Jan Feb 2025final

JAN FEB

2025

Upcoming GCMS Events

February 28

April 4-6

July 14-17

Mission Statement Bringing physicians together to improve the health of our community.

TABLE OF CONTENTS In this issue: 7

Editor's Page Minh-Thu Le, MD................................................................... 4 President's Page James Rogers, MD................................................................ 5 The Importance of Social Connections Nancy Yoon, MD, MPH.......................................................... 7

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Inspire® Hypoglossal Nerve Stimulation: An Effective treatment for Obstructive Sleep Apnea Melanie Chisam, PA-C and Steven Gradney, MD.................10 A Mediterranean Getaway Minh-Thu Le, MD..................................................................14 Retirement Plan Options for Physicians: 457(b) Plans John Davis, CFP...................................................................19 The Next 150 Years In Medicine Destri Eichman, BA..............................................................22

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Building Wealth Through Acquiring Real Estate Randy Lyons........................................................................23 Exciting Alliance Event Coming Soon Barbara Hover....................................................................24

Vol 84, NO. 1 JAN-FEB 2025 Editor’s Note: All materials for the Journal must be submitted by the first of the month prior to publication.

Co-Editors: Jim Blaine, MD Minh-Thu Le, MD

Junior Co-Editor: Andrew K. Le

Managing Editor: Dalton Boyer

Editorial Committee: Michael S. Clarke, MD Frank Cornella, DDS, MD Dalton Boyer Andrew Le Jean Harmison Barbara Hover Nancy Yoon, MD Jana Wolfe

SOCIETY OFFICERS Professional Directory......................................................25

James Rogers, MD President Vu Le, MD Secretary Jim Blaine, MD Treasurer

14

Sanjay Havaldar, MD Immediate Past President

Council Members: David Haustein, MD Melissa Gaines, MD Steven Gradney, MD Keith LeFerriere, MD Kyle John, MD Jaya LaFontaine, MD Nancy Yoon, MD

22

Managing Director:

On the Cover: Rene' and Joe

Micka with an (in)famous monkey atop the Rock of Gibralter. Details on page 16!

The GCMS Journal is available online:

www.gcms.us

Jean Harmison

Executive Office: 4730 S. National Ave. Suite A1 Springfield, MO 65810 email: director@gcms.us www.gcms.us All communications should be sent to the above address. Those marked for the attention of a particular officer will be referred.

EDITOR'S PAGE

by Minh-Thu Le, MD

Happy New Year! 2025 has a nice ring to it, doesn’t it? A lot has already happened this year, both for the positive and negative.

What will it bring for GCMS and the journal, I wonder? We are discussing social networks in this journal and GCMS is a wonderful way to make connections with our colleagues and physician families.

In this journal Dr. Jim Rogers encourages us to make meaningful New Year’s resolutions that include more social interactions with our colleagues to foster our community of physicians.

With GCMS’s 150th anniversary year, we reflect on what medicine and our community of physicians have accomplished. Destri Eichman is the MU M3 class president doing her clinical rotations here and has some insight on what she thinks will be challenges in the coming 150 years for her colleagues and herself.

Dr. Nancy Yoon discusses Social Connections and how important they are to fostering not only balance in our lives but also trust in our communities. Why is that important?

Read her article to find out!

The Inspire® device has changed many people’s lives for the better, allowing them to sleep better, have more energy to do more in their social networks and families. Melanie Chisam and Dr. Steven Gradney have partnered up to write about how Cox and Mercy have become leaders in the implementation of

this device in our area.

Speaking of families and social connections, I have a piece about a vacation my family took in 2023 with fellow GCMS member, Dr. William Micka, and his family. It’s a detailed account of places to see in the Mediterranean and how to see them!

Don’t forget about the Alliance to get your spouse connected with other spouses in our physician community. We have several things planned in the coming months, so keep your eyes and ears open to be involved in this dynamic group.

This includes the family event at the Discovery center that is always highly anticipated!

And to help you become financially free to think about more fun things, both Arvest and Forvis have advisors that are ready to help you make the most of your income and be able to be more socially connected in our community. See their articles for real ways to accomplish your financial goals and protect what you have for future generations.

Please peruse these pages at your leisure. We have a couple of surprises for you this 150th year of GCMS!

Make sure to register for the MSMA meeting in April as our own former GCMS President, GCMS President Jim Rogers, MD and MSMA President-Elect Brian Biggers, MD

4 • JAN FEB 2025 • GCMS Journal

Dr. Brian Biggers, is installed as the next 2025-2026 MSMA President!

PRESIDENT'S PAGE

by James Rogers, MD

150 Years and Still Caring The start of the new year frequently stimulates plans, goals, and hopes for change. These resolves are for improvements, advancements, or intents to do better. As we focus what is in front and are eager to get going, there are some sobering notes. Most New Year's resolutions last less than 4 months. In fact, only about 6% of US adults with a New Year's resolution stick to it beyond one year.

In fact, some have identified the second Friday in January as "quitter's day," as that is when most are likely to give up on their efforts.

Okay, JT, where we going with this? If you stuck with me this long, hold on for a little longer. I am a firm believer that if we do not pay attention to history, we are doomed to make the same mistakes again. And, more importantly, "You cannot tell where you are going if you do not know where you have been."1 Could this be a possible contributor to the dismal results of New Year's planning? This created my need to understand our 150 years of medical legacy.

I found myself immersed to better understand our rich heritage. In reviewing original records, tubs of photos, notes, and decades of the Journal publications, I noted there were some common, reoccurring themes.

1. Relentless pursuit to relieve suffering. Reports and records chronicle long hours and careful observations

to monitor treatments and interventions all for the sake of the patient.

2. Strong commitment to doing right over being right.

When dedicated to collaborative care for the benefit of the patient, you can begin to see multidisciplinary meetings being organized to focus different expert opinions to perform a collective care plan.

3. Extremely strong professional relationships appear to be necessary to accomplish the first two themes.

These key relationships built on mutual respect enabled vigorous challenges resulting in mutual education that enable the care and constantly improves the quality.

Let the rich legacy of the last 150 years of the Greene County Medical Society help us resolve to make 2025 better than 2024.

My challenge for each of us in 2025 is to be an active member of the "Physician Community." Let us engage with each other like those before us so we may unselfishly commit our talents to the improvement of the patients we are privileged to serve.

1

Quote by Maya Angelou

Renew your GCMS Membership Today

The 1874 Southwest Missouri Medical Society Record Book

JAN FEB 2025 • GCMS Journal • 5

Focus on what’s most important to you.

Tailored Tax, Wealth Management, and Family Office to help you prepare for what’s next.

forvismazarsprivateclient.us Forvis Mazars Private Client services may include investment advisory services provided by Forvis Mazars Wealth Advisors, LLC, an SEC-registered investment adviser, and/or accounting, tax, and related solutions provided by Forvis Mazars, LLP. Past performance does not guarantee future performance.

All investments may lose money.

6 • JAN FEB 2025 • GCMS Journal

The Importance of Social Connections

by Nancy Yoon, MD, MPH, Chief Medical Officer Springfield-Greene County Health Department

In the Surgeon General’s 2023 report “Our Epidemic of Loneliness and Isolation,” 1 Dr. Vivek Murthy calls attention to the connection between loneliness and isolation to our health and well-being. The report explains the cultural, community, and societal dynamics that drive connection and disconnection. It was developed through a review of decades of research from the fields of sociology, psychology, neuroscience, political science, economics, and public health. Given its profound consequences, our society needs to make concerted efforts to invest in social connections in our schools, workplaces and civic organizations. If we fail to do so, we will continue to see adverse effects in our individual and collective health and well-being.

The report explains that social connection “encompasses the interactions, relationships, roles, and sense of connection individuals, communities or society may experience.” The three components of social connection are structure, function, and quality. Structure refers to the number and variety of relationships, and the frequency of interactions with others. Function refers to the degree to which others can be relied upon for various needs. The quality of relationships indicates the degree in which they are positive, helpful or satisfying.

Over many decades, our society appears to have become less socially connected. Key indicators include decreased levels of individual social participation and community involvement, and increased use of technology. In addition, trust in each other and major institutions has also decreased, corresponding with the increase in levels of polarization.

Impacts on health and well-being A 2022 study found that only 39% of U.S. adults felt very connected to others.2 Additional recent surveys found that approximately half of U.S. adults report experiencing loneliness, with some of the highest rates among young adults.3-4 Social isolation and loneliness are independent risk factors for cardiovascular disease, dementia, depression, and premature mortality from all causes.5 Lacking social connection can increase the risk for premature death as much as smoking up to 15 cigarettes a day.6 There are several economic effects from the lack of social connections. Social isolation among older adults alone accounts for an estimated $6.7 billion in excess Medicare spending annually, largely due to increased hospital and nursing facility costs.7 Stress-related absenteeism from work attributed to loneliness costs an estimated $154 billion annually.8 Social isolation and loneliness also predict increased risk for developing depression and anxiety. There have also been significant links between a

lack of social connection and death by suicide.9 Given the totality of evidence in numerous studies, social connection may be one of the strongest protective factors against self-harm and suicide.

Impacts on communities Social capital refers to the resources to which individuals and groups have access through their social networks. This includes both social support and social cohesion (the sense of solidarity within groups). Trust is a critical component of socially connected communities. Higher levels of trust have been linked to improved population health, economic prosperity, and social functioning. Community-level social capital is positively associated with a reduced burden of disease and risk for all-cause mortality. A meta-analysis of several studies found that a oneunit increase in social capital increased the likelihood of survival by 17% and of self-reporting good health by 29%.10 Socially connected communities also have greater resilience to natural disasters, community safety, and lower levels of violence.

Strategies to advance social connections The report lays out a framework with six foundational pillars for catalyzing tangible action steps. They are: • • • • • •

Strengthen social infrastructure in local communities Enact pro-connection public policies Mobilize the health sector Reform digital environments Deepen our knowledge Build a culture of connection

Within the health sector, there are several actions that health workers and systems can take: • • • •

•

Explicitly acknowledge social connection as a priority for health Educate patients on the benefits of social connection and the risk factors for social disconnection.

Actively assess patients’ level of social connections to identify those who are at increased risk Leverage interventions that provide psychosocial support to patients, including involving family or other caregivers in treatment, group therapies, and other evidence-based options Work with community organizations to create partnerships that provide support for people who are at risk for, or are struggling with loneliness and isolation

JAN FEB 2025 • GCMS Journal • 7

A study from Gallup and West Health11 showed that 70% of Americans would prefer to be asked about both their physical health and their mental health during appointments with their primary care providers (PCPs). The research also found that 66% of U.S. adults have been asked about their mental health by their PCPs or family practitioners, whereas 32% of adults said that had never happened (2% had no answer).

hhs.gov/surgeongeneral/priorities/recipes/index.html) References 1. United States. Public Health Service. Office of the Surgeon General.

(2023, May). Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General's Advisory on the Healing Effects of Social Connection and Community. Department of Health and Human Services, Washington, DC. 2. Gallup Inc., Meta. The State of Social Connections. Washington D.C.: Gallup Inc.; 2022.

3. Cigna Corporation. The Loneliness Epidemic Persists: A Post-Pandemic Look at the State of Loneliness among U.S. Adults. 2021.

4. Bruce LD, Wu JS, Lustig SL, Russell DW, Nemecek DA. Loneliness in the United States: A 2018 National Panel Survey of Demographic, Structural, Cognitive, and Behavioral Characteristics. Am J Health Promot. 2019;33(8):1123-1133.

5. Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a metaanalytic review. Perspect Psychol Sci. 2015;10(2):227-237.

6. Holt-Lunstad J, Robles TF, Sbarra DA. Advancing social connection as a public health priority in the United States. Am Psychol.

2017;72(6):517-530.

7. Flowers L, Houser A, Noel-Miller C, et al. Medicare Spends More on Socially Isolated Older Americans. Washington, D.C.: AARP Public Policy Institute; 2017.

8. Bowers A, Wu J, Lustig S, Nemecek D. Loneliness influences avoidable absenteeism and turnover intention reported by adult workers in the United States. Journal of Organizational Effectiveness: People and Performance. 2022;9(2):312-335.

Each of us can take steps now to strengthen our social connections and relationships. We can also address this with our patients and colleagues. In his closing remarks in his report, Dr. Murthy says, “We can build lives and communities that are healthier and happier. And we can ensure our country and the world are better poised than ever to take on the challenges that lay ahead. Our future depends on what we do today.”

9. Van Orden KA, Witte TK, Cukrowicz KC, Braithwaite SR, Selby EA, Joiner TE, Jr. The interpersonal theory of suicide. Psychol Rev. 2010;117(2):575-600.

Visit https://mentalhealth417.com/ for local mental health resources and information on the men’s mental health campaign “Hey man, you good?”

11. West Health-Gallup Survey on Mental Health in America, Oct. 1-13, 2024

Additional reports from the Surgeon General: Parents Under Pressure: The U.S. Surgeon General’s Advisory on the Mental Health & Well-Being of Parents (https://www.hhs. gov/sites/default/files/parents-under-pressure.pdf) Recipes for Connection: A tool that provides inspiration for diverse and creative forms of gathering over food (https://www.

8 • JAN FEB 2025 • GCMS Journal

10. Gilbert KL, Quinn SC, Goodman RM, Butler J, Wallace J. A metaanalysis of social capital and health: A case for needed research.

Journal of Health Psychology. 2013;18(11):1385-1399.

JAN FEB 2025 • GCMS Journal • 9

Inspire® Hypoglossal Nerve Stimulation: An Effective Treatment for Obstructive Sleep Apnea

by Steven Gradney, MD, Department of Sleep Medicine, Mercy Hospital, Springfield and Melanie Chisam, PA-C, Department of Pulmonology and Sleep Medicine, CoxHealth, Springfield

Overview: Obstructive Sleep Apnea (OSA) Obstructive Sleep Apnea (OSA) is a sleep related breathing disorder, characterized by repetitive collapse of the upper airway during sleep. It is estimated that 15-30% of males and 10-15% of females in North America have at least mild obstructive sleep apnea [1]. OSA is most often caused by posterior collapse of the tongue toward the oropharynx/ velopharynx during inhalation. The result is partial collapse (hypopnea) or total collapse (apnea) of the upper airway. If left untreated, OSA can cause many comorbid conditions, including but not limited to, hypertension, diabetes, atrial fibrillation, myocardial infarction, stroke, and dementia. The first line treatment for moderate to severe OSA is Continuous Positive Airway Pressure (CPAP) therapy. However, approximately 46% of patients give up on their CPAP by year 3.5 of therapy [2]. Therefore, there is a great need for a viable alternative treatment option for these individuals who do not tolerate CPAP. In this article, we will detail the fundamentals of hypoglossal nerve stimulator (HNS) therapy, its mechanism of action, candidates who are suitable for HNS treatment, and what providers and patients alike can expect from the process.

Of note, as of the date of publication of this article, the Inspire Hypoglossal Nerve Stimulator is the only FDA approved HNS on the market, therefore, HNS and Inspire will be used interchangeably throughout.

How Inspire HNS Therapy Works Inspire therapy involves the use of a surgically implanted nerve stimulator designed to maintain an open airway during inspiration during sleep. The device is analogous to a cardiac pacemaker, however, instead of there being a set rate, the pacer works on the patient’s normal breathing pattern. There is a sense lead/accelerometer in the chest, which signals a cuff of electrodes around the protrusor branches of the hypoglossal nerve toward the end of the patient’s exhalation period. This stimulates the hypoglossal nerve to contract the genioglossus and geniohyoid muscles to protrude the tongue, thus, preventing collapsibility of the airway during inhalation and preventing the primary cause of OSA. The Inspire HNS device consists of a compact Implantable Pulsatile Generator (IPG), or pacemaker, and a stimulation electrode cuff. This is a minimally invasive procedure with two small incisions: one on the right chest and one 10 • JAN FEB 2025 • GCMS Journal

submandibularly on the right side of the neck. The IPG is implanted under the skin on the right side of the chest. The stimulation cuff is placed around the protrusor branches of the hypoglossal nerve and the wire is tunneled under the skin and inserted into the IPG, connecting the two components.

Four to six weeks after implantation, the device is activated by an Inspire-certified Sleep Medicine provider and programmed specifically for each patient. When the patient turns the device on at night, it delivers a gentle stimulus to the muscles of the airway via the hypoglossal nerve (as above), ensuring that the airway remains open and unobstructed.

Candidate Criteria for Therapy Inspire therapy is not suitable for every patient with OSA. While the criteria for Inspire therapy is discussed below, it is important to note that all individuals who are not compliant with CPAP need to be evaluated by a sleep medicine provider for further assistance or other treatment options. Also of note, eligibility criteria is subject to change based on insurance coverage guidelines. In general, for Inspire HNS therapy, individuals must meet the following criteria for eligibility: Moderate to severe OSA • An apnea-hypopnea index (AHI) of 15 – 100 by either home sleep test or in lab polysomnography.

• It is best practice for an assessment of severity of OSA via sleep testing to have been done within the last 2 years.

Absence of central sleep apnea • The central component of the AHI must be < 25% of the total.

CPAP intolerance • Candidates must have attempted and failed (or currently failing) CPAP therapy due to inefficacy or intolerance • OR there is a contraindication to use of CPAP • OR patient is unwilling to use CPAP/refuses CPAP therapy (this is a new indication and some insurances may not cover yet based on this indication alone) Weight (BMI) • < 40 for most commercial payors • < 35 for government insurances (Medicare/Medicaid/ Tricare)

Appropriate airway anatomy • Must exhibit <75% complete concentric collapse on upper airway exam • Performed by ENT or Sleep Medicine physician.

Evaluation • A comprehensive evaluation by a sleep specialist is essential to determine eligibility for Inspire, and to discuss the process with patients.

The Process: What You and Your Patients Can Expect Inspire qualification, implantation, and post implant care is a process for patients, and they should not expect to be implanted immediately, without workup. The process of receiving Inspire therapy involves 4 stages: evaluation, surgical implantation, clinical programming, and long term follow up.

1. Evaluation: This stage includes sleep testing via in-lab sleep study or home sleep study (insurance dependent), clinical evaluation by a Sleep Medicine provider, clinical evaluation by a ENT provider, and a Drug-Induced Sleep Endoscopy (DISE) performed by an ENT or Pulmonary specialist. The DISE is performed to assure the patient’s upper airway anatomy is amenable for HNS implantation.

This is a quick outpatient procedure where the patient is given medication to induce sleep, and the provider views the airway with a scope. The DISE is only performed if the patient meets all other criteria.

2. Implantation: The device is surgically implanted as described above. The procedure is typically performed under general anesthesia and lasts up to two hours. Most patients can return home on the same day of surgery. A one to two-week follow-up is generally performed by the ENT provider to ensure normal healing progression.

3. Clinical programming: Following a recovery period of approximately 4-6 weeks, the device is then activated in the Sleep Clinic by an Inspire certified provider. The device is started at a low stimulation, where the patient first feels

the stimulus and the tongue protrudes just in front of the bottom incisors. The patient is then instructed on use of the remote that controls the functionality of the device. The level of stimulus is gradually adjusted by the patient to find a comfortable and effective setting. This stage typically takes at least an additional 8 weeks.

4. Reassessment: Once therapy is started, the patient is usually seen in the sleep clinic or by telecommunication methods monthly to assure adequate tongue motion and assess efficacy of therapy for the patient. After clinical followup suggests the patient has reached an optimal stimulation level, they will undergo an in-lab HNS titration study. This consists of the patient utilizing Inspire while being monitored and titrated in the lab to assure improvement/resolution of their OSA. Adjustments can be made real time during this study if deemed necessary by the sleep technician. Follow up with the sleep provider usually occurs within 30 days of the sleep study to review results and make any necessary changes to the device. After stabilization, follow up with an Inspire sleep medicine provider is recommended every 6 months for device care.

Utilizing Inspire Therapy Unlike CPAP therapy, which requires the use of a mask and continuous airflow via the CPAP machine itself, Inspire therapy operates internally and does not involve continuous external equipment. The device is controlled via a small remote, which allows patients to turn the device on prior to bedtime, pause therapy in the night if needed, and off once awake. During sleep, the device emits a subtle electrical pulse at the end of exhalation, to protrude the tongue and keep the airway open during inhalation. Most individuals quickly adapt to these sensations, and many do not feel them if awakened at night. It has been reported that 92% of patients report that the experience is significantly more comfortable than CPAP therapy [3].

Benefits of Inspire Therapy Inspire therapy offers several notable advantages for patients: No CPAP machine or mask • One of the primary benefits is the elimination of the need for a CPAP mask and machine. Many patients find the mask, hose, and pressure of the air uncomfortable Enhanced sleep quality • Many users report improved sleep quality, with more restful and uninterrupted sleep Better bed partner satisfaction • Inspire therapy can significantly reduce snoring, leading to improved sleep quality for both the patient and their bed partner.

JAN FEB 2025 • GCMS Journal • 11

Minimal maintenance • The device requires little maintenance, aside from using the remote to turn it on and off as needed. The remote runs on AA batteries that are replaced as needed.

• IPG lasts approximately 11-12 years.

Risks and Potential Side Effects While Inspire therapy is generally safe, there are some risks associated with the procedure.

• •

•

Infection: As with any surgical procedure, there is a risk of infection at the implant site.

Discomfort: Some patients may experience mild discomfort when the device stimulates the airway muscles, though this is usually temporary and adjustments can be made to the device for comfort.

Device malfunction: As with all medical devices, there is a small risk of malfunction, although this is rare. Regular follow-up visits with a Sleep Medicine Provider are essential to monitor the device's performance and address any potential issues.

Is Inspire Therapy Right for Your Patient?

For patients interested in Inspire therapy, the first step is to request a referral to a qualified Sleep Medicine provider.

Both CoxHealth and Mercy Hospital have established Inspire programs. Both systems currently manage hundreds of patients with the Inspire device, and both have dedicated slots for evaluation and treatment of Inspire patients in both the Sleep and ENT specialties. All patients referred will be evaluated by a highly qualified sleep provider who will work with the patient to assure all requirements for Inspire implantation are met before referral to ENT. If the patient is a candidate for Inspire, they will be referred to CoxHealth or Mercy’s ENT team for consultation, DISE, and implantation if DISE determines proper airway anatomy.

Both CoxHealth and Mercy Hospital’s ENT teams have dedicated clinic and OR slots available for Inspire patients who are referred from their respective Sleep Centers. The patient would follow the above outlined post implant care pathway after implantation.

Why Southwest Missouri?

With over 500 implants being conducted since May of 2021, both CoxHealth and Mercy Hospital have vast experience with Inspire HNS therapy. Both systems have received adequate training and recognition of Excellence by Inspire Medical Systems.

• Mercy Hospital has two Inspire Sleep Providers of Excellence, Tim Davi, NP-C and Dr. Steven Gradney.

• Cox Health has two Inspire Sleep Providers of Excellence, Melanie Chisam, PA-C and Dr. Rutwik Patel.

12 • JAN FEB 2025 • GCMS Journal

• CoxHealth has two ENT providers of Excellence, Dr. An-

thony Bentley and Dr. David Gilley.

• CoxHealth has been awarded Care Team of Excellence by

Inspire Medical Systems.

• CoxHealth has been awarded the very first ever Center of Excellence by Inspire Medical Systems.

Both CoxHealth and Mercy Hospital are passionate about taking care of their sleep medicine patients. They welcome referrals to their clinics for evaluation, management, and treatment with Inspire HNS for patients who are unable to tolerate CPAP therapy.

References 1. Kline MD, Lewis R. “Clinical presentation and diagnosis of obstructive sleep apnea in adults.” UpToDate.” 09 Oct.2024. https://www.uptodate. com/contents/clinical-presentation-and-diagnosis-of-obstructivesleep-apnea-in-adults. Accessed 30 December 2024.

2. Gabryelska, Agata, et al. “Factors Affecting Long-Term Compliance of CPAP Treatment-a Single Centre Experience.” Journal of Clinical Medicine, U.S. National Library of Medicine, 27 Dec. 2021, https://pmc. ncbi.nlm.nih.gov/articles/PMC8745469/#B3-jcm-11-00139. Accessed 30 December 2024.

3. Suurna, Steffen, Boon , et al. Laryngoscope. 2021; Nov;131(11): 2616-2624.

CONNECTED. We believe when we work together, big change happens. Families get healthier. Communities grow stronger.

Lives change. Right now, side by side, our providers are shaping our future – strengthening it and making it a little bit brighter for everyone.

“

When neighbors help neighbors, it makes all the difference.

”

coxhealth.com 417-269-INFO CoxHealthNow Portal & App

JAN It’s FEB 2025 • 13 the• GCMS rightJournal thing.

A Mediterranean Getaway

by Minh-Thu Le, MD Our GCMS president, Dr. James Rogers, has been touting all year how he would like us doctors to be a physician community and GCMS, so I thought it would be fun to share a trip that my family took with Dr. William Micka’s family. We have cruised with them four times and will be doing a fifth next October 2025! This is a step-by-step itinerary, so if you’re inclined to go on this cruise, you’ll know exactly what to do!

We cruised with the Enchanted Princess, on a 14-day Mediterranean cruise in July 2023. This was our first cruise on this cruise line and it was phenomenal. For reference, I have cruised Carnival, Royal Caribbean, Disney x 3, and Norwegian Cruise lines. Princess was as good or better than all of them.

For those wanting advice on traveling internationally, especially with three generations, limited foreign language ability, and in-laws/grandparents that don’t speak English, you are also welcome to read.

The Flights Our plane trip was booked through EZ Air (as recommended through Princess) and we had minimal issues with any of the flights there and back. As far as packing, we each packed a carryon and two large suitcases for the six of us. Our carry-ons were checked by Austrian air in New Jersey for being too big. I was afraid of vital things being lost in transit, so insisted we carry on as much as we could but had to check it anyway! It made it to our final destination safe and sound in Athens from New Jersey via Austria. Our large suitcases had our formalwear and shoes and were both about half full in anticipation of the shopping we would do at the ports. Our flights were good, even in economy.

The first had a layover in New Jersey. It was eight hours and made so much better by the United lounge there where we could shower, eat two meals and have drinks.

You can get a day pass and so we did for my in-laws who are not United loyalists. It was the best money spent of the trip in my mind as we had driven five hours from Springfield to Columbia (picking up my son from the Mini-Med School camp), then to Kansas City, and had just three hours of sleep to start our plane trip. Definitely better than the three hours spent at the hotel the night prior for twice as much! There were no delays and we actually made it to Athens ahead to schedule by way of Austria.

The way through Austrian customs was quick and efficient. We have Global Entry for all of us and it’s so worth it. We were able to have a great Greek lunch and some foot exploration around our Airbnb as our apartment was getting cleaned for us. I booked it within walking distance of the Parthenon. The return trip was a direct transatlantic flight on American air from Rome to Dallas (DFW). We booked a transfer outside Princess who was also early and as we were getting out of the ship and terminal with all our luggage. At DFW, we just enough time to get through customs with Global Entry, security, and to our gate for our last leg. There was a minor 30 minute delay on the jetway as toilet paper had to be delivered to our plane. HAHAHA! 14 • JAN FEB 2025 • GCMS Journal

This was our second trip to this region and I would always recommend taking as much in your carry-on luggage as you can (packing cubes are useful to maximize space) because you never know what streets, taxis, buses or trains you might need to schlep through to get to your final destination. Because we were early to Athens, we may have had nowhere to put our luggage for a couple of hours. Luckily, they were able to keep our luggage until our apartment was ready.

Additionally, some old European buildings don’t have elevators.

Again, ours did.

Specifics From Each Port Athens: Like I said previously, we got in early and ate a wonderful lunch at a nearby cafe from our Airbnb. We forgot our European outlet adapters, but a quick email to the manager and two were personally delivered to us. They also gave us recommendations for dinner and sightseeing. It was amazing. We did more than I expected there, including the Parthenon, shopping in their wellknown central market and exploring by foot the areas around where we stayed. What struck me the most about Athens were two things: how beautiful the people are, and how marble is everywhere! Entire sidewalks for miles of marble and on most every building as well. We took a private van to the port the next day on Embarkation Day! I was so impressed how easy embarking was. We had a 12-12:45 pm time and were on the ship within 15 minutes of arriving. (We’ve done other cruises out of Cape Canaveral pre-pandemic, and none have been this quick.

Maybe they are more efficient to keep people from congregating due to COVID-19.

An example of the architectural ingenuity of buildings built into the side of the cliffs in Santorini, Greece

Santorini, Greece: You have to either hike up a steep staircase, go on the back of a donkey, or take a cable car from the base of the cliff where the city is built. The cable car is 5€ per person and

can get busy, but going later in the day will miss the crowds in the morning. We had no wait. My husband and his parents were there before us, but we met up when the kids and I came. After some miscues from me, but helpful tips from a tour agency off the main street, we took a public bus to Oia, famous for their white buildings and blue domes, for about 2€ each way per person and went souvenir shopping and got some great photo ops. Most stores there took credit cards (take one where you don’t have exchange fees—our United Visa card worked well as we bought everything in euros). My kids got gelato and smoothies with their stateside exchanged euros. Because the cable car line was an hour wait to get back down, we all hiked down the staircase which took about 30 minutes. I would recommend having good, grippy shoes as the stairs are made of well-worn pebbles and I slipped and fell twice in my heyDudes with no grip soles. You also have to navigate around the donkeys and some poo as well.

I would not go down if it’s raining.

had to get a couple taxis for the ten of us (the Micka’s booked this one too) to make it there which would have incurred more cost as well as missing at least an hour of the tour. We brought a couple of umbrellas and didn’t mind the little bit of rain at all. My kids did the hop on-hop off site seeing tour with Dr. Micka and his family (about 20-25€ each) and my in-laws found shops to buy souvenirs, while my husband and I walked to several churches and monuments, got to as high as we could, and took some great pictures. The rain held off. The taxi and tour operators are very aggressive in Messina as you get out of the boat. If you don’t book an excursion, someone will be happy to sell you one as you are going across the crosswalk!

Kotor, Montenegro: We bought a high speed boat excursion to see the submarine caves and Blue Cave as well as the Lady of the Rocks Catholic Church located on an island in the bay. We had tickets to go into the church, but this was the day we were running late, lost my in-laws, so didn’t wait in the long line to get in. We were able to swim in the cool waters at Blue cave which was refreshing! Our boat operator told us about the sites we saw and it was very enjoyable. This is near Croatia and my phone actually welcomed me to Croatia when we were there. The Micka’s did this excursion with us and were so gracious when we couldn’t get our act together to start the tour.

Cast depicting Pompeii's rapid destruction and ash deposition. Casts of victims from the eruption of Mount Vesuvious in 79 CE are displayed in glass and metal cases

Basilica Cattedrale di Santa Maria Assunta in Messina, Italy

Messina, Sicily: This was the tour we missed. We communicated with the boat operator the day of and realized he was in an entirely different port than where our ship was docked. We were at the port of Messina, he was at the port of Naxos. He was about 50 kms away and because it was raining and more storms were on the way, we decided to just stay in Messina. We would have

Naples, Italy: We toured Pompeii this day and did the shorter four hour tour. The Micka’s also hiked Mt. Vesuvius and did the Pompeii tour in the afternoon getting the same guide we did in the morning. My MIL would not have been able to do the hike whatsoever. We had time to grab some pizza lunch before going back to Naples and shopping. My husband went his own way, in-laws another, while the kids and I went back to the ship—but not before I bought some clothes and accessories (and Father’s Day gifts) at the terminal building which has a dozen or so shops.

So if you didn’t want to get out of the boat terminal at all, you could happily shop there. I also weathered the deluge that came shortly after I separated from my husband because he wanted to sightsee in town. He was soaked when he returned to the ship as were many others. We were lucky that our tour ended early to miss the rain as well. (We were prepared though: My in-laws had one umbrella, and my kids had the other, while I was happy in my wide brimmed sun hat shopping indoors. My husband has never believed in carrying an umbrella!)

Barcelona, Spain: This was my husband’s favorite stop. We took a tour with my son as our guide and ended up at Primark, JAN FEB 2025 • GCMS Journal • 15

a large clothing store similar to H&M where everything was so reasonably priced, we did most of our shopping there. You could even buy luggage there. The kids and their grandparents headed back early and my husband and I ate at a tapas restaurant for lunch and found a great grocery store where he bought vacuum packed hams and prosciutto. We wandered off the beaten path around the main tourist shopping area, found a building that looked like it was an old medical school and a cool free exhibit inside of modern art made with recycled materials and electricity. I would have liked to see the Pablo Picasso Museum outside the city. We will definitely be coming back in the future.

Gibraltar, UK: At the southern tip of Spain lies this city, and we were there on King Charles’ birthday, so banks and several stores were closed for the holiday. We ended up walking around again, and no one in our family wanted to see the monkeys, so hubby and I planned on walking to the castle, taking some pictures and heading back down. We managed to find a couple of churches and met a nice Gibraltarian family at one who graciously drove us further up the rock, so we didn’t have to walk up the hill. The Mickas took a taxi to see the monkeys, though, and had a grand time. One sat on their son’s shoulder and one bit Dr. Micka when he tried to pet it as it walked across his lap. Another leapt on an unsuspecting tourist, stole some unopened ice cream from her as she walked out of a shop and ate it right in front of her!

Everything is in pounds and pence here, so bring some, or use your credit card.

expected. The views were spectacular though. You’re able to see all the major sites from this viewpoint. I bought genuine Marseille soaps with the 72% le huere stamped on them and a beautiful ornament while there. We walked to the metro at the old port where we got dropped off feeling pretty good about the day so far. We were able to enlist a kind lady who spoke no English to help us with the tickets to and from the train station on the metro. We were disappointed in the train station itself. It seemed like there were few workers and no one to help navigate things.

We figured out how to buy tickets to Avignon but neglected to find out that there were two trains leaving at the same time, on different tracks, one much slower than the other. I was hoping to eat at a Michelin star restaurant, have some French provincial wine and visit the Popes’ palaces there which was only a five minute walk from the restaurant. We had given ourselves a couple hours to do this, but the trip there took two hours and we barely made it on the train back that we had purchased. So we only saw Avignon from the train. We did see some vineyards, mountains/cliffs, and fruit farms. Our tickets were 32€ per person each way for the fast train. So quite reasonable if we had taken the right train to Avignon TGV. (If you book earlier than the same day, it would be cheaper.) There, we would have had to take a separate city train or a taxi to the city center. I did use my French to get directions to not get off our slow train early as my husband would have done and totally would have missed our train back.

Luckily, the fast trains go back and forth several times a day, so we were never in danger of not getting back to Marseille in time to catch the ship. We just would have been out a few more euros.

If going to Marseille, I’d recommend learning some French words like apres (after), avant (before) and quand (when) and Ou est (where is?). It was the only city that I felt no one spoke enough English to be able to communicate confidently. It’s a city with many migrants/immigrants, so even with knowing some French, it is difficult to communicate.

Notre-Dame de la Garde in Marseille, France

Marseille, France: We took a Princess transfer to the city from the port for $16.00/ person round trip, then separated, with my kids and in-laws going shopping and husband and I planning to go out of the city by train. However, before that, we hopped on a city bus which happened to be going to the Basilica of NotreDame de la Garde, the highest point of the city. The bus trip there was only 2€ per person and we paid 6€ to get back down by little tourist train car that was there when we were finished touring it. The church itself was pretty, but not as impressive inside as I 16 • JAN FEB 2025 • GCMS Journal

Throne Room in the Palazzo Reale in Genoa, Italy

Genoa, Italy: We really had no plans this day, and my husband just wanted to visit some churches and buildings. The kids and

in-laws did what they did best—shop! They were able to get further into the city by taking the metro to a modern shopping mall which suited them well. I was really proud of them. We ended up going to two museums in homes previously owned by the Genovese upper class and seeing a couple churches as well.

Museo di Palazzo Reale was also converted to the palace for the royal family. For just 11€ per person for both museums, it was well worth it. Many representative paintings from both homes dated between 1500-1800 are in a separate exhibit housed in the lower level of the Reale. They were spectacular. Getting from one to the other was not that difficult walking and we passed by one of the main churches, the Basilica della Santissima Annunziata del Vastato which was also amazing. It reminded me more than of the churches in Rome. The ceiling frescos alone are worth a visit. When visiting these, wearing conservative clothing covering shoulders and knees is most proper. Many churches won’t let you in even if they are free to enter otherwise. We ate outside at a small restaurant off the main city center, across from another church and then rambled to our hearts’ content.

The Ship The Enchanted is in the Medallion class of ships, and our “medallion” got us in and out of the ship seamlessly. We used the app to keep track of our family and friends that also took the same cruise. The ship is big. Navigating it the first day or two is a learning curve, but we never really got lost and had the same dining room every night to keep everyone from getting lost. We were on deck 10 aft in an unobstructed balcony for the hubs and me and an inside stateroom across the hall for the kids and inlaws. The rooms were to our satisfaction and we slept so well.

We were able to keep our same table with servers Sheldon and Talefero the whole two weeks. Our “Santorini” dining room hostess, Alina, was invaluable if we needed to move up our time because of things we wanted to do in the evening. My inlaws spent a small fortune at the EFFY jewelry store, and had raffles they wanted to be at by 9 pm every night. We ate with a fairly large group of 10, with our six and the Micka’s four, and our dinner time was officially at 8 pm, but we could sometimes come earlier if our table was not being occupied. We did have to remind them that we had two weeks of cruising, so they didn’t give away our table that second week!

My daughter has food allergies. We told the head waiter the first night, and she was able to see the menu the day prior and pick her food so they would be sure to prepare it without her allergens and cross contamination. She never had a reaction.

With my daughter’s birthday, our anniversary, and mine and my son’s birthday happening all within a couple weeks of the cruise, I asked for celebration days on several days to get the splendid complimentary chocolate cake and it was delightful.

Livorno, Italy/ Pisa: As I stated prior, we booked our bus to Pisa the same morning and could have bought tickets at the meet up location. Princess provided a free shuttle to the city center where we met the tour bus. Had we planned just a little more, we could have gone inside the tower and a couple churches in that same vicinity. It is free to enter the churches, but you do need to obtain a ticket from a separate building on site or online. The tower is a paid ticket. They were turning women in tank tops or spaghetti straps away telling them to cover their shoulders first. It was still enjoyable for all of us even if we didn’t have time to get tickets and tour the buildings. Enough shopping for the in-laws and a lot of history and photo ops for me. The tower is walkable from the shuttle bus terminal but does take about 10-15 minutes. The tour dropped us off and picked us up 2 hours later with about a 50 minute drive there and back. We did get lunch and gelato before leaving.

Rome: We spent 3 days here in 2017 and did all the major sites at that time, so just took a transfer to the airport directly from the ship. The Mickas spent an extra day touring the city before their trip home.

The buffet was also very large with enough options for our families. The first day, an attendant reminded everyone to wash hands prior to entering, but I never saw anyone after that. (Even pre-pandemic on our Disney cruises, someone was always at the entrance reminding people to wash hands.) We were told that they did have labor shortages in almost every area on the ship.

They had special dessert and crepes days which I would have liked notice of, but we happened upon them easily enough. We LOVED the pizzeria which was also complimentary for all. We typically ate there pre-dinner/ post- excursions. Their fresh oven pizzas were as good as I’ve ever had.

We did not get the alcoholic drink package. We did participate in wine tastings for a nominal fee per person. With coffee, orange juice, lemonade, milk and tea as drinks on board, we didn’t find it necessary for other drinks. I do enjoy an occasional glass of wine and have a list of mixed drinks I like. My husband drinks tequila and bourbon/whisky, rarely. Other tastings would probably be popular if Princess offered them. I would have paid for those. I like learning about things and so find wine, whisky, and other drink tastings fascinating. Surprisingly, the Disney cruises we’ve been on had a wider selection of these.

We didn’t do any of the specialty dining, but the Micka’s went to the Crown Grille and said it was good—maybe not worth the up charge though. They had a complimentary one that was scheduled for them, but they could have scheduled it themselves at a different restaurant.

JAN FEB 2025 • GCMS Journal • 17

We didn’t have internet on board either by design, so we wouldn’t be tempted to work (clinic phone notes can wait) on sea days, and so the teenaged kids would interact with people more. We did have cellular service on port days through our carrier with 5GB high speed internet to keep in contact with our family and house sitter. We found all the staff on board to be lovely and accommodating and very professional.

aired in the 1960’s-70’s.

We did get to experience the spa the second week to access the Enclave hot tub, steam rooms, and aromatherapy showers as well as the the heated tile beds. I had several good naps there!

For $149.00 for the week, it was worth so much more.

Some Things I Have Learned: 1. If traveling with others, communicate your expectations early. Many of the hiccups we faced were because we failed to communicate our wants out of the vacation. And also, communication barriers lent itself to misunderstandings.

2. When traveling to a foreign country where you don’t speak the language and no one speaks English, sign language helps a lot!

3. The spa is worth every penny you spend there.

4. Book your dining as early as you can when you get on ship, especially if you plan on eating a sit-down dinner every night.

This includes the specialty restaurants. Princess will book specialty dining for you if it’s included in your cruise otherwise.

If you want a specific restaurant, you must book it—the earlier the better.

5. The customer service desk is the Mecca of all questions. The least busy time is around 11 pm to 12 am. Have a medallion you lost contact with from your phone or just lost? The batteries may fail, and you can get a new one. (There is a phone app that connected with the medallions which was a learning curve.) We found out we all upgraded to gold status when my son lost his the second week and got a new one in a different color. His friend noticed it and my son said, “I’m sure they just gave me whatever color they had left over because I lost mine.” HAHA. This was his second replacement after the first ran out of batteries. I also found my daughter’s hat there in the lost and found before she even knew she lost it!

6. Always check if there is a similar train going to the same place you are that is not yours—this would include tours too. You may get on the slow boat to China (or train to Avignon) otherwise.

Also, check boarding passes carefully. Figure out what ports you are arriving at and book excursions from the right port.

7. Spend your money on where you think you’ll enjoy it the most.

Had we known my in-laws were not keen on seeing historical sites, I probably would have booked more expensive excursions for just the hubby and me. They would have been happy as clams and I would have been too!

8. Almond milk is complimentary. That made my two weeks!

Maybe other drinks besides what I mentioned are too. I just didn’t ask.

9. Always buy extra souvenirs (and account for it in extra luggage space) for the people at home. There’s always someone who would appreciate you giving them something from your travels and showing them you are thinking about them. International plane travel has a free checked luggage, so bring a big one!

10. Thank your staff profusely and give them good ratings on all your cruises. They really go above and beyond. I wrote down every person’s name I spoke with to mention them on my survey I will receive. Even the photographers and performers/ dancers get recognized.

My kids enjoyed the teen area as a space just for them. The activities were engaging enough for them, and they made friends on the ship. They were upset when the “Beach Club” (teen area) was closed and always were there as soon as it opened. One thing they did complain about were the scheduled activities.

There were times that all the kids were engaged socializing, playing ping pong or a video game or board game together and they would make them all stop and all do a scheduled activity or movie and whoever wouldn’t, would have to leave, so most of them left to galavant elsewhere maybe not as safe and secure.

My kids only used the pools once. My daughter spent hours at the mini putting green (she’s a golfer). My son was determined to “finish” a video game that he had never played at the teen club.

I thought the pools were spacious enough and there was always a hot tub on deck to relax in. Rene Micka and I would be found “hiding out” there.

My in-laws (who are in their mid 60’s) loved the ship as well. My FIL worked out every morning at the gym and walked the track and around the decks, had a nap each day, and could be found at the buffet otherwise. He LOVED the shows. His favorite was the Rock Opera show. He also won the speed Sudoku challenge the one morning he played it as we were waiting to get off the ship for our Pompeii excursion.

I quite liked the new Jim Henson Muppet vignette show called Inspired Silliness which premiered on the ship the first week.

A producer of the show was there, and they used real Muppets from Jim Henson’s Muppet studio. I grew up with the Muppets, but was not familiar with the early skits he did which were performed that night again for possibly the first time since they 18 • JAN FEB 2025 • GCMS Journal

Well, it was nice to come back to a clean, made bed every day.

I also loved sitting on the balcony with some sweets and coffee enjoying the ocean. If you like to dance, then the Enchanted is for you! We saw lots of dancing, from ballroom, to hip-hop, and just swaying. Lots of people were enjoying themselves.

I hope this inspires someone to take their family to the Mediterranean and on a cruise! I’d love to talk to you if you do!

Retirement Plan Options for Physicians: 457(b) Plans

By John Davis, CFP® | Managing Advisor | Forvis Mazars Private Client

When it comes to retirement planning, 457(b) plans offer a valuable opportunity for physicians to save and invest for their golden years. However, not all 457(b) plans are created equal. There are two primary types of 457(b) plans: governmental and non-governmental. While both share the common goal of providing tax-advantaged retirement savings through deferred compensation, they differ in several key aspects. In this article, we will explore the nuances between governmental 457(b) plans and nongovernmental 457(b) plans, helping you to make informed decisions about your retirement strategy.

Governmental 457(b) Plans Governmental 457(b) plans are designed for physicians employed by certain tax-exempt organizations. They are backed by state or local governments. These plans often exhibit unique characteristics that set them apart from their non-governmental counterparts.

1. Eligibility & Participation Governmental 457(b) plans typically offer flexibility in terms of eligibility. A wider range of physicians and practice types are generally eligible to participate in these plans. Like other employer-sponsored plans, contributions reduce taxable income and grow tax-free in the plan until withdrawals in retirement. Contributions to these plans are held in trust, providing protections to employees similar to those of 401(k) or 403(b) plans.

plans in that physician participants cannot roll their balances into other retirement accounts unless they switch employers or quit. However, if a physician retires early, they may withdraw funds without incurring the usual 10% early withdrawal penalty.

Non-Governmental 457(b) Plans Non-governmental 457(b) plans cater to physicians of tax-exempt organizations that are not backed by state or local governments and are instead owned by the employer. These plans offer their own unique benefits and considerations.

1. Eligibility & Legal Requirements Non-governmental 457(b) plans often impose stricter eligibility requirements. These plans are commonly referred to as “top hat” plans. Typically, participation is limited to a select group of management or highly compensated employees. 457(b) plans are required to remain exempt from Title I or ERISA since it would require the investments to be held in trust. Assets in these plans are permitted from being held in anything but a rabbi trust. Due to this, assets in non-governmental 457(b) plans can be subject to your employers’ creditors in the case of a bankruptcy issue.

2. Contributions One enticing feature of governmental 457(b) plans is the catch-up contribution provision. Physicians over the age of 50 can utilize the same age 50 catch-up provisions available with 401(k) and 403(b) plans. That feature is not available with their non-governmental counterpart. This can be a game changer for physicians who haven't been able to maximize their savings in previous years. Another added bonus is that 457(b) plan contributions do not count against annual deferral limits in 401(k) or 403(b) plans. Like several other employer-sponsored plans, governmental 457(b) plans can offer a Roth contribution option. This is an option not available in the nongovernmental counterpart.

2. Contributions & Withdrawals Like their governmental counterparts, non-governmental 457(b) plan withdrawals are not subject to the 10% early withdrawal penalty. One significant disadvantage of nongovernmental 457(b) plans is their limited flexibility in regard to distributions. Physician participants are subject to the withdrawal rules set by the plan. The default schedule is a lump-sum distribution within 60 to 90 days of severance from your employer. This distribution will be sent to your employer as the holder of the assets and routed to you via payroll as ordinary taxable W2 income.

Conversely, contributions are generally subject to FICA and Medicare at the time they vest. Some non-governmental 457(b) plans offer more flexible distribution options over many years, but this decision is often irrevocable once elected.

3. Rollovers & Withdrawals Governmental 457(b) plans share similar rollover rules to employer-sponsored plans like 401(k) and 403(b)

3. Rollover Options Unlike their governmental counterparts, physician participants in non-governmental 457(b) plans cannot JAN FEB 2025 • GCMS Journal • 19

rollover their balances into other retirement accounts— with the exception of other non-governmental 457(b) accounts—if they change employers or retire. This lack of portability means less flexibility upon separation of service or retirement.

with their financial goals and employment circumstances.

When considering the nuances of each of these plan types, consulting a Forvis Mazars Private Client™ professional can provide valuable guidance to help you evaluate if contributing to a 457(b) makes sense for you.

What to Consider In summary, 457(b) plans offer valuable opportunities for tax-advantaged retirement savings, but the differences between governmental and non-governmental plans can significantly impact a physician’s retirement strategy.

Governmental plans tend to be more accessible to a broader range of physicians, offering more advantageous contribution options. Non-governmental plans, on the other hand, have limited flexibility and fewer protections due to certain legal requirements. This puts a greater emphasis on proactive planning before electing to take part in these plans.

Forvis Mazars Private Client services may include investment advisory services provided by Forvis Mazars Wealth Advisors, LLC, an SEC-registered investment adviser, and/ or accounting, tax, and related solutions provided by Forvis Mazars, LLP. The information contained herein should not be considered investment advice to you, nor an offer to buy or sell any securities or financial instruments. The services, or investment strategies mentioned herein, may not be available to, or suitable, for you. Consult a financial advisor or tax professional before implementing any investment, tax or other strategy mentioned herein. The information herein is believed to be accurate as of the time it is presented and it may become inaccurate or outdated with the passage of time. Past performance does not guarantee future performance. All investments may lose money.

Understanding these distinctions can help empower physicians to make well-informed decisions that align

Personalized financial advice that changes with your needs.

Everyone has different financial goals and priorities, and they change and grow as you do. That’s why it’s important for me to get to know you and understand what you’re working toward. Together, we can create a personalized financial plan that fits your needs today and helps you build the tomorrow you deserve.

Ron Penney, CFP®, ChFC® Private Wealth Advisor Penney, Murray & Associates A private wealth advisory practice of Ameriprise Financial Services, LLC 417.881.9200 1342 E Kingsley St, Ste E, Springfield, MO 65804 ron.c.penney@ampf.com ameripriseadvisors.com/ron.c.penney Not FDIC or NCUA Insured | No Financial Institution Guarantee | May Lose Value AR license #235655 Investment advisory products and services are made available through Ameriprise Financial Services, LLC, a registered investment adviser.

Certified Financial Planner Board of Standards Inc. owns the certification marks CFP®, CERTIFIED FINANCIAL PLANNER™ and CFP (with plaque design) in the U.S. Ameriprise Financial cannot guarantee future financial results.

Ameriprise Financial Services, LLC. Member FINRA and SIPC. 20 Securities • JAN FEBoffered 2025 •by GCMS Journal © 2024 Ameriprise Financial, Inc. All rights reserved.

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The Next 150 Years in Medicine

by Destri Eichman, BA, third-year medical student at the University of Missouri-Columbia School of Medicine

Given today’s medical advancements, it’s easy to forget that medicine was once an invention itself – a product of human compassion and curiosity rather than common knowledge.

It evolved as we learned more about the intricacies of the human body and its compliance to biochemical and physical manipulation. Medicine, therefore, became a tool to combat the trials of its time, reflecting the collective awareness of society at any given moment.

We can readily observe how medicine has responded to the body’s mysteries and historic challenges. From Diocles’ early anatomical explorations in 300 BC, revealing what was hidden beneath flesh, to the invention of the microscope in 1590, which uncovered the seemingly invisible causes of disease, and to the outbreak of the Civil War in 1861, which spurred rapid advancements in surgical techniques, each era has brought fundamental progress.

Within the past 150 years, the exponential growth of technological innovations, public health initiatives, and biomedical research has fueled a wave of discovery unmatched by any other sector. Antibiotics revolutionized the treatment of infectious disease, while imaging technologies like X-rays, CT scans, and MRIs unlocked new dimensions of diagnostic precision. Public health efforts from sanitation initiatives to vaccine development eradicated diseases like smallpox and combated global threats such as SARS-CoV-2. The growth of biomedical research has been exponential, from the discovery of DNA’s structure in 1953 to the introduction of personalized medicine in the form of pharmacogenomics and immunotherapy.

For me, one of the greatest achievements in the last 150 years has been the expanding role of women in medicine.

When Elizabeth Blackwell became the first woman in the U.S. to earn a medical degree in 1849, she laid the foundation for generations of women to innovate and heal while still navigating inequities in salary, work-life balance, and professional isolation. Women now represent over 55% of students in the country’s MD-programs and they are entering fields once dominated by men including general surgery, radiology, and emergency medicine. The contributions of women are breaking barriers and enriching medicine with diverse perspectives essential for meeting the challenges of the future.

It is truly inspiring to look back at how far medicine has come in the past 150 years. The breakthroughs of the past century and a half are a testament to humanity’s ingenuity and perseverance. While this progress gives us hope, I must admit that I look forward to the future of medicine with a sense of both excitement and dread. It is apparent that the world of medicine is an ever-expanding landscape with the 22 • JAN FEB 2025 • GCMS Journal

potential to transform people’s lives with advanced technologies and innovations. Despite this, medicine still grapples with some of the same hurdles today that it did 150 years ago. Inequities persist, as the poor continue to face disproportionate barriers to care, and the sickest among us find themselves standing up to a system that does not prioritize them. Global public health trends, from rising chronic disease rates to the looming effects of climate change on health, paint a disheartening picture of unmet needs. Moreover, while strides have been made in diversifying certain aspects of the medical profession—such as the growing representation of women— we still fall short of building a healthcare workforce that reflects the diversity of the populations we serve. This perpetuates inequities and limits the cultural competence needed to deliver empathetic care.

The most shocking, but not surprising, trend I see in medicine both in the last 150 years and, I anticipate, for the future 150 years is the prioritization of profits over patient care. Drug prices continue to skyrocket, private equity firms funnel money into emergency departments and skilled nursing facilities exploiting billing loopholes, rural and urban hospitals continue to close because they do not make ‘business sense’, healthcare systems prioritize elective procedures over preventative and primary care, insurance companies chokehold providers and patients to protect their bottom line, and the list goes on and on.

So, I must ask: what good is the advancement of medical technology if the average citizen cannot afford to use it?

I believe in the power of human ingenuity so much that I imagine we could have cures for some of humanity’s most crippling diseases within the next 150 years. But it is much more profitable to treat a disease than cure it.

Even as a future pediatrician, it is hard for me to maintain unbridled optimism about the next 150 years of medicine.

Do things like AI-assisted electronic medical records and genetically targeted treatments make me excited about the future? Absolutely. These technologies will revolutionize how we approach patient care. However, as we look ahead to the next 150 years, we must first grapple with the enduring challenges that remain. Let us remember the sole purpose as to why medicine was invented in the first place—to heal.

Money does not heal. Creating systems that are equitable, inclusive, and sustainable heals. Only by addressing these foundational issues can we ensure that medicine continues to evolve as a force for good in society over the next 150 years.

Building Wealth Through Acquiring Real Estate

by Randy Lyons, Senior Client Advisor for Arvest Wealth Management in Springfield

One challenge high net-worth individuals in the medical field may face is deciding how to put their money to work. Many medical professionals earn six-figure salaries, and it can be tempting to stow additional income in a high-interest savings account or succumb to lifestyle inflation and spend it.

Real estate can increase in value over long periods of time, and investing in property is no longer limited to developers and others in the real estate industry. High earning health care professionals may want to consider acquiring real estate to diversify their investment portfolio, build equity and earn income, and boost their cash flow.

Diversify Investment Portfolio Contributing to a 401(k) to build retirement savings is one of the most common ways people can get started investing, while others may choose to purchase stocks or contribute to startups and small businesses. Real estate can have a better rate of return than other investment opportunities, but thoroughly researching real estate companies and properties before buying or investing is crucial to success. It might also be helpful to assess the state of your investment portfolio before seeking to add real estate investments to the mix.

While real estate investments can diversify your portfolio, consulting a trusted financial advisor can help you determine how buying or investing in property may benefit or fit in with your existing financial goals and investments.

Build Equity and Earn Income While homeownership comes with high up-front costs, it also comes with key long-term advantages. Making monthly mortgage payments builds equity, increasing your ownership value over time. Owning a home may also serve as a hedge against inflation. Purchasing, managing and maintaining a rental property may be another option to acquire real estate.

Consider commercial versus personal properties and the advantages and disadvantages that come with each before making a final decision. Owning a rental house or apartment might seem easier than owning an office space or building, but with the right team and the necessary resources, either opportunity has the potential to be successful. However, it may be best to start by owning your own home before progressing to owning any rental property.

achieve this. Aside from buying a house or rental property, there are less direct ways to invest in real estate and still boost cash flow, including real estate investment trusts (REITs) and exchangetraded funds (ETFs). As with any investment opportunity, REITs and ETFs come with both risks and rewards. REITs are companies that own rental properties like apartments, office buildings and retail centers that typically distribute the income from these properties to their shareholders in yearly dividends. ETFs are professionally managed diversified stock portfolios that can allow people to invest in credible REITs without looking into them individually. While both can provide reasonable investment returns, researching REITs and ETFs before deciding to invest is critical to making a successful investment. Have a trusted financial advisor help you thoroughly weigh the pros and cons of each option before choosing to invest.

Acquiring real estate properties or investing in real estate is a highly involved process, but either could yield significant financial success when done carefully and correctly.

Remember to take current and future financial plans and investments into account, consult with a trusted financial advisor as needed and research every investment opportunity thoroughly before making a commitment.

Randy Lyons is a Senior Client Advisor for Arvest Wealth Management, Member FDIC, FINRA, SIPC. He may be reached at rlyons@arvest.com.

Boost Cash Flow Financial independence in retirement should be one of the main goals for high earners, and creating additional sources of income outside of their careers is one way to help them JAN FEB 2025 • GCMS Journal • 23

Exciting Alliance Events Coming Soon

by Barbara Hover, President GCMS Alliance GCMSA held their annual meeting December 19 at Cooper Estates Club House. All who attended enjoyed a potluck brunch with a holiday theme. We wish to thank Barbara Blaine and Cathy Leiboult for organizing this event. Barbara also shared holiday crackers from England. English “crackers” are like exploding fortune cookies with crowns and dad jokes. Reading our cracker jokes out loud brought groans and rolling eyes.

Join the GCMS Alliance Today!

Donna Corrado, MSMA Alliance State President, installed officers for 2025: Barbara Hover - president, Christine Rice – secretary, and Cathy Leiboult - treasurer. The Alliance fiscal year is January 1 through December 31. Dues are now payable online for 2025.

We welcome new members and new ideas.

Physician Family Night at the Discovery Center will be held February 28th from 6:00 to 9:00 PM. The evening is open to all physicians in the area and includes a child-friendly menu and private admission to the museum. We thank Ferrell Duncan Foundation and Mercy for their sponsorship. The Discovery Center has something of interest for all ages. It is a great opportunity to spend quality family time, visit with old friends and meet new colleagues. We hope to see you there.

24 • JAN FEB 2025 • GCMS Journal

Left to right: Christina Rice, Cathy Leiboult, Barbara Hover, Donna Corrado, and Jim Rogers, MD.

professional directory

To Advertise in this directory call Jean Harmison at the Society office: 417-887-1017.

Please Note: Changes to ads will be made quarterly and must be submitted in writing.

H Denotes GCMS Membership “A” Denotes GCMS Applicant GCMS Member Ad Rates: $10.00 per 2” sq. • Non-Member Ad Rates: $13.75 per 2”sq.

Direct Primary Care ASCENT DIRECT PRIMARY CARE, LLC MATTHEW GREEN, DO H

Mission Statement

Bringing physicians together to improve the health of our community.

Dermatology, Procedural

MICHAEL H. SWANN, MD H BRETT NEILL, MD MICHAEL KREMER, MD JOHN CANGELOSI, MD AUTUMN BERTHOLDI, PA-C PATSY DUGGAN, PA-C LORI MILLER, NP-C HANNAH LEE, FNP-BC BROOKLYN FORT, FNP-C 3850 S. National Ave, Suite 705 Springfield, MO 65807 (Located inside Hulston Cancer Building-7th floor) 1240 E. Independence Springfield, MO 65804 Phone: 417-888-0858 • Fax: 417-889-0476 www.swanndermatology.com Hollister Location 590 Birch Rd, Ste 2c Hollister, MO 65672 PH. 417-690-3858 Fax 417-690-3862

Family Medicine www.ascentdpc.com 417-595-0956 413 N McCroskey, Ste 2 Nixa, MO 65714

Lebanon Location 331 Hospital Drive Suite C Lebanon, MO 65536 Phone : 417-344-7200 Fax : 417-344-7299

3800 S National Ste 700 Springfield, MO 65807 (417) 269-8817 American Board of Family Medicine

Marc Carrigan, MD

Eye Surgery/Ophthalmology EYE SURGEONS OF SPRINGFIELD, INC. C. BYRON FAULKNER, MD H Comprehensive Cataract Ophthalmology

JUDD L. McNAUGHTON, MD H Comprehensive Cataract Ophthalmology Diplomates, American Board of Ophthalmology 1330 E. Kingsley St. • Springfield, MO 65804

Phone 417-887-1965 • Fax 417-887-6499 417eyecare.com

Eye Surgery/Ophthalmology MATTAX • NEU • PRATER EYE CENTER JAMES B. MATTAX, JR., MD, FACS …

American Board of Ophthalmology

LEO T. NEU III, MD, FACS H

Cameron Crymes, MD Kristin Crymes, DO Matthew Dalke, MD Katie Davenport-Kabonic, DO Kristen Glover, MD Kyle Griffin, MD Shelby Hahn, MD Laura Isaacson, DO Evan Johnson, MD Michael Kabonic, DO Eric Lesh, DO Taylor Ross, MD

Gynecology WOMAN’S CLINIC www.womansclinic.net Leaders in Minimally Invasive Gynecology & Infertility

DONALD P. KRATZ, MD, FACOG H

American Board of Ophthalmology

DAVID NASRAZADANI, MD

AMY LINN, FNP-BC

DREW A. YOUNG, MD THOMAS PRATER, MD, FACS H American Board of Ophthalmology

JACOB K. THOMAS, FACS, MD H BENJAMIN P. HADEN, MD H American Board of Ophthalmology

MICHAEL S. ENGLEMAN, OD MARLA C. SMITH, OD MATTHEW T. SMITH, OD 1265 E. Primrose Springfield, MO 65804 417-886-3937 • 800-995-3180

Internal Medicine MERCY CLINIC– INTERNAL MEDICINE WHITESIDE RAJ ANAND, MD JAMES T. ROGERS, JR. MD, FACP H Board Certified in Internal Medicine

MARIA DELA ROSA, MD

NELSON DELA ROSA, MD AMANDA MCALISTER, MD ALEJANDRA ROA, MD KELLY TRYGG, MD GABBY BONNER, NP STEVEN BOWLIN, MD Board Certified in Internal Medicine

STEPHANIE HOVE, NP CARRIE KUGLER, PA COURTNEY WEATHERFORD, PA JENNIFER WHITE, PA VICTOR GOMEZ, MD

American Board of Obstetrics and Gynecology

American Board of Ophthalmology Monett Satellite Location (Inside CoxHealth Urgent Care) 2200 E. Cleveland Ave Monett, MO 65708 Phone: 417-888-0858 • Fax: 417-889-0476

Family Medicine COXHEALTH FAMILY MEDICINE RESIDENCY FAMILY MEDICAL CARE CENTER

American Academy of Family Nurse Practitioners

Board Certified in Internal Medicinee

2115 S. Fremont, Suite 2300 Springfield, MO 65804 Phone 417-820-5600 Fax 417-820-5606

Urology MERCY CLINIC UROLOGY (FREMONT) ERIC P. GUILLIAMS, MD, FACS H

American Board of Urology

VANESSA MCCONNELL, APRN, DNP, FNP-C

ROBERT D. JOHNSON, MD, FACS H

1135 E. Lakewood, Suite 112 Springfield, MO 65810

TYRUN K RICHARDSON, MD

Located inside Tri-Lakes Family Care 1065 Hwy 248 Branson, MO 65616 Phone 417-887-5500 Fax 883-8964 or toll free 877-966-2607 Monday-Thursday 8am-4:30pm Friday 8am-12pm

American Board of Urology American Board of Urology

MARK J. WALTERSKIRCHEN, MD, FACS American Board of Urology

Phone 417-820-0300 Fax 417-882-9645 1965 S Fremont, Ste. 370 Springfield, MO 65804

JAN FEB 2025 • GCMS Journal • 25

Internal Medicine ADULT MEDICINE & ENDOCRINOLOGY JONBEN D. SVOBODA, MD, FACE, ECNU American Board of Endocrinology JAMES T. BONUCCHI, DO, ECNU, FACE American Board of Endocrinology NICOLA W. GATHAIYA, MD, ECNU, FACE, CCD American Board of Internal Medicine American Board of Endocrinology STEPHEN M. REEDER, MD, FACP American Board of Internal Medicine ANA MARCELLA RIVAS MEJIA, MD, CCD American Board of Internal Medicine American Board of Endocrinology

Neurosurgery SPRINGFIELD NEUROLOGICAL AND SPINE INSTITUTE CoxHealth Jared Neuroscience West Tower • 3801 S National, Ste 700 Springfield, MO 65807 • 417-885-3888

Neurosurgery: H. MARK CRABTREE, MD, FACS EDWIN J. CUNNINGHAM, MD MAYUR JAYARAO, MD J. CHARLES MACE, MD, FACS H CHAD J. MORGAN, MD MICHAEL L. MUMERT, MD SALIM RAHMAN, MD, FACS ANGELA SPURGEON, DO ROBERT STRANG, MD

Interventional Neuroradiology

JACQUELINE L. COOK, FNP-BC, CDCES, CCD

MICHAEL J. WORKMAN, MD

KELLEY R. JENKINS, FNP-C, CDCES

TED A. LENNARD, MD

ALINA CUMMINS, PA-C STACY GHOLZ, FNP-C SHELLEY L. CARTER, DNP JESSICA A. CROUCH, FNP-C Phone (417) 269-4450 960 E. Walnut Lawn, Suite 201

Springfield, MO 65807

Nephrology

Physiatry: KELLY OWN, MD

Physician Assistants: JOSHUA BARBIERI, PA-C MARK BROWN, PA-C ERIC CHAVEZ, PA-C BLAKE MARTIN, PA-C HEATHER TACKETT, PA-C

Nurse Practitioner: EMILY CROUSE, NP-C BILL HAMPTON, ANP-BC ROZLYN MCTEER, FNP BRANDON RUBLE, ACNP-AG ALYSSA CHASTAIN, FNP

Obstetrics/Gynecology COXHEALTH PRIMROSE OB/GYN SPRINGFIELD NEPHROLOGY ASSOCIATES, INC. 1911 South National, Suite 301 Springfield, MO 65804 Phone 417-886-5000 • Fax 417-886-1100 www.springfieldnephrology.com

MARCUS D. MCCORCLE, MD, FACOG Diplomate, American Board of Obstetrics and Gynecology

THOMAS M. SHULTZ, MD, FACOG

STEPHEN E. GARCIA, MD H

Diplomate, American Board of Obstetrics and Gynecology

ETHAN T. HOERSCHGEN, MD

GREGORY S. STAMPS, MD, FACOG

American Board of Internal Medicine American Board of Nephrology American Board of Internal Medicine American Board of Nephrology

GISELLE D. KOHLER, MD H

American Board of Internal Medicine American Board of Nephrology

Diplomate, American Board of Obstetrics and Gynecology

P. MICHAEL KIDDER, DO, FACOOG

DAVID L. SOMMERFIELD, MD

Diplomate, American Osteopathic Board of Obstetrics & Gynecology

SUSAN A. WOODY, DO H

Phone 882-6900 1000 E. Primrose • Suite 270 Springfield, MO 65807

American Board of Internal Medicine American Board of Nephrology American Board of Internal Medicine American Board of Nephrology

26 • JAN FEB 2025 • GCMS Journal

Obstetrics/Gynecology SPRINGFIELD OB/GYN, LLC MATTHEW H. TING, MD, FACOG H American Board of Obstetrics & Gynecology

909 E. Montclair, Suite 120 Springfield, MO 65807 Phone 417/882-4466 • Fax 417/890-5631

Oncology/Hematology

Otolaryngology MERCY CLINIC– EAR, NOSE & THROAT BENJAMIN L. HODNETT, MD, PHD H ERICH D. MERTENSMEYER, DO, FAOCOO AARON R. MORRISON, MD A. DANIEL PINHEIRO, MD, PhD, FACS H RAJEEV MASSON, MD

ONCOLOGYHEMATOLOGY ASSOCIATES OF SPRINGFIELD, MD, P.C.

Diplomates, American Board of Otolaryngology

WILLIAM F. CUNNINGHAM, MD, FACP

MELISSA COONS, FNP

MARK J. VAN ESS, DO, FAOCOO

SHELBY BRITT, PA

American Board of Internal Medicine American Board of Medical Oncology

TAHRA LOCK, NP

JIANTAO DING, MD H

ELIZABETH (BETSY) MULLINGS, FNP

American Board of Internal Medicine American Board of Hematology American Board of Medical Oncology

PAUL STRECKER, FNP Audiology

ROBERT J. ELLIS, MD, FACP

American Board of Internal Medicine American Board of Hematology American Board of Medical Oncology

BROOKE GILLETT, DO

American Board of Internal Medicine American Board of Medical Oncology

V. ROGER HOLDEN, MD, PhD

American Board of Hematology American Board of Medical Oncology

DUSHYANT VERMA, MD, FACP

American Board of Internal Medicine American Board of Hematology American Board of Medical Oncology

Springfield Clinic 3850 S. National, Ste. 600 Springfield, Missouri 65807 Monett Clinic 802 US Hwy 60 Monett, Missouri 65708 Phone 882-4880 Fax 882-7843 Visit our website: www.ohaclinic.com

JASON BOX, AuD, CCC-A MAMIE JAYCOX, AuD, CCC-A JENNIFER PLOCH, AUD ALLISON WHITE, AUD, CCC-A Phone 417-820-5750 Fax 417-820-5066 1229 E. Seminole, Ste. 520 Springfield, MO 65804

Plastic Surgery

MERCY CLINIC– FACIAL PLASTIC SURGERY MATTHEW A. KIENSTRA, MD, FACS

American Board of Facial Plastic & Reconstructive Surgery American Board of Otolaryngology

Phone 417-887-3223

1965 S. Fremont, Ste. 120 Springfield, MO 65804 facialplasticsurgeon.com

Psychiatry JAMES E. BRIGHT, MD H Diplomate, American Board of Psychiatry & Neurology.

Practice Limited to: Adult Psychiatry Phone 882-9002 1736 E. Sunshine, Ste. 400 Springfield, MO 65804

It’s our turn to care for you.

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Member FDIC Qualifications required, see a dedicated Private Banker for more details.

JAN FEB 2025 • GCMS Journal • 27

GREENE COUNTY MEDICAL SOCIETY 4730 S NATIONAL AVE, SUITE A1 SPRINGFIELD, MO 65810 Change Service Requested

28 • JAN FEB 2025 • GCMS Journal

PRSTD STD U.S. POSTAGE PAID PERMIT NO. 816 SPRINGFIELD, MO.