July 2018

Governor’s Corner

Matt Hollon, MD MPH FACP

The American College of Physician and by extension our chapter is first and foremost a membership organization. The simple fact is that without you all, we don’t exist. I have spent a good part of the past decade in leadership roles in various professional organizations considering the fundamental tenets of success as a membership organization. Tenets that center on the collegiality, support, and advocacy we can provide for you in the valuable and rewarding work you do. Tenets that our executive council validated at our chapter’s recent strategic planning retreat in early June and that play out through the many activities of our chapter highlighted in this newsletter!

Once every 4 years during the transition to a new Governor our chapter strategizes about the years ahead. This year we gathered at the Graham Visitor’s Center in the Washington Park Arboretum in Seattle on a mild and rainy day to chart our course forward. To open the retreat we asked council members from across the state to reflect on why they volunteered their time to ACP and our chapter. What we heard from council members captured why we all volunteer hundreds of hours each year to help the chapter run.

At the forefront of these reflections we heard council members enthusiastically share that being an ACP member provides meaningful collegiality and connection – a sense of belonging to our profession. One council member reflected on the joys of the annual “reunion” that happens each year at the state chapter meeting. Others reflected on the broader connection to the internal medicine community across the nation through ACP’s national meeting. Many reflected on their collegial and supportive connections through Chapter interest groups such as Women In Medicine (see the summary of recent activities in this newsletter) and Early Career Physicians and the hosted events that bring us together to share the commonalities of challenges and joys in caring for others.

Other council members highlighted the opportunities our organization and chapter provide for continuing education and professional growth – from the opportunity to earn “Maintenance of Certification” (MOC) points at our Chapter’s exceptional and nationally recognized Annual Scientific Meeting (for details of this year’s chapter meeting see the report in this newsletter from Program Chairs, Rachel Safran, MD and Jared Klein, MD) to ACP’s pre-imminent annual meeting for internal medicine physicians – Internal Medicine 2019 will be in Philadelphia next April. Speaking of MOC, stay tuned for ongoing work between ACP and the ABIM on a society MOC pathway that would be offered by the College and certified by the ABIM. Beyond continuing education, the College serves as the “go to” resource in supporting internal medicine physicians on everything from practice support to wellbeing through ACP’s “Physician Wellbeing and Professional Satisfaction Initiative”.

We also heard from council members about the crucial role that our organization serves in effective advocacy. For me the biggest hook into the College over the past decade has been the realization that few things are as powerful with our legislators as physicians speaking with a unified voice advocating for programs and policies that support and improve patient care, our professional experience, and the health of our communities. Our Chapter’s ongoing and influential participation in ACP Leadership Day each May (see details from this year’s session in this newsletter) continues to be a highlight of the work of our chapter. In the years to come, our chapter is committed to ramping up our state level advocacy efforts in partnership with other physician organizations in the state. To this end we recently partnered with public health officials in the state as well as the Washington State Medical Association and other specialty societies to address firearm violence as a public health issue. With council member, Dr. Leah Marcotte, as our representative, the collaboration launched efforts to bring attention to this serious public health problem (for further details, see Dr. Marcotte’s summary in this newsletter).

The Executive Council did not spend the entire strategic planning retreat in reflection. We have an outstanding chapter and an amazing Annual Chapter Meeting. We all owe Dr. Joyce Wipf deep gratitude for her leadership of the chapter these past four years. We also have opportunities to continue to enhance and expand our work on your behalf. We see opportunities to improve our advocacy efforts at the state level and to provide additional opportunities to all of you to lend your voice to this effort (see details of the upcoming advocacy “workshop” in this newsletter). We also see opportunities to improve our communication with members and continue our work on a comprehensive multi-modal communication plan. Lastly, we see continued opportunity to reach out to all of you and create a sense of community among internists across the state through continued regional activities and membership engagement.

In short, for all of us as internal medicine physicians, the American College of Physicians is our “professional home” – a professional home that plays the central role in sustaining and enhancing the work we do and the settings in which we do this work. Certainly based on the sacrifices we all make as physicians, we recognize better than most everyone else that we can only expect to get out as much as we put in. Simultaneously, I think we all understand that the valuable thing about organizations is that they can be more than the sum of our individual contributions. We most definitely would not be the outstanding Chapter we are without you all. We deeply appreciate your support and involvement. If you have ideas about how we continue to enhance our Chapter and the value of your membership please do not hesitate to email me at mhollonmdfacp@gmail.com.

Governors of Montana, Alaska, and Washington including outgoing Governor Dr. Joyce Wipf and incoming Governor Dr. Matt Hollon addressing attendees at the Northwest Reception at the national ACP meeting in New Orleans, April 2018. The national meeting provides internists cutting edge updates for the practice of medicine and a wonderful connection to the broader internal medicine community. Internal Medicine 2019 will be in Philadelphia, April 11-13, 2019.

Matt Hollon, MD MPH FACP

Seeking Members Interested in Chapter Leadership Opportunities

Are you a self-starter interested in developing educational opportunities, policy-setting at the state level, and collaborating with colleagues to address the professional needs of internists? Do you want more leadership experience to prepare you for future endeavors? Contact us to learn more and get involved in the Washington Chapter!

Opportunities can range from one-time tasks to committee involvement or leadership roles and empower you to utilize your passion, expertise, and skills all while advancing the mission of ACP. We invite you to connect with our chapter.

We are looking for interested, committed, passionate leaders who are willing to contribute towards a vibrant and diverse chapter serving the needs of our members. The process is easy!

• First, log into ACP Online to complete the chapter volunteer interest form. This will streamline the submission process by pre-populating your membership information.
• Second, complete the interest form.
• Third, we will follow-up with you directly within 2 weeks.

https://forms.acponline.org/webform/chapter-volunteer-interest-form

Internal Medicine 2018, New Orleans – Washington Chapter ‘Doctor’s Dilemma’ Team Takes 3rd in a Field of Over 50 Teams!

Eric Tanenbaum, MD, Perrin Romine, MD and Alex Taylor, MD
Internal Medicine Residents, University of Washington

It’s not often that Internal Medicine residents are made to feel like rock stars, which is why we are so grateful for Washington ACP Chapter’s support of our Doctor’s Dilemma bid. In retrospect, none of us are sure why we agreed to be publicly grilled on medical trivia, although despite being tremor and arrhythmia-inducing it was shockingly fun. The competition offered a break from the gravity of medicine and a chance to share a lighthearted bonding experience with our team and residents from around the world. The mix of embracing our competitive nature and enjoying the wit and infectious enthusiasm of Dr. Moe Hagman, the moderator of the final competition, made the experience particularly memorable.

Of course, the opportunity to see (and eat our way through) New Orleans and attend the national conference was amazing by itself. And educational—nothing motivates learning like knowing you will need to recall medical minutiae from potentially any discipline at the drop of a hat in front of a large group of your mentors and their peers. We are not sure how we got to the final round, but can’t wait to watch from the comfort of the audience as future generations of residents spar in this unique and exhilarating competition.

Alex Taylor, MD, Perrin Romine, MD, and EricTanenbaum, MD

Doctor’s Dilemma Question Development Committee-Call for Volunteers

The Doctor’s Dilemma® Question Development Committee launched earlier this year. This Committee writes and reviews questions for the national Doctor’s Dilemma Competition held at the annual ACP Internal Medicine Meeting.

Question writers work both individually and in collaborative teams. Each team is assigned to develop questions within the eleven knowledge areas of internal medicine.

The Committee has already generated over 400 questions for competition. Committee members write four questions per month over four months.

At this time, we are seeking volunteers to build a pipeline for the Committee. This is an excellent opportunity for physicians in academic medicine or with teaching experience to serve on a national committee that fosters resident knowledge in a friendly, competitive environment.

More information on the Doctor’s Dilemma Question Development Committee, qualifications for volunteering, and an application can be found here.

Please contact Melanie Pizarro at DoctorsDilemma@acponline.org or at 215-351-2697 with questions.

WA chapter ACP Membership

Gary Forbes, MD, FACP and Kemi Nakabayashi, MD, FACP

Summer can be a busy time of integrating work and family time but also can be enriching and fun with pearls gleaned from the ACP national meeting, fresh seasonal produce and longer daylight hours. July 1 to June 30 is our ACP membership cycle, and members of our WA chapter ACP council have been invigorated with new ideas after our recent council retreat in early June. We expect plans for a focused member survey and new approaches to regional outreach will enhance value in your ACP membership. Some dialogue and grassroots effort is still required to help us make the most out of our chapter resources and individual time and effort. Along with chapter governor Matt Hollon in Spokane, Henry Mroch and Rachel Safran are eager to support Eastern Washington. In other locales outside of greater Seattle, we encourage you to dialogue with Carletta Vanderbilt (Bellingham), Gary Forbes and Sarah Schmidt (Port Townsend), Deepthi Mani (South Sound-Puyallup), Jennifer Balde (Tri-Cities), Rachel Reeg (Wenatchee), and Mary Shepard (Vancouver) or contact Kemi Nakabayashi at nakabayashimd@gmail.com.

We also need mentors for medical student and residents. We would be particularly appreciative of volunteers from rural parts of Washington, international medical graduates, and all ethnic groups, in particular members of the Under-represented in Medicine groups (Hispanic, African-American, and Native American) to match with our doctors in training. Let us know if you are interested!

Our council members are also eager to support members who are eligible to apply for Fellowship. Apply now to be eligible to participate in Fellowship Convocation at IM 2019 in Philadelphia or when the meeting returns to the west coast in Los Angeles in 2020! Basic eligibility to apply for Fellowship includes being an ACP member for at least 5 years with various types of ACP activity and CME participation. Most members in clinical practice in any setting will meet the other eligibility requirements as summarized on the ACP website.

Women in Medicine News

ACP Women in Medicine committee continued periodic Saturday breakfast/brunch get togethers and hosted a discussion on sexual harassment in March. Our Washington chapter received a Tooker Evergreen All-Star award at the national meeting recognizing our committee’s efforts including sustaining and expanding the Dim Sum Around the Sound idea. This past year Dr. Jennifer Balde began organizing events in the Tri-Cities. Here is a note from her:

We would like to see more events across the state and are currently planning breakfast/brunch gatherings in multiple locales in WA in early October. Let us know your interests. We hope to see you at an event!

Dr. Erin Edwards

Dr. Cathrine Wheeler

Dr. Jennifer Balde

ACP Calls for Policies that Better Support Women and their Families and Improve Health Outcomes

A new policy paper, approved by the Board of Regents and published in Annals of Internal Medicine, examines the unique challenges women face within the U.S. health care system and calls for policies to better support them. The paper addresses a wide range of issues, such as support for paid family and medical leave, recommendations on policies to reduce domestic violence, sexual abuse and harassment, and participation in clinical trials.

The paper also addresses access to coverage, including coverage for medically necessary reproductive services, and opposition to policies that would create barriers to their access to reproductive health services.

ACP urges policymakers to strongly consider how to better integrate women’s health needs over the course of their lifetime. Ensuring that women have access to non-discriminatory health care coverage is essential to improving the overall health and well-being of women living in the U.S., and a longstanding goal of ACP.

Call for Internist Award Nominations

To recognize the outstanding efforts of Internists in our state, we need your nominations for the following awards:

• Washington ACP Internist of the Year

  We seek to honor a community-based internist considered to be a role model by his or her peers. Nominees should possess excellent clinical skills, dedication to patients, enthusiasm for medical practice, leadership, and the ability to maintain humanity and a healthy balance between professional and personal interests that we can all strive to emulate. Internists who have championed innovations in practice to promote healthy patient behaviors will be given special consideration.

• Washington ACP Community Service Award

  We seek to recognize an internist or group of internists who have an exceptionally positive impact on their community through volunteer activities

• ACP Golden Apple Award

  We seek to honor volunteer teachers who have made a substantial contribution to the education of medical or other health profession students in his/her community. Balancing teaching with all the other demands of our profession is an important contribution to the future of internal medicine

• Laureate Award

  The Laureate Award honors Fellows and Masters of the College who have demonstrated by their example and conduct an abiding commitment to excellence in medical care, education, or research and in service to their community, their Chapter, and the American College of Physicians. The awardee is a senior physician and Fellow or Master of long-standing, with acknowledged excellence and peer approval in the field of internal medicine. The recipient of this award bears the title Laureate of the Washington Chapter.

• Washington ACP Full-time Faculty Clinician-Educator of the Year

  We seek to honor an academic-based internist considered to be a role model by his or her peers. Nominees should possess excellent clinical skills, dedication to patients, enthusiasm for medical practice, leadership, exceptional teaching and mentoring skills, and the ability to maintain humanity and a healthy balance between professional and personal interests that we can all strive to emulate. A commitment to developing/disseminating academic work, regional and national recognition for teaching, publishing scientific research, and/or curriculum development will be given special consideration.

• Washington ACP Hospitalist of the Year

  We seek to honor a hospitalist considered to be a role model by his or her peers. Nominees should possess excellent clinical skills, dedication to patients, enthusiasm for medical practice, leadership, and the ability to maintain humanity and a healthy balance between professional and personal interests that we can all strive to emulate. Hospitalists that have championed quality improvement projects and innovations in practice which promote hospital improvement will be given special consideration

Please take a few minutes to tell us who is deserving of a recognition award by submitting your nomination with a brief statement why this person should be considered for the award. The deadline for submitting your nomination is September 9, 2018.

W-ACP Chapter Awards Submission Form

Awards will be presented at the Washington Chapter ACP Annual Meeting, November 2 & 3, 2018 in Seattle, Washington. Questions? Please contact ACP Executive: Kimberly Conn at kim@wsma.org

Washington Chapter of ACP Partners with Other Professional Societies to Address the Health Impacts of Firearm Violence

ACP Executive Council member, Dr. Leah Marcotte (fifth from the left), joins public health officials and leaders of other state professional societies at the “Call to Action” to address the public health impact of firearm-related injury and death. Our Chapter continues to expand our advocacy efforts at the state level through partnerships with other state organizations such as the Washington State Medical Association, the Washington Academy of Family Physicians, and the Washington Chapter of the American Academy of Pediatrics.

ACP has made firearm violence prevention a priority nationally and in 2015 released a Call to Action with 50 supporting organizations including the American Bar Association with specific policy recommendations to reduce firearm-related injury and death.

On June 19, 2018, the WA ACP Chapter participated in a media event organized and led by King County Public Health to communicate a joint statement and pledge by multiple local medical societies for the prevention of firearm-related injury and death. ACP was joined by representatives from WA American Academy of Pediatrics, WA State Medical Association, King County Medical Society, WA EMS and Trauma Steering Committee and Harborview Injury and Prevention Center.

The joint statement defines firearm violence as a public health issue with the impetus on the medical community to focus on prevention. At a provider level, the statement encourages clinicians to screen for risk factors for firearm injury and death and to counsel patients regarding firearm safety.

Next steps include a working meeting to begin a collaborative public health approach toward firearm violence prevention in Washington state. To read more: blog post of event; joint statement.

Leadership Day

Leadership Day is the College’s annual two-day advocacy event in Washington, DC that enables members from our Chapter to bring our issues of concern to Washington State lawmakers. This is a great opportunity for the College to bring our policy priorities to Congress and try to influence the legislative process on behalf of internal medicine. Key priorities this year included:

• Reducing Unnecessary Administrative Tasks on Physicians and Patients
• Expanding Coverage and Stabilizing the Insurance Market
• Reducing Prescription Drug Costs
• Funding for Workforce, Medical and Health Services Research, Public Health Initiatives
• Promoting Continued Action to Address the Epidemic of Opioid Use
• Reducing Firearms-Related Injury and Death
• Making Graduate Medical Education (GME) Funding More Effective

The Washington State delegation this year included Matt Hollon MD MPH, Gary Forbes, MD, Erin Sutcliffe MD, Carrie Horwitch MD MPH, Josh Liao MD MSc, Taylor Christensen MD, Kim Vanatta MD, Elena Derkits MD MPH, and Neil Varada MD

The Washington Delegation meets with Senator Maria Cantwell, May 2018.

Below one of the residents, Dr. Taylor Christensen, in the delegation as well as the student member, Neil Varada, both reflect on the experience.

Dr. Taylor Christensen

During Leadership Day this year, I was amazed at how interested the members of Congress were in our specific stories that illustrated the issues we were talking with them about. Senator Cantwell listened intently to my description of how funding cuts for healthcare research led to the abrupt and premature end of my health policy PhD work. And when I finished my story she acknowledged the importance of prioritizing funding research that will help us solve our healthcare spending issues.

And during a brief meeting with Spokane’s house Representative, Cathy McMorris Rodgers, she focused almost exclusively on getting to know me and hearing about my training experience and career goals, probably because she knew that my training at the Spokane Teaching Health Clinic was in part thanks to her work to get funding for teaching health centers. I could tell she was excited to see the product of her efforts, which I believe will help her stay motivated to continue supporting this funding.

Neil Varada MSIII PNWU

A Medical Student Goes to Washington

It is hard not to be awestruck by the splendor of Washington DC. The solidity and stateliness of the neoclassical facades give all onlookers a sense of gravitas. Being a third-year medical student looking out on the Mall from the Capitol building, it is hard to imagine that your voice can do much to change the mind that is Washington. However, as I saw first hand in the National Archives, often times great things can happen when a few people get together with the mindset of changing the status quo. Though the Capitol building can be considered perfection in marble, the laws that govern our practice of medicine could benefit from a bit of a polish. Being able to share my experience as a student in Washington with our politicians was truly an honor. As a physician, our most powerful tool is perhaps our ability to listen and gather information from our patients. Yet making a diagnosis of opiate use disorder or prescribing a month’s supply of insulin is only half the work. We understand when our patients come back, that there are limitations that aren’t spoken about in Harrison’s. From the lack of access for addiction treatment to the skyrocketing costs of medications, these stories and experiences I have gathered over the last few years as a student complemented the experiences of residents and the physician members of the delegation.

The hot-button topic this year in Washington was the Opioid Epidemic. It was a topic many in DC wanted to gather information on and was one of the key priorities the ACP laid out. Many bills were highlighted during our discussions with politicians including increasing the availability of addictionology services by funding treatments for addiction. Yet the ACP also laid out other topics that required urgent action as well that I personally had a special interest in. One of the topics discussed was Graduate Medical Education funding. With positions locked up at levels set in 1996, the ACP set out a task to increase slots by 15,000 over the next five years. As a medical student and hopeful Internist, this was an area I helped to touch upon as part of the delegation. Furthermore, the skyrocketing prices of prescription drugs was another such field that the ACP wanted to speak on, trying to find a way to create increased transparency and accountability in drug pricing and to improve access to cheaper generic medications. One of the ways to do this was to make the wholesale prices of drugs more transparent, creating a “Kelly Blue Book” of drug prices if you will. In addition, we discussed other important issues, such as stabilizing the insurance markets, reducing administration tasks on physicians and patients, providing funding for health services research, and creating policies to reduce firearm-related injuries and/or deaths.

2018 has been a whirlwind year for medicine in the United States. Our combined voices of medical professionals are needed to help navigate the system to help our patients. Our country was built on the vision of creating a “more perfect Union,” and it is great to see that we continue to make it an even better place today.

November 1-3, 2018 WA-ACP Annual Meeting – Speaker and Program Highlights

Rachel Safran, MD and Jared Klein, MD, MPH, Planning Committee Co-Chairs

This year’s Washington State ACP meeting is shaping up to be one of the best yet! The meeting will be held November 1-3, 2018 at Bell Harbor Conference Center in Seattle, WA. Thanks to an enthusiastic planning committee we have a great mix of previously energizing speakers as well as many new speakers from around the state. The program has a well-balanced blend of topics that are sure to engage internists in all areas of practice and phases of life. We are once again offering the MOC pre-course, as well as a choice of inpatient or ambulatory medicine pre-courses. Ripe for the times – our ambulatory pre-course focuses on addiction and pain management while the inpatient pre-course features cutting edge lectures such as updates on cirrhosis and delirium management. The main program offers a variety of workshops, including hands-on experience with point-of-care ultrasound and lower extremity exams, as well as case-based sessions on palliative care and spirometry interpretation. Plenary sessions will span the gamut of medicine from osteoporosis and insomnia to the impacts of climate change on health. And join us for the first annual WA-ACP debate – tune in to see two highly respected internists deliberate the guidelines and evidence around hypertension management. The main meeting will again be simulcast to Spokane, providing an invaluable opportunity to enjoy our quality content across the state.

Mark your calendars for Nov 1-3, 2018 as registration information will be available soon.

2018 Washington ACP Story Slam – please submit your stories!

Do you have a story involving your experiences as a physician that you would like to share with the Washington ACP audience?

This is a call to you, our members and trainees, to submit a short story or essay. We are looking for stories that capture the human side of our work, are personally meaningful and highlight your passion for medicine or medical training. ACP judges will select the top 3 submissions for oral presentation during the annual meeting (November 2&3, 2018).

Stories should be limited to 400 words. Please email your stories to: Kimberly Conn, ACP Executive, at admin@washingtonacp.org. The deadline for submission is 10/6/18.

Advocacy Corner

Advocacy co-chairs: Genevieve Pagalilauan, Bruce Smith, Carrie Horwitch

Health and Public Policy Committee Chairs Genevieve Pagalilauan, MD FACP and Carrie Horwitch, MD MPH FACP along with council members Kemi Nakabayashi, MD FACP and Gary Forbes, MD FACP attending the 2018 Washington State Medical Association Legislative Summit in Olympia. Our Chapter is committed to expanding our advocacy efforts at the state level.

We as physicians advocate for our patients all the time. To help them get the appropriate medication and services to care for their health.

We also need to be advocates for policies and procedures that can impact our patients, our profession and our communities.

Please join us on Thursday July 19 from 5:30-8pm for Advocacy Made Easy at South Campus, Vista Room , University of Washington. You will learn how to make changes at the local and state level and how we can do more to advance ACP policies that help our patients and our profession.

If you are interested in attending please RSVP to carrieho@comcast.net

American College of Physicians has been very active in several policy areas: universal coverage and access to care, reducing unnecessary burdens on physicians, gun safety, gender and diversity equality as well as many more.

If you want to become more active and have an easy way to communicate with your Federal representatives and Senators Please join the Advocates in Internal Medicine. Below are the links to the Advocacy pages and policies of ACP. I hope you will join AIMn, to make sure your voice is heard in DC.

• Advocacy in Action
• Current Public Policy Papers
• ACP Policies & Recommendations
• ACP’s Advocacy Home Page

Advocates for Internal Medicine Network

Join more than 15,000 colleagues in the Advocates for Internal Medicine Network (AIMn) in advocating for the interests of internal medicine in Washington, D.C. The AIMn program is for ACP members interested in participating in federal advocacy. It is designed to help members engage with their federal lawmakers on policy issues important to ACP and internal medicine.

WA-ACP Spring Scientific Scholarship Day – May 18, 2018

Our fourth annual Spring Scientific Scholarship Mentoring Day held May 18 at UW South Campus Center was a success! We had over 50 people register to attend the event. The objectives for the day:

• Encourage scientific study in Research, Quality Improvement and Medical Education by students, residents and early career physicians.
• Provide opportunity for trainees and ECP to submit and present abstracts of their projects in Research, QI and medical education.
• Mentoring in small groups to explore career goals and professional life

The day’s program and activities were co-directed by Kim O’Connor, MD, FACP and Joyce Wipf, MD, FACP, and developed in conjunction with our Resident and Student Councils and advisors, and our Residency Leadership Advisory Group, co-chaired by Alvin Calderon, MD, PhD (Virginia Mason) and Ken Steinberg, MD, FACP (UW).

Special thanks to so many individuals who helped to conduct the Spring Scientific Day, including regional program directors, our outstanding plenary speakers and panel discussants, and mentors who co-led focused mentoring lunch discussions. A large cadre of faculty served as reviewers and judges of the submitted and presented abstracts, led by Ananth Shenoy, MD.

This year approximately 20 abstracts were accepted, with 9 oral abstract presentations and 12 accepted for poster presentation. All showed impressive quality, design, innovation and effort. The abstracts were reviewed and winners selected by several teams of judges.

Congratulations to the abstract competition winners:

Student abstract: Neil Varada, PNW University of Health Sciences

Resident poster abstract: Mayuree Rao, MD and Meghna Shah; MD, University of Washington
Honorable mention poster: John Geyer, MD, University of Washington

Resident oral abstract: Heather Bukiri, MD, Virginia Mason Medical Center
Honorable mention: Christopher Ghiathi, MD, University of Washington

Early Career Physician oral abstract: Tyra Fainstad, MD, University of Washington

2018: We will soon begin to plan next year’s Spring Scientific Scholarship Day. If you are interested in being on the Planning Committee please contact Joyce Wipf or Kim O’Connor.