- Residents Are Well Represented at ACOI
- Remember The Patient
- Student Debt Weighs Heavily on Choices
- Honest Resident Feedback is Essential
- Board Question of the Month
- Interesting Case of the Month
- Advocacy
- Florida Challenge to Health Care Reform Act Moves Forward
- Supreme Court Refused to Hear California Challenge to Health Care Reform Act
- News of Note
- Resident/Fellow Check List of Responsibilities
- ACOI Contacts
- Council on Education and Evaluation
RESIDENTS ARE WELL REPRESENTED AT ACOI
I would like to offer sincere thanks to two individuals who have just completed their service representing residents and fellows at the ACOI leadership level. Mat Hardee, D.O., completed his internal medicine residency at Northeast Regional Medical Center in Kirksville, MO and is now enjoying an office-based practice in rural Missouri. Mat's two years on the ACOI Board of Directors were marked by his thoughtful comments and valuable insights on how ACOI's actions and potential actions would affect residents.
Belinda Kakos, D.O., completed a two-year term on the ACOI Council on Education and Evaluation, the group responsible for oversight of osteopathic internal medicine residency training programs and standards. Belinda is in a combined emergency medicine/internal medicine residency program at St. John Providence Hospital in Warren, MI. Belinda, too, brought a much-needed candid view to the Council as it deliberated on the issues that most deeply affect residents and fellows. One of the strengths of both the Board of Directors and the Council on Education and Evaluation is their recognition of the important role that residents and fellows play in our organization. Both bodies actively seek out resident input on the key issues they address and they are particularly attuned to generational differences when determining how best to proceed for the College as a whole. Replacing Mat as the Board representatives is Kelly Schiers, D.O., who is a first-year pulmonary fellow at Kennedy Memorial Hospital in Stratford, NJ. Kelly introduces herself in an article elsewhere in this newsletter. The new resident representative to the Council on Education and Evaluation has not yet been named. Any resident or fellow interested in the position should contact me at the e-mail address below. In order to be considered, you must have the permission of your program director and be able to serve for two years. I urge all of you to consider the resident representatives as your voice in the College's proceedings. Your input is actively sought and always appreciated.Brian J. Donadio, FACOI
Brian J. Donadio, FACOI, is the Executive Director of the American College of Osteopathic Internists. He may be reached via email at bjd@acoi.org.
REMEMBER THE PATIENT
The day is very full. Getting to the hospital in the morning, getting "sign out" about the night's events, making sure everything is in place, seeing patients, checking on labs and tests, making sure everyone on the team is doing what needs to be done, then teaching rounds, lectures. All the time, making sure that patients who need to be discharged are taken care of, the paperwork is done, the dictation is up to date, maybe there is some teaching for the team. While all this is going you need to think about future plans, board exams, job or fellowship applications, maybe your current research project. In addition to all of this going on at work, you likely also have a family or significant other outside of work who would like to spend some time with you.
I wanted to write this short article to ask you to remember the patient. Recently, many hospitals have been focusing on patient satisfaction. The hospital is spending lots of money to find out what patients' needs are and what would make them happier about their stays in the hospital. I think this has become an issue in many places due to the fact that physicians (particularly students and residents) do not have as much time to focus on the patients, and with this, it becomes easy for us to lose sight of what our job is.
This is certainly the case in Residency. By the end of internship, the patient can easily become the enemy. The next admission is someone who is providing more work, less sleep and keeping you from things you need to get done. The relationship has become distorted.
It is hard to remember that the patient is someone who comes to you asking for your help. This can be very hard to see when a patient is demanding or disgruntled.
Try to do something tomorrow. Sit next to a patient on their bed. Ask them how they are doing, but also ask about their fears or anxieties. Let this patient explain how he does not want to be sick, or how he is scared to be in the hospital, away from family. This takes time and it also can make you feel a little uncomfortable, but it can really make you think of a patient as a person. Caring for someone will certainly take up your time and might mean less time to study, read, or be at home with your loved ones, but it is what it means to be a physician. Try to not let this get lost in the craziness of the day.
Please contact me with any questions or comments. Scott Girard, DO Scott Girard, DO, is a hospitalist in Danville, PA. He completed his internal medicine training at Geisinger Medical Center in Danville in July, 2008. During his training, Scott served for two years as the resident representative to the ACOI Board of Directors. He now serves as liaison and advisor for residents and the College. He may be reached at slgirard@geisinger.edu.
STUDENT DEBT WEIGHS HEAVILY ON CHOICES
Greetings Residents and Fellows, I am extremely excited about starting my two-year appointment as your representative to the ACOI Board of Directors and look forward to acting as your voice and liaison. I have just recently returned from this year's convention in San Francisco, and in anticipation of planning next year's resident and student sessions, I spent time speaking with many of you from around the country. The Board and I are interested in what you are thinking, and hearing about the issues that you face, so please continue to share your feedback and ideas with us. One common worry that many students and residents voiced was that of financial unease. Particularly troubling was the choice of a discipline, coupled with the decision of where to practice in order to overcome the substantial debt that most of us have accumulated. "I can't not subspecialize when I have a quarter-million in loans," one resident told me. Unfortunately, some feel pressure to practice in certain fields or to move to more lucrative areas of the country, solely from fear of financial instability. Beyond the worry, there's frustration regarding what can be done about this. If any of this sounds familiar, I encourage you to read the ACOI White Paper Phoenix Physician (www.acoi.org/WhitePaper.pdf). I admit, before this convention, I was not familiar with the concept of the Phoenix Physician or the Medical Home. At its core, The Medical Home (introduced in 1967 by the American Academy of Pediatrics) strives to create a physician-directed team of health care professionals, tending to patients in the most efficient manner possible. This concept, supported by many national medical associations, aims to increase access to care, improve health outcomes and decrease medical costs. The Phoenix Physician, which is a concept created by the ACOI Board of Directors, would be one trained with the ability to implement the concepts of the Medical Home, among other skills needed in order to successfully practice any discipline in any region. The average debt of a medical school graduate in 2009 was $156,456 according to the AAMC. While there is fear and frustration associated with the cost of education, I think the majority of physicians would agree it is important to practice the type of medicine that appeals to you in a location of your choosing. Ideas of tuition caps, increasing grants/scholarships and loan repayment programs are all valid; however, as young physicians we need skill sets in order to adapt to evolving modern medical challenges. For patients and doctors both, the Phoenix Physician concept could be a lifesaver. Read the White Paper. I'm interested in hearing what you think. Feel free to email me at acoiresidentrep@gmail.com Kelly Schiers, DO ACOI Board of Directors Resident Representative Kelly Schiers, DO, is a first year pulmonary fellow at the University of Medicine and Dentistry of New Jersey. She may be reached via email at kelly.schiers@gmail.com..
HONEST RESIDENT FEEDBACK IS ESSENTIAL
In mid-September, I found myself in Bethesda for my last meeting as the resident representative on the ACOI's Council on Education and Evaluation. The Council meets every few months, to discuss and hold accountable residency programs across the country. I have sat in these meetings and listened earnestly as the Council members who are ACOI program directors and directors of medical education, attempt to develop processes that enhance the educational experience. Some of the best minds in our profession sit at that table committed to the resident experience.
As I have done these last two years, I shall share my experiences. This last meeting, significant time was spent in both revising the Basic Standards and reviewing resident concerns with their respective programs. Indeed, it was the latter portion of the meeting that I found most rewarding. As most of you know, at the end of each year we are required to fill out an evaluation form about our respective training programs. Failure to fill out the evaluation results in a monetary fine. These evaluations are taken quite seriously, indeed, they may be your only avenue to voice your concerns. I cannot emphasize enough the need for your honest input. The Council reads through all the evaluations and attempts to create the big picture. I sincerely believe that there are members on the Council that truly care about your training. After all, we are not only the future of the profession, we are the NOW. You only have one opportunity to train. Make the most of it! I would like to take the opportunity to thank all the Council members for giving me a memorable educational experience and a glimpse at the time and talent required to lead an effective organization. Belinda Kakos, DO Belinda Kakos, DO, just completed her term as the Resident Representative on the ACOI Council on Education and Evaluation. She is an emergency medicine/internal medicine resident at St. John Providence Health System..
BOARD QUESTION OF THE MONTH
This series of questions is to help residents understand how board questions are written and what kind of infomation these questions are testing. In order for residents to better understand the process, the ACOI has asked several former certifying board members to write this feature. This month's question is by Vicky Leo, DO, a general internist and past chairwoman of the American Osteopathic Board of Internal Medicine. Dr. Leo practices in Leechburg, PA.A 27 year old nurse has an annual PPD through employee health. At 72 hours 10mm of induration is noted. There is no surrounding erythema. History and physical exam are normal and a chest x-ray is normal. Your advice should be?
- No further action is required
- Repeat the test in 1-3 weeks
- Initiate isoniazid prophylaxis for 9 months
- Initiate treatment with rifampin and pyrazinamide for 6 months
- Initiate treatment with rifampin, pyrazinamide and ethambutol for 6 months
INTERESTING CASE OF THE MONTH
Presented by Jermaine Clarke, DO, a gastroenterology fellow, and Drew J. Chiesa, DO, an internal medicine resident, both of Kennedy Memorial Hospital, Cherry Hill, NJ, University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine.Click the case title below to view the report.
FLORIDA CHALLENGE TO HEALTH CARE REFORM ACT MOVES FORWARD
A federal judge in Florida refused to dismiss claims challenging the constitutionality of select provisions of the Patient Protection and Affordable Care Act (ACA) on October 14. The suit under consideration by the court was brought by 20 states and the National Federation of Independent Business. Specifically, the senior US District Court Judge for the Northern District of Florida ruled that the case may go forward to examine the constitutionality of the individual mandate and the expansion of Medicaid created under the ACA. The judge did dismiss the states' claims challenging the constitutionality of the employer mandate and the creation of state-based insurance exchanges, finding that they did not create legitimate constitutional questions. This case is just one of several cases brought across the country challenging the constitutionality of the healthcare reform law. The American College of Osteopathic Internists continues to monitor this and other cases. SUPREME COURT REFUSES TO HEAR CALIFORNIA CHALLENGE TO HEALTH CARE REFORM ACT The United States Supreme Court refused to hear a constitutional challenge brought in response to the ACA. Specifically, a former Republican state lawmaker from California asked the Court to consider his suit after a federal appeals court decided he did not have standing to challenge the constitutionality of the individual mandate established in the healthcare reform law. His case is still pending before the 9th Circuit Court of Appeals. It is common for the Supreme Court to refuse to hear cases that are still pending in lower courts. As previously noted, there are a number of cases working their way through the federal court system. The US Supreme Court will likely consider the constitutionality of certain provisions of the ACA within the next few years. To date, many of the legal arguments have asked whether Congress overreached the powers provided for in the Commerce Clause of the Constitution. Tim McNichol, JD Timothy McNichol, JD, is the Deputy Executive Director of the ACOI and is responsible for the College's advocacy efforts. He may be reached via email at tmcnichol@acoi.org..
President
tmorley@comcast.net
Jack D. Bragg, DO, FACOI
President-Elect
jackbragg@hotmail.com
Kelly Schiers, DO
Board of Directors Resident Representative
schierka@umdnj.edu
Brian J. Donadio, FACOI
Executive Director
bjd@acoi.org
Timothy W. McNichol, JD
Deputy Executive Director
tmcnichol@acoi.org
Susan B. Stacy, FACOI
Director of Administration and Finance
susan@acoi.org
Christina A. Smith
Post-Doctoral Training Coordinator
christy@acoi.org
Keisha L. Oglesby
Membership Coordinator/
Certification Liaison
keisha@acoi.org
jbulger@geisinger.edu
Robert A. Cain, DO, Vice Chair
racain@sbcglobal.net
Gary L. Slick, DO (AOBIM)
aobim@mail.com
Susan M. Enright, DO
senright@genesys.org
Joanne Kaiser-Smith, DO
jksdoc@aol.com
Robert T. Hasty, DO
hasty@nova.edu
Joanna R. Pease, DO
strixvaria@sbcglobal.net
Frederick A. Schaller, DO
frederick.schaller@touro.edu
John M. Kauffman, Jr., DO
jkauffman@vcom.vt.edu
Resident Representative TBA