February-March-April 2022 Colorado Medicine

VO LU M E 1 1 9

NO. 1

FEB-APRIL 2022

COLORADO MEDICINE ADVOCATING EXCELLENCE IN THE PROFESSION OF MEDICINE

HELPING PHYSICIANS WHEN YOU NEED HELP

C O NTE NT S

HELPING PHYSICIANS WHEN YOU NEED HELP Since 2020, CMS has had a strategic objective to help physicians when you need help, and we have worked to provide resources through the COVID-19 pandemic, protect confidential peer assistance counseling and represent you in countless legislative battles. But when the Marshall and Middle Fork fires broke out and members fled their homes, CMS leaders saw a very real and acute need to help those affected and jumped into action.

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WHAT TO EXPECT FROM THE 2022 LEGISLATIVE SESSION

D E PA R TM E NT S

10 Medical news • CPHP awards CMS Spirit in Medicine Award

CMS Director of Government Affairs Emily Bishop gives an overview of the top issues for physicians in the 2022 legislative session and why it matters to you.

• CMS recognizes retiring DMS executive director

12 COLORADO NALOXONE PROJECT MAKES GAINS IN HARM REDUCTION Colorado aims to be a national leader in naloxone distribution. Starting in the emergency department, leaders are expanding a successful model to other areas of the hospital to dispense naloxone directly to at-risk patients at discharge.

14 PHYSICIAN BURNOUT IN ORGANIZATIONS AND PRACTICE ENVIRONMENTS

In part two of a three-part series, Alexander von Hafften, MD, and Jeremy Lazarus, MD, continue exploring physician burnout and place a call to action for addressing wellness through organizational strategies.

16 CAROL’S WISH

The Colorado Ovarian Cancer Alliance established a financial assistance program named for a woman passionate about patients getting the care they need without being imperiled by unmanageable medical costs. Learn more about Carol’s Wish.

28 FINAL WORD: TURN TO CMS WHEN YOU ARE IN NEED

CMS Immediate Past President Sami Diab, MD, knows the highs and lows of practicing medicine, and how finding the right place to turn for help can be challenging. A strategic goal set at the beginning of his presidency gives members one lifeline: to reach out to CMS when you need it.

• CMS launches member spotlight series 11

Welcome to two newly hired component society executives

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COPIC Comment: Practice Quality Reviews

20 Reflections: A beginning or an ending 22

Introspections: Uncertain moments

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Partner in Medicine Spotlight: Panacea Financial

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Reflections: A beginning and an ending

I N S I D E

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C M S

President’s letter

CO LOR AD O M E D I CAL SOCI E T Y 7351 Lowry Boulevard, Suite 110 • Denver, Colorado 80230-6902 720.859.1001 • fax 720.859.7509 • www.cms.org

OFFICERS, BOARD MEMBERS, AMA DELEGATES, and STAFF 2021-2022 OFFICERS

BOARD OF DIRECTORS

AMA DELGATION

Mark B. Johnson, MD, MPH President

Brittany Carver, DO Enno F. Heuscher, MD, FAAFP, FACS Rachelle M. Klammer, MD Chris Linares, MD Evan Manning, MD Zachary Miller, MS Michael Moore, MD Edward Norman, MD Lynn Parry, MD Leto Quarles, MD Kim Warner, MD Hap Young, MD

David Downs, MD, FACP Carolynn Francavilla, MD Rachelle Klammer, MD Katie Lozano, MD, FACR A. "Lee" Morgan, MD Jan Kief, MD Tamaan Osbourne-Roberts, MD Lynn Parry, MD Brigitta J. Robinson, MD Michael Volz, MD

Patrick Pevoto, MD, RPh, MBA President-elect Hap Young, MD Treasurer Bryan Campbell, FAAMSE Chief Executive Officer Sami Diab, MD Immediate Past President

AMA PAST PRESIDENT Jeremy A. Lazarus, MD

COLORADO MEDICAL SOCIETY STAFF Bryan Campbell, FAAMSE Chief Executive Officer Bryan_Campbell@cms.org

Amy Berenbaum Goodman, JD, MBE Senior Director of Policy Amy_Goodman@cms.org

Dean Holzkamp Chief Operating Officer Dean_Holzkamp@cms.org

Kate Alfano Director of Communications and Marketing Kate_Alfano@cms.org

Emily Bishop Director of Government Affairs Emily_Bishop@cms.org

Ms. Gene Richer, M Ed, CHCP™ Director of Continuing Medical Education Gene_Richer@cms.org

Susanna Barnett Membership Coordinator Susanna_Barnett@cms.org

Dianna Fetter Senior Director of Business Development Dianna_Fetter@cms.org

Chet Seward Chief Strategy Officer Chet_Seward@cms.org

Paige Brophy Director of Membership Services Paige_Brophy@cms.org

Crystal Goodman Executive Director, Northern Colorado Medical Society Crystal@nocomedsoc.org

Tim Yanetta Manager of IT/Membership Tim_Yanetta@cms.org

COLORADO MEDICINE (ISSN-0199-7343) is published bimonthly as the official journal of the Colorado Medical Society, 7351 Lowry Boulevard, Suite 110, Denver, CO 80230-6902. Telephone 720-859-1001; outside Denver area, call 1-800-654-5653. Periodicals postage paid at Denver, Colo., and at additional mailing offices. POSTMASTER, send address changes to COLORADO MEDICINE, P. O. Box 17550, Denver, CO 80217-0550. Address all correspondence relating to subscriptions, advertising or address changes, manuscripts, organizational and other news items regarding the editorial content to the editorial and business office. Subscriptions are available for $36 per year, paid in advance.

COLORADO MEDICINE magazine is the official journal of the Colorado Medical Society, and as such is also authorized to carry general advertising. COLORADO MEDICINE is copyrighted 2006 by the Colorado Medical Society. All material subject to this copyright appearing in COLORADO MEDICINE may be photocopied for the non-commercial purpose of education and scientific advancement. Publication of any advertisement in COLORADO MEDICINE does not imply an endorsement or sponsorship by the Colorado Medical Society of the product or service advertised. Published articles represent the opinions of the authors and do not necessarily reflect the official policy of the Colorado Medical Society unless clearly specified.

Bryan Campbell, Executive Editor; Kate Alfano, Managing Editor; and Dean Holzkamp, Assistant Editor. Design by Scribner Creative.

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C M S

P R E S I D E NT ’ S

LE T TE R

Moving past words to take action for Colorado physicians Mark B. Johnson, MD, MPH

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n or around 1129 CE, Henry of Huntingdon published the first edition of the Historia Anglorum, an early recounting of the history of England. In it he tells what is now considered to be the apocryphal story of King Canute and the ocean tides. According to the legend, King Canute (c. 990-1035 CE), wishing to teach his fawning courtiers that secular power is vain compared to nature or the supreme power of God, placed his throne in the sand near the sea and commanded the ocean waves to stop.

While we may assume the members of King Canute’s court learned the lesson, many elected and appointed officials in the U.S. and around the world have apparently missed its implications. We cannot command the coronavirus to disappear. We cannot demand that it quit infecting us. We cannot by royal or official fiat pronounce that we no longer have a pandemic, and make it so. We forbid or ignore the use of preventive measures at our own peril.

We have already seen thousands of unnecessary and preventable deaths from COVID by claiming or pretending that it was not here or by declaring that it was not dangerous.

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While we may assume the members of King Canute’s court learned the lesson, many elected and appointed officials in the U.S. and around the world have apparently missed its implications.

At least 10 states, three of which border Colorado, have forbidden the mandating of mask use (these bans have been blocked, suspended or are not being enforced in five of the states). Medical, school and public health officials have been fired or placed on leave for encouraging vaccinations, mask use or social distancing.

These groups have also been subjected to written, verbal and physical abuse for taking stands to protect the health of their patients and communities. Frontline workers have been killed for attempting to uphold public health orders. And still the outbreak rages on. As of this writing, we continue to see over 2,000 deaths per day from COVID in the United States.

Behind all of these more obvious occurrences, many of our society members work quietly in overwhelming circumstances far from the public’s eye. Last week some of these issues were brought to light in an open letter from the Colorado Chapter of the American College of Emergency Physicians. Citing instances of transport and transfer inadequacies and shortages of staff, hospital beds and testing materials, our emergency department colleagues described working conditions that are reminiscent of scenes from war zones or those seen in the aftermath of hurricanes, floods, fires or volcanoes.

The Colorado Medical Society joined them in a call for better communication: between hospital facilities, within the EMS system, and with patients and citizens to educate and to improve transparency, cooperation and oversight. We endorsed their call for more adequate financial incentives for our local workforce in light of extravagant payments for short-term out-of-state travelers.

The unique issues faced by our rural colleagues also need special attention, and work guidelines for clinicians who are ill need to be clearly set considering the workforce shortages. Finally, to quote from their letter, “your health care team members are not doing well. This crisis is taking its toll. Physicians are burning out, being threatened, harassed and assaulted in the ED” and “we are at a breaking point.”

As a society of physicians, we, too, cannot command the virus to stop or declare that the pandemic is no longer with us. But we can work, and we are working, with the state legislature, the governor’s office, the state health department and the state’s hospital systems to address those issues that are affecting our members and our patients so forcefully during these stressful times. We are also working closely with the American Medical Association to influence those issues that need a national response. Thank you for your membership and support! Without that we truly would be just as impotent as King Canute, trying to stay the ocean’s tides. ■

TO ALL OF THE CMS MEMBERS AND PRACTICES WHO RENEWED YOUR MEMBERSHIPS IN 2022!

Your membership matters, and what you get from your membership matters more.

This year, our focus is to help bring joy back into your daily practice of medicine.

We sincerely thank each and every member for your membership, and for all you do for the patients of Colorado!

Interested in learning more about upcoming events and programming in your community for you as our member?

Scan the QR code to get connected!

SAVE THE DATES! The Colorado Medical Society looks forward to bringing joy to our members this year through regional summits paired with our CMS Board of Directors meetings. Pending public health guidance, these in-person events will include robust programming such as CME and networking events, all available as a member benefit at no cost to you!

APRIL 22-24 NORTHERN COLORADO JULY 22-24

SOUTHERN COLORADO

SEPT. 16-18 SUMMIT COUNTY, CMS Annual Meeting

Check cms.org/events for the latest updates.

Plus, our membership team is scheduling practice visits around the state.

Please reach out to us at membership@cms.org for your personal listening sessions.

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C OV E R

CMS: Helping physicians when you need help Kate Alfano, CMS Director of Communications and Marketing

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hysicians are conditioned to expect and prepare for the worst, especially after two years in a pandemic assessing and repositioning to meet a constant barrage of challenges. CMS meets you in this sphere, pledging to help physicians when you need help and supporting you as you help others.

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The membership team identified 76 physicians who live or work in the disaster area and reached out to each member personally to ask if they were affected and if CMS could be of assistance.

In a recent example, CMS leaders and staff were deeply saddened when the devastating Marshall fire and Middle Fork fire raged through Superior and portions of Louisville, Colo., on Dec. 30, 2021. CMS President Mark B. Johnson, MD, MPH, and his family were a few of the thousands forced to flee their homes, and he was stuck in a moment of terror as his daughter and granddaughters were caught on the highway surrounded by thick, black smoke. Fortunately, they were led out of danger by a highway patrol officer flashing his car’s lights and driving on the wrong side of the highway. Johnson and his family spent three restless nights in a Longmont hotel but returned to their home to find it intact with only minor damage from smoke and ash.

Under Johnson’s leadership, CMS staff jumped into action, embracing the strategic objective to help physicians when they need help. The membership team identified 76 physicians who live or work in the disaster area and reached out to each member personally to ask if they were affected and if CMS could be of assistance. Three physicians responded that they had lost their homes and a dozen more were displaced from their practice temporarily. Feedback was unanimously positive, with members thankful for CMS’s help in this capacity.

CMS was able to provide information on rental homes and legal assistance to those who needed it, and opened a special application period for the CMS Jane Nugent Cochems Trust. Staff also reached out to the American Medical Association to apply for disaster relief funds through the AMA Foundation. In just 10 days the foundation approved the CMS application and CMS leadership met to divide the funds.

“The AMA Foundation’s Disaster Relief Program was established by the AMA to help physicians and communities recover from the natural disasters that are increasingly becoming the norm,” said AMA Foundation President Heather Smith, MD, MPH. “We are honored to help Colorado’s physicians in this time of rebuilding and stand ready to offer financial support again if a future need arises.

We are grateful for this partnership with the Colorado Medical Society and hope this relationship continues to benefit the physician community.”

CMS Director of Membership Services Paige Brophy said, “The AMA funds will be directed specifically to the practices to assist with expenses that may have been incurred due to damage, to help get them back up and running to best assist patients, while supporting our physician community so they can go back to doing what they love – practicing medicine as soon as possible. While the amounts distributed won’t cover the loss completely, our hope is they can bridge a gap and provide security until insurance claims are processed.”

The CMS Cochems Trust funds were used to support a physician who lost her home completely, to help with immediate expenses now and over the next few months as the family rebuilds their life, Brophy said.

And CMS President Johnson said, “We can never predict tragedy striking our members and communities, but when it does, CMS wants to help. Looking ahead we will continue to do this. Helping physicians when they need help is a broad umbrella to bring us in when disaster happens, and we encourage members to remember CMS as a primary source of assistance when you are in need.” ■

Colorado Medical Society strategic plan, in brief • Advance diversity, equity and inclusion within CMS through a DEI strategic plan • Help physicians when they need help, and be recognized by Colorado physicians as the primary source for assistance when they are in need • Grow membership and increase engagement • View the strategic plan at cms.org/about/strategic-plan

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F E ATU R E

What can physicians expect from the 2022 session?

Emily Bishop, Director of Government Affairs

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he C o lor ado Legi slature convened during the second week of January for the 2022 session. Many social distancing measures that have become familiar over the last two years continue.

Notably for physicians is the option to testify virtually or in writing – which the CMS Advocacy Team notes has been a fantastic opportunity to open public engagement to more diverse voices.

The legislature has identified behavioral health and solutions to the state’s workforce shortages as its main health care priorities. CMS is prioritizing the following issues as well, along with several others.

Here’s an overview of what you can expect to see: Scope of practice

Both physician assistants and optometrists have filed or are planning bills to expand their scope of practice inappropriately. CMS's position is that Colorado is best served when health professionals work together as multidisciplinary, integrated teams, delivering patient care in the ways their training and education have prepared them for.

Workforce solutions

The pandemic has exacerbated long-standing workforce shortage prob-

lems. Funding must be used wisely to address immediate needs and lay the foundation for a more robust, resilient, and diverse health care workforce for Colorado’s future.

Medical liability

A stable medical climate enables physicians to do their jobs and serve Colorado patients. CMS is always against any efforts to destabilize the current medical liability status-quo.

Health plan administrative burdens

The crush of administrative burdens driving prac tice cost s and burning out physicians and their teams is not lessening. State and national physician polling data show that prior authorization burdens have actually increased over the past few years. Add to that the continued imbalance of power in the marketplace as demonstrated by the inabilit y of out-of-network physicians to bundle claims for Colorado-regulated plans, and these burdens are driving physician dissatisfaction.

Public health

COVID-19 and public health measures continue to hold the spotlight. Measures must be grounded in science and physicians need to continue to be recognized as playing a key role in responding to the pandemic.

Behavioral and mental health

The new Behavioral Health Administration and the months-long stakeholder engagement of the Behavioral Health Transformation Task Force have underscored the need for changes to serve Coloradans’ mental and behavioral health care needs. ■

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Anticipated challenges of the 2022 Colorado legislative session

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D E PA R TM E NT S

M E D I C A L

N E W S

CPHP awards CMS Spirit in Medicine Award The Colorado Physician Health Program awarded the Colorado Medical Society Foundation Trust the Spirit in Medicine Award in recognition for our contribution to their annual fundraising campaign. The funds raised support health services for Colorado physicians. In the virtual awards presentation, Angela Graham, MPH, CPHP donor relations manager, and Amanda Kimmel, MPA, CPHP director of public affairs, specifically thanked CMS for our work to fight to maintain confidential peer assistance counseling in Colorado, stating that this victory would not have been possible without our efforts and those of our members. ■

D E PA R TM E NT S

M E D I C A L

N E W S

Kathy Lindquist-Kleissler recognized for 32 years of service Kathy Lindquist-Kleissler was honored at the Jan. 22, 2022, CMS Board of Directors meeting for her exemplary service as Denver Medical Society executive director. Lindquist-Kleissler retired at the end of January after 32 years in the position, having greatly advanced the society’s mission in serving Denver physicians. Congratulations! ■

D E PA R TM E NT S

M E D I C A L

N E W S

CMS launches new member spotlight series

Member Spotlight

The Colorado Medical Society is proud to launch the CMS member spotlight in 2022. In January we met Vinh Chung, MD, a board-certified dermatologist and fellowship-trained Mohs surgeon in southern Colorado, who believes physicians can lead patients through the process of attaining health and lead a health care team to deliver effective and efficient medical care. ■ “Being the smartest or the highest-ranking person is not enough,” Chung said in the question-and-answer article. “We must inspire and lead our team to move towards a clearly defined vision of what excellent medical care looks like.”

Do you want to be spotlighted this year?

Contact membership@cms.org to self-nominate or to nominate one of your colleagues

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cms.org/articles/ member-spotlight-vinh-chung-md

D E PA R TM E NT S

M E D I C A L

N E W S

Welcome, new component society executives!

The Denver Medical Society and Northern Colorado Medical Society have hired new executive directors.

We welcome them to the Colorado Medical Society community and support their crucial efforts to support physicians on the local level.

Stefanie Carroll, MNM, joined the Denver Medical Society as its executive director in January 2022. Stefanie has a successful 20-plus-year track record in nonprofits and higher education institutions, including most recently at National Jewish Health and the University of Denver Sturm College of Law. Her professional work has spanned event management, program creation, marketing and communications, community outreach, volunteer recruitment, strategic planning, fundraising, and board development for national and local organizations. She holds a Masters of Nonprofit Management (MNM) degree and is a graduate of the Denver Metro Chamber Leadership Foundation’s Colorado’s Civic DNA Fellows program. Stefanie is thrilled to bring her creativity, skills and entrepreneurial background to help build the future of DMS.

Crystal Goodman joined the Northern Colorado Medical Society as its executive director in December 2021. Crystal has worked in the senior living industry for more than 20 years, most recently as the executive director at The Lodge at Greeley. Her most treasured career experience was working with Cameron Camp, MD, to train staff, families, and health care professionals on his Montessori Approach to Dementia Care, to help change the way caregivers and families approach loved ones with dementia and Alzheimer’s to improve their quality of life. She has a Bachelor of Arts Degree in Mass Communications and Media Arts with a specialization in Public Relations from Southern Illinois University. She also obtained her Professionals in Human Resources Certification in 2017. With over a decade of sales and marketing experience, she has organized many events with local not-for-profit organizations. She is honored to be a part of NCMS and is looking forward to connecting with northern Colorado physicians. ■

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The Colorado Naloxone Project is making Colorado a national leader in hospitalbased harm reduction Donald Stader, MD FACEP Rachael Duncan, PharmD

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n 2020, 93,331 Americans were lost to overdose. Preliminary data from 2021 shows that, for the first time, this number will surpass 100,000.1 A record 1,477 Coloradans died from an overdose in 2020, a 38 percent increase from 2019, driven by a spike in fentanyl fatalities. Opioids accounted for nearly two in three of overdose deaths, and overdoses involving fentanyl made up two-thirds of all opioid analgesic deaths, which is more than double that in 2019.2 Naloxone is key to addressing the opioid crisis, especially as overdose trends have shifted away from prescribed opioids toward illicits (especially fentanyl). Colorado has been an early adopter in promoting regulations and laws that promote naloxone distribution. Now, a new initiative supported by the Colorado Medical Society, the Colorado Naloxone Project, promises to make Colorado a national leader in naloxone distribution.

The goal of the Colorado Naloxone Project (CNP) is for all hospitals and e m e rg e n c y d e p a r t m e n t s ( E D s) to dispense naloxone to individuals at risk for opioid overdose. This recognizes that hospital-based clinicians often encounter and care for patients at risk of overdose, making hospitals and EDs key sites of intervention. One Delaware study found that of patients who died of an overdose, 52 percent visited an emergency department in the three months prior. 3 In 2020, Colorado hospitals saw over 65,000 patients who are at risk for overdose: Patients with opioid use disorders, therapy, or who have been poisoned by or overdosed opiods, all of whom would likely benefit from discharge with naloxone. Finally, data shows that while prescribing naloxone is an evidencebased intervention, patients with opioid use disorders often fail to fill prescriptions at pharmacies. There are three studies

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in the medical literature that document naloxone prescription fill rates of less than 1-2 percent.4,5,6 Considering this evidence, the CNP has championed a low barrier approach where naloxone is dispensed directly to at-risk patients prior to their departure from the hospital, along with overdose prevention education. There is no need to get a prescription, go to the pharmacy or apply for a prior authorization. This direct, low threshold model is made possible and sustainable by House Bill 20-1065, which the Colorado General Assembly passed in 2020. This law requires insurance carriers to reimburse hospitals that provide a covered person with naloxone upon discharge. However, the bill only pertains to plans regulated by the Colorado Division of Insurance and does not cover Colorado Medicaid or federally regulated plans. Hence,

the CNP is also working with Colorado Medicaid to try to improve reimbursement for Medicaid patients, and hopes to have appropriate reimbursement set up for take-home naloxone by mid-2022.

The partnership of CNP with payers, governmental organizations and medical organizations has been key in pushing forward a sustainable reimbursement model to assure naloxone dispensing is not dependent on grant funding, and becomes a regular aspect of clinical care, as it should be.

So, what have the results of the project been to date? In a word, remarkable.

The CNP was launched in March 2021, and by the end of 2021, 111 hospitals and emergency departments in Colorado had signed onto the project. This represents over 95 percent of hospitals and EDs, all committed to dispensing naloxone.

Over 22 organizations, including CMS, proudly participate as partners in the project. In addition, the CNP has been able to secure a $500,000 grant from the Colorado Office of Behavioral Health to provide naloxone to hospitals to dispense to patients. In total, the CNP has

secured over 10,000 doses of naloxone for Colorado hospitals and harm reduction agencies in its first year. Thus far, CNP-participating hospitals dispensed 2,777 take-home naloxone kits in 2021.

While most hospitals have started the project by dispensing naloxone in the emergency department, the CNP has begun pilots in labor and delivery (L&D) units assessing the impact of naloxone dispensing to substance use by affected mothers and their families. We hope in 2022 to continue to expand naloxone dispensing to all areas of the hospital and into prehospital settings.

As the Colorado Naloxone Project enters its second year, we are grateful for the tremendous partnership and dedication of organizations and clinicians across the state. As the COVID-19 pandemic continues to draw much of our attention, it is important to also recognize the growing toll that the opioid and substance use crises are having in Colorado and across

the nation. It is our hope that all clinicians strongly consider recommending, prescribing and, when possible, dispensing naloxone to at-risk patients. In doing so we can help save lives and curb the overdose numbers in Colorado. Together, we can start to address the opioid overdose crisis and build the addiction treatment system that our patients not only need but deserve. ■ For more information on the Colorado Naloxone Project, please visit our website: www.naloxoneproject.com and feel free to contact Don Stader, MD, at don@staderopioidconsultants.com.

1. Courtesy of the U.S. Department of Health & Human Services, hhs.gov, 200 Independence Ave, Washington, D.C. 20201. Accessed 1.14.22.

2. Courtesy of the Colorado Health Institute, www.ColoradoHealthInstitute.org, 1999 Broadway, Suite 600, Denver, CO 80202.

Accessed 1.14.22.

3. June 2019 Commission Report. Delaware Drug Overdose Fatality Review Commission. https://attorneygeneral. delaware.gov/wp-content/uploads/ sites/50/2019/07/2019-DelawareDrug-Overdose-Fatality-ReviewCommission-Report-Final.pdf 4. Spivey CA, Wilder A, Chisholm-Burns MA, Stallworth S, Wheeler J. Evaluation of naloxone access, pricing, and barriers to dispensing in Tennessee retail community pharmacies. J Am Pharm Assoc.

2020;60(5):694-701.e1. doi:10.1016/j. japh.2020.01.030 5. Ruff AL, Seiler K, Brady P, Fendrick AM. Naloxone fill rates after opioid overdose.

J Addict Med Ther Sci. 2019;5(1):001-002.

DOI: 10.17352/2455-3484.000027 6. Kilaru AS, Liu M, Gupta R, et al. Naloxone prescriptions following emergency department encounters for opioid use disorder, overdose, or withdrawal [published online ahead of print, 2021 Mar 24]. Am J Emerg Med. 2021;47:154-157. doi:10.1016/j.ajem.2021.03.056

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Physician burnout: Call to action –

ORGANIZATIONS AND PRACTICE ENVIRONMENTS Jeremy Lazarus, MD Past President, American Medical Association Alexander von Hafften, MD Physician Health Committee, Alaska State Medical Association

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his is the second of three articles on physician burnout. The first ran in the fourth-quarter 2021 issue of Colorado Medicine and the third will run in the second-quarter issue 2022. Burnout is a syndrome of emotional exhaustion, depersonalization, cynicism, detachment and sense of low personal accomplishment.1 Approximately 50 percent of physicians and medical students were experiencing burnout prior to the COVID pandemic.2,3 Interventions to prevent burnout that are only directed at individual physicians and medical students are insufficient. This article summarizes a general framework for organizational and practice environment interventions to prevent and reduce physician and medical student burnout.

Physician and medical student vulnerability

Impacts on patients and organizations

Competitiveness, perfectionism and goal orientation are rewarded on the pathway to becoming a physician. Conscientiousness, obsessiveness, self-doubt and sense of responsibility are reinforced by medical training and clinical practice.

These characteristics contribute to the belief that burnout is a deficit of individual resilience. Yes, some physicians and medical students may be vulnerable to burnout, but most physicians and medical students are very resilient. Burnout is an individual response to a systemic problem, not a deficit of individual resilience.

Physician burnout decreases quality of care, patient safety and patient satisfaction; increases malpractice risk; and may increase hospital admissions and readmissions. 3,4,5,6 Physician burnout decreases physician engagement and productivity and increases early retirement and physician turnover. 3,7 Replacing a physician costs 2-3 times a physician’s annual salary. The mean cost to replace a physician is $500,000 to $1,000,000. 3,7

When beginning medical school, medical students have better well-being than age-group peers. 3 The risk for burnout begins early in medical training.

During medical school, medical students have more symptoms of burnout than nonmedical graduate students. 3 Burnout increases during residency with prevalence rates between 41-90 percent.3 The Accreditation Council for Graduate Medical Education (ACGME) duty hour limits have not improved sleep, reduced clinical errors or reduced burnout. 3

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Two common organization myths about physician burnout are: 1) creating a culture of physician wellbeing conflicts with other organization objectives, and 2) effective interactions are cost prohibitive. 8 Both myths are false.

Call to action In 1989, the American College of Emergency Physicians (ACEP) raised the alarm about declining professional wellbeing.

Since the 2000s, concern and momentum have increased. Organizations including the National Academy of Medicine (NAM), American Medical Association

(AMA), American Association of Medical Colleges (AAMC), and the ACGME have led efforts to increase awareness of burnout and to improve the conditions and circumstances driving burnout.

In 2016, the AMA hosted a summit of leading health care organization CEOs. The CEOs unanimously concluded that physician burnout is a pressing issue of national importance for patients and the health care delivery system; and physician well-being is critical to the long-term clinical and financial success of health care organizations.4 In 2018, the Federation of State Medical Boards (FSMB) adopted a policy regarding physician wellness and burnout.

The FSMB policy includes recommendations for state medical boards, state governments, the Centers for Medicare and Medicaid Services (federal CMS), accreditation organizations, insurers, EHR vendors, hospitals, employers, professional medical societies, training programs and physicians.9

Organization and practice environment

The nine organization strategies include:8

Shanafelt and Noseworthy summarized, “extensive evidence suggests that the organization and practice environment play critical roles in whether physicians remain engaged or burn out.” 8 They use a five by seven matrix to illustrate how national, organizational, work unit and individual factors may contribute to burnout. Any specific factor contributes to at least one of seven dimensions driving burnout.

1.

Acknowledge, assess physician well-being and burnout

2.

Select leaders who have the ability to listen, engage, develop and lead physicians

3.

Develop and implement targeted work unit interventions

4.

Cultivate community at work

The seven dimensions include:8

5.

Incentivize quality of care and patient satisfaction rather than production

6.

Align values and strengthen culture consistent with organizational mission

7.

Promote flexibility and worklife balance

8.

Provide resources to promote resilience and self-care

9.

Institute, evaluate and fund evidence-based strategies to reduce burnout

Recommendations and resources to promote individual physician health and wellbeing

Members of a specific work unit determine which dimension is most important and which strategies to implement.8

What resources are available for physicians regarding self-care and wellness?

What resources are available for physicians feeling burned out? The third article will provide recommendations and resources to promote individual physician health and wellbeing. ■

1.

Workload and job demands

2.

Efficiency and resources

3.

Meaning in work

4.

Culture and values

5.

Control and flexibility

6.

Social support and community at work

7.

Work-life integration

In the same publication, Shanafelt and Noseworthy summarized interventions into nine organization strategies to reduce burnout.

Summary 1.

Physician wellbeing is the foundation of health care quality and outcomes.

2.

Physician wellbeing is a shared responsibility and interventions must be comprehensive and sustainable.

3.

The organization and practice environment must have a culture of wellness for physicians as well as for patients.

4.

Reducing physician burnout begins by creating a culture of wellness, optimizing workflows and supporting personal resilience.

5.

Physician wellbeing must be measured and organizational leaders rewarded for improvements and accountable for decreases – just like other mission-critical goals.

1. Maslach C, Jackson SE: The measurement of experienced burnout. Journal of Occupational Behavior 2:99-113, 1981 2. Dyrbye LN, Shanafelt, CA, Sinsky PF et al: Burnout among health care professionals: A call to explore and address this underrecognized threat to safe, high-quality care. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC, 2017 3. American Psychiatric Association. APA Wellbeing Ambassador Toolkit Physician Burnout and Depression: Challenges and Opportunities, Slide 16, January 2018 4. Noseworthy J, Madara J, Cosgrove D, et al: Physician burnout is a public health crisis: A message to our fellow health care CEOs [Internet].

Health Affairs. March 2017 5. Shanafelt, TD: Enhancing meaning in work: prescriptions for preventing physician burnout and promoting-patient centered care. JAMA 302(12):1338-1340, 2009 6. Shanafelt, TD, Balch CM, Bechamps G, et al: Burnout and medical errors among American surgeons. Ann Surg 251(6):995-1000, 2010 7. Shanafelt T, Goh J, Sinsky C: The business case for investing in physician well-being. JAMA Internal Medicine 177(12):1826-1821, 2017 8. Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: Nine organizational strategies to promote engagement and reduce burnout. Mayo Clinic Proceedings 92(1):129–46, 2017 9. Federation of State Medical Boards, Policy 2018. Physician wellness and burnout. 2018. Available from: https://www.fsmb.org/siteassets/ advocacy/policies/policy-on-wellness-and-burnout.pdf This article was originally published in the Alaska State Medical Association (ASMA) bimonthly newsletter, Heartbeat.

It has been reprinted with permission.

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Carol’s Wish

Edward A. Dauer, LL.B. MPH

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he co-pay was stunning: $600 for one set of doses. It was early in Carol’s treatment for late-stage ovarian cancer, yet this additional medication was essential; and her need for it was likely to be repeated who knew how often.

Chemotherapy had impaired Carol’s immune system to the point that she could not safely tolerate further infusions. Waiting for her blood counts to recover on their own could take weeks – at best a delay but worse, a risk to the efficacy of the chemo regimen itself. Hence the prescription, and the pharmacy’s news about the co-pay, for a drug that might boost her recovery quickly enough to reduce that risk.

Carol was lucky. She was relatively well-insured with a Medicare plan, and her personal circumstances allowed her to meet the copays without seriously impairing the rest of her life – several times over, as it happened, during her three years of recurring treatments. She was nonetheless deeply troubled: “How do less fortunate people deal with something like this?”

Too many people don’t deal with it at all. Because they can’t.

Forty percent of American families are unable to cover an unexpected expense as small as $400. Some might manage by borrowing on credit cards or a payday loan, or from friends or family. But one in eight couldn’t manage $400 at all. Not even once. Yet studies across all of health care show that medical costs cause more than one in five patients to become noncompliant or abandon their prescribed therapies. For lethal diseases, with drugs and procedures often at their most expensive, the consequence is not just excess morbidity. In an unknowable number of cases it can mean death. The problem has a name: financial toxicity.

Inspired by Carol’s insight and by her wish that no one’s health be imperiled by unmanageable medical costs, COCA – the Colorado Ovarian Cancer Alliance – established a financial assistance program that was named, following her death from the disease, Carol’s Wish.

The need is enormous. Neither COCA nor those who initiated the program could dent the problem in any significant way just by seeking donations and making financial grants. The design criteria for Carol’s Wish were therefore unusual, if not unique: The program would provide expertise, counseling and financial support other than cash grants; it would eventually become self-sustaining; it would generate a return greater than its costs; and, although initially focused on gynecologic cancers, it would be a proof of concept and a template for adoption in any case of medical financial need.

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On referral from physicians, the counselors at Carol’s Wish work with patients one by one, analyzing their circumstances and locating assistance wherever possible – from insurance optimization, from public programs unknown to the patient, from private and public foundations, from corporate assistance funds – usually from all of those and more. In its first two years of operation the program’s return on investment has been greater than 10 to one. Almost all of the design criteria have been achieved.

Financial assistance generated by the program is not a return to COCA. COCA pays the program’s costs, but the benefits come to the patients it serves – and to their providers, whose care is more likely to be paid for by patients who become more able to pay. The program’s ability to be self-sustaining therefore depends materially on providers’ appreciation of that point, as well as the advantages to their patients’ health and medical care.

The challenge of financial toxicity continues to be vast. But the moral and professional imperatives to save lives is also vast.

And that was Carol’s Wish.

Edward A. Dauer, LL.B. MPH, is dean emeritus and professor emeritus of law at the University of Denver: edauer@ law.du.edu For further information about Carol’s Wish, including support opportunities, please visit the COCA website: www.colo-ovariancancer.org/programs.

For information about physician referrals of patients to the program, please contact the program Director: rachel@carolswish.org. ■

D E PA R TM E NT S C O M M E NT

Practice Quality Reviews: A checkup for your medical practice Gerald Zarlengo, MD, Chairman & CEO COPIC Insurance Company

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ne of the benefits that COPIC offers is the perspective we have based on our interactions across health care.

By working with a broad and diverse population of physicians and medical practices, we gather collective

insight about key risks, claims trends and other challenges. Then, we take this knowledge and look at how we can disseminate it to our insureds to improve patient care. One of the ways this happens is through our Practice Quality Reviews.

What are Practice Quality Reviews?

Practice Quality Reviews are performed with COPIC-insured medical practices every two years by registered nurses in accordance with risk management guidelines.

The reviews consist of three parts.

1.

An informational assessment and systems review discussion with appropriate practice representatives and/or physicians

existing guidelines, updating focus points, and adding some new areas such as telehealth and information privacy/ security to reflect changes in health care.

6.

Documentation of patient communication

7.

Advanced practice providers

What are the Level One Guidelines?

8.

Information privacy and security

Level One Guidelines include general guidance along with an outline of “best practices" and “things to avoid.” The guidelines are broken down into the following areas:

9.

Allergies and adverse drug reactions

1.

Systems for:

2.

A medical records review

a.

Patient follow-up tracking

3.

A summary report discussion

b.

Consultation and referral tracking

c.

Tracking test results, incidental findings, and surgical specimens

The reviews are designed to help develop and improve systems, promote patient safety and maintain records that accurately reflect the care provided.

The guidelines used are determined by actual medical liability claims and incident reports. Guidelines believed to have significant impact on the frequency, severity and defensibility of medical liability claims are referred to as Level One Guidelines.

This last year, our Patient Safety and Risk Management team conducted an in-depth evaluation of these guidelines and how they corelated with emerging claims trends as well as issues we identified through discussions with medical practices. This resulted in revising some

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d.

Reviewing reports and correspondence

e.

Patient notification of results

10. Medication safety practices 11. Vital sign documentation 12. Clinical documentation In addition to Level One Guidelines, the reviews also utilize specialty-specific guidelines that outline additional considerations that may be applicable to certain medical specialties and practices.

Some examples of these guidelines include: • Unsolicited reports/test results • Interpretation/translation services

2.

Informed consent processes

• Verification of patient identity

3.

Procedures for an officebased emergency

• Transitions of care

4.

In-office procedures

5.

Telehealth

• Peer review (professional review) • Informed refusal • Electronic communication

What happens after a review?

Af ter the reviewer has completed the assessment, a summary report is provided to facilitate discussion with the practice representatives. We encourage physicians and advanced practice providers to participate in this feedback session. In addition, the reviewer will help identify if there are COPIC resources and/ or other resources that can be useful in helping a practice address any areas for improvement.

What are the benefits of these reviews?

Practice Quality Reviews are not structured as a rigid process to find things that are wrong. Instead, we approach these as an educational opportunity centered around informative discussions with the nurse reviewers to further improve practice systems, enhance patient care and mitigate risks to prevent claims. We take all the necessary steps to minimize disruption to the professional lives of those involved, while providing valuable feedback through a “fresh set of eyes” that draws upon COPIC’s insight and experience. In addition, all eligible insureds receive one COPIC point for completing the review and having the associated report prepared. Insureds who meet all Level One Guidelines applicable to their practice will receive one additional COPIC point.

If you have questions about the Practice Quality Reviews, please contact COPIC’s Patient Safety and Risk Management department at (720) 858-6396. ■

Our Partners in Medicine program connects industry leaders and physician members of CMS to improve patient care and help physicians achieve personal and professional satisfaction.

For more information, visit

www.cms.org/partners

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R E F LE C TI O N S

A beginning or an ending Hannah Klatzkow

Hannah Klatzkow is a third-year medical student at the University of Colorado. Originally from Florida, she is now overjoyed to call this beautiful state “home.” She plans to pursue internal medicine residency, with particular passion towards critical care.

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he had come to the hospital at the request of her rheumatologist. A few months ago, she noted an insidious aching in her arms and legs. A few weeks passed and she struggled to gather the strength to get out of her car.

Shortly after, she became bothered by the persistent challenge of getting a full breath of air. Steroids hadn’t been helping, and the only abnormality in a flurry of labs was a positive ANA. Something was wrong, and while her care team feverishly searched for answers, she was admitted for IVIG and heftier dosing of steroids.

I joined my team at morning sign-out, and they were full of excitement for me to meet her. An undiagnosed rheumatological issue seemed like the perfect case for a third-year medical student, unique in its kind across the inpatient floors.

And I met my residents with a reciprocal excitement – finally, I would make sense of those infinite crazy-named labs we learned in my first year of school; finally I would match a patient to those vignettes I had studied so many times before my Step 1 exam.

Over the next few days, this excitement didn’t lapse. I found myself totally engrossed in her clinical course. I followed her labs closely, refreshing them whenever I made it back to my workstation. I did my most complete physical exams, searching for an undiscovered rash, assessing changes in her proximal strength, and meticulously feeling each joint space between her fingers. Beyond the fascinations with her disease state, she simultaneously grew to be my favorite patient due to her magnetic personality.

She was in her 30s and gushed over the marriage to her high-school sweetheart.

Her arms showed 5 scattered footprint tattoos, one for each of the kids she loved so well. The oldest was 17 and the youngest was a newborn, both a surprise and a 20

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blessing, she said. With every visit I made, even the ones before the sun had even touched the morning sky, she met me with the warmest smile. Despite being in pain and unrelenting fatigue, and despite dealing with confusion and betrayal by the very body she lived in, she remained effortlessly full of love. Her entire life was a display of this.

She stayed in the hospital for more than a week. She was continuously poked and prodded so we could send off more labs, most of which returned as negative. Day after day, I tried my best to encourage patience, but the desire for answers was becoming increasingly difficult to subdue.

Our last step had been gathering a muscle biopsy, and when the pathology resulted, our answer finally arose – dermatomyositis. In the absence of cutaneous findings, it was a surprising diagnosis. I was excited to share this with my team, as it was an ending to our mystery and an ending to the uncertainty that the patient had been experiencing for so many months. Upon sharing the news, I noticed the instant drop in my resident’s facial expression.

As I’d soon learn, this was not the good ending I ignorantly believed it to be.

Dermatomyositis is heavily associated with malignancy. Often, it is triggered by the malignancy itself; if an initial finding is absent, a highly increased prevalence of future malignancy remains in its place. In terms of numbers, it is a six-fold increase in prevalence, with cancer most commonly discovered in the first year following the diagnosis of dermatomyositis. I pored over the journal articles describing this association and wondered how it had never been noted in my prior studying.

And while I had been so excited to explore this case just a week prior, I was now faced with the poignant reminder of how studied medicine translates to real people. This patient, up on the sixth floor,

sitting with her husband and FaceTiming her kids, would now need to be evaluated for one of the harshest words in the hospital – cancer.

Despite these new findings, my patient had finished her regimen of IV medications and no longer needed to stay in the hospital. She would arrange to follow-up with the rheumatologist back in her hometown. After my team updated her on the potential gravity of her new diagnosis, instilling the importance of close follow-up, she still mustered that warm smile and met us with gratitude for our work. She was discharged soon after, and I don’t know where the story goes from there. Her hometown care is separate from our electronic health records, so I never will find out.

It’s been about two months now, and little things still spark reminders of this patient. All I can do is hope that she’s doing okay. I can hope that they haven’t found concerns for cancer, that her pain and weakness has stayed controlled with steroids, and that she remains functional in a body just 10 years older than mine.

Most of all, I hope that she’s regained the strength to pick up her newborn baby.

As I continue to move through rotations, meeting new patients every day, I try to remind myself of the impact of this experience. I think of how real these labs and images are, and the significance of what the exam findings mean for the patient.

I try to remind myself that long after the teaching point has been covered and a new diagnosis is added to a discharge summary, the patient will continue to be shaped by these findings. While the tie between medicine and the lived experience of it may be an obvious lesson, it is certainly one that comes with a never-ending depth to be explored. ■

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I NTR O S P E C TI O N S

Uncertain moments Luke St. John

Critical reflective writing holds a prominent place in the Medical Humanities curriculum at Rocky Vista University, College of Osteopathic Medicine. Beginning in the first semester of Medical Ethics, students engage in critical reflection to explore their own assumptions and biases and how their values impact their practice. This submission is selected and edited by Nicole Michels, PhD, chair of the Department of Medical Humanities, and Alexis Horst, MA, writing center instructor.

Luke St. John is deeply passionate about medicine and the challenges and rewards it brings. He has worked in both EMS and psychiatry since 2010 and had thought emergency medicine was his calling, but following his experience with cancer, is now pursuing a career in oncology. Luke has lived in Colorado since 2013, married his wife Alexis in July 2021 after two years together in medical school, and enjoys fly-fishing, hiking, cooking and taking their dogs on walks together.

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remember the first cardiac arrest I was called to as a brand-new EMT in 2010. A man lay motionless on the concrete behind a workout facility as our ambulance pulled up, and soon I was compressing his chest, sweating and breathing heavily as I sang the Bee Gees's “Stayin’ Alive” in my head to keep rhy thm. But that up-close encounter with death at 19 wasn’t personal, it was a professional experience, and now that man is a distant memory. But sometimes mortality is inherently more personal.

My grandmother passed away on May 15, 2021. It wasn’t totally unexpected; there were a few years of cognitive decline due to Alzheimer's, a couple recent falls requiring trips to get scanned for bleeds,

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and a text the day before from relatives who forewarned distant family of her likely passing as her condition deteriorated. As I write now and ruminate on her death, a renewed appreciation of mortality has paradoxically been brought to life, and I am reminded of some of the motivation behind my decision to pursue medicine.

I applied to medical school with every intention of turning my health care provider role into a permanent career.

I received the acceptance call every hopeful medical school applicant works toward, and I felt my ambition to become a physician was guaranteed. It’s moments of accomplishment like this that lent themselves toward feeling invincible. “If I can do this,” I thought, “I can do anything.”

And then suddenly, death became more personal than it has ever been. Five months before school started, I was diagnosed with cancer... “Wait, me?”

That right-sided axillary swelling I showed my PCP while getting immunization records for school turned into something less innocuous and more menacing. My PET scan results lit up like a Christmas tree as the surgeon who was preparing to biopsy a lymph node pointed out all the cancer in my body. Three days later, I had a diagnosis. But if there’s one thing more crippling than a diagnosis, it’s the uncertainty of an unknown future, and with it, the intimate realization of my own mortality.

The “what ifs” were incessant, and at the top of that list was death. Not CPR-on-astranger death, my death. The guaranteed future I felt so sure of was ripped out from under me in a matter of days. The transition from provider to patient was emotionally tumultuous, and most frightening was a sense of no longer feeling in control of my own fate. Fear often predominated my thoughts, and with fear came an immense feeling of vulnerability.

Six rounds of chemo over four months were enough for me to be cleared into remission – t wo weeks before orientation. As school began, the brain fog cleared, my energy restored and hair regrew, whatever opportunistic infection had been antagonizing my lungs met its match as my immune system bounced back , and the per vasive thought s of uncertainty made room for the onset of MSK and all its origins, insertions and actions. Two years of school have passed and as I begin rotations, I think of how it felt to go to a physician as a patient and the vulnerability I felt that others feel too. This time I’m the one wearing the

white coat, but with a fresh perspective of the emotional and mental strain involved when mortality becomes personal.

T h e l o s s of a l ove d o n e i s l i ke wise personal, and my grandmother’s passing reminded me to appreciate the moments we shared. I was recounting some fond memories of her while on a walk with my wife. She’s never met my grandma, so I did my best to paint her a picture. I told her of my grandmother’s professionally trained opera singing and how her lyric soprano timbre soared boldly and beautifully through our little church on Sundays. I bragged about a couple of her recipes that have been passed down: her chicken, which I learned recently from my mother I’d been making erroneously with cumin instead of curry, and her rolls she’d bake up by the dozens around Thanksgiving with butternut squash to give them unparalleled moisture. If I had to pick a favorite memory though, it was the way she’d say she loved me as we hugged, her embrace drawn out to make sure she had squeezed all the love out before letting go, her smile beaming as she’d look up and say “Bless ya!”

As I try to plan my future after medical school, I’m forced to reconcile what I can control with what I cannot. And although an uncertain future may at times seem unique to my circumstance, isn’t it a ubiquitous, human-defining trait? Our mortality is both incredibly personal and a universally shared experience. Empathizing with those moments of vulnerability in our patients can connect us to them and can enable us to envision our own mortality in a remarkable way.

I appreciate and cherish the memories of my grandmother, the emotion they bring, and the times with her that made me feel most at peace. The hugs, the homemade food, the stories and laughter – they all contribute to the legacy she leaves behind. And as I look ahead toward a future with uncertainties, I'm transported back via memories to those moments where I felt more certain, imagining her gentle voice as she hugged me tightly.

“Bless ya,” she says. “Bless ya.” ■

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PA R TN E R

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M E D I C I N E

S P OTLI G HT

Physician-founded national bank helps Colorado physicians and trainees with student loan refinance and practice financing

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ow should a physician handle their finances in training and early in their career? Why isn’t there a place physicians can go to that understands what it is like to train so long, and borrow so much for the honor of treating patients? Michael Jerkins, MD, and Ned Palmer, MD, found themselves asking the same questions, and that ultimately led them to start Panacea Financial – the bank for doctors and doctors-in-training.

Like many physicians, Jerkins and Palmer Panacea Financial is powered by their were financially frustrated in residency partner Primis Bank, a publicly-traded, and early practice. As two practicing multi - billion dollar bank and FDIC Med-Peds physicians, they went from member. Panacea provides doctors and borrowing for every expense in medical medical students with checking/savings school, to living month to month in resi- accounts, PRN Personal Loans, student dency (while also supporting a family), to loan refinance and commercial loans. finally becoming an attending. But at none of these stages did they have a bank that “It was important for us to build something recognized the issues they faced. that made doctors’ lives a little easier,” Jerkins said, as he described Panacea’s “It was as if the banks didn’t even try to focus on putting the physician at the understand what my financial life cycle center of both their products and their was,” said Palmer, a pediatric hospital- service. “That is why we made sure every ist. “All they saw were some numbers doctor has access to 24/7 live customer on a spreadsheet but not my earnings service and their own their own free potential or lifetime employability. It was personal banker. It’s also why the interplainly obvious that there needed to be est rates on our consumer loans don’t a bank that was created for doctors that depend on metrics that can hurt early-caactually understood us.” reer physicians like debt-to-income ratio or credit score.”

Jerkins, an outpatient Med-Peds physician, recounted, “I will always remember Now, Panacea Financial is a Colorado an experience I had in residency when Medical Society Partner in Medicine and I needed a few thousand dollars for has exclusive offerings to CMS members car repairs. Banks told me I needed a across the state. Jerkins explained, “Our co-signer to receive any loan. At the physician community benefits from strong hospital, I was entrusted with people’s medical societies and the Colorado Medilives, but at the bank I was being treated cal Society is no exception with its work like an adolescent.” to improve the health of Colorado. That is why we are extremely proud to support Based on their experiences, it was clear CMS and its members by giving them the physician community needed a better the benefits of a bank built for doctors, way. Medical training and cost-of-living by doctors.” are not getting cheaper, and physicians should have healthier options regarding Doctors have seen and appreciated their debt. As physicians themselves, they felt custom-made services as Panacea Finanuniquely qualified to build better prod- cial has seen massive growth nationally. ucts and services to meet their commu- Every day, Panacea continues to help nity; their experiences led them to build a physicians across the country refinance nationwide digital bank for doctors called student loans, pay for residency tranPanacea Financial. sitions, build surgery centers, or buy into their practice. Jerkins is especially

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excited about supporting private practice in Colorado saying, “Our commercial line was specifically built for physicians to start, build, or grow their practice and ultimately maintain independence.”

Want to learn how Panacea Financial helps CMS members? Visit https:// panaceafinancial.com/ref/CMS/ today. ■

“

Our physician community benefits from strong medical societies and the Colorado Medical Society is no exception with its work to improve the health of Colorado. That is why we are extremely proud to support CMS and its members by giving them the benefits of a bank built for doctors, by doctors.”

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R E F LE C TI O N S

A beginning and an ending Amanda Hunt

Amanda Hunt is a third-year medical student. She grew up in southeastern Wisconsin on the edge of Lake Michigan with her younger sister and her parents. Things that bring her joy include reading with a cup of hot cocoa as snow is falling outside, hiking, playing basketball and thrift shopping. She would love to become a critical care anesthesiologist while living and working here in Colorado.

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ransplant surgery – it was thrilling, it was intense, and I felt privileged. I was about one week into my experience, when I was told we had a case at Children's Hospital. Initially my brain went “Oh, I love the kiddos, I’m excited to go to Children’s Hospital!” When a split second later, my brain went “Wait, what sort of case calls for a transplant team at Children's Hospital?” I followed the fifthyear resident to the hospital. We walked in, traveling the hopeful and colorful hall-

ways, found a pair of computers, and sat to read about the case. It was a 3-yearold girl who had been in a car accident a couple weeks prior and had been determined to be brain dead. Our team was to help in the process of donating her kidneys and liver.

As normally happens, when time of death is called, it is all adrenaline. We have only a couple minutes to preserve the precious organs this young girl was donating.

The surgery felt like the usual blur – the blue drapes covered her small body. The incision was made with less precision but plenty of speed. Her kidneys were perfectly small and tan and her liver was smooth and a deep burgundy. We were able to put her organs on ice and the team quickly whisked them away to save lives.

Meanwhile, my adrenaline was decreasing. It was my turn to do the “medical student job” and close up our patient. At first I was calmly numb; this small 3 yearold little girl with her life now ended was to be sewn up to be returned to her family for a burial service. Once I finished the last stitch, removed the draping and saw her face – without warning I became anything but numb. It felt like an egg was in my throat, I couldn’t swallow. My feet felt like they were nailed 20 feet into the earth.

My eyes seemed to blink in slow motion and my vision went blurry, obscured by tears. I was putting this sweet 3-year-old girl, with pigtails still held up by tiny pink bands, into a body bag. This should not be happening. Her life should not be over.

I silently zipped the bag and walked out. I tried to tell my resident where I was going, but the egg in my throat hadn’t moved. So I just pointed to the door, ripped off my sterile gloves and gown, and walked out.

Frantic to hide my tears, I raced to the locker room to realize I didn’t have my children’s badge on me, so I couldn’t escape. Instead, I hid in a corner and simply cried.

Her life was ending, but two others were about to have a new beginning. ■

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F E ATU R E

F I N A L

WO R D

Turn to CMS when you are in need Sami Diab, MD, CMS Immediate Past President

Medicine has never been as challenging as it is now, and I extend my sincere wishes of

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health and joy in these times to all members of the Colorado Medical Society.

ontinuing the work that began during my presidency, CMS is doing exciting work toward our strategic goal to help physicians when we need help. Operationalizing this, we in leadership with the CMS staff are strengthening an infrastructure for our society to be the source CMS members turn to when you are in need.

The Colorado Medical Societ y has always aimed to help members but very strongly embraced this mission through the COVID-19 pandemic and to protect confidential peer assistance counseling.

Fast-forward to December 2021 when the devastating Marshall and Middle Fork Fires affected our Boulder community.

We knew we had to step in. Through the discovery that more than 70 CMS physician members could have been geographically located in the zone of devastation, CMS sought disaster assistance from the American Medical Association for physicians and practices. Read more about this work and our own financial assistance through the COCHEMS trust in our cover story starting on page 6.

But we don’t always know when physicians will need help, so we ask you to reach out. We are also building our resources for physician wellness. This is an issue close to my heart, and there is great need right now to make sure physicians have the mental and emotional support that is specialized for our unique circumstances.

It is easy to lose the joy of medicine in administrative hassles, negative patient outcomes, and the overt negativity some are showing to physicians and nurses perhaps due to their own life stresses. It can sometimes be difficult to find someone who understands our plight clearly and can help guide us through.

I am greatly encouraged by the work of the CMS Committee on Physician Wellbeing, led by Deborah Saint-Phard, MD, to continually monitor best practices in wellness. The committee brought two recommendations to the CMS Board of Directors that were approved at the January meeting.

The first of two new programs CMS staff and volunteer leaders will now begin

developing is a peer-to-peer living room program. The model will bring a small group of physicians together with a facilitator for thoughtful and confidential discussions in members’ homes. The second program the board approved for initial development will make free coaching services available to all CMS members through a contract with a vetted and trusted provider. We hope these will be the first two stairsteps to getting help when you feel the small, nagging issues getting larger, with the third step being our peer assistance counseling provider.

In short, we say often that your membership matters to CMS. Most important, you matter to CMS, and we want to support you however we can to help you bring joy back into your daily practice of medicine.

We thank you for being one part of the Colorado Medical Society. With our voice as CMS members, we make a real impact in our state: for our patients, for our colleagues and for the future physicians who will come after us. Be well. ■

But we don’t always know when physicians will need help, so we ask you to reach out.

The Colorado Medical Society membership team wants to hear how we can continue to be your best partner and to find your roadmap to the best use your membership. If you are interested in scheduling a listening session, please contact membership@cms.org.

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