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PhysicianCollegialityIs it lost?

MetroDoctors The Journal of the Hennepin and Ramsey Medical Societies November/December 2000 1

V O L U M E 2 , N O . 6 N O V E M B E R / D E C E M B E R 2 0 0 0

C O N T E N T SPhysician Co-editor Thomas B. Dunkel, M.D.Physician Co-editor Richard J. Morris, M.D.Managing Editor Nancy K. BauerAssistant Editor Doreen M. HinesHMS CEO Jack G. DavisRMS CEO Roger K. JohnsonProduction Manager Sheila A. HatcherAdvertising Manager Dustin J. RossowCover Design by Susan Reed

MetroDoctors (ISSN 1526-4262) is published bi-monthly by the Hennepin and Ramsey MedicalSocieties, 3433 Broadway Street NE, BroadwayPlace East, Suite 325, Minneapolis, MN 55413-1761. Periodical postage paid at Minneapolis,Minnesota. Postmaster: Send address changes toMetroDoctors, Hennepin and Ramsey MedicalSocieties, 3433 Broadway Street NE, BroadwayPlace East, Suite 325, Minneapolis, MN 55413-1761.

To promote their objectives and services, theHennepin and Ramsey Medical Societies printinformation in MetroDoctors regarding activitiesand interests of the societies. Responsibility is notassumed for opinions expressed or implied insigned articles, and because of the freedom givento contributors, opinions may not necessarilyreflect the official position of HMS or RMS.

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2 PHYSICIAN’S SOAP BOXMonica Mykelbust, M.D.

4 FEATURE: COLLEGIALITYCollegiality Used to Begin in the Doctors’ Lounge. Is it Still There?

6 Loss of Collegiality Results in Physician Isolation

8 Winter CME Conference

9 “Connections” — A Mentoring Program

10 COLLEAGUE INTERVIEWJoseph Rigatuso, M.D., Ph.D.

12 2001 Blue Plus Primary Care Clinic ProviderService Agreement Review

14 HMS/RMS Physicians Assume Leadership Roles at MMA

AMA Delegates and Alternate Delegates

15 HMS/RMS Physicians Receive MMA Awards

HMS/RMS Members Serve as MMA Trustees

16 HMS and RMS Members Participate in MMA Annual Meeting

20 Using a Cell Phone While Driving — A Risky Venture?

23 Medical Student Recruitment Activities

RAMSEY MEDICAL SOCIETY

24 President’s Message

25 RMS Update/Leaders Honored/Saints Family Night/Honoring Bruce Vento

26 Applicants for Membership/In Memoriam

27 RMS Alliance

HENNEPIN MEDICAL SOCIETY

29 Chair’s Report

30 HMS News/New Members/In Memoriam

31 Lupo Installed as Chair/Stepping Stones Gala

32 HMS Alliance

On the cover: Collegiality used tobegin in the Doctors’ Lounge. Wherehas it gone? Pictured: Jean Watson,M.D., Abbott NorthwesternHospital. Articles begin on page 2.

MetroDoctorsDoctors

2 November/December 2000 MetroDoctors The Journal of the Hennepin and Ramsey Medical Societies

P H Y S I C I A N ' S S O A P B O X

T

Building Relationships Between Physicians

B Y M O N I C A M Y K L E B U S T , M . D .

“THE MAKING OF A DOCTOR.” In recent times we hear a greatdeal on this subject. Public television specials explore medical schooland residency training, sleep deprivation, and the intensity of patientcare responsibilities. Newspaper articles discuss adverse effects of thisprofession on a physician’s family life. Radio reports sensationalizeextreme behaviors resulting from the stressors of a medical career. Whatwe hear less about are the relationships between physicians: collegiality.

These bonds are as powerful as physician-patient relationships andthe loyalties may run as deep. They define, in part, a physician’ssatisfaction with his/her job. Colleagues define who we are profession-ally and set standards that we judge ourselves by.

The making of a physician colleague begins early. It may beginwith a conversation with a community doctor who shows up at thepicnic that first day of medical school. The mutual respect andcooperation that exists between anatomy partners may later grow toprofessional collegiality.

Perhaps like no other profession, medical training builds on a richhierarchy. As a first year medical student one is acutely aware of his/herstatus — close to nursing assistant, definitely below nurse. Many of usacted as the gopher for the senior medical student on our team. Fromthe mixed feelings of intimidation and respect we resolved: 1) to nevertreat an under-classmate in such a humiliating way; or 2) to avenge ourpain once in power.

As the torch is passed from year to year, additional knowledge andresponsibility accumulate. When we enter residency, we are again at thebottom of the totem pole. Not quite rock bottom, thank goodness thereis a medical student on the team!

These are the beginnings of the relationship between physicians.In residency, competition and cooperation strike a balance in

collegial relationships. Yet, we are all still beneath the master, theconsultant. No matter what our knowledge base, we lack experience.We remain in awe of the practicing physician.

Once we are out on our own, establishing our own practice style,we struggle with true collegial relationships. That is, those relationshipsmarked by authority equally vested in each of a number of colleagues.

Within our own specialties we may seek those with commonvalues but differing knowledge base. Between specialties we may choose

experts in their field, professionals that will take good care of “our”patients and perhaps educate us a bit at the same time.

Meeting and connecting with colleagues has never been morechallenging. Our “practice time” is crunched more than ever. It is moreand more difficult to find physicians willing to spend “free time” towork together on projects related to improving our profession or ourorganizations. Many of us don’t work in a common setting. Many don’tfrequent the hospital doctors’ lounge. We have trained our clinicsupport staff to protect us from interruptions, to weed out unnecessarycalls. Even our staff meetings are poorly attended. So, how are we toestablish and maintain these very important relationships?

May I offer a few suggestions?First and foremost, I believe is the power of communication. We

need to speak with our colleagues face-to-face or by phone wheneverpossible. The written referral letter and e-mail are also essential. Weneed to consider interrupting our routine to speak to a colleagueregarding patient care in a timely manner, to remove communicationbarriers.

We need to view each other as partners, equal in this profession ofcaring for others. We need to educate each other. With the informationexplosion, no individual can possibly keep up with it all.

We need to compliment each other, show gratitude for each other’stime, ideas, and efforts. We are our own best support system. We needto make time for socializing with those in our profession. Take time todiscuss recreation, world politics, joys of parenting. We are a remarkablegroup of enlightened, fascinating, educated people. We need to learn tohave fun again. We need to commit to being instrumental in thepositive development of at least one colleague each year. We all owe it toour own mentors.

As many pieces of our profession seem to become fragmented, let’sreturn to collegiality as a source of intellectual stimulation, stressreduction, and reward. ✦

Monica Myklebust, M.D. is a family physician at Northeast MedicalClinic in Minneapolis, and is a member of the HMS Board of Directors.

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F E A T U R E S T O R Y

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B Y R I C H A R D W O E L L N E R , M . D .

D o c t o r s ’ L o u n g e

Collegiality Used to Begin in the

Is it Still There?

Doctors’ loungesare almost emptyof doctors andconversation,and even the rollsgo uneaten.

Collegiality — “The relationships of colleagues”

Community — “A group of individuals sharing interests of pursuits” with “commonness, sharing, participation”

Webster’s Dictionary

IN OUR PROFESSION, LOSS OF COLLEGIALITY has become a major problem to thosewithin and without the practice of medicine. In an AMA conference last year, Dr. Jay Jayasankardefined Collegiality as a “shared goal of common purpose while according... respect for eachother….”(1) Have we begun to lose this goal?

I entered medicine in the late 50s and early 60s, at the zenith of medical professional andpublic engagement in organizations. In 1962 I joined the nascent St. Louis Park MedicalCenter, the predecessor of the Park Nicollet Clinic — one of 28 doctors in the entire group.We met together, lunched together, shared patients and advice, and worked together hardand cooperatively to build a practice. In the Minneapolis medical community, good or badhospital education programs and staff meetings were regularly and faithfully attended. Mostdoctors belonged to, and were active in, specialty societies like the Minneapolis SurgicalSociety or the Minneapolis Society of Internal Medicine, and a myriad of sub-specialty so-cieties. The Hennepin and Ramsey County Medical Societies included nearly all the Twin Citiesphysicians. Meetings of these groups were attended by a lot of doctors who gave up family,personal, and patient time to be there. Hospital doctors’ lounges were filled with conversa-tions between doctors of various specialties, persuasions, and groups, who argued and braggedto one another, drank coffee, ate rolls, and didn’t have to be in the office very early.

Almost 40 years later, the relationships have changed. Hospital education conferences,Grand Rounds, and business meetings struggle to get 20 doctors to attend. I recently at-tended a Grand Rounds presented by a national researcher on new trends in breast cancerscreening and imaging — along with nine other doctors, none of which were women. Doc-tors’ lounges are almost empty of doctors and conversation, and even the rolls go uneaten.The Minneapolis Society of Internal Medicine struggles to fill six or eight tables at its quar-terly dinners to hear famous speakers. A year or two ago, a Minneapolis physician receivedboth the Hennepin County Medical Society’s most prestigious award and his own hospital’s“Doctor of the Year” award at his hospital’s annual dinner. None of his office partners both-ered to attend.

What has happened? Is there really a lack of medical community and participation, orare doctors putting their efforts and attention elsewhere?

Doctors now are busy and pressured, but realistically I don’t think much more so than inthe past. The types of pressure are perhaps different, but the hours and stress are much thesame as they were when I started in practice. Physicians are no more nor no less polite and


Much of our medicaldisconnectedness orlack of communitymay reflect an overallAmerican change,rather than oneunique to ourprofession.

respectful to one another now than they were 40 years ago. Medical education is less commu-nal. The rude and crass professorial bullies who traumatized medical students and colleaguesthankfully are long gone, replaced by a “kinder, gentler” and just as knowledgeable group ofeducators, who attract smaller and smaller audiences. Forty years ago, there were few educa-tional alternatives to medical meetings other than reading rather dull journals. Within thepast decade or two, viable options for learning have proliferated. On-line and printed courses,web searches and e-mail have enabled us to learn without the annoyance of human interaction.

Many physicians’ priorities may have changed. Hours and effort spent at one time inpatient care and medical relationships may now be more oriented to family, children, andpersonal goals. There are gender and generational differences in our priorities. One of therecruiters for a large medical group told me that the main, and often the first question askedby applicants is “If I come to work for the Clinic, how will it affect my personal andfamily life?” Little about “How will being here help me practice the best medicine?” Whilewomen traditionally have a greater responsibility for family and children, these priorities mayloom larger than the medical community ones. Physicians reared in the era of “community”activity have a firmer devotion to associations and group activities than younger people whoare not “joiners.” Is this a change for better or worse?

“Medical sociology” has seen a change in responsibility for all the things that affect ourprofessional lives. The cost, size, and complexity of medical groups and hospitals has takenthe responsibility for controlling our lives away from the individual and put it in the hands ofnon-medical decision-makers. Physicians have become “providers” and are considered to bea rather cranky and needing-to-be controlled part of “health systems.” Many doctors react tothis by becoming 9 to 5 (or 8 to 6) workers, and, since they no longer have much business oradministrative responsibilities, ignore them.

Another and perhaps the most important factor, in the decline of medical communityexpression is what Robert Putnam refers to as “the howling league phenomenon.” In hisbook Putnam demonstrates with a wide variety of statistics that personal and collegial in-volvement in a wide spectrum of political, civic, and leisure activities has dramatically de-clined from a peak in about 1960 to an increasingly low level now.(2) Americans of all descrip-tions are no longer “joiners.” They participate less in communal activities, from bowlingleagues to medical professional organizations. Copious, well-documented data from a varietyof sources shows that this change is not merely nostalgia for a past that never was, but a realand significant phenomenon. Much of our medical disconnectedness or lack of communitymay reflect an overall American change, rather than one unique to our profession.

Is this all bad? Can we still practice good medicine disconnected from our colleagues?Jayasankar doesn’t think so.(1) He fears that the progressive personal disconnection from thecommunity of physicians will lead to a decline in the quality of medical practice, an erosionof mutual and public trust, and an increasing abandonment of control of our profession toothers. This may produce a progressive spiral of alienation, disconnectedness, and furtherloss of community. Other alternatives for a physician’s time, effort, and connections becomemore appealing. Medicine as a profession will suffer if physicians ignore each other.

To these concerns I would add another equally important one: Medical practice is fun.Without colleagues, collegiality, and shared community, the fun of our practice will erodeand disappear. I hope this never happens. ✦

References:1. Jayasankar, S. Jay: “How to Regain Collegiality” AMA Leadership Development Conference, Mi-

ami, March 25-28, 20002. Putnam, Robert D.; Bowling Alone, The Collapse and Revival of American Community, Simon &

Schuster, New York, 2000. ISBN 0-684-83283-6

Richard Woellner, M.D. is retired from Park Nicollet Clinic where he specialized in internalmedicine/pulmonary diseases.


WWHAT HAPPENED TO THE DAYS of medi-cal staff conferences attended by 80 percent ofthe hospital’s physicians? Why don’t we see oneanother in the physician lounges, on the wards,or at specialty department meetings? The loss ofphysician collegiality can be felt at many levels,but it ultimately results in physician isolation.

Why does collegiality matter? Who losesif we cannot maintain it? First, the patient loses.Most of us can recall not addressing a clinicalproblem because it was out of our specialty.

When I refer a patient for consultation, do Icommunicate to the consulting physician andintroduce the patient and issues? I need to com-municate for the patient, and guide themthrough the medical maze, and avoid “turfing”them to fend for themselves.

Secondly, the “system” loses. Cost contain-ment is a terrible problem and could be the ruinof our health care system. For the physician, itis both an individual issue and a larger systemissue. It needs to be studied from a collabora-tive, “big picture” viewpoint. Approaching costcontainment from a narrow, isolated, self-serv-ing view cannot allow understanding of the big-

Loss of Collegiality Results inPhysician Isolation

B Y P E T E R D A L Y, M . D .

ger picture, and hence, missing solution oppor-tunities. Quality can be compromised if excessemphasis is placed on efficiency, or commer-cialism within the system. Are substitutedmedical devices or drugs truly as effective as theoriginal prescribed choice, or is the health sys-tem cutting quality for political or commercialreasons? Physician collaboration and commu-nication is needed to solve such issues.

Thirdly, the physician loses if collegialityis eroded. Our ability to be our patient’s advo-cate is markedly diluted when we function as asingle isolated physician. When we place com-mercialism and profit above the caring of ourpatient, we act in an egocentric self-servingmanner. Business concerns are not inherentlyevil, but they must be balanced to prevent com-promising our patient’s humanity. If we cannotdo so, the public’s perception of our professionis eroded. If the public does not trust us, webecome regarded as technicians, a service linefor which we are bartered, and a commodity tobe exchanged. The patients will turn to the le-gal system for resolve since they lack trust. Wewill begin to regard our service as a chore, ourpatient as purely a revenue center, and our pro-fession as only a business. The humanity can beseen hemorrhaging out of our pores.

Therefore, with the lifeblood of patients,health care delivery systems, and physicians atstake, as well as quality, cost containment andself-respect, the loss of collegiality is definitely aproblem worth fixing.

How did we lose it? Dr. S. J. Jayasankarcited multiple reasons:• Loss of control• Onerous regulations

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• Unreasonable expectations• Indiscriminate charges• Competition – MDs; Others• The professional liability vice• Rapid changes• Time squeeze• Reimbursement squeeze• Changes in family and spousal roles• Balancing of multiple responsibilities• Coarsening of interpersonal interactions• Increasing electronic communication• Decreasing personal contact and

communicationWe have less time for collegiality. We no

longer leave family demands (such as a child’steacher conference or piano recital) for ourspouse. Many of us with children consider itmore important to be at that recital, than atanother meeting, and often rightly so. Declin-ing reimbursement means longer hours for pa-tient care and less time for collegiality. E-mail,voice-mail messages, and pagers have replacedpersonal contact between physicians. Humanto human interaction is sacrificed at the altar ofspeed and efficiency. As we become more iso-

lated from one another, we are prone to divisivecomments about one another’s care delivery,competition between each other, and worsenedcynicism of hospitals.

How can we regain collegiality? First, weneed to recognize its importance. If we under-stand that we lose quality and control by notcollaborating amongst ourselves, then perhapswe will allow some short-term loss of clinicaltime and income to meet with our peers andcommunicate.

Second, we can seek out channels of col-laboration. We need to be willing to participatein local medical society functions, many ofwhich can include family activities (i.e. winterCME activities). Serving in a physician leader-ship role at your hospital promotes collegiality.Creating margin in our schedules for giving in-put at medical staff meetings fosters improve-ment rather than cynicism. Conflict resolutionrequires honesty, trust, and communication, andunfortunately time.

Third, we can use technology in a sup-portive role, not a primary role. Althoughtechnology may improve efficiency and speed,

the ability of one soul to convey caring to an-other soul often requires the human interactionand moves at a slower rate. Remember, suchhumanity, despite its inherent inefficiency, willsave our profession.

Fourth, we have to be able to change. Onewise author has observed, “To live is to change;and to be perfect is to have changed often.” Weall need improvement in our communicationskills, willingness to negotiate, and openness toview our individual concerns as a part of thebigger picture. These broad tasks require change.

As we all know, it is being our patient’sadvocate that sets us apart from simply beingtechnicians of the human body. Rememberingand preserving the humanity of a patient maybe inefficient and difficult to quantify, but es-sential to healing the individual patient. Re-membering and preserving collegiality in ourprofession may also be inefficient and difficultto quantify, but it is essential to healing our pro-fession. ✦

Peter Daly, M.D., is an orthopaedic surgeon andChief of Staff at St. Joseph’s Hospital. He is a mem-ber of the RMS Board of Directors.

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L

“Connections” — A Mentoring Program

LAST YEAR THE UNIVERSITY of MinnesotaMedical Alumni Association rolled out a newMedical Student mentoring program that wasdesigned to be non-academic, would not haveto involve the office/hospital at all unless thestudent requested it, and was to be as flexible asthe student and mentor wished it to be. Of the165 students in the first year class, about 130signed up for this opportunity! We had about100 mentors, many of whom have been veryexcited about this opportunity to meet withinteresting, bright, and eager students. This con-tact with practicing physicians will make a tan-gible difference to many of these young menand women, possibly affecting their careerchoice, helping them better understand whatthey will be doing in their chosen profession,and just making a difference in the lives of twopeople.

Because last year’s program was the initial“dry run,” we did not enlist the medical societ-ies’ assistance. This year, I wanted to get a wideraudience participation that was not limited toUniversity of Minnesota Alumni. I know thereare many of you out there that haven’t the timeor inclination to have a student in your clinicalpractice. This program allows physician-studentinteraction where it may actually be more in-teresting and, in the long run, more influential.We anticipate this would involve you and thestudent through all four years of Medical School,depending on both the student’s and your deci-sion.

Working together with Jack Davis andRoger Johnson, the Medical School, the Min-nesota Medical Foundation, and the U of MMedical Alumni Association, we have developed

our own letterhead and logo that defines the“Connections” between all of us. After all, eachof the participating groups is looking at a dif-ferent side of the same issue, and all of us have astake in the success and happiness of those whowill be “us” in the future. You will be receiving aletter under the signatures of Drs. Virginia Lupo,John Gates, Greg Vercelloti, and myself. Istrongly encourage you to participate for bothyou and a student. One perk will be an invita-tion to the Medical Student White Coat Cer-emony at Northrup Auditorium on Saturday,January 13, 2001.

Additional projects that need your involvement:• The Alumni Association is beginning a

process this year whereby potential medi-cal students that are having their medicalschool interview would stay at the homeof a physician during their stay in the TwinCities. We already have 70 physicianssigned up, but we need more!

• If any physician, especially those recentlyretired or who would like to get involved

with medical student examinations, wouldlike to act as Physician-Evaluators for stu-dents completing their primary careclerkships over the course of the next 12months, an opportunity presents itself forthis kind of involvement.

• The Medical School is looking for inter-ested and supportive physicians to inter-view potential medical students as part oftheir application process. Having startedthis last year myself, I can attest to the en-joyment of this interview to help both theMedical School in its duty, as well as help-ing and supporting the student. Both ofthe last two items could be referred to:Ilene Harris, Ph.D., Professor and Direc-tor, Medical School Office of Education,MMC 33, 420 Delaware Street SE, Min-neapolis, MN 55455. Phone: 612-625-9497; Fax: 612-626-4200; E-mail:[email protected].

Thanks, in advance, for your interest inthese very rewarding programs. ✦

B Y E U G E N E O L L I L A , M . D .P r e s i d e n t , U n i v e r s i t y o f M i n n e s o t aA l u m n i A s s o c i a t i o n

Reminder…metrodoctors.com

census sheetcan be completed

online.

www.metrodoctors.com/census


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C O L L E A G U E I N T E R V I E W

How does the compensation of employed physicianscompare with those in the private sector?

While I do not have direct knowledge of the compensation plans of everymedical practice, I am confident that the way physicians are compensatedwithin the HealthPartners Medical Group and Clinics is similar to thoseof other practices. We started with the principle that we pay competitivelyto attract the highest skilled physicians available. We also work on theprinciple that patients want access to see their physician, as well as high-quality care and service from them. To that end, our compensation isbased upon our ability to provide such access and service. The measuresthat make up our physician compensation include such things as patientsatisfaction, quality of care, ability to effectively see patients and indi-vidual and team contributions on behalf of our clinics and patients. Com-pensation to our physicians is designed in such a way that rewards qualityof care and in no way interferes with our day-to-day clinical decisions.

What do you consider the major problem or problemsfacing the employed physician today?

Identifying only with the health organization, without the interest andactivity in promoting and maintaining the profession of medicine. One isnever just an employed physician. One is always a practitioner of the artand science of medicine as well as a representative of the profession ofmedicine.

Of course, we have many allegiances to our alma mater, to our church,to our employer and all of these are important. But we belong to thestream of healers/physicians, including such figures as Hippocrates, Susruta,Osler, Banting and Best, Lillehei and many thousands of unnamed physi-cians whose only goal was the care of the patient.

I am concerned about the growing burden of documentation. Somewould expect that I would mention the lack of independent practice orlack of input into plan direction and management. However, those arenot issues. You must practice good medicine as an individual physicianand as a plan.

In general, do employed physicians have a true voice in thecarrying out of their jobs?

Yes. In my experience the primary requirement of integrated care deliverysystems and multi-specialty group practices is to practice good medicine.I have felt no interference in my practice of medicine in the past 25 yearsof working for Group Health and HealthPartners. Yes, we have a referralnetwork and select hospitals, but those resources are very broad and in-clude all the necessary services. Employed physicians can be, and are, in-volved in the management committees of physician management andadministration.

How is the HealthPartners Physician’s Associationorganized? What role does it play?

All employed physicians of HealthPartners are members of theHealthPartners Physician’s Association. Officers are chosen by majorityvote of all HealthPartners physicians who vote. The role is to work withthe medical council to create and maintain a practice environment forphysicians that will promote their ability to give good medical care totheir patients and to continue their own professional development.

Joseph Rigatuso, M.D., Ph.D.

Editor’s Note: “Colleague Interview” provides HMS and RMS mem-bers with an opportunity to ask questions of their colleagues who arein unique roles. In this issue, some of the interview questions wereasked by: Drs. Jamie Santilli, Sarah O. Cowell, and Lyle J. Swenson.Dr. Rigatuso is President, HealthPartners Physician’s Association.


What is the role of the HealthPartners Medical Counciland how does it function?

The Medical Council is the leadership team for the HealthPartners Medi-cal Group and Clinics (HPMG) and consists of the physicians and ad-ministrators that support both the physicians and clinics within our HPMGcare delivery system. The council sets the vision, strategy, and directionfor the medical group within the context of the larger HealthPartnersorganization. The medical leaders representing primary care, medical andsurgical specialties, behavioral health, centralized patient care services, careimprovement and research, are represented on the council. In addition,the administrative leadership supporting these care areas also participateon this council. The expanded leadership group led by the council in-cludes all of the clinic chiefs of professional services and managers, thedepartment heads, and ancillary support services such as pharmacy, labservices, etc.

These leadership teams meet on a regular basis to discuss clinical,operational, educational and financial issues affecting the medical group.One important element to the success of the work of the Medical Coun-cil, and other clinic or department leadership teams is the forums we needto continue to provide for feedback and participation by all of the staffphysicians within our medical group.

Can organized medicine effectively advocate for theemployed physician?

Yes. I believe employed physicians in integrated care delivery systems canand do benefit a great deal. Many physicians are active in their respectivespecialty societies and do receive much of the continuing education, medicalliterature, and other academic resources from those associations. Much ofthe continuing medical education (CME) in health plans, as well as hos-pital based CME-course offerings are accredited through the MMA, andAMA. Another often overlooked benefit derived by employed physiciansis the support given by organized medicine by way of supporting medicaleducation at the medical school level and at the community level. Thislatter effort is the well attended and successful community internship spon-sored by HMS and RMS.

There is a very important place for organized medicine at the county,state and national level. That is specifically the political/social environ-ment of medicine and the standing of the profession within the commu-nity.

There is a need for organized medicine to offer some benefit for theprofession that is not related to clinic, place of employment, specialty oracademic resources. What remains in my opinion is professional promo-tion and monitoring and reacting to professional challenges at the politi-cal and social level. The best examples of these activities include legislativeand inter-professional cooperation, as well as community-based publichealth initiatives.

How can organized medicine attract more employedphysicians to its membership?

The development of medicine, of course, parallels the development ofscience in general — both contributing to and adapting from all areas ofscience. But societal and industrial changes also affect medicine and mustbe incorporated into its development. So what does this all have to dowith membership in organized medicine? We are all specialists, that is wespecialize in some branch of medicine and struggle to keep up in thatlimited area of medicine. In order to meet the challenges of the rapidlychanging medical marketplace we need to pool our resources — bothintellectual and financial. If we are unable to maintain the unique stand-ing of respect and trust that the medical profession has achieved, not onlywill our profession be diminished, but the care given to our patients willalso be diminished. We must come together as physicians, from all walks— private practice, managed care, hospital practice, and academic medi-cine — if we are to meet the challenges of the 21st century.

We are all well aware of the forces seeking to change the practice ofmedicine as well as the profession of medicine itself. We need to cometogether to better understand and deal with the societal and business forcesthat affect the practice of medicine. There is only one way to meet thechallenges and to maintain the world’s best health care — by comingtogether in organized medicine. The advantage is the ability to have ourmessage heard in the public as well as in the legislative and other govern-mental arenas.

What advantages does membership in the MMA,Hennepin or Ramsey medical societies and AMA give theemployed physician?

There is competition and areas of overlap among the societies. However,physicians need to interact as a profession. This common action mustinvolve physicians from all specialties, including physicians at all levels oftraining, both residents and medical students. By coming together withinorganized medicine, we can better promote the health of patients in ourcare as well as the public health of all our citizens — by speaking as astrong united profession with the best health interests of our nation. Iencourage membership in these societies because working together wecan support such areas as research and education to improve both thescience of medicine and the delivery of medical care. This can only bedone effectively through the efforts of all physicians working together inorganized medicine, and working with government and other organiza-tions of healthcare professionals. ✦


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2001 Blue Plus Primary Care Clinic ProviderService Agreement Review

Editor’s Note: During the last several years,physicians and their practice administratorshave faced increasing economic pressures withpatient demand escalating at the same time thatmanaged care companies have gained dispro-portionate market power and have virtuallyunlimited negotiating power. The need to beaware of the provisions contained in provideragreements with the health plans is more criti-cal today than ever in the past.

In response to the growing need for infor-mation that is useful in analyzing the provi-sions in provider agreements, the HennepinMedical Society, the Ramsey Medical Society,the Minnesota Medical Association and theMinnesota Medical Group Management Asso-ciation have agreed to collaborate withHealthcare Management Resources andLockridge Grindal PLLP, to provide physiciansand practice administrators with current in-formation regarding provider agreements. Thefollowing information is designed to give you,your attorney and your accountant a startingpoint to consider the contractual decisions thatcould make a significant impact on your prac-tice.

The following article was originally sentas a memo to HMS and RMS members. Theagreement reviewed is the 2001 BLUE PLUSPRIMARY CARE CLINIC PROVIDER SER-VICE AGREEMENT. After you have reviewedthe analysis, please give us your opinion aboutthe value of this work and the method of pre-sentation. Your comments will be used to makeimprovements in future analyses.

THIS ARTICLE PROVIDES a brief analysis ofsome of the most significant terms of the newBlue Plus Primary Care Clinic Provider ServiceAgreement (the “Agreement”). In a significantand welcome departure from past practices, BluePlus has provided advance copies of the Agree-ment to us for review. The information providedin this article is not a substitute for legal andaccounting advice. Providers interested in de-termining the specific application of this Agree-ment to their practices or in negotiating theterms of the Agreement should discuss the mat-ter with their own attorneys, accountants andconsultants. Providers may wish to review pre-vious memos addressing the Blue Plus andAware Provider Service Agreements since manyprovisions are similar. Comments from theseprevious analyses are particularly relevant sincethe Agreement requires that PCCs (PrimaryCare Clinics) agree to “abide by the terms andconditions set forth herein and in any attach-ments to this agreement, including the AwareAgreement.”

• What has changed? This Agreement con-tains a number of small but significantchanges from the current contract. TheAgreement also responds to the recent leg-islation prohibiting contract stacking.

• Payment. The basic financial provisions ofthe contract are similar in structure to pre-vious contracts. Blue Plus pays based on afee schedule that is approximately 10 per-cent above Medicare and then withholds apercentage — usually 10-15 percent. Thisarrangement effectively passes risk to thePCC in the amount of the withhold. Re-turn of the withhold depends on meetinga very difficult to control “utilization tar-get” which even includes services not pro-vided or arranged by the PCC. Costs

charged against the target include the to-tal patient costs, subject to a $20,000 stop-loss, and 20 percent of costs between thefirst $20,000 and $60,000 — again effec-tively transferring substantial risk to thePCC ($28,000). Blue Plus will take 75percent of any gain (the difference betweenactual cost and the target) and limits thePCC percentage of any gain to 10 percentof the target. In addition, Blue Plus maykeep the withhold moneys for the year plus135 days (versus 120 days in old contract)and keep any earnings on the money with-held. Utilization target exceptions now in-clude mental health, chemical dependencyand chiropractic services generally. III(A)

• Maximum Charge Increase. This new pro-vision — “The Maximum Charge Increaseas permitted by Blue Plus” — requiresPCC’s to limit annual increases in regularbilled charges to not greater than the an-nual increase in the Consumer Price In-dex for all Urban Consumers (“CPIU”).This index, of course, provides no realisticestimate of health care inflation. Blue Pluswill employ a “Charge Audit” to determineif a PCC’s charge increases from year toyear exceed the increase in the CPIU.Charges in excess of the cap will result inproportionately reduced payment of thepercentage paid. This additional privatecontractual restriction on providers isunreasonable and is unrelated to any mean-ingful measurement of health care costs.III(C)(4)

• Contract Stacking. Blue Plus has re-sponded to the new contract stacking lawby deleting provisions reserving the rightto develop rates and provisions for addi-tional reimbursement for additional costsassociated with work related injuries and


illnesses and patient care coordination un-der a certified or non-certified workerscompensation plan. Blue Plus has also re-moved the provision applying the Agree-ment to Health Services provided undercertified and uncertified workers compen-sation, disability or other benefit plans.

• Obtaining Patient Consent. The PCCnow has the obligation to obtain patientconsent or authorization for releasing in-formation to Blue Plus or a Plan Sponsor.This is a new and additional administra-tive burden on PCCs. II(I)(f )

• Referral Risk. PCCs are required to referEnrollees only to providers that have con-tractual relationships with Blue Plus. ThePCC will now be responsible for Enrolleecosts incurred as a result of a referral to anon-participating provider. There is unfairfinancial risk for PCCs in this provision inas much as the Agreement does not ap-pear to oblige Blue Plus to provide PCCswith a current or accurate list of partici-pating providers on an ongoing basis. Theavailability of timely information shouldbe required and providers should have norisk for errors made by or lack of timelyinformation from Blue Plus. II(1)(m)

• Blue Plus Pricing. Effective January 1,2001, Blue Plus payment for service codeswithout prices on the Medical Assistanceschedule for Public Program Enrollees willbe at Blue Plus pricing. III(B)(2)

• Credentialing and Recredentialing. Pro-vider participation in Blue Plusrecredentialing is required on not morethan an annual basis and no less often thanevery two years. Where follow-up is nec-essary, recredentialing may now occur asoften as Blue Plus determines necessary(i.e., monthly or quarterly). All PCCHealth Care Professionals providing ser-vices under the Agreement now must meetcredentialing standards and obtain ap-proval for participation by theCredentialing Committee. Certain listednew and current Health Care Profession-als (but not physicians) are exempt fromrecredentialing unless a potential qualityof care issue arises. The PCC is respon-sible for maintaining certain informationabout and insurance coverage on these ex-empt Health Care Professionals. If, for any

reason, a PCC employee does not meetcredentialing standards, he or she will betreated as a non-participating provider. Ifnotice of non-participating status is notgiven to an Enrollee, the PCC must ac-cept Blue Plus’ fees for the non-participat-ing provider and also “be responsible forany applicable non-participating penaltypayments required in Enrollee contracts.”VI(2), (4), (5), (6)

• Appeal of UR Decisions. Blue Plus,PCCs, and Enrollees shall each have theright to appeal an initial UR decisionthrough Blue Plus’ Peer Review Process.The Appeal process is binding unless theEnrollee initiates an external appeal. VII(8)

• Termination. The Agreement now pro-vides that Blue Plus can terminate theAgreement immediately upon written no-tice if the PCC fails to meet Blue Plus’credentialing standards. Termination isnow no longer a bar to Agreement renewal

— the contract will now renew on noticefrom Blue Plus, although a provider maystill give notice of termination at any time.Termination at any time other than at theend of a term of the Agreement will resultin a PCC forfeiting any amounts withheldby Blue Plus. X(1), (2), (3)

• Network Access Only Arrangements.Under these types of arrangements, BluePlus provides only access to its provider net-work and does not provide administrativeor claims payment services. These arrange-ments will not be subject to the Agreement’swithhold settlement payment calculationprovisions. This raises an issue since underthe Agreement, the PCC also agrees thatthe “terms for payment” under the Agree-ment (presumably including a withhold)may be assigned to a plan sponsor. It is notclear what provisions will then apply forsettling any withhold under these kinds ofarrangements. XI(3) ✦

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HMS/RMS Physicians Assume Leadership Roles at MMA

AMA Delegates and Alternate Delegates

Blanton Bessinger, M.D.Installed as the 134th PresidentMinnesota Medical Association

Robert K. Meiches, M.D.Re-elected Chair,Board of Trustees

David L. Estrin, M.D.Re-elected Secretary

Michael B. Ainslie, M.D.Elected Treasurer

Gary D. Hanovich, M.D.Re-elected Speaker of the House

Frank J. Indihar, M.D.Re-elected Delegate

Carolyn J. McKay, M.D.Re-elected Delegate

Kenneth W. Crabb, M.D.Re-elected Alternate Delegate


Community Service AwardThis award honors MMA members who are ac-tively engaged in the practice of medicine and havean outstanding record of community service.

Mark L. Jacobson, M.D., MPH (HMS)Frank T. Pilney, M.D. (RMS)Eugene W. Ollila, M.D. (HMS)

President’s AwardThis award is presented to those members of theAssociation who have made outstanding contri-butions in service, but have never been elected to amajor office or recognized by the MMA for theirdedication and commitment.

Ronald E. Cranford, M.D. (HMS)

Stop the Violence AwardThe MMA Stop the Violence Award is presentedto a physician, an individual, or a group with anoutstanding record of attempting to eliminate vio-lence and abuse.

Carolyn J. Levitt, M.D. (RMS)

Fifty Club AwardThe MMA annually recognizes its members whohave given 50 years of service to the practice ofmedicine.

Frank Bonello, M.D. (RMS)Hector M. Brown, M.D. (RMS)James S. Cole, M.D. (HMS)William R. Fifer, M.D. (HMS)James P. Ginsberg, M.D. (HMS)

HMS/RMS Physicians Receive MMA AwardsDonald F. Holm, M.D. (HMS)Elizabeth K. Jerome, M.D. (HMS)Edward H. Kelly, M.D. (RMS)Harold D. Kletschka, M.D. (HMS)Charles H. Manlove, Jr., M.D. (RMS)Donn G. Mosser, Sr., M.D. (HMS)James Y. Nakamura, M.D. (RMS)Maxine O. Nelson, M.D. (HMS)Neil Palm, M.D. (RMS)Edmund A. Post, M.D. (RMS)Robert W. Reif, M.D. (RMS)Richard Sells, M.D. (RMS)Marcus Shelander, M.D. (RMS)Ernest J. Sowada, M.D. (RMS)William E. Stephens, M.D. (HMS)Norman A. Sterrie, M.D. (HMS) ✦

HMS/RMS Members Serve as MMA Trustees

Lyle J. Swenson, M.D.East Metro

Karen K. Dickson, M.D.West Metro

Thomas B. Dunkel, M.D.East Metro

Lee H. Beecher, M.D.West Metro

John W. Larsen, M.D.West Metro

Robert K. Meiches, M.D.West Metro

Henry T. Smith, M.D.West Metro


HHMS and RMS members submitted a total of30 resolutions for consideration by the year 2000House of Delegates. Below is a listing of theactions taken:

#101 – Employer Compensationto Physicians for Time to Ac-quire CMEAuthor: Omer K. Sanan, M.D. (RMS)

HOUSE ACTION: ADOPTED AS AMENDED

RESOLVED, that the MMA endorse the con-cept that all physicians be allowed adequatetime and payment to acquire required con-tinuing medical education (CME), and beit further

RESOLVED, that the MMA provide informa-tion to physicians, from published sources,detailing policies for reimbursement and de-ductibility of CME within Minnesota andthroughout the United States, and be it fur-ther

RESOLVED, that the MMA develop a reportthat describes current methods to fully de-duct the cost of required continuing medi-cal education and assess the need for chang-ing current tax laws to ensure full deduct-ibility of required CME.

#102 – Creation of a Citizen’sAdvisory CouncilAuthor: Robert Geist, M.D. (RMS) and RebeccaThoman, M.D (HMS)#103 – MMA Support for Pa-tient Advocacy/Alliances, andEducationAuthor: Lee Beecher, M.D. (HMS)

HOUSE ACTION: SUBSTITUTE RESOLUTION

102 WAS ADOPTED IN LIEU OF RESOLUTIONS 102AND 103RESOLVED, that the MMA Board of Trustees

assess and implement various methods of ob-taining citizen/community input in the de-velopment and implementation of MMApolicy and programs, and be it further

RESOLVED, that the title of Substitute Reso-lution 102 be Citizen Input.

#104 – Conflict of Interest PolicyAuthor: Robert Geist, M.D. (RMS) and T. MichaelTedford, M.D. (HMS)

HOUSE ACTION: NOT ADOPTED

RESOLVED, that the Minnesota Medical As-sociation Board of Trustees develop a con-flict of interest policy regarding members’competing professional/financial interestsand their roles and responsibilities as votingmembers of MMA committees to be pre-sented to the House of Delegates for discus-sion and approval in 2001.

#201 – Opposition to State Pre-Emption of Local OrdinancesRegulating TobaccoAuthor: Neal Holtan, M.D. (RMS)


RESOLVED, that the MMA oppose attemptsto adopt state law that pre-empts local ordi-nances that restrict the sale and use of to-bacco.

#202 – Opposition to State Pre-Emption of Local OrdinancesRegulating FirearmsAuthor: Neal Holtan, M.D. (RMS)

HOUSE ACTION: REFERRED TO MMA BOARD

OF TRUSTEES

RESOLVED, that the MMA seek to changecurrent Minnesota law that pre-empts localordinances regulating the sale and use of fire-arms.

#203 – Repeal of the ProviderTaxAuthors: Albert J. Heimer, M.D. and Rainer G.Rocheleau, M.D. (RMS)

HOUSE ACTION: ADOPTED

RESOLVED, that the MMA continue to en-dorse and lobby at the next session of theMinnesota Legislature as a high priority, therepeal of the 2 percent provider tax.

#204 – Study of the Pricing ofPrescription DrugsAuthor: Donald Hannon, M.D. (RMS)


RESOLVED, that the MMA urge the Minne-sota Congressional delegation to continuetheir investigation of the pricing structureof the pharmaceutical industry, and be it fur-ther

RESOLVED, that the MMA delegation to theAmerican Medical Association House of Del-egates carry a resolution asking the AMA toinclude in their current activities related tothe problem of increasing pharmaceuticalcosts the development of a plan for equitablepricing of pharmaceuticals for all Americans,and develop legislation to promote this plan.

#205 – Study of the MinnesotaPrescription Drug ProgramAuthor: Craig Mommsen, M.D. (RMS)


RESOLVED, that the MMA promote the Pre-scription Drug Program (formerly SeniorDrug Program) to ensure it meets the needsof qualified Minnesotans for access to pre-scription drugs at an affordable price, andbe it further

HMS and RMS Members Participate inMMA Annual Meeting


RESOLVED, that the MMA monitor the De-partment of Human Services’ required an-nual report to the Legislature to determineif further improvements to the program arenecessary.

#206 – Osteoporosis andDensitometryAuthor: J. Michael Gonzalez-Campoy, M.D.(RMS)


RESOLVED, that the MMA establish policyrecognizing osteoporosis as a major healthproblem in our state, and be it further

RESOLVED, that the MMA pursue avenues tocreate awareness of osteoporosis and restrictclinical densitometry practice to appropri-ately trained physicians, thereby improvingthe level of care for these patients, and be itfurther

RESOLVED, that the MMA adopt AMA PolicyH-425.981 as MMA policy: The MMA “(1)advocates for the use of bone densitometryas an important tool in assessing fracture riskand in the diagnosis of osteoporosis; (2) advo-cates that a clinical evaluation accompanyany bone mass measurement for the evalua-tion of fracture risk and osteoporosis; (3)advocates for the continued participation ofthe patient’s physician in the diagnosis, treat-ment, and prevention of osteoporosis; and(4) encourages private third-party payers toprovide coverage for bone mass measurementtechnology and services for those individu-als at high risk of osteoporosis.

#207 – Support of Minnesota’sAcademic Medical Centers andthe Funding Base of theUniversity of MinnesotaMedical SchoolAuthor: Neal Holtan, M.D. (RMS)


RESOLVED, that the MMA strongly supportthe State of Minnesota’s initiatives and ad-vocacy for all of its academic medical cen-ters’ educational activities, and be it further

RESOLVED, that the MMA actively supportand participate in the University of Minne-sota Medical School’s 2000-2001 efforts toreceive an expanded and secure funding base.

#209 – Coordination of ClinicSurveys and Chart AuditsAuthor: Kenneth Dedeker, M.D. (HMS)


RESOLVED, that the MMA work with healthplans, the Minnesota Department of Health,and appropriate accrediting agencies to finda mechanism to reduce the intrusion and costof duplicative surveys and audits.

#300 – Opposing the Carveoutof Mental Health and ChemicalDependency BenefitsAuthor: Karen Dickson, M.D. (HMS) and Min-nesota Psychiatric Society


RESOLVED, that the MMA oppose the carv-ing out of psychiatric and chemical depen-dency treatment from general medical carein health insurance and managed care pro-grams, and be it further

RESOLVED, that the MMA delegation to theAmerican Medical Association carry a reso-lution to the AMA asking the AMA to workto eliminate mental health and chemical de-pendency carveouts so that benefits for men-tal health are managed and administered likeother health care services, and be it further

RESOLVED, that the MMA develop and con-duct an educational program aimed at pa-tients, employers, and other interested par-ties to promote the advantages of health careinsurance policies that integrate medical, sur-gical, psychiatric, and chemical dependencyservices in any clinical setting.

#303 – MMA to Co-Sponsor aCommunity Conference toDiscuss: What Comes AfterManaged Care?Authors: Robert Geist, M.D. (RMS) and RebeccaThoman, M.D. (HMS)


RESOLVED, that the MMA in cooperationwith other interested parties produce and titlea conference devoted to discussing and rec-ommending action regarding the next gen-eration of health care delivery and financingsystems.

#304 – Improved Reimburse-ments for Blood Products andBlood SafetyAuthor: Kenneth Nollet, M.D. (RMS)


RESOLVED, that the MMA delegation to theAmerican Medical Association (AMA) carrya resolution to the AMA House of Delegatescalling on the AMA to advocate for improvedreimbursement to hospitals for services re-lated to blood products and blood safety, andbe it further

RESOLVED, that the MMA delegation to theAMA request that the AMA advocate for theappropriate adjustments to the market bas-ket mechanism used by the Health Care Fi-nancing Administration (HCFA) for pay-ments to hospitals which will result in ad-equate reimbursements to cover the costs forblood products and blood safety.

(Continued on page 18)

HMS and RMS members caucus jointly during the MMA Annual Meeting.


carry a resolution to the AMA House ofDelegates that the AMA lobby Congress toamend laws governing health plans to removeall provisions of law that permit physiciansto enter into global risk-sharing contractswith health plans for services other than theirown such as from a hospital, laboratory, con-sultant, or pharmacy.

#307 – ObesityAuthor: J. Michael Gonzalez-Campoy, M.D.(RMS)


RESOLVED, that the MMA recognize obesityas a major endemic health problem, by en-dorsing existing AMA policy on obesity (H-150.953 and H-440.902) and be it further

RESOLVED, that the MMA develop a state-wide education campaign, in conjunctionwith interested parties, to create awarenessof the modifiable causes of obesity, obesitycomplications, and effective, sustained obe-sity treatment.

#308 – Lack of Coverage forObesity and Related ConditionsAuthor: J. Michael Gonzalez-Campoy, M.D.(RMS)


RESOLVED, that the MMA introduce legisla-tion to secure adequate reimbursement tophysicians for the care of patients with obe-sity and for prescribed medications, and beit further

RESOLVED, that the MMA review existingAmerican Medical Association policy regard-ing coverage for obesity services, and eitherendorse current policy, or introduce policyto secure adequate coverage for the epidemicof obesity.

#309 – Patient Protection inUtilization Review of Psycho-therapy ReviewAuthors: Lee Beecher, M.D. (HMS) and Minne-sota Psychiatric Society


RESOLVED, that the MMA develop and ad-vocate Minnesota state legislation prohibit-ing utilization review organizations, healthplans, or insurance plans from requiring dis-closure of psychotherapy case notes as a con-dition of medical necessity review or insur-ance reimbursement.

#310 – Plans Pay for Out ofNetwork Physicians, But NotAlways Their RxAuthors: Lee Beecher, M.D. (HMS) and Minne-sota Psychiatric Society


RESOLVED, that the MMA work with Min-nesota health plans to provide coverage forpharmaceutical prescriptions that are com-pliant with plan formularies, when writtenby physicians who are otherwise eligible forhealth plan reimbursement according to theenrollee’s health plan contract.

#311 – Cell Phone Use WhileDrivingAuthor: Carl Burkland, M.D. (HMS)#312 – Banning Cellular PhoneUse While Driving PolicyAuthor: Carl Burkland, M.D. (HMS)#313 – Driving While Using aCellular PhoneAuthor: Range Medical Society#315 – Sleepy Driving Pre-vention and DetectionAuthor: MMA Committee on Public Health andPreventive MedicineHOUSE ACTION: SUBSTITUTE RESOLUTION #311WAS ADOPTED IN LIEU OF RESOLUTIONS 312,313, AND 315RESOLVED, that the MMA educate Minne-

sota physicians and the public about the dan-gers of driver inattention due to factors in-cluding, but not limited to, sleepiness, cel-lular phone use, electronic devices (e.g., ste-reo, global positioning systems, televisions),and the use of certain medications.

#305 – AMA Study of NationalHealth SystemsAuthor: John B. Coleman, M.D. (RMS)


RESOLVED, that the MMA delegation to theAmerican Medical Association carry a reso-lution calling on the AMA to study and is-sue a report of the findings of the study aboutthe health care systems of Canada, England,Germany, Norway, and Sweden with respectto costs; the waiting time for elective proce-dures; who pays for the care; and the emer-gence of private physician practices and hos-pitals, and be it further

RESOLVED, that the MMA delegation to theAmerican Medical Association also ask theAMA to develop a national health care sys-tem model for the United States with fea-tures designed to address unique aspects ofhealth care in the United States.

#306 – Prohibit Global RiskSharing Contracts BetweenProviders and Health PlansAuthors: Robert Geist, M.D. (RMS) and RebeccaThoman, M.D. (HMS)


RESOLVED, that the MMA lobby the Minne-sota State Legislature to amend laws govern-ing health plans to remove all provisions ofthe law that permit physicians to enter intoglobal risk sharing contracts with health plansfor services other than their own (such asfrom a hospital, laboratory, consultant, orpharmacy), and be it further

RESOLVED, that the MMA delegation to theAmerican Medical Association delegation

(Continued from page 17)

RMS and HMS members discuss resolutions and reference committee reports.


(See related article by Carl Burkland, M.D., onpage 20 of this issue of MetroDoctors.)

#400 – Continuation ofMinnesota Maternal MortalityStudiesAuthor: Elisa Wright, M.D. (HMS) and Minne-sota Section of the American College of Obstetri-cians and Gynecologists


RESOLVED, that the MMA work with theCommissioner of Health to seek to continueDepartment of Health authority to accesshealth records regarding maternal mortalitystudies (Minn. Stat. 145.90), and be it futher

RESOLVED, that, if necessary, the MMA workwith the Department of Health to introducelegislation in this area.

#402 – National PractitionerData Bank ProtectionAuthor: Robert Moravec, M.D. (RMS)


RESOLVED, that the MMA oppose any at-tempts to open the National PractitionerData Bank to public level of query, and be itfurther

RESOLVED, that the MMA delegation to theAmerican Medical Association continue tosupport the AMA position of opposing anyattempt to open the National PractitionerData Bank to public query.

#403 – Empower MinnesotaPhysicians to CollectivelyNegotiate Contracts withHealth PlansAuthor: Robert Tatreau, M.D. (RMS)

HOUSE ACTION: REFERRED TO THE MMABOARD OF TRUSTEES

RESOLVED, that the MMA, as a high priority,study legislation that provides state actionimmunity legislation that has passed in statessuch as Texas, and be it further

RESOLVED, that MMA consider developingand supporting legislation that permits thephysicians of Minnesota to collectively ne-gotiate the terms and conditions of contractswith health plans.

#404 – Education of PhysiciansRegarding Tortured andTraumatized RefugeesAuthor: Neal Holtan, M.D. (RMS)


RESOLVED, that the MMA continue to sup-port and develop education programs forphysicians who see refugees among their pa-tients to enable the physician to assess therefugee for the possibility of post-traumaticstress, depressions, or medical injury due totorture or war trauma, and be it further

RESOLVED, that the MMA educate Minne-sota physicians to uphold the principles ofhuman rights by assisting, if requested, todocument the physical and psychologicaleffects of torture.

#407 – Methadone Mainten-ance TreatmentAuthor: Lee Beecher, M.D. (HMS) and Minne-sota Psychiatric Society


RESOLVED, that the MMA endorse AmericanMedical Association policies H-95.957 andH-95.964 regarding use of methadone main-tenance therapy in clinics and in the officesof physicians properly trained and adminis-tratively monitored.

#408 – Patient SafetyAuthor: Kenneth Dedeker, M.D. (HMS)


RESOLVED, that the MMA continue to workwith local and national efforts to reducemedical errors and improve patient safety,and be it further

RESOLVED, that particular attention be paidto the issues of: (1) need for and methods toidentify root causes of errors; (2) data pri-vacy and confidentiality; (3) mechanisms toreduce the culture of blame in the health careindustry; and (4) mechanisms for the equi-table distribution of associated costs.

#409 – Coverage of Experi-mental/Investigational StudiesAuthor: Kenneth Dedeker, M.D. (HMS)

HOUSE ACTION: REFERRED TO THE MMABOARD OF TRUSTEES

RESOLVED, that the MMA Board of Trustees

appoint a task force to address the issues ofclinical research in Minnesota with particu-lar attention to at least: (1) approval agen-cies; (2) facility and researcher participationwith the participant member managed careorganization, as applicable; and (3) themechanism for assignment of reimbursableand non-reimbursable expenses, and be itfurther

RESOLVED, that the MMA pursue negotia-tions with managed care organizations, clini-cal research groups (e.g., University of Min-nesota), governmental agencies, and consum-ers to develop an organized systematic ap-proach to clinical studies done in Minnesotawith Minnesota residents. ✦


T

Using a Cell Phone While Driving —A Risky Venture?

Editor’s Note: The following is an excerpt froma speech given by Dr. Burkland, a family phy-sician and West Metro Delegate to the MMA,during the MMA Annual Meeting.

THE BEGINNING OF THIS YEAR, I startedto notice how many drivers were using cellphones while they were driving. I am computerilliterate so I went over to my daughter’s apart-ment and she got me into the Internet so I couldsee what they were saying about cellular phoneusage by drivers.

I noticed that there were several personaltragic stories by parents of children who werekilled by a driver while they were using a cellu-lar phone and their pleas that no one seemed tobe listening or doing anything about correctingthis dangerous behavior.

One victim’s mother’s reply to the state-ment that we don’t need any new laws regulat-ing cell phone use stood out: “everybody thinksit’s their freedom to have this phone. My sonhad a right to life.”

At that moment, and as my daughter satnext to me, I decided to advocate for her andmy family’s driving safety now while they werestill alive and not after one of them had beenkilled by one of these drivers.

The National Highway Traffic Safety Ad-ministration (NHTSA) held a well-attendedpublic hearing on July 5, 2000 on the potentialsafety implications with so much technology pil-ing up in American cars. Drivers distracted whileusing advanced in-vehicle technologies that al-low them to phone, fax, e-mail, obtain routeguidance, view infrared images on a head-updisplay, operate multimedia entertainment sys-tems, or use the Internet.

CNN News commenting on this publichearing on the risks of distracted drivers stated

that the NHTSA estimated that 25 percent ofthe 6.3 million crashes in the U.S. each yearinvolved a distraction. That was 8,000 crashes aday and as many as 30 percent of fatal crasheswere caused by distraction.

Rossalyn G. Millman, Deputy Adminis-trator, NHTSA stated that: “Using a wirelessphone or other device while driving can be dis-tracting and drivers should not talk on a phoneor use these devices while their vehicles are inmotion.” (Keep in mind, this agency has thepower to set vehicle safety standards but has nojurisdiction over portable phones, the regula-tion of which largely remains a state and localmatter.)

What do the hand-held phone manufac-turers say in their owner’s manual about the safeuse of cellular phones while driving?

Nokia: Road safety comes first.Don’t use a hand-held phone while driv-ing; park the vehicle first.

AT and T — Traffic safety.We recommend that you do not use thephone when you are driving a vehicle. Parksafely and then make your call. Remem-ber, road safety always comes first!

While the above manufacturers have de-cided that the only safe use of a hand-held cel-lular phone by a driver whose vehicle is in mo-tion is its nonuse, other manufacturers have triedto articulate in their owner’s manual an adequatesafety policy for these drivers which excludesthis essential overriding principle.

The Cellular Telecommunications Indus-try Association (CTIA) has put considerable ef-fort into getting the “safer use” message across,using its campaign “Safety: Your Most Impor-tant Call” (CTIA, 1998). The campaign’s cen-tral message is that it is a driver’s first responsi-bility to drive safely and includes 10 points to con-sider when using a mobile phone while driving.

These ten tips are taken from Ericsson’sowner manual for an example. (See sidebar) Iwill make some remarks about some of them:#2 When available, use a hands-free device.

Does this mean it is safer? If no, why notjust say don’t use a hand-held cellularphone while driving. It is apparent manu-facturers clearly recognize the potentialrisks of in-vehicle cellular phone use.

#3 Be able to access your wireless phone with-out removing your eyes from the road.

Is this possible? Will people do it?#4 Let the person you are speaking with know

you are driving; if necessary, suspend thecall in heavy traffic or hazardous weatherconditions.

You mean you wouldn’t automaticallysuspend the call in heavy traffic or hazard-ous weather conditions?

#6 If you need to make a call while moving,dial only a few numbers, check the roadand your mirrors, then continue.

I thought point #3 said not to removeyour eyes from the road. Will anyone dialonly a few numbers?

And finally#7 Do not engage in stressful or emotional

conversations that may be distracting. HowB Y C A R L E . B U R K L A N D , M . D .


can you know if a conversation will be orwill become stressful or emotional?Furthermore, by using phrases in these

safety tips such as “if necessary, if possible, dialsensibly, assess the traffic, and if you need tomake a call while moving,” the manufacturerleaves it to the discretion of the driver to deter-mine if it is safe for him or her to use their cel-lular phone in any particular situation while theyare driving.

This lack of precise safety guidelines in-creases the risks that the individual followingthem will make an inappropriate and danger-ous driving decision.

The landmark article by Redelmeier thatsuggested an association between cellular tele-phone calls and motor vehicle collisions ap-peared in the New England Journal of Medicineon February 13, 1997.

Three conclusions in this article have beenwidely quoted in the news media and used ascorroborating data by individuals trying to getsupport for any legislative action to regulate cellphone usage by drivers while their motor ve-hicles are in motion.

The conclusions were that:1. Using a cellular telephone was associated

with a risk of having a motor vehicle colli-sion that was about four times as high asthat among the same drivers when theywere not using their cellular telephone;

2. This relative risk was similar to the hazardassociated with driving with a blood alco-hol level at the legal limit; and

3. They observed no safety advantage tohands-free as compared with hand-heldtelephones.Violante published a second much quoted

case control study on cellular phones and fataltraffic collisions using data from the OklahomaState Department of Public Safety database in1998.

The study results and findings are below:1. Total traffic related accidents were

233,000, of which 1,548 were fatal. Of thevehicles involved in fatal accidents, 4.2percent had mobile phones and 7.7 per-cent of the fatalities with phones presentwere reported to be using the phone at thetime of collision.

2. Drivers reported to be using a phone atthe time of collision had a nine-fold riskof a fatality over the one without a phone.

3. Drivers reported to have a phone presentin their vehicle were at twice the risk for afatality as drivers without phones.

4. Drivers with phones were more likely toincur a collision due to “wandering” fromtheir lane.

5. Drivers with phones had an increasedchance of striking a pedestrian.

6. Drivers with phones had an increased riskof overturning their vehicle.

7. Drivers using phones were at three timesthe risk of a fatality over alcohol/drug use.

8. Results suggest that phone use is associ-ated with driver inattentiveness to speedand lane position.

9. Risk of phone involved fatalities increasewith age.Another study by Violante (1996) on cel-

lular phones and traffic accidents found:1. An increased crash risk of 34 percent ex-

isted for those with mobile phones in theircars, and

Your wireless telephone gives you the powerful ability to communicateby voice — almost anywhere, anytime. But an important responsibilityaccompanies the benefits of wireless phones, one that every user mustuphold!

When driving a car, driving is your first responsibility. When us-ing your wireless phone behind the wheel of a car, practice good com-mon sense and remember the following tips:1. Get to know your wireless phone and its features such as speed dialand redial. If available, these features help you to place your call withouttaking your attention off the road.2. When available, use a hands free device. If possible add an addi-tional layer of convenience and safety to your wireless phone with oneof the many hands free accessories available today.3. Position your wireless phone within easy reach. Be able to accessyour wireless phone without removing your eyes from the road. If youget an incoming call at an inconvenient time, if possible, let your voicemail answer it for you.4. Let the person you are speaking with know you are driving; ifnecessary, suspend the call in heavy traffic or hazardous weather condi-tions. Rain, sleet, snow, ice, and even heavy traffic can be hazardous.5. Do not take notes or look up phone numbers while driving. Jot-ting down a “to do” list or flipping through your address book takes

attention away from your primary responsibility — driving safely.6. Dial sensibly and assess the traffic; if possible, place calls whenyou are not moving or before pulling into traffic. Try to plan calls whenyour car will be stationary. If you need to make a call while moving,dial only a few numbers, check the road and your mirrors, then con-tinue.7. Do not engage in stressful or emotional conversations that maybe distracting. Make people you are talking with aware you are drivingand suspend conversations which have the potential to divert your at-tention from the road.8. Use your wireless phone to call for help. Dial 9-1-1 or other localemergency number in the case of fire, traffic accident or medical emer-gencies. Remember, it is a free call on your wireless phone.9. Use your wireless phone to help others in emergencies. If you seean auto accident, crime in progress, or other serious emergency wherelives are in danger, call 9-1-1 or other local emergency number, as youwould want others to do for you.10. Call roadside assistance or a special non-emergency wireless assis-tance number when necessary. If you see a broken-down vehicle posingno serious hazard, a broken traffic signal, a minor traffic accident whereno one appears injured, or a vehicle you know to be stolen, call road-side assistance or other special non-emergency wireless number.

Wireless Phone Safety TipsProvided by Ericsson



2. Talking for more than 50 minutes permonth resulted in a 5.58 fold increased riskof having a crash, higher than any other incar activity.Since these early articles there has been ex-

tensive research on this issue that has tended tocorroborate and add to the previous findings.

A number of these studies addressed theconcern about the degree of awareness of thesedrivers using their cellular phones and demon-strated that drivers were not necessarily awareof their driving performance while they wereengrossed in a call.

Frequently, the potential hazards cited bysome cellular telephone users (such as being care-ful while dialing) do not match the problems(such as lane meandering) cited by nonusers whoare sharing the road.

The NHTSA states that contrary to ex-pectations, the majority of drivers were talkingon their telephones rather than dialing at thetime of the crash. A few drivers also were startledwhen their cellular telephones rang and, as theyreached for their phones, they ran off the road.

Other driver factors included driving too fastfor conditions or failing to yield. The overwhelm-ing majority of cellular telephone users were inthe striking vehicle, and struck cars or other largeobjects that were in clear view of the driver.

Based on these reports, W. Riley Garrott,a spokesperson for the NHTSA stated at thepublic hearing on July 5, 2000 that “conversa-tion itself, is the most prevalent single behaviorassociated with cellular telephone related crashes.What this means is hands-free phones will nottotally solve this problem.”

Hands-free equipment won’t eliminate thedistraction problem and conversation is the cul-prit.

A Gallup Poll on CNN taken this yearfound that 67 percent of Americans would sup-port a law banning cell phone use while driving.

I think that this poll reflects that Ameri-can drivers are experiencing and noticing thisunawareness on the part of drivers using theircellular phones while driving.

These drivers are seen and felt not only tobe annoying but also to present a clear and im-mediate danger to the safety of other driversaround them.

Further, it is felt that these drivers havecrossed the line, whereever the line was, and thattheir use of cellular phones is now seen as dif-ferent from the other in-car activities of puttingmake-up on, eating, flossing, shaving, brushingteeth, etc.

At least 18 countries have enacted legisla-tion restricting cell phone use while driving.Australia, Austria, Israel, Norway, Portugal,South Africa, and Switzerland have specific leg-islation against hand-held car phone use.

Earlier, on March 22, 1999, Brooklyn,Ohio became the first city in the United Statesto pass an ordinance banning the use of hand-held cellular phones while driving. In 1996,Brooklyn was also the first town to require theuse of seatbelts.

There are some similarities between legis-lating for mobile phone use while driving andthe seatbelt legislation issue of the early 1980s.Initial public and political opinions were gen-erally against the need for legislation; it tookseveral years for people to realize the importanceof seatbelt legislation.

Experience from the passage of seatbelt leg-islation has shown that if mobile phone legisla-tion is implemented, it is likely to be introducedin a phased manner. This could mean that themost unsafe types of usage (if these usage typesexist and can be identified) could be targetedlong before any wide-ranging legislation is in-troduced. In the case of mobile phones, thiscould mean an initial restriction placed on hand-held phones only.

And finally, most importantly what aboutthe victims?

In Minnesota, the State Highway Patrolsays driver distractions, such as using a cellphone, were a leading cause of crashes in 1999accounting for 14 percent of fatal crashes, 25percent of injury crashes and 25 percent of prop-erty-damage crashes.

“We do not take driving as seriously as weshould” said Lt. Mark Peterson, a 17-year vet-eran with the Minnesota State Patrol.

Behind these statistics are devastated fami-lies and communities. “Parents should not haveto bury their children.” Cried out one motherwhose child was killed in a mobile phone re-lated accident.

Crashes due to cellular phone use are notacts of God, they are foreseeable and preventable.

For yourself, for your family, for your pa-tients and their families, I ask you to pass thisresolution endorsing this policy. ✦

(Continued from page 21)


Medical Student Recruitment ActivitiesLunch ’n LearnOver 200 medical students attended the “Lunch’n Learn” session sponsored by HMS, RMS, andMMA on Tuesday, September 26. Drs. FrankIndihar, Robert Meiches and Virginia Lupo, andJoel Oberstar (4th year medical student) ad-dressed the benefits of organized medicine fromthe county, state, and national levels. ✦

Student PicnicOn a sunny August evening,the medical student class of2004 gathered at Como Parkfor a welcoming picnichosted by the U of M secondyear students. HMS, RMS,and MMA representatives were also invited toshare information on our organizations and en-courage medical student involvement. ✦

PRESIDENT ’S MESSAGEJ O H N R . G A T E S , M . D .

RMS-Officers

President John R. Gates, M.D.

President-Elect Robert C. Moravec, M.D.

Past President Lyle J. Swenson, M.D.

Secretary Jamie D. Santilli, M.D.

Treasurer Peter H. Kelly, M.D.

RMS-Board Members

Kimberly A. Anderson, M.D.

Charles E. Crutchfield, III, M.D.

Peter J. Daly, M.D.

Kelley C. du Ford, Medical Student

Thomas B. Dunkel, M.D.

Michael Gonzalez-Campoy, M.D.

James J. Jordan, M.D.

F. Donald Kapps, M.D.

Kathryn M. Klingberg, M.D., Resident Physician

Charlene E. McEvoy, M.D.

Ragnvald Mjanger, M.D.

Thomas F. Rolewicz, M.D.

Paul M. Spilseth, M.D.

Jon V. Thomas, M.D.

David C. Thorson, M.D.

Randy S. Twito, M.D.

Russell C. Welch, M.D.

RMS-Ex-Officio Board Members

Blanton Bessinger, M.D., MMA President-ElectRaymond Bonnabeau, M.D., Sr. Physicians

Association PresidentKenneth W. Crabb, M.D., AMA Alternate DelegateStephen P. England, M.D., Community Health

Council ChairMichael Gonzalez-Campoy, M.D., Education

Resource Council ChairEleanor Goodall, Alliance PresidentFrank J. Indihar, M.D., AMA DelegateWilliam Jacott, M.D., U of MN RepresentativeF. Donald Kapps, M.D., Council on

Professionalsim & Ethics ChairMelanie Sullivan, Clinic AdministratorLyle J. Swenson, M.D., Public Policy Council ChairRussell C. Welch, M.D., Communications

Council Chair

RMS-Executive Staff

Roger K. Johnson, CAE, Chief Executive OfficerDoreen M. Hines, Assistant Director


TWhat will Physician Collegialitybe for the Future?

Friday, January 26, 2000

North Oaks Country Club

THE ISSUE OF PHYSICIAN collegiality hasbeen a topic of some concern in recent yearsand was actually a major forum at the Leader-ship Conference of the American Medical As-sociation held in Miami this past spring.

We physicians pride ourselves in being pro-fessionals and with that “professional” designa-tion comes an obligation to behave in a “profes-sional manner.” This description implies a col-legial interaction of respect for the perspectivesand expertise of our fellow physicians who workshoulder-to-shoulder in the selfless care of ourpatients.

That is, of course, the classic image. How-ever, we are in the midst of a major paradigmshift. Many of us older physicians, i.e., those ofus in our late 40s, 50s or older, actually did findmedicine a calling. A calling that very often wasall-consuming — consumed our time, on oc-casion consumed our families and relationships— and did result in a quality of care that we seein our community, that as I have said before, issecond to none.

We find younger physicians going intomedicine in our community having a somewhatdifferent perspective. Medicine may indeed bea profession and a calling, but it needs to beviewed now in the context of family, avocationalinterests, and increasingly, the professional con-cerns and issues of the spouse.

Repeatedly, when I talk with young physi-cians about joining a practice to work towardpartnership, there is a hesitancy — a hesitancythat implies the commitment in time and ener-gies and personal resources that might be re-quired to achieve partnership in a busy clinicalpractice may not be consistent with their per-sonal aspirations. Consequently, I would sub-mit that the issue of physician collegiality is notjust a deterioration of professional interchangeas we find ourselves hoisted on the petard ofmanaged care, but has more insidious roots inthe major paradigm shift of the values of ourentering physicians. Quite frankly, I can’t blamethem. When I look back on every other nightcall during my internship, I must ask if it was

really necessary for me to run that gauntlet toenter the professional solidarity while almostpsychotically sleep deprived.

We are evolving into a new kind of profes-sion. One where continuity of care provided byone physician willing to give the considerablecommitment of after-hours to provide that con-tinuity will simply not be the norm. Hospitalists,clinical specialized physicians, and the use ofphysician extenders in the forms of nurse prac-titioners or PAs have already demonstrated theirvalue and implications for the change of theprofession.

What will physician collegiality be for thefuture? I’m confident of only one thing — itwill be different. ✦

Mark Your Calendar!

RMSAnnual Meeting

Installation of

Robert C. Moravec, M.D.130th President


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RMS UPDATE

DR. BLANTON BESSINGER, MMA presi-dent, and Dr. Joseph Rigatuso, MMA East MetroTrustee, were honored at a RMS champagnereception at the Minnesota Medical Association

ANOTHER SUMMER, an-other successful RMS FamilyNight at the Saints. Well over100 physicians, spouses, andchildren enjoyed the Saint PaulSaints game on August 29,2000.

The weather was great. Thedogs and brats were well-cookedand the pictures prove that ev-eryone had a great time. ✦

Physician Leaders Honored at MMA Annual Meeting

RMS Family Night at the Saints

Blanton Bessinger, M.D., MMA President; Randolf D.Smoak, M.D., AMA President; John Van Etta, M.D.,MMA Past President; and Joseph Rigatuso, M.D.,Outgoing MMA East Metro Trustee during the MMAAnnual Meeting.

Annual Meeting in Duluth onWednesday, September 13, 2000.

Dr. Bessinger was inaugu-rated as the 134th president of theMMA in ceremonies at the MMAAnnual Meeting. His wife,Bonnie, and other family mem-bers joined him for the occasion.Dr. Bessinger is a pediatric cardi-ologist and is the Director ofChild Advocacy and Child Policyfor Children’s Hospitals and Clin-ics, Minneapolis and St. Paul.

Dr. Joseph Rigatuso washonored for completing nine yearsof service representing the EastMetro District on the MMABoard of Trustees. Dr. Rigatuso is

Physicians attending to toast Drs. Bessingerand Rigatuso are: (from left) Chad Boult,M.D., Kenneth Nollet, M.D., J. MichaelGonzalez-Campoy, M.D., Frank Indihar, M.D.,Robert Geist, M.D., and Tim Crimmins, M.D.

Judy Jacott, Gwen Crabb, Dr. Bill Jacott and Dr. John Gates.

Allison Welch, Brenda Andrewson, and Dr.Russell Welch.Dr. Mark Steinhauser and son,

Kenneth.

Dr. Charles Terzian with his wife, Helen, anddaughter, Anna.

Looking for awinter escape?

Join us in Cancun

Feb. 17-24, 2000

for the RMS/HMSMedical Conference

See page 8 for more information.

a pediatrician with HealthPartners and president,HealthPartners Physician’s Association. ✦


Applicants for Membership

We welcome these new applicants forRamsey Medical Society membership.

ActiveJimmie L. Browning, M.D.University of KansasFamily PracticeUnited Family Practice

Victor S. Cox, M.D.Yale UniversityOtolaryngologyOtolaryngology & Head and Neck Surgery, P.A.

Michael B. Johnson, M.D.St. Louis UniversityOtolaryngologyEar, Nose & Throat SpecialtyCare of Minnesota, P.A.

Tim D. LaBelle, M.D.London OntarioEmergency MedicineWoodwinds Hospital

David V. Power, M.D.University of Dublin/University of MinnesotaFamily PracticeBethesda University Family Physicians

Steven M. Tredal, M.D.University of Iowa College of MedicineEmergency MedicineUnited Hospital

Active-1st Year in PracticeBrent R. Asplin, M.D., MPHMayo Medical SchoolEmergency MedicineRegions Hospital

Daniel P. Hoeffel, M.D.University of PennsylvaniaOrthopaedic SurgerySummit Orthopedics

Andrew J. Portis, M.D.University of AlbertaUrologyMetropolitan Urologic Specialists

Thomas W. Scheider, M.D.Creighton UniversityFamily PracticeHealthEast Woodbury Clinic

Caroline M. Tahara, M.D.Creighton UniversityInternal MedicineHealthPartners - White Bear Lake

ResidentJaspal Singh, M.D.Sardal Patel Medical College, IndiaFamily PracticeBethesda University Family Physicians

Student(University of Minnesota)

Kathryn H.O. BermanMeghan E. GruisAmy E. Candy HeinleinChad R. LaurichValerie J. Meyer

(Harvard Medical School)

Roland Brusseau ✦

In MemoriamEDWARD C. MCELFRESH, M.D., died onAugust 10 at the age of 58 from complicationsas a result of a lung transplant received in June.He was Chief of Orthopedics at the Minneapo-lis Veterans Hospital and associate professor oforthopedic surgery at the University of Minne-sota. He graduated from the University of Ne-braska, completed his internship at the Univer-sity of Minnesota, and his residency at the MayoClinic. Dr. McElfresh joined RMS in 1976.

RONALD J. “BUZZ” PIZINGER, M.D., 59,died on October 10. He graduated fromCreighton University Medical School. He com-pleted his internship at St. Paul-Ramsey Medi-cal Center, residencies at the VA Hospital andthe University of Minnesota, and did a fellow-ship in gastroenterology at the VA Hospital andthe University of Minnesota. Dr. Pizinger joinedRMS in 1974.

MARCUS L. SHELANDER, M.D., a urolo-gist, died October 1 at the age of 75. He gradu-ated from the University of Minnesota MedicalSchool, completed his internship at St. Mary’sHospital, and his residency at the University ofMinnesota. Dr. Shelander was the Medical Direc-tor of East Metropolitan Health Organizationfrom 1994-1999. He joined RMS in 1956. ✦

Community Workshop Honors Bruce Vento

Workshop participants were: Dr. Victor Corbett, Sgt. MamieSingleton, Carla Arny and Pat Crutchfield (not pictured are Drs.Charles Crutchfield and Brian Rank).

THE 5TH ANNUAL Community Health/Spiritual Workshop was held on Saturday, Sep-tember 16, 2000 at the Free At Last Church.Sgt. Mamie Singleton and the Youth Initiative

Mentoring Academy sponsored the workshop.Dr. Charles Crutchfield was emcee for the pro-gram, which honored Congressman Bruce Ventofor his outstanding contributions to the com-

munity. Pat Crutchfieldand Carla Arny presenteda Mini Health Fair to aclassroom of young com-munity children. Thekeynote speaker was Dr.Brian Rank who spokeon the topic of lung can-cer. The event ended withan open forum panel dis-cussion with all of theparticipants. ✦


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RMS ALLIANCE NEWSE L E A N O R M . G O O D A L L

A Message to Spouses ofRamsey Medical Society Physicians

What’s Important to You?Or, Why You Need to Take Partin the RMS Alliance

What matters in your life? For most of us, Ithink the answer is fairly automatic. My hus-band/wife, my children, my grandchildren, myfriends, my work, my religion…and we mayeven move on to those special things that giveus great satisfaction such as, my garden, mak-ing art, writing, playing the piano, volunteerwork, and so on. The priority order of thesethings, their importance to us, changes over alifetime.

What is it that’s missing from the abovelitany of what’s important or what matters inyour life? What is missing is YOU! What areyou doing that is specifically beneficial to you?Let’s hope that your relationship with the adultyou care most about is a good one; your chil-dren or grandchildren (in true Lake Wobegonfashion) are all good looking and above aver-age; your spouse’s work is going well and is atthe best level of enjoyment for him or her thatmedicine offers at this time; if you have a joboutside the home, your work is rewarding; ifyour job is home and family, you can look aroundand pat yourself on the back.

Now what? What about you? Your ownpersonal satisfaction? I’ve alluded to Maslow’s“Hierarchy of Needs” before but let’s have a littlerefresher. Everyone has needs and those lowerlevel needs must be satisfied first before we canmove to the higher levels. In priority order, theseneeds are Hunger — if you don’t have enoughto eat, nothing else is important. Security — ifyou don’t feel safe, you can think of little elseother than protecting yourself and your family.Shelter — once you’ve satisfied hunger andsafety, you need a roof over your head and someclothes to ward off the elements. The last needMaslow calls Self-Actualization— becoming thebest person you can be, making the most of yourtalents, skills, gifts and realizing your potential.Now, are these easily understood, or do theypose some questions? I think the latter. They

pose questions such as, what are the particulargifts I have? How exactly do I determine mypotential? And, how will I know when I am thebest person I can be?

Introspection is always hard, but it’s an ex-ercise that is truly good for the soul (and usu-ally the mind and body as well). Taking a goodhard look at oneself is the baseline of many pro-grams that focus on bringing participants togood mental emotional and physical health. So,I want you to get a little introspective. Find aquiet, kindly place, take a cup of your favoritebeverage and do some thinking — by yourselfand about yourself. Think about your gifts, yourtalents, your skills and ask if you’re making thebest use of them, at this time.

If you answer yes, then you are in harmony,your life is in alignment with the physical, men-tal, emotional, spiritual aspects all in sync. Youact, you think, you feel, and you know in anintegrated way. You likely have achieved self-actualization.

I’m going to assume that for most of usthe answer is yes, to some extent, in some areasof our lives and no, we haven’t reached that levelin other areas. “Okay, okay,” you say. “I barelyhave time to do all I’m expected to do as it is. Idon’t have time to work on ‘self-actualization.’In fact, I’m not sure I even have time to take acup of tea to a quiet place for half an hour ofthinking…let alone actually do anything about it!”

We are all busy. Everyone I know is busy.But, if you’re anything like me, sometimes that“busy” makes me feel as if I’m on a hamster’swheel running as fast as I can but going aroundthe same circle and not really getting anywhere.We become caught up in doing stuff — stuffthat may, or may not, be making the best use ofour gifts, talents and skills.

But, “I just don’t have the time to get in-volved.”

Time. The most illusive of all things we have,and we never seem to have enough of it. Mymessage is exactly about that. This day, this jour-ney through life can be spectacular and fulfill-ing. It can be, like the hamster wheel, pointless

and unrewarding. And, since with most thingsthere is no absolute black and white, but onlyshades of gray, it can be all things in between, indifferent amounts at different stages of our lives.

As you think about your life, your time,how to make best use of things for YOU, I wantyou to consider taking part in the RMS Alli-ance. We have many areas of community ser-vice: First Steps — mentoring teen moms; WigsWithout Worry — free wigs to needy individu-als who have hair loss due to medical treatment;Caring Hearts for the Homeless — hygiene sup-plies for homeless persons; Sexual Violence Cen-ter — prevention education in schools; Grow-ing Home — befriending/mentoring neglectedand abused kids; and Body Language — theannual week-long Health Fair for third graders.We are also part of a state-wide Alliance pro-gram to provide HIV/AIDS education foldersto all middle schools that request them (6,000folders in St. Paul last year). And, we’re part ofthe nation-wide Alliance program to StopAmerica’s Violence Everywhere (SAVE).

So, as you think about what you have tooffer, what matters to you, think about the Alli-ance. It offers fulfillment, friendship and fun.It’s rewarding, refreshing and relaxing. You willgain knowledge, grow personally and give back.If you are currently a member, come and joinus at programs and events that fit your needs. Ifyou are not a member yet, become one! TheAlliance needs YOU and YOU can gain muchfrom the Alliance. ✦

“A musician must make music, an artist must paint,a poet must write, if he is to be ultimately at peacewith himself. What a man can be, he must be.”

Abraham Maslow, 1954.

(For information on programs, community service op-portunities, and/or membership please call EleanorGoodall. Home763/441-8303; Office 651/268-6107.)



IHMS-Officers

Chair Virginia R. Lupo, M.D.

President David L. Swanson, M.D.

President-Elect T. Michael Tedford, M.D.

Secretary Richard M. Gebhart, M.D.

Treasurer Michael B. Ainslie, M.D.

Immediate Past Chair David L. Estrin, M.D.

HMS-Board Members

Ben Baechler, Medical Student

Michael Belzer, M.D.

Carl E. Burkland, M.D.

Herbert K. Cantrill, M.D.

William Conroy, M.D.

Dianne Fenyk, Alliance Co-PresidentJames P. LaRoy, M.D.

Barbara C. LeTourneau, M.D.

Monica Mykelbust, M.D.

Ronald D. Osborn, D.O.

Joseph F. Rinowski, M.D.

Richard D. Schmidt, M.D.

Marc F. Swiontkowski M.D.

T. Michael Tedford, M.D.

D. Clark Tungseth, M.D.

Trish Vaurio, Alliance Co-PresidentJoan M. Williams, M.D.

HMS-Ex-Officio Board Members

E. Duane Engstrom, M.D., Senior Physicians AssociationLee H. Beecher, M.D., MMA-TrusteeKaren K. Dickson, M.D., MMA-TrusteeJohn W. Larsen, M.D., MMA-TrusteeRobert K. Meiches, M.D., MMA-TrusteeHenry T. Smith, M.D., MMA-TrusteeRobert Finke, MMGMA Rep.

HMS-Executive Staff

Jack G. Davis, Chief Executive OfficerNancy K. Bauer, Associate Director

CHAIR ’S REPORTD A V I D L . E S T R I N , M . D .

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IT’S HARD TO BELIEVE a year has passedsince assuming the position of HMS board chair.I have been honored to participate, with physi-cians from the metro area as well as out-state, inissues important to our patients, our commu-nities, and our fellow physicians. Let me reviewat this time some of what we have accomplishedtogether.

The past year we have made progress to-wards fairer managed care contracts; we havepartnered with medical group administrators toshare with our members issues raised as a resultof independent review. We are working with theMMA to advocate for the adoption of futurecontracts consistent with the AMA model con-tract. We have explored other models of healthcare delivery, and will continue to strive for bet-ter alternatives. We continue to work on build-ing coalitions with others to advocate for whatis best for our patients. Board strategic plan-ning has helped shape our work plan, and hasresulted in a revised mission statement (whiche-mail and the Internet afforded our member-ship the opportunity to help shape). Our ex-panded website continues to attract significant“hits” every month. We have supported themedical school and have served as mentors formedical students. We established a forum wherechiefs of staff and vice presidents of medical af-fairs meet to discuss issues of common concern.We are exploring, with ethicists, a physician’sduty to the patient and the potential conflictsthat may arise within our health care system.We have continued advocacy in our communi-ties, especially for improving immunizationrates, reducing violence, and putting a stop totobacco exposure.

There are many reasons why HMS is astrong and thriving organization. Our hardworking staff is dedicated, talented and effec-tive. We have an active Alliance that does somuch good for our communities. We have com-mitted physicians who work tirelessly on behalfof their patients and their fellow physicians. Weare indebted to our families who allow us toserve patients and the medical profession dur-ing otherwise discretionary time. Medical stu-

dent and resident involvement in organizedmedicine encourages me, for they represent thefuture. Though we have accomplished much,sustained physician involvement will be requiredfor us to continue to realize our goals.

We are an organization with much diver-sity, yet this diversity is also a source of strength.We represent different specialties and practicesettings. We represent physicians nearing retire-ment and those who have recently entered prac-tice. We represent physicians employed by largeorganizations and those in private practice. Werepresent those active in medical associations orspecialty societies as well as those who presentlyare not.

I believe there are many core values weshare in common. We want to do the right thingfor our patients. We want the ability to recom-mend the most appropriate facilities, procedures,medications, and specialists for our patients. Webelieve in supporting medical education. Webelieve in promoting the public health. We be-lieve physicians should champion the medicalneeds of our communities. We believe that phy-sicians should be responsible first for the care ofthe patient, not the cost to the payer.

I have a vision of the future where physi-cians play a central role in health care; wherephysicians are respected for their compassion,caring, and dedication to their patients.

The Hennepin Medical Society has beenan effective vehicle for advancing our patient-centered physician agenda. Through the con-tinued involvement of those physicians currentlyactive, and the future efforts of those not pres-ently as involved, I believe we can realize thatvision.

To my colleagues and friends, I sincerelythank you for the opportunity to have served aschairman of HMS. It has truly been an honorand a privilege. Thank you for your ideas, yoursupport, and most of all, your friendship. ✦


In MemoriamTAGUE CLEMENT CHISHOLM, M.D., apediatric surgeon, died on September 7 at the ageof 84. He graduated from Harvard Medical Schooland completed his training at Childrens HospitalBoston, and Peter Bent Bingham Hospital Bos-ton. Dr. Chisholm joined HMS in 1948.

CHARLES FRIEND, M.D., died on Septem-ber 28 from a severe congestive lung condition.He was 79. He graduated from Tufts UniversityMedical School and completed his internship atSt. Barnabas Hospital. Dr. Friend opened a pri-vate practice on Lake Street in the 50s, specializ-

HMS NEWS

Charles M. Baker M.D.University of MinnesotaPediatric CardiologistChildren’s Heart Clinic, P.A.

Peter H. Bernhard, M.D.Michigan State Univ. College of Human MedicineUrology/Urologic SurgeryUrology Associates, Ltd.

Daniel Teh-An Chow, M.D.Northwestern University Medical SchoolObstetrics & GynecologyJohn A. Haugen Assoc., PA

Tore Detlie M.D.Univeristy of MinnesotaRadiologySuburban Radiologic

David L. Dunn, M.D., Ph.D.University of Michigan Medical SchoolGeneral SurgeryUniversity of Minnesota Dept. of Surgery

Paul Gerard Dworak M.D.Creighton University School of MedicineOrthopedic SurgeryOrthopaedic Consultants, PA

Thomas Knickelbine M.D.University of Wisconsin Medical SchoolInternal MedicineMinneapolis Cardiology Associates

Christopher J. Kovanda, M.D.Wayne State University School of MedicinePlastic SurgeryMidwest Plastic Surgery

Michael Joseph Legris, M.D.University of California School of MedicineNephrologyKidney Disease/Critical Care Associates, P.A.

Sheryl Ann Louie, M.D.Loyola UniversityObstetrics & GynecologyObstetrics & Gynecology West, P.A.

Marc W. Manley, M.D.University of Washington School of MedicinePublic HealthBlue Cross and Blue Shield of Minnesota - St. Paul

Rebecca L. Mitchell M.D.University of Wisconsin Medical SchoolInternal MedicineNow Care Medical Center

Frank B. Norberg, M.D.University of North Dakota School of MedicineOrthopedic SurgeryOrthopedic Medicine & Surgery, Ltd.

Kimberly H. Perkins, M.D.University of New Mexico School of MedicineFamily PracticeQuello Clinic

Richard F. Shronts M.D.University of MinnesotaNeurologyNoran Neurological Clinic

Loren N. Vorlicky, M.D.University of MinnesotaOrthopaedicsOrthopaedic Consultants, P.A. - Edina

Thomas C. Winegarden M.D.University of MinnesotaPsychiatryRonald D. Groat, M.D.

Robert J. Wood M.D.University of MinnesotaGeneral SurgeryGillette Children’s Specialty Healthcare

ResidentAzber A. Ansar, M.D.Al-Ameon Medical College, Kamataka UniversityInternal MedicineMercy Health System of Chicago

Daren S. Danielson, M.D.University of MinnesotaGeneral SurgeryHennepin County Medical Center

Aloke Kumar Mandal, M.D.Georgetown University School of MedicineTransplantationHennepin Faculty Associates

Michael John Ornes, M.D.University of Wisconsin Medical SchoolInternal MedicineAbbott-Northwestern Hospital

Alexander V. Panyutich, M.D.Minskij Medical Institute, Minsk, Byelorus, USSRHematology/OncologyUniversity of Minnesota

Mark Prebonich, M.D.Wayne State University School of MedicineInternal MedicineAbbott-Northwestern Hospital

Suzanne M. Skoog, M.D.University of MinnesotaInternal MedicineAbbott-Northwestern Hospital

Student(from the University of Minnesota)

Richard W.E. BurgBrant N. HackerDaryl J. KorFrederick J.P. LangheimDaniel Lee MarkBenjamin J. McKinleyPatrick Francis O’KeefeMartin D. Zielinski ✦

New MembersHMS welcomes these new members to the

Society as of August 2000. Schools listed indi-

cate the institution where the medical degree

was received.



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ELIZABETH K. JEROME, M.D. was recog-nized as the “pioneer in adolescent medicine inthis community” at the first annual SteppingStones Gala sponsored by the Hennepin Medi-cal Society and the Hennepin Medical SocietyAlliance. More than one hundred guests at-

THE ANNUAL MEETING of the HMS Boardof Directors was held on Thursday, October 12,2000, at which time Virginia Lupo, M.D. wasinstalled as its 94th Board Chair. Dr. Lupo ischief of the OB/GYN Department at Hennepin

Lupo Installed as New HMS Board Chair

Stepping Stones Gala a Success

County Medical Center and a maternal healthspecialist.

David L. Swanson, M.D., internal medi-cine/dermatologist at North Clinic, succeededto the role of President, and T. Michael Tedford,

M.D. otolaryngologist at Southdale Otolaryn-gology, was installed as president-elect.

In addition, Diane A. Dahl, M.D. washonored for her term as a member and Presi-dent of the Hennepin Medical Foundation. ✦

ing in family care. He also worked at the SpanoMedical Clinic in Minneapolis for nearly 20 years.Later, he founded his own clinic in northeast Min-neapolis. Dr. Friend joined HMS in 1950.

EDGAR G. INGALLS, M.D., died in Septem-ber at the age of 85. He graduated from the Uni-versity of Minnesota Medical School. He practicedOB/GYN at Abbott Northwestern Hospital formore than 40 years. He was a Founding Fellow ofAmerican College of Obstetricians and Gynecolo-gists. Dr. Ingalls joined HMS in 1949.

C. KENT OLSON, M.D., a neurosurgeon, diedin September at the age of 81. He graduated fromthe University of Minnesota Medical School andcompleted his internship at Minneapolis GeneralHospital. Dr. Olson joined HMS in 1994. ✦

tended the dinner and silent auction raisingnearly $7,000 for three adolescent health clin-ics serving youth in the west metro area. JanMalcolm, Commissioner of the Minnesota De-partment of Health, served as the emcee, andMichael Resnick, Ph.D., was the keynotespeaker. The event also commemorated the 90thanniversary of the Hennepin Medical SocietyAlliance. ✦

In Memoriam(Continued from page 30)

Volunteers Wanted!

Dr. Carol Johnson, Superinten-dent of the Minneapolis Pub-lic Schools, encouraged physi-cians to volunteer their time toserve as a student mentor atthe recent Senior Physician As-sociation luncheon.

For more information contact:Robin Cousins, MPS VolunteerOffice, at 612/668-3983.

Diane A. Dahl, M.D. is honored by VirginiaR. Lupo, M.D., for her term as President ofthe Hennepin Medical Foundation

David L. Estrin, M.D. receives the outgoingchair’s award from Virginia R. Lupo, M.D.

Elizabeth Jerome, M.D. addresses the group. Commissioner Jan Malcolm serves as emcee.


I

HMS ALLIANCE NEWS

Trish VaurioCo-President

Dianne FenykCo-PresidentIN 1995, THE AMA ALLIANCE initiated a

program to raise awareness of violence amongchildren and teens. Now in its sixth year, thisnational program entitled SAVE (Stop America’sViolence Everywhere) unites AMAA volunteersacross the country who work at the local levelto foster non-violent methods of coping and be-havior. Included under the SAVE umbrella aretwo paths of action: SAVE-A-Shelter and SAVESchools From Violence.

Although the second Wednesday of Octo-ber has been designated “SAVE Today,” the workand the anti-violence message of the Allianceare continual. Across the country, Alliances pro-vide educational materials for children, teach-ers, and community leaders to facilitate class-room discussions on issues related to violence.As part of the SAVE program, state and county

Alliances provide battered women, their fami-lies, and homeless families with financial andemotional support, and simple, effective lessonsin conflict resolution.

The Hennepin Medical Society Alliancehas participated in SAVE in a myriad of ways:we have sponsored shelter showers for Perspec-tives Transitional Housing and ProjectOffstreets; we have an on-going collection forwish-list items for the Minneapolis Crisis Nurs-ery; we distributed thousands of Pledge AgainstViolence forms to Minneapolis third graders(who then see their signed pledges on display atBody Works in the form of a “Peace Rainbow”);we collected food items for Metro area foodshelves; we distributed mittens and gloves toBannecker School students through the “YouAre Gloved” program; we worked at Kids’ Cafe;

and we purchased a “brick” tohelp sponsor new construction atthe West Metro Crisis Nursery.

This year’s SAVE Todayproject focuses on the message,“I Can Stop Violence.” The pro-gram incorporates a two-sidedpuzzle that features youth vio-lence statistics. Geared towardolder elementary students, thepuzzle declares, “I can stop vio-lence by…” and has a large blankarea for the child to draw a pic-ture of a positive way to demon-strate conflict resolution.

Funded by a grant from theAMA Foundation, the AMA Al-liance purchased 50,000 puzzlesfor free distribution to those Al-liances across the country thattook the initiative to develop aprogram around them and applyfor them (in the form of a grant).The HMSA created a programutilizing the puzzles, applied forand received 800! (This was oneof the highest totals in the coun-

try and HMSA has been featured on the frontpage of Newsline, News and Information for Al-liance Leaders).

We will incorporate the SAVE puzzle atBody Works, our five-day health education fairthat teaches third grade students about theirbodies and how to keep them healthy. By en-larging the puzzle and using Velcro strips wewill make it possible for several students to helppiece it together using teamwork. An Alliancevolunteer will lead a discussion on various waysto use hands in a positive manner. The childrenwill receive a SAVE puzzle to take home to sharewith a caring adult.

Body Works serves approximately 2,500students a year, and we have only 800 puzzles.We plan to purchase an additional 200 puzzles(at $1.35 a piece) so that the first 1,000 stu-dents that come through Body Works will re-ceive one. As usual, our Holiday Tea and SilentAuction will raise funds to pay for the additionalpuzzles. If any of you have an interest in pur-chasing puzzles to help us give one to more than1,000 third graders at this year’s Body Works,we would gladly accept your donation!

HMSA thanks all of you who attended andall of you who gave a donation to Stepping-Stones: A Gala Promoting a Foundation forHealthy Choices, our fund-raiser for The An-nex Teen Clinic, TAMS and West SuburbanTeen Clinic. Special thanks to HMS, Medica,Children’s Hospitals and Clinics and Dr. JohnFenyk for purchasing sponsor tables for theevent. The successful evening was the highlightof our 90th year. As of this printing, the finalfigure has not been determined — we will letyou know in the next issue. ✦

Dianne Fenyk, Co-President

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