SEP OCT
2026
TABLE OF CONTENTS
In this issue:
67
Editor's Page Minh-Thu Le, MD................................................................... 3 President's Page Melissa Gaines, MD.............................................................. 4 Beyond "Who needs the WHO" The real-world Impact of the U.S. Withdrawal David Barbe, MD.................................................................. 6
10
The Childhood Vaccine Schedule: When Vaccine Policy Departs from Science. Kayce Morton, DO...............................................................10 Getting to Zero Suicide Kyle John, MD.....................................................................14
What to Do when an IRA is Interfering with your Backdoor Roth David Koppenheffer and Michelle Kyriakais........................17
14
Jordan Valley Health Center Residency Class of 2029....................................................................19
CoxHealth Family Medicine Residency Springfield Class of 2029...................................................20 Something Phishy This Way Comes: Spotting Scams to Prevent Fraud Darline Mabins.....................................................................26
27
Open Field Health Collaborative Nancy Yoon, MD................................................................27 Professional Directory...................................................29
Vol 85, NO. 5 SEP OCT 2026 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 David Barbe, MD Jaya LaFontaine, MD Dalton Boyer Andrew Le Jean Harmison Barbara Hover
SOCIETY OFFICERS Melissa Ganies, MD, FACP, FAAHPM President Vu Le, MD Secretary Sanjay Havaldar, MD Treasurer James Rogers, MD Immediate Past President
Council Members: Barbara Hover James Rogers, MD Melissa Gaines, MD Rachelene Middleton, MD Jim Blaine, MD Sanjay Havaldar, MD Jaya LaFontaine, MD John Steinberg, MD Taylor Brooks, MD Vu Le, MD
22
On the cover: September is suicide awareness month
Managing Director: Jean Harmison
Executive Office:
The GCMS Journal is available online:
www.gcms.us
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
As fall approaches and we start seeing the colors change on the trees, we also start seeing changes in the milieu of patients in the hospital and clinics-- more illnesses, infections, and visits where we can make an impression on our patients. The moral injury that our job title inherently brings seems to be less important than treating those individuals that seek out our expertise to help them live through another day. I am very excited about this issue, where several important articles (all no less important than the other) are published. Former GCMS president, AMA president, and WMA president, Dr. Barbe, has a poignant article about what has happened since the US has pulled out of the World Health Organization and how the domino effect reaches us. A nice segue to vaccinations and how we all should be counselling our patients, and especially parents of children, during this age of misinformation from both our government and other influencers on-line comes from another former president of GCMS, Dr. Kayce Morton. September is suicide awareness month, and Dr. Kyle John writes that it is not too lofty to think that we can go to ZERO suicides through education and programming through the ZERO SUICIDE program. Dr. Nancy Yoon comes back to us in a new position, but still focused on public health in Missouri, introducing an exciting non-profit
program that physicians can be involved in called the “Open Field Collaborative.” Meetings start in October for those wanting to collaborate with other like-minded individuals for the health of our community. October also brings a collaboration between Forvis, CoxHealth, and GCMS for financial wellness seminars for all physicians at different times of their career. This is non-branded and a no soliciting event. Look and see which week may apply to you! All physicians are welcome! Arvest has an article about financial scams and Forvis reminds us to use the backdoor ROTH as an investment strategy in this edition as well. Our current GCMS president, Dr. Melissa Gaines, reminds us of our theme of the year, “Light in the Window,” focusing on the physician family, and I was glad to see so many physician families at the zoo event this past month as well! Our next big event is the GCMS Foundation Bash September 26th and I hope to see many more there as we give to strengthen community programs! And last, but never least, please familiarize yourself with the new family medicine residents in town. They are the future of GCMS and our community!
JULY AUG 2026 • GCMS Journal • 3
PRESIDENT'S PAGE By Melissa Gaines, MD, FACP, FAAHPM
The Light We Carry Together August 29 was a beautiful representation of what we envision with GCMS Together. More than 350 physician families gathered for Family Night at the Zoo, enjoying an evening of shared experiences, laughter, and connection. The event was funded by the GCMS Foundation and coordinated through the collaboration of the Alliance and Council. Watching physicians connect outside of the clinical environment reminded me that sometimes the simplest experiences can build meaningful community, and occasionally, the physicians and the animals were surprisingly difficult to tell apart! This is the professional home we hope to create through GCMS Together: a place where physicians and their families feel they belong. The candle in the window was gifted to our physicians through the Alliance to start a family tradition by placing an electric candle in a window as a welcoming light for loved ones returning home. Families are encouraged to make it a simple, shared symbol of love, care, and support. A light waiting for you before walking through the door. Recently, I had the privilege of learning more about early Alzheimer’s disease, and one message particularly stayed with me. Improvements in the diagnosis and treatment of chronic diseases mean that many people are now less likely to die from conditions such as cancer or heart failure before developing dementia. Medicine has helped us live longer, and that success creates a new responsibility: we need to pay attention to brain health. As physicians, we have an opportunity to help our patients think not only about living longer, but about preserving cognition, function, independence, and quality of life. I have also been reflecting on the increasingly complex conversations surrounding vaccines and prevention. It is difficult to reconcile the remarkable advances in science that have allowed vaccines to prevent devastating diseases—and are now being approved as treatments for melanoma—with changes in childhood vaccine recommendations that may not be supported by the same body of scientific evidence. My first reaction is, I don’t have time for another emotionally charged conversation about prevention. Our office visits are already full. But perhaps that is exactly why these conversations matter. My goal will be to remain curious 4 •JULY AUG 2026 • GCMS Journal
about the patient’s perspective while empathetically telling the truth. Curiosity helps us understand what our patients have heard and what experiences have shaped their beliefs. Empathy preserves the relationship. And telling the truth, clearly and respectfully, using the best available evidence, is part of our responsibility as physicians. Our GCMS Advisory Committee is actively responding to the changing landscape surrounding vaccines and other public health priorities. This is a vital role for organized medicine: providing physicians with accurate information, elevating the physician voice, and advocating for the health of our patients and community. As I reflect on Family Night at the Zoo, I am reminded that resilience is not built only through programs addressing burnout. It is built through belonging, community, and meaning. It grows when we know one another beyond our titles and specialties. When we have people with whom we can laugh, learn, disagree respectfully, and share the privilege of caring for others. Thank you for being part of GCMS Together and for helping us build the physician community our region needs. I invite you to join as a member and participate in our upcoming events. As always, I am honored to serve as your President!
Mission Statement Bringing physicians together to improve the health of our community.
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JULY AUG 2026 • GCMS Journal • 5
Beyond "Who Needs the WHO?": The Real-World Impact of the U.S. Withdrawal By David Barbe, MD
Abstract Background: Following the formal January 2026 U.S. withdrawal from the World Health Organization, global health infrastructure has shifted from a centralized model to a fractured, multi-lateral network. The loss of American funding triggered a $2.5 billion budget reduction, a 55% contraction of WHO departments, and critical data-sharing blocks. For practicing physicians and their patients, these macroscopic shifts translate into dangerous clinical blind spots in research, disease surveillance, and vaccine development. To protect our patients and communities, physicians cannot rely entirely on traditional federal channels for information but must also actively embrace independent reporting networks, maintain heightened diagnostic vigilance, and participate in local datareporting efforts. In January 2025, President Trump issued Executive Order 14155, signaling the intent to withdraw the U.S. from the World Health Organization (WHO). This historic departure resulted in the complete termination of American financial contributions, the immediate recall of embedded Centers for Disease Control and Prevention (CDC) personnel, and an absolute halt to U.S. participation in all official technical working groups. The United States formally completed its exit from the WHO on January 22, 2026. The executive order triggered an intense debate over global health governance, institutional efficiency, national sovereignty, and the broader implications of American isolation. An article titled “Who Needs the WHO?” appeared in the March–April 2025 GCMS Journal, outlining the history of the organization, the potential fallout of a U.S. withdrawal, and the stated justifications for the exit. That article concluded with the author’s prediction that a diplomatic compromise would ultimately be reached to avoid a complete withdrawal. As we now know, that prediction was wrong; the compromise never materialized. The impact on practicing physicians and clinical researchers worldwide is no longer academic. It is operational. As the global health architecture splinters, the medical community must directly confront the clinical, fiscal, and epidemiological realities of a post-U.S. WHO. The Budgetary and Resource Impact on the WHO The loss of its largest benefactor has thrown the WHO into an unprecedented fiscal crisis. Historically, the United States supplied 15% to 18% of the agency’s total operating budget through a combination of mandatory assessed contributions and voluntary, flexible grants—amounting to approximately 6 •JULY AUG 2026 • GCMS Journal
$700 million to $750 million per twoyear (biennium) budget cycle. When the U.S. halted its funding, a financial cascade ensued as several European nations and international donors scaled back their own commitments, resulting in a roughly $2.5 billion drop in total funding. The abrupt elimination of these funds, coupled with an unresolved diplomatic standoff over $260 million to $280 million in unpaid U.S. dues from the 2024–2025 cycle, forced immediate and drastic budgetary contractions: • Initial 2026–2027 Proposed Base Budget: $5.3B • Enacted Post-Exit Base Budget: $4.2B (A structural reduction of $1.1B) • Current Biennium Funding Deficit: $1.05B (Approximately 25% of the baseline remains unsecured) To prevent an outright institutional collapse, the remaining World Health Assembly member states ratified a 20% increase in their own assessed annual dues. Even with this aggressive internal intervention and emergency cost-containment measures, the WHO entered the 2026–2027 biennium facing a stark funding shortfall. This financial deficit fundamentally alters the nature of global health infrastructure and crisis response. Unrestricted public funding has largely vanished, leaving the agency increasingly dependent on tightly "earmarked" revenue streams from private philanthropy—such as the Bill & Melinda Gates Foundation—and regional consortia like the European Union. For practicing physicians around the world, this shift means the WHO has lost its fiscal agility. The Director-General no longer possesses the flexible financial capital or human resources required to rapidly deploy emergency aid to contain localized outbreaks before they expand into global threats. Departmental Consolidation and Workforce Reductions To match its diminished financial capacity, the WHO has undertaken the most drastic structural reorganization in its 78-year history. Under the direction of Dr. Tedros Adhanom Ghebreyesus, the organization’s sprawling administrative apparatus is being consolidated. The total number of internal WHO departments at headquarters is undergoing a massive contraction, collapsing from 76 distinct departments down to just 34—a 55% reduction. This bureaucratic streamlining is directly tied to severe workforce downsizing. By mid-2026, the WHO was on track to eliminate approximately 2,371 positions globally, representing
JULY AUG 2026 • GCMS Journal • 7
a roughly 25% reduction from its peak personnel capacity. Administratively, leadership has concentrated these personnel cuts heavily within the Geneva headquarters. The strategic intent is to preserve country-level delivery offices and defend core technical operations in high-vulnerability regions. However, the loss of thousands of senior technical experts and epidemiologists has thinned the agency’s institutional memory and slowed its global regulatory review pipelines. The Fragmentation of Infectious Disease Surveillance and Research For U.S. and international clinicians, the most immediate consequence of the withdrawal is the fracturing of international data exchange. Per federal directives, U.S. government scientists and CDC epidemiologists are strictly prohibited from co-authoring scientific literature or directly sharing raw sequencing data with WHO-affiliated networks. This formal decoupling has severely disrupted global pathogen surveillance and research. In response to this isolation, the United States has moved aggressively to construct an alternative, independent public health architecture. Following the dissolution of traditional USAID frameworks, the administration is finalizing an "America First" network of bilateral health agreements. Rather than channeling information through a centralized United Nations clearinghouse, the U.S. now relies on exclusive, one-on-one data-swapping compacts with select allied nations. Structural Shifts in Disease Surveillance Models: 1. Centralized Model (Pre-2025): All member nations (including the U.S.) fed raw epidemiological data into a centralized WHO clearinghouse, which then redistributed universal health intelligence globally. 2. Bilateral Model (Post-2026): The United States operates independently, establishing distinct, localized, one-onone data-swapping channels directly with approved allied partners, completely bypassing the unified UN framework. This fragmentation creates significant diagnostic information gaps. To maintain clinical awareness, medical associations and academic research institutions are forced to bypass formal state channels entirely. American clinicians now rely heavily on informal, peer-to-peer communication networks, openaccess preprint servers, and independent digital tracking databases to monitor trans-border viral mutations and vectorborne migrations in real time. Immunization Disparities Across Borders The operational divide between developed nations and lowand middle-income countries has widened significantly under this new paradigm, particularly regarding vaccine access, delivery, and uptake. Impact on Low- and Middle-Income Countries
In the Global South, the combined impact of the WHO's budget shortfalls and the freezing of parallel USAID funding have disrupted frontline clinical operations. Essential, longrunning disease eradication campaigns—specifically targeting polio, malaria, and multi-drug-resistant tuberculosis—are experiencing immediate delivery failures across sub-Saharan Africa and parts of South Asia. Without the logistical and financial support of U.S.-backed distribution mechanisms, regional infrastructures are degrading. This vulnerability has sparked localized resurgences of vaccine-preventable childhood illnesses, threatening decades of hard-won global progress. Impact on U.S. Vaccine Research and Production Conversely, the United States faces an entirely different set of epidemiological challenges. By isolating itself from the WHO’s Global Influenza Surveillance and Response System (GISRS), American medical institutions are experiencing a significant diagnostic blind spot. Domestic laboratory networks now face a compressed lead time for analyzing seasonal genetic drift in contagious diseases, directly hindering the ability of American manufacturing facilities to accurately formulate biannual influenza and respiratory vaccines. Furthermore, this geopolitical split has triggered an unprecedented domestic countertrend. Recognizing the immediate threat of borderless pathogens, several U.S. state health departments and large municipal authorities are actively attempting to bypass federal restrictions. By utilizing independent legal mechanisms, these local entities are using backchannels to establish direct data-sharing relationships with the WHO to ensure their local healthcare systems receive early warnings of emerging global variants. Conclusion: Implications for and Responsibility of the Practicing Physician A reasonable question for a U.S. physician to ask is, “How does all of this affect me and my patients?” The post-U.S. global health landscape is fragmented, financially constrained, and structurally diminished. For domestic clinicians, this shift requires a profound change in perspective. As formal, centralized international surveillance and research channels erode, the responsibility for maintaining public health security shifts downward. Local physicians can no longer rely entirely on top-down federal alerts; protecting our patients and communities places new demands on our dayto-day practice. In this new era, we must: • Devote active attention to the scientific outcomes of independent research networks and open-access global data streams. • Actively participate in and report clinical findings to localized, clinician-driven electronic reporting registries. • Maintain heightened diagnostic vigilance for novel or atypical clinical presentations of transmissible diseases. • Demonstrate unwavering advocacy for evidence-based immunization information, actively promoting vaccine JULY AUG 2026 • GCMS Journal • 8
acceptance to mitigate the inevitable rise in domestic disease transmission and global pathogen importation.
apply in our clinical decision-making that the combination of AI and human intelligence results in the best information.
The question "Who Needs the WHO?" has been answered by reality: we do, and the global medical community does. While international grievances regarding the agency's vulnerabilities were valid, the resulting withdrawal of support has yielded a structural and financial "cure" far worse than the organizational “disease”. Our collective challenge now is to bridge these geopolitical fractures, restore collaboration at all levels, and provide low- and middle-income countries with the resources required to prevent, identify, and suppress outbreaks at their source—recognizing that this is not just an act of global equity, but the only way to safeguard global health.
References 1. World Health Organization. Draft Proposed Programme Budget 2026– 2027: Financing Realities in a Transitional Biennium. Geneva, Switzerland: World Health Organization; 2025. Institutional Document WHA78/7. 2. United States White House. Executive Order 14155: Formalizing the Conclusion of United States Participation in the World Health Organization. Washington, DC: Federal Register; January 22, 2025. 3. Gostin LO, Finch AM, Standard JE. The structural consequences of global health balkanization: Finances, surveillance, and sovereignty after the US-WHO decoupling. Health Aff (Millwood). 2025;44(11):18421851. doi:10.1377/hlthaff.2025.01104 4. Garrett L, Wenham C. Scaling back at Geneva: How a 25% workforce reduction impacts the World Health Organization's outbreak response capacity. Lancet Global Health. 2026;14(3):e155-e162. doi:10.1016/S2214109X(26)00012-X 5. Gavi, the Vaccine Alliance. The Global South Immunization Chasm: Tracking Supply Chain Degradation and Resurgent Polio and Malaria in Post-USAID Funding Environments. Geneva, Switzerland: Gavi Secretariat; 2026.
Author’s note: This article was prepared in proper “augmented intelligence” fashion using an appropriate combination of the author’s independent opinion, experience, research, drafting, and editing supplemented by AI information-gathering, editorial, stylistic, and formatting assistance to improve both content and clarity of information. I support the principle we
9 •JULY AUG 2026 • GCMS Journal
The Childhood Vaccine Schedule: When Vaccine Policy Departs from Science By Kayce Morton, DO, FAAP, FSLM, Pediatric Hospitalist, St. Louis Children's Hospital at CoxHealth
Vaccination should not be a partisan issue. The relevant questions are clinical and scientific: Which diseases threaten children in the United States? At what ages are children most vulnerable? When will the immune response be strongest? Which schedule produces the best protection with the fewest missed opportunities and the lowest burden for families? Instead of focusing our time on thoughtful conversations with parents, we are increasingly confronting a crisis of trust. We see it every day--in clinical encounters, across social media, and even in our own conversations with friends and family. When public health guidance is filtered through a political lens rather than grounded in scientific evidence, uncertainty grows, misinformation flourishes, and families are left unsure whom to trust. That erosion of trust becomes more consequential when federal guidance itself departs from the established evidence-based framework. This year the federal childhood immunization recommendations did just that, narrowing from the routine protection against 18 diseases to universal recommendations for only 11. Hepatitis A, hepatitis B, rotavirus, meningococcal disease, influenza, and COVID-19 were shifted toward risk-based or shared clinical decisionmaking categories, while an August executive order directed that measles, mumps, and rubella eventually be administered as three single-disease injections and that childhood immunizations be given at separate visits to the maximum extent feasible.1 The American Academy of Pediatrics (AAP) no longer endorses the federal schedule and continues to publish its own evidence-based schedule. This issue is not about the act of revising recommendations. Good science changes when better evidence emerges. The concern is that these revisions were imposed without new evidence demonstrating that the established schedule is unsafe or that the proposed alternatives improve outcomes. The childhood schedule is not a random list. It is an integrated prevention strategy built from disease epidemiology, agespecific risk, immune response, vaccine effectiveness, safety surveillance, feasibility, and access. Timing matters because delaying a vaccine also delays protection. That interval is not neutral; it is time during which a child remains at the highest risk of vulnerability. Administering recommended vaccines during the same visit is a longstanding evidence-based practice. It allows children to become protected at the appropriate age and 10 •JULY AUG 2026 • GCMS Journal
reduces missed opportunities. Before the recent federal reversal, CDC bestpractice guidance specifically supported simultaneous administration for eligible vaccines and encouraged combination products when appropriate.3,4 Requiring separate visits adds transportation, time away from work and school, copayments, scheduling barriers, and more chances for a child never to complete the series. These burdens fall hardest on rural families, families with limited transportation, and those with less flexible employment. The proposal to split MMR is especially difficult to defend scientifically. The currently licensed MMR vaccines have decades of effectiveness and safety data, while separate measles, mumps, and rubella vaccines have not been available in the United States since 2009. Replacing one proven combination vaccine with three injections would not improve protection; it would increase the number of injections and logistical barriers. The 2026 AAP schedule supports licensed combination vaccines and is explicit that recommendations are calibrated to the ages at which children are vulnerable and most likely to respond. 2,5 The broader safety record is also substantial. The National Academies' review concluded that existing surveillance systems provided confidence in the safety of the recommended schedule and warned that intentionally assigning children to delayed or alternative schedules would expose them to greater risk of vaccine-preventable illness.6 Observational evidence likewise demonstrates that undervaccination is not harmless; delayed or missing DTaP doses, for example, have been associated with a substantially higher risk of pertussis in young children.7 The consequences are already visible. The debate is occurring while population protection is eroding. CDC data for the 2025-2026 school year show MMR coverage among kindergarteners at 92.4%, below the greater-than-95% level needed to reliably prevent sustained measles transmission. About 280,000 kindergarteners attended school without documentation that they had completed the MMR series. Exemptions from one or more school-required vaccines increased from 3.6% to 4.2% in a single year - a 17% relative increase - and rose in 41 states and the District of Columbia.8 These are not abstract percentages. As of August 20, 2026, the United States had reported 2,777 confirmed measles cases, already exceeding the 2,289 cases reported in all of 2025 and representing the highest annual level in 35 years.
Figure 1. Kindergarten vaccination coverage and exemption rates in Missouri compared with national rates during the 2025–2026 school year. Missouri remained below the national vaccination rate for every vaccine shown, while its exemption rate exceeded the national rate. Sources: CDC SchoolVaxView and KFF State Health Facts. AI generated
Ninety-four percent of 2026 cases were associated with outbreaks.9 Measles had been declared eliminated in the United States in 2000. Its return at this scale shows what happens when immunity gaps grow. The national decline is even more concerning when viewed through a Missouri lens. During the 2025–2026 school year, only 89.5% of Missouri kindergarteners had completed the MMR series—nearly three percentage points below the national rate of 92.4% and well below the approximately 95% coverage needed to reliably prevent sustained measles transmission. Coverage was similarly low for DTaP at 88.8%, polio at 89.6%, and varicella at 89.0%. At the same time, 6.3% of Missouri kindergarteners had an exemption from one or more vaccines, compared with 4.2% nationally. Nearly all Missouri exemptions were nonmedical. This is not a one-year fluctuation: Missouri’s exemption rate increased from 4.7% in 2023–2024 to 5.2% in 2024–2025 and 6.3% in 2025–2026, while MMR coverage continued to decline. For Missouri physicians, the margin of safety is not merely narrowing; in many communities, it is already gone. AAP President Andrew D. Racine, MD, PhD, FAAP, summarized the stakes clearly: 'For some diseases like measles, even a small decrease in vaccination rates can lead to more outbreaks of disease because community immunity requires over 95% of susceptible individuals to be immunized.' He also emphasized the appropriate response to uncertainty: pediatricians should offer accurate information and empathetic conversation, because families who have both tend to choose vaccination.10
Professional consensus matters. The AAP position is not an isolated specialty opinion. Twelve major medical and health organizations formally endorsed the 2026 AAP schedule, representing more than one million clinicians, and the coalition supporting it has grown to more than 200 medical, nursing, and public health organizations. 2,11 This collective support reflects the perspective of professions across newborn care, primary care, obstetrics, adolescent medicine, pharmacy, infectious diseases, public health, schools, and hospitals. Consensus alone does not prove a claim. In this case, however, consensus reflects a transparent body of evidence, decades of real-world monitoring, and the judgment of professionals who diagnose and treat the diseases vaccines prevent. Federal leadership should strengthen that process, not substitute political direction for it. Physicians do not need to defend an agency, an administration, or a political party. We should defend a standard: immunization recommendations must be transparent, evidence-based, independently reviewed, and revised when credible new evidence warrants revision. Disease risk, vaccine performance, safety data, and implementation realities should determine the schedule. Greene County Medical Society joins these organizations and endorses support for continued use of the 2026 AAP childhood and adolescent immunization schedule. We support reliable vaccine access and coverage; strong post-licensure safety surveillance; clear public reporting JULY AUG 2026 • GCMS Journal • 11
of benefits, risks, and uncertainty; and respectful shared decision-making that does not misrepresent a routine recommendation as optional when the evidence supports universal protection. We will continue to advocate for children and families by supporting accurate information, equitable access to vaccines, and immunization recommendations grounded in transparent scientific evidence. Clinicians should remain a steady source of clarity. We can acknowledge questions without amplifying disproven claims, explain why timing matters, and make vaccination as accessible as possible. The goal is not to win a political argument. It is to keep children in Greene County, Missouri, and across the country from suffering illnesses we already know how to prevent. GCMS position statement: Childhood immunization policy should follow transparent evidential review, preserve timely access, and retain the AAP schedule unless credible evidence justifies change. References 1. Executive Order 14420. Delivering Gold Standard Childhood Vaccine Recommendations for Americans. August 10, 2026. https://www.whitehouse.gov/ wp-content/uploads/2026/08/eo-14420.pdf 2. O'Leary ST, et al.; AAP Committee on Infectious Diseases. Recommended Childhood and Adolescent Immunization Schedule: United States, 2026. Pediatrics. 2026;157(3):e2025075754. doi:10.1542/peds.2025-075754.
3. Centers for Disease Control and Prevention. General Best Practice Guidance for Immunization: Timing and Spacing of Immunobiologics. Accessed August 24, 2026. https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-2-generalbest-practice-guidance.html 4. Centers for Disease Control and Prevention. Vaccines and Other Immunizing Agents in the Child and Adolescent Immunization Schedule. November 21, 2024. https://www.cdc.gov/vaccines/hcp/imz-schedules/child-schedule-vaccines.html 5. American Academy of Pediatrics. Executive order to reduce childhood vaccines unscientific, dangerous. AAP News. August 11, 2026. https://publications.aap. org/aapnews/news/35792/ 6. Institute of Medicine. The Childhood Immunization Schedule and Safety: Stakeholder Concerns, Scientific Evidence, and Future Studies. National Academies Press; 2013. https://doi.org/10.17226/13563 7. Glanz JM, Narwaney KJ, Newcomer SR, et al. Association Between Undervaccination With DTaP Vaccine and Risk of Pertussis Infection in Children 3 to 36 Months of Age. JAMA Pediatr. 2013;167(11):1060-1064. doi:10.1001/ jamapediatrics.2013.2353. 8. Centers for Disease Control and Prevention. Vaccination Coverage and Exemptions among Kindergartners, 2025-2026 School Year. Updated August 17, 2026. https://www.cdc.gov/schoolvaxview/data/index.html 9. Centers for Disease Control and Prevention. Measles Cases and Outbreaks. Updated August 21, 2026. https://www.cdc.gov/measles/data-research/index. html 10. Jenco M. AAP president: As kindergarten measles vaccination rates decline, 'the risk is real.' AAP News. August 18, 2026. https://publications.aap.org/ aapnews/news/35827/ 11. American Society of Hematology. ASH Signs on to Statement of Support for AAP's Immunization Schedule. 2026. https://www.hematology.org/advocacy/ testimony-and-correspondence/ash-signs-on-statement-of-support-for-aapsimmunization-schedule
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Getting to Zero Suicide By Kyle John, MD
awareness programs, and structured follow-up after a suicidal crisis—have replicated evidence, while multi-component/multi-level strategies combining several of these (i.e. Zero Suicide) appear most effective. Zero Suicide is a quality improvement model that transforms system-wide suicide prevention and care, to save lives. Healthcare, at its heart, should be about saving lives; Zero Suicide aims to do just that. Zero Suicide includes the foundational belief that suicide deaths, for those under the care of health systems, are preventable. When it comes to patient safety, the only acceptable number of losses due to errors in quality of care is zero. Imagine St. Louis’s Cardinals stadium full to the brim with spectators, over 45,000 of them enjoying a playoff game in October. Now imagine every one of those same spectators as a suicide statistic. In 2024, over 49,000 Americans died by suicide, and 12.2 million Americans reported having suicidal ideation while 2.2 million attempted suicides. Suicide is the 10th leading cause of death in the United States, but the 2nd leading cause of death among 10 to 34-year-olds. Globally, suicide rates are down nearly 23% over the past twenty years. Countries like China and India are primarily responsible for the decline, but countries in eastern Europe and Finland, which have historically had higher rates, have also seen significant decreases in their rates of suicide. The United States stands out among all countries for our 36% increase in rates of suicide over the same period. While men continue to outnumber women 4:1 when it comes to deaths by suicide, rates among women and our youth are increasing. Suicide rates increase with age and are higher in White Americans>American Indians/Alaska Natives>Hawaiian/Pacific Islanders>Black Americans. Guns are used in 50% of suicide deaths and are lethal 90% of the time. While women attempt suicide more often than men, they chose overdose and suffocation more frequently, and those means are less lethal. Drivers of change to rates of suicide include economic cycles (recessions raise rates), restriction of lethal means, alcohol policy, access to mental health care and health expenditure, social isolation and socioeconomic disadvantage, and media reporting of celebrity suicides. What reduces suicide rates? Restriction of access to lethal means has the strongest evidence base of any suicide prevention intervention and is the cornerstone of effective population-level strategy. Beyond means restriction, a consistent set of interventions—responsible media reporting, alcohol policy, primary care physician education in depression management, school-based mental-health
The Zero Suicide model provides a practical framework for system-wide transformation towards safer suicide care. Zero Suicide is based on the realization that people experiencing suicidal thoughts and urges often fall through the cracks, despite the majority having seen a provider prior to their death; 45% of people who die by suicide saw their primary care provider within the previous 30 days. Developed at the Henry Ford Hospital system in 2012 as they endeavored to design, “Perfect Depression Care,” it grew from a partnership
between the Office of the Surgeon General and the National Action Alliance for Suicide Prevention. Zero Suicide is backed by eight current NIMH studies. Together, these studies support that, beyond lethal means reduction, having suicide care embedded in the medical chart, written clinical workflows, and data collection are the most effective practices. Additionally, the data proves that screening, treatment, and management strategies work to decrease rates of suicide. Henry Ford decreased their suicide rate by nearly 80% after implementing the strategies at the core of the Zero Suicide effort. There are seven primary components of the Zero Suicide Model: JULY AUG 2026 • GCMS Journal • 14
1) Lead a. The first step is leadership mobilizing staff to truly believe that suicide can be prevented, and that doing so is a system-wide priority that is the responsibility of every staff person. b. Leadership must both help staff see and believe that suicide can be prevented and provide tangible support in a safe and blame-free environment — what is known as just culture. 2) Train a. It is essential that all staff members have the necessary skills to provide excellent care, which in turn will help staff to feel more confident in their ability to provide caring and effective assistance to patients with suicide risk. b. Provide staff training commensurate with their roles in providing safer suicide care. c. Repeat training, at least every three years. 3) Identify a. All individuals in care are screened for suicidal thoughts and behaviors at intake and at every subsequent encounter. b. A full assessment of suicide risk is completed at intake to gather information about past suicide thoughts and behaviors and other risk factors. c. Whenever an individual screens positive for suicide risk, an assessment and full risk formulation are completed 4) Engage a. A pathway to care that instills hope and is recovery focused b. Collaborative safety planning c. Counseling on access to lethal means d. The steps taken by providers to maintain the patient's engagement in, and commitment to, their care while working collaboratively with the individual e. Maintaining communication with the individual between appointments and during transitions f. The pathway is embedded and documented in an electronic health record g. Supporting healthcare workers who provide care for individuals at risk of suicide 5) Treat a. All individuals with suicide risk, regardless of setting, receive interventions and treatments that directly address suicidal thoughts and behaviors. Individuals with suicide risk are collaboratively engaged and offered treatment in the least restrictive setting possible. b. Efforts are made to find or adapt interventions and treatments to be culturally appropriate for the individual in care. c. There are evidence-based treatments for suicide prevention. 6) Transition a. Careful attention is paid to the transition of individuals 15 •JULY AUG 2026 • GCMS Journal
at risk of suicide between providers of care. Statistically, the transition period with the highest risk is between inpatient and outpatient care. However, each transition is a vulnerable time and requires careful planning to make sure individuals receive the care they need. b. The transition from the emergency department (ED) to behavioral health care is another critical transition. c. The period between a primary care visit and an appointment at behavioral health outpatient services can also be risky. 7) Improve a. Determining if the interventions, workflows, and procedures are working the way they are intended to, is vital. b. Organizations should use data to focus improvements and to celebrate successes. c. Start early and start small. Research proven treatments for suicidal ideation include: • Collaborative Assessment and Management of Suicidality (CAMS Care) • Most affordable and accessible $415-$542, teen training can be added • Training can be completed online or in a group • Utilizes the Suicide Status Form – 3 phases of treatment • Dialectical Behavioral Therapy • Targets suicidal ideation with a thorough assessment, monitoring, and skill learning towards reduced hospitalization. Therapists are available between sessions. • Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP) • Antidepressants have shown to be helpful in reducing the risk of suicide associated with depression, and ketamine has proven to be the quickest in reducing suicidal ideation. Lithium has the most robust data to support its reduction in suicidal risk. Transcranial Magnetic Stimulation (TMS) has also shown efficacy for reducing both treatment resistant depression and suicidal ideation but works best in conjunction with medication. There are many resources available to help any organization begin the journey of preventing death by suicide. Zero Suicide Resources https://zerosuicide.edc.org 1) Readiness 2) Organization Self-Study 3) Work Plan Template 4) Data Dashboard 5) Workforce Survey 6) Financing Suicide Care 7) Training and Courses 8) Resources for specific populations – Native American, Military, Children, Healthcare workers, specific settings – ER, inpatient, behavioral health The American Foundation for Suicide Prevention https://afsp. org/
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What to Do When an IRA Is Interfering With Your Backdoor Roth By Dave Koppenheffer, CFP & Michelle Kyriakakis, CPA The backdoor Roth IRA is one of the best strategies for high-income families to accumulate additional tax-advantaged saving. By making a nondeductible contribution to a traditional individual retirement account (IRA), and then converting the balance into a Roth, those who earn too much to contribute directly to a Roth can still take advantage of the potential for tax-free growth. One of the most common obstacles is an existing IRA. This often comes from a rollover of a former employer plan, prior deductible traditional IRA contributions, or balances held in simplified employee pension (SEP) or Savings Incentive Match Plan for Employees (SIMPLE) IRAs. Why Do Existing IRAs Create a Problem? The issue is the pro rata rule. For conversion purposes, the IRS aggregates all an individual’s traditional, SEP, and SIMPLE IRAs and treats them as one account. When a Roth conversion occurs, it is treated as a proportional mix of pre-tax and after-tax dollars (using the value of all IRA assets as of December 31st of the year of conversion). You cannot convert only the nondeductible portion. In many cases, pre-tax balances make up the majority of total IRA assets. As a result, a conversion that was expected to be mostly tax-free can generate significant taxable income. This can feel like a dealbreaker. And while an existing IRA does complicate the strategy, it doesn’t end the conversation. Instead, there are three primary ways to address it. 1. Reverse rollover 2. A one-time Roth conversion 3. Make nondeductible contributions and convert in the future Option 1: Reverse Rollovers While it is common to roll employer-sponsored retirement plans into a traditional IRA, the reverse is also often allowed. Many 401(k) and 403(b) plans permit incoming rollovers from IRAs. If the employer plan allows it, pre-tax IRA dollars can be rolled into the retirement plan, effectively removing them from the pro rata calculation. This can clear the path for clean backdoor Roth contributions going forward. A few important caveats apply. First, not all plans accept reverse rollovers, so plan rules must be reviewed. Second, employer plans generally accept only pre-tax IRA dollars. Any after-tax basis must remain in an IRA. Third, SIMPLE IRAs cannot be converted during the first two years of beginning participation in the plan. And, lastly, plan fees, investment options, and access to advice should be evaluated before proceeding. Option 2: A One-Time Roth Conversion Another option is to eliminate the pre-tax IRA balance altogether through a Roth conversion. At first glance, this may seem impractical—particularly for high-income taxpayers—because the converted amount becomes taxable income. However, there are situations where this approach makes sense. Temporary income reductions due to career transitions or significant charitable deductions can create lower-tax years that are wellsuited for conversions.
For physicians who work later in life and accumulate large pre-tax balances, the assumption of substantially lower retirement tax rates may never materialize. This reduces the benefit of waiting and makes the prospect of conversion more attractive. Lastly, when the existing IRA balance is relatively small, and the time horizon for Roth growth is long, the long-term benefit of tax-free growth can outweigh the upfront tax cost. Option 3: Nondeductible Contributions & Future Conversion When neither reverse rollovers nor conversions are attractive today, a longer-term strategy still exists: making annual nondeductible IRA contributions and waiting to convert in the future. This approach builds after-tax basis that can be converted to Roth during retirement or in a lower-income year. Unlike brokerage assets, IRA contributions preserve the ability to ultimately move funds into a Roth. For example, assume a 50-year-old physician has a $100,000 pre-tax IRA and makes 10 years of nondeductible contributions at current limits ($8,600 per year), earning a hypothetical 5% annually. After 10 years, the IRA would be worth approximately $270,000, of which $86,000 would represent nondeductible contributions. At that point, roughly one-third of a Roth conversion would be nontaxable. Careful tracking is essential. Nondeductible contributions must be reported on Form 8606 and retained over time. If basis is not properly documented, those dollars risk being taxed again upon distribution. Conclusion A pre-tax IRA can feel like a hard stop when considering the backdoor Roth. The pro rata rule makes missteps easy and unintended income common. However, this highlights a broader risk in financial planning: inertia. The goal is to avoid allowing roadblocks to turn into dead ends. Each solution—reverse rollovers, strategic conversions, or accumulating nondeductible contributions—comes with trade-offs and timing considerations. When evaluated intentionally and with the guidance of a qualified professional, what first appears to be an obstacle can become a manageable planning opportunity. For many high-income physicians, that opportunity is reclaiming the long-term, tax-free benefit of the Roth IRA. 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.
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Jordan Valley Community Health Center Residency Class of 2029 Nwanne Ude, MD - My name is Dr. Nwanne Ude, and I began my Family Medicine residency at Jordan Valley Health in June 2026. Joining Jordan Valley has been one of the most meaningful steps in my medical journey. The organization’s commitment to serving the community— especially individuals and families who often face barriers to care—reflects the kind of physician I’m working hard to become. Jordan Valley Health's focus on accessible treatment, preventive care, and whole person wellness aligns perfectly with my values and the way I approach medicine. I earned my M.D. from Sumy State University in Ukraine and have had the privilege of practicing medicine and health education in Nigeria. Those experiences shaped my approach to patient care: listening closely, treating patients with compassion, and making sure they understand their treatment plans and feel supported every step of the way. I believe strongly in meeting people where they are and helping them take ownership of their health through education, prevention, and guidelinebased treatment. Outside of residency, I’m a wife and a mother to two wonderful boys who bring joy, energy, and purpose to my life. They are my motivation and the reason I strive for balance and growth every day. I’m grateful for the path that led me here and excited for the physician I’m becoming—one grounded in service.
Zeeshan Ali Khan, MBBS - I am Dr. Zeeshan Ali Khan, I was born and brought up in India, where I began my medical journey and completed my medical education. I later moved to the United States to continue my education and pursue postgraduate medical training. As an international medical graduate, building my career in a new country has been a journey filled with challenges, learning, and growth. It has taught me to stay patient, work hard, and never give up on my goals. I am currently a Family Medicine resident in Springfield, Missouri. I moved here from Chicago with my wife, Sama, and our six-month-old son, Zakariya, to pursue my residency training. My entire family lives in Chicago, so moving away was a big step for us, but it has also been an important part of my journey. Springfield’s combination of urban and rural communities has given me the opportunity to serve people from different backgrounds and care for those who truly need medical attention. My long-term goal is to pursue a career in pain management and help patients live healthier, more comfortable lives. I believe medicine is not only about treating a disease, but also about understanding the person behind the illness and being there for patients when they need help the most. Outside of medicine, I enjoy playing cricket and pickleball, watching movies, and spending quality time with my wife and son. I especially enjoy family-oriented activities and making memories with them. My family gives me strength and motivates me to keep growing, both personally and professionally.
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CoxHealth Family Medicine Residency Springfield Class of 2029 John Bohon, DO - Howdy! My name is John Bohon. I grew up in Kirksville, MO, alongside my parents and two younger brothers. I enjoyed the community so much that I remained in the area to attend Truman State University for my undergraduate education. I then made the long trek up to the north part of town to attend A.T. Still University for my medical education. My wife Parker and I met while volunteering at a youth Christian organization during college. We moved to Springfield - where Parker is originally from - in the summer of 2024 and welcomed our daughter Lachlan to the world in August of 2025. On this earth, those two girls are the most important people to me. My father taught me early on that the relationships we hold with others matter deeply. My passion is people. I think Family Medicine is the single greatest option as a doctor for taking care of individuals across all ages and stages of life. My current interests include pediatrics, men’s health, lifestyle medicine, sports medicine, and osteopathic manipulative medicine. I am largely concerned, however, with acquiring the necessary skills to meet any of my community's health care needs. CoxHealth FMR is full of great folks who are committed to making me a well-rounded physician and supporting me in my role as a husband and father. I am very pleased to complete my training here in Springfield and remain near family. During my free time, I like to be at the lake or out in the woods doing a number of different outdoor hobbies. Abbey Collins, MD - Hi! My name is Abbey Collins. I grew up in Mountain View, a small town in north-central Arkansas. I completed my undergraduate studies in Biology at Arkansas State University in Jonesboro and later attended University of Arkansas for Medical Sciences (UAMS) for medical school. Growing up, I had the opportunity to
go on mission trips to Haiti and Indonesia, and my love for serving the underserved grew even more being a part of the Honors in Global Health Track at UAMS. Through this track I had the opportunity to rotate in a rural area of my state as well as learn more about all the different factors that affect healthcare across the globe. I chose family medicine because it allows physicians to build long-term relationships with their patients and get to know each one personally. In addition, you never know what you may see on a day-to-day basis due to seeing such a wide range of ages and health needs. I knew that CoxHealth was where I wanted to be because it valued these relationships and community needs while also providing the comprehensive training that I was looking for. Outside of medicine, I enjoy reading, working out, cooking/ baking, watching Formula 1, and spending time with my husband. I am so excited to continue my training here at CoxHealth and look forward to exploring everything Springfield has to offer! Andrew Farrell, DO - Hello! My name is Andrew Farrell, and I am from Republic, Missouri. Growing up, I played soccer until graduating high school and enjoyed camping around Table Rock Lake with my family. I attended Washington University in St. Louis where I obtained a Bachelor of Arts in Biochemistry and Anthropology with a focus in Global Health and the Environment. I then completed medical school at Kansas City University College of Osteopathic Medicine – Joplin campus. I was first drawn to family medicine while working alongside a family medicine physician during a mission trip to Panama and seeing how she interacted with her patients, where she sought to meet all their needs despite the barriers her patients faced. Throughout medical school, my favorite rotations were in family medicine, and I saw the benefits patients had when having a primary care physician for many years. I desired to form similar relationships with my patients and work proactively with them to improve their health. Spending a few weeks with CoxHealth confirmed to me that these goals would be met in a fully supportive JULY AUG 2026 • GCMS Journal • 20
(316) 712-1821 Dustin Roy Gaines
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environment that would challenge me to be the best physician I can be. Outside of medicine, I continue to follow soccer leagues around the world and enjoy watching NFL games with my family each week (go Broncos!). I also enjoy cooking new recipes and trying new local restaurants. I’m looking forward to continuing my training by returning to the Springfield area! Nathan Garlow, MD – Hello! My name is Nathan Garlow, and I grew up in Salina, Kansas. I completed my undergraduate degree in biochemistry at the University of Kansas, then attended the University of Kansas School of Medicine. Prior to medical school, I lived in the Philippines for three years, an experience that continues to shape my perspective on culture and community and ultimately led me to find my home in family medicine. During my training, I developed a strong appreciation for full-spectrum family medicine, with relationships at the center of patient care. I was especially drawn to CoxHealth because of its emphasis on relationship-centered, comprehensive training, and I knew it would be a great place to continue my growth as a physician. My clinical interests include procedures and international medicine. Outside of medicine, I enjoy playing pickleball, staying active, and exploring coffee shops and local restaurants around Springfield. I also enjoy traveling and trying new hobbies. Abby Glynn, MD - Hi! My name is Abby Glynn. I was born in Indiana and have moved too many times to count throughout my life. I have lived in Indiana, Colorado, Tennessee, Kansas, Arkansas, and now here in Missouri. I went to undergrad at Washburn University in Topeka, KS and got my degree in forensic chemistry. I took two years off from school, got married, moved states, and worked as a pharmacy technician before pursuing medicine. I attended medical school at the University of Arkansas for 22 •JULY AUG 2026 • GCMS Journal
Medical Sciences in Little Rock, Arkansas. I discovered my love for Family Medicine towards the end of my third year. I had come into medicine expecting to be a forensic pathologist, but the world had other plans for me. I fell in love with the diverse patient population, broad scope of practice, and continuity of care that Family Medicine offers. I love to learn about my patients’ lives and this specialty allows me to do just that! I was drawn to CoxHealth for residency because of the amazing sense of community that they create. You can just tell that everyone loves what they do and who they work with. I can’t wait to care for the Springfield community! Outside of medicine, I enjoy reading, weightlifting, exploring new coffee shops and breakfast places, and watching a good TV series (anything from Kid’s Baking Championship to 90 Day Fiancé to Ghost Adventures). I love anything that allows me to spend time with my husband, Johnny, and our dog, Goober. Erin Hover, MD - Hello! My name is Erin Hover. I was born and raised in Edmond, Oklahoma. I have one older brother, and growing up I could often be found in a library with my nose in a book, or playing with one of our many pets (dogs, cats, chickens, and more). I attended Oklahoma State University (Go Pokes!) to study biochemistry and molecular biology, and met my husband there. After undergrad I worked as an EMT for a local ambulance service for two years, which sparked my interest in medicine. I attended medical school at the University of Oklahoma (Boomer Sooner!) and have the unique experience of supporting both OU and OSU for sports. I chose to go into Family Medicine because I enjoy the continuity of care and seeing patients throughout different stages of their lives. Primary care is the backbone of medicine, and I have a variety of medical interests, including procedures, women's health, preventative care, and more. While visiting residency programs, CoxHealth immediately stood out to me as a place that truly cares about both their residents and their patients. I was put at ease by how friendly and welcoming everyone is and hope to display those values towards my patients and coworkers alike. I am excited to be a part of this community! Outside of medicine, I continue to enjoy reading and
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spending time with my husband and dogs. I also enjoy crocheting, weightlifting, gaming, being in nature, and spending time with family and friends. Dagen Jones, MD - Hello! My name is Dagen Jones. I was raised in Thayer, MO, a small town just north of the Missouri-Arkansas border. Growing up, I spent most of my free time enjoying the outdoors and playing any sport I could. After high school, I attended University of Missouri – Columbia (M-I-Z!) where I played lots of intramural sports, watched many Mizzou games, worked as a scribe at Missouri Orthopaedic Institute, and ultimately earned my Bachelor of Health Science. I was offered the opportunity to stay at Mizzou for medical school. I completed my first 2 years at the main campus in Columbia, then I transferred to Mizzou’s Springfield Clinical Campus to complete the final two years of clinical training. And now, I’m thrilled to spend the next few years growing and serving with the Family Medicine Residency at CoxHealth in Springfield, MO. I chose family medicine because of the broad scope of training, the emphasis on lifestyle medicine principles, building relationships with patients, and having continuity of care. One of my particular interests within family medicine is sports medicine. I also enjoy doing anything procedural. Outside of medicine, you’ll find me sharing life with my incredible fiancée, spending time with our friends & family, playing or watching sports (big surprise, right?), and enjoying the outdoors…usually wherever there’s water. I look forward to all the memories and relationships to be made in the coming years! Tharron Roy, MD - Hello, my name is Tharron Roy. Though born in Tulsa, Oklahoma, I grew up in Lebanon, Missouri. I enlisted in the Army National Guard prior to graduating high school and took a gap year to complete my initial entry training. I then attended Missouri State University, where I earned a Bachelor of Science in Cell and
Molecular Biology. During the latter years of college, I worked as a technician in the Neurotrauma ICU at Mercy Hospital. I was then privileged to attend the University of Missouri School of Medicine, where I earned my MD. Upon entering medical school, I commissioned as an officer in the Army National Guard Medical Corps, where I plan to continue serving throughout my career. Family Medicine has always felt like my calling. I am passionate about building meaningful, long-term relationships with patients and their families, helping them take an active role in their care. I am particularly focused on combating chronic diseases and supporting patients struggling with addiction, emphasizing education and empowerment to achieve lasting health improvements. My goal is to develop a broad scope of practice that allows me to serve patients across all stages of life and in a variety of settings. In addition, I aim to refine the skills necessary to practice combat medicine for the Army National Guard when called upon. My faith is central to my life—Jesus Christ is my Lord and Savior. I have a beautiful wife, Hope, and together we have a blended family with five daughters. We enjoy spending time homesteading, going to and serving at church, and visiting Silver Dollar City. I am also a big fan of the Kansas City Chiefs and enjoy lifting weights. I feel incredibly blessed to be where I am today and am grateful for the opportunity to serve others through medicine. Natalie Ryan, DO - Hi y’all- my name is Natalie Ryan! I am from Lexa, Arkansas, a small town in the Mississippi Delta, and I am the youngest of three girls. I attended the University of ArkansasFayetteville where I earned a degree in Public Health. After working for the Louisiana State Health Department, my journey led me to attend Arkansas College of Osteopathic Medicine in Fort Smith, Arkansas to pursue a lifelong dream of becoming a family medicine physician. My passion and respect for family medicine began at a young age. I was drawn to the opportunity to build meaningful, long-term relationships with patients and to provide full spectrum care. I am interested in preventive care, patient education, and procedures. I chose CoxHealth for its endless opportunities in patient care and community value focus. I am certain that this program will provide me with the tools I need to become a well-rounded physician. JULY AUG 2026 • GCMS Journal • 24
Outside of medicine, you can find me outdoors. Whether it is at a dirt track watching sprint car racing, brushing blinds to prepare for duck hunting season, or chasing nieces and nephews around, I love spending my time in the fresh air, staying connected to the lifestyle I grew up with. I look forward to exploring what Springfield has to offer! Zenobia Tucker, DO – Hello! My name is Zenobia Tucker. I am a member of a six-generation farming family north of Willard, MO who traded in her acting career in Los Angeles for a white coat at KCU-Joplin. I am excited to start my training at CoxHealth Family Medicine Residency – Springfield – the hospital where I was first
inspired to become a doctor while completing shadowing and volunteering experiences during high school. Lifestyle medicine and women’s health are two areas I am passionate about, and I look forward to learning even more about from the fantastic team at CoxHealth FMR. I spend my free time in book clubs, at the movies, watching live music, running local 5Ks, and taking care of the farm with my family and fiancé.
Congratulations to the Class of 2029!!!
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Something Phishy This Way Comes: Spotting Scams to Prevent Fraud By Darline Mabins, private banking advisor for Arvest Bank – Springfield Region
In today’s chronically online world, scam and spam messages seem to be ubiquitous. While people may be better at recognizing phishy calls, emails and texts than before, scammers are becoming bolder, choosing to impersonate employers, financial institutions, well-known companies and more. The Federal Trade Commission saw a 25% increase from 2024 to 2025 in reported losses to all types of fraud, totaling around $16 billion. For high earners, fraud prevention should be at the top of your financial health checklist. Busy professionals like healthcare workers, especially those with long hours or irregular schedules, may find it difficult to stay aware of fraudster tricks and malicious activity. Being able to spot scams and protect your financial information from imposters is critical, so here are some tips to help you recognize and avoid commonly reported scams. Investment Scams Investment scams typically come with get-rich-quick claims, offering to help you make money quickly and easily by allowing you to invest in new money-making opportunities, including cryptocurrency and other forms of digital currency. Most people never get their investment money back, and losses to investment-related scams totaled around $7.9 billion in 2025. • How to spot this scam: The FTC reports that investment scammers often pique consumers’ interest through infomercials and online and social media advertisements, inviting them to attend free events and seminars, order free materials or watch free videos to learn the secret to success. They make claims about big, guaranteed returns with minimal effort on the front end but offer very little information about what the actual investment is. • How to avoid this scam: Investments should always be well thought out, so take time to research what you would allegedly be investing in. Never make an investment based solely on what you see online because scammers can easily invent stories and testimonials. Investments always involve some level of risk, so if it sounds too good to be true, it probably is. Job Scams Job scams are often advertised the same way real companies advertise open positions: on job sites, social media sites like LinkedIn and more. Fraudsters often post a fake job listing with the intention of gaining access to personal information and money, and texts from scammers posing as recruiters are a newer method the FTC has seen in the first half of 2026. Losses to job scams in 2025 totaled nearly $1 billion. 26 •JULY AUG 2026 • GCMS Journal
• How to spot this scam: Be wary of jobs with vague descriptions or employers who offer to send you money before you start work. Scammers may advertise completely remote positions, like telehealth jobs, to try and draw in high earners who are more advanced in their careers. • How to avoid this scam: Verify job listings before completing any applications or offering any personal information. Search the name of the company or the person who reached out to you plus “scam,” “review” or “complaint.” Don’t trust any company or individual who says they’ll send you a check to deposit in return for gift cards or a specific amount of money, and consult someone you trust if you’re suspicious about a job offer. Imposter Scams Imposter scams include people posing as your bank, a business, the government or even a relative to get you to give them money. According to the FTC, Americans reported losing $3.5 billion to imposter scams in 2025, and these scams accounted for nearly one in three fraud reports last year. • How to spot this scam: Unsolicited emails, phone calls or texts may be from imposters. These messages typically contain some sort of “warning” about a nonexistent problem or issue that requires immediate attention, such as a potentially unauthorized transaction or a locked credit card. • How to avoid this scam: Don’t click on any links in a message you weren’t expecting. If you are unsure if the threat is real, contact the business or organization that is issuing the alleged warning via their official email address, phone number or website. Elder Fraud Those who are taking care of older loved ones may be concerned about them fall victim to fraud, but there are ways that you can help protect them and help them protect themselves from financial exploitation. Watch for these things: • A new caretaker or friend who suddenly begins conducting financial transactions on behalf of the elder. • Erratic or unusual banking transactions, or changes in banking patterns such as frequent large withdrawals, including at the ATM, or uncharacteristic internet charges or attempts to wire large sums of money. • Unexplained disappearance of funds or valuable possessions. • Unusual or sudden changes in a will or other financial documents. Continued on page 28
Open Field Health Collaborative By Nancy Yoon, MD MPH, Assistant Professor, Kansas City University
Open Field Health Collaborative (www. openfieldhealthcollaborative.org), a 501(c)(3) Missouribased nonprofit, is dedicated to transforming the conditions that shape health by reconnecting people, food, and care at the community level. Founded by a collective of physicians, educators, and community leaders, Open Field integrates lifestyle medicine, One Health and nature-connectedness, food systems transformation, and relationship-centered leadership and healing to support equitable, sustainable, and community-driven health outcomes. Community-engaged Lifestyle Medicine We bring the pillars of lifestyle medicine to life within our community. By connecting people to nourishing food, to one another, and to supportive healthcare relationships, we build lasting partnerships with local farmers, community organizations, and health professionals who are deeply committed to our shared flourishing.
Session 1: Orientation Session 2: Toward Health- Frameworks and practical strategies Session 3: Nutrition- Food stories, nutrition myths, treating, preventing, reversing chronic disease, food sampling Session 4: Nutrition- Nutrient density, fiber, budgetwise meal makeovers Session 5: Mind- Working with the mind, understanding habits and stress Session 6: Movement- Natural movement, nature and exercise Session 7: Sleep- Restorative sleep and deep rest Session 8: Closing- Potluck, review and reflections, moving forward *Any session (2-7) can be expanded into multiple sessions or a full program
Springfield Community Gardens (SCG) has collaborated with us since the beginning, even before we were an organization, to provide our patients and community with fresh, local, nutrient-dense produce. Our Food is Medicine work is the fruition of this deeply connected partnership. What is a Health Circle? Health Circles are clinician and community co-facilitated gatherings that create intentional space for lifestyle medicine education, community-building, and human connection. They are not a class and not a clinic visit. In a Health Circle, the curriculum follows the six pillars of Lifestyle Medicine — optimal nutrition, physical activity, stress management, restorative sleep, connectedness, and freedom from harmful substances. But the curriculum is always adapted to the people in the room: their questions, their goals, their challenges, their cultural practices and beliefs. Every circle is unique. Most circles include a Food is Medicine produce prescription program connecting the participants to nutrient-dense fresh food that only a local food system can offer. Health Circle facilitators are trained in embodied leadership through the HEAL (Healthy Embodied Agile Leadership) pathway. This is not health education delivered from the front of a room. Facilitators practice deep listening, noticing opportunities to build and bolster motivation, and presence with difficulty and suffering. They offer guidance through their compassion along with their expertise. Connection is the priority. A Sample General Lifestyle Medicine Health Circle Program 27 •JULY AUG 2026 • GCMS Journal
A Sample of Other Health Circle Program Formats Book Club-based: A more open and informal format with topics grounded in a book discussion. Previous books include Braiding by Sweetgrass-Robin. Wall-Kimmerer and Seven Circles: Indigenous Teachings for Living by WellChelsey Luger and Thosh Collins. Mind-Body-Spirit: Focused on overall mental health and wellbeing. Sample topics: Mind, Habits & Other Adventures in Being Human, Mind and Body, How To Cook Your Life, Practical Stress Relief, and How Nature Heals.
Diabetes Remission: LEADR (Lifestyle Empowerment Approach for Diabetes Remission) - a 12-week American College of Lifestyle Medicine-certified program designed for those with diabetes or at-risk for diabetes who are interested in preventing, treating and if possible, reversing their diabetes with lifestyle medicine approaches. Weekly Community Nature & Health Circles • Timeline: October Wednesdays 2:30 pm - 4:00 pm • Location: Springfield Conservation Nature Center 4601 S Nature Center Way, Springfield, MO 65804 • Who: CoxHealth patient community These weekly community health circles bring lifestyle medicine to life in a relaxed, supportive group setting. Co-facilitated by Family Medicine physicians and Department of Conservation staff, these circles offer CoxHealth patients a path to healing from stress and chronic illnesses. This pilot program is free to attend. CoxHealth patients can self-refer or be referred by their care team. The Open Field Fellowship The Open Field Fellowship is a twelve-month cohort experience that brings clinicians and community leaders into formation together through embodied leadership, ecological medicine, and community health practice — developing not just individual leaders but the cross-sector relationships and shared vision that communities need to move toward genuine health. It is called a fellowship because it implies belonging. It implies mutual obligation, shared risk, genuine relationship. Fellows are not customers of a program. They are co-travelers in a formation that asks something real of each of them and gives something real in return.
The mixed cohort is the fellowship's most important structural feature. Clinicians and community leaders — food systems leaders, naturalists, conservation professionals, social workers, nonprofit leaders — in formation together. Not because community leaders are there to educate clinicians about the real world, or because clinicians are there to lend credibility to community health work. Because genuine formation requires encounter with people whose knowledge, authority, and experience are different from your own. Because the cross-sector relationships the fellowship builds are themselves a primary outcome, not a byproduct. Every community already has the pieces. The fellowship gives those pieces a reason and a framework to find each other. Who Is Called Not everyone. The ones who already feel the pull. For those who know health is bigger than healthcare — and are ready to build what comes next. The Open Field Fellowship is not for everyone who works in health or community or conservation. It is for those who already sense — even if they cannot yet articulate it — that the work they have been trained for is insufficient to the moment they are living in. Who feel the gap between what the systems around them are asking of them and what they know, in some deep place, health actually requires. We invite you to join us in this field. Whether as a potential fellow, an artist, a partner, or a supporter, we welcome your presence in this emerging work. If you are a clinician looking to refer a patient or want to learn more about how to get involved, please reach out to us at info@OpenFieldHealthCollaborative.org
Continued from page 26 Learning to recognize common scams can help you spot others by knowing what to look for and how to avoid falling victim to financial fraud. When in doubt, take a moment to research and think through the situation. Scammers typically want access to your personal information, so make sure your bank accounts and accounts associated with your financial information stay secure. Adding a private banker to your financial team can be a great way to add an extra layer of security around your bank accounts. Some banks, like Arvest, have fraud alert programs to help stop fraud before it happens, as well as programs to
28 •JULY AUG 2026 • GCMS Journal
help recover your accounts and money in case financial fraud does occur. If you experience financial fraud, contact your bank or credit card company immediately so they can help recover any stolen funds and secure your accounts and cards. You may also want to report any instances of fraud or scams to the Federal Trade Commission at reportfraud.ftc.gov. Darline Mabins is a private banking advisor for Arvest Bank – Springfield Region. She can be reached at dmabins@arvest. com.
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 ELIZABETH SPENCERI, 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 Monett Satellite Location (Inside CoxHealth Urgent Care) 2200 E. Cleveland Ave Monett, MO 65708 Phone: 417-888-0858 • Fax: 417-889-0476 Lebanon Location 331 Hospital Drive Suite C Lebanon, MO 65536 Phone : 417-344-7200 Fax : 417-344-7299
Family Medicine www.ascentdpc.com 417-595-0956 413 N McCroskey, Ste 2 Nixa, MO 65714
Family Medicine COXHEALTH FAMILY MEDICINE RESIDENCY FAMILY MEDICAL CARE CENTER 3800 S National Ste 700 Springfield, MO 65807 (417) 269-8817 American Board of Family Medicine
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
Marc Carrigan, MD Cameron Crymes, MD Kristin Crymes, DO Kristen Glover, MD Kyle Griffin, MD Shelby Hahn, MD Laura Isaacson, DO Evan Johnson, MD Katie Davenport-Kabonic, DO Michael Kabonic, DO Jessica Standeford, MD
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 American Board of Ophthalmology
DAVID NASRAZADANI, MD American Board of Ophthalmology
DREW A. YOUNG, MD
Gynecology WOMAN’S CLINIC
www.womansclinic.net Leaders in Minimally Invasive Gynecology & Infertility
DONALD P. KRATZ, MD, FACOG H
American Board of Obstetrics and Gynecology
AMY LINN, FNP-BC
American Academy of Family Nurse Practitioners
ANGIE JONES, WHNP-BC
THOMAS PRATER, MD, FACS H
1135 E. Lakewood, Suite 112 Springfield, MO 65810
JACOB K. THOMAS, FACS, MD H American Board of Ophthalmology
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
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 Ophthalmology
American Board of Ophthalmology
Internal Medicine
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
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
ROBERT D. JOHNSON, MD, FACS H
American Board of Urology
TYRUN K RICHARDSON, MD American Board of Urology
Phone 417-820-0300 Fax 417-882-9645 1965 S Fremont, Ste. 370 Springfield, MO 65804
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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: VYACHESLAV MAKLER, DO 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
JACQUELINE L. COOK, FNP-BC, CDCES, CCD
Interventional Neuroradiology
KELLEY R. JENKINS, FNP-C, CDCES
Physiatry:
ALINA CUMMINS, PA-C
TED A. LENNARD, MD
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
MICHAEL J. WORKMAN, MD
KELLY OWN, MD JESSE STOKKE, DO
Physician Assistants: JOSHUA BARBIERI, PA-C MARK BROWN, PA-C ERIC CHAVEZ, PA-C KEVIN STOKES, PA-C HEATHER TACKETT, PA-C
Nurse Practitioner:
Nephrology
EMILY CROUSE, NP-C MINDY GRANT, NP-C BRANDON RUBLE, ACNP-AG ALYSSA CHASTAIN, FNP
Obstetrics/Gynecology SPRINGFIELD NEPHROLOGY ASSOCIATES, INC. 1911 South National, Suite 301 Springfield, MO 65804 Phone 417-886-5000 • Fax 417-886-1100 www.springfieldnephrology.com
COXHEALTH PRIMROSE OB/GYN 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
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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 ONCOLOGYHEMATOLOGY ASSOCIATES OF SPRINGFIELD, MD, P.C. WILLIAM F. CUNNINGHAM, MD, FACP
American Board of Internal Medicine American Board of Medical Oncology
JIANTAO DING, MD H
Otolaryngology
MERCY CLINIC– EAR, NOSE & THROAT BENJAMIN L. HODNETT, MD, PHD H ERICH D. MERTENSMEYER, DO, FAOCOO AARON R. MORRISON, MD RAJEEV MASSON, MD MARK J. VAN ESS, DO, FAOCOO Diplomates, American Board of Otolaryngology
SHELBY BRITT, PA MELISSA COONS, FNP TAHRA LOCK, NP ELIZABETH (BETSY) MULLINGS, FNP
American Board of Internal Medicine American Board of Hematology American Board of Medical Oncology
PAUL STRECKER, FNP
ROBERT J. ELLIS, MD, FACP
JASON BOX, AuD, CCC-A
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
Audiology
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
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
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
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Qualifications required, see a dedicated Private Banker for more details. 31 •JULY AUG 2026 • GCMS Journal
GREENE COUNTY MEDICAL SOCIETY 4730 S NATIONAL AVE, SUITE A1 SPRINGFIELD, MO 65810 Change Service Requested
32 •JULY AUG 2026 • GCMS Journal
PRSTD STD U.S. POSTAGE PAID PERMIT NO. 816 SPRINGFIELD, MO.