Fall 2023 Colorado Medicine by Colorado Medical Society

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COLORADO MEDICINE ADVOCATING EXCELLENCE IN THE PROFESSION OF MEDICINE

ADVOCATE, BELONG, EDUCATE, ENGAGE OMAR MUBARAK, MD, MBA 2023-2024 CMS PRESIDENT

PLUS

PRIMER ON NEW CHRONIC PAIN LAW PHOTOS FROM THE CMS ANNUAL MEETING PARTNER SPOTLIGHT: TIPS ON MAKING FEDERAL STUDENT LOAN PAYMENTS

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ADVOCATE, BELONG, EDUCATE, ENGAGE Newly inaugurated CMS President Omar Mubarak, MD, MBA, shares his journey to leadership and urges everyone to get involved to protect the profession of medicine. CMS is already an essential organization; he believes it will become the biggest change agent Colorado physicians have. PAGE 3 ⊲

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HOW DO I SUPPORT A STRUGGLING COLLEAGUE? Helping a struggling colleague is one of the most important and unique things you can do as a physician. Read more from CPHP medical director Scott Humphreys, MD, on the importance of checking in.

8 UCHEALTH HONORED BY AMA FOR PROMOTING WELLBEING OF HEALTH CARE WORKERS UCHealth has earn gold-level recognition from the American Medical Association for their efforts to address and prevent burnout among their health care providers.

20 FINAL WORD: COLORADO LEADS THE WAY WITH NEW LAW ON CHRONIC PAIN Kate Nicholson, executive director and founder of the National Pain Advocacy Center, celebrates a new Colorado law that will protect patients who have chronic pain and use opioids for pain management, and the physicians who provide care for them.

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TOGETHER: A REPORT FROM THE 2023 CMS ANNUAL MEETING

Colorado Medical Society members from around the state gathered in Vail to celebrate, learn and connect with each other and the medical society. See photos of the fun. 17

REFLECTIONS:

INTROSPECTIONS:

COPIC COMMENT:

PARTNER IN MEDICINE SPOTLIGHT:

MEDICAL NEWS:

STUDENTS AND PHYSICIANS LEARNED TOGETHER AT WHITE COAT WISDOM

Colorado medical students spent a chilly morning in October gleaning knowledge from a line-up of experienced physician speakers, learning how to chart their own path in medicine. 19

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RUN FOR A CMS LEADERSHIP POSITION IN 2024

CMS encourages all physician members to consider running for a leadership position in 2024. The nomination period is open through Jan. 31, 2024, and the election takes place in August.

Conversations with myself A shift in perspective From grants to legislative advocacy – COPIC commitment to improving health care Federal student loan repayments are back

Living Room Conversations brings physicians together for wellbeing

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 2023-2024 OFFICERS

BOARD OF DIRECTORS

AMA DELEGATION

Omar Mubarak, MD, MBA President

Brittany Carver, DO Elizabeth Cruse, MD, MBA Kamran Dastoury, MD Amy Duckro, DO Gabriela Heslop, MD Enno F. Heuscher, MD, FAAFP, FACS Dakota Hitchcock, MSS Rachelle M. Klammer, MD Marc Labovich, MD Chris Linares, MD Michael Moore, MD Rhonda Parker, DO Lynn Parry, MD Sean Pauzauskie, MD Leto Quarles, MD Hap Young, MD

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

Kim Warner, MD President-elect Hap Young, MD Treasurer Patrick Pevoto, MD, MBA Immediate Past President Dean Holzkamp Chief Executive Officer

AMA PAST PRESIDENT Jeremy A. Lazarus, MD

COLORADO MEDICAL SOCIETY STAFF Dean Holzkamp Chief Executive Officer Dean_Holzkamp@cms.org

Cecilia Comerford Executive Director, Boulder County Medical Society Cecilia_Comerford@cms.org

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

Dorcia Dunn Program Manager, Membership Dorcia_Dunn@cms.org

Jennifer Armstrong Program Manager, Government Affairs and Communications Jennifer_Armstrong@cms.org

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

Cindy Austin Director of Membership Cindy_Austin@cms.org

Mihal Sabar Director of Accounting Mihal_Sabar@cms.org

Virginia "Ginny" Castleberry Executive Director Denver Medical Society Virginia_Castleberry@cms.org

Chet Seward Chief Strategy Officer Chet_Seward@cms.org

Kim Vadas Director of Continuing Medical Education and Recognized Accreditor Programs Kim_Vadas@cms.org Debra Will Director of Business Development Debra_Will@cms.org Tim Yanetta IT/Membership Manager 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. 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. Guest editorials and letters to the editor are published at the sole discretion of the Colorado Medical Society on a space-available basis. Dean Holzkamp, Executive Editor, and Kate Alfano, Managing Editor. Design by Scribner Creative.

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Advocate, belong, educate, engage ADAPTED FROM THE INAUGURAL ADDRESS OF THE 2023 COLORADO MEDICAL SOCIETY ANNUAL MEETING Omar Mubarak, MD, MBA

I just want to tell you a little bit about me, why I think the organization is important, and why I think CMS is going to be a huge change agent for all of us now and in the future. So, about me. I was born and raised here in Colorado; I went to Colorado Academy from kindergarten through 12th grade. And I was born at St. Joseph’s Hospital where I now practice. I went to the University of Colorado for undergraduate and I got a degree in molecular, cellular and developmental biology. I love Colorado; I didn’t want to leave, so I went to medical school here. And then when I was thinking about what I wanted to do in life, I knew that I wanted to become a vascular surgeon from a young age, because my father was a thoracic and general surgeon. Then I knew I would have to leave the state because there wasn’t a vascular surgery fellowship at the University of Colorado at the time. I went to Michigan State and Henry Ford Hospital, which I’m very fortunate I did, because that is where I met my wife. She takes care of me in every endeavor of my life. My family has a very strong history in medicine in Colorado. As I mentioned, my father was a general and thoracic surgeon who practiced at Lutheran Medical Center. My wife, Leslie, is a rheumatologist. My sister, Hanan, is a PhD in pharmacology, who spent most of her career here. So we have a lot at stake in Colorado in the medical field. And we want to see the medical field improve. We know the strains of medicine; we talked about them all day at the CMS Annual Meeting – occupational stress, scope of practice, dealing with insurance companies and prior authorization, and dealing with health care systems. These are just some of the challenges doctors are experiencing, and that I experience as a private practitioner.

CMS is already an essential organization...... it 's going to become organization t he biggest change agent we have To understand why I’m here today, you have to understand the evolution of my career since I came back from Henry Ford Hospital in 2006. I told myself that if you work hard as a physician, and you know what you’re doing, and you practice good medicine, you’re going to be fine. That was my belief. And over the next decade of my career, I realized that is not true. You could be an amazing doctor, and you could work yourself to death, and the system itself could bring you down. Arguing with insurers, arguing with health care systems, you could go crazy. Right around that time, an article came out from Forbes about why private practice is dying. That led me to go back and get an MBA at the University of Colorado, because I just couldn’t believe how things had changed from my father’s generation to my generation. Even while I was going though the MBA program, we started making major changes in my practice; we started creating office-based labs, and even bought our own building and created a space that functions as an office-based lab on some days and an ambulatory surgery center (ASC) on other days, allowing us to drive down health care costs for patients and help our business thrive. Things were getting much better and we were doing well, but a certain event in my life led me to recognize that there was something just wrong. It was when we started to partner with a group called Western Slope Cardiology in Grand Junction, which technically is still an underserved area. This group of cardiol-

ogists wanted to work with us to create their own office-based lab. But a hospital system literally decided to destroy the group by removing their privileges. The hospital administration must have thought that once this group is gone – the largest group of cardiologists serving an underserved area – that the hospital would get some of them and the ones that they didn’t get or didn’t want will just move on. The hospital created a closed system, initially only for cardiology but now they’re a completely closed system, so only physicians employed by the hospital could have privileges and all others were excluded. I contacted Sami Diab, who was the president of CMS at the time, and talked to one of my local representatives, Iman Jodeh. I told them I couldn’t even believe this was legal. I had 10 years of experience on med exec for Presbyterian St. Luke’s and the only way I thought you could remove somebody’s privileges was if they did something very wrong. But Sami did some research for me and I learned that it is legal to take away physicians’ privileges that simply. I thought, you’ve got to be kidding me. Then Sami said, if you don’t like it, get involved. That’s what you’ve got to do as a doctor. Know that this is coming from California and they’re doing it in other places, just wiping out private practices. I thought back to a statement that I learned in Latin, which is vive ut vivas, which translates to “live so that you may live.” What it really means is live your life every day to the fullest extent to get the PAGE 4 ⊲

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A DVO C ATE , B E LO N G , E D U C ATE , E N G AG E : C O N T

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most out of life, almost unapologetically. And I thought you’ve got to get involved. That’s all there is to it. So I got more and more involved with Sami and I worked on the Independent Physician Task Force for two years. And that’s how I got here, standing in front of you as CMS president.

CMS is moving us, Colorado physicians, forward. My vision of CMS is that it is already an essential organization. If people don’t realize that, they’re kidding themselves. It’s an essential organization for doctors in the state of Colorado to have a voice and to function. But it is going to become, I believe, with people like myself, with President-elect Dr. Kim Warner, the biggest change agent we have. So I encourage everyone to try to tell every doctor that they know to join. Today’s medicine is difficult. We heard about it all day long [in the Annual Meeting educational sessions]. There are administrative burdens, burnout, battles with payers, corporatization of medicine, scope creep. That’s just some of it. AMA President-elect Dr. Bruce Scott very eloquently summarized the issues AMA is addressing for physicians on a federal level. You have to become involved to protect our profession because medicine is so incredibly rewarding. Every single time I’m just about to throw up my hands because I have had it, there’s some patient who yanks me back and makes me remember why it’s worth it. One particular gentleman went to a hospital in Grand Junction with a ruptured thoracic aneurysm, which is essentially fatal. You can rupture an abdominal aortic aneurysm and the retroperitoneum will contain it so you have several hours. But a thoracic aneurysm bursts in your chest and there’s nothing to hold that back. The patient showed up to the hospital and the thoracic surgeon and vascular surgeon which they replaced us with after they became a closed system did not want to care for the patient. So they airlifted him from Grand Junction all the way to St. Joseph’s Hospital where I placed a thoracic endograft percutaneously with just two access points; one in the common femoral artery on each side. He’s the PAGE 6 ⊲

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Dr. Tracy Cerniglia Joined in 2001

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A DVO C ATE , B E LO N G , E D U C ATE , E N G AG E : C O N T

main provider for his family. He has three kids. I reflected on that experience with gratitude and wonder: What job gives you that kind of reward? There simply isn’t any comparison. The height of technology is ridiculous. The things you can accomplish with that technology is unbelievable. And then the effect you can have on an entire family is amazing. That’s what medicine is – just incredible. We have to advocate, belong, educate, engage. You’re going to hear that mantra over and over from CMS. Because CMS as an organization is moving us, Colorado physicians, forward. In just 2023, CMS affected through advocacy, your patients, your practice and the profession. In terms of patients, CMS reduced the prescription administrative burden requirements for serious mental health. And we ensured care for chronic pain. For your practice, we drove an audit on the Medicaid RAC audit program, which I personally felt the pain of and so did many of the people at PSL that I worked with who are in private practice. We prohibited

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If you love medicine, and you want to make it good for your kids, to possibly pave the way for them to become doctors, you have to get involved unnecessar y processing fees when being reimbursed for billed claims. And in terms of our profession, we defeated trial lawyers’ efforts to increase rates, number of settlements and physician exposure to personal liability. We also achieved important guardrails around psychologists’ prescriptive authority and physician assistants; I personally helped with that one. But we have big plans and there are big problems, and it’s not going to stop. I wish I had a silver bullet to make it all better but it’s not going to stop. That’s why we need CMS, because every year is going to be a different fight. And if you love medicine, and you want to make it good for your kids, to possibly pave the way for them to become doctors, you have to get involved.

The key advocacy fights that we face are credible threats on non-economic damage caps and passing our prior authorization reforms to make it so that we don’t have to take time away from patients to complete the same stupid preauth all the time. These efforts by CMS mimic everything Dr. Scott, the president-elect of the AMA, was talking about and all the pressures we feel. CMS is also going to have a membership forum and take a comprehensive review of our value proposition and market demands to analyze what doctors need in Colorado and what we can do to help them. I would also encourage every member to talk to the physicians that you know who aren’t involved, and convince them. Advocate, belong, engage, educate; let’s do this. We can make it better. Thank you very much. ■

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How do I support a struggling colleague? Scott Humphreys, MD, Medical Director Colorado Physician Health Program (CPHP) As physicians, we are trained to do many extraordinary things. We are very aware of our exclusive abilities to diagnose a patient’s ailment and harness the wonders of modern medicine to give them their life back as well as years that come after that. But the long-standing tradition of medical training and practice is that we do so as an island of calm, unaffected by all that we wrestle with. To quote the pioneer of modern medical education, Sir William Osler, imperturbability. Over the course of almost 40 years, the Colorado Physician Health Program (CPHP) has evaluated over 6,000 Colorado physicians. This experience shows, time after time, in just about every case seen, physicians are affected. We are af fected by malpractice stress, our changing practice environments, staffing issues, bureaucratic requirements, and the list goes on. Beyond that, we are also humans. We are vulnerable to everything that affects our fellow humans: depres-

sion, life changes, divorce/breakups, financial issues, strained relationships, aging parents, our children’s challenges, job securit y, and psychiatric illness including substance disorders. For most of us, some of our most important relationships are with our colleagues. We have practiced together for years and shared triumphs and losses. Our educational backgrounds are similar, and we usually have a lot in common. Regardless of how intimate you consider these relationships with colleagues, they are important to you, and you are important to them. It is common to only begin to worry about our fellow doctors when it seems their work is affected. This is way too late! Work, especially patient care, is the last thing to be impacted when one of us is struggling. The most consistent thing to look out for is a change in behavior.

Often, this involves withdrawing from social interactions. When someone appears not themselves and distant, that is the time to reach out. Keep in mind, you are an important relationship to your colleague. You may not be best friends in the traditional sense, but you are sharing your lives. Please reach out, invite them for a cup of coffee or another break. It is sometimes difficult to ask someone about their life and it can feel intrusive. But they may be in a place where they feel they have no one to talk to. It may be your caring and supportive outreach that makes the dif ference between ongoing suffering and finally seeking the help they know they need. Helping a struggling colleague is one of the most important and unique things we can do as physicians. Also, keep in mind you are not alone in this, please reach out to us at CPHP. We are here to help. ■

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Joy

UCHealth honored by AMA for promoting wellbeing of health care workers UCHealth

UCHealth has earned gold-level recognition from the American Medical Association as a Joy in Medicine™ organization. The prestigious AMA distinction is granted only to organizations that attest to the rigorous criteria of the Joy in Medicine™ Health System Recognition Program and demonstrate a commitment to preserving the wellbeing of clinical care team members through proven efforts to combat work-related stress and burnout. “We are very honored to have been recognized by the AMA with this award,” said Margaret Reidy, MD, chief medical officer for UCHealth. “Our partners in HR, Security, Informatics, IT and Quality, among many others, have helped in this work.” Burnout rates among the nation’s physicians and other health care professionals spiked dramatically as the COVID-19 pandemic placed acute stress on care teams and exacerbated long-standing system issues. The lingering impact of

work-related burnout remains an obstacle to achieving national health goals.

“Health care organizations that have earned recognition from the AMA’s Joy in Medicine Health System Recognition Program are leading a national movement that has declared the wellbeing of health professionals to be an essential element for providing high-quality care to patients, families and communities,” said Jesse M. Ehrenfeld, MD, AMA president. “Each Joy in Medicine recognized organization is distinguished as among the nation’s best at creating a culture of wellness that makes a difference in the lives of clinical care teams.” In 2020, UCHealth unveiled the Professional Fulfillment Model as the framework to develop resources and programs that support the behavioral health and wellbeing of every UCHealth team member.

A FEW EXAMPLES OF THIS WORK INCLUDE: • First Call, a free 24/7 support call line available to every employee • Workplace safety efforts, including resources to address and prevent workplace violence, like the SAFE initiative and new visitor management systems • Initiatives to cultivate an environment of mutual respect, such as Unconscious Bias training, Being an Upstander training, Just Culture approach to HR and Peer Review situations, and I Need Clarity as a safety phrase • Diversified modes of communication to effectively cascade news, including streamlined email channels, launch of new podcasts and the development of the Physician and APP Advisory Council • Epic sprints to evaluate and improve EHR and workflows • In Basket redesign for work f low efficiency • System -wide physician and APP orientation • Peer support program for physicians, APPs and nurses • Individual coaching program that has reduced burnout for participants by 29 percent relatively “We have much more to do in this space,” said Dr. Reidy. "We recognize that clinician wellbeing is essential to the quality of care we provide and we are committed to continuing this work.” Since its inception in 2019, the Joy in Medicine™ Health System Recognition Program has recognized more than 100 organizations across the country. In 2023, a total of 72 health systems nationwide earned recognition with documented efforts to reduce system-level drivers of work-related burnout and demonstrated competencies in commitment, assessment, leadership, efficiency of practice environment, teamwork and support. ■

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Where to Drop Off Your Medications There’s a convenient takeback location near you! You’ll find your nearest Medication Takeback Dropbox at TakeMedsSeriously.org/safe-disposal

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R E F LE C TI O N S

Conversations with Myself Celina Sarangi Special Thanks to Sam Rodriguez

Celina Sarangi is a third-year medical student at the University of Colorado School of Medicine. She is applying into family medicine due to her interest in community health and preventive medicine. Her piece is dedicated to her father-in-law, Sam Rodriguez, who continues to support her love of poetry.

I wanted to check in with you. How are you? Observing our inner environment Allows us to show up more profoundly As a family member, student doctor, colleague, and community member. What was joyful about today? Which experiences, sounds, or smells? I would love to hear that story. Could you tell me, sparing no detail? By focusing on our joy Our happiness restores our humanity.

Could you tell me how you Made a difference today? To just one person. How you pursued a goal? Just one thing you learned. By observing our impact Our confidence restores our humanity. Did you make space today To align yourself with your values? How did you fill your bucket So that you may continue to fill others’? By improving our work-life balance Our peacefulness restores our humanity.

Which connection did you nurture today Where someone felt heard or included? How did you amplify their voice Or echo their values? By treating others considerately Our kindness restores our humanity. Our humanity Is our pulse. Our signature of life. Our impact. Our advocacy. Our wellness. ■

Reflective writing is an important component of the University of Colorado School of Medicine curriculum. Beginning in the first semester, medical students write essays, stories or poetry that reflect what they have seen, heard and felt. The Reflections column was co-founded by Steven Lowenstein, MD, MPH, and Tess Jones, PhD. It is now co-edited by Dr. Lowenstein and Kathryn Rhine, PhD. It is dedicated to the memory of Henry Claman, MD, Distinguished Immunologist and Professor at the University of Colorado, and founder of the Arts and Humanities in Healthcare Program.

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From grants to legislative advocacy – COPIC commitment to improving health care Gerald Zarlengo, MD Chairman & CEO, COPIC Insurance Company

Since the day COPIC was founded, one of our core ideals was to be more than just an insurance company. We have always recognized our unique role in health care and the responsibility to use our insight, experience and assets to contribute in meaningful ways. Two long-standing and prominent areas that highlight this are grant funding and legislative advocacy. GRANT FUNDING THROUGH THE COPIC MEDICAL FOUNDATION Grants to support promising initiatives and programs in health care are a cornerstone of the COPIC Medical Foundation’s (CMF) mission. We continue to focus on funding around the issue of reducing fragmentation across care settings. A top concern in the field of patient safety, breakdowns in care from a fragmented health care system can lead to readmissions, missed diagnoses, medication errors, delayed treatment, duplicative testing and procedures, and reduction in quality of care leading to general patient and provider dissatisfaction. For CMF, contributing to a solution to this safety concern means supporting scalable or replicable solutions, focusing on the testing of new ideas or growing existing solutions, and then seeing avenues for larger application. Funding cycle – CMF is accepting applications Nov. 1, 2023 through Jan. 12, 2024 for its 2024 cycle of grant funding. Criteria – To be considered for funding, organizations must meet the following minimum criteria:

• Approach or program has demonstrated potential for uptake or replication by the health care community

• Organization is designated as a

501(c)(3) organization or has an identified fiduciary

Deadlines and applications – Grant applications are due Jan. 12, 2024 by

5 p.m. (Mountain Time). Applications can be emailed to mhintze@copic.com. Applicants can expect to hear from CMF regarding potential support by March 31, 2024. Download the grant requirements and application on the COPIC website at www.copicfoundation.org. LEGISLATIVE ADVOCACY – ENGAGEMENT TO IMPROVE MEDICINE COPIC has long believed that taking an active role in advocating on legislative issues is an important way to allow the health care community to devote its resources to quality improvement and patient care. Our Public Affairs team oversees year-round state-level legislative advocacy efforts that are done in collaboration with partner organizations such as the Colorado Medical Society and Colorado Hospital Association. These efforts center on monitoring initiatives that may impact the tort environment, change regulatory oversight, create unreasonable burdens on health care delivery or reduce access to quality health care. Our goal is to provide our insureds a sense of assurance in knowing that COPIC is keeping an eye on legislative issues so they can focus on their patients. Key aspects of legislative advocacy COPIC’s proactive and collaborative approach toward legislative advocacy includes the following:

• Monitoring and reviewing proposed

legislation: Ever y year, there are many bills brought forth that have the potential to impact health care. COPIC reviews introduced bills throughout the

legislative session, assessing each for possible unintended consequences impacting patient safety, tort, quality of care and other liability issues.

• Building relationships with state

legislators and regulators: COPIC engages with legislative and regulatory leaders year-round to identify opportunities to work together and serve as a trusted resource to inform policy and regulations impacting health care delivery by providing facts, research, and evidence-based data to assist in their understanding of the medical, legal and economic implications of health care-related bills.

• Political contributions and campaign

support: Each election cycle, COPIC works to identif y candidates that support our priority issues. We work hard to build their trust and understanding, which includes supporting them with bill reviews and analysis as well as supporting their campaigns for election or reelection.

As we get ready for the 2024 legislative session, our Public Affairs team is focused on preparing for the challenges that may emerge. In particular, our efforts are focused on reinforcing reforms that have created a balanced, stable tort environment in Colorado for over 35 years, and the importance of defending those reforms in order to protect access to care and reduce costs. We look forward to working with our health care partners on issues that connect back to COPIC’s mission to improve medicine in the communities we serve. ■

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I NTR O S P E C TI O N S

A shift in perspective Zachary Roland

Zachary Roland is a fourth-year osteopathic medical student at Rocky Vista University. Originally from Union, Ky., Zachary served six years in the United States Air Force before attending medical school and is interested in pursuing a career in orthopedic surgery. Student Doctor Roland spent a year as an Osteopathic Principles and Practices Fellow and enjoys being outside and spending time with family.

My father told me throughout my childhood, “You’ll change your mind many times before you figure it out.” This comment always came after I told him my new career plan. About every six months or so, I would have an experience where I would decide “I want to do that!” Whether I was set on becoming an engineer or a lawyer, each time my father repeated those words. This was until about eight years ago when I told him I wanted to be a family medicine physician. Maybe it was the look in my eyes or the sound of my voice, but it was one time when I remember that he didn’t repeat those words to me. I thought I was done with the question, “What am I going to be when I grow up?” I sit here now, completely and utterly wrong. I also wonder “Am I good enough?” Medical school is a bear of an undertaking. The schooling is so rigorous that we must make decisions on how we are going to complete it. What are my goals? Do I want to be at the top of the class? Do I want to honor all my classes? Do I want to “just” pass my classes? Do I want to prioritize my school/family/life balance? I star ted medical school like most students, studying countless hours hoping for a perfect score. However, long days of studying were short lived after finishing my first block. The exams were more challenging than I had expected, and I earned an average score. This made me quickly reprioritize my goals to study as much as it took to understand concepts and do moderately well without reaching the point of diminishing returns. This new goal allowed me to have the work-life balance that I wanted and gave me the

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opportunity to spend the majority of my time with family. However, I didn’t take the time to complete things that would help me be more competitive down the road. When I reflected on these goals in my later years of school, I wondered if they were the right ones. The “retro-spectroscope,” an instrument synonymous with hindsight, shows a clear view of all the things you did wrong or right and all the goals you should have pursued instead. After a previous rotation experience, I spend most days looking through it. What caused me to review my medical school journey? For myself, the third year of schooling has been the most difficult. Not for the usual reasons of the information being too much or the tests being too difficult. It has been the most difficult because I truly enjoyed all my rotations. As I completed each rotation, I would reflect on whether or not I wanted to do this for the rest of my life. Each coming with a resounding, “yes”, because all of these specialties – from pediatrics, to OB-GYN, to psychiatry – could be done in family medicine. My decision was final and unwavering. Or so I thought. The final months of my core rotations were completed in the surgical specialty. Within the first few days of orthopedic surgery, my unwavering decision wasn’t so unwavering. The previous excited feeling that I had experienced during my prior rotations felt like a whimper of excitement and fun when compared to the first week of my surgical experience. If holding an instrument and trying to answer the questions from the attending was this exciting, how would it feel doing more? Each time

I did something more, or something new, or even more of the same, it was more fun and more exciting than the last. It is the only time that, when finishing a rotation, I wasn’t “open to new specialties.” Simply thinking about orthopedic surgery, or any surgery, makes my heart race and I get a huge smile on my face. I even dream about it most nights now. If any rotation makes you have the same feeling, you’re probably in the right place. If I were to restart medical school from the beginning, I would suggest a few things to myself. Allow yourself to be open to new things as you never know what you might be interested in. Also, try to shadow different specialties, even the ones you aren’t interested in, to see if it changes your mind. Lastly, and I now believe most importantly, set challenging goals, and do your best to surpass them whenever possible. There is only good that can come from doing better than expected. This experience made me look through the retro-spectroscope to take a good look at what I have done. Am I good enough to pursue such a competitive specialty? I found that my goals for the first couple of years didn’t align with my current desires. The problem is, we can only do something about it in the present. So, I discussed this with the attending I was with who gave me the best advice I could have received. When I asked if it was “too late,” he responded with saying, “Who cares? If you want to do it, do it.” With these words of wisdom, I will work as hard as I can from now until Match Day trying to do everything that I can to be both competitive and show passion for my dream job. ■

Mobility matters. Rehab therapy can help. Completing the tasks of everyday life can be overwhelming after an illness or injury. Our rehabilitation therapy team at the Good Samaritan Society provides individualized support during every phase of your patient’s recovery. When your patient is facing physical challenges or needs help with speech, language or swallowing, we’ll help them heal faster so they can get back to living.

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Federal student loan payments are back! Updates and tips Michael Jerkins, MD, M.Ed President and Co-Founder, Panacea Financial

Since 2020, many physicians, like millions of other Americans, have benefited from the temporary suspension of federal student loan payments due to the COVID19 pandemic. Federal student loan payments resumed in October, meaning those millions of student loan borrowers are now required to make payments. Do you have federal student loans? Are you ready to make payments? Here’s what you need to know about updates to federal student loan policies and programs and strategies for managing your loans. FEDERAL STUDENT LOAN CHANGES: NEW INCOME-DRIVEN REPAYMENT PLAN AND ON-RAMP TO PAYMENTS About 1 in 5 student loan borrowers surveyed had risk factors that indicated that they would struggle when payments resumed, according to a report from ConsumerFinance.gov. As the payment pause ended, the Department of Education (DOE) announced an optional on-ramp approach to repayment and a new income-driven repayment plan to help borrowers that may be at risk.

STUDENT LOAN ON-RAMP The sudden resumption of payments could be financially overwhelming for many individuals, so the on-ramp was designed by the DOE to gradually reintegrate borrowers into the rhythm of student loan payments. By utilizing this provision, borrowers have a one-year grace period for missed payments from Oct. 1, 2023 to Sept. 30, 2024. Those who have missed or made late payments won’t be reported to credit reporting agencies, be considered in default, or be sent to collection agencies, but interest will still accrue during this time. If you are considering whether you should take advantage of this on-ramp, know that the White House recommends that if borrowers can pay on their loans, they should. The on-ramp is meant to help borrowers who are unable to make their payments and need time to adjust to the new expense. NEW IDR PLAN Replacing the Revised Pay-As-You-Earn plan, the new income-driven repayment plan, Saving on A Valuable Education (SAVE), is the most affordable plan to date and could help doctors by:

• Eliminating all of the remaining

monthly interest for loans when a monthly payment is made. Meaning your balance will not grow as long as you make your monthly payments – even when that monthly payment is $0 because your income is low.

• Excluding spousal income for married borrowers who file taxes separately.

TRANSITIONING TO STUDENT LOAN REPAYMENT The payment pause is over, so borrowers are now transitioning into repayment. This can be difficult, but taking proactive steps to choose the best repayment strategy for your needs can make it a little easier:

• Review your loans: Be sure you understand the specifics of your loan, such as interest rates, repayment options, and potential benefits or programs available.

• Assess your finances: Evaluate your current financial standing to determine the feasibility of the repayment terms.

• Consider repayment plans: Explore

the different repayment plans offered by the DOE, which will adjust your payments based on your income level.

• Increasing the amount of income that • Seek expert advice: Navigating is considered non-discretionary. (This could be particularly useful for residents and trainees).

student loans can be challenging, especially for doctors who often have six-figure student debt balances. A student loan advisor can provide a customized repayment plan based on your unique financial needs and goals.

MANAGING YOUR STUDENT LOANS Don’t let the transition from forbearance to repayment overwhelm you. Panacea Financial is here to help every step of the way with Student Loan Refinancing and Student Loan Consultations built for doctors. Learn more and take advantage of CMS exclusive discounts at panaceafinancial.com. ■

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A REPORT FROM THE 2023 COLORADO MEDICAL SOCIETY ANNUAL MEETING

Photos and text by Kate Alfano, CMS Director of Communications and Marketing Colorado Medical Society members from around the state gathered for the 2023 Annual Meeting in Vail Sept. 22-23. Attendees enjoyed social time, a movie screening, excellent programming with CME credits and COPIC Points, and more. Plus, lots of opportunities to enjoy the mountains and fall colors. It was just nice to be together, and this theme carried throughout the weekend. Save the date for the 2024 Annual Meeting in Breckenridge, Sept. 13-14! 1. Incoming CMS President Omar Mubarak, MD, MBA, right, repeats the oath of office from Outgoing CMS President Patrick Pevoto, MD, MBA. 2. Mark Johnson, MD, MPH, left, who completed his year as immediate past president, receives a certificate of service recognizing his time on the Board of Directors from Patrick Pevoto, MD, MBA. 3. Edward Norman, MD, right, receives a certificate of service after serving two terms on the CMS Board of Directors. 4. Amanda Besmanoff, representing the Center for Personalized Education for Professionals (CPEP) speaks with an attendee at Friday's welcome reception. 5. CMS was honored to recognize the physicians celebrating 50 years since graduating medical school. With Omar Mubarak, MD, MBA, third from left are: Jack Stachler, MD, FACC; Nathan Persoff, MD; and Krishna Murthy, MD. 6. Brad Radochonski, right, representing COPIC, speaks with an attendee at Friday's welcome reception. 7. Rep. Cathy Kipp, D-Fort Collins, addresses the audience at the screening of "Theatre of Thought." 8. Medical student leaders from the University of Colorado School of Medicine and Rocky Vista University represent at the Annual Meeting. 9. Speaker Aneesh Garg, DO, talks about embracing failure to improve care. 10. AMA President-elect Bruce Scott, MD, addressed attendees as the COMPAC luncheon keynote speaker, detailing the AMA's Recovery Plan for America's Physicians. 11. April Randle, MD, center, was recognized as COPIC's 2023 Humanitarian Award Winner. The award was presented by Beverly Razon, COPIC senior vice president of public affairs, right, and Omar Mubarak, MD, MBA, left. 12. Eric Zacharias, MD, COPIC director of medical education, presented a session on preventing medication errors. 13. President and president-elect pose with their spouses. From left: Leslie Rose, MD, with her husband Omar Mubarak, MD, MBA; and CMS President-elect Kim Warner, MD, with her husband, CMS Past President Rick May, MD. 14. Patrick Pevoto, MD, MBA, right, receives a certificate of service recognizing his year as CMS President from Omar Mubarak, MD, MBA, left.

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Students and physicians learned together at White Coat Wisdom The Colorado Medical Society Medical Student Section (CMS MSC) hosted White Coat Wisdom on Saturday, Oct. 7. More than 60 students from CMS President Omar Mubarak, MD, MBA, welcomed medical students to the University of Colorado School of Medicine White Coat Wisdom. and Rocky Vista University School of Osteopathic Medicine attended to network with physicians and learn about leadership, finances, wellbeing, medical liability insurance, starting a practice, and more. Many students are looking for mentors; if you are a physician willing to mentor a student, please Speakers, from left: Ben Zimmerman, MD; Jacob Mathew, DO; Aneesh Garg, contact membership@cms.org. DO; Omar Mubarak, MD, MBA; Kelsey Sherman, MD; Sarah Snow, MBA.

Kelsey Sherman, MD, led a rapid rounds discussion on achieving wellbeing in medicine.

Jacob Mathew, DO, speaks with Dakota Hitchcock after after his session on financial considerations for new physicians.

Lynn Parry, MD, right, shares her experience in medicine with Jamie Pfahl. C O LO R A D O M E D I C I N E

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Living Room Conversations brings physicians together for wellbeing Living Room Conversations, created by the Colorado Medical Society Committee on Physician Wellbeing, brings together a small group of local physicians to meet in person and discuss a wellbeing topic. CMS collaborated with two component societies, Denver Medical Society and El Paso County Medical Society, to host events in October.

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Living Room Conversations in Denver was held Oct. 5 and featured a discussion about the book “Together” by U.S. Surgeon General Vivek Murthy, MD, MBA. Living Room Conversations in Colorado Springs was held Oct. 12 and featured a discussion about the book “Flourish: A Visionary New Understanding of Happiness and Well-being” by Martin Seligman. CMS thanks the two members who opened their homes to host these events. ■

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Nomination period open: Run for a CMS leadership position in 2024 Have you thought about a leadership role in the Colorado Medical Society? We encourage physicians and medical students of all walks of life, perspectives, backgrounds, practice settings, career stages and geographic locations to consider a leadership position now or in the future. The nomination period for the 2024 election – during which members elect the president-elect and members of the Colorado delegation to the American Medical Association – is open through Wednesday, Jan. 31, 2024. The election takes place in August. If you aren't ready to run for office, a first step to leadership is to get to know your medical society and a great way to do this is by attending a CMS or component society event or committee meeting that fits one of your passions. Upcoming committee and council meetings are listed in each ASAP e-newsletter, and upcoming meetings and events can be found at cms.org/events. Don’t know where to star t? Contact us at membership@cms.org and we can help you find your path in CMS. ■

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Colorado leads the way with new law restoring provider discretion and individualized care for chronic pain

Kate Nicholson; Executive Director and Founder, National Pain Advocacy Center With opioid pain medication, 59-yearold Kenneth Maestas, a Latino man with quadriplegia, lived a full life. He raised his son as a single father, managed a Walmart store, worked as the legislative policy director for the Colorado Cross Disability Coalition, and contributed to his rural Colorado community. In August 2019, Kenny wasn’t feeling well and went to the doctor. His regular physician had left the practice, so he saw a new provider. The new provider abruptly stopped Kenny’s opioid medication: Kenny went from taking 30 milligrams of oxycodone three times a day to zero. Kenny fared poorly with the opioid taper. When his breathing became extremely labored, his son called 911. At the hospital, Kenny flatlined. He woke on a ventilator, grateful to be alive, but deeply troubled by the trauma that the results of the medically inappropriate forced taper put his child through. S.B. 23-144, signed into law by Gov. Polis on May 4, 2023, is designed to protect people like Kenny who have chronic pain and use opioids for pain management. With the passage of S.B. 23-144, Colorado became one of the first states legally to reverse harm to patients with chronic pain from well-intended policies aimed at reducing addiction and overdose that were too often implemented as one-sizefits-all mandates. Most notably, dosage guidance in the Centers for Disease Control and Prevention’s 2016 prescribing guidelines was widely misapplied in ways that risk patient safety, as the agency has repeatedly acknowledged. As a result, nearly half of all primary care clinics in the U.S. will refuse to treat a person with chronic pain who takes opioids. A dozen studies show that forced opioid tapering is on the rise and that it actually increases risks of suicide

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and overdose, in addition to destabilizing people’s health and lives But you can’t protect patients’ access to care unless you also protect their health care providers. With S.B. 23-144, Colorado became one of the first states to safeguard providers from the threat of unwarranted regulatory oversight. THE LAW:

• DEFINES CHRONIC PAIN and explic-

itly notes that the source of the pain (i.e., whether it stems from cancer or multiple sclerosis) cannot be the basis for interfering with medically necessary treatment including prescribing of scheduled medications.

• REMOVES THE THREAT OF DISCI-

PLINE FROM PROVIDERS. Prescribers cannot be subjected to oversight for prescribing opioids for chronic pain as long as their records are accurate and the prescribing is for a legitimate medical purpose in the usual course of professional practice. Nor can they be disciplined solely for prescribing at a dosage that exceeds preset morphine milligram equivalents (MME) found in guidelines.

• PROMOTES CLINICIAN DISCRE-

TION AND INDIVIDUALIZED CARE IN DECISIONS ABOUT TAPERING. Health care providers cannot be forced to taper a patient simply to meet a preset MME if the patient is stable and compliant and not experiencing serious harm from their medication.

• PRO H I B ITS D I S C R I M I N ATI O N

AT PHARMACIES AND CLINICS. Pharmacies, carriers and pharmacy benefit managers cannot have policies refusing to fill opioid prescriptions altogether, or prescriptions that deviate from a preset MME. Policies at clinics

and health care practices requiring physicians to refuse to prescribe opioids solely on the basis of MMEs are similarly forbidden. It’s important to remember that the specter of opioids amid an addiction and overdose crisis blamed on prescribing them for pain has had far-reaching implications for patients even when opioids are not prescribed. When Quána Madison, a Black woman with chronic pain following preventive surgeries for cancer, went to a Colorado emergency room for help, for example, she asked the treating nurse to use a smaller gauge needle to draw her blood due to her hypersensitivity to pain. Rather than care for her, the nurse assumed she was exaggerating to seek drugs, and reported Quána to the police. S.B. 23-144 is intended to restore balance and ensure that all patients with chronic pain receive appropriate care without discrimination. For the law to have an impact, it must be implemented. Providers must feel free to exercise their clinical discretion, treat patients as individuals, and – where appropriate – prescribe opioids for chronic pain. ■ 1. Colorado Medical Society website, ht t ps: // w w w.cms .org /ar t icles / colorado-leads-in-protecting-painpatients-and-their-providers 2. Dowell et al., No Shortcuts to Safer Prescribing, N Engl J Med 2019; 3 8 0 : 2 28 5 -2 28 7, a n d t h e 202 2 CDC updated guideline, ht tps: // w w w.cdc .gov/mmw r/ volumes / 7 1 / rr/rr7103a1.htm?s _cid=rr7103a1 _w (although the CDC removed arbitrary dosage thresholds from the topline recommendations in its 2022 updated guideline, patients continue to suffer discrimination and harm. 3. C o l o r a d o M e d i c a l S o c i e t y website, https://cms.org/advocacy/ tapering-studies 4. Id. 5. Minnesota is the only other state that provides some safeguards to prescribers. https://mnphysicalmedicine.com/ 202 2 / 0 8 / 0 8 / l a w - c h a n g e - h e l p s patient s-f ighting- chronic-painin-minnesota/

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COLORADO PHYSICIAN OR MEDICAL STUDENT CALLS 720-810-9131. 24/7 line answered by a Masters-Level Licensed Clinician (LCSW, LPC) to assess the clinical need of the caller, including life-threatening situations.

CONFIDENTIALITY IS REVIEWED AND PEER SUPPORT SERVICES ARE INITIATED. Only in circumstances where an individual is a threat to self or others or as outlined in the Medical Practice Act would confidentiality be breached. Doc2Doc Wellbeing Consulting has the same reporting obligation as all licensed Colorado physicians.

PHYSICIAN CALLER RECEIVES WELLBEING SUPPORT FROM A PEER PHYSICIAN. If Doc2Doc Wellbeing Consulting is the best fit based upon the caller’s presentation, a physician will return the physician’s call for the first of three free peer consultations. If CPHP traditional comprehensive evaluation services are a best fit based upon caller’s presentation OR if more help is needed at the end of three free Doc2Doc Wellbeing Consulting sessions, CPHP’s process will commence to ensure client has appropriate treatment supports in place.