April 16, 2007

Radical Change In GME In Store For SE Michigan
DMC Looks To Land DO school; Expand Primary Care Reach
Beaumont, Oakland U Go To School
Letter From Dean Mentzer On Recent Changes In GME
Response To Deans' Letter From Dr. Haapaniemi
Editor's Column: Testing
Governor To Speak At MSMS Leadership Summit
Hear Lawmakers And Futurist At HOD
Physician Speakers Wanted For School Health Programs

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Radical Change In GME In Store For SE Michigan

By PAUL NATINSKY
As the graduate medical education picture continues its radical transformation in Southeast Michigan, a number of new developments have occurred. To bring you the most up-to-date and unvarnished coverage of what key players are thinking; we have included several items in this edition of the Detroit Medical News Online.

The first piece is a story covering Detroit Medical Center CEO Mike Duggan’s speech at the 15th Annual Rhoades Lecture March 23 in Detroit. Next is a brief story about the new Oakland University/Beaumont Hospital medical school. The third item is a letter distributed by e-mail by Wayne State University School of Medicine Dean Robert Mentzer, MD, and Executive Vice Dean Robert Frank, MD, which was obtained by the Detroit Medical News late last week. The final item is a response to Dean Mentzer’s letter from John Haapaniemi, DO, who serves as Chief of Staff at DMC’s Sinai-Grace Hospital in Detroit and the WSU Medical School and the Michigan State University College of Osteopathic Medicine.

The Detroit Medical Center’s proposal to MSU for the osteopathic satellite school and the proposal for branding the venture can be viewed at: http://www.med.wayne.edu/pdfs/DMC_proposal_to_MSU_DO_school.pdf
http://www.med.wayne.edu/pdfs/DMC_proposal_for_MSU_branding.pdf

DMC Looks To Land DO School; Expand Primary Care Reach

By PAUL NATINSKY
The graduate medical education stew just keeps boiling over in Southeast Michigan. The latest development is the Detroit Medical Center’s bid to house the Michigan State University College of Osteopathic Medicine’s southeast Michigan satellite campus.

DMC CEO Mike Duggan focused his presentation indirectly on that issue at the 15^th Annual Francis P. Rhoades Memorial Lecture March 23 at the Detroit Yacht Club. DMC is a leading candidate to host MSUCOM’s satellite school that initially will train 50 medical students in Southeast Michigan, and later 100.. The Medical Center would locate the school at Hutzel Hospital on its Downtown Detroit campus. By press time, DMC had become the leader in the MSUCOM sweepstakes as news broke that Oakland University and Beaumont Hospital had agreed to form a medical school.

“We’re going to do the training with Michigan State students regardless of whether we get the college or not,” said Duggan. “When the dust clears, Michigan State’s osteopathic college is going to be in one of two places; it’s either going to be on the Oakland University Campus in Rochester or it’s going to be down (in Detroit). It may not be politically correct (to say this), but I’ve seen all the proposals and, realistically, they’ve got two outstanding proposals to choose from.”

Duggan’s rationale for DMC’s involvement with osteopathic education is as follows. Two hospitals, Sinai-Grace in northwest Detroit and Huron Valley Sinai in Commerce Township have a total o570 beds and 30,000 annual admissions. They represent between 35 and 38 percent of DMC’s capacity, but only house 15 to 17 percent of the hospital system’s students and residents. Duggan says DMC can easily support allopathic residencies downtown while hosting osteopaths at Sinai-Grace and Huron Valley.

Further, Duggan said that while WSU provides the most matches for DMC’s downtown campus, resident’s from MSU are not represented there. He said the next highest match after WSU for the downtown campus is students from Damascus University in Syria, followed by a medical school in Pakistan.

Most of the WSU residents are specialists. Duggan believes DMC can host those specialist residencies downtown and establish an osteopathic primary care residency program at underutilized Sinai-Grace and Huron Valley hospitals.

Duggan said whatever scenario takes place, it won’t interfere with the $75 million-per-year deal that DMC has with WSU for the jointly sponsored residencies. He views the two ideas as complementary. Duggan thinks the DMC can offer MSU students and residents exposure to trauma centers and other features that are absent in the university’s 23-hospital network and endear a percentage of students to the city of Detroit, potentially helping the ebb the regions looming physician shortage and current lack of primary care physicians.

There are also financial considerations for the DMC. Hutzel Hospital sits half empty and loses $12 million per year. Leasing that space to an MSU satellite campus would go a long way toward rebuilding Hutzel’s bottom line. Both the landing of the MSU satellite and the establishment of future residency programs at DMC work toward one of Duggan’s primary goals.

“The choices I will always make,” said Duggan, “is to make sure DMC is on financially solid enough ground that Hutzel and Receiving hospitals stay open.”

Beaumont, Oakland U Go to School

By Paul Natinsky
In a move touted as a partial solution the widely anticipated and impending physician shortage, Oakland University and Beaumont Hospitals announced April 5 plans to open a new medical school with the first class expected to in 2010. The news comes fast on the heels of Oakland’s bid for the Michigan State University College of Osteopathic Medicine’s Southeast Michigan satellite campus, which is presumably now a non-starter.

Studies indicate that Michigan could be short as many as 4,400 doctors by 2020, Beaumont CEO Kenneth Matzick told the Detroit News.

Wayne State University recently increased its medical school enrollment by 10 percent and Michigan State University is relocating one of its campuses to Grand Rapids and establishing a southeast Michigan campus, likely at Hutzel Hospital in Detroit, partly in response to the anticipated shortage.

Beaumont and OU have filed a letter of intent with the Liaison Committee for Medical Education, which is part of the accreditation process for medical schools.

Letter From Dean Mentzer On Recent Developments In GME

Dear Colleagues,

Michigan State University is establishing a southeast Michigan satellite of its College of Osteopathic Medicine. Institutions bidding to host the DO school include Macomb Community College and the Detroit Medical Center. The DMC proposal would headquarter the DO school satellite at the old Hutzel Hospital, on the campus it shares with Wayne State University. Ultimately, the decision will come to a vote by the eight elected members of the Michigan State University Board of Trustees on May 16-17, following a tour of competing sites scheduled for May 1.

As awareness of this issue has increased, many of you have voiced concerns about the potential impact of the DMC proposal on our medical education programs, and many of you have asked what you can do to advocate for the school and its students. (The links to the DMC proposal were originally inserted here by the deans.)

With our two peer Michigan medical schools, the Wayne State University School of Medicine authored the report to Governor Jennifer Granholm on Michigan physician work force requirements. We support MSU's strategy to alleviate the projected shortage of physicians in Michigan. However, we firmly believe that an osteopathy school satellite on this campus will jeopardize the academic programs of the School of Medicine and compromise our contributions to the City of Detroit.

If, following your review of the DMC proposal, you wish to make your opinion known to those voting on this issue, please contact each member of the Michigan State University Board of Trustees. (The original letter contained contact information for each trustee.)

The Wayne State University School of Medicine is distinguished by its faculty and graduates, who carry on the school's longstanding tradition and commitment to our tripartite mission of education, research, and clinical care. We have achieved the depth and breadth of our programs over 139 years of learning, discovery, and service in the City of Detroit, southeast Michigan, and beyond.

Response To Deans' Letter From Dr. Haapaniemi

Dear Colleague,

I was very surprised to read Dr. Mentzer's letter yesterday to the medical community suggesting that DMC's proposal to house MSU COM's southeastern campus "will jeopardize the academic programs of the School of Medicine and compromise our contributions to the City of Detroit."

I was an undergraduate student at MSU when the MD school started there. I was also present when the DO school joined the same East Lansing campus, and I went on to graduate from MSU COM in 1975. I saw both schools develop and grow in a collegial fashion. Wayne State University and the Detroit Medical Center are critically important to the City of Detroit and this region. Several US cities have 4 or more medical schools. With the double threat of the local economy and the looming physician shortage we should work together and welcome MSU COM just as we welcome Oakland University's new medical school in an effort to help solve the challenges ahead.

The proposal by the DMC to forge a relationship with MSU COM has been put forth with a pledge from DMC administration that WSU students and GME programs not be jeopardized. In a presentation to the Wayne County Medical Society last month Mike Duggan, CEO of the DMC, shared his vision of GME in southeastern Michigan. He outlined a plan that would protect WSU educational programs on the central DMC campus and at the same time offer educational programs to MSU COM at the Sinai Grace and Huron Valley Sinai hospitals. These DMC hospitals have significant capacity to provide teaching sites, patients and physician educators for students and residents not currently used by WSU. This seems to be a win-win plan for WSU SOM, MSU COM, the city of Detroit, and for the DMC hospitals as well as their more than 2000 physicians, most of whom are non-faculty private practitioners.

Editor's Colomn: Testing

By JOSEPH WEISS, MD
Originally, we faced board examinations. If we passed boards, we were a board-certified physician. There were no more examinations and we carried the title of “board certified” for life.

The rapid changes in information and understanding, made that designation of certified-for-life untenable. The next step was requiring recertification. To keep that designation of “board certified,” the American specialty boards mandated retaking the certification examination every 10 years. The physician community considered the requirement appropriate, though it required a sustained and expensive effort. This periodic retaking of boards satisfied the public also. However the medical education community remained discontent.

Next came the requirement that before a physician could take re-certification she needed to complete a number of preliminary tests called modules. In the case of Internal Medicine and medical subspecialties, a group of five modules. Each module included 60 questions and we had to gain a passing score on each module before being allowed entrance to the proctored recertification examination.

But that was not enough. The re-certification directors next required that we obtain affidavits from patients, colleagues and our hospital affirming your character and competency.

But there is still more. Now to become eligible to take a re-certification examination, we must submit all the above plus undertaking what the Board calls “a self evaluation of practice performance.” The Board provides a template in an area pertinent to our practice such as hypertension, diabetes, osteoporosis, or in my case, rheumatoid arthritis. We collect data as required by the Board’s template through the process of abstracting 50 patient charts. After filling in the data, we must send out patient surveys and make sure those surveys return to our office and are completed. Then we send the required information to the Board. In turn, the Board remits an “improvement plan.” We then implement their plan, and within six months must submit a report that shows changes in our practice. If the Board judges that the changes are improvements, we are given credit for the module. In order to maintain your certification, we need to obtain a Board passing grade on at least two practice improvement modules. Of course, we must also pass the recertification examination.

Each element of re-certification has merit. However, the overall effect is to make excessive demands on physicians’ time. The cost of re-certification is in the thousands of dollars. The time required to take these pre examination modules, to abstract charts, to obtain patient surveys, and to prepare for the examination itself, is in the hundreds of hours.

The re-certification examination alone, given every five to seven years would suffice to test us. I would leave to our specialty societies the decision as to how physicians should modify and improve practice. The zeal to reform should give way to a rule of reason.

Governor To Speak At MSMS Leadership Summit

Michigan Gov. Jennifer Granholm will join a list of distinguished speakers at the 4th annual MSMS Leadership Summit on Wednesday, May 16, at the Radisson Hotel in Lansing. The Governor will speak about "Health Care As Part of Michigan's Economic Plan." Other topics and speakers will include: "Health Care in Business" (Chris Sullivan, MCSSP, National Director, Healthcare Provider Solutions, Microsoft Corporation); "Consumer Directed Health Care" (John Casillas, F ounder, The Medical Banking Project; Steven Selinsky, Consultant for Consumer Choice Health Care in Michigan and Wisconsin, Humana; and Fred Williams, Director of Benefits and Strategic Alliances, Quest Diagnostics Corporate Headquarters); "Worksite Wellness" (David Hom, Vice President for Employment Brand Total Rewards, Pitney Bowes; Cyndy Parker, RN, MHA, Care Management Manager, DaimlerChrysler Integrated Health Care & Disability; and Peggy Shepanski, Dow Chemical Preventative Health Program); "'Future of Medicine' Task Force Report" – MSMS Board Member F. Remington Sprague, MD); "Legislative Update" (several k ey state legislators); and "Insurance Reform" (key state legislators, MSMS Legal Counsel Daniel J. Schulte, JD; and Clarence Chou, MD, President, Wisconsin Medical Society). For more information, visit www.msms.org/leadershipsummit. Or contact Melinda Sandford at MSMS at (517) 336-7575 or msandford@msms.org.

Hear Lawmakers And Futurist At HOD

MSMS invites all members to earn up to 3.5 hours of AMA PRA Category 1 Credit(s)™ and learn about several interesting topics during two afternoon House of Delegates sessions on Saturday, April 28. The Physician Issues Forum, 12:00-2:00pm, will offer 1.5 hours of AMA PRA Category 1 Credit(s)™, and will address health care issues in the state and federal legislatures. Confirmed speakers include US Congressman John Dingell (D-Dearborn), state Sen. Roger Kahn, MD (R-Saginaw), and futurist David Ellis, of the Detroit Medical Center. To register, contact Jeanne Miller at (517) 336-5726 or jkmiller@msms.org. "Health Care Crisis: Single Payer Solution?", 2:30-4:30 p.m., will offer up to two more credits. The programs are free and open to any MSMS member. To register, contact Angie Kemppainen at (517) 336-5724 or akemppainen@msms.org.

Physician Speakers Wanted For School Health Programs

At the direction of a 2006 House of Delegates resolution, MSMS is gathering the names of physicians and medical students willing to volunteer as guest speakers at local schools on health issues. Physicians and medical students with expertise in areas such as healthy weight (nutrition, fitness), tobacco, bullying, mental health (depression, anxiety), substance abuse and other school age-appropriate health topics are encouraged to volunteer. Names will be shared with various patient advocacy and health organizations with existing educational outreach programs for schools (such as the National Kidney Foundation of Michigan). If you are interested in volunteering, email your full name, address, phone number, the county (or counties) you would be willing to visit, and the topics you could speak about to Jessy Sielski at MSMS at jsielski@msms.org (subject line: "Volunteer Speaker").

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