Society of General Internal Medicine SGIM TO PROMOTE IMPROVED PATIENT CARE, RESEARCH, AND EDUCATION IN PRIMARY CARE AND FORUM GENERAL INTERNAL MEDICINE Volume 26 • Number 2 • February 2003

2003 ANNUAL MEETING GENERALIST PHYSICIANS AS AGENTS FOR CHANGE: EDUCATION AND RESEARCH, PRACTICE AND POLICY Helen Burstin, MD, MPH and Linda Headrick, MD, MS

he SGIM Annual Meeting is rap- can serve as agents for change at every idly shaping up to be an innovative point where we interface with the health Tinternational meeting for general care system. Against a background of in- internists from the U.S., Canada, and creasing concerns with the loss of physi- many other countries. In addition to the cian autonomy, the erosion of profession- Contents exciting venue of Vancouver, British Co- alism, and the inability of the health care lumbia, we are also collaborating with our system to address problems of quality and 1 Generalist Physicians as Agents for colleagues from the Canadian Society of access, the knowledge and skills of gen- Change: Education and Research, Internal Medicine (CSIM) for the first eral internists are ideally suited to provide Practice and Policy time. Vancouver is an incredibly entic- leadership, change and improvement. ing locale and our conference facilities are In Education: Generalists are the 2 Career Support Task Force Update at the epicenter of an amazing range of backbone of clinical training for medical activities for you and your family. With students, residents, and fellows. As we 3 President’s Column the mountains only 30 minutes from embrace 21st century health care, we can Vancouver, outdoor activities include vis- use our role as change agents to ensure 4 Research Funding Corner its to Grouse Mountain or the Capilano that we are offering medical education Extension Bridge. As you think about that meets the challenge of an evolving, your vacations for the year, please con- more diverse healthcare system. 4 One-on-One Mentoring Program at the sider that a trip to the SGIM Annual In Research: General internists are a Annual Meeting and the New Year-Long Meeting in Vancouver can be the perfect critical force, through the documentation Mentoring Program launching point for amazing vacations and improvement of the quality, access, and cruise ship excursions. and outcomes of health care services. We 5 ACGIM Column We are also hopeful that the annual can more effectively use research to in- meeting theme will inspire many of you fluence health policy and improve the 6 Helpful Tools: ACP-ASIM Guide to from different paths in general internal delivery of appropriate health care ser- Preparing for the Abstract Competition medicine—education, research, practice vices. and policy—to meet and share your In Practice: Primary care physicians 6 UpToDate Goes Mobile thoughts about general internists as po- can effectively serve as change agents in tential agents for change. As generalists, ways that will immediately benefit our 11 Classified Ads we have a unique lens through which to patients and our practices—using con- examine the health care system and we continued on page 7 SGIM FORUM

SOCIETY OF GENERAL INTERNAL MEDICINE OFFICERS

PRESIDENT Career Support Task Force Update Martin F. Shapiro, MD, PhD • Los Angeles, CA [email protected] • (310) 794-2284 Sankey Williams, MD

PRESIDENT-ELECT JudyAnn Bigby, MD • Boston, MA he August 2002 issue of SGIM Our goal for the coming year is to [email protected] • (617) 732-5759 Forum unveiled two new initia- conduct one site visit of each type, and tives to support SGIM members in use that experience to develop a better IMMEDIATE PAST-PRESIDENT T Kurt Kroenke, MD • Indianapolis, IN their daily work. One of these was the site visit program. Our goal for the [email protected] • (317) 630-7447 SGIM Career Support Task Force, future is to conduct more visits each which met in Washington, DC October year. TREASURER th th Eliseo Pérez-Stable, MD • San Francisco, CA 7 and 8 . The following people We also discussed a reverse site visit [email protected] • (415) 476-5369 attended the retreat: Julia Arnsten, Jim program, in which a particularly Byrd, Marshall Chin, David Karlson, successful division of general internal SECRETARY Julie Machulsky, Carol Mangione (by medicine is designated a host institu- Ann B. Nattinger, MD, MPH • Milwaukee, WI [email protected] • (414) 456-6860 conference call), Kay Ovington, Martin tion, and people in other divisions are Shapiro, Bill Tierney, and Sankey invited to visit it on a specific day for SECRETARY-ELECT Williams (Chair). presentations, discussions, and consulta- William Branch, MD • Atlanta, GA [email protected] • (404) 616-6627 tions. Several divisions could be host Site Visit Program institutions, each with its own focus or COUNCIL A new site visit program is the Task in its own region. Bill Tierney and Jim Christopher Callahan, MD • Indianapolis, IN Force’s highest priority for the coming Byrd will be contacting ACGIM [email protected] • (317) 630-7200 year. In this program a team of senior members to describe the program and Kenneth Covinsky, MD, MPH • San Francisco, CA SGIM and ACGIM members will travel determine the level of interest in it. [email protected] • (415) 221-4810 to an institution to assess its general Susana R. Morales, MD • New York, NY internal medicine activities and suggest A New Mentoring Program [email protected] • (212) 746-2909 ways that general internists might SGIM has two mentoring programs. Eileen E. Reynolds, MD • Boston, MA improve what they do and contribute “One-on-One Mentoring” at the [email protected] • (617) 667-3001 more effectively to the institution’s Annual Meeting will enable several Gary E. Rosenthal, MD • Iowa City, IA missions. dozen residents, fellows, and junior [email protected] • (319) 356-4241 The group identified three types of faculty members to meet individually Harry P. Selker, MD, MSPH • Boston, MA site visit opportunities. In one type, a with senior SGIM members and discuss [email protected] • (617) 636-5009 division chief invites SGIM to send a issues related to the junior person’s EX OFFICIO site visit team, either because the professional development. In the Regional Coordinator division chief is newly appointed or “Research and Education Mentorship Jane M. Geraci, MD, MPH • Houston, TX because the division chief is facing new Program,” a junior faculty member [email protected] • (713) 745-3084 opportunities or challenges. One identifies a research mentor at another Editor, Journal of General Internal Medicine division chief has already contacted us institution and competes for money to Eric B. Bass, MD • Baltimore, MD about such a visit. In the second type, pay one year of travel costs, limited [email protected] • (410) 955-9868 the chairperson of medicine invites us research costs, and an honorarium for Editor, SGIM Forum because the institution does not have a the mentor. This program provides Melissa McNeil, MD, MPH • Pittsburgh, PA division of general internal medicine mentorship for fewer than five people [email protected] • (412) 692-4886 and the chairperson is considering each year. HEALTH POLICY CONSULTANT establishing one. Again, a newly We therefore designed a third Robert E. Blaser • Washington, DC appointed Chair of Medicine has mentoring program and made it our [email protected] • (202) 261-4551 contacted us about such a visit. In the second highest priority for the coming EXECUTIVE DIRECTOR third type, we solicit an invitation from year. The new program, limited to David Karlson, PhD an institution because its general junior faculty members, will be open to 2501 M Street, NW, Suite 575 internists are not well connected with educators, administrators, and research- Washington, DC 20037 SGIM or ACGIM and we believe the ers. A person at one institution will be [email protected] (800) 822-3060 institution could benefit. We have matched with a mentor at another (202) 887-5150, 887-5405 FAX identified one such institution but institution in the same SGIM region. recognize that there are many others. continued on page 9

2 PRESIDENT’S COLUMN

TRIANGULATION Martin F. Shapiro, MD, PhD

came to the United States a quarter American people three kinds of organiza- of a century ago, wanting to see this do not vote for tions that should be doing Icountry adopt a health care system politicians who a lot more and could shape like virtually every other industrialized raise taxes, and this debate and its out- nation in the world that would guaran- there are no come. In the fashion of the tee health care for all of its people. It scenarios for day, let’s characterize this has not happened and appears very creating a univer- triad as a triangle of unlikely to happen any time soon. I sal program of inaction (“axis” being have spent a good part of my career health care that do spoken for, and “evil” not researching issues in access to care, like not involve tax being conducive to a number of others in SGIM, but increases. Politi- reasoned discourse). They nothing meaningful has been done to cians are just doing their jobs. are: our academic medical institutions, end the appalling inequities in health Private organizations such as the organized medical profession, and care in this country. The time has come Physicians for a National Health Plan researchers on health care delivery and for a just war: one against a health care do what they can, but their influence its organization. Let’s take them one at a system that needs to be fundamentally has been limited because they do not time. reconstituted. Who are to be the appear to be speaking on behalf of Many academic medical centers are generals in this war? major interest groups or voting blocks. engaged in struggles to the death for The answer is not to be found in Is there no one who can lead the charge market share. Medical schools have the private sector. While it has shown a and convince the nation that the time tended to bifurcate care between the fair bit of interest in efficiency, it has has come to act? I believe that there are continued on page 8 done next to nothing about promoting access and equity. The HMOs, other private insurers, and pharmaceutical SGIM companies have made a lot of money off the current health care system. That is, of course, their right in a capitalist FORUM economy. If given the opportunity, many corporations will exploit it to the fullest. They will charge as much as they EDITOR Mark Liebow, MD, MPH • Rochester, MN can for their products, manipulate the Melissa McNeil, MD, MPH • Pittsburgh, PA [email protected] • (507) 284-1551 [email protected] • (412) 692-4886 market to put their competition out of P. Preston Reynolds, MD, PhD, FACP • Baltimore, MD [email protected] • (410) 939-7871 business, and induce demand when it ASSOCIATE EDITORS does not necessarily advance health and James C. Byrd, MD, MPH • Greenville, NC Valerie Stone, MD, MPH • Boston, MA may even harm it. Of course, some [email protected] • (252) 816-4633 [email protected] • (617) 726-7708 companies are extremely ethical and Joseph Conigliaro, MD, MPH • Pittsburgh, PA Brent Williams, MD • Ann Arbor, MI many do put limits on their behavior. [email protected] • (412) 688-6477 [email protected] • (734) 647-9688 But, on balance, they are one of the Giselle Corbie-Smith, MD • Chapel Hill, NC Ellen F. Yee, MD, MPH • Albaquerque, NM most profitable sectors of the American [email protected] • (919) 962-1136 [email protected] • (505) 265-1711 Ext. 4255 economy, and have no incentive to David Lee, MD • Boise, ID address issues such as lack of insurance [email protected] • (208) 422-1102 and disparities in care. What about the politicians? They Published monthly by the Society of General Internal Medicine as a supplement to the Journal of General Internal Medicine. have not delivered a system that SGIM Forum seeks to provide a forum for information and opinions of interest to SGIM members and to general internists and those engaged in the study, teaching, or operation for the practice of general internal medicine. Unless so indicated, articles do not resolves these problems. Should we not represent official positions or endorsement by SGIM. Rather, articles are chosen for their potential to inform, expand, and challenge readers’ opinions. hold them accountable? Alas, they are SGIM Forum welcomes submissions from its readers and others. Communication with the Editorial Coordinator will assist the doing what they perceive to be the author in directing a piece to the editor to whom its content is most appropriate. The SGIM World-Wide Website is located at http://www.sgim.org bidding of their constituents. The

3 SGIM FORUM

Research Funding Corner Joseph Conigliaro

his month’s Research Funding purchases will be allowed only if they stand why female athletes are more TCorner focuses on women’s health. are project specific (used only on this susceptible to certain types of injury. project) and the cost does not exceed The purpose of this announcement is to 30 percent of the requested direct costs. stimulate and foster a wide range of Title URL for more information: http:// basic, translational, and patient- Population Specific Research Projects www.komen.org/grants/available.asp oriented clinical studies to develop optimal prevention, rehabilitation, and Sponsor Title training strategies for injuries and Susan G. Komen Breast Cancer Women’s Health in Sports and overuse syndromes in the female athlete Foundation Exercise—NICHD throughout the life spectrum. This PA may also be applicable to studies on Deadline Sponsor women with disabilities. This PA will September 17, 2003 National Institute of Child Health and use the National Institutes of Health Human Development (NICHD) Deadline Note (NIH) research project grant (R01) Applicants must register electronically Deadline award mechanism. URL for more before submitting an application. June 01, 2003 information: http://grants1.nih.gov/ Registration will be from July 1, 2003, The National Institute of Child grants/guide/pa-files/PA-02-115.html through September 17, 2003. Health and Human Development Please contact joseph.conigliaro@ The Komen Foundation is currently (NICHD) is looking to fund research med.va.gov for any comments, sugges- accepting applications for innovative applications to study women’s health in tions, or contributions to this projects studying the epidemiology of sports and exercise in order to under- column. SGIM breast cancer within specific popula- tions at risk. The focus of the program is to identify unique needs, trends, barriers, and solutions to breast health One-on-One Mentoring Program at the care among African American, Asian Annual Meeting and the New Year-Long American, Native Hawaiian and Pacific Islanders, Hispanic/Latina, Native Mentoring Program American, Lesbian, Low Literacy, and Marshall H. Chin, MD, MPH and Eric J. Thomas, MD, MPH other defined communities. Areas of interest include cancer prevention and his year SGIM members have the can help shape their careers. Mentors control; behavioral science; epidemiol- Topportunity to participate in two and mentees are matched based upon ogy; and health service delivery pro- mentoring programs: the traditional mutual interests and expectations. The grams. Preference will be given to One-on-One Mentoring Program at the mentor-mentee pair meets in-person applicants who demonstrate collabora- Annual Meeting in Vancouver, or a new during the annual meeting, with the tion with a community-based organiza- Year-Long Mentoring Program for option of continuing the relationship tion. Only projects supportive of the faculty. beyond that time. Past participants in Komen mission will be considered. SGIM’s program have found this opportu- Particular emphasis will be given to One-on-One Mentoring Program nity to be worthwhile and important in projects that are innovative and non- Participants in the One-on-One helping them sort out important career duplicative of other efforts and have the Mentoring Program at the annual decisions and dilemmas. potential for national application. A SGIM meeting frequently state that it Mentees should prepare for their maximum of $250,000 (combined direct was one of the best things they did at meeting with their mentors by develop- and indirect costs) may be requested for the meeting. This program gives ing a clear agenda for the session. the two-year period. Indirect costs are students, residents, fellows, junior Clarity will enable mentees to avoid allowed but may not exceed 25 percent faculty, or mid-career faculty the vague, general responses to their of the requested direct costs (or a opportunity to develop one of the many requests. Are you looking for someone maximum of $50,000). Equipment relationships with a senior mentor that continued on page 9

4 ACGIM COLUMN

FINDING YOUR PATH Robert Centor, MD

Editor’s Note—This column marks the During those times that you were the entire group. first regular column of the Association of emotionally engaged you worked harder The path continues by discussing Chairs of General Internal Medicine and worked more effectively. During the role of emotional engagement by (ACGIM). This column offers an those times when you did not feel customers and how customers develop a opportunity for more regular communica- emotional engagement you just went passion for an organization. We have all tion between ACGIM and SGIM through the motions. seen this in medicine where patients do members. This is a welcome addition to the The second step in the path is become emotionally attached to their regular FORUM columns. recognizing that each employee has primary care physician. This is very innate talents that allow for emotional important to the institution. Those who ast year, in the SGIM Forum, I engagement. These talents differ for minimize the importance of this reviewed three books for leaders. each person. The key is to allow people relationship err in valuing the physi- LAs many of my friends know, my to use their talents in a way that is cian. favorite is titled “First, Break All the emotionally satisfying. This book does The ninth step involves under- Rules.” This book focuses on manage- include a review of 34 different talents standing how to enhance customer ment more than leadership. It uses data that each of us may possess. Each of us engagement. Many academic centers collected by the Gallup organization, to succeeds in some talents greater than forget that the primary care groups and provide framework for understanding others. The Gallup organization’s physicians often sustain the emotional high quality management. authors have written a book titled “Now attachment to the institution. The Gallup organization also Discover Your Strengths” which goes While this book is predominantly publishes management articles on a into these talents in great depth. Being concerned with improving profits in website titled the Gallup Management exposed to the idea that people view business, I quickly made connections Journal (gmj.gallup.com). I frequent the world differently and are comfort- with successful divisions of general this site to see new articles. I was able in the world with different sets of internal medicine, successful practices excited to see that they had published a talents is a very important concept. and even successful ward teams. I new book titled “Follow This Path.” The third step on our path is to recommend this book predominantly for This book extends the lessons of “First, understand that talent combinations those in leadership positions, whether Break All the Rules” at an organiza- lead to success. What the Gallup division directors, program directors, tional level. organization suggests is that you find out clerkship directors or other administra- I offer this review and highlight the why truly successful workers are passion- tive positions. Those who are consider- concepts that they champion. ate about their work. What makes the ing leadership and management I recommend reading “First, Break great ward attending? What makes the positions might want to read this book All the Rules” prior to reading this book great clinic attending? What makes the to see whether or not they have the (although this book certainly can stand great researcher? Why are they passion- talents and desire to work with people on its own). The book’s principle theme ate? That may help one find others who to try to maximize their emotional is that great organizations tap into may succeed at that task. engagements to the organization. This emotions and maximize the percentage The fourth step is to maximize the book emphasized the importance of of emotionally engaged employees. number of engaged employees. This developing individual relationships with “Follow This Path” refers to the steps refers to the questionnaire from “First each team member. The great managers that help one take an organization Break All the Rules.” Engaged employ- maximize overall production using towards greater success. I will summarize ees are happy with their work environ- emotional support. SGIM the path with gross simplifications. ment and feel supported. The first step requires that one The next step requires one to acknowledge that emotions play a major understand how to maximize the role in driving outcomes. When you number of engaged employees. This is think about your experience as a followed by understanding that having medical student, house officer or faculty employees who are not engaged and not member you may or may not have been emotionally attached to your group in emotionally engaged at all times. many ways decreases the productivity of

5 SGIM FORUM

Helpful Tools: ACP-ASIM Guide to Preparing for the Abstract Competition Patrick Alquire, MD

he American College of Physi- and makes use of performance bench- those chapters that are most pertinent cians-American College of marks or task completion checklists. to their needs. The website also lists the TPhysicians and the Michigan State Originally developed to assist students rules for the ACP-ASIM Abstract University Primary Care Fellowship and residents participating in the ACP- competition and the judging criteria for Program has assembled a concise ASIM Abstract Competition, the both clinical vignettes and research instructional Guide on scientific chapters are sufficiently generic to be projects. communication skills. The Guide is use by novices for all types scientific designed to assist novice researchers in meetings that include oral or poster The Guide’s chapters are: preparing and delivering research results presentations. The content of the 1. Writing a Research Abstract or case reports, from writing the abstract chapters can be used independently by 2. Write a Clinical Vignette Abstract to delivering the poster or oral presenta- learners or delivered by experienced 3. Preparing a Research Presentation tion. The Guide includes information faculty as part of a core research 4. Preparing the Clinical Vignette on communication skills for both curriculum in a training program. The Presentation traditional, hypothesis-based research Guide is freely available on the public 5. Preparing a Poster Presentation and clinical vignettes. Each of the 8 portion of the ACP-ASIM website, 6. Selecting Visual Aids chapters provides a rationale and goal http://www.acponline.org/srf/ 7. Preparing Visual Aids for a specific type of scientific commu- index.html. Potential users are encour- 8. Giving the Oral Presentation SGIM nication, includes illustrative examples, aged to review the titles and download

UpToDate Goes Mobile Eric W. Vogel, MD, Jennifer Erskine MD MSIS, Russell Maulitz MD PhD

he highly popular clinical informa with concise, practical answers to the includes a new updated CD-ROM Ttion resource UpToDate (http:// kind of questions they regularly encoun- version for a PC every four months, and www.UpToDate.com) has taken the next ter. Over 6,000 topics are presented in a access to the Internet version of the step in its evolution, with a new version textbook-style format, and the database database with a username and password. being released for handheld computers. also includes many illustrations, figures, An exciting new addition to the Although the hardware and software videos, links to MEDLINE abstracts, a UpToDate subscription package for 2003 requirements are a bit expensive for complete drug information database, is the availability of access via Pocket someone without the right equipment and patient information handouts. PC handheld computer at no extra cost. already, this product is a big leap UpToDate would technically not be Although handheld computers based on forward in delivering information — considered an “evidence-based” re- the Palm platform are more widely in and authoritative answers to common source, as it currently lacks formal rules use, the sheer size of the UpToDate patient-care questions — at the point of for data inclusion such as those used in database required the expandability and care. In this article, we will discuss our articles from the Cochrane Database of graphics capability that is currently only experience in using UpToDate in Systematic Reviews. Nonetheless, available with handheld computers general, the workings of the newest UpToDate is a well-regarded resource using the Pocket PC operating system version of the program for handhelds, known for content that is peer-re- from Microsoft. The Pocket PC units and its strengths and areas for improve- viewed, well referenced and constantly that have been confirmed to work with ment from the practicing clinician’s updated based on newly published UpToDate include the Toshiba e570 and standpoint. information, and the editors of e740, the Hewlett-Packard/Compaq Readers of the SGIM Forum are UpToDate are considering a more iPAQ series (3600 and higher), the probably familiar with UpToDate explicit evidence-based format in the Hewlett-Packard Jornada 560 series, the already, but to review, UpToDate is a future. An annual personal subscription Dell AXIM and the Casio Cassiopeia E- subscription-based clinical information costs $495 for new subscribers ($395 for 200. Although the price of these units resource designed to provide physicians renewals, $195 for trainees), and continued on next page

6 GENERALIST PHYSICIANS continued from page 1 tinuous quality improvement strategies change in the health plans, hospitals, As we write this article, we are amazed to improve chronic care, deploying and clinics where we practice. and humbled by the response to the call information technology to make care General internists are promoting for workshops and precourses. We look more evidence-based, exploring new change and improvement in each forward to a meeting that imparts care models, such as hospitalists, and area—but we can do more. From the excellent scholarship and learning enhancing collaborative relationships 2003 SGIM annual meeting, we hope opportunities, while focusing on our with office staff and consultants. that we can emerge as an activated unique role as change agents. With a In Policy: Generalists can influence force of generalist physicians ready and record number of submissions, it should policy on multiple levels of the health able to serve as change agents. Partici- prove to be a meeting you won’t want to care system. At the macro level, we can pants will gain new knowledge, skills, miss! SGIM support local, state, and national and tools for generalists who seek to legislative action that will positively return home with a renewed passion for Editor’s Note—Dr. Burstin and Dr. affect patients and providers. At more change in the elements of our profes- Headrick are the SGIM Annual Meeting micro levels, we can work to effect sional lives and the lives of our patients. Co-Chairs for 2003.

UPTODATE continued from previous page varies by features, the average new PC or Web versions, but there are a few of nine potential articles, categorized Pocket PC will run about $500. In differences. The handheld version does into “Most Relevant Topics” and addition, you will need to purchase a 1- not contain the photographs, videos, “Related Topics”, and we chose the gigabyte (GB) memory expansion and some of the full-text graphics that “Inferior Vena Caval Filters” article. module to hold the UpToDate database, the other versions have. Also, the The chapter on this topic had 8 either as an IBM Microdrive (about search interface and navigation work a subtopics to choose from, and a figure $300 retail) or a Compact Flash card little differently in order to eliminate illustrating the various models available. (about $500 retail), plus a storage reader the need for excessive scrolling through We learned that the effectiveness of (about $30) to connect the memory text that can be a problem with the these filters had not been well studied module directly to your desktop or small-sized screens in handheld devices. in carefully controlled trials. There was laptop PC for installation. Thus, users Our experience of using the a discussion of the results of the few who start from scratch and seek to get desktop version of UpToDate has been trials that had been completed, along “to the bedside” with subscription and that it is a useful resource that provides with potential complications. Overall, all hardware may face a stiff $1300- detailed, comprehensive answers to with the slight delays while the proces- $1500 in initial investment—the same questions we have about patient care. sor loaded the various pages, it took less as for some ultra-light-weight comput- We have installed the database on than two minutes to access the page ers. desktop computers for our residents to with the information we were looking The installation package for the use at Drexel University, and the for. Searches on other topics were also Pocket PC comes as a 2-CD ROM set. residents have also been quite happy easy to navigate and quickly led to the The process of adding the UpToDate with the utility of the database in section with the answers we needed. software to your Pocket PC involves finding clinical information to help One problem we encountered with installing the database directly from a them in their patient care. the program is the graphics. The figures Windows-based PC to the 1 GB storage The handheld version of UpToDate and tables included were hard to module through the storage reader, and has proved to be similarly useful. One visualize, and required scrolling to view then installing the UpToDate utilities to example of a search we did on the all their data. It appears that the figures the Pocket PC’s internal memory. The handheld version concerned the utility from the PC version were not re- Toshiba e740 unit we received for of vena caval filters in preventing formatted for the small screen size on review came with UpToDate pre- recurrent pulmonary embolism. After handhelds, so this is an area that could installed on a 1GB Compact Flash card, opening the UpToDate program on the be improved in the future. As the so we cannot comment on the actual Pocket PC, we were presented with a capabilities of handheld computers ease and reliability of the installation screen to enter search terms. After improve in the future, UpToDate will process. entering “filter” in the search field, we also look to add their photos and video The Pocket PC version of got a list of nine potential keyword to the mobile version. UpToDate delivers the same extensive matches, and chose “Filter, Inferior Overall, UpToDate for Pocket PC is database of textual information as the Vena Caval”. This led to another screen continued on page 9

7 SGIM FORUM

TRIANGULATION continued from page 3 poor (assigned to the public hospitals) legacy in the area of health care reform incentive to care for some patients, but and the rest, but in many places it is is well known, but there are no major not others. It must find a mechanism for becoming ever harder for the poor to medical organizations that are doing financing care that will assure that the get acute or ongoing medical care. much to move the national debate services to be provided to all are Deans and hospital administrators towards a fundamentally different sufficient. To this end, the decision- quietly complain about some aspects of system of care. making about this should not be left to the health care system (like allotments That brings us to the health care politicians who want to minimize taxes, for residency training) but they have researchers—the third point of the to doctors who want to optimize not promoted fundamental reform in triangle. These are people who devote incomes, or to private companies that health care in anything like a sustained their time to studying the health care want to maximize profits. It must be way. system and trying to make it better. made by a group that can remain What can these medical schools do? Unfortunately, the field has been immune to these parochial goals and get Don’t they have to scramble to survive? shaped by the politicization of funding above the fray. Of course, but their voices are not heard for the research. Access to care is Americans can stand together and marginally fundable from support something if they understand its time to time, and importance. Adding a year to the life of We need to use our brains, fundamental reform all African Americans (whose life along the Canadian- expectancy is several years less than our voices, our professional European lines as a that of whites) would avoid as many studiable problem is not deaths in a month as occurred in the skills and our immense political fundable at all. The World Trade Center collapse. The case capital to stand up and insist topics that get studied has to be made coherently. No one can are the ones that the express better the urgency of the on change. funding agencies situation and the direction in which we advocate as important: need to go than the representatives of refinements in the report medical practitioners, the institutions in any sustained way advocating for a cards for HMOs; interventions to curb that educate them, and the researchers system that is meaningfully different medical errors; and the like. These are who study the system. We need to get from the current one. Look, by contrast, reasonable questions, but people who every medical school, every medical at their perpetual campaign on behalf of lack any health care probably care less center and every medical organization NIH funding and the like. That is about error rates and sigmoidoscopy behind this great national priority, and where they have placed their emphasis, rates than they do on how to get their get our researchers to conduct the not on a financing system for health chronic disease treated (if they know research (even if marginally funded) care that will improve the health of that they have it). Yet, even the most that will help to put the system in place. their communities. idealistic of researchers gets diverted There will be a diversity of perspec- The second point in our triangle of from his or her agenda by the available tives on what to do. Some, like me, will inaction is medical organizations. Of funding opportunities. favor a single payer approach; others course, the AMA remains at the top of What can we do? It is time to will advocate other arrangements. the list, but SGIM and all the others transform our triangle of inaction into a There should, however, be no dissent on share responsibility. We put out state- triangle offence (with apologies to Phil the fundamental need to provide ments from time to time about how Jackson). If it worked for Michael everyone with care that is equitably things need to be better, but we do not Jordan and Shaquille O’Neal, it can distributed according to need, and for do much. We certainly do not do work for us. We need to use our brains, which cost is not a barrier of any anything in a sustained way. I attended our voices, our professional skills and consequence. There will be much a session on disparities at an AMA our immense political capital to stand resistance from vested interests. That is conference a few months ago. They up and insist on change. We need to their job. That is not our job. Effecting distributed a summary statement of run the risk of offending the benefactors this kind of change will not be a “slam their legislative goals for the year. of our institutions, and our advocacy dunk,” but, like getting patients to stop Virtually all of them were aimed at the cannot be about more money for smoking, if we don’t try, we won’t pocketbook issues of physicians, and physicians or hospitals. succeed. SGIM none at fundamental reform to improve This cannot be cosmetic change. It access and provide universal insurance. must eliminate the incentive to provide The AMA’s unfortunate historical too much care or too little, and the

8 CAREER TASK FORCE continued from page 2

During the year, they will meet at the facilitate collaboration among SGIM Other Issues national meeting and again at the members in the future. We also discussed how we could help regional meeting, and will talk at least junior clinician educators get the once a month by telephone. The Guidelines for Faculty Appointment recognition they need for promotion by relationship will end after one year SGIM’s “Clinician-Educator and giving medical grand rounds at hospitals unless both agree to renew it. Clinician-Investigator Job Description other than their own. A “speakers’ Marshall Chin is leading efforts to Work Group,” led by David Calkins, has bureau” that could connect junior identify mentors quickly, so a pilot been charged with developing guide- faculty members with divisions looking program can start at SGIM’s 2003 lines for clinician investigators and for qualified speakers is being piloted in national meeting. Plans include inviting clinician educators to use for measuring SGIM’s Mid-Atlantic Region. Such an current and former SGIM officers and or evaluating their current or prospec- activity might be more appropriate at council members, mentors in the “One- tive positions and assist them in the regional level, because of travel on-One Mentoring Program,” and negotiating with current or prospective expenses. Therefore, we will monitor ACGIM members to volunteer as employers. Therefore, rather than the Mid-Atlantic Region initiative, mentors. The new program will be addressing this issue independently, Jim while thinking about what a national announced to junior faculty members Byrd, who is a member of the Work program might look like. with other materials about the 2003 Group, will keep this task force apprised We welcome members’ feedback national meeting. To help the people in of the Work Group’s results. and advice. SGIM this program succeed, Bill Tierney will develop and lead a precourse on mentoring at SGIM’s 2003 national UPTODATE meeting. We will waive the course fee continued from page 7 for people who participate in the new a welcome addition to the UpToDate will, as they emerge from beta testing, mentoring program. family of products. For those who can also be worth a look. SGIM afford the initial hardware investment, Editor’s Note—Eric W. Vogel, M.D., is Collaboration this is one of the best mobile resources Director of the Internal Medicine Resi- We identified three activities that now available for helping physicians dency Program at Drexel University might improve collaboration among our find authoritative answers to questions College of Medicine; Jennifer Erskine, members. If we can identify which of that arise from their daily patient M.D., MSIS, completed her fellowship in our members have grants that are encounters. It is also probably the first medical informatics at the Institute for described in electronic databases, such portable program of its type to become Healthcare Informatics, Drexel University, as CRISP, databases in other federal available and hence offers a solution in Philadelphia; Russell Maulitz, M.D., agencies like the VA and CDC, and the here and now; competitors, such as Ph.D., is the director of the Institute for those in private foundations like the a handheld version of the American Healthcare Informatics, Drexel University, Robert Wood Johnson Foundation, we College of Physicians’ PIER Project Philadelphia. All are practicing primary will develop a way of making the (http://pier.acponline.org/index.html) care physicians. information readily accessible to our members who are looking for collabora- tors. Second, we will add to membership MENTORING PROGRAMS application and renewal materials a continued from page 4 question that asks whether the appli- cant is looking for collaborators, so we to review your CV in a constructive the time and opportunity to pursue your can understand better how many way? Do you need help meeting key interests? How can you be more members are interested in collaborators individuals in your field of interest? Do efficient? What academic goals should for curriculum development, writing you need advice on a specific project or you establish as a clinician-educator? grant proposals, and identifying sites for paper? Do you have a conflict in your How can one raise a family and achieve research studies. Third, we will work current setting that an outsider can one’s professional goals? As a person of with Annual Meeting Program staff and evaluate objectively? Are you at one of color, how do you motivate your Program Chairs to identify opportuni- the natural transition points in your institution to address some of your ties at SGIM’s 2003 national meeting career and need some advice about unique concerns? When is it time to for people interested in collaboration to which path to explore? What further consider changing institutions? These meet and talk with each other. Finally, training and skills do you need for your are the types of questions you can we will consider using GroupWare to career path? How can you negotiate for continued on next page

9 SGIM FORUM

MENTORING PROGRAMS continued from page 9

also appropriate for section chiefs is a new mentoring and …the mentor-mentee pair faculty who would like networking resource under the auspices to discuss balancing of the Association of Chiefs of General may choose to work on a family and work. The Internal Medicine (ACGIM). The research project together or goal of the program is to ACGIM program can complement the provide substantial new SGIM Year-Long Mentoring else develop and evaluate a mentorship for faculty Program for those who are section new curriculum. that goes beyond what chiefs. Contact ACGIM for more can be provided during information on the section chief the typical one-time mentoring program. bring to the SGIM One-on-One meeting of the SGIM One-on-One Mentoring Program. Mentoring Program. For example, the Sign Up mentor-mentee pair may choose to work Don’t be shy. Almost all of us can New Year-Long Mentoring Program on a research project together or else benefit from mentoring. Look for the for Faculty develop and evaluate a new curriculum. application materials for the two SGIM is starting a new, exciting Mentors and mentees will meet at the mentoring programs in the annual longitudinal Year-Long Mentoring national SGIM meeting and possibly meeting program announcement Program that is open to faculty who the regional SGIM meeting. Additional package or check the SGIM web site would like to benefit from regular contact throughout the year will occur (www.sgim.org). Many enthusiastic, contact with a senior SGIM mentor by phone and email. While the fre- generous mentors are eager to get to from another institution over the course quency of contact will vary depending know you! If you are interested in being of one year. The program is open to upon the needs of the mentee and a mentor contact Sarajane Garten faculty with any career focus including availability of the mentor, we expect ([email protected]) in the national clinical care, education, administration, that on average contact will occur office to receive the appropriate and research. The Mentoring Program is monthly. An additional resource for materials. SGIM

Department of Veterans Affairs Health Services Research & Development (HSR&D) Assistant Director, Quality Enhancement Research Initiative, (QUERI) Health Science Officer, GS-601-14 or GS-601-15 ($78,265-119,682)

HSR&D Service is recruiting for a full-time Health Science Officer to manage the Agency’s Quality Enhancement Research Initiative (QUERI). QUERI is a nationally recognized program using a systematic approach to enhance health care quality and outcomes by promoting the use of research evidence for clinical policy-making and practice. The VA offers a unique opportunity as an integrated health care system, with a strong research component, to identify, implement, and measure the impact of evidence based best practices. QUERI develops or enhances databases, identifies clinical research findings or recommendations, supports development of evidence-based clinical practice guidelines, identifies clinical performance gaps or problems, and develops strategies to effect organizational change to close these gaps.

The Assistant Director will be responsible for the day-to-day management of scientific and administrative issues and will provide leadership and guidance for the continued development of the program. The ideal candidate will have successfully completed all requirements for a Ph.D. (or equivalent doctoral degree) in an academic field of health or health-related sciences. The successful applicant will demonstrate that s/he has worked independently in planning, organizing, and/or conducting research related to health care systems and management and has effectively managed a research program. A GS-15 position may be available for an exceptionally well-qualified individual with a national reputation and demonstrated leadership in developing and managing a research/translation program. Appointment to the GS-15 position is dependent on the recommendation of an expert panel after review of the applicant’s qualifications, contributions, and professional standing.

Interested candidates should forward a detailed C.V., including a listing of publications to the address below. Additional application material may be required. Full vacancy announcement may be viewed at

http://jsearch.usajobs.opm.gov/summary.asp?OPMControl=IJ0238

VAMC (05) 508 Fulton Street Durham, NC 27705 Attn: Carlene Wilson (919) 286-6901

VA is an Equal Opportunity Employer

10 CLASSIFIED A DS

ment of Medicine at the University of Pittsburgh is cine at the University of Colorado Health Sciences Positions Available and Announcements seeking a clinician-educator with a career interest Center is seeking a clinician-educator to begin ap- are $50 per 50 words for SGIM members and in palliative care. Primary clinical responsibilities proximately January 1, 2003. Candidates should be $100 per 50 words for nonmembers. These include attending on an in-patient, palliative care board certified interested in a career as a clinician, fees cover one month’s appearance in the consult service, and seeing patients in an ambula- practicing and teaching general internal medicine. Forum and appearance on the SGIM Web- tory palliative care office. Teaching responsibilities The physician will practice nine half-days initially, site at http://www.sgim.org. Send your ad, include developing curricula and teaching pallia- with the opportunity for one half-day attending for along with the name of the SGIM member tive care at all levels of medical education. Oppor- primary care residents’ clinical education. The cli- sponsor, to [email protected]. It is assumed tunities available for general medicine practice ei- nician educator’s role offers full-time faculty status that all ads are placed by equal opportunity ther as a hospitalist or in an ambulatory setting. and opportunity for academic promotion judged on employers. Board certification in Internal Medicine is required. criteria of demonstrated excellence as a clinician/ Candidates who have completed fellowships in educator/scholar. Starting salary and faculty ap- Geriatrics, Palliative Medicine or General Internal pointment are commensurate with experience. ASSOCIATE CHIEF FOR CLINICAL RE- Medicine are preferred. The Section of Palliative Teaching activities include attending two months SEARCH. The Section of General Internal Medi- Care and Medical Ethics consists of a multi-disci- on the general medical inpatient services. The fac- cine at Boston University School of Medicine is plinary group of doctors, nurses, psychologists, phi- ulty share the responsibilities for after-hours call recruiting for a full-time faculty member at the losopher-ethicists, PharmD’s, social workers and with other members of the group practice. These Associate Professor or Professor level to serve as the chaplains. We see over 1,500 patients with diverse clinician-educators may collaborate with other fac- Associate Chief for Clinical Research. Candidates diseases ranging from cancer to chronic liver dis- ulty in clinical research projects, but are not ex- must have substantial experience as the principal ease and heart failure. The Section works closely pected to be clinician-researchers. Contact Jean investigator on federally or foundation funded re- with the Center for Bioethics and Health Law as Kutner, M.D., Acting Head, Division of GIM, search grants. Proven leadership and management well as the Center for Research on Health Care. UCHSC, 4200 East Ninth Avenue, Box Bl80, Den- abilities are essential and experience mentoring The Section has NIH and private foundation re- ver, Colorado 80262; Fax 303.372.9082 or e-mail research trainees and/or junior faculty is desirable. search support as well as funded education programs at Jean [email protected]. The University of Please forward CV to Jeffrey Samet, MD, Chief, for students, residents and fellows in an array of sub- Colorado is committed to Equal Opportunity and Section of General Internal Medicine, Boston specialties. Academic rank and salary will be com- Affirmative Action. Medical Center, 91 E Concord Street, Suite 200, mensurate with qualifications. Review of applica- Boston, MA 02118. tions will begin immediately and will continue un- CLINICIAN EDUCATORS. The Division of Gen- til position is filled. Send letter of interest and C.V. eral and Geriatric Medicine at the Kansas Univer- ASSOCIATE PROGRAM DIRECTOR: We are to Robert M. Arnold, M.D., University of Pitts- sity Medical Center is recruiting internal medicine establishing a new APD position in our university burgh, 933W-MUH, 200 Lothrop Street, Pitts- clinicians who seek to provide outstanding care in affiliated, community hospital based residency. We burgh, PA 15213 (Fax 412-692-4314) or e-mail our expanding academic practice. Individuals with pride ourselves on innovative curricula, cutting edge [email protected]. Starting date is July 2003. The educational interests will help develop innovative practice, and providing residents with a challeng- University of Pittsburgh is an Affirmative Action, programs at all levels of medical student education, ing and supportive educational environment. We Equal Opportunity Employer. and for our respected internal medicine residency. are looking for a person with at least 5 years of Interested candidates should submit a C.V. to Jeff medical education experience who has a commit- CLINICIAN-EDUCATOR FACULTY POSI- Whittle, MD, MPH; Director, Division of General ment to excellence and the passion needed to TION. The Division of GIM, Department of Medi- continued on next page achieve it. Send responses to Mark Rosenberg, Di- rector, Internal Medicine Residency at [email protected] or 5050 NE Hoyt St., Suite 540, Portland, OR 97213. PROGRAM DIRECTOR Internal Medicine Residency

CLINICIAN-EDUCATOR. Beth Israel Deaconess Medical Center, a major teaching hospital of The Department of Medicine of Good Samaritan Hospital, a 271-bed commu- Harvard Medical School, seeks physician to join nity teaching hospital affiliated with the Johns Hopkins School of Medicine, prominent Division of General Medicine. The Di- vision recently celebrated its 30th anniversary and seeks an experienced clinician educator with program management experience has a preeminent role in the teaching, clinical and to lead our internal medicine residency program. Candidates should minimally research missions of the hospital. Our Primary Care have an MD/DO degree, be certified by the American Board of Internal Medi- Residency track started in the early 1970s and has graduated >200 residents. Numerous opportunities cine, and be eligible for licensure in the State of Maryland. to teach students, categorical and primary care resi- dents in inpatient and outpatient settings. Our prac- Please forward CV in confidence to: tice has multidisciplinary supports facilitating care provided by faculty, general medicine fellows and Dr. John Rogers, MD, Chairman, Department of Medicine residents. Interested candidates should forward let- Good Samaritan Hospital, 5601 Loch Raven Blvd. ters of application and their curriculum vitae to Russell Morgan Building, Suite 502, Baltimore, MD 21239 Carol Bates, M.D., Search Committee Chair, Beth Fax: (410) 532-4997. E-mail: [email protected]. EOE Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215. Fax 617-667-9619. [email protected]. The Beth Israel Deaconess Medical Center is an Equal Opportu- nity/Affirmative Action Employer.

CLINICIAN EDUCATOR. The Section of Pallia- tive Care and Medical Ethics within the Depart-

11 SGIM FORUM Society of General Internal Medicine 2501 M Street, NW Suite 575 Washington, DC 20037

CLASSIFIED A DS continued from previous page and Geriatric Medicine, Kansas University Medi- FELLOWSHIP, GIM AT NEW YORK UNIVER- for Health Services and Policy Research in the cal Center; 5026 Wescoe; 3901 Rainbow Boulevard; SITY/BELLEVUE. NYU’s Division of Primary Care College of Public Health and the University of Iowa Kansas City, KS 66160. Email [email protected]. 2-year Fellowship Program has openings for candi- Public Policy Center, as well as eligibility for VA KUMC is an Equal Opportunity/Affirmative Ac- dates for academic year 2003–2004. Fellows HSR&D funding. Positions will include substan- tion employer. Not a J-1 position. prepare for academic general internal medicine ca- tial protected time for independent investigation reers through formal training and practical, and will allow faculty to spend 25% of their effort FELLOWSHIP, GIM – HARVARD MEDICAL mentored experience in clinical research and medi- in hospitalist or ambulatory-based clinical tracks. SCHOOL – A joint program of the teaching hos- cal education, including courses on research meth- Candidates at the Associate Professor level should pitals of Harvard Medical School invites applicants ods, clinical epidemiology, health policy, clinical have 5 or more years of experience and an estab- for a two-year research-oriented fellowship to be- teaching, curriculum design, leadership, psychoso- lished track record in obtaining extramural fund- gin July 1, 2004. The program offers each Fellow cial medicine, cross-cultural medicine/immigrant ing. This is a tenure-track position; academic rank an appointment at Harvard Medical School and one health and quality improvement. Masters degrees and tenure will depend on candidates’ qualifications of its affiliated hospitals. Most Fellows complete an are optional. For inquires, Dr. Mark Schwartz, and expertise as is consistent with University policy. M.P.H. degree at the Harvard School of Public [email protected]. For applications, The Division resides in the heart of the University Health. This program is designed for individuals [email protected] or 212-263-8895. of Iowa campus in Iowa City, which offers a re- who wish to pursue research careers that emphasize nowned public school system and wonderful col- the techniques of epidemiology, health services re- PHYSICIAN-INVESTIGATORS—MORE lege town lifestyle. Interested candidates should search, biostatistics, and decision sciences. Appli- THAN CORN GROWING IN IOWA. The Divi- send a letter expressing their interest in the posi- cants must be BC/BE in internal medicine by 7/1/ sion of General Internal Medicine at the Univer- tion and a current CV to Gary E. Rosenthal, MD, 04. For information and application forms, contact sity of Iowa seeks creative physician-investigators Director, Division of General Internal Medicine, Elizabeth Amis, Harvard Faculty Development and with expertise in health services research, health University of Iowa Hospitals and Clinics SE618 Fellowship Program in General Internal Medicine, policy, and chronic disease epidemiology at the GH, 200 Hawkins Drive, Iowa City, IA 52242. Beth Israel Deaconess Medical Center, 330 Assistant or Associate Professor levels. Successful Email: [email protected]. The University Brookline Avenue, Boston, MA 02215, Phone 617- candidates will join a growing multi-disciplinary of Iowa is an Equal Opportunity/Affirmative Ac- 667-5384, [email protected]. Deadline 3/ research group with substantial federal and non-fed- tion Employer. Women and minorities are strongly 15/03. The participating institutions are equal op- eral funding and with expertise in a variety of quan- encouraged to apply. portunity employers. Underrepresented minority titative and qualitative methods. Faculty will have candidates are encouraged to apply. opportunities for joint appointments in the Center