a1novemberdecember00 by Advocates for Better Health

Nov/December 2000

Doctors MetroDoctors Physician Collegiality Is it lost?

Doctors MetroDoctors Physician Co-editor Thomas B. Dunkel, M.D. Physician Co-editor Richard J. Morris, M.D. Managing Editor Nancy K. Bauer Assistant Editor Doreen M. Hines HMS CEO Jack G. Davis RMS CEO Roger K. Johnson Production Manager Sheila A. Hatcher Advertising Manager Dustin J. Rossow Cover Design by Susan Reed MetroDoctors (ISSN 1526-4262) is published bimonthly by the Hennepin and Ramsey Medical Societies, 3433 Broadway Street NE, Broadway Place East, Suite 325, Minneapolis, MN 554131761. Periodical postage paid at Minneapolis, Minnesota. Postmaster: Send address changes to MetroDoctors, Hennepin and Ramsey Medical Societies, 3433 Broadway Street NE, Broadway Place East, Suite 325, Minneapolis, MN 554131761. To promote their objectives and services, the Hennepin and Ramsey Medical Societies print information in MetroDoctors regarding activities and interests of the societies. Responsibility is not assumed for opinions expressed or implied in signed articles, and because of the freedom given to contributors, opinions may not necessarily reflect the official position of HMS or RMS. Send letters and other materials for consideration to MetroDoctors, Hennepin and Ramsey Medical Societies, 3433 Broadway Street NE, Broadway Place East, Suite 325, Minneapolis, MN 554131761. E-mail: nbauer@mnmed.org. For advertising rates and space reservations, contact Dustin J. Rossow, 4200 Parklawn Ave., #103, Edina, MN 55435; phone: (612) 2377363; fax: (612) 831-3260; e-mail: djrossow@aol.com. 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.

CONTENTS VOLUME 2, NO. 6

NOVEMBER/DECEMBER 2000

PHYSICIAN’S SOAP BOX

Monica Mykelbust, M.D.

FEATURE: COLLEGIALITY

Collegiality Used to Begin in the Doctors’ Lounge. Is it Still There?

Loss of Collegiality Results in Physician Isolation

Winter CME Conference

“Connections” — A Mentoring Program

COLLEAGUE INTERVIEW

Joseph Rigatuso, M.D., Ph.D.

2001 Blue Plus Primary Care Clinic Provider Service Agreement Review

HMS/RMS Physicians Assume Leadership Roles at MMA AMA Delegates and Alternate Delegates

HMS/RMS Physicians Receive MMA Awards HMS/RMS Members Serve as MMA Trustees

HMS and RMS Members Participate in MMA Annual Meeting

Using a Cell Phone While Driving — A Risky Venture?

Medical Student Recruitment Activities

RAMSEY MEDICAL SOCIETY

24 25 26 27

President’s Message RMS Update/Leaders Honored/Saints Family Night/ Honoring Bruce Vento Applicants for Membership/In Memoriam RMS Alliance HENNEPIN MEDICAL SOCIETY

29 30 31 32

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Chair’s Report HMS News/New Members/In Memoriam Lupo Installed as Chair/Stepping Stones Gala HMS Alliance

The Journal of the Hennepin and Ramsey Medical Societies

On the cover: Collegiality used to begin in the Doctors’ Lounge. Where has it gone? Pictured: Jean Watson, M.D., Abbott Northwestern Hospital. Articles begin on page 2.

November/December 2000

PHYSICIAN'S SOAP BOX

Building Relationships Between Physicians

“THE MAKING OF A DOCTOR.” In recent times we hear a great deal on this subject. Public television specials explore medical school and residency training, sleep deprivation, and the intensity of patient care responsibilities. Newspaper articles discuss adverse effects of this profession on a physician’s family life. Radio reports sensationalize extreme behaviors resulting from the stressors of a medical career. What we hear less about are the relationships between physicians: collegiality. These bonds are as powerful as physician-patient relationships and the loyalties may run as deep. They define, in part, a physician’s satisfaction with his/her job. Colleagues define who we are professionally and set standards that we judge ourselves by. The making of a physician colleague begins early. It may begin with a conversation with a community doctor who shows up at the picnic that first day of medical school. The mutual respect and cooperation that exists between anatomy partners may later grow to professional collegiality. Perhaps like no other profession, medical training builds on a rich hierarchy. As a first year medical student one is acutely aware of his/her status — close to nursing assistant, definitely below nurse. Many of us acted as the gopher for the senior medical student on our team. From the mixed feelings of intimidation and respect we resolved: 1) to never treat an under-classmate in such a humiliating way; or 2) to avenge our pain once in power. As the torch is passed from year to year, additional knowledge and responsibility accumulate. When we enter residency, we are again at the bottom of the totem pole. Not quite rock bottom, thank goodness there is a medical student on the team! These are the beginnings of the relationship between physicians. In residency, competition and cooperation strike a balance in collegial relationships. Yet, we are all still beneath the master, the consultant. No matter what our knowledge base, we lack experience. We remain in awe of the practicing physician. Once we are out on our own, establishing our own practice style, we struggle with true collegial relationships. That is, those relationships marked by authority equally vested in each of a number of colleagues. Within our own specialties we may seek those with common values but differing knowledge base. Between specialties we may choose

experts in their field, professionals that will take good care of “our” patients and perhaps educate us a bit at the same time. Meeting and connecting with colleagues has never been more challenging. Our “practice time” is crunched more than ever. It is more and more difficult to find physicians willing to spend “free time” to work together on projects related to improving our profession or our organizations. Many of us don’t work in a common setting. Many don’t frequent the hospital doctors’ lounge. We have trained our clinic support staff to protect us from interruptions, to weed out unnecessary calls. Even our staff meetings are poorly attended. So, how are we to establish and maintain these very important relationships? May I offer a few suggestions? First and foremost, I believe is the power of communication. We need to speak with our colleagues face-to-face or by phone whenever possible. The written referral letter and e-mail are also essential. We need to consider interrupting our routine to speak to a colleague regarding patient care in a timely manner, to remove communication barriers. We need to view each other as partners, equal in this profession of caring for others. We need to educate each other. With the information explosion, no individual can possibly keep up with it all. We need to compliment each other, show gratitude for each other’s time, ideas, and efforts. We are our own best support system. We need to make time for socializing with those in our profession. Take time to discuss recreation, world politics, joys of parenting. We are a remarkable group of enlightened, fascinating, educated people. We need to learn to have fun again. We need to commit to being instrumental in the positive development of at least one colleague each year. We all owe it to our own mentors. As many pieces of our profession seem to become fragmented, let’s return to collegiality as a source of intellectual stimulation, stress reduction, and reward. ✦ Monica Myklebust, M.D. is a family physician at Northeast Medical Clinic in Minneapolis, and is a member of the HMS Board of Directors.

B Y M O N I C A M Y K L E B U S T, M . D .

November/December 2000

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

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FEATURE STORY

Collegiality Used to Begin in the

Doctors’ Lounge Is it Still There?

Collegiality — “The relationships of colleagues” Community — “A group of individuals sharing interests of pursuits” with “commonness, sharing, participation” Webster’s Dictionary

Doctors’ lounges are almost empty of doctors and conversation, and even the rolls go uneaten.

IN OUR PROFESSION, LOSS OF COLLEGIALITY has become a major problem to those within and without the practice of medicine. In an AMA conference last year, Dr. Jay Jayasankar defined Collegiality as a “shared goal of common purpose while according... respect for each other….”(1) Have we begun to lose this goal? I entered medicine in the late 50s and early 60s, at the zenith of medical professional and public engagement in organizations. In 1962 I joined the nascent St. Louis Park Medical Center, the predecessor of the Park Nicollet Clinic — one of 28 doctors in the entire group. We met together, lunched together, shared patients and advice, and worked together hard and cooperatively to build a practice. In the Minneapolis medical community, good or bad hospital education programs and staff meetings were regularly and faithfully attended. Most doctors belonged to, and were active in, specialty societies like the Minneapolis Surgical Society or the Minneapolis Society of Internal Medicine, and a myriad of sub-specialty societies. The Hennepin and Ramsey County Medical Societies included nearly all the Twin Cities physicians. Meetings of these groups were attended by a lot of doctors who gave up family, personal, and patient time to be there. Hospital doctors’ lounges were filled with conversations between doctors of various specialties, persuasions, and groups, who argued and bragged to one another, drank coffee, ate rolls, and didn’t have to be in the office very early. Almost 40 years later, the relationships have changed. Hospital education conferences, Grand Rounds, and business meetings struggle to get 20 doctors to attend. I recently attended a Grand Rounds presented by a national researcher on new trends in breast cancer screening and imaging — along with nine other doctors, none of which were women. Doctors’ lounges are almost empty of doctors and conversation, and even the rolls go uneaten. The Minneapolis Society of Internal Medicine struggles to fill six or eight tables at its quarterly dinners to hear famous speakers. A year or two ago, a Minneapolis physician received both the Hennepin County Medical Society’s most prestigious award and his own hospital’s “Doctor of the Year” award at his hospital’s annual dinner. None of his office partners bothered to attend. What has happened? Is there really a lack of medical community and participation, or are doctors putting their efforts and attention elsewhere? Doctors now are busy and pressured, but realistically I don’t think much more so than in the past. The types of pressure are perhaps different, but the hours and stress are much the same as they were when I started in practice. Physicians are no more nor no less polite and

BY RICHARD WOELLNER, M.D.

November/December 2000

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

respectful to one another now than they were 40 years ago. Medical education is less communal. The rude and crass professorial bullies who traumatized medical students and colleagues thankfully are long gone, replaced by a “kinder, gentler” and just as knowledgeable group of educators, who attract smaller and smaller audiences. Forty years ago, there were few educational alternatives to medical meetings other than reading rather dull journals. Within the past decade or two, viable options for learning have proliferated. On-line and printed courses, web searches and e-mail have enabled us to learn without the annoyance of human interaction. Many physicians’ priorities may have changed. Hours and effort spent at one time in patient care and medical relationships may now be more oriented to family, children, and personal goals. There are gender and generational differences in our priorities. One of the recruiters for a large medical group told me that the main, and often the first question asked by applicants is “If I come to work for the Clinic, how will it affect my personal and family life?” Little about “How will being here help me practice the best medicine?” While women traditionally have a greater responsibility for family and children, these priorities may loom larger than the medical community ones. Physicians reared in the era of “community” activity have a firmer devotion to associations and group activities than younger people who are not “joiners.” Is this a change for better or worse? “Medical sociology” has seen a change in responsibility for all the things that affect our professional lives. The cost, size, and complexity of medical groups and hospitals has taken the responsibility for controlling our lives away from the individual and put it in the hands of non-medical decision-makers. Physicians have become “providers” and are considered to be a rather cranky and needing-to-be controlled part of “health systems.” Many doctors react to this by becoming 9 to 5 (or 8 to 6) workers, and, since they no longer have much business or administrative responsibilities, ignore them. Another and perhaps the most important factor, in the decline of medical community expression is what Robert Putnam refers to as “the howling league phenomenon.” In his book Putnam demonstrates with a wide variety of statistics that personal and collegial involvement in a wide spectrum of political, civic, and leisure activities has dramatically declined from a peak in about 1960 to an increasingly low level now.(2) Americans of all descriptions are no longer “joiners.” They participate less in communal activities, from bowling leagues to medical professional organizations. Copious, well-documented data from a variety of sources shows that this change is not merely nostalgia for a past that never was, but a real and significant phenomenon. Much of our medical disconnectedness or lack of community may reflect an overall American change, rather than one unique to our profession. Is this all bad? Can we still practice good medicine disconnected from our colleagues? Jayasankar doesn’t think so.(1) He fears that the progressive personal disconnection from the community of physicians will lead to a decline in the quality of medical practice, an erosion of mutual and public trust, and an increasing abandonment of control of our profession to others. This may produce a progressive spiral of alienation, disconnectedness, and further loss of community. Other alternatives for a physician’s time, effort, and connections become more appealing. Medicine as a profession will suffer if physicians ignore each other. To these concerns I would add another equally important one: Medical practice is fun. Without colleagues, collegiality, and shared community, the fun of our practice will erode and disappear. I hope this never happens. ✦

Much of our medical disconnectedness or lack of community may reflect an overall American change, rather than one unique to our profession.

References: 1. Jayasankar, S. Jay: “How to Regain Collegiality” AMA Leadership Development Conference, Miami, March 25-28, 2000 2. Putnam, Robert D.; Bowling Alone, The Collapse and Revival of American Community, Simon & Schuster, New York, 2000. ISBN 0-684-83283-6

Richard Woellner, M.D. is retired from Park Nicollet Clinic where he specialized in internal medicine/pulmonary diseases. MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

November/December 2000

Loss of Collegiality Results in Physician Isolation

WHAT HAPPENED TO THE DAYS of medi-

cal staff conferences attended by 80 percent of the hospital’s physicians? Why don’t we see one another in the physician lounges, on the wards, or at specialty department meetings? The loss of physician collegiality can be felt at many levels, but it ultimately results in physician isolation. Why does collegiality matter? Who loses if we cannot maintain it? First, the patient loses. Most of us can recall not addressing a clinical problem because it was out of our specialty.

B Y P E T E R D A LY, M . D .

When I refer a patient for consultation, do I communicate to the consulting physician and introduce the patient and issues? I need to communicate for the patient, and guide them through the medical maze, and avoid “turfing” them to fend for themselves. Secondly, the “system” loses. Cost containment is a terrible problem and could be the ruin of our health care system. For the physician, it is both an individual issue and a larger system issue. It needs to be studied from a collaborative, “big picture” viewpoint. Approaching cost containment from a narrow, isolated, self-serving view cannot allow understanding of the big-

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November/December 2000

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ger picture, and hence, missing solution opportunities. Quality can be compromised if excess emphasis is placed on efficiency, or commercialism within the system. Are substituted medical devices or drugs truly as effective as the original prescribed choice, or is the health system cutting quality for political or commercial reasons? Physician collaboration and communication is needed to solve such issues. Thirdly, the physician loses if collegiality is eroded. Our ability to be our patient’s advocate is markedly diluted when we function as a single isolated physician. When we place commercialism and profit above the caring of our patient, we act in an egocentric self-serving manner. Business concerns are not inherently evil, but they must be balanced to prevent compromising our patient’s humanity. If we cannot do so, the public’s perception of our profession is eroded. If the public does not trust us, we become regarded as technicians, a service line for which we are bartered, and a commodity to be exchanged. The patients will turn to the legal system for resolve since they lack trust. We will begin to regard our service as a chore, our patient as purely a revenue center, and our profession as only a business. The humanity can be seen hemorrhaging out of our pores. Therefore, with the lifeblood of patients, health care delivery systems, and physicians at stake, as well as quality, cost containment and self-respect, the loss of collegiality is definitely a problem worth fixing. How did we lose it? Dr. S. J. Jayasankar cited multiple reasons: • Loss of control • Onerous regulations The Journal of the Hennepin and Ramsey Medical Societies

• • • • • • • • • • • •

Unreasonable expectations Indiscriminate charges Competition – MDs; Others The professional liability vice Rapid changes Time squeeze Reimbursement squeeze Changes in family and spousal roles Balancing of multiple responsibilities Coarsening of interpersonal interactions Increasing electronic communication Decreasing personal contact and communication We have less time for collegiality. We no longer leave family demands (such as a child’s teacher conference or piano recital) for our spouse. Many of us with children consider it more important to be at that recital, than at another meeting, and often rightly so. Declining reimbursement means longer hours for patient care and less time for collegiality. E-mail, voice-mail messages, and pagers have replaced personal contact between physicians. Human to human interaction is sacrificed at the altar of speed and efficiency. As we become more iso-

lated from one another, we are prone to divisive comments about one another’s care delivery, competition between each other, and worsened cynicism of hospitals. How can we regain collegiality? First, we need to recognize its importance. If we understand that we lose quality and control by not collaborating amongst ourselves, then perhaps we will allow some short-term loss of clinical time and income to meet with our peers and communicate. Second, we can seek out channels of collaboration. We need to be willing to participate in local medical society functions, many of which can include family activities (i.e. winter CME activities). Serving in a physician leadership role at your hospital promotes collegiality. Creating margin in our schedules for giving input at medical staff meetings fosters improvement rather than cynicism. Conflict resolution requires honesty, trust, and communication, and unfortunately time. Third, we can use technology in a supportive role, not a primary role. Although technology may improve efficiency and speed,

the ability of one soul to convey caring to another soul often requires the human interaction and moves at a slower rate. Remember, such humanity, despite its inherent inefficiency, will save our profession. Fourth, we have to be able to change. One wise author has observed, “To live is to change; and to be perfect is to have changed often.” We all need improvement in our communication skills, willingness to negotiate, and openness to view our individual concerns as a part of the bigger picture. These broad tasks require change. As we all know, it is being our patient’s advocate that sets us apart from simply being technicians of the human body. Remembering and preserving the humanity of a patient may be inefficient and difficult to quantify, but essential to healing the individual patient. Remembering and preserving collegiality in our profession may also be inefficient and difficult to quantify, but it is essential to healing our profession. ✦ Peter Daly, M.D., is an orthopaedic surgeon and Chief of Staff at St. Joseph’s Hospital. He is a member of the RMS Board of Directors.

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Products and Services Offered to RMS Members by RCMS, Inc. For more information call 612-362-3704. MetroDoctors

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November/December 2000

Ramsey and Hennepin Medical Societies offer the

2001 Winter Medical Conference Saturday, February 17-Saturday, February 24, 2001 (Presidentâ&#x20AC;&#x2122;s Week)

Moon Palace Resort The spectacular Moon Palace resort is a 123 acre paradise located 20 minutes from downtown Cancun, Mexico and seven miles from the airport on Cancunâ&#x20AC;&#x2122;s tranquil south shore. Nestled between pristine 1,975 ft. white sand beach and 55 acres of tropical foliage, the Moon Palace offers 2,031 air conditioned Superior Deluxe rooms with double whirlpool, most with ocean view or partial ocean view, terrace, mini bar, coffee maker and hair dryer. 12 buffet and a la carte restaurants, seven bars including swim up bars, two oversized free style pools, two indoor pools, six tennis courts, two basketball courts, two fitness centers, miniature golf, kids club, one Discotheque, daily activity program and theme nights.

ALL INCLUSIVE RATES (AIR, HOTEL, MEALS, BEVERAGES, TAXES AND GRATUITIES) $2,099* per physician/single $1,999* per physician/double occupancy $1,259* per spouse/guest, double occupancy $1,449* per third adult in room $749* per child age 17 and under * Please add $107.00 per air seat for departure tax and fees.

Deposit of $500 per person due by Tuesday, December 5, 2000. Full payment due by Thursday, December 28, 2000. Space is limited. The above rates do not include the conference registration fee. For further infomation on the medical conference call RMS/HMS (612-362-3705) or email: dhines@metrodoctors.com. Departure: Saturday, February 17, 2001 - Mpls. Charter Terminal 2:50 p.m. - arrive Cancun 6:35 p.m. Departure: Saturday, February 24, 2001 - Cancun 10:00 a.m. - arrive Mpls. Charter Terminal 1:50 p.m.

CALL TO SAVE YOUR SPACE. Darla at Hobbit Travel (612-252-9493 ext. 3339)

INCLUDED IN ALL INCLUSIVE Airfare, 7 nights hotel, transfers All meals, snacks and beverages 12 buffet and a la carte restaurants to enjoy all meals and snacks Unlimited domestic and imported beverages Every room includes double jacuzzi Welcome cocktail reception and dinner Sunday evening Kids Club featuring daily supervised activities Mini golf and kids playground Bicycles and roller blades 2 outdoor pools / 6 outdoor jacuzzis 2 indoor pools / 2 indoor jacuzzis 4 swim up bars Dive tank and non-motorized water sports: introductory diving lesson, snorkeling, windsurfing, paddle boats, and kayaking Shuttles to downtown Cancun Entertainment nightly 6 lit tennis courts Full gym with steam room and sauna Access to all Palace Resorts, with complimentary shuttles several times daily 2 excursions per person -additional excursions available at extra cost All local taxes and gratuities

18 hole championship golf course available at Playacar via shuttle.

“Connections” — A Mentoring Program

LAST YEAR THE UNIVERSITY of Minnesota

Medical Alumni Association rolled out a new Medical Student mentoring program that was designed to be non-academic, would not have to involve the office/hospital at all unless the student requested it, and was to be as flexible as the student and mentor wished it to be. Of the 165 students in the first year class, about 130 signed up for this opportunity! We had about 100 mentors, many of whom have been very excited about this opportunity to meet with interesting, bright, and eager students. This contact with practicing physicians will make a tangible difference to many of these young men and women, possibly affecting their career choice, helping them better understand what they will be doing in their chosen profession, and just making a difference in the lives of two people. Because last year’s program was the initial “dry run,” we did not enlist the medical societies’ assistance. This year, I wanted to get a wider audience participation that was not limited to University of Minnesota Alumni. I know there are many of you out there that haven’t the time or inclination to have a student in your clinical practice. This program allows physician-student interaction where it may actually be more interesting and, in the long run, more influential. We anticipate this would involve you and the student through all four years of Medical School, depending on both the student’s and your decision. Working together with Jack Davis and Roger Johnson, the Medical School, the Minnesota Medical Foundation, and the U of M Medical Alumni Association, we have developed

BY EUGENE OLLILA, M.D. President, University of Minnesota Alumni Association

MetroDoctors

with medical student examinations, would like to act as Physician-Evaluators for students completing their primary care clerkships over the course of the next 12 months, an opportunity presents itself for this kind of involvement. •

our own letterhead and logo that defines the “Connections” between all of us. After all, each of the participating groups is looking at a different side of the same issue, and all of us have a stake in the success and happiness of those who will be “us” in the future. You will be receiving a letter under the signatures of Drs. Virginia Lupo, John Gates, Greg Vercelloti, and myself. I strongly encourage you to participate for both you and a student. One perk will be an invitation to the Medical Student White Coat Ceremony at Northrup Auditorium on Saturday, January 13, 2001. Additional projects that need your involvement: • The Alumni Association is beginning a process this year whereby potential medical students that are having their medical school interview would stay at the home of a physician during their stay in the Twin Cities. We already have 70 physicians signed up, but we need more! •

If any physician, especially those recently retired or who would like to get involved

The Journal of the Hennepin and Ramsey Medical Societies

The Medical School is looking for interested and supportive physicians to interview potential medical students as part of their application process. Having started this last year myself, I can attest to the enjoyment of this interview to help both the Medical School in its duty, as well as helping and supporting the student. Both of the last two items could be referred to: Ilene Harris, Ph.D., Professor and Director, Medical School Office of Education, MMC 33, 420 Delaware Street SE, Minneapolis, MN 55455. Phone: 612-6259497; Fax: 612-626-4200; E-mail: harri001@umn.edu.

Thanks, in advance, for your interest in these very rewarding programs. ✦

Reminder… metrodoctors.com census sheet can be completed online. www.metrodoctors.com/census

November/December 2000

COLLEAGUE INTERVIEW

Joseph Rigatuso, M.D., Ph.D. Editor’s Note: “Colleague Interview” provides HMS and RMS members with an opportunity to ask questions of their colleagues who are in unique roles. In this issue, some of the interview questions were asked by: Drs. Jamie Santilli, Sarah O. Cowell, and Lyle J. Swenson. Dr. Rigatuso is President, HealthPartners Physician’s Association.

Q A

How does the compensation of employed physicians compare with those in the private sector? While I do not have direct knowledge of the compensation plans of every medical practice, I am confident that the way physicians are compensated within the HealthPartners Medical Group and Clinics is similar to those of other practices. We started with the principle that we pay competitively to attract the highest skilled physicians available. We also work on the principle that patients want access to see their physician, as well as highquality care and service from them. To that end, our compensation is based upon our ability to provide such access and service. The measures that make up our physician compensation include such things as patient satisfaction, quality of care, ability to effectively see patients and individual and team contributions on behalf of our clinics and patients. Compensation to our physicians is designed in such a way that rewards quality of care and in no way interferes with our day-to-day clinical decisions.

What do you consider the major problem or problems facing the employed physician today? Identifying only with the health organization, without the interest and activity in promoting and maintaining the profession of medicine. One is never just an employed physician. One is always a practitioner of the art and science of medicine as well as a representative of the profession of medicine. Of course, we have many allegiances to our alma mater, to our church, to our employer and all of these are important. But we belong to the stream of healers/physicians, including such figures as Hippocrates, Susruta, Osler, Banting and Best, Lillehei and many thousands of unnamed physicians whose only goal was the care of the patient. I am concerned about the growing burden of documentation. Some would expect that I would mention the lack of independent practice or lack of input into plan direction and management. However, those are not issues. You must practice good medicine as an individual physician and as a plan. 10

November/December 2000

In general, do employed physicians have a true voice in the carrying out of their jobs? Yes. In my experience the primary requirement of integrated care delivery systems and multi-specialty group practices is to practice good medicine. I have felt no interference in my practice of medicine in the past 25 years of working for Group Health and HealthPartners. Yes, we have a referral network and select hospitals, but those resources are very broad and include all the necessary services. Employed physicians can be, and are, involved in the management committees of physician management and administration.

How is the HealthPartners Physician’s Association organized? What role does it play? All employed physicians of HealthPartners are members of the HealthPartners Physician’s Association. Officers are chosen by majority vote of all HealthPartners physicians who vote. The role is to work with the medical council to create and maintain a practice environment for physicians that will promote their ability to give good medical care to their patients and to continue their own professional development.

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

What is the role of the HealthPartners Medical Council and how does it function?

How can organized medicine attract more employed physicians to its membership?

The Medical Council is the leadership team for the HealthPartners Medical Group and Clinics (HPMG) and consists of the physicians and administrators that support both the physicians and clinics within our HPMG care delivery system. The council sets the vision, strategy, and direction for the medical group within the context of the larger HealthPartners organization. The medical leaders representing primary care, medical and surgical specialties, behavioral health, centralized patient care services, care improvement and research, are represented on the council. In addition, the administrative leadership supporting these care areas also participate on this council. The expanded leadership group led by the council includes all of the clinic chiefs of professional services and managers, the department heads, and ancillary support services such as pharmacy, lab services, etc. These leadership teams meet on a regular basis to discuss clinical, operational, educational and financial issues affecting the medical group. One important element to the success of the work of the Medical Council, and other clinic or department leadership teams is the forums we need to continue to provide for feedback and participation by all of the staff physicians within our medical group.

The development of medicine, of course, parallels the development of science in general — both contributing to and adapting from all areas of science. But societal and industrial changes also affect medicine and must be incorporated into its development. So what does this all have to do with membership in organized medicine? We are all specialists, that is we specialize in some branch of medicine and struggle to keep up in that limited area of medicine. In order to meet the challenges of the rapidly changing medical marketplace we need to pool our resources — both intellectual and financial. If we are unable to maintain the unique standing of respect and trust that the medical profession has achieved, not only will our profession be diminished, but the care given to our patients will also be diminished. We must come together as physicians, from all walks — private practice, managed care, hospital practice, and academic medicine — if we are to meet the challenges of the 21st century. We are all well aware of the forces seeking to change the practice of medicine as well as the profession of medicine itself. We need to come together to better understand and deal with the societal and business forces that affect the practice of medicine. There is only one way to meet the challenges and to maintain the world’s best health care — by coming together in organized medicine. The advantage is the ability to have our message heard in the public as well as in the legislative and other governmental arenas.

Can organized medicine effectively advocate for the employed physician? Yes. I believe employed physicians in integrated care delivery systems can and do benefit a great deal. Many physicians are active in their respective specialty societies and do receive much of the continuing education, medical literature, and other academic resources from those associations. Much of the continuing medical education (CME) in health plans, as well as hospital based CME-course offerings are accredited through the MMA, and AMA. Another often overlooked benefit derived by employed physicians is the support given by organized medicine by way of supporting medical education at the medical school level and at the community level. This latter effort is the well attended and successful community internship sponsored by HMS and RMS. There is a very important place for organized medicine at the county, state and national level. That is specifically the political/social environment of medicine and the standing of the profession within the community. There is a need for organized medicine to offer some benefit for the profession that is not related to clinic, place of employment, specialty or academic resources. What remains in my opinion is professional promotion and monitoring and reacting to professional challenges at the political and social level. The best examples of these activities include legislative and inter-professional cooperation, as well as community-based public health initiatives.

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

What advantages does membership in the MMA, Hennepin or Ramsey medical societies and AMA give the employed physician? There is competition and areas of overlap among the societies. However, physicians need to interact as a profession. This common action must involve physicians from all specialties, including physicians at all levels of training, both residents and medical students. By coming together within organized medicine, we can better promote the health of patients in our care as well as the public health of all our citizens — by speaking as a strong united profession with the best health interests of our nation. I encourage membership in these societies because working together we can support such areas as research and education to improve both the science of medicine and the delivery of medical care. This can only be done effectively through the efforts of all physicians working together in organized medicine, and working with government and other organizations of healthcare professionals. ✦

November/December 2000

2001 Blue Plus Primary Care Clinic Provider Service Agreement Review Editor’s Note: During the last several years, physicians and their practice administrators have faced increasing economic pressures with patient demand escalating at the same time that managed care companies have gained disproportionate market power and have virtually unlimited negotiating power. The need to be aware of the provisions contained in provider agreements with the health plans is more critical today than ever in the past. In response to the growing need for information that is useful in analyzing the provisions in provider agreements, the Hennepin Medical Society, the Ramsey Medical Society, the Minnesota Medical Association and the Minnesota Medical Group Management Association have agreed to collaborate with Healthcare Management Resources and Lockridge Grindal PLLP, to provide physicians and practice administrators with current information regarding provider agreements. The following information is designed to give you, your attorney and your accountant a starting point to consider the contractual decisions that could make a significant impact on your practice. The following article was originally sent as a memo to HMS and RMS members. The agreement reviewed is the 2001 BLUE PLUS PRIMARY CARE CLINIC PROVIDER SERVICE AGREEMENT. After you have reviewed the analysis, please give us your opinion about the value of this work and the method of presentation. Your comments will be used to make improvements in future analyses.

November/December 2000

THIS ARTICLE PROVIDES a brief analysis of

some of the most significant terms of the new Blue Plus Primary Care Clinic Provider Service Agreement (the “Agreement”). In a significant and welcome departure from past practices, Blue Plus has provided advance copies of the Agreement to us for review. The information provided in this article is not a substitute for legal and accounting advice. Providers interested in determining the specific application of this Agreement to their practices or in negotiating the terms of the Agreement should discuss the matter with their own attorneys, accountants and consultants. Providers may wish to review previous memos addressing the Blue Plus and Aware Provider Service Agreements since many provisions are similar. Comments from these previous analyses are particularly relevant since the Agreement requires that PCCs (Primary Care Clinics) agree to “abide by the terms and conditions set forth herein and in any attachments to this agreement, including the Aware Agreement.” •

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What has changed? This Agreement contains a number of small but significant changes from the current contract. The Agreement also responds to the recent legislation prohibiting contract stacking. Payment. The basic financial provisions of the contract are similar in structure to previous contracts. Blue Plus pays based on a fee schedule that is approximately 10 percent above Medicare and then withholds a percentage — usually 10-15 percent. This arrangement effectively passes risk to the PCC in the amount of the withhold. Return of the withhold depends on meeting a very difficult to control “utilization target” which even includes services not provided or arranged by the PCC. Costs MetroDoctors

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charged against the target include the total patient costs, subject to a $20,000 stoploss, and 20 percent of costs between the first $20,000 and $60,000 — again effectively transferring substantial risk to the PCC ($28,000). Blue Plus will take 75 percent of any gain (the difference between actual cost and the target) and limits the PCC percentage of any gain to 10 percent of the target. In addition, Blue Plus may keep the withhold moneys for the year plus 135 days (versus 120 days in old contract) and keep any earnings on the money withheld. Utilization target exceptions now include mental health, chemical dependency and chiropractic services generally. III(A) Maximum Charge Increase. This new provision — “The Maximum Charge Increase as permitted by Blue Plus” — requires PCC’s to limit annual increases in regular billed charges to not greater than the annual increase in the Consumer Price Index for all Urban Consumers (“CPIU”). This index, of course, provides no realistic estimate of health care inflation. Blue Plus will employ a “Charge Audit” to determine if a PCC’s charge increases from year to year exceed the increase in the CPIU. Charges in excess of the cap will result in proportionately reduced payment of the percentage paid. This additional private contractual restriction on providers is unreasonable and is unrelated to any meaningful measurement of health care costs. III(C)(4) Contract Stacking. Blue Plus has responded to the new contract stacking law by deleting provisions reserving the right to develop rates and provisions for additional reimbursement for additional costs associated with work related injuries and

The Journal of the Hennepin and Ramsey Medical Societies

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illnesses and patient care coordination under a certified or non-certified workers compensation plan. Blue Plus has also removed the provision applying the Agreement to Health Services provided under certified and uncertified workers compensation, disability or other benefit plans. Obtaining Patient Consent. The PCC now has the obligation to obtain patient consent or authorization for releasing information to Blue Plus or a Plan Sponsor. This is a new and additional administrative burden on PCCs. II(I)(f) Referral Risk. PCCs are required to refer Enrollees only to providers that have contractual relationships with Blue Plus. The PCC will now be responsible for Enrollee costs incurred as a result of a referral to a non-participating provider. There is unfair financial risk for PCCs in this provision in as much as the Agreement does not appear to oblige Blue Plus to provide PCCs with a current or accurate list of participating providers on an ongoing basis. The availability of timely information should be required and providers should have no risk for errors made by or lack of timely information from Blue Plus. II(1)(m) Blue Plus Pricing. Effective January 1, 2001, Blue Plus payment for service codes without prices on the Medical Assistance schedule for Public Program Enrollees will be at Blue Plus pricing. III(B)(2) Credentialing and Recredentialing. Provider participation in Blue Plus recredentialing is required on not more than an annual basis and no less often than every two years. Where follow-up is necessary, recredentialing may now occur as often as Blue Plus determines necessary (i.e., monthly or quarterly). All PCC Health Care Professionals providing services under the Agreement now must meet credentialing standards and obtain approval for participation by the Credentialing Committee. Certain listed new and current Health Care Professionals (but not physicians) are exempt from recredentialing unless a potential quality of care issue arises. The PCC is responsible for maintaining certain information about and insurance coverage on these exempt Health Care Professionals. If, for any

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reason, a PCC employee does not meet credentialing standards, he or she will be treated as a non-participating provider. If notice of non-participating status is not given to an Enrollee, the PCC must accept Blue Plus’ fees for the non-participating provider and also “be responsible for any applicable non-participating penalty payments required in Enrollee contracts.” VI(2), (4), (5), (6) Appeal of UR Decisions. Blue Plus, PCCs, and Enrollees shall each have the right to appeal an initial UR decision through Blue Plus’ Peer Review Process. The Appeal process is binding unless the Enrollee initiates an external appeal. VII(8) Termination. The Agreement now provides that Blue Plus can terminate the Agreement immediately upon written notice if the PCC fails to meet Blue Plus’ credentialing standards. Termination is now no longer a bar to Agreement renewal

The Journal of the Hennepin and Ramsey Medical Societies

— the contract will now renew on notice from Blue Plus, although a provider may still give notice of termination at any time. Termination at any time other than at the end of a term of the Agreement will result in a PCC forfeiting any amounts withheld by Blue Plus. X(1), (2), (3) Network Access Only Arrangements. Under these types of arrangements, Blue Plus provides only access to its provider network and does not provide administrative or claims payment services. These arrangements will not be subject to the Agreement’s withhold settlement payment calculation provisions. This raises an issue since under the Agreement, the PCC also agrees that the “terms for payment” under the Agreement (presumably including a withhold) may be assigned to a plan sponsor. It is not clear what provisions will then apply for settling any withhold under these kinds of arrangements. XI(3) ✦

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November/December 2000

HMS/RMS Physicians Assume Leadership Roles at MMA

Blanton Bessinger, M.D. Installed as the 134th President Minnesota Medical Association

Michael B. Ainslie, M.D. Elected Treasurer

Robert K. Meiches, M.D. Re-elected Chair, Board of Trustees

David L. Estrin, M.D. Re-elected Secretary

Gary D. Hanovich, M.D. Re-elected Speaker of the House

AMA Delegates and Alternate Delegates

Frank J. Indihar, M.D. Re-elected Delegate

November/December 2000

Carolyn J. McKay, M.D. Re-elected Delegate

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Kenneth W. Crabb, M.D. Re-elected Alternate Delegate

The Journal of the Hennepin and Ramsey Medical Societies

HMS/RMS Physicians Receive MMA Awards Community Service Award This award honors MMA members who are actively engaged in the practice of medicine and have an outstanding record of community service. Mark L. Jacobson, M.D., MPH (HMS) Frank T. Pilney, M.D. (RMS) Eugene W. Ollila, M.D. (HMS) Presidentâ&#x20AC;&#x2122;s Award This award is presented to those members of the Association who have made outstanding contributions in service, but have never been elected to a major office or recognized by the MMA for their dedication and commitment. Ronald E. Cranford, M.D. (HMS)

Stop the Violence Award The MMA Stop the Violence Award is presented to a physician, an individual, or a group with an outstanding record of attempting to eliminate violence and abuse. Carolyn J. Levitt, M.D. (RMS) Fifty Club Award The MMA annually recognizes its members who have given 50 years of service to the practice of medicine. Frank Bonello, M.D. (RMS) Hector M. Brown, M.D. (RMS) James S. Cole, M.D. (HMS) William R. Fifer, M.D. (HMS) James P. Ginsberg, M.D. (HMS)

Donald F. Holm, M.D. (HMS) Elizabeth K. Jerome, M.D. (HMS) Edward H. Kelly, M.D. (RMS) Harold D. Kletschka, M.D. (HMS) Charles H. Manlove, Jr., M.D. (RMS) Donn G. Mosser, Sr., M.D. (HMS) James Y. Nakamura, M.D. (RMS) Maxine O. Nelson, M.D. (HMS) Neil Palm, M.D. (RMS) Edmund A. Post, M.D. (RMS) Robert W. Reif, M.D. (RMS) Richard Sells, M.D. (RMS) Marcus Shelander, M.D. (RMS) Ernest J. Sowada, M.D. (RMS) William E. Stephens, M.D. (HMS) Norman A. Sterrie, M.D. (HMS) â&#x153;Ś

HMS/RMS Members Serve as MMA Trustees

Lee H. Beecher, M.D. West Metro

John W. Larsen, M.D. West Metro

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Karen K. Dickson, M.D. West Metro

Robert K. Meiches, M.D. West Metro

The Journal of the Hennepin and Ramsey Medical Societies

Henry T. Smith, M.D. West Metro

Thomas B. Dunkel, M.D. East Metro

Lyle J. Swenson, M.D. East Metro

November/December 2000

HMS and RMS Members Participate in MMA Annual Meeting

HMS and RMS members submitted a total of 30 resolutions for consideration by the year 2000 House of Delegates. Below is a listing of the actions taken: #101 – Employer Compensation to Physicians for Time to Acquire CME Author: Omer K. Sanan, M.D. (RMS) HOUSE ACTION: ADOPTED AS AMENDED RESOLVED, that the MMA endorse the concept that all physicians be allowed adequate time and payment to acquire required continuing medical education (CME), and be it further RESOLVED, that the MMA provide information to physicians, from published sources, detailing policies for reimbursement and deductibility of CME within Minnesota and throughout the United States, and be it further RESOLVED, that the MMA develop a report that describes current methods to fully deduct the cost of required continuing medical education and assess the need for changing current tax laws to ensure full deductibility of required CME. #102 – Creation of a Citizen’s Advisory Council Author: Robert Geist, M.D. (RMS) and Rebecca Thoman, M.D (HMS) #103 – MMA Support for Patient Advocacy/Alliances, and Education Author: Lee Beecher, M.D. (HMS) HOUSE ACTION: SUBSTITUTE RESOLUTION 102 WAS ADOPTED IN LIEU OF RESOLUTIONS 102 AND 103 RESOLVED, that the MMA Board of Trustees

November/December 2000

assess and implement various methods of obtaining citizen/community input in the development and implementation of MMA policy and programs, and be it further RESOLVED, that the title of Substitute Resolution 102 be Citizen Input. #104 – Conflict of Interest Policy Author: Robert Geist, M.D. (RMS) and T. Michael Tedford, M.D. (HMS) HOUSE ACTION: NOT ADOPTED RESOLVED, that the Minnesota Medical Association Board of Trustees develop a conflict of interest policy regarding members’ competing professional/financial interests and their roles and responsibilities as voting members of MMA committees to be presented to the House of Delegates for discussion and approval in 2001. #201 – Opposition to State PreEmption of Local Ordinances Regulating Tobacco Author: Neal Holtan, M.D. (RMS) HOUSE ACTION: ADOPTED AS AMENDED RESOLVED, that the MMA oppose attempts to adopt state law that pre-empts local ordinances that restrict the sale and use of tobacco. #202 – Opposition to State PreEmption of Local Ordinances Regulating Firearms Author: Neal Holtan, M.D. (RMS) HOUSE ACTION: REFERRED TO MMA BOARD OF TRUSTEES RESOLVED, that the MMA seek to change current Minnesota law that pre-empts local ordinances regulating the sale and use of firearms. MetroDoctors

#203 – Repeal of the Provider Tax Authors: Albert J. Heimer, M.D. and Rainer G. Rocheleau, M.D. (RMS) HOUSE ACTION: ADOPTED RESOLVED, that the MMA continue to endorse and lobby at the next session of the Minnesota Legislature as a high priority, the repeal of the 2 percent provider tax. #204 – Study of the Pricing of Prescription Drugs Author: Donald Hannon, M.D. (RMS) HOUSE ACTION: ADOPTED AS AMENDED RESOLVED, that the MMA urge the Minnesota Congressional delegation to continue their investigation of the pricing structure of the pharmaceutical industry, and be it further RESOLVED, that the MMA delegation to the American Medical Association House of Delegates carry a resolution asking the AMA to include in their current activities related to the problem of increasing pharmaceutical costs the development of a plan for equitable pricing of pharmaceuticals for all Americans, and develop legislation to promote this plan. #205 – Study of the Minnesota Prescription Drug Program Author: Craig Mommsen, M.D. (RMS) HOUSE ACTION: ADOPTED AS AMENDED RESOLVED, that the MMA promote the Prescription Drug Program (formerly Senior Drug Program) to ensure it meets the needs of qualified Minnesotans for access to prescription drugs at an affordable price, and be it further

The Journal of the Hennepin and Ramsey Medical Societies

RESOLVED, that the MMA monitor the De-

partment of Human Services’ required annual report to the Legislature to determine if further improvements to the program are necessary. #206 – Osteoporosis and Densitometry Author: J. Michael Gonzalez-Campoy, M.D. (RMS) HOUSE ACTION: ADOPTED AS AMENDED RESOLVED, that the MMA establish policy recognizing osteoporosis as a major health problem in our state, and be it further RESOLVED, that the MMA pursue avenues to create awareness of osteoporosis and restrict clinical densitometry practice to appropriately trained physicians, thereby improving the level of care for these patients, and be it further RESOLVED, that the MMA adopt AMA Policy H-425.981 as MMA policy: The MMA “(1) advocates for the use of bone densitometry as an important tool in assessing fracture risk and in the diagnosis of osteoporosis; (2) advocates that a clinical evaluation accompany any bone mass measurement for the evaluation of fracture risk and osteoporosis; (3) advocates for the continued participation of the patient’s physician in the diagnosis, treatment, and prevention of osteoporosis; and (4) encourages private third-party payers to provide coverage for bone mass measurement technology and services for those individuals at high risk of osteoporosis. #207 – Support of Minnesota’s Academic Medical Centers and the Funding Base of the University of Minnesota Medical School Author: Neal Holtan, M.D. (RMS) HOUSE ACTION: ADOPTED AS AMENDED RESOLVED, that the MMA strongly support the State of Minnesota’s initiatives and advocacy for all of its academic medical centers’ educational activities, and be it further RESOLVED, that the MMA actively support and participate in the University of Minnesota Medical School’s 2000-2001 efforts to receive an expanded and secure funding base.

HMS and RMS members caucus jointly during the MMA Annual Meeting.

#209 – Coordination of Clinic Surveys and Chart Audits Author: Kenneth Dedeker, M.D. (HMS) HOUSE ACTION: ADOPTED AS AMENDED RESOLVED, that the MMA work with health plans, the Minnesota Department of Health, and appropriate accrediting agencies to find a mechanism to reduce the intrusion and cost of duplicative surveys and audits. #300 – Opposing the Carveout of Mental Health and Chemical Dependency Benefits Author: Karen Dickson, M.D. (HMS) and Minnesota Psychiatric Society HOUSE ACTION: ADOPTED AS AMENDED RESOLVED, that the MMA oppose the carving out of psychiatric and chemical dependency treatment from general medical care in health insurance and managed care programs, and be it further RESOLVED, that the MMA delegation to the American Medical Association carry a resolution to the AMA asking the AMA to work to eliminate mental health and chemical dependency carveouts so that benefits for mental health are managed and administered like other health care services, and be it further RESOLVED, that the MMA develop and conduct an educational program aimed at patients, employers, and other interested parties to promote the advantages of health care insurance policies that integrate medical, surgical, psychiatric, and chemical dependency services in any clinical setting.

#303 – MMA to Co-Sponsor a Community Conference to Discuss: What Comes After Managed Care? Authors: Robert Geist, M.D. (RMS) and Rebecca Thoman, M.D. (HMS) HOUSE ACTION: NOT ADOPTED RESOLVED, that the MMA in cooperation with other interested parties produce and title a conference devoted to discussing and recommending action regarding the next generation of health care delivery and financing systems. #304 – Improved Reimbursements for Blood Products and Blood Safety Author: Kenneth Nollet, M.D. (RMS) HOUSE ACTION: ADOPTED AS AMENDED RESOLVED, that the MMA delegation to the American Medical Association (AMA) carry a resolution to the AMA House of Delegates calling on the AMA to advocate for improved reimbursement to hospitals for services related to blood products and blood safety, and be it further RESOLVED, that the MMA delegation to the AMA request that the AMA advocate for the appropriate adjustments to the market basket mechanism used by the Health Care Financing Administration (HCFA) for payments to hospitals which will result in adequate reimbursements to cover the costs for blood products and blood safety.

(Continued on page 18)

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November/December 2000

(Continued from page 17)

#305 – AMA Study of National Health Systems Author: John B. Coleman, M.D. (RMS) HOUSE ACTION: NOT ADOPTED RESOLVED, that the MMA delegation to the American Medical Association carry a resolution calling on the AMA to study and issue a report of the findings of the study about the health care systems of Canada, England, Germany, Norway, and Sweden with respect to costs; the waiting time for elective procedures; who pays for the care; and the emergence of private physician practices and hospitals, and be it further RESOLVED, that the MMA delegation to the American Medical Association also ask the AMA to develop a national health care system model for the United States with features designed to address unique aspects of health care in the United States. #306 – Prohibit Global Risk Sharing Contracts Between Providers and Health Plans Authors: Robert Geist, M.D. (RMS) and Rebecca Thoman, M.D. (HMS) HOUSE ACTION: ADOPTED RESOLVED, that the MMA lobby the Minnesota State Legislature to amend laws governing health plans to remove all provisions of the law that permit physicians to enter into global risk sharing contracts with health plans for services other than their own (such as from a hospital, laboratory, consultant, or pharmacy), and be it further RESOLVED, that the MMA delegation to the American Medical Association delegation

carry a resolution to the AMA House of Delegates that the AMA lobby Congress to amend laws governing health plans to remove all provisions of law that permit physicians to enter into global risk-sharing contracts with health plans for services other than their own such as from a hospital, laboratory, consultant, or pharmacy. #307 – Obesity Author: J. Michael Gonzalez-Campoy, M.D. (RMS) HOUSE ACTION: ADOPTED AS AMENDED RESOLVED, that the MMA recognize obesity as a major endemic health problem, by endorsing existing AMA policy on obesity (H150.953 and H-440.902) and be it further RESOLVED, that the MMA develop a statewide education campaign, in conjunction with interested parties, to create awareness of the modifiable causes of obesity, obesity complications, and effective, sustained obesity treatment. #308 – Lack of Coverage for Obesity and Related Conditions Author: J. Michael Gonzalez-Campoy, M.D. (RMS) HOUSE ACTION: NOT ADOPTED RESOLVED, that the MMA introduce legislation to secure adequate reimbursement to physicians for the care of patients with obesity and for prescribed medications, and be it further RESOLVED, that the MMA review existing American Medical Association policy regarding coverage for obesity services, and either endorse current policy, or introduce policy to secure adequate coverage for the epidemic of obesity.

RMS and HMS members discuss resolutions and reference committee reports.

November/December 2000

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#309 – Patient Protection in Utilization Review of Psychotherapy Review Authors: Lee Beecher, M.D. (HMS) and Minnesota Psychiatric Society HOUSE ACTION: ADOPTED RESOLVED, that the MMA develop and advocate Minnesota state legislation prohibiting utilization review organizations, health plans, or insurance plans from requiring disclosure of psychotherapy case notes as a condition of medical necessity review or insurance reimbursement. #310 – Plans Pay for Out of Network Physicians, But Not Always Their Rx Authors: Lee Beecher, M.D. (HMS) and Minnesota Psychiatric Society HOUSE ACTION: ADOPTED AS AMENDED RESOLVED, that the MMA work with Minnesota health plans to provide coverage for pharmaceutical prescriptions that are compliant with plan formularies, when written by physicians who are otherwise eligible for health plan reimbursement according to the enrollee’s health plan contract. #311 – Cell Phone Use While Driving Author: Carl Burkland, M.D. (HMS) #312 – Banning Cellular Phone Use While Driving Policy Author: Carl Burkland, M.D. (HMS) #313 – Driving While Using a Cellular Phone Author: Range Medical Society #315 – Sleepy Driving Prevention and Detection Author: MMA Committee on Public Health and Preventive Medicine HOUSE ACTION: SUBSTITUTE RESOLUTION #311 WAS ADOPTED IN LIEU OF RESOLUTIONS 312, 313, AND 315 RESOLVED, that the MMA educate Minnesota physicians and the public about the dangers of driver inattention due to factors including, but not limited to, sleepiness, cellular phone use, electronic devices (e.g., stereo, global positioning systems, televisions), and the use of certain medications.

The Journal of the Hennepin and Ramsey Medical Societies

(See related article by Carl Burkland, M.D., on page 20 of this issue of MetroDoctors.) #400 – Continuation of Minnesota Maternal Mortality Studies Author: Elisa Wright, M.D. (HMS) and Minnesota Section of the American College of Obstetricians and Gynecologists HOUSE ACTION: ADOPTED AS AMENDED RESOLVED, that the MMA work with the Commissioner of Health to seek to continue Department of Health authority to access health records regarding maternal mortality studies (Minn. Stat. 145.90), and be it futher RESOLVED, that, if necessary, the MMA work with the Department of Health to introduce legislation in this area. #402 – National Practitioner Data Bank Protection Author: Robert Moravec, M.D. (RMS) HOUSE ACTION: ADOPTED RESOLVED, that the MMA oppose any attempts to open the National Practitioner Data Bank to public level of query, and be it further RESOLVED, that the MMA delegation to the American Medical Association continue to support the AMA position of opposing any attempt to open the National Practitioner Data Bank to public query. #403 – Empower Minnesota Physicians to Collectively Negotiate Contracts with Health Plans Author: Robert Tatreau, M.D. (RMS) HOUSE ACTION: REFERRED TO THE MMA BOARD OF TRUSTEES RESOLVED, that the MMA, as a high priority, study legislation that provides state action immunity legislation that has passed in states such as Texas, and be it further RESOLVED, that MMA consider developing and supporting legislation that permits the physicians of Minnesota to collectively negotiate the terms and conditions of contracts with health plans.

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#404 – Education of Physicians Regarding Tortured and Traumatized Refugees Author: Neal Holtan, M.D. (RMS) HOUSE ACTION: ADOPTED AS AMENDED RESOLVED, that the MMA continue to support and develop education programs for physicians who see refugees among their patients to enable the physician to assess the refugee for the possibility of post-traumatic stress, depressions, or medical injury due to torture or war trauma, and be it further RESOLVED, that the MMA educate Minnesota physicians to uphold the principles of human rights by assisting, if requested, to document the physical and psychological effects of torture.

appoint a task force to address the issues of clinical research in Minnesota with particular attention to at least: (1) approval agencies; (2) facility and researcher participation with the participant member managed care organization, as applicable; and (3) the mechanism for assignment of reimbursable and non-reimbursable expenses, and be it further RESOLVED, that the MMA pursue negotiations with managed care organizations, clinical research groups (e.g., University of Minnesota), governmental agencies, and consumers to develop an organized systematic approach to clinical studies done in Minnesota with Minnesota residents. ✦

#407 – Methadone Maintenance Treatment Author: Lee Beecher, M.D. (HMS) and Minnesota Psychiatric Society HOUSE ACTION: ADOPTED AS AMENDED RESOLVED, that the MMA endorse American Medical Association policies H-95.957 and H-95.964 regarding use of methadone maintenance therapy in clinics and in the offices of physicians properly trained and administratively monitored. #408 – Patient Safety Author: Kenneth Dedeker, M.D. (HMS) HOUSE ACTION: ADOPTED AS AMENDED RESOLVED, that the MMA continue to work with local and national efforts to reduce medical errors and improve patient safety, and be it further RESOLVED, that particular attention be paid to the issues of: (1) need for and methods to identify root causes of errors; (2) data privacy and confidentiality; (3) mechanisms to reduce the culture of blame in the health care industry; and (4) mechanisms for the equitable distribution of associated costs. #409 – Coverage of Experimental/Investigational Studies Author: Kenneth Dedeker, M.D. (HMS) HOUSE ACTION: REFERRED TO THE MMA BOARD OF TRUSTEES RESOLVED, that the MMA Board of Trustees

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November/December 2000

Using a Cell Phone While Driving — A Risky Venture? Editor’s Note: The following is an excerpt from a speech given by Dr. Burkland, a family physician and West Metro Delegate to the MMA, during the MMA Annual Meeting.

THE BEGINNING OF THIS YEAR, I started to notice how many drivers were using cell phones while they were driving. I am computer illiterate so I went over to my daughter’s apartment and she got me into the Internet so I could see what they were saying about cellular phone usage by drivers. I noticed that there were several personal tragic stories by parents of children who were killed by a driver while they were using a cellular phone and their pleas that no one seemed to be listening or doing anything about correcting this dangerous behavior. One victim’s mother’s reply to the statement that we don’t need any new laws regulating cell phone use stood out: “everybody thinks it’s their freedom to have this phone. My son had a right to life.” At that moment, and as my daughter sat next to me, I decided to advocate for her and my family’s driving safety now while they were still alive and not after one of them had been killed by one of these drivers. The National Highway Traffic Safety Administration (NHTSA) held a well-attended public hearing on July 5, 2000 on the potential safety implications with so much technology piling up in American cars. Drivers distracted while using advanced in-vehicle technologies that allow them to phone, fax, e-mail, obtain route guidance, view infrared images on a head-up display, operate multimedia entertainment systems, or use the Internet. CNN News commenting on this public hearing on the risks of distracted drivers stated BY CARL E. BURKLAND, M.D.

November/December 2000

that the NHTSA estimated that 25 percent of the 6.3 million crashes in the U.S. each year involved a distraction. That was 8,000 crashes a day and as many as 30 percent of fatal crashes were caused by distraction. Rossalyn G. Millman, Deputy Administrator, NHTSA stated that: “Using a wireless phone or other device while driving can be distracting and drivers should not talk on a phone or use these devices while their vehicles are in motion.” (Keep in mind, this agency has the power to set vehicle safety standards but has no jurisdiction over portable phones, the regulation of which largely remains a state and local matter.) What do the hand-held phone manufacturers say in their owner’s manual about the safe use of cellular phones while driving? Nokia: Road safety comes first. Don’t use a hand-held phone while driving; park the vehicle first. AT and T — Traffic safety. We recommend that you do not use the phone when you are driving a vehicle. Park safely and then make your call. Remember, road safety always comes first! MetroDoctors

While the above manufacturers have decided that the only safe use of a hand-held cellular phone by a driver whose vehicle is in motion is its nonuse, other manufacturers have tried to articulate in their owner’s manual an adequate safety policy for these drivers which excludes this essential overriding principle. The Cellular Telecommunications Industry Association (CTIA) has put considerable effort into getting the “safer use” message across, using its campaign “Safety: Your Most Important Call” (CTIA, 1998). The campaign’s central message is that it is a driver’s first responsibility to drive safely and includes 10 points to consider when using a mobile phone while driving. These ten tips are taken from Ericsson’s owner manual for an example. (See sidebar) I will make some remarks about some of them: #2 When available, use a hands-free device. Does this mean it is safer? If no, why not just say don’t use a hand-held cellular phone while driving. It is apparent manufacturers clearly recognize the potential risks of in-vehicle cellular phone use. #3 Be able to access your wireless phone without removing your eyes from the road. Is this possible? Will people do it? #4 Let the person you are speaking with know you are driving; if necessary, suspend the call in heavy traffic or hazardous weather conditions. You mean you wouldn’t automatically suspend the call in heavy traffic or hazardous weather conditions? #6 If you need to make a call while moving, dial only a few numbers, check the road and your mirrors, then continue. I thought point #3 said not to remove your eyes from the road. Will anyone dial only a few numbers? And finally #7 Do not engage in stressful or emotional conversations that may be distracting. How The Journal of the Hennepin and Ramsey Medical Societies

can you know if a conversation will be or will become stressful or emotional? Furthermore, by using phrases in these safety tips such as “if necessary, if possible, dial sensibly, assess the traffic, and if you need to make a call while moving,” the manufacturer leaves it to the discretion of the driver to determine if it is safe for him or her to use their cellular phone in any particular situation while they are driving. This lack of precise safety guidelines increases the risks that the individual following them will make an inappropriate and dangerous driving decision. The landmark article by Redelmeier that suggested an association between cellular telephone calls and motor vehicle collisions appeared in the New England Journal of Medicine on February 13, 1997. Three conclusions in this article have been widely quoted in the news media and used as corroborating data by individuals trying to get support for any legislative action to regulate cell phone usage by drivers while their motor vehicles are in motion.

The conclusions were that: 1. Using a cellular telephone was associated with a risk of having a motor vehicle collision that was about four times as high as that among the same drivers when they were not using their cellular telephone; 2. This relative risk was similar to the hazard associated with driving with a blood alcohol level at the legal limit; and 3. They observed no safety advantage to hands-free as compared with hand-held telephones. Violante published a second much quoted case control study on cellular phones and fatal traffic collisions using data from the Oklahoma State Department of Public Safety database in 1998. The study results and findings are below: 1. Total traffic related accidents were 233,000, of which 1,548 were fatal. Of the vehicles involved in fatal accidents, 4.2 percent had mobile phones and 7.7 percent of the fatalities with phones present were reported to be using the phone at the time of collision.

Drivers reported to be using a phone at the time of collision had a nine-fold risk of a fatality over the one without a phone. 3. Drivers reported to have a phone present in their vehicle were at twice the risk for a fatality as drivers without phones. 4. Drivers with phones were more likely to incur a collision due to “wandering” from their lane. 5. Drivers with phones had an increased chance of striking a pedestrian. 6. Drivers with phones had an increased risk of overturning their vehicle. 7. Drivers using phones were at three times the risk of a fatality over alcohol/drug use. 8. Results suggest that phone use is associated with driver inattentiveness to speed and lane position. 9. Risk of phone involved fatalities increase with age. Another study by Violante (1996) on cellular phones and traffic accidents found: 1. An increased crash risk of 34 percent existed for those with mobile phones in their cars, and

(Continued on page 22)

Wireless Phone Safety Tips Provided by Ericsson Your wireless telephone gives you the powerful ability to communicate by voice — almost anywhere, anytime. But an important responsibility accompanies the benefits of wireless phones, one that every user must uphold! When driving a car, driving is your first responsibility. When using your wireless phone behind the wheel of a car, practice good common sense and remember the following tips: 1. Get to know your wireless phone and its features such as speed dial and redial. If available, these features help you to place your call without taking your attention off the road. 2. When available, use a hands free device. If possible add an additional layer of convenience and safety to your wireless phone with one of the many hands free accessories available today. 3. Position your wireless phone within easy reach. Be able to access your wireless phone without removing your eyes from the road. If you get an incoming call at an inconvenient time, if possible, let your voice mail answer it for you. 4. Let the person you are speaking with know you are driving; if necessary, suspend the call in heavy traffic or hazardous weather conditions. Rain, sleet, snow, ice, and even heavy traffic can be hazardous. 5. Do not take notes or look up phone numbers while driving. Jotting down a “to do” list or flipping through your address book takes

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The Journal of the Hennepin and Ramsey Medical Societies

attention away from your primary responsibility — driving safely. 6. Dial sensibly and assess the traffic; if possible, place calls when you are not moving or before pulling into traffic. Try to plan calls when your car will be stationary. If you need to make a call while moving, dial only a few numbers, check the road and your mirrors, then continue. 7. Do not engage in stressful or emotional conversations that may be distracting. Make people you are talking with aware you are driving and suspend conversations which have the potential to divert your attention from the road. 8. Use your wireless phone to call for help. Dial 9-1-1 or other local emergency number in the case of fire, traffic accident or medical emergencies. Remember, it is a free call on your wireless phone. 9. Use your wireless phone to help others in emergencies. If you see an auto accident, crime in progress, or other serious emergency where lives are in danger, call 9-1-1 or other local emergency number, as you would want others to do for you. 10. Call roadside assistance or a special non-emergency wireless assistance number when necessary. If you see a broken-down vehicle posing no serious hazard, a broken traffic signal, a minor traffic accident where no one appears injured, or a vehicle you know to be stolen, call roadside assistance or other special non-emergency wireless number.

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(Continued from page 21)

Talking for more than 50 minutes per month resulted in a 5.58 fold increased risk of having a crash, higher than any other in car activity. Since these early articles there has been extensive research on this issue that has tended to corroborate and add to the previous findings. A number of these studies addressed the concern about the degree of awareness of these drivers using their cellular phones and demonstrated that drivers were not necessarily aware of their driving performance while they were engrossed in a call. Frequently, the potential hazards cited by some cellular telephone users (such as being careful while dialing) do not match the problems (such as lane meandering) cited by nonusers who are sharing the road. The NHTSA states that contrary to expectations, the majority of drivers were talking on their telephones rather than dialing at the time of the crash. A few drivers also were startled when their cellular telephones rang and, as they reached for their phones, they ran off the road.

November/December 2000

Other driver factors included driving too fast for conditions or failing to yield. The overwhelming majority of cellular telephone users were in the striking vehicle, and struck cars or other large objects that were in clear view of the driver. Based on these reports, W. Riley Garrott, a spokesperson for the NHTSA stated at the public hearing on July 5, 2000 that “conversation itself, is the most prevalent single behavior associated with cellular telephone related crashes. What this means is hands-free phones will not totally solve this problem.” Hands-free equipment won’t eliminate the distraction problem and conversation is the culprit. A Gallup Poll on CNN taken this year found that 67 percent of Americans would support a law banning cell phone use while driving. I think that this poll reflects that American drivers are experiencing and noticing this unawareness on the part of drivers using their cellular phones while driving. These drivers are seen and felt not only to be annoying but also to present a clear and immediate danger to the safety of other drivers around them.

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Further, it is felt that these drivers have crossed the line, whereever the line was, and that their use of cellular phones is now seen as different from the other in-car activities of putting make-up on, eating, flossing, shaving, brushing teeth, etc. At least 18 countries have enacted legislation restricting cell phone use while driving. Australia, Austria, Israel, Norway, Portugal, South Africa, and Switzerland have specific legislation against hand-held car phone use. Earlier, on March 22, 1999, Brooklyn, Ohio became the first city in the United States to pass an ordinance banning the use of handheld cellular phones while driving. In 1996, Brooklyn was also the first town to require the use of seatbelts. There are some similarities between legislating for mobile phone use while driving and the seatbelt legislation issue of the early 1980s. Initial public and political opinions were generally against the need for legislation; it took several years for people to realize the importance of seatbelt legislation. Experience from the passage of seatbelt legislation has shown that if mobile phone legislation is implemented, it is likely to be introduced in a phased manner. This could mean that the most unsafe types of usage (if these usage types exist and can be identified) could be targeted long before any wide-ranging legislation is introduced. In the case of mobile phones, this could mean an initial restriction placed on handheld phones only. And finally, most importantly what about the victims? In Minnesota, the State Highway Patrol says driver distractions, such as using a cell phone, were a leading cause of crashes in 1999 accounting for 14 percent of fatal crashes, 25 percent of injury crashes and 25 percent of property-damage crashes. “We do not take driving as seriously as we should” said Lt. Mark Peterson, a 17-year veteran with the Minnesota State Patrol. Behind these statistics are devastated families and communities. “Parents should not have to bury their children.” Cried out one mother whose child was killed in a mobile phone related accident. Crashes due to cellular phone use are not acts of God, they are foreseeable and preventable. For yourself, for your family, for your patients and their families, I ask you to pass this resolution endorsing this policy. ✦ The Journal of the Hennepin and Ramsey Medical Societies

Medical Student Recruitment Activities Lunch ’n Learn Over 200 medical students attended the “Lunch ’n Learn” session sponsored by HMS, RMS, and MMA on Tuesday, September 26. Drs. Frank Indihar, Robert Meiches and Virginia Lupo, and Joel Oberstar (4th year medical student) addressed the benefits of organized medicine from the county, state, and national levels. ✦

Student Picnic On a sunny August evening, the medical student class of 2004 gathered at Como Park for a welcoming picnic hosted by the U of M second year students. HMS, RMS, and MMA representatives were also invited to share information on our organizations and encourage medical student involvement. ✦

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November/December 2000

PRESIDENT’S MESSAGE J O H N R . G AT E S , M . D .

What will Physician Collegiality be for the Future? THE ISSUE OF PHYSICIAN collegiality has

President John R. Gates, M.D. President-Elect Robert C. Moravec, M.D. Past President Lyle J. Swenson, M.D. Secretary Jamie D. Santilli, M.D. Treasurer Peter H. Kelly, M.D.

been a topic of some concern in recent years and was actually a major forum at the Leadership Conference of the American Medical Association held in Miami this past spring. We physicians pride ourselves in being professionals and with that “professional” designation comes an obligation to behave in a “professional manner.” This description implies a collegial interaction of respect for the perspectives and expertise of our fellow physicians who work shoulder-to-shoulder in the selfless care of our patients. That is, of course, the classic image. However, we are in the midst of a major paradigm shift. Many of us older physicians, i.e., those of us in our late 40s, 50s or older, actually did find medicine a calling. A calling that very often was all-consuming — consumed our time, on occasion consumed our families and relationships — and did result in a quality of care that we see in our community, that as I have said before, is second to none. We find younger physicians going into medicine in our community having a somewhat different perspective. Medicine may indeed be a profession and a calling, but it needs to be viewed now in the context of family, avocational interests, and increasingly, the professional concerns and issues of the spouse. Repeatedly, when I talk with young physicians about joining a practice to work toward partnership, there is a hesitancy — a hesitancy that implies the commitment in time and energies and personal resources that might be required to achieve partnership in a busy clinical practice may not be consistent with their personal aspirations. Consequently, I would submit that the issue of physician collegiality is not just a deterioration of professional interchange as we find ourselves hoisted on the petard of managed care, but has more insidious roots in the major paradigm shift of the values of our entering physicians. Quite frankly, I can’t blame them. When I look back on every other night call during my internship, I must ask if it was

RMS-Board Members

Kimberly A. Anderson, M.D. Charles E. Crutchfield, III, M.D. Peter J. Daly, M.D. Kelley C. du Ford, Medical Student Thomas B. Dunkel, M.D. Michael Gonzalez-Campoy, M.D. James J. Jordan, M.D. F. Donald Kapps, M.D. Kathryn M. Klingberg, M.D., Resident Physician Charlene E. McEvoy, M.D. Ragnvald Mjanger, M.D. Thomas F. Rolewicz, M.D. Paul M. Spilseth, M.D. Jon V. Thomas, M.D. David C. Thorson, M.D. Randy S. Twito, M.D. Russell C. Welch, M.D. RMS-Ex-Officio Board Members

Blanton Bessinger, M.D., MMA President-Elect Raymond Bonnabeau, M.D., Sr. Physicians Association President Kenneth W. Crabb, M.D., AMA Alternate Delegate Stephen P. England, M.D., Community Health Council Chair Michael Gonzalez-Campoy, M.D., Education Resource Council Chair Eleanor Goodall, Alliance President Frank J. Indihar, M.D., AMA Delegate William Jacott, M.D., U of MN Representative F. Donald Kapps, M.D., Council on Professionalsim & Ethics Chair Melanie Sullivan, Clinic Administrator Lyle J. Swenson, M.D., Public Policy Council Chair Russell C. Welch, M.D., Communications Council Chair RMS-Executive Staff

Roger K. Johnson, CAE, Chief Executive Officer Doreen M. Hines, Assistant Director

RMS-Officers

November/December 2000

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really necessary for me to run that gauntlet to enter the professional solidarity while almost psychotically sleep deprived. We are evolving into a new kind of profession. One where continuity of care provided by one physician willing to give the considerable commitment of after-hours to provide that continuity will simply not be the norm. Hospitalists, clinical specialized physicians, and the use of physician extenders in the forms of nurse practitioners or PAs have already demonstrated their value and implications for the change of the profession. What will physician collegiality be for the future? I’m confident of only one thing — it will be different. ✦

Mark Your Calendar!

RMS Annual Meeting Friday, January 26, 2000 North Oaks Country Club

Installation of

Robert C. Moravec, M.D. 130th President

The Journal of the Hennepin and Ramsey Medical Societies

R M S U P DAT E

Physician Leaders Honored at MMA Annual Meeting DR. BLANTON BESSINGER, MMA presi-

Physicians attending to toast Drs. Bessinger and Rigatuso are: (from left) Chad Boult, M.D., Kenneth Nollet, M.D., J. Michael Gonzalez-Campoy, M.D., Frank Indihar, M.D., Robert Geist, M.D., and Tim Crimmins, M.D.

Annual Meeting in Duluth on Wednesday, September 13, 2000. Dr. Bessinger was inaugurated as the 134th president of the MMA in ceremonies at the MMA Annual Meeting. His wife, Bonnie, and other family members joined him for the occasion. Dr. Bessinger is a pediatric cardiologist and is the Director of Child Advocacy and Child Policy for Children’s Hospitals and Clinics, Minneapolis and St. Paul. Dr. Joseph Rigatuso was honored for completing nine years of service representing the East Metro District on the MMA Board of Trustees. Dr. Rigatuso is

a pediatrician with HealthPartners and president, HealthPartners Physician’s Association. ✦ Ramsey Medical Society

dent, and Dr. Joseph Rigatuso, MMA East Metro Trustee, were honored at a RMS champagne reception at the Minnesota Medical Association

Blanton Bessinger, M.D., MMA President; Randolf D. Smoak, M.D., AMA President; John Van Etta, M.D., MMA Past President; and Joseph Rigatuso, M.D., Outgoing MMA East Metro Trustee during the MMA Annual Meeting.

RMS Family Night at the Saints ANOTHER SUMMER, another successful RMS Family Night at the Saints. Well over 100 physicians, spouses, and children enjoyed the Saint Paul Saints game on August 29, 2000. The weather was great. The dogs and brats were well-cooked and the pictures prove that everyone had a great time. ✦

Dr. Charles Terzian with his wife, Helen, and daughter, Anna.

Judy Jacott, Gwen Crabb, Dr. Bill Jacott and Dr. John Gates.

Looking for a winter escape?

Join us in Cancun Feb. 17-24, 2000 for the RMS/HMS Medical Conference Dr. Mark Steinhauser and son, Kenneth.

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Allison Welch, Brenda Andrewson, and Dr. Russell Welch.

The Journal of the Hennepin and Ramsey Medical Societies

See page 8 for more information.

November/December 2000

In Memoriam EDWARD C. MCELFRESH, M.D., died on August 10 at the age of 58 from complications as a result of a lung transplant received in June. He was Chief of Orthopedics at the Minneapolis Veterans Hospital and associate professor of orthopedic surgery at the University of Minnesota. He graduated from the University of Nebraska, completed his internship at the University of Minnesota, and his residency at the Mayo Clinic. Dr. McElfresh joined RMS in 1976.

Applicants for Membership We welcome these new applicants for Ramsey Medical Society membership.

Active Jimmie L. Browning, M.D. University of Kansas Family Practice United Family Practice Victor S. Cox, M.D. Yale University Otolaryngology Otolaryngology & Head and Neck Surgery, P.A. Michael B. Johnson, M.D. St. Louis University Otolaryngology Ear, Nose & Throat SpecialtyCare of Minnesota, P.A.

Thomas W. Scheider, M.D. Creighton University Family Practice HealthEast Woodbury Clinic Caroline M. Tahara, M.D. Creighton University Internal Medicine HealthPartners - White Bear Lake

Resident Jaspal Singh, M.D. Sardal Patel Medical College, India Family Practice Bethesda University Family Physicians Student (University of Minnesota)

Tim D. LaBelle, M.D. London Ontario Emergency Medicine Woodwinds Hospital David V. Power, M.D. University of Dublin/University of Minnesota Family Practice Bethesda University Family Physicians Steven M. Tredal, M.D. University of Iowa College of Medicine Emergency Medicine United Hospital

Active-1st Year in Practice Brent R. Asplin, M.D., MPH Mayo Medical School Emergency Medicine Regions Hospital Daniel P. Hoeffel, M.D. University of Pennsylvania Orthopaedic Surgery Summit Orthopedics Andrew J. Portis, M.D. University of Alberta Urology Metropolitan Urologic Specialists 26

November/December 2000

Kathryn H.O. Berman Meghan E. Gruis Amy E. Candy Heinlein Chad R. Laurich Valerie J. Meyer

RONALD J. “BUZZ” PIZINGER, M.D., 59, died on October 10. He graduated from Creighton University Medical School. He completed his internship at St. Paul-Ramsey Medical Center, residencies at the VA Hospital and the University of Minnesota, and did a fellowship in gastroenterology at the VA Hospital and the University of Minnesota. Dr. Pizinger joined RMS in 1974. MARCUS L. SHELANDER, M.D., a urologist, died October 1 at the age of 75. He graduated from the University of Minnesota Medical School, completed his internship at St. Mary’s Hospital, and his residency at the University of Minnesota. Dr. Shelander was the Medical Director of East Metropolitan Health Organization from 1994-1999. He joined RMS in 1956. ✦

(Harvard Medical School)

Roland Brusseau ✦

Community Workshop Honors Bruce Vento THE 5TH ANNUAL Community Health/

Mentoring Academy sponsored the workshop. Dr. Charles Crutchfield was emcee for the program, which honored Congressman Bruce Vento for his outstanding contributions to the community. Pat Crutchfield and Carla Arny presented a Mini Health Fair to a classroom of young community children. The keynote speaker was Dr. Brian Rank who spoke on the topic of lung cancer. The event ended with an open forum panel disWorkshop participants were: Dr. Victor Corbett, Sgt. Mamie cussion with all of the Singleton, Carla Arny and Pat Crutchfield (not pictured are Drs. participants. ✦ Charles Crutchfield and Brian Rank).

Spiritual Workshop was held on Saturday, September 16, 2000 at the Free At Last Church. Sgt. Mamie Singleton and the Youth Initiative

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The Journal of the Hennepin and Ramsey Medical Societies

RMS ALLIANCE NEWS ELEANOR M. GOODALL

A Message to Spouses of Ramsey Medical Society Physicians What’s Important to You? Or, Why You Need to Take Part in the RMS Alliance

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The Journal of the Hennepin and Ramsey Medical Societies

and unrewarding. And, since with most things there is no absolute black and white, but only shades of gray, it can be all things in between, in different amounts at different stages of our lives. As you think about your life, your time, how to make best use of things for YOU, I want you to consider taking part in the RMS Alliance. We have many areas of community service: First Steps — mentoring teen moms; Wigs Without Worry — free wigs to needy individuals who have hair loss due to medical treatment; Caring Hearts for the Homeless — hygiene supplies for homeless persons; Sexual Violence Center — prevention education in schools; Growing Home — befriending/mentoring neglected and abused kids; and Body Language — the annual week-long Health Fair for third graders. We are also part of a state-wide Alliance program to provide HIV/AIDS education folders to all middle schools that request them (6,000 folders in St. Paul last year). And, we’re part of the nation-wide Alliance program to Stop America’s Violence Everywhere (SAVE). So, as you think about what you have to offer, what matters to you, think about the Alliance. It offers fulfillment, friendship and fun. It’s rewarding, refreshing and relaxing. You will gain knowledge, grow personally and give back. If you are currently a member, come and join us at programs and events that fit your needs. If you are not a member yet, become one! The Alliance needs YOU and YOU can gain much from the Alliance. ✦ “A musician must make music, an artist must paint, a poet must write, if he is to be ultimately at peace with himself. What a man can be, he must be.” Abraham Maslow, 1954. (For information on programs, community service opportunities, and/or membership please call Eleanor Goodall. Home763/441-8303; Office 651/268-6107.)

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Ramsey Medical Society

What matters in your life? For most of us, I think the answer is fairly automatic. My husband/wife, my children, my grandchildren, my friends, my work, my religion…and we may even move on to those special things that give us great satisfaction such as, my garden, making art, writing, playing the piano, volunteer work, and so on. The priority order of these things, their importance to us, changes over a lifetime. What is it that’s missing from the above litany of what’s important or what matters in your life? What is missing is YOU! What are you doing that is specifically beneficial to you? Let’s hope that your relationship with the adult you care most about is a good one; your children or grandchildren (in true Lake Wobegon fashion) are all good looking and above average; your spouse’s work is going well and is at the best level of enjoyment for him or her that medicine offers at this time; if you have a job outside the home, your work is rewarding; if your job is home and family, you can look around and pat yourself on the back. Now what? What about you? Your own personal satisfaction? I’ve alluded to Maslow’s “Hierarchy of Needs” before but let’s have a little refresher. Everyone has needs and those lower level needs must be satisfied first before we can move to the higher levels. In priority order, these needs are Hunger — if you don’t have enough to eat, nothing else is important. Security — if you don’t feel safe, you can think of little else other than protecting yourself and your family. Shelter — once you’ve satisfied hunger and safety, you need a roof over your head and some clothes to ward off the elements. The last need Maslow calls Self-Actualization— becoming the best person you can be, making the most of your talents, skills, gifts and realizing your potential. Now, are these easily understood, or do they pose some questions? I think the latter. They

pose questions such as, what are the particular gifts I have? How exactly do I determine my potential? And, how will I know when I am the best person I can be? Introspection is always hard, but it’s an exercise that is truly good for the soul (and usually the mind and body as well). Taking a good hard look at oneself is the baseline of many programs that focus on bringing participants to good mental emotional and physical health. So, I want you to get a little introspective. Find a quiet, kindly place, take a cup of your favorite beverage and do some thinking — by yourself and about yourself. Think about your gifts, your talents, your skills and ask if you’re making the best use of them, at this time. If you answer yes, then you are in harmony, your life is in alignment with the physical, mental, emotional, spiritual aspects all in sync. You act, you think, you feel, and you know in an integrated way. You likely have achieved selfactualization. I’m going to assume that for most of us the answer is yes, to some extent, in some areas of our lives and no, we haven’t reached that level in other areas. “Okay, okay,” you say. “I barely have time to do all I’m expected to do as it is. I don’t have time to work on ‘self-actualization.’ In fact, I’m not sure I even have time to take a cup of tea to a quiet place for half an hour of thinking…let alone actually do anything about it!” We are all busy. Everyone I know is busy. But, if you’re anything like me, sometimes that “busy” makes me feel as if I’m on a hamster’s wheel running as fast as I can but going around the same circle and not really getting anywhere. We become caught up in doing stuff — stuff that may, or may not, be making the best use of our gifts, talents and skills. But, “I just don’t have the time to get involved.” Time. The most illusive of all things we have, and we never seem to have enough of it. My message is exactly about that. This day, this journey through life can be spectacular and fulfilling. It can be, like the hamster wheel, pointless

November/December 2000

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The Journal of the Hennepin and Ramsey Medical Societies

CHAIR’S REPORT DAVID L. ESTRIN, M.D.

HMS-Officers

HMS-Board Members

Ben Baechler, Medical Student Michael Belzer, M.D. Carl E. Burkland, M.D. Herbert K. Cantrill, M.D. William Conroy, M.D. Dianne Fenyk, Alliance Co-President James P. LaRoy, M.D. Barbara C. LeTourneau, M.D. Monica Mykelbust, M.D. Ronald D. Osborn, D.O. Joseph F. Rinowski, M.D. Richard D. Schmidt, M.D. Marc F. Swiontkowski M.D. T. Michael Tedford, M.D. D. Clark Tungseth, M.D. Trish Vaurio, Alliance Co-President Joan M. Williams, M.D. HMS-Ex-Officio Board Members

E. Duane Engstrom, M.D., Senior Physicians Association Lee H. Beecher, M.D., MMA-Trustee Karen K. Dickson, M.D., MMA-Trustee John W. Larsen, M.D., MMA-Trustee Robert K. Meiches, M.D., MMA-Trustee Henry T. Smith, M.D., MMA-Trustee Robert Finke, MMGMA Rep. HMS-Executive Staff

Jack G. Davis, Chief Executive Officer Nancy K. Bauer, Associate Director

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IT’S HARD TO BELIEVE a year has passed since assuming the position of HMS board chair. I have been honored to participate, with physicians from the metro area as well as out-state, in issues important to our patients, our communities, and our fellow physicians. Let me review at this time some of what we have accomplished together. The past year we have made progress towards fairer managed care contracts; we have partnered with medical group administrators to share with our members issues raised as a result of independent review. We are working with the MMA to advocate for the adoption of future contracts consistent with the AMA model contract. We have explored other models of health care delivery, and will continue to strive for better alternatives. We continue to work on building coalitions with others to advocate for what is best for our patients. Board strategic planning has helped shape our work plan, and has resulted in a revised mission statement (which e-mail and the Internet afforded our membership the opportunity to help shape). Our expanded website continues to attract significant “hits” every month. We have supported the medical school and have served as mentors for medical students. We established a forum where chiefs of staff and vice presidents of medical affairs meet to discuss issues of common concern. We are exploring, with ethicists, a physician’s duty to the patient and the potential conflicts that may arise within our health care system. We have continued advocacy in our communities, especially for improving immunization rates, reducing violence, and putting a stop to tobacco exposure. There are many reasons why HMS is a strong and thriving organization. Our hard working staff is dedicated, talented and effective. We have an active Alliance that does so much good for our communities. We have committed physicians who work tirelessly on behalf of their patients and their fellow physicians. We are indebted to our families who allow us to serve patients and the medical profession during otherwise discretionary time. Medical stu-

The Journal of the Hennepin and Ramsey Medical Societies

dent and resident involvement in organized medicine encourages me, for they represent the future. Though we have accomplished much, sustained physician involvement will be required for us to continue to realize our goals. We are an organization with much diversity, yet this diversity is also a source of strength. We represent different specialties and practice settings. We represent physicians nearing retirement and those who have recently entered practice. We represent physicians employed by large organizations and those in private practice. We represent those active in medical associations or specialty societies as well as those who presently are not. I believe there are many core values we share in common. We want to do the right thing for our patients. We want the ability to recommend the most appropriate facilities, procedures, medications, and specialists for our patients. We believe in supporting medical education. We believe in promoting the public health. We believe physicians should champion the medical needs of our communities. We believe that physicians should be responsible first for the care of the patient, not the cost to the payer. I have a vision of the future where physicians play a central role in health care; where physicians are respected for their compassion, caring, and dedication to their patients. The Hennepin Medical Society has been an effective vehicle for advancing our patientcentered physician agenda. Through the continued involvement of those physicians currently active, and the future efforts of those not presently as involved, I believe we can realize that vision. To my colleagues and friends, I sincerely thank you for the opportunity to have served as chairman of HMS. It has truly been an honor and a privilege. Thank you for your ideas, your support, and most of all, your friendship. ✦ November/December 2000

Hennepin Medical Society

Chair Virginia R. Lupo, M.D. President David L. Swanson, M.D. President-Elect T. Michael Tedford, M.D. Secretary Richard M. Gebhart, M.D. Treasurer Michael B. Ainslie, M.D. Immediate Past Chair David L. Estrin, M.D.

HMS NEWS Aloke Kumar Mandal, M.D. Georgetown University School of Medicine Transplantation Hennepin Faculty Associates

New Members HMS welcomes these new members to the Society as of August 2000. Schools listed indicate the institution where the medical degree was received.

Charles M. Baker M.D. University of Minnesota Pediatric Cardiologist Children’s Heart Clinic, P.A. Peter H. Bernhard, M.D. Michigan State Univ. College of Human Medicine Urology/Urologic Surgery Urology Associates, Ltd. Daniel Teh-An Chow, M.D. Northwestern University Medical School Obstetrics & Gynecology John A. Haugen Assoc., PA Tore Detlie M.D. Univeristy of Minnesota Radiology Suburban Radiologic David L. Dunn, M.D., Ph.D. University of Michigan Medical School General Surgery University of Minnesota Dept. of Surgery Paul Gerard Dworak M.D. Creighton University School of Medicine Orthopedic Surgery Orthopaedic Consultants, PA Thomas Knickelbine M.D. University of Wisconsin Medical School Internal Medicine Minneapolis Cardiology Associates Christopher J. Kovanda, M.D. Wayne State University School of Medicine Plastic Surgery Midwest Plastic Surgery Michael Joseph Legris, M.D. University of California School of Medicine Nephrology Kidney Disease/Critical Care Associates, P.A.

November/December 2000

Sheryl Ann Louie, M.D. Loyola University Obstetrics & Gynecology Obstetrics & Gynecology West, P.A. Marc W. Manley, M.D. University of Washington School of Medicine Public Health Blue Cross and Blue Shield of Minnesota - St. Paul Rebecca L. Mitchell M.D. University of Wisconsin Medical School Internal Medicine Now Care Medical Center Frank B. Norberg, M.D. University of North Dakota School of Medicine Orthopedic Surgery Orthopedic Medicine & Surgery, Ltd. Kimberly H. Perkins, M.D. University of New Mexico School of Medicine Family Practice Quello Clinic Richard F. Shronts M.D. University of Minnesota Neurology Noran Neurological Clinic

Michael John Ornes, M.D. University of Wisconsin Medical School Internal Medicine Abbott-Northwestern Hospital Alexander V. Panyutich, M.D. Minskij Medical Institute, Minsk, Byelorus, USSR Hematology/Oncology University of Minnesota Mark Prebonich, M.D. Wayne State University School of Medicine Internal Medicine Abbott-Northwestern Hospital Suzanne M. Skoog, M.D. University of Minnesota Internal Medicine Abbott-Northwestern Hospital

Student (from the University of Minnesota)

Richard W.E. Burg Brant N. Hacker Daryl J. Kor Frederick J.P. Langheim Daniel Lee Mark Benjamin J. McKinley Patrick Francis O’Keefe Martin D. Zielinski ✦

Loren N. Vorlicky, M.D. University of Minnesota Orthopaedics Orthopaedic Consultants, P.A. - Edina

In Memoriam

Thomas C. Winegarden M.D. University of Minnesota Psychiatry Ronald D. Groat, M.D. Robert J. Wood M.D. University of Minnesota General Surgery Gillette Children’s Specialty Healthcare

Resident Azber A. Ansar, M.D. Al-Ameon Medical College, Kamataka University Internal Medicine Mercy Health System of Chicago Daren S. Danielson, M.D. University of Minnesota General Surgery Hennepin County Medical Center

TAGUE CLEMENT CHISHOLM, M.D., a pediatric surgeon, died on September 7 at the age of 84. He graduated from Harvard Medical School and completed his training at Childrens Hospital Boston, and Peter Bent Bingham Hospital Boston. Dr. Chisholm joined HMS in 1948. CHARLES FRIEND, M.D., died on September 28 from a severe congestive lung condition. He was 79. He graduated from Tufts University Medical School and completed his internship at St. Barnabas Hospital. Dr. Friend opened a private practice on Lake Street in the 50s, specializ(Continued on page 31)

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The Journal of the Hennepin and Ramsey Medical Societies

Lupo Installed as New HMS Board Chair THE ANNUAL MEETING of the HMS Board

M.D. otolaryngologist at Southdale Otolaryngology, was installed as president-elect. In addition, Diane A. Dahl, M.D. was honored for her term as a member and President of the Hennepin Medical Foundation. ✦

Volunteers Wanted! Dr. Carol Johnson, Superintendent of the Minneapolis Public Schools, encouraged physicians to volunteer their time to serve as a student mentor at the recent Senior Physician Association luncheon. David L. Estrin, M.D. receives the outgoing chair’s award from Virginia R. Lupo, M.D.

Diane A. Dahl, M.D. is honored by Virginia R. Lupo, M.D., for her term as President of the Hennepin Medical Foundation

For more information contact: Robin Cousins, MPS Volunteer Office, at 612/668-3983.

Stepping Stones Gala a Success ELIZABETH K. JEROME, M.D. was recog-

nized as the “pioneer in adolescent medicine in this community” at the first annual Stepping Stones Gala sponsored by the Hennepin Medical Society and the Hennepin Medical Society Alliance. More than one hundred guests at-

Elizabeth Jerome, M.D. addresses the group.

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tended the dinner and silent auction raising nearly $7,000 for three adolescent health clinics serving youth in the west metro area. Jan Malcolm, Commissioner of the Minnesota Department of Health, served as the emcee, and Michael Resnick, Ph.D., was the keynote speaker. The event also commemorated the 90th anniversary of the Hennepin Medical Society Alliance. ✦

Commissioner Jan Malcolm serves as emcee.

The Journal of the Hennepin and Ramsey Medical Societies

In Memoriam (Continued from page 30)

ing in family care. He also worked at the Spano Medical Clinic in Minneapolis for nearly 20 years. Later, he founded his own clinic in northeast Minneapolis. Dr. Friend joined HMS in 1950. EDGAR G. INGALLS, M.D., died in September at the age of 85. He graduated from the University of Minnesota Medical School. He practiced OB/GYN at Abbott Northwestern Hospital for more than 40 years. He was a Founding Fellow of American College of Obstetricians and Gynecologists. Dr. Ingalls joined HMS in 1949. C. KENT OLSON, M.D., a neurosurgeon, died in September at the age of 81. He graduated from the University of Minnesota Medical School and completed his internship at Minneapolis General Hospital. Dr. Olson joined HMS in 1994. ✦ November/December 2000

Hennepin Medical Society

of Directors was held on Thursday, October 12, 2000, at which time Virginia Lupo, M.D. was installed as its 94th Board Chair. Dr. Lupo is chief of the OB/GYN Department at Hennepin

County Medical Center and a maternal health specialist. David L. Swanson, M.D., internal medicine/dermatologist at North Clinic, succeeded to the role of President, and T. Michael Tedford,

HMS ALLIANCE NEWS

IN 1995, THE AMA ALLIANCE initiated a

program to raise awareness of violence among children and teens. Now in its sixth year, this national program entitled SAVE (Stop America’s Violence Everywhere) unites AMAA volunteers across the country who work at the local level to foster non-violent methods of coping and behavior. Included under the SAVE umbrella are two paths of action: SAVE-A-Shelter and SAVE Schools From Violence. Although the second Wednesday of October has been designated “SAVE Today,” the work and the anti-violence message of the Alliance are continual. Across the country, Alliances provide educational materials for children, teachers, and community leaders to facilitate classroom discussions on issues related to violence. As part of the SAVE program, state and county

November/December 2000

Alliances provide battered women, their families, and homeless families with financial and emotional support, and simple, effective lessons in conflict resolution. The Hennepin Medical Society Alliance has participated in SAVE in a myriad of ways: we have sponsored shelter showers for Perspectives Transitional Housing and Project Offstreets; we have an on-going collection for wish-list items for the Minneapolis Crisis Nursery; we distributed thousands of Pledge Against Violence forms to Minneapolis third graders (who then see their signed pledges on display at Body Works in the form of a “Peace Rainbow”); we collected food items for Metro area food shelves; we distributed mittens and gloves to Bannecker School students through the “You Are Gloved” program; we worked at Kids’ Cafe; and we purchased a “brick” to help sponsor new construction at the West Metro Crisis Nursery. This year’s SAVE Today project focuses on the message, “I Can Stop Violence.” The program incorporates a two-sided puzzle that features youth violence statistics. Geared toward older elementary students, the puzzle declares, “I can stop violence by…” and has a large blank area for the child to draw a picture of a positive way to demonstrate conflict resolution. Funded by a grant from the AMA Foundation, the AMA Alliance purchased 50,000 puzzles for free distribution to those Alliances across the country that took the initiative to develop a program around them and apply for them (in the form of a grant). The HMSA created a program utilizing the puzzles, applied for and received 800! (This was one of the highest totals in the coun-

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Dianne Fenyk Co-President

Trish Vaurio Co-President

try and HMSA has been featured on the front page of Newsline, News and Information for Alliance Leaders). We will incorporate the SAVE puzzle at Body Works, our five-day health education fair that teaches third grade students about their bodies and how to keep them healthy. By enlarging the puzzle and using Velcro strips we will make it possible for several students to help piece it together using teamwork. An Alliance volunteer will lead a discussion on various ways to use hands in a positive manner. The children will receive a SAVE puzzle to take home to share with a caring adult. Body Works serves approximately 2,500 students a year, and we have only 800 puzzles. We plan to purchase an additional 200 puzzles (at $1.35 a piece) so that the first 1,000 students that come through Body Works will receive one. As usual, our Holiday Tea and Silent Auction will raise funds to pay for the additional puzzles. If any of you have an interest in purchasing puzzles to help us give one to more than 1,000 third graders at this year’s Body Works, we would gladly accept your donation! HMSA thanks all of you who attended and all of you who gave a donation to SteppingStones: A Gala Promoting a Foundation for Healthy Choices, our fund-raiser for The Annex Teen Clinic, TAMS and West Suburban Teen Clinic. Special thanks to HMS, Medica, Children’s Hospitals and Clinics and Dr. John Fenyk for purchasing sponsor tables for the event. The successful evening was the highlight of our 90th year. As of this printing, the final figure has not been determined — we will let you know in the next issue. ✦ Dianne Fenyk, Co-President

The Journal of the Hennepin and Ramsey Medical Societies