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MetroDoctors The Journal of the Hennepin and Ramsey Medical Societies January/February 2001

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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

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2 PHYSICIAN’S SOAP BOXManaged Care System Beyond Repair

4 FEATURE: WORKER SHORTAGEWhere Have all the Doctors Gone?

8 No Room in the Inn

10 Twin Cities Area Hospitals Facing a Capacity Crunch

12 COLLEAGUE INTERVIEWPaul F. Bowlin, M.D.

16 Blazing New Trails —Reclaiming Independence and Self-Reliance

18 Shortage of Health ProfessionalsChallenges Health Care Delivery System

20 Medical School Applicants on the Decline

22 Fostering Medical Students

28 CME Conference: Abusive Behavior in the Medical Workplace

RAMSEY MEDICAL SOCIETY

24 President’s Message

25 RMS Annual Meeting

26 Applicants for Membership

27 RMS Alliance

HENNEPIN MEDICAL SOCIETY

29 Chair’s Report

30 HMS In Action

31 HMS News/Hoban Scholars/In Memoriam

32 HMS Alliance

On the cover: The Twin Cities arefacing a shortage of medicalworkers. Articles begin on page 4.(Photo: © Pulschen/CustomMedical Stock Photo.)

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2 March/April 2001 MetroDoctors The Journal of the Hennepin and Ramsey Medical Societies

Managed Care System Beyond Repair

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

HEditor’s Note: An earlier version of this editorial was published in TheSaint Paul Pioneer Press Tuesday, December 26, 2000:17A.

HEALTH CARE WAS A MAJOR ISSUE in the recent election.Candidates leveled various degrees of criticism against the currentManaged Care/Health Maintenance Organization system. Fewdefended it. Why? And what happens next?

HMOs have failed in their promises to control costs and deliverquality care. Employers experience double-digit price increases to insureemployee health benefits. Families complain about the lack of patientfocused care.

The HMO system was created in 1973 as it promised to control arapid rise in medical cost-price inflation. What triggered this inflation?

The first step toward inflation was taken in 1943. The WageControls Board found a way to raise worker pay despite the World WarII wage freeze; tax-free dollars could be added to a paycheck if themoney was used for health care insurance—fringe benefits were born.With the real price of quality medical goods and services hidden,inflation developed with the increased demand for more and better care.The inflation was funded in part by transfer of money into medicinefrom other vital segments of the economy. In 1965, demand inflationwas further stimulated by Medicare and Medicaid legislation. Althoughthis piecemeal approach to American style National Health Insurancemeant that the majority of citizens had tax-subsidized coverage, the nearpoor must still fend for themselves.

By 1973, policy makers and legislators thought it politicallyimpossible to take away the popular tax subsidies driving inflation.Instead, they turned to HMO power for rationing the supplies of careavailable to the client populations of the ‘buyers of care’ in industry andgovernment. All were led to believe that HMO corporations, driven byprofit motives to keep people healthy, would more wisely spendinsurance dollars than could Americans themselves. The impossiblepromise of the HMO Act of 1973 was to meet the conflicting goals ofquality and open access to care on a fixed budget. It has not worked.

Certain basic flaws have caused failure of the HMO system, asystem which functions by means of corporate command and controlnetworks. One flaw is that “health maintenance” was never more than a

slogan since there are no medical means to keep a large populationhealthy comparable to public heath measures. But the chief flaw hasbeen that managers must invoke their own wisdom for allocation ofresources since they lack the accurate and prompt information availablein any other industry where spending by thousands or millions ofconsumers is guided by prices. Yergin and Stanislaw (in The Command-ing Heights, 1998) noted that the same lack of market information fromconsumer spending resulted in the collapse of the nationalizedcommand and control industrial networks in Western Europe. By 1980,these planned industries suffered from inflation, poor quality products,erosion of infrastructure, and enlarging bureaucracies in futile attemptsto solve their problems with even more planning. The inherentinefficiencies of these economically blind bureaucracies created arelentless need for subsidies despite the efforts of good and well-meaning managers. There is no real remedy for these inept authoritariancommand and control structures.

It is curious that policy makers now routinely deplore authoritar-ian command and control structures for any industry but continue tosupport them for rationing medical care. Meanwhile, the practicalresponse of HMO industry managers has been to protect theircorporate treasuries. Many strategies are used. These include queuing(delay or denial of patient care), selling policies to only the healthy andwealthy, raising premium prices while they can to subsidize theirweighty bureaucracies, and transferring financial risk of insuring care toclinics. A sign reported to hang in one Medicaid HMO on the WestCoast reads, “Cost, access, quality — pick any two.”

It is no wonder that the HMO system has generated publicconcern and caught the attention of political candidates. What’s next?

One proposal would transfer power from HMOs to governmentusing a single payer system, such as in Canada. This would ration careby fixing the supplies as well as prices for producing services based onthe wisdom of planners and policy makers. Meanwhile, the currentpolicy and practice of U.S. federal and state “single payers” is to enticethe Medicare population and to force the less powerful Medicaidpopulation into HMOs in order to ration their care.

In contrast, private insurance proposals aim to return choice andfinancial power to people by having them retain their own money toinsure health care. Advocates believe that all people, employed or not,should be eligible, and note that “job lock” from fear of losing healthinsurance would be eliminated. These proposals would make peopleprice sensitive for ordinary medical expenses, fully cover major expenses,B Y R O B E R T W . G E I S T , M . D .


and, theoretically, could be expanded into cost-effective healthinsurance for all Americans.

Tax credit proposals would have the government return or givemoney, on an income related basis, directly to individuals for buyinginsurance. Support for this type of tax credit might prove politicallydifficult, since it would eliminate the current popular employer-basedsystem of insuring health care.

Medical Savings Accounts (MSAs) coupled with a major medicalinsurance policy would put about 40 percent of health care dollars intoan individual’s own bank account for ordinary expenses such as officevisits, laboratory tests, prescription drugs, and so forth. The other 60percent would pay for the associated major medical policy. The averageMSA family spends only 30 percent of the dollars from their savingsaccount each year and can invest the rest for future health care needs.

For this reason, MSAs are often called “medical IRAs.” Major medical/MSA policies have the same tax advantage now enjoyed by HMOs, butsevere congressional restrictions have made MSA policies almostunmarketable.

Will our newly elected political leaders find a way to replace thefailed HMO system of manager and policy-maker sovereigns rationingcare? Will people, with the power of using their own money to purchasemedical care, again be kings in the medical marketplace? It is not a surething. That’s why political leaders need a loud and clear message fromthe American people to find the best system—one for the benefit ofpatients. ✦

Robert W. Geist, M.D. is a retired urologist, residing in North Oaks, MN.


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

W

Wo r k e r S h o r t a g e

Where Have all

the Doctors Gone?

B Y P E T E R B O R N S T E I N , M . D .

IntroductionThe SPIDA ExperienceWorker shortages are no surprise during a booming economy. Many physicians haveexperienced frustration when attempting to admit patients to a hospital, only to be told“There are no beds.” Actually, there are often physical beds, but no staff for those beds.Although the hospital staffing crisis has been well known, from nurses to pharmacists tosocial workers to therapists of all stripes (administrators, too?), little has been expressedabout a physician shortage.

At our practice, St. Paul Infectious Disease Associates, Ltd., (SPIDA) we have beenlooking for a new physician for over two years. Although we briefly had a new physicianin the summer, this California import, with no ties to Minnesota, soon left to return tohis wife in Orange County. Although we have interviewed many fine applicants, nonehad a Minnesota connection.

The effect of our physician shortage has been a change in the nature of our practice.Gone is the in-office IV infusion business, a victim of low margins reimbursed to us bythe few insurance companies that would pay for this service. Closed is the highly com-mended Travel Medicine service. Our low reimbursement from insurance companies,and time-intensive nature of high-quality pre-travel counseling meant little return forthis business. Additionally, our appointments ballooned to a five to seven week waitingperiod for new referrals. Because we became so busy doing only what we could do, infec-tious disease consultations, we gave up most of our invasive procedures, such as lumbarpunctures and central venous catheters to the radiologists and nurse-staffed PICC lineservices. We now only schedule patients sent from other physicians — no “walk-ins” orunreferred patients. As our services have become more proscribed, we are more depen-dent on reimbursement from patient services to pay our salary and that of any new hires.It should come as no surprise that it is difficult to offer a nationally competitive salarybased on local reimbursement.

What is the Effect of the Problem?Longer Wait Times for AppointmentsAs fewer physicians are available, waits for non-emergent appointments become longer.Physicians and surgeons will continue to triage important cases. For some hospitals, thishas meant more “off-hour” surgeries and procedures, as overloaded surgeons push morecases to the end of the day.

Although thehospital staffingcrisis has been wellknown, from nursesto pharmacists tosocial workers totherapists ofall stripes(administrators,too?), little hasbeen expressedabout a physicianshortage.


Fewer internistsavailable meansmore patients beingsent to medicalsub-specialists formanagement ofproblems previouslyhandled by thegeneral internist.

(Continued on page 6)

More Physician Practices Closed to New PatientsIn St. Paul, as the number of retiring internists exceeds the number of new internists, itbecomes more difficult to find an internist open to new patients. While many familypractitioners are capable of handling complex and geriatric patients, this is an area inwhich internists have been especially trained. Fewer internists available means more pa-tients being sent to medical sub-specialists for management of problems previously handledby the general internist. Some internists have closed their practice to new Medicare pa-tients. This helps them bring the age of their patient panel downward, and perhaps in-crease their income and ease their workload.

Hospitals Having Trouble Retaining Physicians for StaffAs seen at the recent opening of Woodwinds Campus in Woodbury, there is increasingreluctance of already overextended physicians and surgeons to travel to a new hospital,even one as beautiful as Woodwinds. Few specialist physicians are hungry enough to addan hour of driving time to see a handful of patients, unless they already live in the Woodburyarea.

More Difficulty With Continuity of CareMuch has been written about the rise of hospitalists, and their effect on continuity of careof the patients. Yet, for already overextended primary care specialists, the time spentcaring for ever-sicker hospitalized patients draws them away from their busy clinics.Hospitalist services make it easier for these primary care physicians to stay at their clinics.For busy hospitals, this means physicians that are more facile at manipulating the hospi-tal systems to get the patients out faster.

The effect on specialty groups has been different. Busy specialists have also trans-formed their physicians into hospital-based physicians, in order to increase their effi-ciency in caring for their heavy loads. The most striking example I have observed is incardiology services, where a patient may have separate cardiologists who manage theircare on the wards, read their echocardiogram, do a transesophageal echocardiogram (ifindicated), perform cardiac catheterization, and, if necessary, place a pacemaker or defibril-lator. No wonder the patients and I don’t know who their cardiologist is!


(Continued from page 5)

The Genesis of the ProblemWhen trying to attract new physicians, theproblems we have can be summarized as:no pay, no weather, and nobody in training.

Relatively Lower PayI won’t delve into this area too deeply.Much has been written elsewhere about allthe reasons pay is lower for many physi-cians in the Twin Cities than in other com-parably sized and expensive cities. The listof reasons is long: Medicare reimbursementrates, penetration of managed care,MinnesotaCare provider tax, etc. It is fairto note, however, that there are some areasof the country, such as California, wherethings may be even worse than here.

Reduced TrainingMany specialists in St. Paul have expressedto me the deficit in trainees in their spe-cialty at the University of Minnesota. Sev-eral different medical specialists tell me theretirement rate exceeds the training rate fortheir discipline. For example, the Univer-sity has not graduated a trainee in infec-tious diseases in over three years. No doubt,some of this is due to a nationally orches-trated attempt to reduce the number ofspecialist physicians begun over 10 yearsago. However, national strategies can havedeleterious effects on local conditions.Most subspecialty trainees are at major aca-demic metropolitan areas of New York,Chicago, San Francisco and Boston. If, bythe time they are in their early thirties, theyhave already established roots in their com-munities, it is a high barrier to bring themto another community.

Fewer FTE’s?Are there fewer physicians, physiciansworking less strenuously, or some just plainworking less? The answer is all of the above.In addition to fewer specialists coming into

training, many primary care physicians arelooking at “total lifestyle” — time with thefamily, other avocations — as being asimportant as the practice of medicine. Thisis not necessarily a bad thing, but some-thing to be worked into the equation. Theentrance of women into medicine, andindeed all aspects of American professionallife, has also changed practice patterns. Itis too simplistic to look at only the factthat female physicians are more likely totake time away from practice to care fortheir families. Male physicians with pro-fessional wives also need to spend moretime taking care of their families than whenwomen stayed home alone. Some malephysicians may also choose to relinquishthe practice of medicine while their bet-ter-paid spouses provide more for theirfamily unit than the male physician spousecould.

Earlier RetirementsLet’s face it. Despite the troubles with thestock market at the end of 2000, we havejust finished the longest economic growthperiod in American history, and one of thelongest Bull Runs on Wall Street as well.For many older physicians, these eventshave accelerated the growth of their retire-ment portfolios, and making feasible anearlier retirement. This phenomenon is notisolated to physicians, as many teachers andother professionals are faced with similarhappy circumstances.

Practice StressAgain, this is an area of which much hasbeen written, and I will not recapitulate ithere. This is a popular essay topic in Medi-cal Economics. Additional practice stressand uncertainty does all the more to pressthe older physicians to early retirement.

Minnesota WeatherThe price of a perfect Minnesota summeris six months of winter. For most people

south of a line stretching from Boise toDenver to Chicago to Cincinnati to Phila-delphia, surviving and enjoying a Minne-sota winter is inconceivable. Even mymother, born and raised in Chicago, ex-claimed to me when I told her I was mov-ing to St. Paul said, “What do they do upthere in the winter, sit around in theirhouses?” As much of the U.S. populationgrows up in the south, it is difficult to con-vince them to move north.

What to Expect ifNothing ChangesContinued Exacerbation of ProblemUnless changes occur, I would expect tosee continued slow progression of the prob-lems we are already dealing with. The im-pending demographic tsunami of seniorsmeans more people requiring cardiovascu-lar, oncologic and orthopedic care. As phy-sicians become more stressed, and unableto hire help, they will choose to limit theservices they provide to those that are ei-ther most required to save lives or increasetheir income. Follow-up appointments willbe curtailed. This will mean more delaysof therapy, and perhaps lives lost, as pa-tients wait to see physicians.

Physicians Dropping out of ManagedCare Plans, Perhaps MedicareAs physicians and surgeons find themselveswith more work to do, it will be easier todrop the lowest paying plans. Currently,for most practices, the lowest payors arealso those with the largest panels of pa-tients—Medicare, Blue Cross, Medica andHealthPartners. While size matters, if somepractices are 20 to 30 percent too busy, itwill be easier to relinquish the lowest pay-ing group, no matter how large. EvenMedicare is not off the table.

Referral of Non-Urgent Casesto Other LocalitiesIf physicians are too busy, and booked out


tals or health plans to publicize the crisesfacing health care. Their public relationsdepartments will not allow them to expressany information that may undermine theconfidence of the public in their institu-tions.

Working More Closely With ManagedCare Organizations and HospitalsTighter integration with managed care in-formation systems may increase physicians’ability to obtain important healthcare in-formation about their patients. I wouldcertainly appreciate having more timelyand accurate information when seeing pa-tients referred from other physicians.

Hospitals are spending a lot of timeand money to upgrade their informationmanagement systems. Learn them. Learnhow to use the computer. Most of thesesystems are designed to increase the speedand accuracy of information management.If these systems do not help you, then letthe hospitals and health care systems knowthis is occurring.

Global WarmingHey, warmer winters may not be that bad.When Florida is flooded by rising globaltides, people will need to go somewhere.

ClosingThat Which Doesn’t Kill UsMakes Us StrongerWhen this crisis ends, chances are physi-cians may be in a stronger position thannow. There is no substitute for what phy-sicians and surgeons do. A system that doesnot support us will notice when we are notable to take care of them. Hopefully, thissupport will come before too many livesare lost, and not after. ✦

Peter Bornstein, M.D., an infectious dis-ease specialist, practices at St. Paul Infec-tious Disease Associates.

too far ahead, it may become necessary tosend non-urgent cases out of town for care.No doubt this occurs already for some spe-cialized care, especially cancer surgery. Per-haps it will also occur with other less spe-cialized cares.

Remedies for the SituationIncrease PayOf course, more money would certainlyhelp, from a basic economic standpoint.But with a limited supply of healthcare dol-lars, physicians join other providers at thetable. “Get it done in 2001” buttons areappearing on nurses around the Twin Cit-ies, reflecting their determination forhigher pay in their new contract negotia-tions. I suspect many physicians will besympathetic to their position.

A popular sentiment among physi-cians is to demonize managed care ad-ministrators, especially when reading pub-lished reports of munificent consulting feesfor plans of dubious value. While thereexists a natural adversarial tension betweenphysicians and administrators, it is impor-tant for physicians to realize the entirehealthcare system in Minnesota is relativelyunderfunded.

Physicians may also have to get aggres-sive about seeking income from non-pa-tient care sources, which are not under tightrestriction by Stark II laws. Other incomesources may include direct consulting withindustry and healthcare entities, increasedmedicolegal work, and office-based re-search for pharmaceutical and devicemanufacturers.

Repealing the MinnesotaCare taxwould be helpful, but alone would not beenough to keep physicians in practice.

Increase Training in Minnesotaand the Twin CitiesKey groups or hospitals may have to sub-sidize training to ensure an adequate sup-ply of practitioners. Partnering with the

University of Minnesota is important, butit may be important for hospitals or largepractices to look at other potential teach-ing institutions as well. An example isHenry Ford Hospital, Detroit, where I didmy residency, which has academic affilia-tions with several centers, such as the Uni-versity of Michigan, Ann Arbor and CaseWestern Reserve University, Cleveland.Minnesota would be better off being a netexporter of well-trained practitioners, thana net importer.

The University of Minnesota shouldbe strengthened by the legislature and com-munity to increase training for physicians,pharmacists and nurses, as well as otherallied health professionals. Although I havenoticed general antipathy toward the Uni-versity from many physicians, we all needa strong University as the best source forfuture practitioners.

Increase Grassroots Lobbying About theNature of Healthcare Provider ShortageGrassroots lobbying needs to start wheregood healthcare starts: the patient-physi-cian relationship. Physicians need not beshy about talking with their patients andfamilies about the problems facinghealthcare providers. Most seniors have noidea that Medicare benefits differ from stateto state, and that Minnesota is on the lowend of the reimbursement scale. This is es-pecially galling considering we pay thesame Medicare tax rates as the high reim-bursement states. The United States Con-gress determines Medicare reimbursementrates. I tell seniors who are frustrated totell the congressional representatives whatis happening to them. Most people alsohave no idea that physicians pay an extratax to support MinnesotaCare.

And when your patients cannot beadmitted to the hospital in a timely fash-ion, do not blame a non-existent “bedshortage.” The real problem is that hospi-tals are understaffed. Don’t expect hospi-


N

No Room in the Inn

B Y G . P A T R I C K L I L J A , M . D . ,F A C E P

(NO ROOM IN THE INN and now the stableis full, so the poor little donkey has no place togo.) Recently, TV news programs, nationalmagazines and even the Minneapolis Star Tri-bune featured stories on “Packed ERs TurningAway Ambulances” (Star Tribune, January 7,2001). These stories, however, have not focusedon the underlying problem creating the ambu-lance diversions. The problem is not too manyindividuals coming to the emergency room;rather it is a lack of available inpatient hospitalbeds.

Unfortunately, we continue to have thosewho believe that if only people with non-emer-gency problems wouldn’t use ERs then the emer-gency departments would not be overcrowded.In fact, the recent Minnesota Public Radiodiscussion of this issue resulted in several in-dividuals calling in stressing the view that if onlypatients with sore throats would go to their doc-tor instead of the ER, the problem would goaway. Even U.S. Surgeon General David Satcher,M.D., in an article published in the October14, 2000 Boston Globe, reported to have saidthat the only thing that will help the problem isto educate people not to go to the emergencyroom unless they really need to.

The current problem of ambulance diver-sions in the Twin Cities is NOT related to peoplefilling our emergency rooms with minor medi-cal problems. While the emergency departmentremains a safety net for people who otherwisewould not have access to care, this is not thereason that ambulances are diverted. Minormedical problems may fill up the emergencydepartment waiting rooms, but it is the seri-ously ill patients who are filling up all of ouremergency department beds.

Patients are being held in emergency de-partments for long periods of time because thereis not enough available staffed beds in the hos-pitals to admit the acutely ill and injured in ourcommunity. This is particularly true for criticalcare beds.

There are a number of reasons for this on-going problem. One is certainly the lack of ad-equate health care professionals such as RNs,X-ray techs, lab techs and others. It may also bea lack of individuals to clean rooms once pa-tients are discharged so they are quickly readyfor the next admit. We may be unable to dis-charge patients because there is not a place inthe community, such as nursing homes, withavailable beds to which they can be safely dis-charged.

Lastly, we must realize that the patientscoming to our emergency rooms are sicker andolder than they were ten years ago. This meansthat a greater percentage of ER patient admis-sions are to a critical care bed. When our emer-gency room beds become filled with sick pa-tients waiting for admission, the logical thingfrom the hospital’s perspective is to try and di-

vert ambulances to other facilities since we can-not close our doors to those who walk in.

The Twin Cities ER Medical Directorsbegan realizing three or four years ago that hos-pitals were diverting ambulances with increas-ing frequency. While this was a new phenom-enon in the Twin City area, it actually startedoccurring in other parts of the country muchearlier. Today almost all major metropolitan ar-eas in the United States are facing the same prob-lem.

Over the last two years the HennepinCounty EMS Council has attempted to addressthis issue and recently noted that the numberof ambulance diversions in the Twin Cities hasincreased on a monthly basis. In one situation,an ambulance was turned away from three hos-pitals before they finally were allowed to go to afourth hospital. It was almost like the ambu-lance was driving from motel to motel hopingto find a sign outside that said “vacancy” ratherthan “full.”

The east metro system also had similarconcerns during this period of time and adopteda policy that only two hospitals in the East MetroEMS System could be closed at any one time.The Hennepin County EMS Council (WestMetro EMS System) adopted a similar policy.While this policy helped for a period of time, asthe number of diversions increased and the timehospitals wished to remain closed became longer,the EMS system once again became stressed.

On November 1, 2000, the HennepinCounty EMS System, that includes hospitals inHennepin, Anoka, Carver and Scott Counties,adopted a new ambulance diversion policy. Ifhospitals felt they had reached maximum ca-pacity they could request to close for a maxi-mum of four hours. This would hopefully al-low them to bring in additional resources to dealwith the patients waiting for admission in the


emergency rooms. At the end of this period theywould have to reopen for a minimum of fourhours. In addition, only two hospitals in thesystem could be closed at any one given timeassuring that patients would always have a facil-ity to which they could be transported.

Also, if the other hospitals in the systemfelt they were being totally overwhelmed, theycould request that all hospitals in the systemreopen for a minimum of four hours. It wasalso clarified that ambulances that were alreadyen route to a hospital would continue to thathospital if the hospital decided to close duringthe transport period. Ambulance crews who feltthey had a critical patient needing immediateemergency care could, in all cases, bring thatpatient to the closest emergency room even ifthey were closed.

Finally, an Internet connection was estab-lished between all hospitals and ambulance dis-patch points in the Twin Cities. A system calledEMSystem was funded by a grant from theMetro Regional EMS Board, Minnesota De-partment of Health, and Hennepin CountyCommunity Health. This system allows allambulance dispatchers and emergency depart-ments to have computer access to the open andclosed status of all hospitals in the greater TwinCities area. In addition, hospitals can changetheir status from open to closed on-line. Thesystem also keeps track of how long hospitalshave been closed and notifies them when theyhave to reopen. Hopefully the system will pro-vide data on the frequency and length of allhospital closures enabling us to better plan forthe future.

While we currently have a system for am-bulance diversions that is working fairly well, itobviously creates other problems for physicians.Ambulances deliver patients to hospitals wheretheir physician does not have privileges. Thisobviously destroys the continuity of care as wellas making it difficult to access the patient’s medi-cal records. It also means that physicians at thereceiving hospital will be asked to care for pa-tients that they are not familiar with and whomthey know will not remain their patients oncedischarged.

Most importantly, it does nothing to cor-rect the underlying problem, which is lack ofin-hospital bed capacity. The current diversionpolicy does not provide a remedy if all of thehospitals in the Twin Cities area are over capac-

ity at the same time. The plan at this point callsfor all hospitals to remain open to all ambu-lances and the hospitals will have to figure out away to take care of the patients as they keepcoming in.

In the long term, we must readjust our sys-tem to assure that we have the in-hospital ca-pacity to adequately care for the acutely ill and

injured. If we do not, we will continue to facethe problem of how patients needing acutemedical care can find “room in the inn.” ✦

G. Patrick Lilja, M.D., FACEP, is medical direc-tor Emergency and Trauma Services, North Me-morial Health Care. He is also medical director ofNorth Memorial Medical Transportation.

West Hospitals Oct. Nov. Dec. East Hospitals Oct. Nov. Dec.Abbott Northwestern 2 2 5 Children’s – St. Paul 0 0 0Children’s – Mpls. 0 0 0 Fairview Ridges 2 0 0Fairview Riverside 1 9 0 Regions 0 0 1Fairview Southdale 0 0 8 St. John’s 0 0 1Fairview U of M 1 1 10 St. Joseph’s 0 0 0Hennepin County 4 3 2 United 2 2 8Mercy 1 2 5 Woodwinds 0 0 0Methodist 3 3 8North Memorial 1 3 12Ridgeview 0 0 1 MONTHLY TOTAL 4 2 10St. Francis 0 0 0Unity 6 6 17MONTHLY TOTAL 19 29 68

Hospital Closing SummaryMonthly Closings by Hospital (4th Quarter 1999)

* Table does not include multiple openings in a single day, and no system alerts were issued for East MetroHospitals indicating they were required to open.

*Number of days in month when MRCC required all west metro hospitals to open

Month Total Required OpeningsOctober 1November 5December 16Total 22

West Hospitals Oct. Nov. Dec. East Hospitals Oct. Nov. Dec.Abbott Northwestern 18 9 27 Children’s – St. Paul 0 0 0Children’s – Mpls. 0 0 0 Fairview Ridges 4 6 4Fairview Riverside 1 2 4 Regions 8 11 4Fairview Southdale 3 4 6 St. John’s 10 8 12Fairview U of M 20 7 6 St. Joseph’s 9 2 2Hennepin County 28 9 13 United 9 8 6Mercy 2 0 2 Woodwinds 0 3 0Methodist 9 6 21North Memorial 13 1 10Ridgeview 0 1 1 MONTHLY TOTAL 40 38 28St. Francis 1 0 0Unity 7 1 3MONTHLY TOTAL 102 40 93

* In reviewing reports created by EMSystem that was implemented September2000, multiple entries related to single closing events were noted. These werereported previously as separate closing events. Repeated events are likely dueto users editing previous entries. This report counts only closing events thatwere followed by a period of time being open.

** The Hennepin County EMS System ambulance diversion policy was changedNovember 1, 2000. The revised policy states no more than two hospitals inthe west metro area can be closed at one time. When the third hospital at-tempts to close, all west metro hospitals are required to open.

*** Table does not include multiple openings in a single day, and no system alertswere issued for East Metro Hospitals indicating they were required to open.

**Number of days in month whenMRCC required all west metrohospitals to open

***

Month Total Required OpeningsOctober 11November 3December 4Total 23

EMSystem Summary*Monthly Closings by Hospital (4th Quarter 2000)

The report does not count times whenonly labor/delivery was closed


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Twin Cities Area HospitalsFacing a Capacity Crunch

B Y A N N S C H R A D E R

IT’S CRUNCH TIME for Twin Cities area hos-pitals. Like most other hospitals in the U.S., theyare facing significant capacity issues. This articleaddresses the reasons for the capacity issues andwhat hospitals can do/are doing about it.

The reasons for the capacity crunch aremanifold: the looming “boomer bulge,” the rap-idly shrinking number of people entering healthcare (especially nursing) professions, recent up-swings in acuity and complexity of care, the be-ginning stages of “baby boomer” demand, etc.

The impacts of this tightening capacitysituation are obvious: more ambulance diverts,increased demand on ERs, and chronic staffingchallenges. Needless to say, the increase in trans-fers, diverts and delayed admissions has resultedin increasingly frustrated physicians, nurses andpatients.

It’s a truly sobering situation. At a not-too-distant point, if robust solutions aren’t devel-oped and implemented, patients may experiencedelays in scheduling of treatment and the finan-cial viability of hospitals will be threatened.These solutions cannot be attained by hospitalsacting alone. This article addresses the elementsof the capacity crunch, what hospitals/healthcaresystems are doing to ameliorate the situation —and why hospitals can’t provide long-term solu-tions by themselves.

Financially FetteredThe irony is that even though area hospitals areoperating at or near capacity, they aren’t ben-efiting financially. There are many reasons forthis, chief among them being poor reimburse-ment from Medicare and Medicaid. HMOs arepaying their costs, but just barely. The reim-bursement issue is glaringly illustrated by the

fact that Medicare and Medicaid combined payonly 80 percent of their patients’ incurred costsfor care, while constituting almost 50 percentof hospital volume.

Reimbursement might be less of an issueif Minnesota hospitals were for-profit businesseswith high margins. Instead, hospitals here arelow-margin, nonprofit entities. HealthEast’s hos-pitals make their margin on just 8 percent oftheir business — and they are experiencing theirthinnest margins ever, further limiting alreadynarrow options for reinvesting and retooling.

Yet another financial squeeze stems fromincreased lengths-of-stay (LOS). Hospitals aretypically paid per stay, not by how many days apatient is under hospital care. Therefore, hospi-tals lose money on any patient who stays be-yond the allotted dollars for their particular di-agnosis. Increasing LOSs are occurring for avariety of reasons, key among them the agingpopulation and increased acuity.

Physicians face ever-increasing pressures,making them less available in the hospitals, at atime when patients are presenting with morecomplex medical needs and are requiring morecare coordination. Hence, some patients end upstaying a day or two longer in the hospital. LOSis the classic financial Catch-22 for hospitals —increased staffing demands that result in increasedexpenses, combined with fixed payments for suchpatients, which results in decreased net margin.

Divert DilemmaAccording to a recent StarTribune article, head-lined “Packed ERs saying no to ambulances,”Twin cities-area hospitals went on divert statusabout 1,000 times last year. The article statedthat the nationwide hospital crunch “has increas-ingly left (ER) patients backed up like planeswaiting for takeoff during a storm,” and gavethe impression that the safety of patients is be-

ing routinely jeopardized because of the increas-ing number of diverts.

While the number of diverts has gottenuncomfortably high, the actual number of im-pacted ER patients is smaller than the articlewould lead one to conclude, for a couple of rea-sons. First, it has to be kept in mind that mostER patients never encounter a divert situation,because they don’t arrive by ambulance. In fact,more than 80 percent of ER patients are notbrought to the hospital by ambulance. Second,even in cases where ambulances are diverted,these vehicles and their crews are, in essence,mobile intensive care units. So, few diverts be-come life-or-death situations. But when they do,the ambulance crew has the authority to over-ride the divert, and take their patient to the near-est hospital.

But what about the capacity situation gen-erally? Isn’t it true that hospitals occasionally getso full that they can’t accommodate any moreinpatients? Yes, this is happening, and it is ofcourse a troubling trend.

Long-Term Care ComplicationsBecause of the capacity crunch, long-term carefacilities are being asked to take more patients,the rationale being that such facilities have of-ten served a transition role for recuperating pa-tients who don’t need all of the services involvedwith hospital care, but still need monitoring andmedical attention. But this is not a viable strat-egy, for a number of reasons. First, long-termcare facilities are even more impacted by theindustry’s staffing shortages. A state legislativetask force noted that $90 million dollars wouldneed to be spent in the next two years to attractand retain workers. It’s not expected that thelegislature will pony up the suggested amount.

And as a recent Star Tribune editorial (“Ac-tion on long-term care needed this session,”


The most criticalelement necessary for

hospitals to gainsome breathing room

is adequatereimbursement rates.

January 22) noted, the future of long-term careis a huge question mark for reasons other thanstaffing shortages, among them facilities that “areaging into obsolescence.”

The editorial noted that as many as a dozenlong-term care facilities in Minnesota mightclose this year — taking them totally and per-manently out of any “recuperating” strategy,even if such a strategy were otherwise viable. Italso noted another of the task force’s key recom-mendations: The state should immediately startshifting away from having long-term care facili-ties as the centerpiece of its senior care policies.

The long and the short of the task force’srecommendations is that long-term care wouldnot be in any position in the future to serve anenhanced “recuperating” role to relieve pressureon hospital beds — quite the opposite. In fact,the existence of fewer nursing homes will exac-erbate hospitals’ capacity problems not just bymaking fewer “recuperating” beds available, butby putting some nursing home patients back inhospital beds. This will only exacerbate LOSrates and make fewer beds available for otherpatients. Unless viable alternatives to nursinghomes are created that can take the pressure offof hospital capacity, the cycle will only worsen.

Fewer Nurses, But Patients AplentyIronically, just as the nation’s boomers start turn-ing into seniors, the number of young peopleentering the nursing profession — and the num-ber of people who are staying in the profession— is slowing markedly. The practical and per-turbing effect is that, just as the need for morebeds to handle the boomers and their medicalneeds is increasing, hospitals are being forcedto staff fewer beds.

How serious is this staffing shortage? Interms of both people and time, very serious in-deed. According to some industry experts, thenursing shortage is an enduring one, threaten-ing to last for the next 20+ years. University ofMinnesota Medical School Dean Al Michael wasquoted in a recent newspaper article to the ef-fect that nursing schools are already havingtrouble filling their rosters. And with the aver-age age of nurses in the Twin Cities metro areastanding at 47, it’s not hard to see what the im-plications are when these folks reach retirementage — let alone the issues of early retirement,job changes, etc.

Area hospital administrators are address-

ing the shortage situation in a variety of ways.One tactic that’s being implemented is chang-ing assignments and responsibilities among carestaff, so that nursing time is more fully spent onthose activities that require nursing expertise.HealthEast and other healthcare systems are alsolooking to other countries, such as the Philip-pines, to develop a pipeline of high-qualitynurses and techs. But these are, for the mostpart — and by necessity — “make-do” efforts,which do not change the fact that the staffingshortage is a long-term phenomenon, and onethat is not easily mitigated.

sota Hospital and Healthcare Partnership alsohas a working group that is focused on meetingcapacity challenges.

One very vital factor in easing the EastMetro area’s capacity crunch is the new 70-bedhospital at Woodwinds Health Campus inWoodbury. Opened last August, this full-ser-vice hospital has surgical and intensive care ca-pabilities, with comprehensive adult and pedi-atric emergency room services. With its abilityto handle 2,000 emergency room patients amonth, the hospital promises to be a signifi-cant and timely element in keeping down thenumber of diverts in the East Metro area, anddealing with the increasing number of more-acute patients. It will also provide critical bedcapacity for handling short-term patient increasescaused by such seasonal phenomena as flus.

ConclusionAs noted above, hospitals are giving intense at-tention and energy to solving capacity issues.These efforts — including doing everything intheir power to make it easier for physicians tomanage patient care in an effective, expedientmanner — must continue unabated. But hos-pitals can’t solve the problem alone.

The most critical element necessary forhospitals to gain some breathing room is ad-equate reimbursement rates. Simply put, thelegislature and Congress need to “up” the Medi-care and Medicaid payment rates to hospitals,so that these programs are actually coveringthe cost of care. On these and other health carefinance issues, the standard behavior of state andfederal governments has been an unwillingnessto recognize or to respond appropriately to thetrue costs. It remains to be seen whetherpolicymakers can effectuate a “sea change” intheir mentality and their attendant resource al-locations that will help enable hospitals to getahead — and stay ahead — of the financial curve.

Beyond obtaining better reimbursement,easing the capacity crunch will require theRamsey and Hennepin Medical Societies andothers representing the medical profession topartner with hospitals, medical transportationproviders and policymakers to design a long-term solution that truly addresses the “rightplace, right time” cycle in a community-basedsystem of care. ✦

Ann Schrader is Chief Operating Officer,HealthEast Care System.

Long-term, strategic efforts are underway.Among them is an East Metro workforce devel-opment task force, which is moving to increasethe supply of RNs and pharmacy, radiology andlab techs. Local hospitals are also pushing for acollaboration among themselves, state and lo-cal governments and colleges to attract and edu-cate talent for RN and tech positions.

Countering The Capacity CrunchEast Metro hospital administrators have begunwork on minimizing the operational effects ofthe capacity crunch. Among the solutions be-ing put in place are better bed management/utilization plans, which include such aspects asearlier-in-the-day discharges. Physicians are alsodoing advance education of patients and fami-lies regarding discharge, to assure that when thepatient gets discharged, he or she has someoneat the ready to take them out of the hospital.Also, changes are being instituted in the wayelective surgeries are scheduled, and hospitalsare revisiting whether certain types of patients,who in the past have been routinely hospital-ized, can be effectively taken care of in otherways. Still at question is whether we have the“right place, right time” solutions that operatesystematically for the community. The Minne-


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

Paul F. Bowlin, M.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, interview questions were asked by Drs.:Bruce Adams, E. Duane Engstrom, William E. Jacott, Dennis Lee, Will-iam E. Petersen, Jamie Santilli, Richard K. Simmons, and Kent Wilson.

As a member of the University of Minnesota AdmissionsCommittee for 10 years, were there any characteristics ofapplicants that you predicted would make them outstand-ing physicians?

This question addresses one of the greatest frustrations I experienced as amember of the Admissions Committee. We had no method of routinefollow-up on students selected by the committee. It would be very helpfulif the selection process had some statistical measures addressing such stu-dent outcomes as: medical school GPA, performance on national boards,residency choice, and finally, the student’s ultimate practice location. Thesecorrelations would require data sets extending out six to 10 years. Suchcorrelations are not kept by the medical school. They should be.

That said, the committee did use certain selection criteria. In myopinion the most important criteria beyond academic parameters, are evi-dence of strong internal motivation for medicine and evidence of a “car-ing” personality or attitude. These qualities may be ascertained by theapplicant’s attempts to investigate medicine as a career, to participate inpatient contacts in some fashion as well as information gained from thepersonal interview and recommendation letters.

In the end, you must realize that the selection process has consider-able unavoidable subjectivity to it. Overall, the committee has done anoutstanding job of selecting applicants considering the meager follow-upinformation available.

Do you think there is, or will be, a physician shortage inMinnesota? What factors have contributed to a shortageand what may be done as a remedy?

I have no current data to answer this question factually. My impression isthat there may be physician shortages developing in certain specialtiesand sub specialties. However, I have no facts to back up this impression.As for potential future remedies vis-à-vis physician shortages, the answersare complex and multiple.

Medicare and Medicaid payment schedules for Minnesota are so lowthat physician incomes are seriously impacted when compared with otherparts of the country. We can train good physicians in Minnesota, but wecannot force them to practice in Minnesota when they can earn substan-tially more elsewhere. Our congressional delegation should insist on Medi-care payment adjustments.

It has been shown in published studies that applicants to medicalschool who come from rural communities have the greatest potential forreturning to rural communities to practice medicine. Therefore, specialconsideration in the selection process might be given to rural applicantsinterested in family practice.

Nominal increases in incoming class size might be considered. How-ever, this would require cooperation from the state legislature in increas-ing the funding to the medical school. Is this a realistic expectation?

On a more philosophic and futuristic note, I have recently read aninteresting book by a Harvard Business School professor namedChristiansen. It is entitled The Entrepreneurs Dilemma. In it he describesthe rise and fall of certain well-run companies that have become victimsof what Christiansen calls “disruptive technology.” He implies that thebest candidate for disruptive technology in medicine would be the com-puterized medical record. The further implication of this being that suchtechnology could open the door to wider use of lesser trained medicalpersonnel, i.e., physician assistants, nurse practitioners and Pharm D’s;thereby decreasing the need for primary care physicians (read lower costpersonnel). It is only a short leap from that construct to the assumption


that fewer physicians may be needed in the future! An interesting thought!The Christiansen book should be required reading for all physician lead-ers.

How can the University of Minnesota Medical SchoolAdmissions Committee increase the number of students whowould have an interest in a rural primary care practice?

A partial response to this question was posited in the previous answer, i.e.,select more applicants from rural origins and you will probably have moretrained primary care physicians returning to their rural roots to practicemedicine. An additional aspect of the answer would be to emphasize andexpand the RPAP (Rural Physician Associate Program) at the medicalschools. This has been an effective recruitment tool for rural practice. Apotential third answer to this question might be the newly developed for-eign medical opportunities now being offered by the medical school. Thirdworld medicine experiences have the potential of increasing student inter-est in primary care and secondarily in rural medicine.

Do you believe it necessary for a Vice President of MedicalAffairs to continue practicing medicine in order tomaintain credibility?

The question refers to my six year stint as director of medical affairs atFairview Southdale Hospital from 1986-1992. I have only my personalexperience to relate to this question. In my case, it made no difference.But then I had been in practice in the community for almost 30 years, waswell known by the staff of the hospital, and was asked by the staff leadersto take the position. A younger person with less time in practice or withno ready made medical staff relationships might find some continuingpatient contacts necessary to maintain credibility with his/her peers. Inother words it is dangerous to generalize in this area. Each situation mustbe judged on the multiple elements brought to the decision table.

What was the most rewarding experience as Vice Presidentof Medical Affairs?

My whole experience as director of Medical Affairs was rewarding for me.I have very warm feelings for the hospital, administration and its medicalstaff for the six years of working together. Two things stand out in mymemory. The 1987-1990 period was a time when measurement of clini-cal quality of care rose to prominence. We began with a development of aquality department allied with a quality committee of the medical staff. Itwas a learning experience for all. The cooperation of the medical staffleaders and the hard work of the quality staff resulted in the gradual in-crease in number and accuracy of measurements and a demonstrable re-duction in adverse clinical events in the hospital. The cooperation of themedical staff was remarkable. Interestingly, my closest mentor in this pro-cess was Harvey Golub, a member of the Southdale Hospital Board ofTrustees and later the CEO of American Express. His insight into the

quality of care process was absolutely brilliant.The second memory I have is the remarkable cooperation from the

medical staff leaders I received on the occasional need to mete out medicalstaff discipline. Discipline is a task to be avoided if at all possible. It maybring long term consequences for both parties yet, on the rare occasionwhen tough discipline was called for, the medical staff leaders performedadmirably and the recipients of the discipline were better for it. A veryrewarding record and memory.

How did you manage the tension inherent in a medicalstaff/hospital administrative relationship?

This question recognizes the potential difficulties at the border of clinicalpractice and administrative necessities. As the complexities of hospitalcare increase, the potential for conflict at the edges increases. In truth, Iexperienced little difficulty with this. In administrative meetings I alwaysrepresented the concerns of the medical staff. In medical staff meetings Itried to explain the hospital’s position. Two ploys helped: humor alwayslightens up a difficult or tense presentation. I used it liberally. Secondly,you always should be well prepared. Physicians respond to documenta-tion, literature references, etc. So do hospital administrators. The onlytime the resolution of issues was not satisfactory was when I approachedthe subject matter in a too cavalier fashion. In other words, there are nosimple issues only less complex ones.

You served on the Metropolitan Health Board—what wasits charge?

This question requires that I dredge up ancient history. It refers to myseven year stint on the Metropolitan Health Board from 1977-1984. Therewere only two physicians on this appointed body most of that time. Thisvolunteer service was my first experience in health care politics. The Boardwas quite political. It had a monitoring and planning function vis-à-vishealth care facilities in our seven county metro area. However, the Board’smajor function was to implement the Certificate of Need (CON) legisla-tion passed by the state legislature in the early seventies. This was a majorpublic attempt via legislation to control the content, location, and mix ofhealth care facilities in the name of cost control. All capital expendituresby health care entities over $250,000 were required to go through theCON process. The hearings were very contentious. The physicians andhospital members argued for market forces to control capital spendingdecisions while most board members opted for bureaucratic central plan-ning. In 1980 and 1981 the board embarked on a four phased approachto close hospital beds and limit expenditures for the rapidly advancingtechnology such as CT scanners and MRI machines. This outraged theprovider members of the Board and ultimately resulted in my submittinga carefully referenced minority report to the Board’s final hospital closingdocument. Almost incidentally, the state legislature came to the realiza-tion that the CON efforts were counter-productive in the health care




community. By 1985 and 1986 the Certificate of Need law was repealed.That was the end of attempts to control health care costs by centralizedplanning of capital expenditures. It just will not work.

Recently many hospitals in the metro area have requiredambulances to drive to other facilities due to bed/staffingissues. Do you feel we are on the verge of a hospital healthcare crisis? What strategies should be used to prevent thecontinued diversion of patients to other facilities? Wouldthese issues have been a role for the Metropolitan HealthBoard?

Diversion of ambulances due to lack of available beds has been a periodicproblem in our community for many years. The current economic reali-ties dictate that we run a “lean” hospital system vis-à-vis beds. Insurers areloath to pay for “empty beds” or “moth balled beds.” This system courtsdisaster under a public health emergency scenario, i.e., bioterrorism, largechemical or radiation spills, etc. Our public health policy is relatively si-lent on this issue and public interest or money is not available to addressthe implications of such a bed shortage.

If the ambulance diversions now occurring are due to hospital staff

shortages rather than bed unavailability this is a problem of considerableconcern to me. I worry about the health and welfare of our colleagues inthe nursing profession. Increased job stress, demand for longer hours,sicker patients to care for, and a general lack of respect for their efforts, alladd up to lower recruitment, early retirements, and more competitionfrom other industries for bright young people. This truly could be thebeginning of a real crisis in hospital care. Prevention strategies will varydepending upon the cause. Medical staff triage policies, emergency roomobservation units, and rapid discharge plans have all been tried with vary-ing success. On the staffing side of the issue, longer term efforts are neededto attract bright young people into nursing. A tough assignment in theface of competition from medicine, law, and high tech industries.

We cannot escape the reality that healthcare is labor intensive, stress-ful, and requires highly trained, dedicated, altruistic individuals. Healthcare professions must be restructured to attract such people against thecompetition posed by other attractive vocations. My seven year experi-ence on the Metropolitan Health Board leads me to opine that the HealthBoard would not be up to the task of solving the questions posed. TheMetropolitan Health Board was a prime mover in reducing the numberof hospital beds under the assumption that empty beds were non-produc-tive and cost the system money. On the other hand, the MetropolitanHealth Board could be a player in public health disaster planning in areassuch as recruitment of nursing home beds, use of military facilities, andout of area evacuations etc.

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Can you give us your thoughts on the basic HippocraticOath and how this relates to the new economic forcesphysicians are subjected to in practice?

This is a fascinating question — one I have thought about at some length.The Hippocratic Oath requires physicians to do what they feel is best fortheir patient and above all else not to harm the patient. The managed careenvironment asks the physician to interpose cost in his/her decision vis-à-vis care of the patient. The tension inherent in this change of philosophyis obvious.

In my opinion, cost considerations per se, in a physician’s decisionmaking are not wrong or unethical. However, the process used to con-sider the cost implications of a specific decision may have anti-Hippo-cratic consequences. Examples that come to mind are:1. Physician risk contracts that reduce physicians income if patient care

costs exceed a predetermined level;2. The threat of annual contract non-renewal solely on the determina-

tion that the physician’s practice is not cost-effective;3. Denial and/or substitution of requested diagnostic tests based solely

on computerized standard practice parameters with no exceptions;4. Denial and/or substitution of prescribed drugs based on an estab-

lished formulary with no exceptions; and5. I’m sure the reader can name other egregious inroad on the Oath

better than I.As the managed care systems have become more sophisticated and

sensitive to patient and physician’s concerns, certain modifying processeshave been developed that blur the anti-Hippocratic tenor of the relation-ship, i.e.:1. Allowable exceptions in diagnostic testing and prescribing;2. Appeal procedures;3. “Opt out” clauses that allow individual patients to share in costs of

non-formulary drugs or non-protocol tests; and4. Attempts to measure overall patient’s severity or burden of illness in

individual practices as a way of modifying financial penalties.The end result of all these machinations has been an overall decline

in the quality of a physician’s practice environment due to:1. The “hassle factor;”2. Challenges to physician autonomy;3. Increased non-productive time spent dealing with insurance matters;4. Increased office overhead secondary to staff additions necessary to

deal with managed care entities;5. Decline in the quality of the doctor-patient relationship due to out-

side interference; and6. Etc.

What are one or two conclusions you have reached afteryour career as a practicing physician, a public volunteer,and as a hospital Vice President of Medical Affairs?

1. The one-on-one doctor-patient relationship still rules in medicine.It is the most effective means of improving health of individuals.

2. Physicians continue to be the most honest, ethical, caring, well-in-tentioned professionals in the world.

Please feel free to add any other thoughts or concerns youhave about the profession of medicine.

I have enjoyed answering these very well thought out questions. My thanksto my colleagues that posed them to me.

This opportunity to make a few additional comments must be seized.To those colleagues who are discouraged about the current state of medi-cine and the practice environment I say, “Take Heart.” Medicine is still awonderful profession filled with many satisfactions at the doctor-patientlevel. Yes medical practice is changing, but the essence of the doctor-pa-tient relationship endures. The public needs us to work with and advisethem as medicine evolves into a better system for both patients and thosewho provide care.

Finally, I believe that the dysfunction in our health care system at itscore is one of an abnormal funding/economic factors. Employment basedhealth insurance has outlived its usefulness. Our society has the ability toinsure all citizens at affordable base cost while preserving strong elementsof user choice, tax deductibility, and public support of low income citi-zens. At this time our society lacks the political will to embark on thevarious experiments necessary to test the proposed changes. We shouldencourage those efforts as much as possible.

Thank you for the opportunity to express myself on these very diffi-cult issues. ✦


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Editor’s Note: The following five physiciansagreed to participate in this article exploring thereasons for leaving a group practice environmentand the challenges/rewards of independent prac-tice. The next issue of MetroDoctors will inter-view physicians making the move from indepen-dent to group practice.• David Gilbertson, D.O., family physician,

St. Anthony Park Clinic, St. Paul, MN• Richard Morris, M.D., allergy, asthma and

immunology, Allergy and Asthma Care, P.A.,Maple Grove, MN (opening February 19)

• T. Michael Tedford, M.D., otolaryngology,Ear, Nose & Throat Clinic and Hearing Cen-ter, Edina, MN

• James Zavoral, M.D., preventive cardiology,Preventive Cardiology Institute, Edina, MN

• Kimberly Anderson, M.D., internal medi-cine, Adult Medicine, St. Paul, MN

IT MAY NOT EQUATE TO THE settling ofthe West but the unfolding story of metro doc-tors seeking independence and personal fulfill-ment is part of a great American tradition.

I recently talked with five of them — someare well down the trail toward independence andothers are just starting out. It was great to hearexcitement and anticipation again in the voicesof doctors — tempered of course with a healthydose of apprehension.

Making the Decision toChoose IndependenceDoctors are choosing to go back to indepen-dent practices because they want to be respon-sible for their decisions again. They want to prac-

tice styles of medicine that match their valuesand their patients’ expectations.

I heard variations on this common story:I merged my practice into a big system. They

told me I could continue to practice as I had. Laterthey said I was costing them too much money. Iwasn’t meeting goals. Then they said they were go-ing to close the office. That’s when I decided I hadto get out.

Reporting to non-doctors bred dissatisfac-tion and damaged collegiality. As Gilbertson putit, “We stopped caring about each other underregimented business models and processes.”System executives “were not seen as account-able to doctors, their involvement felt more likeinterference than leadership” Morris asserted.

How Practices ChangeAfter the BreakWhen I asked about their return to indepen-dence, without hesitation they said:• I’m much happier and my patients can tell

it.• I set my own pace and focus of my activities.• I decide how much time to spend with each

patient.Operating at a human scale matters to these

doctors. In smaller settings patients don’t haveto navigate layers of bureaucracy to get to them.In independent groups, doctors have intimateknowledge of the business side of the practiceand they bear the consequences of decisions. AsMorris quipped, “I can make on-the-spot deci-sions — I don’t need a committee to make mis-takes for me.”

They learned they can survive after walk-ing away from corporate medicine. “There wasnot nearly the competition for patients that Iexpected,” said Kim Anderson, M.D. “Thereare so many people out there looking for a morepersonal style and higher standard of care.”

Anderson talked about an older patientwilling to bear a much higher co-pay if he couldstay with her. I asked her why conventional(HMO) wisdom maintains that patients aren’tloyal and they’ll switch plans and groups to savea few dollars. We wondered what happens to

Blazing New Trails –Reclaiming Independence and Self-Reliance

B Y B O B T H O M P S O N

I asked them why they felt a loss of enthu-siasm and dedication after joining a system-owned group. “Our work turned into an eightto five routine,” lamented David Gilbertson,D.O. “The culture of large organizations is theproduct of compromise,” said Michael Tedford,M.D., adding: “They resist change, they missopportunities.” Richard Morris, M.D. observed,“There may be some economies of scale butmostly their bigness just feels cumbersome, in-efficient.”

“You have to get outwhen you believe

your patients are notgetting the kindof care you wantto give them.”

T. Michael Tedford, M.D.


the doctor-patient relationship when too manyaspects of medicine are viewed through the lensof marketing and finance.

Among the five I spoke to, none were surehow their incomes would fare over the next fewyears. Some said lower incomes are more a partof larger medical trends than any personal deci-sions about practice settings. While nobody ex-pected to make big financial strides by goingindependent, being in control gave them a newsense of security. “At least I feel I can continueto practice medicine the way I want to and Ididn’t feel that way before,” emphasized JamesZavoral, M.D.

Reasons to ConsiderIndependenceThe right time to consider a change is whenyou feel it in your gut. The depth of emotionthat drove these doctors out of systems and intoindependent practice was palpable.

Tedford put it bluntly; “You have to getout when you believe your patients are not get-ting the kind of care you want to give them.”He continued, “When the culture is not con-sistent with your values and the compromisesyou’re making are not honestly acceptable, makea change.”

“You have to practice a style of medicinethat fits your values and your beliefs,” echoedGilbertson.

Advice to ColleaguesConsidering IndependenceAlmost uniformly everyone said, “go for it” whileadding a few cautions.

“Be clear about the type of practice youwant,” Morris advised and then, “sleep on it awhile, don’t act out of emotion, and talk to yourfamily about how it will affect them.” Return-ing to independence is easier, Zavoral pointedout, “When you have loyal patients who appre-ciate a high quality and personal style of medi-cine.”

You can’t take loyalty to the bank so “fi-nancial literacy about the business side of a prac-tice is essential,” Gilbertson cautioned. He re-minds colleagues that “having enough capitalto make independent decisions is a great ad-vantage.” Anderson added a warning born ofexperience, “Don’t take on a lot of overhead earlyon.”

Freedom and independence don’t meangoing it alone. Morris felt that joining a net-work, in his case Minnesota Specialty Physicians,strengthened his resolve and eased the change.Tedford urged “Choose a knowledgeable, expe-rienced consultant to help. Give yourself twicethe lead time that you expect — and stay flex-ible.”

The Future of Medical PracticesAfter telling me their experiences and

hopes, I asked them about future prospects forAmerican medicine.

Anderson recounted how one system medi-cal director told her “doctors are at the bottomof the power chain now.” Gilbertson saw moreof the older generation of doctors leaving medi-cine as soon as they could financially swing it.

Morris’ pessimistic side saw “applicants tomedical schools declining, an increasingly regi-mented health care system, and continued con-trol by insurance companies and financiers.” Hisoptimistic side saw “creativity coming back asmore doctors are engaging in strategies to im-

prove care and to make medicine a more re-warding profession.”

Zavoral predicted new variations on fee-for-service medicine would make a comeback.Gilbertson anticipated “Medical savings ac-counts will give patients the flexibility to buythe kind of care they want from whom theywant, although HMOs and insurers will fightMSAs right to the end.” Tedford believes“Greater personal responsibility for the costs ofcare will stimulate patients to hold physiciansdirectly accountable for services they provide.”

For this group of doctors and all those oth-ers striking out on the trail to independence,they’ll be ready to satisfy the demand for medi-cine on a human scale. ✦

Bob Thompson is an independent hospital andphysician consultant. Bob has worked across theU.S. enabling doctors, hospitals and hospital sys-tems to improve their performance and regain asense of purpose. He once worked for a large healthcare system in the Twin Cities. He can be reachedat [email protected], or 952/929-7270.

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Shortage of Health ProfessionalsChallenges Health Care Delivery System

OUR NATION IS EXPERIENCING a short-age of health professionals, which is reflectedhere in Minnesota. What is at risk for Minne-sotans is continued access to the quality of healthcare that we have come to expect and rely upon.

The shortage is already challenging ourhealth care delivery system. As our populationages, this shortage will become more acute, pri-marily because the increased demand will comeat a time when a large number of health profes-sionals are approaching retirement age. Cur-rently, not enough younger workers are beingtrained to fill the projected gap.

The workforce shortages are felt most dra-matically in the areas of nursing, dentistry, phar-macy, and medical technology, but there’s also ashortage of rural physicians and specialty phy-sicians, particularly in the areas of internal medi-cine, general surgery, pediatrics, obstetrics/gy-necology, geriatrics, and cardiology.

The University of Minnesota AcademicHealth Center is supporting a statewide effortinvolving MnSCU and Minnesota’s private col-leges to solve the workforce problem. Duringthe last year, the AHC has developed a visionwith an overarching goal to prepare the newhealth professionals who improve the health ofour communities, discover and deliver new treat-ments and cures, and strengthen the economicvitality of our health industries. Our vision issupported by our strategic plan, which includesa detailed approach to addressing the health careworkforce shortages.

That plan, however, is dependent on re-ceiving funding from the Minnesota Legislature.Overall, the University of Minnesota is request-ing $221.5 million from the Legislature overthe next biennium, which includes $33.7 mil-lion for the AHC. The AHC request includesthree primary components:

1. Core funding to close the gap between rev-enues and expenses in the Medical School.

2. An investment to rebuild the MedicalSchool’s faculty.

3. An investment to address shortages inMinnesota’s health care workforce.Regarding the third item, we’re asking the

state to provide $7.1 million to address workforceshortages in nursing, pharmacy, dentistry, andmedical technology. That funding would be usedfor the following purposes:

• The College of Pharmacy proposes to ex-pand its enrollment by 50 percent beginning infall 2002. This includes creating a site in Duluthfor 50 students, who will complete three yearsof the program there. The fourth-year experi-ential clerkships for students will be providedat locations outside of the Twin Cities, includ-ing Duluth, St. Cloud, and Rochester. Today,there is already a critical shortage of pharma-cists, with over 200 unfilled openings in Min-nesota. That shortage is projected to grow asthe population ages, and we increasingly relyon drugs for chronic health problems related toaging. An enrollment increase will bring Min-

nesota to the national average of 3.1 pharmacygraduates per 100,000 people. It will ensure thatMinnesota has sufficient pharmacists to play alarger role in patient care, managing drug thera-pies, and reducing medication errors.

• The School of Nursing proposes to es-tablish a satellite of its Bachelor of Science Nurs-ing (BSN) program in Rochester by fall 2002.That program will be part of the University ofMinnesota campus in Rochester, and a collabo-rative effort with Mayo Foundation andMnSCU. The joint effort will enroll a total of60 students — 30 in the University’s BSN pro-gram, and 30 students in MnSCU programs atWinona and Mankato. This is a first step to-ward addressing statewide nursing shortages.Today in Minnesota, there are more than 1,700openings for registered nurses, and 180 posi-tions for nurses with specialty preparation,which reflects the national shortage of nurses.As health care shifts from hospital settings tothe community and home, and as the state’spopulation ages, the demand for nursing carewill continue to increase.

• The Academic Health Center proposesestablishing a satellite of its highly ranked medi-cal technology program in Rochester, in collabo-ration with the MnSCU system and the MayoFoundation as part of the development of theUniversity of Minnesota campus in Rochester.The program would enroll 20 students each year.Currently, there are nearly 100 unfilled open-ings for medical technologists statewide, andMinnesota continues to have a shortage of thesehealth care professionals despite the fact thatthere are three accredited medical technologyprograms in the state. Demand for medical tech-nologists is accelerating with medical advancesand the increasing complexity of diagnostic pro-cedures.

B Y F R A N K B . C E R R A , M . D .


• The School of Dentistry proposes estab-lishing a new program designed to recruit andtrain dental professionals in rural communities,where the need is greatest. The request will funda full-service, low-cost dental clinic in partner-ship with MnSCU and Hibbing CommunityCollege, and a second clinic in conjunction withthe Otter Tail County Public Health Depart-ment. Under the plan, 20 percent of the school’sundergraduate dental and dental hygiene stu-dents and 12 of its graduate dental residents willserve clinical training rotations in one of the clin-ics. These students will provide services for 8,000to 10,000 patients. School officials say thatabout 50 percent of students of such rural pro-grams join existing rural practices upon gradu-ation and that about 10 percent open new prac-tices. Rural communities are already experienc-ing a shortage of dentists and dental hygienists.The shortage will become critical statewide asmore than 21 percent of the state’s dentists areexpected to retire in the next 10 years.

Medical SchoolCurrently, there is a shortage of about 300 phy-sicians in Minnesota. Included in the Univer-sity of Minnesota legislative request is $16 mil-lion to stabilize our Medical School’s core fund-ing. Since 1992, the cost of education in theMedical School has exceeded revenues becauseof reduced patient care fees. Many measures havebeen taken to offset the deficit, including sell-ing the University’s hospital, streamlining op-erations, and raising tuition by 28 percent. Inaddition, the school lost 84 faculty positions and86 staff positions because of market forces. TheMedical School has used $67 million in cashreserves and endowments to cover shortfalls.Today, despite these efforts, a gap remains be-tween revenues and expenses. In order to main-tain current enrollments and provide primarycare physicians and specialists for Minnesota,the Medical School is requesting this fundingto stabilize its budget. Without these funds, theMedical School will be forced to cut core pro-grams and enrollments. This will mean fewerdoctors for Minnesota at a time when we needmore doctors to care for our aging population.

The Medical School is also seeking fundsto hire additional clinician-scientists and re-es-tablish its leadership in education, research, andpatient care.

Throughout our history, the AcademicHealth Center has prepared the health profes-

sionals who care for Minnesotans when they aresick. Now our future — and the future healthof Minnesotans — is at risk. Through our stra-tegic planning process, we’ve realigned resourcesand reduced costs within our schools and col-leges. We are now well positioned to preparethe health professionals of the future. However,we need a new covenant with Minnesota andits communities to ensure a healthy future. Weneed your help in this effort. Please contact yourlegislators and let them know that you support

the University of Minnesota Academic HealthCenter legislative request. Please join the AHCCommunity Network by contacting the AHCOffice of Communications at 612-624-5100 orsign up on-line at www.ahc.umn.edu/legislative/2001/postcard.html. Thank you. ✦

Frank B. Cerra, M.D. is Senior Vice Presidentfor Health Sciences, University of Minnesota Aca-demic Health Center.

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Medical School Applicantson the Decline

WHY ARE THERE FEWER NUMBERS ofmedical school applicants? This is a questionthat has attracted the attention of all of us —both professionals and the public at large. Thelocal press, as well as publications from the As-sociation of American Medical Colleges, havereported on the steady decline in the number ofmedical school applicants over recent years. Forthe national applicant pool this trend began in1997 and it has continued through to thepresent time. The highest number of medicalschool applicants ever was reached in 1996 with46,968 applicants. This decreased to a nationalapplicant pool of 37,136 for the 2000 enteringclass.

Historically, ebbs and flows have been ob-served in the size of the national pool of medi-cal school applicants. In 1988, a decliningapplicant pool reached its nadir and a less com-petitive applicant pool, as evidenced by declinesin Medical College Admissions Test (MCAT)scores and undergraduate grade point averages,emerged. In contrast, the more recent decreasein the number of medical school applicants hasnot been associated with decreasing qualifica-tions. In fact, there has been an upward trendin applicants’ academic qualifications (e.g., meanundergraduate GPA has risen, MCAT scoreshave increased) despite the reduced applicantpool. Also, recent applicant levels are still con-siderably higher than in 1988 when there werefewer than 27,000 medical school applicants.

While the number of applicants has var-ied considerably, the number of students thatmedical schools have enrolled and graduated(approximately 16,000 students a year) has re-

mained stable over the past two decades. Hence,the ratio of accepted applicants has ranged from1.7 to 2.9. In 2000 the ratio was 2.3 (16,301accepted applicants and 20,835 non-acceptedapplicants). Many applicants are not acceptedbecause of the competitiveness of the medicalschool applicant pool, rather than due to poorqualifications.

plicant pool was at its lowest level in 1987. Also,the most recent decline in the number of appli-cants began in 1995 (vs. 1997 nationally). Theapplicant trends at the University of MinnesotaDuluth School of Medicine have been similarto those at the University of Minnesota Medi-cal School - Minneapolis. Mayo Medical Schooldid not begin experiencing the most recentdownward trend in number of applicants until1999. The second area of discrepancy is relatedto the number of entered students. While thenational figures for entering students have re-mained fairly constant at approximately 16,000,the University of Minnesota Medical School -Minneapolis has had a decrease in entering classsize from 238 in 1983 to the current class sizeof 165. Entering class size at University of Min-nesota Duluth School of Medicine has shown aslight variation over the same time period (48-53 students/year) and Mayo Medical School’sentering class size has increased from 40 to 42in that same time frame.

Although, the number of rejected appli-cants continues to exceed the number of appli-cants accepted into medical school each year,and the competitiveness of the applicant pool isnot being compromised by the decreasing ap-plicant pool, there is mounting concern overthe possible factors contributing to the fewernumber of medical school applicants. Further,there is an underlying fear that the future phy-sician workforce may suffer from lack of quali-fied graduates. Though no precise cause for thedecline has been identified, it is theorized thatfactors in two domains may be contributing tothe applicant decline. Namely, those related spe-cifically to medicine and those related to thebroader social context. The individual factorshave been cited as the following:

Except for two specific areas, the data forthe University of Minnesota Medical School -Minneapolis has mirrored that of the nationalpool. In the first area, declines in the applicantpool have been observed earlier here than na-tionally. With 786 applicants, the University ofMinnesota Medical School - Minneapolis ap-

Establishing aphysician workforce

to practice themedicine of

tomorrow and tomeet the healthcare

needs of peoplefrom a greater

variety of culturesrequires vision and

focused effort.

B Y M A R I LY N J. B E C K E R , PhD. ,LP


• Decrease in physician compensation;• Perceived loss of physician autonomy;• Heightened fears of malpractice litigation;• Growth of managed care;• Strong economy;• Increasing variety of challenging, high-pay-

ing professions/careers;• Natural highs and lows of interest in pro-

fessional schools; and• Rise in educational debt.

Simply stated, there are concerns about thedecrease in the attractiveness of medicine as acareer due to “negative images of contemporarymedical practice,” the increased appeal of othercareer options for high ability individuals, andthe costs associated with pursuing a medical ca-reer.

The challenges of contemporary medicalpractice are apparent and recognized by physi-cians and applicants alike. The current declinein medical school applicants has led many tothink broadly about the future of medicine, the

“whole” of being a physician (in terms of boththe positive and negative aspects), medical prac-tice and services in Minnesota, and the poten-tial for upcoming physician shortages within ourstate.

Without a doubt, there continues to be apool of highly qualified individuals seeking toenter the medical profession. However, there isno guarantee that this situation will continue,or that the diversity of Minnesota’s physicianworkforce will automatically increase with theincreasing diversity of the population of Min-nesota. Establishing a physician workforce topractice the medicine of tomorrow and to meetthe healthcare needs of people from a greatervariety of cultures requires vision and focusedeffort. The Medical School has evolved to meetthe needs of medical students and futurehealthcare needs of Minnesota through exten-sive recruitment efforts, an enriched curriculum,establishing an increasingly diverse student body,and providing new options in dual degree pro-

grams (MD/MPH, MD/MBA). There also ex-ist many challenges and opportunities for phy-sicians. It is through direct contact withphysicians that students learn of the “possibili-ties” of a career in medicine, of what it is like tobe a physician, of the new frontiers in medi-cine, of how to pursue a medical career. TheHennepin and Ramsey Medical Societies, inconjunction with the Medical School, have be-gun to strategize on ways to collaborate to pro-mote careers in medicine and establishmeaningful connections between our presentand future physicians. The myriad of opportu-nities for physicians in the 21st century makesthis healing profession an attractive career. TheMedical School is anxious to partner with thecommunity to attract the brightest and mostcompassionate students into medicine. ✦

Marilyn J. Becker, Ph.D., LP, is Director of Ad-missions for the University of Minnesota MedicalSchool.


Fostering Medical Students

HHMS AND RMS have been very visible at anumber of recent medical student activities.

• Lunch ’n Learn — On January 9, nearly200 first and second year medical students gath-ered to learn about the pros and cons of thePatient Bill of Rights, presented by Ann Kinsella,J.D., Assistant Attorney General, and MichaelScandrett, J.D., Executive Director, Council ofHealth Plans. Janis Amatuzio, M.D., forensicpathologist, will be the featured speaker at theFebruary 15 session.

• Mentoring Program — First year medicalstudents and their physician mentors met forbreakfast to kick-off the “Connections” programon Friday, January 12. Eugene Ollila, M.D.,president of the University of Minnesota Medi-cal Alumni Society and former HMS Chair,spoke about the unlimited opportunities formutual growth and nurturing in this physician/medical student mentoring program. HMS,RMS, the U of M Medical School, and Medi-cal Alumni Society are the co-sponsors of thisprogram. Numerous HMS and RMS membersare participating in this mentoring program.

Eugene Ollila, M.D., President of the MedicalSchool Alumni Society addresses the students.

Craig Eckfeldt, Greg Vercellotti, M.D., HeatherStefanski and Eugene Ollila, M.D. at thementoring program breakfast.

Ben Baechler, Ann Kinsella, J.D., MichaelScandrett, J.D., Kelley du Ford, and Adam Kimfollowing the January Lunch ‘n Learn program.

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• White Coat Ceremony — BlantonBessinger, M.D., Virginia Lupo, M.D., ReubenBerman, M.D., Eugene Ollila, M.D., and RogerJohnson, RMS CEO, joined the U of M medi-cal school faculty members at the podium toaddress first year medical students at the “whitecoat” presentation ceremony on January 13. Inaddition, Drs. David Swanson (HMS President)and Robert Moravec (RMS President-elect), dis-tributed Cross Pens to the students.✦

First-year medical students receive their white coats.

Reuben Berman, M.D., provides a historical perspective ofcaring for patients.

Greg Vercellotti, M.D., Senior Associate Dean for Education, addresses themedical students.

Medical students recite “The Minnesota Oath of New Physicians.”

Caitlin Anderson receives her Cross Pen from Drs. DavidSwanson and Robert Moravec.

PRESIDENT ’S MESSAGER O B E R T C . M O R A V E C , M . D .

RMS-Officers

President Robert C. Moravec, M.D.

President-Elect Peter H. Kelly, M.D.

Past President John R. Gates, M.D.

Secretary Jamie D. Santilli, M.D.

Treasurer Peter J. Daly, M.D.

RMS-Board Members

Kimberly A. Anderson, M.D., Specialty Director

Victor S. Cox, M.D., Specialty Director

Charles E. Crutchfield, III, M.D., At-Large Director

Kelley C. du Ford, Medical Student

Thomas B. Dunkel, M.D., MMA Trustee

Michael Gonzalez-Campoy, M.D., At-Large Director

James J. Jordan, M.D., Specialty Director

F. Donald Kapps, M.D., Specialty Director

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

Charlene E. McEvoy, M.D., At-Large Director

Ragnvald Mjanger, M.D., Specialty Director

Kenneth E. Nollet, M.D., Ph.D., At-Large Director

Thomas F. Rolewicz, M.D., Specialty Director

Paul M. Spilseth, M.D., At-Large Director

Lyle J. Swenson, M.D., MMA Trustee

Jon V. Thomas, M.D., At-Large Director

David C. Thorson, M.D., Specialty Director

Russell C. Welch, M.D., At-Large Director

RMS-Ex-Officio Board Members &Council Chairs

Blanton Bessinger, M.D., MMA PresidentPaul J. Dyrdal, M.D., Sr. Physicians Assoc. PresidentKenneth W. Crabb, M.D., AMA Alternate DelegateStephen P. England, M.D., Community Health

Council Chair*Michael Gonzalez-Campoy, M.D., Education

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

Professionalsim & Ethics ChairMelanie Sullivan, Clinic Administrator*Lyle J. Swenson, M.D., Public Policy Council Chair*Russell C. Welch, M.D., Communications

Council Chair

*Also elected RMS Board Member

RMS-Executive Staff

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


IFrom Where I Sit

I AM HOPEFUL that this will be an eventfulyear in the history of the Ramsey Medical Soci-ety. I thank you all for the privilege of beingyour president and the confidence you haveshown in leading this organization.

This current issue of MetroDoctors describesa shortage of health care specialists, nursing staff,technical and therapy staff, all of which lead toa staffed bed shortage, increased burnout andincreased attrition. Recently, both Ramsey andHennepin Medical Society staffs have organizedregular hospital leadership meetings to discussthese issues, as well as others, that affect healthcare in our community. In January, the short-age of long-term care beds was discussed. Theimpact of recent closures of long-term care fa-cilities and shortage of long-term care beds hasresulted in increased lengths of stay for hospi-tals. Hospitals and their medical staff are find-ing themselves unable to provide adequatecontinuity of care and appropriate transitionsof care for the acutely ill patients. These issuesare of immediate concern to every physician inthe state, whether you practice urgent or emer-gency care, pediatrics or geriatrics, primary careor a specialty care. The inability to hire quali-fied staff to help reduce the growing burden onexisting practitioners is acutely felt across thecontinuum of care.

The health care system is finding itself as-saulted for its rate of accidents, medical errors,and patient safety problems. The 1999 Insti-tute of Medicine report entitled To Error is Hu-man, described patient errors and medicalmistakes in terms of possible deaths per year.Whether or not you subscribe to the numbersgenerated from the report, it did launch a na-tional effort on safety and it will continue to bea focus for discussions on quality improvementfor years to come.

We should very soon have available to usthe next Institute of Medicine report (due outnow) focusing on the overuse/underuse of medi-cal care and problems with delivery, efficiency,and other measures of quality and performance

improvement. I understand that there will besix themes to the next report:• Safety — patients should not suffer harm

from care that is intended to help them;• Effectiveness — patients should receive

care that is proven on scientific grounds tobe helpful and that avoids care that isknown to be harmful;

• Patient Centeredness — delivery of re-spectful treatment with a focus on indi-vidual value-driven treatment;

• Timeliness — health care should not wastethe time of patients or health care profes-sionals, rather it should be responsive tothe needs of patients;

• Efficiency — health care should avoidwaste of supplies, energy, and resources,while striving to reduce the re-work neces-sary in our current system;

• Equity — health care should reach allAmericans regardless of race, gender, age,or ability to pay.On a national level, a leading group of

Fortune 500 companies and other large healthcare purchasers have founded “The LeapfrogGroup” by creating and committing to a com-mon set of purchasing principles to drive “leaps”in patient safety. Their goal is to mobilize em-ployer purchasing power to initiate break-through improvements in the safety and overallvalue of health care to American consumers. Ifyou haven’t already done so, you should becomemore familiar with this group by logging ontotheir website at www.leapfroggroup.org. Theinitial selection of three safety standards showsus the most important issues upon which tofocus (from the point of view of business andbenefit and human resource leaders.) These ini-tiatives are based on scientific evidence, feasi-bility of implementation in the near future, and



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THE 130TH ANNUAL MEETING of theRamsey Medical Society attracted over 100 phy-sicians, spouses, and guests to the North OaksGolf Club on Friday, January 26, 2001.

Dr. Robert Moravec was installed as presi-dent by outgoing president, Dr. John Gates.

Dr. Moravec presented his agenda for RMSthat includes: continuing the role of RMS as anadvocate for the patient/doctor relationship andassist where possible other groups that advocatefor the same thing; becoming an accredited pro-vider of CME because continuing medical edu-cation is a key element of good medical care;working for the continuation of credentialing

services of physicians and recognizing the roleRMS and HMS have played in providing thecredentialing service to physicians; involvingRMS in working on the issue of patient safety.

Dr. Wayne Thalhuber was presented withthe RMS Community Service Award for 2000.Dr. Thalhuber was recognized for the work hehas done to educate physicians in end of lifecare issues, in working with patients who areexperiencing the end of life, and for his work inadvocating hospices.

Dr. Joseph Rigatuso was recognized for hislong service representing the East Metro on theMMA Board of Trustees and for his service to

130th RMS Annual MeetingRobert C. Moravec, M.D. Installed as President

RMS as an MMA Delegate and Board mem-ber. He was presented with a framed calligra-phy of the Commendation Resolution adoptedby the MMA House of Delegates.

The evening concluded with the viewingof a thought-provoking video titled “EscapeFire” by Dr. Donald Berwick, the founder, presi-dent, and CEO of the Institute for HealthcareImprovement. If you are interested in borrow-ing the video to view, call the RMS office at(612) 362-3706. ✦

Dr. Robert Moravec honors Dr. Joseph Rigatusofor his years of service representing the EastMetro on the MMA Board of Trustees.

Dr. Gretchen Crary and her husband, David.Dr. Tony Giefer and his wife, Mary Ann.

Dr. Robert Moravec is installed as the newpresident by Dr. John R. Gates.

Drs. Peter J. Daly and Peter H. Kelly with theirwives, Nancy Kelly and Lulu Daly.

Dr. Wayne Thalhuber receivedthe RMS Community ServiceAward for 2000.

Dr. Robert Moravec, President, resides inStillwater with his wife, Mari, and their twoyoung sons.


RMS UPDATE

Applicants forMembership

We welcome these new applicants forRamsey Medical Society membership.

ability to measure their presence or absence inthe health care system.

The initial selections are:• Prescriptions in hospitals should be com-

puterized. Computerized physician orderentry systems should be implemented toreduce serious prescribing and transcrip-tion errors;

• Certain elective procedures and treatmentsshould be guided to hospital and clinicalteams that are more likely to produce bet-ter results. Evidence-based hospital refer-ral would be used to reduce the chances ofcomplications and improve survival forseveral key procedures and surgeries; and

• Hospital ICU care should be managed bya physician certified (or eligible for certifi-cation) in critical care medicine. When“intensivists” are quickly available for allICU patients, the risk of dying in the ICUhas been shown to be reduced by more that10 percent.Right now, our collective ability to respond

to these purchasing challenges is limited at best.We are a fractured and intensely protective pro-fession that will have a difficult time adaptingto these challenges under the old paradigm (andI don’t mean just physicians — I include hospi-tals, “integrated” health care systems, nurses,therapists and all other health care profession-als). I see one of the roles for organized medi-cine as working collaboratively with organizationssuch as The Leapfrog Group and our other in-terested professional associations, so that theirinterests in improving patient outcomes andpatient safety are met head on with our bestideas, strategies and abilities.

I believe that the Ramsey Medical Society,Hennepin Medical Society, and MinnesotaMedical Association can play a role in thesequality improvement initiatives. I challenge eachand every one of you to look for ways to beinvolved either at your hospital, clinic, medicalsociety, or through coalition groups. I wouldalso challenge each of you to have a dialoguewith your patients on patient safety and heardirectly from them what issues scare our patientsthe most and how we can best address theirneeds. ✦

ActiveRene P. du Cret, M.D.University of TexasRadiologySt. Paul Radiology, P.A.

Timothy C. Goertzen, M.D.University of ManitobaDiagnostic Radiology/Vascular andInterventional RadiologySt. Paul Radiology, P.A.

Christopher A. Jackson, M.D.University of MinnesotaDiagnostic Radiology/NeuroradiologySt. Paul Radiology, P.A.

Thomas E. Jones, M.D.Duke UniversityFamily PracticeQuello Clinic, Ltd.

Jennifer J. Mehmel, M.D.University of MinnesotaPediatricsAspen Medical Group - Bandana

John P. Miller, M.D., Ph.D.University of ConnecticutClinical Pathology/Blood Banking/Transfusion MedicineAmerican Red Cross

Jane C. Pederson, M.D., M.S.University of MinnesotaGeriatric Medicine/Internal MedicineStratis Health

Suzanne S. Teragawa, M.D.University of MinnesotaFamily PracticeAspen Medical Group - Bandana

Garrett R. Trobec, M.D.University of MinnesotaFamily PracticeNorth Suburban Family Physicians -Shoreview

Anne M. Weisensee, M.D.University of MinnesotaDiagnostic RadiologySt. Paul Radiology, P.A.

1st Year PracticeRonnell A. Hansen, M.D.University of MinnesotaDiagnostic RadiologySt. Paul Radiology, P.A.

Jyothi B. Kesha, M.D.Kasturba Medical College, IndiaUrologyMetropolitan Urologic Specialists, P.A.

Student(University of Minnesota)

Cheri N. Hauger

Transfer into RMS — ActiveDaniel E. Larkin, M.D.Medical College of Wisconsin - MilwaukeeFamily PracticeHealthEast Rice Street Clinic

Transfer into RMS — 1st YearPracticeJeffrey S. Phelan, M.D.Creighton UniversityDiagnostic RadiologySt. Paul Radiology, P.A.

Transfer into RMS — StudentGraham S. Clark ✦


President’s Message


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

A Message for Spouses of Physicians

Make a DifferenceWe are all citizens of our communities. And,you know what? Citizenship is not a spectatorsport! It’s important that we participate, that weadd value to our community and, in this way,we make a difference.

That’s what membership in the RamseyMedical Society Alliance is all about — makinga difference. Improving the health and well be-ing of our community. And, when we work to-gether on this goal, we make things happen.“Together” is the operative word here. We can’tdo it alone. It is a little easier with a group. And,when we all pull together, with as many RMSAlliance members and friends as possible, wecan do it!

In this case, the “it” we are doing is theBody Language Health Fair. The year 2001marks the 15th Annual Health Fair for thirdgrade children in the St. Paul Schools. We are ahuge success in this endeavor. School officials,who assist the Alliance in making arrangements,tell us that it is one of the most popular outingsthe children go on. Teachers tell us that it isrewarding and that it meets much of their healtheducation curriculum needs. The kids tell us thatthey learn lots and that it is fun.

So, how many Alliance members andfriends do you figure it takes to teach 1,500 pluskids about their bodies and the importance ofkeeping them healthy? Whatever number youguessed, it is probably an understatement. Weneed lots and lots and lots of volunteers to “staff”the various booths. WE NEED YOU to be oneof these volunteers. Each booth covers a differ-ent topic of health education. Pick one that in-terests you, say to yourself, “I can do this forone morning in April to help out, and give us acall to volunteer. The booths each have writtengoals and objectives and volunteers follow a shortscript — so you don’t have to be a health care“expert” in any field. Also, each booth has aChairperson who will mentor you through theprocess.

What are these booths? And, what do theyteach?

Nutrition: Teaches children to identify themajor food groups in the Food Guide Pyramidso that they can select a healthy diet, with a fo-cus on aiming for a healthy weight.

Physical Fitness: Teaches children the im-portance of exercise for life and inspires themto exercise.

Hospital Room: Teaches children about ahospital setting to minimize their anxiety abouthospitals, familiarize them with commonly usedequipment and introduce them to infectioncontrol procedures.

Skeletal: Teaches children about bones, theirfunctions and how to take good care of theirbones. Demonstrates sports safety equipmentand motivates them to follow safe procedureswhen at play.

Mental Health: Teaches children to developgood mental health by increasing self esteem andpromoting respect for oneself and others. Dealswith emotions, actions and consequences.

HiTECH Heart: Teaches children about hearthealth and promotes healthy lifestyles. Givesthem an understanding of how the heart worksand how to take care of it, through the use of alarge heart model with a functioning pump.

The overall goals of the Health Fair are: 1)to enrich and expand the third grade health cur-riculum; and, 2) to reach children at an earlyage to teach them positive attitudes and habitsthat lead to lifelong physical and mental health.

This is an important endeavor. The schooldistrict, the teachers, the children all say so. It’sa chance for us, as Alliance members, to giveback, to participate in our community life andto make a difference, potentially a lifelong,healthy difference, for hundreds of children ev-ery year.

Be a part of this. It is exciting, it feels goodto be doing good. And, it’s fun! Body LanguageHealth Fair will be held April 23-26, at theUnited Hospital Heart & Lung Building. Planto help out. Check your calendar for a little freetime on these days and call us. YOU ARENEEDED! ✦

For further general information about the RMSAlliance or to find out about volunteer opportuni-ties at the Health Fair, please call Eleanor Goodall,H: (763) 441-8308 or W: (651) 268-6107.

BODY LANGUAGEHEALTH FAIR

April 23-26, 2001

Add value to your community.

Volunteer now for anexceptional, worthwhile,

fun experience.

Sandi Butler demonstrates the use of astethoscope in the Hospital Room booth.


Cost: $45.00, which includes continental breakfast, registration, and syllabus.

SAVE THE DATE!!

Abusive Behavior in the Medical Workplace: Its Effect on Employee Satisfaction,

Retention, and Patient Safety

Thursday, May 3, 20018:00 a.m. – 12:15 p.m.

Holiday Inn — Minneapolis West9970 Wayzata Boulevard, Minneapolis, MN 55426

Audience: Physician Leaders, Medical Staff Officers, VicePresidents for Medical Affairs, Nursing Home MedicalDirectors, Chief Executive Officers, Chief Nursing Of-ficers, Human Resource Executives, and others involvedin promoting healthy, abuse-free medical environments.

Local and national experts will discuss abusive behavior in the medical workplace, its impact on employees andpatients, how to address it, and how to create healthy, abuse-free workplaces.

This activity has been approved for AMA PRA credit.Contact Nancy Bauer, Hennepin Medical Society,

(612) 623-2893 for further information.

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Jointly Sponsored by:Healthcare Human Resources Association of Minnesota

Hennepin Medical SocietyMinnesota Medical Association

Ramsey Medical Society


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HMS-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.

Jeffrey Christensen, M.D.

William Conroy, M.D.

Dianne Fenyk, Alliance Co-PresidentPaul A. Kettler, M.D.

James P. LaRoy, 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.

D. Clark Tungseth, M.D.

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

HMS-Ex-Officio Board Members

Barbara H. Subak 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-TrusteeDavid W. Allen, Jr., MMGMA Rep.

HMS-Executive Staff

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

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CHAIR ’S REPORTV I R G I N I A R . L U P O , M . D .

Editor’s Note: This letter was sent to FrankCerra, M.D., Senior Vice President for HealthSciences, University of Minnesota’s AcademicHealth Center, on behalf of HMS members insupport of the AHC’s legislative budget request.It is being reprinted here for information.

THE HENNEPIN MEDICAL SOCIETY un-derstands the importance of the state’s role insupporting health education and research, andtherefore, endorses the University of Minnesota’sAcademic Health Center legislative request of$33 million.

Minnesotans have come to expect first classhealth care, delivered from first class institutions.A top tier health care education infrastructureto support those expectations is needed. Cur-rent funding streams are no longer able to meetthe core needs of the medical school and as aresult the future of health education is in jeop-ardy.

For that reason, we support the legislativerequest of $16 million to secure the core fund-ing for medical school programs at the Univer-sity of Minnesota Medical School.

We also understand that the future of ourhealth care infrastructure, including our healthcare industries, relies on the highest quality re-search done in public institutions with the sup-port of public and private dollars. As the statesupport of medical education decreases, so toohas the University’s ability to attract and retaina full load of quality research faculty. While toptier medical schools receive over 95 percent offunds available through the National Institutesof Health, the University’s Medical School hasdropped from that top tier. We also understandthat for every one million research dollarsbrought into the state by University faculty, 38jobs are generated for the Minnesota economy.

For that reason, we support the bienniallegislative request and long-term investment ofjust over $10 million to replenish the nearly 20percent drop in teaching and research faculty ofthe Academic Health Center.

Finally, the Academic Health Center’s

schools of nursing, dentistry, pharmacy andmedicine are working creatively to expand itsability to meet the workforce demands of ourhealth care system.

For that reason, we support the bienniallegislative request and long-term investment of$7.4 million to educate health professionals.

On behalf of Hennepin Medical Society,we urge the 2001 Legislature to support the corefunding and long-term investment plans of theAcademic Health Center by fully funding theirlegislative request. ✦

A Call for DelegatesIf you are interested in serving as aDelegate, please contact us at yourearliest convenience

A Call for ResolutionsResolutions are due at the HennepinMedical Society no later than Friday,May 11.

HMS CaucusWednesday, May 23, 20017:00-8:30 a.m. at Park Nicollet Clinic— Naegele Auditorium, St. Louis Park

MMA Annual MeetingWed.-Fri., September 19-21, 2001St. Cloud, MN

If you have any questions contactKathy Dittmer, executive assistant, at

(612) 623-2885.


HMS IN ACTIONJ A C K G . D A V I S , C E O

HMS in Action highlights activities thatyour leadership and executive office staffhave participated in, or responded to,between MetroDoctors issues. We solicityour input on these activities and encour-age your calls regarding issues in which youwould like our involvement.

A mini-Community InternshipProgram was offered for three HobanScholars, each of whom is working towarda Masters degree in Health Care Administra-tion. (See related photos on the next page.)

Jack Davis and Nancy Bauer, along with SisterMary Madonna Ashton, Mick Johnson andDr. Chris Johnson (Park Nicollet Foundation)and Barbara Dickey (St. Mary’s Clinics) metwith Assistant Health Commissioners andsenior staff at the Minnesota Department ofHealth to explore opportunities for leadershipon expanding statewide the “CaringClinics” model of mainstreaminguninsured patients into existing primarycare clinics and help with the pharmacy costissue.

HMS and RMS continue to operate MCSM(central credentialing) on an interim basis.The Minnesota Joint PurchasingCoalition (MJPC) seems to be on track toselect a final vendor, with final interviewsscheduled. MCSM may continue its interimoperation past the February 28 deadline, if theMJPC requires more time.

HMS is part of a loosely organized “con-tract coalition,” which has draftedlegislation that focuses on three issues: (1) fulldisclosure to patients; (2) full disclosure tophysicians; and (3) prohibition of silentamendments. Senate staff has agreed to draftthe legislation.

The HMS ad hoc Ethics Committee hasauthored Ethical Principles and anattestation document for physicians tosign and frame for their clinics. We have

distributed the revised draft to the board andwill have a full discussion and hopefullyadoption at our March board meeting.

Nancy Bauer met with Paul Bowlin, M.D.and Neal Holtan, M.D. to develop a planto involve the Senior PhysiciansAssociation in the issue of bio-terrorism. The idea is to have retiredphysicians available in the event of a terroristattack. A presentation to the Senior PhysiciansAssociation is planned for this summer.

HMS and RMS held another medical student“Lunch ‘n Learn.” More than 200medical students attended to hear aboutpatient protection legislation.

Nancy Bauer attended the kick-off breakfastfor the “Connections” mentoringprogram. Jointly sponsored with RMS,AHC and the Medical Alumni Society at theUniversity, 275 member physicians volunteeredfor 165 mentoring spots. The purpose of thebreakfast was to introduce the student andtheir mentor. Eugene Ollila, M.D. is thePresident of the Alumni Society. HMS playedan active role.

David Swanson, M.D. and Nancy Bauerrepresented the medical society at the medicalstudent White Coat Ceremony. VirginiaLupo, M.D. and Reuben Berman,M.D. were featured speakers. Our participa-tion, along with RMS’s, was referred to anumber of times from the podium.

HMS and RMS, at the request of severalphysicians in hospital leadership positions,convened a group called the “Metropoli-tan Hospital Physician LeadershipCommittee.” The Committee is made upof VPMA’s and Chiefs of Staff. Thesemeetings have been held over the last year orso on a quarterly basis. The agenda hasincluded JCAHO issues, U of M AHCupdate, credentialing concerns, disruptive

physician policy, medical manpower short-ages, emergency room diversion problems andnursing home capacity issue. A meeting withSenator John Hottinger has been scheduledfor February 27, at noon, to discuss: (1) nursinghome funding, staffing, and capacity issues;(2) the ER diversion and hospital bed capacityproblems; and (3) planning for possibleservice interruption due to 2001 metropolitanhospital nursing contract renewal.

Nancy Bauer and Jack Davis, along withspouses, attended the annual meeting ofthe Ramsey Medical Society at NorthOaks Country Club. Robert Moravec, M.D.was installed as their new President.

Leaders of the Hennepin and Ramsey MedicalSocieties have been combining efforts withthe Employers Association and HennepinCounty to offer a new health care product tosmall employers in the Twin Cities through anAccountable Provider Network. Themodel is envisioned to be inclusive of localproviders and seeks to restructure the systemto allow for more direct accountability by thepatient, the physician, and the employer.

January 24, 2001 marked the date of the last“official” meeting of the Success By 6®

Phillips and Powderhorn HealthyBabies Collaborative. However,members are encouraged to continue to meetthe needs of the communities throughcontinued networking and sharing ofresources at quarterly “brown bag” lunches tobe held at Abbott Northwestern Hospital andby becoming involved in the Way To Growinitiatives in both the Phillips andPowderhorn neighborhoods.✦


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Hoban Scholars Participate inCommunity Internship Program

In MemoriamHMS NEWS

Brian Cooper, John Jendro, and Eric Nielsen,all recipients of the Thomas W. and Mary KayHoban Scholarship, recently participated in aHMS sponsored Community InternshipProgram. Following their observation oforthopedic, cardiovascular and general surgery;neurology, neonatology, and radiology;pediatrics and emergency medicine, the internsreturned to their daily routines of work and

RICHARD P. DOE, M.D., Ph.D. diedDecember 11 in Carmel, CA, his home since1988. He was 74. He was a graduate of theUniversity of Minnesota Medical School andreceived his Ph.D. in biochemistry. He did arotating internship at Permanente FoundationHospital in Oakland, CA, and an internalmedicine residency as well as an endocrinologyfellowship at the VA Hospital in Minneapolis.He was a professor emeritus at the University ofMinnesota Medical School. Dr. Doe joinedHMS in 1978.

HOWARD L. HORNS, M.D., died onJanuary 10. He was 88. He graduated from theUniversity of Minnesota Medical School. Dr.Horns was a former associate dean of theUniversity of Minnesota Medical School andretired from the old Nicollet Clinic. In 1989 theUniversity honored him with the Harold S.Diehl award for long and distinguished service.Dr. Horns joined HMS in 1950.

KATHERINE C. GOODMAN M.D., MPH,died December 14 at the age of 83. Shegraduated from the University of Alberta,Faculty of Medicine, Edmonton. She completeda fellowship in pediatric cardiology at Children’sMemorial Hospital in Chicago, where herresearch helped establish the link betweenRubella and birth defects. She was an assistantprofessor of anatomy at the University ofMinnesota. Dr. Goodman joined HMS in 1980.

ALVIN L. SCHULTZ, M.D., died January 19at the age of 79. He graduated from theUniversity of Minnesota. Dr. Schultz was aprofessor emeritus of medicine at the Universityof Minnesota. He served as Chief of Medicine ofHennepin County Medical Center from 1965to 1988 where he helped to establish a programto train residents in internal medicine. In 1992,he received the Charles Bolles Bolles-Rogers andShotwell awards for his outstanding contribu-tions and achievements in the medical field. Dr.Schultz joined HMS in 1955.

LEO A. ZAWORSKI, M.D., died January 11.He was 81. He graduated from the MedicalCollege of Wisconsin, Milwaukee. He practicedin Northeast Minneapolis at the NortheastMedical Clinic and at St. Mary’s Hospital. Dr.Zaworski joined HMS in 1985. ✦

Thanks again to the following HMSphysicians who agreed to serve as faculty:Raul Cifuentes, M.D.William Conroy, M.D.Paul Crowe, M.D.Peter Dyrud, M.D.David Estrin, M.D.David Joesting, M.D.Eric Johnson, M.D.Phillip Murray, M.D.Bruce Norback, M.D.Eugene Ollila, M.D.Chris Roland, M.D.Jeff Vespa, M.D.

school. All three are enrolled in MastersDegree programs in Health Care Administra-tion. Eric Nielsen provided this evaluation ofthe program: “To summarize my experience,the results were nothing but positive and wellworth my time. Besides experiencing thedelivery of care, I was able to have intriguingdiscussions with all the doctors. I learned agreat deal!” ✦

Intern Eric Nielsen with Dr. David Estrin.

Dr. Phil Murray with intern Brian Cooper.


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HMS ALLIANCE NEWS

Trish VaurioCo-President

Dianne FenykCo-PresidentTHE HENNEPIN MEDICAL Society Alliance

has been a dedicated partner to the MedicalSociety for 90 years. We have changed with thetimes to meet the needs of both society and ourmembers, but we have not wavered from ourmission of promoting health and well-beingthrough education, advocacy, and service.

In January and February, we educated2,800 inner city third graders about their bod-ies and making healthy choices at Body Works.As all others before it, our 18th Body Workskept the traditional design of a health educa-tion fair, but was updated to reflect changes insociety — students signed an anti-violencepledge and one thousand “I Can Stop Violence”puzzles were distributed to Minneapolis teach-ers to use in their classrooms. As part of ourpartnering responsibilities to the Medical Soci-ety, Body Works includes a session on prevent-ing dog bites and we distribute the dog-bite bro-chure HMS has purchased from the AnimalHumane Association.

Another example of how we address cur-rent educational needs is our HIV/AIDS edu-cation folder. To date, more than 200,000 ofthese folders have been distributed in Minne-sota. Several copies of the folder were translatedinto Russian and delivered to educators in that

country by Hennepin Medical Society Alliancemember Penny Chally. As a result, some physi-cians and teachers in Russia are using the fold-ers as a teaching tool. Additionally, the foldershave been taken to Kenya and Tanzania; dis-tributed to students in Texas and Wisconsin;and used as a resource by the Hopkins SchoolDistrict’s HIV/AIDS Task Force. Teachersthroughout Minnesota have stated that they usethe folder as a resource in their health educa-tion classes. One out-state teacher said that ourfolder is her only HIV/AIDS resource. We willsoon be sending out HIV/AIDS folder orderforms to principals and superintendents for nextyear’s classes. To make things easier for theschools, the order form has been added to ourwebsite (another example of how we changewith the times).

For the past eight years, HMS and theHennepin Medical Foundation have been ex-tremely supportive of Body Works and the HIV/AIDS folder. We are grateful for both the fi-nancial and the moral support that you give tothese two programs. By working together, ourtwo organizations educate more people, pro-mote better health for our community andstrengthen the bonds of the family of medicine.It’s a good partnership!

In our 90 year history, our organizationhas changed in many ways, but one thing re-mains the same — we are always proud of thephysicians of the Hennepin Medical Society —after all, we ARE married to you!

We especially look forward to honoringyou on Doctor’s Day, March 30. It was on thisdate in 1842, that Dr. Crawford W. Long ofJefferson, Georgia, administered the first etheranesthetic for surgery. His history-makingachievement and the continuous efforts by doc-tors to alleviate human suffering form the basisfor celebrating Doctors’ Day. Each year onMarch 30, HMSA places recognition certifi-cates, flowers and candy in the doctors’ loungesof several local hospitals as a token of our re-spect and gratitude. This year when you stop inthe Doctors’ lounge on Doctors’ Day — you’llknow who is sending the hugs, the pats-on-the-back, and the handshakes — your partners, themembers of the Hennepin Medical Society Al-liance! ✦

Dianne Fenyk, HMSA Co-President

Thank YouDoctors

NationalDoctors’ Day

March 30Cheryl Steffen, a health educator from the Minneapolis Heart Institute Foundation, teachesthe students using their HiTECH Heart.

Continuing Medical Education, Medical School, Academic Health CenterRadisson Hotel Metrodome, Suite 107, 615 Washington Avenue S.E., Minneapolis, MN 55414

(612) 626-7600 • 1-800-776-8636 • www.med.umn.edu/cme

The University of Minnesota is an equal opportunity educator and employer

C O N T I N U I N G M E D I C A L E D U C A T I O NContinuing Education and Extension, University of Minnesota

2nd Annual Upper MidwestBrain Tumor SymposiumMarch 23 • Radisson South •

Bloomington

13th Annual Course onCardiac ArrhythmiasApril 20 • Earle Brown HeritageCenter • Brooklyn Center

Allergy and ClinicalImmunologyApril 27 • Weisman ArtMuseum • Minneapolis

Aging Skin: Implications forWound Healing, Skin Cancerand Skin CareMay 4 • Gateway Center on theU of MN Campus • Minneapolis

Family Practice Review:Update 2001May 7-11 • Radisson HotelMetrodome • Minneapolis

Lillehei Symposium:Cardiovascular Care forPrimary PractitionersMay 21-22 • RadissonRiverfront Hotel • St. Paul

Clinical Hypnosis WorkshopsMay 31-June 2 • Earle BrownCE Center • St. Paul

North Central NeonatologyIssues ConferenceJune 8-10 • The Grand GenevaResort and Spa • Lake GenevaWI

Annual Surgery Course:GastointestinalJune 13-16 • Hyatt • Mpls.

Pan American Society ofPigment Cell ResearchJune 14-17 • Regal Minneapolis

2001 CME Calendar

Topics and Advances inPediatricsJune 21-22 • Radisson HotelMetrodome • Minneapolis

GI Topics for the PrimaryCare PhysicianJune 25 • Radisson Plymouth

Remodeling and Progressionof Heart Failure (ISHR)July 12-14 • MinneapolisConvention Center

Endorectal UltrasonographySeptember 4 • Minneapolis

Pelvic Floor WorkshopSeptember 5 • Minneapolis

Principles of Colon andRectal SurgerySeptember 6-8 • MinneapolisHilton and Tower

Heart Failure Society ofAmerica: 5th AnnualMeetingSeptember 9-12 • WashingtonDC

Internal Medicine ReviewOctober 10-12 • RadissonHotel Metrodome• Minneapolis

Evaluation and Managementof Peripheral Vascular andCerebrovascular DiseasesOctober 15-16 • RadissonHotel Metrodome• Minneapolis

32nd Annual SeminarObstetrics and GynecologyOctober 22-23 • RadissonHotel Metrodome• Minneapolis

2001marchapril

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