Governor's Message

Dear Oregon ACP Colleagues and Friends -

We are in a season of transitions. It is a time when many among us face endings and fresh beginnings. It’s a special time of hope and renewal, as well as a time for celebration of achievements and accomplishments. This has been on my mind since I watched my younger son walk across the stage this month to get his high school diploma. Unlike his older brother who graduated in 2020, we were able to celebrate this time with family and community. His path forward means a new time is also starting in my own life.

However, it must be acknowledged that such times of transition can also be times of stress and loss – loss of friends and family connections when making a big move, changes to plans or hopes for the future that require adjustment and mental reframing, and the difficulty of facing the new and the unknown.

As we welcome students, interns, and new colleagues into our professional family, please take a moment to reflect on what such times of transition have meant to you. If we are helping a child or mentee plan a big move, consider the paths of our own lives and what makes us optimistic and strong when facing the unknown, when facing inevitable pitfalls ahead. Let us make time to ask how others are doing and pause to really listen for the answer. Let us offer community if that is lacking, perspective if a longer view is needed, and active help if someone is at risk.

I’ve hesitated in the past to share my own difficulties, failures, and frustrations unless I feel the embrace of friendship and know that kindness (more than I tend to give myself) will be the response. It can be a leap of trust to share and that sharing should not be taken for granted. Let us take the stigma out of seeking help. There are many ways that our training and ongoing professional work can leave scars. While I loved my years of training, it was also a time when I was forced to confront the limits of my power to support, treat, cure, and care for people. It was a time when I was stretched to my own limits. It was also a time when I witnessed up close the failure and cruelty of our systems.

An estimated 300 physicians die by suicide in the U.S. per year and physicians who took their lives were less likely to be receiving mental health treatment compared with non physicians who took their lives. The risk starts early. In one study, 23 percent of interns had suicidal thoughts and 28% of residents experienced a major depressive episode during training (compared to 7-8% of similarly aged individuals in the U.S. general population). The suicide rate among male physicians in practice is 1.41 times higher than the general male population and among female physicians 2.27 times higher than the general female population.

Ten Facts about Physician Suicide and Mental Health

If you need help, please reach out to someone you trust. Acknowledging the need for help is the first step. Difficulty finding that help should not be the next; don’t forget the many resources ACP offers on the I.M. Emotional Support Hub. And don’t forget that the problem with which you struggle may be systemic. As Dr. Darilyn Moyer, EVP & CEO for ACP points out, “You can’t ‘yoga’ yourself out of the problem of physician burnout.” Drivers of burnout include workload, work inefficiency, lack of autonomy and meaning in work, work-home conflict. Drivers of moral injury include bearing witness to and participating in the failures of our systems to provide care to the people to whom we’ve dedicated ourselves. If you are confronting systemic factors in your workplace that are affecting your well-being and contributing to burnout, look to the ACP Well-being Pa ge which offers resources for promoting healthy systems and advocating for change.

The infusion of fresh energy, hope, and inspiration that accompanies this time of transition needs to be bolstered, supported, and encouraged to take root. We are here for you. We need you. For those who have new starts this summer, remember you are not alone. Step into your calling with pride, confidence, and endless curiosity. As Mark Twain wrote, “Twenty years from now you will be more disappointed by the things that you didn’t do than by the ones you did do. So throw off the bowlines. Sail away from the safe harbor. Catch the trade winds in your sails. Explore. Dream. Discover.”

In hope and solidarity,

Jenny

Jenny Silberger, MD FACP

Governor, Oregon Chapter of ACP

Save the Dates

October 26th - 28th, 2023 |Oregon Chapter Scientific Meeting, Salem, Oregon

February 13th, 2024 | Advocacy Day, Salem, Oregon

April 18th - 20th, 2023 | Internal Medicine Meeting, Boston, Massachusetts

Advocacy Updates

In March, Oregon ACP’s Health and Public Policy Committee (HPPC) hosted its 4th annual Advocacy Day in Salem. Guest speakers from the College came to Oregon in support of the event. Dr. Sue Bornstein (immediate past Chair of the Board of Regents) shared her personal journey into advocacy, and David Pugach J.D. (VP for Governmental Affairs and Public Policy) provided an update on national policy priorities. Approximately 70 people attended, many for the first time, and met with 19 legislators to advocate for Oregon ACP’s priority issues, including legislation addressing climate change, access to quality, affordable healthcare, and workforce issues in our state.

In addition to meeting with legislators during Advocacy Day, the HPPC led advocacy efforts via multiple avenues on behalf of the chapter in recent months. The committee chair, Dr. Joel Burnett coordinated with other members of the committee to author and publish a letter in the Oregonian regarding firearm injury prevention legislation. They also submitted written testimony for legislative committee hearings on access to affordable, quality healthcare and on firearm injury prevention bills and organized a letter writing campaign in support of firearm injury prevention legislation.

In May, HPPC members and other Chapter members joined nearly 400 ACP members at ACP Leadership Day 2023 in Washington DC to advocate in support of federal legislation addressing reductions in administrative burdens, strengthening the physician workforce, and protecting patient access to quality health care by supporting adequate physician payment rates. Leadership day is an inspiring opportunity to learn about advocacy and then to practice the skills immediately. Physician advocates educate our legislators about the lived experience of doctoring in the United States while providing guidance on how to make things better for patients and physicians.

While in Washington DC, Oregon ACP’s HPPC leadership team including Drs. Joel Burnett, Kelsi Manley, Logan Jones, and Adam Obley received special recognition from ACP as ‘Advocates for Internal Medicine’ for their advocacy work at the state and national level.

Oregon was actively involved in the Resolution Process this spring as well. Please see the outcomes at the Board of Governors and Regents for the resolutions the Chapter sponsored and/or co-sponsored:

Resolution 3-S23: Developing Educational resources to Train Physicians about the Evolving Threats of Climate Change on Human Health - Recommended for adoption/implementation
Resolution 7-S23: Supporting and Advocating for Concurrent Disease Targeted and Hospice Care - Referred to committee for further study
Resolution 10-S23: Advocating Against Restrictive Clauses in Physician Employment Contracts - Recommended for adoption/implementation with amendments
Resolution 12-S23: Updating ACP Policy to Eliminate the Ban against Blood Donation from Men Who Have Sex with Men - Recommended for adoption/implementation with amendments
Resolution 13-S23: Acknowledging Healthcare-sponsored Voter Engagement as a Health Equity Strategy to Address Social Determinants of Health - Recommended for adoption/implementation with amendments

For a detailed update on all the resolutions debated at the Spring 2023 Board of Governors Meeting, follow this link. If you have an idea you would like to suggest to ACP, consider submitting a resolution email to the Oregon ACP Governor. Let us know if you need any help or need information on how to propose a resolution.

Congratulations to Oregon Members!

After an incredibly exciting series of runoff rounds at the national Doctor’s Dilemma Competition in San Diego in April, Oregon’s Doctor’s Dilemma team came in second place and advanced to the finals in a wildcard spot. Their strategic bidding earned them the spot despite a wrong answer. Then, in an amazing turn of events, the team WON the national competition. This is an impressive achievement for our state which is relatively small and has been involved in Doctor’s Dilemma for only ten years. The team included three residents from OHSU, Drs. Doug Rice, Arjun Pande and Gabriel Monti, who provided a nail-biting show for those of us who were able to attend.

Oregon was well represented in San Diego by our students and residents who presented posters. It was great to be able to stop by a corner of the exhibit hall and hear presentations by Drs. Steven Liu, Megan Schluentz and Riyad Seervai. Medical student, Emily Burney, won first prize for her poster, “Assessment of Barriers to Dual-Language Prescription Translation at a Portland Federally Qualified Health Center.”

At convocation in San Diego, Oregon celebrated a national award winner, Dr. Avi O’Glasser, who was awarded the Walter J. McDonald Award for Early Career Physicians which recognizes outstanding achievement by a physician member who is within 16 years of graduating medical school.

Congratulations to our chapter members on election to Fellow of the American College of Physicians so far this year. The distinction recognizes achievements in internal medicine.

Nicolette O Rosendahl, DO FACP

Mengyu Zhou, MD FACP

Sonam Kiwalkar, MD FACP

Nicholas Nelson MD FACP

Bhaskar Ongole, MBBS FACP

Jacob P Casey, MD FACP

Richard L Hsu, MD FACP

Kevin M Piro, MD FACP

Arun Thekkekarott Kuruvila, MBBS, MD FACP

Joel Burnett, MD FACP

Laura K Byerly, MD FACP

Adama Diarra, DO FACP

Robert G Fojtasek, MD FACP

Paula A Folger, MD FACP

Jill R Hansen, MD FACP

Xiaoyan Huang, MD FACP

Robert L Jones, MD FACP

Joshua D Jones, MD FACP

Briana N Ketterer, MD FACP

Kaleb Keyserling, MD FACP

Abigail Lenhart, MD FACP

Bailey Pope, MD FACP

Hannah Iris Rose, MD FACP

Matthew Wiest, DO FACP

Jane M Zhu, MD FACP

Fellowship is elected upon the recommendation of peers and the review of the ACP’s Credentials Subcommittee. They may now use the letters “FACP” after their name in recognition of this honor. Please join me in celebrating these physicians!

Wellness Offering: Summer Reading Recommendations from Oregon ACP Leaders

If you’re looking for some good summer reading, these were books recommended at a recent Council meeting. I offer this unfiltered list as a reminder that you can pick up a book at any hour of the day or week and it will be a distraction, escape, opportunity to recharge or a moment to reconnect with yourself. The right book will feed your soul. It is there, waiting for your attention to return to it, and it can take you to another place and time when you need that. I hope you find something deserving of your attention on this (or another) list this summer!

Lessons in Chemistry | Bonnie Garmus
Deep River | Karl Marlantes
Circe | Madeline Miller
We Are Legion (We Are Bob) | Dennis E Taylor
Anything by Author Russell Banks
Cloud Cuckoo Land | Anthony Doerr
The Ten Thousand Doors of January |Alix E. Harrow
Letter to a Young Female Physician: Thoughts on Life and Work |Suzanne Koven
The Swerve: How the World Became Modern | Stephen Greenblatt
The Birthday Boys | Beryl Bainbridge
Babi Yar: A Document in the Form of a Novel | Anatoli Kuznetsov
Horse | Geraldine Brooks
Range: Why Generalists Triumph in a Specialized World | David Epstein
How to Love the World: Poems of Gratitude and Hope | James Crews
Thistlefoot | GennaRose Nethercott
This is How It Always Is | Laurie Frankel
In the Heart of the Sea | Nathaniel Philbrick

Join the Advocates in

Internal Medicine Network (AIMn)

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This network helps you contribute to the effort while saving you time and energy. You will NOT be spammed by messages. At key moments, the AIMn will alert you that you are needed and will make it easy to email your legislator.

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Renew your membership to continue your complimentary access to JournalWise, DynaMedex, and enjoy exclusively deep member discounts for MKSAP, Resolve (Physician Compensation services), Group insurance plans through AGIA, and so much more. Dues are also tax deductive! Renew today!

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Member Op Ed

The Promise and Pitfalls of AI in Medicine: Implications for Physicians in 2023

R Logan Jones, MD

The ACP has long advocated for “Patients Before Paperwork” – an initiative aimed at reinvigorating the patient-physician relationship.1 Until recently, there have been few if any potential solutions that could lead to large-scale and meaningful improvement in allowing clinicians the opportunity to be patients facing, and less computer facing. Enter 2023 - “The Birthyear of AI” (you heard it here first). We now have the capability to harness and authentically use the computer screen that has long drawn us away from being face to face with patients, to re-insert ourselves into a true interpersonal clinical encounter.

AI's ability to rapidly analyze large volumes of data and identify patterns can be harnessed to automate tedious administrative tasks, thus relieving physicians of a significant part of their workload and allowing them to dedicate more time to patient care. 2 For instance, AI can streamline claims processing, revenue cycle management, clinical documentation, and medical records management, tasks that are currently contributing to the burnout of healthcare professionals. Personally, AI has helped me to build the scaffolding for complex project management activities, provided outlines for patient education on medical conditions, helped me prepare for educational talks, and boosted my academic productivity. And if you’re wondering – yes, it did help me convert my bullet points into the first rough draft of this paper. If you haven’t watched someone, use an AI chat bot, it will take but a few minutes to see the implications of streamlining or even eradicating many tasks that lead busy clinicians to feel a death by a thousand cuts.

With regards to patient care innovations, AI technologies, such as machine-learning algorithms (MLAs), have also been shown in some instances to match or even surpass human experts in their diagnostic performance, potentially leading to improved patient outcomes. For more than a decade, the specialties of radiology and pathology, which are heavily image based, have been a ripe field for AI to take on the clinician as the gold standard of diagnostic certainty. While MLAs have been shown to be more sensitive and have better inter-rater reliability when reviewing large batches of routine images such as mammograms when compared to radiologist, specialists still reign in being able to identify atypical findings and interconnect disparate details into a comprehensive impression. 3 However, the exponential growth in MLA interconnectedness with external resources has demonstrated impressive growth. Thus, as clinical specialists, internal medicine physicians should no longer feel insular from the encroachment of MLA into the domain of bedside medicine.

EMRs and the modern-day medical record (read: SOAP notes and the problem oriented medical record) were pioneered and championed by Larry Weed. 4 Whether aware of it or not, physicians across the country have been following his roadmap for creating a medical record that would one day be empowered by computers. This promise has long been seen as a fantastical future and out of reach. The promises of real-time clinical decisions support have, at best, required significant human input to the point of being a hindrance to clinical care. No longer is that true. While recently heralded innovations like Epic’s Sepsis Model fell short when published in 2021 – it’s very conceivable that 2023 iterations and beyond will be a different tune. 5 AI algorithms are able to now freely “crawl” the internet and amass further understanding of the world without human oversight. So, be prepared to see the likes of EPIC, Cerner, and other tech giants get in line to match their AI & MLAs against the ability of patient-facing clinicians to diagnose and treat their patient. With the ability to actually keep up with changing literature, never needing to sleep, and actually being able to review the 1000+ data points patients generate daily – I have little faith that clinicians will be able to keep up with AI for the screening and diagnosing of medical conditions. 6,7

In addition to becoming second fiddle in the diagnostic arms race to AI, we may inevitably also be replaced with regards to interacting with patients. With the boom of remote and virtual medicine à la Covid-19, the explosion of using electronic messaging as a means to deliver patient care has been embraced and has even become a reimbursable activity. The next frontier of patient-facing AI will be its use in the electronic “in-box”. Researchers at the University of Maryland School of Medicine (UMSOM) found that ChatGPT was an effective solution for medical searches for patients. They showed that 88% of patient inquiries were answered with accurate information, with the added benefit of being delivered in patient-friendly language. 8 While this exercise showed definite room for improvement, it presents the concern that “Dr. Google” will no longer be many patients’ primary care, rather it will become “Dr. AI”. The result of which? I worry that patients may engage with the medical system less, medical complaints may go unseen longer while being “managed” by AI, and result in the possible paradox of us having worse outcomes as we actually see and spend less time with our patients.

Additional considerations of risk for patients as we see AI promulgate through all aspects of our life is the significant concern is the potential for AI systems to perpetuate and even exacerbate existing biases. If the data used to train AI systems reflect biases rooted in the myriad social determinants of health, these biases can be incorporated into the system's outputs, potentially leading to inequities in care. Poorly designed systems can also misdiagnose, and programs that learn as they go can produce a host of unintended consequences once they start interacting with unpredictable humans. 9 Privacy and confidentiality of data are additional areas of concern with the use of AI in healthcare. The need for large datasets to train and validate AI algorithms can conflict with the need to protect patient data. This was particularly evident during the global response to COVID-19, where the lack of reliable, real-time data due to privacy concerns hindered the use of AI in formulating an effective response. 9 Finally, the risk of over-reliance on AI is another potential downside. While AI can greatly aid physicians and clinicians in their work, it is crucial to remember that it is merely a tool and not a replacement for human medical judgment. While the sensitivity to provide early and accurate diagnoses of clinical syndromes like sepsis seem like an inevitable, over-reliance on AI could lead to errors if the AI system malfunctions or if it is used outside of its validated scope. It could also potentially result in a decline in the diagnostic and decision-making skills of physicians if they become too reliant on AI.

Finally, the widespread adoption of AI in healthcare could potentially impact the financial earning capacity of individual physicians and lead to job losses. Although AI cannot replicate the empathy and compassion inherent to the practice of medicine, nor have there been demonstrable forays into replicating the expertise in physical diagnosis (although MLAs are in the space of cardiac auscultation), there is still the risk of job displacement due to automation. Especially in roles heavily involved with data management and administrative tasks. However, this also provides an opportunity for healthcare professionals to shift their focus more towards patient care and other areas that cannot be automated, and also may come as a relief considering shortage of between 37,800 and 124,000 physicians by 2034. 10

In all, AI has demonstrated the potential to revolutionize healthcare, enabling physicians to reduce their administrative burden, enhance diagnostic accuracy, and spend more time at the bedside providing patient care. The potential applications are seemingly limitless, but we are in a pandora’s box moment – and it seems the lid is wide open and shutting it is no longer an option. Thus, for better or for worse, we are living in an AI augmented world. Thus, it is up to us in this early time to ensure that we are part of the conceiving and constructing the new world we find ourselves in.

Before Paperwork Initiative | ACP. Published May 16, 2023. Accessed May 24, 2023. https://www.acponline.org/advocacy/where-we-stand/patients-before-paperwork-reducing-administrative-burdens
D’Souza R. Council Post: Solving Healthcare’s Human Problem: Combining AI-Led Analytical Thinking With Compassion. Forbes. Accessed May 24, 2023. https://www.forbes.com/sites/forbestechcouncil/2022/06/14/solving-healthcares-human-problem-combining-ai-led-analytical-thinking-with-compassion/
Hickman SE, Woitek R, Le EPV, et al. Machine Learning for Workflow Applications in Screening Mammography:Systematic Review and Meta-Analysis. Radiology. 2022;302(1):88-104. doi:10.1148/radiol.2021210391
Aronson MD. The Purpose of the Medical Record: Why Lawrence Weed Still Matters. The American Journal of Medicine. 2019;132(11):1256-1257. doi:10.1016/j.amjmed.2019.03.051
Habib AR, Lin AL, Grant RW. The Epic Sepsis Model Falls Short—The Importance of External Validation. JAMA Internal Medicine. 2021;181(8):1040-1041. doi:10.1001/jamainternmed.2021.3333
Gal DB, Han B, Longhurst C, Scheinker D, Shin AY. Quantifying Electronic Health Record Data: A Potential Risk for Cognitive Overload. Hospital Pediatrics. 2021;11(2):175-178. doi:10.1542/hpeds.2020-002402
Hersh WR, Cohen AM, Nguyen MM, Bensching KL, Deloughery TG. Clinical study applying machine learning to detect a rare disease: results and lessons learned. JAMIA Open. 2022;5(2):ooac053. doi:10.1093/jamiaopen/ooac053
Center U of MM. UM SCHOOL OF MEDICINE STUDY FINDS CHATGPT HELPFUL FOR BREAST CANCER SCREENING ADVICE, WITH CERTAIN CAVEATS. Accessed May 24, 2023. https://www.prnewswire.com/news-releases/um-school-of-medicine-study-finds-chatgpt-helpful-for-breast-cancer-screening-advice-with-certain-caveats-301798102.html
Writer APHS. Risks and benefits of an AI revolution in medicine. Harvard Gazette. Published November 11, 2020. Accessed May 24, 2023. https://news.harvard.edu/gazette/story/2020/11/risks-and-benefits-of-an-ai-revolution-in-medicine/
AAMC Report Reinforces Mounting Physician Shortage. AAMC. Accessed May 24, 2023. https://www.aamc.org/news/press-releases/aamc-report-reinforces-mounting-physician-shortage