BCMSScript. Newsletter of the Bucks County Medical Society
Winter Edition
President’s Message OUR MISSION The Bucks County Medical Society strives to advance the professional and personal development of its physician members by providing educational and practice related resources as well as legislative advocacy. Moreover, the Bucks County Medical Society seeks to promote optimal outcomes for our patients as well as the public health of the Bucks County community.
EDITORIAL BOARD Marilyn Heine, MD, Editor in Chief J. Matthew Bohning, MD Hannah Do, MD John Gallagher, MD John Pagan, MD, MBA
As we navigate these ever-changing times in the medical field, it is imperative that we stay committed to continuing education, advocacy, and honoring the dedicated physicians who serve our community. Our recent events have been a testament to this commitment. In March 2023, we held Part 2 of our virtual webinar series, titled “How to Sustain your Practice in Today’s Turbulent Times.” This session focused on “Steps to Fix Prior Auth: Headway Made, More To Do.” This event provided essential insights and strategies for tackling the challenges of prior authorizations, a common concern in our medical practices. Following a lengthy hiatus due to the pandemic, we resumed our in-person Membership and Business Meeting in April 2023. This event with over 55 attendees allowed us to come together, to learn, and to celebrate our members who have provided 50, 40, 25, and 10 years of medical service. PAMED President F. Wilson Jackson III, MD, attended to recognize the honorees and shed light on the broader healthcare landscape. In early October 2023, we had the pleasure of hosting several of our county’s state lawmakers at our legislative reception. Their interest in our advocacy issues and in developing rapport with Bucks CMS members speaks to the growing influence of our society. Later in October, Bucks CMS delegation members traveled to the House of Delegates in Hershey, PA, where they testified and voted on key physician issues, amplifying our voice on the state policymaking stage. One more exciting development is that Bucks County Medical Society member Arvind Cavale, MD, was elected PAMED Vice President. Looking ahead, I’m committed to enhancing our society’s engagement through our website and social media channels, to keep you informed and involved. We are working on a facelift to our current website, to provide you with a more user-friendly and exciting platform. As we enter the new year, let us continue to grow, learn, advocate, and support one another. Together, we will keep advancing the practice of medicine in Bucks County. Thank you for your dedication and commitment to the Bucks County Medical Society. Warm regards, Hannah H. Do, MD President, Bucks County Medical Society
Team Physician: Helping Young Athletes Play the Long Game
New Members Lindsay Balceniuk MD Desiree Desanto Howard Eisenbrock DO George L Geisler DO Michael Albert Ibrahim DO Biren Kishor Juthani DO Shea Laird Danielle Rachel Lee MD Benjamin D Liba MD
Kieran Cody, MD, FAAOS Orthopedic Sports Medicine Specialist in Central Bucks County
Dany Daniel Morel MD Ingrid Nelson Shanae Nguyen DO Krishna Patel MD Justin Philip MD Ami B Raval MD Michael Thomas Scott MD Gregory R Steinberg DO
Reinstated Members
Each fall, night comes a little earlier, days are a little cooler, and high school football is in the air. I have had the privilege of serving as the team physician for Central Bucks East High School, my alma mater, for the past 26 years. Admittedly, when I attended high school, I only saw the football field when it was the finish line for a cross country race; but each year now I stand on the sidelines and look forward to another season.
Uzma Ali MD Csaba G Berces MD Angela M Camasto MD Sean Thomas Duffy DO Brian Fang MD Kayla Garley DO Lior Gecht MD Christopher Genesio Arthur Nathan Gorham DO Jonathan Goulazian Carrie A Hufnal MD
I am frequently asked by other physicians, exactly what it means to be a sports physician for a high school. In this position, I am the head of the team responsible for ensuring the health and wellbeing of all the school’s student athletes. I work closely with the athletic trainers who are on the front lines. The trainers are the ones who see the athletes daily and make the first assessment of any injury. There is no doubt that they know the students better than I ever could, and I depend on them heavily to keep me informed and guide treatments. A big part of my role is to provide game day coverage for football and wrestling. I am there to assess injuries and make the call on when or if the athlete can return to play. I must admit that as an alumnus of the school I cover, I can get a bit wrapped up cheering the kids on as well!
Yuna Huh Sherry Jose MD George Anthony Krakowski MD Marc Adam Lavine MD, FACS Nisarg Patel Suhani Patel Rachel A Polish DO Rochelle Sfida-Pestrak Brittney Shupp DO Kathy Adda Tran Gast DO
Alpenglow
The return-to-play decisions are some of the more difficult parts of the job. There is no doubt these kids are under a lot of pressure to play, self-imposed, as well as from teammates, parents and coaches. One of the hardest parts of my job is to separate the medical reality of an injury from the emotional drive to return to play; I often need to protect the athlete from themselves. While playing a collision sport always carries some risk of injury, my goal is to mitigate that risk and always think about what is best for the athlete in the long term. They will be on the field for only a short period of time, but I want to keep them healthy for the rest of their lives.
Orange trees at sunset Aglow against winter sky Look up, see beauty
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— Marilyn Heine, MD, FACEP, FACP, FCPP
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The Heavy Lift: Bucks County Emergency Health Services Bariatric Support Unit Gerald Wydro, MD Regional Medical Director Bucks County Emergency Health Services
Obesity is an epidemic in the United States and continues to worsen with each passing year. The Centers for Disease Control and Prevention reports the prevalence of obesity in the United States is 42%, while severe obesity has almost doubled over the past two decades.1 Obesity has significant impacts on a patient’s health while also increasing the demand for healthcare services. In addition, it presents logistical challenges for Emergency Medical Services (EMS) in the movement and transportation of this patient population. Stretcher size and capacity; provider injury; ingress and egress from the ambulance patient compartment are just a few of the challenges.
150 transports annually by the two regional bariatric units. The volume of requests continues to increase over each year. The most common dispatch types for the BSU are respiratory distress, falls, and emergency transportation. The Bucks County Bariatric Support Unit program is well received by patients and EMS providers. The system provides a safer alternative to standard ambulance transportation with enhanced vehicles, stretchers, and equipment. The program has allowed for safe transportation of hundreds of patients over the years with no reported falls, drops, or EMS provider injuries. More than 20% of the patients utilize the system more than one time. This regionally based BSU transport system provides for the safe movement of patients during prehospital care, treatment, and transport in Bucks County.
Many EMS systems transport bariatric patients on traditional stretchers with inherent risk to the patient and EMS providers. Increased incidence of work-related back injuries, as well as patient falls and drops are possible. Progressive EMS systems maintain dedicated Bariatric Support Units (BSU) to transport this special patient population. The unit carries a larger bariatric stretcher, rated up to 1,000 lbs. capacity, patient movement devices, ramps, and winches to move the patients safely into the patient compartment.
The BSU program is a collaborative of EMS agencies and Bucks County Emergency Health Services with support from the Commonwealth of Pennsylvania Emergency Medical Service Operating Fund.
Bucks County Emergency Health Services maintains a regional BSU transport system serving our suburban EMS system. Bucks County communities are served by 14 EMS agencies covering 622 sq. miles and over 620,000 residents. Annual requests for EMS exceed 54,000 dispatches coordinated by a single 911 emergency communications center. The BSU program, started in 2007, utilizes 2 specialty equipped ambulances built on a heavy-duty chassis strategically located throughout the county. The BSU ambulance rendezvouses with the on-scene EMS unit and combines crews to assist with transport of the patient and EMS crew to the hospital. The decision to request the BSU is at the discretion of the responding EMS agency guided by a regional guideline on bariatric transportation.2 There are over 250 dispatches and
References 1https://www.cdc.gov/obesity/data/adult.html 2https://www.buckscounty.gov/DocumentCenter/View/6084/ Bucks-County-Emergency-Medical-Service-Bariatric-Units-Update-2019-PDF
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Nature and Wellness One Click at a Time George Heyrich, MD, FACC, FSCAI, FSCCT Specialist in Cardiovascular Disease and Interventional Cardiology in Lower Bucks County
Photography can be an excellent hobby for physicians. As an interventional cardiologist, I have captured tens of thousands of images which immediately affect patients’ care and guide their therapy. I first developed an interest in photography as a medical student at Georgetown University enrolling in a beginner’s course there. It offered an opportunity to explore the local community and capture images during weekly assignments that provided alternate focus from the biochemistry lab or anatomy department. The ability to capture unique moments or experiences and provide a 2-D representation of 3-D life aligns well with a skill set as a physician.
demographics, and habitat of bird wildlife appeals to my academic side of scientific study. These skill sets promote a better understanding of the unique environment in which you were present during image capture.
One of the most significant benefits of nature photography for physicians is its ability to reduce stress. Engaging with the serene environment of natural landscapes and wildlife offers a tranquil escape from the demanding clinical setting. and allows physicians to unwind, reduce anxiety, and promote relaxation.
Modern photography is readily accessible to all that are interested. More than 1 trillion pictures are taken annually with iPhones. The ease post-processing image manipulation in the digital age has revolutionized the opportunity for display in a video or a print format. In conclusion, nature photography serves as a valuable and therapeutic hobby for physicians. It helps reduce stress, promotes mental health, and enhances observation skills. Moreover, it fosters a stronger connection with the natural world, contributes to a better work-life balance, offers social opportunities, encourages personal growth, and can even be used as a teaching tool. The advantages of nature photography extend not only to physicians’ personal lives but also to their professional roles, ultimately benefiting both the individuals and the patients they care for. As physicians capture the beauty of nature through their lenses, they, in turn, discover the beauty of a balanced and harmonious life.
Nature photography encourages mindfulness, where physicians immerse themselves in the present moment, shifting their focus away from work-related stressors. It is a creative outlet that promotes mental well-being. The process of setting up shots, experimenting with lighting, and framing the perfect image challenges the mind and fosters creativity. The sense of accomplishment derived from capturing beautiful moments in nature can boost self-esteem and alleviate symptoms of burnout that are often associated with the medical profession. I am particularly fond of bird photography. Capturing the fleeting image of a speeding hummingbird or the majestic grandeur of a blue heron in the marshland presents challenges of image capture with regard to focal length, depth of field, shutter speed, and lighting conditions. Better understanding the natural environment,
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You are wearing a white coat, but wait… Are you a physician? • X-ray ordering rose 441% among nonphysicians.
Marilyn Heine, MD, FACEP, FACP, FCPP Emergency physician and hematologist oncologist in Bucks County
• Nonphysicians needed twice the number of biopsies to screen for skin cancer. • Patients were 15% likelier to get an antibiotic from a nonphysician.
We all agree that our health care system needs critical improvements; however, allowing nonphysicians such as nurse practitioners (NPs), physician assistants, and others to diagnose and treat patients without any physician oversight is a step in the wrong direction. NPs and physician assistants are valuable members of the health care team, but they are not a replacement for physicians. Patients deserve care led by physicians—the most highly educated, trained, and skilled health care professionals. Sadly, when examined by a health care professional in a “white coat,” it’s common for patients to believe they’re being seen by a physician, particularly where NPs who hold a doctoral degree introduce themselves as “Doctor.”
• 6.3% of NPs prescribed opioids to more than half of their patients, compared with 1.3% of physicians. Find out why education matters to medical scope of practice, with information that compares physicians with NPs, physician assistants, nurse anesthetists, psychologists, and naturopaths. d ed to lea s are train Physician ation and 20x the clinical traioininengrs With the
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The American Medical Association (AMA) and Pennsylvania Medical Society (PAMED) prioritize advocacy that strongly supports physician-led teambased care where all members of the team use their unique knowledge and valuable contributions to enhance patient outcomes. Studies show that removing physicians from the care team results in higher costs and lower quality of care.
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These AMA articles describe key differences between the education, training, and certification of physicians compared with NPs and physician assistants.
Not Ready for Independent Practice A study published in the Journal of Nursing Regulation (https://tinyurl.com/yc5cxc6j) found that over one-third of family nurse practitioners had not interpreted results from diagnostic tests in more than 10 cases. Of the nearly 4,000 family nurse practitioners surveyed for the study, almost 60% said their training was done fully or mostly online.
Why education matters Compared with NPs, physicians have 20 times more hands-on clinical training. And while all physicians get vital hands-on instruction, 60% of NP programs are mostly or completely online, with questionable consistency between programs. Physician assistant programs usually run about two years long. There is no residency requirement for NPs or physician assistants. In contrast, physicians’ training includes four years at a medical school—none of which are online-only—along with three to seven years of residency and fellowship training, depending on the physician specialty they pursue.
A three-year study (https://tinyurl.com/3jeup3m7) of emergency departments in the Veterans Health Administration found NPs delivering care without physician supervision or collaboration increased lengths of stay by 11% and raised 30-day preventable hospitalizations by 20% compared with emergency physicians.
Expanding nonphysicians’ scope of practice increases costs. For example:
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• 91% say a physician’s education and training are vital for optimal care • 3/4 would wait longer and pay more to be treated by a physician • 62% said patients are most likely to be harmed from scope of practice changes
An overwhelming majority of physician assistant program directors and educators said that their current curriculum does not prepare graduates to practice without “a supervisory, collaborating or other specific relationship with a physician.” More than 90% of physician assistant students themselves have said the collaborating physician relationship is either essential or very important.
Truth in Advertising
An Impactful Coalition – Advocacy in Action
Patients deserve to know who is providing their health care and their education and training. The AMA and PAMED believe that all health care professionals— physicians and nonphysicians—should be required to accurately and clearly disclose their training and qualifications to patients. The AMA's Truth in Advertising campaign has been enacted in over 20 states, informing the public about who is and is not a physician. PAMED was an early proponent of requiring a name badge to identify the type of health care professional a patient is seeing.
The AMA Scope of Practice Partnership (SOPP) is a coalition that was developed over 15 years ago and is comprised of more than 110 state medical and national specialty societies and osteopathic associations. Through strong collaboration, the coalition is instrumental in defeating scope expansion bills across the U.S. In 2023, AMA SOPP advocacy advanced Truth in Advertising laws and achieved more than 100 statelevel victories to protect against inappropriate scope expansions by nonphysicians. The coalition:
The AMA SOPP provides grants for state-based advocacy. PAMED has received SOPP funding on several occasions. This support helped PAMED advance the name badge requirement, survey Pennsylvanians on their views regarding the role of a physician, display billboards with impactful messages in key legislative districts, and develop a website “How White Coats Work” with a related brochure (imaged below in miniature) to educate policymakers and the public on the level of education and training of physicians compared with nonphysicians.
• Struck down legislation that would have allowed physician assistants to practice independently without physician oversight; • Beat pharmacist-prescribing bills; • Defeated legislation that would have allowed optometrists to perform surgery; and • Stopped bills that would have expanded scope of practice for NPs and other advanced practice registered nurses. At the federal level, the AMA leads medicine’s strong opposition to a bill that would endanger the quality of care that Medicare and Medicaid patients receive and is expected to be nonphysicians’ current advocacy focus in Congress. The AMA leads a coalition opposing the U.S. Department of Veterans Affairs (VA) Supremacy Project, which aims to set national standards of practice for all health care professionals that provide care in the VA system. The AMA is one of the only national organizations that created model bills and hundreds of advocacy tools for medicine to set the record straight for policymakers on scope of practice. Even in the states where certain nonphysicians practice independently, research evident in the AMA Health Workforce Mapper demonstrates that nonphysicians have not gravitated to rural areas.
Physician Advocacy Is Essential – Tell Your Story Check out this PAMED issue brief and call to action to engage on this urgent issue. And learn more about the AMA’s advocacy on scope of practice.
Patients Prefer Physician-led Care
Advice to patients: As you receive medical care from a health care professional in a white coat, feel encouraged to ask, “You are wearing a white coat, but are you a physician?”
In a survey of U.S. voters: • 95% say it is important to them for a physician to be involved in their diagnosis and treatment
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Lawmakers impact our practice of medicine. Make sure your voice is strong: Join PAMPAC.
Congratulations!
Congratulations to Bucks County Medical Society member Arvind R. Cavale, MD, FACE, FCPP, PCEO! Dr. Cavale was elected Vice President of the Pennsylvania Medical Society at the 2023 House of Delegates.
The Physicians’ Voice in Politics
Pennsylvania Medical Political Action Committee
JOIN PAMPAC HERE: www.PAMPAC.org
House of Delegates Wrap Up Thank you to the Bucks County Medical Society Members who were PAMPAC Members in 2023 Commonwealth Club John J. Pagan, MD, FACS Capitol Club Judith Gallagher-Braun, MD | Marilyn J. Heine, MD, FACEP, FACP Marion E. Mass, MD | Steven M. Orland, MD Keystone Club J. Matthew Bohning, MD | George P. Heyrich, MD Robert S. Mirsky, MD | Mary B. Toporcer, MD
At the Pennsylvania Medical Society House of Delegates, attendees participated on-site or remotely. The meeting included networking, policymaking, education, entertainment, elections, and leadership recognition. PAMED will provide updates on policy development. The Bucks CMS delegation was led by Marilyn Heine, MD, and included J. Matthew Bohning, MD, John Gallagher, MD, Daniel Latta, MD, Robert Mirsky, MD, Marion Mass, MD (alternate delegate), John Pagan, MD (ex-officio); and Judith GallagherBraun, MD, and Richard Leshner, DO, who participated remotely.
Sustainer Level Mary E. Pagan, MD | Rachael M. Sampson, MD Other Contributors Andrew Ball, MD | Arvind R. Cavale, MD, FACE, FCPP Hannah Huong Do, MD | Erin M. Fly, DO John Gallagher, MD | Mitchell M. Greenspan, MD Daniel Haimowitz, MD, CMD, FACP Bindukumar C. Kansupada, MD, MBA Michael J. Mehnert, MD | David S. C. Pao, MD
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Legislative Reception
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Many thanks to all the legislators, members of their staff, physicians, and PAMED staff who helped make the Bucks County Medical Society Legislative Reception this fall a success! We appreciate the opportunity to discuss our advocacy issues and develop relationships with state legislators and their staff.
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400 Winding Creek Blvd. Mechanicsburg, PA 17050-1885
Upcoming Events!
• The Bucks County Medical Society Board meets bimonthly. • Bucks CMS members are welcome to attend Board meetings. For details, please contact buckscms@pamedsoc.org • Plans are forthcoming for an Annual Membership Meeting in April and a Legislative Reception in September.
Best wishes in the New Year! We thank you for your membership and welcome you to contact us anytime at buckscms@pamedsoc.org
PRSRT STD U.S. POSTAGE PAID HARRISBURG, PA PERMIT NO. 922