2010 Sept/Oct

Jan/February 2010

In This Issue: • A Fond Farewell • Meet PCM’s Board and Executive Committee • Honoring Choices Minnesota • Teens and Alcohol

Ahead of the Curve

A national leader in wean rates When you’re faced with a particularly difficult respiratory patient who needs specialized ventilation care, consider a national leader. Consider Bethesda Hospital and our Respiratory Care program, established nearly 30 years ago and one of the first of its kind in our region. Since the founding of our program, we’ve been ahead of the curve in treating ventilation patients, thanks in part to a dedication to high acute care nursing ratios and therapy staffing. As a result our ventilator weaning rates are among the best in the nation, with 70 percent of the vent patients we see fully weaned, according to a study by the National Association of Long Term Hospitals.

When you need to move a patient on to the next step, it’s good to know you can turn to a leader in managing complex cases. Turn to Bethesda.

For more information, visit www.bethesdahospital.org.

Contents VOLUME 12, NO. 1

2

JANUARY/FEBRUARY 2010

Index to Advertisers TCMS Logo Description

3

PResident’s MessAge

The Time is Right

By Edward P. Ehlinger, M.D., MSPH

5

Welcome to the Twin Cities Medical Society

By Sue Schettle, CEO

6 8

TCMS Officers and Board Members A Letter to the Members

By Jack G. Davis

Page 12

9

ColleAgue inteRvieW

Roby C. Thompson, M.D.

11

Honoring Choices Minnesota: A Community Approach to Advance Care Planning

12

A Fond Farewell

By William E. Jacott, M.D.

13

YouR voiCe

Teens & Alcohol—Not a Faceless Statistic

By Carl E. Burkland, M.D.

15

Research Brief: Behavioral Impact of Graduated Driver Licensing on Teenage Driving Risk and Exposure

By Pinar Karaca-Mandic, Ph.D., and Greg Ridgeway, Ph.D.

Page 9

17

New Health Care CEO: Neeraj Chepuri, M.D., CEO, Consulting Radiologists, Ltd.

20 21 22 30

Healthy Menus Minneapolis Update New Members In Memoriam Career Opportunities

eAst MetRo

23 24 25 26

President’s Message

On the cover: New TCMS logo and officers. Logo description on page 2; TCMS leadership on pages 6-7.

Update from the EMMS Foundation Board of Directors Senior Physicians/Caring Hearts for Homeless People EMMS Represented at AMA Interim Meeting West MetRo

26 27

28 29 30

Page 11 MetroDoctors

The Journal of the Twin Cities Medical Society

WMMS Awards Hoban Scholarships Charles L. Murray, M.D. Receives Charles Bolles Bolles- Rogers Award/Health Care Dinner Party, Naples, FL WMMS Board of Directors Celebrate the End of an Era Frank S. Rhame, M.D. Receives First a Physician Award WMMS Alliance 100th Celebration January/February 2010

1

January/February Index to Advertisers

Doctors MetroDoctors

Acute Care, Inc. .................................................31 Advanced Dermatology Care........................... 4 AmeriPride...........................................................19 Bethesda Hospital ............. Inside Front Cover Crutchfield Dermatology ................................20 Custom-Rx Compounding Pharmacy ....... 20 Family HealthServices Minnesota, P.A. ......32 HCMC Preparedness Practicum ..................18 Healthcare Billing Resources, Inc. ...............16 Lockridge Grindal Nauen P.L.L.P. ...............29 Mankato Clinic ..................................................30 Minnesota Epilepsy Group, P.A. ...................24 Minnesota Physician Services, Inc. ..............14 The MMIC Group ................................................

Inside Back Cover Neurosurgical Associates, Ltd.......................... 4 Open Cities Health Center, Inc. ..................32 Pediatric Home Service ........................................

Inside Back Cover SafeAssure Consultants, Inc. ............................ 2 Southside Community Health Services .....32 University of Minnesota CME ..........................

Outside Back Cover Uptown Dermatology & SkinSpa, P.A. ......16 Weber Law Office ............................................... 5

THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY

TCMS Officers

President Edward P. Ehlinger, M.D. Physician Co-editor Lee H. Beecher, M.D. Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Thomas B. Dunkel, M.D. Physician Co-editor Charles G. Terzian, M.D. Managing Editor Nancy K. Bauer Assistant Editor Katie R. Snow

President-elect Thomas D. Siefferman, M.D.

TCMS CEO Sue A. Schettle Production Manager Sheila A. Hatcher Advertising Representative Betsy Pierre Cover Design by Outside Line Studio

Past President Ronnell A. Hansen, M.D.

MetroDoctors (ISSN 1526-4262) is published bi-monthly by the Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. Periodical postage paid at Minneapolis, Minnesota.

Postmaster: Send address changes to MetroDoctors, Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413.

To promote its objectives and services, the Twin Cities Medical Society prints information in MetroDoctors regarding activities and interests of the society. 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 TCMS. Send letters and other materials for consideration to MetroDoctors, Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. E-mail: nbauer@metrodoctors.com.

For advertising rates and space reservations, contact: Betsy Pierre 2318 Eastwood Circle Monticello, MN 55362 phone: (763) 295-5420 fax: (763) 295-2550 e-mail: betsy@pierreproductions.com MetroDoctors reserves the right to reject any article or advertising copy not in accordance with editorial policy.

Non-members may subscribe to MetroDoctors at a cost of $15 per year or $3 per issue, if extra copies are available. For subscription information, contact Katie Snow at (612) 362-3704.

Secretary Anthony C. Orecchia, M.D. Treasurer Melody A. Mendiola, M.D.

TCMS Executive Staff

Sue A. Schettle, Chief Executive Officer (612) 362-3799 sschettle@metrodoctors.com Jennifer J. Anderson, Project Director (612) 362-3752 janderson@metrodoctors.com Nancy K. Bauer, Assistant Director, and Managing Editor, MetroDoctors (612) 623-2893 nbauer@metrodoctors.com Kathy R. Dittmer, Executive Assistant (612) 623-2885 kdittmer@metrodoctors.com Katie R. Snow, Administrative Coordinator (612) 362-3704 ksnow@metrodoctors.com

ON-LINE ON-LINE

For a complete list of TCMS Board of Directors go to www.metrodoctors.com.

OSHA OSHA COMPLIANCE COMPLIANCE Employee Employee Training Training

TCMS Logo Description Schaefer Design Co. was retained to create a logo for the Twin Cities Medical Society that referenced two separate long-standing histories and would communicate elements of unification, community, dedication to advancing health and professionalism.

Circles are used as a dynamic symbolization of the seven counties comprising the Twin Cities Medical Society. A stylized representation that not only visualizes a river, but also expresses growth and vitality flows through the circles. The color green was selected as it is often used academically as the color for the discipline of medicine (Academic Costume Code & Ceremony Guide).

L CIA y S P E Societ al T c i N d U Me CO DIS

$10 Per Employee Join Us At One of Our Upcoming “Violence in the Workplace� Seminars FOR MORE INFO CALL: SafeAssure @ 1-800-920-7233 OR East Metro Medical Society @ 612-362-3799

www.safeassuremedical.com 2

January/February 2010

MetroDoctors

The Journal of the Twin Cities Medical Society

President’s Message

The Time is Right EdwARd p. EhLiNgER, M.d., MSph

AFTER TWO DAyS OF DISCUSSING THE MyRIAD of possible implications

for college students of the pending national health care reform legislation, I was in need of something clearer and more concrete to calm my anxieties and ease my frustrations before boarding the plane back to Minneapolis from Washington D.C. I thought, “What could be more concrete than the exhibits in the National Building Museum?” So, in the midst of rush hour, I took the Metro from Foggy Bottom to Judiciary Square and entered the museum one hour before its scheduled closing time.

Given my time constraints and that this was my first visit, I thought I’d do a whirlwind tour of the museum’s exhibits to get a dispassionate “Cliff Notes” overview of its contents before heading to the airport.

The first gallery met my expectations. It was filled with architectural bric-a-brac from buildings all over the country. Unique and beautiful cornices, balusters, festoons, modillions, volutes, and other building curiosities filled the room. I was in and out in 10 minutes. My world was becoming rational and objective again.

I expected a similar experience in the second gallery, which was a comprehensive look at parking structures in the United States. While there were multiple “bricks and mortar” displays of parking garages and ramps, the underlying message of the exhibit was that we devote a lot of money and space to house vehicles that, on average, spend over 90 percent of their existence parked. The historical displays also pointed out that the rapid acceptance of the automobile by the early 20th century society dramatically changed the physical and cultural character of our cities in a laissez-faire way. Urban planning and infrastructure development to accommodate the automobile only occurred after a great deal of haphazard and damaging change had already occurred.

As I left the “House of Cars” exhibit, I could sense the return of some nervousness about the effects that public policies (or lack thereof) have on the everyday lives of people. When I entered the last exhibit, my dream of having a simple and manageable experience at the museum was completely shattered. This exhibit, “The Places We Live,” was purposely set up to agitate those of us who have the resources and ability to travel and visit museums — and who have the ability to promulgate change in our society.

The exhibit began by confronting all visitors with this statement: “In 2008, for the first time in human history, more people lived in cities than in rural areas. One-third of these urban dwellers — more than one billion people — resided in slums…The United Nations forecasts that the number of slum dwellers will double to two billion people within the next 25 years. Poverty is urbanizing at breakneck speed, and there are few overarching plans to address how cities can accommodate this rapid influx of humans.”

The exhibit then graphically and objectively allowed visitors to consider what it means to live in a city in the 21st century. Via a multimedia installation, people were admitted into the homes of 20 families in four slums around the world: Kibera in Nairobi, Kenya; Dharavi in Mumbai, India; the “barrios” of Caracas, Venezuela; and the “kampongs” of Jakarta, Indonesia. The pictures and the voices told a chilling story of how people live in the fastest-growing human habitat — urban slums. Even for someone who has worked in urban public health for nearly 30 years, I was staggered and stunned. Fortunately, the museum closed before I became too overwhelmed.

Sitting in the airplane on the way back to MSP and my car (motionless for 48 hours in a parking ramp), I was grateful that no one was seated next to me. I needed time to absorb what I had heard in the (Continued on page 4) MetroDoctors

The Journal of the Twin Cities Medical Society

January/February 2010

3

President’s Message (Continued from page 3)

health care reform discussions and observed in the National Building Museum. I needed to fi gure out what I was supposed to do with all of this jumbled and chaotic information.

Knowing that I was to be its fi rst president, I was not surprised that my thoughts quickly turned to the newly formed Twin Cities Medical Society (TCMS), an organization established to address the health and medical

care issues of a large metropolitan area. It was also not lost on me that my experiences of the previous two days were probably provided as an atypical in-service on the role of the president of the TCMS. At a time when our medical care system is costing too much and excluding too many, when our public health infrastructure is crumbling because of lack of sustained investment, and when urbanization is affecting the lives of everyone in our society, there arises a critical

need for leadership — not just individual leadership but organizational leadership. It seemed obvious, what better time for the TCMS to assume that leadership? Not only is there a challenge and opportunity for the TCMS to assume this leadership, there is also a profound responsibility to do so. Who else but the physicians in the Twin Cities area has the experience, knowledge, skills, position, connections, and power to bring health care reform, medical care, and public health together for the benefi t of the individuals we treat and the urban community in which we live?

I was thinking of that question when the fl ight attendant brought me back to consciousness with what I thought was going to be the usual words spoken upon landing. Instead I heard, “Welcome to the Twin Cities Medical Society. The current time is right to make a difference in your community. Please check to be sure that you’ve included all your health care reform, medical care, and public health issues as you depart. And may healthy people in a healthy community be your fi nal destination.”

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January/February 2010

MetroDoctors Ad - 20091117.indd 1 11/30/2009 4:07:34 PM The Journal of the Twin Cities Medical Society

MetroDoctors

Welcome to the Twin Cities Medical Society SUE A. SChETTLE, CEO

T

he Twin Cities Medical Society is poised to hit the ground running in January 2010 with some new and some returning leadership from the former EMMS and WMMS. This group of physician leaders is ready to take on the challenges and opportunities that face metro area physicians. In addition to the board of directors, there are five staff people working behind the scenes at the medical society. They include: Sue Schettle serving as the chief executive officer; Nancy Bauer, managing editor of MetroDoctors and assistant director; Jennifer Anderson, who is the project coordinator spearheading the Healthy Menu labeling initiative; Katie Snow, the administrative coordinator for the society and EMMS Foundation and is taking the coordinating role in the Honoring Choices Minnesota advance care planning project; and Kathy Dittmer, who keeps us all on our toes, getting us where we need to be and on time, serving as the executive assistant. Jack Davis will continue to serve in 2010 as a transition consultant. All of us are dedicated to the physicians of the Twin Cities Medical Society and to supporting and helping to carry out its mission.

The Twin Cities Medical Society Board of Directors was elected by the membership of the former East Metro Medical Society and West Metro Medical Society as part of the Plan of Merger documents. The board is representational of the geographic membership of both societies and this was done purposely so as to ensure that both organizations were proportionately represented.

There are five elected officers of the TCMS Board of Directors. Edward Ehlinger, M.D. will serve as the first president of TCMS; Ronnell Hansen, M.D. will serve as past-president; Thomas Siefferman, M.D. will serve as president-elect; Melody Mendiola, M.D. will serve as treasurer; and Anthony Orecchia, M.D. will serve as the secretary. All officers serve on the TCMS executive committee.

MetroDoctors

The remaining 15 directors are physicians who have served as board members on the former East Metro Medical Society and West Metro Medical Society boards of directors. There are two directors who are also serving in an at-large position on the TCMS executive committee. Those individuals include Peter Dehnel, M.D. and Edwin Bogonko, M.D. The remaining directors include: Arthur Beisang, M.D., Peter Boosalis, M.D., Peter Bornstein, M.D., Carl Burkland, M.D., Eric Christianson, M.D., Laura Dean, M.D., Ken Kephart, M.D., Paul Kettler, M.D., Stephen MacLeod, BDS, MB ChB, Nick Meyer, M.D., Frank Rhame, M.D., Phil Stoltenberg, M.D. and Peter Wilton, M.D., MB, BCh. In addition to the 15 directors, there are two slots for Young Physicians, defined as physicians under the age of 40. Those two representatives are Marie Witte, M.D. and Stephanie Stanton, M.D. Dr. Chad Roline and Dr. Clint Hawthorne will serve as the resident representatives, and Jessica Voight and Melanie Fearing will serve as the medical student representatives. The five officers and 15 directors have voting privileges.

The TCMS Board of Directors also has a spot at the table for those physicians who are serving as Trustees from the East Metro and the West Metro Districts of the Minnesota Medical Association. Currently there are three representing the East Metro District, Charles Terzian, M.D., Stuart Cox, M.D. and Dave Thorson, M.D.; and six representing the West Metro District including Michael Ainslie, M.D., Beth Baker, M.D., Ben Chaska, M.D., Don Jacobs, M.D., Roger Kathol, M.D., and Jim Young, M.D. In addition, any physician who is serving as an officer of the MMA and who is a member of the TCMS is also included on the board. Currently there are three who are serving in that role — Lyle Swenson, M.D. as speaker of the House, Karen Dickson, M.D., vice-speaker of the House, and Ben Whitten, M.D., MMA president. We also

The Journal of the Twin Cities Medical Society

have two spots filled by Candace Simerson and Shari Ohland representing the Minnesota Medical Group Managers Association.

Lastly, the board of directors is comprised of TCMS physicians who are serving as a Delegate or Alternate Delegate to the American Medical Association. Those physicians include Blanton Bessinger, M.D., Kenneth Crabb, M.D., David Estrin, M.D., and Ben Whitten, M.D. (who also serves as an MMA officer).

If you have any questions about the TCMS Board of Directors or its activities, please contact Sue Schettle at (612) 362-3799.

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January/February 2010

5

Sheila Ryan Photography

TCMS Officers

Edward P. Ehlinger, M.D., MSPH President

Thomas D. Siefferman, M.D. President-Elect

Anthony C. Orecchia, M.D. Secretary

Melody A. Mendiola, M.D. Treasurer

Ronnell A. Hansen M.D. Past President

Board Members

6

Michael B. Ainslie, M.D. West Metro Trustee

Beth A. Baker M.D., MPH West Metro Trustee

Arthur A. Beisang, III, M.D. Director

Peter J. Boosalis, M.D. Director

Peter F. Bornstein, M.D. Director

Carl E. Burkland, M.D. Director

V. Stuart Cox, III, M.D. East Metro Trustee

Kenneth W. Crabb, M.D. AMA Delegate

Laura A. Dean, M.D. Director

January/February 2010

Blanton Bessinger, M.D., MBA AMA Alternate Delegate

Benjamin W. Chaska, M.D. West Metro Trustee

Peter J. Dehnel, M.D. At-Large

MetroDoctors

Edwin N. Bogonko M.D. At-Large

Eric G. Christianson, M.D. Director

Karen K. Dickson, M.D. MMA Officer

The Journal of the Twin Cities Medical Society

Sheila Ryan Photography

Melanie G. Fearing Medical Student Representative

Clint R. Hawthorne, M.D. Resident Representative

Donald M. Jacobs, M.D., FACS West Metro Trustee

Roger G. Kathol, M.D. West Metro Trustee

Nicholas J. Meyer, M.D. Director

Shari M. Ohland, CMPE, MHA MMGMA Representative

Sheila Ryan Photography

David L. Estrin, M.D. AMA Alternate Delegate

Kenneth N. Kephart, M.D., CMD Director

Paul A. Kettler, M.D. Director

Stephen MacLeod, BDS, MB ChB Director

Frank S. Rhame, M.D. Director

Chad E. Roline, M.D. Resident Representative

Candace S. Simerson, COE, ACMPE MMGMA Representative

Stephanie D. Stanton, M.D. Young Physician

Phillip H. Stoltenberg, M.D. Director

Lyle J. Swenson, M.D. MMA Officer

Charles G. Terzian, M.D. East Metro Trustee

David C. Thorson, M.D. East Metro Trustee

Jessica M. Voight Medical Student Representative

Benjamin H. Whitten, M.D. AMA Alternate Delegate

Peter B. Wilton, M.D., MB, BCh Director

Marie L. Witte, M.D. Young Physician

James A. Young, II, M.D. West Metro Trustee

MetroDoctors

The Journal of the Twin Cities Medical Society

Sue Schettle TCMS Chief Executive Officer January/February 2010

7

A Letter to the Members Dear Twin Cities Medical Society (TCMS) Members; [Formerly Hennepin County Medical Society (HCMS), Ramsey County Medical Society (RCMS), Hennepin Medical Society (HMS), Ramsey Medical Society (RMS), West Metro Medical Society (WMMS) and East Metro Medical Society (EMMS)] It’s been my pleasure to have served as the CEO of the medical society of west metro physicians. Not long after the year of my birth Tom Cook began his career as the Executive Director of HCMS and stayed for 25 years. He was followed by Tom Hoban, who also stayed for 25 years, and I’ve held the position for 15 years. For my entire life and for those of you who are around 65, there have only been three executives for your Society. That fact says volumes for the privilege that all three of us have felt for working closely with the physician community in and around Minneapolis.

I began my medical career journey as an orderly at Methodist Hospital in the early ’60s. There I met and quickly (before she could come to her senses) married Marilyn and she has been my ever-supportive partner for the last 44 years.

During my career I was a junior administrator at a rural hospital, I represented a pharmaceutical company, I was a clinic administrator, I was a medical staff administrator at a major metropolitan hospital, I developed and ran a physician owned HMO in the model of Physicians Health Plan, and I was president of Select Care for HealthSpan before becoming the CEO of your medical society. Each of those positions had varying relationships with physicians. However, with virtually no exception, the physician interactions during my 15 years with WMMS have all been positive.

Your medical society has been blessed with volunteer physician leaders who have worked tirelessly in support of the practice of medicine and for the patients you serve. The Board Chairs who I have been privileged to work with include: Diane Dahl, M.D.; James Meyer, M.D.; Burton Schwartz, M.D.; Eugene Ollila, M.D.; William Schoenwetter, M.D.; Edward Spenny, M.D.; David Estrin, M.D.; Virginia Lupo, M.D.; David Swanson, M.D.; T. Michael Tedford, M.D.; Michael Ainslie, M.D.; Michael Belzer, M.D.; James Rohde, M.D.; Paul Kettler, M.D.; Anne Murray, M.D.; Richard Schmidt, M.D.; Edward Ehlinger, M.D. (Pres.); Peter Dehnel, M.D. (Pres. Elect).

To special people who, without their able assistance, the Society’s accomplishments would have indeed been slim — thank you. They include, Nancy Bauer whose efforts with MetroDoctors have been outstanding, Kathy Dittmer who has managed to herd cats and get us to meetings on time, at the right location and with the right materials, and Jennifer Anderson who is a rising star on the trail for sound public health policy. We are all indebted to others for our ability to succeed.

With Sue Schettle’s appointment as CEO and outstanding incoming leadership, the future looks bright for the Twin Cities Medical Society. There’s some important work that needs to be attended to. These include continued vigilance for the public health of the community you seek to serve, your patients unobstructed access to you, your ability to maintain unrestrained clinical autonomy, continued connection to medical education and research, financial viability for your practice, and a seat at the table for the health reforms that are undoubtedly on the horizon. Now, more than ever, your active participation and membership are critical. Those who choose to sit on the sidelines will have no voice in complaining about the outcome.

And lastly, to each of you, thank you for your contribution and participation in this satisfying journey.

8

January/February 2010

MetroDoctors

The Journal of the Twin Cities Medical Society

COLLEAGUE INTERVIEW

A Conversation With

Roby C. Thompson, M.D.

R

oby Calvin Thompson, Jr., M.D., is professor of orthopaedic surgery and vice dean for clinical affairs at the University of Minnesota School of Medicine. He obtained his medical degree from the University of Virginia School of Medicine; served as an intern and assistant resident in surgery at Columbia-Presbyterian Medical Center, New york; and completed his residency and Anne C. Kane Fellowship at New york Orthopaedic Hospital, Columbia-Presbyterian Medical Center. Dr. Thompson is board certified in surgery and orthopaedic surgery.

Questions were provided by: Drs. Lee Beecher, Benjamin Chaska, Thomas Dunkel, William Jacott, and Stephen MacLeod.

You have had a diverse career, one that includes clinical medicine, academic medicine and administrative medicine. What advice would you give to a young physician who is contemplating their future career direction? What was your favorite area?

My career has involved clinical practice, academic medicine and administration and they have all had a common theme for me. I have always been committed to the challenge and rewards of the practice of medicine.

The complexities of arriving at a correct diagnosis and applying the most appropriate therapy have been a constant in my professional life. That constant prompted me to seek an academic career where I could teach and do research as part of the excitement in the challenge of medicine.

My administrative roles were in some ways the result of my pride in the University of Minnesota and my desire to help keep the institution in a position of prominence in the medical world.

My advice to a young physician in career selection would be to seek out the motivating driver in their attraction to medicine as a profession, and focus their talents around that motivation.

Getting new graduates to become involved in the leadership of professional societies is a challenge. As somebody who has had numerous leadership positions, what are some of the benefits of involvement that may not be obvious?

Some of the unexpected benefits of assuming leadership positions in professional societies, for me have included:

MetroDoctors

The Journal of the Twin Cities Medical Society

• •

A network of colleagues that I have learned to admire and respect.

Exciting new knowledge about business, organizational methods, and exposure to non-medical professionals in finance, marketing, publishing, etc.

In your distinguished career in both clinical medicine and medical leadership, you have dealt with increasing pressure for academic faculty to generate revenues from their patient care activities. What are the key problems and challenges this poses, and what are your recommendations for addressing this important issue?

The need for academic physicians to generate clinical revenues for support of the academic mission has always been present in some disciplines more than others (e.g., the surgical disciplines have been dependent to a large degree for academic support on their clinical revenue throughout my career). Recently, all disciplines have come under more pressure to produce clinical revenue for support of the academic mission, as outside support for research dollars has become more constrained, and as the size of our medical school classes has been expanding, there is a need for more faculty and more patient exposure for education. All of these are continuing to drive the need for faculty to practice as they teach and do research. My own assumption has been that as academic clinicians we should be compensated for our clinical activities at a community competitive rate for what we do, and the benefits we receive as academic clinicians must then offset the use of some of that revenue for the educational and research mission we elect to pursue.

(Continued on page 10)

January/February 2010

9

Colleague Interview (Continued from page 9)

Academic careers are successful for those who value contact with students, intellectual challenges and collegiality in their professional life.

These rewards are worthy of investing in the academic mission.

That said, there is a pressing need for the future in medical education to define our needs and the societal value of our graduates. There needs to be a community-based support for the medical education mission, and that needs to be coordinated with the other resources available for funding, including philanthropy, tuition and faculty contributions.

What role should adjunct community clinical faculty play in medical student and residency education, and (how) should they be paid? Comments?

Adjunct faculty plays an invaluable role in medical student and resident education. There has to be value to the medical school and the adjunct faculty for this to be successful. The compensation for the participation in the teaching program will vary based on the value provided to the school or the community faculty member. In some cases the added value of having a resident to work with may provide compensation in and of itself, while in others it might require some form of compensation for time and effort by the community faculty. We have recently been trying to address this in our school, and find that it varies from discipline to discipline and have left the decisions on community faculty appointments and compensation up to the individual departments and their needs.

The U of M has undertaken a review of its ethical and administrative guidelines regarding “conflicts of interest” for faculty who receive money from pharmaceutical companies and device manufacturers. Give us an update on this work.

The “conflicts of interest” policies will be adopted in the next two weeks and will be public by the time this article is published.

What was the biggest challenge in merging the medical school department silos into a single multi-specialty group called UMP? The biggest challenge in merging the 18 clinical practice groups into one group was financial. How did we capitalize the new venture and could we accept transparency in our finances? We had three basic forms of practices in our 18 departments, LLCs, Partnerships and Not-for-profits. We were forming a Not-for-profit corporation so the prior Not-for-profits could simply roll over. However, the partnerships and LLCs had ownership and in the case of the LLCs vested interests. We had no resources to buy out those structures, and they were asked to “contribute” their accounts and ownership to the new organization. Fortunately, we had very few faculty who opted out because of the process we went through in defining the structure and its benefits to the organization as a whole. The willingness to accept transparency of financial data was less contentious, but it took a lot of time to get everyone on board and, fortunately, it was a non-issue once we got it set up.

10

January/February 2010

What motivated you to stay on so long as chairman of UMP? I was asked to become chairman of the board of UMP in 2000, when Dr. Scott Giebink stepped down as the first chair of the board. I was then asked to become the chief executive officer of the organization in 2001 and remained as CEO and chair of the board until 2004 when I stepped down and the board elected Dr. Leo Furcht as the new chair. I was still doing surgery until 2004 and then restricted my practice to an office-based practice. My tenure at UMPhysicians was based on my good health, my enjoyment in seeing the organization grow and flourish and my desire to remain in a leadership position until Fairview had selected its new CEO, Mark Eustis.

Orthopaedic surgeons are paid four to five times as much as primary care physicians. This is a problem for recruitment of medical graduates into lesser paid specialties.

Should specialty pay differences be addressed and how?

The differential in physician compensation has grown as we have become more and more specialized. This differential is essentially market based and unless we have more governmental control of health care expenditures, I don’t see that changing. The market will change compensation as we have seen in cardiovascular medicine and surgery, dermatology, etc.

Can you explain how small animal science interacts with rehabilitation and orthopaedic surgery? What are the advances in orthopaedic surgery for war injured folks?

What role will the foundation play in future medical development?

We have had an active collaboration between the School of Veterinary Medicine and Orthopaedics for 30 years. At present, Dr. Clohisy as department chair of Orthopaedics has a training grant and has Vet School faculty on the grant, who are studying sarcomas in animals.

The use of Bone Morphogenetic Proteins to speed fracture healing has had wide use in the war injured of the last 10 years (not without controversy). But the most important contributions have been in rapid access to a tiered medical system for triage, stabilization, and eventual definitive care. The current war injuries with high number of amputees have prompted giant steps forward in prosthetic design and development.

As you look back on your medical career, what are the most pleasing and satisfying achievements?

The two most satisfying aspects of my career are the successes I enjoyed in patient care and the good outcomes I was fortunate to enjoy, and the success of the residents that I had a part in recruiting and training. The latter is probably my source of greatest satisfaction.

What are your plans for the future?

I plan to have more time for myself and my family while I still enjoy good health, and I hope to be involved part time as a consultant or in business in a way that allows me to be in control of my time.

MetroDoctors

The Journal of the Twin Cities Medical Society

Honoring Choices Minnesota: A Community Approach to Advance Care Planning ONE OF THE PROJECTS that the Twin Cities

Medical Society is continuing to focus on in 2010 is Honoring Choices Minnesota (HCM).

This initiative has experienced great growth and success in the past six months. Honoring Choices Minnesota is a comprehensive, collaborative approach to advance care planning that is beginning in the Twin Cities metro area, using the internationally-recognized Respecting Choices® program as a model and guide.

The majority of local hospitals and health plans are involved, along with several home care/hospice and health care organizations.

ICSI is engaged and is starting work on a palliative care initiative including standards for quality and cost measurement. All of these groups are represented on the advisory committee, and committee members have created a shared advance directive form for all systems across the state to use. Seven locations will pilot the HCM program and materials from January through June, 2010.

At a training course held in early November, 2009, 45 people were certified by Respecting Choices® faculty to be facilitators. Those individuals can use Respecting Choices® tools and methods to help patients understand their

options for future medical care as it relates to their medical condition; as well as have discussions with the patient’s family and loved ones to reflect upon their decisions in light of personal values, religious beliefs, or cultural perspectives. Ten people were certified as instructors, enabling them to teach future training courses for health care professionals to become facilitators. In this way, HCM can grow and become self-sustaining.

For additional information on this community initiative, please contact Twin Cities Medical Society at (612) 362-3704, e-mail KSnow@metrodoctors.com, or visit www.metrodoctors.com/choices.cfm.

HCM Pilot Sites • • • • • • • Course attendees break into small groups to discuss details of the HCM pilots.

MetroDoctors

The Journal of the Twin Cities Medical Society

Fairview Eagan & Rosemount Clinics Fairview Oxboro Clinic Fairview Red Wing Medical Center Fairview Ridges Hospital & Homecare Hennepin County Medical Center Medicine Clinic HealthEast – St. Joseph’s Hospital Unit 4000 (cardiac) & Midway Clinic HealthPartners – Riverside Clinic, Brooklyn Center Clinic & CHF Clinic at Regions

January/February 2010

11

A Fond Farewell AFTER 18 yEARS OF SERVICE to The Joint

Commission (10 on the Board of Commissioners and eight as Special Advisor for Professional Relations) my relationship will be discontinued at the end of 2009. Thus this will be the last article I will write for MetroDoctors. As directed by The Joint Commission Board, I have focused my activity in the past eight years on engaging physicians and physician organizations in the accreditation process, patient safety and quality activities. During these 18 years, I have seen The Joint Commission change from a regulatory, process-focused organization to one that is more focused on clinical care. A good example of this is the Tracer Methodology. This is a technique used by surveyors to follow the path of a patient through an organization and along the way, note compliance with standards.

In the last issue of MetroDoctors, I discussed the new Joint Commission statements on vision and mission. The enterprise vision is: all people always experience the safest, highest quality, best-value health care across all settings.

In order to implement the enterprise vision, the Board and staff have undergone a signifi cant strategic planning process. Four strategic imperatives have been identifi ed to help achieve that goal: 1. Improve the quality and safety of health care. 2. Exceed customer expectations.

3. Commit to staff and excel operationally. 4.

Maintain strong fi nancial performance. All very challenging and accompanied by a number of goals and tactics.

Mark Chassin, M.D., president of The Joint Commission, puts it this way. “My vision for The Joint Commission includes an even stronger focus on helping to provide the best possible care for patients. Central to this

By william E. Jacott, M.d.

12

January/February 2010

new vision is an effort to facilitate more rapid and widespread development and adoption of proven solutions. We will be working with hospitals to identify and develop, through the application of robust process improvement methods, effective interventions that will produce greatly improved levels of safety and quality. And we will rapidly put these interventions in the hands of our accredited hospitals.”

As The Joint Commission continues to provide this improved accreditation process and service to hospitals, questions arise about competition. There are two other organizations that have been granted deemed status by CMS. Det Norske Veritas Healthcare (DNVHC) Inc. is a subsidiary of Det Norske Veritas, a Norwegian organization whose primary business has been offering classifi cation and testing services to the maritime and manufacturing industries.

DNVHC has been conducting accreditation of hospitals since they have received deeming authority from CMS in Sept. 2008. Their accreditation requirements are based on the 1986 CMS Conditions of Participation and the ISO 9001 standards. The other organization is the American Osteopathic Association (AOA) whose mission is to advance the philosophy and practice of osteopathic medicine. The program began as a way to ensure that osteopathic students received their training in facilities that provided high quality patient care. So far, the number of hospitals accredited by these two

organizations is small, but The Joint Commission must continue along the enterprise vision pathway to maintain its domination in the fi eld.

Looking ahead, our profession and the health care organizations we belong to face several challenges with respect to accreditation.

First, we need to make the accreditation process relevant while delivering value to institutions.

That is, we must demonstrate that the processes of pre-survey preparation, self assessment, and on-site evaluation for standards compliance can result in more positive health care outcomes.

The question remains: when institutions and/or health care professionals are evaluated through the accreditation process, does it make a difference in how care is delivered? I believe it does.

We are moving from anecdotal responses to more evidence-based responses. With our increasing ability to collect and analyze data from performance measurement, we are generating and demonstrating more documented positive outcomes.

It’s been a great trip. I continue to be impressed with The Joint Commission leadership and staff. It has also been a pleasure to meet and interact with so many talented and dedicated leaders in the fi eld — chief medical offi cers, medical society leaders, medical staff leaders, CEO’s and practicing physicians. The Joint Commission Board, which I had the privilege to Chair in 1999 and 2000, is a unique and experienced body with a broad background of talent. It has also been a pleasure to serve on the Metropolitan Hospital Physician Leadership Committee sponsored by EMMS and WMMS. This is a unique organization with opportunities to discuss and agree upon common issues and policies.

My thanks and admiration to all the good people in health care.—WmJ

MetroDoctors

The Journal of the Twin Cities Medical Society

YOUR VOICE

Teens & Alcohol— Not a Faceless Statistic

A

t the MMA annual meeting held in Rochester this last September, the House of Delegates adopted the resolution to oppose efforts to lower the minimum legal drinking age from 21 years. This policy sends the right message about MMA’s concerns relating to the dangers and consequences of alcohol use by young adults under age 21.

Congress, in 1984, passed the National Purchase Act to encourage each state to enact a minimum legal purchase age of 21 by 1986 because of the number of underage alcohol-impaired drivers who were involved in fatal crashes. States that failed to raise the legal age for the purchase and public possession of alcohol faced a 10 percent decrease in their annual amount of federal money they received for highway construction and maintenance. Within four years, all 50 states had established 21 as the minimum legal drinking age (MLDA).

Under a banner called the Amethyst Initiative, about 130 college and university presidents called on lawmakers to consider lowering the drinking age from 21 to 18, saying that the “twenty-one (MLDA) was not working” and that a “culture of dangerous, clandestine ‘binge drinking’….had developed” at U.S. colleges and universities.

They claimed that the development of this “binge drinking culture” among college students occurred subsequently to changes in the drinking-age law. They urged the Amethyst Initiative to provide a national debate about the drinking age. Their alternative approach to controlling the consumption of adult beverages by younger Americans was to teach responsible drinking in high school.

This plan was similar to the approach used by many states to educate and license young drivers. A certified alcohol educator would teach high school graduates, who chose to consume alcohol, about the legal, ethical, health and safety issues related to alcohol consumption.

Passing this course would result in a license to drink. If you violated it, the license to drink would be taken away right away.

Insurance Institute for Highway Safety president Adrien Lund, thought that it was irresponsible to assert that this untested education program would bring down highway safety crashes that went down 30 percent when the drinking age was raised.

I believe there are at least three major facts that support not lowering the drinking age to 18: First, maintaining the MLDA at age 21 is about protecting

By Carl E. Burkland, M.d.

MetroDoctors

The Journal of the Twin Cities Medical Society

the public health and the public safety. Lives are saved and injuries are prevented. The Minnesota Department of Public Safety officials oppose lowering the drinking age because of the high rates of young, inexperienced drivers in car accidents.

Second, this next point is very important to me and I want my fellow colleagues to think about it. Statistics that document car crashes and car fatalities that involve preventable carnage wrought by alcohol misuse are not faceless. To me, to you, to emergency personnel, to police officers, and to firemen, alcohol statistics have a face with a history. As a nurse once said, “you can talk about policy but when you stare at a human face, it’s a whole different story.”

Society’s opinion about alcohol is ambivalent. I think we far too often identify with the rights of the alcohol abuser and not with the rights of the victim. We need a shift to occur in society and identify first, more with the victim’s plight than with the alcohol abuser’s plight. After all we, or one of your family members, could be an innocent victim of someone who is illegally misusing alcohol. Would you have a Teflon attitude toward someone who was misusing alcohol if one of your family members was one of their innocent victims?

Third, the science here is clear. The present law best serves the common good to first do no harm. In a 2009 Hazelden newsletter supporting keeping the current legal drinking age at 21, it stated that there was no evidence that lowering the drinking age would solve alcohol-related traffic accidents and other unintentional injuries.

Instead, it would simply give young people easier access to alcohol.

A national survey of 16-21 year olds found that teens from states with a higher MLDA drank less frequently. If a person waited until age 21 before taking their first drink, their risk of becoming alcohol dependent and abusing alcohol decreased by over 60 percent.

In 2000, New Zealand lowered its MLDA to 18. Since then, alcohol related crashes have risen 12 percent among 18 to 19 year olds and 14 percent among 15-17 year olds.

A March 2009 article in the American Journal of Preventive Medicine noted that research conducted by the University of Minnesota and the CDC on binge drinking of active-duty military personnel found that binge drinking rates were highest among personnel between the ages of 17 and 25, with about five million episodes of binge drinking among personnel under the legal drinking age of 21.

Mandy Stahre, MPH, who helped author the study stated that “our study clearly shows that binge drinking is a significant public health (Continued on page 14)

January/February 2010

13

Teens and Alcohol (Continued from page 13)

problem in the military, which is dangerous to both the drinkers and those around them. It also underscores the importance of implementing effective strategies to prevent underage and binge drinking, such as maintaining and enforcing the age 21 minimum legal drinking age and increasing alcohol excise taxes.”

A July 2009 article in the Journal of the American Academy of Child and Adolescent Psychiatry compared binge-drinking prevalence rates among youths and young adults in the U.S. between 1979 and 2006. They found that: • Binge drinking among high school seniors was at a historic low, more than one-third lower than its peak in 1979-1983.

• There were signifi cant reductions in relative risk for binge drinking among 12 to 20 year old males but no signifi cant changes in the relative risk for binge-drinking were observed among 12 to 20 year old females.

• There was no reduction in binge-drinking in 18-20 year old college men, whereas their non-student counterparts in the age range of 18 to 20 years old had a reduction in their relative risk for binge-drinking.

• The highest rates of binge drinking were among males 21 to 23 years old. This trend did not differ by student status.

• And 21 to 23 year old college women experienced larger increases in binge-drinking rates than their non-student counterparts, ages 21 to 28 years old.

This study concluded that the reduction in binge-drinking among youths 12-20 years old is likely to be at least partly attributed to the adoption of the uniform drinking age of 21 years. And furthermore, these results suggest that binge-drinking problems among college students would best be addressed by interventions specifi c to the campus environment and by interventions targeted toward women and not by presuming that the MLDA or other laws had been ineffective.

In summary, there is no silver bullet or easily uttered soundbite that will proclaim the solution to deterring under-age drinking.

The anti-smoking model — education, higher taxes and enforced age restrictions — was successful and should be used to curb under-age drinking. Maintaining the MLDA at 21 is yet another important part of the solution, especially since it further discourages drinking beginning at even younger ages.

Physicians should ask their young patients specifi c questions regarding the amount of alcohol they consume per day and/or on the weekends while they are performing routine physical examinations or when seeing them for medical or troubled behavior problems. I am surprised by the honest answers I get.

Frank and free communication is vital in addressing the solution to this possible life-changing under-age drinking problem.

Proceeds from MPS help to support the medical society’s operations.

Please consider our business partners listed below as you look to reduce your operational costs.

Our partners include: • AmeriPride Services (linens and apparel) • SafeAssure Consultants (OSHA compliance) • Berry Coffee (beverages and food) • AED Professionals (AED distributor) • Stanton Group (group/individual insurance) • IC System (debt collection)

T O LEARN MORE C ALL 612-362-3704 OR VISIT : WWW . METRODOCTORS . COM / SERVICES . CFM

14

January/February 2010

MetroDoctors

The Journal of the Twin Cities Medical Society

Research Brief:

Behavioral Impact of Graduated Driver Licensing on Teenage Driving Risk and Exposure MOTOR VEHICLE CRASHES are the leading

cause of death among teenagers. In 2005, a total of 5,300 teenagers, ages 13 to 19, died in a motor vehicle crash, representing 33 percent of all deaths among this age group. Various studies have attributed this increased risk level to factors such as a lack of driving experience, tendency to drive at riskier times (night time), and fellow teenage passengers that lead to a distracting environment for the driver.

Over the last 12 years, almost all U.S. states have adopted graduated driver licensing (GDL) policies, which have been previously implemented in Australia, New Zealand, and several Canadian provinces as tools to reduce traffi c hazards for teenagers. These policies introduce three distinct licensing stages: learner’s permit, intermediate license, and full licensure.

The fi rst two stages typically involve requirements on the minimum number of hours of supervised driving, as well as driving restrictions especially in high-risk situations (night-time and with teen passengers). These restrictions are gradually lifted as teen drivers mature and advance to the next stage. The fi nal stage, “full licensure,” removes all the restrictions. The purposes of these policies include expanding the learning process, reducing risk exposure, improving driving profi ciency and encouraging safe driving.

Previous literature evaluating the impact of GDL policies of the 1990s has demonstrated the policies’ effectiveness on reducing teenage-involved fatal crashes. However, the mechanisms through which these reductions are achieved are unexplored. In particular, does GDL help improve teen driving, or does it

By pinar Karaca-Mandic, ph.d., and greg Ridgeway, ph.d.

MetroDoctors

pinar Karaca-Mandic, ph.d.

simply limit the number of teens on the road especially in high-risk situations? The diffi culty in investigating this issue is due to the unavailability of good estimates of how many teenage drivers are on the roads at any given time, and how that varies with the GDL policies.

(In a sports analogy, it is like trying to guess a baseball player’s batting average using only the number of hits.) Moreover, it is unknown whether GDL policies have long-term effects on teenage driving. For example, do GDL exposed teens become better drivers in the future?

Alternatively, do GDL regulations shift risky driving to older teens by disallowing them to mature through risky behavior while they are younger? Our goal is to investigate such behavioral implications of the GDL policies.

Study Design

We estimate a structural model that separately identifi es GDL’s effect on the relative teenage prevalence and relative teenage riskiness. We also distinguish between states that implement stricter GDL policies. Our ability to identify the relative crash risks and relative exposure relies on data from two-car crashes and the information contained in the counts of teen/ teen, teen/adult, and adult/adult crashes. There are only certain relative risks and exposures that would make a particular collection of crash

The Journal of the Twin Cities Medical Society

counts plausible. If many of the accidents involve teen/teen collisions then either the teenrelative risk is high or there are many [more] teens on the road relative to adults. The counts of teen/adult and adult/adult crashes can be used to identify how much the number of teen/ teen crashes depends on risk and how much depends on exposure.

We model these crash frequencies as a function of the teenage driving exposure and driving risk, both relative to those of adults.

Next the relative amount of teenage driving and teenage driving risk are related to the GDL policies as well as other state-year level driving related laws and demographic information.

The model is estimated jointly in a two-level hierarchical modeling framework.

We use a relatively new dataset called the State Data System (SDS) which has data from 1990 to 2005. This data is very similar to the Fatal Analysis Reporting System (FARS) data used extensively by previous research on traffi c safety. While FARS reports only fatal accidents, SDS includes all police reported crashes and provides information on all persons involved in the crash (age, gender, drinking, status, etc.) as well as detailed information on the crash (location, time, road type, road conditions, number of vehicles involved, etc.) and on all the vehicles involved (make, model, year). Unfortunately, not all states report to SDS. We obtained data from 12 states.

Findings

We fi nd that the GDL policies have reduced the number of accidents by 15 to 17 year-olds by limiting the amount of teenage driving rather than by improving teenage driving. More specifi cally, GDL reduces relative teen prevalence by 5 percent during the day and 15 percent (Continued on page 16)

January/February 2010

15

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during the night. Stricter GDL policies, especially those with night-time restrictions have been significantly more effective in limiting teenage driving at night. For instance, a GDL policy rated “good” (i.e. most strict) by the Insurance Institute of Highway Safety reduces teen prevalence at night time by 43 percent while a GDL policy rated “fair” reduces it by 12 percent. We do not find statistically significant effect of the policies rated “marginal” (i.e. least strict) on relative teen prevalence.

We investigate whether driving under GDL restrictions results in a cohort of drivers that have reduced risks in the future, although the effects during the early teen years might be insignificant. Although we do not find evidence that GDL policies make teenagers become better drivers in later years, future research should revisit this issue as more teens graduate from the GDL policies.

From a public health perspective, our findings suggest that more restrictive GDL policies for 15 to 17 year-old drivers reduce teen accidents and fatalities. Stronger GDL policies defer unrestricted driving, thus reducing teens’ exposure to high risk driving situations. Recent neurological studies may help explain our findings. In particular, National Institute of Mental Health researchers found that regions of the brain governing impulse control, prioritization, and strategy (the dorsal lateral prefrontal cortex) are still “under construction” during teen years and do not develop fully until early 20s (Giedd, 2004). Ultimately, biological or behavioral maturation, rather than experience, may be the mechanism through which GDL reduces teens’ driving accident risk. Naturally, further research may provide insight into optimal GDL policy structure, as well as how alternative policies might influence learning by teen drivers.

Reprinted with permission, University of Minnesota School of Public Health, Research Brief, October 2009.

Pinar Karaca-Mandic, Ph.D., assistant professor, Division of Health Policy and Management, School of Public Health, University of Minnesota.

Greg Ridgeway, Ph.D., senior statistician, RAND Corporation.

MetroDoctors

The Journal of the Twin Cities Medical Society

New Health Care CEO: Neeraj Chepuri, M.D., CEO, Consulting Radiologists, Ltd.

Editor’s note: MetroDoctors is continuing to highlight newly named health care executives. Each CEO has been asked to outline his/her vision and challenges for their organization as well as offer some personal insights.

What or who inspired you to pursue a health care career?

My father has been one of the greatest influences on my life including my career choices. He grew up in India, and did not have the educational opportunities I had to become a medical doctor. As far back as I can remember he wanted me to follow a career that allowed me to be involved in patients’ health care — a critical time in everyone’s life. I value all of the advice and mentoring he has given me over the years.

What is the best career advice you received?

I received advice from one of my mentors when I was in medical school.

At the time there was a great deal of uncertainty about a future in specialists. There was a strong move toward primary care and a concern that there would be no jobs in radiology or specialist medicine. However, this was the area that I was interested in, and an area where I felt I could make a difference.

My mentor told me that good people would always be needed in medicine who could provide value to patients. He advised me to follow my dreams and to do what I thought would best help take care of patients. I took that advice and ran with it. Seven years later as I came out of my fellowship program, jobs in specialized areas, particularly in radiology, were available and I now feel very fortunate to be the president of a large radiology group, centered in Minneapolis.

What motivated you to leave clinical practice to become an administrator? What new skills are needed for this career?

I have not really left my clinical practice to become an administrator — 50 percent of my time remains devoted to my clinical practice as a neuroradiologist. It is my belief, and Consulting Radiologists, Ltd. (CRL) as an organization has agreed, that the best administrator for a health care practice is an individual who understands the process of delivering care to patients. As such, a combined physician/leader is viewed by my organization as the ideal position from which to lead a large health care organization. In fact, we are developing a corps of physician leaders within our organization. These physician leaders range from Finance

MetroDoctors

The Journal of the Twin Cities Medical Society

Committee Chair, Practice Operation Committee Chair, Chief Technology Officer, Chief Quality Officer, Chief of Medical Staff Affairs, and Chief of Strategy and Development.

These are new roles for our physicians. They do require new skills, and I have personally been involved with a physician leadership course at the University of St. Thomas. In addition, I have received personal coaching, and have read numerous articles and books on the topic of leadership, physician leadership, and physician leadership within health care. This has been a learning journey for me as well as for my organization.

What aspect of modern clinical care, in your opinion, has made the greatest difference in the lives of the most people?

As a radiologist, I see a lot of contributions that imaging has made to patient care. It is truly amazing that we can dissect the internal structure of a patient without the use of knives or sharp instrumentation. We now have a great degree of certainty about the size of abnormalities, the structure of abnormalities, the physical and biochemical composition of these abnormalities and, to some extent, even the pathological nature of these abnormalities. This helps a great deal in being able to treat the abnormality and to return the patient back to a normal state of health.

This has made a tremendous impact on our ability to deliver health care to our patients.

A great deal of research has been done through the American College of Radiology regarding the appropriate use of imaging studies. For example, when a patient presents to a primary care physician with a complaint such as back pain, there are rigorous research appropriateness criteria for determining who should have an MRI, who should have an x-ray, and who should be treated medically without any type of imaging. Unfortunately this information is often not available to our primary care physicians at the time a patient presents to them. Also, imaging referrals are influenced by factors such as patient request (after (Continued on page 18)

January/February 2010

17

New Health Care CEO (Continued from page 17)

reading something on the internet, perhaps), and fear of litigation.

This “defensive” style of medicine clearly drives a subset of imaging referrals and is one cause of imaging over-utilization.

In response, CRL as well as other radiology groups is going on an education offense — trying to make it easier for our referring physicians to access appropriateness criteria at the time of imaging referral. We are also engaged in a large educational program trying to get to our referral community and let them know about the best time to order which test.

How do radiologists (in general) deal with the excess use of scans in this new environment?

The central business notion of CRL is that when medical imaging is used appropriately, the overall quality of patient’s health care is increased and the overall cost to the health care system is reduced. We believe that a lot of the over-utilization of imaging in health care today is related to improperly aligned incentives, and incomplete education about the useful areas of medical imaging. We have been working for quite a while with the American College of Radiology (ACR) in promoting the ACR appropriateness criteria for medical imaging. We strongly feel that medical imaging has a role in health care, and there have been quite dramatic and significant gains due to medical imaging. Unfortunately, there is some misuse and overuse of medical imaging, which we are quite interested in stomping out.

Do your radiologists also recommend other studies, and since there is a conflict of interest, who monitors this?

When CRL radiologists are interpreting imaging studies, occasionally there is a need for further follow-up scans to either monitor the progression of a disease or to answer a question that was brought about by a certain type of imaging study. At this point, following ACR appropriateness criteria, the next imaging study would be recommended, and this is a service that we provide to the referring doctors since the referring doctors often do not know which study would be most appropriate next. There is not really a conflict of interest, as most of the revenue from these additional studies actually goes to our hospital and partner facilities, and not to us. There is no national monitoring board for who recommends further scans. However, there is a great deal of internal monitoring between physicians, as we do need to recommend the additional studies to our referring physicians as well as to our patients. Overall, a very small percentage of imaging studies performed are recommended by radiologists. The vast majority of over-utilization of imaging is not from recommendations of radiologists, but referred by non-radiologists.

How much does competition from other imaging sites, hospitals and clinics increase the cost? And, why is the cost of a CT in Japan or Germany so much less than here in the U.S.?

There are several reasons why advanced medical imaging such as CT and MRI cost more here in the U.S. than in Japan or Europe. I don’t believe that the reason is competition — in fact I believe that competition reduces the cost. In the Twin Cities, there is quite a bit of competition for outpatient imaging, and that has led to a significantly lower cost and higher quality than what is seen elsewhere in the country.

Lessons Learned from Recent Disasters

To understand the differences in imaging costs between the United States and Europe or & Applicability to Metro Planning Japan, we have to look at the payer side. In the United States, there is a large consumer demand Wednesday, February 17, 2010 for medical services, particularly high-technology services such as imaging. A large percentage of Full day conference held at: the population also has health insurance, which Earle Brown Heritage Center basically insulates the consumers of health care 6155 Earle Brown Drive resources from their true costs. So, from the Brooklyn Center, MN 55430 perspective of the consumer, we have a large demand, and a hidden cost that is borne by the industry and nation, but not by the individual MARK YOUR at the time of the health care episode.

CALENDAR!

Other societies do not have as high a consumer-culture drive for high-tech health care. I believe that is the key factor. The other countries Brochure with REGISTRATION available ONLINE at www.hcmc.org/cme also use other types of payment structures such Contact: Katy Williams at 612-873-6483 or Email: katherine.mcandrewswilliams@hcmed.org as single-payer systems that place limits on the amount of high-tech health care delivered (rations). What is right for Japan or Europe is not necessarily right for the U.S. We must look for ® a health care system that fits with the consumer

PREPAREDNESS PRACTICUM 2010

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January/February 2010

MetroDoctors

The Journal of the Twin Cities Medical Society

09-193.LO.HealthStyleSmallAdTall2:Layout 1 9/25/0

mentality in the U.S., but also does not ration health care. I don’t think the U.S. consumer will tolerate rationed care.

In general, do you think patients today are better informed about health topics than in earlier times and why or why not?

Absolutely, I believe that patients are better informed about health care today. There are several reasons for this. The widespread use of health information on the internet has made health care readily accessible to everybody. Everyone is now looking on the internet for advice about personal health issues, as well as issues of health that effect family members and friends. The internet is a tremendous resource, and is one of the truly revolutionary features of our time.

In addition, there is a great deal of discussion among people about health care related issues, much greater than I remember seeing as a child. Health care has taken a prominent role in popular culture with news, TV shows, and movies. Americans are fascinated with health care.

What will the impact of the pay reductions be on your organization?

It is unclear what type of pay reductions will be taking place as part of the overall health care reform which will occur sometime within the next few years. Our hope is that the health care reform will be focused on quality and overall cost reduction. We believe, that as an organization, CRL provides a great deal of quality, and again we believe that when medical imaging is used appropriately it actually reduces the overall cost of health care. As such, we feel that we can minimize the impact to our organization. However, we are concerned that some of the proposals in front of Congress are really not related to increased quality and overall health care system cost reduction, but are simply out to reduce reimbursement for certain types of procedures. This would actually have the opposite of the intended impact as it would reduce the quality of care for patients and increase the overall cost for the health care system. We are working with various governmental bodies to try and make sure overall quality of health care is the overriding concern in any health care reform that occurs.

How do you deal with multiple EMRs in sending out the reports and images to the referring doctors?

We have had our internal information system for the past four years and our internal image distribution system for three years. We are now in the process of linking our information systems and our image distributions systems to other systems and EMRs throughout our imaging network in order to provide easy access to reports and images to referring doctors and patients.

During this process, we have realized that radiology is the field of medical information.

It is a fast changing field, and it has become clearer to us that we must be experts in dealing with information being sent to multiple electronic medical records as well as multiple imaging systems. As such, we do have an information technology staff of eight, led by a Chief Technology Officer who is also a physician. We also have a non-physician Chief Operations Officer. We feel that these structural moves will help us get the information to our patients and customers efficiently in a short period of time.

What message about health and wellness do you most wish to communicate to your patients?

As physicians, we are partners in our patient’s health care. In the end, the patient is the one who has the most control over their health and wellness. The lifestyle choices we make such as what we eat, how we exercise, whether or not we smoke, dramatically affect our ability to stay healthy. I wish I could communicate this better to patients.

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MetroDoctors

The Journal of the Twin Cities Medical Society

January/February 2010

19

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Healthy Menus Minneapolis Update Much has happened in the past few months related to menu labeling, locally and on the national stage. Healthy Menus Minneapolis had a very successful summer recruiting supporters all over Minneapolis who want a local ordinance requiring Minneapolis fast food establishments to list calories on their menus, menu boards and drive-thru areas. Jennifer Anderson, with the help of a core group of volunteers, attended several different community health events educating people on the importance of menu labeling in Minneapolis and how they can help bring an ordinance to Minneapolis.

Nationally, there is a menu labeling bill in both the House and Senate as part of health care reform legislation. The Senate has passed their bill and now the House will take up deliberations. Healthy Menus Minneapolis supports a comprehensive national menu labeling bill that will help consumers make healthy informed choices at the point of purchase.

For more information about Healthy Menus Minneapolis, please contact Jennifer Anderson, project coordinator, at (612) 3623752 or janderson@metrodoctors.com.

Visit us at www.metrodoctors.com and

forum.metrodoctors.com To find new career opportunities, past issues of MetroDoctors and information on the latest news, events and legislative issues!

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January/February 2010

MetroDoctors

The Journal of the Twin Cities Medical Society

Ranji Varghese, M.D. Respiratory Consultants Pulmonary

New Members Sumner T. McAllister, M.D. Apple Valley Medical Clinic, Ltd. Family Medicine

Sarah M. Vernon, M.D. Park Nicollet Heart & Vascular Center Internal Medicine/ Cardiovascular Diseases

Dana L. Metzger, D.O. Fairview Highland Park Clinic Urgent Care

Hoo yin Wong, M.D. Metro Urology, P.A. Urology/Urological Surgery

Robert A. Mittra, M.D. VitreoRetinal Surgery, P.A. Ophthalmology

Resident Physicians

Active Carl B. Burkland, M.D. North Clinic, P.A. Internal Medicine/Pediatrics/ Hospitalist Diana G. Crintea-Stoian, M.D. Fairview Ridges Clinic Internal Medicine Stefan DeBoel, M.D. North Memorial Heart and Vascular Institute Cardiology Laura A. Diamandopoulos, M.D. Minnesota Heart Clinic Internal Medicine Cory R. Ecklund, M.D. Riverwood Healthcare Center Family Medicine Nazih N. Farah, M.D. Consulting Radiologists, Ltd. Diagnostic Radiology

Kirana Narayana, MBBS HealthEast Cancer Center Pulmonary Critical Care Medicine William R. Phipps, M.D. Reproductive Medicine Infertility Assoc.

Obstetrics/Gynecology Lawrence G. Richmond, M.D. Park Nicollet Clinic-Plymouth Family Medicine

Simon N. Fenton, M.D. Allina Medical Clinic West St. Paul Family Medicine

Kayvon S. Riggi, M.D. Orthopedic Medicine & Surgery, Ltd. Orthopaedic Surgery/ Sports Medicine

Ronald W. Glinski, M.D. Metro Urology, P.A. Urology

Alison C. Rudy, M.D. Anesthesiology, P.A. Anesthesiology

Kimberly J. Haycraft-Williams, M.D. Fairview – Andover Clinic Family Medicine

Steven C. Skildum, M.D. Family HealthServices MN Family Medicine

Tara L. Kelly, M.D. Family Health Services MN Family Medicine

Neil A. Stein, M.D. Metro Urology, P.A. Urology/Urological Surgery

Matthew K. Kissner, M.D. Specialists in General Surgery, Ltd. General Surgery

Richard D. Taylor, M.D. North Memorial Heart and Vascular Institute Internal Medicine/Cardiology/ Cardiac Electrophysiology (IM)

Julie O. Laidig, M.D. No address specified Pediatrics Andrew J. Larson, D.O. Twin Cities Dermatopathology Dermatology Denise H. Long, M.D. Family HealthServices MN Family Medicine MetroDoctors

Alden R. Tetlie, M.D. Family HealthServices MN Family Medicine Mary K. Tuohy, M.D. Family HealthServices MN Family Medicine Brandy L. Utter, M.D. Allina Medical Clinic Shoreview

The Journal of the Twin Cities Medical Society

University of Minnesota Mahsa Abdollahi, M.D. Kamaldeen T. Aderibigbe, M.D. Shaheen R. Alanee, M.D. Nino Alapishvili, D.O. Osamah T. Aldoss, MBBS Tamas Alexy, MBBS Osama A. Alsaied, MBBS Alain Alvarez, M.D. Brandon J. Anderson, M.D. Bhavana C. Anand, MBBS Ganesh Asaithambi, M.D. Ned A. Austin, M.D. Mohan P. Ayyaswamy, MBBS Nathan C. Bahr, M.D. Brett Baloun, M.D. Maisha N. Barnes, M.D. Todd A. Barrett, M.D. Mark G. Bartlett, M.D. Mrunmayee Barve, MBBS Megan Baxter, M.D. Heather A. Bechtel, M.D. Julie M. Bennett, M.D. Sonja M. Bjerk, MBBS Stephen J. Bloechi, M.D. Juan Jose Blondet-Teixeria, M.D. Thomas J. Bollinger, M.D. Kristina J. Braun, M.D. Adam C. Breunig, M.D. Philip A. Brooks, M.D. Lori D. Bryant, M.D. Michael Q. Bui, M.D. Marco A. Caccamo, M.D. Jori S. Carter, M.D. Kelly J. Casserly, D.O. Phillip L. Chaffin, M.D. Sara M. Champlin, M.D. Katherine Chang, M.D. yeilim Cho, MBBS Eun Ju Choi, M.D. Melissa T. Choi, M.D. Toby Christie-Perkins, M.D. Peter K. Chweyah, MBBS Jessica M. Cici, M.D. Efkan M. Colpan, M.D. Keith Craig, M.D. Laura E. Cudzilo, M.D. Donna L. D’Souza, MBBS

Jeffrey R. Dahlen, M.D. Peter K. Dahlstrom, M.D. Daniel A. Danczyk, M.D. Stephen F. Darrow, M.D. Anna M. DePompolo, M.D. Lindsey L. Deuster, M.D. Elizabeth L. Dickson, M.D. Li Ding, MBBS Mankpondehou E. Djevi, MBBS Patrick T. Dornack, MBBS George Dreszer, M.D. Byron Eddy, M.D. Zainab Elsarawy, M.D. Nicolai A. Esala, D.O. Anna G. Euser, M.D. Abeer B. Farrag, M.D. Gwenyth A. Fischer, M.D. Maren E. Flynn, M.D. Carolyn J. Foley, M.D. Nicholas R. Fossland, M.D. Claudia K. Fox, M.D. Mary L. Fredrickson, M.D. DeAnna J. Friedman, M.D. Daniel W. Giles, M.D. Noah I. Goldfarb, M.D. Sarah W. Grahn, M.D. Gurjeet S. Grover, MBBS Jack D. Hagan, M.D. Kathy I. Hakanson, M.D. Kelly M. Halderman, M.D. Brian J. Hanson, M.D. Tasma Harindhanavudhi, MBBS Ameer E. Hassan, M.D. Luke T. Hawes, M.D. Clint R. Hawthorne, M.D. John P. Heimerl, M.D. Kathleen A. Hecksel, M.D. Elizabeth R. Hofbauer, M.D. Def-Chen T. Huang, M.D. Sarah L. Hutto, M.D. Kimberly A. Indovina, M.D. Jennifer L. Irani, M.D. Jennifer K. Ische, D.O. Jennifer F. Iverson, M.D. Katherine M. Jacobs, D.O. Mollie M. James, M.D. Christina J. Jarosch, M.D. Malinda M. Jorgensen, M.D. Ingrid B. Kaijage, MBBS Heidi J. Kamrath, M.D. Muneera R. Kapadia, M.D. Alesia Kaplan, M.D. Elissaios K. Karageorgiou, M.D. Nicole A. Karras, M.D. Kapilmeet Kaur, MBBS Louis J. Kazaglis, M.D. Ryan Kelly, M.D. Joseph R. Kelly, M.D. Christopher B. Komanapalli, M.D. yoel Korenfeld Kaplan, M.D. (Continued on page 22)

January/February 2010

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In Memoriam

New Members (Continued from page 21) Jennifer A. Krueger, M.D. yogesh Kumar, MBBS Nghia H. La, M.D. Health L. Labere, MBBS Chalton C. Lacema, MBBS Angela J. Lamb, M.D. Molly M. Lammie, D.O. Thai Lee, D.O. Robert B. Levy, M.D. Ming Li, MBBS Melanie R. Lind Ayres, M.D. Jennifer A. Longo, M.D. Jon W. Loo, M.D. Marc A. Lubin, M.D. Nathan E. Lueck, M.D. Jeffrey T. Luna, MBBS Mary B. Mackenzie, M.D. Jennifer E. Maki, M.D. Bryana K. Malner, D.O. Catherine G. Manabat, M.D. John W. Mathewson, M.D. Kristine G. Matson, M.D. Kathleen G. May, D.O. Annie L. Meares, M.D. Abbey L. Mello, M.D. Michael D. Miedema, M.D. Christa Miller, M.D. Wes Miller, M.D. Tasadug H. Mir, MBBS Mohi Mitiek, M.D. Amir A. Moheet, MBBS Brian P. Moran, M.D. Sabeen Munib, M.D. Preetika Muthukrishnan, MBBS Wesley K. Nahm, M.D. Daisy C. Nieto, M.D. Oluwakemi T. Olowoyo, MBBS James C. Olson, D.O. Andrew P. Olson, M.D. Elizabeth C. Olson, M.D. Megan T. Otis, D.O. Julie R. Overboe, D.O. James A. Owusu, M.D. Manju Pandey, M.D. James W. Pate, M.D. Sapna Patel, MBBS Swaroop Pawar, MBBS Edwin C. Pereira, M.D. Erik J. Peterson, M.D. Gregory D. Poduska, M.D. Pamela R. Portschy, M.D. Vitaliy y. Poylin, M.D. Alexa A. Pragman, M.D. Jonathan T. Pribila, M.D., Ph.D. Jerrod D. Quarles, M.D. Lipi M. Ramchandani, MBBS Pablo A. Ramirez, MBBS Mary Elizabeth T. Rashid, M.D. Jason T. Rasmussen, M.D.

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January/February 2010

Ronald Reiter, MBBS Jason A. Ricco, M.D. Dominic Rossini, D.O. Javad A. Sajan, M.D. Tiare E. Salassa, M.D. Shaden Sarafzadeh, M.D. Basar Sarikaya, MBBS Emily M. Schaaf, MBChB, M.D. Amy B. Schminke, M.D. Ian W. Schwartz, M.D. John E. Selickman, M.D. Ellen M. Selkie, M.D. Miriam C. Shapiro, M.D. Amit K. Sharma, MBBS Jason R. Sheffler, D.O. Matthew A. Sherrill, MBChB, M.D. Daniel Shibru, M.D. Prashant Shrestha, M.D. Jasvir Singh, M.D. Charanjeet Singh, MBBS Marek J. Siorek, M.D. Israel O. Sokeye, MBBS Harveen K. Soodan, MBBS Dimitrios G. Stalikas, MBBS Mark D. Stephany, D.O. Daniel J. Stephens, M.D. Thanasak Sueblinvong, MBBS Riaz Tadia, MBBS Ruby W. Tam, D.O. Elisa M. Tanaka, D.O. Heather A. Taylor, M.D. Savita S. Thorat, MBBS Dinesh Thawrani, M.D. Sarah A. Traxler, M.D. Katharine D. Tumilty, M.D. Anita Udayamurthy, M.D. Chinwe Umez, M.D. Anjali S. Vaidya, MBBS Ciro A. Vasquez, M.D. Silvia M. Vilarinho, MBBS Jeffrey M. Vinocur, M.D. Madhuri Vuppalanchi, M.D. Hengbing Wang, MBBS John F. Wechter, M.D. Laura M. Wellington, M.D. Karen L. Williams, M.D. Shelly M. Williams, MBBS Jon D. Wilson, M.D. Alison C. Wing, M.D. Kosuke yasukawa, MBBS Megan M. Zaander, M.D. Rebecca J. Zadroga, MBBS Zhuo-yi Zhang, M.D.

Medical Student (University of Minnesota) Christopher L. Thompson

HOWARD B. BURCHELL, M.D., died recently at the age of 101. He graduated from the University of Toronto Faculty of Medicine. He was a retired Mayo Clinic and University of Minnesota physician and cardiologist.

WILLIAM R. GLENNy, M.D., a retired pathologist in Saint Paul for close to 40 years, died on January 1, 2009, at the age of 82. Dr. Glenny graduated in Sequim, Washington, in the class of 1952.

GEORGE OTTO HILGERMANN, M.D. died recently at the age of 84.

He graduated from the Marquette Medical School, now the Medical School of Wisconsin in 1948. He interned at the Charles Miller Hospital in St. Paul, and completed his residency in ophthalmology at the University of Minnesota and Minneapolis VA Hospital. From 1949-1951 he was in active duty in the USNR. Dr. Hilgermann was an associate professor of ophthalmology at the University of Minnesota.

MILTON M. HURWITZ, M.D. died in October at age 91. He graduated from the University of Minnesota Medical School in 1940 and worked at the Charles T. Miller Hospital in St. Paul. He had a private practice in St. Paul from 1945 to 1990, but remained very involved with Miller Hospital as it merged with St. Luke’s Hospital and later became United Hospital.

The Milton M. Hurwitz ExerCare Fitness Center at United Hospital, was named after Dr. Hurwitz to honor his years of service.

LOWELL D. LUTTER, M.D., “Hap,” had a four year battle with cancer before he died on October 4 at 70 years. He was an orthopedic surgeon who graduated from the Pritzker School of Medicine, University of Chicago in 1965.

HERSCHEL LEON PERLMAN, M.D., 95, died on November 19, 2009.

He graduated from the University of Minnesota Medical School in 1941. He served in the Army in the South Pacific during WWII. Discharged as a Major he went on to do post graduate training in ob-gyn and internal medicine before settling in Minneapolis where he worked for many years as a general practitioner. Initially in solo practice he went on to work at St. Louis Park Medical Center. Dr. Perlman became an associate clinical professor in family practice and served as chief of staff at Methodist Hospital. He retired in 1979 and moved to Sun City, AZ. JULIEN VICTOR PETIT, M.D., passed away on November 8, 2009. He was 93. He graduated from the University of Minnesota Medical School.

He was an Army Captain during WWII, serving in France from 1942-1945.

Dr. Petit was a private practice physician for 41 years, serving Fairview Hospitals. He was chief of staff at Fairview Riverside. He was an avid traveler, and a student of Civil War history and Minnesota history, belonging to the Civil War Round Table, the Minnesota Historical Society Grant Board & Friends of Grand Portage.

VERNON L. SOMMERDORF, M.D., age 88, died on October 19. He graduated from the University of Minnesota Medical School in 1952 and practiced in St. Paul for more than 50 years at Payne Avenue Medical Associates, MinnHealth Clinic in Afton, and finally, at the U of M Geriatric Clinic at the St. Paul Wilder facility. He was a former president of the Ramsey County Medical Society, the Ramsey County Academy of General Practice, the Minnesota Academy of Medicine, and a former chief of staff at Mounds Park Hospital. He received the Ramsey Medical Society’s 2005 Community Service Award in recognition of his significant work hosting foster children, volunteer work at St. Mary’s Health Clinics, volunteer work with the Conway-Battle Creek Living at Home/Block Nurse Program, and service at First Baptist Church in St. Paul. Dr. Sommerdorf also served in the Minnesota House of Representatives from 1964 to 1972.

MetroDoctors

The Journal of the Twin Cities Medical Society

eMMs President’s Message

Final Thoughts RONNELL A. hANSEN, M.d.

IN 2009, EVOLVING PUBLIC POLICy has proposed potentially tumul-

tuous changes to the practice of medicine, perhaps driving a stake to the core of independent physician practice and the autonomy of the patient/ physician relationship. While integration of EMMS/WMMS into TCMS in 2010 will ideally serve to benefit our metro-wide members by virtue of financial stability and numeric force of voice, it is up to each of us now practicing to well understand the threat which politically expedient and socially popular state and national legislation, in the guise of “health reform,” poses to both our practices and our patients.

While large organizations such as the AMA claim to speak on our collective behalf (perhaps 17 percent of physicians belong to the AMA), it is up to us delivering the care to decide if the claim of representation is accurate, and the bargaining position touted in trade is truly feasible, realistic, or even desirable. We must understand, current proposals ostensibly seek to structure payments to physicians based upon outcomes, but fail to appropriately recognize that individual patient outcomes do not equate to the metrics of population statistics.

Nationally proposed Accountable Care Organizations will effectively transfer the unwanted role of rationing patient services onto us, financially at risk physicians. Legislators perpetuate popular entitlement “free” or “low cost” care to their constituents, side-stepping tough policy true cost drivers including unchecked patient demand for services which appear “cheap” due to tax subsidies. The result is an apparent low cost to patients with little mechanism addressing personal responsibility in lifestyle choices, and unnecessary/duplicative costs in medicine associated with lack of tort reform in medical liability. Such cost drivers will almost certainly be complicated by new congressional attempts to “ration care supply,” when a primary economic basis of the problem is, in actuality, tax subsidized consumer demand.

I do not deny or minimize that those of us providing care must improve our overall quality uniformity and use expensive high technology methods more appropriately to moderate costs.

After countless hours in study of economics, however, it remains unclear to me (as well as many respected economists) how the current reform package will either meet calculated budget estimates (read as “fake accounting”) or will actually address any true cost drivers. What it does appear to do is widen the entitlement population and impose almost assured significant reduction in reimbursement for services we will provide (if we so choose) to those covered. Medicare is a good history lesson — are we doomed to repeat it?

Simple math suggests the 30 million new insured will be achieved at the cost of nearly $700K per person if one assumes a $2T outlay over 10 years. There are many options more fiscally responsible, and professionally fair — which also empower, self-moderate, and motivate patients in use of their own health care. Time is very short. As individual physicians, we must immediately take our well-studied concerns directly to the architects of policy, before the government and corporate practice of medicine becomes the new American standard of care.

MetroDoctors

The Journal of the Twin Cities Medical Society

January/February 2010

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Update from the EMMS Foundation Board of Directors Last Meeting

The East Metro Medical Society (EMMS) Foundation met on Monday, October 19, 2009, and reviewed the progress of the foundation-led advance care planning initiative known as Honoring Choices Minnesota.

Many local hospitals, health plans, and clinics around the Twin Cities are involved; for more information, visit http://www.metrodoctors. com/choices.cfm.

Board Appointments

Dr. Kent Wilson, retired otolaryngologist from Midwest Ear Nose and Throat, was re-elected as president of the EMMS Foundation Board of Directors for a second two-year term. Dr. Mark Destache, of Associated Anesthesiologists, was also re-elected for a second two-year term. Dr. Charlene McEvoy, a pulmonologist at HealthPartners, was elected as an at-large member for a two-year term ending in 2011.

The Foundation Board is looking for candidates to serve on the Board of Directors as at-large directors.

EMMS Foundation Awards Gifts

The EMMS Foundation has a gifting policy that was adopted in 2006 which states that the Foundation Board may grant up to 4 percent of the three year market average of its fund to organizations or projects that have asked for funding and who meet the criteria established by the Board. Two awards were granted in 2009, one went to Honoring Choices Minnesota and the other to West Side Community Health Services. The funding to Honoring Choices Minnesota supported the educational programs offered in July and November. The second award was given to the West Side Community Health Services to help support their operations.

Foundation Looking for Grant Writer

The Honoring Choices Minnesota project has the distinct possibility of becoming a rather large initiative with far-reaching implications.

With this in mind, the EMMS Foundation is beginning to interview grant writers who can help to obtain funding to support this project for the long term.

Kent Wilson, M.D.

Minnesota Epilepsy Group is the largest and most comprehensive epilepsy program in the Midwest. As a regional referral facility, we are the recognized leader in treating epilepsy and other seizure-related conditions in patients of all ages, from infants to the elderly. We also offer comprehensive neuropsychological assessment for a broad range of acquired or developmental neurological conditions in both adult and pediatric patients.

Adult Epileptologists Deanna L. Dickens, MD Julie Hanna, MD El-Hadi Mouderres, MD Patricia E. Penovich, MD

Mark Destache, M.D.

Pediatric Epileptologists Jason S. Doescher, MD Michael D. Frost, MD Frank J. Ritter, MD Functional Neuro-Imaging Wenbo Zhang, MD, PhD

Appointments (651) 241-5290

225 Smith Avenue N St. Paul, MN 55102 www.mnepilepsy.org

Neuropsychologists Elizabeth Adams, PhD Robert Doss, PsyD Ann Hempel, PhD Donna Minter, PhD Gail Risse, PhD Charlene McEvoy, M.D.

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January/February 2010

MetroDoctors

The Journal of the Twin Cities Medical Society

EMMS Senior Physicians Association

East Metro

The EMMS Senior Physicians Association met in October and heard Roland Birkebak, M.D., a retired orthopedic surgeon, speak about his experience as a volunteer medical director in Fiditi, Nigeria. He served not only as a surgeon and internist, but also as an administrator, engineer, architect, electrician, plumber, spiritual advisor and much more. Dr. Birkebak went to Nigeria to work with the Good Samaritan Society of America (TGSSA), beginning in 2002.

Initially, a medical clinic was intended for the TGSSA building, but when two individuals died after being unable to pay bribes for treatment at the government-run hospital, plans were made to build a new hospital.

Dr. Birkebak also held medical clinics at various government hospitals in the area and started a permanent medical clinic at the TGSSA village site in 2004. A Nigerian doctor and public health nurse currently staff the clinic and volunteer physicians from the U.S. and Canada have been involved on a shortterm basis. One of the government health officials says that the new TGSSA hospital will be “the Mayo Clinic of West Africa.� To learn more about the organization, volunteering or donating, please contact Dr. Birkebak at (651) 429-3240 or visit www.TGSSA.org.

Dr. Birkebak helped to ensure the hospital was built according to comprehensive, American standards.

Will Your Organization Share With Those Less Fortunate?

Supply Drive February 1-28, 2010

The 18th annual Caring Hearts for Homeless People drive will collect health and hygiene supplies and over-the-counter medications for homeless adults and children in the east metro area. Donated items will be sorted and distributed to the homeless through the following programs: Health Care for the Homeless, Listening House of St. Paul, and SafeZone Resource Center. Please consider putting out a collection box at your office and encouraging employees to donate. Many clinics and hospitals are involved in this year after year.

Please call Katie Snow, East Metro Medical Society Foundation, at (612) 362-3704 or e-mail her at KSnow@metrodoctors.com if your organization would like to participate.

You will then receive posters and lists of suggested items to donate. The drive runs through the month of February and volunteers will pick up the items at your office in early March.

Rollie Birkebak, M.D. recounts the challenges of both medicine and construction in Nigeria.

MetroDoctors

The Journal of the Twin Cities Medical Society

Sponsored by HealthEast Care System and East Metro Medical Society Foundation

January/February 2010

25

EMMS Represented at AMA Interim Meeting Ronnell Hansen, M.D., president of the East Metro Medical Society and Sue Schettle, chief

executive officer of the East Metro Medical Society, attended the 2009 Interim Meeting of the American Medical Association in Houston, Texas, November 7-10.

This meeting of the American Medical Association was well attended and many of the delegates and alternate delegates spoke at reference committees about the AMA’s recent support of the U.S. House health reform bill. Many of the speakers questioned the AMA on their support of the reform bill, yet other testifiers commended the AMA for taking a leadership role in the health care reform debate. The results of the testimony Ken Crabb, M.D., Blanton Bessinger, M.D., Ron concluded with a 14-part resolution on Hansen, M.D. and Dave Thorson, M.D. enjoy time together in Houston, Texas.

health system reform that restates, strengthens and expands existing AMA policy.

Other EMMS physicians who attended include Blanton Bessinger, M.D., Ken Crabb, M.D., Dave Thorson, M.D. and Laura Dean, M.D.

Ron Hansen, M.D. and Sue Schettle attend a breakfast meeting at the AMA meeting.

WMMS Awards Hoban Scholarships The Thomas W. and Mary Kay Hoban Scholarship was established by the West Metro Medical Foundation in honor and recognition of the extensive and exemplary career of the 25-year Chief Executive Officer of the then Hennepin Medical Society, Thomas W. Hoban and his wife, Mary Kay, a nutritionist. Since that time, over 80 scholarships have been awarded to students pursuing graduate level education in health care management/administration as well as nutrition. The original intent of the Hoban

Scholarship was to sunset this offering after 10 years. Now, 15 years later, the final cohort of scholars has been selected: • Meredith (Meg) Bruening, Nutrition (Ph.D.), University of Minnesota • Carissa Glatt, Public Health Nutrition, School of Public Health, University of Minnesota • Paula Halverson, Health Care MBA, University of St. Thomas

• •

•

• •

2009 Hoban Scholars and representatives from the Selection Committee. Pictured from left, back row: Bonnie Francisco, Dana Quinn (scholar), Carissa Glatt (scholar), Tim Signorelli, Paula Halverson (scholar), William Petersen, M.D., Paul Hamann, M.D., chair. Front row: Richard Frey, M.D., Rebecca Sanchez, Cassandra Silveira (scholar), Lakmini Nanayakkara-Kidder (scholar), Elizabeth Sauer (scholar), Jamie Stolee (scholar). Scholar not pictured: Meredith Bruening.

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January/February 2010

Lakmini H. Nanayakkara-Kidder, Health Care MBA, University of St. Thomas Dana Quinn, Master of Healthcare Administration, Master of Business Administration, University of Minnesota School of Public Health and Carlson School of Management Elizabeth Sauer, Public Health Administration & Policy Masters Program, University of Minnesota School of Public Health Cassandra Silveira, Masters in Nutrition, University of Minnesota Jamie Stolee, Health Care MBA, University of St. Thomas

Thank you to the Hoban Scholarship Selection Committee: Paul R. Hamann, M.D., chair; Paul Bowlin, M.D.; Richard Frey, M.D.; Bonnie Francisco, clinic administrator; Thomas and Mary Kay Hoban; Virginia Lupo, M.D.; Darla Morris-Preble, R.N, clinic administrator and former Hoban Scholar; William R. Petersen, M.D.; Rebecca Sanchez, former Hoban Scholar; Marvin Segal, M.D.; Doug Shaw, former clinic administrator; Timothy Signorelli, clinic administrator; and Christine Taddy-Bloom, former Hoban Scholar.

MetroDoctors

The Journal of the Twin Cities Medical Society

Charles L. Murray, M.D. Receives Charles Bolles Bolles-Rogers Award

The nomination for Dr. Murray described him as an outstanding clinician and oncologist, epitomizing what a physician stands for. Although now retired, he spent his medical career dedicated and

devoted to his patients, often making arrangements for home visits. He had a strong passion for teaching as evidenced by always working with medical students and residents. This commitment to education and his influence on many young physicians was acknowledged as he received the Distinguished Teacher of the Year award. He is known as a tremendous innovator of care – always looking for new, better ways of enhancing patient care. He was instrumental in developing the tumor registry used throughout the state and region (The Up- On behalf of the West Metro Medical Society and Park Nicolper Midwest Oncology Registry let Methodist Hospital Medical Staff, Steven Duane, M.D. Charles Murray, M.D. with the Charles Bolles BollesSystems or “TUMORS”), pro- presents Rogers Award. viding a resource for research opportunities and benefitting patient care. The clinical research programs (CCOP) for many of ATTENTION all Minnesota the west metro areas as well as the Cancer Program Physicians Residing in at Methodist Hospital were established through his vision and Naples, Florida leadership. He was one of the most insightful people regarding computerized medical records.

He is a leader in medicine, in8th Annual Minnesota volved in many boards and has Health Care Dinner Party received many awards.

The West Metro Medical Society Board of Directors has the honor of selecting the award recipient from the nominations submitted by medical staffs of the west metro area hospitals.

Edward Ehlinger, M.D. WMMS president, introduces the CBBR Award recipient.

Photos by: George Byron Griffiths

MetroDoctors

The Journal of the Twin Cities Medical Society

Monday, March 15, 2010 Pelican Marsh Golf Club, Naples, Florida Cocktails: 6:00 p.m.

Dinner: 7:00 p.m.

Cost: $55.00 per person (estimated) Spouse/guest invited If you are planning to be in Naples at that time, please contact Thomas W. Hoban with your Naples address at (239) 948-4492 or th8159@earthlink.net

January/February 2010

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W e st M e t r o

Charles L. Murray, M.D. was presented with the Charles Bolles Bolles-Rogers Award at the Park Nicollet Foundation Celebration of Life event on Saturday, October 3, 2009.

The Charles Bolles Bolles-Rogers Award was established in 1951. Mr. Bolles-Rogers served on the St. Barnabas Hospital Board of Trustees and was president of that Board for many years. Originally called the St. Barnabas Bowl, an engraved sterling silver Revere Bowl is given to a physician in recognition of his/ her professional contribution to medicine on the basis of medical research, achievement or leadership. The West Metro Medical Society serves as the guarantor of the award.

Edward Ehlinger, M.D., president, West Metro Medical Society, presented the award to Charles L. Murray, M.D. highlighting the following accomplishments.

WMMS Board of Directors Celebrate the End of an Era OH WHAT A NIGHT! The WMMS board of

directors held its fi nal meeting on Thursday, October 22, 2009 marking the end of the West Metro Medical Society and the beginning of the Twin Cities Medical Society. Edward Ehlinger, M.D., president of WMMS, presided over the celebration of the term of Richard D. Schmidt, M.D., out-going chair and the board members as they complete their service to the medical society. Jack Davis, CEO, was also recognized as he retires from this position at the end of the year.

Frank Rhame, M.D. was selected as the third recipient of the First A Physician Award, recognizing his passionate work on HIV/AIDS (see related article). The evening concluded with an outstanding presentation by Scott Hillstrom, Esq., founder and chairman, The HealthStore Foundation, on the work of his charitable organization operating a franchise network of 85 medical clinics serving

Benjamin Whitten, M.D., MMA president and TCMS member, addressed the WMMS Board and guests.

28

January/February 2010

Thank you to board members completing approximately 50,000 of the world’s poorest their service: people each month in East Africa.

J. Paul Carlson, M.D. Dr. Ehlinger addressed the board noting Laurie Drill-Mellum, M.D. that in addition to the pending merger with Brian Henjum, M.D. the East Metro Medical Society, 2009 has seen J. Riley McCarten, M.D. our public health efforts focus on a local calorie Gregory Pfl aster, M.D. labeling policy and trans fat phase-out in MinKarin Tansek, M.D., West Metro Trustee neapolis food establishments. WMMS has also Trish Vaurio, WMMA representative joined EMMS in an exciting new initiative, an David Walcher, M.D. advance care planning project called “Honoring Choices Minnesota,” modeled after a successful program in La Crosse, WI. And, the medical society continues to be a strong advocate for the profession through active advocacy at the Capitol along with the EMMS, MMA, the Minnesota Group management Association and the Minnesota Provider Coalition, and for our patients with aggressive work in the public health arena.

Edward Eh- Edward Ehlinger, M.D. presents the WMMS Chair's Award to linger, M.D. has Richard Schmidt, M.D. been selected as the fi rst president of the Twin Cities Medical Society, beginning January 2010. Incoming board members of TCMS from the west metro include: Edwin Bogonko, M.D.; Carl Burkland, M.D.; Eric Christianson, M.D.; Melanie Fearing, medical student representative; Kenneth Kephart, M.D.; Paul Kettler, M.D.; Stephen MacLeod, BDS, MB ChB; and Chad Roline, resident representative. Sue Schettle, CEO of the East Metro Medical Society, will serve as the fi rst CEO of the Twin Cities Scott Hillstrom, Esq., founder and Medical Society.

chairman, The HealthStore Foundation, discussed the work of his charitable organization serving East Africa.

MetroDoctors

The Journal of the Twin Cities Medical Society

Frank S. Rhame, M.D. Receives First A Physician Award

F

MetroDoctors

W e st M e t r o

rank S. Rhame, M.D. was presented with the First A Physician Award by the West Metro Medical Society at their annual Board of Directors meeting on October 22, 2009.

The “First A Physician” award recognizes a member of the West Metro Medical Society who exemplifi es the profession of medicine.

The work of this “unsung hero” has resulted in an outstanding contribution to community and/or the governance and success of the West Metro Medical Society. Community service, work on public policy issues, or other noteworthy volunteer service contributing to improving the health of the population defi nes the leadership and commitment to medicine by this individual.

In presenting this award, Jack Davis stated that “Dr. Rhame truly embodies the humanitarian spirit of the award. An infectious disease specialist, Dr. Rhame has focused his career on researching and caring for patients with HIV/ AIDS. In addition to working on HIV in the United States, he is also a well-traveled humanitarian. In the past seven years, Dr. Rhame has participated in activities on infection control and AIDS care in Russia, Ukraine, Kenya and India, working for such organizations as the American International Health Alliance, Children’s HeartLink, Medical Advocates for Social Justice, Nairobi Hospital and Universal Aid for Children, Inc.” Dr. Rhame is an adjunct professor in the infectious disease section of the University of Minnesota School of Medicine and an adjunct associate professor in the epidemiology division of the University of Minnesota School of Public Health. He is currently the research director of Clinic 42, a private HIV outpatient clinic at Abbott Northwestern Hospital, and is a practicing infectious diseases specialist with The Doctors, a branch of the Allina Medical Clinic in Minneapolis. He is also a member of the core curriculum faculty for the American Academy of HIV Medicine, and a medical advisor for the Midwest AIDS Training and Education Center, where he has organized educational programs on HIV for health care professionals since 1992.

Frank Rhame, M.D. receives 2009 First a Physician Award presented by Edward Ehlinger, M.D. (left) and Jack Davis (right).

The Journal of the Twin Cities Medical Society

The Lawyers & Lobbyists

That Doctors Trust Lockridge Grindal Nauen helps our health care clients meet the challenges posed by today’s rapidly changing health care environment. The firm’s attorneys and lobbyists provide representation in: •Government relations.

•Litigation and administrative law.

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612-339-6900 www.locklaw.com Legal Innovators. Government Advocates.

January/February 2010

29

SAVE THE DATE

100

WMMS Alliance 100th Annual Meeting & Celebration Sunday May 16th, 2010 Interlachen Country Club 1:30 - 4:00 p.m.

The WMMSA 100th Annual Meeting committee is planning an afternoon brunch, annual meeting and program to honor West Metro Medical Society Alliance (formerly Hennepin County Medical Auxiliary) past and present members for their 100 years of enduring volunteerism to promote a healthy community.

Please mark your calendars now so you don’t miss this special celebration!

Career Opportunities

CAREER OPPORTUNITIES

Introducing the “Career Opportunities” section of MetroDoctors!

A great avenue for professionals to learn about job opportunities AND a perfect place for recruiters to promote openings!

Recruiters, call for our special recruitment rate.

Betsy Pierre, ad sales 763-295-5420 betsy@pierreproductions.com 30

January/February 2010

see Additional Career opportunities on page 32.

The Mankato Clinic, is recruiting for the following BC/BE primary care physicians to join our well-established practice in the region’s leading multi-specialty group:

• • • •

Family Practice Hospitalist Internal Medicine Pediatrics

The Mankato Clinic is physician owned with a service area population of over 300,000. We offer outstanding benefits including generous CME allowance, health/disability/life and medical malpractice insurance, 401(k) plan and more.

Mankato has exceptional recreational and cultural activities, excellent private and public school systems and Minnesota State University, Mankato.

If you would like to join our growing practice, submit a detailed CV or call Mark S. Matthias, M.D., Chief Medical Officer at 507-389-8756 or Dennis Davito, Director of Provider Placement at 507.389.8654, Fax: 507.625.4353, Email: ddavito@mankato-clinic.com.

MANKATO CLINIC An AAAHC-accredited Clinic • www.mankato-clinic.com

MetroDoctors

The Journal of the Twin Cities Medical Society

MetroDoctors

The Journal of the Twin Cities Medical Society

January/February 2010

31

CAREER OPPORTUNITIES

Please also visit www.metrodoctors.com for Career opportunities.

Southside Community Health Services Join a team of caring individuals, providing quality healthcare to a culturally diverse patient population.

Southside Community Health Services is seeking Full-time/ Part-time Family Practice Physicians to work in our family practice/community clinic locations in St. Croix. We provide a full range of medical services, including OB care, to the underserved community. Practice is clinic based only, with weekends and holidays off. Great benefits and salary with paid malpractice. Applicants may qualify for student loan repayment programs.

Please fax or email resumes to: Human Resources Telephone: 612-821-2798 Fax: 612-821-2818 Email: humanresources@southsidechs.org

Family Practitioner • •

Family Practitioner/OB Family Practitioner – Med/Peds

Open Cities Health Center (OCHC) has an opening for the positions above. We would like to have these position filled by January 2010. OCHC provides cost-effective, quality health care to patients from a wide range of socioeconomic backgrounds and ethnic groups. We have been in existence since 1967 providing culturally competent primary and preventive health care and related services to all people throughout the Twin Cities Metropolitan Area.

Candidates must have demonstrated ability in the provision of primary medical care within the bounds of the specialty; strong personal and professional communication skills; knowledge of and desire to work within a public health/community medicine model of service delivery and; respect and concern for patients regardless of economic status, race, gender, ethnic background or disability.

Minimum qualifications: current Minnesota licensure; graduate from an accredited school of medicine; board certified or eligible and a; strong community health/public health orientation.

Salary is negotiable depending upon experience and qualifications. Cover letters and CV may be submitted via fax, e-mail or mailed to:

Lashell Barnes, Human Resources Manager Open Cities Health Center, Inc. 409 North Dunlap Street, St. Paul, MN 55104 651-290-9211 / 651-290-9210 (fax) lashell.barnes@ochealthcenter.com

Great Partners, Great Staff, Great Patients, Excellent Income & Lifestyle Family HealthServices Minnesota, P.A. is looking for several Board Certified/Eligible Family Physicians to fill full-time, part-time or shared positions.

Join our Independent Group of 64 physicians serving 13 clinic sites.

FOR MORE INFORMATION PLEASE CONTACT:

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

32

January/February 2010

MetroDoctors

The Journal of the Twin Cities Medical Society

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University of minnesota

c o n t i n u i n g m e di c a l e du c ati o n

Upcoming CME Courses www.cmecourses.umn.edu Primary care

aLSO OFFereD

cardiac arrhythmias: an interactive Update for Primary care april 2, 2010 Learn the recognition, evaluation and treatment of common heart rhythm problems from experts in Cardiology and Cardiac Electrophysiology

World Symposium (Lysosomal Disease Network) February 10 – 12, 2010 (Miami, FL) Manage and understand diagnostic options for patients with lysosomal storage diseases, and identify the latest findings in the natural history of these diseases

allergy and clinical immunology april 9, 2010 New clinical strategies for diagnosis and management of allergic conditions Family medicine may 12 – 14, 2010 Update on common topics and on infection & respiratory, cancer, and common hospital and ER topics

SUrGery Lillehei cardiology Symposium april 19 – 20, 2010 Designed to serve the cardiovascular educational needs of all clinicians who care for patients with diseases of the heart and blood vessels Bariatric education Day may 27, 2010 An overview for maximizing success with bariatric surgical procedures, while minimizing complications and readmissions advances in Hepatic, Biliary, and Pancreatic Surgery June 2 – 5, 2010 Top US surgeons will provide comprehensive updates on Hepatic, Biliary, and Pancreatic Surgery

advanced Pediatric Dermatology may 14, 2010 Updates on enhancing skills in the recognition and management of common and selected dermatologic problems seen in pediatric patients Topics and advances in Pediatrics 2010 June 10 – 11, 2010 Practical approaches in Pediatrics, Clinical Pearls, Special Lectures, Clinical Roundtables Workshops in clinical Hypnosis June 10 – 12, 2010 Instruction in the theory and application of hypnosis in a clinical setting Free on-line courses available for cme credit are listed below. Visit cme website at www.cme.umn.edu.

• • • • • •

Fetal Alcohol Spectrum Disorders (FASD) Heart Failure in Children Supraventricular Tachycardia in Children Dyslipidemia in Children Congenital Adrenal Hyperplasia Reducing Recurrent Preterm Birth

All courses are held in the Twin Cities unless noted

Office of continuing medical education 612-626-7600 or 1-800-776-8636 www.cme.umn.edu email: cme@umn.edu