AMA eVoice Weekly Newsletter
Public health: a second specialty
While the topic of public health is always important, I've found it particularly relevant in recent weeks—for several reasons. The first is that just two weeks ago the U.S. House of Representatives decided to take action to pass the Family Smoking Prevention and Tobacco Control Act.
An April 3 USA Today article called the vote a "historic move." I agree. It's a big step, a victory for public health. The bill would give the Food and Drug Administration the power to regulate the tobacco industry and tobacco products. Our nation needs this.
Smoking is still the number one preventable cause of death in the United States, taking more than 400,000 American lives each year. And our children are affected too. Every day, 1,000 of them become new smokers.
This bill will not only protect the health of Americans, particularly our nation's youth, but it will also stop illegal sales of tobacco products to children. And it will further restrict marketing, especially to kids, and require more informative package health warnings. The Senate reportedly will take up its version of the bill later this month.
And I must say this couldn't have come at a more appropriate time. Last week was National Public Health Week—a time when a myriad of advocates joined in support of pieces of legislation like this one. Physicians nationwide recognized contributions to public health and highlighted issues that are important to improving the public's health. The first full week in April has been declared as such since 1995.
Organized by the American Public Health Association (APHA), National Public Health Week kicked off the APHA's "Building the Foundation for a Healthy America" campaign. This is an effort to insert public health into ongoing policy discussions directed at improving the nation's health system.
I can't stress enough how important this observance is to physicians and health care. We as a nation have been falling behind in many important measures of what it means to be healthy. While our country's life expectancy has reached a record high of 78.1 years, we still only rank 46th, behind Japan and most of Europe, as well as countries such as Guam, South Korea and Jordan. We're also among the top 10 countries that have the most people with HIV/AIDS. And the list goes on and on. But so does the AMA's work on this front.
We are a national leader on public health issues. And we have various public health programs and initiatives to prove it. From programs committed to the elimination of racial and ethnic health care disparities to our Roadmaps for Clinical Practice Series which assists physicians in integrating disease prevention and health promotion into routine clinical care, the resources are endless.
We also broke new ground with Disaster Medicine and Public Health Preparedness, the only online, peer-reviewed journal of its kind, which emphasizes public health preparedness and disaster response for all health care and public health care professionals globally. Read more about the latest issue online, as well as past issues of the journal.
We can have all the resources and programs in the world, but I believe the way to improving the public's health starts with us—the nation's physicians. I teach my medical students that all physicians, whether they realize it or not, have a second specialty: public health. In fact, I even give a lecture, entitled "Everyone's second specialty." I provide them with clinical vignettes relating to virtually every specialty and ask them to describe what they need to do for the patient involved and what they need to do to protect the health of the public. I make sure they're aware of reporting and contact tracing mechanisms and reportable disease requirements.
The world is a pretty small place these days, given airline travel and worldwide commerce.The next new infectious disease may be smoldering in a civet in Africa or a chicken in the Guangdong province of China. And the infected patient may be present in your office rather than in an emergency room.
So we are all partners in this public health enterprise,with important roles to play in prevention, in recognition of reportable diseases, and in remembering that the hoof beats we're hearing may just be a zebra this time.
We honor our public health colleagues for their work and pledge to be responsible partners with them.
E-mail comments, questions and replies to Dr. Nielsen
1) AMA outlines views on achieving Obama administration's health reform goals
An April 13 letter (PDF) from the AMA to President Barack Obama offered physicians' support for his administration's eight principles for health care reform and outlined a framework for action.
In the letter, the AMA highlighted the impact that liability has on health care costs, the importance of building on the current employer-based system to promote individual choice and ownership of health insurance, and removing antitrust barriers to quality improvement efforts. The AMA also voiced its support for health information technology, for efforts to improve the value the nation gets from its health care spending, and for greater care coordination.
The administration's principles are: (1) protecting families' financial health, (2) making health coverage affordable, (3) aiming for universality, (4) providing portable coverage, (5) guaranteeing choice, (6) investing in prevention and wellness, (7) improving patient safety and quality, and (8) maintaining long-term fiscal sustainability.
View an AMA news release about the letter.
2) Proposed scope-of-practice expansion defeated in Florida Legislature
Florida physicians earned an important victory last month when legislation that would have expanded authority for the state's optometrists failed to gain support with lawmakers. The AMA joined the Florida Medical Association (FMA) in strongly advocating against the bill, with AMA Board of Trustees member Cecil Wilson, MD, testifying to a Florida Senate committee.
In fighting the legislation, the FMA used the AMA's geographic mapping tool, which lists the practice locations of every actively practicing physician in all 50 states and provides an overlay of the locations of the corresponding nonphysician providers. These maps invalidate the argument that expanding nonphysician providers' scope of practice will enable increased access to care for rural patients, demonstrating that physicians and nonphysicians are equally accessible in metropolitan and rural areas.
AMA members can view the more than 500 maps the AMA created to assist the Federation of Medicine in combating access-to-care claims.
Read an American Medical News story about recent physician battles over optometry scope expansions.
3) Three months left to review your WellPoint/Anthem contract
The physician protections of the WellPoint/Anthem multidistrict litigation (MDL) class action settlement agreement are set to end July 15. After that date, WellPoint/Anthem no longer will have to comply with the settlement terms.
Physicians who are contracted with WellPoint/Anthem are encouraged to review their contract and contact their WellPoint/Anthem provider representative to determine how the settlement termination will affect their business relationship with the health insurer.
Download a check list (PDF) of key settlement terms.
Download the complete settlement agreement (PDF).
Visit the Web site to access information about MDL settlements as well as other settlements with health insurers.
In addition, AMA members can visit download the AMA's Model Managed Care Contract (PDF).
4) AMA resource spells out FTC's "red flags rule"
A new resource (PDF) from the AMA can help physicians incorporate a simple identity theft prevention and detection program into their existing compliance and Health Insurance Portability and Accountability Act security and privacy policies.
The AMA developed this resource, which includes a sample policy (PDF), in the wake of Federal Trade Commission (FTC) regulations known as the "red flags rule," which require certain entities to develop and implement programs to protect consumers from identity theft. In response to FTC staff indications that the rule will apply to physician practices, the AMA expressed its concerns and successfully delayed implementation of the rule until May 1.
The AMA is continuing its efforts to persuade the FTC that physicians are not "creditors" and therefore should not be subject to the rule.
5) Ethics in Brief: Today is National Healthcare Decisions Day
At some point for everyone, it will be time to discuss the end of life. The reluctance of many to engage in this conversation is understandable because most do not like to think of their own mortality. But as the population ages and technologies appear that provide the opportunity for continued life, however one defines it, these discussions become more and more important.
Physicians have a prominent role to play in discussing end-of-life issues with patients. Because they are so intimately involved in the decisions that patients must make, physicians must be knowledgeable about such patient options as surrogate decision makers, also known as durable power of attorney for health care, and advance directives. Physicians should encourage patients to document their treatment preferences or appoint a health care proxy in the event that a health decision must be made when the patient is unable to make it.
Today, April 16, is recognized as National Healthcare Decisions Day, and the AMA and many other national and regional medical and legal organizations have come together to promote the benefits of advance planning. Physicians should take this opportunity, with the national focus on health care planning, to discuss with their patients how, why and when to make these decisions.
6) AMA resources can answer your Health IT questionsWhat can technology do for your practice? Do you have enough advances in place? Or are you missing out on an efficient method that could be serving you well?
AMA members are encouraged to read the AMA members-only article "Information Technology solutions: Consider the potential savings," one of several members-only health information technology (Health IT) resources offered by the AMA's Practice Management Center. This particular resource provides a breakdown of potential savings for a physician practice as well as a list of Health IT solutions available for physicians and their practices.
If you're an AMA member, don't lose access to valuable resources such as this. Visit the AMA Web site to renew your membership. If you're not a member, join the AMA today and begin receiving them.
7) In JAMA: Severe hypoglycemia associated with increased risk of dementia for older adults with type 2 diabetes
Hypoglycemic (low blood sugar level) episodes that are severe enough to require hospitalization are associated with a greater risk of dementia for older adults with type 2 diabetes, according to a study in the April 15 issue of the Journal of the American Medical Association (JAMA), a theme issue on diabetes.
1) Report: Half of Americans believe HIV stigma reinforces anti-gay bias
The New York-based Gay Men’s Health Crisis released a report last week containing an analysis of recent public opinion data on HIV/AIDS. The report, Understanding Public Opinion Toward HIV/AIDS, shows that while many public perceptions of HIV/AIDS and people living with HIV/AIDS have changed significantly since the 1980s, some have not changed at all. For example, the report states that in 2006, half of Americans believed that HIV/AIDS contributes to anti-gay bias, nearly the same amount that believed this two decades earlier.
2) Komen grants funding to GLBT and HIV/AIDS groups
Three Philadelphia organizations that serve the gay, lesbian, bisexual and transgender (GLBT) and the HIV/AIDS communities are among 38 recipients of a grant from Susan G. Komen for the Cure, which works to raise awareness of and funding for breast-cancer prevention and treatment, according to the Philadelphia Gay News.
The Mazzoni Center, a GLBT health clinic; the HIV/AIDS service organization Blacks Educating Blacks About Sexual Health Issues; and the Metropolitan Area Neighborhood Nutritional Alliance will each receive $40,000.
3) In the Vancouver Sun: Unequal treatment for transsexuals
In British Columbia, Canada, male-to-female transsexuals—those born with male bodies who identify as women—can have genital surgery paid for by Canada’s health care system. But female-to-male transsexuals—those born with female bodies who identify as men—have been cut off from Medical Services Plan coverage for nearly 15 years when it comes to construction of male genitalia, according to a recent story by the Vancouver Sun.
1) Submit your online testimony
The AMA-IMG Section will collect online testimony through tomorrow, April 17, as part of its virtual congress. The AMA-IMG Section Governing Council will review all submitted testimony and post final versions of the resolutions by April 30 for ratification by the virtual congress. All AMA-IMG members may submit testimony and vote in the final ratification process.
Review the resolutions. Then e-mail your testimony by tomorrow, April 17.
Final ratification votes should be e-mailed by May 7.
Contact J. Mori Johnson by calling (312) 464-5678 or by sending an e-mail if you have questions.
2) Vote for the section’s next leaders
The AMA-IMG Section will conduct elections for its 2009-2012 governing council through May 13. AMA-IMG members whose e-mail address the AMA has on file will receive an election ballot.
If you do not receive an election ballot by tomorrow, April 17, visit the Web site and register, then cast your vote.
Contact Carolyn Carter-Ellis at (312) 464-5397 or send her an e-mail if you have questions.
3) Register to attend the AMA-IMG Assembly meeting in Chicago
Mark your calendars for the AMA-IMG Section Assembly meeting, which will take place June 12–15 at the Hyatt Regency Chicago. Scheduled events include:
Submit your registration form before May 22 by e-mail or fax it to (312) 464-5845.
Visit the AMA-IMG Web site for the assembly meeting’s full schedule and to register to attend.
Contact J. Mori Johnson at (312) 464-5678 or send an e-mail if you have any questions or if you wish to give an organizational report during the AMA-IMG Section Congress.
Brought to you by the AMA Section on Medical Schools
1) AMA-SMS resolution deadline is next week
The AMA-SMS Governing Council is seeking ideas and actual language for resolutions about important issues related to academic physicians for consideration at the Annual Meeting of the AMA House of Delegates. Resolutions are due April 20.
Resolutions for the AMA-SMS’s November meeting, to be held in conjunction with the 2009 Interim Meeting of the AMA House of Delegates, will also be accepted for discussion at the June meeting.
Send an e-mail with questions or to submit a proposed resolution.
2) AMA Interim Meeting webcasts added to archives
The AMA Organized Medical Services Section (OMSS) is offering two 90-minute educational webcasts: “Physicians as Targets and How to Avoid Being One” and “Organized Medical Staffs and Disruptive Behavior,” on its Web pages. Both programs provide AMA PRA Category 1 Credit™.
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.
3) In American Medical News: States offer school loan repayment deals
In order to draw more physicians to areas lacking adequate medical care, states such as New York and Texas plan to exchange school loan repayments for physician agreements to work in medically underserved communities for a set time, according to an article in the April 6 issue of American Medical News.
4) Virtual Mentor clinical case covers avoiding the appearance of faculty favoritism
A clinical case documented in the April issue of Virtual Mentor, the AMA’s online ethics journal, explores how faculty gifts to individual residents or students may be perceived as favoritism.
Visit the Virtual Mentor Web site to access the April issue and view this case.
1) Participate in exciting media rotation with Discovery Health
Medical students are encouraged to apply for the AMA/Discovery Health internship (PDF), 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. 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.
2) Deadline extended to apply for AMA-MSS convention committee positions
Are you interested in becoming more involved in the AMA-MSS? If so, then apply for one of the various convention committees that expedite the conduct of business at each AMA-MSS Assembly meeting. Positions are available on the community service project committee, the logistics and resources committee, the reference committee, the hospitality committee and many more. The deadline to apply for seats on any of the convention committees is April 21.
3) Mark your calendars: AMA-MSS Assembly meeting deadlines
In preparation for the AMA-MSS Assembly meeting, June 11-13 at the Hyatt Regency Chicago, please keep the following deadlines.
The AMA-MSS also will hold its annual Medical Specialty Showcase, where physicians from specialty societies represented in the AMA House of Delegates will provide comprehensive information on medical specialties for students entering the residency selection process.
Watch for more information about educational sessions, featured speakers and the national service project, “Covering the Uninsured and Protecting Access to Care.”
4) In Virtual Mentor: ethics in clinical research
Ever since Edward Jenner injected a boy with pus from a cowpox pustule on the theory that doing so would protect the lad from smallpox, research with human subjects has formed the bridge between basic science breakthroughs in the lab and advances in patient care. Today, more federal research money than ever before is dedicated to clinical and translational research.
The April issue of Virtual Mentor, the AMA’s online ethics journal, explores the challenges of protecting human-research subjects and assuring the scientific integrity of research outcomes.
5) Fourth-year students: Look into the AMA Alliance’s Physicians-in-Training Host Program
Are you digging in your pockets to pay for hotel after hotel while on the residency interview trail? Are you feeling anxious over that looming expense? If so, and if you’re an AMA member, you can take advantage of the AMA Alliance’s Physicians-in-Training Host Program, which provides housing for fourth-year medical students as they interview for residencies. AMA Alliance volunteers will host you in their home. And at a time when you need to save every dollar, that’s a pretty good deal.
Visit the AMA Web site to renew your AMA membership or to join the AMA and have access to valuable resources such as this.
6) Register for the American Physician Scientists Association Annual Meeting
The American Physician Scientists Association will hold its annual meeting in conjunction with the Association of American Physicians and the American Society for Clinical Investigation from April 24–26 at the Fairmont Hotel in Chicago. Registration is ongoing.
The meeting will enable interaction between students at all levels of training, including clinical and research faculty, public health advocates and leaders in industry. It will include forums about funding and career development, panel discussions and a poster session during which students and residents can present their work.
Brought to you by the AMA Minority Affairs Consortium
1) Learn more about political involvement and leadership
Video of a presentation about political campaigns during a recent leadership seminar for Hispanic physicians is available online. The presentation provides valuable tips that can help you run a successful advocacy or political campaign.
The seminar, which provided Hispanic physicians with strategies and practical information for effective political involvement and leadership, took place in October 2008 as part of the Hispanic Physician Outreach Initiative (HPOI). Developed by the AMA-MAC, the HPOI aims to increase the participation and leadership of Hispanic physicians in the AMA, strengthen advocacy efforts on Hispanic health care issues, and identify and address the professional needs of the AMA’s Hispanic physician members.
View the video:
2) CDC offers HPV brochures for American Indian and Alaska Native women
The Centers for Disease Control and Prevention (CDC) has developed HPV brochures for American Indian and Alaska Native women.
1) Interim Meeting webcasts added to archives
The AMA-OMSS has posted a pair of 90-minute educational webcasts to its Web pages: “Physicians as Targets and How to Avoid Being One,” and “Organized Medical Staffs and Disruptive Behavior.” Both of these programs provide AMA PRA Category 1 Credit™.
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.
2) AMA-OMSS Assembly meeting fast approaching
The AMA-OMSS Assembly meeting will be held June 11–13 at the Hyatt Regency Chicago.
3) AMA offers guidance in developing code of conduct
The new Joint Commission leadership standard covering code of conduct, LD.03.01.01, took effect Jan. 1, 2009. The standard’s Elements of Performance requires, among other things, that hospitals have a code of conduct that defines acceptable, inappropriate and disruptive behavior, and that leaders create and implement a process for managing disruptive and inappropriate behaviors.
In response to these actions, the AMA adopted policy that calls for medical staffs to develop and implement their own code of conduct in their medical staff bylaws. Under the policy, hospitals should also have a code of conduct applicable to members of the board, management and all employees.
To assist medical staffs with implementation of a code of conduct in accordance with AMA policy and consistent with the Joint Commission leadership standard, the AMA Office of the General Counsel, in conjunction with the AMA-OMSS, drafted a model code of conduct for insertion in medical staff bylaws.
In addition, AMA members can access the "Physicians' Guide to Medical Staff Organization Bylaws” (PDF), an excellent resource for medical staffs and their bylaws committees.
1) By the Associated Press: No strength in numbers for America’s uninsured
The number of uninsured has grown to an estimated 50 million people because of the recession, according to a recent story by the Associated Press, and some are worried if their unorganized voice will really be heard.
2) Kaiser Family Foundation offering Web program on health reform
A new reference guide by the Kaiser Family Foundation, a non-profit, private operating foundation that focuses on major health care issues, summarizes the key strategies for expanding coverage to the nation’s 45 million people without health insurance and explains how policy options can be combined to form comprehensive reform proposals. The guide, “Approaches to Covering the Uninsured,” will be detailed as part of an online program from 1 to 2:15 p.m. EST April 29.
Register for the program.
3) Apply for internal medicine residency review committee
The AMA-RFS is accepting applications for the resident member seat on the Accreditation Council for Graduate Medical Education’s (ACGME) Residency Review Committee (RRC) for Internal Medicine. The resident member participates as a full voting member in all internal medicine RRC activities, including program review and policy discussion. The position is a two-year term that begins July 1, 2010.
Resident members must be able to devote 30 to 35 hours to program review before each meeting. All related travel and meeting expenses are covered by the ACGME.
4) Register for AMA-RFS Assembly meeting
Online registration is ongoing for the AMA-RFS Assembly, which will take place June 11–13 at the Chicago Hyatt Regency. The assembly is an excellent opportunity to network with resident and fellow physicians from around the country, participate in policy-making sessions and attend informative educational sessions.
Following is a list of important assembly deadlines:
1) Take advantage of special educational program at Annual Meeting
The AMA Advisory Committee on Group Practice Physicians, the AMA Organized Medical Staff Section and the AMA-SPG will sponsor an educational program at the Annual Meeting of the AMA House of Delegates that is geared toward senior physicians.
The session, scheduled for June 13, is titled “Keeping senior physicians in practice: Issues of competency, recertification and the value of experience.” This program will help attendees understand the value that senior physicians bring to a practice, the most common age-related issues to be aware of, and practical solutions and environmental adjustments to address those issues. John A. Fromson, MD, assistant clinical professor of psychiatry at Harvard Medical School and a nationally recognized expert on physician health, will be the keynote speaker.
Watch for more details about this session in future editions of eVoice.
2) Senior physician liaison meeting set for June
Plan to attend the AMA-SPG liaison meeting from 4 to 5 p.m. June 12 at the Hyatt Regency Hotel in Chicago. The meeting will be held as part of the Annual Meeting of the AMA House of Delegates. The AMA-SPG is seeking representation from each state on senior-oriented programs that can be presented for discussion at both the Annual and Interim meetings.
Brought to you by the AMA Women Physicians Congress
1) Cast your vote in the AMA-WPC online election
Voting for positions on the AMA-WPC Governing Council is taking place through April 27. Open positions include two at-large members and two designated representatives. Profiles of each candidate are available online.
All female members of the AMA are eligible to vote and should have received an e-mail inviting them to do so.
Send an e-mail if you have not received that e-mail, or if you have questions.
2) New AMA video highlights women physicians in the military
Do you work with female physicians that are serving or have served in the military? Do you have female patients who have served in the military? If you answered “yes” to either question, then check out a new video posted on the AMA-WPC Web site about women physicians in the military.
The video is a recording of an educational session offered during the 2008 Interim Meeting of the AMA House of Delegates. The session discussed the needs and issues of concern to women physicians who are serving or who have served in the military. It also points out issues that physicians should be aware of when treating female patients who served in the military.
1) AMA-YPS Assembly meeting fast approaching
Young physicians, mark your calendars: This year’s AMA-YPS Assembly meeting will be held June 11–13 at the Hyatt Regency Chicago.
Visit the Web site to register for the meeting.
View a draft agenda (PDF).
E-mail Jane Ascroft by May 1 to submit resolutions and to volunteer for reference, AMA House of Delegates handbook review and credentials committees. E-mail her resolutions by May 1.
2) Apply for AMA-YPS community service awards
The AMA-YPS invites nomination forms for its annual community service awards. Through these awards, the section strives to not only recognize excellence in community service activities carried out by young physicians but to encourage similar efforts by other doctors. Nominations are due May 1.
Nominees must be AMA members. Recipients will be selected by the AMA-YPS Governing Council and honored for their work during the AMA-YPS Assembly meeting June 12.
Visit the Web site for more information, to download a nomination form or submit a nomination electronically.
3) Register for child care at the Annual Meeting
Physicians with children attending the Annual Meeting of the AMA House of Delegates are encouraged to register for Camp AMA. Child care is available for children ages 6 months to 12 years old and will include arts and crafts, games and activities from June 12–16 at the Hyatt Regency Chicago.
Camp AMA is provided by Accent on Children’s Arrangements Inc. and will be made available if a minimum number of children are registered by May 5.
4) Apply for AMA-YPS Governing Council positions
Candidates interested in a position on the AMA-YPS Governing Council are encouraged to submit nominations (Word) by June 1. Open positions include chair-elect, who serves a three-year term as chair-elect and immediate past chair; speaker, who serves a two-year term; alternate delegate, who serves a two-year term; and member at-large, who serves a two-year term.
All terms begin at the close of the Annual Meeting of the AMA House of Delegates. After June 1, nominations will only be accepted from the floor at the June 12 AMA-YPS Assembly meeting. Candidates whose nomination forms are received before June 1 will be posted on the AMA-YPS Web site.
5) AMA GME e-Letter: mismatch?
On March 19, nearly 30,000 applicants to the National Resident Matching Program learned where they will obtain their residency training. This year’s Match was the largest in history—and one of the most competitive. These statistics bolster the AMA’s belief that the nation needs to increase graduate medical education (GME) positions by removing a cap on them.
“If we’re serious about expanding the medical work force, it’s time to expand the number of GME positions. If we can take the cap off ... then American society will be better served,” AMA President-elect J. James Rohack, MD, told the Associated Press.
Visit the Web site for more about this topic and others in the April issue of the AMA GME e-Letter.
6) In Virtual Mentor: ethics in clinical research
Ever since Edward Jenner injected a boy with pus from a cowpox pustule on the theory that doing so would protect the lad from smallpox, research with human subjects has formed the bridge between basic science breakthroughs in the lab and advances in patient care. Today, more federal research money than ever before is dedicated to clinical and translational research.
The April issue of Virtual Mentor, the AMA’s online ethics journal, explores the challenges of protecting human-research subjects and assuring the scientific integrity of research outcomes.
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