San Antonio Medicine April 2020

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IN THIS ISSUE Primary Care Physicians – Medical Student Perspective

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Primary Care Physicians

– Medical Student Perspectives

Being a Primary Care Physician will make me a Better Social Advocate

By Brittany Johnson and Zahra Mohamed................................12 Treating the Whole Patient

By Chelsea Mendonca .............................................................13 The Role of Primary Care Physicians in Rural Healthcare By Steven Hlozek .................................................14 Why Pursue a Career in Primary Care?

By Christian Jacobsen, and Zaid Mahmood, MD ......................15 “Found” in Rural Medicine

By Anna Rogalska ....................................................................16 Pride in Practice By Timothy L. Counce Jr., Anthony D. Martinez, Jenna M. Rivera and Amy Ko .....................17 Redefining Health: Value-Based Healthcare at Long SOM By Chelsea Easley, Aarushi Aggarwal, Rahul Patel and Madeline Hazle................................................................................................................18 Dear Medical Students By Hannah E. Korman, MD and Michelle Rodriguez, MD, JD...............................19 Medical Mission to Neive, Colombia By Nicole Hernandez, MD, DDS, Sean Catlett, Daniel Perez, DDS, and Roberto Fajardo, PhD ........................................................................................................................20 Head Start in the Direction of Child Wellness By Jennifer Gaertner and Sara Grisales...........................22 BCMS President’s Message....................................................................................................................................8 BCMS Alliance......................................................................................................................................................10 12 Myths About Suicide By Uchenna Umeh, MD ..................................................................................................24 Benefits of Needle Exchange Programs & Supervised Injection Facilities By Catherine Cahill, Laura Jaremko, and Jacqueline Yeager ......................................................................................................................................26 BCMS Legislative News........................................................................................................................................28 COVID-19 Resources .......................................................................................................................................... 30 Business of Medicine: How to dispose of storage devices containing PHI and other sensitive data

By Laura Hale Brockway, Texas Medical Liability Trust ......................................................................................32 BCMS Circle of Friends Physicians Purchasing Directory ......................................................................................36 Recommended Auto Dealers ................................................................................................................................39 Auto Review: 2020 BMW 740i By Steve Schutz, MD ..........................................................................................40 PUBLISHED BY: SmithPrint Inc. 333 Burnet San Antonio, TX 78202 Email: medicine@smithprint.net PUBLISHER Louis Doucette louis@smithprint.net ADVERTISING SALES: AUSTIN: Sandy Weatherford sandy@smithprint.net BUSINESS MANAGER: Vicki Schroder

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APRIL 2020

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VOLUME 73 NO. 4

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BCMS BOARD OF DIRECTORS ELECTED OFFICERS Gerald Q. Greenfield, Jr., MD, PA, President Rajeev Suri, MD, Vice President Rodolfo “Rudy” Molina, MD, President-elect John Joseph Nava, MD, Treasurer Brent W. Sanderlin, DO, Secretary Adam V. Ratner, MD, Immediate Past President

DIRECTORS Michael A. Battista, MD, Member Brian T. Boies, MD, Member John D. Edwards, MD, Member Vincent Paul Fonseca, MD, MPH, Member Danielle Hilliard Henkes, Alliance Representative David Anthony Hnatow, MD, Member Lyssa N. Ochoa, MD, Member Gerardo Ortega, MD, Member Manuel M. Quinones, Jr., MD, Member John Milton Shepherd, MD, Member Richard Edward Hannigan, MD, Board of Ethics Co-chair Nora Lee Walker, MD, Board of Ethics Co-chair Charles Gregory Mahakian, MD, Military Representative George Rick Evans, Legal Counsel

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San Antonio Medicine • April 2020

Jayesh B. Shah, MD, TMA Trustee Ramon S. Cancino, MD, Medical School Representative Corinne Elizabeth Jedynak-Bell, DO, Medical School Representative Robyn Phillips-Madson, DO, MPH, Medical School Representative Ronald Rodriguez, MD, PhD, Medical School Representative Carlos Alberto Rosende, MD, Medical School Representative Stephen C. Fitzer, CEO/Executive Director (ex-officio)

BCMS SENIOR STAFF Stephen C. Fitzer, CEO/Executive Director Melody Newsom, Chief Operating Officer Yvonne Nino, Controller August Trevino, Development Director Mary Nava, Chief Government Affairs Officer Phil Hornbeak, Auto Program Director Mary Jo Quinn, BCVI Director Brissa Vela, Membership Director Al Ortiz, Chief Information Officer

PUBLICATIONS COMMITTEE Kristy Yvonne Kosub, MD, Chair John Joseph Seidenfeld, MD, Vice Chair Louis Doucette, Consultant Charles Hirose Hyman, MD, Member Tzy-Shiuan B. Kuo, MD, Member Fred H. Olin, MD, Member Alan Preston, Community Member Rajam S. Ramamurthy, MD, Member Adam V. Ratner, MD, Member David Schulz, Community Member Alexis A. Wiesenthal, MD, Member Tyler Adams, Student Member Chinwe Anyanwu, Student Member Darren M. Donahue, Student Member Donald Bryan Egan, Student Member Christopher Hsu, Student Member Aishwarya Devesh Kothare, Student Member Anirudh Madabhushi, Student Member Anjali Surya Prasad, Student Member Teresa Samson, Student Member Cara Jillian Schachter, Student Member Stephen C. Fitzer, Editor

PRESIDENT’S MESSAGE

The Better Management Model: Private Practice or Employed?

By Gerald Q. Greenfield Jr., MD, 2020 BCMS President Traditionally, new graduates of training programs sought to either set up their own practices or to join a previously established practice. These practice opportunities ranged in size from one to over 100 physicians. Each of these practices was guided by physicians who defined and provided the product, which was medical care. Management of the practice, or the day-to-day running of the practice, was typically by a practice manager or CEO who had training in business and/or business administration, often an MBA. More recently, graduates are opting to be employed physicians.

In this practice mode, the physicians work FOR the organization but do not determine its direction. Newer physicians want to “do medicine” and to leave “the other stuff ” to someone else. That someone else has the responsibility of managing the office personnel, supplies and the contracts of the practice.

The managed physician model is in fact similar to the private practice model. In both, the physician chooses to do that for which he or she is trained – provide medical care. Both seek to have the management aspect of providing that care performed by someone with a different skill set. Just as these two backgrounds operate differently, their goals may also differ. The business aspects of contracting, personnel management and supply chain usually seek the least expensive option. However, as we have seen in medicine, cheap is not always better. With physician leadership, the most appropriate equipment and compensation for medical care can be obtained even if they are not the least expensive. The innuendo associated with personnel management, however, is often outside of even the most accomplished physician’s skill set. They can provide a vision and a goal, but the selection of support personnel to reach that goal may be better done by someone skilled in business management.

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In the private practice model, physicians set the tone and course of the practice; they determine what services are provided and how this will be done. The medical risks and opportunities can often only be identified by a physician. Management skills, much like other skills, can be learned if given the proper instruction. In fact, today’s physicians who obtain a post baccalaureate degree will frequently obtain an MBA rather than an MS or an MPH. With these skills, they are better equipped to judge the fiscal opportunities available and balance them with the requirements of the employed physician. In this way, with appropriate physician input and leadership, the care provided in an employed-physician model can be equal to that provided by a private practice.

In the brave new world of medicine, there will be an ongoing comparison between private practice and employed physician opportunities. Only time will tell which option, if either, provides the best care for patients. In both cases, leadership by physicians will be necessary to assure that the practice of medicine does not become mercenary.

Gerald Greenfield, MD, is an Orthopedic Surgeon in Bexar County and is the 2020 President of the Bexar County Medical Society.

BCMS ALLIANCE

We Get It

By Nichole Eckmann, BCMSA President-elect

The Bexar County Medical Society Alliance (BCMSA) is a group of physician spouses with various skills and passions, yet dedicated to their families and supportive of the physician spouse’s rigorous schedule and often absenteeism from the household. The Alliance, with it’s 100+ years of existence, has evolved from a time physician spouses were home taking care of the family 100% of the time to being spouses that are business owners, professionals or otherwise working outside the home, putting an equal amount of work into their career—in a balancing act that often is challenging.

So, why do I spend my time sitting on boards like the BCMSA, with my crazy schedule, i.e. making breakfast for 6 kids every morning, taking time for exercise, running a real estate business, attending school functions, getting kids to and from football, basketball, baseball or track practice and making dinner almost every night?… Why, you ask? The answer is simple: camaraderie and a way to give back to the community.

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The medical life is one of a kind, one that you don’t understand unless you are living it. When I attend a board meeting or an event, I always connect with a member that “just gets it.” Sometimes that’s all we need to help us cope: someone who can lend an ear who “gets it.” We know the medical journey is a tough one, and we want to welcome new members to the Alliance with open arms and let them know we understand… and that we are here for them!

We are also very blessed to be living this sometimes unpredictable and fast- moving life, so what better way to give back than through community outreach. This is a great way to re-energize as an individual and reconnect with people within the community to make an impact. We are passionate and supportive spouses with various skills, impacting our community in various ways--the possibilities are endless!

Nichole Eckmann is the BCMSA President-elect in 2020.

PRIMARY CARE PHYSICIANS –

MEDICAL STUDENT PERSPECTIVE

Being a Primary Care Physician Will Make Me a Better Social Advocate

By Brittany Johnson and Zahra Mohamed

In early 2019, UT Southwestern Medical Center published a mapping tool that reported life expectancy by gender, race, and zip code in Texas. Highlights from the publication revealed that “life expectancy was longest – 97.0 years – in the 78634 ZIP code in Hutto, Texas (near Austin) and was shortest – 66.7 years – in the 76104 ZIP code in Fort Worth,” and that life expectancy was strongly associated with poverty. Imagine, losing 30 years of life from having the misfortune to reside in a community without resources. Furthermore, the average life expectancy for Black women and men was six years shorter than their White and Hispanic counterparts.

Time and time again, research confirms that health outcomes follow gradients predetermined by social demographics. Poverty and race overwhelmingly paint a picture of compromised health and a shorter lifespan.

Both the explanations and the solutions to health disparities are convoluted, multidisciplinary, and time and resource intensive. All efforts aimed at promoting health equity must embody true advocacy for the disenfranchised, resourcefulness, compassion, and access. Primary care physicians (PCP) are uniquely qualified to personify all of these objectives, and ultimately, contribute to the collective advancement of vulnerable populations in matters of health and beyond. The dynamics of a well-cultivated relationship between a PCP and his or her patient are ripe with opportunities for empowerment, knowledge and resource dissemination, and reciprocal realizations.

For many patients, PCPs are among the first “faces” that a patient encounters and, in non-emergency situations, they are usually the first physician the patient meets. To the extent that first impressions are lasting impressions, PCPs have the privilege of “setting the tone” and contributing to lasting impressions—good or bad—of patient/physician relationships. As a PCP, my demonstration of compassion, empathy, respect, and cultural sensitivity will directly influence patient trust, adherence, and receptiveness—measures that will directly impact health outcomes. PCPs can promote widespread patient advancement by establishing the patient as an agent in shared medical decision making and implicitly laying the groundwork for the expectation of compassionate, competent care. And because em-

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powerment does not exist in a vacuum, a PCP who motivates a patient to take ownership while engaging with the institution of healthcare can also motivate patients to demonstrate agency in matters of legislation, politics, and social conditions. It is my hope that after our initial encounters, my patients will come to demand high standards of care along every step of their health journey, and recognize that they possess power in the daily occurrences of their life.

As a PCP, specifically a family medicine doctor, my relationship with patients is continuous and evolving. This ongoing access allows for rapport formation and a more comprehensive understanding of a patient’s needs, including potential financial, social, and psychological obstacles. True knowledge of the strengths and limitations of one’s patient population allows for informed advocacy and practical solutions. Physicians whose practices are defined by more finite patient interactions may be limited in their capacity to holistically gage patient needs.

PCPs are pivotal for patient health. They offer preventive services, help manage chronic conditions, and are gatekeepers to patient wellbeing. For socioeconomically vulnerable populations, PCPs are doubly essential, as they identify and address needs that extend far beyond the clinic. Yet, health does not exist in isolation. A physician who truly serves vulnerable patient populations must analyze healthmodifying, disparate social conditions. To be a physician, one must diagnose and treat the physical ailments of their patient. To be a PCP one must adopt a daily consideration of the holistic mosaic of health and use each piece to better serve the patient. Accordingly, my competency as a PCP is predicated on my capacity to be an effective social advocate.

Brittany Johnson and Zahra Mohamed are medical students at UIWSOM.

References: New interactive map first to show life expectancy of Texans by ZIP code, race, and gender. UTSW. https://www.utsouthwestern.edu/newsroom/articles/year-2019/life-expectancy-texas-zipcode.html. Accessed January 10, 2019

PRIMARY CARE PHYSICIANS –

MEDICAL STUDENT PERSPECTIVE

Treating the Whole Patient – My Push Towards Primary Care

By Chelsea Mendonca

It was the first day of Gynecology clinic as a third-year medical student. My first patient that morning came in with what I had heard too many times referred to as a “laundry list” of complaints. When the worried patient presented, there was a quick bond. She shared her concerns with me, both socially and medically, entrusting me with a very vulnerable aspect of her life that was beyond the scope of gynecology. Upon presenting the patient to my attending physician, her response was “After we address her gynecological concerns, we’ll defer the rest to her primary care provider.” These words affected me deeply. I wanted to address all her concerns or at least be able to follow up with her about her other concerns, understanding the time limitations of a clinic visit. This was not the first time hearing this statement, “refer to primary care provider.” As a medical student, I knew that I wanted to be the type of physician that could address each concern of my patients; I needed to be “that” type of primary care provider.

Throughout the four years of medical school, the curriculum is disease-based. Students learn about the pathophysiology, the symptomology, and treatment options of disease after disease. We are taught to tell patients to quit smoking, eat better, and exercise daily to minimize risk factors. However, actually getting to sit down and discuss options with patients and provide preventative care is an aspect of primary care that really appeals to me.

During medical school, I was given the opportunity to participate in an elective called Culinary Medicine that taught me to focus on the health implications of diets. The class inspired to take what I had learned and teach it to patients. During my Family Medicine

clerkship, the next year, the skills learned from the Culinary Medicine elective helped to educate and empower a woman with newly diagnosed type 2 diabetes who felt defeated by her A1c results and her inability to make lifestyle changes. With that patient, we spent an hour together exploring barriers, reviewing important dietary concepts, and developing a practical plan that she understood and could implement. She left feeling confident and ready to make changes in her lifestyle. Whether it be counseling a newly diagnosed diabetic on diet and lifestyle changes or a young woman on her contraception options, a primary care career allows me to empower patients to take control of their health.

During the first year of medical school, I met one of my Family Medicine mentors during Primary Care Week while attending a breakfast that was being held. One of the biggest factors that helped plant the seed for a career in primary care in me was connecting with primary care physicians early-on during medical school, when they really took an interest in mentoring me and providing me with opportunities to enhance my interests.

Being able to provide comprehensive care to patients while giving each of them the ability to take control of their own health is my passion and why I choose to pursue a career in Family Medicine and primary care.

Chelsea Mendonca is a fourth-year medical student at UT Health San Antonio Long School of Medicine.

visit us at www.bcms.org

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MEDICAL STUDENT PERSPECTIVE

The Role of Primary Care Physicians in Rural Healthcare

By Steven Hlozek

Primary care physicians possess a dynamic role in the care of their patients that is unlike any other specialty. The primary care physician must maintain a broad range of knowledge, because an appointment with a primary care doctor is often the starting point for patients in need of treatment for more specific health problems. The primary care physician must sort out those patients that may be remedied in the office and those that require consultation to a specialist for a more specific health problem. It is a challenging specialty with a crucial role in the health care hierarchy.

In rural America, the primary care physician (PCP) faces additional challenges simply due to location of practice. She or he must care for patients with limited resources when compared to those physicians practicing in metropolitan areas. Limitations can include decreased access to the newest technology for diagnosing, physical lack of infrastructure such as community hospitals, and lack of specialty physicians in the region.1 While these resources may be abundant in urban centers or areas adjacent, they are scarce in rural areas.1 However, for those physicians willing to accept these unique challenges, the rewards can be great. The rural physician is entwined in the community and is deeply respected. They have a greater impact because they are not just treating the community but are a part of it. They care for multiple generations, often witnessing families come into existence and grow. They will be involved in community traditions, sporting events, weddings, and festivals. Known by all in the community, they may even approach a legendary status of sorts.

I can still remember the intimate nature of my family’s relationship with our local physician. He had practiced in our community for the life of his career. He cared for me, my sister and many others in our family. He was known for his skill and amiable demeanor. As a child, I do not remember fearing doctor visits but rather, looking forward to going to his office to see the nurses and possibly get a lollipop. Under the influence of my childhood imagination, I can 14

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remember categorizing him as a jolly white coated being, possibly a wizard, with great knowledge, who also had great taste in candy! We went to his office for healthcare and an update on local happenings.

It never failed that Mom would fall into a particularly lengthy conversation with the physician, after all we had to fill him in on what had happened in our lives since our last visit. Even now, looking at my childhood vaccination records, seeing his handwriting is nostalgic. Though he no longer practices, he will forever be remembered by so many in our community because he was such an essential part of our lives.

For the primary care physician practicing in rural America, the health of the community is truly in their hands. Though patients living in rural areas are few in comparison to metropolitan areas, these patients have the same illnesses and require the same treatments, often in an environment with fewer resources. To physicians courageous enough to work under these circumstances, come great rewards unique to this occupation. The rural physician is more connected to the community and grows with it. He or she will see families over a lifetime and will follow them as they change. Even after retirement, the rural physician will have a lasting impact on those for whom cared. I know that I look back with fondness on my memories of our local physician and these memories inspired me to become one myself.

Steve Hlozek is a first-year medical student at the UT Long School of Medicine in San Antonio, TX. References Nielsen M, D’Agostino D, Gregory P. Addressing Rural Health Challenges Head On. Missouri Medicine.

2017:363-366. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140198/. Accessed January 15, 2020.

Why Pursue a Career in

PRIMARY CARE PHYSICIANS –

MEDICAL STUDENT PERSPECTIVE

Primary Care?

By Christian Jacobsen, MSII UT-LSOM and Zaid Mahmood, MD

As a second-year medical student, I’m faced with the task of deciding which medical specialty to pursue. As any decision in life, each option is riddled with pros and cons. Factors to consider include passion for your work, lifestyle, income, and so forth. Among these choices lies primary care. What is it about primary care that allures students? With the help of Dr. Zaid Mahmood, family medicine resident in Wichita, Kansas, we compiled a list of reasons why you should consider pursuing a career in primary care.

The diversity is compelling: I’ve heard the phrase, “you can know an inch-wide a mile deep, or you can know a mile-wide an inch deep.” Primary care attempts to conquer the latter. Granted, a primary care physician may see much of the same old… a man with high BP noncompliant with his medication or high glucose readings. However, one can’t predict what will be behind door #3, something that many medical specialists can’t say themselves. Diversity is manifest in the wide range of patient populations encountered, the diagnoses discovered and medications delivered. On any particular morning you’ll be explaining the risks of high blood pressure, and in the afternoon catching a delivered newborn in your arms. Dr. Mahmood made the remark that he “wanted to feel he could provide a wide sense of care.” It can be frustrating for patients to switch doctors every time they present with a symptom outside a specialist’s organ of interest.

Being a primary care doc allows you to be the “one-stop-shop” for many patient needs.

Relationships: For Dr. Mahmood, emergency medicine was too short-lived. Patients would come and go, and hopefully you’d never see them again.

Yet, as humans we have it in our nature to build and foster relationships. Ironically, we find ourselves in an odd ethical situation when we want to see our patients again, but not necessarily wish sickness upon them. Enter primary care and preventative medicine. A primary care physician doesn’t act only as a fireman, extinguishing flames as they come, but also as a conductor, steering patients into healthy habits and away from danger as they grow old. With this in mind, mothers come for baby check-ups, they bring their children

for school vaccinations, and they come to be seen when sick themselves. Only primary care can foster these types of long-term family relationships.

Dynamic: Are you interested in living anywhere you’d like? Primary care specialties allow the flexibility to maintain a sustainable patient volume anywhere. Many subspecialties require a high patient volume to fuel their practice and are thereby tethered to large cities. Having diversity in the care you provide allows for flexibility in the type of patient you see, increasing your pool of potential patients. Granted, this flexibility comes with a catch. One must keep in mind that the type of practice desired may not be entirely feasible, given the location. For example, being an academic physician teaching at a medical school while simultaneously taking care of OB and pediatric patients at a hospital, while performing C-sections and other surgeries, may not be compatible. Rural facilities do not have all of the resources that an urban hospital center possess. Some compromises will be made.

Conclusion: Finding yourself in the middle of deciding which field of medicine to pursue, consider these questions. Do you value having a wide knowledge base? Do you cherish social interaction and developing relationships? Do you value understanding the big picture over expertise? Would you like to practice wherever you’d like? Primary care might be the fit for you. Primary care is in desperate shortage and has a promising and bright future ahead.

Christian Jacobsen, is a second year medical student at UTLSOM.

visit us at www.bcms.org

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PRIMARY CARE PHYSICIANS –

MEDICAL STUDENT PERSPECTIVE

“Found” in Rural Medicine

By Anna Rogalska, MS3 UIWSOM

Speaking about rural medicine, our minds naturally draw to the idea of snake bites, farming injuries and cedar allergies. But when we dive deeper into the population at hand, there is much more to this demographic career path than meets the eye.

When tackling rural populations in Texas, physicians are faced with unique challenges as they encounter geographical barriers in coordinating care. Many patients cannot, or simply will not, drive into the city for specialist evaluations, emergency care or interdisciplinary management. Therefore, they have high expectations of their primary care physician (PCP). Patients who are deserving of the same standards of care may achieve this goal surprisingly through a PCP who may have less resources and a smaller team.

Outsourcing cannot be done as readily if specialists aren’t down the street. In many ways, this is the heart of family medicine trained to do “everything,” because you will do everything. A rural physician does their best with the tools at hand, while assuming the critical role as an advocate for the community.

Dr. Shelley Kohlleppel is a family physician working in the Texas Hill Country who has roots in the community she serves. Growing up as a child of nine in the town of La Coste, Dr. Kohlleppel had to work hard to pursue her aspirations of medical school. After exploring her interests in various practice styles, she returned to the small-town area where she grew up to serve the local community as a physician.

Despite the challenges that arise with owning and running a solo practice, Dr. Kohlleppel recently has invited medical students to her clinic. She loves teaching and provides students the independence to apply their knowledge. Simultaneously, medical students assist in her practice, allowing for more patients to be seen and heard. “Yes, the extra hand is always helpful, but medical students also keep us on the cutting edge of new recommendations and research that can assist in well-rounded management for our patients,” says Dr. Kohlleppel.

Despite some of the limitations when practicing rural medicine, student doctors have the opportunity to explore their own calling in a diverse learning environment. The impact physicians make serving these close-knit communities is more than simple healthcare; it ensures the continuation of small-town America.

Anna Rogalska is an MS3 at the University of the Incarnate Word School of Osteopathic Medicine.

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San Antonio Medicine • April 2020

PRIMARY CARE PHYSICIANS –

Pride in Practice

MEDICAL STUDENT PERSPECTIVE

By Timothy L. Counce Jr., He/Him/His; Anthony D. Martinez, He/Him/His; Jenna M. Rivera, She/Her/Hers; Amy Ko, She/Her/Hers LGBTQI+ Bibliography

In the Spring of 2019 we founded Pride in Practice, the LGBTQI+-focused student group at the University of the Incarnate Word School of Osteopathic Medicine. Since its creation, we have hosted talks from doctors who cared for patients during the AIDS crisis, heard from persons living with HIV, invited same-sex parents to share their experience, and developed a Safe Space training that we offer our classmates. In forming and running this organization, we have learned so much, and wanted to share this with the readers of San Antonio Medicine.

Providing care to LGBTQI+ patients can seem daunting to medical professionals. This might stem from the uniqueness of care, or the newness of exposure some folks have to this vibrant community. As members of the LGBTQI+ community, we came to the consensus that affirming, comforting, and kind healthcare providers make all the difference in how we experience healthcare. We think that a great place to start is when physicians are open and respectful towards these special patients. Every journey of a thousand miles begins with a single step. Take the plunge!

The enthusiasm for our training from attendees has been buoying.

Our fall training explored how to better understand the LGBTQI+ community, and in the spring, we are giving a second phase of the training that deals with healthcare issues relevant and specific to the LGBTQI+ community. We believe in the idea that we can’t do better unless we know better.

Below you can find articles discussing the nuances of primary care for these patients, guides on better understanding the community, and organizations in Bexar county that can assist in your care of this unique group of patients. The list is neither complete nor comprehensive by any means, but we think it’s a great springboard.

We hope this collection of resources can better facilitate a happier and healthier Bexar county!

Timothy L. Counce Jr., MS, Anthony D. Martinez, MBS, Jenna M. Rivera, MBS, Amy Ko, BA, are all medical students at the UIW SOM.

1. AFFIRMING PROVIDERS | Synchronicity. https://www.synchronicity-counseling.com/copy-of-local-resources.

2. McNamara MC, Ng H. Best practices in LGBT care: A guide for primary care physicians. Cleve Clin J Med. 2016;83(7):531-541.

3. Care for Transgender Adolescents - ACOG. American College of Obstetricians and Gynecologists. https://www.acog.org/Clinical-Guidanceand-Publications/Committee-Opinions/Committee-on-Adolescent-Hea lth-Care/Care-for-Transgender-Adolescents?IsMobileSet=false. Published January 2017.

4. Yeung H, Luk KM, Chen SC, Ginsberg BA, Katz KA. Dermatologic care for lesbian, gay, bisexual, and transgender persons: Epidemiology, screening, and disease prevention. Journal of the American Academy of Dermatology. 2019;80(3):591-602.

5. Almeida J, Johnson RM, Corliss HL, Molnar BE, Azrael D. Emotional Distress Among LGBT Youth: The Influence of Perceived Discrimination Based on Sexual Orientation. J Youth Adolesc. 2009;38(7):10011014.

6. Makadon HJ. Ending LGBT invisibility in health care: the first step in ensuring equitable care. Cleve Clin J Med. 2011;78(4):220-224.

7. Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab.

2017;102(11):3869-3903.

8. Rafferty J, Health C on PA of C and F, Adolescence CO, Section on Lesbian G. Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents. Pediatrics. 2018;142(4).

9. GLAAD Media Reference Guide - Lesbian / Gay / Bisexual Glossary Of Terms. GLAAD. https://www.glaad.org/reference/lgbtq. Published September 9, 2011.

10. Reisner SL, Poteat T, Keatley J, et al. Global health burden and needs of transgender populations: a review. The Lancet. 2016;388(10042):412436.

11. Bonvicini KA. LGBT healthcare disparities: What progress have we made? Patient Education and Counseling. 2017;100(12):2357-2361.

12. Goldstein Z, Khan M, Reisman T, Safer JD. Managing the risk of venous thromboembolism in transgender adults undergoing hormone therapy. J Blood Med. 2019;10:209-216.

13. Knight DA, Jarrett D. Preventive Health Care for Men Who Have Sex with Men. AFP. 2015;91(12):844-851.

14. Knight DA, Jarrett D. Preventive Health Care for Women Who Have Sex with Women. AFP. 2017;95(5):314-321.

15. Pride Community Clinic - AARC. https://www.aarcsa.com/pride-community-clinic/.

16. San Antonio AIDS Foundation. San Antonio AIDS Foundation. https://sanantonioaids.org/.

17. The Kind Clinic | Access to PrEP and PEP, HIV Testing & General Wellness. Kind Clinic. https://kindclinic.org/.

18. Transgender Education Network of Texas. TENT. https://www.transtexas.org.

19. 05 - The Fenway Institute | Fenway Health: Health Care Is A Right, Not A Privilege. https://fenwayhealth.org/the-fenway-institute/.

20. Creating an LGBTQ-friendly practice. American Medical Association. https://www.ama-assn.org/delivering-care/population-care/creatinglgbtq-friendly-practice. visit us at www.bcms.org

17

PRIMARY CARE PHYSICIANS –

MEDICAL STUDENT PERSPECTIVE

Redefining Health:

Value-Based Healthcare at UT Long SOM

By Chelsea Easley, Aarushi Aggarwal, Rahul Patel and Madeline Hazle, Officers of the VBHC Student Organization

In the summer of 2018, a small group of medical students, along with the support of their advisor Dr. Fred Campbell, founded the Value Based Health Care (VBHC) student organization at Long School of Medicine. They set their sights on tackling value-based care, an exciting new model of healthcare spreading throughout the country. The mission of the organization is simple: to educate students at UT Health San Antonio about the principles of VBHC and to inspire the next generation of healthcare professionals to improve upon our current medical system. The belief is that by learning about models of care that focus on reducing costs while improving patient outcomes, these trainees will be able to one day deliver effective and affordable health care to the populations they serve.

Since its inception, this new VBHC has held several meetings on topics including its basic principles, Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMHs). In a partnership with WellMed Medical Group, we produced “Choosing Wisely” cards that were distributed at the UT Health Regional Physicians Network Summit as well as to medical students rotating on their Family Medicine clerkship. In each of the first two years, we’ve held an evening seminar, highlighting topics in value-based care.

The inaugural seminar in January of 2019 was a great success, featuring Dr. Christopher Moriates, a huge catalyst for VBHC in Texas.

This past January, we organized another VBHC Evening Seminar, bringing together almost 100 healthcare workers from the UT Health San Antonio community - faculty, students, hospital administrators, and other healthcare professionals - to discuss the principles of value-based health care and current practicing entities that 18

San Antonio Medicine • April 2020

represent it, such as the UT Regional Physicians Network. The keynote speakers, John Hornbeak, former CEO of Methodist Healthcare, and Dr. Chandana Tripathy, Director of Primary Care at the MARC, provided a riveting discussion on why value works and how UT Health San Antonio is aiming to implement it.

In addition to the general meetings and evening seminar, this organization has initiated an endeavor to bring forth the “Value Based Healthcare Elective”, a series of discussion-based sessions modeled after Dell Medical School’s VBHC modules. The course will integrate guest speakers for each topic, explain fundamentals of VBHC, and most importantly, present how students can get involved in being a part of the change. After almost 2 years of working with the UT Health San Antonio’s administrative team, this elective has finally been approved for implementation in Fall 2020.

The transition to new leadership gained momentum shortly after this year’s seminar, and very enthusiastic students were selected for the board. Part of the benefit that comes with inheriting such a young organization is the potential directions it can go. The new officers echoed that enthusiastic sentiment. Both previous officers and the upcoming team are thrilled to remain involved with this organization as it finds ways to shine a brighter spotlight on this rising trend in healthcare. The physician’s profession was created for patients, and that mentality should continue to guide future medical decisions.

Chelsea Easley, Aarushi Aggarwal, Rahul Patel, and Madeline Hazle are medical students at the UT LSOM and are Officers of the VBHC Student Organization.

PRIMARY CARE PHYSICIANS –

MEDICAL STUDENT PERSPECTIVE

Dear Medical Students

By Hannah E. Korman, MD; with corresponding author Michelle Rodriguez, MD, JD

The end of the school year is closer than you know. Medical school can be a grind, but I do not want you to lose sight of why you came here. While our paths may all be different, the guiding light on our journey toward medicine often starts the same: with the desire to help people. The details on that desire may have been a bit fuzzy, but the desire has always been there. In this letter, I want to demonstrate the ways practicing family medicine can help you keep that fire burning.

When we come to medical school, we dream of helping people. Most of us did not qualify that dream – we wanted to be there for the old, the young, the healthy, and the sick. Training in Family Medicine gives you the skills to help whomever walks through your door in whatever condition they may be. My training in various specialties, including pediatrics, obstetrics, and geriatrics has taught me there are principles that are universal to medicine. Practicing one has made me better at practicing the others.

Training in family medicine has helped me understand that things which seem important to us as doctors may not be as important to patients. I have learned that you cannot expect a patient to trust your judgment if you do not understand what is important to him or her. Practicing family medicine gives us the opportunity to build trust with our patients by not only managing their uncontrolled diabetes, but also being there when they need the splinter removed from their finger.

Finally, I want you to know that being there for people’s problems, big and small, makes you a part of your community. An unexpected benefit of practicing primary care in San Antonio has been learning from my patients about community events, infrastructure projects, and all the ways our town is changing and growing. While our patients have different levels of knowledge and understanding about their medical problems, what binds us is our shared sense of community. This bond has provided my work with greater context and meaning that has been invaluable to me during my training.

Practicing primary care, and family medicine in particular, has been a meaningful experience for me. It has been humbling. It has been educational. And it has sustained the desire to help people that first drew me to pursue medicine. As you move forward in your training and you consider specialty options, I want you to remember what got you started in the first place. Remember that, and make the choices which keep that part of you alive because keeping it alive will make you a happier person and a better doctor.

Sincerely, Hannah E. Korman, MD is a second-year resident in the UT Health San Antonio Department of Family and Community Medicine.

Michelle Rodriguez, MD, JD is Assistant Professor and Assistant Clerkship Director in the UT Health San Antonio Department of Family and Community Medicine

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PRIMARY CARE PHYSICIANS –

MEDICAL STUDENT PERSPECTIVE

Medical Mission to Neiva, Colombia

By (left to right) Daniel Perez, DDS; Roberto Fajardo, PhD; Nicole Hernandez, DDS; Sean Catlett (inset).

The San Antonio community has a reputation for helping those in need. One only needs to remember the city’s response to evacuees after Hurricane Katrina and the current mobilization to help those potentially stricken with the corona virus. Service-oriented medical students, residents, and faculty from the University of the Incarnate Word School of Osteopathic Medicine and the University of Texas Health Science Center at San Antonio continue this tradition, working together to help indigent children with deformities as part of the Healing the Children medical mission to Neiva, Colombia. This amazing medical mission, truly a traveling, comprehensive clinic, provides surgical care for children with cleft lip and palate, a variety of deformities and burn scar contractures, as well as untreated club foot and hip dysplasia.

Founded in 1993 by former Colombian-born San Antonio resident, Carlos Fajardo, this mission has continued for twenty-six consecutive years. Each year the mission team, with approximately 100 surgeons, physicians, nurses, speech therapists, orthodontists, dentists and more, visit Neiva and perform more than 150 surgeries in four and a half days. Over its history, this program has provided approximately 4,000 free surgical procedures, thousands of hours of speech therapy, thousands of dollars in free dental equipment, and many hours of public health training in the non-surgical treatment of club foot and hip dysplasia.

For the past eight years, Daniel Perez, DDS and Roberto Fajardo, PhD have led a local team of students and residents on the trip.

Their local team fundraises through events such as the annual Clubs 20

San Antonio Medicine • April 2020

and Scrubs for Kids charity golf tournament, while additionally making significant clinical and logistical contributions to the medical mission. Dr. Perez is an associate professor of Oral and Maxillofacial Surgery and Program Director for the department at UT Health San Antonio. Dr. Fajardo is an associate professor of Anatomy and Biomedical Science at the University of the Incarnate Word School of Osteopathic Medicine. He is also the logistical director of the trip. To help better train the next generation of physicians, Drs. Perez and Fajardo have taken medical students, as well as orthopedics and OMFS residents, to Colombia every year. The experiences have been invaluable according to past trainee participants.

Stories abound from this mission trip, but one helps to characterize the comprehensive care provided by the Healing the Children program to Neiva, Colombia. At about the age of 7, one of the oral surgeons met a boy we’ll call Federico (not real name of patient).

He had been orphaned as a child because his parents did not feel they had the resources to raise him with a large cleft palate deformity. Federico’s grandmother, who volunteered to raise him, heard about Healing the Children’s medical mission from a friend. Federico, always joyful, began to show more confidence and happiness after his initial palate surgery. Unfortunately, he continued to have major speech impediments due to his reliance on his epiglottis to produce sound. Three years later, Federico returned to our program to receive an intense three-day speech therapy session from the mission’s speech therapy team from Teacher’s College, Columbia University. Federico’s grandmother insisted that he keep up with his

PRIMARY CARE PHYSICIANS –

MEDICAL STUDENT PERSPECTIVE speech therapy exercises in the year between mission trips. It is indeed our team along with her love that carried Federico to a better day. He is now about 15 years old and brimming with confidence because he has learned to use his reconstructed palate to achieve more normal pronunciation. The surgical team built him a guitar and the speech therapy team taught Federico how to play it.

After twenty-six consecutive years of dedicated service to the healthcare of children, heartwarming stories like this can be found among any of the service programs offered during the medical mission. Although the Neiva medical mission program is not well known, it is a model for global health care and education. What started, admittedly, as a parachute mission almost three decades ago has evolved into a thriving service to the Colombian people with help from different regions around the world. Drs. Perez and Fajardo coordinate with surgeons in Colombia to ensure that every child receives appropriate follow-up care during the year. Two years ago, the team held its first interdisciplinary symposium and will host another this year in efforts to promote further dialogue with experts in Colombia.

Over the past five years, Dr. Sergio Nossa (Colombia), along with

orthopaedic surgeon mission volunteers from Harvard Medical School, have taught non-invasive techniques to treat club foot and congenital hip dysplasia to classrooms of medical students, residents, nurses, and public health professionals. The cleft team collaborates with local geneticist Dr. Henry Ostos and experts at Columbia University to study the genetics of cleft palate. Leaders in the medical world are truly working together to provide the best care possible for the Colombian people.

The future of the program is bright. San Antonio contributes the second largest contingent to the Colombian medical mission and it continues to grow. Drs. Perez and Fajardo, with incredible support from UT Health San Antonio and the University of the Incarnate Word School of Osteopathic Medicine, will continue to work together and reinforce the tradition of San Antonio standing to help those in need.

Nicole Hernandez, MD, DDS works at UT Health San Antonio; Sean Catlett is a medical student at the UT Long School of Medicine in San Antonio; Daniel Perez, DDS works at UT Health San Antonio; and Roberto Fajardo, Ph.D. began the program with Neiva, Colombia.

THANK YOU to the large group practices with 100% MEMBERSHIP in BCMS and TMA ABCD Pediatrics, PA

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Contact BCMS today to join the 100% Membership Program! *100% member practice participation as of March 20, 2020. visit us at www.bcms.org

21

PRIMARY CARE PHYSICIANS –

MEDICAL STUDENT PERSPECTIVE

Head Start in the Direction of

Child Wellness

By Jennifer Gaertner, OMS-III, and Sara Grisales, OMS-III

Childhood obesity and wellness remain prevalent concerns in the United States, and remain on the forefront as crises of national public health. In June of 2019, the CDC reported 18.5% of children and adolescents were obese, 18.9% of which were from lowincome groups. The World Health Organization has acknowledged the global rise in overweight and obese children, and declared the prevention of childhood obesity a high priority.

Social determinants of health, specifically poverty, are paramount in influencing childhood obesity, wellness, and lifelong health outcomes.

The San Antonio Head Start Program (Head Start) was enacted to provide health and education services to children, and examine the state of childhood obesity and wellness. Head Start focused on two Bexar County districts in particular, based on poverty level and minority population served; “Central San Antonio, which contains Edgewood (EISD), and San Antonio (SAISD) school districts, where much of this poverty is concentrated.”6 In comparison to other districts in Bexar County, EISD and SAISD residents have very limited resources and lower median incomes.6 Head Start was implemented to increase the percentage of children who received certain health services including Early and Periodic Screening, Diagnostic and Treatment (EPSDT), and provide basic healthcare including physical exams, dental exams, nutrition, and other health preventative screenings.

In January of 2019, the Head Start project collected over 3,000 surveys from caregivers of funded children within the SAISD and EISD school districts. SAISD collected 2,222 completed Wellness Assessment surveys from its 2,243 participants (99% response rate); EISD collected 805 completed Wellness Assessment surveys (100% response rate), with 777 of those EISD 805 surveys receiving repeat 22

San Antonio Medicine • April 2020

funding since their enrollment in 2017. Responses to survey questions were analyzed per question and compared within and against Districts. Questions included nutritional intake, dental health and parental perceptions of child health.

When comparing EISD and SAISD Wellness Assessment baselines, EISD with a poverty rate of 56% exhibited overall optimal wellness data in comparison to SAISD which had a poverty rate of 49% (See Table 1). This in part is due to the breadth of schools and population surveyed, which is apparent in the range of responses.

The ranking for suboptimal baseline answers was based on the overall mean percentage incorporating data from both EISD and SAISD. The overall mean percentage of children who consumed less than the recommended three vegetables a day was a startling 92%, and consuming less than three fruits a day was 85%. A mean of 46% of families were not asked, or did not recall being asked, by their physician/pediatrician concerning their child’s learning, development, or behavior.

However, both districts reported low consumption of soda; an overall combined mean of 9% of children consumed 1 or more sodas daily. This number may be deceptively low, given the defini-

PRIMARY CARE PHYSICIANS –

MEDICAL STUDENT PERSPECTIVE

tion of soda was subjective, and was not clarified within the survey to include other sugar-sweetened beverages, juices, sweetened-tea, or sports drinks. This shortcoming is taken into consideration for subsequent surveys.

Only 21% of caregivers brought their children to Urgent Care Centers, Hospital Emergency Rooms, or other medical care facilities other than a Doctor’s Office. Between 9-11% range of EISD caregivers sought services outside of a Doctor’s Office compared to the 10-47% range of caregivers in SAISD. This variable may result from the location and number of available pediatrician or family physician offices compared to other health care facilities.

Further, it was startling that a mean 8% of caregivers from the over 3,000 surveys collected were concerned about their child’s weight. In future studies, caregiver perceptions of their child’s health would be more useful if correlated with objective measures to create a discerning picture of child wellness.

This large-scale data collection from local families is crucial to understanding the impact of socioeconomic barriers on child wellness within San Antonio, unearthing deficiencies in child health, and sparks conversation on how to address those deficiencies whether through

funding or targeted educational programs. Physicians are called upon to address the needs of these children, and discuss healthy lifestyle changes with the 79% of caregivers who bring their children to a physician’s office. Addressing the needs of these families, and the future needs of a rapidly-growing San Antonio, is essential for ensuring the future success of children living in these areas.

Jennifer Gaertner is a third-year medical student at University of the Incarnate Osteopathic School of Medicine, as is Sara Grisales.

visit us at www.bcms.org

23

MENTAL HEALTH

12 MYTHS ABOUT

SUICIDE

By Uchenna Umeh, MD

1 2

3

4

5

6

7

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Suicide is not a real problem; As we all know, suicide is a real problem in our world today, it is now the second leading cause of death in our youth.

Asking or talking to your teen about suicide causes suicidal behavior; Talking about suicide not only increases awareness and puts an end to the shame and stigma, but it also helps teens explore other options and keeps open communication lines.

The person/family needs more prayers and more Jesus; while having a sense of belonging to a community or spiritual group is always encouraged and actually protective of suicide, it does not in and of itself prevent suicide. However, many suicidal persons have been known to say that when they reached out for help, they were told they were being dramatic and selfish and needed to pray more.

Religious persons do not die by suicide; just this past summer we heard about the young American pastor, active in the mental health arena, who actually lost his life to suicide. There have been many others including a Nigerian pastor as well.

Denial: It does not happen to our ethnicity or family (Blacks, Asians); this thought process as we know is erroneous, and Black kids were recently documented as attempting and dying by suicide at a higher rate than other races.

Only a professional can identify a child at risk for suicide; one of the reasons for my book and my work in the suicide arena is to increase awareness by educating everyone about the signs so we are all more empowered.

Once someone is suicidal, they will always be suicidal; for the most part, suicidal thoughts and behavior are situational and temporary. Most suicidal persons need to know that their feelings can and do pass once they are equipped with the right tools to deal with their thoughts and have the necessary support they need.

Only people with mental illness are suicidal; When I was going through my suicidal stage, I had never been diagnosed with mental illness, I did, however, experience a lot of life challenges which shook my core and caused me to consider myself a failure and not worthy of life. During the financial crisis of 2008, there was a sharp rise in suicides as a result of the enormous financial San Antonio Medicine • April 2020

9

losses these people had experienced.

Most suicides happen suddenly and without warning; we know that 4 out of 5 teens who attempt suicide leave a sign. The decision to suicide is hardly ever a one-off thing, it is usually a culmination of events over time leading to “overwhelmedness”, an inability to cope, and a perceived or real lack of support.

10 Someone who is suicidal wants to die; in all honesty, most suicidal people do not want to die. They simply want their pain, suffering and despair to end. They often feel like they have exhausted all their options and they also have the means to end their lives at that moment.

11 Someone who is threatening suicide is not going to carry it out; I like to say “do not underestimate the power of determination”. We can never be too sure that someone will not carry out their threat. We must, therefore, take every suicide threat seriously. Part of the reason suicide is on the rise is because these people don’t feel they have any support; they feel all alone.

12 People who die by suicide are selfish and taking the easy way out; because these people have been suffering for a while, the majority of them actually feel like suicide not only puts an end to their suffering, it also frees them from being a burden.

Many suicide attempt survivors say they feel their lives are a burden to those around them.

All-in-all, suicide is a complex issue; but suicide prevention must be front and center in everyone’s minds in today’s world.

Uchenna Umeh, MD, aka Dr. Lulu the Momatrician, lives in San Antonio Texas where she owns a direct primary pediatric practice where she sees only high-risk youth. She can be reached at www.youthhealthcenter.com or send email to drlulu@youthhealthcenter.com or 802-768-1180.

Dr. Umeh recently released the book called “A Teen’s Life”. It takes a critical look at youth suicide from the teen’s perspective. The book is available on Amazon and my website www.teenalive.com/books, for inquiries: askdoctorlulu@gmail.com.

PUBLIC HEALTH

Benefits of Needle Exchange Programs & Supervised Injection Facilities

By Catherine Cahill, Laura Jaremko, and Jacqueline Yeager

Tucked into the crevices of the River Walk, concealed beneath the bridges, and blending into the background of the bustling city of San Antonio, TX lies a world that many don’t acknowledge, and very few have experienced. Within this realm of “Hidden San Antonio” lives a population of people who have created their own community, support network, and contracts of social governance.

Here, it is a general rule to tread lightly, picking through the maze of overgrown foliage, litter, and used syringes. Many people living here are no strangers to the necessity of Naloxone, and the memory of friends who have overdosed hangs painfully in the air like a thick cloud of fog that refuses to dissipate.

According to the 2019 Point-in-Time Count, roughly 17% of San Antonio’s homeless population reports current substance abuse (South Alamo Regional Alliance for the Homeless, 2019). Individuals struggling with substance use disorder are often stigmatized by healthcare providers. This results in inadequate access to even the most minimal healthcare services, and a higher than average risk of infectious disease and serious health complications (Potier et al., 2014). Over the past 12 years in San Antonio, underground needle exchange programs (NEPs) have provided clean syringes and injection kits to people suffering from substance use disorder with the goal of harm reduction by preventing the spread of infectious diseases, namely Human Immunodeficiency Virus (HIV), Hepatitis C (HCV), and Hepatitis B (HBV).

Needle exchange programs and supervised injection facilities (SIFs) have been a lightning rod of controversy nationwide since their emergence in the 1970s. In a 2017 study in the United States, only 39% of 1004 people surveyed supported syringe services programs (McGinty, et al., 2018). There are concerns that these programs result in higher rates of drug-related crimes, increased numbers of dirty needles in public places, and more exposure to infectious disease, subsequently placing undue financial strain on tax26

San Antonio Medicine • April 2020

payers (Elkins, 2018). Because needle exchange programs and supervised injection facilities are not intended to prevent injection drug use, opponents worry that reducing disease spread and promoting “safe” injection practices are idealistic goals that indirectly condone injection drug use by providing people who inject drugs with the means to continue using illicit substances.

Fueled by the AIDS epidemic and the ongoing opioid crisis in the United States, the negative perception of these syringe services programs has started to change across the country. Social service agencies, medical entities, and government policies have become more aware of and open to the growing research indicating that these programs are effective at reducing mortality and the spread of infectious, yet treatable diseases (Potier et al., 2014). This shift in attitude has allowed for substantial progress, such as San Antonio’s September 2019 approval of funding for the first legal NEP in Texas (Nowlin, 2019).

In their short tenure, NEPs and supervised injection facilities across North America have already seen success. Clients of these programs have better access to healthcare and exhibit fewer harmful behaviors, allowing for a better quality of life. There are also benefits to the surrounding community, such as promoting proper disposal of used needles and decreasing drug injections in public. Research indicates that these programs provide safer and more regulated means to inject drugs, leading to decreased risk of disease spread and fewer instances of overdose (McNeil et al., 2014). A study in West Virginia showed that after closure of a local syringe services program, there was an increase in reported cases of HIV and HCV, as well as increased community rates of overdose (Allen et al., 2019).

Furthermore, a study based in Philadelphia indicated that the majority of surveyed healthcare providers and people who inject drugs supported the opening of supervised injection facilities in the local community (Harris et al., 2018).

PUBLIC HEALTH

Needle exchange programs and supervised injection facilities also provide people who inject drugs with access to basic health services such as health insurance, behavioral health treatment, rehabilitation, and medication. A group in Baltimore, MD provides efficient and inexpensive mobile wound care as an adjunct to their needle exchange services (Robinowitz et al., 2014). Many of these programs provide sorely needed HIV/HCV/HBV testing, immunizations, and referrals for treatment. Once established, they also help facilitate access to health insurance and enhance access to preventive health.

Some programs recruit people who inject drugs via peer-based programs, drawing on the universal human need for empathy and understanding, which are often-neglected aspects of healthcare for people with substance use disorder.

By welcoming people in, giving them clean needles, and educating them on safe injection practices, the hope is that these patients will stay for onsite detoxification services, sign up for health insurance, agree to needed medical referrals, or even enter a long-term treatment facility. In practice, research shows that increasing engagement with these programs results in increased use of these basic health services (Gaddis et al., 2017; Hay et al., 2016). Furthermore, it has been found that participation in these programs is independent of an individual's current housing state, criminal justice status, and previous health diagnosis (Ashford et al., 2018).

San Antonio, in recent years, has seen a rise in HCV infections and neonatal abstinence syndrome in conjunction with the national opioid epidemic (Bridger, 2018). The implementation of a peer-delivered needle exchange program, connected to healthcare facilities and mental health and rehabilitation services, will help combat these effects of intravenous drug use. Most importantly, these programs will provide basic human rights to people who inject drugs by offering compassionate care in a safe and non-judgmental environment, improving their quality of life and the health and safety of the entire community.

Catherine Cahill (left), Laura Jaremko (middle), and Jacqueline Yeager (right) are second year medical students at the University of Incarnate Word School of Osteopathic Medicine.

Resources

South Alamo Regional Alliance for the Homeless (SARAH). (2019). 2019 Point-in-Time Count Report.

Retrieved from https://www.sarahomeless.org/wp-content/uploads/2019/05/2019-PITReport_Digital-Copy.pdf

Potier, C., Laprévote, V., Dubois-Arber, F., Cottencin, O., & Rolland, B. (2014). Supervised injection services: What has been demonstrated? A systematic literature review. Drug and Alcohol Dependence, 145, 48–68. https://doi.org/10.1016/j.drugalcdep.2014.10.012 Mcginty, E. E., Barry, C. L., Stone, E. M., Niederdeppe, J., KennedyHendricks, A., Linden, S., & Sherman, S. G. (2018). Public support for safe consumption sites and syringe services programs to combat the opioid epidemic. Preventive Medicine, 111, 73–77. doi: 10.1016/j.ypmed.2018.02.026 Elkins, C. (2018, May 3). Benefits and Risks of Needle Exchange Programs. Retrieved from https://www.drugrehab.com/2017/11/06/prosand-cons-of-needle-exchange-programs/ Nowlin, S. (2019, September 25). Bexar County’s Needle Exchange Program Is Finally Funded. Lawmakers Should Make Sure It Stays That Way. San Antonio Current. Retrieved from https://www.sacurrent.com/thedaily/archives/2019/09/25/bexar-countys-needle-exchange-program-isfinally-funded-lawmakers-should-make-sure-it-stays-that-way McNeil, R., Small, W., Lampkin, H., Shannon, K., & Kerr, T. (2014).

“People knew they could come here to get help”: An ethnographic study of assisted injection practices at a peer-run ‘unsanctioned’ supervised drug consumption room in a Canadian setting. AIDS and Behavior, 18(3), 473– 485. https://doi.org/10.1007/s10461-013-0540-y Allen, S. T., Grieb, S. M., O’Rourke, A., Yoder, R., Planchet, E., White, R. H., & Sherman, S. G. (2019). Understanding the public health consequences of suspending a rural syringe services program: A qualitative study of the experiences of people who inject drugs. Harm Reduction Journal, 16(1), 33. https://doi.org/10.1186/s12954-019-0305-7 Harris, R. E., Richardson, J., Frasso, R., & Anderson, E. D. (2018). Perceptions about supervised injection facilities among people who inject drugs in Philadelphia. International Journal of Drug Policy, 52, 56–61. https://doi.org/10.1016/j.drugpo.2017.11.005 Robinowitz, N., Smith, M. E., Serio-Chapman, C., Chaulk, P., & Johnson, K. E. (2014). Wounds on wheels: Implementing a specialized wound clinic within an established syringe exchange program in Baltimore, Maryland.

American Journal of Public Health, 104(11), 2057–2059. https://doi.org/10.2105/AJPH.2014.302111 Gaddis, A., Kennedy, M. C., Nosova, E., Milloy, M.-J., Hayashi, K., Wood, E., & Kerr, T. (2017). Use of on-site detoxification services co-located with a supervised injection facility. Journal of Substance Abuse Treatment, 82, 1–6. https://doi.org/10.1016/j.jsat.2017.08.003 Hay, B., Henderson, C., Maltby, J., & Canales, J. J. (2016). Influence of Peer-Based Needle Exchange Programs on Mental Health Status in People Who Inject Drugs: A Nationwide New Zealand Study. Frontiers in Psychiatry, 7, 211. https://doi.org/10.3389/fpsyt.2016.00211 Ashford, R. D., Curtis, B., & Brown, A. M. (2018). Peer-delivered harm reduction and recovery support services: Initial evaluation from a hybrid recovery community drop-in center and syringe exchange program. Harm Reduction Journal, 15(1), 52. https://doi.org/10.1186/s12954-018-0258-2 Bridger, C.M. (2018). Public Health: Responding to the Opioid Epidemic. 21st Annual Premier Women’s Healthcare Conference. Retrieved from https://www.sanantonio.gov/Portals/0/Files/health/News/Presentations/AUG2018_PathwaysToHope.pdf ?ver=2018-09-12-153753-757

visit us at www.bcms.org

27

BCMS LEGISLATIVE

BCMS Physician and Alliance members continue with First Tuesdays in the District visits On Feb. 18, physician and Alliance members, along with a medical student visited the district office of State Representative Ina Minjarez (District 124), as part of the continued efforts of the First Tuesdays in the District program. The program’s intent is to visit with members of the state legislature in their local, district offices during the interim as a way to maintain contact and offer assistance to our legislators between legislative sessions. Among the topics discussed during the meeting were: redistricting, the homeless, infant and maternal issues, scope of practice and mental illness.

Many thanks to the following individuals who attended the meeting: Physicians – Alex Kenton, MD and John Shepherd, MD; BCMS Alliance members – Jennifer Lewis, Virginia Profenna, Ryan Ramos and Jenny Shepherd; and Marc Ghosn, medical student.

To learn more about how you can get involved or for local discussion on this and other legislative advocacy topics, consider joining the BCMS Legislative and Socioeconomics Committee by contacting Mary Nava, chief government affairs officer and committee liaison at mary.nava@bcms.org.

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San Antonio Medicine • April 2020

Above: BCMS physicians and Alliance members, along with a medical student and staff member visit with Rep. Ina Minjarez in the Texas House District 124 office in San Antonio. Attendees from l-r are: Ryan Ramos, BCMS Alliance; Mary Nava, BCMS chief government affairs officer; Alex Kenton, MD, chair of the BCMS Legislative and Socioeconomics Committee; Marc Ghosn, medical student at UIW School of Osteopathic Medicine; Jennifer Lewis, BCMS Alliance (standing – in dark jacket); Rep. Ina Minjarez; Virginia Profenna, BCMS Alliance (standing – in white top); Jenny Shepherd, BCMS Alliance and TMA Alliance VP of Legislative Affairs; and John Shepherd, MD, BCMS board member.

COVID-19

Novel Coronavirus Disease 2019

(COVID-19)

With all the recent news, it’s important to be informed with facts about the disease and know how to protect yourself from this and any contagious disease/virus.

Bexar County Medical Society has reliable resources to help educate you and answer questions you may have. Go to www.BCMS.org for more information.

The Bexar County Medical Society works to update information gathered from local, state, national and international sources every day. Here is a sample of that content as of mid-March.

• Pre-approved COVID-19 Testing Now Available in San Antonio for Your Patients-March 17, 2020Legal Aspects of Patient Quarantine • Metro Health Letter to Physicians-How to Access COVID-19 Testing for Your Patients-March 16, 2020 • Practical Answers to COVID-19 Questions for Your Practice-TMA March 13, 2020 • When a Patient Presents COVID-19 Protocol Recommendaions for Doctors COVID-19 Phone Hotlines

General Public Hotlines • San Antonio Metro Health District (210) 207-5779 • Texas Dept. of State Health Services (DSHS) Hotline 877-570-9779 7 am to 6 pm

COVID-19 Local Health Entities Full List by County-DSHS

PHYSICIAN AND HEALTHCARE WORKERS HOTLINES • San Antonio Metro Heath Epidemiology (210) 207-8876 • Outside San Antonio, Texas DSHS Region 8 (210) 949-2000; after hours (210) 949-2121 • COVID-19 Local Health Entities Full List by County-DHSH • San Antonio Metro Health – This is our local source for information on any public health issue. Their Novel Coronavirus 30

San Antonio Medicine • April 2020

webpage has information for the San Antonio community and has resources to track global information.

• COVID-19 Global Map – Displays a global map and lists confirmed cases, deaths and recovered cases by country/region.

• COVID-19 Print Materials – This site includes printable posters in multiple languages: – What is COVID-19 – Reduce Your Risk COVID-19 Information from SA Metro Health Dept. of Epidemiology specific for : • Clinicians (March 2, 2020) • Hospitals (March 2, 2020) • Home Health Care (March 2, 2020) • Long Term Care And Nursing Homes (March 2, 2020) • Mental Health Providers (March 2, 2020) Local Hospitals News and Information • Baptist Health System – Visitor Guidelines • CHRISTUS Santa Rosa Health System – What is CHRISTUS Doing to Plan and Prepare for – COVID-19?

• Methodist Hospital System – COVID-19 - Homecare Instructions • University Health System – Coronavirus:What you need to know

COVID-19

– Worried you were exposed to coronavirus? Guidelines from University Health System • South Texas Regional Advisory Council (STRAC) COVID-19 Information – STRAC is designated by the Texas Department of State Health Services (DSHS) to develop, implement and maintain the regional trauma and emergency healthcare system for the 22 counties in Trauma Service Area P (TSA-P). This page includes: – RHMOC Documents – Federal Guidances – Applications logins – Local and State Links • Texas Department of State Health Services (DSHS) – This is the Texas source of information for current situation updates about COVID-19. It includes detailed information for a multitude of public and business types.

– Public – Hospitals & Healthcare Professionals – Travelers – CDC Guidance for Businesses and Employers – Printable Materials – This includes posters in English and Spanish for : • Coronavirus Alert for Healthcare Settings • Symptoms of Coronavirus • Stop the spread of Germs • Centers for Disease Control and Prevention (CDC) – This link provides a wealth of information and what you need to know about COVID-19. This page is updated as the situation changes. A few of the direct links are: – How it spreads – Prevention & treatment – Frequently asked questions • World Health Organization (WHO) – Rolling Updates on Coronavirus Disease (COVID-19)- Provides a ist of news, events and speeches from WHO on COVID-19 – Coronavirus Disease (COVID-19) Outbreak- This page provides information and guidance from WHO including: – Protect Yourself – Your questions answered – Travel advice – Protect Yourself – Situation reports – Media resources

– Technical guidance – Research and Development • Texas Medical Association (TMA) – This site has updated news and information. As more reports come in on the spread of coronavirus COVID-19, TMA has convenned a task force of public health experts to help Texas physciains prepare for the next phase. Included on this page is information on: – Recommendations for Infection Control – Persons Under Investigation (PUI) – Specimen Collection and Testing – Clinical Care – Infection Control and Personal Protective Equipment (PPE) – Home Care – Specialty Physicians Guidelines – Printable Materials for Healthcare Settings • Related Articles – A Guide to What to Know About COVID-19 – Caution Urged as Officials Continue to Monitor Coronavirus – City of San Antonio Issues Public Health Emergency Declaration – Facts Not Fear | What you need to know about the COVID-19 outbreak – Preparing for a pandemic: What should I buy?

Are there places I should avoid?

– Share Facts, Not Fear – A Guide: How to Prepare Your Home for Coronavirus – What US Hospitals Should Do Now to Prepare for a COVID-19 Pandemic – Keep Calm and Prepare – Dont try to make your own hand sanitizer – Coronavirus: the new disease COVID-19 explained-South China Morning Post-UPDATED DAILY – Test Show the Coronavirus Can Live on Some Surfaces for Up to 3 Days-March 11, 2020 – Coronavirus calendar: Here are the events cancelled or postponed in the San Antonio Area-This list will be updated regularly as information becomes available

visit us at www.bcms.org

31

BUSINESS OF MEDICINE

HOW TO DISPOSE OF STORAGE DEVICES CONTAINING PHI AND OTHER SENSITIVE DATA

By Laura Hale Brockway, ELS, Assistant Vice President, Marketing, Texas Medical Liability Trust

Improper disposal of electronic devices and media puts the information stored on those devices at risk for a breach. And when devices contain protected health information (PHI), it puts your patient’s data at risk. What can you do to protect PHI when you want to dispose of equipment such as desktops, laptops, tablets, copiers, servers, smartphones, hard drives, and USB drives? The Office for Civil Rights and the National Institute of Standards and Technology offer the following guidance. 1, 2 Paper Destroy paper using cross-cut shredders that produce particles that are 1 x 5 millimeters in size or pulverize/disintegrate paper materials using disintegrator devices equipped with 3/32-inch security screen.

Microforms Destroy microforms (microfilm, microfiche, or other reduced image photo negatives) by burning. When material is burned, residue must be reduced to white ash.

Cell phones, personal digital assistants, and other hand-held devices Shred, disintegrate, pulverize, or burn devices in a licensed incinerator.

Routers, copy machines, fax machines Shred, disintegrate, pulverize, or burn devices in a licensed incinerator.

ATA hard drives, SCSI drives, flash drives, and USBs Shred, disintegrate, pulverize, or burn devices in a licensed incinerator.

Floppy disks, zip disks Shred, disintegrate, pulverize, or burn devices in a licensed incinerator.

CDs, DVDs Destroy in order of recommendations: Remove the Information-bearing layers of disc media using a commercial optical disk grinding device.

• Incinerate optical disk media (reduce to ash) using a licensed facility.

• Use optical disk media shredders or disintegrator devices Sources 1. Office for Civil Rights. Guidance on disposing of electronic devices and media. July 2018 OCR Cybersecurity Newsletter. Available at https://www.hhs.gov/sites/default/files/cybersecurity-newsletter-july-2018-Disposal.pdf . Accessed August 23, 2018.

2. National Institute of Standards and Technology. Guidelines for media sanitization. September 2006. Available at https://ws680.nist.gov/publication/get_pdf.cfm?pub_id=50819 . Accessed August 23, 2018.

Laura Hale Brockway can be reached at laura-brockway@tmlt.org.

Reprinted with permission from Texas Medical Liability Trust.

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San Antonio Medicine • April 2020

visit us at www.bcms.org

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PHYSICIANS PURCHASING DIRECTORY Brought to you by the BCMS Circle of Friends

By supporting these sponsors with your patronage, you are supporting the BCMS. ACCOUNTING FIRMS

“Leaders in Healthcare Software & Consulting”

www.kreagermitchell.com “Client-centered legal counsel with integrity and inspired solutions”

ARCHITECTURE Sol Schwartz & Associates P.C. (HHH Gold Sponsor) Celebrating our 40th anniversary, our detailed knowledge of medical practices helps our clients achieve a healthy balance of financial, operational, clinical and personal well-being.

Jim Rice, CPA 210-384-8000, ext. 112 jprice@ssacpa.com www.ssacpa.com “Dedicated to working with physicians and physician groups.”

ASSETT WEALTH MANAGEMENT

LK Design Group, Inc. (HH Silver Sponsor) LK Design Group has over 24 years of experience designing various medical and hospital buildings. We have experience in both ground up developments and re-design of interior spaces for medical professionals.

Lynn Kuckelman Peters President 210-824-8825 Lynn.p@lkdesigngroup.com Kristin Savage Director of Business Development 210-824-8825 Kristin.s@Lkdesigngroup.com www.lkdesigngroup.com

ATTORNEYS Bertuzzi-Torres Wealth Management Group (HHH Gold Sponsor) We specialize in simplifying your personal and professional life.

We are dedicated wealth managers who offer diverse financial solutions for discerning healthcare professionals, including asset protection, lending and estate planning.

Mike Bertuzzi First Vice President Senior Financial Advisor 210-278-3828 Michael_bertuzzi@ml.com Ruth Torres Financial Advisor 210-278-3828 Ruth.torres@ml.com http://fa.ml.com/bertuzzi-torres

ACCOUNTING SOFTWARE

Express Information Systems (HHH Gold Sponsor) With over 29 years’ experience, we understand that real-time visibility into your financial data is critical. Our browser-based healthcare accounting solutions provide accurate, multi-dimensional reporting that helps you accommodate further growth and drive your practice forward.

Rana Camargo Senior Account Manager 210-771-7903 ranac@expressinfo.com www.expressinfo.com

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San Antonio Medicine • April 2020

Constangy, Brooks, Smith & Prophete (HHH Gold Sponsor) Constangy, Brooks, Smith & Prophete offers a wider lens on workplace law. With 190+ attorneys across 15 states, Constangy is one of the nation’s largest Labor and Employment practices and is nationally recognized for diversity and legal excellence.

Kathleen Barrow Partner 512-382-8796 kbarrow@constangy.com Ashlee Mann Ligarde 512-382-8800 aligarde@constangy.com John E. Duke Senior Counsel 512-382-8800 jduke@constangy.com www.constangy.com “A wider lens on workplace law.”

Kreager Mitchell (HHH Gold Sponsor) At Kreager Mitchell, our healthcare practice works with physicians to offer the best representation possible in providing industry specific solutions. From business transactions to physician contracts, our team can help you in making the right decision for your practice.

Michael L. Kreager 210-283-6227 mkreager@kreagermitchell.com Bruce M. Mitchell 210-283-6228 bmitchell@kreagermitchell.com

Norton Rose Fulbright (HHH Gold Sponsor) Norton Rose Fulbright is a global law firm. We provide the world’s preeminent corporations and financial institutions with a full business law service. We deliver over 150 lawyers in the US focused on the life sciences and healthcare sector.

Mario Barrera Employment & Labor 210 270 7125 mario.barrera@nortonrosefulbright.com Charles Deacon Life Sciences and Healthcare 210 270 7133 charlie.deacon@nortonrosefulbright.com Katherine Tapley Real Estate 210 270 7191 katherine.tapley@nortonrosefulbright.com www.nortonrosefulbright.com “In 2016, we received a Tier 1 national ranking for healthcare law according to US News & World Report and Best Lawyers”

ASSETS ADVISORS/ PRIVATE BANKING

BB&T (HHH Gold Sponsor) Banking Services, Strategic Credit, Financial Planning Services, Risk Management Services, Investment Services, Trust & Estate Services — BB&T offers solutions to help you reach your financial goals and plan for a sound financial future.

Claudia E. Hinojosa Wealth Advisor 210-248-1583 CHinojosa@BBandT.com www.bbt.com/wealth/start.page "All we see is you"

Jeanne Bennett EVP | Private Banking Manager 210 343 4556 Jeanne.bennett@amegybank.com Karen Leckie Senior Vice President Private Banking 210.343.4558 karen.leckie@amegybank.com Robert Lindley Senior Vice President Private Banking 210.343.4526 robert.lindley@amegybank.com Denise C. Smith Vice President | Private Banking 210.343.4502 Denise.C.Smith@amegybank.com www.amegybank.com “Community banking partnership”

BankMD (HHH Gold Sponsor) We believe Physicians deserve specialized products and services to meet the challenging demands of their career and lifestyle.

Moses D. Luevano Market President 512-663-7743 mdl@bankmd.com www.bankmd.com “BankMD, "Specialized, Simple, Reliable" Banking for Doctors”

BB&T (HHH Gold Sponsor) Checking, savings, investments, insurance — BB&T offers banking services to help you reach your financial goals and plan for a sound financial future.

Joseph Bieniek Vice President Small Business Specialist 210-247-2985 jbieniek@bbandt.com Ben Pressentin 210-762-3175 bpressentin@bbandt.com www.bbt.com

BANKING

Amegy Bank of Texas (HHH Gold Sponsor) We believe that any great relationship starts with five core values: Attention, Accountability, Appreciation, Adaptability and Attainability.

We work hard and together with our clients to accomplish great things.

BBVA Compass (HHH Gold Sponsor) We are committed to fostering our clients’ confidence in their financial future through exceptional service, proactive advice, and customized solutions in cash management, lending, investments, insurance, and trust services.

Josh Collins SVP, Global Wealth Executive 210-370-6194 josh.collins@bbva.com Mary Mahlie SVP, Private Banking 210-370-6029 mary.mahlie@bbva.com Mark Menendez SVP, Wealth Financial Advisor 210-370-6134 mark.menendez@bbva.com www.bbvacompass.com "Creating Opportunities"

Broadway Bank (HHH Gold Sponsor) Healthcare banking experts with a private banking team committed to supporting the medical community.

Ken Herring 210-283-4026 kherring@broadwaybank.com Daniel Ganoe Mortgage Loan Originator 210-283-5349 www.broadwaybank.com “We’re here for good.”

The Bank of San Antonio (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians.

Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community.

Brandi Vitier, 210-807-5581 brandi.vitier@thebankofsa.com www.thebankofsa.com

Synergy Federal Credit Union (HHH Gold Sponsor) Looking for low loan rates for mortgages and vehicles? We've got them for you. We provide a full suite of digital and traditional financial products, designed to help Physicians get the banking services they need.

Synergy FCU Member Services (210) 750-8333 info@synergyfcu.org www.synergyfcu.org “Once a member, always a member. Join today!”

BUSINESS CONSULTING Waechter Consulting Group (HH Silver Sponsor) Want to grow your practice? Let our experienced team customize a growth strategy just for you.

Utilizing marketing and business development tactics, we create a plan tailored to your needs!

Michal Waechter, Owner (210) 913-4871 Michal@WaechterConsulting.com “YOUR goals, YOUR timeline, YOUR success. Let’s grow your practice together”

COMMERCIAL PROPERTY MANAGMENT

Investment Realty Company, L.C. (HHH Gold Sponsor) We act as Trusted Advisors leveraging our expertise as we assist Physicians in making the best commercial real estate decisions for their practices whether it's leasing, purchase or asset acquisiton.

Connie P. Raub Executive V. Pres., Broker Associate Realtor 210.314.7838 cpraub@investmentrealty.com Joanne Vollmer Mirelez, CCIM, MHA, Broker Associate Realtor 210.314.7843 joanne@investmentrealty.com Miranda Rihn, Associate Realtor 210.642.5429 mrihn@investmentrealty.com www.InvestmentRealty.com Expect Extensive research, innovative solutions, value added services, unparalleled service."

DIAGNOSTIC IMAGING

Touchstone Medical Imaging (HHH Gold Sponsor) To offer patients and physicians the highest quality outpatient imaging services, and to support them with a deeply instilled work ethic of personal service and integrity.

Caleb Ross Area Marketing Manager 972-989-2238 caleb.ross@touchstoneimaging.com Angela Shutt Area Operations Manager 512-915-5129 angela.shutt@touchstoneimaging.com www.touchstoneimaging.com "Touchstone Imaging provides outpatient radiology services to the San Antonio community."

FINANCIAL ADVISOR

Elizabeth Olney with Edward Jones ( Gold Sponsor) We learn your individual needs so we can develop a strategy to help you achieve your financial goals.

Join the nearly 7 million investors who know. Contact me to develop an investment strategy that makes sense for you.

Elizabeth Olney, Financial Advisor (210) 493-0753 Elizabeth.olney@edwardjones.com www.edwardjones.com/elizabetholney "Making Sense of Investing"

FINANCIAL SERVICES

SWBC ( 10K Platinum Sponsor) SWBC for Personal and Practice: Physician programs for wealth management and homebuying; For Your Practice: HR administration, payroll, employee benefits, property insurance, and exist strategies Jon M. Tober SWBC Mortgage—Sr. Loan Officer NMLS #212945 (210) 317-7431 jon.tober@swbc.com Maria Martinez SWBC Insurance Services, Commercial Lines Producer (210) 376-3478 maria.martinez@swbc.com Michael Gugliotti SWBC PEO, Sales Manager 830-980-1236 MGugliotti@swbc.com www.swbc.com SWBC family of services supporting Physicians and the Medical Society

Aspect Wealth Management (HHH Gold Sponsor) We believe wealth is more than money, which is why we improve and simplify the lives of our clients, granting them greater satisfaction, confidence and freedom to achieve more in life.

Jeffrey Allison 210-268-1530 jallison@aspectwealth.com www.aspectwealth.com “Get what you deserve … maximize your Social Security benefit!”

BankMD (HHH Gold Sponsor) We believe Physicians deserve specialized products and services to meet the challenging demands of their career and lifestyle.

Moses D. Luevano Market President 512-663-7743 mdl@bankmd.com www.bankmd.com “BankMD, "Specialized, Simple, Reliable" Banking for Doctors”

Bertuzzi-Torres Wealth Management Group ( Gold Sponsor) We specialize in simplifying your personal and professional life. We are dedicated wealth managers who offer diverse financial solutions for discerning healthcare professionals, including asset protection, lending and estate planning.

Mike Bertuzzi First Vice President Senior Financial Advisor 210-278-3828 Michael_bertuzzi@ml.com Ruth Torres Financial Advisor 210-278-3828 Ruth.torres@ml.com http://fa.ml.com/bertuzzi-torres

Elizabeth Olney with Edward Jones ( Gold Sponsor) We learn your individual needs so we can develop a strategy to help you achieve your financial goals.

Join the nearly 7 million investors who know. Contact me to develop an investment strategy that makes sense for you.

Elizabeth Olney Financial Advisor (210) 493-0753 Elizabeth.olney@edwardjones.com www.edwardjones.com/elizabeth-olney "Making Sense of Investing" Avid Wealth Partners (HH Silver Sponsor) The only financial firm that works like physicians, for physicians, to bring clarity and confidence in an age of clutter and chaos. You deserve to be understood and wellserved by a team that's committed to helping you avidly pursue the future you want, and that's our difference.

Eric Kala CFP®, CIMA®, AEP®,

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visit us at www.bcms.org

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PHYSICIANS PURCHASING DIRECTORY continued from page 35 CLU®, CRPS® Founder & Wealth Management Advisor 210.446.5752 eric.kala@nm.com avidwealthpartners.com “Plan it. Do it. Avid Wealth”

HEALTHCARE BANKING

Amegy Bank of Texas ( Gold Sponsor) We believe that any great relationship starts with five core values: Attention, Accountability, Appreciation, Adaptability and Attainability. We work hard and together with our clients to accomplish great things.

Jeanne Bennett EVP | Private Banking Manager 210 343 4556 Jeanne.bennett@amegybank.com Karen Leckie Senior Vice President Private Banking 210.343.4558 karen.leckie@amegybank.com Robert Lindley Senior Vice President Private Banking 210.343.4526 robert.lindley@amegybank.com Denise C. Smith Vice President | Private Banking 210.343.4502 Denise.C.Smith@amegybank.com www.amegybank.com “Community banking partnership”

BBVA Compass (HHH Gold Sponsor) We are committed to fostering our clients’ confidence in their financial future through exceptional service, proactive advice, and customized solutions in cash management, lending, investments, insurance, and trust services.

Josh Collins SVP, Global Wealth Executive 210-370-6194 josh.collins@bbva.com Mary Mahlie SVP, Private Banking 210-370-6029 mary.mahlie@bbva.com Mark Menendez SVP, Wealth Financial Advisor 210-370-6134 mark.menendez@bbva.com www.bbvacompass.com "Creating Opportunities"

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San Antonio Medicine • April 2020

HEALTHCARE CONSULTING

INSURANCE

CareAllies (HHHH 10K Platinum Sponsor) CareAllies works side-by-side with health care providers to accelerate the transition to valuebased care, helping improve the quality, value and experience of care for patients and make health care better for everyone.

Sabrina Moreno, Network Operations Senior Manager (713) 437-3088 X 523088 Sabrina.Moreno@careallies.com info@careallies.com https://www.careallies.com/ “For Better Health and Better Business”

TMA Insurance Trust (HHHH 10K Platinum Sponsor) Created and endorsed by the Texas Medical Association (TMA), the TMA Insurance Trust helps physicians, their families and their employees get the insurance coverage they need.

Wendell England 512-370-1746 wengland@tmait.org James Prescott 512-370-1776 jprescott@tmait.org John Isgitt 512-370-1776 www.tmait.org “We offer BCMS members a free insurance portfolio review.”

HOSPITALS/ HEALTHCARE SERVICES

Warm Springs Medical Center Thousand Oaks Westover Hills (HHH Gold Sponsor) Our mission is to serve people with disabilities by providing compassionate, expert care during the rehabilitation process, and support recovery through education and research.

Central referral line 210-592-5350 “Joint Commission COE.” Methodist Healthcare System (HH Silver Sponsor) Palmire Arellano 210-575-0172 palmira.arellano@mhshealth.com http://sahealth.com

INFORMATION AND TECHNOLOGIES

Express Information Systems (HHH Gold Sponsor) With over 29 years’ experience, we understand that real-time visibility into your financial data is critical. Our browser-based healthcare accounting solutions provide accurate, multi-dimensional reporting that helps you accommodate further growth and drive your practice forward.

Rana Camargo Senior Account Manager 210-771-7903 ranac@expressinfo.com www.expressinfo.com “Leaders in Healthcare Software & Consulting”

Humana (HHH Gold Sponsor) Humana is a leading health and well-being company focused on making it easy for people to achieve their best health with clinical excellence through coordinated care.

Jon Buss: 512-338-6167 Jbuss1@humana.com Shamayne Kotfas: 512-338-6103 skotfas@humana.com www.humana.com

OSMA Health (HHH Gold Sponsor) Health Benefits designed by Physicians for Physicians.

Fred Cartier Vice President Sales (214) 540-1511 fcartier@abadmin.com www.osmahealth.com “People you know Coverage you can trust”

INSURANCE/MEDICAL MALPRACTICE

Texas Medical Liability Trust (HHHH 10K Platinum Sponsor) Texas Medical Liability Trust is a not-for-profit health care liability claim trust providing malpractice insurance products to the physicians of Texas. Currently, we protect more than 18,000 physicians in all specialties who practice in all areas of the state. TMLT is a recommended partner of the Bexar County Medical Society and is en-

dorsed by the Texas Medical Association, the Texas Academy of Family Physicians, and the Dallas, Harris, Tarrant and Travis county medical societies.

Patty Spann 512-425-5932 patty-spann@tmlt.org www.tmlt.org Recommended partner of the Bexar County Medical Society

The Bank of San Antonio Insurance Group, Inc. (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians.

Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community.

Katy Brooks, CIC 210-807-5593 katy.brooks@bosainsurance.com www.thebankofsa.com “Serving the medical community.”

MedPro Group (HH Silver Sponsor) Medical Protective is the nation's oldest and only AAA-rated provider of healthcare malpractice insurance.

Kirsten Baze 512-375-3972 Kirsten.Baze@medpro.com www.medpro.com ProAssurance (HH Silver Sponsor) ProAssurance professional liability insurance defends healthcare providers facing malpractice claims and provides fair treatment for our insureds. ProAssurance Group is A.M. Best A+ (Superior).

Delano McGregor Senior Market Manager 800.282.6242 ext 367343 DelanoMcGregor@ProAssurance.com www.ProAssurance.com/Texas

MEDICAL BILLING AND COLLECTIONS SERVICES

Acumen Systems, LLC (HHH Gold Sponsor) Acumen Systems specializes in helping practices become more efficient and profitable, and aims to accelerate their growth with proven successes and systems Christiane Escobar, CMRM Certified Medical Revenue Manager 210-687-5506 cescobar@acumen.systems Angeles Hubard Medical Revenue Representative

210-867-3834 ahubard@acumen.systems https://acumen.systems When was the last time your medical practice had a check-up?

Commercial & Medical Credit Services (HH Silver Sponsor) A bonded and fully insured San Antonio-based collection agency.

Henry Miranda 210-340-9515 hcmiranda@sbcglobal.net www.cmcs-sa.com “Make us the solution for your account receivables.”

MEDICAL FURNITURE

MEDICAL SUPPLIES AND EQUIPMENT Henry Schein Medical (HH Silver Sponsor) From alcohol pads and bandages to EKGs and ultrasounds, we are the largest worldwide distributor of medical supplies, equipment, vaccines and pharmaceuticals serving office-based practitioners in 20 countries. Recognized as one of the world’s most ethical companies by Ethisphere.

Tom Rosol 210-413-8079 tom.rosol@henryschein.com www.henryschein.com “BCMS members receive GPO discounts of 15 to 50 percent.”

MORTGAGE CBI Group (HHH Gold Sponsor) From reception to waiting rooms to workstations, CBI Group is your trusted partner for turnkey office furnishing solutions. Our culturedriven approach and unique access to factory-direct pricing allow us to work within any budget/timeline.

Brent Warrilow 210-504-3740 brent.warrilow@cbi-office.com Brody Whitley 210-741-0438 brody.whitley@cbi-office.com Craig Hewines 210-941-1257 craig.hewines@cbi-office.com www.cbi-office.com

MEDICAL PRACTICE

UT Health Physicians (HHH Gold Sponsor) UT Health Physicians, the faculty practice of UT Health San Antonio, features the region's most comprehensive array of specialists & sub-specialists. Now offering free, secure access to your patients’ records. Most health plans accepted.

For referrals or questions, contact: Jose Gamez, Director, Physician Relations (210) 450 8347 GamezJ4@uthscsa.edu www.UTHealthcare.org “Offering daily grand rounds with no-cost CME to local physicians since 1969.”

PrimeLending (HHH Gold Sponsor) Doctor Loans, Construction Loans, VA Loans, Conventional and FHA Loans.

Cleo Garza Sr. Loan Officer NMLS#218858 210-483-4907 cleo.garza@primelending.com www.lo.primelending.com/cleo.garza Home Loans Made Simple

OFFICE FURNITURE

CBI Group (HHH Gold Sponsor) From reception to waiting rooms to workstations, CBI Group is your trusted partner for turnkey office furnishing solutions. Our culturedriven approach and unique access to factory-direct pricing allow us to work within any budget/timeline.

Brent Warrilow 210-504-3740 brent.warrilow@cbi-office.com Brody Whitley 210-741-0438 brody.whitley@cbi-office.com Craig Hewines 210-941-1257 craig.hewines@cbi-office.com www.cbi-office.com

PRACTICE SUPPORT SERVICES

SWBC ( 10K Platinum Sponsor) SWBC for Personal and Practice: Physician programs for wealth

management and homebuying; For Your Practice: HR administration, payroll, employee benefits, property insurance, and exist strategies Maria Martinez SWBC Insurance Services, Commercial Lines Producer (210) 376-3478 maria.martinez@swbc.com Michael Gugliotti SWBC PEO, Sales Manager 830-980-1236 MGugliotti@swbc.com Debbie Marino SWBC Employee Benefits, SVP Corporate Relations (210) 210-525-1248 DMarino@swbc.com www.swbc.com SWBC family of services supporting Physicians and the Medical Society

Acumen Systems, LLC (HHH Gold Sponsor) Acumen Systems specializes in helping practices become more efficient and profitable, and aims to accelerate their growth with proven successes and systems Christiane Escobar, CMRM Certified Medical Revenue Manager 210-687-5506 cescobar@acumen.systems Angeles Hubard Medical Revenue Representative 210-867-3834 ahubard@acumen.systems https://acumen.systems When was the last time your medical practice had a check-up?

PROFESSIONAL ORGANIZATIONS The Health Cell (HH Silver Sponsor) “Our Focus is People” Our mission is to support the people who propel the healthcare and bioscience industry in San Antonio.

Industry, academia, military, nonprofit, R&D, healthcare delivery, professional services and more!

President, Kevin Barber 210-308-7907 (Direct) kbarber@bdo.com Valerie Rogler, Program Coordinator 210-904-5404 Valerie@thehealthcell.org www.thehealthcell.org “Where San Antonio’s Healthcare Leaders Meet” San Antonio Group Managers (SAMGMA) (HH Silver Sponsor) SAMGMA is a professional nonprofit association with a mission to provide educational programs

and networking opportunities to medical practice managers and support charitable fundraising.

Tom Tidwell, President info4@samgma.org www.samgma.org

REAL ESTATE SERVICES COMMERCIAL

CARR Healthcare (HHH Gold Sponsor) CARR Healthcare is the nation’s leading provider of commercial real estate services for tenants and buyers.Our team of healthcare real estate experts assist with start-ups, lease renewals, expansions, relocations, additional offices, Purchases and practice transitions Matt Evans Agent 210-560-1443 matt.evans@carr.us www.carr.us “Maximize Your Profitability Through Real Estate”

Investment Realty Company, L.C. (HHH Gold Sponsor) We act as Trusted Advisors leveraging our expertise as we assist Physicians in making the best commercial real estate decisions for their practices whether it's leasing, purchase or asset acquisiton.

Connie P. Raub Executive V. Pres., Broker Associate Realtor 210.314.7838 cpraub@investmentrealty.com Joanne Vollmer Mirelez, CCIM, MHA, Broker Associate Realtor 210.314.7843 joanne@investmentrealty.com Miranda Rihn, Associate Realtor 210.642.5429 mrihn@investmentrealty.com www.InvestmentRealty.com Expect Extensive research, innovative solutions, value added services, unparalleled service."

KW Commercial (HHH Gold Sponsor) We specialize in advising Medical Professionals on the viability of buying & selling real estate, medical practices or land for development Marcelino Garcia, CRE Broker Assciate 210-381-3722

continued on page 38

visit us at www.bcms.org

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PHYSICIANS PURCHASING DIRECTORY continued from page 37

Marcelino.kwcommercial@gmail.com Leslie Y. Ayala Business Analyst/ CRE Associate 210-493-3030 x1084 Leslie.kwcommercial@gmail.com www.GAI-Advisors.com “Invaluable Commercial Real Estate Advice for The Healthcare Professional”

www.favoritestaffing.com “Favorite Healthcare Staffing offers preferred pricing for BCMS members.”

TELECOMMUNICATIONS ANSWERING SERVICE

For questions regarding services, Circle of Friends sponsors or joining our program please contact August Trevino, Program Director at 210-301-4366, August.Trevino@bcms.org, bcms.org/COF.html

STAFFING SERVICES

Favorite Healthcare Staffing (HHHH 10K Platinum Sponsor) Serving the Texas healthcare community since 1981, Favorite Healthcare Staffing is proud to be the exclusive provider of staffing services for the BCMS. In addition to traditional staffing solutions, Favorite offers a comprehensive range of staffing services to help members improve cost control, increase efficiency and protect their revenue cycle.

Donna Bakeman Office Manager 210-301-4362 dbakeman@favoritestaffing.com

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San Antonio Medicine • April 2020

TAS United Answering Service ( Gold Sponsor) We offer customized answering service solutions backed by our commitment to elite client service. Keeping you connected to your patients 24/7.

Dan Kilday Account Representative 210-258-5700 dkilday@tasunited.com www.tasunited.com “We are the answer!"

Join our Circle of Friends Program The sooner you start the sooner you can engage with our 5700 plus membership in Bexar and all contiguous counties.

For questions regarding Circle of Friends Sponsorship or sponsor member services please contact: Development Director, August Trevino august.trevino@bcms.org or 210-301-4366 https://www.bexarcv.com/secure/bcms/cofjoin.htm

RECOMMENDED AUTO DEALERS • • • •

Bluebonnet Chrysler Dodge Ram 547 S. Seguin Ave New Braunfels, TX 78130 Matthew C. Fraser 830-606-3463

We will locate the vehicle at the best price, right down to the color and equipment.

We will put you in touch with exactly the right person at the dealership to handle your transaction.

We will arrange for a test drive at your home or office. We make the buying process easy!

When you go to the dealership, speak only with the representative indicated by BCMS.

11001 IH 10 W at Huebner San Antonio, TX Esther Luna 210-690-0700

Northside Chevrolet 9400 San Pedro Ave. San Antonio, TX 78216

Northside Ford 12300 San Pedro San Antonio, TX

David Espinoza 210-912-5087

Marty Martinez 210-525-9800

GUNN AUTO GROUP

GUNN AUTO GROUP

GUNN Acura 11911 IH 10 W San Antonio, TX

GUNN Honda 14610 IH 10 W San Antonio, TX

Coby Allen 210-625-4988

Eric Schwartz 210-680-3371

Northside Honda 9100 San Pedro San Antonio, TX 78216

Cavender Audi Dominion 15447 IH 10 W San Antonio, TX 78249

Sean Beardsley 210-988-9644

Rick Cavender 210-681-3399 KAHLIG AUTO GROUP

Mercedes Benz of San Antonio 9600 San Pedro San Antonio, TX

Mercedes Benz of Boerne 31445 IH 10 W Boerne, TX

North Park Mazda 9333 San Pedro San Antonio, TX 78216

William Taylor 210-366-9600

James Godkin 830-981-6000

Scott Brothers 210-253-3300

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

North Park Subaru 9807 San Pedro San Antonio, TX 78216

North Park Lexus 611 Lockhill Selma San Antonio, TX

North Park Lexus at Dominion 21531 IH 10 W San Antonio, TX

North Park Subaru at Dominion 21415 IH 10 W San Antonio, TX 78257

Mark Castello 210-308-0200

Tripp Bridges 210-308-8900

Justin Blake 888-341-2182

Stephen Markham 877-356-0476

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

North Park Toyota 10703 SW Loop 410 San Antonio, TX 78211

North Park Lincoln 9207 San Pedro San Antonio, TX

North Park VW at Dominion 21315 IH 10 W San Antonio, TX 78257

Justin Boone 210-635-5000

Sandy Small 210-341-8841

James Cole 800-611-0176

Cavender Toyota 5730 NW Loop 410 San Antonio, TX Gary Holdgraf 210-862-9769

Land Rover of San Antonio 13660 IH-10 West (@UTSA Blvd.)

San Antonio, TX Ed Noriega 210-561-4900

Porsche Center 9455 IH-10 West San Antonio, TX Matt Hokenson 210-764-6945

Call Phil Hornbeak 210-301-4367 or email phil.hornbeak@bcms.org

AUTO REVIEW

2020 BMW 740i

By Stephen Schutz, MD

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San Antonio Medicine • April 2020

AUTO REVIEW

We’re seeing the swan song of what used to be the quintessential “I’m successful“ automotive status symbols—full-size German luxury sedans like the BMW 7-series, Mercedes S-class, and Audi A8. The same can be said for the Lexus LS, although, obviously, it’s not German.

I’m sorry to see these majestic cars fade. While I’m a big fan of the BMW X7, Mercedes GLS, and Audi Q8—and I actually own a Lexus LX 570—I grew up when those big German sedans ruled the roads. And truth be told, they’re still excellent vehicles despite their declining popularity. While they lack a hatch and some utility, as well as the ability to sit higher and see over traffic better, those cars are still wonderful for long-distance travel or even just going to the grocery store.

And now there’s an important price advantage as well. The factories have to continue pumping out product despite the fact that demand is dropping, which means there are deals to be had. As long as the market demands more luxury SUVs and fewer sedans, people willing to drive a luxury sedan will be able to buy one at a discount.

I recently drove a BMW 740i and thoroughly enjoyed it. It reminded me of why these cars were so coveted in the 1980s and 90s, and why they’re still a good choice today.

The 740i’s interior is beautiful. Everything you look at and touch looks and feels expensive, and the seats are to die for. Naturally, there are gee whiz tech features and big screens galore, as there are in all luxury vehicles these days. And this big BMW is a reminder that analog gauges in luxury sedans are about as common as the Dodo bird, which I guess is fine since the new screens are much easier to read than the old instruments and offer the advantage of configurability. Still, I can’t help missing BMW’s old gauges with their clear white numbers and soft orange backlighting.

The 740i’s exterior design is understated from the side and the rear. However, from the front you find your eyes drawn to the huge grille. And it is huge. I’ve made fun of the X7’s grille previously, and the one on the 740i looks around the same size. It seems to overwhelm the front end, honestly. Why do they do that?

One word: China. The Chinese like bling on and in their cars, and since they have the largest car market in the world, they get what they want. Does it look terrible? No. Does it look tasteful? I don’t think so, but what do I know? Let’s call it questionable.

Driving the 740i is what it’s about, of course. While sitting behind the wheel of either the Mercedes S-class or Lexus LS always makes me think I should be in the back seat; the 740i is different.

It’s wrong to say that it’s any more athletic than those aforementioned cars, but the BMW badges on the car make me think “driver” more than “passenger”.

The engine in the 740i is BMW’s ubiquitous 335HP twin-turbo inline-six coupled with the even more ubiquitous ZF 8-speed automatic transmission. A more powerful twin-turbo V8 is available for more money, but I see no reason to choose that over the six.

Naturally, the 7 is significantly larger than the first generation, which hit our shores back in the early 1980s. A bigger car that’s also heavier is always going to be a less sporting drive then something smaller and lighter, and that’s the case here. If driving excitement is what you want, get a five series (especially the wonderfully nasty M5). Still, the 740i is nice to drive and certainly very comfortable. Call it a boulevardier with special abilities on the interstate.

Like all German cars, many options are available, which can drive the $87,000-ish base price up significantly, at least in theory.

Realistically, however, most people are going to pick something relatively well optioned off the lot and pay a lot less than sticker.

And given the current market realities, most of these cars will be leased. (As always, call Phil Hornbeak for your best deal on a 740i or any other new vehicle.)

BMW, like all luxury manufacturers, is having to manage the slow decline of its former flagship, the 7-series sedan. That reality is good news for would-be luxury car customers who can buy or lease one for a lot less than sticker price. If that’s you, call Phil Hornbeak and pick up a 740i. It’s a very nice car.

Unrelated to my review, Tyler Hoover and Doug DeMuro from YouTube came up with a challenge I thought readers might enjoy: Pick three vehicles for your fantasy garage. You have an unlimited budget, but these are your only wheels—you can’t drive anything else. Have fun! (My list: 2020 BMW X7, 2018 Porsche GT3 Touring 6-sp, and 1970 Hemi Cuda Coupe 4-sp.)

To get your best deal on a new BMW, call Phil Hornbeak at BCMS at 210-301-4367.

Stephen Schutz, MD, is a board-certified gastroenterologist who lived in San Antonio in the 1990s when he was stationed here in the US Air Force. He has been writing auto reviews for San Antonio Medicine since 1995.

visit us at www.bcms.org

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