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Virtual Mentor: exploring the ethics of medicine

I suspect that each of us, at one time or another, has encountered a homeless person, perhaps while working in a hospital or emergency room or while simply walking down the street.

Estimated to be between 2.3 and 3.5 million, this segment of the U.S. population is more likely to be diagnosed with a number of health problems, including obstructive lung disease, hepatic diseases, skin and orthopedic problems, and infectious diseases. The homeless also are more inclined to suffer from chronic physical and mental illnesses and have shortened life spans associated with the lack of adequate housing and nourishment.

As physicians, how do we help these people? For guidance, I encourage you to view this month's Virtual Mentor, which examines the medical and ethical challenges we face in assisting this disparate community of people whose health problems are exacerbated by their homelessness. The cases, commentaries and personal accounts in this edition explore the needs of homeless veterans, treatment decisions for homeless patients and academic programs that introduce medical students to providing care for the homeless. These articles will make you think about how we can better serve this segment of the community that desperately needs help.

Medical care for the homeless is just one of the many timely and important subjects addressed in Virtual Mentor, the AMA's monthly online ethics journal. Published by the AMA Ethics Group for nearly a decade, this outstanding teaching resource explores the ethical and professional challenges that medical students, residents and physicians are likely to confront in their training or daily practice. Virtual Mentor covers every field of medicine and can easily be searched by discipline or topic. It is a wonderful contribution the AMA makes to medical education on timely ethical concerns.

Each issue contains original articles and commentary on a given theme such as access to care, quality-of-life considerations in clinical decision-making, public roles of physicians or the conflict of values in the clinic. In January, the journal introduced "On Call," a medical student forum that delves deeper into the subject matter of that particular issue. And, at the end of last year, Virtual Mentor was accepted by the U.S. National Library of Medicine for MEDLINE indexing, an important achievement for any medicine- or science-based journal (electronic or otherwise). Virtual Mentor articles will be available online through the National Library of Medicine beginning in April.

I regularly use Virtual Mentor with my students at the University at Buffalo School of Medicine and Biomedical Sciences and strongly encourage all of you—especially physician educators, residents and medical students—to check it out.

Virtual Mentor is unique in that it's the only widely published ethics journal that is free, with no subscription requirement. The journal is also different in its scope, focusing exclusively on medical ethics and medical ethics education. This allows the journal to examine in detail the questions that medical students and practicing physicians confront on a daily basis.

Another great feature of the journal is that it's student- and resident-driven; theme issue editors are selected each year through a competitive process among medical students and resident physicians.

These student and resident editors are heavily involved in the editorial process. With help from Virtual Mentor's staff editors, each theme issue editor selects a theme for one month, defines the ethical and professionalism concerns inherent in that theme, and generates case narratives that provide opportunities to examine those concerns in clinical and educational contexts. One of my former students, David Block, MD, who's now a psychiatrist in San Francisco, served as the theme issue editor for the April 2004 issue. A biography of Dr. Block and those of other past theme issue editors can be viewed online.

Theme issue editors work directly with contributors and edit content before the issue is posted online, which occurs the first business day of the month. Themes for upcoming months can be viewed on the journal's Web site. In February, Virtual Mentor will examine physicians' professional responsibility in preventing violence and abuse and will feature a podcast—Virtual Mentor's second—that discusses how medical students should handle the mistreatment or embarrassment many of them experience at the hands of clinical faculty.

If you have knowledge or expertise in an area that a future issue will explore and would like to contribute, send an e-mail to the journal's staff and view instructions about submitting articles. And, to medical students and residents, I encourage you to apply for a theme issue editor position later this year.

Virtual Mentor also is home to the John Conley Ethics Essay Contest for medical students. Each March, the journal poses a question in medical ethics or professionalism as the topic for that year's contest. All medical students are invited to submit essays of up to 2,000 words in response to the question.

The contest's winning author receives a $5,000 prize, and the winning essay is published in an appropriately themed issue of the journal. An announcement of this year's contest topic, as well as instructions for entering, will appear in the journal's March issue on the topic of difficult patient-physician encounters.

Helping physicians and medical students live up to the highest standards of ethics and professionalism is a core objective of the AMA, and one of the ways we accomplish that is through Virtual Mentor. If you don't already read the journal, I hope you'll do so—and begin to discover the considerable insight and wisdom this valuable resource provides.

Please send comments, questions and replies to amaprez@ama-assn.org.

E-mail comments, questions and replies to Dr. Nielsen

1) AMA effort vital in blocking health insurers' merger plan

2) Study: Large health insurers dominate markets in many parts of United States
The vast majority of health insurance markets in the United States are dominated by one or two health insurers, according to a new study by the AMA that examined insurer competition in markets across the country. Most alarmingly, in nearly all 314 metropolitan areas studied, there is evidence that patients and physicians have fewer options and are left vulnerable to the demands of health insurers.

The AMA's newly updated Competition in Health Insurance: A Comprehensive Study of U.S. Markets finds that 94 percent of metropolitan areas have a combined health maintenance organization (HMO) and preferred provider organization (PPO) commercial market that can be considered "highly concentrated," according to an index used by federal regulators to assess anticompetitive markets. Examining the HMO and PPO markets separately, the AMA study finds that an even greater number of metropolitan areas are "highly concentrated" according to the federal index.

"Health insurers claim that eliminating rivals through mergers creates greater efficiency and lower health care costs, but this just isn't the case," AMA President-elect J. James Rohack, MD, said. "Patient premiums, deductibles and copayments have soared in this increasingly consolidated market, without an increase in benefits. The AMA urges federal and state agencies to enforce antitrust laws that prohibit harmful mergers and restore a competitive balance to health insurance markets."

To order a copy of this study, visit the AMA Bookstore or call (800) 621-8335 and mention item number OP427108. This study is free to AMA members and available to the public for $150.

3) United Healthcare extends physician appeal deadline
Responding to requests from the AMA, United Healthcare (UHC) extended the deadline regarding physician appeals for its physician rating program, the Premium^® physician designation program (PDP), to Feb. 11.

UHC will adjudicate all properly filed appeals received by this date prior to using or releasing these new physician ratings. Physicians who are unable to meet this new deadline may still appeal their rating at any time, and UHC will update changes in physician ratings on a weekly basis.

Last week, the AMA sent several blast e-mails to alert physicians to the original PDP appeal deadline of Jan. 27. The response to these alerts was overwhelming, as multitudes of physicians sought to view their PDP data. The AMA thanks UHC for extending the deadline.

Physicians contracted with UHC in parts of 37 states and in 20 specialties are rated in the PDP. If you would like additional information about which physicians are covered under the program, how to access the physician data and how to appeal a PDP rating, send an e-mail. Please do not include text or attachments. The information you need will be automatically returned to you.

4) Apply by Feb. 15 for Joan F. Giambalvo Memorial Scholarship
Researchers interested in exploring issues impacting women in medicine are encouraged to apply for the Joan F. Giambalvo Memorial Scholarship. Applications are due Feb.15.

Established by the AMA Foundation in conjunction with the AMA Women Physicians Congress, the scholarship provides funding for projects that aim to advance the progress of women in the medical profession and strengthen the AMA's ability to identify and address the needs and interests of women physicians and medical students.

In its third year, the scholarship has been awarded to five researchers, including last year's winners Sue Yom, MD, and Maurice Clifton, MD. Dr. Yom, an assistant professor of radiation oncology at the University of California, San Francisco, used the funds to examine why women faculty leave the profession and to explore costs incurred by respective institutions because of this lack of retention. Dr. Clifton, an associate dean for admissions and student affairs with Mercer University School of Medicine in Macon, Ga., is researching obstacles that prevent more women from practicing in rural areas.

Visit the AMA-WPC Web site to learn more and apply.

5) Make your voice heard at the 2009 National Advocacy Conference
Join together with your colleagues and stand as advocates for patients, physicians and the future of medicine at the National Advocacy Conference, March 10–11 at the Grand Hyatt Washington Hotel in Washington, D.C. The cutoff date for room reservations is Feb. 4.

The conference features a Capitol Hill briefing, health system reform sessions, the Dr. Nathan Davis Awards for Outstanding Government Service program, the AMA Foundation Excellence in Medicine Awards dinner and the AMA Alliance Capitol Conference, winter session.

6) In JAMA: Using heart biomarker levels to guide therapy does not improve outcomes for heart failure patients
Using a measure of the hormone N-terminal brain natriuretic peptide (BNP) to guide therapy for older patients with heart failure did not improve overall clinical or quality of life outcomes compared to patients receiving conventional symptom-guided therapy, according to a study in the Jan. 28 issue of the Journal of the American Medical Association (JAMA).

In an accompanying editorial, authors write that there may be some usefulness of BNP as a biomarker of heart failure.

Preview an editorial on this topic.

1) AMA-GLBT seeks nominations for its 2009–2010 advisory committee
Two at-large positions and three slotted positions on next year's AMA-GLBT Advisory Committee will open this spring.

The AMA-GLBT Advisory Committee includes three at-large positions, appointed by the AMA Board of Trustees, and four slotted positions, appointed by the Gay and Lesbian Medical Association as well as various AMA sections. Slotted positions represent the AMA Medical Student Section (MSS), the AMA Resident and Fellow Section (RFS) and the AMA Young Physicians Section (YPS). Visit the AMA-GLBT Web site to view and download application materials.

Individual candidates who are interested in at-large positions should e-mail application materials for consideration. E-mail applications to the AMA-MSS, AMA-RFS or AMA-YPS if interested in slotted representative seats.

Call (312) 464-4335 or visit the AMA-GLBT Web site for more information about the AMA-GLBT Advisory Committee.

1) Apply for a position on the AMA-IMG Section Governing Council
Candidates interested in a position on the 2009–2012 AMA-IMG Section Governing Council are encouraged to submit materials by Feb. 20. Qualified candidates must be current AMA members who are IMGs with relevant organized medicine leadership experience as well as plenty of time to commit to the group for three years.

Visit the AMA-IMG Web site for nomination forms.

E-mail materials for consideration. Materials should be sent no later than Feb. 20. Online elections will take place in April.

Call J. Mori Johnson at (312) 464-5678 for more information.

2) Participate in new AMA-IMG Section virtual congress
As part of the AMA-IMG Section's new virtual congress format, resolutions submitted by April 3 for consideration during the section's annual congress will be placed on the AMA-IMG Section Web site for review and online testimony submissions. This new format should increase the participation of AMA-IMG Section members and will allow the section's resolutions to be included in the AMA House of Delegates handbook.

The AMA-IMG Section Governing Council and resolutions committee will serve as the reference committee by reviewing all submitted testimony and finalizing resolutions by April 27. AMA-IMG Section members will vote between April 30 and May 7 to approve or not approve each resolution in its final form.

E-mail resolutions for consideration. Resolutions are due no later than April 3.

Visit the AMA-IMG Web site to view resolution writing guidelines. Call (312) 464-5397 with questions.

Brought to you by the AMA Section on Medical Schools

1) Do you like receiving CME credit for AMA-SMS sessions?
The AMA-SMS Governing Council is interested in your feedback on whether or not the section should continue to ask for continuing medical education (CME) credit for its educational sessions. The process of completing a credit application has become very labor intensive, especially for the limited number of credit hours that the section requests.

Send an e-mail with your comments regarding this topic.

2) Get a glimpse of AMA advocacy
The AMA is assertively involved in advocacy efforts related to the most vital issues in medicine today, including expanding coverage for the uninsured and increasing access to care, improving public health, and reforming the medical liability and Medicare physician payment systems.

View past issues of the AMA Advocacy Update, which provides a snapshot of the AMA's advocacy on behalf of physicians and their patients.

3) January's Virtual Mentor explores medical care for the homeless
The homeless—estimated to number between 2.3 and 3.5 million—are more likely than the general population to suffer from chronic physical and mental illnesses. They also have shortened life spans associated with the lack of adequate housing and nourishment, according to this month's issue of Virtual Mentor.

The cases, commentaries and personal accounts inside this month's issue address the medical and ethical challenges physicians face in helping this disparate community of people whose health problems are exacerbated by their homelessness. Topics for discussion include the needs of homeless veterans, treatment decisions of homeless patients and academic programs that introduce medical students to providing care for homeless patients.

4) Study: The impact of team-based learning on medical students' attitudes
In a recent Medical Education Online study (PDF), researchers compared how medical students' attitudes about the team-based learning process changed between the first and second year of medical school.

Boonshoft School of Medicine at Wright State University integrated team-based learning into its preclinical curriculum in 2002. The study showed that significant changes in students' attitudes were noted in the areas of professional development and satisfaction with team experience and peer evaluation.

1) Apply for AMA-MAC Governing Council position by Jan. 31
Represent your medical student colleagues on the AMA Minority Affairs Consortium (MAC) Governing Council. The AMA-MAC is a national advocacy forum focusing on minority health and professional issues. Representing nearly 3,000 AMA-MAC members, the nine-member governing council influences and contributes to AMA policy and program development through its seat in the AMA House of Delegates and other mechanisms on issues of importance to minority physicians and patients and the AMA.

Busayo Obayan, from Boston University School of Medicine, is the current medical student representative on the AMA-MAC Governing Council. E-mail Obayan for more information.

Visit the Web site to apply for this or other leadership roles within the AMA by Jan. 31.

2) Register for Medical Student and Resident/Fellow Lobby Day
The 2009 Medical Student and Resident/Fellow Lobby Day will be held March 8–9 at the L'Enfant Plaza Hotel in Washington, D.C. Lobby Day is an excellent opportunity to increase your awareness of legislative issues affecting medicine, foster relationships with legislators through political involvement and gain real-life education in the practical aspects of physician advocacy.

Lobby Day activities include interactive educational sessions on effective advocacy and lobbying techniques, briefings on legislative issues that are before Congress and a full afternoon on Capitol Hill to meet with legislators and their staffs.

Registration is free. A limited number of free hotel rooms are available for AMA members.

Visit the Web site for more information and to register. The deadline to register is Feb. 4.

3) Mark your calendars for upcoming AMA-MSS Region meetings
AMA-MSS Regions 2, 5, 6 and 7 have upcoming meetings, and you're invited to attend.

• The AMA-MSS Region 2 meeting, "Forensics in medicine," will be held Apr. 3–4 at the Kansas City University of Medicine in Kansas City, Mo.
• The AMA-MSS Region 5 meeting, "Together toward tomorrow," will be held Feb. 27 at Wright State University in Dayton, Ohio.
• The AMA-MSS Region 6 meeting, "Understanding how actions of lawmakers and policymakers will impact our lives as physicians," will be held Mar. 7–8 at George Washington University School of Medicine in Washington, D.C.
• The AMA-MSS Region 7 meeting, "Surviving and thriving during medical school and residency," will be held Feb. 7 at the Massachusetts Medical Society in Waltham, Mass.

Visit the Web site for more information on these meetings and a list of states in each region, or to learn more about organizing a region meeting.

4) AMA-MSS Chapter of the Week: University of Arkansas for Medical Sciences holds charitable event
The AMA-MSS chapter at the University of Arkansas for Medical Sciences recently held an event that coincided with the Little Rock Compassion Center Toy Giveaway (LRCC). Students promoted registration for ARKids First, the state-funded Medicaid children's health insurance program, informed families of local free clinics for the uninsured and promoted hypertension awareness through free blood pressure screenings.

As part of the event, about 100 needy families received toys to give to their children, who otherwise would not have had toys for Christmas. Each family also received a Christmas dinner package, including canned green beans, corn, yams, cranberry sauce, instant potatoes and boxed stuffing. Students, professors and employees of the University of Arkansas Medical Sciences schools donated the food.

E-mail Matthew Forestiere for more information on this project.

5) Apply for exciting media rotation with Discovery Health
Medical students are encouraged to apply for the AMA/Discovery Health internship, a four-week program during which one AMA medical student member will help develop a medical education program that will air on the Discovery Health Channel.

Available only to AMA medical student, and resident and fellow members, this exciting opportunity provides hands-on experience in translating scientific data into an entertaining and informational program. The selected student will work primarily at Discovery Communications headquarters in Silver Spring, Md., and travel to relevant on-site and studio shoots for the program.

Visit the Web site for more information and to apply. A stipend of $3,000 will be provided to cover living expenses. Dates and length of the rotation are flexible. Applications are due April 17.

6) AMA GME e-Letter: Rediscovering real patients
The electronic medical record (EMR) is a much-needed tool in modern medicine but has an unfortunate side effect—the "iPatient"—which is an abstraction of the real patient resulting from the availability and demands of the EMR. The January issue of the AMA GME e-Letter features this concern and notes that such cases can put the intimate doctor-patient relationship at risk.

Subscribe to this free monthly e-mail newsletter.

Brought to you by the AMA Minority Affairs Consortium

1) Become a part of AMA-MAC leadership
Positions on the AMA-MAC Governing Council will be available this spring. Submit your application to be part of AMA-MAC leadership by Feb. 16.

The AMA-MAC Governing Council includes two elected at-large positions, one elected delegate position and five positions appointed by various organizations and AMA sections.

Interested candidates should visit the AMA-MAC Web site for nominations forms and more information.

1) View AMA-OMSS Interim Assembly Meeting materials
The AMA-OMSS is pleased with the positive and supportive outcomes of its assembly resolutions and other items of business discussed during the 2008 Interim Meeting of the AMA House of Delegates (HOD). The AMA-OMSS submitted a resolution on behaviors that undermine safety, which was adopted by the AMA-HOD as policy.

Visit the Web site to view the full 2008 AMA-OMSS Interim Assembly Meeting summary and PowerPoint presentation, as well as its disposition of actions.

2) Download free copy of AMA-OMSS presentation for medical staffs, hospital boards
The AMA-OMSS developed two PowerPoint presentations—one for medical staffs and another for hospital boards—to provide information on the section and its mission, duties and past actions.

AMA members can visit the AMA-OMSS Web site to view and download these presentations free of charge.

3) AMA Annual Meeting webcasts added to archives
The AMA-OMSS is offering four 90-minute educational webcasts, including "Transitioning to an improved hospital discharge," "Keys to the successful implementation of the revised Joint Commission Medical Staff Bylaws Standard MS.1.20," "Creating a new future for a new day with a revamped organized medical staff structure" and "Physician hospitals of America: Reclaiming quality patient care through physician leadership."

Three of the webcasts provide AMA PRA Category 1 Credit™. Visit the AMA-OMSS Web site to access these webcasts and learn more about each one.

Accreditation statement
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Designation statement
The American Medical Association designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

4) Align your bylaws with Joint Commission standards
Because medical staff bylaws are considered a contract and are legally binding in most states, it is extremely important that they are well-designed and well-written. The fourth edition of the "Physician's guide to medical staff organization bylaws" contains practical guidance on bylaws development, model bylaw language, information on emerging issues and recent trends in medical staff re-engineering. The guide will be especially helpful to medical staffs as they update their bylaws to align with Joint Commission standards.

AMA members can download the guide (PDF) at no charge.

5) Resource helps strengthen physician-hospital relationship
A printable version of the "Principles for strengthening the physician-hospital relationship," developed by the AMA-OMSS and adopted by the AMA House of Delegates, is available online (PDF). These principles are designed to improve the working relationship between physicians and hospitals and ultimately foster better patient care and improve patient safety.

Send an e-mail to order a poster of the principles for your medical staff lounge.

1) Apply by Feb. 15 for Joan F. Giambalvo Memorial Scholarship
Researchers interested in exploring issues concerning women physicians are encouraged to apply for a 2009 Joan F. Giambalvo Memorial Scholarship by Feb. 15. Established by the AMA Foundation in conjunction with the AMA Women Physicians Congress, the scholarship provides funding to help researchers advance the progress of women in the medical profession and identify and address the needs of women physicians and medical students.

Visit the AMA-WPC Web site to learn more and apply for up to $10,000 in funding.

2) NBME seeking resident representatives
The AMA-RFS is seeking applicants for resident representative seats on the National Board of Medical Examiners (NBME). The NBME prepares and administers qualifying examinations and represents the academic, practice and licensing communities.

The board includes two resident representative positions appointed by the AMA-RFS Governing Council for four-year terms. Responsibilities include attending one three-day meeting per year; meeting expenses will be covered.

Applications are due Feb. 2. Visit the AMA-RFS Web site for more information and to apply.

3) AMA-RFS awards recognize its members for leadership
Have you demonstrated leadership among resident physicians or in the areas of advocacy? The AMA-RFS is accepting applications for two awards—the Paul Ambrose Award for Leadership Among Resident Physicians and the Jordan Fieldman, MD, Award.

Award recipients will be funded for travel to the AMA-RFS Annual Assembly Meeting in June, where they will be recognized.

Visit the AMA-RFS Web site for more information and an application. Applications are due Feb. 27.

4) What's ahead in health care?
Changes in medicine influence the delivery of patient care. That's why it's important to know what the issues and trends are.

2008 Health Care Trends, a newly updated publication from the AMA, details the issues and trends shaping medicine today and how they affect physicians and their patients. The report includes information on health status and demographics of the U.S. population, factors affecting health care spending, and changes in the physician work force. It also covers patient expectations and perceptions, the public health system, trends in technology, and changes in medical education and physician continuing professional development.

Visit the Web site for more information or to download this resource. Health Care Trends is updated every two years by the AMA Council on Long Range Planning and Development.

Contact Don Zeigler, the AMA's director of long range health care trends, at (312) 464-5320 for more information.

Contact Carrie Domangue at (312) 464-4391 for a free copy of the 2008 Health Care Trends CD.

1) AMA-SPG Governing Council nomination due Feb. 16
The AMA-SPG is seeking nominations for its governing council. The AMA-SPG Governing Council, comprising seven physicians age 65 and older who are either retired or practicing medicine, advises the AMA Board of Trustees and staff on issues that bear directly on senior physicians.

Nominations are due Feb. 16. Visit the AMA-SPG Web site for nomination materials, including the current AMA-SPG Governing Council roster.

E-mail Alice Reed with questions.

2) AMA Foundation honors senior physician with Jack B. McConnell, MD, Excellence in Medicine Award
The AMA Foundation will honor senior physician Richard Baylor, MD, for his efforts in volunteerism with the Jack B. McConnell, MD, Excellence in Medicine Award.

Dr. Baylor recently stepped down from his position as medical director at Northern Neck Free Health Clinic in Kilmarnock, Va., where he has provided health care to thousands of low-income patients. At the age of 85, he remains a daily presence at the clinic and continues to lobby for free clinics locally, with state government and through statewide associations.

Each year the AMA Foundation honors a select group of physicians, residents, fellows and medical students who exceed standards of volunteerism, public service and leadership.

Visit the AMA Foundation Web site or call (312) 464-4200 for more information.

Brought to you by the AMA Women Physicians Congress

1) Joan F. Giambalvo Memorial Scholarship Fund applications available online
Researchers interested in exploring issues concerning women physicians are encouraged to apply for a 2009 Joan F. Giambalvo Scholarship by Feb. 15. Established by the AMA Foundation in conjunction with the AMA Women Physicians Congress, the scholarship provides funding to help researchers advance the progress of women in the medical profession and identify and address the needs of women physicians and medical students.

Visit the AMA-WPC Web site to download an application.

Send an e-mail for more information.

2) Apply for a position on the AMA-WPC Governing Council
Slotted positions on the AMA-WPC Governing Council and two at-large positions will become available this spring.

The AMA-WPC Governing Council includes four elected at-large positions, one appointed position by the American Medical Women's Association and three appointed representatives from various AMA sections.

Interested candidates should visit the AMA-WPC Web site for more information and to download an application. Nominations are due by Feb. 16.

1) Sign up for AMA-YPS policymaking committee
The AMA-YPS Governing Council invites you to take part in one of three short-term policymaking committees.

The purpose of these committees is to study priority issues of the AMA-YPS with the goal of developing resolutions on one or more of the following topics: scope of practice, medical student loan debt and competition between nonprofit and for-profit hospitals.

Committees for each of these topics will operate between mid-February and the end of April. The AMA-YPS anticipates two to three conference calls for each committee, as well as electronic communications between calls.

E-mail Jane Ascroft by today, Jan. 30, with questions or to sign up for a committee.

2) Deadline today, Jan. 30, for AMA-YPS Young at Heart Award nominations
Nominations for the 2009 AMA-YPS Young at Heart Awards are due today Jan. 30.

Nominees should be AMA members who are not eligible for AMA-YPS membership and whose support and guidance have strengthened the AMA-YPS through organizational aid, support of AMA-YPS issues in reference committee and causes (and on the floor of the AMA House of Delegates), or support of AMA-YPS leadership development.

Nominators must be members of the AMA-YPS Assembly.

E-mail your nomination; mail it to 515 N. State St., Chicago, IL, 60654; or fax it to (312) 464-5845.

Visit the Web site for more information or to submit a nomination.

3) AMA-GLBT Advisory Committee applications due Feb. 6
AMA-YPS positions on both the AMA Minority Affairs Consortium (MAC) Governing Council and the AMA Advisory Committee on Gay, Lesbian, Bisexual, and Transgender (GLBT) Issues will be available this spring. The AMA-YPS has slotted seats in these AMA special group governing councils: the AMA-GLBT Advisory Committee, the AMA-MAC and the AMA Women Physicians Congress.

Complete the application materials and forward them to the AMA-YPS Governing Council no later than Feb. 6 to be considered for these positions.

Visit the AMA-GLBT Web site to apply for the AMA-GLBT Governing Council position.

Visit the AMA-MAC Web site to apply for the AMA-MAC Governing Council position.

Send an e-mail with your application materials as well as any related questions.

4) What's ahead in health care?
Changes in medicine influence the delivery of patient care. That's why it's important to know what the issues and trends are.

2008 Health Care Trends, a newly updated publication from the AMA, details the issues and trends shaping medicine today and how they affect physicians and their patients. The report includes information on health status and demographics of the U.S. population, factors affecting health care spending, and changes in the physician work force. It also covers patient expectations and perceptions, the public health system, trends in technology, and changes in medical education and physician continuing professional development.

Visit the Web site for more information or to download this resource. Health Care Trends is updated every two years by the AMA Council on Long Range Planning and Development.

Contact Don Zeigler, the AMA's director of long range health care trends, at (312) 464-5320 for more information.

Contact Carrie Domangue at (312) 464-4391 for a free copy of the 2008 Health Care Trends CD.