t florida nternist - acp · [email protected] jason m. goldman, md, facp ... suite 220...

From The GovernorIn This Issue

From the President Page 3

New Fellows Page 4

Council of Young PhysiciansPage 4

2012 Annual Associate Meeting AwardsPage 5

2012 Annual Scientific Meeting Agenda Page 6

Council of AssociatesPage 7

Legislative Update Page 8

Membership CornerPage 9

Michelle L. Rossi, MD, [email protected]

Warm greetings to you, my friends and colleagues! This is my first “Governor’s Welcome.” I freely admit that it took some time to compose properly. I am humbled by the trust you have placed in me, and seek to serve you well. We find ourselves in tumultuous times, but there is always room for optimism and idealism. I am grateful for this platform, through which I’d like to share a little of myself and my ideas. As I begin my time as Governor for our vibrant Chapter, I’d like to thank those who served before me: you leave large footsteps to follow, and I appreciate your example. Through your mentorship, I learned to rely on our Chapter. I have witnessed the wonderful things that can be accomplished when we combine our collective strength towards a shared purpose. The concepts of personal/professional renewal, faith in our mission, trust in each other, and simple perseverance are dear to me. My faith in these lofty but straightforward principles has been reinforced through my experience in the Florida Chapter ACP, and through my interactions with you. During my tenure, I hope to inspire others to become more engaged - just as I was motivated by those who served before me.

I’m excited for our next meeting and hope that you are as well. It will be a special time for me: I have the pleasure of granting our Council of Associates (COA) the latitude to update aspects of our meeting to meet the needs of associates and young physicians. Dr. Morganna Freeman-Keller, whose accomplishments are already appreciated by many of you, is Chair of that exceptional group. She is a dear friend of mine, and I’m particularly touched by the innovations the COA will implement. Dr. Ricardo Correa will follow her as Chair of the COA – together; they will lead a concurrent session for our Scientific Meeting in September at the PGA Resort and Spa. It will feature an Evidence Based Medicine tutorial and interactive discussion, a presentation on how to craft relevant Power Point presentations, and the first of a Leadership Toolkit Series.

I also plan to introduce a Council of Student Members (CSM) for our Chapter. Guidance from National ACP has been helpful in providing the logistics for the creation of that Council. Our current construct does not do justice to the number of excellent medical schools with gifted students who are training in our state. Dr. Maria Cannarozzi will be the Chapter Advisor for that

group, in order to mentor the students and provide them organizational memory. The Chair of the CSM will serve on the GAC. Input from the CSM will help us cultivate those who will follow, and provide insight into the programming needs of our student members.

As you probably already realized, our Chapter and our members are a constant source of encouragement for me. I hope to formalize my feelings into programming for membership. I ‘d like to implement a Humanism in Medicine Lecture Series as part of our educational sessions. The first lecture will take place at our Scientific Session this year. The Associates’ Meeting would ideally feature a speaker that will resonate with our resident and student members. More to follow, as I firm up the sessions and speakers. If you have ideas regarding this or anything, feel free to share them.

The Leadership Day experience on Capitol Hill was quite exhilarating for our Chapter this year. Thanks to each of you who took the time to attend. I don’t want to encroach upon Dr. Zimmer’s arena, since he is Governor for our Legislative endeavors - but I can’t help but to comment on this year’s successes. Please see his comments for the Chapter’s perspective. Our own Dr. Bo Tucker, our Chapter’s Legislative Chairman for many years, was named one of ACP’s four most effective Internal Medicine Legislative Advocates for the year! We are proud of him, his leadership, and his humility in seeking to make Florida a better place for all of us who practice here. I was also touched by having the opportunity to have my three seasoned residents accompany me on legislative visits this year for one last time. I will be sad to lose two of them to fantastic training opportunities, but they know that they will remain close regardless. At the same time, I was delighted to meet with so many other inspirational residents – and might need to borrow them for my team next year! My accomplished and aforementioned friend, Dr. Morganna Freeman-Keller (who was last year’s ACP Health Policy and Practice Legislative Intern) was videotaped giving a congressional member pitch to serve as an example for our associate members. Her message can be found on the ACP National website.

We truly can be the change we want to see in our world. It simply takes each of you doing what you already do each day, celebrating the fact that you make a difference, and granting our Chapter a prominent place in your life!

I would like to express my sincere thanks and gratitude to Himangi Kaushal, MD, FACP for her leadership and organization in obtaining excellent speakers for the upcoming 2012 Annual Scientific Meeting, Sept 7 - 9 at PGA National Resort - Job well done!

Lastly: I have to thank Dawn, Chris, and Bridget who serve as the backbone for our organization. Without you, we could not accomplish all that we do. We all appreciate your dedication.

Sincerely,

Michelle

The Florida inTernisTNewsletter of the Florida Chapter of the American College of Physicians

Volume 11, No. 1

August 2012 http://www.acponline.org/chapters/fl

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Executive Committee

Michael A. Zimmer, MD, FACPGovernor/[email protected]

Michelle L. Rossi, MD, [email protected]

Stuart B. Himmelstein, MD, FACPImmediate Past [email protected]

Karen Echeverria-Beltran, MD, [email protected]

Jason M. Goldman, MD, [email protected]

N.H. Tucker, III, MD, FACPLegislative [email protected]

Editorial Board

Michael A. Howell, MD, MBA, [email protected]

The Florida Internist is the official publication of the

Florida Chapter,American College of Physicians.

Editorial & Publishing Offices

1000 Riverside Ave., Suite 220Jacksonville, FL 32204

800-542-8461

[email protected]@comcast.net

www.acponline.org/chapters/fl

Florida Chapter 2012 John Tooker Evergreen Award

OPPOSITION TO UNCONSTITUTIONAL IMPINGEMENT ON PHYSICIAN FREE SPEECH

Legislation was proposed in the 2011 Florida Legislative Session that, in its original form, would have prohibited any physician, under any circumstances, from asking a patient if they or any member of their household owned a firearm. The penalty for violation of the law was to be a $5,000,000 fine and a felony conviction, which automatically would have resulted in the revocation of the offending physician’s medical license. The Florida Chapter vigorously opposed the legislation (HB155 and SB 432) because it impinged upon a physician’s First Amendment Right to Free Speech and was an intrusion on the physician-patient relationship. The Chapter and its weekly Tallahassee delegation lobbied against the bill, its representatives testified against it, its Voter Voice program resulted in hundreds of messages to legislators, and ultimately the bill was amended to allow physicians to ask such questions, but not to harass patients. The criminal penalties and fines were also eliminated. Upon the bill being signed into the law, the Chapter teamed with the Florida Academy of Family Physicians and others to have the law declared unconstitutional by a federal court. The Court has preliminarily enjoined the law, which therefore cannot be enforced, and has indicated that the law is, indeed, an unconstitutional impingement of free speech. The Florida Chapter received enormous support from the press, public, and its own membership for having taken such a principled stand against government intrusion into the physician-patient relationship.

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Register NOW for the Florida Chapter 2012 Annual Scientific Meeting

September 7 - 9, 2012 PGA National Resort & Spa

Please contact the PGA National Resort & Spa At 1‐800‐633‐9150

for room reservations. Be sure to request the FL Chapter ACP Group Room Rate: $119.00 – S/D

Hotel reservations must be made prior to Thursday, August 23, 2012, after which, reservations will be accepted on space availability only and at the current rate.

Detailed agenda and registration forms are available on the Florida Chapter’s Website at http://www.acponline.org/chapters/fl

or call the Florida Chapter Office at 800‐542‐8461 for additional information. *Please see 2012 Annual Meeting agenda on page 6

GovErnor’s Advisory CounCil

Michael A. Zimmer, MD, FACP Governor/PresidentTampa

Michelle Rossi, MD, FACP GovernorGainesville

Jose F. Arrascue, MD Atlantis

Carmel J. Barrau, MD, FACP Miami Daniel Bendetowicz, MD, FACP Fort Myers

Mary T. Busowski, MD, FACP Winter Springs

Maria L. Cannarozzi, MD Orlando

Jeffrey M. Davis, MD, FACP Oldsmar Karen Echeverria-Beltran, MD, FACP Orlando N. Lawrence Edwards, MD, FACP Gainesville George Everett, MD, MS, FACP Orlando Malcolm T. Foster, Jr, MD, MACP Jacksonville Morganna Freeman-Keller, DO Gainesville Jason M. Goldman, MD, FACP Coral Springs R. Scott Hanson, MD, MPH, FACP Tallahassee

Stuart B. Himmelstein, MD, FACP Delray Beach

Jeff G. House, DO, FACP Jacksonville

Michael L. Howell, MD, MBA, FACP Orlando

David P. Hurwitz, MD, FACP Indialantic

Pran M. Kar, MD, FACP Orlando

Kedar S. Kirtane Gainesville

FroM THE PrEsidEnTMichael A. Zimmer, MD, FACP

ACP Governor for Florida President, Division of Advocacy and Member Benefits

[email protected]

I wanted to review this past year’s accomplishments as well as our plans for this fall’s meeting. Your chapter had a productive year. In April, I met with all the other ACP governors from across the

country at the Board of Governors in New Orleans prior to the start of Internal Medicine 2012. Your chapter shined as a bright star, winning an Evergreen Award due to your hard work in fighting the famous Docs versus Glocks issue. This Florida law resulted in prosecuting a physician as a felon if he asks a patient whether or not he has a gun in his home. Fortunately, we won the fight when US district court judge Marcia Cooke enjoined the state from enforcing statutes 790.338(1), (2), (5), and (6) on June 29, 2012. Furthermore, your chapter submitted a resolution which the Board of Governors approved for study by the Board of Regents to revise membership to attract more hospitalists to ACP.

Later, in June, I met with the Medical Practice Quality Committee (MPQC) as the Vice-Chair to review many issues confronting the practicing internist. The MPQC studied various options to introduce to Congress for not only eliminating the SGR which will result in a 30% cut in payments to physicians starting January 1, 2013 but also in replacing the current fee for service model with an outcomes based quality paradigm that would award physicians for achieving certain clinical benchmarks. Furthermore, the MPQC reviewed the Informatics Committee’s recommendations to amend unrealistic standards currently in place in the 2nd stage of Meaningful Use Certification. Additionally, the MPQC addressed the need to educate our members of the upcoming changes in the American Board of Internal Medicine in the Maintenance of Certification Program (MOC) that will take place in 2013. Those changes will include the requirement to complete a module every year.

The following week, I met as the representative of my class of Governors (2014) with the other class representatives in the Executive Committee of the Board of Governors (BOG) to review the upcoming resolutions for this fall’s BOG meeting in Vancouver, British Columbia. Two of those resolutions came from your chapter involving the ABIM. You asked to reduce the cost of recertification, currently $2,000 every 10 years as well as to work to elimination of the current written examination and replacement with other tools of assessment. Additionally, in June, 2012, your chapter’s leadership spent time in Washington, DC on Leadership Day to lobby your Congressional members to halt the SGR cut as well as support other legislation to protect physicians’ practices, including tort reform and setting up health care courts.Moreover, your chapter’s leaders spent time representing you at the Florida Medical Association’s House of Delegates. Your chapter successfully passed a resolution that re affirmed the current TIME (truth in medical education) law that would stipulate that all professionals who call themselves “doctor” must display their license. For example, Doctor of Nurse Practitioner could not simply call herself Doctor or simply have initials DNP but would have to display her nursing license.

Looking forward to this fall, your chapter has the fortune of Himangi Kaushal MD FACP associate program director of the University of Miami Medical School regional campus organizing and presenting our scientific program. She will have speakers who will cover the Florida state medical licensure CME mandated two hour courses of Prevention of Medical Errors and Domestic Violence. Furthermore, your chapter meeting will update you on the latest developments in didactic areas of Internal Medicine such as neurology and endocrinology as well as in clinical practice communication realms of interpersonal skills and transitions of care.

I want to thank you all of our dedicated members ranging from the northwest corner of Pensacola to the northeast of Jacksonville to the southeast of Miami and to the Southwest of Fort Meyers who have taken time away from their busy medical practices and families – often at significant cost -- to study and protect the needs of Florida’s internists and thereby fulfill ACP’s mission statement: to enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine.

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Craig S. Kitchens, MD, MACP Gainesville

John Langdon, MD, FACP Winter Park

Joshua D. Lenchus, DO, RPh, FACP Davie

Joe L. Lezama, Jr, MD, FACP Lutz

Kay M. Mitchell, MD, MACP Jacksonville Kenneth Nix, Jr, MD, FACP Jacksonville

Cristina Pravia, MD, FACP Miami John F. Rubin, MD, FACP Boca Raton

Ignacio A. Sotolongo, MD, FACP St. Petersburg

Brett E. Stanaland, MD, FACP Naples

Stephen N. Symes, MD Miami N. H. Tucker, III, MD, FACP Jacksonville

Claudio D. Tuda, MD, FACP Miami Beach Robert M. Walker, MD, FACP Tampa

Frederick K. Williams, MD, FACP Atlantis

Membership, Education and MeetingsBridget H. [email protected]

legislation, Practice Management, Professional liability insurance Dawn R. Moerings Executive Director [email protected]

Chapter Counsel, Contract reviewChristopher L. Nuland, Esq. 1000 Riverside Ave., Ste 115 Jacksonville, FL 32204 (904) 355-1555 (904) 355-1585 [email protected]

CongratulationsNew Fellows

Bolanle A. Akakabota, MBBS, FACPAhmed M. Alikhan, MD, FACP

Saint A. Amofah, MBChB, FACPLouisa A. Appea-Danquah, MBChB, FACP

Ankush K. Bansal, MD, FACPLuis R. Caceres, III, DO, FACPRazvan M. Chirila, MD, FACP

Vijay K. Chowdhary, MD, FACPDavid B. Felker, MD, FACP

Syed A.K. Gilani, MBBS, FACPR. Scott Hanson, MD, MPH, FACP

Sayyed T. Hussain, MD, FACP

Susan J.G. Laenger, MD, FACPPeter A. Lewis, MD, FACP

Soling Li, DO, FACPFausta Nazaire, MD, FACPJose M. Nieto, DO, FACP

Barbara H. Sanford, MD, FACPNeville B. Sarkari, MD, FACPAndrea Sciberras, DO, FACP

Joseph M. Sperduto, MD, FACPNiharika N. Suchak, MBBS, FACP

Carl Suchar, DO, FACPRichard F. Timmons, MD, FACP

Council of young PhysiciansJoshua D. Lenchus, DO, RPh, FACP, SFHM - Chairman

The Council of Young Physicians (CYP) continues to recruit members around the State as it plans to launch its new webinar series. Relevant topics to these early-career members will be offered to all who are interested, not merely young physicians. Topics may include contract negotiations, asset protection, how to say “no,” work-life balance, and many more. We look forward to beginning this series in advance of this fall’s scientific session. As a reminder, if you have graduated medical school within the last 16 years, you are eligible to become a member of the CYP. If interested in joining this group, please contact the Chapter office ([email protected]) or its chair, Joshua D. Lenchus, DO, FACP, SFHM ([email protected]) and look out for a planning session at the scientific session. Hope to see you at the PGA Resort in September.

The Florida Chapter congratulates the following new Fellows who participated in the 2012 Convocation Ceremony

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Doctors Dilemma

Congratulations to the following Doctors Dilemma teams

from the Florida Chapter ACP Associates Meeting!

These teams will compete again at theFlorida Chapter ACP Regional Meeting in

September at the PGA National Resort & Spa in Palm Beach Gardens. The winning team from

the Regional Meeting will then compete at the 2013 ACP National Competition.

Florida Chapter ACP 2012 Annual Associates Meeting

March 24 & 25, 2012 - Orlando, Florida

Congratulations to the Winners of the Associates & Medical Students Competitions !!

Associates Oral Competition

First Place - Jesal V. Popat, MD University of South Florida Sudden Cardiac Death: A Possible Link to a Popular Herbal Remedy?

Second Place - Matthew Schmitt, MD Orlando Health Acquired Factor V Inhibitor of Unknown Etiology Following Dental Extraction

Third Place - Morganna Freeman-Keller, DO University of Florida Cannabis Hyperemesis Syndrome: An Emerging Cause of Intractable Nausea and Vomiting

These three associates will present at the 2012 FL Chapter ACP Annual Scientific Meeting, September 7 - 9 in Palm Beach Gardens, FL

Associates Poster Competition Clinical Vignette Kimberly Kolkhorst, DO University of South Florida Priapism - An Unusual Presentation of Familial Adenomatous Polyposis

research Julio G Peguero, MD Mt Sinai Medical Center The Use of Nitrates for the Prevention of Contrast-Induced Nephropathy

Medical Student Poster Competition Jonathan Beilan, MS III University of Central FL College of Medicine Mousing for a Diagnosis: Cat Scratch in an Immunocompromised Host

University of South FloridaBrian Coe, MD

Vadin Lall-Dass, MD Kellee Oller, MD

University of Miami - Jackson Memorial Hospital

Jorge Cabrera, MD Fernando Calmet, MD

Jose Sandoval, MD

University of Miami Regional Campus Joao Braghiroli, MD Camilo Ortega, MD

Carlos Silva, MD

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Florida Chapter ACP 2012 Scientific Meeting

September 7 - 9, 2012 Designing the New Landscape of Medicine – The Critical Role of the Internist

This activity has been approved for AMA PRA Category 1 Credits™.

Friday, September 07, 2012 7:00 - 8:00 a.m. Registration & Breakfast 8:00 a.m.

Governors’ Welcome Michelle L. Rossi, MD, FACP, Governor, ACP Florida Chapter Himangi Kaushal, MD, FACP, Program Director Presiding

8:15 a.m. Communication & Interpersonal Skills in Today’s Environment Daniel M. Lichtstein, MD, FACP 9:15 a.m. Updates on New Diabetes and Obesity Medicine Gianluca Iacobellis, MD, PhD. (invited) 10:15 a.m. Networking Break with Exhibitors 10:45 a.m. Primary Care Approach to Genetic Cancer Syndromes Jason M. Goldman, MD, FACP 11:45 a.m. Practical Update in Outpatient Neurology James Goldenberg, MD 12:45 p.m. ACP Governors Luncheon: Future of Obama Care Christopher L. Nuland, Esq. 2:00 p.m. Atrial Fibrillation - Finding Some Order Amid the Chaos Steven Borzak, MD 3:00 p.m. Networking Break with Exhibitors 3:30 p.m. Update in Geriatrics Joseph G. Ouslander, MD 4:30 p.m. Principles of Pain Management for the Primary Care Practice Andrea Sciberras, MD, FACP 5:30 p.m. Adjourn

Saturday, September 08, 2012 7:00 - 8:00 a.m. Registration/Breakfast 8:00 a.m. Scientific Session Himangi Kaushal, MD, FACP, Presiding 8:05 a.m. Herbal Supplements and the Kidney Warren Kupin, MD 9:05 a.m. Transitions of Care Jennifer W. Caceres, MD, FACP 10:05 a.m. Networking Break with Exhibitors 10:30 a.m. HIV- Is It Just More of the Same? Larry M. Bush, MD, FACP 11:30 a.m. Inaugural Humanism in Medicine Lecture: Is There A Future for Internists in American Medicine?

Cecil B. Wilson, MD, MACP 12:30 p.m. Business Meeting/Town Meeting 1:00 p.m.

ACP Governor’s Luncheon: A Crowed Exam Room: Does Government Have a Place in the Physician-Patient Relationship? Michelle L. Rossi, MD, FACP and Christopher L. Nuland, Esq

2:30 p.m. Sudden Cardiac Death: A Link to a Popular Herbal Remedy? Jesal V. Popat, MD (University of South Florida) 2:45 p.m.

Cannabis Hyperemesis Syndrome: An Emerging Cause of Intractable Nausea and Vomiting Morganna Freeman-Keller, DO (University of Florida)

3:00 p.m. Networking Break with Exhibitors 3:30 p.m. Prevention of Medical Errors (2 Hr. State Mandated Course) Cliff Rapp, LHRM & Christopher Nuland, Esquire 3:30 - 4:15 p.m. Medical Student & Associate Leadership Toolkit Series: Giving an Effective PowerPoint (courtesy of ACP) 4:30 - 5:00 Council of Associates Board Meeting - Morganna Freeman-Keller, DO, Chair 5:30 p.m. Adjourn 6:00 p.m. Poster Judging 7:30 p.m. Reception and Awards Presentation Sunday, September 09, 2012 7:30 a.m.

Fellowship Mentoring Breakfast (FACP) (pre-registration required) Continental Breakfast for attendees

8:00 - 10:15 a.m. Breakfast Program for Medical Students & Associates: Introductory Lecture on EBM Basics - Ricardo Correa, MD 8:30 a.m. Scientific Session Himangi Kaushal, MD, FACP, Presiding 8:35 a.m. Domestic Violence (2 Hr. State Mandated Course) Panagiota V. Caralis, MD, JD 10:35 a.m. Networking Break with Exhibitors 11:00 a.m. Doctors’ Dilemma™ Univ of Miami /Jackson Memorial Univ of Miami /Regional Campus Univ of South Florida 12:00 p.m. Announcements and Adjournment

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Council of AssociatesMorganna Freeman-Keller, Chair

Great news! Our CoA Leadership continues to grow - it was a pleasure to see so many new faces at our last meeting. Please extend a warm welcome to our new resident representatives:

Sean Donovan, Mayo Clinic JacksonvilleShelley Singh & Mathew Farbman, Mt SinaiPrabhava Bagla & Alex Li, Florida HospitalTulisa Larocca, U Miami Regional Campus

Keely Fischbach & Shyla Gowda, USFKe Ning, UF Jacksonville

I’d also like to take this opportunity to thank our outgoing members Drs. David Franco (Florida Hospital), Faraz Kureshi (Mayo Clinic Jacksonville), Ramandeep Bambrah (UF Jacksonville) and Kellee Oller (USF) for all their hard work as Council Representatives. Good luck to each of you in your future careers!

Congratulation to Ricardo Correa, winner of the Facebook “Like” Challenge iPad! Please be sure to visit our Chapter Facebook Page: http://www.facebook.com/#!/pages/American-College-of-Physicians-Florida-Chapter/118582481512437

What’s Coming In 2012?- Recruit-A-Resident Program: Our CoA has developed a PowerPoint to talk to new interns about the great benefits of Associate Membership with ACP. This has been shared with

all of our campus representatives to present to new interns in July. We have also developed a membership survey to identify new ways that ACP can benefit you! - Fall Chapter Meeting: Save the date - it will be September 7-8 at the PGA Resort in West Palm Beach! Also, thanks to valuable CoA input about the content available to Student and Associate members, plans are in place to include the following activities:

- Evidence-Based Medicine Workshop (thanks to CoA Representative Ricardo Correa!)

- Developing an Effective Powerpoint (adapted from ACP National meeting)

- Leadership Toolkit Series (continuing basis with different topics at each meeting)

- Pitfalls of Publication (thanks to David Franco; potential topic for Spring)

- Council of Student Members: Medical students interested in IM/subspecialties as a career would have a voice in Chapter activities. CoA representative from each campus may serve as a resident mentor to the student representative. If you know of a motivated medical student who’s interested in IM and they would like to be a part of our Student Council, nominate them by emailing Dawn Moerings, Chapter Coordinator, at [email protected].

This will be my last CoA newsletter, as I am moving on as the Regional Representative to the National Council of Associates. It has been a great experience for me as CoA Chair, and a wonderful opportunity to meet with students and residents who are passionate about Internal Medicine. At our September meeting, please be sure to extend warm congratulations to Ricardo Correa and Joao Braghiroli, who will be taking over as Council leadership!

Spiritedly,

Morganna Freeman-Keller, DOFlorida Chapter CoA [email protected]

Florida Chapter ACP 2012 Annual Scientific Meeting September 7 - 9, 2012

PGA National Resort & Spa – Palm Beach Gardens, FL Group reservation # (800) 633-9150 ~ Special group rate: $119 (s/d) cutoff 8/17/2012

FEATURED ACTIVITIES

Leadership Toolkit Series Morganna Freeman-Keller, DO, National ACP Representative and Former ACP Health Policy Intern

Associate & Medical Student Happy Hour

Evidence-Based Medicine Workshop Ricardo Correa, MD, Chair-Elect, ACP FL Council of Associates

Doctor’s Dilemma Competition University of Miami Jackson Memorial ~ University of Miami Regional Campus ~ University of South Florida

Please Join Us! Florida Chapter ACP (800) 542-8461

For information on Program & Meeting Registration: http://www.acponline.org/about_acp/chapters/fl/

Special Guest Speaker: Humanism in Medicine Cecil B. Wilson, MD, MACP

Former AMA President and President-Elect, World Medical Association

ACP Governor’s Luncheon A Crowded Exam Room: Does Government Have a Place in the Physician-Patient Relationship?

Michelle L. Rossi, MD, FACP, ACP Governor Florida Chapter Christopher L. Nuland, JD

Student & Associate Special Events

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legislative update

Christopher L. Nuland, Esq.

When the dust cleared from the Capitol early Saturday morning, the Florida Chapter could take great pride in its engagement in Tallahassee politics.

The Chapter also had extraordinary session in several areas. The PIP bill that passed late Friday night included benefits for physician services and retained the $5,000 set-aside for physician fees, both of which were components for which the Chapter lobbied. By contrast, fees for non-emergency services were cut to $2,500, and massage therapists and acupuncturists will no longer be able to access PIP benefits.

After two years of work, the Legislature passed the High School Athlete Concussion bill (HB 291), which requires medical clearance of a concussed athlete before he or she can return to competition. The Chapter had been supporting that legislation since its introduction two years ago. The Chapter and Medicine also succeeded in several defensive efforts, notably defeating attempts to require a posting of physician fees, attempts to remove physical education from Florida middle schools, as well as legislation that would have allowed ARNPs to prescribe controlled substances.

One obvious disappointment was the failure of tort reform to advance. In an effort to produce a “grand compromise,” the Senate combined tort reform with an expansion of optometrists’ scope of practice. Instead of obtaining extra votes, however, the combined legislation gathered opponents who disliked either the scope of practice issue or the tort reform, and the result was that neither passed

Thank you to all those who contacted their legislators or went to Tallahassee to lobby for your profession and patients. This was one of the longest, strangest, and most volatile sessions in recent memory, and the Chapter should be justly proud of its accomplishments in such a tumultuous year.

Florida Workers’ Comp rates on the rise

Last fall I wrote about the pending rate request by the National Council on Compensation Insurance (NCCI) set to take effect on January 1st, 2012. That date has come and gone and the state of Florida did increase rates on average by 8.9%. All indications point to another rate increase coming for January 1st, 2013. Along with the three main factors listed below, medical inflation and the increase in narcotics consumption are having a negative impact on workers compensation carrier profits. After 7 years of falling premiums, the tide has turned and we can most likely expect rates to rise for the foreseeable future.

There are three major challenges facing the workers compensation line in Florida as well as the entire country:

1. Deteriorating Underwriting Results – For the first time since 2001, the combined loss ratio for private carriers has risen to 117%. This is unstable in the current economic environment. Carriers start to see profit at about 100% or less.

2. Political Environment – The establishment of the new Federal Insurance Office will most certainly increase the possibility of greater regulation for property & casualty companies.

3. Frequency of Claims – For the first time in thirteen years, the national level of claims frequency has increased and looks to be trending that way.

These three factors in addition to others like the Patient Protection and Affordable Care Act (PPACA) have created an uncertain environment for the future of workers’ compensation rates in Florida and have lead to a rate increases for 2012 and 2013. This may be the start of a trend and the changing “cycle” that appears to be inevitable based upon history.

Now more than ever the time is right to look into a dividend programs like the ones offered by OptaComp (A rated AM Best) offered through a number of medical societies. This is a great way to offset the rising premiums. Call your agent or the team at Danna-Gracey 800-966-2120 for additional information.

Tom Murphy is a workers’ compensation and medical malpractice insurance specialist with Danna-Gracey, an independent insurance agency based in downtown Delray Beach with a statewide team of specialists dedicated solely to insurance coverage placement for Florida’s doctors. To contact him call (800) 966-2120, or email: [email protected].

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Membership Corner Jason M. Goldman, MD, FACP Membership Chairman

In my career to date, I have had the opportunity to experience many aspects of the medical profession as it relates to primary care. I have worked as a hospitalist and as a private practice physician with exposure to both emergency care and to chronic disease management. Throughout all of these various incarnations, the one constant has been the American College of Physicians. This great organization has always provided me with resources and support for all aspects of my medical career. It is, perhaps, for this reason, that I have chosen to become so involved in the chapter and repay it for the many benefits it has offered. As the chairman of membership and current Treasurer, I have been able to readily appreciate how integral the College is for its members and the practice of internal medicine.

The College has so much to offer all internists, whether hospital or office based, employed or solo practice physician. First and foremost, the college is dedicated to education. To that end, the physician can find a plethora of resources on the College website including peer reviewed journals, practice guidelines, up to date information on treatment of disease and multiple opportunities for CME credit. All members can benefit from this vast wealth of knowledge. The office based physician can find a tremendous amount of material in the practice resource center with a practical approach for implementing new and innovative methodologies to reviewing coding, billing and reimbursement. All internal medicine physicians, in any stage of practice, can benefit from the certification and recertification resources that the college offers.

In addition to the educational component, the college also has a strong legislative and advocacy based division that constantly strives to improve the practice of medicine for all internists and ensure the rights of the patients. All of us can be proud of the work that the college has done in this area as they have defended our rights and prevented egregious affronts to our liberties.

The benefits from the college are both at a state and a national level with the member being able to access both. Our Florida Chapter has worked hard to provide substantial benefits to the members that encompass not only the previously mentioned national resources but also local benefits ranging from access to legal advice from our general counsel to various discounts on insurance premiums and other business products.

If you are a current member and reading this article, then I thank you for your continued support of the college and hope you are enjoying all it has to offer. If you are not yet a member, then I encourage you to join so that you will also be able to reap the many rewards that membership permits. Becoming an internist shows your commitment to helping the patients in a comprehensive manner but your membership in the American College of Physicians shows true dedication to the advancement of our noble profession.

WelcomeThe Florida Chapter extends a warm

welcome to our new members!

Panagiota J. Aggeletos, MD Palm HarborZahid M Akram, MD New Port RicheySusmitha Apuri, MD Land O LakesJose R Arias, Jr MD Altamonte SpringsTatiana V Arkhipenko, MD Saint PetersburgNoman Ashraf, MBBS TampaAliyah Baluch, MD TampaTohmina Begum, MD Lake CityRashida S Blake, MD Pembroke PinesLorena Del Pilar Bonilla, MD Coral GablesGabriel E Breuer, MD JupiterGiovanni Campanile, MD Key WestJose V Castellanos, MD Boca RatonMichael J Cavanaugh, MD MiamiVeeraish Chauhan, MD BradentonGordon L Chen, MD MiamiJessica E Chen, MD MiamiKhaza Chowdhury, MBBS Fort MyersJose A Cobiella MiamiCurtis B Cochrane, MD DunedinSusan G Coe, MD JacksonvilleAnnabelle Cohen, MD MiamiEnrique A Cortes, MD Land O LakesChauncey W Crandall IV, MD JupiterJohnathan B davidson, MD gainesvilleJuan R Del Rio, MD HialeahSheetal R Deo, MBBS TallahasseeVaishali V Desai, MD LakelandDavid Ecker, MD TampaMichael Ehrenman MD MiamiJoseph H Etienne, MD MiramarJimmy Daniel Fernandez, MD Coral GablesTammy Ferro, DO Belleair BeachErnesto Fuentes, MD Pembroke PinesTameka S. Funny, DO TallahasseeJusto Manuel Garcia, MD MiamiFlorian Gegaj, MD OxfordInna Genel, MD Palm Beach GardensMalika George, MD Altamonte SpringsHilton Gomes, MD MiamiM Gopalakrishnamoorthy, MBBS Punta GordaKristen L Hagar, MD PlantationRebecca Lynn Hoffman, MD StuartIngrid C Jones-Ince, MD TallahasseeJoyce Ann Jose, MD Winter GardenOmar Junaid, MBBS TampaFreeman Kamuru GainesvilleAdli J Karadsheh, MD Saint JohnsShakib A Khan, MBBS Wesley ChapelChang Lim Kim, MD MargateMuaiad Kittaneh, MD MiamiSeba L Krumholtz, MD Boca RatonShweta Kurian, MD MiamiYolanda V Lewis, MD Port Saint LucieGonzalo J Loveday, MD JupiterRosanto A Macam, MD RockledgeFrancisco J Machado, MD TampaElena Malyutina, MD Doral

Raaid H Mannaa Mannah, MD SebringWilliam F McGrogan, MD TampaMichael A McLean, MD MiamiDiana Mendez, MD Panama CityVictor W Mikhael, MD Winter ParkAbdal Mirza, MD NaplesAlejandro R Mosquera, MD Miami BeachJayan Nair, MBBS GainesvilleAudwin B Nelson, MD SebringJuan C Nova, MD Howey in the HillsJudepatricks M Onyema, MD DebaryHeidy Ormeno, MD Indn Hbr BchAurora Oughourlian, MD MiamiMark S Pankonin, MD PhD MiamiJoseph D Paolucci, MD ZephyrhillsJim Parkerson, DO Temple TerraceSapna Patel, MD TampaRicardo L Perez, MD MiamiSunanda Ponnavolu, MD Winter HavenMohammed A Quader, MD Jacksonville BeachBrian Rajca, MD GainesvilleMyra A Reed, MD Panama City BeachBeatriz E Restrepo, MD HollywoodLogan M Richards, MD Gulf BreezeMara M Rodriguez, MD MiamiMadeleine Rodriguez-Alonso, MD MiamiCynthia Patricia Roever, MD Palm HarborJulio M Romero, MD MiamiElizabeth A Rommel, MD TampaEric S Rosen, DO TampaSeth D Rosen, MD Port St LucieLisa M Rubiano, DO WestonSheryl D Sabillo, MD WestonKarthikeyan Sai, MD ClearwaterThomas Samuel, MD Cooper CityAlex Reinemer Seamon, MD GainesvilleAsif Rashid Shah, MBBS TallahasseeHarshal Shah, MBBS JacksonvilleUday Shankar, MBBS MiamiMazin M Shikara, MBChB JupiterSarah J Smalley, MD ValricoFrederick Smith, MD MiamiDaniel J Soberon, MD MiamiJason B Stansberry, MD GainesvilleJason Scott Starr, DO JacksonvilleSasha T Sutherland, MD LakelandMichael T Tees, MD TampaSujatharani Thiruman, MBBS TavaresGabriel Tinoco, MD MiamiJonatan D Valdez Diaz, MD OrlandoKaren Valledor, DO Miami BeachAugustin A Vargas, MD JupiterCarla Mosby Ward, MD ValricoJorge A Yu Chung, MD DoralAdelor Jose Zamora, II MD LakelandLouise Zhou, MD JacksonvilleAndrea J Zimmer, MD GainesvilleDavid C Zuckerman, MD Miami Beach

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Back from the Edge: Coping with Physician stressby David Hanscom, MD

(continued on page 13

Our culture expects doctors to be strong and stoic. Physicians do nothing to belie that impression—they rarely discuss their personal issues. It’s an unspoken rule that if you’re ever feeling stressed, you put your head down and persevere. That’s why I didn’t know that my close friend and fellow surgeon was on the edge. One afternoon last year, he left after assisting me in a complicated spine surgery. We shook hands and he said, “Nice case.” It came as an incredible shock when I heard that three hours later, he was dead from a self-inflicted gunshot to his head.

I later found out that my colleague was under enormous personal stress. His problems were complicated, but I know that much of his stress stemmed from his habit of constantly beating himself up. This led to uncontrollable anxiety, which had been building for several years. The tragedy is that he didn’t seek help earlier. He didn’t feel that he could.

My colleague’s story is not an isolated case. In fact, one in 16 physicians reported having contemplated suicide, according to a study published in the Archives of Surgery. This rate is higher than the general public (6.3 percent vs. 3.3 percent). Only 26 percent sought out help.1 Out of my 80 medical school classmates, four killed themselves within three years of completing their training. Another dozen colleagues have committed suicide.I can imagine how those doctors felt before deciding to end their lives. About 10 years ago, I was driving home one evening after a busy day at the clinic. I was agitated. I was in my mid-40s and was experiencing crippling anxiety on a daily basis. My anxiety had begun to rear its head 12 years earlier, and for the past year, I had struggled. I saw no way out. I was done.

That night, I weighed all of my options and decided that was it—once I pulled into the garage, I would close the door behind me and leave the car running. But at the final moment, I turned off the car. I thought of two classmates whose physician fathers had taken their own lives during my classmates’ teenage years. I knew how devastating it was, how hard it had been on them. I had a young son. I felt that I couldn’t abandon him and leave a legacy of death. If it weren’t for my family, I have no doubt that I would have left the motor running.

Burnout

Burnout contributes to the stress that can drive physicians to thoughts of suicide. About 40 percent of physicians experience burnout, according to the California Medical Board.2 Doctors live with a combination of pressures that can result in burnout: suppressed anxiety, perfectionism, and massive amounts of stress.

Medical authorities have made some effort to limit stress on doctors. For example, there are now laws limiting residents’ work to 80 hours per week. Enforcement of these rules is spotty, though, and the older hierarchy feels that these guidelines are too lenient. Physicians face many stresses:

running a business, angry patients, surgical complications, threat of litigation, partner problems, etc. As a surgeon, it’s not uncommon to operate for 10 or 12 hours and then go to the office for another four hours to catch up on paperwork.

Stress management skills are not part of the medical training process. No one provides physicians with the tools to assess their mental health. There are no preventative mental health resources, such as mental health professionals on staff; there’s no one to easily talk to about the stress. Any hint of mental distress causes the hospital to examine under a microscope the physician’s ability to practice.

litigation stress

Physicians face intense stress when they are named as a defendant in a medical malpractice lawsuit. Most physicians will face a suit at some point in their career, but few are prepared to cope with litigation. Malpractice suits are a frontal assault on physicians’ professional integrity, thrusting them into an alien environment where they are not in control. Litigation can have the same emotional impact as the death of a loved one.

suppressed Anxiety

Physicians are conditioned to be really tough. From the first day we walk into the anatomy lab of medical school, it’s understood that we are essentially in boot camp. The intention is to quickly weed out those who cannot cut it. The ones who can suppress their anxiety are the ones who survive.

Early in my practice, I always thought I was in control. It didn’t matter what I encountered—angry patients, billing problems, even a malpractice suit—I remember thinking, “I can take it. Bring it on.” All physicians are used to being in control, especially when it comes to anxiety.Anxiety cannot be suppressed forever. Research has shown that the more one tries not to think about something, the higher the chance it is thought about.3 Many physicians find themselves in a state of chronic anxiety. When this happens, surgeons may quit doing the bigger cases or stop doing surgery altogether. Addictions begin to surface. Other dysfunctional coping mechanisms, such as aggressive behavior toward staff and residents, are common. And then there is suicide.

Perfectionism

Doctors hold up perfectionism as one of the highest virtues of their profession. Most physicians would agree that “perfect” is the standard for our medical culture. It’s both implicitly and explicitly taught from the time they enter medical school. Unfortunately, many mentors react severely to their underlings when a given task is performed in a less-than-perfect manner.

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(continued from page 12

is the standard for our medical culture. It’s both implicitly and explicitly taught from the time they enter medical school. Unfortunately, many mentors react severely to their underlings when a given task is performed in a less-than-perfect manner.But what does perfectionism really accomplish? Nothing. It’s a destructive trait. As doctors, our goal is 100 percent success for every patient. But that’s not humanly possible. If you torture yourself over every case that doesn’t turn out perfectly, you can’t do your job well. The energy burned up by judging yourself negatively is the energy you need to perform at the highest level.

Since there’s no such thing as perfection in the human experience, the difference between reality and expectation will determine the degree of your unhappiness. For many physicians, failure to meet the standard of perfection engenders growing anxiety, anger, and guilt that facilitate suicide.

reprogramming

I was able to escape the perfectionist trap by using a technique known as neuro-cognitive reprogramming, which involves writing down your thoughts to create new, alternate neurological pathways. These pathways connect the thoughts with sight and feel. In David Burns’s book, Feeling Good,4 one of his tools is to write down negative thoughts and then categorize them. By using Burns’s writing methods and facing my anger, I was able to work myself out of the abyss. For me, it has been life altering.

There are other reprogramming methods. They include mindfulness/meditation, awareness, group dialogue, auditory methods, art, role playing, music, and many other techniques. Broken down, each follows a pattern of three parts: (1) awareness, (2) detachment, (3) reprogramming. Each person’s journey will be unique.

Going Forward

As a medical community, we must recognize that anxiety is not a dirty word and that it’s not a sign of weakness to admit that you have anxiety. Members of the medical community must engage in a dialogue about allowing doctors to speak openly about their stresses. Each of us is so good with our façade that we couldn’t imagine that the other physician is anything less than completely together. We are human, too, however, and we are suffering—badly. With an open dialogue, the medical community can start to heal its own members.

Dr. David Hanscom is an orthopedic spine surgeon at the Swedish Neuroscience Institute in Seattle, Washington, and is a member of The Doctors Company.

references1. McCoy KL, Carty SE. Failure is not a fate worse than

death. Arch Surg. 2011;146(1):62-63. 2. Duruisseau S, Schunke K. Physician wellness as

constrained by burnout. Medical Board of California Newsletter. November 2007;104:1.

3. Wegner DM, Schneider DJ, Carter SR 3rd, White TL. Paradoxical effects of thought suppression. J Pers Soc Psychol. 1987;53:5-13.

4. Burns D. Feeling Good. New York, NY: HarperCollins; 2000.

sidebar

Alleviating the Stress of a Malpractice ClaimThe Doctors Company, the nation’s largest insurer of physician and surgeon medical liability, goes beyond a superior legal defense for members facing a claim. We created regional Litigation Education Retreats to help members who are involved in a malpractice claim.

Each retreat provides a safe and supportive environment for physicians and their spouses to become familiar with the litigation process and to learn constructive methods for alleviating stress and anxiety. It’s also a valuable opportunity for them to meet others experiencing a claim.

To learn more about our unique program and how attending a Litigation Education Retreat helped one physician, visit www.thedoctors.com/ler watch our six-minute video, or visit www.thedoctors.com. Participating physicians may also be eligible for up to 6.5 CME credits.

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As a company built by doctors for doctors,

The Doctors Company/FPIC is on a mission

to relentlessly defend, protect, and reward

doctors who advance the practice of good

medicine. To learn more about how we can

protect your livelihood and reputation with

outstanding malpractice insurance services,

call (800) 741-3742.

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Announcement of Candidates for the

Election of ACP Governor

Florida ChapterThe Governor-elect (GE) election is well underway. ACP will mail ballots to the voting membership the end of August and the deadline to vote for your next chapter Governor will be the end of October.

As a Governor, they serve as the official representative of the College for the chapter, providing a link between members at the local level and leadership at the national level. The Governor has a variety of responsibilities at both levels.

This year we have two superb candidates who are running for Governor-elect, Jason M. Goldman, MD, FACP and John G. Langdon, MD, FACP. We want to acknowledge and thank them both for their enthusiastic work on behalf of our Chapter over the years. To learn more about the background and experience of our candidates, see their biographies and vision statements which will be made available on our Chapter’s Web site.

Please look for your GE ballot to come in the mail first week of September and be sure to vote!

Michael A. Zimmer, MD, FACP President/Governor, Florida Chapter, American College of Physicians

Michelle L. Rossi, MD, FACPGovernor, Florida Chapter, American College of Physicians

legal FAQsFor information specific to your state of practice, contact The Doctors Company/FPIC’s Risk Management Department

Do physicians licensed in Florida who prescribe controlled substances need to notify the Department of Health?

Yes. Pursuant to Florida Statute 456.44(2), physicians licensed in Florida who prescribe any controlled substance as defined in s.893.03 for the treatment of chronic, nonmalignant pain must designate himself or herself as a controlled substance prescribing practitioner on the practitioner profile.

What basic elements comprise the informed consent process?

Explanation of the proposed treatment or therapy, risks and benefits, likelihood of success, treatment alternatives, and potential outcome with no treatment. The risk list need not be exhaustive, but rather material to the specific procedure, anesthetic, and patient involved.

Can a patient have a friend or family member pick up a prescription?

Yes. Moreover, the patient does not need to provide the pharmacist with the name of such friend or family member in advance.

When a physician receives a release signed by a patient for a full and complete copy of the chart, can the doctor withhold records relating to other records he received from other physicians and/or labs, etc.?

No. A complete copy of all of the contents of the file must be produced unless the request is limited to specific information; for example, when the request is for all medical records “…pertaining solely to treatment of my…” or for a specific time period, whereby the request states “…all records on or after…”

Does HIPAA Privacy Rule compliance establish Security Rule compliance?

No. However, many of the requirements set forth by the Privacy Rule satisfy those required by the Security Rule in terms of a covered entity having in place appropriate administrative, physical, and technical safeguards for the protection of protected health information. However, the Security Rule contains security standards that must be implemented. Moreover, there are implementation specifications that are either required or addressable. If implementing a specification is not reasonable and appropriate, the covered entity must document why and must implement an equivalent alternative measure that is reasonable and appropriate.

Does the HIPAA Security Rule require specific technology?

No. Security Rule standards are technology-neutral and thus do not require the use of specific technology. A covered entity is free to choose technologies appropriate for its particular practice.

What is meant by “discovery”?

Discovery is pre-trial devices that are used by one party to obtain information about the case. Forms of discovery include depositions, written interrogatories, and production of documents or things, including medical records and personal records. Discovery could also include physical and mental examinations, requests for admissions, and information necessary to

support a claim for damages.

Yep, I asked the question and I have no hesitation stepping out there on that fragile slab of melting ice. Healthcare is changing daily and medicine is moving closer to looking different as the politics change with each election cycle. So, what really is in it for physicians? Granted we inherently want our patients to receive the best care possible and we have sworn an oath to protect the sanctity of each patient’s well-being. At some point, and for some that point is now, preparing for the present day future becomes very expensive. The continued decline in reimbursement cannot be offset by the limited dollars offered for becoming electronically connected or developing a patient centered medical home. The demands of increased care coordination and management are pushing the solo and small group practice doctor to the brink of pulling their hair out or closing their practices, whichever is less painful. We want to improve the accountability of the care we provide yet we need resources to properly reorient the “system” to achieve those goals.

Change is really what accountable care is all about so part of the question is whether internists are ready to step into the challenge of change or let change manage us? Adapting to a mindset of accountable care will mean that some of us have to change the way we practice medicine and the way we manage our patients. The expectation will be that if we do our jobs well there is a sharing in the results of a collaborative arrangement with a payer because our patients fare better clinically in the intermediate and long run.

Physicians and other healthcare providers deserve to be rewarded for delivering great comprehensive care and achieving great clinical outcomes. Success in meeting this goal means renewed vitality in sharing information and finding new and creative ways to engage our patients to share in the journey of wellness. Traditionally, it has always been on the backs of the doctors to get patients well. The new era demands that we spend the time and energy to educate our patients to join the journey to wellness and to take ownership of their outcomes. The collaborative part has to involve patients and payers with each stepping up to the plate to participate. Everyone benefits when the patient enjoys improved health and costs will be more aligned with payment methodology with increased efficiency and effectiveness.

Before I go too far down the road of depending on the adherence of patients to clinical practice guidelines and lifestyle changes for the outcomes implied above, I realize that the average patient is quite content to allow us to manage their situation with minimal participation in the action steps. Researchers have recognized the knowledge chasm between what we want for our patients and our ability to communicate it in a way they understand. Nonetheless, the entire system must step up and engage and embrace the patient through better case management, education, care coordination, improved access, and the participation in true medical home development.

Accountable Care: What’s in it For Physicians?Michael L. Howell, MD, MBA, FACP, Editor

Don Berwick, former Administrator of the Centers for Medicare and Medicaid Services, believes in the “Triple Aim” goals for improving care to all citizens: better quality care, better health for all populations by addressing the cause of health conditions, and reduction in per-capita costs. Berwick believes costs should be reduced by eliminating “waste, needless hassle,” and “what does not make sense in our health care system.” “He emphasizes that costs should not be reduced by eliminating any helpful care or by “harming a hair on any patient’s head.”

Is there adequate reimbursement on the table to allow physicians to change the historical dynamics of today’s clinical practice and achieve the goals set by Berwick? It is very difficult to say the least when annually reimbursement is challenged due to antiquated formulas. And commercial payers will continue to find themselves hard pressed to keep up with flawed reimbursement principles if left to manage the population alone. Volume-based healthcare must transform itself into value-based healthcare. The simple math is that comprehensive and coordinated care takes more time and that will undoubtedly reduce reimbursement for the doctors providing great care. Therefore, reduction and elimination in wasteful behaviors has to start the day followed by improvements in connectivity between the ambulatory and inpatient worlds reducing redundancy and waste of resources. Physicians and their clinical teams must embrace new methods of communicating with patients thereby increasing the probability of increased understanding of healthcare instructions and improving adherence and avoiding costly medical errors. And patients must be held accountable through the payers of the healthcare. Smokers and many who shun healthy activities leading to higher risk medical conditions should have higher premiums but maintain lower cost access to benefits such as wellness programs, nutritional counseling, smoking cessation classes, and similar opportunities to return to a state of wellness. Care Coaches should be included as options to serve in outreach roles to facilitate the physician care provided in the office setting. And the list of interventions can go on and on.

The days of providing healthcare services in a stand-alone or silo’d manner have come and gone. Clinical integration and collaborative care must be embraced and perfected. Seasoned physicians must break free of the “way we have always done it” and use their experiences to work with the newer physicians to carve out experience-based pathways that embrace efficient, cost effective, and clinically sound patient care. We can be individuals in practice and make the care we provide unique to our patients but we must manage the care of our patients. Where possible we must use the clinical evidence to determine our course of care and take responsibility for the outcomes. As we demonstrate the level of excellence from our efforts, the payer systems must continue to be urged to adjust reimbursement to reflect the cost of care we are providing to the new patient of today.

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We are proud to partner with The Doctors Company, the nation’s largest insurer of physician and surgeon medical liability. The Doctors Company offers industry-leading coverage and extensive benefits unmatched by any other insurer.

A BOLD IDEA AT WORK

The Doctors Company has arrived at an important milestone. This year marks the fifth anniversary of the Tribute® Plan, a financial benefit that provides doctors with a significant reward when they retire from the practice of medicine.

Today, over 1,300 Tribute awards have been distributed, and 22,700 members have qualified for a Tribute award when they retire from the practice of medicine. The average balance for members who have qualified for an award is $11,500.

DOCTORS ARE TALKING ABOUT THE TRIBUTE PLAN

What do members of The Doctors Company say? The vast majority of doctors would recommend the company to their peers. Fully 96 percent have said that they will likely remain with The Doctors Company until they retire.

Watch the special five-year anniversary video to find out what members of The Doctors Company are saying about the Tribute Plan. Visit www.thedoctors.com/tribute.

THE TRIBUTE PLAN:

Five Years of Rewarding Doctors

©2012 J8685F 7/12

THE DOCTORS COMPANY • 1000 RIVERSIDE AVE. STE. 800 • JACKSONVILLE, FL 32204

8685F_Email_FPIC_070212_v2.indd 1 7/2/12 11:01 AM

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Endorsed by

FLORIDA CHAPTER www.thedoctors.com/fpic

Richard E. Anderson, MD, FACPChairman and CEO, The Doctors Company

Tribute Plan projections are not a forecast of future events or a guarantee of future balance amounts. For additional details, see www.thedoctors.com/tribute.

We created the Tribute Plan to provide doctors with more than just a little gratitude for a career spent

practicing good medicine. Now, the Tribute Plan has reached its five-year anniversary, and over 22,700

member physicians have qualified for a monetary award when they retire from the practice of medicine.

More than 1,300 Tribute awards have already been distributed. So if you want an insurer that’s just

as committed to honoring your career as it is to relentlessly defending your reputation, request more

information today. Call (800) 741-3742 or visit us at www.thedoctors.com/tribute.

We do what no other medical liability insurer does. We reward loyalty at a level that is entirely unmatched. We honor years spent practicing good medicine with the Tribute® Plan. We salute a great career with an unrivaled monetary award. We give a standing ovation. We are your biggest fans. We are The Doctors Company.

FL_FCACP_END.indd 1 7/9/12 1:49 PM

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Florida Chapter Governor’s NewsletterBG1005

Have You Moved?Address Need Updating?

Don’t miss out on important communications from the FloridaChapter and the American College of Physicians. If you areplanning a move, have moved, changed your phone numberand/or e-mail address, please let us know. Contact Member

Services at 800-523-1546 or visit the ACP website athttp://www.acponline.org/private/mbrconn

to update your contact information.













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