Cap Scan - April 2021 by Capital Medical Society

APRIL EDITION, VOLUME 2021, NO. 4

ANESTHESIOLOGY ASSOCIATES OF TALLAHASSEE ESTABLISHES SCHOLARSHIP ENDOWMENT FOR MEDICAL STUDENTS AT THE FSU COLLEGE OF MEDICINE By Pam Irwin, CMS Executive Director No one is more aware of the impact of excellent medical education or medical school debt than a physician. That awareness can spur actions to lend a hand to the next generation of physicians. Anesthesiology Associates of Tallahassee (AAoT) is a group of physicians who are paying it forward. Investing in future physicians is in their blood. AAoT has been the primary provider of anesthesia services in Tallahassee since the 1980’s, with members joining the group and staying for decades until retirement. They are deeply rooted in the medical community serving key roles at both local hospitals and most surgery centers. Their families grow up here, and many of their children pass through TCC and FSU and go on to medical careers. Some of their children have returned as second generation physicians or allied health professionals. The physicians of AAoT support medical students by teaching and defraying the cost of medical education. Even during the COVID-19 pandemic, as one of the specialty groups at the most significant risk of contracting COVID-19, they are relentless in their support of medical students.

By establishing The Anesthesiology Associates of Tallahassee Scholarship Endowment at the Capital Medical Society Foundation in 2020, they are further investing in the future of medicine. The FSU College of Medicine, established in 2000, was built upon years of dedication and perseverance to prepare future physicians. The need for more physicians in rural areas of Northwest Florida spurred the Florida State University Program in Medical Sciences (PIMS) in the 1970’s. By completing the first year of medical school through this program, students could transfer to the University of Florida in Gainesville to complete their M.D. studies. Drs. Mark Applegate, Mark Cannella, Kevin Draper, James (Michael) Frankland, Greg McLanahan, and Steve Mnookin are either PIMS or FSU College of Medicine graduates. The FSU College of Medicine’s teaching model provides communitybased learning opportunities. Clinical education is provided by outstanding physicians in the community, not in one teaching hospital, but in hospitals, skilled nursing facilities, managed-care facilities, managedcare organizations, private clinics, and other outpatient settings. These community physicians are paid a monetary stipend by the

FSU College of Medicine for their time educating medical students. An anesthesia elective has been offered to all seniors each year. Clerkship faculty for the FSU College of Medicine’s Tallahassee Regional Campus has included anesthesiologists from AAoT since 2003, helping to educate the first graduating class in 2005. Anesthesiologists “share” students rotating through Tallahassee Memorial HealthCare and Capital Regional Medical Center. The appointments include: Mark Applegate, M.D. Appointment 4/15/2011 Robert Atwater, M.D. Appointment 3/29/2004 Vipul V. Bhimani, M.D. Appointment 11/16/2016 Mark Cannella, M.D. Appointment 1/21/2011 Jesus Diaz, M.D. Appointment 11/10/2016 David Draper, M.D. Appointment 11/20/2007 James Frankland, M.D. Appointment 5/5/2004 John C. Green, M.D. Appointment 11/8/2016 Richard Henry, M.D. Appointment 4/20/2006 Elizabeth Horton, M.D. Appointment 11/9/2016 Nancy Loeffler, M.D. Appointment 11/26/2003 CONTINUED ON PAGE 3

CAPITAL MEDICAL SOCIETY 2021 MEETINGS CALENDAR April 20, 2021 Virtual CME (1-Hour) Panel Discussion – Exploring the Long-Term Consequences of a COVID-19 Diagnosis 6:30 pm

May 18, 2021 Virtual CME (1-Hour) Panel Discussion – Bringing it All Together: Expanding the Scope of Type 2 Diabetes Management 6:30 pm CONTINUED ON PAGE 7

BOARD OF GOVERNORS Rohan Joseph, M.D., President

I N T H I S I SS U E :

MISSION: TO PROMOTE THE PRACTICE OF MEDICINE FOR THE ULTIMATE BENEFIT OF THE PATIENT. (850) 877-9018 Fax: (850) 878-0218 www.capmed.org

Paresh Patel, M.D., President-Elect

The Anesthesiology Associates of Tallahassee Scholarship Endowment....................................................1 Professional Notes..............................................................4 In Memoriam........................................................................5 CMS Virtual Lunchtime Learning Seminars..................6 Capital Medical Society 2021 Meetings Calendar.......7 COVID-19 – One Year Later...............................................8 Metastatic Breast Cancer Awareness Month..............10 Simpler Times..................................................................... 11 CMS Foundation Physician Wellness Program.......... 12 Donate to the CMS Foundation..................................... 13 CMS Foundation: We Care Network............................ 14

Sarah Ko, M.D., Secretary/Treasurer Ken Whithaus, M.D., Immediate Past President Nicole Balmer, M.D. David Burns, M.D.

HAPPY BIRTHDAY!

Russell Cole, M.D.

{APRIL BIRTHDAYS}

Amulya Konda, M.D. Helen Paulson, M.D. Shawn Ramsey, D.O.

Joseph Chen, M.D. – 2nd

J. Anthony Giralt, M.D. – 13th

Andrea Stephens, CMS Alliance

Amy Reimer Neal, M.D. – 3rd

Briana Thompson, M.D. – 13th

Cody VanLandingham, M.D.

Amanda Shearer, M.D. – 3rd

Louis St. Petery, M.D. – 14th

Julia Weeks, M.D.

Duncan Postma, M.D. – 4th

Edward Forster, M.D. – 15th

Michael Ford, M.D. – 5th

Stephanie Lee, M.D. – 18th

Maria Andrews, M.D. – 7th

Jongin Julia Baek, M.D. – 20th

Randy Reese, M.D. – 7th

Lisa Cook, M.D. – 20th

Barbara Jaeger, M.D. – 8th

Ira Wayne Freilich, M.D. – 20th

Eduardo Serrano, M.D. – 8th

William Placilla, M.D. – 20th

Jesse Judelle, M.D. – 9th

R. James Mabry, M.D. – 21st

Terry McCoy, M.D. – 10th

Jana Bures-Forsthoefel, M.D. – 24th

Vikki McKinnie, M.D. – 10th

James Davenport, M.D. – 25th

Israel A. Oloye, M.D. – 10th

Mary Swain, M.D. – 25th

Gillian Richmond, M.D. – 10th

Clifton Bailey, M.D. – 27th

Allison K. Moore, D.O. – 11th

Shalini Golla, M.D. – 29th

Adanna Amanze, M.D. – 12th

Farhat Khairallah, M.D. – 29th

Mansukhlal Padalia, M.D. – 12th

Julian Hurt, M.D. – 30th

Graham Whitaker, M.D. Pam Irwin, Executive Director, CMS

PUBLICATION EDITOR Frank Skilling, M.D.

MANAGING EDITOR Shannon Boyle

GRAPHIC DESIGN Gandy Printers

EDITOR EMERITUS Charles E. Moore, M.D.

ARE YOU INTERESTED IN WRITING AN ARTICLE FOR CAP SCAN?

Please contact Shannon Boyle at sboyle@capmed.org. All articles submitted will be reviewed by your peers prior to publishing.

Cap Scan is published during the first week of each month and is the official publication of the Capital Medical Society. Advertising in Cap Scan does not imply approval or endorsement by the Capital Medical Society. The opinions expressed are those of the individual authors and do not necessarily reflect the official policies of the Capital Medical Society. 2

Charles Cooper, M.D. – 13th

HAPPY BIRTHDAY! WE ARE SO GLAD YOU WERE BORN!

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

DID WE MISS YOUR BIRTHDAY? IF SO, PLEASE EMAIL ROSALIE CARLIN AT RCARLIN@CAPMED.ORG!

THE ANESTHESIOLOGY ASSOCIATES OF TALLAHASSEE SCHOLARSHIP ENDOWMENT

CONTINUED FROM COVER

William Marchio, M.D. Appointment 11/8/2016 Greg McLanahan, M.D. Appointment 4/15/2011 Jeffrey Myers, M.D. Appointment 1/12/2004 James O'Neill, M.D. Appointment 1/19/2005 Brence Sell, M.D. Appointment 1/21/2004 David D. Stapleton, M.D. Appointment 11/9/2016 Liberty E. Taylor, M.D. Appointment 11/10/2016 James Totten, M.D. Appointment 1/26/2011 Brett C. Wenleder, M.D. Appointment 11/14/2016 Christopher Wilhoit, M.D. Appointment 3/11/2004 Fast forward. Dr. Nancy Loeffler is a past President of the Capital Medical Society Board of Governors and serves as Secretary of the Capital Medical Society Foundation (CMSF). Many of their physicians, like Dr. Brence Sell, are deeply engaged in organized medicine. Dr. Sell is the Vice President of the Florida Society of Anesthesiologists (FSA). Dr. Mark Applegate and Dr. Mark Cannella have both served on the CMSF Scholarship Committee. Dr. Cannella still serves on that committee. The CMSF Scholarship Committee awards up to $50,000 annually to Florida State University College of Medicine students. The Capital Medical Society Foundation Scholarship Fund has been one of the most successful and wellrespected programs first established by Capital Medical Society more than 33 years ago. Archived records since 1997 document that Capital Medical Society Foundation has provided scholarships totaling $698,489 to students in the PIMS program, the precursor to FSU College of Medicine, University of Florida medical students, and FSU College of Medicine students. $681,000 of those scholarships have been awarded to FSU College of Medicine students beginning with its inaugural Class of 2005. Many of those past recipients are now

practicing in Tallahassee. Some serve on the Scholarship Committee. In 2018, Anesthesiology Associates of Tallahassee established an endowment at the FSU College of Medicine to establish a legacy award in anesthesiology. “Recipients of this award must be a fourth-year student in good academic standing and have completed a rotation in an anesthesia elective. Preference is given to those who have successfully matched in Anesthesiology and have expressed an interest in returning to Tallahassee, or the North Florida Panhandle following residency.” AAoT fosters interest in medicine by being a frequent sponsor of “observer” undergraduate students considering a variety of medical fields. They serve as a clinical site for nurse anesthetists, anesthesiology assistants, and for students from the FSU College of Medicine and the Alabama College of Medicine. But, this medical practice wants to do more. They liked the Capital Medical Society Foundation’s scholarship fund model of putting scholarship checks directly into medical students’ hands, and they wanted to establish a community legacy to encourage FSU College of Medicine students in the community. The monetary stipends paid by the FSU College of Medicine to this band of anesthesiologists had been pooled and left unspent. This pool became the seed gift to establish The Anesthesiology Associates of Tallahassee Scholarship Endowment with the Capital Medical Society Foundation. Interest earned on this endowment will provide additional scholarship funding to be awarded. It was the goal of AAoT that other physicians and like-minded donors would join them and donate to AAoT’s endowment to increase the funding available through this permanent scholarship pipeline. The Capital Medical Society Foundation Scholarship Fund is unendowed. It is dependent on annual donations and Holiday Auction income to provide funding for scholarships each year.

Scholarships will be awarded to medical students with financial needs who are in good academic standing in their first or secondyear of medical school at the Florida State University College of Medicine and third and fourth-year medical students at the Tallahassee Regional Campus of FSU College of Medicine. Preference is given to North Florida residents and students who plan to practice in North Florida after completing their residencies. Others may grow this endowment by making a gift to the CMS Foundation for The Anesthesiology Associates of Tallahassee Scholarship Endowment by check or online at https://capmed.org/donate/. Dr. Frank Walker, chair of the Capital Medical Society Foundation’s Scholarship Committee, said, “Attending medical school is a costly proposition these days. I am pleased and proud of my fellow physicians who are helping support medical students.” Nearly two-thirds of actively practicing physicians still carry debt from medical school, according to a 2019 national survey by Weatherby Healthcare. Of those physicians, 32% had more than $250,000 in debt. The high cost of medical school loans weighs heavily on doctors for many years following graduation. One-third of respondents (34%) expected to take at least ten years to pay off their student loans. The physicians of Anesthesiology Associates of Tallahassee, like many medical practices in Tallahassee, are visionary dream makers. They are helping shape the future of medicine by investing in medical education. We thank them and the many physicians who are helping educate the next generation of physicians and are supporting CMS Foundation scholarship opportunities for medical students. If you would like more information about how to support medical school scholarships, please contact Pam Irwin at pirwin@capmed.org or call 850-559-8611.

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

PROFESSIONAL NOTES

PROFESSIONAL NOTES Dr. Andrea Friall was an Honoree at the Capital Area Healthy Start Coalition’s 2021 Angel Awards Celebration on February 11, 2021. The event was a kickoff for Healthy Start’s 30th birthday and to honor those who allowed the Capital Area Healthy Star Coalition to make an impact on our local community. This organization works to improve the health of pregnant moms, infants, and families. Congratulations to Dr. Friall and to Capital Area Healthy Start Coalition!

On March 5, 2021, Dr. Andrea Friall had the pleasure of serving as the Doctor of the Day by the invitation of The Honorable Colleen Burton. The honor allowed her to sit on the House floor and watch our elected leaders in action.

On March 9, 2021, Dr. Alan Chen presented a check for $13,020 to the Leon County School Board from Dr. Ginaldi's Healthy Kids Art Contest (http://youtu.be/oSciSkg6ZD0?t=2440). The contest was started six years ago by the late Dr. Sergio Ginaldi and supported by his colleagues at Radiology Associates of Tallahassee. The original theme was healthy lungs but has expanded to depict different versions of wellness. It allows local elementary art students to design and create images that spread awareness about wellness. Students and art teachers highly anticipate the contest. The art teachers submit the best artwork to Radiology Associates. A panel of judges selects 12 artworks for inclusion in a calendar. The proceeds from calendar sales support the participating schools' art programs. The funding helps purchase art supplies and equipment. This year, the theme was "Let's Play," encouraging students to compose images featuring their favorite activities. Though the 2020 contest kicked off during the pandemic's height, that presented an opportunity to reinforce ways to stay safe and active during the lockdown. Twelve schools participated. Dr. Sergio Ginaldi passed away on Sept. 5. His colleagues are determined to continue the annual art contest in his memory.

CMS Members: If you receive accolades, please let us know, so we can include you in this section! Email the details to Shannon Boyle at sboyle@capmed.org. 4

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

IN MEMORIAM

BENJAMIN LAND BIVINS, M.D. 1939 - 2021

WILTON RODGERS KANE, M.D. FEBRUARY 1, 2021

JOSEPH PAGANO, M.D. 1962 - 2021

Dr. Kishor Muniyappa 4012 Kelcey Ct Ste 103| Tallahassee, FL 32308

Phone 850.297.0351 | Fax 850.297.0352

Inspiring Good Health

www.TALLYGASTROHEALTH.com CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

CMS VIRTUAL LUNCHTIME LEARNING SEMINARS

CAPITAL MEDICAL SOCIETY VIRTUAL LUNCHTIME LEARNING SEMINARS ~ These seminars will be virtual until further notice ~ MARK YOUR CALENDARS FOR THE REMAINING SPRING 2021 LUNCH AND LEARN SEMINARS: April 21, 2021 What’s the Cure? Proper Reporting and Use of Your COVID Funding The CARES Act introduced two critical assistance programs to health care practitioners in the midst of the Coronavirus pandemic. The Provider Relief Fund (PRF), issued by the Department of Health & Human Services, provided a muchneeded cash infusion for physician practices over the past year. Meanwhile, the Paycheck Protection Program (PPP) helped many businesses stay afloat and keep employees employed in the face of plummeting revenues. However, the PRF proceeds have specific and stringent reporting and auditing requirements once certain thresholds are met. And while PPP loans are not taxed if the funds are used appropriately and forgiven, there are specific guidelines you must follow to avoid issues. With additional guidance being released regularly, it’s hard to stay on top of what you need to do. During this presentation, we’ll provide the most recent update on reporting of PRF payments, a refresher on how these PRF funds can be used, the PRF audit requirement, PPP2 eligibility, expanded definitions of non-payroll expenses for PPP purposes, PPP loan forgiveness, and any tax and financial reporting requirements resulting from PRF and PPP. Learning Objectives: After our presentation, you’ll be able to: • Separately track PRF and PPP funds; • Understand PRF reporting requirements • Understand the PPP loan and forgiveness process; • Assess eligibility for PPP2 loans • Review tax liability obligations of any PPP and PRF funding received; and, • Assess the tax implications to a medical practice if it received both PRF and PPP money – and how this could affect loan forgiveness or the repayment of PRF funds

May 19, 2021 Take Your Practice’s Revenues to the Max Think you’re getting the most money out of your practice? According to The Medical Group Management Association (MGMA), American medical practices lose $125 billion every year in unpaid and underpaid claims. So how do you stop the bleeding? During this webinar, we’ll show how you could discover thousands of dollars in lost practice revenues by analyzing scheduling gaps, copays collected, proactive billing, follow up, past-due collection efforts and more. Through case studies, you’ll see how a walk-through of your processes in each phase of your revenue cycle (including patient intake, mid-revenue cycle, and collections improvement) will help you find missed opportunities. Learning Objectives: After our presentation, you’ll be able to: • Learn how to conduct a walk-through of the administrative and financial functions of each phase of their revenue cycle • Find missed opportunities for capturing more revenue • Determine better ways to fill the schedule • Evaluate the requirements for each third-party payors • Identify inconsistencies in coding and billing by practitioners Speakers: Nadia Batey, CPA and Jay Hutto, CPA, James Moore CPAs and Consultants Sponsor: Liz Thiele, TMH Federal Credit Union (https://www.tmhfcu.org/)

On February 17th, Sheila Erwin, CPC, CPPM, Senior Consultant at Medical A/R Revenue Solutions, gave an excellent program on E/M Office Coding Changes in 2021.

Speakers: Nadia Batey, CPA and Jay Hutto, CPA, James Moore CPAs and Consultants Sponsor: Liz Thiele, TMH Federal Credit Union (https://www.tmhfcu.org/)

Registration Required Time: 12:30 PM to 1:30 PM No Cost for these virtual seminars. For more information or to RSVP, please contact Rosalie Carlin at (850) 877-9018 or rcarlin@capmed.org. 6

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

In addition to presenting the seminar, we thank Medical A/R Revenue Solutions (http://medarsolutions.com/) for sponsoring the February 17th Virtual Lunchtime Learning Seminar.

CAPITAL MEDICAL SOCIETY 2021 MEETINGS CALENDAR

CAPITAL MEDICAL SOCIETY 2021 MEETINGS CALENDAR CONTINUED FROM COVER

September 14, 2021 Celebration Awards Dinner University Center Club at FSU 6:30 pm September 21, 2021 CME Panel Discussion – Updates and Debates in Cancer Screening 6:30 pm Location TBA

October 19, 2021 CME (2-Hours) Prevention of Medical Errors 6:30 pm Location TBA November 16, 2021 CME Health Disparities and Social Determinants 6:30 pm Location TBA

December 2, 2021 CMS Foundation Holiday Auction Time and Location TBA

Wolfson Children’s and Nemours Children’s specialists are here for Leon County kids and providers. Our Wolfson Children’s Specialty Centers at Tallahassee Memorial HealthCare bring doctors from two nationally recognized children’s health organizations close to home. Specialties we provide in Tallahassee include: Pediatric cardiology to diagnose, treat and manage congenital heart conditions; on-site testing Appts: 850.629.4861 • Fax: 850.629.4859 Pediatric gastroenterology for diseases of the digestive tract

Pediatric urology for complex urinary and genital conditions

Pediatric pulmonology for common and complex lung conditions

Pediatric hematology for all types of acute and chronic blood disorders

Appts: 904.697.3600 • Fax: 904.697.3927 To learn more, contact Wolfson Children’s Business Development Specialist Faithe Galloway Zoda at 850.559.3072 or Faithe.Zoda@bmcjax.com. TMH.org/Wolfson ©2021 Baptist Health

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

COVID-19 — ONE YEAR LATER

COVID-19 — ONE YEAR LATER An online survey was conducted by the Capital Medical Society between March 4 and March 8, 2021 in Leon, Gadsden, Jefferson, and Wakulla Counties to assess the impact of the COVID-19 pandemic on medical practices that may be affecting healthcare access, healthcare outcomes, and the economic aspects of local medical practices. Surveys were sent to a total

of 118 practice managers and office managers of 53 primary care practices (Family Medicine, Pediatrics, Internal Medicine, OB&GYN) and 65 specialty medicine practices. The survey was anonymous. There were a total of 15 respondents. Respondents were also given the opportunity to share lessons learned from the pandemic.

Q1. Describe the state of your practice ﬁnances now compared to before the COVID-19 pandemic. 6.67%

Better than before

60%

More than before

Same as before

33.33%

Answered: 15 Skipped: 0

100

Q2. How has your staﬃng level changed since before the COVID-19 pandemic? 6.67%

I have more staﬀ members today

40%

I have fewer staﬀ members today

No change Answered: 15 Skipped: 0

53.33%

Q3. How does your total in-person patient visit volume now compared to before the COVID-19 pandemic? 73.33%

I’m seeing fewer patients today

20%

I’m seeing more patients today

No change Answered: 15 Skipped: 0

6.67%

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

100

COVID-19 — ONE YEAR LATER

Q5. How does your practice’s telehealth use now compare to your overall use in 2020?

Q4. Did the pandemic cause your practice to start using telehealth?

I’m using telehealth more than last year

80%

Yes

33.33%

I’m using telehealth less than last year 0%

No, we were already using telehealth

20%

Answered: 15 Skipped: 0

40%

100

I’m using it about the same

13.33%

I’ve never used telehealth

13.33%

Answered: 15 Skipped: 0

Q6. Do you agree with this statement? “Patients missing routine screenings or treatments has become a major issue.”

100

66.67%

60%

6.67%

40%

Not Sure Answered: 15 Skipped: 0

Q7. Is COVID-19 vaccine hesitancy an issue with your patients?

Yes Yes

100

Answered: 15 Skipped: 0

26.67%

Q8. What lessons have you learned from the pandemic that you will apply to your practice of medicine going forward? Masks and social distancing. Communication with staﬀ and patients is key. Being transparent with the employees to keep a positive environment. Prepare for the unforeseen. Be prepared as anything can happen. We need to have more PPE on hand than previously. We need to continue to push vaccinations. Answered: 5 Skipped: 10

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

METASTATIC BREAST CANCER AWARENESS MONTH

METASTATIC BREAST CANCER: UNFINISHED PROMISES By Karen Russell, M.D. I have a print of a mixed media work hanging outside my office in the hallway: a mosaic face of a smiling woman with long hair and a green background. This entire conversation piece is made up of tiny bras cut out of catalogs and pasted to form the likeness of an amazing woman named Jennifer. She was one of my first patients when I came out of fellowship, a young nurse with a seemingly routine breast cancer that quickly became metastatic, leading her to die from her disease much sooner than expected. Her grieving husband gave me this print to always remember her. I see her every day when I walk past, and think of the hundreds more like her already in my brief career who don’t have art to commemorate their lives. Metastatic Breast Cancer (MBC) Awareness Month is now one of many Florida advocacies, established in April, 2019. It bookends the pink month of October and reminds us we still have a long way to go in tackling this formidable killer. MBC has claimed the number two cancer mortality in women since 1987, when it was overtaken by lung cancer, but remains a bitter opponent with around 40,000 deaths every year in the U.S. Amazingly, death rates have dropped 40% from 1989 to 2017, through improved access to prevention and better treatment options once a diagnosis is made, so that many women and men never develop metastatic disease (American Cancer Society, Statistics). About 6% of women are diagnosed with MBC de novo, and approximately 30% of women diagnosed with breast cancer go on to develop MBC in their lifetime. The most recent inclusive five-year survival for MBC is 28%, but for many it has become a chronic illness. Some women can live for 10 to 20 years with treatment, typically those patients who are hormone receptor expressing. Per the best assessment of the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) data, there are about 150,000 U.S. women/ men living with MBC currently. “Breast Cancer” should now be redefined as “Breast Cancers.” The term encompasses at least four different major disease

subtypes based on molecular expression of hormone receptors (Estrogen and Progesterone receptors), HER2, or the lack of both, which has been dubbed Triple Negative Breast cancer (TNBC). In addition to this, we now know much more about the underlying biology of breast cancer than ever before from gene sequencing, and can often pick the “needle out of the haystack” for more aggressive ER+ breast cancers. There is often discordance between the receptors found in a primary breast cancer and a recurrence, so a metastasis biopsy is always obtained and receptors are repeated to guide changes in therapy. Given that most breast cancers are ER+/ HER2- (70%), most MBC patients are also ER+/HER2-, allowing us to use endocrine therapy for many of these patients for years before chemotherapy is considered. In the past six years, oral CDK 4/6 inhibitors of the cell cycle (palbociclib, abemaciclib) have emerged which lengthen the duration of effect of usual aromatase inhibitors (anastrazole, letrozole, exemestane). Everolimus, a spin-off of anti-rejection drugs used in transplant medicine, can also amplify endocrine effect. The IM injection fulvestrant may also be combined with these therapies, and an oral form of this medication is now being developed. Additionally, we now know about an enzyme called PIK3CA, and about 15-30% of women with ER+/ HER2- MBC may express this and receive treatment with the new targeted oral alpelisib. HER2 expressing MBC has several new agents as well, with trastuzumab (Herceptin) being the first game changer in cancer targeted therapies in 1998 when approved with Taxol for MBC. Now there are multiple new agents that can block HER2 for long term control of the disease, including several oral formulations and three new medications in the last 18 months! While HER2 expressing tumors have notoriously been more aggressive, these new medications have leveled the playing field in many ways for multiple lines of therapy. Triple Negative Breast Cancer has the lowest survival rate and predominantly affects younger women and Black women, frequently associated with germline

10 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

mutations in BRCA or other tumor suppressor genes. We cannot use the many new medications that now give ER+ or HER2+ MBC patient longevity, so there are less “tools in the toolbox”. Some TNBC MBC patients thankfully will respond to chemotherapy plus immunotherapy such as atezolizumab, which has been largely ineffective in ER+ or HER2-expressing breast cancer. In 2020, there was approval of the promising drug sacituzumab govitecan, an antibody-drug conjugate seeking a new target in the Trop-2 receptor, which is often overexpressed in TNBC. MBC patients now should all have germline genetic testing completed. If one has a BRCA gene or similar tumor suppressor gene mutation, oral targeted therapy known as PARP inhibitors (e.g. olaparib) can be used as yet another regimen to increase survival. Sequencing of the tumor genome itself in MBC can also in certain cases yield additional targets for new therapies. Research is the “Cure” for cancer, and certainly most medical oncology novel drug research is done first in the metastatic patient, then applied to the curative setting. Unfortunately, only about 3-4% of U.S. adult patients with cancer enroll on trials, largely because there is a lack of access for patients to clinical research in many communities. There are currently several MBC clinical trials available in Tallahassee and other options open at our regional academic centers of excellence to care for these women and men. All in all, it is more difficult for physicians to face breast cancer deaths today because there are so many more options. Every oncologist, and truly every physician, thinks of his or her “Jennifers”, the patients who died before the newest life-changing drug was designed, and wonders at the timing of it all. Thankfully, there are still many victories to be lived as most breast cancer patients are cured in 2021, and those that are not can thrive and survive for longer than at any time before, with the continued hope of the next therapy being developed.

SIMPLER TIMES

A WHOLE LOT ABOUT NOTHIN By Charles D. Williams, M.D., FACR, FAAP (“Pedro”) I was running late getting to work. I had run out of Total cereal and had to eat 12 bowls of that other stuff. I was trying to be my colon’s best friend. This put me behind and put me to thinking. Having time to do nothin has not been given it’s full due. It seems that many of us are so busy and responding to what is happening at the moment that we don’t have enough time to do nothin. We find ourselves working hard and making good time but we don’t know where we’re headed and we miss out on the simple pleasures of living. I noticed this past summer that even many kids didn’t have the chance to do nothin. They were being taken to swimming lessons, ball practice, music lessons and the list goes on. Their entire days were filled. They were so busy trying to respond to their parent’s wishes and trying to please their parents that they didn’t have enough time to simply enjoy being a kid. Summers aren’t spent doing nothin anymore. Summer time has become almost as hectic as the school year. Summer activities seemed to begin before the school year has ended and perhaps some of these activities do have some value. I wonder that while we strive to provide our children with every available opportunity, we are causing them to miss out on something else – the simple pleasure of living. The pleasure of living without obligations or schedules, the pleasure of enjoying moments as they come and just being a kid cause there isn’t anything more exciting to do. All of us miss some things from our own generation. In my time the freedom of a country boy was endless and we used it. We used our imagination to occupy ourselves and entertainment didn’t cost a dime. Any day could be a good day but it was left up to us to make it so. Wouldn’t it be wonderful having a summer of doing nothin? Days doing whatever struck our fancy. Days hanging out with your best friend – in my case my wife. It’s so easy to close my eyes and open up a wandering mind and see events of my summer childhood: taking off long handles, going barefooted to toughen up my feet and saving the wear and tear on my good shoes,

watching Mama airing the mattresses with sunshine, chasing mosquito hawks, noticing tall fragrant pines, smelling bacon and eggs and a pine scent in crisp morning air, hearing blue jays squawk their good mornings, and walking down a country road in the summer and smelling newly mowed hay. The scents, sounds and sights of summer – what memories and images they evoke. On lazy afternoons sitting with Grandma, there wasn’t much to disturb the tranquility except the angry scolding of blue jays. Their call will always remain a link to sitting in a rocker on the front porch with Grandma as she shared her memories and her past. She passed along family traditions, shared wisdom and moral values and showered us with love to last a lifetime. Back in Simpler Times there was plenty of time to appreciate your surroundings, plenty of time to talk to your family and friends, plenty of time for your parents to listen and hear your concerns, and time to day dream and ponder and decide what kind of person you wanted to be when you grew up. There was time to decide what kind of road you wanted to travel down in your life. These opportunities as a kid of doing nothin allowed a kid to use his or her imagination and dream and even figure who he or she is and where he or she is going. Even as adults doing nothin allows us to appreciate the simple pleasures in our own life and to figure out what we want in the remainder of our years and if we need to change direction. It allows us to get refreshed, refueled and ready to do something. We’re all so busy – both adults and children. Still we all sometimes need time to do nothin. There’s one problem as I see it. It’s hard knowing when you’re through. Reprinted with author permission from More Simpler Times. Dr. Williams’ sequel book, More Simpler Times, can be purchased from the Capital Medical Society. All proceeds from the book are donated to the Capital Medical Society Foundation’s We Care Network program. The total sales from his books have raised over $39,000 for the CMS Foundation’s We Care Network.

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

CMS FOUNDATION PHYSICIAN WELLNESS PROGRAM

SOME DAYS JUST AREN’T AS BRIGHT AS OTHERS THE CMSF PHYSICIAN WELLNESS PROGRAM IS HERE FOR YOU CMS Members, No denying that the last 12+ months could have been a bit better and brighter. If your days don't seem as bright, we hope you take advantage of this program. The CMSF’s Physician Wellness Program will pay for up to six completely confidential wellness coaching sessions with any of the counselors enrolled in our program (contact information located on right column). Pick up the phone and call any of the resources noted here. Telehealth options available during COVID-19.

Local Wellness Coaching Resources: • Paul Deitchman, Ph.D. - 850-878-3571 • Tracey Morse, Ph.D. - 850-556-7944 • Debra Weaver, Ph.D. - 850-942-5585 • Stephen Wright, Ph.D. - 850-222-3045 You can learn more about the program at https://capmed.org/members-only/ physician-wellness/, by emailing Pam Irwin at pirwin@capmed.org, or calling CMS at (850) 877-9018.

Special thanks to MagMutual Foundation and others who are helping the CMSF fund this program.

Announcing the Retirement of CMSF Physician Wellness Program Wellness Coaching Provider: C. Vincent Dix, Ph.D., LLC Effective March 31, 2021 We appreciate the services Dr. Dix has provided to local physicians since the inception of the Capital Medical Society Foundation’s Physician Wellness Program in 2017.

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

DONATE TO THE CMS FOUNDATION

The Impact of Private Support:

Donate to the CMS Foundation – We Thank Our Donors We thank the following donors who made a gift to the CMS Foundation this past month: Honor a Doctor – Capital Medical Society Foundation – Area of Greatest Need Jill Bauer – In Honor of Jesse Blake Bauer, M.D. Cynara Miller – In Memory of William Pericles Miller, M.D. Prime Meridian Bank – In Honor of Michael W. Forsthoefel, M.D. and Garrison Rolle, M.D. Honor a Doctor – We Care Network Endowment Fund Gavin Boone – In Honor of Roy Forman, M.D. Scholarship Fund David Bellamy, M.D. – In Memory of Benjamin Land Bivins, M.D. David Bellamy, M.D. – In Memory of Wilton Rodgers Kane, M.D. David Bellamy, M.D. – In Memory of Georgia Yola Katopodis We Care Network Joan Sharman St. Elizabeth Ann Seton Catholic Church

The Capital Medical Society Foundation’s community of donors strategically help fulfill its mission “to support the charitable efforts of physicians and others, increase access to healthcare, promote education and serve the community’s health needs through innovative projects that are exemplary, affordable and dignified.” ➢ Access to healthcare is increased through gifts to the We Care Network and the We Care Network Endowment Fund. More than $112.3 million in donated specialty medical and dental care has been provided to low-income, uninsured patients since the program was created in 1992. In fiscal year 2019-20, which ended June 30, 2020, more than $6.9 million in health care was donated. Gifts support the operational expenses of the program including salaries and benefits of the case management team who coordinate the donated care. ➢ To provide incentives to keep medical students trained at the FSU College of Medicine in the Big Bend after completion of their residencies and help meet the growing demand for physicians in Florida, gifts to the Scholarship Fund provide scholarships to FSU College of Medicine students who have expressed an interest in returning to the Big Bend to practice after completion of their residencies. $31,000 was awarded in 2020. ➢ Gifts to the Capital Medical Society Foundation help provide operational resources for the Capital Medical Society Foundation. In addition, modest grants are awarded to area non-profits whose programs improve access to healthcare for the underserved. In 2020, the CMSF awarded a total of $10,000 in grants to Elder Care Services for their In-Home Services Program and the Big Bend Hospice Foundation for bereavement services. Gifts to Honor and In Memoriam: You can make a gift to the CMS Foundation in memory of someone who has passed away or in honor of someone, such as a fellow physician, you hold in high esteem or has taken care of you or your family. The CMS Foundation will send an acknowledgement letter to those you memorialize and honor. How to Give: Through the generosity of donors, funds have been created in order to establish financial stability to meet our mission. You can make a gift at any time to one of the CMS Foundation’s current funds: 1) Capital Medical Society Foundation-area of greatest need 2) The Capital Medical Society Foundation Endowment 3) We Care Network 4) We Care Network Endowment 5) The Anesthesiology Associates of Tallahassee Scholarship Endowment 6) Scholarship Fund 7) The Ronald G. Pickett Endowment 8) Physician Wellness Fund Gifts should be made payable to the CMS Foundation and indicate on the memo line of your check to which designation you would like to give. Bring your check to the CMS Office or mail it: Capital Medical Society Foundation ~ 1204 Miccosukee Road ~ Tallahassee, FL 32308. Gifts may be made by credit card or direct debit from the CMS website. If you would like to discuss a gift of appreciated securities, an insurance policy, designation of retirement plan assets, estate gift, or multi-year pledge, please contact:

Your gifts to the Capital Medical Society Foundation transform lives in the Big Bend.

Pam Irwin Executive Director pirwin@capmed.org or (850) 877-9018 or after hours at (850) 559-8611 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

CMS FOUNDATION: WE CARE NETWORK

FOUNDATION

We Care Network

THANK YOU To our CMS members and We Care Network partners who provided healthcare to new patients in February 2021. Your generosity and support of the We Care Network makes a difference.

Physicians Christopher Babl, M.D. Venkata Bavikati, M.D. Marie Becker, M.D. Dhananjay Bendre, M.D. Andrew Borom, M.D. Tim Broeseker, M.D. David Burns, M.D. Alan Ming-Fong Chen, M.D. Armand Cognetta Jr., M.D. William Dixon IV, M.D. Chesley Durgin, M.D. Alberto Fernandez, M.D. Romyll Garcia, M.D. W. Harris Green, M.D. Larry Harper, M.D. Celeste Hart, M.D. Muhanad Hasan, M.D. Todd Hewitt, M.D. Marc Inglese, M.D. Amit Jain, M.D. Arjun Kaji, M.D. Farhat Khairallah, M.D. Sayeed Khalillullah, M.D. James Killius, M.D. Fang Sarah Ko, M.D. Amulya Konda, M.D. Maribel U. Lockwood, M.D. Michael Mangan, M.D. Hector Mejia, M.D. Tod Morris, M.D. Manoela Mota, M.D. Jayan Nair, M.D. Mitchell Peabody, D.O. Michael Pentaleri, M.D. Jorge Perez de Armas, M.D. Cybelle Pfeifer, M.D. Ovidiu Popa, M.D. Hussein Rayatzadeh, M.D. James Renehan, M.D. Allison Retzer, M.D. Adrian Roberts, M.D. Abel Romero-Corral, M.D. Tim Ruark, M.D. Jamey Sarvis, M.D. Philip Sharp, M.D. Gadi Silberman, M.D. Joshua Somerset, M.D.

Bhavik Soni, M.D. Matthew Standridge, M.D. Amanda Stephens, D.O. Lucas Stowers, M.D. Mary Swain, M.D. Christian del Carpio Tenorio, M.D. John Thabes, M.D. Alexander Ramirez Valderrama, M.D. Beatriz Cepeda Valery, M.D. Kaisa van der Kooi, M.D. Robert Watson, M.D. Tony Weaver, M.D. William Yaakob, M.D. Daniel Yang, M.D. Charles Yowell, M.D. Samuel Yu, M.D. Dentists Briano Allen, D.D.S. Walter Colón, D.M.D. William McFatter, D.D.S. Lawrence Pijut, D.M.D. Frank Swerdzewski, D.D.S. Lawrence Weaver, D.D.S. Facilities Advanced Urology Institute Airway Works, LLC Anesthesiology Associates Apalachee Primary Care Bastien Dental Care Beachton Denture Clinic BioTelemetry, Inc. Bond Community Health Center Capital Premier Womens Health, PA Care Point Health & Wellness Center Dermatology Associates Digestive Disease Clinic Enhanced Endodontics Eye Associates of Tallahassee Florida Cancer Specialists & Research Institute Frank Swerdzewski, DDS FSU PrimaryHealth Gadsden County Health Department Gynecologic Oncology of Tallahassee Jessie Furlow Medical Center Ketchum, Wood, & Burgert Pathology Associates Lawrence J. Pijut DMD PA Madison Medical Center Manocha, McSoley, Balan, and Manocha Dentistry Neighborhood Medical Center North Florida Nephrology Associates North Florida Regional Thyroid Center North Florida Women’s Care North Monroe Medical Center Periodontal Associates of North Florida

14 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

Radiology Associates of Tallahassee Red Hills Dental Associates Southern Medical Group, P.A. Tallahassee Diagnostic Imaging Tallahassee Ear, Nose, and Throat Tallahassee Enhanced Care Tallahassee Memorial Family Medicine Residency Program Tallahassee Memorial HealthCare TMH Physician Partners Cancer and Hematology TMH Physician Partners Cardiology and Internal Medicine TMH Physician Partners Cardiothoracic Surgery Specialists TMH Physician Partners Gynecologic Oncology Specialists TMH Physician Partners Pulmonary, Critical Care, and Sleep Specialists TMH Physician Partners Radiation Oncology Specialists TMH Physician Partners Heart Rhythm Clinic TMH Physician Partners Surgical Specialists TMH Physician Partners Urology Specialists TMH Physician Partners Wakulla TMH Transition Center Tallahassee Plastic Surgery Clinic Tallahassee Orthopedic Clinic TOC Canopy Wakulla County Health Department Wakulla Medical Center Women’s Imaging Center

Please contact Diana Bixler at dbixler@capmed.org or 201-0130 if you are a We Care Network volunteer and you provided volunteer specialty care in the month of February 2021, and your name is omitted.

The We Care Network strongly encourages our volunteer physicians and dentists to send their value of donated services to us. The value of donated services is important for us to share with our funders and the community. In addition, up to five hours, per biennium, of CE credit may be fulfilled by performing pro bono medical and dental services to We Care Network patients, if we have received documentation of value of services. You can send your value of donated services via fax to Diana Bixler at (850) 2010085 or mail to 1204 Miccosukee Road, Tallahassee, FL, 32308. Thank you!

CMS FOUNDATION: WE CARE NETWORK

We thank our referring providers from February 2021:

Ebonie Allen, APRN

David Keen, M.D.

Charlie Richardson, M.D.

Anne Ananga, APRN

Farhat Khairallah, M.D.

Carla Robertson, APRN

Katrina Ball, APRN

Fang Sarah Ko, M.D.

Tim Ruark, M.D.

Karen Bartley, M.D.

Amulya Konda, M.D.

Karen Russell, M.D.

Daniel Breivogel, APRN

Stefanie Kreamer, M.D.

Lucilita Salvador, P.A.

Fran Bridges, APRN

Elaine Larkins, APRN

Jamey Sarvis, M.D.

Frances Carney, APRN

Jessica Lea, APRN

Jeannine Silberman, M.D.

Stephanie Chandler, APRN

Ashok Manocha, D.D.S.

Hardeep Singh, M.D.

Victor Chou, D.M.D.

Damon McMillan, M.D.

Sharnjeet Singh, P.A.

Melba Colon-Renta, M.D.

Kelley Miller, APRN

Jon Soble, M.D.

Deborah Congdon, APRN

Marcia Morris, APRN

Abisoye Somorin, APRN

Easa Darwish, APRN

Manoela Mota, M.D.

Alanna Steaple, APRN

Elizabeth Dickens, M.D.

Christopher Murphy, D.O.

Frank Swerdzewski, D.D.S.

Nathalie Esellem, APRN

Charles Murrah, M.D.

Franckel Taylor, APRN

Cynthia Evans, APRN

Chukwuma Okoroji, M.D.

Briana Thompson, M.D.

Alberto Fernandez, M.D.

Rose Origa, APRN

Faye Tinson, APRN

Sharron Foster, M.D.

Jorge Perez de Armas, M.D.

Barrett Tolley, D.D.S.

Gabrielle Gardner, APRN

Lisa Perkins, APRN

Teresa Tullos, APRN

Charmaine Gilmore, APRN

Lawrence Pijut, D.M.D.

Kaisa van der Kooi, M.D.

Muhanad Hasan, M.D.

Fabiola Puga, M.D.

Dwanna Ward-Boahen, APRN

Hantz Hercule, M.D.

Stephen Quintero, M.D.

Jeffrey Wasserman, D.O.

Todd Hewitt, M.D.

Hussein Rayatzadeh, M.D.

Shana Wood, APRN

Okanta Jackson, M.D.

James Renehan, M.D.

Anneka Johnson, APRN

Brandi Richardson, APRN

DURING THE MONTH OF FEBRUARY 2021, THE WE CARE NETWORK: RECEIVED 215 REFERRALS, WITH 115 PATIENTS NEW TO THE PROGRAM

SCHEDULED 76 APPOINTMENTS WITH VOLUNTEER PHYSICIANS AND DENTISTS

$179,999.62 IN DONATED CARE WAS REPORTED BY WE CARE VOLUNTEERS

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

Cap Scan Newsletter 1204 Miccosukee Road Tallahassee, FL 32308 Return Service Requested

Your gifts to the Capital Medical Society Foundation transform lives in the Big Bend.