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Inspire SGIM Inform To Promote Improved Vol. 31 Connect Patient Care, Research, and Education in Primary Care and Num. 6 FORUM General Internal Medicine June 08 The Society of General Internal Medicine FROM THE REGIONS The Safety-Net at Risk Elizabeth A. Jacobs, MD, MPP Dr. Jacobs is Associate Professor of Medicine, Stroger Hospital of Cook County and Rush University Medical Center. She is also a Deputy Editor of JGIM, a member of the SGIM Health Disparities Task Force and Health Policy committees, and a former council member of the Midwest region of SGIM. CONTENTS he past two years have not been good for public hospitals in the TUnited States. The traditional safety-net institutions that provide care 1. From the Regions for the most disadvantaged in our major urban centers are coming 2. This Month in JGIM under increasing pressure—and some are cracking. Martin Luther King, 3. President’s Column Jr.-Harbor General Hospital in Los Angeles closed after losing certifica- 4. Abstractions tion with the Centers for Medicare and Medicaid Services (CMS), its 5. Innovations major source of revenue. Two-storied public hospitals, Grady Memorial Hospital in Atlanta and Stroger Hospital in Chicago (formerly known as 6. In Training Cook County Hospital), have both faced dramatic financial crises. While 1 7. Morning Report the cause of these crises is multi-factorial, a common thread is inade- 8. Funding Corner quate oversight by the elected officials responsible for these hospitals’ 9. Funding Opportunities financial health. 10. Endgame In the case of Martin Luther King, Jr.-Harbor General Hospital, County Supervisors had known for at least four years that the hospital Heading to the Finish Line was at risk of losing its certification with CMS, yet they failed to com- Remember summer camp? Most of the mit the resources needed to bring the quality of care up to a level that week was highly organized, but several both assured patient safety and satisfied CMS. The story of Grady is hours were set aside for "free choice." more complex, but fiscal mismanagement on the part of the politically For many of us, this was our favorite appointed governance board is an important part of the story. The gov- time. This issue of Forum represents ernance board did not enforce recommended cost-cutting or provide ad- the second-to-last issue for the current editorial team. To commemorate the equate oversight of revenue generation, contributing to its mounting impending transition, we gave our 25 deficit. In a frequently cited example, one in five Medicaid bills over the associate editors license to break from past three years was kicked back to Grady because they were improp- the usual structure of their columns. In erly filed. Similarly, the Cook County Bureau of Health lost a large por- other words, free choice. Some of them tion of its revenue after a planned phase-out of federal funding took took us up on it. We hope that you like effect. Despite the fact that the Cook County Board knew about this the results and that you will join us in pending loss of $50 million in annual revenue for four years prior, billing thanking our wonderful associate editors for Medicare and Medicaid services was not put in place until after the for sustaining the Forum for three phase-out. As a consequence of the resulting gap in funding, services exciting years. and jobs were dramatically cut and the budget reduced 11% over a —Rich Kravitz, span of a few months. Malathi Srinivasan, Tina Slee continued on page 11 THIS MONTH IN JGIM I’ll Write a Non-peer-reviewed Article Any Day Adam J. Gordon, MD, MPH, FACP, FASAM SOCIETY OF GENERAL INTERNAL MEDICINE s I close out my term as the As- Two surprises happened over OFFICERS Asociate Editor of the SGIM the years: not one potential intervie- President Forum, I am happy to reflect. My wee turned down being interviewed Lisa V. Rubenstein, MD, MSPH North Hills, CA [email protected] (818) 891-7711 role as editor of the “This Month in for a featured TMIJGIM piece, and President Elect JGIM” (TMIJGIM) column has been not one potential interviewee asked Nancy A. Rigotti, MD Boston, MA productive, invigorating, and re- to be “co-author” on the TMIJGIM [email protected] (617) 724-4709 warding. Too bad my academic in- SGIM Forum article. The latter sur- Immediate Past-President stitution is less excited about my prise, co-authorship, involved a Eugene Rich, MD Omaha, NE [email protected] (202) 887-5150 work in this role: I should have debate among the SGIM Forum edi- Treasurer been working on my research and torial staff when TMIJGIM origi- Jeffrey Jackson, MD, MPH Bethesda, MD publishing my own peer-reviewed nated: Should we “offer” a [email protected] (202) 782-5603 work. co-authorship to every interviewee? Secretary Through 18 TMIJGIM articles In the end, we decided to offer this Valerie Stone, MD, MPH Boston, MA [email protected] (617) 726-7708 over three years, I have explored if the interviewee requested it. No Secretary Elect with corresponding authors who interviewee did. Monica L. Lypson, MD Ann Arbor, MI have published their work in the Perhaps interviewees recognized [email protected] (734) 764-3186 Journal of General Internal Medicine that the SGIM Forum was not a COUNCIL (JGIM) the origins of their research, peer-reviewed publication and co- Marshall Chin, MD, MPH their research career, and the trials authorship would not be “valued” Chicago, IL and tribulations of original clinically by their academic institutions—even [email protected] related investigations. I found it though the publication was about (773) 702-4769 easy to communicate with the cor- their work and their experiences. Karen DeSalvo, MD, MPH, MSc New Orleans, LA responding authors. They seemed As an academic clinical investi- [email protected] to be excited about having their gator, like many of the interviewees (504) 988-5473 work featured in another format for the TMIJGIM column, I recog- Arthur G. Gomez, MD outside of JGIM. nize that peer-reviewed published Los Angeles, CA [email protected] The TMIJGIM piece was much literature is the “currency” of an (818) 891--7711 more about the interviewee and academic career. In the tenure and Said A. Ibrahim, MD, MPH their work than my “review” or in- non-tenure streams, promotions are 2 Pittsburgh, PA terpretation of the work. Often the judged primarily with the number [email protected] (412) 688-6477 TMIJGIM articles had more expres- and quality of peer-reviewed publi- Laura Sessums, MD, JD sions from the author-interviewee as cations and peer-reviewed grants. Washington, DC quotes than my original thoughts. Reflecting on my recent promotion [email protected] experience, I dutifully catalogued all (202) 782-5560 EX OFFICIO COUNCIL MEMBERS my peer-reviewed articles regarding Donna L. Washington, MD, MPH Los Angeles, CA Regional Coordinator “quantity” (primarily the number) [email protected] Donald Brady, MD Atlanta, GA and the “quality” (the nebulous (310) 478-3711 ext. 49479 [email protected] (404) 616-31171 journals’ impact factors). In the clini- ACGIM President cal-educator’s world, peer-reviewed Health Policy Consultant Frederick Brancati, MD, MHS Baltimore, MD Lyle Dennis [email protected] (410) 955-9843 case reports and original research Washington, DC are also valued extremely highly by [email protected] Editors, Journal of General Internal Medicine Martha S. Gerrity, MD, PhD Portland, OR promotion committees. Many pro- Executive Director [email protected] (503) 220-8262 motion committees are not similarly David Karlson, PhD Ext. 55592 asking for quantification or quality 2501 M Street, NW, Suite 575 William M. Tierney, MD Indianapolis, IN Washington, DC 20037 [email protected] (317) 630-6911 factors of their faculty’s non-peer- [email protected] reviewed publications. (800) 822-3060; Editors, SGIM Forum (202) 887-5150, 887-5405 Fax Rich Kravitz, MD, MSPH Sacramento, CA Why not? [email protected] (916)734-2818 Director of Communications Non-peer-reviewed publications Malathi Srinivasan, MD Sacramento, CA and Publications [email protected] (916)734-7005 include commentaries and opinions, Francine Jetton letters to the editors, print or Washington, DC Associate Member Representative [email protected] Hannah E. Shacter St. Paul, MN web-based reviews, book chapters, (202) 887-5150 [email protected] (612) 963-6813 editorials, and even SGIM Forum continued on page 13 PRESIDENT’S COLUMN What Does it Take to Make a Difference: SGIM at the Crossroads Lisa Rubenstein, MD SGIM Despite national results showing internal medicine training at the top EDITORS IN CHIEF Rich Kravitz, MD, MSPH [email protected] of student quality ratings, more than Malathi Srinivasan, MD [email protected] 80% of our students are choosing MANAGING EDITOR Christina Slee, MPH [email protected] specialist careers. ASSOCIATE EDITORS hen the call came telling me and Rich) and their Councils had de- Abstractions Jeff Jackson, MD, MPH [email protected] W I’d been elected President, I veloped the basis for linking SGIM’s ACGIM didn’t know whether to be thrilled numerous activities into a more co- Anna Maio, MD [email protected] or terrified. Having not been on herent, agile whole by creating Ask Expert Council for several years, I won- three core mission committees (for Nina Bickell, MD, MPH [email protected] dered what I would find when I research, education, and clinical Carol Horowitz, MD, MPH [email protected] joined the SGIM leadership team. practice). SGIM’s