MMA Proposed Governance Changes by Advocates for Better Health

It’s time to see beneath the surface. September 8–10, 2013 http://www.mayo.edu/transform/

Contents VOLUME 15, NO. 3

Index to Advertisers

In thIs Issue

M AY / J U N E 2 0 1 3

Governance, Membership and Engagement By Peter Dehnel, M.D.

PresIdent’s Message

Let Your Voice Be Heard By Edwin N. Bogonko, M.D.

tCMs In aCtIon

By Sue Schettle, CEO

Page 9

letters PersPeCtIves

•

Member Input Critical to MMA’s Mission By Dave Thorson, M.D.

•

Race for Relevance: 5 Radical Changes for Associations: Executive Summary

•

History of MMA Actions Regarding the House of Delegates and the Board of Trustees with Personal Commentary By Lyle Swenson, M.D.

•

Colleague Interview: A Conversation With: Michael Ainslie, M.D.; Benjamin Chaska, M.D.; Stuart Cox, M.D.; Ronnell Hansen, M.D.; Carolyn McClain, M.D.; Douglas Pryce, M.D.; and Thomas Siefferman, M.D.

Page 25

•

A Guide to Writing Resolutions

•

Sample Form for Resolutions

New Members

Twin Cities Obesity Prevention Coalition Kicking Off 2013 with a Bang By Jennifer Anderson, MA

East Metro Medical Society Foundation Update

West Metro Medical Foundation Staying True to its Mission

In Memoriam

Career Opportunities

luMInary of twIn CItIes MedICIne

Paul F. Bowlin, M.D. Page 32 MetroDoctors

2013 MMA Annual Meeting

The Journal of the Twin Cities Medical Society

On the cover: This issue is dedicated to educating TCMS members about the proposed changes to the MMA governance structure to be voted on in September. Read all about it!

May/June 2013

Doctors MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY

Physician Co-editor Lee H. Beecher, M.D. Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Gregory A. Plotnikoff, M.D., MTS Physician Co-editor Marvin S. Segal, M.D. Physician Co-editor Richard R. Sturgeon, M.D. Physician Co-editor Charles G. Terzian, M.D. Managing Editor Nancy K. Bauer Assistant Editor Katie R. Snow TCMS CEO Sue A. Schettle Production Manager Sheila A. Hatcher Advertising Representative Betsy Pierre Cover Design by Outside Line Studio MetroDoctors (ISSN 1526-4262) is published bi-monthly by the Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. Periodical postage paid at St. Paul, 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.

May/June Index to Advertisers

TCMS Officers

President: Edwin N. Bogonko, M.D. President-elect: Lisa R. Mattson, M.D. Secretary: Carolyn McClain, M.D. Treasurer: Kenneth N. Kephart, M.D. Past President: Peter J. Dehnel, 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, Associate Director, and Managing Editor, MetroDoctors (612) 623-2893 nbauer@metrodoctors.com Andrea Farina, Executive Assistant (612) 623-2885 afarina@metrodoctors.com Barbara Greene, MPH, Community Engagement Director, Honoring Choices Minnesota (612) 623-2899 bgreene@metrodoctors.com Katie R. Snow, Project Coordinator (612) 362-3704 ksnow@metrodoctors.com Kristine Stevens, Project Coordinator (612) 362-3706 kstevens@metrodoctors.com For a complete list of TCMS Board of Directors go to www.metrodoctors.com.

Billing Buddies MN .........................................12 Crutchfield Dermatology.................................. 2 DMG Financial Group ...................................10 Fairview Health Services .................................31 Healthcare Billing Resources, Inc. ...............29 Lockridge Grindal Nauen P.L.L.P. ...............30 Minnesota Epilepsy Group, PA ....................13 MMIC ................................ Outside Back Cover Saint Therese.......................................................27 Transform 2013 (Mayo Clinic).................... Inside Front Cover Uptown Dermatology & SkinSpa................30 Winona Health ..................................................31

Crutchﬁeld Dermatology “Remarkable patient satisfaction from quality service, convenience and excellent results”

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.

Exceptional Care for All Skin Problems

Charles E. Crutchﬁeld III, M.D.

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. Advertisements published in MetroDoctors do not imply endorsement or sponsorship by TCMS. 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.

May/June 2013

Board Certiﬁed Dermatologist

Psoriasis & Acne Specialist 1185 Town Centre Drive Suite 101 Eagan, MN 55123

Your Patients will Look Good & Feel Great with Beautiful Skin.

Appointments 651-209-3600

www.CrutchﬁeldDermatology.com

MetroDoctors

At your request, we have same day appointments available for your patients with acute skin care needs.

The Journal of the Twin Cities Medical Society

IN THIS ISSUE...

Governance, Membership and Engagement

WHAT SHOULD THE GOVERNANCE STRUCTURE of the Minnesota Medical Association look like? This edition of MetroDoctors focuses on the proposed governance changes for the MMA. The proposal was launched last summer as a means to improve the operational effectiveness of the organization and improve its interaction with members. A first step in the process — reduction of the MMA board size — was adopted at the last annual meeting. This will likely be reopened for debate and a vote at this year’s MMA annual meeting in September — so plan now to attend and strongly consider being a delegate. The genesis for the proposed structure is contained within the book, Race for Relevance: 5 Radical Changes for Associations (2011) by Harrison Coerver and Mary Byers. A short summary of that book is included in this edition on page 9. Articles included to help put this issue in perspective: a succinct history of MMA actions, written by Lyle Swenson, M.D., MMA past president, which helps to put this current proposal in context of the traditions of the MMA. A commentary on behalf of the MMA is written by Dave Thorson, M.D., current chair of the MMA’s Board of Directors. The “Colleague Interviews” provide input from seven physicians all of whom have served as MMA delegates, and many in leadership positions. Some names you might recognize: Michael Ainslie, M.D., Ben Chaska, M.D., Stuart Cox, M.D., Ron Hansen, M.D., Carolyn McClain, M.D., Doug Pryce, M.D., and Thom Siefferman, M.D. Complementing this issue, Marv Segal continues to enhance our knowledge of pillars of the medical community with his “Luminary” of Paul Bowlin, M.D. To help put the proposed governance changes in an even larger context, consider how our national medical societies approach governance, membership and engagement. Here is a very brief summary of the American Academy of Pediatrics (AAP) and the American Medical Association (AMA). “Messy democracy” is a term used to describe the resolution process at the AAP’s recent Annual Leadership Forum. Each March, the AAP holds what is essentially its “house of delegates” meeting, to debate and vote on a host of resolutions submitted over the previous year. There are three reference committees into which

By Peter Dehnel, M.D. Member, MetroDoctors Editorial Board

MetroDoctors

The Journal of the Twin Cities Medical Society

these resolutions are divided for discussion, input and refinement before the final voting by the full assembly at the meeting. The resolutions that are accepted are considered “advisory” to the AAP’s Board of Directors. The assembly even votes on its “top 10” resolutions to convey a sense of prioritization to the Board. There are 207 voting members who represent the 60,000 members of the AAP. The AMA also has a similar representative process working on behalf of its members. There are reference committees that consider proposed reports and resolutions prior to voting by the full House of Delegates. The house of AMA delegates vote at two meetings through the year on resolutions submitted for consideration. The reports and resolutions that are adopted carry more weight in terms of implementation for the AMA. Most importantly, it does provide for extended member input. There are a total of 524 delegates that represent the 220,000 members of the AMA. In both of these national organizations, the resolution process is essential to reflect the current and important issues of the membership. The reference committees provide very rich input into the final “product” of this process — the resolutions. It is not precise, however, and can even seem awkward and inefficient — truly messy democracy. Membership and member engagement are two separate, but closely related, concepts. An organization needs to have the right governance structure to achieve the goals and objectives of the organization. These may include a goal for membership levels and also a measurable goal for the levels and types of member engagement. Reaching these goals and objectives are even more challenging for medical organizations at this time, given the seismic changes currently happening in health care and health care insurance. Regardless of your opinion of the proposed governance changes for the MMA, your engagement is essential to coming up with the best outcome for physicians in this region. Please contact Sue Schettle or Nancy Bauer at TCMS if you are looking for ways to get more involved in this and other issues. Thank you in advance for your participation! May/June 2013

President’s Message

Let Your Voice Be Heard EDwiN N. BOgONkO, M.D.

SPRING OF 2013 IS UPON US and it is hard not to think of all that lies ahead. A health care

landscape that is changing and likely to present us with new beginnings including a health insurance exchange and migration to various total cost of care models. As a profession, we face an ever-dwindling number of independent physicians who have been the pillar of our society’s membership. In this issue, we invite you to participate in the discourse surrounding proposed changes to the MMA governing structure. For many, it is unclear what those changes mean yet, for some, change is inevitable and indeed welcome. As these discussions move forward, it is important to take a look back to understand our history and the legacy our forefathers handed down. In reviewing TCMS history, I noted that our precursor — the St. Anthony and Minneapolis Union Medical Society was formed on June 20, 1855 marking the beginning of the oldest medical organization in continuous existence in the state of Minnesota — one year older than the MMA. The purpose of our creation was to cultivate the science and art of medicine, promote the interchange of professional experience, encouragement of professional zeal and the promotion of a friendly feeling among its members. One remarkable St. Paul leader was Eduard Boeckmann, M.D. He is best remembered for his undying devotion to his profession and the Society. He developed catgut absorbable suture technology and was to later endow proceeds to the library of RCMS to the latter’s unquestionable prosperity. He died in 1926 at the age of 79. His determination to ensure a library for the RCMS members was a testament to the unrelenting principle of physician leaders of their time — that the elements that underlie the best medical care then (and now) were “education, practice qualification, a library to share gathered knowledge and a membership organization to hold all things together.” In an op-ed written in 1995, John Coleman M.D. opined that “the leaders gone before us left behind legacies that we thoughtlessly leave to a few officers to preserve for us rather than taking up the privilege of offering our own ideas and labors. We have an obligation to do better, to help regulate ourselves, support care delivery systems designed to better the care our patients get as well as continue to retain a position of honor and esteem in our communities.” In these changing times, it has become even more imperative that we, in organized medicine, take responsibility to see that we adapt to a changing social structure in such a way that we preserve the best of our practice to the benefit of our patients … to honor those before us who contributed valuable time and material resources to ensure our profession thrives. The changes being proposed by the MMA are as profound as they are groundbreaking — challenging history with a hopeful but unproven redial to a new paradigm of organized medicine, with little time for reflection. Many of you have raised valid questions. For example, as proposed, the House of Delegates ceases to be the policy making arm of the MMA with its obituary carefully written; the MMA board will shrink to more than half its current size and its composition a hoped for balance between representation and competency; MMA officers will craft policy more and more and it is unclear what oversight the membership will be entitled to of both the board and of employed staff of the association. What there may be no debate about is the introduction of listening sessions and policy forums to engage members in matters of importance to our profession. The question, however, may well be why haven’t we had these avenues available to the members in the first place. Nevertheless, should the House of Delegates be abolished or phased out over time until the suggested mechanisms have been validated? I am very well aware that the proposed changes are a result of ongoing apathy among physicians toward organized medicine, dwindling membership and poor attendance at the House of Delegates (HOD) — the (Continued on page 10)

May/June 2013

MetroDoctors

The Journal of the Twin Cities Medical Society

tCMs In aCtIon SUE A. SChETTLE, CEO

TCMS Board Discusses MMA Governance Proposal

The TCMS Board of Directors April 2013 board meeting was dedicated to discussing MMA’s governance changes. TCMS is the largest component medical society of the MMA and therefore we felt that serious consideration should be given to educating and engaging the TCMS Board of Directors about the proposed changes that will come up for a vote in September. The outcome of the April 2013 board meeting will be shared with MMA leadership. Consultant Tim Signorelli was engaged to assist in the facilitation of the discussion. Resolutions Due

It’s not too late to submit a resolution for consideration by the TCMS Caucus and the MMA House of Delegates. Resolutions must be received by Monday, May 20 (email to nbauer@metrodoctors.com). Attend the TCMS Caucuses on Wednesday, June 5, 6 p.m. and Monday, September 16, 6 p.m. Lastly, attend the MMA House of Delegates, Friday-Saturday, September 20-21. Contact Nancy Bauer

for more information. Honoring Choices Minnesota

The Honoring Choices Minnesota initiative continues to move full steam ahead with multiple moving parts on any given day. Many community presentations have been given across the state by staff and volunteer “Ambassadors.” An additional 30 individuals have been trained to facilitate discussions with family members about end-of-life care preferences. Another training program will be held later in the year. Kent Wilson, M.D. and Barbara Greene have been working with key stakeholders to develop three continuing medical MetroDoctors

education e-learning modules that can be used in Minnesota and other parts of the country. I have been spending my time developing a business model with the eye toward sustainability of the program for years to come. And Savage Makes Three!

Jennifer Anderson, project coordinator for the work of the Twin Cities Obesity Prevention Coalition is pleased to report that Savage has become the third city to adopt a Healthy Eating Active Living resolution, approved at a recent City Council meeting. TCOPC has an aggressive 2013 planned and is optimistic that a whole host of other cities will jump on board with Eagan, Eden Prairie and Savage. See related story on page 25. TCMS Legislative and Policy Committee

The TCMS Legislative and Policy Committee meets on a monthly basis. Meetings with the top 15-key health care leaders are being scheduled and TCMS physicians serving on the committee have been asked to testify at hearings related to raising the tobacco tax. On April 10, 2013 Peter Dehnel, M.D. chair of the TCMS Legislative and Policy Committee and I met with Senator Melisa Franzen (DFL-49). Senator Franzen is the vice-chair of the Senate Finance Health and Human Services

Committee and is a supporter of continued funding for graduate medical education programs which aligns with one of TCMS’ legislative priorities. Dr. Dehnel and I discussed TCMS’ support of increasing the price of tobacco through a tobacco tax as well as the importance of funding the Statewide Health Improvement Program among other issues. Peter Dehnel, M.D. also met with Deputy Minority Leader Representative Jim Abeler (R 35A) on Tuesday, April 2, 2013. Tyler Winkelman, M.D., member of the TCMS Legislative

and Policy Committee met with DFL Majority Leader Representative Erin Murphy (DFL 64A) in March.

Senior Physicians Association

The 2013 Senior Physicians Association luncheon events are posted online with the first luncheon scheduled for Tuesday, May 7. Carol Falkowski will be the guest speaker discussing the Minnesota drug scene. Visit our website, www. MetroDoctors.com for more information on all the events and how to join the Senior Physicians Association. Don’t miss out enjoying lunch with colleagues and hearing fantastic speakers. We hope you are able to join us!

Peter Dehnel, M.D. chair of the TCMS Legislative and Policy Committee and TCMS CEO Sue Schettle (right) met with Senator Melisa Franzen (DFL-49).

The Journal of the Twin Cities Medical Society

May/June 2013

LETTERS

This letter is a request that the MMA convene a meeting with the Minnesota Nurses Association, the Minnesota Academy of Physicians Assistants, the Minnesota Academy of Family Physicians, the Minnesota branch of the American College of Physicians and perhaps a patient advocacy group to define the appropriate levels of training and certification necessary to provide acceptable primary care to Minnesota patients as well as develop parameters and a definition of exactly what entails “primary care.” It is not intended to criticize anyone or any group. Presently there at least four types of professionals all providing “primary care” — broadly and loosely defined. Therefore, there is either a requirement of an excessive level of training for some of these providers or an inadequate level of training for others in order to provide appropriate and effective care for the patients. The other possibility is that the definition of primary care is too broad. There are Physician Assistants, Nurse Practitioners, Family Practice Doctors, and Doctors of Internal Medicine essentially serving the same or similar functions. The training required for these providers ranges from six to seven years of post-secondary study to 10-11 years of study. The Family Practice specialty training began at Duke University in 1965 as the result of the feeling that the “General Practitioners, (GP), with nine years of post-secondary training was inadequate to meet the medical needs of the increasing complex patient. Initially, they were trained to care for the entire spectrum of patients from infancy to old age — deliver babies, care for fractures, and even perform some surgical procedures. When the Family Practice doctor needed more “advanced” help, he or she 6

May/June 2013

consulted a surgeon or a specialist of Internal Medicine. The Internal Medicine specialists were trained to manage the care of cardiac, neurological, pulmonary, nephrology, endocrine, infectious problems along with other “medical” problems. Over the years, pregnancy care and deliveries have been taken over by the Obstetrician. Few if any Family Practice doctors can afford the malpractice coverage required of physicians performing obstetric work and most hospitals would not accept the liability of allowing anyone other than an Obstetrician to deliver babies. The ones who are still performing this service are dwindling and their replacements are not being trained. The same scenarios apply to some extent for fracture care, Pediatrics and Surgery. A similar process has developed with Internal Medicine. Subspecialists such as Cardiologist, Neurologist, Nephrologist, Endocrinologist and others have displaced their specialty. Thus the Internists are now adult “primary care” doctors as well. Many of the female patients prefer to receive their “primary care” from their Gynecologist or commonly their female Gynecologist Nurse Practioner or Physician Assistant. Nurse Practitioners and Physician Assistants provide much of what is labeled “primary care” throughout the country. In fact more than half of the states allow Nurse Practitioners to function independent of any physician allowing them to prescribe medication, order and interpret laboratory and radiographic studies. The issue even becomes more cloudy when one adds the function of Geriatricians, “Alternative or Holistic” providers or, as has been suggested in a

recent Los Angeles Times article, Optometrists and Pharmacists, as “primary care providers.” There has also been a recent development in Minnesota of utilizing EMTs to “monitor and assess” patients in their own homes. If someone such as myself with a medical degree is confused by this plethora of “providers” and their “scope of practice,” I cannot help but believe that clinic administrators, insurance provider committees, let alone the patients must be confused as to the appropriate level of care that is indicated and needed. I would, therefore, urge MMA to work with the relevant organizations to define what level of education, training and certification is needed to provide appropriate care to the patients of Minnesota that is safe, effective and at an appropriate cost to the entire system. Let us eliminate the cost to the medical system of requiring excess years of training if they are not required. The “policy makers” are suggesting that many more primary care providers will be needed to provide the growing need. Just what level of training is required and exactly what the scope and expectations of “primary care” is needs to be defined before the plans and funding can be developed to meet this “need.” Respectfully submitted, Dennis J. Callahan M.D., Orthopaedic Surgeon

MetroDoctors

The Journal of the Twin Cities Medical Society

Perspectives

Member Input Critical to MMA’s Mission

magine this scenario: A major health care bill is moving through the U.S. House of Representatives. It will affect constituents in numerous ways both monetarily and in their day-to-day lives. Now, what would happen if when it comes up for a vote only 156 representatives (of the 435 total) show up? There’d be a few repercussions I would imagine. Yet, this is happening each fall with the House of Delegates (HOD) at MMA’s Annual Meeting. We have seats for 275 members but struggle to entice even 100 delegates to show up. Sure, delegates are voluntary and don’t get paid like members of Congress but they do serve a similar role as representatives for a much larger group. Decreasing participation at the HOD is only one symptom of the challenge we face to engaging our members. In addition to overall attendance dropping over the last 10 years: • The delegates who attend are older and less diverse than the membership as a whole. • Surveys of HOD attendees tell us the issues discussed there are not necessarily the most important facing physicians. • We have also heard, too often, that a few loud voices dominate the agenda. • Finally, the issues that are acted on by the HOD do not always align with the strategic priorities that have been identified by our Board of Trustees. Given these signs, it should be clear

that we are not living up to our potential. In order for MMA to remain a vibrant and respected organization we must meet our mission: “To provide advocacy, information, education, and leadership for Minnesota physicians and their patients.” This means we must find ways to ensure we are representing as many Minnesota physicians as possible. Things have to change and that means taking a hard look at MMA’s governance structure. Governance Polarity

MMA is faced with something the association management world refers to as “governance polarity” — balancing two goals that are interdependent and have an ongoing tension between them and the need. For MMA those two polar goals are:

1) the need for nimbleness and efficiency in decision-making with 2) the need for inclusiveness and diversity of perspective. How do we promote member input, while supporting structures that allow quick, strategic decision making? The goal for any association with this governance polarity is to manage it, rather than solve it — to maximize the upsides of both goals while avoiding the downsides. For a governance structure that meets the goals of nimbleness and efficiency the upsides are that it is more focused, strategic, and better situated to respond quickly to emerging and complex problems. The downsides are that it runs the risk of not relating to all members, can result in “group think,” and it puts much more demand on a smaller number of leaders. (Continued on page 8)

“these changes are not about keeping or eliminating the hod. they are about what mechanisms and structures will best position MMa to gather important input from members, will help engage our members in more of what we do, and will allow us to best serve physicians.”

By Dave Thorson, M.D., Chair, MMA Board of Trustees MetroDoctors

The Journal of the Twin Cities Medical Society

May/June 2013

Medical Care Organizations Telemedicine Perspectives Member Input (Continued from page 7)

For a governance structure that meets the goals of inclusiveness and diversity the upsides are that it allows all voices to be heard, it provides more opportunities for participation, and promotes a broader buyin on the final decisions. The downsides of this structure are that it is slower and more inefficient, it dilutes the focus of the organization, and it can be less strategic. In 2012, the HOD discussed a new governance structure that would manage this governance polarity. It acted to restructure the Board of Trustees so that it is smaller and its members are elected based on competencies and characteristics needed to be successful. This would allow it to be focused, strategy-based and able to act quickly to respond to the dynamic world of health care policy. In order to ensure that all voices have the chance to be heard the HOD also discussed creating a new Policy Council comprised of members across the state that would facilitate forums to gather member input and recommend positions to the Board. This would open up the policy discussions to all members of the MMA, not just the few who attend a HOD meeting. It also discussed moving elections for officers, trustees, and AMA delegates to the entire MMA membership. Will This Succeed?

We don’t know for sure if this will be successful but we do know we are not alone in looking at these issues. The Governance Task Force reviewed how other state medical societies are dealing with these challenges. A survey of medical society executives showed that of those states that responded at least 14 have significantly modified their HOD, with seven eliminating their HOD altogether. The discussion of these proposed changes have been very healthy. The 2012 HOD devoted an entire reference committee to this topic and directed the MMA to continue the discussion in 2013. By the 8

May/June 2013

end of the annual meeting, the HOD had approved recommended changes to the Board of Trustees that will restructure its size and composition. We have begun a three-year process for reducing the size of the board from 33 members to between 12 and 14. We are also moving from a board membership that is currently solely based on geography to one that will be based on both geography and identified competencies. This will provide us with a group that is better situated to provide the expertise we need moving forward. Next Steps

The 2012 HOD also directed the MMA to continue discussing governance changes such as member-wide elections, eliminating the HOD and creating a new Policy Council. Plus, the HOD recommended that MMA gather more member input and begin piloting listening sessions and policy forums to determine whether these tools will increase member involvement. A new task force, the Governance 2.0 Task Force, has been appointed to help guide this forward. The new task force includes members from last year’s task force with new members as well. They will gather information, review the issues and bring recommendations to the Board of Trustees and the 2013 HOD for review and action. Critics have argued that these changes are designed to limit member input in MMA policy development. I would argue the exact opposite. Our current structures are not reaching most of our members — especially our younger members. They are not interested in it, they don’t understand it, and they tell us it is not addressing the policy issues that are most important to them. This has to change if we are to thrive. Critics have also said the HOD is nearing sacred status and that eliminating it will remove the best mechanism we have for member input. I agree that we have to encourage, not discourage, member input on important issues. But when we look at the numbers, members are not engaging in the HOD. The proposed listening sessions

and policy forums will prove to be critical pieces in increasing member input. These changes are not about keeping or eliminating the HOD. They are about what mechanisms and structures will best position MMA to gather important input from members, will help engage our members in more of what we do, and will allow us to best serve physicians. We welcome your comments. We value your opinions. We depend on your continued support. Members of the 2012 Governance Task Force: Benjamin Chaska, M.D. (Chair), Beth Baker, M.D., Don Jacobs, M.D., Fatima Jiwa, M.D., Mark Liebow, M.D., Paul Matson, M.D., and Rahul Suresh (Medical Student). Members of the 2013 Governance 2.0 Task Force: Ken Kephart, M.D. (Chair), Beth Baker, M.D., Stuart Cox, M.D., Don Jacobs, M.D., Fatima Jiwa, M.D., Paul Matson, M.D., Robert Moravec, M.D., David Sproat, M.D., and Rahul Suresh (Medical Student). Dave Thorson, M.D. is a family physician in White Bear Lake, Minnesota and a member of the Twin Cities Medical Society. He currently serves as a TCMS Trustee to the Minnesota Medical Association’s Board of Trustees, where he also serves as its Chair.

MetroDoctors

The Journal of the Twin Cities Medical Society

Race for Relevance: 5 Radical Changes for Associations Exective Summary

xcerpted, adapted, and reprinted with permission of the publisher from the book Race for Relevance: 5 Radical Changes for Associations, copyright 2011, by Harrison Coerver and Mary Byers, CAE. The authors’ followup companion book, Road to Relevance: 5 Strategies for Competitive Associations, was published in March 2013. Both books are available at www.asaecenter.org/bookstore and amazon.com. The Imperative for Change

The traditional association operating model — one that’s dependent on direction and decision making by volunteers and supported by members — isn’t working as well as it once did. Most associations are tradition driven, slow and risk averse. They are characterized by offerings of a broad range of programs, services, products and activities. The model is tied to face-to-face interaction through meetings, conferences, conventions and seminars. And although this is changing, most associations still rely heavily on print for publications, communications and information delivery. It used to be that companies automatically joined their trade associations, paid their dues, attended meetings, and volunteered on boards and committees. Professionals naturally joined their professional societies, paid their dues, attended meetings, and volunteered on boards and committees. Life was good. But things have changed. Now professionals expect value and companies demand return for MetroDoctors

their investment. Members are extremely busy, constraining their ability to participate and be involved. Competitors offer programs and services once the sole purview of associations. Members have diverse and conflicting interests and a variety of needs and expectations regarding membership — and there’s a growing gap in these expectations with each succeeding generation. Technology provides members uncountable alternatives and unlimited, immediate access to products and services now more readily available outside the association environment.

The Journal of the Twin Cities Medical Society

While most associations and professional societies are not in immediate danger, they will struggle if they cling to conventional approaches and structures. Trade associations will have members, but they will lose market share and influence. Professional societies will have members, but they will lose relevance as their members’ average age climbs. If they are not careful, they risk going the way of some community and civic organizations. It’s true the Jaycees still exist. The Shriners are still around. The Rotary is still meeting. The Knights of Columbus, the Kiwanas, and the Lions are still here. But as Robert Putnam documented in Bowling Alone, these community and civic organizations and others like them grew and thrived until the 1960s and 1970s, when they began to experience widespread membership declines. Putnam attributed this collapse to four trends: pressures of time and money, mobility and sprawl, television, and generational differences. The trends affecting today’s trade associations and professional societies are similar. As a result, they are in the same race for relevance that many civic and community nonprofits are losing. The associations that will thrive — not just survive — are those that undertake these five radical changes: • Overhaul the governance model and committee operations: Use a small, competency-based board for thoughtful, effective decision making. Put professional association staff in charge of identifying the right volunteers for the right committee and (Continued on page 10) May/June 2013

Medical Telemedicine Perspectives Care Organizations Race for Relevance (Continued from page 9)

•

task force work — and for managing those committees and task forces. Empower the CEO and enhance staff expertise: Take full advantage of staff expertise. Rigorously define the member market: Zero in on the markets you can serve well — and only those markets.

•

Rationalize programs and services: Identify and operationalize only those products and services that reflect your organization’s mission and that your organization can deliver consistently and effectively. Typically this will mean a very narrow line of products and services. Build a robust technology framework: Put in place the framework to support

the delivery of value that was not conceivable in the past. The current association model is based on members coming to the association: coming to conferences and seminars, coming to committee or task force meetings, coming to fundraising events, and coming to trade shows. The technology-based associations will turn this around and take the association to the member. The sequence of change is of major importance in a successful transformation. First, we start with the right governance. Next come decisions regarding the member market that will lead to the right program and product mix. And finally, we focus on determination of the best technologies to deliver the elements of the benefits package. These are radical changes, but they can be accomplished one step at a time.

President’s Message (Continued from page 4)

body charged to set policy direction. At TCMS, we can do more to collaborate with MMA around membership engagement, HOD attendance and the whole premise of promoting TCMS/MMA goals and strategies. What we cannot do is abdicate our responsibility of promoting the ideals of our society, preserving our history and being custodians of a very important tenet — representation and cementing the democratic space so that the voice of every physician will always find its amplitude through the society. As Paul Hawken asserts — “All is connected ... no one thing can change by itself.” As the largest component medical society aligned with MMA, we are stakeholders in a process of change that requires our due participation — one that counts. Let your voice be heard. Or else, we may well be unknowingly propelling ourselves into a race to irrelevance. I encourage all members to attend the MMA annual meeting this fall, on September 20-21. 10

May/June 2013

MetroDoctors

The Journal of the Twin Cities Medical Society

History of MMA Actions Regarding the House of Delegates and the Board of Trustees with Personal Commentary Editor’s Note: Dr. Lyle Swenson has been a delegate to the House of Delegates at the MMA Annual Meeting each year since 1987, and has served as vice-speaker (20072008), speaker (2008-2010), president-elect (2010-2011) and president of the MMA (2011-2012). He is currently immediate past-president. He has written this article to elucidate the recent history leading to the proposed changes to the House of Delegates and the governance structure of MMA.

•

n 2009, the Minnesota Medical Association formed an Annual Meeting Work Group “to review the goals, functions and structure of the MMA Annual Meeting, develop a desired model, and report back to the 2010 House of Delegates.” At the 2010 MMA Annual Meeting, the Work Group presented a resolution, No. 106,1 which summarized their findings and made recommendations to the House of Delegates. Even though these findings addressed mostly delegate interest and participation, with only one statement addressing the resolution and policy setting process, resolution 106 called for a 16 member Resolution Review Committee to take responsibility for ensuring that 1) all resolutions receive careful consideration, 2) resolution authors be contacted to discuss their resolution, 3) resolutions and discussion be posted online, 4) policy themes be identified, and 5) a democratic but streamlined process for resolution consideration be developed. This resolution also called for delegates to be appointed by MMA to increase engagement and attendance at the Annual Meeting, and By Lyle Swenson, M.D. MetroDoctors

that a comprehensive report of the Annual Meeting be published for the membership. This resolution was adopted. The Resolution Review Committee devised and implemented a resolution review process that was initiated prior to the 2011 Annual Meeting.2 In response to this process, members of TCMS submitted a resolution calling for a moratorium on the implementation of resolution 106, including the formation of a new bylaws work group.3 The original resolved of resolution 102 (HOD2011) called for removal of barriers to the submission of resolutions, and reaffirmation of the House of Delegates as the policy creating body of the MMA. This resolution was amended by the reference committee to read as follows: • Resolved, that the MMA continue to refine the resolution review process and report back to the 2012 House of Delegates meeting with an evaluation and recommendations for modifications with proposed bylaws changes, if appropriate, consistent with MMA policy 420.78; and be it further

The Journal of the Twin Cities Medical Society

Resolved, that the MMA continue to explore, through the Governance Task Force, the governance responsibilities of the House of Delegates and the Board of Trustees. This resolution, as amended by the reference committee, was not extracted for discussion on the floor of the House of Delegates, and was adopted as amended. The Governance Task Force, was formed as directed, and its chair gave an update of their work at the MMA Board of Trustees meeting on January 21, 2012. This presentation included a list of governance responsibilities adapted from the National Association of Corporate Directors, and the “Governance Work Group Charge.” This charge, developed by MMA staff, was as follows: Explore the issues of MMA Governance looking at: • the structure of our governing bodies, including the House of Delegates, Board of Trustees, and Executive committee • the role of each group, and • how these roles align with MMA strategic direction Final recommendations will be developed to align our governance with the strategic directions identified through our strategic planning and provided to the MMA House of Delegates in September 2012. The charge developed for the Governance Task Force, and related materials were presented to the Board of Trustees as information only, and no action by the Board of Trustees was requested by the staff or the task force. The members of (Continued on page 12)

May/June 2013

Medical Care Organizations Telemedicine Perspectives History of MMA Actions (Continued from page 11)

the task force appointed, up to that date, were listed in the presentation; none of the eight original authors of the resolution from the Twin Cities Medical Society were included. The House of Delegates is referred to as “outdated” in this presentation. Also included in the presentation at the January 21, 2012 Board of Trustees meeting was the first consideration of the book entitled Race for Relevance, by Harrison Coerver and Mary Byers. This book was recommended to Board members as a resource for how associations can respond to current challenges. In the book, and in the section on governance, there is no mention of a House of Delegates type of structure, and the authors address the governance issue by discussing board and committee structure and function. An update using the same materials, including the charge, was presented with very little change at the March MMA Board of Trustees meeting. Again, no action by the Board was requested. Regarding the House of Delegates, the material

May/June 2013

stated that, in addition to the House of Delegates being outdated, it was “not serving the best interests of MMA,” and that there has been a “legislative model shift to Association Model.” Themes from the book Race for Relevance were discussed, and attendees were divided into small groups for discussion of House of Delegate and Board issues. In his commentary printed in American Medical News in July, 2012, Dr. Steven Stack, chair of the AMA Board of Trustees, referring to the AMA House of Delegates, states that “The House of Delegates truly is a crown jewel within our profession. It is unparalleled anywhere in the nation in its inclusive and comprehensive representation of physicians.” Can there be such a dramatic difference between the MMA House of Delegates and the AMA? A letter was sent on July 9, 2012 by Peter Dehnel, M.D., president of the Twin Cities Medical Society at the time, and George Apostolou, M.D., president of the Lake Superior Medical Society, to Dave Thorson, M.D., chair of the MMA Board of Trustees, expressing concern over changes in governance being proposed by the Governance Task Force and being discussed by the MMA Board of Trustees. They called for more membership involvement in the process. On July 14, 2012 the Governance Task Force made its report to the MMA Board of Trustees. The charge was again restated. Extensive background material was provided regarding the role of governance, stakeholders, governance as leadership, MMA strategy and goals, attributes of the House of Delegates and the Board of Trustees, limitations of the House of Delegates and the Board, and perceived advantages/disadvantages of competencybased versus geographically-based representation on the Board. Recommendations were made for a smaller competency-based Board, three standing committees (Governance, Nominating, Administration and Finance), a Policy Advisory Council of 40 members, idea/opinion forums, and an annual member meeting. The House of Delegates would be eliminated in this proposal, and some of the features, such as being a forum for discussion of issues,

would be replaced by the Policy Council and policy forums, which would be held at least twice a year. In the discussion of attributes and areas for improvement, the question of where policy is established was not addressed. In “ideas for change,” however, when referring to the House of Delegates, the materials state that “Use for advisory/input purposes on strategic issues but not as decision-making body.” There was extensive discussion of the task force proposed changes. The Trustees made a considerable number of recommendations, and initially asked that the task force incorporate these recommendations into a revised proposal. Members of the task force expressed a desire to not revisit their work on the proposal. The Board then approved a motion to have the MMA Executive Committee incorporate the Board’s recommendations into a revised proposal. The action of the Board also called on the Executive Committee to decide whether the revised proposal should be forwarded to the MMA House of Delegates at the 2012 Annual Meeting, and if it did decide to do this, that the revised proposal be reviewed by the Board at its September meeting and that all annual meeting delegates have adequate time to review and discuss the model. One specific recommendation by the Board was to “Pilot policy forums before deciding whether to eliminate the House of Delegates.” However, the revised governance model after action by the Executive Committee reverted back to the original model that called for elimination of the House of Delegates and put responsibility for proposing legislative and regulatory policy, referred to as “external policy,” to the Board of Trustees, while ceding operational policy, referred to as “internal policy,” not to the Board, but to the Governance Committee. Following this action by the Executive Committee on August 6, 2012, a late resolution was crafted,4 and a timeline for implementation was devised. One reference committee at the 2012 Annual Meeting would be dedicated to discussion of the Governance Task Force and Executive Committee’s recommendations and the resolution. The proposal was communicated to the membership by website

MetroDoctors

The Journal of the Twin Cities Medical Society

posting, emails, articles in MMA News and Physician Advocate, and a webinar. In preparation for discussions of Resolution 400, an agenda was published, containing eight major areas for discussion.5 The ensuing testimony in the Reference Committee at the 2012 MMA Annual Meeting showed support for changes that had the potential to make the Board of Trustees more efficient and more accountable to the membership. There was also broad support for increased opportunities for participation and involvement with expansion of the concepts of policy forums and listening sessions. Serious reservations were raised, however, regarding the concentration of decision-making, policy development, and policy-making authority in the hands of a small number of individuals with no accountability to the membership. There was also concern expressed that these same individuals would essentially choose their own successors, and that they might choose like-minded individuals, with no real input from the membership. One of the biggest concerns was that if the House of Delegates was eliminated, the long-standing grassroots, representative nature of the MMA would not be continued, and even though there may be multiple avenues for input and discussion in the future, the ability of physician members not serving on the Board to set policy through the resolution and reference committee process would be irrevocably lost. At the House of Delegates, it is customary for physician leaders to address the delegates, and for the MMA CEO to give a report. At the Annual Meeting last September, the CEO, rather than reporting on the activities of the MMA over the past year, gave a forceful presentation advocating for approval of Resolution 400 as recommended by the Governance Task Force and the Board of Trustees. With the extensive and far-ranging discussion and input at the Reference Committee, the committee amended the resolution to allow changes to the size and composition of the Board of Trustees and to begin piloting the listening sessions and policy discussions, with report back to the House of Delegates in 2013. The MetroDoctors

resolution stated, however, that no further decisions would be made on the future of the House of Delegates until the 2013 Annual Meeting. This amended resolution was adopted by the House of Delegates.6 Personal Commentary:

The physicians of the MMA have known for many years that we face growing challenges of membership, declining participation in many MMA activities, relevance to members, and frustration with certain aspects of the Annual Meeting and how the House of Delegates functions. Serious and sincere efforts have been made to address these challenges. The original resolution 102 in 2011, submitted by physicians of TCMS, was a part of these efforts, and sought to strengthen and improve the resolution process and the policy-making role of the House of Delegates. This resolution was amended by the reference committee, calling on the Governance Task Force to explore the governance responsibilities of the House of Delegates and the Board of Trustees. The charge given to the task force

The Journal of the Twin Cities Medical Society

was to explore how the existing roles of our governing structure align with MMA strategic direction, and to make final recommendations to align governance with strategic direction developed by the Board. This charge directly contradicted the intent of the original resolution. At the meeting of the Board of Trustees in July of 2012, and at the reference committee at the 2012 MMA Annual Meeting, serious reservations have been raised regarding the proposed governance changes, which require further deliberation. What began as an effort to strengthen the representative and democratic nature of our association has led to an effort to concentrate control and decision-making authority within a smaller Board and the committees of the Board. The events referred to here represent a small part of the 160 year history of the Minnesota Medical Association, but how we, the physicians of Minnesota, respond to our current challenges will affect our association, and our profession, for many years to come. References available upon request.

May/June 2013

Medical Care Organizations Telemedicine Perspectives

Colleague Interview: Several TCMS physicians were invited to provide their perspectives on the proposed changes to MMA’s governance structure. • Michael Ainslie, M.D., pediatric endocrinologist, TCMS Trustee to the MMA Board, former chair, MMA Board of Trustees, delegate to the MMA House of Delegates, former president of TCMS; • Benjamin Chaska, M.D., family physician, TCMS Trustee to the MMA Board, chair of the 2012 MMA Governance Task Force, delegate to the MMA House of Delegates; • Stuart Cox, M.D., otolaryngologist, TCMS Trustee to the MMA Board, delegate to the MMA House of Delegates, former president of TCMS; • Ronnell Hansen, M.D., radiologist, delegate to the MMA House of Delegates, former president of TCMS; • Carolyn McClain, M.D., emergency medicine, delegate to the MMA House of Delegates, at-large director, TCMS Board of Directors; • Douglas Pryce, M.D., internal medicine, delegate to the MMA House of Delegates; • Thomas Siefferman, M.D., pediatrics, delegate to the MMA House of Delegates, former president of TCMS.

Michael Ainslie, M.D. You have made the decision to join MMA and TCMS. Why did you make that decision? I joined because my clinic was part of the organized medicine section. I wasn’t active until about 15 years ago when health care reform appeared on the horizon. I felt, and still feel, that it is important to be involved in that.

The attendance numbers for the MMA House of Delegates have steadily been going down over the last 10 years. Do you believe this is because the House of Delegates structure is outdated or is it just a fact that fewer members want to go to meetings today? A little of both. Relevancy is the key. Many feel that what is discussed is not immediately relevant to their practice. We always have to ask the question: How will this decision help a physician’s practice? How do we ensure that we are hearing from members on key advocacy issues when they don’t seem interested in attending the House of Delegates? Listening sessions that may be coming are a way to keep connected in your area.

What would you say to younger physicians who tend not to be joiners as to why they should join MMA/TCMS? What is your “elevator speech” on why to join?

Your specialty helps you in your education. MMA/TCMS helps you in your profession. No one else cares about your practice of medicine.

It has the potential to really help get more physicians — both members and non-members involved. It also has the potential to isolate the governance and staff from the members.

May/June 2013

MetroDoctors

The Journal of the Twin Cities Medical Society

I think the listening sessions will help. I think if done right where everyone is heard it will feel as though more are involved. The resolution process has become bogged down in process, not product.

I think there is truth in both of these statements. The House of Delegates requires you to leave your practice and your home for a number of days. It is expensive to attend. It can be very intimidating with its many arcane rules and structures. And, people and the times have changed. We are all overcommitted. We communicate instantly with our colleagues every day. Waiting to talk to them once a year seems almost an afterthought. And it is a shame. I love the collegiality of the House of Delegates. I really enjoy the repartee. And I am always impressed by the collective intellect and judgment of the House. Together we are able to leverage the best efforts of individuals for excellence of thought, wisdom, charity and character.

How should TCMS help members weigh in on this governance discussion? Open, frank discussions, small trials of these changes with feedback to governance staff, and a willingness to try something new.

Benjamin Chaska, M.D.

How do we ensure that we are hearing from members on key advocacy issues when they don’t seem interested in attending the House of Delegates?

You have made the decision to join MMA and TCMS. Why did you make that decision?

We need to go to our membership. I am intrigued by the potential of our new listening sessions. I would like to see us expand this from a passive activity to one that energizes our members and invites them to higher levels of participation.

I have been a member of organized medicine at all levels since I was in medical school. I was first influenced by a general surgeon who took me to a local surgical society house of delegates. After that I started reading the AMA News and was hooked. Here was a place where physicians could come together to discuss, lead and influence the major issues of our time. What would you say to younger physicians who tend not to be joiners as to why they should join MMA/TCMS? What is your “elevator speech” on why to join? Joining MMA/TCMS provides you with many opportunities to meet your colleagues. It is a place where people really care that you are a physician. It helps you to be involved, know what is going on and most importantly a chance to help shape your future. Being an active member of MMA/TCMS makes you better. You learn and grow personally and professionally through your interactions with your colleagues. MetroDoctors

The Journal of the Twin Cities Medical Society

The supporters of MMA’s new governance proposal have argued that it is needed to find better ways to engage more members on the key public policy issues facing physicians today. Critics see it as removing members from the policy decision making. What do you believe? I think it is very important for the voice of medicine to be heard, whatever the venue! I am saddened to see the long and continuing decline of our members’ interest in attending the MMA House of Delegates. My first preference would be to re-energize the House of Delegates by making participation so compelling that our colleagues would compete to attend. We should do that. And, we should continue to look for better ways to engage our colleagues. Today, most MMA members do not participate in making policy decisions. I think that the listening sessions and policy forums provide new and broader forums for input into policy decision making. Many more physicians will be involved than we have seen recently. I think that the proposed Policy Council model is one way for us to seek input from our membership and will provide an opportunity for a much more diverse audience. We have been speaking of this as an either/or proposition. I think there are ways to make this a both/and opportunity. The (Continued on page 16)

May/June 2013

Medical Care Organizations Telemedicine Perspectives Colleague Interview (Continued from page 16)

model proposed last year kept the Annual Meeting and added the Policy Council, which meets in addition to the Annual Meeting, and also added the policy forums and listening sessions. I see this as an expansion of opportunities for input. Is the resolution process the best way to ensure that MMA addresses the issues that are most important to Minnesota’s physicians and their patients? If not, is there a better way to gather needed member input? The resolution process is a good way for physicians to bring issues forward. It has been around a long time and it brings forward compelling new ideas and causes us to re- examine former assumptions. At its best the resolution process provides an opportunity for a single physician with keen insight, drive, passion and outstanding ideas to move the entire profession. On the other hand, for some, it can be difficult to use and cumbersome. At its worst it can be superficial and a waste of time. I think the listening sessions and policy forums have the potential to enhance member input. The listening sessions are easier to understand and attend. And little preparation is needed. While the policy forums have the potential to lead to deeper understanding and higher quality policy proposals. How should TCMS help members weigh in on this governance discussion? The members of TCMS should be actively involved in discussing the governance of our organization. This is too important to let someone else do. The governance discussion is really about renewal; renewal of the best that the profession has to offer. It is an opportunity to improve on what we have done. It is also an opportunity to evaluate what we have done and to decide to keep it or change it. We need to make our voices heard. We should participate in the listening sessions and policy forums. We should review what is being said and done at the TCMS Board. And we should make sure that the MMA House of Delegates is filled with our colleagues. When this discussion is done we need and deserve to have the very best governance model we can imagine and agree upon. It needs to serve the profession and enable our best thoughts to come forward. It needs to enable us to lead medicine into a better future. It has been a privilege to be a member of TCMS and the MMA. I wish to thank all of my colleagues for all that you do every day and every way for medicine and our patients! 16

May/June 2013

Stuart Cox, M.D. You have made the decision to join MMA and TCMS. Why did you make that decision? For a number of reasons: information, good source of medical legislation, and local/state medical business, collegiality, influence — organized medicine provides the infrastructure for the possibility of legislative change. What would you say to younger physicians who tend not to be joiners as to why they should join MMA/TCMS? What is your “elevator speech” on why to join? Get involved, don’t let things happen to you, find out what is happening and make an effort to influence it. If nothing else you will at least find out what is coming. It is hard for physicians, especially young physicians who have so much on their plate, to give more time. However, there are a lot of powerful forces who want to manipulate us and our patients, they are more than happy to see us roll over. This is part of our job as patient and community advocates. The attendance numbers for the MMA House of Delegates have steadily been going down over the last 10 years. Do you believe this is because the House of Delegates structure is outdated or is it just a fact that fewer members want to go to meetings today? I think both of these are true; the more difficult question is how do we react to this. How do we ensure that we are hearing from members on key advocacy issues when they don’t seem interested in attending the House of Delegates? This is a very difficult and important question. I think the legislative emails are very helpful/informative, but it is difficult to know how widely they are used. The dissolution of the MMA’s Legislative Committee was very unfortunate. It was excellent as a legislative update, but a very poor vehicle for getting membership involved. There was the impression on that committee that all the policy decisions had already been made, and we were there just to hear the reports and rubber-stamp what had been MetroDoctors

The Journal of the Twin Cities Medical Society

proposed by the executive committee. Members, particularly physician members, want to feel they have some influence. If they feel they are not involved in the decision-making they are unlikely to donate their time. This means a lot more work for staff, but is vital for a healthy membership organization. There was a lot of passivity in the Legislative Committee because the members were not empowered — this becomes a self-fulfilling prophecy and disinterest increases. I suspect this is at least part of the failing of the House of Delegates. As a board member, I have seen a number of resolutions get ignored or twisted so they are far from the intent of the author. If members who have done the work of carrying through a resolution feel ignored, they are much less likely to participate. The supporters of MMA’s new governance proposal have argued that it is needed to find better ways to engage more members on the key public policy issues facing physicians today. Critics see it as removing members from the policy decision making. What do you believe? The criticism of the HOD is valid; however, the proposed governance changes are going in the wrong direction. The goal should be to engage and empower the membership. The new structure is OK as far as engagement but there is currently no avenue for empowerment. Shrinking the board makes us more nimble but significantly decreases the sphere of membership influence. The policy forums are a good platform for involvement, but in its current structure there is nothing binding that the new smaller board has to follow any of their recommendations. I fear this will breed further frustration and disinterest. Is the resolution process the best way to ensure that MMA addresses the issues that are most important to Minnesota’s physicians and their patients? If not, is there a better way to gather needed member input? I don’t know. The resolution process is messy and often timeconsuming; however, I currently have not seen a better model. It is democratic and allows for the single voice — this often leads to inefficiency and more work but it empowers membership. How should TCMS help members weigh in on this governance discussion? TCMS needs to move very carefully. The new governance dramatically decreases the influence the component medical societies have in the MMA.

Ronnell Hansen, M.D. You have made the decision to join MMA and TCMS. Why did you make that decision? My first practice supported the East Metro Medical Society and the MMA, the corporation paying physician memberships in support of physician “professional societies” and the medical community — all partners were given memberships. What would you say to younger physicians who tend not to be joiners as to why they should join MMA/TCMS? What is your “elevator speech” on why to join? Before joining any “society,” ask: 1) type of association desired (professional, trade, etc.); 2) options and mechanism of potential contributory roles; 3) what value does the society provide; and 4) type of membership representation (members vs committees). I would encourage making a decision to join based upon these criteria. The attendance numbers for the MMA House of Delegates have steadily been going down over the last 10 years. Do you believe this is because the House of Delegates structure is outdated or is it just a fact that fewer members want to go to meetings today? Several factors contribute — the growing number of employed physicians likely being significant. Also, busy schedules of employed/private practice physicians and ability/willingness to take time off — influenced by evolving reimbursement, regulatory/ reporting, and productivity policies (in which MMA and TCMS are players). Professional societies should be advocating member physician concerns in these areas, not necessarily focusing on adopting/implementing policy of others. Also important is the perceived return for attending a meeting and providing input on society policy (is the society leadership really listening?). Employed status may dissociate a feeling of “connection” to health policy (felt done by the “system”) — so why attend? As small/ independent physicians struggle to “keep the lights on” and system physicians juggle burgeoning schedules, it’s tough to take time off; already in short supply. If physicians feel, for the time (Continued on page 18)

MetroDoctors

The Journal of the Twin Cities Medical Society

May/June 2013

Medical Care Organizations Telemedicine Perspectives Colleague Interview (Continued from page 17)

and financial sacrifice, the society policy formation mechanism is not a fair, evidence-based, or truly member driven one, they are less inclined to attend, or join/maintain the society in the first place. Societies, to some degree, are beneficiaries of a legacy system — physicians “just always were members” — the current value component assumed, membership considered the ethical/ community thing to do (which it still can be). Recent changes in health policy and payment reform will likely test tacit assumptions of “value” — and maybe it should. For whom and under what bias are the societies working? I am not suggesting current society work is not important; it can have dramatic effect on community health and resource management. I do question whether “professional society” is the role all societies are fulfilling very well — for all membership a primary question. If not protecting the profession or formulating/supporting policy based upon member concerns, those seeking professional support may look elsewhere (AMA fallout after HR3200, and ultimately the ACA, is a good example). How do we ensure that we are hearing from members on key advocacy issues when they don’t seem interested in attending the House of Delegates? First question: did members always seem “uninterested” in the HOD? If not, why the change (past 10 years)? — returning us to points outlined above, asking “how did we get here?” — especially if “we” as a professional society are one of the major influences in policy. Who have historically been most interested (or more recently disinterested)? Likely those most personally invested in practice viability (will it be there tomorrow?) and ability to deliver their vision of physician-patient relationship: I would suggest small/private practice. I am not suggesting employed/large system physicians do not share the same concerns — however, acuity and immediacy of issues may be different between the two groups. For employed, systems presumably are not viewed as “their practice to lose” — though certainly one can lose their position, including by advocating concerns in contradiction to employer preference or interest, even if that interest does not serve the ideal of the profession of medicine or the patient. Absolutely this “chilling effect” happens and is why there are laws against corporate practice of medicine. Independent viability (including physician autonomy in large systems) remains centerpiece to patient-centered care management of resources or system money is secondary. Current society supported models placing financial/ insurance risk on physicians (tried and failed before) threaten this duty to patient via reduced autonomy from gate keeping. Committees/forums on the issues take place, but seem less about analysis and advocacy than commercials and mechanisms for implementing the policies. Whether this is an appropriate role for a “professional society” can be debated; however the de facto outcome has likely resulted in reduced participation of somewhat 18

May/June 2013

demoralized and exhausted physician base. If the “professional” support component from the “society” to the membership has become skewed to large systems and certain payment schemes which threaten options for practice type and autonomy from gate keeping, I suggest we have a self-fulfilling problem. The supporters of MMA’s new governance proposal have argued that it is needed to find better ways to engage more members on the key public policy issues facing physicians today. Critics see it as removing members from the policy decision making. What do you believe? I believe the latter — the former intending to mean: faster to respond/agree on policy. Nimbleness is laudable — but at what price? Future/potential members will decide. Physicians may be at a dividing point. From my perspective, MMA recent policy reflects staff/smaller collective (committee) bias — evident in policy action/inaction, committee selection/outcomes, advocacy, and inclusion/exclusion of member HOD input now amplified through a few member super committee resolution pre-HOD screening “veto power.” A counter argument will be: “we cannot support all members all of the time,” or “we don’t get enough input” — both can be true — however, a structural hierarchy which limits representation, information, competing information/unintended consequences, or positions counter to current staff/health reform bias appears ongoing — and makes competing information/positions either less likely to be included, or simply dismissed. I personally find that unfortunate. At the time of health reform presentation (HR 3200) in 2009, AMA was perhaps 17 percent of physicians — but to sway opinion, the AMA was presented for public/legislative consumption as “American Physicians.” Ironically, subsequent opposing views to Washington from an actual majority of physicians were marginalized by everyone with an agenda — again unfortunate. Society policy needs more attention to economic reality than ideology, admission to past failures of similar policy, inclusion of more (not less) opinions for discussions/solutions, and they likely need to look outward for unbiased expertise more so than inward from limited super committees who have members with preconceptions. Is the resolution process the best way to ensure that MMA addresses the issues that are most important to Minnesota’s physicians and their patients? If not, is there a better way to gather needed member input? The HOD resolution mechanism serves the professional aspect of the societies very well. Democracies and even Republics have a common challenge of hearing from many with divergent viewpoints. The benefit: new facts/education or ways of approaching the problem — and it’s better than oligarchy. With significant loss of independent/smaller practice and massive consolidations, the professional society may be near a tipping point, as many physicians who would otherwise participate feel powerless, i.e. what role MetroDoctors

The Journal of the Twin Cities Medical Society

can physicians play, as the die appears cast? Further confounding, if members feel the super committee resolution screening process and potential elimination of the HOD biases and curtails a fair hearing of resolutions which take time and thought — why participate? Largest final question for the societies: once nearly everyone becomes employed (where practice type and policy is dictated by the system) — what remains of the professional value of the society? A secondary question: are TCMS and the MMA at that point fulfilling different roles, and do they belong as integrated memberships? How should TCMS help members weigh in on this governance discussion? Current members should contact TCMS directly with concerns. A demoralized base is tough to survey; a multifaceted approach including direct-to-member survey and leadership discussion at large group or system staff meetings may be the best potentials — then bringing that data to MMA. TCMS may have to hold a large member meeting at some point specifically on this topic.

What would you say to younger physicians who tend not to be joiners as to why they should join MMA/TCMS? What is your “elevator speech” on why to join? Today, more than at any time in the past, physicians face a tremendous amount of oversight and scrutiny from the government, hospitals, insurance companies and the general public. Physicians, more than any other professional group, need to guide this discussion. MMA/TCMS is our voice. The attendance numbers for the MMA House of Delegates have steadily been going down over the last 10 years. Do you believe this is because the House of Delegates structure is outdated or is it just a fact that fewer members want to go to meetings today? The House of Delegates does some things well, but the formal structure of our meetings, in particular, the strict adherence to the rules of order, makes me less likely to join the discussion. I have felt much more energized by the casual conversations I have had with my fellow MMA members at the Annual Meeting outside of the House of Delegates than during the House of Delegate sessions. How do we ensure that we are hearing from members on key advocacy issues when they don’t seem interested in attending the House of Delegates?

Carolyn McClain, M.D. You have made the decision to join MMA and TCMS. Why did you make that decision? The health care landscape is changing rapidly and physicians need to be actively involved in order to guide the process in ways that will improve health care and not just increase administrative burdens and further limit our ability to practice medicine. Joining MMA and TCMS was a way to become better informed about the issues, advocate for both physicians and patients and ultimately to have my voice heard. MetroDoctors

The Journal of the Twin Cities Medical Society

Having more frequent meetings throughout the state in smaller venues would allow more physicians to get involved and become more informed about the issues that are facing physicians in this state. The supporters of MMA’s new governance proposal have argued that it is needed to find better ways to engage more members on the key public policy issues facing physicians today. Critics see it as removing members from the policy decision making. What do you believe? Given that each year attendance at the House of Delegates has been decreasing, it does appear that change is necessary. I do believe that the current structure is not representing Minnesota physicians as well as it could be. The new initiative, creating smaller more localized meetings, affords us an opportunity to engage physicians who otherwise might not be involved and have not previously had a voice in the MMA. Local meetings are also a way to showcase to our membership how valuable MMA is to Minnesota physicians.

(Continued on page 20)

May/June 2013

Medical Care Organizations Telemedicine Perspectives Colleague Interview (Continued from page 19)

Douglas Pryce, M.D.

You have made the decision to join MMA and TCMS. Why did you make that decision?

The strength of the resolution process is that it helps physicians craft a focused and persuasive argument for change. However, this same process can be intimidating for those who are not actively involved in the organization and in this way may discourage dialogue about issues that are important to Minnesota physicians. Physicians may feel more comfortable bringing up or addressing issues via email or phone, for instance. After soliciting input from a broad base, chairs of committees could systematically address issues raised by the general membership. Particularly poignant issues could then be elevated to the level of the MMA Board, where MMA policy could be set. This strikes me as a good way to reach a broader audience and to ensure that we are hearing the diverse voices of our membership.

I care about the current state and future of medicine and a well organized medical community is needed to guide policy makers and policy. I see MMA as a reputable and effective organization in it for the long haul.

How should TCMS help members weigh in on this governance discussion? I think TCMS is doing a good job of keeping our membership aware of possible governance changes. The next step will be to collect and organize any feedback we receive. It will be critical that parties who may disagree with the current plan are not disenfranchised from the process and from MMA. Whatever our governance structure looks like, we will need to move forward with as broad a coalition as possible brought into our future plans. If we do not, we risk alienating members both old and new. I believe this governance change is a good way to increase involvement in our organization and to better represent Minnesota physicians.

What would you say to younger physicians who tend not to be joiners as to why they should join MMA/TCMS? What is your “elevator speech” on why to join? There is a lot going on and we can have an effect with the organization and access that MMA has already set up; participation is easier than on your own. The attendance numbers for the MMA House of Delegates have steadily been going down over the last 10 years. Do you believe this is because the House of Delegates structure is outdated or is it just a fact that fewer members want to go to meetings today? It is ok if you are presenting an issue; but, overall there are too many issues thus a diluted effect. How do we ensure that we are hearing from members on key advocacy issues when they don’t seem interested in attending the House of Delegates? We might be able to use our resources to identify key informants and ask them for help on particular issues. The supporters of MMA’s new governance proposal have argued that it is needed to find better ways to engage more members on the key public policy issues facing physicians today. Critics see it as removing members from the policy decision making. What do you believe? We are removed, as evidenced by less than robust numbers, and being heard needs to be balanced with effectiveness and not overwhelming — thus listening.

May/June 2013

MetroDoctors

The Journal of the Twin Cities Medical Society

Is the resolution process the best way to ensure that MMA addresses the issues that are most important to Minnesota’s physicians and their patients? If not, is there a better way to gather needed member input? Not sure what to do. How should TCMS help members weigh in on this governance discussion? Show good outside examples/evidence of a better way of accomplishing what we all need to do and desire.

Thomas Siefferman, M.D. You have made the decision to join MMA and TCMS. Why did you make that decision? It is essential for members of any profession to have a collegial method of interacting and advocating for your profession. What would you say to younger physicians who tend not to be joiners as to why they should join MMA/TCMS? What is your “elevator speech” on why to join? You are now a professional and you will hopefully be busy in your profession. Unfortunately, that means you cannot always be current on political and governmental actions that affect your profession and it is important that you maintain an interaction with doctors and support staff that also have a keen interest in medicine. The attendance numbers for the MMA House of Delegates have steadily been going down over the last 10 years. Do you believe this is because the House of Delegates structure is outdated or is it just a fact that fewer members want to go to meetings today? Medicine has become extremely busy and our interaction with other physicians has suffered. Attendance at the HOD has decreased due to the perceived lack of benefit in attending and at the loss of productivity if one attends. MetroDoctors

The Journal of the Twin Cities Medical Society

How do we ensure that we are hearing from members on key advocacy issues when they don’t seem interested in attending the House of Delegates? We definitely need some kind of forum both physical and electronic to stay abreast and to receive input on advocacy needs. The supporters of MMA’s new governance proposal have argued that it is needed to find better ways to engage more members on the key public policy issues facing physicians today. Critics see it as removing members from the policy decision making. What do you believe? Because the membership is loosing its only ability to affect direction and policy at both the Board of Trustees level as well as the staff level with the currently planned structure of policy forums, then this is purely a power grab. The BOT argue that they will have listening sessions, but there is no way for these sessions to generate policy or advocacy. If the BOT and staff don’t like what they hear, then they don’t have to listen. Also the BOT issues its own Nominating Committee so they only get “qualified” people further limiting any possible change in BOT direction and staff responsiveness. Is the resolution process the best way to ensure that MMA addresses the issues that are most important to Minnesota’s physicians and their patients? If not, is there a better way to gather needed member input? The resolution process has worked since the discovery of democracy. It is not the most efficient, but the most inclusive and responsive. The proposed policy forums and listening sessions could be an effective way of generating policy and direction to the BOT and MMA staff, but they have purposely removed any overriding authority from the membership by way of these forums. Once physicians perceive that it’s great that the BOT has graced us with listening sessions — but then the BOT does not listen or act if they find it inconvenient — then the membership will stop attending and will disappear. How should TCMS help members weigh in on this governance discussion? The next HOD is probably going to be its last! There must be a resolution passed changing the current proposed structure and response to planned policy forums and listening sessions. If a super majority of the policy forum proposes a policy change to the BOT, then the BOT MUST follow the change. If such a resolution does not occur, then the membership will become purely a source of revenue for the MMA and not important for guiding its policies.

May/June 2013

Medical Telemedicine Perspectives Care Organizations

A Guide to Writing Resolutions

There are two major avenues for a delegate to help shape MMA policy. One is to elect good leaders, and the other is to introduce timely and relevant resolutions. This document will help you write, introduce and see your resolution through the reference committees and House of Delegates. Privilege to Introduce Resolutions Resolutions may be submitted by members of the House of Delegates, members of the Board of Trustees, component medical societies, or committees or sections of the MMA. Unacceptable Resolutions Resolutions must be implementable. Resolutions that ask for illegal action, as determined by MMA staff, or that address multiple issues which are unrelated or not relevant, as determined by the Speaker of the House of Delegates, may be rejected by the Speaker and may not be considered. Deadlines The 2013 deadline for submission of a resolution to the MMA office is July 12, 2013. Late resolutions will be considered only if they are of a truly urgent nature.

CALL TO ACTION TCMS Resolutions Needed by May 20, 2013 TCMS Caucuses 2013 MMA Annual Meeting and House of Delegates See details on page 33.

May/June 2013

Format — General Considerations All else being equal, resolutions that are clear and specific have the best chance of being adopted. MMA staff is always available to help with format and wording of a draft resolution. MMA staff will process all resolutions as they are submitted. Minor deviations from the necessary format will be editorially corrected. In case of significant deviations, such as those in which correction might affect the content, the author will be contacted for revision. Format — The Resolve Resolve(s) are the only part of a resolution that the House of Delegates will act upon. The syntax of a resolve should clearly indicate to the reader the expectation or action desired of the MMA. Format — The Whereas The whereas portion of a resolution, the preamble to the resolve(s), should provide vital background information to support the requested action. The House of Delegates may discuss the content of whereas clauses of a resolution, but does not act on them. Responsibilities of the Author The author of a resolution should be available to speak and/or answer questions both at the reference committee meeting and, if needed, on the floor of the House of Delegates. Testimony by Experts If a delegate wishes to arrange for expert testimony to a resolution before the reference committee and the expert is not an MMA member, permission first must be obtained from the Speaker or Vice-Speaker of the House of Delegates. Sample Resolution A sample resolution is on the next page and may serve as a guide to the required format.

MetroDoctors

The Journal of the Twin Cities Medical Society

Resolution Writing Sample Form for Resolutions For assistance with writing resolutions, please contact the Minnesota Medical Association

Title of Resolution:

Title should reflect the subject and the requested action.

Sponsor:

Name of the component medical society, MMA committee or individual submitting the resolution.

Author:

Name of the individual physician(s) responsible for content.

Whereas Clause(s):

give reasons for seeking a position or action by listing concerns, facts, potential effects upon physicians, patients, practice of medicine, etc. Try to keep each fact or thought within a separate â&#x20AC;&#x153;whereasâ&#x20AC;?.

whEREAS, __________________________________________________________________________ ____________________________________________________________________________________ _______________________________________________________________________________ , and whEREAS, __________________________________________________________________________ ____________________________________________________________________________________ _______________________________________________________________________________ , and whEREAS, _________________________________________________________________________ ____________________________________________________________________________________ _____________________________________________________________________ , therefore be it

The Resolved Clause(s):

State the position(s) or actions(s) you wish the MMA to take on the issue. The Resolved Clause is the only portion on which the house of Delegates will act. The Resolved Clause should stand alone and not contain external references.

RESOLVED, that the Minnesota Medical Association ____________________________________ ____________________________________________________________________________________ ___________________________________________________________________ , and be it further RESOLVED, that the Minnesota Medical Association ____________________________________ ____________________________________________________________________________________ ___________________________________________________________________________________ .

MetroDoctors

The Journal of the Twin Cities Medical Society

May/June 2013

New Members

Michael M. Haley, D.O. Park Nicollet Methodist Hospital Radiation Oncology

Susan Schloff, M.D. Associated Eye Care Ophthalmology, Pediatric Ophthalmology

Joseph W. Akornor, M.D. Metro Urology Urology

Brian G. LaBine, M.D. Sports & Orthopaedic Specialists Internal Medicine, Sports Medicine

Margarita Sevilla, M.D. Sports & Orthopaedic Specialists, P.A. Sports Medicine

Sandra Z. Beulke, M.D. Lakeview Clinic, Ltd. Family Medicine

Steven Levin, M.D. University of Minnesota Graduate School Thoracic Surgery

Anshu Sharma, M.D. Camden Physicians Family Medicine

Patricia E. Blumenreich, M.D. Psychiatry

Jeffrey T. Lynch, M.D. Associated Eye Care Ophthalmology, Pediatric Ophthalmology

Kevin G. Spaeth, M.D. Associated Anesthesiologists, P.A. Anesthesiology

Eric A. Melum, M.D. Associated Anesthesiology, P.A. Anesthesiology

Paul W. Sperduto, M.D. Waconia Radiation Therapy Center, Inc. Radiation Oncology

Jeffrey E. Nowak, M.D. Childrenâ&#x20AC;&#x2122;s Respiratory and Critical Care Specialists, P.A. Pediatrics, Pediatric Critical Care, Psychiatry

Beth Ann Staab, M.D. Noran Neurological Clinic Neurology

Kimberly A. Bohjanen, M.D. University of Minnesota Physicians Dermatology Mark H. Brakke, M.D. Allina Medical Clinic-Coon Rapids Family Medicine Chris T. Buntrock, M.D. Avera Marshall Southwest Ophthalmology Assoc., P.A. Ophthalmology Srinath Chinnakotla, MBBS University of Minnesota Physicians Transplant Surgery Andrew H. Cragg, M.D. Vascular Specialists of Minnesota Diagnostic Radiology Kirsten Erickson, M.D. Minneapolis Radiation Oncology, P.A. Radiology, Radiation Oncology Constance L. Gilloon, M.D. Northwest Anesthesia, P.A. Anesthesiology Stephen T. Gott, M.D. Associated Anesthesiologists, P.A. Anesthesiology Dawn L. Graham, M.D. Camden Physicians Family Medicine

May/June 2013

Tanya L. Oyos, M.D. Northwest Anesthesia, P.A. Anesthesiology

David H. Strothman, M.D. Institute for Low Back & Neck Care Orthopedic Surgery

Heidi M. Pazlar, M.D. Camden Physicians Family Medicine

Klaus Suehler, M.D. Midwest Internal Medicine-Hospitalist Group Internal Medicine

Anne G. Pereira, M.D. Hennepin Healthcare System, Inc. Internal Medicine

Matthew K. Sundblad, M.D. Northwest Anesthesia, P.A. Anesthesiology

Tjorvi E. Perry, M.D. Northwest Anesthesia, P.A. Anesthesiology

Steven E. Swanson, M.D. United Neurosurgery Associates Neurological Surgery

David J. Rhude, M.D. Camden Physicians Internal Medicine, Rheumatology

Troy D. Wolter, M.D. Fairview â&#x20AC;&#x201C; Fridley Clinic Orthopedic Surgery

Mark E. Rosenberg, M.D. University of Minnesota Vice Dean for Medical Education Internal Medicine, Nephrology

Dennis A. Woolner, M.D. Minneapolis Radiology Associates Diagnostic Radiology

Javaid Saleem, M.D. Camden Physicians Family Medicine MetroDoctors

The Journal of the Twin Cities Medical Society

Twin Cities Obesity Prevention Coalition Kicking Off 2013 with a Bang A focus on access to healthy foods, changes in vending and concessions in city facilities including parks and programs, and development and promotion of physical activity opportunities falls in line with the desire of city leadership to continue to provide the best healthy eating and active living options for all residents and visitors to Savage. Savage became the third Minnesota municipality to craft and unanimously pass a Healthy Eating Active Living resolution at their March 4, 2013 City Council meeting, following in the footsteps of Eagan and Eden Prairie in 2012. “The approval of this resolution is indicative of our strong desire to continue past efforts in support of programs, services and facilities which promote a

By Jennifer Anderson, MA Project Manager

MetroDoctors

sustainable healthy lifestyle for our residents,” said Mayor Janet Williams. Any city can develop a resolution, but the meat of the work happens in the months after its passage as communities work to put the strategies in place, paving the way to make the healthy choice the easy choice for its residents. The city of Eagan passed a resolution in March 2012. Because they are at the one year mark since passage, the coalition will be looping back with Eagan city staff to take a deeper look at their path to implementation, evaluating partnerships that may have been formed, identifying what worked and what didn’t work in the process, were there barriers to implementation and if so, what were they, and most importantly, is the strategy sustainable? A report will be available later in the year on the long-term process that communities have put in place to implement and maintain strategies. TCOPC is planning an aggressive approach for 2013. Over 120 cities in the

The Journal of the Twin Cities Medical Society

seven-county metro area have been identified and will be contacted in early 2013 with the goal of having at least a third begin the resolution development process. 2013 marks the final year of support for the Twin Cities Obesity Prevention Coalition from Blue Cross and Blue Shield’s Center for Prevention. The coalition was fortunate to have secured a five-year contract that began in January 2009 and ends in December 2013. In the fall of 2012, a sustainability plan was created and implemented with a portion of that plan focused on raising funds from state and national foundations to continue the work into 2014. Additional funding is currently being sought with the goal of shoring up commitments to our work by the end of July. We hope to report back in the upcoming months that we will be continuing the important work of the Twin Cities Obesity Prevention Coalition and needing your continued support as a physician member of the Twin Cities Medical Society.

May/June 2013

East Metro Medical Society Foundation Update Development Officer to be engaged in early 2012. Andrea Carlson Nelson was brought on board to interview current and past board members as well as past donors to the Foundation. She also assisted in the development of a legacy video that highlighted the significant endowment that was given to the East Metro Medical Society by Dr. Eduard Boeckmann. The video is narrated by EMMS Foundation Board member, and Development Committee Chair, Frank Indihar, M.D. In 2012 we raised 50 percent more in contributions from

The East Metro Medical Society Foundation board of directors completed strategic planning at the end of 2011. The outcomes of that strategic planning session included the development of three fiveyear goals. The goals are listed below: Goal #1 — Raise the recognition of the East Metro Medical Society Foundation within the TCMS East Metro membership to 60 percent; develop a specific communications plan by the end of 2013. In 2011 a survey was conducted asking whether or not east metro members were aware of the East Metro Medical Society Foundation. We were quite surprised, and a bit humbled, by the fact that many of you didn’t realize we had an active Foundation. Our opportunity then was to raise the recognition of the East Metro Medical Society Foundation within the TCMS East Metro membership. A newsletter was developed that will be sent out twice a year highlighting the work of the Foundation including our highly successful Honoring Choices Minnesota initiative. We also hosted the first Annual East Metro Medical Society Foundation event in November 2012, which over 100 people attended.

Dr. Eduard Boeckmann, 1899 Ramsey County Medical Society president.

2013 EMMS Foundation Board

Goal #2 — Raise funds to increase the size of our endowment; create a development plan to achieve this by December 2011. A development plan was indeed created by the end of 2011 and included the dedication of dollars to support a contract

Kent Wilson, M.D. EMMS Foundation President

Amin Alishahi, medical student Donald Asp, M.D. David Bonham, M.D. Kenneth Britton, D.O. Mark Destache, M.D. John Diehl, JD Frank Indihar, M.D. Henri Minette, JD, MPH Robert Moravec M.D. Andrew Thomas M.D. Nathan Wayne, CPA Kent Wilson, M.D.

By Sue Schettle, TCMS CEO

May/June 2013

MetroDoctors

The Journal of the Twin Cities Medical Society

members than in 2011. We also received a sizable pledge from a board member for a designated fund in estate plans to be used as an endowment for EMMS Foundation philanthropic programs. We plan to build on the success of 2012 into 2013.

Society Foundation. This is the largest project/initiative that we have ever done and the EMMS Foundation board of directors believes wholeheartedly that we need to continue to support its good works. A sustainability plan, crafted in

2012, will be refined in early 2013. It is the goal of the Foundation to make Honoring Choices Minnesota sustainable over time and to move onto another wonderful project. That’s our goal in 2014.

Goal #3 — Support Honoring Choices Minnesota; develop a sustainability plan; identify successor program by 2014. Honoring Choices Minnesota is, hands down, the signature project of the medical society through our East Metro Medical

From left: Craig Bowron, M.D., Joseph Amberg, M.D., and Dwight Townes, M.D., enjoying the EMMS Foundation Annual Meeting.

Frank Indihar, M.D. (left), development committee chair, and Craig Svendsen, M.D., HCM advisory committee member.

Cardiac Care at Saint Therese Strengthening the Heart for a Healthier Life

Blending specialized skilled nursing with supervised exercise and education, Cardiac Care at Saint Therese gives your patients the confidence and tools to be successful at home. Cardiac Care at Saint Therese offers... • Integrated programming connecting doctors, nurses, rehab specialists, clinical nutritionist and on-site pharmacists • Specially trained staff; skilled in cardiac rehab • On-site EKG • Cardiologist coordination • Post-discharge coordination to help prevent hospital readmissions SA I N T TH E R E S E of N E W H O P E

Winner of the 2012 Boeckmann Award, Peter Daly, M.D. with wife, Lulu Daly.

MetroDoctors

The Journal of the Twin Cities Medical Society

To learn more call 763.531.5028 or visit sttheresemn.org/cardiaccare 8000 Bass Lake Road • New Hope, MN 55428

May/June 2013

West Metro Medical Foundation Staying True to its Mission As chairman of the West Metro Medical Foundation, it is my pleasure to update you on its recent activities. The Board of Directors participated in a strategic planning initiative throughout 2012, which culminated in the adoption of a new mission statement: Improving the health of the community through strategic initiatives, underscoring “access to health care” as an over-arching strategic focus. Under this umbrella, projects that direct services to the following focus priorities will be considered for grant funding: • Improving access to care for the uninsured and underinsured • Domestic violence • Obesity prevention • Medical student education Through member interviews, we affirmed that overall giving is based on each physician’s values with their career, faith and passion in the community. Therefore, WMMF will support and promote

By Richard D. Schmidt., M.D., chair

May/June 2013

projects/programs where member physicians have opportunities to be engaged and involved through volunteer opportunities. We also learned that you are mostly interested in keeping the giving local — within the Twin Cities. A monetary grant from WMMF, which can be further leveraged by active physician involvement, can make a huge impact on a local effort focused on improving the health of our community. In my letter to you last fall, requesting a donation to the WMMF, I described the Phillips Neighborhood Clinic, and WMMF’s commitment to support them — through an initial strategic initiatives grant of $7,500 and a challenge to you for a matching grant of up to $3,000. You rose to the occasion. Your designated donations totaled $6,000. Together, the Phillips Neighborhood Clinic received a total contribution from WMMF of $16,500. But, that’s not all. Our goal is to also support programs where physicians can be engaged through volunteerism. The Phillips Neighborhood Clinic offers opportunities for physicians and medical students to work side-by-side, providing care to the uninsured and underinsured in our local community. I hope you will explore how your services can be best utilized. Contact them at www.phillipsneighborhoodclinic. com. WMMF also featured the clinic in a MetroDoctors article and assisted in the promotion of their annual fundraising/ silent auction event, held on March 7, 2013. This partnership exemplifies how WMMF is holding true to its mission to improve the health of the community through strategic initiatives. Another example of a strategic

WMMF Board Members: Lisa A. Bishop, MBChB *Joseph Bocklage, M.D. Robert Fraser (medical student) *Paul R. Hamann, M.D. Elizabeth Hurliman, M.D., Ph.D. *Chris Johnson, M.D., secretary/ treasurer *Richard D. Schmidt, M.D., chair James K. Struve, M.D. Carrie A. Terrell, M.D. Joseph M. Tombers, M.D. *Denotes Finance Committee Member

partnership in process is the Mills Health Clinic. Kasey Justensen, M.D., a TCMS member, approached WMMF requesting funding assistance with a new, free medical clinic serving the uninsured in the west metro suburbs that she and her husband were opening. Although financial assistance was denied as the charitable organization status was pending and other details needed to be addressed, WMMF offered to assist in the promotion of the clinic and recruit volunteer physicians once the issues were resolved. She was encouraged to reapply for funding in 2013. A “member spotlight” article on Dr. Justensen appeared in the March/April issue of MetroDoctors, and with its 501(c)(3)

MetroDoctors

The Journal of the Twin Cities Medical Society

status confirmed, promotion of the Mills Health Clinic grand opening, held on February 24, 2013, was disseminated to all TCMS members. Physician volunteers are needed. Contact Dr. Kasey Justenson at millsclinic@millschurch.org. WMMF will continue to monitor and support this relationship with Mills Health Clinic to improve the health of the community through strategic initiatives. Lastly, each year a $3,000 scholarship is awarded by WMMF to a medical student. This grant is administered through the Minnesota Medical Foundation at the University of Minnesota. The Thomas P. Cook Scholarship, named after a former executive of the Hennepin County Medical Society (now Twin Cities Medical Society), is given to a student for excellence in leadership. Carly Turgeon, now a third year medical student, was the 2012 recipient. To those of you who have contributed to the West Metro Medical Foundation, my personal thank you. The board will continue to be good stewards of your generosity. To those of you who have not contributed, donations are accepted all year, with a targeted request mailed in the fall. I hope you will make WMMF a priority for your charitable giving. I extend a challenge to each of you, whether you are a current donor, or not, to please reach out to the organizations I’ve highlighted

above — volunteer your time and talents for the benefit of the community. And, if you know of other worthy community programs that fit within our mission and strategic areas of focus, encourage them to apply for WMMF funding consideration and partnership. For more information and grant guidelines, visit the foundation website at www.metrodoctors.com. WMMF also has the honor of serving as the facilitator of the Charles Bolles Bolles-Rogers Award and the Shotwell Award. The 2012 recipients of these awards were:

Shotwell Award — presented annually to a person within the State of Minnesota for a noteworthy effort in dedicated service to mankind; significant break-through in some form of medical research or significant contribution to the field of medicine; and innovations and/or improvements in health care delivery. Senator Linda Berglin Thank you again for your support of the West Metro Medical Foundation.

Charles Bolles Bolles-Rogers Award — given to an outstanding physician, nominated by his/her medical staff peers, based on professional contribution to medical research, achievement, and/or leadership. Anthony Spagnolo, M.D. Joseph Westermeyer, M.D. The Charles Bolles Bolles-Rogers Award.

The Shotwell Award.

MetroDoctors

The Journal of the Twin Cities Medical Society

May/June 2013

In Memoriam CHESTER C. BORRUD, M.D., passed away on February 22, 2013 at the age of 90. Dr. Borrud attended medical school at the University of North Dakota and Temple University in Philadelphia. He completed his residency in internal medicine in Minneapolis and Grand Forks. In addition to being co-founder of Harmon Park Clinic in North Dakota, he was also a founding member of the American Academy of Family Practice. Dr. Borrud became a member in 1972. KATHRYN GREEN, M.D., age 75, passed away on February 14, 2013. Dr. Green graduated from the University of Minnesota Medical School and completed a residency and fellowship in pediatric neurology. Dr. Green became a member in 1978. MURRAY H. HUNTER, M.D., passed away January 23, 2013 at the age of 88. Dr. Hunter attended the Medical College of Wisconsin and practiced family medicine. He became a member in 1951. JOHN KERSEY, M.D., age 74, passed away on March 10, 2013. Dr. Kersey graduated from the University of Minnesota Medical School in 1964. He was the founding director of the University of Minnesota Cancer Center and a pioneer in pediatric leukemia care and research. WILLIAM E. PRICE Jr., M.D., passed away at the age of 90 on February 17, 2013. Dr. Price practiced urology in Minnesota. He became a member in 1954.

Search for Twin Cities Medical Society on Facebook and follow us on Twitter 30

May/June 2013

MetroDoctors

The Journal of the Twin Cities Medical Society

Career oPPortunItIes

Please also visit www.metrodoctors.com

Visit TCMS at www.metrodoctors.com

Fairview Health Services Opportunities to fit your life Fairview Health Services seeks physicians to improve the health of the communities we serve. We have a variety of opportunities that allow you to focus on innovative and quality care. Shape your practice to fit your life as a part of our nationally recognized, patient-centered, evidence-based care team.

With just one click you will find information on the latest TCMS news, events and legislative issues; Board and committee actions; past issues of MetroDoctors;

Whether your focus is work-life balance or participating in clinical quality initiatives, we have an opportunity that is right for you: • • • • •

Dermatology Emergency Medicine Family Medicine General Surgery Geriatric Medicine

• • • • •

Hospitalist Internal Medicine Med/Peds Ob/Gyn Palliative

• Pediatrics • Psychiatry • Urgent Care

Visit fairview.org/physicians to explore our current opportunities, then apply online, call 800-842-6469 or e-mail recruit1@fairview.org.

and new career opportunities!

Sorry, no J1 opportunities. fairview.org/physicians TTY 612-672-7300 EEO/AA Employer

Recruit

With

MetroDoctors!

Boating, Beethoven, Bluffs and more! www.winonahealth.org

Join our progressive healthcare team, full-time opportunities available in these areas:

Rates starting as low as $175—call today! Options for website listings available as well. www.metrodoctors.com

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

MetroDoctors

The Journal of the Twin Cities Medical Society

• Dermatology • Family Medicine • Hospital Medicine

• Internal Medicine • Oral Surgery • Orthopedics

• Pediatrics • Podiatry • Urgent Care

Winona, a sophisticated community nestled between beautiful bluffs and the mighty Mississippi— kayak the rivers, fish the streams, watch the eagles, take in world-class performances during the Beethoven and Shakespeare festivals and stand inches away from a Van Gogh at the MN Marine Art Museum. Learn more at visitwinona.com.

Contact Cathy Fangman • cfangman@winonahealth.org 855 Mankato Ave. • Winona, MN 55987 • 800.944.3960, ext. 4301 • winonahealth.org May/June 2013

luMInary of Twin Cities Medicine By Marvin S. Segal, M.D.

PAUL F. BOWLIN, M.D. The 3rd year medical student entered a medicine ward of the Minneapolis V.A. Hospital for his first teaching rounds. His newly purchased and crisply starched short white coat — with, of course, the shiny stethoscope prominently displayed and peeking from a side pocket — was proudly worn. There he met Paul Bowlin, M.D., attending physician — a reserved though easily approachable young staff physician who shared his considerable fund of internal medical knowledge in a clear, interesting and easily digestible fashion. Paul began the pathway through his successful medical career at the U of M where he obtained B.A., B.S. and M.D. degrees — the later, some 60 years ago — and was academically honored with election to both Phi Beta Kappa and Alpha Omega Alpha. His Navy internship and Seattle residency were followed by a cardiology fellowship at our V.A. Hospital. After nearly 30 years of private practice, he embarked upon an administrative tack — first as Director of Medical Affairs at Fairview Southdale Hospital and later as the Director of Development for the Fairview Corporation. Dr. Bowlin also became deeply engaged in professional community endeavors. He served for many years as a member of the U of M Medical School Admissions Committee. He now refers to that position of significant responsibility as, “interesting, hard work and very enjoyable.” His leadership abilities were recognized by his peers as he was elected to serve as the president and board chair of the Hennepin Medical Society, and he was also the proud recipient of the Charles Bolles Bolles-Rogers Award for the outstanding example he set through many contributions to his profession. Paul states that the six years (1977-83) he spent on the Metropolitan Health Board was “quite a learning experience.” His gubernatorial appointment, along with but one other physician, found him in a distinct minority as the Board tackled complex issues such as Certificate of Need and recommendations for community hospital closures during that difficult time span for our metropolitan medicine. After dealing with problems that included 32

May/June 2013

which hospitals would be approved to make important capital expenditures such as CT imaging equipment and, more importantly, which hospitals should close their doors, Dr. Bowlin and others issued a minority report via the Minnesota Medical Association, strongly recommending that the marketplace be allowed to determine those outcomes rather than legislation by edict from above. As a result of his efforts, the State Legislature cancelled that legislative component. Today there are activities and actual hospital settings continuing to thrive in our midst, which were once earmarked for termination. Others did cease to function, however those decisions were determined by market forces and not by arbitrary detached determiners. Paul and his wife, Helen, have enjoyed their family and travel since his official retirement at age 65. However, it’s not at all surprising that he remains well versed in the massive changes currently affecting our profession. His opinions regarding physician-administration relationships, primary physician shortages, mid-level provider utilization and effects relating to the Affordable Care Act are crisp and meaningful. When asked what the most gratifying portion of his long career has been, without hesitation he stated, “why of course, clinical practice and patient contact were the best!” It is also gratifying for that former 3rd year medical student to be able to help honor his former teacher as a true Luminary of Twin Cities Medicine. This last page series is intended to honor esteemed colleagues who have contributed significantly to Twin Cities medicine. Please forward names of physicians you would like considered for this recognition to Nancy Bauer, managing editor, nbauer@metrodoctors.com.

MetroDoctors

The Journal of the Twin Cities Medical Society

CALL TO ACTION 2013 MMA Annual Meeting and House of Delegates TCMS Caucuses Resolutions Needed This year, perhaps more than ever before, your voice and attendance is needed at the MMA House of Delegates meeting, September 20-21, 2013 at the Minneapolis Marriott Northwest, Brooklyn Park, MN. The House of Delegates will vote on the Governance Structure proposals as presented last fall and refined throughout the year based on committee input and member listening sessions. In addition, delegates in attendance will determine the 2013 focus priorities for MMA leadership and staff. For status updates on 2012 House of Delegates resolutions go to: http://www.mnmed.org/AbouttheMMA/AnnualMeeting/2012HODResolutionTracker.aspx Call for Resolutions Due by Monday, May 20, 2013 â&#x20AC;&#x201D; email to nbauer@metrodoctors.com In addition to the Governance changes, what issues and priorities would you like MMA to focus their time and energy on? Where is your passion? Sample resolutions are available on the TCMS website: www.metrodoctors.com. Click on In Action tab, then Caucus. Attend TCMS Caucuses: Wednesday, June 5, 2013, 6 p.m. Monday, September 16, 2013, 6 p.m. Broadway Ridge Building 3001 Broadway Street NE, Minneapolis, MN 55413 Attend MMA Annual Meeting and House of Delegates Friday-Saturday, September 20-21, 2013 Minneapolis Marriott Northwest (formerly Northland Inn) 7025 Northland Drive North Brooklyn Park, MN 55428 For more information contact Nancy Bauer at nbauer@metrodoctors.com or (612) 623-2893.

MetroDoctors

The Journal of the Twin Cities Medical Society

May/June 2013

Peace, love and litigation support. We protect your peace of mind. And it’s why we’re the right choice for physicians. Medical liability insurance is just the beginning. We protect what matters most, with proven results. It’s a movement, and we’d love to have you join us. Contact your independent agent or broker, or go to PeaceofMindMovement.com to see what MMIC can do for you.