We are pleased to announce that Covenant HealthCare Interventional Cardiologists (pictured above left to right) Bashar Al Jayyousi, MD, FACC, FSCAI; Manoj Sharma, MD, FACC, FSCAI and Anwar Zaitoun, MD, FACC, FSCAI, RPVI, are now able to diagnose CMD using a unique physiological diagnostic option – the Coroventis CoroFlow Cardiovascular System. This new option will ensure patients suffering from chronic angina caused by CMD are properly diagnosed, so the best course of treatment for them can be identified.
• Patients presenting to the ER with chronic angina.
• Patients with a negative stress test, but are still suffering from angina.
• Patients whose coronary arteries appear clear under angiography, but are still suffering from angina.
• Patients still suffering from angina post-PCI.
• Patients who have been told they suffer from indigestion, but cannot find relief for their symptoms.
• Female patients who suffer from angina as they are more likely to be affected by CMD than men.
For patients suffering from CMD, the journey from first experiencing chest pain symptoms to having the cause accurately diagnosed can be long and stressful. We are pleased to offer this critical diagnostic tool that opens a new pathway to improving patients’ lives.
To refer a patient or for help determining if a CMD diagnostic test should be considered, please contact Covenant Cardiology at 989.583.4700.
CovenantCardiology.com
Saginaw County Medical Society
2022-2023
OFFICERS
President Tiffany K. Kim MD
President-Elect Mark G. Greenwell MD
Past President Anthony M. Zacharek MD
Secretary Caroline G.M. Scott MD
Treasurer Miriam T. Schteingart MD
Board of Directors
Christopher J. Allen MD
Furhut R. Janssen DO
Mary J. McKuen MD
Kai Anderson MD
Jennifer M. Romeu MD
Elizabeth M. Marshall MD
Bulletin Editor Louis L. Constan MD
Retiree Representative
Caroline G.M. Scott MD
Resident Representatives
Jessica H. Faris MD (OB)
Mohammed A. Saiyed MD (FM)
Yuri J. Kim MD (IM)
Medical Student Representatives
Ann Sobell, MD Candidate, Class of 2023
Mary Galuska MA, MD Candidate, Class of 2024
MSMS Delegates
Elvira M. Dawis MD
Anthony M. Zacharek MD
Christopher J. Allen MD
Miriam T. Schteingart MD
Kala K. Ramasamy MD
Jennifer M. Romeu MD
Karensa L. Franklin MD
Judy V. Blebea MD
Elizabeth M. Marshall MD
MSMS Alternate Delegates
Caroline G.M. Scott MD
Waheed Akbar MD
Mohammad Yahya Khan MD
Nicholas E. Haddad MD
Mary J. McKuen MD
Kai Anderson MD
Claudia C. Zacharek MD
Cecilia E. Kraus-Horbal DO
Peer Review Ethics Committee
Waheed Akbar MD, Chair
Caroline G.M. Scott MD
James R. Hines MD
MSMS Region 7 Representative
Mildred J. Willy MD
MSMS President
Thomas J. Veverka MD
Executive Director
Joan M. Cramer
Administrative Assistant
Keri L. Benkert
MSMS Member Service Representative
Heather L. Foster (517) 336-5719
The Bulletin can be viewed online at www.SaginawCountyMS.com under the Bulletin tab.
EDITOR
Louis L. Constan, MD
EXECUTIVE DIRECTOR
Joan M. Cramer
DESIGNER
Lori Krygier
Saginaw County Medical Society
350 St. Andrews Rd., Ste. 242, Saginaw, MI 48638-5988
Telephone (989) 790-3590 | Fax (989) 331-6720
Cell (989) 284-8884 | jmcramer@sbcglobal.net
Hours By Appointment | SaginawCountyMS.com
All statements or comments in the Bulletin are those of the writers, and not necessarily the opinion of the Saginaw County Medical Society. Contributions are welcome. We publish committee reports, letters to the editor, Alliance reports, public health activities of the members, and some personal items (birthdays, weddings, graduations and like events).
The Editor determines which are accepted. Advertisements are accepted as space is available at our going rates. Members may advertise office information, professional services, skills, and procedures, also at our going rates. We do not accept advertisements from nonmembers, or non-Saginaw hospitals.
The Bulletin is mailed free of charge to SCMS members as part of their membership. Complimentary copies are sent to various other parties. Others may subscribe at the rate of $50 per year.
It’s that time of year… THANKSGIVING! It is during this time that we focus on being grateful. We teach our children to be grateful in hopes that they will grow up to be good people who are aware of how blessed they are to live in a country that is free and prosperous, to not be entitled and to realize that it takes hard work to be able to have toys and games they so desire. But what about the adults, we know all of this so what do we need to focus on during this time of year? How about the tough stuff, like having gratitude when life is hard? But why? When life is hard can’t we just sulk and feel sorry for ourselves?
Dr. Robert A. Emmons of the University of California, Davis, is an expert on gratitude and has done much research on this topic. He states, “it is precisely under crisis conditions when we have the most to gain by a grateful perspective on life. In the face of
demoralization, gratitude has the power to energize. In the face of brokenness, gratitude has the power to heal. In the face of despair, gratitude has the power to bring hope. In other words, gratitude can help us cope with hard times.”
He reports that he has determined that “a person who experiences gratitude is able to cope more effectively with everyday stress, may show increased resilience in the face of trauma-induced stress, and may recover more quickly from illness and benefit from greater physical health.”
He says clinical trials indicate that the practice of gratitude can lower blood pressure, improve immune function and facilitate more efficient sleep. It’s also been associated with higher levels of good cholesterol (HDL), lower levels of bad cholesterol (LDL), fewer symptoms of depression, less fatigue and higher levels of heart rate variability (a marker of cardiac health).
So now we know why we need to practice gratitude for the wellbeing of ourselves and everyone around us. The following are ways to implement the choice of being grateful:
1. Write it down – whether it is a thank you note to a friend or journaling, putting your gratitude down on paper gives us tangible ways to reinforce reasons to be grateful.
2. Verbalize gratitude – thank a coworker for being a team player, compliment or praise your child
3. Shift your attitude – quit complaining for three weeks (which will help establish a habit), be grateful for the small stuff: Hot shower, brisk walk, cup of coffee.
If we practice gratitude on a daily basis, when life is good then when life is tough our habits we have established will carry us through and allow us to always be thankful!
“It is precisely under crisis conditions when we have the most to gain by a grateful perspective on life."
As a thank you for your loyalty as a member of the SCMS/ MSMS and for paying early all physicians who pay their 2023 dues in full by November 30 will receive a $100 coupon towards a CME course at an MSMS educational session. Visit https:// msms.org/lms for upcoming live events and on-demand webinars.
• Online CLICK HERE
• Fax to (517) 481-3976
• Mail to: MSMS Membership Department | PO Box 950 East Lansing, MI 48826-0950
• Installment payments available – call (517) 336-5716
SCMS/MSMS dues are not deductible as a charitable contribution but may be deductible as an ordinary and necessary business expense (check with your tax specialist). SCMS dues are 100 percent deductible, and 81.1 percent of MSMS dues are deductible (a portion of MSMS dues is attributable to lobbying activities). The SCMS and MSMS are non-profit organizations focused on improving the lives of physicians so they may best care for the people they serve. Click HERE for Benefits of SCMS Membership.
The strength and effectiveness of SCMS/MSMS as your professional association is predicated on strong membership. The free CME course is just a small token of appreciation for your continued support of organized medicine.
For questions about membership or if you have not yet received your 2023 dues invoice, please contact Joan Cramer, SCMS Executive Director at jmcramer@sbcglobal.net or (989) 284-8884.
• Because all physicians need to “fund their voice.”
• National polls show physicians as one of the most respected professions. Sadly, they don’t use their clout often enough to preserve their profession and protect their patients.
• There is strength in numbers. Together we are stronger.
If you would like to write an article of interest to your colleagues for publication in a future issue of The Bulletin, please contact Joan Cramer at jmcramer@sbcglobal.net for further information.
Articles are not designed for self-promotion, but rather as information for members.
Medical Arts Building I 4705 Towne Centre Road, Suite 204 Saginaw, Michigan 48604 2,450 square feet
Call for details (989) 284-2659
FROM
Anything GoesBy Louis L. Constan, MD
What are little boys made of?
Snips and snails
And puppy-dogs’ tails, That’s what little boys are made of. What are little girls made of?
Sugar and spice
And everything nice, That’s what little girls are made of.
T
his rhyme, common when I was a child, painted a simple picture of humanity; there are boys and girls and they each have their role. Simplistic…and wrong! For several reasons: First, there is no universally recognized definition of what makes one a boy or what makes one a girl; and further, girls can be as capable as boys in any occupation you can think of; and finally, how boys and girls relate (in and out of the bedroom) may not make sense just looking at their anatomy. The world of sexual identity and sexual relationships has expanded hugely, from just boys and girls…to boys and girls plus LGBTQIA’s.
The medical community, as a whole, has no trouble with this brave new world, but, for me at least, it is still a lot to wrap my head around. And though I know I’ll never understand why LGBTQIA’s feel the way they do, I know that I’m bound to respect those feelings. Not only is patient autonomy a core principle of medical ethics, tolerance is an enduring American value celebrated by our country’s founding fathers, who believed that people’s freedoms, outside of certain community service or private employment situations, is inviolably private. So, within those parameters, anything people can do they should do. Anything goes.
“Anything Goes” is also the name of a great Broadway Musical, brainchild of some of America’s greatest artists, chockfull of brilliant staging and songs, and a perennial favorite since 1934. In the plot, a cross-section of American society, traveling together on an ocean liner, refuse to accept the rigid social, cultural and especially sexual roles of a then Puritan society.
The title song tells it all: “Times have changed…and if today…the Puritans landed on Plymouth Rock…Plymouth Rock would land on them.” These 1934 Americans were breaking free from Puritanical ideas of morality. Those
Puritans (of whom it was often said, “had a haunting fear that someone, somewhere, may be happy”), if they arrived in America in 1934, would be repudiated and crushed by a giant rock.
That 1934 expansion of boy/girl roles has, today, radically expanded to include LGBTQIA equality, bringing a challenge or two for us doctors. What do we say when we open that exam room door? What do we call the patient? What pronoun do we use? There are 78 possible genderassociated pronouns. He/him and she/ her…no longer adequate. Now it’s Zie, Sie, Zim, Zir, etc., etc. What/who? Need to ask. What about those health maintenance/preventive medicine issues? A “woman” may need prostate cancer screening. A “man” could get ovarian cancer. Finally, what specialist colleagues do we call for help? New ones, such as “Gender Reassignment Surgeons.”
These challenges though, when you put them in perspective, are not any greater than our usual struggles keeping track of all the new developments in genetics, pharmacology, oncology, microbiology. We can handle this. And we sorely need to. LGBTQIA’s commonly have negative encounters with the medical system. Judgements, refusal of care, PREJUDICE…bad outcomes. We cannot have that.
continued on page 7These challenges though, when you put them in perspective, are not any greater than our usual struggles keeping track of all the new developments in genetics, pharmacology, oncology, microbiology.
from page 6
For the public in 1934, “Anything Goes,” was an exuberant celebration by a society that was becoming unshackled from the chains of Puritanism. For the public in 2022, 88 years later, LGBTQIA inclusion means that everybody, not just boys/girls, becomes unshackled from the chains of a judgmental society.
If today, those Puritans landed on Plymouth Rock…they’d find a society that respects all forms of human intimate expression. They’d find boy, girl and LGBTQIA. Yes, Anything Goes.
If you find it difficult to communicate with your doctor; if you find it hard to get personal attention from an 'impersonal healthcare industry'; if you don't understand all those insurance-company rules; if you don't know how to change your bad health habits; if you think you may be on unnecessary medications; if you are perplexed by those annoying health-product advertisements; and if you'd like to know which are your greatest health risks - you'll appreciate this Family Doctor's advice, gleaned from 44 years of practice.
Each chapter is illustrated with real-life examples from his and other doctors' practices. Each chapter ends with 'bonus' essays written by the author and published in newspapers and magazines giving the doctor's viewpoint. This will give you a unique perspective and allow you to 'get into the mind' of a doctor. Sweet!
Available on Kindle (different cover but same book) and paperback.
Available on Amazon by clicking HERE 1
Read previous issues of The Bulletin at www.SaginawCountyMS.com under the Bulletin tab
All statements or comments in The Bulletin are those of the writer, and not necessarily the opinion of the Saginaw County Medical Society (SCMS).
The Bulletin is made available electronically for members as an informational service. Reliance on any such information is at the user's own judgment.
The SCMS, its officers and employees, cannot guarantee the accuracy, reliability, completeness or timeliness of any information, and may not be held liable for any individual’s reliance on our web or print publications. For questions or the latest information, please contact Joan Cramer of the SCMS at (989) 284-8884 or jmcramer@sbcglobal.net
Retired physicians meet for lunch every Wednesday at 12 noon at IHOP, 2255 Tittabawassee Road in Saginaw. Those attending are responsible for their own lunch, and the informal gathering lasts about an hour. Join your retired colleagues whenever you like!
THE GROUP ALWAYS MEETS IN THE BACK ROOM. If you are told no one from the group is there, please go directly to the back room and check for yourself!
If you have questions, please contact Joan Cramer at (989) 284-8884 or Dr. Caroline Scott at (989) 295-2721.
Our goal is to save lives through prevention, intervention, and aftercare.
Our Network trains individuals in evidence-based suicide prevention with the hope of destigmatizing suicide, increasing help-seeking behaviors, and caring for those impacted by suicide.
Thank you Midland Community Foundation for hosting an ASIST (Applied Suicide Intervention Skills Training). We so appreciate our six CMU Medical Students for your willingness to learn these lifesaving skills!
Saginaw Spirit Mental Health Awareness Night – Saturday, February 11, 2023. Talk Today | Hope for Tomorrow
The Saginaw Spirit welcomes Barb Smith Suicide Resource and Response Network for a fun night of hockey and fundraising. Cheer on the Spirit as they face off against the Windsor Spitfires on Saturday, February 11, 2023, at 7:05 p.m. at the Dow Event Center in Saginaw. The Network will receive $5 for each ticket sold. Purchase tickets online at: https://www.saginawspirit.net/groupsales/, Group ID BARBSMITH, and password SPIRIT.
The National Suicide Prevention Lifeline is now 988 Suicide & Crisis Lifeline
988 has been designated as the new three-digit dialing code that will route callers to the new Suicide & Crisis Lifeline. The old Suicide Prevention Lifeline phone number (1-800-273-8255) will continue to function indefinitely.
The Lifeline’s network of over 200 crisis centers has been in operation since 2005, and has been proven to be effective. It’s the counselors at these local crisis centers who answer the contacts the Lifeline receives every day. Numerous studies have shown that callers feel less suicidal, less depressed, less overwhelmed and more hopeful after speaking with a Lifeline counselor.
The Department of Health and Human Services released data showing a 45% increase in overall volume in August 2022 compared with August 2021, representing 152,000 more contacts that include calls, chats and texts. Are you in a crisis? Call 988 or text TALK to 741741.
Third Thursday of each month at 7 p.m.
Zion Lutheran Church 545 7th Street, Freeland, Michigan
(Behind Pat’s Grocery Store on Midland Road in Freeland)
Caduceus meetings are available to health care industry professionals, and have adopted many of the principles of 12-Step programs.
Caduceus meetings are “closed” meetings for recovering health care professionals including, but not limited to, nurses, doctors, dentists and pharmacists.
We engage in group discussions where members may want to speak up, ask questions or share thoughts with fellow members.
Mission: To prevent suicide through education, connection to resources, and support for those impacted by suicide.
Tuesday, January 17, 2023 - Horizons Conference Center, 6200 State Street, Saginaw Board Meeting - 5:30 p.m.
Membership Meeting Joint with the Saginaw County Dental Society - Social (cash bar) at 6:30 p.m., followed by dinner, meeting and program at 7 p.m. Speaker To be announced
Topic - "The Link between Oral Health and Cardiac Health" Email meeting notices will be sent in early January. Online reservations are required.
Tuesday, February 21, 2023 - CMU College of Medicine, 1632 Stone Street, Saginaw Board Meeting - 5:30 p.m.
There is no Membership Meeting in February.
Tuesday, March 21, 2023 - Via Zoom Board Meeting - 6:30 p.m. There is no Membership Meeting in March.
Tuesday, April 18, 2023 - Horizons Conference Center, 6200 State Street, Saginaw Board Meeting - 5:30 p.m.
Membership Meeting - Social (cash bar) at 6:30 p.m., followed by dinner, meeting and program at 7 p.m. Speaker TBD Topic TBD
Email meeting notices will be sent in early April. Online reservations are required.
Saturday-Sunday, April 22-23, 2023 - The Henry in Dearborn 158th Annual MSMS House of Delegates
Tuesday, May 16, 2023 - Horizons Conference Center, 6200 State Street, Saginaw Board Meeting - 5:30 p.m.
Annual SCMS and SCMS Foundation Membership Meetings
Social (cash bar) at 6:30 p.m., followed by dinner, meetings and program at 7 p.m.
Email meeting notices will be sent in early May. Online reservations are required. 12th Annual SCMS Foundation Golf Outing – date TBD
Information courtesy of CMU College of Medicine and CMU Health
The CMU College of Medicine produces an annual report to update external community partners and stakeholders, current and prospective students, and CMU employees on our progress during the prior academic year. This year’s Annual Report for FY2122 celebrates the College of Medicine’s milestone of graduating more than 500 physicians, highlights the College’s outstanding education and research activities, and showcases the many ways the College continues to fulfill its mission.
Hard copies are available by contacting CMU College of Medicine communication team at cmedmarcom@cmich.edu.
Central Michigan University College of Medicine Street Medicine Student Interest Group has served 103 patients experiencing homelessness through mobile-free clinics in Mount Pleasant and Saginaw. These clinics provide a variety of services to underserved and uninsured individuals.
Patients are referred to appropriate medical centers for follow-up and also meet with a CMU Health supervising physician and a Great Lakes Bay Health Centers social worker to strategize plans of action to target each patient’s areas of concern. The clinics were held at Rescue Ministries of Mid-Michigan and Old Town Christian Outreach Center in Saginaw, and have been held throughout 2022.
This work was made possible by a Strengthening the Safety Net Grant sponsored by Blue Cross Blue Shield of Michigan
The Principal Investigator is Neli Ragina, Ph.D., CMU College Of Medicine Associate Professor and Director of Students and Residents Research. Additional faculty leadership is provided by Sethu Reddy, MD, Senior Associate Dean for Research.
Learn more about the grant here: https://bit.ly/3gSJNOs
Ihad a Match Day experience unlike the average medical student. I was in the middle of a six week study abroad program in Malawi, Africa studying obstetrics and gynecology. Don’t get me wrong, it was a once in a lifetime experience and I wouldn’t have changed the timing for the world; however, the 12 noon Match Day results in Michigan translated to 7 p.m. results for me across the globe. Talk about building anxiety! The excitement fueled by my overwhelming nerves finally reached an all-time peak when I received the Match Day results email: I was moving to Saginaw to train to become an emergency medicine physician!
Moving to a new city, no matter how near or far, presents a host of challenges: Days of packing, establishing a mortgage, changing your address on nearly every important document in your life, and creating a new group of friends and neighbors can all be incredibly stressful.
Once residency orientation started, I had to work hard at establishing a “new normal.” New commute to work, new names and faces to learn, and a new set of expectations. The beginning of residency is truly a transformational time in life.
I am now five months into residency. Throughout my journey thus far, the quote “Bloom where you are planted” has remained present in my mind. This quote was made famous by Saint Francis de Sales, Bishop of Geneva, in the 1600s. It speaks to taking advantage of opportunities in your life and
being grateful for the blessings around you. Even through the long hours, stressful situations, and occasional feelings of inadequacy and imposter syndrome, I remember I am in the role I have worked and prayed for my entire academic career. If you haven’t experienced it before, imposter syndrome is real and can make you feel like you don’t deserve to be where you are at in your career. You can feel like a desert cactus trying to survive in a harsh Michigan winter. But yet, cacti are tenacious and can still thrive in the most adverse of climates. Likewise, we new interns can bloom in our new environment no matter how tough or unanticipated it will be.
One thing has certainly been incredibly easy - establishing a support network of fellow residents and clinical support staff. Central Michigan University Graduate Medical Education truly attracts some of the highest quality residents who are looking to support each other both academically and personally. Thank you to the Covenant and St. Mary’s physicians and staff for welcoming myself and all the fellow CMU residents into your family and being the roots to our education. Thank you to the program directors who position our leaves into the sun, so we have the best opportunity to thrive. And thank you to everyone who provides us constructive feedback to help fertilize our garden. Thank you for allowing us to bloom where we are planted. It will take years of growing and pruning, but I can’t wait for what is in store!
Central Michigan University Graduate Medical Education truly attracts some of the highest quality residents who are looking to support each other both academically and personally.
In March 2022, the Nominating Committee consisting of Dr. Millie Willy, Past President as Chair, Dr. Tony Zacharek as President and Dr. Tiffany Kim as President-Elect, asked the SCMS Board to consider amending the Bylaws to allow all delegates and alternates to have a vote. It was the Nominating Committee’s opinion that if we have active and retired members giving of their time and serving the SCMS, they should be entitled to a vote. New members to the Board generally start as an alternate delegate as they learn the Board process. Past presidents serving as alternate delegates offer a wealth of history and experience on SCMS issues.
Per the Bylaws, officers and directors have voting privileges. Each June, the officers and directors vote for three delegates who are not already serving in a voting position as an officer or director to be voting members of the Board. Any additional delegates and alternate delegates do not have a vote. Alternate delegates include past presidents who want to stay involved on the Board. SCMS quorum is one-third of voting Board members.
After thoughtful consideration, the Board voted at the September 18, 2022, Meeting to approve an Amendment to the Bylaws. The relevant sections of the Bylaws follow, with text to be removed in red-strikethrough, and text to be added highlighted yellow:
of this Society. To be eligible for election as a delegate or an alternate, the member must have been an active member of this Society for at least two years.
Section 1. The Board of Directors shall consist of the president, president-elect, the immediate past president, the secretary, the treasurer, the editor of the Bulletin, six directors to be elected from among the membership, and three members which shall be elected from the pool of MSMS Delegates the duly elected delegates and alternate delegates. The current president shall act as chair of the Board. The secretary of this Society shall act as secretary of the Board. The Past President will remain on the SCMS Board whether s/ he retires or remains in active practice. The Board will appoint a retiree representative to the Board to serve a one (1) year term. The Board of Directors shall have the power to appoint resident representative(s) and medical student(s) for terms to be determined at their discretion to serve on the Board. The resident representative(s) and medical student(s) shall not be subject to Section 2 of Chapter XIV herein requiring attendance at fifty percent (50%) of Board meetings, but the resident representative(s) and medical student(s) shall make every effort to attend as many meetings as possible so as to effectively represent their peers. The retiree representative, resident representative(s) and medical student(s) will be non-voting members of the Board.
Section
The delegates, and in their absence or disability, the alternate delegates, shall attend and faithfully represent the members of this Society in the House of Delegates of the Michigan State Medical Society, and shall make a report of the proceedings of the House of Delegates at the next following regular meeting
Syed S. Akhtar MD
Arshad Aqil MD
Catherine M. Baase MD
Nathanial Bartosek Student
Kayla Bennett Student
J.G. Marc Bertrand MD
Wendy S. Biggs MD
Marshall A. Brown MD
Sarah Bunker Student
Thomas M. Burkey MD
Ana V. Camagay MD
Arlene Chan Student
Wing Lee Cheune Student
John F. Cherry MD
Virginia R. Dedicatoria MD
Rosalinda A. Elazegui MD
Frederick W. Foltz MD
Jack E. Goodwin MD
Halimah Hamidu-Egiebor Student
Duane B. Heilbronn, Jr. MD
Steven L. Jensen MD
Robert V. Kasemodel MD
Sambasiva R. Kottamasu MD
Yanyu Long MD
In accordance with the Bylaws and SCMS policy, the proposed Bylaws Amendment will be published in two issues of The Bulletin, and brought before the membership for a vote to approve at the next occurring Membership Meeting on Tuesday, January 17, 2023.
If any member has questions or concerns about the proposed Bylaws Amendment, please email Joan Cramer at jmcramer@sbcglobal.net by December 31, 2022.
Emmanuel Luciano Lorenzo MD
Carlotta M. Maresca MD
Christina L. Maser MD
Joanne E. Mathew MD
B. Babu Paidipaty MD
Che Song Park MD
Christa M. Persyn MD
Sundarachalam Pindicura MD
Brianna C. Pitre DC
Nivin A. Qudeimat MD
Nathan M. Razbannia MD
Lekha K. Richardson MD
Aron M. Schneider DO
James F. Shetlar MD
Farhad K. Shokoohi MD
Shipra Singh MD
Gregory P. Sutton MD
Tarek A. Taha MD
Cindy Tantilert Student
Andrew S. Wagner MD
Julia M. Walter MD
Larry Wang MD
Liaqat Zaman MD
Ugne Zekonyte Student
The SCMS Board of Directors formed an Ad Hoc Committee of Drs. Chris Allen, Lou Constan, Tiffany Kim, Miriam Schteingart and Tony Zacharek to develop the Mission, Vision and Values Statements of the SCMS. The Committee met on Tuesday, August 16, 2022, via Zoom.
The purpose of the Committee was to establish the Mission, Vision and Values Statements of the SCMS based on prior Board discussion.
• The MISSION STATEMENT communicates the purpose of the organization.
• The VISION STATEMENT provides insight into what the organization hopes to achieve or become in the future.
• The VALUES STATEMENT reflects the organization’s core principles and ethics.
The Committee’s recommendations were approved by the SCMS Board of Directors at their meeting on Tuesday, September 18, 2022.
• Bringing physicians together for the common good
•
In accordance with SCMS policy, the proposed Mission, Vision and Values Statements will be published in two issues of The Bulletin, and then brought before the membership for a vote to approve at the next occurring Membership Meeting on Tuesday, January 17, 2023.
If any member has questions or concerns about the proposed Mission, Vision and Values Statements, please email Joan Cramer at jmcramer@sbcglobal.net by December 31, 2022.
www.SaginawCountyMS.com 120 Years of Serving the Residents of Saginaw County!
Almost 30% of medical students and residents suffer from depression and 10% report having suicidal thoughts. Now, a growing number of medical schools and teaching hospitals are developing programs to identify and help at-risk trainees.
Are you in a crisis? Call 988
Rahael Gupta was leaving the library one night in 2015 when she stepped into a dark, poorly lit street hoping to collide with an oncoming bus. The second-year medical student at the University of Michigan Medical School envisioned her head hitting the asphalt, her brain banging around inside her skull, and the driver leaping out of his vehicle in horror to locate her body.
Gupta had never been diagnosed or treated for depression prior to medical school. But like many medical students, she was overwhelmed. She had moved from Oregon to Michigan — hundreds of miles from close friends and family. She was suffering from chronic stress, anxiety and exhaustion. And then she failed a neuroscience sequence. "I just wanted to end it all," she says.
Unfortunately, Gupta's experience is not uncommon. In a recent study, 9.4% of fourth-year medical students and residents reported having suicidal thoughts in the previous two weeks. According to the American Medical Student Association (AMSA), medical students are three times more likely to die by suicide as their same-age peers. And while it’s unclear how many physician trainees die by suicide each year, suicide is the leading cause of death among male residents and the second leading cause of death among female residents.
These figures first came to light several years ago. In response, a growing number of leaders in academic medicine have been launching initiatives aimed at helping students and residents navigate the difficult training years. Some schools have instituted small learning communities and developed resilience curricula. Others have implemented interactive online screening protocols and launched extensive support services. Still others are shifting to two-tier, pass/fail grading systems. For residents, national medical organizations are calling for creating more positive work environments and reducing sources of physician burnout, particularly those that do not contribute to patient care. Many of these recommendations are outlined in a 2019 report released by the National Academy of Medicine (NAM): "Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being."
"Academic health centers have been real leaders in terms of trying to put programs in place to help counter burnout, depression, suicide and related problems," says Darrell G. Kirch, MD, co-chair of the National Academy of Medicine Action Collaborative on Clinician Well-Being and Resilience (NAM) and president emeritus of the AAMC. The goal? To ensure young physicians-to-be can access the support they need to feel safe, be healthy and derive purpose from their work.
A Population at Risk Medical training is intense. Medical students and physician trainees study and work long hours, often in stressful environments where they must confront death on a regular basis. According to NAM, overwhelming job demands and insufficient resources can lead to burnout — a workplace syndrome characterized by emotional exhaustion, depersonalization, and a low sense of personal accomplishment from work.
Burnout can have far-reaching implications. It can impact job performance, increase turnover, and lead to medical errors and clinician suffering. "Students will see people suffer and die with illness. They will see families struggle with the loss or impairment of their loved ones and they will confront the issue of patients who can’t afford care. All of those things create enormous stress for people who are in training," says David Muller, MD, Dean for Medical Education at Icahn School of Medicine at Mount Sinai in New York. "We're so focused on taking care of patients and providing quality care that absent from our education is how we take care of ourselves."
Studies show that students arrive at medical school with the same or better mental health as their peers. But after two years, they tend to suffer significant burnout, stress and anxiety. As they continue to progress in their training, they are at significant risk for depression. In a 2014 Academic Medicine study of medical residents, 60% met the criteria for burnout, more than half screened positive for depression, and roughly 8% experienced suicidal ideation. Excessive stress can create a short path to developing a mental disorder, depression and suicidal ideas and behavior," Kirch says.
Many of these trainees know they're in crisis. But only onethird of medical students experiencing burnout or depression seek help — mainly because they're afraid of what it might do to their careers.
Confronted with the startling statistics around burnout and depression, academic medical centers across the country are increasingly making physician well-being a top priority — not only for faculty but also for students and residents. The first step for many of these institutions is hiring a "chief wellness officer."
"That job description creates a whole kind of ethos the institution is concerned about wellness," says Michael F. Myers, MD, Professor of Clinical Psychiatry at State University of New York (SUNY) Downstate Medical Center and author of Why Physicians Die by Suicide: Lessons Learned From Their Families and Others Who Cared Those officers are then charged with developing programs, policies, and procedures that support physicians’ mental health and well-being.
Several medical schools, including Johns Hopkins University School of Medicine, Saint Louis University School of Medicine, and Weill Cornell Medicine, are folding resilience training into students' coursework. In 2016, on the heels of a fourth-year medical student's death by suicide, Mount Sinai developed a four-year wellness curriculum cocreated by senior students and residents in psychiatry. The PEERS (Practice Enhancement, Engagement, Resilience, and Support) program at Mount Sinai enables students to meet in small groups with a faculty facilitator twice a year to tackle stressors specific to each stage of training. Its goal is to provide learners with tangible skills to help manage personal and academic challenges and thrive. Other institutions are hosting town hall-like forums where discussions about the "second victim phenomenon," stress and burnout take center stage.
"There's a lot of suffering among medical students, residents and physicians. As leadership, we can act to decrease their suffering. We can be a voice for cultivating compassion," says Sunny Smith, MD, Clinical Professor in the Department of Family Medicine and Public Health at the University of California San Diego (UCSD) School of Medicine
The increasing push toward small learning communities, as opposed to massive lecture halls, also allows faculty to more easily recognize when a student is struggling. "With learning communities, faculty members know when students don't show up or when they show up with tears in their eyes — and they can connect them with the available resources," Smith says. The smaller, more intimate learning approach also encourages peer support.
Some institutions have even made peer support part of their mental health assistance protocol. At Johns Hopkins, Harvard Medical School and Temple University School of Medicine, peer support programs are available to students, practicing physicians and faculty. "When a crisis hits, we want the person sitting next to our resident, regardless of profession, to know how to get someone help and resources," says Jessica Kovach, MD, Vice Chair of Clinical Psychiatry and Behavioral Science and Associate Professor and Director of the Psychiatry Residency program at Temple University School of Medicine
continued on page 18
The Saginaw County Medical Society Membership Meeting was held on Tuesday, October 18, 2022, at Horizons Conference Center. Tiffany K. Kim MD, President, called the meeting to order at 7:02 p.m. Dr. Kim welcomed members, CMU residents, CMU medical students, guests and candidates Matthew Bierlein, Paul Junge, Amos O’Neal and Kristen McDonald Rivet.
Dr. Kim thanked the following Key Providers in attendance for their ongoing support of SCMS programs:
• Covenant HealthCare – Marcus Atkins, Physician Liaison
• HealthSource Saginaw – Tony Holstine and Scott Taglauer
• Healthway Compounding Pharmacy – Larry Greene and Edward Wright, PharmD
Dr. Kim then conducted the following business of the SCMS:
• The Minutes of the September 20, 2022, Membership Meeting were attached to the Agenda and published in The Bulletin. MOTION: Approve the September 20, 2022, Meeting Minutes as printed. MOTION APPROVED.
• Introduced members approved at tonight’s Board Meeting:
o Active Members:
• Sudeep Raj Aryal MD, Covenant Medical Group Cardiology
• Rikat E. Baroody MD, CMU Health-Surgery
• Franchesca Garcia Robles MD, CMU Health-Pediatrics
• Steven Hermiz MD, Covenant Plastic Surgery
• Adeeba S. Khan MD, CMU Health-Pediatrics
• Narong Kulvatunyou MD, CMU Health-Surgery
• Christina L. Maser MD, CMU Health-Surgery
o Affiliate Member
• Brianna C. Pitre DC, Shields Chiropractic
• Encouraged members to stay up-to-date with the SCMS by reading The Bulletin which is available on our website www.SaginawCountyMS.com under the Bulletin tab.
• Asked members to review Attachment #2, the Mission, Vision, Values Statements approved by the Board, which will be published in the next two issues of The Bulletin, with a vote to approve at the January 17, 2023, Membership Meeting. If anyone has any questions, please contact Joan Cramer or a Board Member.
• Asked members to review Attachment #3, the Proposed Amendment to the SCMS BylawsVoting Privileges of Delegates and Alternate Delegates, which will be published in the next two issues of The Bulletin, with a vote to approve at the January 17, 2023, Membership Meeting. If anyone has any questions, please contact Joan Cramer or a Board Member.
• Notified members the CMU College of Medicine Office of Faculty Development Leadership Series has been rescheduled for Friday, November 4 from 1-2 p.m. The featured speaker is Beth Charlton of Covenant. Additional sessions will be scheduled in the coming year.
• Reminded members the National Suicide Prevention Lifeline is now 988 Suicide & Crisis Lifeline. 988 has been designated as the new threedigit code that will route callers to the new Suicide & Crisis Lifeline. The old National Suicide Prevention Lifeline (1-800-273-8255) remains available to people in emotional distress or suicidal crisis. Calls to 988 increased 45% in August 2022, compared to August 2021, after 988 was launched in July 2022.
• Great Lakes Bay Health Centers are now accepting referrals for adult outpatient psychiatry. Members were asked to contact Amra Bader, Behavioral Health Supervisor at (989) 907-2765 or abader@glbhealth. org for more information.
• Reminded members SCMS/MSMS 2023
Membership Dues are now payable. If 2023 dues are paid by November 30, the member will receive $100 free CME from MSMS.
Dr. Kim noted Dr. Tom Veverka, MSMS President, would be speaking about The Future of Medicine. Before Dr. Veverka’s presentation, Dr. Kim spent a few minutes highlighting Dr. Veverka’s service to the SCMS over the past 15 years. A 27-year member of the SCMS, he has served as a Director, Alternate Delegate, Treasurer and President of the SCMS. He most
continued from page 16 recently served as Region 7 Representative on the MSMS Board of Directors. In April 2022, Dr. Veverka was installed as the 157th President of MSMS, making him only the fifth MSMS president from Saginaw in our 120 year history. Dr. Kim highlighted Dr. Veverka’s career and involvement at St. Mary’s and MyMichigan Hospitals, his work with Trauma Centers, clinical faculty appointments with MSU-CHM and CMU College of Medicine, and his work with MiHIA. Dr. Kim then welcomed Dr. Veverka to the podium where he received a standing ovation from the membership. He said it was an honor to serve the community and the SCMS. He then gave a presentation on The Future of Medicine, a study released by MSMS in June 2021. Hard copies of the report were available at the registration table.
Dr. Kim then introduced candidates for the November election participating in the evening’s Candidates’ Forum:
• State Senator 35th District – Candidate Kristen McDonald Rivet (D)
• State Rep 94th District – Incumbent Amos O’Neal (D)
• State Rep 97th District – Candidate Matthew Bierlein (R)
• Michigan’s 8th Congressional District – Candidate Paul Junge (R)
Each candidate was given three minutes at the podium to tell about themselves and their platform. Annette Glenn (R), candidate for State Senator 35th District, had a scheduling conflict but sent a letter Dr. Kim read to the audience.
Dr. Kim then asked the candidates to address issues submitted by members which included Proposal 3 (Right to Reproductive Freedom Initiative); reimbursement rate cuts; nursing shortages; assault on healthcare workers; price transparency; mental health funding; scope of practice and more.
Dr. Kim thanked the candidates for participating in the Forum, and wished them well in the election.
The next SCMS Membership Meeting will be held on Tuesday, January 17, 2023, at Horizons. The tentative program is "Dental Hygiene and Heart Disease." There being no further business, the meeting was adjourned at 8:40 p.m.
Respectfully submitted, Joan M. Cramer Executive Director
Additionally, several national medical training organizations, including the AAMC, the Accreditation Council for Graduate Medical Education (ACGME), the American Osteopathic Association, and the American Association of Colleges of Osteopathic Medicine, are actively promoting physician wellness and burnout prevention. In 2017, the ACGME revised Section VI of its Common Program Requirements for residency and fellowship training programs to include an enhanced section on well-being. The revisions require programs to provide support to individual residents — including 24/7 access to urgent and emergency care, confidential mental health assessment, counseling, and treatment — and include standards for creating a culture of well-being within residency programs.
In December 2019, the ACGME launched the AWARE suite of resources, including on-demand tools such as a well-being skill development video workshop, an AWARE app, and AWARE podcasts to promote well-being, mitigate the effects of stress and prevent burnout among physician trainees and faculty members.
NAM is also calling on institutions to develop initiatives that promote professional well-being and improve the work environment. Each of these organizations is urging leaders in medicine to make assistance programs, peer support and mental health providers readily available to physicians and trainees.
"It's in the benefit of individuals and society to help human beings who are uniquely qualified to comfort and cure stay in medicine," Smith says. That's where UCSD's Healer Education Assessment and Referral Program (HEAR program) comes in. HEAR is a two-pronged approach to educate and identify colleagues at risk for burnout, depression and suicide through an online, anonymous interactive screening program, or ISP, created by the American Foundation for Suicide Prevention (AFSP).
"The ISP is highly effective at helping people who are not engaged in support and treatment but who are the most at risk and the most reticent to get help," says Christine Moutier, MD, Chief Medical Officer of AFSP. Since its inception in May 2009 among UCSD health science staff and trainees, more than 400 individuals have accepted a referral for treatment. The ISP is now being utilized by 33 hospitals and medical schools, where it connects at-risk physicians, trainees and students with a counselor either in person, by phone or electronically.
While it would be difficult to attribute improvements to any one program – UCSD introduced several changes simultaneously – the rate of suicide at UCSD has dropped dramatically. "There were 13 suicides over the 15-year period
that preceded the launch of the UCSD HEAR Program and in the decade since its launch, there has been one," says Moutier.
At Saint Louis, former Curriculum Dean Stuart Slavin, MD, was determined to assess students' well-being in comparison to national averages. "Our students' mental health was very good at orientation but deteriorated across their four years of medical school," Slavin says. "The only plausible conclusion: We were harming our students." Slavin embarked on an ambitious effort to:
• Reduce unnecessary stressors and enhance the learning environment
• Teach students skills to better manage their stress and encourage help-seeking
• Create more opportunities for students to find meaning in their work
Changes included switching to a pass/fail grading system, cutting curriculum hours, instituting learning communities, and assessing mental health with an optional confidential assessment for depression and anxiety at four points during the pre-clerkship years. The results were striking: The percentage of the Class of 2018 that reported moderate-tosevere symptoms of depression was 4% at the end of their first year and 6% at the end of their second year. In comparison, the percentage of the classes of 2012 and 2013 (which preceded the initiative) that reported these symptoms was 27% at the end of their first year and 31% at the end of their second year.
"We recognized early on that our students suffered from information overload, excessive class time, and unreasonable academic demands, so we reduced that load and the pressure on our students," says Slavin. "In backing off, academic outcomes did not suffer, as might be expected, but rather they improved as did the mental health of our students."
Now an advocate for suicide prevention, Gupta champions changes like these — efforts that focus on lightening the hefty load on physician trainees rather than providing them with more tools in the form of meditation, massage and yoga classes.
For Gupta, taking time away from the intensity of training was lifesaving. After nearly colliding with a bus, Gupta went to her school counselor for help and began therapy within weeks. She started medication and took almost a year off schooling. Now a resident psychiatrist at UCLA, Gupta is newly engaged and thriving. "About a month after I started treatment, I remember walking on that same street where I had those suicidal thoughts," Gupta says. "It was snowy and icy. The sky was gray. The same scene that had looked so formidable and disgusting to me just a month before looked almost beautiful. That's when I knew I was getting better."
Julie Novak’s career at the Michigan State Medical Society (MSMS) has been a rich and full one, spanning countless challenges and successes for Michigan’s physician community over the past nearly 33 years. However, like all things, that partnership is coming to an end, as she and the organization have announced Julie will be leaving MSMS. Julie officially ended her time with MSMS on Friday, November 11, 2022.
"It is with gratitude that we wish Julie the best as she leaves MSMS for new opportunities,” said Mark Komorowski, MD, Chair of the MSMS Board of Directors. "Julie has been an important part of our staff and leadership team for more than 30 years, and her work is greatly appreciated by the member physicians of this organization. As we move forward in the transition to new staff leadership of MSMS, those physicians, the work they do, and the patients they serve will remain our top priority."
Julie joined MSMS in 1990 as chief of health care research, charged with analyzing policy issues, data assessments and membership surveys. Since that time, she has served in a variety of positions related to health care delivery, medical economics, and operations of MSMS, having served as the society’s Chief Executive Officer for the past 14 years.
"Leaving an organization where you have spent most of your career is an important milestone, and I am extremely thankful for and appreciative of the colleagues I have considered partners over the years. I will miss their professionalism and service to the membership of MSMS," Novak said.
MSMS joins the AMA and other Federation members in strongly advocating that Congress avert this 3% payment cut which, without Congressional action, is scheduled to start January 1, 2023. MSMS and others are also advocating for Congress to implement an inflationary update for physicians, extend the 5% APM incentive and prevent the steep increase to the participation requirements for APMs, and waive the 4% PAYGO sequester. You can help in this effort by sending a letter to your congressional members urging them to act swiftly to avert these significant payment cuts.
Other key highlights include:
• Adopts the revised CPT guidelines and codes and the AMA/Specialty Society RVS Update Committee (RUC) recommended relative values for additional E/M visit code families, including hospital visits, emergency department visits, home visits and nursing facility visits. These changes allow time for medical decision-making to be used to select the E/M visit level.
• Imposes a one-year delay of CMS’s policy requiring a physician to see the patient for more than half of the total time of a split or shared E/M visit in order to bill for the service. This action will continue to allow physicians and qualified health care professionals to use history, physical exam, medical decision making (MDM), or more than half of the total time spent with a patient to determine the substantive portion of the split/shared visit in 2023.
• Finalizes new HCPCS codes, G3002 and G3003, and valuation for chronic pain management and treatment services (CPM) for CY 2023 and provided some additional flexibilities, such as the ability to report CPM and other visits on the same date and to report subsequent CPM services as many times as needed in a month.
On November 1, 2022, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2023 Medicare Physician Fee Schedule (MPFS) final rule. This rule impacts payments for physicians and other health care practitioners, and includes changes to the Merit-based Incentive Payment System and alternative payment model (APM) participation options and requirements for 2023.
Although the 2023 MPFS contains a number of helpful policies such as extending payment for telehealth services to all communities in the country and in any originating site setting through the duration of the public health emergency and for 151 days thereafter, there are several policies that are problematic. Most notably, CMS’s decision to finalize the CY 2023 Medicare conversion factor (CF) at $33.06, a decrease of $1.55 or 4.5% from the 2022 CF of $34.61. The decrease is largely a result of an expiring 3% increase funded by Congress through 2022. The additional approximate 1.6% decrease is the result of budget neutrality requirements that stem from revised E/M changes.
• Expands Medicare coverage for colorectal cancer screening in order to align with recent United States Preventive Services Task Force and professional society recommendations.
• Maintains the MIPS performance threshold at 75 points for the 2023 MIPS performance year (2025 payment year).
• Adds five new MIPS Value Pathways related to nephrology, oncology, neurological conditions, and promoting wellness, for voluntary reporting beginning in 2023.
• Creates an advanced incentive payment pathway for certain low-revenue, new entrant accountable care organizations to bolster participation in the Medicare Shared Savings Program.
Please see the following documents for more information:
• AMA MPFS Final Rule Summary
• AMA Estimated Combined Specialty Impact Table
• Final Rule
• CMS Press Release
• CMS Fact Sheet
The Covenant Bariatric and Metabolic Center is accredited as a Comprehensive facility under the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program of the American College of Surgeons and ASMBS. The accreditation demonstrates the surgery center's commitment to delivering the highest quality care for its bariatric surgery patients. The Covenant Bariatric and Metabolic Center is the most preferred accredited facility in the Great Lakes Bay Region.
Patients are recommended to attend a bariatric seminar to discuss what options are best for their individual situation. The Covenant Bariatric Team takes into consideration each individual so patients can be best assisted as they consider bariatric surgery.
The free bariatric seminars are now available on-demand at www.covenantbariatrics.com. In-person and live online seminars continue to be available.
For additional information, contact Libby Palmer, Bariatric Program Administrator, Chad Ringley, MD, FACS, Medical Director/Bariatric Surgeon or Jason Kuhn, DO, Bariatric Surgeon.
Covenant is proud to share several recent accomplishments:
Covenant HealthCare Visiting Nurse Association (VNA) has been recognized by Strategic Healthcare Programs (SHP) as a “Superior Performer” in hospice care for achieving an overall caregiver and family satisfaction score that ranked in the top 20% of all eligible SHP clients for the 2021 calendar year.
Learn about all of the Covenant VNA Services at www. covenanthealthcare.com/vna.
The American Heart Association presented Covenant HealthCare with the Get With The Guidelines - Stroke GOLD PLUS with Target: Stroke Honor Roll Elite Plus and Target: Type 2 Diabetes Honor Roll award for proven dedication to ensuring all stroke patients have access to best practices and life-saving care. Covenant is proud to be one of four hospitals in the state recognized for 10 or more consecutive calendar years.
Learn more about the Covenant Stroke Program at www.covenanthealthcare.com/stroke.
Covenant HealthCare was recently recognized for the second time by the National Safe Sleep Hospital Certification Program as a “National Silver Certified Safe Sleep Hospital” for our commitment to best practices and education on infant safe sleep. The National Safe Sleep Hospital Certification Program was created by Cribs for Kids®, a national infant safe sleep organization.
We are proud to provide children’s services at Covenant from birth and beyond. Even after a baby arrives, they can grow with Covenant as the region’s children’s hospital. Services include the region’s only pediatric emergency care center and the region’s only pediatric intensive care unit. Covenant continues to offer a variety of specialized services including pediatric neurology, neonatal intensive care, rehabilitation and more.
Hyperbaric Oxygen Therapy (HBOT) is the administration of 100% oxygen in a pressurized environment. Diffusing oxygen throughout the body promotes angiogenesis, allowing a chronic wound to get the nutrient and oxygen rich blood it needs to heal. Specialized wound care, including HBOT, is often necessary for optimal treatment of chronic wounds. HBOT is an effective adjunctive therapy used in conjunction with advanced wound care. Along with proper attention to nutrition and other underlying medical problems, we achieve greater healing results. HBOT is a proven treatment for:
• Chronic Refractory Osteomyelitis
• Lower Extremity Diabetic Ulcers
• Radiation Cystitis/Proctitis or Radiation Necrosis
Covenant Wound Healing Center
“There are approximately 6.5 million patients in the U.S. suffering from chronic wounds (e.g. diabetic foot ulcers and pressure ulcers) and approximately 140,000 patients are hospitalized every year with new wounds. Currently, over 23 million people have been diagnosed with diabetes.”*
Covenant Wound Healing & Hyperbaric Medicine Center has a team of experts trained to evaluate your patient’s wound and develop a treatment plan. Using the most advanced technology and research, our wound care team can work with you and your patients to heal wounds quickly.
Nearly two-thirds of doctors are experiencing at least one symptom of burnout, a huge increase from before the pandemic. But the situation is not irreparable, researchers say. Burnout, in medical literature, is defined by increased emotional exhaustion, a more distant approach to the job and a declining sense of personal accomplishment.
The New York Times By Oliver Whang Sept. 29, 2022Ten years of data from a nationwide survey of physicians confirm another trend that’s worsened through the pandemic: Burnout rates among doctors in the United States, which were already high a decade ago, have risen to alarming levels.
Results released in September and published in Mayo Clinic Proceedings, a peer-reviewed journal, show that 63 percent of physicians surveyed reported at least one symptom of burnout at the end of 2021 and the beginning of 2022, an increase from 44 percent in 2017 and 46 percent in 2011. Only 30 percent felt satisfied with their work-life balance, compared with 43 percent five years earlier. “This is the biggest increase of emotional exhaustion that I’ve ever seen, anywhere in the literature,” said Bryan Sexton, the Director of Duke University’s Center for Healthcare Safety and Quality, who was not involved in the survey efforts.
The most recent numbers also compare starkly with data from 2020, when the survey was run during the early stages of the pandemic. Then, 38 percent of doctors surveyed reported one or more symptoms of burnout while 46 percent were satisfied with their work-life balance.
“It’s just so stark how dramatically the scores have increased over the last 12 months,” said Dr. Tait Shanafelt, an oncologist at Stanford University who has led the research efforts. Burnout among physicians has been linked to higher rates of alcohol abuse and suicidal ideation, as well as, increased medical errors and worse patient outcomes. In May, the U.S. surgeon general, Dr. Vivek Murthy, issued an advisory. “Covid-19 has been a uniquely traumatic experience for the health work force and for their families,” he said, adding, “if we fail to act, we will place our nation’s health at risk.”
Dr. Shanafelt noted that most of the studies on burnout among physicians and health care workers at this stage of the pandemic have been focused on certain specialties and geographic hot spots, not on the profession as a whole. With the new data set, he said, “We have, for the first time, real context.”
While the idea of burnout has become ubiquitous, the condition has a definition in medical literature. The Maslach
Burnout Inventory, first published in 1981, measures burnout on three dimensions: Emotional exhaustion, depersonalization from work and sense of personal accomplishment.
When the metric was first proposed, a widely held belief was that burnout could be blamed on the dispositions of individual physicians — “that these are just weaklings,” explained Dr. Colin West, a physician at the Mayo Clinic who helped conceive of the survey efforts. Over time, though, the problem persisted and that belief became outdated. “This couldn’t just be pawned off as a handful of people who couldn’t handle the career,” Dr. West said.
In 2019, the National Academy of Medicine released a 312page report on physician burnout, carefully laying out the current understanding of the issue and steps that people in the medical profession could take to address it. Dr. Shanafelt, who helped write the report, said that evidence suggested that many doctors’ dissatisfaction with their work could be caused by an incongruence between what they cared about and what they were incentivized to do by the health care system.
“We cared about quality of patients’ experience, building relationships with them, and then there were all these things we got paid for,” Dr. Shanafelt said. A doctor may stop looking forward to patient visits if each one is accompanied by a large amount of paperwork; they may feel as if their time is being wasted by an inefficient process. Even something that was once a good thing can become tarnished,” he added.
The researchers noted that the most recent survey’s broad scope has limitations. About 2,500 physicians participated by responding to a mass email, a fraction of the estimated one million practicing physicians in the United States. And the factors that might lead someone to complete a survey on burnout — such as the need for an outlet to express frustration or the lack of time to complete one — could have had complicating effects.
Doctors also exist within an ecosystem of other health workers. Dr. Sexton published a study of more than 70 hospitals in September 2022 that showed burnout is often a local phenomenon. “A lot of a person’s exhaustion score is connected to who they work with,” he said. “There’s a social contagion in burnout. If your colleagues are fried and you’re not, give it six months and you’ll look just like them.”
Doctors were unevenly affected by the early stages of the pandemic. While emergency physicians and family physicians worked around the clock, constantly exposed to Covid-19, many physicians in other specialties were able to reach their patients through telehealth appointments and spend more time with their families. Combined with
a possible optimism that the worst of the pandemic was over, the rise of remote work might explain why emotional exhaustion rates actually fell among surveyed physicians in mid-2020 to the lowest point since the survey began in 2011. But two and a half years into the pandemic, the most recent survey pointed to an overall decline in mental health.
The survey also suggested that some physicians were at higher risk of burnout, including those practicing emergency medicine, family medicine and pediatrics, as well as, women physicians in general. Dr. Shanafelt said this might be because of the shortage of mental health services. “They’ve got 10 minutes to take care of their patients. There’s no psychiatrist or therapist to refer them to because our health care system is overwhelmed,” he said.
The increase in burnout is most likely a mix of new problems and exacerbated old ones, Dr. Shanafelt said. For instance, the high number of messages doctors received about patients’ electronic health records was closely linked to increased burnout before the pandemic. After the pandemic, the number of messages from patients coming into physicians’ In Baskets, a health care closed messaging system, increased by 157 percent.
physicians pointed to the politicization of science, labor shortages and the vilification of health care workers as significant issues. In one survey published in 2021, 23 percent of physicians reported being bullied, threatened or harassed by their patients at work in the past year.
Dr. Sexton added: “On a hopeful note, we know that there are simple interventions that can have as much a positive effect on well-being as the pandemic had a negative effect. So, yes, things are worse during the pandemic, but they’re not so bad that we don’t know how to fix it.”
Dr. West, who has done research on how to combat burnout among health care workers, said that “all the solutions run through a common pathway”: They connect people with their most meaningful activities. “What that means is it’s less important what the specific tactic is,” he said, “and more important to make sure that, whatever the solution is, it’s aligned with our basic, fundamental goals.”
But Dr. West emphasized the need for data to know the prevalence of burnout and how to combat it. “This really provides a 30,000-foot view pulse check,” he said of the survey. “So that we’re not just guided by our feelings and our intuition.”
The Maslach Burnout Inventory (MBI) is the most commonly used tool to self assess whether you might be at risk of burnout. To determine the risk of burnout, the MBI explores three components: Exhaustion, depersonalization and personal achievement. While this tool may be useful, it must not be used as a scientific diagnostic technique, regardless of the results. The objective is simply to make you aware that anyone may be at risk of burnout.
For each question, indicate the score that corresponds with your response. Add up your score for each section and compare your results with the scoring results interpretation at the bottom.
Questions
Never A few times a year
Once a month A few times a month
Once a week A few times a week
Every day
SECTION A 0 1 2 3 4 5 6
I feel emotionally drained by my work
Working with people all day long requires a great deal of effort
I feel like my work is breaking me down
I feel frustrated by my work
I feel I work too hard at my job
It stresses me too much to work in direct contact with people
I feel like I’m at the end of my rope
Total score SECTION A
Questions
Never A few times a year
Once a month A few times a month
Once a week A few times a week
Every day
SECTION B 0 1 2 3 4 5 6
I feel I look after certain patients impersonally as if they are objects
I feel tired when I get up in the morning and have to face another day at work
I have the impression my patients make me responsible for some of their problems
I am at the end of my patience at the end of my work day
I really don’t care about what happens to some of my patients
I have become more insensitive to people since I’ve been working
I’m afraid this job is making me uncaring
Total score – SECTION B
SECTION C 0 1 2 3 4 5 6
I accomplish many worthwhile things in this job
I feel full of energy I am easily able to understand what my patients feel I look after my patients problems very effectively
In my work, I handle emotional problems very calmly
Through my work, I feel that I have a positive influence on people
I am easily able to create a relaxed atmosphere with my patients
I feel refreshed when I have been close to my patients at work
Total score SECTION C
Burnout (or depressive anxiety syndrome): Testifies to fatigue at the very idea of work, chronic fatigue, trouble sleeping, physical problems. For the MBI, as well as for most authors, “exhaustion would be the key component of the syndrome.” Unlike depression, the problems disappear outside work.
• Total 17 or less: Low level burnout
• Total between 18 and 29 inclusive: Moderate burnout
• Total over 30: High level burnout
“Depersonalization” (or loss of empathy): Rather a “dehumanization” in interpersonal relations. The notion of detachment is excessive, leading to cynicism with negative attitudes with regard to patients or colleagues, feelings of guilt, avoidance of social contacts and withdrawing into oneself. The professional blocks the empathy he can show to his patients and/or colleagues.
• Total 5 or less: Low level burnout
• Total between 6 and 11 inclusive: Moderate burnout
• Total of 12 or greater: High level burnout
The reduction of personal achievement: The individual assesses himself negatively, feels he is unable to move the situation forward. This component repr esents the demotivating effects of a difficult, repetitive situation leading to failure despite efforts. The person begins to doubt his genuine abilities to accomplish things. This aspect is a consequence of the first two.
• Total 33 or less: High-level burnout
• Total between 34 and 39 inclusive: Moderate burnout
• Total greater than 40: Low level burnout
A high score in the first two sections and a low score in the last section may indicate burnout.
Neurosurgeon Honored with the Spirit of St. Vincent Award Ascension St. Mary’s Foundation Cornette Ball returns to an inperson event on November 19
Ascension St. Mary’s Foundation is pleased to announce Joseph G. Adel, MD, FAANS, as the 2022 recipient of the prestigious Spirit of St. Vincent Award, presented annually to a highly respected physician who has rendered long and noteworthy service to the Great Lakes Bay community and beyond.
Dr. Adel will be celebrated at the 28th Annual Cornette Ball on Saturday, November 19, beginning at 5:30 p.m. The gala returns to an in-person event following a two-year hiatus and will be held at Horizons Conference Center, 6200 State Street, in Saginaw.
Dr. Adel is a board-certified, dually trained neurosurgeon with Ascension Medical Group Michigan. He provides endovascular interventional procedures, as well as, open cerebrovascular and skull-base neurosurgery to a wide spectrum of patients with complex cranial disorders including acute stroke, aneurysms and arteriovenous malformations.
Under his leadership, Ascension St. Mary’s Hospital achieved comprehensive stroke center (CSC) accreditation from The Joint Commission. This is the highest recognition of its kind which distinguishes hospitals that have specific abilities to receive and treat the most complex stroke cases. Ascension St. Mary’s is the only hospital north of Flint, and one of only 13 hospitals in Michigan, to earn this designation. There are currently fewer than 300 hospitals in the United States that have achieved CSC certification.
“Dr. Adel is very deserving of the Spirit of St. Vincent Award,” says Stephanie J. Duggan, MD, Regional President & CEO, Mid/North Region, Ascension Michigan. “Ascension St. Mary’s Hospital has a legacy of being a center of excellence for stroke and neuroscience care. Dr. Adel continues to advance the stroke program, with a steadfast commitment to continuous quality improvement in patient safety and quality of care. The dedication and compassion he has for people at a time when they are sick, injured and most vulnerable is nothing short of exceptional. He focuses on what is best for the patient and achieving the best outcomes. I am so proud to call him a colleague, friend and member of the Ascension St. Mary’s family.”
The Cornette Ball is one of the grandest black-tie galas in the Great Lakes Bay region. The festive evening includes a cocktail hour, five-course gourmet meal, silent auction and live music by Detroit’s Intrigue.
Special recognition will also be given to the 2020 and 2021 Spirit of St. Vincent honorees, Medley A. Larkin, DO, and Steven T. McLean, MD, since an in-person gala was not able to be held due to the pandemic.
For sponsorship information or details about attending the Cornette Ball, please contact Tammy Weighman at tamera. weighman@ascension.org or 989.284-3773.
Through the generosity of Ascension St. Mary's Foundation, a $1 million 3D mobile mammography breast cancer screening center has been unveiled by Ascension St. Mary’s Hospital to improve access for individuals living in the mid, northern and thumb regions of Michigan.
“This state-of-theart clinic-on-wheels will aid with early detection of breast cancer and decrease lives lost, which is prominent in many rural communities we serve, especially in areas that do not have mammography services,” says Stephanie J. Duggan, MD, Regional President & CEO, Mid/ North Region, Ascension Michigan. “Individuals will receive the same high quality mammography screening as if they traveled to one of our hospital imaging centers.”
A ceremonial blessing and dedication ceremony was held on October 20, 2022. Individuals could tour the 45-foot breast screening center that features a registration area near the front, and private dressing rooms that lead to the advanced 3D tomosynthesis mammography equipment and technology. The mobile center provides a viable option for individuals to obtain a screening mammogram by making these services more accessible to where they live and work.
“This high tech mobile mammography screening center allows people to get a mammogram at a location that is more convenient and closer to their home,” says Christopher A. Garces, MD, breast surgical oncologist, Ascension St. Mary’s Hospital. “The images will be transferred daily from the mobile mammogram system to the hospital where a radiologist will read them within 24-48 hours. Earlier detection of breast cancer can lead to faster treatment and improved outcomes.”
Get advanced care at Ascension St. Mary’s ERs and stroke center
When you experience signs of a stroke, it’s important to call 911 or go to the nearest emergency room. Ascension St. Mary’s emergency rooms provide early stroke intervention, and all of our ERs are connected to specialists at our Comprehensive Stroke Center, recognized for excellence in the care of stroke patients.
Through the latest technology, our team of stroke specialists collaborate on diagnosing your stroke in as little as seconds and deliver the care that’s right for you. We’re beside you from the ER through recovery and rehabilitation.
Find your closest ER location at ascension.org
If you are experiencing a life-threatening emergency or difficulty breathing, go directly to the ER or dial 911.
Great Lakes Bay Health Centers (GLBHC) has officially opened its new Old Town center at 700 Court Street in Saginaw, offering a spacious new hub for a variety of health services in one convenient location.
Staff and community members celebrated with a Ribbon Cutting ceremony on October 27, attended by local and state officials, neighbors and chamber leaders. Congressman Dan Kildee and U.S. Sen. Debbie Stabenow each spoke during the ceremony.
The new building was constructed by Shaheen Development to provide 30,000 square feet of space dedicated to health services for anyone seeking care, regardless of their insurance coverage.
“I am proud to be part of a company where moms and dads can trust they have a good doctor and good support system," said Arnesha West, patient and WIC breastfeeding peer counselor who spoke at the event. "It’s all about making families feel like family. We want to make all moms and dads feel welcome."
Family medicine and OB-GYN service providers began seeing full schedules of patients on November 1. The Women, Infant and Children (WIC) nutrition program and breastfeeding support, Maternal Infant Health Program, and Child and Adolescent Behavioral Health care also are joining. Eye Care, Physical Therapy and Pharmacy will join this winter.
GLBHC Old Town | 700 Court Street | Saginaw, MI 48602
MEDICAL OFFICE HOURS
Monday, Wednesday, Thursday: 8 a.m.-5 p.m. Tuesday: 8 a.m.-7 p.m. (5-7 p.m. telehealth only) Friday: 7 a.m.-5 p.m. (7-8 a.m. telehealth only)
MEDICAL: (989) 921-5372 OB/GYN: (989) 921-5375
After Hours: (989) 776-5384 FAX: (989) 921-5373
OB/GYN OFFICE HOURS
Monday thru Friday: 8:30 a.m.-5 p.m.
YOU’RE INVITED!
Learn more about our brand new facility
TOGETHER EVENT TOUR! Tuesday, December 1, 2022 from 5:30-6:30 p.m.
The one-hour Together Event Tour allows you to experience our mission through stories from patients whose lives changed with the support of quality, accessible healthcare. Great Lakes Bay Health Centers has 33 nonprofit sites that offer primary medical care, dental and behavioral health services to everyone regardless of their insurance coverage or income. Doors open at 5:15 for light refreshments.
To register, contact Jill Armentrout, Fund Development Coordinator, at (989) 751-8866 or jarmentrout@glbhealth. org.
Teaching lives. Healing people. Building community together!
A regular monthly schedule will have the mobile mammography screening center traveling to Oscoda, Chesaning, Birch Run, Frankenmuth, Vassar and Genesee County. It will be available at community health fairs and events, and businesses may also schedule the mobile mammography screening center for their work sites. For more information or to schedule a screening appointment with the mobile mammography center, call Ascension St. Mary’s Imaging Center at (989) 907-8222 or (800) 605-9141.
Saginaw Valley Endoscopy Joins Ascension St. Mary’s Towne Centre Surgery Center
Ascension St. Mary's Towne Centre Surgery Center proudly welcomes the staff and physicians from Saginaw Valley Endoscopy - Erika E. DeGayner, DO; Mark J. Heinzelmann, MD; Shawn M. Ingles, DO; Medley A. Larkin, DO; Harprabhjit Singh, MD; Wael A. Sohl, MD; and Rajeev Tummuru, MD. With the closing of Saginaw Valley Endoscopy on October 13, 2022, all patients are now being seen at Ascension St. Mary’s Towne Centre Surgery Center as of October 14, 2022.
For more than 20 years, Ascension St. Mary’s Towne Centre Surgery Center, located at 4599 Towne Centre Road in Saginaw, has offered a comprehensive digestive care center, providing diagnostic services and medical procedures for the treatment of chronic diseases of the gastrointestinal tract and liver such as heartburn, anemia, acid reflux, ulcers, stomach pain, hemorrhoids and diverticulosis.
Saginaw Valley Endoscopy patients will not experience any disruption in the exceptional care or services they have come to expect. Individuals will receive the same personalized and compassionate care from their physician, with diagnostic testing and medical procedures such as colonoscopies, endoscopic ultrasound (EUS) and esophagogastroduodenoscopy (EGD), performed at Ascension St. Mary’s Towne Centre Surgery Center. For more information about the services available at Ascension St. Mary’s Towne Centre Surgery Center, call (989) 497-3150.
All Seasons Skin and Surgery Center 5
Andersen Eye Associates 23
Ascension St. Mary’s Hospital 27
Barb Smith Suicide Resource & Response Network 7
Bieri Hearing Specialists 1 1
Sudeep Raj Aryal MD
Covenant Medical Group Cardiology 900 Cooper, Suite 4100 Saginaw, MI 48602-5182 Office (989)-583-4700 Fax (989)-583-1394 www.covenanthealthcare.com Cardiovascular Disease, Internal Medicine
Rikat E. Baroody MD
CMU Health - Surgery 912 S. Washington Ave., Ste. 1 Saginaw, MI 48601-2578 Office (989)-790-1001 Fax (989)-790-1002 www.cmich.edu/colleges/cmed/ Surgery - Trauma, Critical Care Franchesca Garcia-Robles MD CMU Health - Pediatrics Assistant Program Director 1000 Houghton Saginaw, MI 48602-5303 Office (989)-746-7804 Fax (989)-746-7751 www.cmich.edu/colleges/cmed/ Pediatrics, Palliative & Hospice Medicine
Steven Hermiz MD Covenant Plastic Surgery 800 Cooper, Suite 1A Saginaw, MI 48602-5371 Office (989)-583-6400 Fax (989)-753-5270 www.covenanthealthcare.com Surgery - Plastic, Reconstructive, Hand and Cosmetic
Adeeba S. Khan MD
CMU Health - Pediatrics Assistant Program Director 1000 Houghton Saginaw, MI 48602-5303 Office (989)-746-7953 Fax (989)-746-7751
www.cmich.edu/colleges/cmed/ Pediatrics
Narong Kulvatunyou MD
CMU Health - Surgery 912 S. Washington Ave., Ste. 1 Saginaw, MI 48601-2578 Office (989)-790-1001 Fax (989)-790-1002 www.cmich.edu/colleges/cmed/ Surgery - Trauma, Critical Care
Christina L. Maser MD
CMU Health - Surgery 912 S. Washington Ave., Ste. 1 Saginaw, MI 48601-2578 Office (989)-790-1001 Fax (989)-790-1002 www.cmich.edu/colleges/cmed/ Surgery - General, Endocrine
Affiliate Member*
Brianna C. Pitre DC Shields Chiropractic 7075 Gratiot Road, Suite 2 Saginaw, MI 48609-6904 Office (989)-781-7700 Fax (989)-781-7783 https://shieldschiropractic.net/ Chiropractor
Covenant Health Care 2
Covenant Wound Healing Center 21
Jan Hauck – Century 21 15
Healthway Compounding Pharmacy 13 , 28
Lori Krygier Graphic Designer 23
Melissa Morse – Bricks Real Estate 20
Shields Chiropractic 21
Wellspring Lutheran Services Home Health 29 & Hospice
If COVID-19 has taught us anything, it has underscored the importance of overall good health in maximizing prevention and minimizing the severity of illness. The keys to better health have always been and will continue to be:
• Maintaining a healthy weight
• Eating a healthy, well-balanced diet
• Managing chronic stress
• Exercising regularly
• Seeing your doctor regularly
• Following through with preventative screenings
We are fortunate to live, work and play in Saginaw County where citizens, hospitals, public health officials, and non-profit organizations work together to develop and regularly update a community health improvement plan. Guided by this plan, these organizations are actively collaborating on comprehensive initiatives to help YOU take better care of yourself and your family.
COVID-19 is still here, but we are moving forward with hope and determination to guide Saginaw to better health. BWell, Saginaw is the overarching theme of Saginaw’s community’s health improvement plan, which – under the leadership of the Saginaw County Health Department – focuses on three priorities:
• Maternal & Child Health
• Obesity
• Mental Health and Substance Use
Work groups for each priority are focusing resources on initiatives to improve each priority.
Maternal & Child Health Obesity Behavioral Health Saginaw HUB Step Up, Saginaw Mental Health and Substance Use Self Care Campaign
As an organization:
• Talk to your leadership to add your name to the list of champions
• Share and promote content developed
• Adopt the brand — use it to support your organization’s work
• Provide financial support when needed
• Work to keep this a sustained effort
As an individual:
• Pledge to improve your health
• Participate in initiatives
• Participate in community health assessment
The following organizations are BWell, Saginaw champions:
• Saginaw County Health Department
• Ascension St. Mary’s
• Covenant HealthCare
• Great Lakes Bay Health Centers
• Saginaw County Community Mental Health Authority
• Saginaw Community Foundation
• CMU Health
• MiHIA
• Saginaw Intermediate School District
• Ten 16 Recovery Network
• Barb Smith Suicide Resource & Response Network
• Saginaw YMCA
• United Way of Saginaw County
• Children’s Grief Center
• STARS
• Women of Colors
• PartnerShift
• Congressman Dan Kildee
• HealthSource Saginaw
• Saginaw Public Schools
• Saginaw County Medical Society
Tuesday, January 17, 2023 - Horizons Conference Center, 6200 State Street, Saginaw Board Meeting - 5:30 p.m.
Membership Meeting Joint with the Saginaw County Dental Society - Social (cash bar) at 6:30 p.m., followed by dinner, meeting and program at 7 p.m. Speaker To be announced Topic - "The Link between Oral Health and Cardiac Health" Email meeting notices will be sent in early January. Online reservations are required
Tuesday, February 21, 2023 - CMU College of Medicine, 1632 Stone Street, Saginaw Board Meeting - 5:30 p.m.
There is no Membership Meeting in February.
Tuesday, March 21, 2023 - Via Zoom Board Meeting - 6:30 p.m. There is no Membership Meeting in March.
Tuesday, April 18, 2023 - Horizons Conference Center, 6200 State Street, Saginaw Board Meeting - 5:30 p.m.
Free CME for Your SCMS/MSMS Membership Renewal by November 30. See page 5 for details!
Membership Meeting - Social (cash bar) at 6:30 p.m., followed by dinner, meeting and program at 7 p.m. Speaker TBD Topic TBD
Email meeting notices will be sent in early April. Online reservations are required.
Saturday-Sunday, April 22-23, 2023 - The Henry in Dearborn 158th Annual MSMS House of Delegates
Tuesday, May 16, 2023 - Horizons Conference Center, 6200 State Street, Saginaw Board Meeting - 5:30 p.m.
Annual SCMS and SCMS Foundation Membership Meetings Social (cash bar) at 6:30 p.m., followed by dinner, meetings and program at 7 p.m.
Email meeting notices will be sent in early May. Online reservations are required.
12th Annual SCMS Foundation Golf Outing – date TBD
All statements or comments in The Bulletin are those of the writer, and not necessarily the opinion of the Saginaw County Medical Society.