D epartment
of
M edicine
Con ne c ti ng T e c h n o lo g y , Ed uca t i o n a n d D i s cove ry w ith H um anis m in Me dicine
Vol. 4 Issue 1 January 2015
A Journey of Discovery
Richard Obenour, MD, Vice Chair of the Department of Medicine (DOM), retired December 2014, finishing a career that started just after Watson and Crick unraveled the DNA double helix and followed the still accelerating trajectory of the information explosion in the medical sciences. After receiving his medical degree from the University of Tennessee, he completed an internship at the historic Knoxville General Hospital during its last year of existence. He started his residency in 1956 when the doors opened at the newly constructed University of Tennessee Memorial Research Hospital (UTMRH). He admitted the very first medical patient to the new facility, a man transferred from the old hospital in a hearse. Dr. Obenour’s training was interrupted when he was drafted into the Navy. After two years, he returned to Knoxville to finish his resident year before moving to Duke University to complete his internal medicine training and start a cardiovascular research fellowship. When the equipment needed to start his research project did not materialize, he accepted an opportunity to study the effects of altered surfactant on the mechanics of breathing. His career in pulmonary medicine was born. In 1962, he came home to practice as the only nonsurgical lung specialist in this region. After six years of solo practice, he brought in his first associate, and over time, the practice grew into the Knoxville Pulmonary Group, precursor to University Pulmonary and Critical Care. In 1973, he became the first pulmonary division chief at UTMH, a post he held until 2004. In 1992, Dr. Al Beasley, then Chair of the DOM asked him to
Points of View At a recent meeting with the residents, I was somewhat surprised to learn that they were not aware of how the federal government funds graduate medical education (GME). The federal government provides nearly 16 billion dollars (called GME dollars) annually to support the education of over 115,000 residents Rajiv Dhand, MD, Chair and fellows in the US. Medicare, the largest federal contributor, provides 3 billion dollars for direct medical education (DME) to support resident salaries, benefits, and faculty time. This support is tied to the percentage of care provided to Medicare
Dr. Obenour pictured with his original spirometer
be his Vice Chief. One of his several accomplishments in that role included the establishment of the Quality Assurance Program. Dr. Obenour recognized early the need for interdepartmental communication and incorporated other departments into the process to study outcomes that are now benchmarks of treatment for pneumonia and other illnesses. He also developed a physician credentialing system that with some modifications is in general continued on page 2
beneficiaries. The indirect medical education (IME) funds, almost 6.5 billion dollars annually, subsidize hospitals for the higher costs of care to run training programs and the severity of illness of patients requiring specialized services that are available only in teaching hospitals. Additional contributions to fund GME are made from federal Medicaid, Veterans Health Administration and the state’s support through Medicaid spending. In 1997, as part of the Balanced Budget Act, the Federal Government “capped” the number of residency positions that would be supported by Medicare and reduced DME payments by $1 billion and IME payments by $8 billion over a period of 5 years. Further growth in the number of residency positions occurred by institutions’ covering the cost of training residents at each center. On April 1, 2013, the budget sequestration went into effect, continued on page 3
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The Pursuit of Excellence: A Marathon not a Sprint Dr. Mark Rasnake, a self-proclaimed “local boy” from nearby Greeneville, Tennessee, graduated from the University of Tennessee at Knoxville with an undergraduate degree in science and mechanical engineering. He went to medical school at the University of Tennessee Health Science Center in Memphis, planning to become an orthopedist, but at some point, internal medicine became more appealing. “I love the intellectual challenge of finding what is broken and the cause and then fixing the problem,” explained Dr. Rasnake. After completing the third and fourth years of medical school at the University of Tennessee Medical Center in Knoxville, Dr. Rasnake placed into an internal medicine residency in the Air Force at Wilford Hall Medical Center in San Antonio, Texas. He added a chief year, then completed his infectious disease fellowship at the same location. While there, he began his research career with a study of hepatitis vaccines in active military recruits. He also investigated burn wound infections in combat veterans, specifically viewing the microbiology and the patients’ outcomes. After completing his training, he continued as Chairman of the Competency Committee, then later functioned as Assistant Program Director of the Infectious Disease Fellowship. He stayed in Texas until July of 2007, when he moved back home to work as an infectious diseases consultant at the UT Medical Center and to teach in the medicine residency. Dr. Tim Panella, then Chairman of the Department of Medicine, recruited him to become our program director, and he transitioned into this role in July 2008. His love for clinical investigation has since blossomed. Many of his residents’ projects have gone to national meetings in the form of posters or case presentations. He recently completed a project with Dr. Brian Reed, PGY-3, on “Water Quality in the Smoky Mountains,” which is now being prepared for publication. Dr. Rasnake hopes that in the future many more of these projects will be published in high impact journals and create national recognition for our program. “Now that we’ve grown the program [in size], it is our job to work to refine the attractiveness,” he explains. His personal goals are to be a great father to his son Alex and to revive his running career. He completed the Farragut halfmarathon in late October taking 10th place in his age group. Even though Alex was “disappointed” that he did not win the race, Dr. Rasnake is right where he wants to be: poised to take on the Covenant Health Knoxville Marathon in spring 2015. His last full marathon was in Knoxville in Spring 2008, and he completed it in three hours and eight minutes. If his run this spring parallels 2008, he will likely count it as he does his current role as program director: contentment with its stability and lofty goals for the future.
A Journey of Discovery
continued from page 1
usage today. In the course of his career, he has served on more than 66 committees and chaired 9 of them. He has served as interim chair of the DOM twice. His career has been a journey of discovery and change. He saw the transition from the x-ray hanging on a view box to the CT scan delivered to his office computer, from treatments aimed at relieving symptoms to disease modifying drugs chosen to target a specific genetic mutation. He has seen a clipboard of vital signs evolve into the electronic medical record. During all this change, his most important observation occurred during his early years at Duke, when his chairman, frustrated with a student’s long-winded and somewhat inept case presentation said, “Tell me what you are going to do for the patient.” Dr. Obenour made that his philosophy, and it has never changed. It is his advice to doctors who may expect to face therapeutic and diagnostic decisions that are hidden in clouds of information. “Always ask what you can do for the patient.” 2
Follow Your Heart “I’ve known since I was in seventh grade that I wanted to be a doctor. That year, we dissected anything from a cow’s heart to a sheep’s eye. In addition, a fellow student’s father who is an orthopedic surgeon in Chattanooga brought in an amputated arm and showed us the anatomy. Ever since that point, I knew medicine was for me,” explained PGY-2 internal medicine resident Dr. Charlie Allderdice. Charlie has since refined his interest to cardiac pathology. His fascination with minimally invasive procedures, specifically percutaneous coronary intervention (PCI), prompted him to do a cardiology elective as a fourth year medical student. That experience lead to his decision to become a cardiologist. In conjunction with cardiology faculty, he is involved with two research projects. The first is a chart review examining the efficacy of the heart failure critical pathway since its implementation in January 2014. He has reviewed over three hundred records of patients admitted during the initial six months with regards to length of stay, all-cause mortality, 30-day readmission and discharge on evidence-based heart failure medicines. The second is a case series investigating Twiddler’s Syndrome and the efficacy of a AIGISRx® Antibacterial Envelope in preventing recurrent twiddling events. Twiddler’s Syndrome is a potentially fatal cause of pacemaker malfunction due to the patient’s manipulation of their device within its subcutaneous pocket resulting in coiling (i.e. twiddling) and dislodgement of the leads. Charlie recently presented his preliminary work as a poster at the Tennessee ACP Conference. His efforts highlight the growing enthusiasm in our program for clinical research while pursuing clinical excellence.
Faculty Awards Several distinguished faculty members received awards at the Department of Medicine’s Annual Faculty Recognition Dinner in December. Timothy Panella, MD, received the Beasley Pylon Award in recognition of his outstanding leadership during his service as chair of the Department of Medicine. The RA Obenour, MD, Distinguished Alumnus Award was presented to William B. Smith, MD, for his outstanding career in his fields of cardiology, nephrology, critical care medicine, and internal medicine, as well as serving as the president of the New Orleans Center for Clinical Research (NOCCR) and Volunteer Research Group (VRG). The London Award for a faculty member who shares a dedication to excellence was presented to James Shamiyeh, MD. The From left to right: Rajiv Dhand, MD, Tina Dudney, MD, James Shamiyeh, MD, Bill Smith, MD recipient of this award is chosen by our internal medicine residents. The RA Obenour, Jr., Award for steadfast dedication to excellence in teaching was presented to Tina Dudney, MD. We congratulate all of these faculty members on their well-deserved recognition.
Points of View continued from page 1 impacting Medicare physician payments, GME, and many other healthcare agencies. The cuts, ranging from 2% to 5%, had a significant impact on various departments and health care organizations. For example, our department faced a significant decline in funding for GME because of this provision. Despite these cuts, we have maintained resident salaries and, in fact, attempted to enhance resources for our residents. However, in the current environment, we must all be conscious of reductions in federal support for GME and take responsible measures to preserve and enhance the quality of education and training provided at our center. We face many challenges, but I am confident that with everyone’s support we can overcome these difficulties. I look forward to many developments in the New Year that will further enrich our program. I wish you all a prosperous and productive 2015. 3
Faculty Announcements
Michael D. Kaufman, MD
Ross M. Nesbit, MD
In Touch
We are pleased to announce new additions to our faculty. Michael D. Kaufman, MD, has been appointed to Clinical Associate Professor. Dr. Kaufman has special expertise in the treatment and management of demyelinating disease. He will serve as the Neurology Clerkship Director. Ross M. Nesbit, MD, has been appointed to Assistant Professor in the Division of Nephrology. Dr. Nesbit is originally from Oak Ridge and completed his nephrology fellowship at Vanderbilt University Medical Center.
Resident Presentations Congratulations to our four residents, Drs. Charles Allderdice, Sachin Amin, Niva Misra, and Brandon Sammons, for their poster presentations at the 2014 Tennessee Chapter of the American College of Physicians annual meeting held in October. They should also be commended for coming in 2nd place in the quiz bowl competition.
Service Awards 25 Years
Jeffrey S. Hecht, MD
CME Opportunities - Mark Your Calendars! • The 3rd Annual Medicine CME Conference, offering 11 hours of CME credit, will be held April 17-18 at the Holiday Inn World’s Fair Site. We hope you can join us for this informative event. • The 11th Annual Hematology Conference Update on Selected ASH Topics, will be held Saturday, February 7, 2015 at the UT Conference Center. • Weekly Cardiology Conferences, which are now available for .75 hour CME credit. • Medicine Grand Rounds, which are generally held on the 2nd and 4th Tuesdays of each month for 1.00 hour CME credit.
Presentations, Publications, Awards Department of Medicine faculty, residents, and fellows share their knowledge and experience by publishing and presenting across the world. For a list of our most recent accomplishments, visit http://gsm.utmck.edu/internalmed/scholars.cfm.
Thank You For Your Support For information about philanthropic giving to the UT Graduate School of Medicine, Department of Medicine, please contact the Development Office at 865-305-6611 or development@utmck.edu. If you would like more information about any of the information in this issue of In Touch, please contact the Department of Medicine at 865-305-9340 or visit http://gsm.utmck.edu/internalmed/main.cfm. We look forward to your input. Thank you.
Stay In Touch! Alumni, please update your contact information by completing the simple form at http://gsm.utmck.edu/internalmed/alumni.cfm or by calling the Department of Medicine at 865-305-9340. Thank you! 4
Volume 3, Issue 4: October 2014 Publishers James Neutens, PhD, Dean Rajiv Dhand, MD, Chair Editor Ronald Lands, MD Administrative Director Susan Burchfield, CAP-OM Contributors Susan Burchfield Rajiv Dhand, MD Christen Fleming, MD Kandi Hodges Ronald Lands, MD Jane Obenour Design J Squared Graphics In Touch is produced by the University of Tennessee Graduate School of Medicine Department of Medicine. The mission of the newsletter is to build pride in the Department of Medicine by communicating the accessible, collaborative and human aspects of the department while highlighting pertinent achievements and activities. Contact Us In Touch University of Tennessee Graduate School of Medicine Department of Medicine 1924 Alcoa Highway, U-114 Knoxville, TN 37920 Telephone: 865-305-9340 E-mail: InTouchNewsletter@utmck.edu Web: http://gsm.utmck. edu/internalmed/main.cfm The University of Tennessee is an EEO/AA/Title VI/ Title IX/Section 504/ADA/ ADEA institution in the provision of its education and employment programs and services.