The Fabulous Fours! Annual Report from the Editor

With the end of 2014, the Southwest Journal of Pulmonary and Critical Care (SWJPCC) completed its fourth year of operation. Our first manuscript was posted on November 11, 2010. We posted 8 manuscripts our first year, 68 in 2011, 113 in 2012 and 164 in 2013 and 167 in 2014 (Table 1).

Table 1. Yearly submissions, total postings and postings by category.

Accompanying our increase in manuscripts, our readership continues to steadily grow, although comparisons to previous years is difficult because the methodology changed in February, 2014 (Table 2).

Table 2. Page views, visits and audience size by month 2014.

SWJPCC continue to evolve and we made some changes in 2014:

• The California Thoracic Society partnered with SWJPCC.
• We added additional associate editors in pulmonary, critical care and imaging from Fresno (Peterson), Albuquerque (Boivin) and Tucson (Arteaga).

Many need to be thanked. First, thanks to our authors. Second, SWJPCC, like all journals, relies upon expert reviewers in order to publish the highest quality manuscripts. We thank the reviewers for their time and effort in the prompt submission of their reviews. A list of reviewers for 2014 is below.

• David Baratz
• Bhaskar Bhardwaj
• Michel Boivin
• Janet Campion
• Gordon Carr
• Michael Gotway
• Steve Klotz
• James Knepler
• Timothy Kuberski
• Manoj Mathew
• Jarrod Mosier
• Michael Peterson
• Robert Raschke
• Julene Robbins
• John Roehrs
• Clement Singarajah
• Karen Swanson
• Henry Tazelaar
• Dona Upson
• Carolyn Welsh
• Lewis Wesselius

Our gratitude goes to the Arizona, New Mexico, Colorado and California Thoracic Societies and the Mayo Clinic Rochester for their support. Thanks to our associate editors who have put in much more work than we had the right to ask. A special note of thanks to those who continue to do regular features in SWJPCC-Bob Raschke and Manoj Mathew for the critical care and pulmonary journal clubs; Mike Gotway, Lew Wesselius and Bob Raschke for the cases of the month; Michel Boivin for the ultrasound for critical care physicians; and Ken Knox for the Medical Image of the Week. SWJPCC acknowledges the Phoenix Pulmonary and Critical Care Research and Education Foundation which has provided the monetary support for SWJPCC, Squarespace our web host, CrossRef for generating the digital object identifiers (doi's) and CLOCK SS for archiving. Last, and most importantly, thanks to our readers. Please visit as often as you can and feel free to provide us with your input.

What’s ahead for 2015? We hope to improve the content, especially the scientific content, for 2015, but we will continue to emphasize clinical medicine and education. Sleep submissions have been lagging and we hope to increase the number of submissions. CME will continue to be offered for the previous 12 Pulmonary, Critical Care, and Imaging Cases of the Month for a total of 36 CME offerings at any one time. We would welcome suggestions for any improvements.

Richard A. Robbins, MD

Editor, SWJPCC

Reference as: Robbins RA. The fabulous fours! annual report from the editor. Southwest J Pulm Crit Care. 2015;10(1):8-10. doi: http://dx.doi.org/10.13175/swjpcc001-15 PDF

The Tremendous Threes! Annual Report from the Editor

With the end of 2013, the Southwest Journal of Pulmonary and Critical Care (SWJPCC) completed its third year of operation. Our first manuscript was posted on November 11, 2010. We posted 8 manuscripts our first year, 68 in 2011, 113 in 2012 and 164 in 2013 (Table 1).

Table 1. Yearly submissions, total postings and postings by category.

Accompanying our increase in manuscripts, our readership has steadily grown to over 12,000/month unique IP addresses and over 16,000/month page views (the number of files that are requested from a site, also known as “hits”) (Figure 1).

Figure 1. Growth of unique IP addresses and page views by month November 2010 to December 2013.

We had some big changes in 2013. Some of which are listed below:

• The Mayo Clinic Minnesota Critical Care partnered with the Arizona, New Mexico and Colorado Thoracic Societies in SWJPCC.
• Continuing medical education was offered for the Cases of the Month in Pulmonary, Critical Care and Imaging
• There was a marked increase in the number of imaging postings, particularly the “Medical Image of the Week”.
• We have begun a monthly series entitled “Ultrasound for Critical Care Physicians” taking advantage of an on-line’s journal capability to display movies.
• A Tucson Pulmonary Journal Club was added.
• We added digital object identifiers (doi) for each posting.
• We began using CrossRef to link references to their doi and to PubMed.
• CLOCKSS began preserving our content.

Many need to be thanked. First, thanks to our authors. You took a chance on a new journal and we appreciate the opportunity to publish your work. Second, thanks to our reviewers.  SWJPCC, like all journals, relies upon expert reviewers in order to publish the highest quality manuscripts. We thank the reviewers for their time and effort in the prompt submission of their reviews. A list of reviewers for 2013 is below:

• Owen Austrheim
• David Baratz
• Jay Blum
• Michel Boivin
• Rohit Budhiraja
• Janet Campion
• John Galgiani
• Michael Garrett
• Richard Gerkin
• Michael Gotway
• Richard Helmers
• Steven Klotz
• James Knepler
• KennethKnox
• Timothy Kuberski
• Calvin Kunin
• Manoj Mathew
• Vijaychandran Nair
• Sairam Pathsarathy
• Vinay Prasad
• Neal Rinee
• Clement Singarajah
• Linda Snyder
• Allen Thomas
• Lewis Wesselius

Our gratitude goes to the Arizona, New Mexico, and Colorado Thoracic Societies and the Mayo Clinic Rochester for their support. Thanks to our associate editors who have put in much more work than we had the right to ask. A special note of thanks to those who continue to do regular features in SWJPCC-Bob Raschke and Manoj Mathew for the critical care and pulmonary journal clubs; Mike Gotway, Lew Wesselius and Bob Raschke for the cases of the month; Rohit Budhiraja for the Sleep Question of the Month; and Ken Knox for the Medical Image of the Week; and Peter Wagner for his wine column, Slurping Around with PDW. SWJPCC acknowledges the Phoenix Pulmonary and Critical Care Research and Education Foundation which has provided the monetary support for SWJPCC and Squarespace our web host. Last, and most importantly, thanks to our readers. Please visit as often as you can and feel free to provide us with your input.

What’s ahead for 2014? We hope to improve the content, especially the scientific content, for 2014, but we will continue to emphasize clinical medicine and education. CME will continue to be offered for the previous 12 Pulmonary, Critical Care, and Imaging Cases of the Month for a total of 36 CME offerings at any one time. We would welcome suggestions for any improvements.

Richard A. Robbins, MD

Editor, SWJPCC

Reference as: Robbins RA. The tremendous threes! annual report from the editor. Southwest J Pulm Crit Care. 2014:8(1):1-3. doi: http://dx.doi.org/10.13175/swjpcc001-14 PDF

Maintaining Medical Competence

“I am free, no matter what rules surround me…because I know that I alone am morally responsible for everything I do.”― Robert A. Heinlein

I recently renewed my Arizona medical license and meet all the requirements. I far exceed the required CME hours and have no Medical Board actions, removal of hospital privileges, lawsuits, or felonies. None of the bad things are likely since I have not seen patients since July 1, 2011 and I no longer have hospital privileges. However, this caused me to pause when I came to the question of “Actively practicing”? A quick check of the status of several who do not see patients but are administrators, retired or full time editors of other medical journals revealed they were all listed as “active”. I guess that “medical journalism” is probably as much a medical activity as “administrative medicine” which is recognized by the Arizona Medical Board. This got me to thinking about competence and the Medical Board’s obligation to ensure competent physicians.

Medical boards focused on preventing the unlicensed practice of medicine by “quacks” and “charlatans” in the first half of the Twentieth Century. The Boards evolved over time to promote higher standards for undergraduate medical education; require assessment of knowledge and skills to qualify for initial licensure; and develop and enforce standards for professional practice. Beginning with New Mexico in 1971, nearly all state medical boards require a prescribed number of continued medical education (CME) hours with Colorado being a notable exception. Colorado’s lack of CME requirements goes against the recent trends. In 2010 the Federation of State Medical Boards (FSMB) House of Delegates voted to adopt a framework for maintenance of licensure to address concerns among policymakers and regulators (1). The FSMB’s framework contains three components: 1. reflective self assessment; 2. assessment of knowledge and skills; and 3. performance in practice.

Self-reflection has long been a mainstay of good medical practice. However, the requirement is vague and most evidence suggests that physicians are not very good at it (2). Assessment and reassessment of knowledge and skills has been present in most medical specialty and subspecialty boards for some time. Furthermore, actively practicing physicians are required to undergo periodic peer review and reapplication for hospital privileges. Further testing and assessment seems costly and largely unneeded. However, medical licensure is above all about seeing and treating patients. What is new is FSMB’s recognition of the importance of active medical practice in determining medical competence. In many instances, policymakers such as chiefs of staff, hospital board members, administrators or members of guideline writing committees have been non- or very limited practicing physicians. Their decisions have often been fundamentally flawed. Quality has been frequently politically defined rather than patient centered and evidence based. In too many cases, hastily adopted guidelines are proven wrong and even potentially dangerous to patients (3).

A physician who directs care should be subject to the “Continued Competency Rule” which is used in Colorado (4). This rule requires that a physician, “if not having engaged in active practice for two or more years…be able to demonstrate continued competency”. It needs to be recognized that those who meet this standard are only competent in their own area of practice. For example, a pulmonary and critical care physician has no business directing neurosurgical care or formulating orthopedic guidelines. Administrative medicine, and for that matter, medical journalism, would do not meet this standard of competency since neither involves taking responsibility for the care of patients. The requirement for physician administrators to be really active in the practice of medicine may be one key to improved medical care and competence. At least it should make them think about directing care or mandating a guideline that they, themselves have to follow.

Richard A. Robbins, MD*

References

1. Chaudhry HJ, Talmage LA, Alguire PC, Cain FE, Waters S, Rhyne JA. Maintenance of licensure: supporting a physician's commitment to lifelong learning. Ann Intern Med 2012;157:287-9.
2. Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. JAMA 2006;296:1094-102.
3. Robbins RA, Thomas AR, Raschke RA. Guidelines, recommendations and improvement in healthcare. Southwest J Pulm Crit Care 2011;2:34-37.
4. http://www.dora.state.co.us/medical/ (accessed 11/5/12).

* The views expressed are those of the author and do not necessarily represent the views of the Arizona, New Mexico or Colorado Thoracic Societies.

Reference as: Robbins RA. Maintaining medical competence. Southwest J Pulm Crit Care 2012;5:266-7. PDF