AOMA Fall Digest 2016

Digest

Arizona Osteopathic Medical Association

SPECIAL EDITION

DOCTORS THAT DO

BRAND AWARENESS CAMPAIGN COMES TO ARIZONA

Volume 31, No. 3 Fall 2016

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AOMA Digest Fall 2016 2 Medical Professional Liability Insurance

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Volume 31, No. 3 Fall 2016

Digest

2016-2017 Board of Trustees President Shannon Scott, DO, FACOFP President Elect

The Official Publication of the Arizona Osteopathic Medical Association

Laurel Mueller, DO, MBA

Contents

Immediate Past President Kristin Nelson, DO, FAOCO-HNS Vice President Angela DeRosa, DO, MBA, CPE Secretary/Treasurer Christopher Labban, DO Executive Director/Editor Pete Wertheim Trustees Danielle Barnett-Trapp, DO Elise Barney DO Craig Cassidy, DO, FACOO Donald Curran, DO Susan Del Sordi-Staats, DO William Devine, DO Datcha Dorvil, DO, MPH David England, MS, DO Michelle Eyler, DO

COLUMNS 2 President’s Message 4 Executive Director’s Message 6 2016-2017 AOMA Board of Trustees 8 What We Have Done For You Lately

FEATURES 9 SPECIAL FEATURE: Doctors That DO Comes to Arizona 18 Protecting YOU and Your Profession 20 My Most Memorable DO Moment 22 ATSU-SOMA: Reinventing Medical School Education 25 Midwestern University’s Health Education Message: Get Involved 28 Federal Loan Repayment Options for Medical Trainees 31 Arizona Public Cord Blood Program

David Leff, DO Kit McCalla, DO, MBA Julie Morrison, DO George Parides, DO, FACOI Wendell Phillips, DO Bunnie Richie, DO, FAAN Resident Trustee Kendra Gray, DO Student Trustees Heidi Kipers, AZCOM, OMS IV Brenda Pecotte de Gonzalez, MPH, MA, SOMA, OMS IV Speaker of the House of Delegates Jeffrey Morgan, DO, MA, CS, FACOI Vice Speaker of the House

AOMA NEWS 32 Welcome New AOMA Members 33 AOA House of Delegates 34 2nd Annual Flagstaff Osteopathic Medical Conference 35 AOMA 36th Annual Fall Seminar 35 Career Center 36 2017 Clinical Case and Poster Competition 37 DOs in the News 38 Birdies for Charity 39 AOMA Business Partners 40 Advertisers Index 40 Calendar of Events

Charles Finch, DO, FACOEP

AOMA Staff Director of Education & Managing Editor Janet Weigel Member Services Manager Sharon Daggett Operations Manager Teresa Roland

Opinions expressed in the AOMA Digest are those of the authors and do not necessarily reflect viewpoints of the editors or official policy of the AOMA, or the institutions with which the authors are affiliated, unless explicitly specified. AOMA Digest does not hold itself responsible for statements made by any contributor. We reserve the right to edit articles on the basis of content or length.

Although all advertising is expected to conform to ethical medical standards, acceptance does not imply endorsement by this magazine. The appearance of advertising in the AOMA Digest is not an AOMA guarantee or endorsement of the product, service, or claims made for the product or service by the advertiser.

Marketing Specialist Doctors That DO Special Feature Andrea Voron

Cover road map of Arizona from the National Atlas of the United States of America® www.nationalatlas.gov Copyright 2016©

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AOMA Digest Fall 2016

President’s Message

Sharing the Traditions of Our Profession When I first saw the 1971 film adaptation of the musical Fiddler on the Roof, the fiddler’s metaphoric representation of communal resistance to change made a lasting impression.

He represents a community’s everpresent fears; a symbol of the traditions he is clinging to as his world Shannon Scott, DO changes around him.

2016 – 2017 AOMA President The main character, Tevye, sings to his six daughters, “Tradition!” impressing upon them how important it is to value generational wisdom. During the years since viewing this masterful tale, I am frequently reminded that DOs share traditions spanning generations of wisdom supporting our family.

A tradition is a belief or behavior passed down within a group or society with symbolic meaning or special significance with origins in the past. As a family of osteopathic physicians, we have much to celebrate among our ‘traditions’. One of the most significant parallels to the fiddler lies within our thoughtful training of osteopathic medical students and residents — the young people who are the future of our family. Osteopathic principles and practices are modeled and taught by physicians entrusting this profession to the next generation.

Our traditions, however, go much deeper.

As our healthcare environment fluctuates, our message remains steady: inclusion and service.

Subsequently, the osteopathic voice becomes stronger with each generation; it is still tradition, but adaptive!

AOMA Digest Fall 2016

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As the DO family grows to over 96,000, respect for osteopathic tradition moves each generation forward. The success of this process relies on engagement – another important part of our osteopathic family’s tradition. Our customary practices set the tone for the next generation to engage with their past and move forward to the future.

The osteopathic family has confirmed value in diversity since its beginning. In 1894, the very first graduating class of the American School of Osteopathy in Kirksville, Missouri included five female physicians. Our traditions of inclusion and engagement also allow us to embrace partnership with patients’ personal and community health care needs.

This issue of the AOMA Digest celebrates our osteopathic family and spotlights the national brand awareness campaign Doctors That DO. We are proud that Arizona was selected by the American Osteopathic Association as one of three states to tell the DO story. The special section on Doctors That DO begins on page 9.

The burgeoning success of osteopathic expansion encourages me to believe the level of engagement we make with our future DOs and patients will translate into world health differences - new horizons for our traditions.

As an example of this, while in medical school, one of my preceptors routinely invited me to volunteer with him at a local homeless shelter.

This volunteer project eventually developed into the dynamic H.O.M.E. program at Midwestern University.

We DOs traditionally engage in the health of our communities outside of the doctor’s office.

As osteopathic physicians, we not only seek out the opportunity to make a difference in the lives of our patients, but also in service activities in our communities. These opportunities include,

President’s Message

but are certainly not limited to, serving on a state or national medical, safety, or school board, providing education at community events, and volunteering with local charities.

What about these experiences would inspire any DO to contemplate the future of their osteopathic family traditions? What would make them want to climb a rooftop and play a fiddle?

Here is a thought: serving these groups will continue traditions set by hard-working pioneer generations of DOs whose wisdom we celebrate today. In advancing our osteopathic oath, the foundation of our practice must expand its focus on health from family to community to global.

This charges everyone in our family to consider the question, “What role can I play in carrying today’s traditions into tomorrow?”

Your Arizona Osteopathic Medical Association membership is an excellent way to ensure the future of the DO profession. In recent years, there have been significant legislative and philosophical changes affecting healthcare. Through advocacy, community involvement, and leadership, the AOMA is looking out for our profession, promoting and protecting osteopathic medicine and its traditions.

Clearly, it’s no time to fiddle around.

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AOMA Digest Fall 2016

Executive Director’s Message

When You Really Need It – Count On AOMA to Be There for You We regularly speak with you about the value of membership with AOMA. Whether it is the brand awareness campaign Doctors That DO, the high-quality continuing medical education, the business of medicine support, or advocacy to protect the profession, there are many ways we serve you and your needs.

Pete Wertheim Without members, AOMA Executive Director AOMA would cease to exist and the more members we have, the better job we can do on your behalf.

But there is a lesser known benefit that is probably one of the most important services we provide: helping members solve problems and overcome impediments to their practices.

These are some of the most time-consuming and challenging problems to address, but also the most rewarding when we are successful.

As AOMA’s executive director, my phone rings at all times during the day and night, even on weekends, and I never know what the next call will entail. Most of the time the call may be a quick question or a suggestion for something a member would like to see us do, or do differently.

Sometimes it is a physician in trouble – big trouble — who needs our help.

One early Saturday morning a few months ago I received a text from an AOMA member physician describing a meeting she had with another physician (whom I will refer to as Dr. L) who was in serious trouble. She asked me to call him so I called Dr. L right away and we spoke for about half an hour. It was the worst of circumstances.

AOMA Digest Fall 2016

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In six days, Medicare was officially revoking Dr. L’s privileges for billing issues based on some findings by Noridian, of which he had already been cleared. Dr. L had numerous unanswered questions and had been trying for weeks to get answers from CMS with no success. He was understandably anxious, frustrated, concerned, and needed my help immediately.

Communicating with Medicare can sometimes be challenging for garden-variety issues, but dealing with Medicare outside of the customary channels can be confusing and overwhelming.

Patience and persistent diplomacy are essential, but, also very time consuming.

Dr. L had rudimentary questions about his due process rights, procedural steps, and his ability to access information about his complaint. The correspondence he received never explained any of this; it is also not easy to locate, and the case worker assigned to Dr. L was not responding to calls or emails. His attorney and others tried to help, but no one could get through to CMS. To make matters worse, Dr. L had to make some critical decisions that would permanently affect his practice. Could the impending revocation decision be stayed? What about the dozens of patients he had scheduled for appointments?

Could they be seen, could they be seen and perhaps not billed for services?

I am by no means an expert on Medicare and all its processes, so I did not have answers to Dr. L’s questions, but I was determined to help him. I also firmly believed in the innocence of Dr. L, but even if I had not it would have made no difference to me. He’s a DO, part of our family, and he needed my help. Even though he was not an AOMA member, that was also not important at the time.

He needed help and I knew he would value the service we provide and become one later.

Executive Director’s Message

After speaking with Dr. L, I wasted no time and started making calls and sending emails to every contact that I knew at CMS or was affiliated with CMS. Even though it was a weekend, I wanted to make sure that the concerns of Dr. L would be first up in the queue Monday morning or sooner.

Throughout the course of the next week, I spent many hours going back and forth with CMS, Noridian, and Dr. L, trying to get answers. Dr. L and I sent emails, texted, and spoke at all different times of the day and night sharing updates as the process unfolded.

While I was not able to get everything I had hoped for him, Dr. L said that I was the only one having any success getting answers to help him.

It was also an important learning experience to understand how a physician in this dire circumstance is treated by CMS, and to get a personal perspective on what it is like for a physician going through such an experience.

Dr. L was under enormous stress and he needed help not just with CMS, but someone to confide in who would give him the benefit of the doubt.

As you can imagine, I would not be sharing this story if it didn’t have a somewhat happy ending.

It took a while, too long, but eventually Dr. L was cleared of the charges levied against him and his Medicare privileges were restored. While I would like to take credit for his exoneration, I cannot, but I am happy to know that I could at least make his situation a little bit easier at the darkest hour.

Dr. L is now an AOMA member and we continue to stay in touch.

This work is not yet finished. I am working with the American Osteopathic Association and others to understand how a physician in this situation could have so much trouble getting information from CMS. There are many questions I am seeking answers to from this case and I am determined to see if there are some changes that can be made so this does not happen to others.

This is a benefit of AOMA membership that I hope none of you ever need, but if you do we are here to help. There are countless other stories.

Every week I spend some time on activities like explaining a new change in Arizona law or providing a referral for an attorney on a licensing issue. Each day brings new challenges and problems to solve. I view these as opportunities.

These are opportunities to help hard working physicians in times of need, and opportunities to learn about the healthcare delivery system and help AOMA become a more effective advocate to improve it.

AOMA membership is an insurance policy of sorts and protection for your profession and well-being. We are preparing for another bustling legislative session and we will be dealing with scope of practice encroachment, healthcare workforce issues, regulatory changes, Medicaid reimbursement, and many other issues. AOMA membership pays for this work on your behalf, among many other things. So whether you want to enjoy a networking event with your peers, or partake in professional development through CME, or perhaps your practice is in jeopardy and you need assistance, AOMA is here for you.

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AOMA Digest Fall 2016

2016-2017 Board of Trustees

EXECUTIVE COMMITTEE

Shannon Scott, DO, FACOFP President

Kristin Nelson DO, FAOCO-HNS Immediate Past President

Laurel Mueller, DO, MBA President Elect

Angela DeRosa, DO, MBA, CPE Vice President

Christopher Labban, DO Secretary/Treasurer

Pete Wertheim Executive Director

TRUSTEES

Danielle Barnett-Trapp, DO District 2 Representative

AOMA Digest Fall 2016

Elise Barney, DO New Physician Representative

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Craig Cassidy, DO, FACOO Specialists

Donald Curran, DO District 7 Representative

2016-2017 Board of Trustees

Susan Del Sordi-Staats, DO District 3 Representative

William Devine, DO District 1 Representative

Datch Dorvil, DO, MPH Member at Large

David England, MS, DO District 4 Representative

David Leff, DO District 4 Representative

Kit McCalla, DO, MBA Member at Large

Julie Morrison, DO District 6 Representative

George Parides, DO, FACOI Member at Large

Wendell Phillips, DO Member at Large

Bunnie Richie, DO, FAAN Member at Large

Kendra Gray, DO Resident Trustee

Heidi Kipers, OMS IV AZCOM Student Trustee

Brenda Pecotte de Gonzalez, OMS IV SOMA Student Trustee

Jeffrey Morgan, DO, MA, FACOI, CS Speaker of the House of Delegates

Charles A. Finch, DO, FACOEP Vice Speaker of the House

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Not Pictured: Michelle Eyler, DO Member at Large

AOMA Digest Fall 2016

What We Have Done for You Lately

What We Have Done For You Lately AOMA is the voice of osteopathic medicine in Arizona, representing the profession as a healthcare stakeholder and community partner. This activity update covers the three month period from July 1, 2016 to September 30, 2016.

Advocacy/Legislative Affairs • Met with representatives from health professions organizations which submitted to the Arizona legislature sunrise applications to expand scope of practice; AOMA positions will be taken to support, oppose, or take no position on each of the applications. Further details to come, positions not finalized at time of publication.

• Actively monitoring progress of Prescription Drug Monitoring Program legislation American Osteopathic Association (AOA) • AOMA received the prestigious Strategic Team Award Recognition (STAR) for its innovative activities in advancing the osteopathic profession • Sent 12 delegates, one alternate delegate, two student delegates, and two student alternate delegates to the AOA House of Delegates in Chicago in July 2016 Continuing Medical Education • Sponsored 7.0 hours of AOA Category 1-A CME credit for the 2nd Annual Flagstaff Osteopathic Medical Conference in August 2016 • Created and posted three new online on demand CME offerings on DOCME.org Member Services • Offered attendance to the 2nd Annual Flagstaff Osteopathic Medical Conference free of charge • Relaunched the AOMA Career Center, offering discounts for members • Offered online CME discount for members at DOCME.org • AOMA Executive Director Pete Wertheim elected to the Board of the Association of Osteopathic State Executive Directors • Political Action Committee • Distributed $7,700 to 13 candidates for office Osteopathic Charities • Launched the 2017 Birdies for Charity campaign Public Relations • In conjunction with the AOA, launched the Doctors That DO brand awareness campaign in Arizona • Co-sponsored the 2nd Annual Flagstaff Osteopathic Medical Conference with Flagstaff Medical Center

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Public Health • Represented AOMA on the Arizona University Immunization Workgroup • Represented AOMA at The Arizona Partnership for Immunization (TAPI) Steering Committee • Working with Save the Cord Blood Foundation on awareness campaign Students & Residents – The Future of the Osteopathic Profession • Introduction and AOMA orientation to incoming students at A. T. Still University’s School of Osteopathic Medicine and Kirksville College of Osteopathic Medicine and Midwestern University Arizona College of Osteopathic Medicine • Announced the 2017 AOMA Clinical Case and Poster Competition For more information about any of these updates, call (602) 266-6699 or email communications@az-osteo.org

MAKE A DIFFERENCE FOR OSTEOPATHIC MEDICINE. Contribute to the AOMA Political Action Committee!

PURPOSE AOMA Political Action Committee (PAC) is an essential vehicle for preserving and fostering the osteopathic medical profession in Arizona. The PAC allows us to endorse and support those candidates for state public office who share our concern about the future of healthcare and improved access to quality care in Arizona.

CONTRIBUTE ONLINE! It’s easier than ever to contribute to the AOMA PAC and make a difference.

Go to www.az-osteo.org/PAC or scan the code.

DOCTORS THAT DO COMES TO ARIZONA

Doctors That DO

Give Them Something to Talk About Seldom in life do the intersections of dreams and opportunities come together so perfectly as it has recently for osteopathic physicians, Alice Chen, DO, the American Osteopathic Association (AOA), and the Arizona Osteopathic Medical Association (AOMA). These intersections do not come by happenstance or lucky breaks; it is the result of hard work, unwavering passion, and a belief that the difficult is only different.

It was a bright cool morning in the Bronx, New York, when Dr. Chen burst through the double doors of St. Barnabas Hospital onto the garden steps below. The tall brick building loomed behind her as she rushed to retrieve her car in the nearby parking lot. She let out a short yawn.

An overnight shift in the emergency room had left her thoroughly exhausted though unusually giddy. She’d have to try to nap on the plane, she thought.

Several hours later, after a red-eye flight, Dr. Chen found herself standing in an unfamiliar place - a glamorous studio in Chicago with a make-up artist and hair stylist preparing her for a professional photo and video shoot.

It all felt surreal to the recent graduate of Arizona’s A.T. Still University-School of Osteopathic Medicine (ATSU-SOMA), miles removed from her usual hospital habitat.

Only a few months earlier, Dr. Chen received an email from the AOA asking her and a dozen other DOs to serve as models in a public awareness campaign, Doctors That DO. The plan was to feature practicing DOs actively serving patients every day. Although she never imagined her face would play such a public role in the campaign, she jumped at the opportunity to advocate for the profession she loves.

After a successful first run, Doctors That DO will launch in Maricopa County, Arizona in early October and continue through November 2016.

Phoenix was one of three cities selected to tell the DO story during the second phase of the national campaign.

The AOMA and the osteopathic community of Arizona have been dreaming of a campaign of this nature for years and there was no better time to act than now.

www.doctorsthatdo.org

It's time to change the conversation from "What is a DO?" to "Who is my DO?" Shannon Scott, DO, FACOFP AOMA President AOMA Digest Fall 2016

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Doctors That DO

A Message to Reach Future Generations The Doctors That DO campaign targets a unique audience - health concious men and women between the ages of 30 and 49. Research reveals that consumers in this segment strongly connect with the DO philosophy. They want doctors who “treat the whole person” and “go beyond to find solutions.” Those elements in combination with further training and modern technology only heighten the appeal for this audience.

As life happens, DOs like other busy professionals may not think they have the time or expertise to promote their brand. We know what branding is when we see it, we know it is important, and most of us unconsciously know when it works – it is familiar to us. When a magazine or patient unintentionally omits the mention of DOs in healthcare, we are reminded why it is so important.

“2017 marks the 125th anniversary of the osteopathic profession; and in that time, we’ve helped millions of patients get better, stay well, and avoid illness all together,” said Jeffrey Morgan, DO, Dean of ATSU-SOMA, “They like what we do; they just don’t know that’s what we do yet.” Doctors That DO is about telling a world seeking our distinctive approach to healthcare what we do for our patients.

“We are quite possibly the best-kept secret of healthcare.”

Jeffrey Morgan, DO, MA, CS, FACOI Dean, A. T. Still University-School of Osteopathic Medicine Arizona 11

AOMA Digest Fall 2016

Doctors That DO

Spreading the Message in Arizona In October 2016, Doctors that DO will go live across the metropolitan Phoenix area.

Messages about the DO’s empathic and integrative approach will flood the valley in the form of billboards and posters. As a result of significant investments from both AOMA and the AOA, a total of 35 locations will tell our story.

Meanwhile, various national campaign elements will continue, including print ads in prominent consumer magazines, digital ads on popular health-focused websites, and social media outreach via the Doctors That DO Facebook page. Overall, the campaign expects to generate over 28 million impressions in Arizona alone and reach 69% of its target audience.

MULTI-FACETED MEDIA CAMPAIGN STRATEGY National • Consumer Magazines - Print ads in prominent magazines, including Women’s Health, Men’s Health, WebMD, and Runner’s World • Digital - Banner ads and 30-second videos on health-focused websites like Healthgrades, WebMD.com, and native health content on digital channels • Paid Search – Highly visible on various search engines like Yahoo and Google • Social Media – Facebook advertising on Doctors That DO consumer page and engagement with influential “mommy bloggers” Local • Out-Of-Home – Billboards, transit shelter ads, and ads in local health clubs • Events – Visibility at partners’ events, including New York City and Chicago marathons

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To some, these projections may seem overly optimistic; but that is far from the truth given the incredible success of the campaign on a national front so far. As of May 2016, some 532,000 people have visited the Doctors That DO website to learn about the DO difference.

Over 314,000 of these visitors actually used the website’s “Find Your DO” search engine.

“We are very pleased to report the campaign has reached 375 million impressions in the first seven months,” said AOA Chief Communications Officer Charlie Simpson.

“Results have exceeded our expectations for audience reach, favorability, and response. The bottom line is we’re getting noticed, and people like what they see.”

CONSUMER RESPONSE TO DOCTORS THAT DO CAMPAIGN October 2015 to May 2016 • •

532,000 Site Sessions 314,000 “Find Your DO” Searches

Doctors That DO

Why Now? Such efforts could not come at a more crucial time. As a result of the Affordable Care Act, there are 215,000 more Arizonans in need of healthcare today than in 2013. Researchers project 26 million more U.S. nonelderly people will be insured by 2017. Like never before, hundreds of thousands of new patients are flooding the healthcare market and looking for their doctor. “Consumer demand is on the rise,” said Caleb Hentges, OMS III at Midwestern University Arizona College of Osteopathic Medicine (AZCOM). “DOs will be at the forefront of healthcare delivery for the next generation of consumers.”

Osteopathic medicine is ranked among the fastest growing segments in U.S. healthcare.

In Arizona alone, the number of DOs licensed has increased by 19% since 2011. Nationally, one in four medical students are enrolled in osteopathic medical schools. There are 1,437 aspiring DOs in Arizona and 347 osteopathic resident physicians in training. “The rapid growth of osteopathic medical schools, the quality of the graduates produced by these institutions, and the desire and willingness of these physicians to serve the under-served population will alter the face of medicine in the United States,” said Stanley Brysacz Jr., DO, longtime champion of the profession.

DOs By the #s • One of the fastest growing segments in healthcare today experiencing 25% growth every 5 years • 1 of every 4 U.S. medical students is enrolled in an osteopathic medical school • More than half of all DOs are under the age of 45 • 40% percent of DOs in active practice are female • More than 55% of DOs in active practice trained in a primary care specialty

At a time when patient demand is high and people are searching, Doctors That DO will educate consumers about osteopathic medicine.

It will open their eyes to a new approach and provide information about another option they have when it comes to their medical care. “Better-informed patients means more questions in the doctor’s office, which means better healthcare,” said Brenda Pecotte de Gonzales,OMS IV at ATSU-SOMA. “But this campaign is just as much for DOs as it is for the public,” adds Dr. Chen. With the rapid growth of the profession, it is important that osteopathic physicians promote its origins and philosophy. Doctors That DO is special because it speaks from the foundational teachings of Andrew Taylor Still, DO, MD. So while the campaign works to educate patients about all their options with regard to physician care, it will also remind the future generation of DOs who they are and why they should be proud. “I can think of no other endeavor more valuable for today’s DOs,” said Kristin Nelson, DO, FAOCOHNS, AOMA Immediate Past President.

“Osteopathic medicine is currently positioned to be a major force in healthcare in the U.S.” Stanley Brysacz Jr., DO AOMA Lifetime Achievement Award Recipient 13

AOMA Digest Fall 2016

Doctors That DO

Our Time to Shine With the launch of Doctors That DO here in Arizona this autumn, the DO profession will gain more visibility than ever. Consumers will drive by billboards of smiling DOs, read about our unique philosophy online while scrolling through Facebook, and consider our approach to healthcare while flipping through WebMD magazine in the waiting room. Like never before, we will be on the minds of our patients.

DOCTORS THAT DO MESSAGES The following messages tested well with consumers.

• There are two types of fully-licensed physicians in the US: MDs and DOs. • Our training and education are very similar and equally rigorous, but DOs come at the practice of medicine from a different philosophy.

• We tend to partner with our patients to help them get healthy and stay well.

• We take a whole person approach to treating our patients.

• Our focus is on wellness and prevention.

• We consider the mind, body, and spirit, not just the symptoms.

• DOs are taught to see the person inside the patient.

• We take care of people, not problems.

This presents a unique opportunity for the DOs of our community to stand up and tell the world who we are, what we do, and why we are proud to be DOs. For some, this may be taking a public role like Dr. Chen, and for others this means sharing our profession with patients, friends, and family members whenever we get the chance.

Whatever the case, we must all do our part to change the conversation, and in so doing, pave the way for the osteopathic physicians of tomorrow.

“Once you realize the body has an inherent ability to heal itself, it changes how you look at the treatment of patients. You are no longer treating a disease, you are helping a person heal.”

Lori Kemper, DO, MS, FACOFP Dean, Midwestern University Arizona College of Osteopathic Medicine AOMA Digest Fall 2016

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Doctors That DO

Doctors That DO | Campaign Toolkit Osteopathic medicine will be prominently featured across Arizona during October and November 2016, making appearances on billboards, transit stations, and other strategic locations both in print and online media. This affords a unique opportunity for members of the osteopathic community to engage with colleagues, friends, and patients about osteopathic medicine. Here are 5 simple ways you can participate in the Doctors That DO campaign.

1. TALK ABOUT IT

Research shows word-of-mouth marketing is one of the most powerful promotional tools we have, with 92% of people trusting recommendations made by friends and family more than all other forms of marketing. This reveals the immense influence each of you wields just by opening your mouth to advocate for the profession daily. If half of all DOs and osteopathic medical students took a few minutes weekly to talk about it, we can personally tell our story to 2.5 million people in just one year!

2. DISTRIBUTE EDUCATIONAL BROCHURES AT YOUR OFFICE

Brochures are an easy way to educate patients and raise public awareness of the profession.

If you are interested in distributing brochures about osteopathic medicine, visit the American Osteopathic Association’s online store at www.osteopathic.org/store to order the desired amount. There, you’ll find campaign brochures along with a variety of other campaign-related memorabilia, including posters and other merchandise.

3. USE A DOCTORS THAT DO BANNER AD IN YOUR SIGNATURE Beyond engaging in conversations, using a banner ad in your email signature is an easy and effective way to raise awareness about the campaign. Visit www.az-osteo.org/ DoctorsThatDO to download the toolkit.

4. SHARE VIDEO ADS FROM THE CAMPAIGN

Videos are an increasingly powerful mode of communication in this visual age, serving as a clear and engaging mode of communication.

A series of videos was created to illustrate the campaign’s scope and messaging. These can be easily downloaded from the AOMA Doctors That DO webpage and shared with your audiences. You are welcome and encouraged to share the videos on your website, in your office, and on social media.

5. ADVOCATE & EDUCATE ON SOCIAL MEDIA

You can also demonstrate your DO pride on your social media accounts by liking and sharing articles, infographics, videos, and testimonials about osteopathic medicine! Each of us has an online community of friends and family who would greatly benefit from understanding what you do.

VISIT THE AOMA WEBSITE

The Arizona Osteopathic Medical Association has compiled a Doctors That DO Campaign Toolkit with links, graphics, videos, messages, and more that you can use to promote the osteopathic profession and your practice.

To learn more, go to: www.az-osteo.org/DoctorsThatDO

Sample email banner ad

www.doctorsthatdo.org 15

AOMA Digest Fall 2016

Doctors That DO

Get in the Game!

G DO

Beginning in early October 2016 look for the Doctors That DO billboards in the Phoenix metropolitan area and you could win prizes!

Pokemon GOTM has been all the rage this year. To get you in the spirit of the campaign, we’ve created a version of this popular scavenger hunt game - DO GO! The national brand awareness promotion will be featured on 35 poster and digital boards around the Valley of the Sun. When you see one, snap a photo and message it to the AOMA Facebook page facebook.com/azosteo, tweet it with #azdogo, or email it to us at communications@az-osteo.org.

With each photo captured you will be entered into a drawing for prizes.

Have some fun with the campaign and show your pride in the osteopathic medical profession!

Entries must be received by December 15, 2016 to be entered into the drawing.

For a map of billboard locations and details visit the AOMA website at www.az-osteo.org/DOGo.

AOMA Digest Fall 2016

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#azdogo RULES FOR DO GO! 1. Contest is open to all AOMA members in good standing (dues current).

2. See a Doctors That DO billboard and snap a photo.

3. Send the photo to AOMA via Facebook message, twitter, or communications@az-osteo.org along with your name and email address. #azdogo 4. Be safe – don’t snap and drive!

5. Have fun!

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Taking Care of YOU and Your Profession Since 1921, the Arizona Osteopathic Medical Association has been a champion for you and your peers. Membership in AOMA ensures that your Association will always be there when you need it. For less than the cost of a cup of coffee per day, you can be part of the only statewide association in Arizona dedicated to protecting and promoting the osteopathic medical profession. Please join us and help us continue to do great things on your behalf.

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AOMA protects you from legislation detrimental to the osteopathic profession AOMA represents you as a community stakeholder in healthcare issues AOMA supports you with superior continuing medical education AOMA provides you with timely business of medicine resources AOMA helps you grow your practice with patient referrals AOMA offers you the skills to become a leader in your profession AOMA creates opportunities for you to network with your peers

Membership doesn’t cost – it pays!

Do you know someone who isn’t a member of the Arizona Osteopathic Medical Association. . . and should be?

Recruit a new member and both the new member and you receive a $100 credit toward membership dues or continuing medical education fees!

Recruiting new members is simple: Review your network of colleagues. You may be surprised who is not a member.

Check their membership status using the online member directory or by calling the AOMA office at (602) 266-6699.

Ask them to join! Express how membership has benefited you.

For all the details on how to recruit a new member* and receive your credit, visit the AOMA website at www.az-osteo.org under the Members tab or contact Sharon Daggett, Member Services Manager, at sharon@az-osteo.org *New member must be an active, dues paying member. Does not apply to recruitment of “out-of-state” or “retired” members.

AOMA Digest Fall 2016

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For about $9 a week, AOMA is a wise investment in protecting your professional practice, enhancing your specialized skills, and furthering your career.

Join today at www.az-osteo.org/Join

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AOMA Digest Fall 2016

My Most Memorable DO Moment During my senior year in high school one of my best friends and I organized a graduation trip to Newport Beach, California employing the services of a travel agency not far from our school.

The travel agent who greeted us was passionate, dedicated, and family focused. Not only did she expertly coordinate the trip, she was interested in the investment of our future and asked us what we wanted to do when we finished college. When I told her that I was interested in becoming a physician, she immediately burst out with energy and passion, and promptly told me that she would like to introduce me to her husband, Dr. Mitch Kasovac, an osteopathic physician, and at that time, Director of Medical Education at Phoenix General Hospital. Not understanding what osteopathic medicine was, I was quite impressed with her interest in me as a person, as well as the opportunities that were to follow.

Over the course of the next several months, that travel agent, Marti Kasovac, introduced me to Dr. Kasovac and the Arizona Osteopathic Medical Association. Given the personal introduction to the profession, this has enabled me to not only continue my education in the osteopathic profession, but also develop many colleagues, opportunities, and growth – both personally and professionally. I am proud to be an osteopathic physician, and provide the care and compassion to patients and families that I serve. This would not have been possible if it were not for the introduction to this great profession by Marti and Mitch Kasovac, DO

Charles (Chip) Finch, DO, FACOEP As an undergraduate, I had the opportunity to shadow in a teen pregnancy clinic with a third year DO student. The midwife we were following gave us the chance to interview the patient first; I was incredibly impressed and moved when the osteopathic medical student spent half an hour with her. He had so much compassion for the patient and ability to calmly approach what could have been a daunting experience. He wasn’t a doctor yet, but he already embodied the kind of doctor I wanted to be, and he’s the reason I understand what a DO is, and can be.

Jamie Shawver, OMS II AZCOM I was invited to present the White Coat address to the University of New England (UNE) Class of 2005. Between receiving the invitation and presentation date of October 3, 2001, a most significant event occurred in the world: the airplanes crashing into the Twin Towers on September 11, 2001. The decision was made to continue with the planned White Coat ceremony date. I was in practice in Arizona at the time, so I faced a long flight to Portland, Maine soon after the airlines returned to the air. On that flight, I started to notice a cardiac arrhythmia.

I was pretty sure I was experiencing premature ventricular contractions (PVCs) based on the intermittent painful “thump” in my chest. I had never experienced anything like that before.

The beats persisted after landing. During my visit to UNE, Dr. Lloyd Buser, the current AOA President, agreed to give me an OMT treatment. The PVCs immediately ceased following his treatment and they have never returned. Thanks Dr. Buser!

Karen J. Nichols, DO, MA, MACOI, CS When I was in family practice in Tucson in the late 1960’s I had a new 85-year-old patient who was having upper thoracic pain. After considerable soft tissue treatment I tried, what we referred to then as the “Kirksville crunch”, and wrapped my arms around her and applied my high velocity low amplitude technique. When finished she looked up at me through her pale blue eyes and said “I haven’t been hugged like that in over 35 years.” The power of touch is awesome.

James Cole, DO, FAODME AOMA Digest Fall 2016

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During my interview at the Arizona College of Osteopathic Medicine (AZCOM), one of my interviewers was James Cole, DO, the founding dean of AZCOM. As I sat nervously waiting for the questions to come, Dr. Cole looked me in the eye and asked me to tell him what was the single greatest act of charity I had ever committed in my life. I spit out something that seemed coherent enough to pass as an answer, but the rest of the day I continued to dwell on that question. That night, I wrote thank you cards to those who had interviewed me. When I got to Dr. Cole, I wrote in his card the real answer to his question.

I still remember Dr. Cole’s smile when he asked the question and the look in his eyes that told me he truly wanted me to search my soul for an answer. Over the last few years, I have gained a better understanding of the man who asked me one of the most thought provoking questions I have ever been asked. He has inspired physicians, deans, and students all across the country and has been an incredible ambassador and advocate for the osteopathic medical profession.

Recently as a member of the Arizona delegation to the AOA House of Delegates, I saw Dr. Cole for the first time since my interview. I went up and reintroduced myself and told him the story of that day. He looked at me and said he had goosebumps because he remembered the interview and the thank you card containing my real answer: forgiving the young man who was responsible for the car accident that took the life of my father.

Caleb Hentges, OMS III, AZCOM It is really difficult to cite my MOST memorable DO moment because there are so many positive ones. The mentionable has to include my personal physician, Dr. Angela DeRosa, who truly takes care of me - mind, body, and spirit; one of my incredible mentors, the amazing Dr. Karen Nichols, who inspires me to be all I can be; and Dr. Shannon Scott, whose friendship and leadership is undeniable.

But ultimately, I consider Dr. Leonard Staff, the most amazing DO I have known. Well into his 80’s, Dr. Staff was a leader and role model, sharing his osteopathic wisdom and support for our profession. I am a better doctor and a better person for having known him.

Kristin Nelson, DO, FAOCO-HNS During the late 1970’s, F. Timm McCarty, DO and I embarked on a mission to provide scholarships for osteopathic medical students. From these discussions and with the help of our wives Marty and Shirley, the Arizona Foundation for Osteopathic Medical Education was formed as a non-profit organization.

Fundraising was next so we talked to the more established members of our osteopathic family, including Drs. Ruth Huffman and Harmon Myers. During a fundraising dinner dance, Dr. Huffman’s patient contributed $20,000 to support osteopathic medicine and scholarships. A year later, Dr. Myers, as executor of a trust for one of his patients, donated $10,000. This was the osteopathic family at that time. Patients loved and supported their doctors and the profession. Over the years those initial dollars plus an annual golf tournament have provided scholarships for more than 50 third and fourth students who currently practice not only in Arizona but throughout the country.

This is one of my many DO happy memories.

Stanley Brysacz Jr., DO 21

AOMA Digest Fall 2016

Osteopathic Community News

Reinventing Medical School Education ATSU-SOMA Revitalizes Medical Education through Innovative, Community-minded Learning

by Karen Scott, A. T. Still University

When Katrina Wilson, OMS IV, was asked why she chose A.T. Still University-School of Osteopathic Medicine in Arizona (ATSU-SOMA) for her medical school education, her response was: “ATSU-SOMA chose me.”

This response is not uncommon at ATSU. Students not only enroll into medical school; they sign on for an experience few others offer.

“Prospective students are attracted to ATSUSOMA in large part due to the early clinical exposure, but also because of the School's mission of service to the medically underserved,” says Dean Jeffrey Morgan, DO, MA, FACOI, CS. ATSU-SOMA is known Jeffrey Morgan, DO Dean - ATSU-SOMA for its trademark “1+3” model where students spend their first year on the Mesa campus completing didactic coursework supplemented by standardized patient interactions, simulations, medical skills, and osteopathic manipulative medicine. During years two through four, students transition to a community health center (CHC) where they immediately gain clinical experience starting their second year, while continuing didactic instruction through distance education technologies.

One year before the school opened in July 2007, ATSU-SOMA and the National Association of Community Health Centers (NACHC) developed this learning model in which success is largely driven by partnerships with a diverse group of CHCs. Partner CHC campuses are selected through a collaborative analysis that involves identifying communities with the highest need.

Currently, ATSU-SOMA partners with 12 CHCs across the nation.

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Community-minded Enterprise A common thread among students is their desire to work at the community level, so ATSUSOMA’s model meshes well with their values. Prior to applying, students typically have some sort of community service exposure like volunteering with underserved populations.

Before enrolling at ATSU-SOMA, Wilson, who is finishing her fourth year at Unity Healthcare in the District of Columbia, worked for Christ House, a D.C.-based medical homeless shelter.

“To me, working for Christ House was the beginning of my education in community medicine,” says Wilson. “I had the opportunity to return to D.C. to continue my medical education through ATSU-SOMA's partnership with Unity Healthcare."

Exposure to the inner workings of a CHC is invaluable. Students report that early clinical experience has proven to be beneficial and seeing different health professions in action has its benefits, too.

“Being at a community health center has helped me understand how one works. I have a better appreciation for the nurses, medical assistants, midwives, social workers, dentists, nurse practitioners, and physician assistants,” says Katrina Wilson, OMS IV Wilson.

ATSU-SOMA

Contextual Learning and Teaching Second-year students work in small group settings, observing patient care and gain an understanding of the local health system and community health practices. Third- and fourthyear students complete their clinical rotations at

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their CHC campus, associated hospitals, as well as with affiliated healthcare providers and at select healthcare institutions.

While students are gaining hands-on clinical experiences, they remain connected to the home campus in Mesa for the didactic portion of ATSUSOMA’s curriculum through video technology.

The curriculum, with its individual courses, is created by faculty in Mesa and delivered to students by video podcast. Physicians serving as Regional Directors of Medical Education facilitate discussions of the curriculum in classrooms at each CHC campus.

In addition, each CHC student cohort is required to complete a community-oriented primary care research project designed to improve the health of their health center patients. Projects range from nutrition programs addressing diabetes, hypertension, evaluation of HPV vaccination, to appointment reminder preferences of patients.

These projects reaffirm students’ knowledge of scientific and clinical principles of medicine, but also provide an experience of how legislation such as the Affordable Care Act plays out in clinical practice. Students see these principles in action on-site at their designated health center campus.

Innovative Community Partnerships In July 2013, ATSU-SOMA and the Wright Center for Graduate Medical Education launched a national family medicine residency program funded through the Health Resources and Services Administration.

The program, which celebrated 21 graduates this summer, is a model for residency programs across the country addressing two of the nation’s most pressing healthcare challenges: the shortage of primary care physicians trained to work with the nation’s most vulnerable populations and the potential changes in federal funding, which may leave thousands of new doctors without a place to complete their training.

These residencies, based out of health centers rather than hospitals, position graduates to navigate the changes and challenges occurring in healthcare while equipping students with the knowledge needed to work at the community level.

Additionally, in 2015, ATSU-SOMA was selected by the American Medical Association (AMA) to join the Association’s Accelerating Change in Medical Education Consortium, a dynamic group of 32 medical schools which share best practices and ideas for developing innovative curricula that can ultimately be implemented in U.S. medical schools.

Reinventing Medical School Education continued on page 24

ATSU’s newest CHC partner, near North Health Services Corporation of Chicago 23

AOMA Digest Fall 2016

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Reinventing Medical School Education continued from page 23

ATSU-SOMA was selected from among 170 eligible medical schools by a national advisory panel, which sought proposals that would significantly redesign medical education. ATSUSOMA is one of three osteopathic medical schools to earn a spot on the AMA’s consortium.

A. T. Still University School of Osteopathic Medicine Arizona Current Enrollment: 423 Class Size: 108 Application Status: 5,886* (Class of 2020)

*The highest number of applicants per seat of all osteopathic medical schools

Residency Match Data 2015 • Number of Matches: 113 • Primary Care: 64.6% • Needed Specialties: 87.6% 2016 • Number of Matches: 102 • Primary Care: 74.5% • Needed Specialties: 86.3% Lifetime Philosophy Choosing a specialty is one of the most important decisions a medical student will make.

At ATSU-SOMA, clinical experiences among rural, urban, and underserved populations help shape students’ mindset from the start.

Higher than the national average, ATSU-SOMA students choose residencies in primary care and needed specialties. In 2016, roughly 86 percent of students chose a needed specialty, and 75 percent chose primary care.

“We are proud to say that, for the most part, our students’ mission-driven, communityfocused mindset is preserved and fostered from the moment they apply to ATSU-SOMA, to the moment they graduate.

“Our philosophy regarding the acceptance process goes both ways; just as carefully as we choose a student, they choose us,” says Dr. Morgan.

For more information, visit atsu.edu/SOMA.

More than just filling vacancies...

It’s about matching personalities, lifestyles, and practice philosophies.

• Retirement • Illness • Sabbatical

• Maternity Leave • CME • Vacation

602-331-1655 www.catalinarecruiters.com AOMA Digest Fall 2016

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Osteopathic Community News

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Midwestern University’s Health Education Message: Get Involved

by Tony Johns, Midwestern University

AOMA MWU Banner 0416.indd 1

The first days of medical school can be daunting, even for the most confident self-starters in the student body. Why? Because during this time, students realize how physicians hold people’s lives in their hands.

The temptation in those early days is to dissociate or disconnect, to focus on the didactic and the textbook, and to concentrate on systems and parts. However, the students at the Arizona College of Osteopathic Medicine (AZCOM) at Midwestern University hear a very strong and clear message on their first day: The way to succeed and provide value to patients is to get involved.

“Dissociating – how can you do that?” Lori Kemper, DO, M.S., FACOFP, Dean of AZCOM states. “We are humans. You have to care about them. I tell our students from day one I want them to consider that the standard of conduct is behaving the way they want their mother’s doctor Lori Kemper, DO Dean - AZCOM to behave. If you think that way, it changes what you do, because your patients are your family. The patient in front of you is the most important thing in your life at that moment.”

The osteopathic message of inclusion and involvement is apparent from the first moments of a student’s tenure at AZCOM. The atmosphere at Midwestern University is surprising to some, particularly to those coming from educational environments where high achievements required a certain ruthlessness. When new students complete orientation at Midwestern University, they realize that AZCOM does things very differently.

“We have a family feel,” Dr. Kemper explains.

“We pursue an open door culture, not just a policy. The students quickly realize, after meeting fellow students and faculty, that there is not a

cutthroat competition here, but an attitude of collaboration, partnership, and compassion. We rely on each other.”

The interreliance does not end at AZCOM’s doors. Because Midwestern University offers 17 doctoral and master degree programs in multiple health science disciplines, AZCOM students and faculty exist in a tremendously diverse educational setting. Midwestern University has adopted the One Health initiative as its fundamental guiding principle, which fosters collaborative learning and research between human and animal health science disciplines.

Thus, osteopathic physicians in training have the unique opportunity to engage with students in other programs, involve themselves in multiand cross-specialty research, and fully embrace the role of being a member of an integrated healthcare team.

“We are a One Health community. We have students from the College of Pharmacy-Glendale and the Clinical Psychology program in our Family Medicine and OMM clinics,” says Dr. Kemper. “Those students can see the benefit of osteopathic manipulative techniques, and our students can see meaningful applications of manipulation in instances, for example, of anxiety and depression.”

MWU’s Message: Get Involved continued on page 26

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AOMA Digest Fall 2016

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MWU’s Message: Get Involved continued from page 25

“I think the more diverse a healthcare team is with respect to what you can offer your patients, the stronger your practice can be,” says Shannon Scott, DO, FACOFP, AOMA President, AZCOM Clinical Associate Professor, and family physician at the Midwestern University Multispecialty Clinic. “As physicians, we rely on the ability to provide our patients with valuable resources and education. For instance, while addressing a patient’s musculoskeletal needs with OMT, you can also discuss their anxiety or depression and recommend mental health services. It is optimal to engage all of our students in these situations, so they can see how osteopathic manipulation can fold into the patient’s general progress.”

The communal relationships enjoyed at Midwestern University through the One Health program have been heavily influenced by AZCOM, which is the University’s largest college with over one thousand students. The principles of inclusion, whole-person, and patientcentric healthcare that have characterized the osteopathic medical profession from its inception set an important example for the other professional programs at the University.

“Osteopathic medicine has always been about inclusion and involvement,” Dr. Kemper says. “The very first class in an osteopathic school had a diverse student population, contrary to societal

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norms at the time. Throughout its entire history, osteopathic medicine has recognized that because all patients are diverse, all students and doctors have to be diverse as well. In the osteopathic profession, we have not only been open to all comers, but we have embraced all comers.

“You go to an AOA House of Delegates meeting or an AOMA convention, and do you know what people do when they see each other? They don’t shake hands. They hug. Why? Because we are all family. Our students become involved as well.

They vote on everything. They are in every single body all the way up to the AOA House of Delegates and Board of Trustees. It is truly like a good family should be. You revere your elders, you embrace all, and you care for the ones who are coming up.”

That level of involvement, advanced and nurtured from the beginning of AZCOM students’ careers at Midwestern University, eventually translates into their healthcare careers. AZCOM faculty and leadership expect that, with a combination of osteopathic and One Health training, these students will become physicians who integrate themselves into both their healthcare networks and their communities.

They are well-prepared to do so because AZCOM students collectively perform between 14,000 and 18,000 TOUCH (Translating Osteopathic Understanding through Community Health) hours of community service per year.

“One of my favorite lectures I give every year is an introduction to pediatric medicine for the students at the Arizona College of Optometry here at Midwestern,” says Dr. Scott. “I make sure I talk about the responsibilities they have, not only in their patients’ health, but also in their communities. They can make a difference by using their training to engage and serve inside and outside of their practices. Our students have an important role. It is certainly fulfilling to challenge students to look outside of the textbook and see the effects.”

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AZCOM’s philosophy for its students is as much about learning who you are as a healthcare professional as it is showing it to the world. The faculty and staff at the College are dedicated to training physicians who are not afraid to become deeply and passionately involved in a patient’s welfare, embracing all of the tools and resources at their disposal, and becoming the best physicians they can be. “Once you’ve broken through the barrier of caring for and caring about a patient, you are touching them in more than one way,” Dr. Kemper says. “You are touching them with your hands, with your speech, and with your mind. If it helps relieve a patient’s suffering, it is a good thing to do.”

Learn more at www.midwestern.edu/AZCOM.

Midwestern University Arizona College of Osteopathic Medicine Current Enrollment: 1,010 Class Size: 258 Application Status: 5912 (Class of 2020)

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Residency Match Data 2015 Number of Matches: 256 Primary Care: 54% Needed Specialties: 82% 2016 Number of Matches: 238 Primary Care: 51% Needed Specialties: 80%

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AOMA Digest Fall 2016

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Federal Loan Repayment Options for Medical Trainees

By Jesse Richards, DO, PGY-1 University of Kansas Internal Medicine Edited by Caleb Scheckel, DO, PGY-1 Mayo Clinic Arizona Internal Medicine

With median education debt for medical residents over $200,000 we have reached the point where managing student loans effectively as a resident or new attending physician is a decision that can save tens of thousands of dollars or more.

The magnitude of this decision, compounded by the arcane and confusing variety of loan repayment plans can lead to confusion and paralysis. However, with a little time investment you can learn the system and figure out what options will work best for you.

The goal of this article is to break down and classify the different options for repaying student loans. In addition, Public Service Loan Forgiveness is briefly discussed because it can change the calculations for certain plans.

Public Service Loan Forgiveness (PSLF) is a current government program that is designed to incentivize a wide range of professionals to work for non-profit and government organizations.

Specifically it states that if you make 120 payments (they do not have to be consecutive) while working at a qualifying 501 (c) organization the remainder of your student loans will be forgiven. There is a lot of debate about the program and whether or not it will be around in the future, but that is how it stands at this time.

For the purposes of this article, we assume a typical graduate, with $200,000 in loans at 6.5% interest, who will be in residency/fellowship for three to six years making roughly $55,000 per year. (See chart on page 29.) Your situation may be different. The repayment calculator on studentloans.gov is a good place to start.

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These plans fall into two categories: plans that qualify for Public Service Loan Forgiveness (PSLF) and plans that don’t.

QUALIFYING PLANS Standard Repayment. This is a simple plan where your loan repayment is amortized over 10 years.

There is no change in your monthly payment; you simply pay down the loan. This option is good for people with relatively low student loans, but a | monthly payment of $2,271 is a large financial burden for most residents. This is a qualifying plan for PSLF, however if you stay in it for ten years there

won’t be any remaining balance to forgive.

Income Driven Repayment Plans.

This is not specifically a plan but rather an umbrella term that encompasses all of the plans where your monthly payment depends on your income instead of your loan amount. One term that needs to be defined for the IDR plans is discretionary income, which the government defines as “the difference between your Adjusted Gross Income and 150% of the federal poverty level for your household”.

Income Based Repayment (IBR). This the first and least restrictive of the income driven plans.

Your monthly payments are capped at 15% of discretionary income. The requirements are that your loan monthly payments constitute a “financial hardship” which virtually all residents qualify for, but few attendings do based on the

A Short Breakdown of Federal Loan Repayment Options for Medical Trainees

By Jesse Richards, DO- PGY-1 University of Kansas Internal Medicine Features Edited by Caleb Scheckel, DO- PGY-1 Mayo Clinic-Arizona Internal Medicine

With median education debt for medical residents over $200,000 we have reached the point where managing student loans effectively as a resident or new attending is forgive halfmagnitude of the interest. ratio of loan balance to income.

Thisof plan allows a decision that can save tens thousands ofgovernment dollars orwill more.

The of this The fourth change is the largest difference. For you to only take your AGI into consideration if decision, compounded by the arcane and confusing variety of loan repayment plans the typical resident, repayment will be around you are married and file taxes separately. If you can 25 lead to of confusion and paralysis.

However, with a little time investment you can make years repayments under the plan the $250 a month on REPAYE, while their loans remaining balance on and your figure loans will be what forgiven, accrue $13,000best a year interest. Since that leaves learn the system out options will work forinyou. $10,000 in additional interest, forgiveness of half though this forgiveness will count as taxable of that saves the resident $5,000. This lowers the income. Finally the maximum payment under IBR The goal of this article is to break down and classifyinterest the different optionstofor effective rate in residency 4% ($8,000 is capped at the Standard repayment. total interest $200,000 in loans). repaying student loans. In addition, Public Service LoanonForgiveness is briefly Pay As You Earn (PAYE).it Similar to IBR but only Finally, you are not participating in PSLF the discussed because can change the calculations forifcertain plans. plan will forgive any remaining balance of your available for individuals who did not take loans loans after 25 years of payments. out before 2007. It uses 10% of discretionary Publicrather Service (PSLF) income thanLoan 15% ofForgiveness IBR, resulting in lower is a current government program that is monthly payments.

Like IBR you can also separate Income Contingent This plan designed to incentivize a wide range of professionals to workRepayment. for non-profit and your income from your spouse’s if you files taxes requires you to pay 20% of your discretionary government organizations. Specifically it states that if you make 120 payments separately. Payment is also capped at the standard income, though it is capped at payments that (they doamount. not have to going be consecutive) while working a qualifying 501c repayment If not for PSLF, would payat your loans off in 12 years instead of the forgiveness occurs after 20 years. of your student standard 10-year repayment.There This leads organization the remainder loans will be forgiven. is atolothigher of minimum, but lower maximum payments than debate about the program and whether or not it will be around in the future, but Revised Pay As You Earn (REPAYE). Identical to other options, however there are no restrictions that is how it stands at this time.

PAYE with four key changes. First, you cannot on qualifying for the program. If you make 25 separate your income from your spouse, even if years of payments the remainder of your loans you file taxes separately.

Second, you can enroll in willyou be forgiven.

For the purposes of this article I am assuming are a typical graduate, with the plan even if you have loans from before 2007. $200,000 in loans at 6.5% interest, who will be in residency/fellowship for 3-6 Third, there is no cap on the maximum payment. yearsifmaking roughly per Fourth, your payments do $55,000 not cover all of year. Your situation may be different. To start Federal Loan Repayment Options continued on page 30 the accruing interest loans, the federal with let’s look at on theyour repayment calculator on studentloans.gov.

29

AOMA Digest Fall 2016

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Federal Loan Repayment Options continued from page 29

PLANS THAT DO NOT QUALIFY FOR PSLF Graduated. A plan where your payments start out low and increase every two years until you have paid off your loans in 10 years. While the initial payments are lower than the standard plan, it ends up paying off in the same time period and paying more interest.

Extended and Extended Graduated. These plans are similar to the standard and graduated loan repayment programs, but they are amortized over 25 years. Essentially you pay interest only in the beginning and slowly pay down the balance. These are not great choices for physicians because the high interest rates on student loans would end up costing hundreds of thousands of extra dollars before payoff.

PRIVATE LOAN REFINANCING There has been a recent growth in the student loan refinancing industry. Five years ago there were a few scattered locations, and now there are dozens of companies who are willing to refinance education debt for medical trainees. The decrease in interest rates can save tens of thousands of dollars, however there are several caveats to refinancing.

First, not all lenders will refinance residents.

At the writing of this document (July 2016) there are only two lenders who will refinance during residency: Damien Rowan Bank (DRB) and Link Capital. DRB offers no capitalization of interest and $100 a month payments during residency.

Link Capital offers no payments until after you graduate from residency.

Second, the interest rates that you can receive on your student loans are very dependent on your personal situation. Lender terms can vary, and the higher your income and credit score, the lower an interest rate you will probably be offered. Keep in mind that even if the rates that you are offered as a resident are not favorable for refinancing, once you become an attending that may change.

It is worth noting that some people may opt for private financing due to “teaser” interest rates that are attractive but also flexible. While interest rates are at generational lows, it is prudent to remember that there is only one direction the Federal Reserve can move interest rates: Up. AOMA Digest Fall 2016

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So flexible rates that are attractively low now could become a real problem in later years of repayment.

Here are suggestions for two good pay off strategies for different career paths. This obviously doesn’t cover every person’s situation, but it does address the situations of a good majority.

1. Fellowship/academic career. Go for PSLF. In this case the most important thing is to get into REPAYE as soon as possible if you are single, and either REPAYE or PAYE if you are married to an income-earning spouse. Take advantage of the interest subsidy and pay the minimum monthly payments. Stay in REPAYE throughout residency and fellowship, then switch to IBR two months before you graduate and start working to take advantage of the capped maximum payment. Continue to work for a nonprofit institution and once you have made 120 payments, have the remainder of your loan balance forgiven.

Hint: skip the mandatory six-month “grace period” by consolidating your loans. Upon approval you can start making those first 12 qualifying payments based upon last year’s income as a medical student. For many of you that will be $0 a month.

2. Private practice and refinance route. Once you start residency look at private refinancing.

If the rate is better than what you would get with REPAYE, then refinance; if not, then opt for REPAYE for the duration of residency and get the interest subsidy. After you graduate, refinance privately with whoever will offer you the lowest interest rate and then aggressively pay your loans off with your salary.

For further reading, check out this White Coat Investor post (http://whitecoatinvestor.com/ what-should-i-do-with-my-student-loans/), which has a great flowchart. If you have additional questions or would like to see a specific financial topic addressed in a future article please feel free to contact the authors at jrichards4@kumc.edu or scheckel.caleb@mayo.edu.

Features

Arizona Public Cord Blood Program Historically, the umbilical cord has been considered medical waste. Today, collected and stored, it is a unique source of life-saving stem cells. More than 80 different diseases can be treated or cured using cord blood.

Umbilical cord blood is blood that remains in the blood vessels of the placenta and the umbilical cord after the baby is born and the cord has been clamped and cut. It contains hematopoietic stem cells, or blood-forming cells (cells that can form other blood cells). These uncontroversial, bloodforming cells are also found in bone marrow. The stored cord blood is made available for transplant to children and adults that have certain genetic or life-threating diseases such as leukemia, lymphoma, many metabolic diseases, and sickle cell anemia.

Established in 2011, the Arizona Public Cord Blood Program was created to advance the collection of and increase the number of cord blood units available for transplantation.

Administered by the Arizona Biomedical Research Commission, the program collects and stores cord blood, lists the cord blood units on national and international registries, and provides education to expectant parents, health professionals, and the public. The Arizona Public Cord Blood Program has partnered with Save the Cord Foundation to advance cord blood awareness, donation, and education in Arizona.

Arizona is a leader in the field of public cord blood donation. Thirty-five Arizona cord blood units have been successfully transplanted to cure life-threatening diseases and 5000 plus cord blood units from Arizona have been collected with over 500 banked and registered with the National Cord Blood Inventory.

Cord Blood Saved Dylan’s Life “He’s a little walking, talking, giggling, laughing miracle.”

At seven weeks of age, Dylan Praskins was diagnosed with a rare form of cancer. After three rounds of chemotherapy, doctors determined that cord blood was the best option for his treatment. Working through the cord blood registry, six out of six cord blood matches were found.

Cord blood transfusion is a really a simple process, but it is amazing what it does. The doctors completely destroyed Dylan’s bone marrow and then through an intravenous tube, the cord blood was injected into his blood stream so that he could grow new bone marrow cells.

“Because an anonymous mom out there donated her cord blood, our son is alive today.”

See Dylan’s story at http://azdhs.gov/biomedical/#cord-blood-home

It is free to donate to the Arizona Public Cord Blood Program and there is no harm to the baby or the mother. The patient/mother must provide written consent prior to delivery. Between birth and delivery of the placenta, the obstetrician collects the placenta into a sterile package and sends it to the cord blood bank where it is processed, tested, and validated. The specimen is cryopreserved within 48 hours.

All obstetricians in Arizona are required by statute to educate expectant parents about saving cord blood, either through public donation or a private cord bank. For some patients, cord blood is the best or only hope for a cure.

For more about the Arizona Public Cord Blood Program, please visit http://azdhs.gov/ biomedical/#cord-blood-home. Physicians may request donation brochures at CordBloodInfo@ azdhs.gov.

31

AOMA Digest Fall 2016

AOMA News

Welcome New AOMA Members Full

2nd Year in Practice Mansoor A. Jatoi, DO Internal Medicine Tucson, Arizona (520) 873-3000 Donald F. Lefevre, DO Internal Medicine Glendale, Arizona (602) 865-2627

3rd Year in Practice Justin M. DeLange, DO Neurology - Board Certified Flagstaff, Arizona (928) 214-2621 Sommer R. Gunia, DO General Surgery - Board Certified Scottsdale, Arizona (480) 629-8390

John N. Bode, DO Diagnostic Radiology Board Certified Phoenix, Arizona (602) 548-7010

Katherine A. Mitzel, DO Emergency Medicine Board Certified Glendale, Arizona (602) 377-7831

Sarah E. Colwell, DO Obstetrics/Gynecology Board Certified Phoenix, Arizona (623) 846-7558

Jamie M. Moenster, DO Plastic Surgery/General Surgery Board Certified Tucson, Arizona (520) 207-3100

Jaldeep H. Daulat, DO Dermatology - Board Certified Lake Havasu City, Arizona (702) 254-1588

Sristi Nath, DO Psychiatry - Board Certified Child & Adolescent Psychiatry Board Certified Scottsdale, Arizona (480) 391-6555

B. J. Ho, DO Obstetrics/Gynecology Board Certified Phoenix, Arizona (623) 846-7558

AOMA gratefully acknowledges all its members for your support of the osteopathic profession and your association.

Your membership ensures that AOMA is looking out for you and enables us to accomplish great things on your behalf.

Thank you!

AOMA Digest Fall 2016

32

Bernadette Quihuis, DO Internal Medicine Board Certified Tucson, Arizona (520) 670-3909 Christopher W. Weyer, DO Dermatology - Board Certified Tucson, Arizona (520) 207-3100

In Memoriam We are all diminished when one of our number leaves us.

We will miss them and continue on for the betterment of our profession in their memory.

Henry W. Rutschow, DO Chintan Shah, OMS III Donald Till, DO

AOMA News

2016 AOA House of Delegates The Arizona Osteopathic Medical Association was well-represented at the 2016 American Osteopathic Association House of Delegates.

Lead by AOMA’s Delegation Chair Stanley Brysacz Jr., DO, 12 delegates, one alternate delegate, two student delegates, and two student alternate delegates attended the four-day event held in Chicago, Illinois on July 21 to 25, 2016.

AOMA Delegate Chair Stanley Brysacz Jr., DO (center) strategizes with the delegates to select nominees to the AOA Board of Trustees at the United Federation of Osteopathic Societies (UFOS) meeting.

AOMA Delegates to the AOA Stanley Brysacz Jr., DO, AOA Delegates Chair James Cole, DO William Devine, DO Charles Finch, DO Deborah Heath, DO Lori Kemper, DO Jeffrey Morgan, DO Laurel Mueller, DO Kristin Nelson,DO Karen Nichols, DO Larry Sands, DO Shannon Scott, DO Angela DeRosa, DO – Alternate Ryan Dyches, OMS – Student Delegate AZCOM Thanh Hoang, OMS – Student Delegate SOMA Ralph Desir, OMS – Student Alternate SOMA Jamie Shawver – Student Alternate AZCOM

AOMA Receives Award AOMA was recognized during the Awards Ceremony Luncheon at the AOA Annual Business Meeting with the Strategic Team Award and Recognition (STAR) Prize for innovative activities to advance the osteopathic profession. AOMA was selected by the AOA Strategic Planning Committee in the osteopathic affiliates category for its endeavors in public policy, brand awareness, and revenue enhancement and expense control. Shannon Scott, DO, AOMA President, and Pete Wertheim, AOMA Executive Director, accepted the STAR prize on behalf of the Association.

AOA Annual Meeting Recap More than 1000 delegates met to create AOA policy on diverse issues impacting physicians.

Some of the most notable resolutions passed covered physician burnout, collective bargaining, concussion safety, medical student finances, student loans, GME funding, substance abuse disorders, ACA grace period abuse, and physicianled team-based care.

Other highlights of the AOA House of Delegates: • Boyd R. Buser, DO was installed as the 120th AOA President and urged his colleagues to “let your DO out” • H-634 Interference – Lawful Off-label Treatment of Patients, AOA resolution submitted by AOMA was approved • National Drug Control Policy Director Michael Boticelli spoke to the attendees at a town hall session on the U.S. opioid epidemic • Robert Orenstein, DO, Editor-in-Chief of the Journal of the American Osteopathic Association, encouraged members of the osteopathic profession to foster a culture for research and education • Andy Slavitt, Acting Administrator for the Centers for Medicare and Medicaid Services, addressed the impending changes with the implementation of MACRA 33

AOMA Digest Fall 2016

AOMA News

CME in the Pines: 2nd Annual Flagstaff Osteopathic Medical Conference With the summer temperatures still above 1000 in Phoenix and Tucson, it was a refreshing 650 with a mountain thunderstorm in Flagstaff for the 2nd Annual Flagstaff Osteopathic Medical Conference (FOMC) at Flagstaff Medical Center.

More than 60 physicians and other healthcare professionals attended the day-long event offering 7.0 hours of AOA Category 1-A CME credit.

Barbara Polstein, DO discussed biotensegrity during her OMM lecture and demonstration.

Charities

Attendees at the 2nd Annual Flagstaff Osteopathic Medical Conference filled the McGee Auditorium at Flagstaff Medical Center.

Co-sponsored by Arizona Osteopathic Medical Association and Flagstaff Medical Center, FOMC featured lectures from seven DOs practicing in northern Arizona. Topics presented were Rib Fractures by Brian Coates, DO; Special Considerations in Caring for Native American Patients at End of Life by Bridget Stiegler, DO; OMM: Practical Approach to Somatic Dysfunction

by Barbara Polstein, DO; Single Accreditation System by Kevin Wilson, DO; Headache Medicine for the Non-Neurologist by Justin DeLange, DO; GI at Flagstaff Medical Center: What We See and What You Need to Know by Gary Cornette, DO; and Wild West Medicine by Laurel Mueller, DO, MBA. In 2015, a survey of osteopathic physicians in northern Arizona revealed support for an osteopathic CME program in this part of the state covering surgical and medical topics from an “all DO” faculty of speakers. The first conference was held in August last year with 30 in attendance.

The 3rd Annual FOMC is scheduled for Saturday, August 19, 2017.

AOMA Digest Fall 2016

34

Fall Seminar

Member Login

Membership

Update Your Member Profile and WIN! You could win a $100 VISA gift card. Please visit the AOMA website and login to update your professional Leadership profile information for the online AOMA & Advocacy Directory. Deadline to be entered into the gift card drawing is January 31, 2017.

Education

See what’s new on your AOMA website.

Download the map for the DOGO scavenger hunt game, register for the 36th Annual Fall Seminar, and sign up for Do Day at the Legislature!

Visit often for future enhancements and features.

AOMA News

GET CONNECTED at the AOMA 36th Annual Fall Seminar

AOMA Career Center: Connecting Talent with Opportunity

Join us for the AOMA 36th Annual Fall Seminar at the Hilton Tucson El Conquistador Resort in Tucson, Arizona. The two-day event is November 12 & 13, 2016, offering 12 lectures.

On Saturday topics scheduled are Depression and Anxiety - John Zaharopoulos, DO; Eating Disorders - Sristi Nath, DO; Pima County Public Health Update - Francisco Garcia, MD; OMM for Primary Care - Anthony Will, DO; MACRA - Tony Rodgers, MSPH; and Zoonotic Diseases: Zika and Measles - Joe Zachariah, DO. Sunday lectures include OMM: Infectious Diseases - William Devine, DO; Adult Vaccination Update - Patrick Hogue, PharmD; Interprofessional Practice - Sean Reeder, DO; Breastfeeding and Lactation - Kendra Gray, DO & Mary Catherine Harrel, MD; Medical Ethics - Denise Atwood, RN, BSS, JD; and Practice Medicine Around the World - David Bryman, DO.

The Arizona Osteopathic Medical Association recently relaunched its Career Center offering enhanced resources for job seekers, expanded options for employers, and new services for property owners and tenants. With an upgraded user interface, the AOMA Career Center is mobile responsive and integrates with your social media accounts.

Register by October 12, 2016 and save $75!

For complete information and to register go to www.az-osteo.org/ FallSeminar The Arizona Osteopathic Medical Association (AOMA) is accredited by the American Osteopathic Association (AOA) to provide osteopathic continuing medical education for physicians. The AOMA designates this program for a maximum of 13.0 hours of AOA Category 1-A CME credits and will report CME credits commensurate with the extent of the physician’s participation in this activity.

Application has been submitted to the American Academy of Family Physicians for Category 1 Prescribed Credits. Determination of credits is pending.

All times, speakers, and topics subject to change.

Looking for that ideal candidate?

• The AOMA Career Center has improved product packaging, job distribution, and resume bank.

• Dedicated to the osteopathic medical community, you can maximize views and responses to your job posting with online ads, boosted postings, and targeted emails.

Searching for a job?

• Open a free account to search for open positions and post your resume.

• The Job Search Resource Center offers resume writing tips, interview advice, and career coaches to assist you.

Buying or selling a practice?

• Search practices for sale.

• Find potential buyers for your practice.

• Explore business opportunities.

Need office space? Have space for rent?

• Locate the perfect office for your practice.

• Find prospective tenants for your building.

• Expand your practice with a second office.

AOMA members receive a 20% discount off all Career Center products. Discover the difference the AOMA Career Center can make for you. Go to www.az-osteo.org/Jobs www.az-osteo.org/ Jobs.

Call the AOMA office to obtain the promo code.

35

AOMA Digest Fall 2016

AOMA News

2017 AOMA Clinical Case and Poster Forum Each spring, the Arizona Osteopathic Medical Association sponsors a Clinical Case and Poster Forum. The poster forum is open to osteopathic medical students, residents, and faculty/ preceptors across the state of Arizona. The Clinical Case competition is open to third and fourth year osteopathic medical students attending medical school in Arizona. This scientific, peerreviewed, evidence-based opportunity showcases the tremendous amount of high quality scholarly activity that is developed on an annual basis.

This year is our ninth annual competition and it is gearing up to be the best year thus far, allowing for the students submitting the top three clinical cases to be invited to deliver an oral case presentation during the Convention on Saturday, April 22, 2017.

The poster forum allows for poster displays over the course of the Convention with the formal judging held on Saturday, April 22, 2017.

The top three posters in each category will be recognized at the awards ceremony and luncheon on Sunday, April 23, 2017.

The AOMA is proud to sponsor this scholarly/research activity, as it has allowed for the delivery of high quality research, increased participation in the Association’s committee structure, as well as an increase in our membership. Most importantly, it is supporting the mission and vision of the organization by promoting the osteopathic medical profession and providing high quality medical education.

Complete details for entry submission, including previous winning entries, are available on the AOMA website under the CME/Clinical Case & Poster Forum tab at www. az-osteo.org.

Direct your questions to Teresa Roland at AOMA at (602) 761-2697 or teresa@az-osteo.org.

Yahya R Nomaan, MS III; Tuong C Ta, MD, PhD; William Peppo, DO

Midwestern University Arizona College of Osteopathic Medicine; University of Arizona, Department of Internal Medicine; Tucson Medical Center, Arizona

Case Presentation

Abstract

Clinical Pres entation: A 45 year old Thai man is brought to the emergency department by friends after he is found at home with confus ion. The patient is unable to provide any his tory. His friends g iv e a his tory of two weeks of s trang e behavior at work s uch as uns teadines s ands elf urination. The patient is als oa heavys moker and has los t about 15 pounds over the pas t three months . Initial head computed tomography s ugges ted early hydrocephalus . T`he head mag netic res onanceimage reveals early obs tructive hydrocephalus , and diffus e leptomeningeal enhancement around the fourth ventricle. Cerebral s pinal fluid taken during an emergent ventriculos tomy revealed normal g lucos e and protein concentrations and a negative cytology. The lumbar puncture was s ignific ant for protein of 828 mg / dl; pos itive for eos inophils ; g lucos e of 23 mg / dl. Acid fas t bacillus s tain,G ram’s s tain, and culture res ults were negative. Des pite the ventriculos tomy, the patient s uffered waxing and waning mentation for the next 5 days until the s erum Cocci compliment fixation tite r came back 1:256.

Intervention: A vent riculoperitoneal s hunt was placed for the communicating hydrocephalus , andan oral antifungal therapy was begun as s oon as a definitive diagnos is was made.

Conclus ion: Coccidioidomycos is s hould be in the differential in a patient with bas ilar meningitis and obs tructive communicating hydrocephalus . The diag nos is is es tablis hed by pos itives erum titers with compliment fix ing antibodies and is s ugges ted by an as eptic meningeal cerebros pinal fluid picture with the pres ence of eos inophils . Treatment is generally oral fluconaz ole (400 mg / d) with ventriculoperitoneal s hunt for relief of intracranial pres s ure.

Pathogenesis and Epidemiology

Coccidioidomycos is goes by multiple names such as Valley F ever, Desert Rheumatis m, and San Juaquin Fever and is endemic to the s outhwes tern U nited States and northern Mexico. The dis eas e produces about 150,000 infections per year, 60 % of which happen here in Ariz ona. This dis eas e primarily manifes ts in the lungs because it s preads via soil born arthros pores that can aeros olize in the wind or be caus ed by other natural events . However, due to the ambiguity of its s ymptoms , and sometimes the lack there of, the pathogen can dis s eminate outs ide of the lungs and become extra pulmonary. The mos t significant extra pulmonary manifes tations are in the central nervous s ys tem and include hydrocephalus and bas ilar meningitis and death. The diseas e is diagnos ed clinically with a high index of s us picion and through laboratory tes ting that includes antigen tes ting. Als o,There are certain demographics that are predis pos ed to developing the dis s eminated dis eas e which are diabetics, thos e with compromis ed immune s ystems , African Americans , Pacific Islanders , and South Eas t As ians

.

A 45 year old Thai man is brought to the emergency department by friends after he is found at home with confus ion. The patient is unable to provide any his tory. His friends give a his tory of two weeks of s trang e behavior at work s uch as uns teadines s and s elf-urination. They als o s tate that he is a heavy s moker and that he has los t about 15 pounds . Initial head computed tomography s ugges ted early hydrocephalus.

The head magnetic res onance imag e reveals early obs tructive hydrocephalus , and diffus e leptomeningeal enhancement around the fourth ventricle. Ches t computed tomography s howed a pulmonary cavitating les ion in his rig ht upper lobe.

Imag es and labs were s ubs equently taken. Images showed hydrocephalus and a s ubsequent ventriculos tomy was done. A lumbar puncture could not be performed due to fear of brain herniation in the s etting of elevated intracranial pres s ure. Bas ed on thes e initial s tudies a nd clinical picture, a working diagnos is revolv ed around malignancy.

Laboratory Studies

Initial

356

130 96

16

3.6

1.0

27

106

12.3

12.4

373 38.3

34 Urine drug screen: negative Ur ine Analysis • SPECIFIC GRAVITY: 1.010; pH: 6, GLUCOSE: Negative • KETONES: Negative; NITRITES: Negative; BACTERIA: None • PROTEIN: 1+ BLOOD: 2+; LEUKOCYTES: 1+; • WBC: 34; RBC: >182 CSF: ventr iculostomy • COLOR: COLORLESS; APPEARANCE: CLEAR; WBC: 0; RBC: 57; PROTEIN: 17; GLUCOSE: 65 • Cytology: Negative

124

89

21

4

22

0.8

CSF: lumbar puncture • COLOR: STRAW; APPEARANCE: CLEAR; RBC: 0; MONOCYTES: 4; BASOPHILS: 3; • WBC: 72; LYMPHS: 70; EOSINOPHILS: 6; PROTEIN: 828; GLUCOSE: 23 Cocci CSF titer 1:1 Cocci CF Ser um titer: 1:256 Cocci Ser ology IgG and IgM: Positive

2

Common American Pathogenic Fungi

Image 1: Chest X Ray. Red circle shows a nodular density in the right middle or upper lobe.

There was no prior X Ray to compare. White circle shows an enlarged aortic knob Image 2: Chest CT: Red circle shows a cavitating lesion in the right upper lobe of the lung.

A B

4 C

Image 3: Head non contrast MRI. A- Dilation of the lateral ventricles B- Dilation of the third ventricle C- Narrowing of the cerebral aquaduct Image 4: Head contrast MRI. Red arrows point to edema suggestive of basilar meningitis or metastatic process.

5

6

Image 5: Head non contrast MRI. White circle shows dilation of third ventricle. White arrows point at an underlying edematous process in the brain parenchyma.

Image 6: Head non contrast MRI. White arrows show dilation of lateral ventricles. Red arrow points at an underlying edematous process in the brain parenchyma.

American distribution of common pathogenic pulmonary fungi. Blastomyscosis; occurs in several endemic areas, the most important of which is in eastern North America, particularly in the western and northern periphery of the Great Lakes Basin. Coccidioidomycosis; described above. Histoplasmosis; found in the droppings of birds and bats in humid areas, particularly in the Ohio River Valley. Cryptococcus; usually found in pigeon droppings in the Pacific Northwest, in both Canada and the United States.

Oral antifungal therapy was initiated as s oon as a definitive diag nos is was made. He was s tarted on intravenous fluconaz ole. N o intrathecal amphotericin was indicated. He began to have cons is tent improvement in his mentation with normaliz ing s odium levels ,at which point his ventriculos tomy was converted into a ventriculoperitoneal s hunt, and his antifungal was changed to fluconaz ole 400 mg PO BID. He will continue to be on fluconaz ole for life, and follows an infectious dis eas es pecialis t who s tates that he has returned to work and has been doing very well.

36

Clinical Case Presentation Deadline (in PDF format): February 24, 2017 (including evidence of IRB submission) Notification to Authors of Acceptance/Exclusion: March 6, 2017 Poster Submission Deadline (in PDF format) March 27, 2017 Deadline to Request Virtual Presentation March 27, 2017

March 27, 2017

Conclusions and Future Directions

Clinical Case Presentation April 22, 2017

• Coccidioidomycosis should be in the differential in a patient with basilar meningitis with obstructive communicating hydrocephalus.

• The diag nosis is established by positive serum titers of compliment fixing antibodies and is suggested by an aseptic mening eal cerebrospinal fluid picture with the presence of eosinophils.

• The more common presentation of this disease process can be understood by this case presentation and can help physicians outside of endemic areas recognize and treat the disease.

• Physician order sets specifically investig ating the Coccidioidomycosis infections should reduce the probability of delayed diagnosis.

References and Acknowledgements Epidemiologic, clinical, and diagnostic aspects of coccidioidomycosis. Saubolle MA, McKellar PP, Sussland D. J Clin Microbiol. 2007;45(1):26.

Goldstein, E. J. C., R. H. Johnson, and H. E. Einstein. "Coccidioidal Meningitis." Clinical Infectious Diseases 42.1 (2006): 103-07. Print.

Romeo, June H., Louis B. Rice, and Irvine G. Mcquarrie. "Hydrocephalus in Coccidioidal Meningitis: Case Report and Review of the Literature."Neurosurgery 47.3 (2000): 773-77. Print.

Risk Factors for Severe Pulmonary and Disseminated Coccidioidomycosis: Kern County, California, 1995– 1996." Wilderness & Environmental Medicine 12.3 (2001): 214-15. Print.

Hector, Richard F., George W. Rutherford, Clarisse A. Tsang, Laura M. Erhart, Orion Mccotter, Shoana M. Anderson, Kenneth Komatsu, Farzaneh Tabnak, Duc J. Vugia, Ying Yang, and John N. Galgiani. "The Public Health Impact of Coccidioidomycosis in Arizona and California." International Journal of Environmental Research and Public Health IJERPH 8.12 (2011): 1150-173. Print.

Thanks to Dr. William Odette for mentorship and selection of this case

Yahya Nomann’s winning case poster from the 2016 competition.

AOMA Digest Fall 2016

February 24, 2017 (including evidence of IRB submission)

Des pite the ventriculos tomy, the patient s uffered from waxing and waning mentation for the next 5 days until the s erum Coccicompliment fixation titer revealed a 1:256 titer. The patient developed s ubs equent hyponatremia, likely due to SIADH s econdary to hydrocephalus .

104

Imaging Studies 1

3

Further Workup

The CSF taken during the emergent ventriculos tomy (performed above the bas ilar meningitis ) s howed normal g lucos e and protein concentrations and a negative cytology. However, the lumbar puncture (perfo rmed below t he les ion) was s ignificant for protein o f 828 mg / dl; pos itive for eos inophils ; g lucos e of 23 mg / dl. This is acommon pres entation in dis s eminated coccidioidomycos is . Acid fas t bacillus s tain, G ram’s s tain, and culture res ults were neg ative.

Hospital Day 7

11.3

9.1

Poster Abstract Submission Deadline:

Clinical Case Finalists Submission Deadline (PowerPoint Presentation)

Fungal Dissemination: A Coccidioides Story Introduction: Coccidioidomycos is , an infection caus ed by the dimorphic s aprophytic fungi Coccidioides immitis , is colloquially known as Valley Fever, Des ert Rheumatis m, and San Joaquin Fever, is endemic to the s outhwes tern U nited States and northern Mexico. This dis eas e is commonly miss ed or has delayed time-to-diagnos is , which can allow the fungal pathogen to dis s eminate out of its initial s ite of infection, the lung. The mos t s ignific ant extra pulmonary manifes tation is into the central nervous s ys tem, whic h res ults in hydrocephalus, bas ilar meningitis and death.

IMPORTANT DATES

Poster Forum Judging April 22, 2017

AOMA News

DOs Honored as Health Care Heroes

Angela DeRosa, DO, MBA, CPE

Two AOMA members were among those honored by the Phoenix Business Journal as 2016 Health Care Heroes for their contributions to keeping Arizonans healthy. The awards recognize physicians, nurses, emergency responders, and volunteers who serve the community.

Angela DeRosa, DO, MBA, CPE, AOMA Vice President, won the 2016 Health Care Hero Award in the Innovator category. Owner of DeRosa Medical, Dr. DeRosa was recognized for her advocacy and support for women and women’s health.

Jennifer Holmgren, DO, was a finalist in the Community Outreach category. Dr. Holmgren is a pediatrician at MVP Kids Care. She was nominated for her work with autistic children through the Early Access to Care program at Phoenix Children’s Hospital.

Twenty six award winners and nominees were recognized at an event held at the Fairmount Scottsdale Princess on August 25, 2016.

Got a DOs in the News item? Send it to communications@az-osteo.org and we will share it in the Digest.

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37

AOMA Digest Fall 2016

Birdies Mean Bucks for Arizona Osteopathic Charities birdiesforcharityaz.com Help Us Reach Our Goal!

You can make Arizona Osteopathic Charities a big bucks winner by making a pledge in the Birdies for Charity competition at the 2017 Waste Management Phoenix Open. Arizona Osteopathic Charities will receive every penny of collected pledges. By making a pledge, you can help provide free sports physicals for school athletes (TOPS), support DOCARE (international medical outreach), support Camp Paz (camping retreat for children who have suffered a death in their life), and provide research awards and scholarships for medical students.

ARIZONA OSTEOPATHIC CHARITIES

We Want Your 2 Cents - Literally!

Simply pledge two cents or more for every birdie that will be made by the PGA Tour players, Thursday through Sunday, at the 2017 Waste Management Phoenix Open and you will be supporting Arizona Osteopathic Charities.

It’s estimated that between 1,300 and 1,800 birdies will be made. To make a pledge online go to birdiesforcharityaz.com and click on “Donate Now”.

Contact Sharon Daggett for more information at sharon@az-osteo.org.

ARIZONA O STEOPATHIC To educate a n d p r o mA o t eRIZONA safe and healthy CHARITIES t uSTEOPATHIC dents and families living for children, sO CHARITIES To educate a n d p r o mA o t eRIZONA safe and healthy t uSTEOPATHIC dents and families living for children, sO To educate a n d p r o m o t e s a f e a n d h e a l t h y CHARITIES Our causes: living for children, s t u d e n t s a n d f a m i l i e s

DOCARE Inte Interrnat nation iona al, N.F N.F..P.

a •r •i •z •o •n •a

T •O •P •S

AOMA Digest Fall 2016

38

The Arizona Osteopathic Charities is a 501 (c) (3) non-profit charitable organization founded in 1997 by the leadership of the Arizona Osteopathic Medical Association (AOMA).

Tax ID #86-6052826 www.azdocharities.org AOMA Digest Fall 2016

To educate a n d p r o m o t e s a f e a n d h e a l t h y 38 Our causes: living for children, s t u d e n t s a n d f a m i l i e s Team of Physicians for Students

Business Partners AOMA’s Business Partners Program provides immediate access to high-quality services and providers.

These businesses offer special rates, services, and discounts to Association members.

For complete details on services, products, and discounts, visit the AOMA website at www.az-osteo.org/BusinessPartners

ACCOUNTING Karpinski, Berry, Adler & Company, PLLC Jason Bernstein, CPA (602) 244-8411 Ext. 201 jason@phxcpa.net 20% discount off regular fees

BANKING Bankers Trust Keith Kormos, Senior Vice President (602) 224-2023 kkormos@bankerstrust.com Special private banking services

BILLING & COLLECTIONS Delivery Financial Services, LLC Jodi Sugaski – Sales Manager (602) 490-3956 Direct Line jsugaski@deliveryfinancial.com Discounted fees XOLMed Revenue Cycle Management Corp.

J. Patrick Laux (602) 396-5900 x101 jplaux@xolmedrcm.com Comprehensive billing and chart review at no charge

DISABILITY INSURANCE CLAIMS AND HEALTHCARE LITIGATION Comitz | Beethe Edward O. Comitz, Esq. (480) 998-7800 ecomitz@cobelaw.com Free consulation for legal services

FINANCIAL Heritage Capital, LLC Kathryn A. Marchwick, CFP (623) 583-6840 kmarchwick@4wfg.com 50% discount on a comprehensive financial plan; no charge for students Mosaic Financial Associates Anthony C. Williams, President (480) 776-5920 anthony@mosaicfa.com Holistic approach to wealth management SoFi Michael Phillips & Team (855) 456-7634 ask@sofi.com $300 welcome bonus on student loan refinancing

HEALTH INFORMATION TECHNOLOGY Information Strategy Design (ISD) Michele Liebau (480) 970-2255 x107 michele@isdesign.com Discounts on two or more ISD services

INSURANCE AFLAC Karen Jones, Independent Agent (602) 229-1970 x213 Supplemental insurance policies available at special rates Mutual Insurance Company of Arizona (MICA) (602) 956-5276 (800) 352-0402 www.mica-insurance.com Medical professional liability insurance

MEDICAL RECORD SCANNING & MANAGEMENT ASDD Document Destruction Ryan Shinn (480) 730-4233 ryanshinn@tch-az.com www.assuredsecurityaz.com Discounts on offsite and onsite services

PAYROLL PROCESSING Payroll Strategies Group Nick Mawrenko (480)577-2552 nmawrenko@gmail.com $0 set up fee for payroll services

PRACTICE MANAGEMENT SyberSafe Nancy Johnson, Managing Director Toll Free: (877) 274-5552 Direct: (480) 779-1933 nancy.johnson@sybersafe.com 10% discount on compliance policy and information security services Wolfe Consulting Group Jim Wolfe, Owner (602) 324-0405 chh@wolfecon.com Free initial problem definition meeting and discounts on a wide array of consulting services

REAL ESTATE RE/Max Excalibur Kevin Weil, Realtor (602) 793-7492 kevin@kevinweil.com Personalized service for physicians and their families

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AOMA Digest Fall 2016

Osteopathic Community News

2016-2017 Calendar of Events October 28, 2016 Dinner with Doctors 6:00 pm Maricopa County Medical Society Courtyard Phoenix, AZ

January 28, 2017 AOMA Board of Trustees Meeting 9:00 a.m.

Midwestern University AZCOM

November 11, 2016 AOMA Board of Trustees Meeting 7:00 p.m.

Hilton Tucson El Conquistador Resort November 12, 2016 AOMA House of Delegates 3:00 p.m.

Hilton Tucson El Conquistador Resort November 12 & 13, 2016 AOMA 36th Annual Fall Seminar Hilton Tucson El Conquistador Resort 10000 N. Oracle Road Tucson, AZ 85704

February 21, 2017 DO Day at the Legislature Arizona State Capitol Phoenix, AZ April 19-23, 2017 AOMA 95th Annual Convention Hilton Scottsdale Resort & Villas 6333 N. Scottsdale Road Scottsdale, AZ April 19, 2017 AOMA Board of Trustees Meeting 7:00 p.m.

Hilton Scottsdale Resort & Villas

Advertisers’ Index MICA...................................Inside Front Cover A. T. Still University.............................Page 17 Midwestern University Body Donor Program.......................... Page 19 Hospice of the Valley...........................Page 19 Catalina Medical Recruiters..............Page 24 Community Partners, Inc...................Page 37 Arizona Osteopathic Charities ........Page 38 AzHeC..................................Inside Back Cover Midwestern University AZCOM.............................Outside Back Cover

April 21, 2017 AOMA House of Delegates 4:00 p.m.

Hilton Scottsdale Resort & Villas

Show support for your state association!

AOMA polo shirts now available in the AOMA store.

SAVE THE DATE!

Available in a variety of colors.

Just $40.

Visit www.az-osteo.org to order.

AOMA Digest Fall 2016

40

Reserve your spot at www.az-osteo.org/DODayRSVP

Connect with the doctors that DO More than 200 Arizona hospitals and providers are improving care coordination and finding success in value-based healthcare through one connection to The Network, Arizona’s statewide health information exchange (HIE), operated by Arizona Health-e Connection.

And, there are no participation fees for community providers.

What one connection allows you to DO: • Make better clinical decisions with more complete patient information One connection to The Network fills in gaps in patient information by connecting to hospitals, labs and other providers.

• Receive real-time alerts and notifications Network alerts of admissions, discharges or transfers (ADTs) or clinical care results care help you better manage your high-needs patients.

• Spend more time with your patients Secure messaging and information sharing through The Network replaces faxes, phone calls and follow-ups that take time away from patient care.

Contact Arizona Health-e Connection and find out how you can connect with the doctors that DO. Call (602) 688-7200 or email TheNetwork@azhec.org.

Arizona Osteopathic Medical Association and Arizona Osteopathic Charities 5150 N. 16th Street, Suite A-122 Phoenix, AZ 85016

Join us for AOMA DO Day at the Legislature.

Reserve your spot at www.az-osteo.org/DODayRSVP

[Celebr ating 20 Years in Arizona] Arizona College of Osteopathic Medicine Thank you to our outstanding preceptors, faculty, and alumni.

19555 North 59th Avenue | Glendale, Arizona 85308 (59th Avenue and Utopia South of the 101)

midwestern.edu