2010 AMA-MSS Annual Meeting

June 10-12, 2010
Hyatt Regency Chicago
Chicago, Illinois

Programming Highlights

• View the complete meeting agenda

Educational programs
More than 700 medical students from across the country attended the 2010 AMA-MSS Annual Meeting, which offered more than 25 educational programs on a range of topics including medicine and the media, surviving and thriving in medical school and residency, benefits of advanced degrees, Healer’s Art, and more. A keynote panel explored the history and transformation of medical education in recognition of the 100th anniversary of the “Flexner Report.”

• Download select educational program presentations

Medical Specialty Showcase
The AMA-MSS hosted its 7th Annual Medical Specialty Showcase, which was a resounding success. More than 50 specialty societies represented in the AMA-HOD were on hand to provide an introduction to their specialties and to offer materials to assist medical students in their career decision-making.

National Service Project event
Despite the weather, more than 40 students participated in an outstanding "National Get Outdoors Day" event at Lincoln Park Zoo as part of the AMA-MSS national service project. The students educated the public about the AMA’s Healthier Life Steps™ program, the concentration of the Section's national service project through 2011. Hundreds of visitors learned about four key health behaviors—poor diet, physical inactivity, tobacco use and excessive or risky use of alcohol. In addition, medical students facilitated healthy lifestyle activities for children, including exercise sessions, and body mass index and blood pressure screenings for adults.

Humanities Initiative
The AMA-MSS held its first annual Humanities Initiative, focusing on Empathy through Art and Poetry, at the 2010 AMA-MSS Annual Meeting. Thirty-three medical students from around the country submitted entries for viewing and judging at the AMA-MSS welcome reception. Congratulations to this year's winners:

• First place: Shawna Bellew, University of Central Florida College of Medicine
• Second place: Seema Varghese, Michigan State University College of Medicine
• Third place: Manuel (Trey) Penton, University of South Florida College of Medicine
• Fourth place: Sonya Hovsepian, Wright State University Boonshoft School of Medicine

Thank you to all who submitted entries, and to those who judged the entries.

Governing Council Elections

The AMA-MSS Assembly elected the following members of the 2010-2011 AMA-MSS Governing Council:

• Vice Chair: George Salloum, Wright State University Boonshoft School of Medicine
• Delegate: Steve Lee, Alpert Medical School of Brown University
• Alternate Delegate: Michael Best, University of Pittsburgh School of Medicine
• At-Large Officer: Busayo Obayan, Boston University School of Medicine
• Speaker: Andrew Lutzkanin, Pennsylvania State University College of Medicine
• Vice Speaker: Paul Mayor, Medical College of Georgia

At the conclusion of the meeting, Christopher Bucciarelli, University of Florida College of Medicine, commenced his term as AMA-MSS Chair, and Meredith Williams, Baylor College of Medicine, commmenced her term as student member of the AMA Board of Trustees (BOT). A special thanks to Hans Arora, AMA-MSS Immediate Past Chair, and Justin Mahida, past student member of the BOT, for their outstanding service.

Policy Highlights

The AMA-MSS Assembly considered 35 items of business spanning a wide range of issues, including taxes on medical school tuition, the cost of the USMLE and COMLEX licensing examinations, the role of physician extenders, and the repeal of the "Defense of Marriage Act." Thirty-one of these items were adopted in some form, seventeen of which will be forwarded to the AMA House of Delegates for consideration at the 2010 Interim Meeting in San Diego.

• Proceedings of the 2010 AMA-MSS Annual Meeting

US Senate Modifies
Medicare Payment Legislation

On Friday, June 18, the US Senate passed H.R. 3962, now called the "Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010," which provides for an increase of 2.2% in Medicare physician payment for June through November of 2010. You may recall the US House passed another version of H.R. 3962 in late May, which called for multi-year increases or freezes in physician payments, in lieu of the 21% cuts that went into effect on June 1.

Now, H.R. 3962 must return to the House to determine whether that chamber will agree with the changes made to the bill in the Senate. The House is not expected to take any votes until Tuesday, June 22. Until the US House passes the bill and the President signs it into law, the Centers for Medicare and Medicaid Services (CMS) has instructed its carriers to process Medicare physician claims at a 21 percent lower rate as of June 18. CMS had placed a hold on paying physician claims with the 21% cut required by the flawed Sustainable Growth Rate formula. If and when H.R. 3962 becomes law, CMS will retroactively adjust any June claims that have been paid at the lower rate. It is unclear, at this time, whether physician offices will be required to resubmit those claims.

One of KMA's five principles for health reform is repeal of the flawed SGR formula. To contact your Congressman about the SGR formula and reductions in Medicare physician payment, click the link below.

Click the link below to log in and send your message:
http://www.votervoice.net/link/target/kyma/FQBrgNcN.aspx

eVoice^® Alert

June 18, 2010

Senate passes six-month SGR fix

The U.S. Senate passed an amended version of H.R. 3962, now called the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010,” by unanimous consent this afternoon. This legislation provides a 2.2 percent Medicare physician payment update for six months, from June 1 through Nov. 30, in lieu of the 21 percent cut scheduled for 2010.

Unfortunately, the U.S. House of Representatives is not scheduled to hold any floor votes until the evening of June 22. As a result, the Centers for Medicare and Medicaid Services (CMS) is instructing its carriers to lift the hold on processing claims for services provided on or after June 1, and to begin processing them under the law’s negative update requirement. In other words, claims will begin to be paid today at the 21 percent lower rate on a first-in/first-out flow basis.

Once H.R. 3962 is passed by the House and signed by President Obama, CMS will retroactively adjust any June claims that have been paid.

View an AMA news release about the Medicare physician payment crisis.

eVoice^® Alert

June 17, 2010

CMS will process claims tomorrow, June 18,
with 21 percent cut

As the clock continues to tick toward the June 18 final deadline for implementation of the 21.3 percent cut in Medicare physician payments produced by the sustainable growth rate (SGR) formula, U.S. Senate debate continued June 17 over H.R. 4213, the American Jobs and Closing Tax Loopholes Act. In addition to providing another short-term reprieve from the impending Medicare cut, the legislation would increase federal Medicaid funding and extend various expiring programs, such as disaster relief and long-term unemployment insurance benefits.

If legislation is not signed into law before the weekend, the Centers for Medicare and Medicaid Services (CMS) will have no option but to instruct its contractors to begin processing Medicare claims for physician services provided in June at rates that reflect the 21.3 percent cut.

Once the House and Senate act to avert the cut, claims will be processed as follows:

• If the submitted charge is higher than the new rate, the contractor will automatically reprocess the claim.
• If the submitted charge is lower than the new rate, the physician should call the contractor.

CMS says almost all physicians submit claims for more than the Medicare rates. No one is going to be reviewing the limiting charge for the period that the cut was in place because CMS assumes Congress will ultimately make the fix retroactive.

The Office of Inspector General and CMS are close to releasing a document to waive patient co-pay requirements for situations such as the retroactive increases that were made to the geographic practice cost index increases. CMS will share that document once it is available.

Congressional inaction is a dereliction of duty

Democrats and Republicans in Congress are responsible for the current Medicare payment debacle. Congress has missed three separate deadlines and is now allowing cuts to go into effect that they pledged they would not allow to occur.

We expect our elected officials to resolve budget issues without punishing physicians, seniors and military families. State medical societies and national specialty societies sent a joint statement to Congress on June 16 that emphasizes this point. Continue to let your representatives and senators know that their inaction is unacceptable, and that it is harming patients and physicians across the country.

Use the AMA Physicians’ Grassroots Network toll-free hotline at (800) 833-6354 to call your lawmakers and tell them to repeal Medicare’s SGR formula once and for all.

Details on Senate impasse over Medicare physician payment cuts

The debate and delay in the Senate centers on growing concerns about how much the legislation would add to the federal deficit. On June 16, a substitute amendment to the House-passed version of the bill, offered by Sen. Max Baucus, D-Mont., was defeated on a bipartisan vote of 45-52. That amendment would have afforded a 19-month reprieve from the scheduled Medicare payment cuts by providing a 2.2 percent update for the remainder of 2010 and an additional 1.0 percent update in 2011. In 2012, physician payments would have been reduced by 33 percent.

After the defeat of his first amendment, Baucus introduced a second substitute amendment late on June 16 with reduced spending and additional funding offsets. The SGR relief provision was scaled back to a six-month, 2.2 percent update that would expire Nov. 30, 2010, after which the 21.3 percent cut originally scheduled for 2010 would take effect. Reports from Capitol Hill on June 17 indicate that this package may still lack the bipartisan support needed to reach the 60-vote threshold that is required to end debate and pass a final bill.

On June 17, an amendment offered by Sen. John Thune, R-S.D., was defeated on a vote of 41-57. The amendment was far less costly than either Baucus proposal, and according to the Congressional Budget Office, would begin reducing the federal deficit. It also would have provided 2.0 percent Medicare physician payment updates for the remainder of 2010 and all of 2011 and 2012, followed by a steep payment cut of well over 30 percent and an additional statutory cut of 4 percent. The Thune amendment also included medical liability caps on non-economic damages and other traditional tort reforms.

Because the Senate is considering substantial revisions to H.R. 4213, the bill will have to be sent back to the U.S. House of Representatives for passage. While House leaders have indicated they are prepared to stay in session late tomorrow, June 18, so that a vote can be held on the bill, it is far from clear that the Senate will be able to complete its consideration before the weekend.

A 61-Year-Old Woman With Intermittent Worsening Abdominal Pain

http://cme.medscape.com/viewarticle/720078?src=emed_case_nl_0&uac=147602PZ

An Atypical Cause of Gastrointestinal Bleeding

http://cme.medscape.com/viewarticle/720456?src=emed_case_nl_0&uac=147602PZ

Medical Student Perspectives: Writing the Residency Application Personal Statement

The residency personal statement process may feel a bit like déjà vu from those days of finger-crossing about getting into medical school. While we all wrote personal statements compelling enough to get into medical school, these four years offer very few opportunities to produce reflective written work. As such, the personal statement may be a larger challenge than expected during the residency application process.

For internal medicine, the personal statement needs to explain why you are choosing a particular career path and what makes you unique. It goes without saying that it should be well written; it also needs to be succinct and direct. This is not the time to brush off your creative writing skills: we have all been warned that personal statements that use a SOAP note structure to be cute, or a yellow brick road theme to be creative are not well received by residency directors.

Keep in mind that the first paragraph and the last paragraph are what get read most often and by the most people. These two paragraphs get skimmed by the administrator to set you up with a good interviewer match, and then by your interviewer five minutes before the interview starts. Open the first paragraph with an interesting story about yourself. Readers are trying to get a sense of who you are and whether you would be a good fit for the culture and tone of the program. The temptation is high to talk about an experience with a patient. Resist the urge. Residency directors know about patients. They don’t know about you. Make yourself the subject of each sentence as often as possible.

In approaching the meat of the essay, use it as an opportunity to breathe life into your ERAS application. Use this part of the essay to explain why your activities during medical school will render you a strong, dynamic physician. Talk about your accomplishments and accolades, but remember that humility goes a long way in this profession. You may also want to talk about earlier experiences in high school or college that led to your decision to go into medicine that may not be apparent in your ERAS application.

The last paragraph is very important. It should act as a summary, but also talk about what you envision for your future. A good question to help you formulate this part of the essay is “Where do I see myself in 10 years?” You may have very specific ideas. You may not. That’s okay. The process of thinking about the future says a lot about your priorities and your goals, which ultimately are of interest to residency directors. Do not feel like this is set in stone either—if you say you want to be a cardiologist in your essay and then decide in a few years that you want to do GI instead, this essay is not going to hold you back.

Your letter should be no more than one page long. End of story.

Some other things to keep in mind:

Think twice about revealing a personal illness. This may bring about questions regarding your ability to perform.

If there is a blemish in your record, you may want to discuss whether or not to touch on it in your essay with a career advisor at your school. If you have a good explanation for the fact that you failed Step 1 (e.g., a serious death in the family), this essay is a good opportunity to explain. But if you didn’t get Honors in your first clerkship and you explain this with, “I had a hard time adjusting to third year,” residency directors are not going to feel very reassured with such an explanation.

Do not talk about the field of medicine. Your reader has been in the field a lot longer than you. Trying to sound authoritative on the subject will backfire on you.
Some tips on the writing process:
Start early. Perhaps the biggest hurdle is getting the first words on the page. Even though the whole application is not due for a few months, try to spend some time now getting your ideas on paper.

Read well written prose with attention to what makes the writing good. A professor I had in college said that to improve your writing, read good writing. So head out to your local newsstand, pick up a New Yorker or an Atlantic Monthly. As tempting as it might be to read a novel, reading non-fiction will probably be more fruitful. Pay attention to the structure and how the concepts are communicated.

Read your old personal statements. The potential for cringing is high, but remember that your essay was good enough to get you into medical school in the first place. Regardless of how much you have changed in the last four years, it is good to reflect on your reasons for entering the medical profession. Now that you have had years away from this piece of writing, note what sentences and paragraphs jump out at you both as strong and weak, and keep those in mind as you start the writing process.

Talk it through out loud. While you may not have been writing op-ed pieces during medical school, you have learned how to communicate information effectively for presentations and rounds. By talking through your ideas aloud, you may be able to make major progress in getting through that first draft.

Accept input from others. A non-medical reader may have good insight on the writing, the organization of the essay, and the content. But remember to trust your gut in terms of modifying anything. Another reader will also pick up typos and serve in a proofreading capacity—always a plus.

I would like to thank Vineet Arora, MD, MA, FACP, Associate Director of the Internal Medicine Residency Program at the University of Chicago, and James Woodruff, MD, FACP, Director of the Internal Medicine Residency Program at the University of Chicago, for their advice and assistance with this article.