THE FUTURE OF GENERAL INTERNAL MEDICINE A

SGIM

FORUMVolume 26 • Number 4 • April 2003

THE FUTURE OF GENERALINTERNAL MEDICINEEric Larson, MD

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At its summer retreat in June 2002,the SGIM Council approved Mar-tin Shapiro’s (incoming President

2002–2003) proposal to establish a taskforce on defining and promoting the do-main of the field for general internal medi-cine. Eric Larson, MD was asked to chairthe SGIM Task Force on the Domain ofGeneral Internal Medicine.

Other Task Force members include:Lynne Kirk, MD; Wendy Levinson, MD;Ron Loge, MD; Eileen Reynolds, MD;Stephan Schroeder, MD; Neil Wenger,MD; Mark Williams, MD—and invitedconsultants included Stephan Fihn, MD;Sheldon Greenfield, MD and LewisSandy, MD.

The Task Force began its missionwith a broad literature review encompass-ing numerous articles relevant to research,education, training, emerging technology,service delivery, reimbursement, physi-cian satisfaction, patient-physician com-munication, and direct patient care. TheTask Force later met at a retreat in Octo-ber 2002 to define the current state of thefield of general internal medicine anddetermine its unique characteristics. Fol-lowing the retreat, the Task Force workedto craft a set of recommendations aimingto initiate dialogue among stakeholderswho share a common vision to boldlyenact changes to strengthen and promotethe field of general internal medicine.

Following is a summary of the reportand recommendations submitted by theSGIM Task Force on the Domain of Gen-

eral Internal Medicine. The report andSGIM can serve as catalysts for the changethat will improve the future of GIM.

To view the full report and recom-mendations, please visit the SGIM Web-site at: www.sgim.org/futureofGIMreport.cfm

Task Force Summary &RecommendationsAmerican medicine is in a state of flux.Advances in medical science, technology,and service delivery offer benefits andopportunities for improved health thatmany people still living would never haveimagined possible. A vast industry hasgrown to provide these services and is apotent force in the U.S. economy.

At the same time, we have a deliverysystem plagued by marked inefficiency,over 40 million uninsured Americanslacking access to general medical care, a

The Task Force would like to get feed-back from SGIM members. After re-viewing the full report online, please:

■■ Email feedback to [email protected], or

■■ Attend the Task Force’s presenta-tion—on the Future of General In-ternal Medicine—during the SGIMAnnual Meeting in Vancouver andprovide feedback at that session.

Contents1 The Future of General Internal Medicine

2 Are You Making A Difference?

3 President’s Column

4 A First Look at Health Policy in the 108thCongress

4 Mentoring Our Current and FutureTrainees: Students, Residents, andFellows at the Annual Meeting

5 ACGIM Column

5 Research Funding Corner

6 Search for a JGIM Editor: OpportunityKnocks Only Every 5 Years

6 The SGIM Women’s Caucus: PromotingProfessional and Personal Development

15 Classified Ads

Society of GeneralInternal MedicineTO PROMOTEIMPROVED PATIENTCARE, RESEARCH,AND EDUCATION INPRIMARY CARE ANDGENERAL INTERNAL MEDICINE

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SGIM FORUM

Are You Making A Difference?Steve Schroeder, MD

Yes, economic times are tough andthe threat of war (by the time youread this we may actually be at

war) is looming. The world around us ischanging in ways that invite discomfortand we have trouble admitting that toourselves. But it is real, and we mustcontinue to live our lives the best waypossible.

It is in times of uncertainty thatmany of us find ourselves clinging towhat feels comfortable and safe. Puttingmoney in a conventional savingsaccount versus investingin the stock market isone way that some mightplot out a more securefuture.

SGIM is alsoexperiencing a time ofuncertainty and isexploring ways to grounditself fiscally. SGIM’sreality is that it closed2002 with quite a sizabledeficit that you will hearmore about at theAnnual Meeting inVancouver. A number offactors contributed tothis deficit, including less than expectedannual meeting and precourse registra-tion and a sharp decline in unrestrictedcommercial support.

In last month’s Forum, SGIMPresident Martin Shapiro outlined anumber of ways that members can helpwith the Society’s fiscal fitness. Contrib-uting to the Make a Difference Cam-paign is one. So for a second year, theSociety is clinging to what is comfort-able and safe by turning to its membersand saying: “We heard what you saidabout issues regarding external fundsand the sources by which we generaterevenue. So a new external funds policywas developed and the amount offunding that can be accepted from ANY

source has been capped. Therefore, tomake up for the loss of funds because ofnew restrictions—and to keep fromclosing 2003 in deficit—we are askingSGIM members to make a personalcontribution to support the organizationwhich provides invaluable services andopportunities to its members.” SGIMneeds your help. It can’t be articulatedmore clearly than that.

SGIM has always exhibited acommitment to its members by main-taining low fees for annual dues, annual

meeting registration, and precourses,while—at the same time—respondingfavorably to member requests for moreservices. If you refer to this year’s “MakeA Difference” Campaign brochureyou’ll see that there are a variety ofprograms and initiatives offered thatmeet everyone’s interests and providesignificant professional developmentopportunities. Even more incrediblethings are on the horizon, but SGIMcannot continue to increase program-ming without seeing an increase inresources for these services.

As the Chair of this year’s Make ADifference Campaign, I am reaching outto each of you and asking: “Are you

There are nearly 3,000members in SGIM and only 78(2.5%) have contributed a totalof $25,000…if the remainingportion of the 3000 memberscould each give $25, it wouldresult in an additional $73,000supporting SGIM this year.

SOCIETY OF GENERAL INTERNAL MEDICINEOFFICERS

PRESIDENT

Martin F. Shapiro, MD, PhD • Los Angeles, [email protected] • (310) 794-2284

PRESIDENT-ELECT

JudyAnn Bigby, MD • Boston, [email protected] • (617) 732-5759

IMMEDIATE PAST-PRESIDENT

Kurt Kroenke, MD • Indianapolis, [email protected] • (317) 630-7447

TREASURER

Eliseo Pérez-Stable, MD • San Francisco, [email protected] • (415) 476-5369

SECRETARY

Ann B. Nattinger, MD, MPH • Milwaukee, [email protected] • (414) 456-6860

SECRETARY-ELECT

William Branch, MD • Atlanta, [email protected] • (404) 616-6627

COUNCIL

Christopher Callahan, MD • Indianapolis, [email protected] • (317) 630-7200

Kenneth Covinsky, MD, MPH • San Francisco, [email protected] • (415) 221-4810

Susana R. Morales, MD • New York, [email protected] • (212) 746-2909

Eileen E. Reynolds, MD • Boston, [email protected] • (617) 667-3001

Gary E. Rosenthal, MD • Iowa City, [email protected] • (319) 356-4241

Harry P. Selker, MD, MSPH • Boston, [email protected] • (617) 636-5009

EX OFFICIORegional CoordinatorJane M. Geraci, MD, MPH • Houston, [email protected] • (713) 745-3084

Editor, Journal of General Internal MedicineJournal of General Internal MedicineJournal of General Internal MedicineJournal of General Internal MedicineJournal of General Internal MedicineEric B. Bass, MD • Baltimore, [email protected] • (410) 955-9868

Editor, SGIM ForumSGIM ForumSGIM ForumSGIM ForumSGIM ForumMelissa McNeil, MD, MPH • Pittsburgh, [email protected] • (412) 692-4886

HEALTH POLICY CONSULTANT

Robert E. Blaser • Washington, [email protected] • (202) 261-4551

EXECUTIVE DIRECTOR

David Karlson, PhD2501 M Street, NW, Suite 575Washington, DC 20037

[email protected](800) 822-3060(202) 887-5150, 887-5405 FAX

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PRESIDENT’S COLUMN

SGIM

FORUM

Published monthly by the Society of General Internal Medicine as a supplement to the Journal of General Internal Medicine.SGIM Forum seeks to provide a forum for information and opinions of interest to SGIM members and to general internists andthose engaged in the study, teaching, or operation for the practice of general internal medicine. Unless so indicated, articles do notrepresent official positions or endorsement by SGIM. Rather, articles are chosen for their potential to inform, expand, andchallenge readers’ opinions.SGIM Forum welcomes submissions from its readers and others. Communication with the Editorial Coordinator will assist theauthor in directing a piece to the editor to whom its content is most appropriate.The SGIM World-Wide Website is located at http://www.sgim.org

MOVING ONMartin F. Shapiro, MD, PhD


Ican’t believe that my year as SGIMPresident is drawing to a close. Ithas been a wonderful experience,

working with dedicated and talentedstaff and with passionate and selflessmembers of the organization. Re-election is not an option, but myinterest in SGIM will not wane. Hereare some whimsical thoughts aboutwhat SGIM should do in the next yearor five, or twenty-five.

Take the lead in defining our specialtyas a discipline. Although other organiza-tions care about general internalmedicine, none is situated as well as usto think about its role, given ourperspectives on education, practice,research and policy. SGIM should havean ongoing component that evaluatesand remodels the discipline as appropri-ate, then interacts with other leadingorganizations, whose cooperation wouldbe needed to implement these changes.The report on the future of GeneralInternal Medicine (highlighted in thisissue of The Forum and to be discussedprominently at our forthcomingmeeting) should be just the start of thisprocess.

Make General Internal Medicine thestrongest unit in every Department ofMedicine in the country. Since there arehundreds of such departments inteaching institutions, this is an enor-mous task. It will require a very largeeffort to assess the status of GIM and toconduct initiatives to educate andintervene at places that need help. Ourefforts this year to site visit someprograms certainly should be a compo-nent of that effort, but it will need toreach a much larger scale to address theneed.

Internationalize the Society. Thisyear, we are promoting a closer link tothe Canadian Society of InternalMedicine. We have a handful ofmembers from Latin America, Japan

and Europe, butdon’t yet havesubstantialconnections withinternal medicinesocieties in thoseregions. It will bea challenge tocreate a Societywhose focus isinternational. Wecan’t replace national societies, but wecan greatly enhance these connectionsand enrich the exchange of ideas in ourmeetings and publications, such thatattendance at our meeting wouldbecome much more relevant to generalinternists abroad.

Strengthen fellowship training inGeneral Internal Medicine. There iscurrently no system in place to examine

the quality of fellowships,to help them developappropriate curricula, toassure that trainees arementored in relevant areasthat may not be strengthsin their institutions, or toassess the outcomes ofthese programs. SGIMshould take the lead inmaking this happen.

Particularly if there is not to be anABIM certification of the programs,there could be something of the sortemanating from SGIM.

Establish a program to promoteplacement of trainees in appropriate facultypositions. Fellows are more or less ontheir own in job searches. We are in theprocess of defining job descriptions and

EDITOR

Melissa McNeil, MD, MPH • Pittsburgh, [email protected] • (412) 692-4886

ASSOCIATE EDITORS

James C. Byrd, MD, MPH • Greenville, [email protected] • (252) 816-4633

Joseph Conigliaro, MD, MPH • Pittsburgh, [email protected] • (412) 688-6477

Giselle Corbie-Smith, MD • Chapel Hill, [email protected] • (919) 962-1136

David Lee, MD • Boise, [email protected] • (208) 422-1102

Mark Liebow, MD, MPH • Rochester, [email protected] • (507) 284-1551

P. Preston Reynolds, MD, PhD, FACP • Baltimore, [email protected] • (410) 939-7871

Valerie Stone, MD, MPH • Boston, [email protected] • (617) 726-7708

Brent Williams, MD • Ann Arbor, [email protected] • (734) 647-9688

Ellen F. Yee, MD, MPH • Albaquerque, [email protected] • (505) 265-1711 Ext. 4255

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SGIM FORUM

A First Look at Health Policy in the 108th CongressRobert Blaser, MASI and Jenn Brunelle, MASI

Mentoring Our Current and Future Trainees:Students, Residents, and Fellows at the AnnualMeetingDonald Bradley, MD


The first session of the 108thCongress began in early January,with Republicans in control of

both the House and Senate. GOPcontrol of the White House and bothhouses of Congress would presumablyallow for smoother enactment oflegislation on domestic issues, but thenarrow margins of control and lack of aclear mandate continue to serve asroadblocks to meaningful change. Thisarticle will discuss the issues affectingall of medicine as well as priority issuesfor SGIM.

Senator (and Dr.) Bill Frist’sascension to Majority Leader could wellbe a positive development for healthpolicy. Sen. Frist has demonstratedleadership on a variety of health policyissues, including development ofprescription drug legislation andstewardship of the Agency forHealthcare Research and Quality(AHRQ), among others. He is aproponent of applying free-marketstrategies to the healthcare deliverysystem. He has also been an ally of theBush Administration on many issuesbefore the Senate, even when that wentagainst the views of physician andpatient groups. Sen. Frist’s relativeinexperience- he is in his second termas Senator- and close relationship withthe President may hinder his accom-plishing his objectives within theclubby Senate environment, but hisleadership will increase the odds ofmeaningful Medicare reform movingforward.

Medicare reform is at the top of theAdministration’s and most legislators’domestic agendas, but all domesticissues are currently overshadowed byforeign policy concerns. There contin-ues to be significant disagreement abouthow best to structure Medicare changes,but the bill passed by the House lastJune will be a likely starting point. This

legislation provided prescription drugcoverage for Medicare beneficiariesamong a plethora of provider givebacks,although many observers characterizedthe drug package as “donut” coverage,i.e. having a significant hole in themiddle. The Administration proposalsfor Medicare reform from the January28th State of the Union Address havenot been warmly received on CapitolHill. The least popular facet of the planappears to be its use of the prescriptiondrug benefit as an inducement forseniors to leave Medicare fee-for-servicefor an HMO-type structure, althoughAdministration spokesmen have denied

such intent. The proposal wouldincrease spending on the benefit from$190 billion to $350 billion.

On issues of specific concern togeneral internal medicine, SGIM facesanother uphill battle for appropriationsfor its priority programs. President Bushsent his fiscal year 2004 (FY04) budgetplan to the new Congress on February 3,proposing cuts to both the Title VIIhealth professions program and theAgency for Healthcare Research andQuality (AHRQ). (Note: As this iswritten, the FY03 omnibus appropria-tions bill has not been finalized.)

Vancouver will represent the secondyear of a dedicated effort to enhance

the meeting experiences of our student,resident, and fellow members. This year,we have several plans for students andresidents to complement all the tradi-tional offerings for trainees at theAnnual Meeting. We strongly believethat for SGIM to retain its vibrant,growing flavor we need to reach out tothe next generation of general internistsgraduating from our medical schoolsand training programs.

In keeping with this theme, wehave designed a “track” for students andresidents at the meeting that willhighlight activities we believe may be ofparticular importance to residents andstudents. Included in this track areSGIM 101, the Clinical VignetteUnknown Session, and some speciallydesignated workshops in addition to a1.5 hour Career Development Work-

shop discussing general medicine careeroptions and job search issues. Morespecific information on the variousworkshops will be included in theregistration packets of all students andresidents attending the meeting. Onemay choose to come and go from thetrack as much as he or she wants; wesimply want to offer some helpfulsuggestions. Also, on Friday morningthere will be the second meeting of theResident and Student Interest Group,led by Frieda Millhouse and AndrewDeFillipis of Emory University. Orga-nized by and for residents and students,this interest group will provide a forumfor these associate members to discusstheir training needs, to have an orga-nized voice within SGIM, and to createa listserve through which they can sharetheir ideas throughout the year. Lastyear a lively discussion about careers


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ACGIM COLUMN

ACGIM: MOVING INTO THEFUTURE WITH SGIMMark Linzer, MD


Research FundingCorner: April 2003Joseph Conigliaro


So much has happened this yearwithin the Association of Chiefs inGeneral Internal Medicine,

ACGIM, and it has flown by. Wemapped out the year with a retreat inDecember of 2001, formulating astrategic plan with numerous dimen-sions and lofty goals. At our retreat inDecember 2002, it was rewarding to seethat most of those goals had been metor exceeded. Here is where we are, anda bit of where we are going.1. Our membership has grown from 49

to 100 chiefs, withover 75% of USmedical schoolsrepresented. Ourmission statementsays that we are anorganization thatadvocates for,informs, supports andconnects chiefs inacademic GIM. If your chief is not amember, I’d be delighted to speakwith her or him (at 608-265-8118, orat [email protected]) so I canextol the virtues of ACGIM. (I amknown for doing this rather enthusi-astically!)

2. We have an active listserve where wediscuss such vital topics as parentalleave policies, models of part timepractice and support for residencyeducation.

3. We’ve started a chiefs e-newsletterwhere we can post position listings,and recent articles of interest to chiefsand other leaders.

4. We are hard at work on a curriculumfor chiefs, and a mentorship programfor new chiefs. Our mentorshipcommittee is connected to the newmentorship program initiated bySGIM, and our chiefs are seeking outinterested junior faculty, as well assenior mentors. Our annual Manage-ment Training Institute at the SGIM

meetings (this year, it will be held onWednesday, April 30th, from 1-5 PM),is open to chiefs and others who leador wish to lead. The three speakerswill address new mechanisms formanaging demands on faculty.

5. We have written an exciting proposalin concert with SGIM for diversity inleadership, called the UNLTD(unlimited) proposal for UNifiedLeadership Training for Diversity. Wewill be seeking funding and writingmore about this shortly.

6. We are planning a “balance corner”on our ACGIM website(www.ACGIM.net), where novel joboptions that support personal-professional balance can be posted.

7. We have formed task forces to definebetter the complex patients seen inGIM, and reasonable productivitystandards.

Finally, we have completed negotia-tions on behalf of ACGIM and SGIMwith ASP (Association of SubspecialtyProfessors, the subspecialty sectionheads and fellowship directors) andAPM (Association of Professors ofMedicine, or department chairs). Thesetwo groups are part of the Alliance forAcademic Internal Medicine. After along series of discussions, ACGIM andSGIM have joined ASP, and are nowwithin the Alliance. I just returnedfrom our first meeting with ASPCouncil which was a stimulating andcollaborative venture; a task force to

Social and Cultural Dimensions ofHealth (PA-02-043)National Institutes of Health (NIH)Deadline: June 01, 2003 andOctober 01, 2003

This is a multi-institute announce-ment for research grant applications onthe social and cultural dimensions ofhealth. The goal of this announcementis to elucidate basic social and culturalconstructs and processes used in healthresearch; clarify social and culturalfactors in the etiology and consequencesof health and illness; link basic researchto practice for improving prevention,treatment, health services, and dissemi-nation; and explore ethical issues insocial and cultural research. Allinstitutes and centers participating inthis PA will accept grants using the R01award mechanism with the total projectperiod not to exceed five years. Thisprogram announcement will expire onDecember 21, 2004, unless reissued.The URL for more information is http://grants.nih.gov/grants/guide/pa-files/PA-02-043.html.

Services and Intervention Researchwith Homeless Persons Having Alcohol,Drug Abuse, or Mental Disorders (PA-02-150)Department of Health and HumanServices (DHHS) and National Insti-tute on Alcohol Abuse and Alcoholism(NIAAA)Deadline: June 01, 2003

NIAAA seeks applications forhealth services research projectsdesigned to study the efficiency,effectiveness, and diffusion of servicesprovided to homeless persons withalcohol, drug abuse, or mental disorders.Specifically this PA encourages researchon the organization, management,integration, and financing of services, aswell as the impact of these factors, on

This level of cooperation at thenational level between ourgroups and the subspecialtyorganizations is unprecedented…

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SGIM FORUM

Search for a JGIM Editor: OpportunityKnocks Only Every 5 YearsAnn B. Nattinger, MD, MPH


One of the most importantpositions within the Society isthe Editor of the Journal of

General Internal Medicine. This positionis very important to SGIM, as JGIM isour flagship publication. JGIM providesa critical forum for publication for ourmembership on topics of interest to thefield of general internal medicine. Thesuccess of our journal is shown in partby the fact that it is now publishedmonthly, that there were 644 originalarticles submitted in 2002, and thatcitations of JGIM articles by othermedical articles are running at an alltime high.

The Editor and Associate Editors ofJGIM make a great contribution notonly to our Society, but also to theentire field encompassed by generalinternal medicine. By the judiciousselection of articles for publication, theEditor literally helps to shape our field.This is an incredible responsibility andhonor. The importance of the JGIM

Editor is shown by the fact that thisindividual is an ex officio member ofthe SGIM Council, and joins the ranksof our illustrious previous editors,including current editor Eric Bass, andbefore him, Sankey Williams, DavidDale, and Robert and Suzanne Fletcher.

The next editor will lead an alreadyoutstanding journal. However, excitingchallenges will allow this editor to puthis/her own imprint on the Journal. Thenext editor will help determine howbest to provide a venue for the publica-tion of material that is very popular atour annual meeting, but difficult topublish, such as innovations in medicaleducation and clinical administration.The term for this editor will likely see agreat increase in the use of the Internetfor dissemination of scholarly material,as well as a move to electronic systemsof handling the editorial process.

JGIM editors serve a 5-year term,and the term of the current editor endsin June 2004. Although it may seem

The SGIM Women’s Caucus: Promoting Professional and PersonalDevelopmentJennifer R. Zebrack, MD and Susan L. Davids, MD, MPH

early to begin the search for the nexteditor, the choice must be made byDecember 2003 in order to assuresufficient time for the transition to thenext editorial team. For those who maybe interested in serving the Society asJGIM Editor, a call for editorial propos-als is available at http://www.sgim.org/jgimsearch.cfm, or by contactingLorraine Tracton at the SGIM office([email protected] or 800-822-3060).Initial letters of interest will be due byJune 1, with invited full proposals dueby September 30, 2003. The SGIMCouncil will interview finalists for theposition at its December 10-12 retreatand a decision will made shortlythereafter. I encourage all those with avision for JGIM’s future to seriouslyconsider this wonderfulopportunity. SGIM

Ann Nattinger is the Chair of theJGIM Editor Search Committee

workshops at nationaland regional meetingson topics such aswomen’s health andfaculty development.

Every two years, anew local or regionalgroup (Host Group) isresponsible for planningthe annual meeting, overseeing thefinances, and providing communicationduring the year. This year, womenfaculty from the Medical College ofWisconsin are proud to be leading theWomen’s Caucus. The faculty involved

in this year’s program include JenniferZebrack, Susan Davids, LuAnn Moraski,Joan Neuner, Mary Ann Gilligan, JulieMitchell, Linda Blust, Sandy Green,Marilyn Schapira, as well as the

It has been 26 years since the foundingof the SGIM Women’s Caucus.

Although women comprised a smallerand less visible group at SGIM meetingsin the early years, this is no longer true.Since its beginning, the Women’sCaucus has played a significant role inenhancing the career development ofSGIM women. The Caucus has pro-vided an opportunity for SGIM womento network with colleagues, developmentoring relationships, and collabo-rate on research and educationalprojects. In addition, the Caucus hassponsored numerous precourses and

…the Women’s Caucus hasplayed a significant role inenhancing the [careers] ofSGIM women.

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quality chasm between the best possiblecare and routine everyday care, andpreviously undisclosed problems relatedto medical errors and unsafe systems.Again, the cost of medical care is risingat double-digit percentages per year,with no evidence that rising costs willlead to better outcomes. Emergencyrooms and hospitals are overcrowded—often due to underdeveloped primarymedical care and lack of access to it.Concerns about terrorism have exposedthe possibility that our current systemmight have minimal to no reserve.

People with sufficient wealth arestarting to seek their care from so-called“boutique” practitioners who offerguaranteed access to the type of caremost insured people would haveexpected to be routine. By contrast,Medicare patients in many communitiesincreasingly find that generalist andspecialist physicians no longer acceptthem as new patients because ofdeclining Medicare reimbursementrates.

General internists, along with otherprimary-care providers, feel particularlyvulnerable in this chaotic environment.As a group, they remain committed toproviding high-quality patient care, butmany struggle with low reimbursement,seemingly endless administrativeburdens associated with practice, anddemands for brief visits that satisfyneither doctor nor patient. Along withthe general decline in the attractivenessof medicine as a field, anecdotes supportthe notion that students who entermedical school interested in general

internal medicine andprimary care may losethat interest based onencounters with disillu-sioned practitioners whoincreasingly find thatthey meet neither theirown nor their patients’expectations. Bycontrast, there seems tobe great demand forwell-trained generalinternists, especially

recently for hospital-based internists.This report examines the domain of

general internal medicine now and inthe light of an uncertain future. Thereport describes the core values andcompetencies of general internalmedicine. Based on the principle that adomain should be defined by patientneeds and preferences, and by providingthe best possible patient care, we makerecommendations that include recom-mitting the field to its core values,paradigm shifts in the practice ofgeneral internal medicine, and changesin training and research.

Core ValuesThe core values of general internalmedicine include expertise in adultpatient care, professionalism, effectivecommunication, and acquiring andsharing knowledge. General internistsaspire to provide care that is compre-hensive, longitudinal, coordinated,patient-centered, and committed toquality. They provide everything frompreventive care to health promotion tocaring for complex and chronic diseases,across the ages from adolescence togeriatrics. Along with their patients,general internists value close, effective,ongoing personal connections.

To support excellence in this broadarray of services, general internists musthave rigor and commitment to evi-dence-based medicine, up-to-dateinformation-management skills, and acommitment to lifelong education forthemselves, their patients, and theircolleagues and trainees. In keeping with

rapidly advancing medicine andexpanding knowledge, general internistsmust be adaptable not only to newknowledge and advances but to newways of sharing them. General internalmedicine has placed special emphasison a patient-centered approach—educating, empowering, and motivatingpatients to change their lifestylebehaviors, and communicating effec-tively, expressing compassion andempathy, with patients and theirfamilies.

Recommendation 1:We believe that general internalmedicine should remain true to itsstrengths—the field’s core values andcompetencies—although market forcesmay tempt the field to abandon themwhile adapting to chaos. These corevalues and competencies are critical toserving our patients’ needs, promotingtheir well-being, and providing compas-sionate care.

Adapting to a Changing EnvironmentBreadth and depth: Generalist care wasreinvented to meet real patient careneeds in the 1970s in the United States,but neither has the lofty goal of trainingcomprehensive generalists been realizedin academia, nor has care by generalistphysicians received any special statuswithin the U.S. healthcare system. Theboundaries between general internistsand other primary-care providers,including physician extenders, havebecome blurred. To distinguish them-selves, general internists should be ableto provide care to patients with mul-tiple, complex, chronic diseases—adistinguishing feature of generalinternists—as well as doing or supervis-ing uncomplicated primary care. If thisbrand of generalism is abandoned, itwill need to be reinvented again.

Recommendation 2:The domain of general internal medi-cine should continue to be both deepand broad—ranging from providing or

FUTURE OF GIMcontinued from page 1

Advances in medical science,technology, and service deliveryoffer benefits and opportunitiesfor improved health that manypeople still living would neverhave imagined possible.

8

SGIM FORUM

FUTURE OF GIMcontinued from previous page


supervising uncomplicated primary careto delivering continuous care topatients with multiple, complex,chronic diseases. As the principalprovider for adults, general internistsneed to have skills in gynecology,dermatology, orthopedics, otolaryngol-ogy, psychiatry, and the internalmedicine subspecialties.

Communication: Most importantly,general internal medicine must adapt tothe dramatic advances in informationsystems, and take a leading role inrealizing the potential of these systemsto improve communication and collabo-ration and to help create more activatedand informed patients. We believeinformation systems can be a positiveforce in achieving and demonstratingimproved outcomes in care.

Recommendation 3:General internal medicine shouldenthusiastically embrace and adapt tochanges in information systems,especially those that promise to increasepartnership with patients, promote self-efficacy, raise efficiency of care, reducecosts, and ultimately improve outcomes.

Mastery: Professional satisfactionwill be increasingly tied to mastery—ideally designed to meet both profes-sional and patient expectations.Mastery and delivering high-qualityservices should be the basis of increasedremuneration of a knowledge-basedcognitive specialty like general internalmedicine.

Traditionally, training in caredelivery and practice management hasbeen minimal and is grossly inadequatefor the new paradigm. General inter-

nists must lead teamsand thus need to masterorganization andmanagement skills toserve that function well.Ideally, skills in organiza-tion and managementcould also address thegap between lifestyleexpectations of peopleentering medicine today

and the current stressful environment ofgeneral internal medicine.

Recommendation 4:Postgraduate and continuing medicaleducation should be tied to mastery—which is ultimately a key element forboth patient and professional satisfac-tion. Mastery for general internalmedicine should include care delivery,practice management, informationsystems, and the organization andmanagement skills required to leadteams, in addition to the traditionalinternal medicine knowledge and skillbase.

A View into the FutureTwo-way communication and connec-tivity will facilitate more and moreinformation exchange between doctorsand patients. Patients will have directaccess not only to their medical recordsbut also to better information aboutmedical services, including costs, risks,and benefits. Although the “traditional”visit will still occur, many more valuableservices will be delivered outside it,including providing patients withinformation and knowledge manage-ment as part of ongoing care. Thedomain of general internal medicinewill require mastery of evidence-basedmedicine. Information technology willhelp internists to keep abreast andorganize the knowledge base to providecare to patients and track outcomes.Patients will want general internistswith not only traditional generalistbedside skills but broad and detailedknowledge to interpret a vast amount ofmedical information.

The content of general internalmedicine will be prevention, health pro-motion, and care of people with commonconditions, including both acute andchronic diseases. Many patients will behighly activated and specifically seekingadvice in partnership with a professionalwho places the patient’s well-being firstand is not compromised by mercantileinterests or by the more focused, possiblyparochial, views of subspecialists. Provid-ers will monitor outcomes of patients intheir practice and communities. Practi-tioners will work in teams of diverse pro-viders and be connected—”wired.” At thesame time, general internists will main-tain close communication with special-ists who share in the management of pa-tients with complex diseases.

Recommendation 5:General internists should usually workin teams and provide services throughtheir own direct contact with patients,traditional telephone communication(directly or through staff), and moreand more asynchronous communicationusing email and other new communica-tion technologies. General internistsshould lead and assume responsibilityfor the care that their team membersgive, aiming to be able to provide 80–85% of the care their patients require,wherever they practice.

Implications for PracticeWhat will distinguish the generalinternists of the future? In diversesettings, most will practice in individualteams, often leading them, rather thanpracticing autonomously. Systemsupport and connectivity to patientsand information systems will be critical.Physicians will need to control sched-ules, increasing flexibility to meetpatient needs and expectations. Theemphasis on self-care and self-efficacythat is nascent today will grow inroutine practice. The internist team willlikely broaden to include nontraditionalproviders offering evidenced-basedservices of proven effectiveness to meet

In diverse settings, most[general interists] will practicein individual teams, oftenleading them, rather thanpracticing autonomously.

9



outcomes that patients value.Reimbursement should promote,

not hinder, the new world of patientcare. Restructured alternatives include asalary, a time-based billing system(similar to the legal profession), orcapitation and patient-managementfees. Electronic records, clinical email,and information systems improvementsshould be implemented, because theycould actually reduce the administrativeburden by simplifying administrativerequirements and lowering costs.“Value-added” internists of the futureshould have reimbursements linked toquality and outcomes rather than onlyto encounters.

Recommendation 6:Current financing of physician services,especially fee-for-service, must beabandoned, reformed, or restructured toinclude reimbursement for servicesprovided outside of traditional face-to-face visits. Physicians should be reim-bursed for time spent supervising long-term care, managing teams, andproviding services by phone and email.Alternatively, physicians could be paida patient-management fee plus reim-bursement for specific services or asalary with incentives for productivity,quality, and improved outcomes. Weendorse the development of reimburse-ment based on quality and outcomes.

Implications for training: Afterthree years of identical graduatetraining in internal medicine, newlyminted internists are expected to becompetent to practice with diversepopulations in disparate settings—ranging from hospitalists, to broad-based generalists in rural practice, togeneral internists only seeing patients inan office, to internists providinggeneralist care predominantly for peoplewith a single disease, e.g., humanimmunodeficiency virus (HIV). Otherswill go on to internal medicine subspe-cialty training or specialized fellowships(e.g., academic general internal medi-cine, informatics, and hospitalists).

In spite of reforms over the years,

the current training programs remainheavily tilted toward inpatient experi-ences. They do not let a trainee developboth the depth and breadth of knowl-edge and skills needed for the clinicalworld of the 21st century, the specialskills required in various settings or fordifferent patient populations. Mosttraining programs do not cover manage-ment—leading team-based care,managing chronic diseases, or masteringinformation systems.

In the years ahead, patients andhealthcare systems in the years aheadwill need “value-added” or “master”general internists for optimalhealthcare. Therefore, the currentthree-year training program should betransformed into a standard four-yearprogram to provide trainees both thebreadth and depth traditionally ex-pected of internists and mastery of coreskills required of modern generalists andof unique skills required for particularsettings and populations.

The first two years would stay muchthe same, providing core experiences ininpatient and outpatient internalmedicine, subspecialties, and non-internal medicine specialties, alongwith acquiring core skills in seeking andintegrating information. The third yearwould include more focused experiencesranging from care for specializedpopulations (geriatrics, commonchronic diseases, HIV, and medicine-pediatrics), specialized settings(hospitalists, rural practitioners, andoffice-based practitioners), and possibleelective time in informatics or research.

During the fourth, so-called“mastery,” year, the resident woulddevote extra time and acquire advancedskills and knowledge required for aspecific type of general internal medi-cine practice or career pathway. Train-ees entering subspecialty fellowshipswould diverge from general internalmedicine residency after two, or at mostthree, years. Those completing a fourthyear would typically earn a certificate ofadded qualifications (CAQ), or itsequivalent, appropriate to their special

generalist mastery area, includinggeriatrics, hospital practice, medicine-pediatrics, and rural general internalmedicine practice. This CAQ wouldsignify their mastery of areas appropriateto their intended general internalmedicine practice. The general internalmedicine residency would be revitalizedby the higher attainment and mastery ofthe next generation of trainees. Theproposal for four-year training wouldallow a better match of training withthe breadth and depth that characterizethe expanding domain of generalinternal medicine. While maintainingthe core values of medicine, and of thefield, this longer training would accom-modate the paradigm shift that weenvision in the practice of generalinternal medicine.

A radical restructuring of the three-year residency might accomplish thistransformation; but if not done well, itrisks giving general internists littledepth, only breadth. Then they mightbe even less distinguishable from non-physician general providers, and end upserving more as gatekeepers, providingonly the most basic simple care,referring to other practitioners ratherthan being comprehensive generalinternists. Thus, the real risk of notimplementing such radical changes inthe training program is the “dumbingdown” of the future general internist byadding the much-needed new skills atthe expense of those core and collateralclinical skills that distinguish generalinternal medicine.

Recommendation 7:General internal medicine residencytraining should be expanded to offer afour-year program to provide bothbroad, deep medical knowledge andother experience and mastery ofadditional skills in informatics, manage-ment, and team leadership. Subspecial-ists would typically diverge frominternal medicine residency after two orthree years. General internal medicineresidents who complete a four-year

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SGIM FORUM


program would earn a certificate ofadded qualification (CAQ) or theirequivalence in special generalist fields.For this recommendation to be viable,reimbursement reform is required.

Implications for research: Thecurrent ominous trends in the environ-ment threaten research less thanpractice in general internal medicine.Given changes already occurring, thereshould be great research opportunitiesin general internal medicine. Researchwill continue to focus on efforts toimprove the diagnosis and treatment ofcommon problems, long-term manage-ment of chronic diseases, doctor–patient communication, and needs ofspecial populations, especially thosewith poor access to care. The incipientchanges that will accompany thedramatic advances in informatics offer abroad new field for generalist research-ers, focusing especially on practiceimprovements pursuing opportunitiesfor transparent, shared information andefforts aimed at converting at times ill-informed consumerism into activated,informed (evidence-based) patientswith a strong sense of self-efficacy.There will also be increased opportuni-ties for research on patient safety,quality improvement, operationsresearch, chronic disease management,self-management, and geriatrics.

At present, however, only a smallfraction of the national investment inmedical research is directed towardthese types of studies, and change inresearch priorities will be necessary tofund them.

Recommendation 8:General internal medicine educatorsand researchers should emerge asleaders, promoting the changes in theacademic world that this new visionimplies. They will need the support oftheir academic leaders, especiallydepartment chairmen. Skill develop-ment and research must expand to letfaculty gain the mastery and tools toteach medical informatics, teamleadership, and practice management.

Research will expand to includepractice and operations management,developing more effective shareddecision-making and transparentmedical records, and promoting theclose personal connection that bothdoctors and patients want. Researchshould continue not only to documentbut also to improve the value ofgeneralist, comprehensive, and continu-ous care.

ConclusionMedicine today is in a state of chaos,albeit within a state of plenty for some.We can see this chaos as an opportunityfor innovation, rather than paralyzingpeople in privileged positions by fear ofan uncertain future. General internalmedicine needs to move from chaos andconfusion to innovation, especiallyregarding its own domain and identity.General internal medicine must adaptto a new world of consumerism, risingpublic expectations, widespreadinformation dissemination, and simulta-neous contradictory pressures to holddown costs while demand for servicesrises from more people surviving to oldage with chronic diseases.

The domain of general internistswill continue to be primary and princi-pal care of adults, increasingly as teamleaders. Open and transparent informa-tion management combined with thebreadth and depth of generalist skill andknowledge can distinguish generalinternists, improve patient well-being,and ideally promote effective andefficient use of resources. Whereverthey practice, general internists shouldaim to provide continuity of care tomeet 80–85% of the ongoing care oftheir patients, with and withoutcommon chronic illnesses.

Many changes are required toaccomplish this vision. Reimbursementchanges are especially needed, becausemuch of the value that a cognitivespecialty provides will not comethrough the typical face-to-face visit.The existing fee-for-service system willneed a major overhaul to provide

incentives for physicians to providecognitive services, especially since wepropose more highly trained generalinternists as the norm. Potentialalternatives include a salary system,case-management fees, or a time-basedpay metric (similar to the legal profes-sion). Payment incentives shouldeventually also reward quality andpromote improved outcomes. Webelieve a four-year residency will givegeneral internists not only the breadth,and depth to provide comprehensiveongoing care, but the mastery of specialskills required in the varied settingswhere generalists practice today, and inthe future. SGIM

Eric Larson is Chair of the SGIMTask Force on the Domain of GeneralInternal Medicine, and a former SGIMPresident.

Calendar of Events

Annual Meeting Dates26th Annual Meeting

May 1–5, 2003Vancouver Convention andExhibition CentreVancouver, BC, Canada

27th Annual MeetingApril 21–24, 2004Sheraton Chicago Hoteland TowersChicago, Illinois

28th Annual MeetingMay 11–14, 2005Sheraton New Orleans HotelNew Orleans, Louisiana

29th Annual MeetingApril 26–29, 2006Westin Bonaventure HotelLos Angeles, California

30th Annual MeetingApril 25–28, 2007Sheraton Centre TorontoToronto, Ontario, Canada

11

MOVING ONcontinued from page 3

promotion criteria that may be helpfulto trainees and the people who hirethem. We can do much more. If weproactively identify the people receivingtraining and if we get to know thedivisions/sections that might berecruiting, we can help make thematches.

Long distance mentorship as a way oflife. We initiated a program this yearthat will provide opportunities for long-distance mentorship for faculty with avariety of job descriptions, who couldbenefit from career support from othersoutside of their institutions. I amhopeful that this program will be verysuccessful, but as I have thought aboutit, I think we all need mentorship andcounsel from others who have somedistance from our everyday professionalactivities. Perhaps we could promotesuch relationships for all of our mem-bers. They need not involve intensesupervision, but it would give us yetanother way to learn from each other,and it would be great fun.

Seriously analyze and evaluate theways in which general internists canachieve a reasonable balance among thecomponents of their lives. Some of ourmembers are doing wonderful workincreasing awareness of the importanceof balance in a professional life. TheSociety itself is not very active in thisregard. We could undertake an initia-tive to gain a better understanding ofwhat the barriers and opportunities are,as well as of the perspectives on thisissue of the members of the Society.With that information in hand, wecould develop a system for monitoringbalance, providing feedback to mem-bers, and the like, to try to really make adifference in how they live their lives.

Figure out how to provide memberswith the new clinical information that theyneed. Members who are very activeclinically often opt to attend meetingsthat are more dedicated to clinicalcontent. While SGIM has a muchbroader agenda than that, it should bepossible to develop creative approachesto assuring sufficient content on the

principal clinical issues that they careabout, in order for them to have thatneed met, if it is their highest priority inselecting a professional meeting toattend.

Activate our membership to pursuetheir policy agendas. SGIM has oftenexpressed its views on health policyissues, but those expressions tend to besomewhat muted by the diversity ofperspectives in the Society. It seems tome that our reluctance in this regard is adisservice to all of our members. Weshould find ways to promote advocacyon behalf of all of our members. If one-third of our members care dearly about aparticular issue, and 80% about another,SGIM should find ways to assure thatboth of these perspectives are promoted.The Society could promote policyperspectives, even when they are inconflict, taking care to document whichmembers are supportive of the pointsbeing presented.

Provide structured critiques to allpeople who present abstracts or clinicalvignettes at our meetings. Everyone canget better. SGIM often is very genteel.Criticisms are not uttered. In the beliefthat criticism is an act of profoundaffection and solidarity, we shoulddevelop a system to assure that everyonewho presents at our meetings gets somemeaningful feedback about their work.That will help them get better.

Create a major role in the Society andits meetings for our senior members. SGIMis fabulous for young faculty and prettydarn good for those in mid-career. Theolder members often have troubleplaying a meaningful role. This iswrong. We should have sessions inwhich they can impart their wisdom,field questions, share experiences withothers. Just getting to know many ofthese people can be inspirational. Thisgreat resource should be exploited fully.

Start a program to broaden culturalawareness in our members. It is hard tokeep up, even with our core skills andknowledge base. It is even harder toremained broadly wise about the world.SGIM should develop activities that

will help our members do that. Bookclubs, lectures and short courses in thehumanities and social sciences, andinitiatives that give as much attentionto the world of ideas as we give to theworlds of patient care and educationcould be very enriching.

As I think about my professionalcareer, I am so happy that SGIM hasbeen there. It allowed me to establishfriendships that will last as long as Ilive. It enabled me to attend scientificsessions that showcase the best scholarlywork that I have encountered in aprofessional meeting. It has empoweredme to go back to my institution andadvocate for the values and perspectivesthat are accepted comfortably in ourSociety, but are sometimes regardedwith suspicion at our local institutions.It has provoked me to think aboutproblems and issues to which I wouldnot have given as much priority. It hasbestowed on me the wisdom of theelders in my field (and some not so old),when I was finding my way profession-ally. It has encouraged me to provideguidance to the careers of others when Ibecame able to do that. It has chal-lenged me to think broadly about issuesthat concern my discipline and medi-cine as a whole.

I hope that many of you will seekleadership roles in SGIM. Make itbetter than we have been able to dothus far. Extend the boundaries of ourdiscipline. Change our institutions, ourhealth care system and our knowledgebase for practicing medicine. Helpothers achieve their potential andtheir dreams. And have a wonderfultime in the process! [email protected] SGIM

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SGIM FORUM

The budget provides no funding forthe Title VII primary care cluster, whichincludes general internal medicine andpediatrics. It proposes just $11 millionfor the Title VII health professionsprogram, of which $10 million isdirected to the Scholarships for Disad-vantaged Students program and $1million to information and analysis.SGIM supports a budget of at least $40million for Title VII grants for generalinternal medicine and pediatrics, and anoverall Title VII and VIII healthprofessions program appropriation of$550 million.

The Administration’s budget planincludes $279 million for AHRQ, a $20million decrease from the agency’s 2002budget of $299 million. SGIM believesAHRQ should receive a budget of atleast $390 million, with a strongcommitment to investigator-initiatedresearch. Dr. Carolyn Clancy’s appoint-ment as AHRQ Director in earlyFebruary is sure to provide the Agencywith the stable leadership necessary forcontinued growth.

The good news on theAdministration’s budget plan is that it isnot binding. It serves as a guide toCongress, which will write the spendingbills. The Health Policy Committee,therefore, is coordinating SGIM’s effortsto advocate for increased funding levelsfor these important programs.

In other issues of interest to SGIMmembers, it appears that the decrease inMedicare physician payment rateswould be stopped by the passage of theomnibus appropriations package ofFY03. This bill includes language thatwould halt the further 4.4 percentreduction in the Medicare physicianpayment update. Medicine is stillseeking a long-term resolution toproblems with the physician paymentformula, however. Due to a long-delayedprovision in the 1997 Balanced BudgetAct, the indirect medical educationadjustment (IME) to teaching hospitalswent from 6.5 percent to 5.5 percent as ofOctober 1, 2002. The academic medicalcommunity and its allies are working to

prevent further reduc-tions.

SGIM has joinedother organizations injoint letters to Congressand has sent its own.These efforts must bereinforced by personalized contacts fromSGIM members to make a strongimpact. SGIM members can getinvolved in several ways:

Write to their members of Congressusing SGIM’s Advocacy Action Center,which can be accessed at: http://www.capwiz.com/sgim/home/, or fromthe SGIM webpage, http://www.sgim.org, click on “Advocacy,”and “Advocacy Action Center.”

Attend the health policy precourseat the Annual Meeting on May 1 tolearn the latest health policy news and

1ST LOOK AT HEALTH POLICYcontinued from page 4

how to effectively advocate for theseprograms.

Participate in SGIM’s Capitol HillDay on May 21 in Washington, DC.SGIM members will be briefed on thestatus of key legislation and will visitthe offices of their members of Con-gress. SGIM members interested inparticipating may contact Dr. DavidCalkins by email [email protected] orJenn Brunelle, SGIM GovernmentAffairs Representative, at [email protected]. SGIM

and mentoring in general internalmedicine occurred between the resi-dents and students and the leaders ofthe general medicine fellows interestgroup, and we anticipate more excitingcollaboration this year.

Again this year there will be a SRFLounge! A special area of the Posterand Exhibition Hall will be availablethroughout the meeting strictly forstudents, residents, and fellows –whether to network, visit with friends,or simply relax. Here there will also betables and displays announcing job andfellowship opportunities in generalinternal medicine. Look for the cornerwith the special posters, tables, andcurtains designating this home base setaside for SGIM’s associate members.Also, don’t forget the popular, tradi-tional outlets such as the Students,Residents, Fellows and First-TimeAttendees Reception and the One-on-One Mentoring Program.

Less widely known, but equallyimportant, are the discounts available tostudents and residents. The first 25medical student SGIM Associate

Members to register for the meeting areeligible for scholarship support of theAnnual Meeting registration fee on afirst-come, first-serve basis. We encour-age Division Chiefs and medical schoolsto sponsor students and help them payfor transportation and lodging. Justdown from the Convention Center, wehave reserved a special block of roomsfor students and residents at the greatlydiscounted price of $89.00 per night forsingle/double/triple or quadrupleoccupancy. These rooms are restrictedfor student and resident use only, andyou must call the SGIM office fordetails. The student & resident hotel iscloser to the Vancouver ConventionCenter than 2 of the 3 host hotels.

This meeting promises to highlightone of the crucial emerging issues forgeneral internal medicine – the recruit-ment and retention of bright, creativeyoung people into this career path. Wehope that the above efforts, along withthe usual nurturing presence of seasonedmembers will make this a memorablemeeting for our students, residents, andfellows. SGIM

MENTORING TRAINEEScontinued from page 4

The budget provides no fundingfor the Title VII primary carecluster…

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RESEARCH FUNDING CORNERcontinued from page 5

previous Caucus Co-Chair, RowenaDolor of Duke.

Not only do we hope this year’sinterest group meeting will provide atime for collaboration, but also a timefor self reflection. This year’s meetingwill include a discussion of thoughtsfrom the book What’s Holding YouBack?: Eight Critical Choices for Women’sSuccess by Linda S. Austin, MD. Thisbook has come highly recommended bymany women leaders. We will befacilitating small groups to discuss a fewof Dr. Austin’s theories—that there arebehaviors common among women thatmay prevent us from reaching our fullpotential in our careers. All currentSGIM Women’s Caucus members andinterested women are invited attendthis year’s interest group meeting, whichwill be held Wednesday, April 30, from5:00 to 6:30p.m.

As reading is one way to enhanceour professional development, the HostGroup is also compiling a recommendedbook list for professional and/or per-sonal growth in women obtained fromwomen leaders in academic medicine.This list will be distributed at theinterest group meeting, with comments

from the contributors about why theyrecommend a particular book.

At the Midwest SGIM AnnualMeeting in Chicago in September 2003,the Women’s Caucus will be sponsoringthe featured faculty developmentprecourse, “4 Habits of AcademicSuccess: Tools for Progress and Perfor-mance.” The “4 Habits” is a literature-based instrument developed by DeborahSimpson, PhD, Professor and AssociateDean of Educational Support andEvaluation at the Medical College ofWisconsin. Dr. Simpson, an expert infaculty development and predictors ofacademic success, utilizes this self-assessment tool to help guide faculty intheir career paths. During interactivesessions, participants will be asked todescribe their passions, their organiza-tion, and apply the “4 Habits” to theirown career, as well as to case scenariosin small groups. In addition, a paneldiscussion consisting of leaders inacademic internal medicine will focuson how proven performers in ourdiscipline incorporate the discussedprinciples, and what they perceive to behabits predictive of academic success.

SGIM members may view informa-

tion about the Women’s Caucus on theSGIM web site (www.sgim.org). Theweb site allows members to review thehistory of the Caucus, join the e-maillistserve, or download a Dues Form. Asalways, the efforts of the Caucus wouldnot be possible without your continuedfinancial support. Annual dues are $30per year and optional. Dues cover thecosts of outside speakers for SGIMWomen’s Caucus-sponsored precoursesor workshops, the reception at theannual interest group meeting, andprojects proposed by members.

We anticipate that the Women’sCaucus will continue to play a vital rolein fostering the professional andpersonal development of SGIM women.Hope to see you at this year’s Women’sCaucus interest group meeting inVancouver! SGIM

If you like to contact us or contrib-ute to the book list, please contact us at:

[email protected]@med.va.gov

Jennifer Zebrack and Susan Davidsare Co-Chairs of the SGIM Women’sCaucus.

making a difference?”Thanks very much to the SGIM

members who have contributed to theCampaign this year. Many of you gavelast year, and others are first-time givers.But we need more members to contrib-ute. There are nearly 3,000 members inSGIM and only 78 (2.5%) have contrib-uted a total of $25,000. It’s true thateconomic times are difficult for everyoneright now, but if the remaining portion of

the quality, cost, access, utilization,outcomes, and cost analyses of care. Ofparticular interest are studies of servicesfor persons who suffer from concurrentalcohol, drug abuse, and mentaldisorders and for persons at risk for orwho have HIV/AIDS or other serioushealth problems. This PA will use theR01, small grant (R03), and explor-atory/developmental research grant(R21) award mechanisms and willexpire on August 15, 2005, unlessreissued. The URL for more informationis http://grants1.nih.gov/grants/guide/pa-files/PA-02-150.html.

Please contact [email protected] for any comments,suggestions, or contributions to thiscolumn. SGIM

Whatever you can comfortablycontribute would make a worldof difference to SGIM.

MAKING A DIFFERENCEcontinued from page 2

the 3000 members couldeach give $25, it wouldresult in an additional$73,000 supporting SGIMthis year.

If you like, you candonate stock or airlinemiles. Whatever you can

comfortably contribute would make aworld of difference to SGIM. Pleasecontact Bradley Houseton, SGIMDevelopment Director for furtherinformation, at [email protected] or(202) 887-5150. SGIM

Steve Schroeder is Chair of the Makea Difference Campaign 2003

WOMEN’S CAUCUScontinued from page 6

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SGIM FORUM

define models of managing chronicillness collaboratively between generalinternists and subspecialists is forming,and we anticipate that ACGIM andSGIM will be offered key roles. Thislevel of cooperation at the nationallevel between our groups and thesubspecialty organizations is unprec-edented, and we are enthusiastic aboutwhat the future may hold.

Another outgrowth of the ASPnegotiations is that Bob Centor, PastPresident of ACGIM, Martin Shapiro,President of SGIM and I are off nextweek to meet with the APM Board(Department Chairs) to advocate foracademic GIM. In doing so, we’ll besharing some of the following bench-marks:a. typical number of work hours for a

full time academic general internist,including teaching in clinic: 31.2(Linzer M. SGIM Forum.2001;24(10)2,7.

MOVING INTO THE FUTUREcontinued from page 5

b. average required institutional invest-ment in each primary care MD:$74,000–$80,000. (Woodcock E.MGM Journal. March/April. 1999;15-22)

c. cost to replace a primary care MDthat leaves the practice: $230,000–$250,000. (Buchbinder S, et al. Am JMgd Care. 1999;5:1431-38.)

d. downstream revenue generated byeach primary care MD by the practiceplan and hospital: 1–6 million dollars.(Schneeweiss R, et al. JAMA.1989;262:370-75).

We’ll also be articulating the value ofacademic general internists, including ourmajor role in education and research, ourcare of complex, underserved andundifferentiated patients, and our servingas role models and mentors for largenumbers of students and residents. Finally,Dr. Shapiro will outline the CareerSupport programs ongoing within SGIM,and how these can be of assistance to

division chiefs and department chairsalike.

So what’s on tap for the future?Aside from moving the programsdescribed above ahead, we’ll be: 1)starting a new committee on research toadvise sections in how to developresearch programs and mentor faculty inresearch, and 2) working in concertwith SGIM on the Career Support sitevisits, mentoring, and our new diversityproposal. We’ll be articulating andcementing the “brand” identity of ournew, vibrant organization, and buildingthe interconnectedness betweenACGIM and SGIM that was sought byits founders and Elnora Rhodes, SGIM’sfirst Executive Director. We are movinginto the future together, and it is a mostexciting time to be doing it. SGIM

Mark Linzer is President of theACGIM, and Chief of General InternalMedicine at the University of Wisconsin.

Y O U ’ R E I N V I T E D T O V I S I TT H E S G I M W E B S I T E

Portal & PathwayTO

Professional Effectiveness & SatisfactionK N O W L E D G E ❖ N E T W O R K I N G ❖ C A R E E R D E V E L O P M E N T

Featuring Links to Resources & ToolsINCLUDING:

Meetings ◆ Publications ◆ Job Listings ◆ Funding Sources◆ Residency & Fellowship Directories ◆

Government Agencies ◆ Search Engines

L o c a t e d a t h t t p : / / w w w . s g i m . o r g

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ACADEMIC PALLIATIVE CARE POSITION.The Palliative Care Program, Medical College ofWisconsin is seeking a physician with an interestin academic palliative care. Experience in symp-tom control or health systems research is desiredbut not required. Contact David Weissman, MD,Froedtert Hospital, 9200 W. Wisconsin Ave., Mil-waukee, WI 53226, [email protected] .

CLINICIAN EDUCATORS. The Division of Gen-eral and Geriatric Medicine at the Kansas Univer-sity Medical Center is recruiting internal medicineclinicians who seek to provide outstanding care inour expanding academic practice. Individuals witheducational interests will help develop innovativeprograms at all levels of medical student education,and for our respected internal medicine residency.Interested candidates should submit a C.V. to JeffWhittle, MD, MPH; Director, Division of Generaland Geriatric Medicine, Kansas University Medi-cal Center; 5026 Wescoe; 3901 Rainbow Boulevard;Kansas City, KS 66160. Email [email protected] is an Equal Opportunity/Affirmative Ac-tion employer. Not a J-1 position.

CLINICIAN EDUCATORS. The Department ofMedicine, Division of General Internal Medicine,at the University of Missouri-Columbia is seekingclinician-educators at the Assistant Professor level,Clinical Scholar’s track, to expand our hospitalistservices. We are looking for personable, energetic,and innovative general internists to join our rap-idly growing, optimistic, and collaborative groupof experienced hospitalists. The successful candi-date will be Board Certified or Board Eligible inInternal Medicine and have exemplary clinicalskills and strong interest in teaching both housestaffand medical students. Experience or interest inmedical education, clinical research, or hospitalprocess improvement is highly desirable. Live andwork in a vibrant university community! The Uni-versity of Missouri Health System offers a competi-tive salary and an outstanding benefits package.Interested candidates should send CV and letter ofinterest in care of Dr. Robert Hodge, Division Di-rector, General Internal Medicine, University ofMissouri-Columbia, Department of Internal Medi-cine, One Hospital Drive, Columbia, MO 65212or via email at [email protected] Ap-plications will be accepted until position is filled.The University of Missouri is an equal opportunity/affirmative action employer. Women and minori-

ties are encouraged to apply. To request ADA ac-commodations; please contact our ADA Coordi-nator at (573) 884-7278 (V/TTY). [04/30/03]

DIVISION CHIEF, GENERAL INTERNALMEDICINE. The Mount Sinai School of Medicineseeks applications for the position of Chief of theDivision of General Internal Medicine of the De-partment of Medicine. The Chief will provide lead-ership and oversight for the clinical, teaching andresearch programs of the Division. The successfulapplicant will possess both the interpersonal skillsand administrative experience necessary to over-see and manage this group of physicians, as well asa proven track record of academic and researchachievement. Recognized clinical and research ex-cellence with a commitment to education in Inter-nal Medicine is required. In addition, the candi-date will be expected to develop his/her own re-search program and mentor junior faculty. Quali-fied candidates must have an MD degree, boardcertification in internal medicine and be eligiblefor licensure in NY State. Letters of Applicationincluding a CV should be sent to: Lorie Tabak,Mount Sinai School of Medicine, Department ofMedicine, One Gustave L. Levy Place, Box 1118,New York, NY 10029; fax 212-876-5844. We arean equal opportunity employer fostering diversityin the workplace.

GENERAL INTERNIST WEST LOS ANGELES:The VA Greater Los Angeles Healthcare System isrecruiting a full-time General Internist for the po-sition of Clinician-Educator in the AmbulatoryCare Line and the Division of General InternalMedicine. The incumbent would work primarily inthe outpatient primary care setting in an environ-ment that includes non-physician providers (NursePractitioners and Physician Assistants) with someinpatient responsibilities, namely at the VA WestLos Angeles Healthcare Center. This position in-cludes responsibility for delivery of direct patientcare, teaching internal medicine trainees and medi-cal students, and on-going scholarly activity in anenriched environment that promotes professionalexcellence. Candidates must be Board-Certified/Board Eligible in Internal Medicine and mustqualify for a faculty position at the Affiliate Uni-versity. U.S. Citizenship is required. Interested can-didates send CV and three (3) references toChonette Taylor, Human Resources Specialist(10A2-CT), West Los Angeles VA Medical Cen-ter, 11301 Wilshire Blvd., Los Angeles, CA 90073,(310) 478-3711 ext. 43186. Qualified applicantswho apply by April 30, 2003 will receive first con-sideration. Position is subject to random drug test-ing. Direct Deposit is required. The Department ofVeterans Affairs is an Equal Opportunity Employer.

HEALTH SERVICES RESEARCHER IN AGING:The Center for Health Care Research and Policy,Case Western Reserve University at MetroHealthMedical Center, in Cleveland, is seeking a physi-cian investigator to join its Programs for Researchand Education on Aging (PREA). The successful

candidate will work alongside Ph.D. researchersfrom sociology, economics, and statistics, as well asphysician researchers who also provide patient carein internal medicine, geriatrics, neurology, and re-habilitation. Current Center research includes workpertaining to palliative care and life limiting ill-nesses, quality of care, post acute care outcomes,patient preferences and quality of life among per-sons with disabilities, and the evaluation of com-munity-based long term care programs. Center fac-ulty also lead education programs related to agingboth at CWRU and as part of the statewide Geri-atric Education Center. The Center is located atMetroHealth Medical Center, a primary affiliate ofCWRU, and one of the premier public hospitals inthe nation. Opportunities for clinical practice areavailable in ambulatory, acute in-patient, rehabili-tation, and long term care settings. Opportunitiesfor student teaching and advising exist in graduateprograms in health services and clinical researchsupported by AHRQ and the NIH, in programsleading to Ph.D., M.D.-Ph.D., and M.S. degrees.Qualifications: A demonstrated record of external,competitive grant funding in aging, teaching andmentoring students, and a history of successful col-laboration with other research professionals. A com-mitment to productive work that is methodologi-cally rigorous and contributes to clinical care and/or public policy issues relevant to older Americans.Faculty rank will be commensurate with thecandidate’s training and experience. For informa-tion about the position contact: Patrick Murray,MD, MS, co-director, PREA or Julia Rose, PhD,MA, co-director, PREA, 2500 MetroHealth Dr.,Cleveland, OH 44109, 216-778-3901, email:[email protected] URL: http://www.chrp.org/index_sub.html. An Affirmative Action/Equal Opportunity Employer. Women and Minori-ties are Encouraged to Apply

HOSPITALIST FACULTY POSITION DIVI-SION OF GENERAL INTERNAL MEDICINE.The Division of GIM, Department of Medicine atthe University of Colorado Health Sciences Cen-ter is seeking a Hospitalist to begin approximatelyJuly 1, 2003. Candidates should be board certifiedinterested in a career as a clinician, practicing andteaching inpatient medicine. The Hospitalist’s roleoffers full-time faculty status and opportunity foracademic promotion judged on criteria of demon-strated excellence as a clinician/educator/scholar.Starting salary and faculty appointment are com-mensurate with experience. Teaching activities in-clude attending six months annually on up to twogeneral medical inpatient services including super-vision of inpatient procedures; medical supervisionof the inpatients observations unit; attending cov-erage of the medicine consultation service. Admin-istrative responsibilities will include input into bedcontrol on the medicine wards, development ofcritical pathways, and quality assurance committeework. Contact Jean Kutner, M.D., Acting Head,Division of GIM, UCHSC, 4200 East NinthAvenue, Box Bl80, Denver, Colorado 80262 by

Positions Available and Announcementsare $50 per 50 words for SGIM members and$100 per 50 words for nonmembers. Thesefees cover one month’s appearance in theForum and appearance on the SGIM Web-site at http://www.sgim.org. Send your ad,along with the name of the SGIM membersponsor, to [email protected]. It is assumedthat all ads are placed by equal opportunityemployers.

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Society of General Internal Medicine2501 M Street, NWSuite 575Washington, DC 20037

SGIM

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sending a resume either by US mail, or fax to303.372.9082 or e-mail at Jean [email protected]. The University of Colorado is com-mitted to Equal Opportunity and Affirmative Ac-tion.

TRAINING IN FACULTY DEVELOPMENT. TheStanford Faculty Development Center is currently

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accepting applications for two month-long, facili-tator-training programs. The training prepares fac-ulty to conduct a faculty development course forfaculty and residents at their home institutions. (1)The Clinical Teaching course introduces a 7-com-ponent framework for analyzing and improvingteaching. (2) The Geriatrics in Primary Care courseenhances primary care physicians’ ability to care

for older patients and teach geriatrics. 2003 pro-gram dates: Geriatrics in Primary Care (September2-26); Clinical Teaching (September 29-October24). Application deadline: June 1, 2003. For infor-mation: visit http://sfdc.stanford.edu or contactGeorgette Stratos, PhD at [email protected].

Executive Director: David Karlson, [email protected]

Director of Operations: Kay [email protected]

Director of Membership: Katrese [email protected]

Member Services Administator: Shannon [email protected]

Director of Regional Services: Juhee [email protected]

Director of Education: Sarajane [email protected]

Who’s Who in the SGIM National Office

Director of Communications: Lorraine [email protected]

Director of Development: Bradley [email protected]

Director of Finance/Administration: Karen [email protected]

THE FUTURE OF GENERAL INTERNAL MEDICINE A

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