in May. The Class of 2007 made a difference near and far, as they instituted a new reflective retreat for themselves as future physicians and also learned around the world.

Before sharing a few of their stories, let’s look at the statistics. Seven of our new physicians are American Indian — Minnesota ranks second among medical schools in graduating American Indians. Almost half of the class is women. Ninety-seven new doctors entered primary care specialties. The rest chose among the broad spectrum of surgical, medical, and hospital-based careers. The majority are Minnesota natives and we expect many, after they complete their residencies, to practice here.

More than half of the new graduates matched to residencies in Minnesota.

Their ties are strong. Many in this class also completed their undergraduate education at the University of Minnesota, and refer to themselves as “triple Gophers.” Class President Sarah Nakib calls herself a “quadruple Gopher,” having also completed a master’s degree in Public Health at Minnesota.

Nakib, who is now a first year resident in the brand-new combined Internal Medicine and Dermatology Program at the University of Minnesota, considers herself well prepared to begin her graduate medical education. So does the rest of her class, according to results of the 2007 Association of American Medical Colleges Graduation Questionnaire. Minnesota students are confident they have acquired

BY HELENE M. HORWITZ, Ph.D.

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Metro Dr SeptOct.pdf 23

the clinical skills required to begin a residency program.

Asked to describe the personality of her class, Nakib says: “Overall, we were a somewhat reserved class, we didn’t ‘rock the boat’ too often. Still, that didn’t get in the way of having a great time in med school. We valued having a sense of humor and took our talent shows very seriously.”

The Class of 2007 knows how to balance the lighter side of life with their professional values and their humanism. The co-chairs of the Gold Humanism Honor Society, Tara Frerks, M.D., and Kathryn Berkseth, M.D., spearheaded the first all-day retreat for fourth-year medical students entitled “After the Match: Transitioning to Residency as a e Humanistic Physician.” The March 14, 2007, retreat provided an opportunity for the seniors to reflect upon their medical school experiences and how they intersected with humanism, to regroup and refocus in anticipation of the upcoming challenges of internship and residency, and to reflect upon what they wish to take with them on the next part of the journey. Medical School Dean Deborah Powell, M.D., gave a moving address, reflecting upon her encounters with the health care system on behalf of family members.

At the conclusion of the day, the students addressed letters to themselves that will be mailed six months into their residency. This opportunity for the “almost physicians” to reflect upon the reason they chose medicine, their concern for the well-being of patients and their affirmation of the worth and dignity of each human being under their care, will become a tradition for the medical school classes that follow.

To develop these humanistic physicians, the educational program must be sensitive

The Journal of the Hennepin and Ramsey Medical Societies

to the needs, values and experiences of individual students.

From this understanding, the concept of the Flexible M.D. emerged. Fifteen percent of the graduating class chose to diverge from the traditional four-year curriculum and took additional time to pursue a variety of interests. These students extended their medical education an average of one additional year.

Four percent of the Class of 2007 completed dual degrees, including nine M.D./Ph.D. physician scientist graduates.

A number of the graduates chose to pursue extensive international experiences while in medical school. Stephanie Smith, M.D., a Gold Humanism Honoree, spent nine months abroad. First, she conducted research in Cape Town, South Africa, and then worked at a public health clinic in Quito, Ecuador. For Smith, the Flexible M.D. provided her with the opportunity to push boundaries and help to create her own vision of enhancing human well-being.

During a volunteer research experience in his first year of medical school, Rob Schleiffarth, M.D., became fascinated by a heart defect in mice. Deciding to pursue the problem, Rob took a year off after completing the basic science curriculum to work under the direction of Anna Petryk, M.D., with support from the Howard Hughes Medical Institute and the Minnesota Medical Foundation. Hoping to combine intricate surgery, patient care, and research in his medical career, Rob is now at the University of Iowa in his first year of a residency in Otolaryngology.

(Continued on page 22)

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21

U of M Class of 2007 (Continued from page 21)

Another graduate and Gold Humanism Honoree now in Iowa is Harrison Hanson, M.D., training in Family Medicine at Mercy Medical Center in Mason City. He is one of 30 students from the Class of 2007 who pursued an interest in rural medicine by participating in the Rural Physician Associates Program (RPAP), a program begun 35 years ago that has more than 360 alumni practicing in small towns in Minnesota. Harrison completed his RPAP experience in his hometown of Long Prairie.

Described as a compassionate leader and dedicated champion of family medicine, Harrison was chosen to receive the Medical Student Award for Contributions to Family Medicine by the Minnesota Academy of Family Physicians. Also an active volunteer, Harrison led a group of high school students on a service project to an orphanage in Mexico, and, nine days after hurricane Katrina hit the Gulf Coast, flew to Mississippi to volunteer at an outreach clinic. Shortly before graduation, this physi-

cian, who began medical school on the Duluth campus, completed a one-month externship in Ghana.

His fellow Duluth classmate and Gold Humanism Honoree, Ross Perko, M.D., also traveled to Africa. Ross, who is now a resident in pediatrics at the University of Minnesota, made a difference in the lives of children in Uganda. As reported in his Iron Range hometown newspaper, the Mesabi Daily News, Perko was moved to help children at the Mulago Hospital in Kampala and at the local orphanage. When the chickens belonging to the orphanage were stolen, and the children no longer had any eggs, he asked his hometown friends and neighbors to help. They gave the $7 cost for purchasing a chicken many times over, helping to pay for food and toys for the children.

As medical students, the Class of 2007 has traveled to far-flung places around the globe as well as to the small towns of rural Minnesota where they positively impacted the health of local communities. They volunteered at inner-city clinics, schools, shelters and churches both here and abroad. Community service and humanism are values strongly held by these new physicians. Now they are bringing these values to the next phase of their education. As Nakib says, “the way we learn has changed a bit. The stakes are higher now…we’re looked to for leadership and decisions.”

Helene M. Horwitz, Ph.D., is associate dean for student affairs at the University of Minnesota Medical School. For more information about the medical school, go to www.med.umn.edu.

Addendum to Article “Medical Students Connecting with Community Physicians” The following HMS/RMS physicians also serve as mentors in the Medical Students Connecting with Community Physicians program. These physicians are in addition to those reported in the July/August issue of MetroDoctors. Thanks again to all physicians participating in this medical student mentoring program.

Seeking an Internal Medicine Physician We are a thriving, five physician independently owned clinic, established in the ‘60s. We are looking for a physician to assume the practice of a departing physician and continue to develop his/her patient base. We are conveniently located next to Fairview Southdale Hospital in Edina.

Future partnership opportunity available.

Please contact:

Cami or Melissa

Southdale Internal Medicine, P.A. 6545 France Ave. S., Suite 225 Edina, MN 55435

952-927-7079

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September/October 2007

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Ioanna Apostolidou, M.D. Jack Bert, M.D. Iris Wagman Borowsky, M.D. Christopher Callahan, M.D. Lisa Capell, M.D. Gretchen Sandvik Crary, M.D. Timothy Crimmins, M.D. Sean Elliott, M.D. Julia Grigoriev, M.D. Kenneth Holmen, M.D. Christine Hult, M.D. Allan Ingenito, M.D. Michelle Johnson, M.D. Kenneth Kephart, M.D. Natalia Kramarevsky, M.D. Kenneth Liao, M.D. Fei Lu, M.D. Lael Luedtke, M.D. Lisa Lyons, M.D. Toni Magnuson, M.D. Jake Matlock, M.D. Clare McCarthy, M.D.

MetroDoctors

Robert Moravec, M.D. J. Bart Muldowney, M.D. Juliana O’Laughlin, M.D. Luis Pagan-Carlo, M.D. Christopher Robert, M.D. Kari Roberts, M.D. Anne Rosenberg, M.D. Ashajyothi Siddappa, M.D. Lance Silverman, M.D. Jay Simonson, M.D. Arif Somani, M.D. William Stauffer, M.D. Thomas Stillwell, M.D. Suzette Sutherland, M.D. Robert Sweet, M.D. Joseph Tashjian, M.D. Umeng Thao, M.D. Jeanette Thomas, M.D. Ezgi Tiryaki, M.D. Paul Tuite, M.D. Jennifer Welsh, M.D. Parin Winter, M.D.

The Journal of the Hennepin and Ramsey Medical Societies

9/11/07 1:59:15 PM

Jacott Elected Chair AMA Senior Physician Group Governing Council

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WILLIAM JACOTT, M.D., has been elected chair of the seven member AMA Senior Physician Group (SPG) Governing Council. The AMA SPG includes AMA member physicians who are 65 and over and retired or semi-retired.

The Governing Council has been around for about 10 years, but has not been visible or integrated into the AMA infrastructure. Recently, the Council has moved to become an important part of the AMA activities. The chartered purpose of the SPG is to provide ancillary membership services to AMA members 65 and over. Up until now it has done this with travel programs, awards, a senior physicians Web site, a newsletter and a 50-year luncheon. In order

to expand the activity and better participate in mainstream AMA activities, the Council has carefully considered strategy to move the SPG toward becoming a Section within the AMA. The Council has taken a number of key steps to accomplish that goal. The winter meeting has been rescheduled from offsite in February to the AMA Interim meeting. Council members have been active participants in House of Delegates reference committee hearings. The first Senior Caucus was held during this year’s annual meeting in June. Work has begun to build a senior physician constituency by developing a network of senior physician groups throughout the country. Two of those

groups already exist here in the Twin Cities. This network could be a powerful advocacy group on such issues as Medicare, geriatric education, and health of the elderly.

The other members of the Governing Council include: Harrison Rogers, Jr., M.D., Georgia; John Knote, M.D., Indiana; Arthur Eberly, M.D., Florida; Virginia Lathum, M.D., Massachusetts; John Nettles, M.D., Oklahoma; and Irwin Kline, M.D., Pennsylvania. Dr. Jacott is from Minnesota and a former member of the AMA Board of Trustees after serving as an AMA delegate. The Council members serve two three-year terms and are appointed by the AMA BOT after an open call for nominations.

Great Partners, Great Staff, Great Patients, Excellent Income & Lifestyle MinnHealth Family Physicians is looking for several Board Certified/Eligible Family Physicians.

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FOR MORE INFORMATION PLEASE CONTACT: Paul Berrisford, 2025 Sloan Place, Suite 35, St. Paul, MN 55117 651-772-1572 • email: pberrisford@fhsm.com

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The Journal of the Hennepin and Ramsey Medical Societies

September/October 2007

9/11/07 1:59:15 PM

23

Law Firm Adds Services, Roger Johnson Joins Government Relations Team

L

ockridge Grindal Nauen P.L.L.P. (LGN) announces that Roger K. Johnson has joined the law firm as a lobbyist and consultant, part of the Government Relations teams in Minnesota and Washington, D.C., effective July 1, 2007. In his new position, Mr. Johnson will provide LGN clients with association management services, grassroots development, lobbying and public relations.

LGN Partner Ted Grindal said, “Roger is an outstanding professional whom I’ve known for 25 years. I look forward to working with him as the firm expands to offer public affairs, public relations and association management

Gregory L. Barth, M.D. Merrill A. Biel, M.D., Ph.D. Carl A. Brown, M.D. Karin E. Evan, M.D. Gary E. Garvis, M.D. William J. Garvis, M.D. Matthew S. Griebie, M.D. Michael B. Johnson, M.D. Nissim Khabie, M.D. Richard M. Levinson, M.D. Stephen L. Liston, M.D. Jeffrey C. Manlove, M.D. Michael P. Murphy, M.D. Julie C. Reddan, M.D. Melvin E. Sigel, M.D. Benhoor Soumekh, M.D. Jon V. Thomas, M.D. Rolf F. Ulvestad, M.D. Larry A. Zieske, M.D. 24

September/October 2007

Metro Dr SeptOct.pdf 26

services for clients working with us in Minnesota and Washington, D.C.” Johnson will advise, assist and advocate for physicians, physician group practices, practice administrators and specialty societies at the Capitol and in state agencies in St. Paul.

“I am very pleased to be affiliated with Lockridge Grindal Nauen,” Johnson said. “I look forward to working with the LGN advocacy team in Minnesota as well as with the attorneys in the LGN Health Care Practice Area on behalf of physicians and other health care professionals.”

A Minnesota native and graduate of the

University of Minnesota, Johnson has held several positions in organized medicine ranging from director of communications at the Minnesota Medical Association to the CEO of the Ramsey Medical Society, a position he held for 13 years until June 1, 2007. He is a Certified Association Executive (CAE).

Founded in 1978, LGN represents a broad base of clients in Minnesota and surrounding states. The firm’s practice focuses on environmental, employment, and health care areas of law and state and federal government affairs.

LGN is soon to be the only Minnesota-based law firm with offices in Washington, D.C.

Ear, Nose & Throat SpecialtyCare takes pleasure in announcing

Ilya Perepelitsyn, M.D. IN THE PRACTICE OF Otolaryngology — Head and Neck Surgery Minneapolis | St. Paul | Burnsville | Coon Rapids Edina | Fridley | Golden Valley | Plymouth Administrative Office: 2211 Park Avenue South, Minneapolis, Minnesota 55404 (612) 871-1144

www.entsc.com

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The Journal of the Hennepin and Ramsey Medical Societies

9/11/07 1:59:16 PM

PRESIDENT’S MESSAGE V. STUART COX, M.D.

RMS Officers

President V. Stuart Cox, M.D. President-Elect Peter B. Wilton, M.D. Past President James J. Jordan, M.D. Treasurer Ronnell A. Hansen, M.D. RMS Elected Board Members

RMS Appointed Board Members

Stephanie D. Stanton, M.D., Resident Physician Kimberly C. Viskocil, Medical Student Marie L. Witte, M.D., Young Physician MMA Officers and Board Members

Lyle J. Swenson, M.D., MMA Vice Speaker of House Todd D. Brandt. M.D., MMA East Metro Trustee Charles G. Terzian, M.D., MMA East Metro Trustee David C. Thorson, M.D., MMA East Metro Trustee RMS Ex-Officio Board Members & Council Chairs

Blanton Bessinger, M.D., AMA Alternate Delegate Peter F. Bornstein, M.D., MPS, Inc. Chair Kenneth W. Crabb, M.D., AMA Delegate Robert W. Geist, M.D., Professionalism & Ethics Council Chair Neal R. Holtan, M.D., Community Health Council Chair Frank J. Indihar, M.D., AMA Delegate, Chair of MN Delegation Carolyn A. Johnson, M.D., Sr. Physicians Association President Mark J. Kleinschmidt, Clinic Administrator Anthony C. Orecchia, M.D. Education Resource Council Chair RMS Executive Staff

Sue A. Schettle, Chief Executive Officer Katie R. Snow, Executive Assistant Doreen M. Hines, Manager, Member Services

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S

“SICKO” HAS ONCE AGAIN thrust the problem of health insurance and medical economics to the front of the public eye. It has probably also bolstered the resolve of several Minnesota politicians to pass a constitutional amendment requiring the government to provide health care for all Minnesota citizens. With the yearly increase in medical spending and the current percentage of our GDP spent on health care, we certainly appear headed for some sort of dramatic change in how we provide and pay for health care.

“Sicko” at least implies that universal health coverage paid for by the national government as in Canada, the United Kingdom and Cuba, is superior to our current system.

Looking at the cost of health care per capita and several health measures, the U.S. is not doing as well as would be expected. However, the problem is endlessly complex. A good starting point is comparing how health care is provided and paid for here compared to the universal health coverage countries. Dr. Bob Geist, in a recent newspaper editorial, points out that we currently have an agreement with private companies that we pay our premiums and they will take care of us. Whereas, in the UK and Canada, the deal is made with the government. They pay their taxes so they will provide health care.

One of the arguments for universal health coverage is the number of uninsured.

Undoubtedly, some cannot afford health insurance. However, many choose to forgo health insurance and rely on “free care.” Insurance is primarily a vehicle to protect our assets in the face of a health care catastrophe. If an individual family has minimal assets, it doesn’t make economic sense to spend a large part of its income to protect its assets. Unfortunately, health insurance in America has morphed into an agreement that we will take your money and then provide you with all the health care you need. This puts an enormous amount of money (power) in the hands of insurers who will benefit by rationing care, and also leads to the assumption by those who pay the pre-

The Journal of the Hennepin and Ramsey Medical Societies

miums that anything that can be done must be done regardless of cost or often unproven outcome. Demand is the primary driver of health care cost.

The MMA’s proposal for health care reform would require that all individuals have insurance coverage. The “basic” insurance will provide a single standardized set of health services for the protection of individual and public health. The State would also ensure affordability through subsidies and tax incentives.

There would also be incentives for employers to offer insurance above the “basic” coverage.

The MMA plan also calls for strengthening the public health system and reforming health care delivery with incentives for improving value.

The health savings account model has put a large part of the decision making on the individual, who, up to this point, has been largely left out of the equation. The model is built on a combination of the HSA and major medical insurance, which is to protect against a health care catastrophe. The HSA is controlled by the individual and can be spent without significant outside restrictions. This could be supplemented further by a third account supplied by the employer to cover expenses after the HSA is exhausted but before major medical kicks in. The advantage of the HSA model is self-rationing, allowing individuals to decide the best health care value, and more freedom of providers to affect pricing. The concern is that people could forgo preventative care and end up choosing “poor quality” health care.

Rationing — a political third rail — is inevitable. The problem with the current system is irrational rationing, where both the patient and the physician lose. Whether we have rationing from the government, private corporations, individuals, or some amalgamation of all three, the escalation of spending on health care cannot increase indefinitely.

September/October 2007

9/11/07 1:59:17 PM

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Ramsey Medical Society

Arthur A. Beisang III, M.D., Director Charles E. Crutchfield, III, MMB, M.D., At-Large Director Laura A. Dean, M.D., Specialty Director, Obstetrics & Gynecology Andrew S. Fink, M.D., At-Large Director Thomas J. Losasso, M.D., At-Large Director Nicholas J. Meyer, M.D., Director Robert C. Moravec, M.D., At-Large Director Jane C. Pederson, M.D., Specialty Director, Internal Medicine Jerome J. Perra, M.D., Director Lon B. Peterson, M.D., Director Thomas D. Siefferman, M.D., Specialty Director, Pediatrics Jacques P. Stassart, M.D., At-Large Director Christina J. Templeton, M.D., Specialty Director, Psychiatry Scott A. Uttley, M.D., Director

Health Insurance and Medical Economics

RMS UPDATE

Smoke-Free Washington County Coalition Update We are celebrating the passing of the Freedom to Breathe Act! Starting October 1, 2007 all workplaces and public places will be smokefree. We have already started our implementation work and have been running into the same question, “What is left to be done, the law already passed?” Well, we have a lot of public education to do to prepare Washington County for the new law. Many people are either not aware or do not fully understand all the details of the new smoke-free law. To educate we are attending many community events, presenting to community organizations and also getting in touch with businesses. Let the countdown begin!

Summer Events DQ Event We held an event in partnership with the Stillwater Dairy Queen where we gave away free Blizzards to those who came out to support the new smoke-free law. It was a huge success! We gave away 199 Blizzards, and it was a wonderful opportunity to hear what Stillwater citizens have to say about their community going smoke-free.

months. In September, Alecia will be entering her senior year at Gustavus Adolphus College.

She is pursuing a degree in Sociology & Anthropology. A strong interest in health care, public policy, and general non-profit work led Alecia to Ramsey Medical Society.

Elizabeth Frosch helps two little girls play Smoke-Free PLINKO at the Washington County Fair.

Woodbury Days We had a table in the community business section at the Woodbury Days August 24-26 giving us another chance to get materials out to citizens on the new law. Additionally, Woodwinds Hospital passed out Freedom to Breathe information cards at the parade.

Smoke-Free Washington County has a Web site!

When you have a minute, check out our Web site: www.smokefreewashingtonco.org. Here you will find information about Freedom to Breathe, secondhand smoke facts, ways to get involved, and an opportunity to tell your story.

Washington County residents enjoying Blizzards at the Sillwater Dairy Queen.

Washington County Fair Smoke-Free Washington County had a booth at the Washington County Fair August 1-5.

We had our new t-shirts on and our PLINKO game was a big hit with the kids. With lots of traffic through the buildings we had a great opportunity to educate Washington County citizens on the new law.

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September/October 2007

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Summer Interns Please welcome our two summer interns: Alecia Gooch and Elizabeth Froch.

Alecia Gooch was a new addition to the SmokeFree Washington County team as of June 15. She is working on community events through the summer

Serving as a community organizing intern, Elizabeth Frosch joined the Smoke-Free Washington County Coalition in June.

Elizabeth works to increase public awareness and educate the community on the statewide smokefree law. As a 2007 graduate of St. Olaf College, Elizabeth brings her social work degree, public health experience, and strong interest in public policy to the implementation process.

Upcoming Events Go to www.smokefreewashingtonco.org to check out our event calendar to find an event in your area. Click on the calendar in the bottom right corner to find upcoming events.

9/15 —Youth Event in Woodbury Students will get the chance to get involved and educate the public by holding signs on busy Woodbury intersections advertising the coming of the new smoke-free law.

10/1 — Implementation Day! Lunch –We encourage everyone to eat out at their favorite restaurant with co-workers or friends for lunch and thank your host/server/ restaurant manager for the Fresh Air! Progressive Dinner – check out our Web site to find out more information on our Implementation progressive dinner starting at Gorman’s restaurant in Lake Elmo www.smokefreewashingtonco.org.

If you are interested in getting involved please contact Cynthia Piette at (651) 4393096 or cpiette@metrodoctors.com.

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The Journal of the Hennepin and Ramsey Medical Societies

9/11/07 1:59:17 PM

Sue A. Schettle as New CEO of RMS

I

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at the legislature. Together with HMS, we staff and manage the Metropolitan Hospital Physician Leadership Committee, which is a committee comprised of medical directors, vice presidents of medical affairs, and chiefs of staff from metro area hospitals who come together quarterly to talk about issues specific to hospitals.

RMS has a core, dedicated group of retired physicians who meet routinely and discuss issues that are sometimes health care related, sometimes not. It is an opportunity for them to meet with friends and to socialize.

I am glad to be a part of an organization like the Ramsey Medical Society that is very alive and active. I am also thrilled at the opportunity presented to me and look forward to working with many of you. If you have comments that you’d like to share with me please feel free to contact me at (612) 362-3799, or e-mail me at sschettle@metrodoctors.com.

In Memoriam DAVID M. CRAIG, M.D. died in his home in Portland, Oregon on June 13, at the age of 90.

He graduated from the University of Minnesota Medical School and interned at Milwaukee County Hospital. Dr. Craig served as a Major in the Army Medical Corps in North Africa and Italy. Upon his return to St. Paul he began practicing with St. Paul Internists and remained there until retirement. Dr. Craig joined RMS in 1947 and served as President in 1969 and was very active in organized medicine.

MICHAEL LOBELL, M.D. died on May 9 in Tucson, Arizona at the age of 70. Dr. Lobell received his medical degree from the University of Louisville School of Medicine and his postgraduate work and residency were spent at the State University of New York Hospitals. He completed clinical and research hematology work at the University of Utah. He served as a clinical professor of medicine at the University of Minnesota, the University of Kansas Medical Center, and for the past six years, at the Arizona Cancer Center. Dr. Lobell specialized in Hematology/Oncology and found his calling in the Arizona desert improving cancer care for the underserved Native American population. He was a member of RMS prior to his move to Arizona in 1991.

The Journal of the Hennepin and Ramsey Medical Societies

“Ethical Issues in Pay for Performance” Speaker: David Satin, M.D. • Post-Doctoral Fellow, Center for Bioethics, University of Minnesota • Assistant Professor, Department of Family Medicine and Community Health, University of Minnesota • Family Physician, University of Minnesota Medical Center (Smiley’s) Residency Program, Minneapolis • AMA Geriatric Pay-for-Performance Work Group Friday, November 16, 2007 7:30 a.m. – 8:30 a.m.

United Hospital John Nasseff Medical Center (formerly the Heart and Lung Center) Miller and St. Luke’s Conference Rooms 255 N. Smith Ave., St. Paul, MN 55102 Lower Level

Sponsored jointly by the Ramsey Medical Society and the medical staffs of United Hospital and HealthEast Hospitals.

The public is welcome.

CME and CEU credits are available.

Please contact Marge Avoles in Physicians Services at (651) 241-8548 with questions about this presentation.

Save the Date Ramsey Medical Society Foundation

Winter Medical Conference 2008 February 23, 2008-March 1, 2008 San Diego, California

September/October 2007

9/11/07 1:59:17 PM

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Ramsey Medical Society

am very excited to dig in as the new chief executive officer of the Ramsey Medical Society. Trying to fill this role that was held by my friend, Roger Johnson, will not be an easy task, but I am up for the challenge and energized by it.

As I take the reins of Ramsey Medical Society I realize that I have stepped into a whirlwind of activity. For a relatively small organization, we have a lot going on and a lot of opportunity for physicians to get involved. We have an active and engaged board of directors and executive committee who meet frequently and get involved in many of the activities of the society. Our foundation board members are engaged and looking forward to future fundraising and gifting possibilities. We have a for-profit subsidiary, Minnesota Physician Services, Inc., that has recently broadened its scope to include the entire state of Minnesota and is focused on entering into new business relationships that will bring additional non-dues revenue to the society.

We have three active councils that include the Education Resource Council focusing on CME, the Professionalism and Ethics Council dealing with the ethical dilemmas physicians sometimes face in the business of health care, and the newly reinvigorated Public Policy Council which is a joint council with the Hennepin Medical Society and focuses on engaging physicians in health care legislation at the local level.

We also are the recipients of two grants to work on smoke-free initiatives in Washington County and Dakota County. The grants help fund two full-time staff members who work on implementing the statewide law in their respective counties. We staff and administer the Minnesota Ambulatory Health Care Consortium, which focuses specifically on monitoring legislation affecting ambulatory surgery and imaging centers. We are active in working with the Minnesota Medical Group Management Association on many initiatives, and I serve on their government affairs committee. We work jointly with the Hennepin Medical Society on the Minnesota Provider Coalition that is comprised of a diverse group of health care organizations working to pool their resources to affect change

Please Join Us

Pleae print or type and return by Monday, December 10, 2007

Call for Nominations

Do you have a colleague who should be recognized for his/her many volunteer activities in the community?

2007 RMS Annual Community Service Award In 1992, Ramsey Medical Society established an annual Community Service $ZDUG WR UHFRJQL]H RQH RU PRUH ´XQVXQJ KHURHV¾ ZKR KDYH PDGH SRVLWLYH contributions to our local community. The award is now entering its fourteenth year. Recipient(s) of the 2007 Community Service Award will be recognized at the RMS Annual meeting in 2008. A commemorative plaque will be presented to the selected physician(s) and the winner(s) of the annual award will be prominently displayed on a perpetual plaque in the Society office. The RMS Board of Directors is seeking physician nominees from the membership.

AWARD CRITERIA

x Nominee must be an active or retired RMS physician member. x Service(s) by candidate must be voluntary in nature, performed locally, and should include one or more of the following elements: (a) leadership and development of special community projects or programs; (b) Participation in civic or service organizations/groups; (c) Participation in educational, charitable, church, or other projects; or (d) Public offices held. x RMS presidents are ineligible for the award until two years after the completion of his/her term of office.

RMS Physician Nominated (Full Name): _________________________________________________________ Describe why you are nominating this physician for the RMS 2007 Community Service Award, including specific community activities above and beyond professional medical work that this person has been involved in. You may also use a separate page if you need more space. (Please print or type and return by Monday, December 10, 2007.)

This nomination submitted by (Full name): _______________________________________________________ Mail nomination form to: Ramsey Medical Society, P.O. Box 131690, St. Paul, MN 55113-0015 Questions call 612-362-3704.

28 September/OctoberOr 2007fax to 612-623-2888/ Email: sschettle@metrodoctors.com.

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9/11/07 1:59:18 PM

CHAIR’S REPORT PAUL A. KETTLER, M.D.

Reflections of 2007

M

MY TERM AS CHAIR of Hennepin Medical

Chair Paul A. Kettler, M.D. President Anne M. Murray, M.D. President-elect Richard D. Schmidt, M.D. Secretary Edward P. Ehlinger, M.D. Treasurer Eric G. Christianson, M.D. Immediate Past Chair James A. Rohde, M.D.

Society is soon ending and this will be my last column. I would like to take time to reflect on this past year’s accomplishments.

HMS staff and many of its physicians have worked hard and championed for a smoke-free workplace. This perseverance has resulted in the passing of the Freedom to Breathe Act, which protects people from secondhand smoke. Without the involvement of physicians, this would not have happened.

Thank you to all who have donated your time and talents in this effort.

The Board also participated in a strategic planning retreat this year to re-look at the organization of HMS and why it exists. Through this process a new mission statement, vision statement, and name change were crafted.

The new mission statement reads “Hennepin Medical Society is an organization of physicians dedicated to improving health care through education, support and advocacy for patients and physicians.” The Board also replaced the current marketing statement with the following vision statement “Providing medical leadership to ensure a healthier and safer community.”

HMS is growing and expanding with our membership increasing over the past several years. The fastest growth is in counties outside of Hennepin, Carver, Scott, Anoka and Western Dakota counties. Physicians within these counties have expressed a “disconnect” with HMS. In response, the Board has discussed and debated the pros and cons of an organizational name change. This was not taken lightly as HMS has a long-standing history and tradition. After much discussion, a new name was recommended by the Board of Directors — West Metro Medical Society (WMMS). This will require approval from the House of Delegates at the MMA annual meeting this September in Mankato. It was felt this name would better reflect the true membership of the society.

The Board also approved a new award, the “First a Physician” award. This award recognizes

HMS-Board Members

Lauren Baker, M.D. Alan L. Beal, M.D. Carl E. Burkland, M.D. Peter J. Dehnel, M.D. Laurie Drill-Mellum, M.D. Kenneth N. Kephart, M.D. Stephen MacLeod, M.D. Frank S. Rhame, M.D. Janette H. Strathy, M.D. Thomas C. Tunberg, M.D. David J. Walcher, M.D. David A. Willey, M.D. HMS-Ex-Officio Board Members

Michael B. Ainslie, M.D., MMA Trustee Martha Arneson, Co-Presiding Chair, HMS Alliance Beth A. Baker, M.D., MMA Trustee Christian L. Ball, M.D., Resident Representative Karen K. Dickson, M.D., MMA Trustee David L. Estrin, M.D., AMA Alternate Delegate Melanie Fearing, Medical Student Representative Donald M. Jacobs, M.D., MMA Trustee Roger G. Kathol, M.D., MMA Trustee Dawn Lunde, MMGMA Representative Richard E. Streu, M.D., Sr. Physicians Association Representative Karin M. Tansek, M.D., MMA Trustee Trish Vaurio, Co-Presiding Chair, HMS Alliance Benjamin H. Whitten, M.D., AMA Alternate Delegate HMS-Executive Staff

Jack G. Davis, Chief Executive Officer Jennifer Anderson, Smoke-Free Project Coordinator Nancy K. Bauer, Assistant Director, and Managing Editor, MetroDoctors Kathy R. Dittmer, Executive Assistant

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The Journal of the Hennepin and Ramsey Medical Societies

a member of HMS who exemplifies the profession of medicine as a result of an outstanding contribution to community service, work on public policy issues or legislative advocacy, or significant contribution to the governance and success of the Hennepin Medical Society. This award will be presented at the Annual Board of Directors meeting in October.

Unfortunately, a lot of work lies ahead.

The Medicare reimbursement for 2008 will be cut almost 10 percent. The system is broken and needs to be fixed once and for all. The AMA and MMA work hard on behalf of physicians and patients but rely on your grassroots efforts to be successful. Please get involved; all it takes is a phone call or an e-mail. In Minnesota there is also a significant campaign to advance a constitutional amendment (MartyDFL) that grants every Minnesotan the right to affordable health care. If this passes in the 2008 session the amendment would appear on the ballot. Physicians need to be involved and engaged on this issue; otherwise the practice of medicine will be legislated by politicians.

The future of medicine lies in our hands and physicians can no longer afford to keep their heads in the sand. Now is the time to get involved. Finally, thank you for allowing me the honor and privilege of being chair of the Hennepin Medical Society.

Welcome New HMS Board Member Stephen MacLeod, M.D.

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29

Hennepin Medical Society

HMS-Officers

HMS IN ACTION JACK G. DAVIS, CEO

HMS in Action highlights activities that your leadership and executive office staff have participated in, or responded to, between MetroDoctors issues. We solicit your input on these activities and encourage your calls regarding issues in which you would like our involvement.

Dianne Fenyk, wife of John Fenyk Jr.,

M.D., past President of the Hennepin Medical Society Alliance, was installed as the 83rd President of the American Medical Association Alliance on June 26, 2007. A reception partially sponsored by the Minnesota Medical Association, Hennepin Medical Society and Ramsey Medical Society took place on June 25, 2007 in Chicago.

Hennepin Medical Society Caucus

took place on May 23, 2007. Over 20 resolutions were presented and approved for submission to the Minnesota Medical Association House of Delegates, which is scheduled to be held in Mankato on September 19-21, 2007. If you haven’t yet registered, please contact Kathy Dittmer at (612) 623-2885. The future focus of the MMA will be determined during this meeting.

The Partnership for a Smoke-Free Scott County has met several times and is focused on the local implementation of the statewide Freedom to Breathe Act. The Act prohibits secondhand smoke exposure in all workplaces including bars and restaurants and will become effective on October 1.

June 5 through June 7, 2007 were the dates for the latest Community Internship Program. The CIP is designed to offer physician shadowing opportunities to individuals who are likely to play a role in setting or implementing health policy at a local, statewide or national level. Legislators, judges, members of Congress, and human resource executives are some examples of the public who are targeted for participation in this program. The June offering focused on the public members and 30

September/October 2007

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senior staff of the Minnesota Board of Medical Practice. See article on page 17.

Sandra Eliason, M.D., HMS member

physician practicing at the Columbia Park Medical Group and Executive Director of the Center for Cross Cultural Health, spoke at the June meeting of the Senior Physicians Association. Dr. Eliason’s presentation focused on her medical travels to Cuba and the Cuban health care system. Her interesting talk was attended by 50 retired physicians and spouses.

Jack Davis and Sue Schettle of the Ramsey Medical Society spoke at a recent meeting of the Children’s Executive Professional Committee. They spoke on the importance of medical professionals being engaged in the policy debate regarding health care and public health issues. They reminded those attending that the 2007 Health Care Omnibus Bill contained 555 pages filled with legislation that might well affect the delivery and financing of health care. It’s important that physicians and other health care professionals participate in the debate in support of their patients.

On July 16 Southdale Pediatrics physicians presented Sen. Geoff Michel, Rep. Ron Erhardt and Rep. Neil Peterson with certificates commemorating the historic passage of the Freedom to Breathe Act. Nancy Ott, M.D. and Lori Skallerud, M.D. presented the certificates of appreciation and thanked the Legislators for supporting the Freedom to Breathe Act. Additional discussion took place regarding health care reform and the concerns of the pediatric community. Peter Dehnel, M.D. and Jack Davis participated in the discussion. This event was organized by Rebecca Thoman, M.D., MMA’s Tobacco Control Advocacy Coordinator.

In a similar event, which took place at St. Francis Regional Medical Center,

Brian Prokosch, M.D. presented a certificate of appreciation to Senator Claire Robling,

MetroDoctors

during a media training program conducted

by Rebecca Thoman, M.D. Senator Robling was appreciative of the recognition and felt that, although conflicted, she had to come down on the side of the health consequences of secondhand smoke.

Jack Davis and Nancy Bauer recently met with Robert Stevens, CEO Ridgeview Medical Center, to explore opportunities for collaboration and outreach.

Senator Claire Robling is presented with a certificate of appreciation by Dr. Brian Prokosch and Michael Baumgartner, President of St. Francis Regional Medical Center.

The Southdale Pediatrics board meeting was selected as the venue for the recognition of three Edina legislators supportive of the Freedom to Breathe Act. Left to right: Nancy Ott, M.D., Rep. Neil Peterson, Rep. Ron Erhardt, Sen. Geoff Michel, and Lori Skallerud, M.D. are pictured with Freedom to Breathe certificates. Rebecca Thoman, M.D., MMA Tobacco Control Advocacy Coordinator, and Jack Davis attended and participated in this award presentation.

The Journal of the Hennepin and Ramsey Medical Societies

9/11/07 1:59:18 PM

HMS NEWS

Welcome New HMS Members

Kapil Gupta, MBBS Hennepin County Medical Center Internal Medicine/Gastroenterology Abraham K. Jacob, M.D. University of Minnesota Physicians Internal Medicine/Pulmonary Disease Robert J. Loegering, D.O. Hennepin County Medical Center Radiology Robert W. McKenna, M.D. University of Minnesota Hematologic Pathology Margaret I. Rice, M.D. Evercare Minnesota Internal Medicine/Geriatric Internal Medicine Aasma Shaukat, MBBS University of Minnesota Gastroenterology Robert A. Taylor, M.D. University of Minnesota Neurology Resident Physicians Hazmer H. Cassim, D.O. Benjamin H. Crenshaw, M.D. Todd L. Eisenberg, M.D. Elizabeth K. Gross, M.D. Aaron J. McCabe, D.O. Patrick J. Raasch, M.D. Matthew T. Reed, M.D. Kathleen A. Rieke, M.D. Gustavo J. Rodriguez, M.D. Charles J. Snow, M.D. Hassan A. Tetteh, M.D. Sabu Thomas, M.D. Ryan M. Williams, M.D.

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With only four weeks until Minnesota goes smoke-free, the Partnership for a Smoke-Free Scott County is educating local businesses and community members on the ins and outs of the new law, effective October 1, 2007.

The Partnership recently had a booth at the Scott County Fair and received very posiBY JENNIFER ANDERSON Project Coordinator, Partnership for a Smoke-Free Scott County

tive feedback from fair-goers who are looking forward to being able to patronize their favorite food and drink establishments without suffering the consequences of secondhand smoke.

One fair attendee mentioned now he would be able to join the local bowling league because of the new law!

Also, be sure to check out our new Web site at www.smokefreescottcounty.org.

In Memoriam ROBERT N. HAMMERSTROM, M.D., FACS died July 13, 2007 at the age of 84. He graduated from the University of Utah College of Medicine in Salt Lake City. Dr. Hammerstrom practiced general surgery in Minneapolis. He served in the U.S. Army in WWII, and in the U.S. Air Force in the Korean War. Dr. Hammerstrom joined HMS in 1958.

EDWARD A. JOHNSON, M.D., age 81, died on July 14, 2007 after a sudden and acute illness.

He graduated from the University of Minnesota Medical School. Dr. Johnson practiced internal medicine at Bloomington Oxboro Clinic for 40 years. He was an active member of the Secular 3rd Order of St. Francis throughout his life. Dr. Johnson joined HMS in 1986.

JEANETTE LOWRY, M.D., died May 17, 2007, after a long illness. She was 86. As a child, she was inspired by her next-door-neighbor, Dr. Nelson, to become a physician. She graduated from the University of Minnesota, and obtained a masters degree in bacteriology from Harvard Medical School. Later, she attended the University of Minnesota Medical School, where she

graduated first in her class. Dr. Lowry was one of the first female residents to train in internal medicine at the University of Minnesota. After residency training, she did research with Dr. Ancel Keyes, whose studies in physiology became groundbreaking. She later joined her husband, Paul, to practice internal medicine with him for many years, until her retirement from Lowry Medical Associates in 1992. Dr. Lowry joined HMS in 1960.

DONALD G. MCQUARRIE, M.D., Ph.D. died on June 19, 2007 at the age of 76. He graduated from the University of Utah and the University of Utah Medical School with highest honors. He did his surgical internship and residency at the University of Minnesota. After serving in the Navy, he joined the surgical staff of the Minneapolis Veteran’s Administration Medical Center as a thoracic surgeon. He was Director of the Surgical Research Laboratory and was a Professor of Surgery at the University of Minnesota for 37 years. He served as Chief of Surgery of the Minneapolis V.A. Dr. McQuarrie joined HMS in1982.

Visit us at www.metrodoctors.com

The Journal of the Hennepin and Ramsey Medical Societies

September/October 2007

9/11/07 1:59:19 PM

31

Hennepin Medical Society

Active Goeffrey Getnick, M.D. The Ear, Nose & Throat Clinic & Hearing Center Otolaryngology, Head and Neck Surgery

Four Weeks Until Smoke-Free Air!

HMS ALLIANCE NEWS ELEANOR GOODALL

Live Each Day as Though it is Your Last For One Day You’re Sure to be Right

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EACH OF US is the only person alive who has

the sole custody of our life. There are thousands of people who have our same education, do the same work, volunteer for public service in their communities, and so on. But our own life, the life of our mind, of our heart, of our spirit or inner essence, is unique and only ours.

We need to realize that life is the best thing ever and that we have no business taking it for granted. Sure the trappings we accumulate are nice, however, do you think you’d care very much about a new car or a larger house if you blew an aneurysm one day, or found a lump in your breast?

We need to care so deeply about our life and its goodness that we want to spread it around. All of us want to do well. But if we don’t also do good along the way, then doing well will not be enough.

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September/October 2007

Metro Dr SeptOct.pdf 34

It is easy to waste our lives. Itâ&#x20AC;&#x2122;s easy to exist instead of live. There is a tendency not to learn this until something bad happens to us. Perhaps the worst ever, as in when a loved one is taken from us prematurely. But we donâ&#x20AC;&#x2122;t have to go through such an event to learn to love the journey, not the destination, to know with certainty that it is not a dress rehearsal and that today is the only guarantee we get.

So, if we are not, at this point, living with our heart and spirit as well as our mind, how do we get there â&#x20AC;&#x201D; without having to go through a life-changing event? Iâ&#x20AC;&#x2122;d like to make a suggestion. Join the Hennepin Medical Society Alliance and work, play and make a difference in your community with other like-minded physician spouses. Through association with this great group of people, we have an opportunity to look at all the good in our world and to try to give some of it back. Itâ&#x20AC;&#x2122;s a chance to add dimension to your life, to have a worthwhile and joyous connection to other human beings. And, when these other human beings are all part of the family of medicine, there is already a basic connection, one that eases the sharing of your ups and downs, the joys and the challenges of a medical marriage.

Think of life as a terminal illness, and if you do, you will live it with joy and purpose.

Continue to grow and to learn. The classroom is everywhere and the exam comes at the very end. Living a full life, helping others â&#x20AC;&#x201D; on your own or through your work with a Medical Alliance â&#x20AC;&#x201D; will help you get a good grade on this ďŹ nal exam. Plus, youâ&#x20AC;&#x2122;ll feel pretty darn good along the journey!

There are no guarantees about the future but feeling good about what you do and having some fun doing it is a good start. Plan on coming to the Hennepin Medical Society Alliance Fall event. Mark your calendar for Tuesday, September 25 and further information will follow. You will gain from personal learning, personal enjoyment, association with friends, plus youâ&#x20AC;&#x2122;ll be part of making our communities better places to live.

MetroDoctors

For further information on the HMS Alliance please contact Martha Arneson arnesonma@msn.com, or call the HMS ofďŹ ce for a referral to other Alliance members (612) 623-2885.

A New AMA Alliance President On June 26, 2007 Dianne Fenyk, HMSA and MMAA member, was inaugurated as President of the AMA Alliance. Itâ&#x20AC;&#x2122;s been 60 years since an Alliance member from Minnesota has held this prestigious ofďŹ ce and all of us who know Dianne are anticipating an awesome year for the current 22,000 Alliance members nationwide under her leadership.

In her inaugural address, Dianne related the Aesopâ&#x20AC;&#x2122;s fable of the wind and sun debating their relative strength, with the ultimate test of said strength causing a man they saw to take off his coat. We all know the ending of this one: The wind blew so hard the man drew his coat tighter; the sun shone so brightly and warmly that he, of course, took off his coat, proving that gentleness can be stronger than force. Dianneâ&#x20AC;&#x2122;s theme for her year in ofďŹ ce is gentleness, and the enormous strength and power it brings to bear. Citing the physicians of America, our heroes and our spouses, she called them the compassionate everyday heroes who face reality every day with courage, with science, with gentleness.

And, as Alliance members, she urged us all to continue to work with the gentle HMS CEO Jack Davis determined power of presents Dianne Fenyk with a congratulatory the sun. proclamation .

The Journal of the Hennepin and Ramsey Medical Societies

9/11/07 1:59:19 PM

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Orbit Systems, Inc. is an Eagan-based

InforMED Group, Inc. is a healthcare

organization specializing in services ranging from network connectivity, mail and Web hosting services, to the complete outsourcing of hardware, software and support.

Discounts are available if you mention MPS, Inc. when you connect with them. They are interested in talking to you about ways that they can help with your IT needs. To learn more about them visit their website at www.orbits.net or call Steve McFarland at 651-767-3322.

technology and marketing services organization that helps physician practices to streamline, manage and grow. They help clinics adopt technology and identify areas to save money, save time, increase revenues, and/or enhance their community image through cost effective marketing. To learn more visit their website at www.informedgroup.com, or call Tom Riester at InforMed at 952-826-6980.

Longstanding business partners continue to offer great services and value

AmeriPride Apparel and Linen Services continues to be a terrific business partner for MPS, Inc. and more importantly, for our members and physician groups across the state. They offer linen services including gowns, lab coats, towels ...you name it. Take a few minutes and let them provide you with a competitive bid for your linen services. You might be very surprised at your savings.

Contact Steve Severson at AmeriPride to get your free bid at 612-362-0334.

Berry Coffee

is a Minnesota based company that has a reputation for world class service by providing coffee and refreshments.

They also provide state of the art equipment for your clinics and hospitals. We have negotiated a group purchasing agreement with Berry Coffee. Be sure to mention MPS, Inc. when you call for your pricing. Contact Bob Dilly at 952-937-8697.

SafeAssure offers OSHA compliance training for clinics. Medical society members receive 50-60% discount on services and training. Visit our website to read testimonials from clinic administrators who have used their services (see website address below).

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