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Pediatric

Digest

DEDICATED TO THE HEALTH OF ARIZONA CHILDREN

SPRING 2013: The History of AzAAP

Paul Baranko, MD, FAAP, with patient; CIRCA 1970’s.


AzAAP President’s Report

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hen Dr. Arturo Gonzalez “passed the gavel” to me last summer it was very clear in my mind that where we are as the Arizona Chapter is due to the extraordinary efforts of those leaders who came before. This issue being dedicated to the history of the Chapter is a prime opportunity to pay thanks and respect to them, those who served as president, officers and staff through our growing years.

Dale Guthrie’s

Presidents REPORT

Dale Guthrie, MD, FAAP, AzAAP President 2012-2014 Dr. Guthrie is the current AzAAP President, and has been a Chapter member for over 20 years. He serves as the liaison to the Partnership for a Drug-Free America and is active on the AzAAP Pediatric Council. His practice, Gilbert Pediatrics, has locations in Gilbert and Mesa.

When I was asked to be in charge of the Tobacco-Free Campaign just over two decades ago, for perspective, smoking was allowed in hospital rooms, even in postpartum/couplet care with the baby in the room. The Chapter leadership was held together by a small handful of dedicated, overworked pediatric professionals. I remember attending my first executive committee meeting, sitting across from Drs. John Kerr, Mary Rimsza, Glen Waterkotte (the latter two from my residency faculty) and explained to the group that I was honored to be among them and recounted that when I was in the sixth grade, I remembered Dr. Kerr coming to Hawthorne Elementary and giving “the talk” to the boys (me) about growing up, puberty, and I still remembered two of the funny stories he told. That began my exposure to the energetic, passionate, and devoted leaders who moved forward children’s health and well-being and the practice of pediatrics in the State of Arizona at times when there was little or no staff to assist. I learned so much from their wisdom and persistence in speaking up for kids in a state where the political climate is not always friendly to us. I hesitate to mention names because there are many who worked on the executive committee who did not have the opportunity to serve as president, but in addition to Glen and Mary, I have been fortunate to have observed the leadership and dedication of Barb Smith, Rickey Williams, Keith Dveirin, Norm Saba, Ron Fischler, Peggy Stemmler and of course our immediate past president, Arturo who did his best to tutor me during my two years as vice president. I am grateful to serve at a time when we have such an expert staff and to be surrounded by a Board of Directors who are qualified, unselfish and who love children. My hope is that with their support and your confidence we can continue to move forward what those founding leaders began. To do that we need to be attentive to all our members, listening to all your voices and being responsive to your needs. We need you to find what you are passionate about and dive in, become involved and help us move the cause of children in the right direction. You can email Dr. Guthrie and our Board of Directors at AzAAPLeadership@AzAAP.org

PediatricDigest, Spring 2013 Page 2


AzAAP Welcome

In this Issue:

AZAAP EXTENDS A WARM WELCOME TO ITS 54 NEWEST MEMBERS WHO JOINED THE CHAPTER IN 2013! page 2

PHOENIX Ernerio Alboliras, MD, FAAP Lisa Bienstock, DDS Manny DeLuca, MD Caroline Finley, PA-C Ramin Jamshidi, MD Vishu Jhaveri, MD, MSA Eunice Lee, MD Dennis Lund, MD, FAAP Michael Magalnick, DO Monica Nania, MD, FAAP Joanne Padilla, PA-C Khristina Ramirez, MD, FAAP Reena Rastogi, MD Mitchell Shub, MD, FAAP Anne Young, DO

President’s Report

NORTHERN AZ Matilda Garcia, MD, FAAP Aaron Knudson, DO Tequa Salehi-Rad, DO Janet Schopen, PA

WEST VALLEY

Member Highlight: Dr. Judith Pendleton

page 5 What Have We Done For You Lately?

page 8

TUCSON

University of Arizona Residency Update

page 11 Peter Chase, MD Carissa Chase, MD Melissa Moore, MD Sivapriya Ramakrishnan, MD, FAAP Donalynn Sherman Scurry, MD, FAAP Shawn Stafford, MD, FAAP Ana Tanase, MD FAAP Amy Wagelie-Steffen, MD FAAP

EAST VALLEY Traci Arney, MN, FNP-C, AE-C, FAANP Edward Basha, MBA Amy Eby, CPNP Richard Heck, MD, FAAP Kelly Hughes, DO Neal Jain, MD FAAP Debra Johnson, MS, RN, CPNP Danielle McBurnett, RN, CPNP, PMHS Marion Memmott, PA-C Beverly Ricketts, NP Sandra Sexton, NP Joseph Werther, MD, FAAP Meredith Workman, MD

page 4

SOUTHERN AZ Gowan Deckey, MD LaTrecia Herring, MD Mahmoud Omari, MD Kathleen Vedock, DO, FAAP

-Pediatric Prepared Emergency Care; -AAP Committee on Pediatric Workforce to launch Arizona Pediatrician Workforce Survey; -Pediatrics in the Red Rocks Conference

page 12 Phoenix Children’s Hospital Residency Update

page 14 AzAAP Over Time: The Early Years

page 16 25 Years Ago: Health Care Needs of Children

page 17

SCOTTSDALE Julie Anfinson, DDS Rachael Blumenthal, DO, FAAP Jennifer Gibler, PA-C Meenakshi Goyal-Khemka, MD, FAAP Adrienne Kurland, MD, FAAP

AzAAP Annual Dues Rates Since 1980

page 18 AzAAP Over Time: Highlights from Recent Past Presidents

page 24 AzAAP Membership History Since 1980

page 26 Jared Berkowitz, MD Jennifer Holmgren, DO Joseph Hayes, DO, FAAP Enrique Lopez, MD Kathleen Nichols, MD, FAAP Jerald Underdahl, MD, FAAP

Best Care For Kids: A Chapter Initiative

page 27 AzAAP Childhood Obesity Committee

back cover AzAAP Career Center PediatricDigest, Spring 2013 Page 3


Member Highlight JUDITH PENDLETON, MD | PENDLETON PEDISTRICS, CHANDLER, AZ

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r. Judith Pendleton is the first doctor in her family. She has lived, studied, and trained in many parts of the US – Harvard in Boston, New Orleans, Louisiana for medical school, UCSD for residency, and Kaiser in Northern California before moving to Arizona. She realized her dream of opening a private practice in 2006. Judy’s faith is a strong part of her vision and her practice. Her practice is about “serving, caring, and love.” She and her team strive to know their patients and families by name, and work hard to sustain a strong relationship between themselves and the families they serve.

Reach Out and Read. We developed a drowning prevention program for our practice, and also created a partnership to provide car seats and booster seats for our children. Jodi Brigola, our practice manager, will make sure the car seat is properly installed, and teach parents how to do this. We participate in primary care research projects, like pediatric migraines and immunizations. WHAT ARE YOUR CHALLENGES IN CARING FOR CHILDREN? Our biggest challenge is trust. People seem to find it harder to trust these days. I feel like I have to convince people to trust me; to trust my training. It seems like parents feel they have to defend themselves. Understanding and meeting different cultural needs is also a challenge. HOW HAS AZAAP AND OTHER ORGANIZATIONS HELPED YOU IN OVERCOMING CALLENGES AND IMPROVING CARE? The Chapter is like another provider for me. Getting the newsletters, alerts to what CMEs are available, updates on the latest immunization schedule all help to keep up with changes in practices without having to track down the information myself. The learning collaboratives also help me to keep up, and think through how to keep my practice at a high level.

Judith Pendleton, MD, FAAP at her practice in Chandler.

WHAT’S DIFFERENT ABOUT YOUR PRACTICE WHEN COMPARED TO OTHERS? We are open to new ideas and very receptive to trying new things like

PediatricDigest, Spring 2013 Page 4

WHAT DO YOU DO FOR FUN? As a single mom and a business owner, there’s not a lot of extra time. I love being involved in my children’s lives, going to plays and soccer games. I’m very involved in my church through Bible study and choir. I also like to be outdoors and reading a real book. I like to laugh. At lunchtimes at work, we get together to watch the Big Bang Theory and laugh out loud.


What Have We Done For You Lately? As a way to keep you informed and better meet the needs of our membership, we are introducing “What Have We Done For You Lately?” to the newsletter. This will be featured regularly and captures activities over the last six-month period. Each feature will have new information about how the Chapter is representing the pediatric profession and working to address issues in child health. GENERAL ORGANIZATIONAL INFORMATION Strategic planning Hosted the 2nd AzAAP All-Staff meeting with 30 individuals from throughout the State (Maricopa County, Flagstaff, Yuma, Navajo Nation, White Mountain Apache Tribe and Snowflake). Partnered with National Bank of Arizona to offer members benefits with an Executive Banking or Private Banking checking account (email Suzy.Powell@nbarizona.com for more info!) Updated the Autism Consensus paper Partnered with Autism Coalition to provide a joint statement about the safety of immunizations Worked with Raising Arizona Kids magazine to create a series featuring our very own Dr. Laurie Jones, a pediatrician mother who proudly breastfed her two babies and became an IBCLC. Collaborated with DrugFreeAz.org to create a new video on the dangers of prescription drug abuse (featuring Dr. Arturo Gonzalez) and to provide inoffice training to our members about SBRIT. Dr. Arturo Gonzalez was appointed to the Special Interest Group on Immigration. IMMUNIZATIONS Through Arizona Partners Against Pertussis (APAP), we collaborated with community partners to challenge healthcare providers to immunize themselves against Pertussis. Along with partners, AzAAP presented to a national audience with the about the power of working in collaboration to combat the challenges of delivering vaccines. Special focus was on the financial struggles of private pediatricians affording to provide vaccines to privately insured patients. Dr. Peggy Stemmler continues to participate on the Executive Committee of TAPI’s Steering Committee. Partnered with TAPI to provide education to our membership about the changes in federal vaccine funding – hosted webinars for members, created handouts for clinicians/ parents/ schools, presented about the subject at our joint Practice Efficiency and the Business of Vaccines conference, communicated regularly to our members and partners via email.

AHCCCS Serve as a liaison between our members and AHCCCS to help resolve problems. Through AzAAP ListServs, we have educated our members about the process of attesting to receive the “Medicaid Bump” in payments. Because the State’s methodology must be approved by CMS, payments will not be sent until July at the earliest. Spent countless hours on the phone and in meetings with our members, their practice managers and other community partners to identify trends in how different plans have interpreted the new vaccine coding requirements. We are continuing to work with AHCCCS to ensure uniform implementation. Continue to advocate for appropriate payment for developmental screening and fluoride varnish application in the office setting. ADVOCACY Presentation on workforce shortages to health community stakeholders including key Senators. Testified in support of bills related to child health, including AzAAP member priority – vaccine reimbursement. AzAAP continues to spearhead stakeholder meetings with legislators Expanded the AzAAP Legislative action Center webpage for members to easily contact their legislators and stay up to date with current legislative activity RESIDENTS Worked with the residency program staff to strengthen the community pediatrics rotation of the Phoenix pediatric residency program. Residents participating on this rotation are invited to shadow AzAAP members and staff at the capitol, at community coalition meetings, and even in short term projects of AzAAP Committees. The PCH Obesity Community Advocacy Group lead by Dr. Paula Lopez and Dr. Emily Stuart is working with AzAAP to integrate our “5210” message into a CATCH-funded program at a shelter for homeless families in Phoenix. Lead by Dr. Heather Dunn (PL-3), our Pediatric Residents hosted a Community Physicians Night where they showcased their advocacy projects and then participated in a job fair. MEDIA AND MARKETING Hired a marketing consultant to help us develop a strategic marketing plan to better position pediatricians as the leading voice in Arizona children’s health. Initiated an “ambassador program” where AzAAP connects our members to the media to comment on stories about children’s issues—several of our members have been on television and radio shows, quoted in newspaper articles and highlighted in magazines. Fostered a partnership with Raising Arizona Kids magazine. Our Facebook and Twitter accounts continue to grow in popularity, and most of our “friends” are PediatricDigest, Spring 2013 Page 5


community members and parents. Are you one of the almost 500 people who “like” us? Initiated new monthly email to potential donors, community partners and members of the media. The content of these publications help share what our membership tells us are pressing issues facing the practice of pediatrics today. CLINICAL EDUCATION Dr. Harold Magalnick presented on behalf of AzAAP at the Arizona Department of Education’s Coordinated School Health conference in Tucson about the role of physicians in schools. Obesity Committee Chair Karen Eynon RN MSN CPNP presented the AzAAP White Paper on Obesity Prevention, Assesment and Treatment at the Phoenix Children’s Hospital CARE Program Symposium on Childhood Obesity. AzAAP Hospitalist Committee planned a “Hospitalist Track” to run concurrently throughout the 36th Annual Pediatrics in the Red Rocks Conference. Registration for the 36th Annual Pediatrics in the Red Rocks Conference opened on March 1st! Learn more on our website, www.AzAAP.org. Co-hosted the 3rd Annual Practice Efficiency and the Business of Vaccines Conference with the Arizona Partnership for Immunizations (TAPI). This year’s conference was the most highly attended and featured a track targetting young physicians. AzAAP’s Oral Health Champion, Dr. Gretchen Hull, continues to educate pediatricians throughout the State on oral health risk assessment and fluoride varnish application. She is also active in discussions with AHCCCS about appropriate payment for fluoride varnish application. Our Newborn Hearing and Screening Champion, Dr. Brad Golner, provided in-office training to our members and their staff in Maricopa and Mohave counties about early Hearing Detection and Intervention Programs (EHDI). OBESITY Updated the AzAAP White Paper: Recommendations for Childhood Obesity Prevention, Assessment and Treatment. Surveyed community organizations active in obesity prevention and intervention to identify the degree to which they currently incorporate “5210” messages that are shared with families as part of well care. Started a facebook page: GetFitAZKids to allow the AzAAP Obesity Committee – and our pediatrician members – an opportunity to have a voice in the community discussion related to childhood obesity. We are working with a marketing consultant on a marketing plan specific to childhood obesity. Participated in multiple stakeholder and coalition meetings hosted by community-based organizations, county health departments, state agencies and private and public health insurers. PediatricDigest, Spring 2013 Page 6

AzAAP Obesity Committee Members with Kurt Warner at a nutrition conference in DC

Thanks to our friends at the Dairy Council of Arizona, seven Obesity Committee members traveled to Washington, DC along with Arizona’s registered dieticians, physical educators and food service personnel to attend a summit hosted by GenYouth and the NFL’s FuelUpToPlay 60 Program. We were some of the only pediatricians in attendance. BEST CARE FOR KIDS Initiated 3rd Learning Collaboratives on Medical Home and Bright Futures. These groups help practices work with colleagues to incorporate work flows to improve patient care and increase efficiency in practice, and offer MOC credits. Planning for Visioning Summits on Integrating Children’s Behavioral Health and Primary Care. These summits will gather recommendations from families and from primary care physical and behavioral health providers on what a new, integrated system of care should look like. Sessions will be held in May/June 2013. Working with hospital emergency departments across the state to be sure they are fully prepared to care for ill and injured children through our Pediatric Prepared Emergency Care Program. Care coordination being tested in 9 practices in Maricopa County, supported by First Things First. Care coordinators, based in primary care practices, help families navigate AzEIP, DDD, and social support systems. Information gathered by the care coordinators is used to work with AzEIP, DDD, and the schools on where families get lost to entry into the system. REACH OUT AND READ Enlisted the Coconino First Things First Regional Council to provide $46,000 in fiscal support to ensure the sustainability and quality of fourteen (14) existing Reach Out and Read clinics in the Coconino region. Secured $19,500 from the Cenpatico Community Reinvestment Fund to purchase children’s books designed to promote the healthy social-


emotional development of young children for Reach Out and Read clinics in La Paz, Yuma, Cochise, Graham, Santa Cruz, and Pinal counties. Participated in numerous community and parent outreach events across the state, including children’s art festivals, IHS-sponsored parenting classes, Head Start parent meetings, etc. and distributed over 2,000 children’s books and talked with parents and family members about the importance of reading to their children. Added fifteen (15) new Reach Out and Read Arizona sites during 2012. Convened a collaborative meeting with several of the states early childhood literacy programs. MEDICAL SERVICES PROJECT Assisted with connectivity among health care providers and students referred to Medical Services Project. Both primary care providers and subspecialists agree to see students through the Program. Mary Ellen Sandeen, FNP (Yavapai County) contacted AzAAP staff hoping to tap into any resources who might help an uninsured student with a malignant tumor. The MSP Medical Director, Dr. Elizabeth McKenna, reached out to Dr. AD Jacobson with Phoenix Children’s Hospital who was able to facilitate treatment. A very favorable outcome for the student is now indicated with continued follow-up care at PCH with Oncology specialists. Regular participation on the school based healthcare council.


University of Arizona Pediatric Residency Update Many changes have occurred our community physician since the last update from the colleagues is absolutely critical University of Arizona Pediatrics in molding the career choices of Residency. Most notable are the pediatric residents and is the 16 new faces that come to greatly appreciated by both the the program residents and every year the as fresh Department of interns. Pediatrics at These faces The University gradually of Arizona. become The last two more years have familiar to been busy for the faculty the residency and program. We community have settled physicians comfortably who help into the mold them facilities at into highly Diamond confident Children’s and Medical Center competent at the senior University of residents Arizona until HealthNetwork ultimately, three and the recently Sean P. Elliott, MD years later, they Director, Pediatric Residency remodeled TMC for graduate the a Children Medical Program program and carry Center. The growth their knowledge into of highly specialized the community and elsewhere. pediatric care at Diamond Every year, approximately 40% Children’s has been of our graduates enter an tremendous, with increased academic position as pediatric solid-organ and bone subspecialty fellows while their marrow transplantation, colleagues pursue primary care complex congenital heart and hospitalist positions. Every disease interventions and care year, several of these for myriad other medically graduates join the Tucson fragile, challenging patients. At community of primary care the same time, the pediatric providers, thus ensuring a residents continue to care for all “return” on the investment other hospitalized pediatric made by the community in patients in Tucson and learn their education. The guidance ambulatory pediatrics under and mentorship provided by mentorship from numerous

PediatricDigest, Spring 2013 Page 8

community and academic physicians. In July 2011, our residency successfully inserted the new ACGME duty-hour restrictions into our curriculum. Now, we are preparing for yet more ACGME changes which go into effect July 2013. These include the Next Accreditation System, a new program of residency program accreditation, and the 2013 Program Requirements, which require us to create Individualized Learning Curricula and reduce the amount of time allowed for critical, inpatient, and ambulatory care experiences. Although seemingly counterintuitive, the new program requirements actually allow the program to innovate in creating a more meaningful learning experience for residents as they contemplate their postgraduate careers. Now, the current high levels of exposure to patient advocacy, international healthcare delivery, discovery via medical research, and medical education are poised to increase yet further, while maintaining the already highly successful training in ambulatory and academic healthcare settings. Staff changes also have occurred. The former


Residency Director, Conrad Clemens, MD, MPH, accepted a position as Associate Dean of Graduate Medical Education and now oversees all GME residency programs at the University of Arizona. In his place, I became the Director in November, 2011. Shortly afterward, the program recruited and matched 16 superb interns. Today, we have completed yet another cycle of recruitment and experienced significantly increased attention from candidates from the East coast and Midwest, a testament to an everincreasing national reputation of academic pediatrics here at

Conrad Clemens, MD, MPH Associate Dean of Graduate Medical Education

the University of Arizona. Despite challenges of new national requirements, duty hour restrictions, GME funding and staffing changes, the Pediatrics Residency at the

University of Arizona Resident’s Night Out

University of Arizona continues to thrive. Our residents continue to pursue fulfilling career choices in the community and at

prestigious academic centers throughout the country, and many return to Tucson after additional experience and training. The mentorship and experience they gain from community and academic members of the AzAAP remains central to their professional growth, and it is clear their education would be sorely limited without the thoughtful contributions of these members. On behalf of the Pediatrics Residency program at the University of Arizona, I wish to send all AzAAP members a heartfelt “thank you” for all that you do to contribute to the educational mission here.


Pediatric Prepared Emergency Care Children get sick and hurt everywhere, and parents drive their ill and injured children to the nearest hospital. But is that local emergency department really prepared to care for children? AzAAP’s Pediatric Prepared Emergency Care program is working to make sure the answer is always YES.

Now hospitals can go through a voluntary certification process to be sure their facility has the right equipment, nurses have pediatric training, and policies reflect the latest pediatric information. In addition to verifying equipment and processes, the site visit team acts as consultants and colleagues to sustain

best practice over time. Member hospitals share great policies and clinical guidelines so that it’s easier to stay up to date with changes in practice. As of March 2013, seven hospitals have been certified as Advanced Care facilities and four as Prepared Plus Care facilities. More are preparing for site visits.

AAP Committee on Pediatric Workforce to launch Arizona Pediatrician Workforce Survey Your participation in this survey is greatly appreciated.

The AAP Committee on Pediatric Workforce (COPW) is about to launch a State Pediatrician Workforce Survey and has chosen our state as one of the first 12 states to be surveyed. This Arizona workforce survey is designed to help our chapter identify current shortages in the Arizona pediatrician workforce by specialty and geographic area as well help us predict future workforce needs. The findings from the survey will help us effectively advocate for the resources needed to address shortages (eg. GME funding, loan repayment programs, appropriate payment for pediatrician services) and help us recruit and retain pediatricians, including pediatric Mary Ellen Rimsza, MD, FAAP medical and surgical subspecialists, in our state. Chairperson AAP Committee on Pediatric

The results of this electronic survey will be shared with our chapter leadership after analysis by the COPW. Individual responses are confidential and all results will be reported in unidentified and aggregated form. We hope that in addition to helping the chapter with advocacy efforts on behalf of the state’s pediatricians, this information will also aid the Chapter in its planning efforts. The COPW also will use the findings of this survey to determine state and regional differences in pediatrician workforce which will assist the AAP in its advocacy work in Washington as well as in the states. This project will be done in phases, and we hope to survey all chapters within the next 12-18 months. Each chapter member will soon be receiving the electronic survey, which should take less than 10 minutes to complete. The questions cover a variety of pediatrician workforce topics including standard demographic questions, hours spent in clinical and non-clinical care, changes in practice patterns and work setting and future career plans.

Hospitals are also partnering to solve universal challenges, such as a shortage of inpatient behavioral health beds and disaster readiness for children. To learn more, visit www.azaap.org/ Pediatric_Prepared_Emergency or contact Dr. Peggy Stemmler at peggy@azaap.org

Pediatrics in the Red Rocks Conference The AzAAP CME Committee is happy to host the 36th Annual Pediatrics in the Red Rocks Conference June 21-23, 2013 at the Enchantment Resort in Sedona. Topics Include: Gastroenterology (Phyllis Bishop MD) Cardiology (Scott Klewer MD) Dermatology (Harper Price MD) Hospitalist Medicine (Chan Lowe MD) Sports Medicine (J Hunt Udall MD) QI (Peggy Stemmler MD) Endocrinology (Joel Hahnke MD) This year’s conference will provide education for primary care and hospitalist pediatricians. Sessions are held in the mornings so the afternoons are free to spend with family. We will again provide opportunities to participate in Committee meetings and several other networking events on Thursday and Friday evenings.

Register Today at www.AzAAP.org!

PediatricDigest, Spring 2013 Page 11


RESIDENCY UPDATE: PHOENIX CHILDREN’S HOSPITAL Written by Dr. Pablo Angulo, DO (PL3, AAP Representative) and edited by Dr. Brett Hurliman and Dr. Jen Kaufman (Chief Residents)

We are delighted to report that the residency program at Phoenix Children’s Hospital/Maricopa Medical Center is winding down another wonderful year! We have successfully filled another fantastic class of 31 categorical pediatric intern residents, as well as 2 pediatric neurology intern residents and 7 combined internal medicine/pediatric intern residents. With over 1,000 applications and 252 interviews, our residents dedicated their time and shared their homes in welcoming applicants from all over the country! In addition, the PCH family is very excited to announce our new residency program director, Dr. Vasu Bhavaraju, who will be starting June 1, 2013. She will be the successor to Dr. Grace Caputo, our beloved and dedicated leader for the past 17 years. We look forward to continued progress in resident education, as well as exciting new changes for our program under the guidance of Dr. Bhavaraju. The program continues to strive for continued teaching and education. Phoenix Children’s Hospital completed another successful annual conference with Pediatric Update this past March 2013. This is a 4 day conference comprised of various pediatric generalists and specialists sharing important pediatric knowledge to community and resident physicians. Residents were given the opportunity to attend the conference and participate in the educational experiences. When the residents have some time away from conferences and work-related obligations, they take time to participate in community advocacy projects. The Phoenix Children’s Hospital Residents, Obesity Prevention/Nutrition group was offered a grant for providing nutrition and Sara Taylor, Neil Kulkarni and Megan fitness classes at UMOM, the largest homeless shelter in Arizona. These residents Doty, supporting Governor Brewer’s have created a multitude of lectures and presentations on healthy nutrition and plan for Medicaid at the Capitol weight loss for the families and children residing at UMOM. It is the hope that appropriate education on obesity will help promote healthy eating, exercise, and weight loss in this population. A tremendous goal of this advocacy group includes having a Farmers Market that provides nutritious vegetables and fruits to the shelter. The program has been very pleased with the hard work and dedication of this group and the impact it is having in the community. In addition to community involvement, our resident program strives to continually review and make improvements where they are needed. Our curriculum committee is hard at work implementing a new advisory system. Improvements include formal mentoring workshops for the attending physicians interested in being advisors. These workshops focus on how to guide residents through their training with regards to their career plans and goals. Thirty new attending physicians have volunteered to be advisors! Furthermore, our program has enacted “Feedback Friday”, a dedicated time for feedback to be given at all levels of residents. Finally, the program is excited by the success of implementing family centered rounds at Phoenix Children’s Hospital, which started this past August on the inpatient GI team. This involves multidisciplinary rounds with families, specialists, and ancillary staff. Due to its remarkable success, family centered rounds have extended to various other inpatient services, including our general pediatrics and Pulmonary teams. These family centered rounds are allowing the best communication and patient care to our families, and we plan to expand this type of rounding to all inpatient services. Our residents take great pride in giving back to our families and understand how stressful it can be when their little ones are in the hospital. Some of our residents have cooked dinners for the families at the Ronald McDonald House. During the month of October, several residents participated in a Halloween Craft activity along with the child life specialists for the children at Maricopa Medical Center. The children paraded the halls in their fancy Halloween costumes in anticipation of receiving treats and prizes. Some of the residents also participated in a special dinner, giftgiving, and pictures with Santa for the patients of our Teen Tot Clinic in December 2012. This is a special service group that helps provide education and support to adolescent parents and their children. As we continue to grow, we are excited for the start of the next academic year. We look forward to continuing to educate medical students and residents, as well as bringing excellent care to the pediatric population of our state and region. PediatricDigest, Spring 2013 Page 12


AzAAP Over Time:

Where We’ve Come From

“Pediatrics has changed markedly since my start with training in 1953. Premie care was oxygen, a warmer and prayer. The polio epidemic was waning down and we soon saw the polio vaccine, the first of the new vaccines. When I started in practice, we had dpt and smallpox as our sole immunizations. Office calls were $4.00 when I started, and house calls of which there often were 4 or 5 a day were in the teens, and weekends were double. House calls gave us great insight into our patients and the ecology of our practice. I remember a discussion with partners about raising the office call to 5 dollars which took a whole evening and trepidation about losing patients because of the increase! We answered all of our off-hour phone calls, triage a word from WWII! We were beeped and then dropped dimes into pay phones at Circle K talking to patients while the trucks rolled by.” -Dr. Herb Winograd, AzAAP Past President 1986-1988

The Early Years: With Help From The History of Arizona Pediatrics By John J. Kerr, MD Previously, as a “Society” any physician who cared for children could belong. After the “Chapter” was formed, only boarded pediatricians could be active voting members.

Early 1950’s; Pediatric community forums in Arizona Says John Kerr (pictured above), “In 1954 there were about a half dozen pediatricians in Phoenix, 3 or 4 in Tucson, one lady pediatrician who worked for the Indian Service with her office in Tuba City (and I forget her name) and me, and that was it!”

1959; Arizona Chapter of the AAP was organized Dick Johns, who came to Phoenix in 1952, served as President of the state pediatric organization. It was called the Arizona Pediatric Society until the AzAAP Chapter was organized in 1959; there were 25 members. 1963; John Kerr, MD, took over as president of the chapter

“Dick Johns told me there was nothing to it, as the only thing the Chapter did was to have a social get together a couple times a year with a speaker on a clinical subject. So, in a weak moment, I said yes.” PediatricDigest, Spring 2013 Page 14

1968; Hugh Thompson, MD, elected President of National AAP Hugh was from Tucson and very active in the society and the formation of the Chapter, and then the activities of the early Chapter. He was also very active on a national level, serving on a number of committees, and then the AAP Board. 1968-1970; Robert F. Crawford, MD Committees on Mental Retardation and Medical Education were most active in both State planning for resident training and attempting to develop a stronger voice in working for improved care of the mentally retarded in Arizona. Effort to provide medical participation and consultation in the sparsely population areas of the State. Constitution changed so as to allow pediatric residents to join the State Chapter. 1971-1973; Charles P. Dries, MD Supported legislation for audio and visual screening and mandatory immunizations of school children. Lobbied for and were successful in obtaining monies for the Premature Transport Project. Developed a study of the long

term direction of crippled children’s services in the State. Legislative Committee was instrumental in getting a state immunization law passed. Increased input into the State Child Crippled Children’s Program, and statewide fee survey. 1974-1976; Walter E. Ahrens, MD Involved in developing the EPSDT Program for Arizona children. Medical liability legislative effort which resulted in the enactment of a 7 Plus 3 Statute of Limitations. Continuing education for the practicing pediatrician has a high priority. April 28, 1977 The first meeting of the incorporators and Executive Committee of the AzAAP was held at Fiesta Inn, 2100 S. Priest, Tempe, AZ at 7 PM. A February 2008 online comment about the resort states,

“The resort is old and needs a complete remodel. Rooms are very small, bathrooms even smaller. I will never go back and would not recommend it to friends.”

Elected individuals present: Dr. Robert S. Ganelin, Chairman Dr. Elmer S. Lightner, Alternate Chairman Dr. James F. Carland, Secretary (excused from meeting) Dr. Robert C. Cannell, Treasurer Dr. David Folkstead


Original Bylaws The objective of the Chapter shall be: To improve the health and welfare of all the infants and children of the State. To unite qualified pediatricians, other interested physicians, and other appropriate health personal of the State of Arizona in a representative organization for the furtherance of the practice of Pediatrics. To study the scientific, economic, social, educational and political aspects of medicine in order to secure and maintain the highest standards of practice in pediatrics; and to prepare and recommend necessary changes in existing or contemplated medical programs. To further the policies and objectives of the American Academy of Pediatrics at the state and local level. To further the interest of Arizona pediatricians in the AAP. Membership Dues

“…If a member fails to pay dues within three months, he shall be declared delinquent. The treasurer will notify him of default, and offer him thirty days to make up the arrears in dues. Failure to comply will result in loss of membership.” “… all meetings of the Chapter shall be conducted in accordance with Robert’s Rules of Order, Newly Revised, where applicable….”

1977-1980; Bob Ganelin, MD Legislative activity on requiring car seats for children and other auto safety measures. Legislation on immunization requirements for children. Metabolic screening directed by Whitey Lightner – hypothyroidism and PKU as main targets – 1978 AZ Legislature passed law requiring newborn screening. Development of a Pediatric Transport Program. 1980-1983; Ken Tollackson, MD ABP Recertification program: $600.00, PREP - $125/year.

Considerable opposition throughout the country. Members urged the ABP to consider other alternatives to a supervised written exam (an office audit was one suggested opinion.) Ipecac initiative – 1 ounce provided to each patient at no cost. 1980 Graduate Medical Education and National Advisory Committee (GMENAC) Report – Projected a surplus of physician of 70,000 by 1990 --- and of General Pediatricians of 7500. “… it is clear that there will be a problem of physician abundance.”

Arizona Pediatric Society Survey Results: Abortion – By a vote of 86 to 61, the members felt that the AAP should not take a public position on the issue of abortion. 63 members tended toward a “pro-choice” position, while 38 members expressed a “pro-life” view. Seat belt legislation: The vote was 116 to 27 in favor of a mandatory infant seat restraint law. The members voted 107 to 22 in favor of becoming involved in an indigent health care program. Comment from a Winter 1982 Town Hall meeting by John Kerr, “I am a happy pediatrician, in the minority…”

1983-1984; George Comerci, MD 1983 – attended a national AAP forum called “Future Shock, Will You Be Unemployed in 1984?” AzAAP Member Survey results: Are you in favor of the AZ Chapter of the AAP actively supporting a bill to raise the drinking age in Arizona from 19 to 21 years? YES – 121

NO – 27

YES – 130

NO 22

Do you agree with the present law regarding the prohibition of sales/advertisement of drug -related materials (Paraphernalia/”head shops”)? 1983 – Phoenix Children’s Hospital began operating as an independent hospital on Sunday, September 18th 1983.

1984-1986; Michael Cohen, MD Development of a statewide drowning prevention program. National discussion regarding recertification from The American Board of Pediatrics. There was always a focus on Pediatrics in the Red Rocks and what was the appropriate curriculum for the 75 attendees. Increased focus of Adolescent Health Care and the establishment of a committee to provide leadership in Arizona. “Annual Regional Meetings took me to Fairbanks Alaska and Honolulu Hawaii. I still look at the photos of sunsets I shot in Hawaii. The highlight of the Alaska trip was flying in a small plane at about 7000 feet around Mount Denali with the late Dr. George Comerci. What a thrill.”

1986-1988; Herb Winograd, MD

“During my tenure there were no real issues. The chapter was small and we pretty much knew each other by first name. An exciting event during that time was the start of Phoenix Children’s Hospital. During my tenure, we expanded the fledgling Sedona educational meetings and enjoyed the planning with our Tucson colleagues. It was a very collegial time with the high point being the BIG Game Thanksgiving weekend when we had a CME session, talked rivalry and had a fun time together. They were simpler times. We, did during that time, bring on the first paid executive director, part time.”

1988-1991; Glenn Waterkotte, MD Hired an executive director, Melanie Wrightson - Her office was in her home for quite a while. This is the time that the chapter started to function as an effective advocate for children and assume some political clout, form subcommittees, and do a lot of things. Winter 1988 – “State of the Union” from Dr. Waterkotte, included four goals: Establish the executive director and office of the AZ Chapter. Draft specific bylaw revisions. Increase awareness of the unique contribution of pediatricians to children’s issues. Continue to find methods for AZ pediatricians to discover what impact they have on children’s issues.

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25 YEARS AGO

HEALTH CARE NEEDS OF CHILDREN BELOW IS AN ARTICLE WRITTEN 25 YEARS AGO BY LYNN TAUSIGG, MD WHICH WAS FEATURED IN THE AZAAP MONTHLY NEWSLETTER ON THE STATE OF HEALTH OF THE CHILDREN IN ARIZONA AND THE LACK OF ADEQUATE RESOURCES. SEE HOW PAST HEALTH CARE NEEDS OF CHILDREN COMPARE TO CURRENT CONDITIONS: A number of recent studies and publications (references) have highlighted some glaring deficiencies in the state of health of the children of Arizona and the woeful lack of adequate resources in many areas. A few observations will highlight the extent of certain problems related to the health of children of our state: More than 1 ,200 babies are born each year to mothers who had no prenatal care. Complications of low birth weight infants include death, mental retardation, and other serious disabilities. The rate of low birth weight babies born in Arizona has risen markedly over the past six years. In fact, the current rate of 63.6 low birth weight infants per 1,000 live births is the highest rate in the past ten years in Arizona. Arizona ranks 20th in the nation for percent of births that are low birth weight. In 1987, 12,342 babies were born to Arizona teenagers which represented 15% of all births. A high percentage of

PediatricDigest, Spring 2013 Page 16

these teenage mothers do not receive adequate prenatal care, resulting in a large number of premature and low birth weight babies with their concommitant serious health problems. Teenage mothers are 60% more likely to have low birth weight babies. Arizona's teenage (15-19 years) birth rate is more than 50% greater than the nation's. For mothers under 15 years of age, the birth rate is also six to eight percent greater than the nation's. In 1986, the birth rate for girls under 15 years of age was the highest ever in Arizona. Arizona ranks 36th out of 51 with respect to percent of all births to mothers under 20 (1984). Arizona ranks 38th out of 51 with respect to percent of infants born to unmarried mothers (1984). Arizona ranks 52nd in the nation on mental health spending for children's services. It is anticipated that at least 13% of our children (more than

125,000) require such mental health services. However, less than 10% of this number receive such services. Two-thirds of severely emotionally disturbed children do not receive appropriate care. Since Arizona ranks 7th out of 50 states with respect to the divorce rate, and fifth out of 50 states with respect to the suicide rate, it is obvious that Arizona's children are at high risk for emotional disturbances. The rate of teenage suicide in Arizona is more than 70% higher than the national average and increased 15% from 1984 to 1985, whereas the national average remained the same. Only one out of seven develop mentally-disabled children appears to be receiving appropriate care. In 1987, the number of child abuse cases reported in Pima County was twice the number reported in 1986. Overall, there are probably more than


18,000 reports of child and sexual abuse in the State of Arizona. Over 30,000 children in Arizona are not fully immunized. The rate of infants dying from Sudden Infant Death Syndrome is 46% higher in Arizona than for the nation. There have been increasing mortality rates for heart disease and cancer for Arizona's children. The issues are obvious! Many of the studies have already been done to demonstrate where the needs are. Similarly, the required programmatic changes are obvious. What is lacking perhaps, is the force

to implement needed changes in policies and programs. That is where we, the pediatricians of the state, and the AAP-Arizona Chapter, must become involved. All the studies and all the proposed programmatic changes will only be as effective as their implementation via new policies and programs. We must continue and increase our educational and lobbying efforts. The above article was featured in the Winter 1988 AzAAP Newsletter; written by Lynn M. Taussig, MD who was Professor and Head of the Department of Pediatrics at the University of Arizona Health Sciences Center.

In Memory Of George D. Comerci, MD 12/3/1931-2/10/2013

Comerci was one of the founding members of the UA Department of Pediatrics, a past president of the American Academy of Pediatrics and a major figure in the development of

AzAAP Annual Dues Rates Since 1980

adolescent medicine as a pediatric subspecialty in the United States.

Vince A. Fulginiti, MD Age 81, died 3/19/2013

Fulginiti was a long time resident of Tucson and is recognized worldwide for his contributions to medicine, medical education and community service.

PediatricDigest, Spring 2013 Page 17


AzAAP Over Time HIGHLIGHTS FROM RECENT PAST PRESIDENTS MARY RIMSZA, MD, 1991-1994 What were some of the major issues that you dealt with during your tenure as President? Hired new executive director I wanted to especially work on child abuse prevention and injury prevention. The issues included passing an infant restraint bill, preventing gun violence, pool fencing, funding and support for CPS programs, and support for development of a state Medicaid program. A major event was the passage of the Child Fatality Review Program legislation which turned out to be amazingly valuable because it allows a non-partisan group to speak out annually on the prevention of child deaths using evidence based information. In your opinion, what have been the major changes in Pediatrics that have occurred over your career? Hospitalists caring for children in the inpatient setting rather than their primary care physician The explosion of pediatric subspecialties. When I started my career a general pediatrician not only cared for inpatients, well nursery babies but also cared for those in the NICU and PICU. We also did procedures that are no longer done by generalists including endocscopy, tympanocentesis, management of ventilated patients, central lines. One thing that has not changed and probably never will is that there will never be enough doctors to care for the poor and uninsured. What do you see as the major issues (either in child health or as a profession) that we face today? Increased reliance of parents on the media and movie stars for their medical information. This culture of pseudoscience regarding issues that impact the health and welfare of children is very concerning. We have folks opposing vaccines and assault weapon bans on the basis of mistruths they hear in sound bites on questionable “Coyote” television. What advice do you have for the AzAAP as an organization? I think it’s important to support the needs of our members while continuing to advocate for children, remembering that what is best for pediatricians is usually also what is best for kids.

RICKEY WILLIAMS, MD, MPH, 1994-1997 What were some of the major issues that you dealt with during your tenure as President? ASIIS was just starting. AzAAP Medical Home Project (now called the Medical Services Project) was begun. Please relate a specific event, memory, or experience that serves as a highlight (or lowlight) of your Presidency. Attending the AAP's Annual Leadership Forum in Chicago to see what the national AAP and other chapters were doing. In your opinion, what have been the major changes in Pediatrics that have occurred over your career? General pediatricians are no longer caring for NICU or PICU patients, and some are not taking care of hospitalized patients at all. PediatricDigest, Spring 2013 Page 18


Nurses are now taking routine physician phone calls on nights and weekends. What do you see as the major issues (either in child health or as a profession) that we face today? Continuing to advocate for pediatricians as giving the best care for children. A threat is all the urgent care centers that are popping up all over the place, weakening the "Medical Home" concept. What advice do you have for the AzAAP as an organization? Continue to be the voice for pediatricians in Arizona. The AzAAP has done an excellent job of that, especially in the last several years.

NORM SABA, MD, 1997-2000 What were some of the major issues that you dealt with during your tenure as President? A tenuous financial status of our chapter requiring us to take a loan from National to right the ship. However, over the next two years we worked with our fellow officers and committee members paid back National and were back in positive financial balance. Please relate a specific event, memory, or experience that serves as a highlight (or lowlight) of your Presidency. Hiring of Sue Braga as Executive Director. Winning the Outstanding Medium Chapter Award from National AAP. Starting a web site and Listserv. In your opinion, what have been the major changes in Pediatrics that have occurred over your career? The move away from private pay insurance to more and more families being on state Medicaid or simply having no insurance. The impact of CMS and other governmental agencies in dictating practice parameters and guidelines has also changed immensely. How very few pediatricians still do both inpatient and outpatient pediatrics and the rise of the pediatric hospitalist. A hot debate rages currently as to whether or not hospitalists should do a fellowship or not. What do you see as the major issues (either in child health or as a profession) that we face today? Vaccine reimbursement and many of the other costs of running a private practice have been a constant challenge. The current move toward ACOs will add another major challenge. Our profession faces a big change as the current trend intensifies dividing practitioners into hospital-based or clinic-based with very few doing both. What advice do you have for the AzAAP as an organization? Stay on top of the issues that affect Pediatricians and other pediatric health care providers and their patients and maintain efficient and effective lines of communication. As challenges continue to mount that will affect those who strive to care for children, our chapter needs to be an advocate and resource. Only by attracting and maintaining active membership and participation will we be successful in facing and meeting those challenges.

BARB SMITH, MD, 2000-2003 What were some of the major issues that you dealt with during your tenure as President? Increased the amount of advocacy that we did for pediatricians. Prior to that most of our efforts had been focused on advocacy for our patients. Al Jacobsen laid the framework for a Practice Management Committee. Defeated onerous legislation that would require second opinions and unnecessary lab work for any child to receive ADD meds and other psych/neuro based meds.

Barb Smith, MD, accepts “Chapter of Excellence Award� from the National AAP PediatricDigest, Spring 2013 Page 19


We added a subspecialist to our Board. Instigation of monthly conference calls to conduct chapter business. This sounds like a simple thing but it seemed sort of revolutionary at the time. Reach Out and Read was expanding around the state. The Medical Home Project (now called Medical Services Project) continued to be a strong program. We worked on obesity, oral health, domestic violence, immunizations and received numerous grants for all of these. In your opinion, what have been the major changes in Pediatrics that have occurred over your career? The first thing I think of is vaccines. When I started practice there were three: DPT (no a),OPV and MMR. No MMR booster. None of the others that we recommend today. The schedule was a lot easier to remember! The most noticeable one in terms of really sick patients is Hib. I think there was rarely a time between our two Tucson PICUs that there was not a least one child with Hib meningitis in hospital. We also had epiglottitis, septic arthritis, cellulitis. My younger partners have never seen a case of Hib meningitis or worried about whether the middle of the night call about a febrile child was actually Hib. These vaccines are a miraculous development in medicine and parent refusal a huge heartache and headache for pediatricians. Perhaps because of some of this, our office practice has moved away from managing mostly physical illness to much more management of behavioral and developmental problems. We hospitalize many fewer patients. We have much less involvement in the hospital whether it is in the NICU, the PICU or the wards. Some of that is good. I shudder to think about the times that I managed PICU patients, sometimes all night, with only me and the resident and maybe a subspecialist. I know I have lost some skills in terms of procedures and taking care of really sick patients, but I think we are also losing important connections for our families that hospitalists and intensivists do not replace. What do you see as the major issues (either in child health or as a profession) that we face today? Although I love the many advocacy programs our chapter continues to support for both pediatricians and patients, I worry that we as pediatricians are increasingly less willing to spend the time and effort that is needed to keep those projects going in our communities. We have valuable knowledge for the public, parents and our governmental leaders that they need to help our children thrive. My view has always been that pediatricians have the best job in the world. It has been a gift and a privilege for me each time I help a family. But with that privilege also comes a wider responsibility to our communities to be involved in issues that may not mean more money for our practices, less time on call, fewer phone calls to answer, more patients crammed into a day. It is the responsibility to speak up for our children in a society which increasingly seems to ignore their value. My last bit of advice to the chapter is: NEVER let Sue Braga retire.

PEGGY STEMMLER, MD, MBA, 2003-2006 What were some of the major issues that you dealt with during your tenure as President? Stabilizing the financial status of the Chapter and what was then the Pediatric Foundation of Arizona. When I became president, the Foundation was a relatively new organization that acted as a fiscal agent for different grants that Chapter members or other related groups received. At the time, there was no requirement that grants pay the overhead costs for managing the money. The result was that Chapter funds were being used to offset the costs of running the Foundation. I helped put policies into place to sustain the Foundation over time, and to keep Chapter funds supporting Chapter projects. By the time the two organizations merged in 2011, they were both on stable financial footing. I also had the luxury of being one of the few, if any, Chapter presidents who did not PediatricDigest, Spring 2013 Page 20


practice. This meant that I spent a lot of time going to meetings on behalf of the Chapter, which helped to seed how the Chapter is now asked to the table for most policy-level meetings impacting children. The bonus is that we are now much better represented, since many members and staff take part in these meetings. In your opinion, what have been the major changes in Pediatrics that have occurred over your career? My training occurred as some of the newer immunizations came on line. Pediatrics has moved from a focus on treating a variety of infectious diseases to needing to react more to social/ behavioral/developmental challenges. Also, children with chronic health conditions are living longer and richer lives, and a challenge of Pediatrics is how to best help families in promoting health and wellness for these kids. What do you see as the major issues (either in child health or as a profession) that we face today? Adapting to the changing demands of care. We are moving toward a payment system that will pay for better outcomes - fewer hospital/ER visits, less absenteeism, early identification of problems – all in the face of an information explosion. Practice will need to adapt to these changing demands, but physicians seem to find it difficult to figure out how. What advice do you have for the AzAAP as an organization? Continue to anticipate what tools and information pediatricians will need for the future, continue to advocate for the common challenges all members face, and work toward healthy pediatric practices!

KEITH DVEIRIN, MD, 2006-2008 What were some of the major issues that you dealt with during your tenure as President? The implementation of the First Things First program. Starting the process of creating a Pediatric Council and of expanding the Board of directors, both of which really took off in the next two years under Ron Fischler. Hiring Rebecca Nevedale as a second full-time staff member alongside the incomparable Sue Braga, who celebrated her 10th anniversary as AzAAP Executive Director during this time. Please relate a specific event, memory, or experience that serves as a highlight (or lowlight) of your Presidency. One highlight was working on the United Healthcare P4P issue. This started because I looked at the data United sent to me for my own practice, and it didn’t make sense to me. So I looked into it further, and found serious flaws in the program in the criteria that were being used to evaluate “quality” of care being provided by pediatricians and in how the data were being gathered. I brought this to the attention of national AAP, and they arranged a meeting at AAP headquarters in Elk Grove Village with the national medical director for United and the national director of the P4P program and others in top management. This resulted in changes to United’s P4P program, and got national AAP looking more into how to measure quality in pediatric practice. I also was invited to give a talk on P4P at the NCE. This to me is a good example of how much of an impact an individual can make in the AAP at the Chapter or National level if they find an issue they care about and get involved. In your opinion, what have been the major changes in Pediatrics that have occurred over your career? The fragmentation of pediatric practice, such that very few of us do everything in our practice that we were trained to do or that we did when we started out. Fewer and fewer pediatricians take care of their own patients in the hospital, and much of the more complicated care is referred to specialists. This is due to many factors, including financial pressures. I think that this is a change that is here to stay. It has made communication and coordination of care more difficult. What do you see as the major issues (either in child health or as a profession) that we face today? Access to care. We have been chipping away at it, but it is still a problem. Too many children and families are still uninsured or underinsured. The Affordable Care Act, as it continues to be fully implemented, will help to some PediatricDigest, Spring 2013 Page 21


degree. But until there is truly universal health coverage in this country this will continue to be a struggle. Unfortunately, I don’t think this issue will be resolved during my professional career. Another major issue going forward is how we are going to pay for medical care. I think this will move away from the current fee-for-service model to a more outcomes-based approach. So there will be more emphasis on quality of care and quality measurement, coordination of care, and the medical home. Individual practitioners will need help in doing this. AAP and AzAAP can play a significant role in helping practitioners adjust to this new reality. What advice do you have for the AzAAP as an organization? One of the most difficult issues of the past and the future for AzAAP is increasing member recruitment and involvement. This will likely continue to be an issue as the fragmentation of pediatric practice and the financial pressures of practice make it harder for pediatricians to come together at the chapter level. But this also makes it more important for them to do so. Please feel free to add anything else that you wish It was an honor, privilege, and pleasure to serve as AzAAP president. I encourage anyone who has an interest to get involved in the Chapter. Find something, an issue, that you are passionate about and pursue it. That is how most of us got our start with AzAAP. You will really enjoy the people you meet and work with, and you never know where it will lead. Plus, it is a nice diversion from the day-to-day practice of pediatrics.

RON FISCHLER 2008-2010 What were some of the major issues that you dealt with during your tenure as President? Establishment of the Pediatric Council in 2007. With the help of AAP national and the dedication of Rebecca Nevedale, we hand-picked members who had interest in the business aspects of pediatrics and held initial meetings in my living room and then created regular meetings with Medical Directors of the various plans. Jeff Couchman, MD agreed to conduct a study of costs and payments for vaccines and we followed the AAP guidelines on managing the data to avoid antitrust issues. Laboriously collected and analyzed thanks to Jeff and members of the Council, our data validated the AAP business case for vaccine pricing and pricing for administration fees and we began “educating” medical directors on the true costs of administering vaccines. We also met with Pharma around providing ample notice of price increases and pricing of new vaccines to assure that pediatricians were not squeezed. The formation of the Obesity Committee under the leadership of Rene Bartos, MD with help from Rob Ziltzer, MD who had become a full time weight specialist . They published a white paper, and created a statewide intiative called 5210 AZ Way To Go! to create awareness and form an intervention strategy for pediatric offices and schools and brought the Chapter significant recognition for its work at the forefront of combatting the epidemic of childhood obesity. “Steven’s Law” mandated insurance coverage for behavioral treatment for children with Autism. Our chapter brought together Developmental Pediatricians with psychiatrists, neurologists, geneticists and experts in special education and created a Consensus Statement on the care of children with Autism that provided up to date guidelines for screening, diagnosis and treatment. Expansion of the Board from a group of 5-6 officers to a larger more diverse Board of 17 that better represented Pediatrics in Arizona including Academic programs, practitioners from rural and urban Arizona , those working in public and private settings , those on Indian Reservations. What advice do you have for the AzAAP as an organization? I look back on my years with AzAAP as challenging and rewarding and I value the relationships I established and strengthened. It is gratifying to see how the organization grew and thrived under Arturo’s able leadership and under the PediatricDigest, Spring 2013 Page 22


reorganization he and Sue Braga engineered. I wish Dale and Delphis much success in the years ahead. I strongly recommend others to get involved in this wonderful organization that speaks for children and for our profession. As long as the organization has a steady influx of new people from diverse settings and new ideas, it will remain fresh and vital. I think the addition of non-physician community leaders to the Board will only strengthen the influence we have. And in these uncertain times for healthcare, that is a good thing.

ARTURO GONZALEZ, MD, 2010-2012 What were some of the major issues that you dealt with during your tenure as President? Appropriate vaccine payment to physicians. We attempted to pass a vaccine bill that would give appropriate payment to Pediatricians and physicians who provide vaccines to their patients. The Bill passed in the House but not the Senate. However, we gained respect from our legislators that the AzAAP Chapter is a force to be reckoned with when it pertains to children's issues. Immigration issues as it pertains to children. With the passing of SB1070 in our state, US children of undocumented parents became a concern as it pertains to their rights as citizens of our country. The Arizona Chapter became the center focus of attention at every National AAP meeting and our opinions on how to deal with this were well respected. I remain involved on a national level as an active member of the National AAP Special Interest Group on Immigration. We created a white paper on immigration that will be given to the Obama Administration as they consider comprehensive Immigration reform. Please relate a specific event, memory, or experience that serves as a highlight (or lowlight) of your Presidency. High: Branding of the Chapter as an organized and respected organization of Pediatricians and allied health professionals. We increased our Board of Directors members from 17 to 25, and for the first time in the history of the Chapter we accepted and included two members of the Business community to our Board. High: Had a second road trip to the Northern part of our state, namely Flagstaff and Tuba City including the Navajo Nation and met with exceptional Pediatricians that care for children and adolescents despite their limitations for resources and specialists. The first trip was to the Douglas/Bisbee region when I was finishing my Vice-President position. Low: Not being able to pass legislation that required private insurance plans to pay appropriately for vaccines which directly affects our members. In your opinion, what have been the major changes in Pediatrics that have occurred over your career? Organized Pediatric Hospitalists that care for hospitalized patients. They did not exist when I finished my residency 20 years ago. Pediatric Residency work hours went from 36 hour calls to 24 hour calls, to now less than that. Most recently, the development of Clinical Integration organizations (CIO) and Accountable Care Organizations (ACO) with or without hospital involvement. The advancement of medical technology at our finger tips with the use of smart phones and iPads. What do you see as the major issues (either in child health or as a profession) that we face today? As a Pediatrician, my concern is that children's health, especially preventative health, is still not a priority for insurance companies and for our legislators. It still bothers me when I hear that a child is not insured and is not getting appropriate medical care. I hope that with the passing of the Affordable Care Act all children are covered for preventative care as well as vaccinations. It upsets me when I hear that our legislators have tried and failed to block Medicaid coverage or SCHIP as "they balance their state budgets". I'm also very concerned about the Obesity epidemic affecting our children. As the powerful country that we are, we should be at the top of the health care delivery, and not where we PediatricDigest, Spring 2013 Page 23


currently are. We all know that children are our future. We need to ensure that we shift our approach to prevention and not only to treatment, especially in mental health which is so fragmented and lacking. We need to invest heavily in research as technology is developing at such a fast pace. If we have healthy children, they will grow up to be healthy adults that can contribute to the future of this country. What advice do you have for the AzAAP as an organization? To continue to actively engage its members to become involved in children's issues in our state because there is power in numbers. Please feel free to add anything else that you wish It has been an honor and the highlight of my medical career to have been President of our prestigious Arizona Chapter of the AAP. I never imagined when I was a kid, and wanted to become a doctor that I would attain such an esteemed position.

AzAAP Membership History Since 1980

Membership numbers prior to 2002 only include “voting members� of National AAP.

PediatricDigest, Spring 2013 Page 24


Best Care For Kids AZAAP CHAPTER INITIATIVE How do you keep up with all of the changes in pediatric care in a world where knowledge is increasing exponentially? How do you get ready for changes in payment where the focus will be on outcomes and not the number of children you see? Best Care for Kids at AzAAP is here to help answer those questions. Our primary care quality improvement initiatives focus on how to think differently about how you practice to prepare for outcomes-based payment. In the words of Dr. Darlene Melk, a group learning participant, The … learning collaborative has served as a key resource in establishing the framework needed for us to improve the service and quality of care we are offering to our patients. We often get caught up in the routine of seeing patients day in and day out, that we forget to take a step back and look at the whole picture. I really appreciated the personalized coaching we received and the crucial education on all the different quality improvement terms and measures that are part of today's ever changing healthcare world. I would highly recommend participation in the collaborative as a way to streamline your quality improvement efforts. Under the collaborative model, 8-10 practices work on small changes over a period of months, and make sure the changes are for the better before they go practice-wide. Monthly conference calls provide a forum to share ideas and learn from one another. After Dr. Ron Jones’ practice started doing huddles and spoke on a conference call about how effective they were and how productivity increased, even those practices that said they didn’t have time for huddles started to rethink the idea. One idea

PediatricDigest, Spring 2013 Page 26

snowballs to other practices with little effort. The focus is on creating different systems of care using the tools the practice has now – EMR or not – to make sure that the right care happens for every child at every visit. Our mantra is “baby steps” – small changes that work toward a bigger goal. Trying harder is great, but putting systems in place to help is even better.

LEARN MORE AT WWW.AzAAP.ORG


AZAAP

CHILDHOOD OBESITY COMMITTEE UPDATE As pediatricians, the childhood obesity epidemic is not exactly “news” to us –we have longdiscussed this growing trend we have seen in our patients. AzAAP has implemented various projects through the years related to childhood obesity. Most recently, we worked to distribute “BMI Wheels” in 2004 and five years later we formalized our activities by forming the AzAAP Childhood Obesity Committee. Some of us on the Committee have volunteered many hours. Some of us have volunteered just one hour to help with an important project. And, some of us simply participate in discussion on the Chapter’s Obesity ListServ. Because our Committee provides a wide range of ways to be involved, it continues to grow in numbers (no pun intended!) Our members are from diverse geographic regions of the State and clinical backgrounds. We are made up of community pediatricians who work in a variety of settings, pediatric subspecialists, nurse practitioners, and even “expert guests” including registered dieticians, university researchers and community health educators. We are all working together to determine what role the AzAAP and our membership should have in solving the childhood obesity epidemic.

Our main focus areas for 2013 are, 1) clinician education, and 2) utilizing the media to provide Arizona with a common obesity prevention message: “5210.” Our media workgroup is very active and has approved a site map for a new website, regularly contributes to print and news stories, and has a new social media strategy to target families: @GetFitAZKids.

clinicians and attractive to families we care for. It is important to our group that we create tools you will actually use to help adhere to the clinical recommendations. We are also surveying community organizations active in obesity intervention to identify what type of nutrition/ physical activity information they feel should be provided to families in their medical home setting.

In regards to clinician education, we continue to see it as our obligation to ensure that our colleagues are up-to-date with the latest clinical research related to childhood obesity. In 2012, our Chapter received (another) award from National AAP in recognition for creating and disseminating, AzAAP White Paper: Recommendations for Childhood Obesity Prevention, Assessment and Treatment. This year, we are utilizing this white paper to update our 5210 AZ Way To Go! obesity prevention toolbox originally distributed in 2009 which received local and national recognition. We have received funding from the Aetna Foundation to update the toolbox and even to fund a professional designer to be sure the tools are easily used by

So what’s next for us? After our current projects are completed, the AzAAP Childhood Obesity Committee will identify strategies to help the AzAAP membership best engage in their communities’ obesity prevention, intervention and policy initiatives. We are excited to venture down this new path and to work in partnership with organizations and individuals equally committed to helping Arizona children and their families make good wellness decisions. We are ALWAYS seeking input and help from members interested in childhood obesity. The amount of time you spend is up to you, but we need YOUR voice. To get involved, email our chair, Karen Eynon, RN MSN CPNP at AzAAPLeadership@azaap.org PediatricDigest, Summer 2013 Page 27


Advancing Pediatric Medicine AzAAP Career Center www.AzAAP.org/career_center Looking for a job? Searching for someone to join your practice? Find pediatric jobs and highly skilled medical professionals on the AzAAP Career Center. Members can post 6-month-spreads free of charge anytime! To place an ad contact AzAAPLeadership@azaap.org or call 602-532-0137 ext. 404.

2600 N Central Avenue Suite 635 Phoenix, AZ 85004


Pediatric Digest - Spring 2013