SGIM

FORUMSociety of GeneralInternal MedicineTO PROMOTEIMPROVED PATIENTCARE, RESEARCH,AND EDUCATION INPRIMARY CARE ANDGENERAL INTERNAL MEDICINE Volume 26 • Number 7 • July 2003

2003 ANNUAL MEETING

GENERALIST PHYSICIANSAS AGENTS FOR CHANGE:VANCOUVER 2003Helen Burstin, MD, MPH

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The energy and creativity were pal-pable in Vancouver, BC—the sitefor the SGIM 2003 Annual Meet-

ing. We were very pleased to hold ourfirst annual meetingin Canada, in collabo-ration with theCanadian Society ofInternal Medicine(CSIM). Our Cana-dian colleagues, in-cluding David Naylor,Wendy Levinson,David Sackett, andour CSIM liaison,Anita Palepu, werevery receptive to ourcollaboration. Andwithout a doubt—Vancouver was anamazing meeting des-tination. Even whenthe weather wasgrand, we still had re-markable attendanceat the meeting. Trulya testament to thehard work of the an-nual meeting programcommittee!

The meeting theme, Generalist Phy-sicians as Agents for Change, set the tonefor the meeting. There was a sense thatthis meeting was somehow different fromother SGIM meetings. The research and

workshops were top-notched, as expectedfrom an SGIM meeting, but there was anadded sense of passion about the currentstate of the US health system and how it

could be improved.Our Peterson lecturer,Dr. David Naylor, of-fered an importantCanadian perspectiveon health and equity.Though a professionalmeeting, the patient’sperspective was heardloud and clear. Dr.Martin Shapiro used aremarkably personallens through which toexamine the healthcare system in hisPresident’s address.Dr. Lisa Iezzoni’s ple-nary session also gavevoice to some of ourmost vulnerable pa-tients.

The lively discus-sion on the “Future ofGeneral InternalMedicine” offered animportant chance for

self-reflection on the future of our disci-pline. Based on the record-breaking num-ber of meeting attendees, abstracts, clini-cal vignettes, innovations, and workshop

Martin Shapiro’s President’sAddress reflected on the challengesof access to care, as well asgeneralists’ unique abilities to carefor patients with complex illnessesand positioning in an area wheremost medical decision makingoccurs.

Contents1 Generalist Physicians as Agents for

Change: Vancouver 2003

2 AHRQ: Present, Past, and Future

3 President’s Column

4 SGIM Honors Colleagues at 2003 Meeting

4 SGIM Career Achievement in MedicalEducation Award: David E. Kern

5 SGIM Glaser Award:Thomas Delbanco, MD

5 John M. Eisenberg Award for CareerAchievement in Research:Daniel Singer, MD

6 2003 Annual Meeting Photo Album

10 Striving To Be The Best

11 Research Funding Corner

15 Classified Ads

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SGIM FORUM

AHRQ: Present, Past, and FutureHarry Selker and Jenn Brunelle

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SOCIETY OF GENERAL INTERNAL MEDICINEOFFICERS

PRESIDENT

JudyAnn Bigby, MD • Boston, MAjbigby@partners.org • (617) 732-5759

PRESIDENT-ELECT

Michael Barry, MD • Boston, MAmbarry@partners.org • (617) 726-4106

IMMEDIATE PAST-PRESIDENT

Martin F. Shapiro, MD, PhD • Los Angeles, CAmfshapiro@mednet.ucla.edu • (310) 794-2284

TREASURER

Eliseo Pérez-Stable, MD • San Francisco, CAeliseops@medicine.ucsf.edu • (415) 476-5369

TREASURER-ELECT

Mary McGrae McDermott, MD • Chicago, ILmdm608@northwestern.edu • (312) 695-8630

SECRETARY

William Branch, MD • Atlanta, GAwilliam_branch@emoryhealthcare.org • (404) 616-6627

COUNCIL

Christopher Callahan, MD • Indianapolis, INccallaha@iupui.edu • (317) 630-7200

Kenneth Covinsky, MD, MPH • San Francisco, CAcovinsky@medicine.ucsf.edu • (415) 221-4810

Eileen E. Reynolds, MD • Boston, MAereynold@caregroup.harvard.edu • (617) 667-3001

Eugene Rich, MD • Omaha, NErichec@creighton.edu • (402) 280-4184

Gary E. Rosenthal, MD • Iowa City, IAgary-rosenthal@uiowa.edu • (319) 356-4241

Ellen F. Yee, MD, MPH • Albuquerque, NMeyee@unm.edu • (505) 265-1711 Ext. 4255

EX OFFICIORegional CoordinatorJane M. Geraci, MD, MPH • Houston, TXjmgeraci@mdanderson.org • (713) 745-3084

Editor, Journal of General Internal MedicineJournal of General Internal MedicineJournal of General Internal MedicineJournal of General Internal MedicineJournal of General Internal MedicineEric B. Bass, MD • Baltimore, MDebass@jhmi.edu • (410) 955-9871

Editor, SGIM ForumSGIM ForumSGIM ForumSGIM ForumSGIM ForumMelissa McNeil, MD, MPH • Pittsburgh, PAmcneilma@msx.upmc.edu • (412) 692-4886

HEALTH POLICY CONSULTANT

Robert E. Blaser • Washington, DCrblaser@mail.acponline.org • (202) 261-4551

EXECUTIVE DIRECTOR

David Karlson, PhD2501 M Street, NW, Suite 575Washington, DC 20037

KarlsonD@sgim.org(800) 822-3060(202) 887-5150, 887-5405 FAX

It has been a tumultuous year for theAgency for Healthcare Research andQuality (AHRQ). As is well known

by SGIM members, the Agency suffereda tremendous loss on March 10, 2002when John Eisenberg, MD, MBA,Director of AHRQ, passed away. Afounding member and former Presidentof SREPCIM/SGIM, Dr. Eisenberg had

led AHRQ since 1997, during whichtime he enhanced the Agency’s role asbeing the place where key issues ofhealth care delivery and quality werestudied. During his tenure, AHRQ’s roleas the most important funder of healthservices research was restored, and hegreatly enhanced the agency’s visibilityin Congress and in the public andprivate sectors. Although his leadershipand friendship are missed, the Agencyand health services researchers werevery fortunate that in February of thisyear, SGIM member Carolyn Clancy,MD was named AHRQ Director byDepartment of Health and HumanServices Secretary Tommy Thompson.She has served as acting Director sinceDr. Eisenberg’s death. Dr. Clancy is anaccomplished health services researcherand active general internist. She held avariety of leadership roles at AHRQsince joining in 1990 and had repre-sented the Agency and its mission verywell on Capitol Hill and widely. SGIMwas active in supporting her appoint-ment.

The Agency’s leadership was not itsonly challenge this past year. Early in

2002, the Bush Administration pro-posed a 16 percent cut to AHRQ’sfunding for FY 2003, which would havetranslated into a 50 percent cut to allnon-patient safety grants and wouldallow for no new grants. SGIM andother organizations worked very hard tomake the case to the Administrationand to Congress that this would be

devastating to healthservices research in thiscountry, and wouldrepresent orders ofmagnitude greater lossesin improvements inhealth care delivery thanthe cuts would save.Fortunately, these cutswere restored by Con-

gress, and in the end, AHRQ receivedan approximately two percent budgetincrease for FY2003.

The Administration’s meagerbudget proposal for AHRQ in 2003 wasa startling wake-up call after years ofsteady increases to the Agency’s budget.Just as the enhanced role of the generalinternist a decade ago brought on bymanaged care had given us a newfoundsense of confidence, recent years’ eventshad perhaps engendered too muchoptimism. The November 1999 releaseof the Institute of Medicine report onmedical errors captured the public’sattention and supported a majorfunding increase at AHRQ to fundresearch in ways to reduce medicalerrors. The Agency’s national leader-ship in addressing patient safety and theinflux of funding was a major boon. Atnearly the same time, the Agencyreplaced its Practice Guideline effortswith a new Evidence-Based PracticeCenter (EPC) program, therebyeliminating a source of Congressionalcontroversy while preserving theAgency’s central role in the translation

The Administration’s meagerbudget proposal for AHRQin 2003 was a startlingwake-up call…

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PRESIDENT’S COLUMN

SGIM

FORUM

Published monthly by the Society of General Internal Medicine as a supplement to the Journal of General Internal Medicine.SGIM Forum seeks to provide a forum for information and opinions of interest to SGIM members and to general internists andthose engaged in the study, teaching, or operation for the practice of general internal medicine. Unless so indicated, articles do notrepresent official positions or endorsement by SGIM. Rather, articles are chosen for their potential to inform, expand, andchallenge readers’ opinions.SGIM Forum welcomes submissions from its readers and others. Communication with the Editorial Coordinator will assist theauthor 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

LESSONS FROMROSE’S LETTERSJudyAnn Bigby, MD

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EDITOR

Melissa McNeil, MD, MPH • Pittsburgh, PAmcneilma@msx.upmc.edu • (412) 692-4886

ASSOCIATE EDITORS

James C. Byrd, MD, MPH • Greenville, NCbyrdja@mail.ecu.edu • (252) 816-4633

Joseph Conigliaro, MD, MPH • Pittsburgh, PAjoseph.conigliaro@med.va.gov • (412) 688-6477

Giselle Corbie-Smith, MD • Chapel Hill, NCgcorbie@med.unc.edu • (919) 962-1136

David Lee, MD • Boise, IDlee.david@boise.va.gov • (208) 422-1102

Mark Liebow, MD, MPH • Rochester, MNmliebow@mayo.edu • (507) 284-1551

P. Preston Reynolds, MD, PhD, FACP • Baltimore, MDpprestonreynolds@comcast.net • (410) 939-7871

Valerie Stone, MD, MPH • Boston, MAValerie_Stone@mhri.org • (617) 726-7708

Brent Williams, MD • Ann Arbor, MIbwilliam@umich.edu • (734) 647-9688

Ellen F. Yee, MD, MPH • Albaquerque, NMefyee@unm.edu • (505) 265-1711 Ext. 4255

Rose* is a patient I inherited fromone of the residents graduatingfrom our primary care program

about 13 years ago. She had diabetesand many social problems. Married,with three sons, she paid more attentionto the health of her two youngest boysthan to her own problems. The young-est son was born with several congenitalheart defects and underwent two cardiacsurgeries. The middle son was hyperac-tive and on Ritalin, having problems inschool, and was emotionally immature.Rose frequently cancelled her appoint-ments but sent me letters (real letters,not e-mail) to explain why, to let meknow how the boys and her husbandwere doing, and to ask me to sendprescription refills.

June 1991—“Billy is working in apet store but doesn’t have any benefitsyet. If he makes it to manager he’ll getinsurance. The boys are doing good[sic]. Bobby’s last surgery was a success.Good for us! Please send prescriptionsfor insulin and syringes. I decreased myinsulin to once a day. I think it’s OK.When Billy gets insurance I’ll make anappointment for my pap.”

February 1992—“I’m glad you likedthe Christmas decorations the boysmade for you. Billy lost his job so that’swhy I missed my appointment. We’retrying to get Medicaid. I had my bloodpressure checked at a health fair and itwas ok. Please send a prescription formy new blood pressure medicine.”

July 1995—“Billy and I lost ourMedicaid again. Billy is working in ashoe store and makes too much money.We’re trying to see if we can make ourshare of the health insurance [the

employee’s shareof the premiumpayment] he getsfrom work. Icancelled mymammogram. I’llget it next monthwhen we getinsurance. I guessI’m doing prettygood except theboys are out of school and boy do theykeep me going. Please send prescriptionsfor insulin, syringes, and my bloodpressure medicine.”

March 1999—“Thanks for comingto see me at Mass General when I hadmy emergency hysterectomy. Boy was Isick. Medicaid is going to pay for everything. You wouldn’t believe the bills.Please send prescriptions for my insulin,

hormones, and bloodpressure medicines. I havean appointment to see younext month but I don’twant to run out.”

September 2002—“Iknow you want me tocome in to get my choles-terol checked again but itwill have to wait until nextmonth. The boys are doing

good. Bobby is really growing now andhis heart is fine. Billy finally stoppedsmoking because his doctor told him hehas emphysema. Can you send prescrip-tions for my 2 blood pressure medicines,my cholesterol medicine, and insulin.Did you know I have to pay $15 everymonth for every medicine you give me?”

Rose’s letters always sound upbeat,

* The names of the family and thedescription of some of the medicalproblems have been changed to ensureprivacy.

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SGIM FORUM

2003 ANNUAL MEETING: AWARD RECIPIENTS

SGIM Honors Colleagues at 2003 MeetingMelissa McNeil, MD, MPH

One of the highlights of anyannual meeting is the presentation of SGIM’s traditional

awards, the SGIM Career Achievement

in Medical Education Award, the GlaserAward, and the John M. EisenbergAward for Career Achievement inResearch. The following article profiles

this year’s winners and provides excerptsfrom the nomination letters for each ofthe three outstanding individualshonored this year. SGIM

David E. Kern, MD, MPH, waschosen as this year’s award winner.

Dr. Kern’s career goal has been toimprove the teaching and practice ofprimary care internal medicine. Hisaccomplishments in this area areamazing. In 1979, just out of fellowship,he developed the Johns HopkinsGeneral Internal MedicineResidency Program. He served asDirector of this program and wasproject director (and principalinvestigator) on associatedUSPHS grants from 1990-1999.The program has gained nationalrecognition for leadership andexcellence in primary careresidency education. Under Dr.Kern’s leadership, the programsucceeded in expanding ambula-tory continuity practice trainingin internal medicine to includetraining in community-basedpractices and training in a homecare program. Dr. Kern served asa leader and facilitator of thedevelopment of curricula thatare part of the GIM ResidencyProgram, such as interviewingskills, and the psychosocialdomain of medical practice, evidence-based medicine, managed care andpractice management, and ambulatorytraining in relevant medical and non-medical specialties. In 1987, he collabo-rated with other members of his division

SGIM Career Achievement in Medical Education Award: David E. KernNominated by Scott M. Wright, MD

to establish the Johns Hopkins FacultyDevelopment Program for ClinicalEducators, which has trained over 300participants in its 10 month, 1/2 day perweek Teaching Skills Program, almost150 participants in its 10 month, 1/2day per week Curriculum Development

Program, 1,500 participants at over 20institutions in its Special ProgramsConsultation Service, and 15 partici-pants in its Facilitator Training Pro-gram. Graduates of these programsinclude not only faculty, fellows, and

chief residents at Johns Hopkins butover 50 faculty from other academichealth centers throughout the region.Finally, Dr. Kern has recently taken theinitiative in creating and is the firstdirector of a new center called theCenter for Educational Excellence in

General Internal Medicine. Thegoal of this center is to raisefunds for, promote research anddevelopment, and influencepublic policy in areas ofphysician education critical tothe public trust.

It should now be clear thatDr. Kern’s educational accom-plishments are built upon acombination of programdevelopment and administra-tive skills, scholarship, dedica-tion to this mission and theneeds of society, and an abilityto work effectively with andbring out the best in others.They constitute an integratedbody of work that has advancededucation and scholarship inprimary care internal medicine.His programs, teaching, andpublications have influenced

and inspired countless clinicians andclinician educators. SGIM is pleased topresent him with this well deservedSGIM Career Achievement in MedicalEducation Award. SGIM

David Kern was presented with SGIM’s CareerAchievements in Medical Education Award byEducation Committee Chair Catherine Lucey.

(C. JEWALL)

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This year’s award winner for SGIM’shighest honor is Dr. Thomas

Delbanco. Dr. Delbanco is the foundingchief of the Division of GeneralMedicine and Primary Care and is thefirst individual at Harvard to hold achair in Primary Care Medicine. He wasa founder and member of the firstSREPCIM Council and as President 10years later he shepherded the Society’sindependence from the AmericanCollege of Physicians and foughtsuccessfully to establish SGIM’s currentname.

Dr. Delbanco led the GeneralMedicine Division at Harvard for 30years, and in that role was tireless in hisefforts to create a true partnershipbetween patients from all walks of lifeand their clinicians. He created a firstclass, one-class primary care practice—an effort that today has been replicatednationwide. He launched one of thefirst primary care residency programs in

SGIM Glaser Award: Thomas L. Delbanco, MDNominated by Russell S Phillips, MD; Mark Aronson, MD; Lisa Iezzoni, MD, MSc

general internalmedicine and this toospread across thecountry. In 1979, withDr. Robert Glaser’ssupport, he createdand led Harvard’sGeneral MedicineFellowship Program,which has sincegraduated more than180 fellows. Many nowhave prominentpositions in academicgeneral medicineteaching and research.

In 1987, he ledthe development ofthe Picker/Common-wealth Program forPatient CenteredCare, forerunner of the Picker Institute,which he chaired between 1994 and2000. These not for profit efforts are

devoted to learning from patients bywatching “through the patient’s eyes”

Dr. Singer is Professor of Medicine atthe Harvard Medical School,

Professor of Epidemiology at theHarvard School of Public Health, andChief of the Clinical EpidemiologyUnit in the General Medicine Divisionof the Massachusetts General Hospital.His record of research is truly remark-able in terms of high quality, innovativeapplications of epidemiologic designs tocommon medical problems, andimpressive in its impact on the dailypractice of medicine.

The nomination for this awardfocused primarily on his research inpreventing stroke in atrial fibrillation(AF). This problem ranks among themost common and important issues ingeneral medicine and geriatrics, as tenpercent of individuals over age 80 have

atrial fibrillation. No otherinvestigator has so effec-tively addressed the manyaspects of optimizingprevention for stroke in AF.His efforts also illustratecreative application of thefull repertoire of epidemio-logic designs. When hebegan his work in the early1980’s, it was unclearwhether or not anticoagu-lants would work or be safe.As a result of his work,anticoagulation is now thestandard of care for thetreatment of AF.

Dr. Singer’s work on AFrepresents two decades of

John M. Eisenberg Award for Career Achievement in Research:Daniel E. Singer, MDNominated by Michael J. Barry, MD and Nancy A. Rigotti, MD

Daniel Singer received the John M. EisenbergAward for Career Achievement in Research. LauraPetersen, who chaired the selection committee,made the presentation. (C. JEWALL)

Thomas Delbanco accepts the Robert J. Glaser Awardfor outstanding contributions to research and educationfrom selection committee chair Nicole Lurie. (C. JEWALL)

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SGIM FORUM

2003 ANNUAL MEETING PHOTO ALBUM

Imposing totem poles brought First Nations spirit tothe registration area. (L. TRACTON)

The Women’s Caucus was among the scores of Interest Groupsmeeting in Vancouver. (L. TRACTON)

Meeting Chair and Co-Chair Helen Burstin (left)and Linda Headrick describe new meetingfeatures. (C. JEWALL)

Anita Palepu (fourth from left), who served asliaison to the Canadian Society of Internal

Medicine, prepares to lead a tour of St. Paul’sTeaching Hospital. (L. TRACTON)

7

Poster sessions, expanded to presentmore research than ever before, werewell-attended. (L. TRACTON)

Research and Education MentorshipAward Selection Co-Chairs Harry

Selker (right) and Preston Reynolds(third from right) congratulate mentor

and mentee pairs John Peabody andKaren DeSalvo, and Clarence

Braddock and Bruce Ling(left to right). (L. TRACTON)

Many students, Residents, Fellows, andFirst Time Attendees enjoyed a specialReception to find out about interestingprograms and meet SGIM’s President andCouncil. (L. TRACTON)

Regional ResidentPresentation Award winners

Blase Polite, Maple Fung,Karen Lin, Sushma

Komakula, Michael LeMay,and Jennifer Gibson (left to

right) share kudos from JuheeKothari, Director of Regional

Services, (right) and JaneGeraci, Regional Coordinator.(second from right). Michelle

Iandiorio is not shown.(C. JEWALL)

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SGIM FORUM

In her Theme Plenary keynote address, LizaIezzoni encouraged the audience to tell theirpatients stories, in order to become agents forchange on their behalf. (C. JEWALL) Jim Sossman presents Heidi Crane with the 2003 Lawrence S.

Linn Award that will provide funding for her research on thehealth-related quality of life for HIV patients. (L. TRACTON)

The Peterson Lecture had David Naylorexploring “Universal Health Insurance:Necessary but Not Sufficient for Equity inHealth Care and Health Status.” (C. JEWALL)

Saturday’s Plenary Session, conducted by Eric Larson, offered attendeesthe opportunity to ask questions about, and provide feedback on theFuture of General Internal Medicine Task Force report. (C. JEWALL)

2003 ANNUAL MEETING PHOTO ALBUM…CONT.

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Judith Bowen accepts the award for Scholarship in MedicalEducation (Educational Methods and Teaching) fromselection committee chair Mark Levine. (C. JEWALL)

Mark Levine (center) presents the award forScholarship in Medical Education (Clinical Practice)to Steven Simon. (C. JEWALL)

Executive Director David Karlson(left) congratulates MartinShapiro on a productive year asPresident. (C. JEWALL)

Past and present students who benefited from his efforts at Yale University showedup en masse to cheer Stephen Huot when Wally Smith (far left) presented him withthe Herbert W. Nickens Award for commitment to cultural diversity in medicine.

(C. JEWALL)

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SGIM FORUM

ACGIM COLUMN

STRIVING TO BE THE BESTJames Byrd, MD

Aconsistent theme of the Chief’sGroup is improvement—improve-ment as managers and leaders,

improvement of our divisions and ourfaculty. Since few chiefs receivedexplicit training for their positions, wedevour literature that will help us doour jobs better. Each year, at our dinnergathering at the SGIM Meeting, amongother things, we share pertinentliterature that we have read in theprevious year.

Recently, I read a remarkable book,Good to Great, by Jim Collins, publishedby Harper Business in 2001. This bookhas value for institutions, leaders andthe rank and file. While intended forbusiness leaders, it has a good fit for

medical institutions, even junior facultymembers who belong to SGIM. Good toGreat is an evidence based evaluation ofover 1,400 companies that appeared onthe Fortune 500 list over a period of 30years. Collins, a former distinguishedStanford School of Business educator, isdirector of a management laboratory inBoulder, Colorado. Among variousactivities, his firm conducts multi-yearresearch projects. Good to Great was theculmination of five years of work by 21investigators who reviewed over 6,000articles and conducted hundreds ofinterviews with executives in the firmsthat met the criteria for success.

The purpose of the project was tofind out how average companies becamegreat companies. To be included in thestudy, a company had to: 1) have a 15

year cumulative stock return at or abovethe market average; 2) have a definedtransition point; and 3) have a 15 yearcumulative and industry specific stockreturn that was three times the marketaverage. They identified 11 companieswhich outperformed the market by 6.9times over the study period. The book isan in-depth study of these companiesand 17 others from similar industriesthat had not fared as well. Familiarcorporations make the list, such asKroger, Circuit City, Gillette, Abbot,Walgreens, and somewhat unfortu-nately, Philip Morris.

What were the findings? How arethe findings applicable to individuals orDivisions of General Internal Medicine?

Like good investigatorswith an open mind,Collins and his team hadunexpected findings.You do not have to be ina great industry to havegreat results; mostturnarounds do notoccur overnight; aunique strategy does not

separate the good from the great. In aninterview in Fast Company, Collinsnoted that the CEOs of the good-to-great companies were mostly anony-mous, and their companies wereunheralded. The leaders combinedpersonal humility with strong profes-sional will.

The consistent findings includedleadership where a culture of disciplinemixed with a spirit of entrepreneurshippermeated the companies. The numberone priority is to hire and retain theright people, or as Collins says, “put theright people on the bus.” Then, there isthe “Hedgehog Concept.” Hedgehogsare simple animals that according toIsaiah Berlin, who wrote an essay TheHedgehog and the Fox, focus on the “onebig thing,” actually two things, food and

housing. The concept for great compa-nies is to focus on what you can bepassionate about, what you can be bestin the world at, and what can drive youreconomic engine.

How do these lessons apply toacademic divisions of General InternalMedicine? First, you do not have to beat Harvard, UCSF, Penn or Washingtonto be successful. Second, as Collinsnotes, do not aspire for competence,strive to be the best Division within theDepartment, the best course director orClerkship director. Change takes time.Outstanding faculty who are disciplinedand creative can take a good GIMDivision and make it great. Goodluck. SGIM

James Byrd is president of theACGIM

…do not aspire forcompetence, strive to be thebest Division within theDepartment…

Calendar of Events

Annual Meeting Dates

27th Annual MeetingApril 21–24, 2004Sheraton Chicago Hoteland TowersChicago, Illinois

28th Annual MeetingMay 11–14, 2005Sheraton New Orleans HotelNew Orleans, Louisiana

29th Annual MeetingApril 26–29, 2006Westin Bonaventure HotelLos Angeles, California

30th Annual MeetingApril 25–28, 2007Sheraton Centre TorontoToronto, Ontario, Canada

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Research Funding CornerShannon Mejri and Joseph Conigliaro

Cancer Control Career DevelopmentAwards for Primary Care Physicians

The American Cancer Societyannually offers more than $130 millionin grants that support cancer researchprojects, training opportunities, andcareer development for scientificinvestigators and health professionalsworking in a variety of disciplines. TheSociety’s research program focuses onbeginning investigators, a program oftargeted research, and an enhancedcommitment to psychosocial andbehavioral, health services, healthpolicy, epidemiological, clinical andcancer control research.

Through the Cancer ControlCareer Development Awards(CCCDA) for Primary Care Physicians,the American Cancer Society seeks toencourage and assist in the developmentof primary care physicians who willpursue academic careers with anemphasis in cancer control. TheCCCDA provides opportunities forpromising individuals to acquire skills inprimary care practice, education, andresearch activities related to cancercontrol. Awards are made for threeyears with progressive stipends of

$50,000, $55,000, and $60,000 per year.Up to $10,000 additional per year forsupport of mentor.

For more information, eligibilityrequirements, and application proce-dures, visit the American CancerSociety’s web site at www.cancer.org. Atthe home page, go to the “Professionals”section and make the following selec-tions: “Research Programs; FundingOpportunities; Index of Grants.”Program Director: Virginia Krawiec,MPA — 404-329-5734 orGinger.Krawiec@cancer.org. 2003CCCDA Recipients are Mary S.Beattie, M.D. from the University ofCalifornia, San Francisco and Israel DeAlba, M.D., M.P.H. from the Universityof California, Irvine.

Women’s Mental Health In Preg-nancy And The Postpartum PeriodRELEASE DATE: June 6, 2003PA NUMBER: PA-03-135EXPIRATION DATE: May 2006

Recognizing that the consequencesof severe untreated postpartum depres-sion and psychosis can be devastatingfor individuals, families, and communi-

ties, the National Institute of MentalHealth (NIMH), the National Instituteof Drug Abuse (NIDA), and theNational Institute of Child Health andHuman Development (NICHD) arelooking to fund research on women’smental health in relation to pregnancyand the postpartum period. This PA willsupport research on perinatal mood andother mental disorders in one of fourareas: (1) clinical course, epidemiologyand risk factors; (2) basic and clinicalneuroscience; (3) interventions; and (4)services. Research is encouraged bothon perinatal non-psychotic mooddisorders and on psychotic disorders.Proposals for this PA can use the NIHResearch Project Grant (R01), SmallGrant (R03), and Exploratory/Develop-mental Grant (R21) mechanisms. Moreinformation can be obtained at http://grants1.nih.gov/grants/guide/pa-files/PA-03-135.html.

Please contact joseph.conigliaro@med.va.gov for any comments, sugges-tions, or contributions to thiscolumn. SGIM

Executive Director: David Karlson, PhDKarlsonD@sgim.org

Director of Operations: Kay OvingtonOvingtonK@sgim.org

Director of Membership: Katrese PhelpsPhelpsK@sgim.org

Member Services Administator: Shannon McKennaMckennaS@sgim.org

Director of Regional Services: Juhee KothariKothariJ@sgim.org

Director of Education: Sarajane GartenGartenS@sgim.org

Who’s Who in the SGIM National Office

Director of Communications: Lorraine TractonTractonL@sgim.org

Director of Development: Bradley HousetonHousetonB@sgim.org

Director of Finance/Administration: Karen LencoskiLencoskiK@sgim.org

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SGIM FORUM

AGENTS FOR CHANGEcontinued from page 1

of the best medical evidence intopractice. The sense of a new, morepositive Congressional attitude wasreinforced when the Agency wasreauthorized in 1999, when “policy” wasremoved from its old name (the Agencyfor Health Care Policy and Research orAHCPR), and in its new name came itsformal designation as the federal agencyfor healthcare quality.

However, this year, the wake-upcall has been received; it is understoodthat nothing can be taken for granted.We now are well aware of the crucialneed for continuing support for theAgency’s role and budget. Indeed, theAdministration has proposed an FY2004AHRQ budget that would allow for nonew grants and would cut all non-patientsafety grants by 15 percent. In response,SGIM and the more than 80 organiza-tions in the Friends of AHRQ coalitionsupport a $390 million budget for

AHRQ. Although theAdministration’sintended cuts forFY2003 were reversed,the changed focus of thenation and Congress andincreasing fiscal pres-sures make the situationvery serious. It will be

critical that we maintain momentumbuilt last year in supporting the Agency.We urge you to help the SGIM HealthPolicy Committee advocate for anincreased budget level for AHRQ.Please spend one minute to contactyour members of Congress using SGIM’sAdvocacy Action Center. You canaccess it at: http://www.capwiz.com/sgim/home/, or from the SGIMwebpage, http://www.sgim.org, clickon “Advocacy,” and “Advocacy ActionCenter.” Also, we welcome thoseinterested in joining the Health PolicyCommittee’s Health Services ResearchCluster, please contact hselker@tufts-nemc.org.

Although we must focus on theFY2004 budget to be sure the Agency’srole as the primary supporter of investi-gator-initiated health services researchis preserved, the Health ServicesResearch Cluster of the SGIM Health

PAST, PRESENT, FUTUREcontinued from page 2

Policy Committee also has longer-termgoals. An argument could easily bemade that AHRQ’s mission easilywarrants a budget on the same scale asthe National Institutes of Health(NIH). However, given that its budgetis currently one percent of the NIH, weare first focusing a more modest, butstill substantial, improvement in itsfunding: “billionization.” The cluster iscurrently developing the specifics of astrategy to put AHRQ on the path toreach this goal. The current strong staffand leadership at AHRQ will helpensure that the Agency continues tothrive. It is up to health servicesresearchers and all SGIM members, whobest understand the importance of thiswork, to spread the word about howAHRQ’s research saves thousands oflives and millions of dollars more thanits actual budget each year. We lookforward to the help of all SGIMmembers in mobilizing national supportfor this goal, using the web-basedapproach described above, by directCongressional contact, by participationin the Health Services ResearchCluster, and by many othermeans. SGIM

Based on the record-breakingnumber of meeting attendees…the state of general internalmedicine is quite robust!

submissions—the state of generalinternal medicine is quite robust! Withthe incredible response to the call for

abstracts and workshops, we tried hardto accommodate additional workshops,posters, and presentations. There was

also a renewed focus on mentoring andnetworking for junior investigators. Thehighly successful one-on-one mentoring

program offered a newopportunity for long-term, long-distancementoring. We alsoexperimented withsessions designed tofacilitate networkingand collaboration. Asusual, the common areasand hallways at the

SGIM meeting were abuzz!Vancouver created a magical venue

for the SGIM annual meeting and our

membership came through again withincredibly highly creative offerings ofthe highest scholarship. We hope thatthe meeting offered new knowledge,skills, and tools to our colleagues whowent home with a renewed passion forour unique role as change agents.Special thanks to Linda Headrick, themeeting co-chair, Sarajane Garten atSGIM, and the whole program commit-tee. See you in Chicago in 2004!

Helen Burstin, MD, MPH, served asChair of the SGIM 2003 Annual Meeting.

We urge you to help the SGIMHealth Policy Committeeadvocate for an increasedbudget level for AHRQ.

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LESSONScontinued from page 3

although the day-to-day struggle to keepthings together comes through loud andstrong. Her family is always on the edgeof financial disaster. In spite of outreachand many attempts at case manage-ment, education about diabetes and theimportance of self-care, and her obviouscapability, she has had significantdifficulty with diabetes self-manage-ment. She thought she was being quiteresponsible just trying to keep herprescriptions up to date. Even thoughRose has poorly controlled diabetes,hypertension, and hyperlipidemia, hermedical record may contain more lettersto me than visit notes.

Rose and her husband werefrequently among the uninsured inMassachusetts. She resisted applying forcoverage through the MassachusettsUncompensated Care Pool. This justdidn’t seem like real insurance to her. Itwas important to her to have insurancebefore she or her husband would accessmedical care. As is well known, theuninsured are more likely than not to beworking families. Even with insuranceand a job, however, her family isfinancially at risk due to their out ofpocket medical costs and low wages.The potential for economic catastropheis just one illness away. Insured or not,she struggles with how to manage out ofpocket medical expenses. In Massachu-setts the co-pays for medications forMedicaid recipients like her childrenhave increased from 50 cents perprescription to $2.00 per prescriptionand are slated to go up to $3.00.

According to an analysis in theNew York University Law Review, morethan half a million middle-class familiesdeclared bankruptcy following an illnessin 1999. This represents nearly half ofall personal bankruptcies. Women who

are heads of families andthe elderly were themost likely to file forbankruptcy due tomedical related costs. In2002 the HarvardWomen’s Law Journalreported that bank-

ruptcy filings by women have increasedby nearly 800% in the last 20 years andhalf of these are due to medical costs.The Commonwealth Fund reported thatin 1999 one in five working adults wascontacted by a collection agency aboutunpaid medical bills. A staggering onein three families with incomes less than

$20,000 per year was contacted.I recently participated in the

development of the MassachusettsHealth Economic Sufficiency Standardissued by the Women’s Education andIndustrial Union (WEIU). WEIU is aMassachusetts based advocacy organiza-tion that for 125 years has promotedeconomic self-sufficiency for womenand their families. As a member of theBoard of Directors I encouraged theorganization to do an analysis of theeconomic burden of medical care andcare giving on Massachusetts families.The estimated burden is significant. Forthe ideal American family of two adultsand two children the economic burdenranges from about $4,000 per year forthe employee’s share of the healthinsurance premium, out of pocketmedical expenses and long-termdisability insurance. If the family doesnot have employer-based insurance and

the wage earner has fair or poor healththe economic impact on the family isabout $15,000 for a non-group healthinsurance premium, out of pocketmedical expenses, and lost income dueto illness. For a single mother and achild with a chronic illness such asasthma, the economic impact rangesfrom $2,700 to $11,000.

Rose does not work outside thehome. Clearly her job is taking care ofher sons and husband and holding thefamily together through difficult times.She is resourceful and resilient. She isgrateful for her health care and the careher children have received. We are

working together to finda way for her to takebetter care of herself andaddress the real threatthat poorly controlleddiabetes presents. Shehas begun to exercise, tomodify her diet to thepoint where one of theboys calls her a vegetar-ian, and is currently upto date on all preventivescreenings. She does usethe computer at home

and has found an on-line discussiongroup for women with diabetes andfamilies to care for. I fully expecthowever that she will continue to writeto me in long hand, inadvertentlyillustrating the true costs that ourirrational and deteriorating health caresystem has on her family. SGIM

As is well known, the uninsuredare more likely than not to beworking families.

According to an analysis in theNew York University Law Review,more than half a millionmiddle-class families declaredbankruptcy following an illnessin 1999.

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SGIM FORUM

JOHN M. EISENBERG AWARDcontinued from page 5

consistent and creative effort that haschanged the practice of medicine. Hiswork has been widely recognized. Hehas written editorials on the subject forthe New England Journal of Medicineand other leading journals, writtennumerous reviews, advised HCFA (nowCMMS) on guidelines for AF, giveninvited presentations to NIH confer-ences, American Heart Association

symposia, and other award lectures. Hehas co-authored the chapter on AF inrecent ACCP Consensus Conferenceson Antithrombotic Therapy and is theChair of the AF chapter being preparedfor the next edition of these interna-tionally renowned guidelines.

In sum, Dr. Singer is an outstandingcandidate for the John EisenbergAward. His record of research is notable

and working with patients to improvecare. He was also responsible for thedevelopment of “Clinical Crossroads,” amonthly series in JAMA, supported bythe Robert Wood Johnson Foundation.A modern day CPC presented at grandrounds in several clinical departmentsat Harvard, Clinical Crossroads focuseson patients and clinicians facingdifficult decisions. These remarkableteaching conferences and publications

exemplify Dr. Delbanco’s fascinationwith bringing the patient as a fullpartner into the care process.

The Koplow Tullis Professorshipcreated for Dr. Delbanco summarizes hisaccomplishments. It stipulates that,“those chosen to hold this professorshipshall have demonstrated ferventdedication to the dignity, involvementand perceptions of all patients, withparticular concern for the needs of the

GLASER AWARDcontinued from page 5

underrepresented, under-served andeconomically disadvantaged. They shallhave manifested considerable energyand creativity as teachers and mentors.In addition they shall have conductedand sponsored research that provedprovocative in challenging conventionand opening new areas of inquiry.”These words well describe Dr. Delbancoand why he is deserving of SGIM’shighest award. SGIM

for its productivity, creativity, andexcellence. He has enhanced theintellectual spirit of general medicineresearch and has imbued in his manyfellows and colleagues enthusiasm andrespect for their research efforts. Asmuch as any general medicine re-searcher, he has changed practice andimproved patient care. SGIM

Y O U ’ R E I N V I T E D T O V I S I TT H E S G I M W E B S I T E

Portal & PathwayTO

Professional Effectiveness & SatisfactionK N O W L E D G E ❖ N E T W O R K I N G ❖ C A R E E R D E V E L O P M E N T

Featuring Links to Resources & ToolsINCLUDING:

Meetings ◆ Publications ◆ Job Listings ◆ Funding Sources◆ Residency & Fellowship Directories ◆

Government Agencies ◆ Search Engines

L o c a t e d a t h t t p : / / w w w . s g i m . o r g

15

INTERNISTThe Syracuse Community Health Center Inc. is a multi specialty health facility with an outstandingopportunity for a committed BC/BE internist looking to make a difference. Competitive compensation and fringebenefit package, including relocation assistance, CME and malpractice coverage. Close to academic medical center,major university, hospitals and family oriented cultural activities. Bi-lingual English Spanish speaking candidates areencouraged to apply.

Submit CV and cover letter to:Winnie RobinsonProvider Recruitment AdministratorSyracuse Community Health Center, Inc.819 S. Salina Street, Syracuse, New York 13202Phone: (888) 867-2025, ext. 2424 Fax: (315)475-1448E-mail: wsrl@schcny.com

FACULTY INTERNIST—GENERAL MEDICINE UNITThe Unity Health System in Rochester, NY, is seeking a BC/BE internist to join the core faculty teaching unitof its outstanding 37 resident Internal Medicine Program. A commitment to medical education is essential; dutieswill include general medicine primary care faculty practice and precepting, as well as other teaching responsibilities.Unity’s Park Ridge Hospital is a suburban, 208 bed, community hospital with excellent facilities, quality care, and acollegial atmosphere. Excellent compensation package. Unity is a major teaching affiliate of the University of Roch-ester School of Medicine and Dentistry.

Send resume to:James M. Haley, MDChairman, Department of MedicineUnity Health System1555 Long Pond RoadRochester, NY 14626FAX: 585-723-7834

CLASSIFIED ADS

Positions Available and Announcementsare $50 per 50 words for SGIM members and$100 per 50 words for nonmembers. Thesefees cover one month’s appearance in theForum and appearance on the SGIM Web-site at http://www.sgim.org. Send your ad,along with the name of the SGIM membersponsor, to tractonl@sgim.org. It is assumedthat all ads are placed by equal opportunityemployers.

FACULTY DEVELOPMENT TRAINING. TheStanford Faculty Development Center is acceptingapplications for its 2004 month-long, facilitator-training program in Contemporary Practice. Train-ing prepares faculty to conduct a faculty develop-

ment course for faculty and residents at their homeinstitutions. The Contemporary Practice curricu-lum addresses issues pertinent to 21st century medi-cine, focusing on both the individual physician-educator and systems of care. Topics include: thecurrent healthcare environment, decision making,quality management, shared decision making, andphysicians as change facilitators. ContemporaryPractice Program dates: February 2–27, 2004. Ap-plication deadline: November 1, 2003. For infor-mation: visit http://sfdc.stanford.edu or contactMerlynn Bergen, PhD at bergen@stanford.edu.

INTERNIST. Piedmont/Triad Metro. Mid-size, pri-vate practice in Piedmont/Triad Metro, NC seek-ing Internist. Average 20-25 patients/day (95%scheduled) and perform 20-30 office procedures/month. Call 1:5. Privileges in one hospital (large

regional hospital). Competitive salary guarantee,bonus, partnership, and comprehensive benefits.Popular city, all amenities. Toll free 888-273-4628or E-mail Tammy@Berendtmedical.com. No J-1’s,please.

INTERNIST. Southern California. We are look-ing for an Internist or Family Practitioner with aninterest in Geriatrics to become part of a solo prac-tice located in beautiful Ventura County, South-ern California. Spanish speaker a plus. First yearguarantee. State of the art facility. Area offers beau-tiful beaches, great schools, cultural activities, andmultitude of family activities. E-mail CV:Lyodkovi@chw.edu, Fax : 805-981-4440, Attn:Leila Yodkovik.

Syracuse Community Health Center, Inc.

Society of General Internal Medicine2501 M Street, NWSuite 575Washington, DC 20037

SGIM

FORUM