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WOMEN IN MEDICINE Supporting Women in Medicine During the COVID-19 Pandemic By Monica Verduzco-Gutierrez, MD...................11 2021 Women Leaders in Medicine Awards Event ............12 2021 UT Health San Antonio Colette M. Kohler Award Recipients .............................................................14 Dianna Burns-Banks, MD Presented with Annual Award in Her Honor By Mary E. Nava, MBA, BCMS Chief Government Affairs Officer...............................16 Breaking the Glass: A Historical Review of Women in Medicine By Cara J. Schachter and Allison Foster .........18 Work-Life Balance: Does it Really Exist? By Lou Anne Wellford, MD ...................................................20 A Working Mom in Progress By Brittany Lenz, MD .............22 Women Surgeons: Current Surgical Training in a Male-Dominated Field By Taylor Sullivan, DO ..........................................................24 Advancing Women’s Health in Medical School By Kathryn Markham and Summer Crawford .......................26 10 Tips for Upcoming Women Physician Leaders By Amita Kumar, MD ...........................................................27 Chapters of the American Medical Women’s Association (AMWA) in San Antonio By Anna Tomotaki, Sofia Russo, Karen Barcenas-Villarreal and Sara Slaton .............................................................28 Creating Resiliency in Health Care By Alan D. Winkler, MHSA ............................................................................31 BCMS President’s Message .................................................................................................................................................8 BCMS Alliance President’s Message ..................................................................................................................................10 Psychodermatology: The Significant Interaction Between the Mind and Skin By Faraz Yousefian, DO, Liliana Espinoza, BS and Chelsea Kesty, MD...................................................................................................................33 We Are The Same By Ivelisse Veláquez Negrón, MD ..........................................................................................................34 Letter to the Editor By Susan V. Walton, LCSW-R, MFA .....................................................................................................35 Artistic Expression in Medicine By Sarah Cox.....................................................................................................................35 Physicians Purchasing Directory.........................................................................................................................................36 Auto Review: 2021 BMW 440i Convertible By Stephen Schutz, MD...................................................................................40 Recommended Auto Dealers .............................................................................................................................................42 PUBLISHED BY: Traveling Blender, LLC. 10036 Saxet Boerne, TX 78006 PUBLISHER Louis Doucette louis@travelingblender.com BUSINESS MANAGER: Vicki Schroder vicki@travelingblender.com ADVERTISING SALES: AUSTIN: Sandy Weatherford sandy@travelingblender.com

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SAN ANTONIO MEDICINE • November 2021

NOVEMBER 2021

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VOLUME 74 NO.11

San Antonio Medicine is the official publication of Bexar County Medical Society (BCMS). All expressions of opinions and statements of supposed facts are published on the authority of the writer, and cannot be regarded as expressing the views of BCMS. Advertisements do not imply sponsorship of or endorsement by BCMS. EDITORIAL CORRESPONDENCE: Bexar County Medical Society 4334 N Loop 1604 W, Ste. 200 San Antonio, TX 78249 Email: editor@bcms.org MAGAZINE ADDRESS CHANGES: Call (210) 301-4391 or Email: membership@bcms.org SUBSCRIPTION RATES: $30 per year or $4 per individual issue ADVERTISING CORRESPONDENCE: Louis Doucette, President Traveling Blender, LLC. A Publication Management Firm 10036 Saxet, Boerne, TX 78006 www.travelingblender.com

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BCMS BOARD OF DIRECTORS ELECTED OFFICERS

Rodolfo “Rudy” Molina, MD, President John Joseph Nava, MD, Vice President Brent W. Sanderlin, DO, Treasurer Gerardo Ortega, MD, Secretary Rajeev Suri, MD, President-elect Gerald Q. Greenfield, Jr., MD, Immediate Past President

DIRECTORS

Michael A. Battista, MD, Member Brian T. Boies, MD, Member Vincent Paul Fonseca, MD, MPH, Member David Anthony Hnatow, MD, Member Lubna Naeem, MD, Member Lyssa N. Ochoa, MD, Member John Shepherd, MD, Member Ezequiel “Zeke” Silva III, MD, Member Amar Sunkari, MD, Member Col. Tim Switaj, MD, Military Representative Manuel M. Quinones Jr., MD, Board of Ethics Chair George F. “Rick” Evans, General Counsel Jayesh B. Shah, MD, TMA Board of Trustees Melody Newsom, CEO/Executive Director Nichole Eckmann, Alliance Representative Ramon S. Cancino, MD, 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 Katelyn Jane Franck, Student Alexis Lorio, Student

BCMS SENIOR STAFF

Melody Newsom, CEO/Executive Director Monica Jones, Chief Operating Officer Yvonne Nino, Controller August Trevino, Development Director Mary Nava, Chief Government Affairs Officer Phil Hornbeak, Auto Program Director Betty Fernandez, BCVI Director Brissa Vela, Membership Director Al Ortiz, Chief Information Officer

PUBLICATIONS COMMITTEE John Joseph Seidenfeld, MD, Chair Kristy Yvonne Kosub, MD, Member Louis Doucette, Consultant Fred H. Olin, MD, Member Alan Preston, Community Member Rajam S. Ramamurthy, MD, Member Adam V. Ratner, MD, Member David Schulz, Community Member Chinwe Anyanwu, Student Member Winona Gbedey, Student Member Cara J. Schachter, Student Member Niva Shrestha, Student Member Taylor Sullivan, DO, Member Faraz Yousefian, DO, Member Neal Meritz, MD, Member Jaime Pankowsky, MD, Member Danielle Moody, Editor 6

SAN ANTONIO MEDICINE • November 2021

PRESIDENT’S MESSAGE

Women in Medicine: Future Challenges By Rodolfo “Rudy” Molina, MD, MACR, FACP, 2021 BCMS President

Your county medical society traditionally dedicates the month of November to celebrate, recognize and honor women in medicine. The pandemic has changed how we hold in-person events, but certainly not how we discuss pressing or interesting topics on this matter. This issue is dedicated to serving our November tradition. In the March 2021 edition of this magazine, I contrasted the challenges that faced the first American woman physician to the present-day challenges of our female colleagues. So, I thought it would be interesting to look ahead and review possible future challenges for women in medicine. First, we should examine what futurists are saying about the world in general, and then apply those predictions to potential challenges that could affect women in medicine. Here are the facts that offer some predictions: • To maintain a nation’s population, the birth rate for a couple needs to be 2.1. In the United States, the birth rate is presently 1.7, and in countries with low birth rates such as Japan, 71% of working age women have returned to the workforce out of necessity. • In the business world, women brokers are more conservative than their male counterparts and take less risks on their investments. They tend to spend more money on education, health care and insurance compared to men. • More women are entering the workforce in the U.S., and not just in medicine. (A prediction: by 2030, women are estimated to hold more than half of the world’s wealth). • In an article recently published discussing the future of business organizations, the Future-Proof Organization discussed different strategies. One piece of advice was to “tech up.” For us in medicine, it will mean other things, including the use of Artificial Intelligence (AI), interoperative EMRs and telemedicine. • In a 1953 Gallop Poll asking preference for either a male or female boss, 66% preferred a male boss and only 4% preferred a female boss. This poll/question has been asked every year since then, and in 2017, 23% preferred a male boss, 21% preferred a female boss and the rest remained neutral.

SAN ANTONIO MEDICINE • November 2021

These are only a few thoughts to begin with. Women today are still dealing with gender stereotypes. Working women are still struggling on how to compromise between their family and job career. A study from the Harvard and Yale Schools of Business following men and women over 20 years found that 90% of the men were still working, whereas only about 50% of the women remained at their jobs. Men are expected to be decisive and driven, whereas women sensitive and communal. If a woman complains or deviates from this stereotype, she is labeled as “not a team player.” A problem with stereotyping is that not all those who are guilty of it are aware of their bias (not just men but women too) and unless this conversation goes forward, gender bias will not change and will remain a future challenge. The COVID-19 pandemic has enabled the use of telemedicine as a new norm. Women in certain specialties may find their niche, balancing raising a family and maintaining a successful medical career by incorporating telemedicine in their practice. I’ve been surprised how many of my patients, both young and old, preferred telemedicine visits. In addition, the use of AI, which is an enormous topic in of itself, may allow some women in certain specialties more time at home by partnering with it. By one analysis, specialties in medicine can be divided into two categories: pattern and non-pattern recognition. The two best examples of pattern recognition in medicine are radiology and pathology. It is in these two specialties where AI has a growing presence. By having AI review radiologic or histologic images for a definitive diagnosis, and programming it so that only complex cases are chosen for human review, this could be a time-saver. This leads us into our next topic. Time management in medicine is not a gender-specific issue and one that we all value. What we do with our time is what gives it value. A mother, wife and doctor prioritizing her time is a struggle without outside support. As more women enter the medical work-

PRESIDENT’S MESSAGE

force, corporate medicine will need to recognize the changing landscape. I am not a “big” fan of corporate medicine, and I feel their true colors were revealed during the pandemic. When we were in lockdown, some employed physicians were laid off and others had their salaries cut. It’s one thing for you as an owner/partner to take a sacrificial pay cut and a very different emotional setback when it’s done to you by management. (My personal bias and not reflecting the views of Bexar County Medical Society; see my article on this topic published Oct. 2019 in this magazine). Corporate medicine will need to adjust its own priorities and align them with the needs of their employees, most of which will be women. We may also be seeing unions playing a bigger role in medicine. The future is uncertain, but we should be certain about our actions when confronted with change. Each of the points discussed above deserves a longer and a more critical review. I purposedly omitted other areas of concern for lack of space and I did not want this article to lose sight of its purpose. This article’s purpose is to serve as a starting point for more conversations to come and how to prepare.

Sources: Books: The Future is Faster Than You Think by Diamandis & Kotler; 2030 by Guillen; Lean In by Sandberg Articles: High-Performance medicine: the convergence of human and artificial intelligence; Nature Medicine: 25, 44-56(2019); The Future-Proof Organization; Harvard Business Review, 42-48 (September-October 2021) Rodolfo “Rudy” Molina, MD, MACR, FACP is the 2021 President of the Bexar County Medical Society.

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BCMS ALLIANCE

The Joys of Being a Woman in Medicine By Marcy Rosen, MD, FACOG

As I pondered this month’s theme, I asked myself: which aspect of “women in medicine” should I explore? The possibilities are broad. Should I focus on the challenges of work/life balance; pay disparities; struggles with fertility and adequate maternity/pumping policies; leadership vacuums; or women missing out on career or academic advancement during times of peak reproductive years? These issues are beginning to be explored in depth within the medical community. But there is another side of being a woman in medicine: a joyful side. I wanted to take this time to reflect on some of the joys being a female physician have brought me:

weekends and exploring their 20s, my medical friends and I were studying, taking high-stress tests, working night shifts and looking forward to our “golden weekend” every month. There was no explanation needed for why I would have to miss an important occasion, they understood. When you are all going through the same process together, you “get it.” That empathy has continued into the real world past residency, as we confront the unique challenges medical careers bring to female physicians in every aspect of our lives. These friends−now colleagues−offer unconditional support and understanding.

A sense of accomplishment Nineteen-year-old me had a dream: to become a doctor. It wasn’t an easy road. There have been twists and turns along the way. Nineteen-year-old me had no idea about some of the roadblocks, setbacks or unrealistic expectations she would have to conquer along the way. But if I were to go back to that idealistic girl, I would tell her, “Keep going! You will get to be a doctor! That accomplishment can never be diminished.” In previous generations, the path would have been so much harder. Maybe it would have been impossible. Now, I have been opened up to new challenges, new aspirations and future accomplishments. Maybe I can create a pathway for someone behind me to achieve their goals.

A model for the future generation I am blessed with two wonderful children. They get to grow up seeing a mother who pursued and achieved her career dreams. The other day, my threeyear-old daughter and I ran into a patient of mine while we were out and about, and we saw the beautiful toddler I had delivered a few years ago. On our way home, my daughter reflected, “you were that baby’s doctor, but you are not my doctor. You are my mommy.” Yes, I am both. She’s getting it. I know that it is imperfect. I will miss moments in my family’s lives that I will regret. They might resent parts of my career. But I will walk this balance beam as carefully as possible so that they know that being a doctor does not, in any way, diminish my role as their mother. There is room in my heart, my brain and my life for all of it. It truly is a joyful realization.

Camaraderie Some of my best female friendships came from my time in medical school and beyond. As we were starting our careers, we were less like colleagues and more like soldiers in a war together. It was trial by fire. At a time when many of my non-medical friends were beginning their jobs, going out on

SAN ANTONIO MEDICINE • November 2021

Marcy Rosen, MD, FACOG is an OB/GYN who lives with her husband, kids and newly adopted cat in San Antonio. Dr. Rosen is a member of the Bexar County Medical Society Alliance.

WOMEN IN MEDICINE

Supporting Women in Medicine During the COVID-19 Pandemic By Monica Verduzco-Gutierrez, MD

n September we celebrated “Women in Medicine” month, which was created to honor the growing number of women in our profession. Since 2019, a little over half of medical students have been women.1 This trend is exciting for the future of health care, especially with data showing a positive association with gender concordance of physicians and their patients. There is less knowledge that currently 77% of frontfacing health care and long-term care workers caring directly for patients are women,2 who unfortunately also had higher rates of COVID-19 infection. Despite efforts to advance women in medicine, the COVID19 pandemic has set us back. Back in September 2020, almost one million women left the workforce.3 That was almost four times the number of men. What happened at that time? September is generally when school starts. For women, responsibility at home and disproportionate child rearing responsibilities cause women to leave the workforce. According to the study by the global nonprofit Catalyst, the main risk factors for women leaving the workforce were: being a mother, being a senior leader and being a Black woman. Unfortunately, during the COVID-19 pandemic, there has been a mass exodus of women from the medical field as well. The proverbial pipeline is leaking now more than ever. The pandemic has set back women’s progress by 25 years in the U.S. workforce.4 And women in medicine were already behind. According to an article by Richter and colleagues in The New England Journal of Medicine,5 over a 35-year period, women physicians in academic medical centers were less likely than men to be promoted to associate or full professor or appointed to department chair, with no apparent narrowing of the gap. I believe we must stop the loss. This was happening even before the pandemic. The massive departure of women from the medical workforce impacts patient care and re-

search. Though the leaky pipeline may be beyond patching, we need to start somewhere. What can employers do? Health care systems, CEOs, business leaders and physician allies can find creative ways to be part of the solution. Women should be paid fairly and promoted, sponsored for specific career opportunities and supported when pursuing those. I believe women should be offered grants or other funds to support their work. We must ensure that women have appropriate time off to care for themselves and their loved ones. Also, consider childcare options for the workplace. As an individual physician or health care leader, I encourage you to nominate a woman for an award or invite her to be a speaker or co-author on a manuscript. You can also write a positive online review or send a positive note to her boss. We can all give her a reason to stay in health care. References 1. https://www.aamc.org/news-insights/press-releases/majority-us-medical-students-are-womennew-data-show 2. https://www.kff.org/coronavirus-covid-19/issuebrief/key-characteristics-of-health-care-workers-andimplications-for-covid-19-vaccination/ 3. https://www.catalyst.org/research/covid-effect-gender-racial-equality/ 4. https://www.americanprogress.org/issues/ women/reports/ 2020/10/30/492582/covid-19sent-womens-workforce-progress-backward/ 5. https://www.nejm.org/doi/full/10.1056/NEJMsa1916935 Monica Verduzco-Gutierrez, MD runs the Post-COVID Recovery Clinic at UT Health San Antonio. She is a member of the Bexar County Medical Society.

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WOMEN IN MEDICINE

2021 Women Leaders in Medicine Awards Event Veronica Johnson Practice Manager of the Year South Texas Renal Care Group

100% Large Practice Group of the Year South Texas Renal Care Group

Christine Aune, MD Pediatrix Medical Group

Vivian Ayoub, MD Conviva Care Centers

Nancy Beaman Banks, MD Clinical Pathology Associates

Maggie Beato, MD Communicare Health Center

Jacquelin Castillo, MD Conviva Medical Center

Liza Chopra, MD Greater San Antonio Emergency Physicians

Valerie HernandezDanner, MD CANO Health

SAN ANTONIO MEDICINE • November 2021

WOMEN IN MEDICINE

Bexar County Medical Society honored several physician leaders during the 2021 Women Leaders in Medicine event on Thursday, September 30. The virtual event was very well attended by colleagues, friends and family of the honorees. The Dianna Burns-Banks Community Service Women Leaders in Medicine Award was also established this year. The first recipient was Dr. Dianna Burns-Banks herself. Congratulations to all honorees.

Sylvia Gutierrez-Zubyk, MD START Cancer Center

Cindy Johnston, MD WELLMED Medical Group

Lauren E. Karbach, MD The San Antonio Orthopedic Group

Sajneet Khangura, MD Gastroenterology Consultants of San Antonio

Karis McCarroll, MD, PA Dermatology SA

Shannon Prevette, MD Conviva Medical Center

Kimberly Stewart, DO Genesis Cancer Care

Aruna Venkatesh, MD University Medicine Associates

Katherine Whiteley, MD University Medicine Associates

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WOMEN IN MEDICINE

2021 UT Health San Antonio Colette M. Kohler Award Recipients UT Health also recognized recipients of the 2021 Colette M. Kohler Award at the BCMS Women Leaders in Medicine Awards virtual event.

Stacey Allen, MD

Emily M. Becker, MD

Christina C. Bird, DO

Monica Chapman, PA

Denise Dahm, MD, MPH

Marjorie David, MD, MS

Hopethe (Hope) Hubbard, MD

Kanapa Kornsawad, MD

Associate Professor/Clinical Director, Perioperative Anesthesia Operations at University Hospital UT Health SA Anesthesiology Department

Associate Professor/Clinical UT Health SA Medicine Department

Assistant Professor/Clinical Director, Pediatric Dermatology & Director, Laser Services UT Health SA Medicine Department

Associate Professor/Clinical Medical Director, Molecular Diagnostic Laboratory UT Health SA Pathology Department

SAN ANTONIO MEDICINE • November 2021

Associate Professor/Clinical Director, Clinical Operations UT Health SA Emergency Medicine Department

Associate Professor/Clinical Director, Robert B. Green Campus Hepatology Clinic UT Health SA Medicine Department

Physician Associate UT Health SA Urology Department

Associate Professor/ Clinical UT Health SA Internal Medicine/Hospital Medicine Department

WOMEN IN MEDICINE

Jennifer LaCoss, MD

Alicia Parker, MD

Laura M. Rosenkranz, MD

Christine B. Taylor, MD

Marcy R. Weimers, MD

Wisdeen Wu, DO

Assistant Professor/Clinical Palliative Care Program Medical Director, UHS UT Health SA Medicine Department

Assistant Professor/Clinical CoDirector, Facial Plastic and Reconstructive Surgery UT Health SA OtolaryngologyHead & Neck Surgery Department

Assistant Professor/Clinical UT Health SA Neurology Department

Associate Professor/Clinical Director, Family Medicine Residency UT Health SA Family and Community Medicine Department

Associate Professor/Clinical Program Director, Advanced Endoscopy Fellowship UT Health SA Medicine Department

Umber A. Salman, MD

Associate Professor/Clinical Medical Director, UT Health Medical Arts and Research and Hill Country Imaging Centers UT Health SA Radiology Department

Assistant Professor/Clinical UT Health SA Pediatrics Department

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WOMEN IN MEDICINE

Francine Prosser-Johnson, Chief Operating Officer for South Texas Center for Pediatric Care (left) and Dr. Dianna Burns-Banks (right) pause for a photo after the award presentation to Dr. Burns-Banks during the BCMS Women Leaders in Medicine Awards event held Sept. 30. Above: BCMS Women Leaders in Medicine Community Service Award presented to Dr. Dianna Burns-Banks on Sept. 30.

Dianna Burns-Banks, MD Presented with Annual Award in Her Honor By Mary E. Nava, MBA, BCMS Chief Government Affairs Officer

calling deeply rooted in her faith…has led to a lifetime of caring for patients and giving back to her community.

The Bexar County Medical Society has established an annual award in honor of past BCMS President, Dr. Dianna Burns-Banks in recognition of her significant and on-going contributions to the practice of medicine and service to the community. The Dianna Burns-Banks, MD Women Leaders in Community Service Award was presented to Dr.

SAN ANTONIO MEDICINE • November 2021

Burns-Banks during the annual BCMS Women Leaders in Medicine Awards event held virtually on September 30. This award will recognize future generations of women leaders in medicine in the years to come. Born and raised in Meridian, Mississippi, Dr. Burns-Banks graduated with honors from Xavier University of Louisiana and completed her medical school, internship and pediatric residency at the University of Louisville. She is a fellow of the American Academy of Pediatrics and also holds a master’s degree in Health Care Administration from Trinity University. Dr. Burns-Banks is a board-certified pediatrician with over 35 years of experience in primary care. She is President and co-owner of South Texas Center for Pediatric Care, a practice with over 100 employees, operating multiple clinics with the focus of improving access to the medically underserved areas in the San Antonio and surrounding communities.

WOMEN IN MEDICINE

Dr. Burns-Banks actually did not start out in pediatrics. She had planned on becoming a pathologist. As a data-driven individual who is also very analytical, Dr. Burns-Banks was working on a Masters in Microbiology when things took a different turn. She decided to enter medical school and finished in 3 ½ years. Dr. Burns-Banks started out working in the emergency room. The 12-hour days were intense, but during that time, she wanted to become a surgeon. By then, she had already been drawn to pediatrics. She found that children are honest, and caring for them seemed more fun. Eventually, she set up her private practice on San Antonio’s East Side. Dr. Burns-Banks was seeing patients not just from the local neighborhood, but from all over San Antonio and beyond. Her passion for caring for the underserved population presented an opportunity to take care of children who didn’t know their full potential. Likewise, caring for more difficult patients presented an opportunity for her to examine how to manage their care in a more economical way. “Medicine should not have to cost what it does,” Dr. Burns-Banks said. Her involvement in Medicaid patient advocacy helped to bring attention to the struggles of Medicaid patients and the physicians who care for them. Coming from a close-knit family, Dr. Burns-Banks was one of three sisters. Her parents always stressed the importance of education and supported her in all her endeavors. They were proud to see her become a doctor. Dr. Burns-Banks was proud to sponsor her dad’s winning bowling team, where she provided the team shirts emblazoned with her practice name. A product of Catholic schools from grade school through the first couple of years of high school, Dr. Burns-Banks believes in divine intervention and credits her faith for all her life’s journey and accomplishments. She also credits her physician mentors, the late Dr. Frank Bryant, who encouraged her to get involved in organized medicine and the late Dr. Al Sanders, who encouraged her to run first for Hospital Chief of Staff and later for BCMS President. In 1986, Dr. Burns-Banks became the first female African-American Chief of Staff at Santa Rosa Children’s Hospital. In 2006, Dr. BurnsBanks became the first female African-American President of the Bexar County Medical Society and second female president overall in the Society’s then 153-year history. She has held numerous positions on councils and committees at the Bexar County Medical Society and the Texas Medical Association, including Chair of both the BCMS Board of Mediations and Membership Committee, has served as a member of the BCMS Legislative and Socioeconomics Committee and delegate to the TMA, as well as Chair of the TMA Committee on Children and Adolescent Healthcare and member of the TMA Council on Constitution and Bylaws. Additionally, she has served as a representative to the State Medical Care Advisory Committee and both the State and Regional Advisory Committees for Medicaid and CHIP.

Dr. Burns-Banks’ list of accomplishments and service to the community is impressive, and some key highlights are her service as Vice Chairman of the Board of the Center for Healthcare Services, the Mental Health Authority for the City of San Antonio, where she championed the concept that the integration of mental health and physical health is essential to providing effective health care. Her work culminated in the creation of the Center’s Dianna Burns-Banks, MD CenterCare Clinic at the Restoration Center. Additionally, Dr. Burns-Banks has previously served on the Board of Managers of the University Health System, appointed by County Judge Nelson Wolff. Currently, she serves as a Board Member on the Lift Fund, Community First Health Plans, Our Lady of the Lake University and The Oblate School of Theology. In 2015, Dr. Burns-Banks launched a project near and dear to her heart – The South Texas Center for Pediatric Care Summer Internship Program. Since the program’s inception, the lives of 35 male and female college-bound students have been positively impacted by their participation in the 7-week paid program. Through the program, students learn how a medical practice works, basic business skills, interaction with patients, interaction with practice staff, employee etiquette, including on-site experience at an office location and participate in a discussion on the community and why we give back. Most recently, in 2020, Dr. Burns-Banks organized the COVID Community Outreach Project, which through her recruitment efforts, helped impact the lives of over 8,000 residents of San Antonio and the surrounding area by signing up to get vaccinated against COVID-19. This project, which she directed from her practice administrative headquarters, included help from her staff, a couple of community volunteers and three medical student volunteers. At the peak of the project, about 100 persons per hour were being registered for COVID-19 vaccinations. If registrants were not able to get transportation or were homebound, the project volunteers helped pick them up to bring them to the vaccination clinics or coordinated having the vaccine brought to homebound patients. Dr. Burns-Banks is a proud mom of two sons, Capt. Michael Burns and Johnathan Burns and is a grandmother of two grandsons. Dr. Burns-Banks said this of receiving the award, “I continue to be surprised when I’m recognized. Nothing I’ve done has ever been a big deal to me.” Mary E. Nava, MBA is the Chief Government Affairs Officer at the Bexar County Medical Society.

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WOMEN IN MEDICINE

Breaking the Glass: A Historical Review of Women in Medicine By By Cara Cara J.J. Schachter Schachter and and Allison Allison Foster Foster

he first medical college in the United States was founded in 1765, yet women would not be allowed to join the ranks of their male colleagues until nearly a century later. Throughout the early years of medical education, it was expressly understood that women were not only intellectually inferior to men, but their designated role in society was exclusively within the domestic sphere. Women who engaged in medical pursuits prior to the women’s health revolution faced discrimination by employers and patients alike. Despite this, several pioneers emerged to challenge the social constructs stacked against women in medicine. Of note, Elizabeth Blackwell became the first woman to graduate from an American medical school, Geneva Medical College, in 1849. Ann Preston established the first allwomen medical board after being barred from training in clinics by the men of the Philadelphia Medical Society. Both women persevered throughout the entirety of their careers to pave the way for generations of female physicians to enter the medical field. They overcame oppression and discrimination from their first medical school application to their very last patient. These two women, along with countless others throughout history, are responsible for many of the rights women in medicine are granted today. Elizabeth Blackwell was the first female to be admitted to an American medical college in 1847. Like many women who came before, her success was preceded by countless failures and rejections. Prior to her admission to Geneva Medical College, Blackwell was rejected more than ten times on the basis of presumed intellectual inferiority, as well as the daunting possibility that she could potentially be successful if 18

SAN ANTONIO MEDICINE • November 2021

given the opportunity to attend. The men in charge of medical education viewed Blackwell as a threat to the careful lines drawn between the male and female spheres of society. Her eventual admission almost wasn’t approved; the men of Geneva Medical College voted unanimously to admit her, believing her admission to be a prank. Blackwell was successful throughout medical school and graduated in 1849, but subsequently Elizabeth Blackwell struggled to find work. Hospitals did not acknowledge her degree or permit her additional training under their physicians. Despite this resistance, she would go on to found the New York Infirmary for Indigent Women and Children in 1857 and the College of New York Infirmary in 1867. After organizing several female medical efforts during the Civil War, Blackwell returned to England and established the London School of Medicine for Women in 1874 before officially retiring from medicine in 1877. Ann Preston was the only surviving daughter of a large Quaker family settled on the outskirts of Philadelphia. After receiving a modest education, Preston developed an initial interest in pursuing medicine

WOMEN IN MEDICINE

while fighting for human rights during the temperance and abolition movements. By 1840, she had established instruction for all-female health classes and began informal training through a medical apprenticeship. After being rejected by all four medical schools in Philadelphia in 1847, Preston graduated as part of the inaugural class of the Female (later Woman’s) Medical College of Pennsylvania in 1851. Shortly after her graduation, the Ann Preston Philadelphia Medical Society ruled that female physicians would no longer be permitted to train in clinics. Preston fought back, recruiting an all-women board that established the Woman’s Hospital, giving female students access to clinical education. By 1866, Preston had risen to become the first female dean

of Woman’s Medical College and made it a priority to improve her students’ educational opportunities, despite the social climate that opposed them. As the result of Preston’s efforts, by 1868 the students of Woman’s Medical College were permitted to return to Philadelphia and Pennsylvania hospitals to work alongside their male colleagues. The opportunity for women to apply for admission, learn and work as equals is an accomplishment that was once unimaginable to the aspiring female physician. Elizabeth Blackwell and Ann Preston are only two examples among countless women throughout history who championed women's roles in health care. Both women stood in direct opposition to the social and societal expectations of their time to pursue careers in medicine. As of 2019, women now comprise the majority (50.5%) of medical students for the first time in history, a true testament to the evolution of their work and the legacy of their careers nearly two hundred years in the making. Cara J. Schachter and Allison Foster are medical students at the UT Health San Antonio Long School of Medicine. Cara is a member of the BCMS Publications Committee.

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Work-Life Balance: Does It Really Exist? By Lou Anne Wellford, MD

SAN ANTONIO MEDICINE • November 2021

s I look back on my career in medicine, I ponder this question and wonder how well I achieved this balance. There were times when I believed I had it all under control and could conquer the world. At other times, it seemed as if I were chasing that elusive unicorn in a fantasy world that would never merge with my daily reality. Is there such a thing as the perfect work-life balance? Probably not, especially since it is a moving target that varies with the stage of your career and family situation. Am I an expert on this topic? By no means. Have I learned all the secrets to obtaining this balance? Certainly not. But after three decades in medicine and raising three children in a dual physician household, I have learned that a suitable balance is achievable. Like everything else in life, however, it takes hard work and frequent reassessment to reach that goal. Perhaps it is easier for me to reach this conclusion now that my children have grown and left home—I actually have time to take a deep breath and sit down long enough to write an article. Ten to fifteen years ago, I was simply in survival mode, barely able to drag myself out of bed in the morning, let alone contemplate such a nebulous concept as a balanced life. Each of you

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Learn to Say “No”—Prioritize what is important and how much time and energy you can devote to each and every commitment. There is no need to prove yourself by being the “yes woman” to every request.

may also have to learn the hard way, by trial and error, until you become so overwhelmed that you decide to take action. Alternatively, my years of mistakes can serve as a guide to save my fellow women in medicine precious time and energy along this learning curve. If only my thirty-year-old self would have listened to such advice: Creep Happens—No matter how welltuned your daily life, an invisible force will creep in to upset that balance. A few extra shifts, adding patients to the clinic schedule and going in on the weekends may be easily justified to help pay for that vacation you’ve dreamt of or for three college tuitions. But once that increased workload becomes the new baseline, then the creep happens again. Alternatively, your personal and family schedule becomes so jampacked that you fall behind in your CME and certification requirements. As a result of this silent shift, it is necessary to frequently monitor where you are and where you want to be in the balance. Forgo the Superhero Status—Who hasn’t tried to overcompensate for missing out on activities with their family? Whether because of guilt, FOMO (fear of missing out) or the Type A personality which draws us to medicine, many of us have tried to be everything to everyone. Supermom. Best Friend. Wonder Wife. Employee of the Month. Of course, this is only sustainable for short periods of time until you collapse in exhaustion (mentally or physically) and can barely function. Simplify life whenever possible and occasionally accept less than perfection. It is okay to send store-bought baked goods to the bake sale instead of homemade cookies after working all day.

Be Present—Minimize distractions whenever possible to be fully present at work or at home. If possible, try not to take work home to allow for quality time with your family and friends. You can also set boundaries with the family to allow maximal concentration while at work. It Really Does Take a Village—Be willing to accept help whenever offered. Delegating or sharing duties with friends, family and co-workers can lighten the burden. Take Care of Yourself—Take time to reward yourself with some “me” time. How is it that you haven’t read a non-medical book in the last ten years when you love to read? Pick up that book. Or watch that show on Netflix you’ve put off for months. Have a spa day. It’s not being lazy to do something to relax or re-energize yourself. Find your passion and make time for it. As for me, in my late fifties, I discovered a passion for writing about some of the incredible medical stories I have encountered in my career. This newfound hobby helped to balance my job-related stress and led to the completion of my first book, a true story about a friend’s heart transplant and the unlikely relationships that developed as a result. (Of course, it didn’t hurt that there was plenty of free time during the early pandemic and quarantine). With the help of these guidelines, I have come to believe that a work-life balance is achievable. And the good news is that such balance is conducive to longevity in your career and beneficial to your health. It will require active adjustments to maintain the balance, but with some work and frequent tweaking, you just may get close to catching that unicorn. Lou Anne Wellford, MD is an emergency physician with Greater San Antonio Emergency Physicians. She completed her training at Brooke Army Medical Center. To learn more about her writings and her book, you can follow her on Facebook @Lou Anne WellfordAuthor. Dr. Wellford is a member of the Bexar County Medical Society.

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A Working Mom in Progress By Brittany Lenz, MD

oday, I woke up my son, got him ready for daycare and kissed him goodbye. I then went to work where I treated 30 patients, rushed home to cram in some cuddles with my little one before bedtime, shared a reheated leftover dinner with my husband and finally had the chance to sit and write these thoughts down at 9 p.m. It was a pretty good day. How different a day looks, before and after parenthood! My husband and I met in college and were married for 10 years before we decided to have a baby. We loved our childless life as two young professionals. We traveled, enjoyed late nights out with friends, and cultivated hobbies and interests outside of work. We adopted the sweetest rescue dog, who allowed us to flex our fledgling co-parenting muscles while requiring minimal change to our lifestyle. The concept of work-life balance never crossed my mind. I could give 100% to my job whenever I needed to, and my husband had his own career goals to focus on. We always made time for each other, but there was an easy flexibility between two adults who understanded each other’s busy professional lives. A decade later, the arrival of our son completely rocked our world. As a new mother and full-time private practice physician, I have struggled to find worklife balance. Yet as I navigate the complexities and challenges of life as a working mom, I can’t help but wonder if such a thing truly exists. Before my son was born, I was confident that I would rise to the challenge of attaining

this elusive balance. I imagined myself deftly astride the proverbial seesaw with my family on one side and my career on the other – both in perfect harmony. Now that I am living it, I would not describe my current life in any sort

SAN ANTONIO MEDICINE • November 2021

of balance. Rather, I have found a carefully timed and slightly frenzied method of getting it all done that is more reminiscent of a struggling entertainer. A woman alternately tossing and catching several tasks at once, shifting and

WOMEN IN MEDICINE

hustling to keep all pieces of her life in the air. And sometimes I must allow the less important things to drop. In all my ruminations about motherhood, the question I had never thought to ask was, “How will I maintain my sense of self ?” As I’m sure every new mother before me has experienced, there is a part of you that grows immensely when your child is born. Your heart swells to a capacity you never thought possible. You are all at once filled with love, hope and fear. But there is also a part of yourself that fades away, or is at least put on hold, to return at a later season of life. I have metamorphosed into an indomitable multitasker. An imperfect, but steadfast task juggler. This, I feel, is a more accurate description of my life as a working mom. Motherhood, especially early on, can be quite lonely. I was lucky to share this time with two of my closest friends from medical school whose babies were born within one month of my son. We spent many late nights and early mornings texting each other. I personally was transitioning out of the Air Force to a private practice, which was a huge change in my career. Though we each had unique circumstances, we had a million of the same concerns. What would we do for childcare? What if our baby became sick? There were countless questions and perils ahead. All the while I was acutely aware of how fortunate I was to be a dermatologist. What about the working parents with unpredictable schedules and 80-hour work weeks? How do they manage? This all came as a surprise to me. I figured I had survived medical school, internship, a tour as an Air Force flight surgeon and the rigors of residency. I had honed my craft in academic medicine for years. Surely, I could succeed as a mother. But as any new mom can tell you, motherhood is so different from pro-

fessional endeavors. It’s personal. Every success and failure hits you right at your core. When I hold my son in the middle of the night, trying to soothe him as he cries with an ear infection, it hurts my soul. Certainly, this would not happen if he didn’t go to daycare. If only I stayed home with him each day, he would never become sick. Such are the irrational fears and self-doubts that creep into a parent’s mind at 3 a.m. The perfect image of balance with my home life on one side and work life on the other quickly dissipated. I was not prepared for the guilt I would experience in these two spheres of my life. I was faculty at a residency program

As we juggle the demands of being a physician and a mother, the best we can do is empathize and support one another as we each find our own rhythm. for years, where I focused on mentoring residents and modeling career development. I love my job as a physician and would never want to give it up, but now I constantly wonder if I am doing enough. Am I continuing to learn and develop myself professionally? The driven medical student inside of me wants to spend hours every weekend reading dermatology journals like I used to, and yet there are only so many hours to spare. At home, I experience similar insecurities. Is my son getting enough interaction, eating the right foods and growing like he should? Are my husband and I spending enough time with him at the end of our busy work days?

Adjusting my expectations and accepting the figurative and often literal messiness of my new life has allowed me to enjoy this time so much more. If our child is warm, fed, healthy and asleep at the end of the day, we consider it a win. My husband and I have found that we are our toughest critics when it comes to parenthood, and we often forget to give ourselves grace. Our son doesn’t need us to be perfect, he just needs us to be there. As time goes on, I have realized my favorite memories are not the shiny Instagram-worthy moments on milestone blankets captured in portrait mode. Instead, I cherish the happy memory of feeding our child from a spoon for the first time. I have also learned that the mom tribe is strong. We working moms continue our juggling act for our families and for our careers. I am comforted knowing that I am in good company, persevering alongside incredible women. These women have been my voices of reason and my personal cheerleaders when I needed them most. They are the bridge between who I was before I became a mom and the person I am now. As we juggle the demands of being a physician and a mother, the best we can do is empathize and support one another as we each find our own rhythm. So, I won’t be kicking myself for not finding balance – I’m not sure I ever will. This new person I have become is stronger and more resilient, and she knows which aspects of her life are too important to ever let drop. Tomorrow, I have the privilege of taking care of patients and making someone’s life better and I will also get to see my son laugh, smile and grow. Brittany Lenz, MD is a member of the Bexar County Medical Society.

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Women Surgeons:

Current Surgical Training in a Male-Dominated Field By Taylor Sullivan, DO

he first surgery I ever scrubbed in was during my second year of medical school. It was a mastectomy with lymph node dissection. After resection of the tumor, the surgeon used paint, borrowed from pathology, to mark the surgical borders of the specimen. She then used a handheld gamma detector to find the sentinel lymph node. This surgery was a beautiful display of chest wall anatomy, neurovascular supply to the upper extremity and use of technology. Not only was this patient cancer-free thanks to this skilled breast surgeon, but it also changed my life and career trajectory. For the time in U.S. history, females make up the majority of medical students at 52.9%.1 Though only 35% of the active physicians are women, this is a significant stride in equalizing the workforce.1 The percentage of women in surgical specialties, however, is only 22%.2 (See Figure 1.) Additionally, Doctor of Osteopathic Medicine physicians are even further underrepresented in surgery. Combining genders, DOs account for 5.6% of surgeons in orthopedic surgery, 4.6% for general surgery, 4% for ENT and vascular surgery, 2.5% for urology and <2% for plastic surgery and neurosurgery.2 There are several reasons as to why women don’t make up more of the surgical workforce. Most students list the perceived lifestyle, inabilFigure 1

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ity to balance work life with family life, extended length of training and discrimination/sexual harassment as reasons not to pursue a surgical career. Personally, I have yet to observe or receive gender discrimination from faculty or other residents. Rather it comes harmlessly from patients or ancillary staff, of both genders, assuming I am anyone but the physician, much less the surgeon. Gentle education and repetitive use of the word “doctor” typically helps get the point across. As of July 2021, women make up 38% of general surgery residents nationwide, and it continues to grow each year.3 As more faculty positions are awarded to female surgeons, opportunism for mentorship opens. I believe ways to increase women in surgery is to provide mentorship and examples of how women can make it all work: they can have their career and their family. I once attended a surgical interest group meeting in medical school and distinctly remember the surgeon advising us to never choose a specialty based off of the perceived lifestyle. Anything can be negotiated in a contract to ensure the balance you want. Several of my classmates from medical school did not give surgery a second thought due to the extended length of training during childbearing years. Seeing female surgical residents ahead of me start a family while in residency makes it seem not easy, but possible. Having mentorship, even from the resident level, can make a big difference, especially for those students on the fence about logistical questions. Lastly, organized medicine, such as the Association of Women Surgeons and the Bexar County Medical Society, typically have mentor programs for students who don’t have one at their home program. One of my original mentors was a female physician whom I

WOMEN IN MEDICINE

worked for while in college at Texas A&M. I still remember the exact time and place when she told me about her breast cancer diagnosis. She then experienced an arduous course of neoadjuvant chemotherapy, followed by a mastectomy and lymph node dissection, followed by more chemo and radiation. I also remember the shockingly immediate effects that lymphedema had on her quality of life. To this day, she still must wear an upper extremity compression sleeve, even while seeing patients, even outside in the hot, Texas heat. After having rotated in various aspects of general surgery during medical school and now intern year, I can’t help but think back to my mentor and the first surgery I participated in. It has inspired me to pursue a career in plastic and reconstructive surgery where I can be part of surgical planning, starting the conversation about reconstruction and microsurgery options from the beginning. I believe that reconstructive surgery will allow me to make patients feel beautiful and confident about themselves after cancer or a traumatic event and can improve their quality of life. Though working eighty hours per week without much time for eating or sleeping was an adjustment, I believe surgery is the most rewarding and challenging area of medicine. Surgical training in 2021 is different for me than it was for my female predecessors, even just a few

short years ago. Though more change should occur, the progress made thus far should be celebrated, steriley, of course. References 1. Women close med school enrollment gap, but others remain. Women Close Med School Enrollment Gap, but Others Remain. (2020, February 28). Retrieved October 4, 2021, from https://www.aafp.org/news/blogs/leadervoices/entry/20200228lv -diversity.html. 2. Data & Reports. AAMC. (2021, June 11). Retrieved October 5, 2021, from https://www.aamc.org/data-reports. 3. Women surgeons: defining the future of surgery. (2021, July 30). Retrieved October 4, 2021, from https://uofuhealth.utah.edu/ notes/postings/2021/07/women-surgery-residents.php#.YVtG 90bMJH0 Taylor Sullivan, DO is graduate of the inaugural class at UIWSOM, current General Surgery resident at UTHSCSA and member of the BCMS Publications Committee.

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Advancing Women’s Health in Medical School By Kathryn Markham and Summer Crawford

he Women’s Health Organization (WHO) at the University of the Incarnate Word School of Osteopathic Medicine (UIWSOM) helps promote the importance of women’s health through many facets. At the core of our organization, this includes education, service and advocacy within our school and the San Antonio community. We help other medical students interested in serving women in the local community find opportunities to further their personal education by providing various seminars and talks. By hosting meetings with UIWSOM resident physicians, faculty physicians and other physicians from the community, we aspire to raise both awareness and interest in a broad scope of topics and issues at the forefront of women’s health. The Women’s Health Organization also serves to encourage other student doctors to explore careers in women’s health. For example, we previously hosted specialty speaker panels to shed light upon differing career paths in women’s health, such as Obstetrics & Gynecology, Urogynecology, Family Practice & Obstetrics (FM-OB) and Reproductive Endocrinology. These events allow for raising questions, vital discussion and enhancement of education and professional communication skills for UIWSOM students. We hope to partner with other organizations at our medical school to host future events that raise awareness for women’s health issues that arise in other medical specialties. 26

The Women’s Health Organization promotes engagement throughout Bexar County to provide services to women and children in need. We work with organizations across the city of San Antonio to sort and package donations for women of all ages in the community. The Women’s Health Organization coordinates regular donation drives to gather hygiene products, food items and other items for local shelters. We prioritize establishing monthly volunteer opportunities for members of our organization to continue to demonstrate our commitment to improving the welfare of women within the community. We are grateful to have continued volunteer and service opportunities that have aided local women during the global COVID-19 pandemic. We strive to create long-lasting positive change for these women that will persist for years to come. In addition to organizing local volunteer and service opportunities, we also promote women’s health by arranging events on campus and by using our social media accounts to spread awareness to a larger population of people. These events help educate future physicians on pertinent women’s health issues, with a special emphasis on those pertaining to women in San Antonio. This education will provide UIWSOM’s future physicians with the foundations needed to care for women in their future practices and throughout San Antonio. We have hosted events on the importance of pap-smears, created educational flyers to raise awareness on topics such as breast and

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cervical cancer, and held meetings with UIWSOM faculty physicians to discuss the importance of quality of care as it relates to female patients. Other examples include teaching our medical students about proper timing of preventative examinations including breast examinations, and the importance of adequate access to menstrual hygiene products. We cultivate knowledge, compassion and dedication to serving local women. Our events bring recognition to preventative medicine practices for physicians within the community, as well as highlight how we can incorporate preventative practices into our treatment plans for our future patients. The Women’s Health Organization helps provide the tools necessary for our future colleagues to be successful in caring for women of all ages, backgrounds and education levels. Through our organization, we hope to create a culture of service and outreach for women’s health at UIWSOM and within Bexar County. Kathryn Markham is a secondyear osteopathic medical student at the University of the Incarnate Word School of Osteopathic Medicine. She is the secretary of the Women’s Health Organization. Summer Crawford is a second-year osteopathic medical student at the University of the Incarnate Word School of Osteopathic Medicine. She is the treasurer of the Women’s Health Organization.

WOMEN IN MEDICINE

10 Tips

for Upcoming Women Physician Leaders

By Amita Kumar, MD

ou are a leader. If you are a physician, you are a leader. You are a leader in your clinic, your family and in your community. It is up to you to decide what to do with that leadership role. As a female physician leader, you have endless possibilities. Your ability to make changes and improve the community around you is in your hands. It might be scary and uncomfortable, and your brain will try to stop you from trying something new and going into uncharted territory. I’m here to tell you that it’s okay to be afraid, and you can do it if you can remember these pieces of advice that I have gathered over the years: Learn to use a calendar − efficiently! Make sure you calendarize everything and start with your own self-care time like sleep, exercise and dinner - at the least. The more protected time you have on your calendar, the better.

Remember why you chose to become a physician. Write it down somewhere that you can refer to easily and often. If you can remind yourself daily, that would be ideal. There will be hard days, and those days will need real reminders so you can put them in the past and be your best self tomorrow.

Be a team player and learn from others. No matter how much you have studied, your patients, co-workers, staff, friends and family have priceless wisdom that will help you if you listen. Your own life (being a daughter, sister, wife, mom) will help you be a better doctor if you learn from your own mistakes.

You are human. Take care of yourself physically and mentally. Imagine you were your patient. What would you tell yourself ? Exercise, even for just a few minutes, every day. Practice gratitude. List five things you’re grateful for each day.

Have fun! It is important that you maintain your own personal identity as well as your professional one. What do you love to do on your days off ? Whether it be reading, watching Netflix, or going out for dinner with a friend, make sure you make time for your hobbies and nurture yourself with interests that energize you!

Invest in yourself. Whether it is CME, a massage or lunch with friends, investing in yourself is crucial to your success. This will help you recharge and refill your bucket to ensure that you can be resilient in whatever life and work throws at you.

Accept advice. Ideally, you should get a business coach and mentor. This has been common practice in the business world for many years. In medicine, we have been trying to do this alone… year after year, decade after decade. There is evidence-based research that coaching has helped great leaders become even more successful than they ever thought they could. Professional coaching has shown to reduce emotional exhaustion and improve overall quality of life. Do not wait until you need it. Start now!

Think twice before you say “no.” There are constant struggles at work and at home that need constant balancing. You may be asked to help a friend, patient or family member, but you have 20 notes to write, 15 messages and 50 documents to review. If you can stop for a minute and help that person, even though you are infinitely busy, it does not go unnoticed and you will go home feeling really good about yourself.

Be positive. A positive attitude helps impact the ability to be resilient and overcome stress and adversity. Factors that may help maximize your resilience include optimism, having a positive attitude and the ability to see failure as a form of helpful feedback – ensuring that you come back stronger, with a lesson learned.

Open your mind/ improve your mindset. Believe in yourself. If you can dream it, you can do it. Only one caveat: You must be willing to dare to dream!

References https://pubmed.ncbi.nlm.nih.gov/31380892/ https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2740206 https://www.ama-assn.org/delivering-care/health-equity/5-hard-won-bits-advice-tomorrow-s-women-physician-leaders https://www.kevinmd.com/blog/2015/01/5-tips-future-physician-leaders.html https://www.thescopeofpractice.com/how-to-be-a-great-physician-leader/ https://www.physicianleaders.org/resources/wellness/mindset/11-tips https://www.medicaleconomics.com/view/challenges-being-female-doctor https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7417925/ https://www.wolterskluwer.com/en/expert-insights/women-in-medicine-face-uniquechallenges https://nam.edu/gender-based-differences-in-burnout-issues-faced-by-women-physicians/

Amita Kumar, MD has been practicing primary care medicine in San Antonio since 2013. She practices at HealthTexas Medical Group. Her special interests include postmenopausal treatments, diabetes and eczema with a strong holistic approach in treating the whole person. Dr. Kumar is a member of the Bexar County Medical Society. Visit us at www.bcms.org

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Chapters of the American Medical Women’s Association (AMWA) in San Antonio By Anna Tomotaki, Sofia Russo, Karen Barcenas-Villarreal and Sarah Slaton

The History of The American Medical Women’s Association The American Medical Women’s Association (AMWA) is an organization of women physicians, medical students and other persons dedicated to serving as the unique voice for women’s health and the advancement of women in medicine. Medical schools across the country, including the UT Health San Antonio Long School of Medicine and the UIW School of Osteopathic Medicine (UIWSOM), have AMWA chapters with student and physician members. AMWA is the oldest multispecialty organization dedicated to advancing women in medicine and improving women’s health. The national organization was founded by Dr. Bertha VanHoosen in 1915 in Chicago, at a time when women physicians were an underrepresented minority. While women in medicine have increased in numbers, problems and issues regarding gender equity persist. AMWA has been addressing these issues for over 100 years. The mission of AMWA is to advance women in medicine, advocate for equity and ensure excellence in health care. The long-term vision of AMWA is a healthier world where women physicians achieve equity in the medical profession and realize their full potential. The Challenges Faced by Women in Medicine What is unique about AMWA is its focus on both personal and professional development as well as its commitment to social issues, professional issues and health issues alike. Some of the key areas AMWA has worked to address over its 100+ year history include the Role Model Gap, Mentoring Gap and Pay Gap between male and female physicians (AMWA, 2020). In 2018, there were over 2,600 male department chairs compared to only 618 female chairs. Additionally, while over half of entering medical school classes consist of women, the makeup of the faculty instructing them looked much different – only 18% of full professors were women in 2019. Furthermore, when evaluating the salaries of new physicians entering the workforce, female physicians earned an average of $26,367 less than their male counterparts (AMWA, 2020). One national study found that among physicians with faculty appointments at 24 U.S. public 28

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medical schools, female physicians make about 10% less than their male counterparts at all academic ranks, even after accounting for age, experience, specialty, faculty rank, and measures of research productivity and clinical revenue ( Jena et al., 2016). Medscape’s 2019 Physician Compensation Report found an even greater disparity, with full-time male primary care and specialist doctors earning 25% and 33% more, respectively, than their female counterparts. In order to advance gender equity in medicine, it is important to recognize the history of the profession, the progress that has been made and the work still to be done. AMWA works to educate the medical and non-medical communities alike regarding the aforementioned issues

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that contribute to the struggle and inequalities faced by women entering this historically male-dominated field. The hope is to continue to work towards a better and more equitable health care environment through which women physicians can better serve patients and the community. The AMWA Chapter at UIWSOM The UIWSOM chapter of AMWA strives to educate and empower future women physicians and health professionals to reach their goals. Through mentorship, community engagement, education, collaboration and leadership, the women of AMWA strive to make a difference in their community while furthering professional development. Together, we continue to address and remedy the inequities in the medical profession and inspire women in health care to realize their worth. UIWSOM’s AMWA chapter has created a community of empowered women, empowering other women. As a group, we lift each other up, listen to one another, inspire, educate and push each other to reach our personal and collective goals. The chapter creates opportunities for mentorship, scholarship and giving back to our community. The organization provides a space for women who are passionate about their professional goals to belong. Aiming for Professional Identity Development The AMWA provides opportunities throughout the United States for women to enhance their professional identities, advocate for equity and improve the overall quality of care. AMWA national members have access to multiple programs to help reach these goals. One of the most vital programs AMWA provides is the AMWA LEADS Leadership Development program. This program educates, empowers and encourages advancement of women in health care through leadership and professional growth. As women in health care, AMWA recognizes that we are already leaders, but encourages us to find our voices and claim the roles we deserve. AMWA IGNITE has proven to be a valuable resource for current female medical students. This program provides frequent live lectures that are designed specifically for this demographic by female physicians across the country. As members at UIWSOM, we have access to the entire IGNITE lecture series library featuring dozens of lectures covering some of the most important topics in health care today, such as reproductive life planning, gender bias and equity, mental health, resilience and infertility among physicians. This lecture series addresses issues we, as future female physicians, could face. These issues of concern to female medical students are not usually addressed in medical school lectures. After watching multiple live lectures through this program, we feel more equipped to navigate the world of health care as female physicians. If you are a female medical student, you should discover the benefits the IGNITE program has to offer.

UT Health San Antonio students pictured left to right: Mahnoor Liaqat "Treasurer," Natasha Paul "Philanthropy co-chair," Sofia Russo "President," Anna Tomotaki "Vice president," Kelsey Kohler "Events Chair," Maryann England "Philanthropy co-chair." Not featured: Katerina Papanikolaou "Secretary."

The AMWA Chapter at the UT Health Long School of Medicine As an integral part of the UT Health Long School of Medicine community for over 20 years, AMWA aims to bring together medical students and physicians for a variety of professional and mentorship opportunities, volunteer experiences and fellowship. Medical students are welcomed as part of the organization as soon as they begin their first year with the hope of providing a support network and community immediately upon starting their journey in medicine. Addressing the Mentor Gap is a key tenet of the chapter. One of the main initiatives is the AMWA Mentorship Program, in which MS1s and MS2s are paired together in an effort to provide them both with meaningful connections and resources to advance their personal and professional goals. Additionally, the Mentor & MenTEA event is a favorite among both students and faculty. First and second year medical students are given the opportunity to hear from a panel of esteemed women in medicine on a variety of important topics, including how to navigate academic medicine versus private practice, maintain work-life balance and manage stressors while also having a successful career. This is a great opportunity to network, meet potential mentors and get advice/guidance from female physicians in the community while sipping on some tea! continued on page 30 Visit us at www.bcms.org

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continued from page 29

of specialties, with the last panel including orthopedic surgery, OB/GYN, family medicine, vascular surgery, pediatrics and dermatology.

In addition to supporting the female students at the Long School of Medicine, AMWA also works to support the members of our community. The Thrivewell Cancer Foundation is dedicated to finding a cure for breast cancer and supporting patients and survivors throughout their journey. AMWA is a big supporter of Thrivewell’s Diva Program, a wellness community-based program for these wonderful, strong women. One of the largest community efforts is an annual MS1 versus MS2 Powderpuff football fundraiser game, which is preceded by a week-long raffle and silent auction that aims to raise funds for the Diva Program. Due to the constraints put in place by the COVID-19 pandemic, the powderpuff game last year was revitalized into a virtual 5K, in which participants were supplied with a guide to several scenic spots around San Antonio to complete the race, in addition to holding an online raffle and auction. Despite the unconventional style of this fundraiser, over $6,000 was raised and donated to Thrivewell. Another way AMWA supports Thrivewell and interacts with the San Antonio community at large is through the Women in Medicine and Law Dinner. This dinner is a festive night celebrating the women in the Diva Program while enjoying good food and meeting female physicians and lawyers in San Antonio. One of the final events of the academic year is the multi-specialty match panel where fourth year students who have matched into a residency program have the opportunity to speak about their experience throughout medical school, choosing a specialty and the residency match process. Every year, the panel hosts women who have matched into a wide range

SAN ANTONIO MEDICINE • November 2021

The Future of the AMWA In a society still grappling with several women’s issues, AMWA seeks to provide a space for female medical students and physicians to connect with each other and lift each other up. While the COVID19 pandemic has provided constraints and challenges to usual events, AMWA has still been able to be an active presence on campus and within the community. The mentality of AMWA lives on in every member of the medical school class and has provided an amazing network of future women physicians that will continue to endure for years to come. References AMWA. (2020, January 9). About AMWA. American Medical Women's Association. Retrieved September 28, 2021, from https://www.amwa-doc.org/about-amwa/. Jena, A. B., Olenski, A. R., & Blumenthal, D. M. (2016). Sex differences in physician salary in US Public Medical Schools. JAMA Internal Medicine, 176(9), 1294. https://doi.org/10.1001/ jamainternmed.2016.3284 Kane, L. (2019, April 10). Medscape Physician Compensation Report 2019. Retrieved September 28, 2021, from https://www.medscape.com/ slideshow/2019-compensation-overview-6011286. Anna Tomotaki and Sofia Russo are medical students at the UT Health Long School of Medicine. Karen Barcenas-Villarreal is a second-year DO/MPH student at the University of the Incarnate Word School of Osteopathic Medicine. Sarah Slaton, a native of Friendswood, TX, is a second-year DO/MPH student at the University of the Incarnate Word School of Osteopathic Medicine.

WOMEN IN MEDICINE

Creating Resiliency in Health Care

ur health care system has a long history of resiliency, so it was not surprising that various adaptations have been quickly implemented, analyzed and adjusted throughout the pandemic. What was surprising was the fragility of the infrastructure undergirding the health care system. As individuals working in health care, we are often asked to modify our work schedules, assume new responsibilities and balance multiple priorities. What we typically aren’t asked to do is reconstruct a diminishing – and sometimes nonexistent – workforce. While much attention has been rightly focused on the expanding importance of women in medicine, that focus typically centers around the increase in female physicians in residency programs in all specialties. It rose from 28.3% in 2007 to 36.3% in 2020, according to the AAMC's Physician Specialty Data Reports from 2008 to 2020. With a steady growth in the number of female medical students, 2019 marked the first time the majority of U.S. medical school students (50.5%) were women. What often is not reported is the growth in women in all sectors of health care – from the exam room to the front desk or from the ER to the patient’s side. In fact, the U.S. Census Bureau’s American Community Survey reveals the number of full-time, year-round workers in health care occupations has almost doubled since 2000, increasing from five million to nine million workers, or 76% of all health care workers. There’s not a single component of the health care system currently not struggling with hiring and retaining qualified health care workers – male or female. The COVID-19 pandemic has brought to light the delicate balance between resilience and fragility, especially as it relates to recruiting, retaining,

managing and engaging our workforce. Although the pandemic has caused both male and female health care workers to exit the workforce – either temporarily or permanently – 76% of that workforce is female. When daycares closed (and continue to open and close sporadically) and school became virtual, many of our health care workers such as medical assistants, x-ray and ultrasound technologists, and nurses exited to meet other family obligations. Turnover within the first six months of employment has skyrocketed, and each day it becomes more challenging to keep our clinics, ambulatory surgery centers and hospitals operational. The stress of providing front-line health care amidst a pandemic that is stretching close to two years in duration has created both a challenge and an opportu-

By Alan D. Winkler, MHSA

nity. We deal with the challenge daily, but we have not leveraged the opportunity to its fullest potential. Medical practices can no longer function in a vacuum of information where processes remain static over long periods of time. Patient demands are increasing, employees expect pay increases, bonuses and benefit enhancement, despite the financial strain with which most practices are struggling; and dependability is defined day-by-day versus over a year or over a career. There has never been a more important time for physicians, advanced practice providers (APPs) and administrative staff in medical practices to collaborate. Acquisitions, changing insurance plan guidelines and state/federal regulatory changes demand additional training and, perhaps most impor-

continued on page 32 Visit us at www.bcms.org

WOMEN IN MEDICINE

continued from page 31

tantly, increased networking among these professionals. Physicians have professional and trade associations, like the Bexar County Medical Society, to keep them abreast of significant changes in the marketplace; APPs have access to information through the Texas Medical Board (PAs) and the Texas State Board of Nursing, as well as through a plethora of trade associations. For medical practice administrators, that link is the Medical Group Management Association and, in particular, the Texas MGMA and the San Antonio MGMA (SAMGMA) chapter. Investing $150 in a joint Texas MGMA/SAMGMA annual membership is reasonable, considering the access to a network of medical practice professionals and the resources (often webinars and printed materials) needed to adapt and thrive. All health care workers depend on having adequate resources,

and there has never been a time when those resources were more important. Collaboration is the key to resiliency – professionally and emotionally – in dealing with unprecedented challenges. Providing opportunities for growth for medical practice leaders is key to creating a stable, financially beneficial, high quality delivery system. Health care’s legacy of episodic challenges followed by periods of quiet seems to have been disrupted permanently. It is one aspect of this field which simultaneously makes it fulfilling and frustrating, or engaging and exhausting. As we welcome a new generation of diverse health care providers, it is important to include all stakeholders in its design. After all, we have a history of resilience to uphold.

SAN ANTONIO MEDICINE • November 2021

References 1. https://www.aamc.org/news-insights/nation-s-physician-workforce-evolves-morewomen-bit-older-and-toward-different-spe cialties 2. https://www.census.gov/programs-surveys/acs.html Alan D. Winkler, MHSA is the current president of San Antonio MGMA and Executive Director of Urology San Antonio, P.A. Alan is also a Fellow in the American College of Medical Practice Executives. The Bexar County Medical Society is a Silver Sponsor of the San Antonio MGMA.

SAN ANTONIO MEDICINE

Psychodermatology:

The Significant Interaction Between the Mind and Skin By Faraz Yousefian, DO, Liliana Espinoza, BS and Chelsea Kesty, MD

The connection between the mind and body has been studied for many decades, and without a doubt, there is a strong link between these two entities. The largest and most visible organ of the body, which is immediately accessible to the public eye, is the skin. In a culture that emphasizes the importance of beauty, any insult to one’s physical appearance can lead to substantial psychological disturbances, or even exacerbate them. Notably, the relationship between the mind and body is reciprocal. As such, any disturbance in the mind can also be manifested in different body organ systems, including the skin. This suggests that any dermatological manifestations or psychological disorders have the potential to initiate an aberrant cycle where both conditions are worsened by the occurrence of the other. To put an end to this cycle, it is important that both psychological and dermatological conditions are identified and treated accordingly. It is highly recommended that health care providers conduct a psychological assessment of their patients in every patient encounter. This evaluation is particularly important in the fields of psychiatry and dermatology, as there are multiple conditions in one specialty that can produce manifestations in the other, and vice versa. In order to ensure the holistic health improvement of the patient, a collaborative approach between psychology and dermatology should be implemented. One current study suggests that approximately 33% of patients seeking dermatological care have some coexisting psychiatric disorder.1 This rate is higher compared to the general patient population, where 20.6% of individuals are believed to suffer from a mental health disorder.2 Some psychiatric disorders that can manifest themselves via the skin include depression, anxiety, personality disorders, body dysmorphic disorder, substance/medication-induced disorders and cutaneous body image dissatisfaction.3,4 For instance, psycho-cutaneous illness can be seen in patients suffering from obsessive-compulsive or anxiety disorders.5 One of the unhealthy coping mechanisms exhibited by these patients is the constant picking of their skin or hair, which can manifest as excoriation and trichotillomania, respectively.5 Additionally, there are several skin disorders that can be triggered or exacerbated by psychological disorders such as psoriasis, atopic dermatitis, alopecia areata, seborrheic dermatitis, acne and pruritus.3,4 Studies report that patients experiencing dermatological illnesses such as psoriasis were found to have a lower quality of life due to their comorbid anxiety and depression.3,4,6 In addition, stress brought on by their psychological disorder can exacerbate their cutaneous findings, thus initiating the aforementioned aberrant cycle.4 This is one of the primary reasons why psychological disorders are commonly evaluated and diagnosed in dermatology patients. Tools such as self-administrative surveys can be given to patients prior to their visit to aid in the detection of psychological findings; however, referral to psychiatrists or psychologists is a very sensitive topic that should be addressed in person with the patient.3

Because of the sensitive nature of this topic, it is vital to have a nonjudgmental, positive and empathic attitude when counseling patients who are suffering from psycho-cutaneous disorders.6 A multidisciplinary approach and collaboration between health care providers including primary care, psychiatry, psychology and dermatology disciplines can provide and create solutions to treat different aspects of a patient’s disease.7 However, this might be a cumbersome undertaking in the short period of time allotted to a single patient encounter. For this reason, the new emergence of psychodermatology, which involves a dermatologist with psychotherapy training, has started to gain more traction and popularity. Psychodermatology focuses on taking the necessary steps to obtain or maintain skin integrity while addressing and managing a patient’s overall mental health. References 1. Psychocutaneous Disorders - Rook’s Textbook of Dermatology - Wiley Online Library. Accessed September 8, 2021. https://onlinelibrary.wiley.com/ doi/abs/10.1002/9781444317633.ch64 2. Lipari RN. Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. Published online 2019:114. 3. Jafferany M. Psychodermatology: A Guide to Understanding Common Psychocutaneous Disorders. Prim Care Companion J Clin Psychiatry. 2007;9(3):203-213. 4. Kuhn H, Mennella C, Magid M, Stamu-O’Brien C, Kroumpouzos G. Psychocutaneous disease: Clinical perspectives. J Am Acad Dermatol. 2017;76(5):779-791. doi:10.1016/j.jaad.2016.11.013 5. Koo J, Lebwohl A. Psychodermatology: The Mind and Skin Connection. AFP. 2001;64(11):1873. 6. Rieder E, Tausk FA. Chapter 104. Psychocutaneous Skin Disease. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, eds. Fitzpatrick’s Dermatology in General Medicine. 8th ed. The McGraw-Hill Companies; 2012. Accessed September 8, 2021. accessmedicine.mhmedical.com/content.aspx?aid=56055085 7. Psychocutaneous Medicine. AMA Archives of Dermatology. 1955;72(6):598-598. doi:10.1001/archderm.1955.03730360104019

Faraz Yousefian, DO is an intern at the Texas Institute for Graduate Medical Education and Research (TIGMER) in San Antonio, Texas. He is a member of Bexar County Medical Society. Liliana Espinoza, BS is currently a PhD candidate in the field of neuroscience at UT Health San Antonio where she studies the early effects of a high fat diet on the motor neurons that innervate the heart. She will be pursuing a medical degree upon completion of her doctoral degree. Chelsea Kesty, MD is a second-year dermatology resident at Lehigh Valley Health Network in Allentown, PA. She completed her medical training at the University of South Florida. Visit us at www.bcms.org

SAN ANTONIO MEDICINE

We Are The Same By Ivelisse Velázquez Negrón, MD

We were made from the same essence Our eyes opened to the same light Our souls were filled from the same hope And our minds from the same strength

You let it all escape through your lips And like a hurricane full of words You figured out how to be free And began your journey to heal

Our bodies carry the same trauma That our ancestors printed in our blood Our hearts ache from the same scars That were carved at an early age

And instead of being me the one who helped you It was you who helped me And by being a mere spectator I ended up being saved

Our innocence was robbed from us Because we never understood consent Society only taught us how to behave And how to embrace guilt when we don’t Guilt of not knowing best Of wanting more than this Of being our true selves Of wanting to be truly free And now we carry the same cloud Because silence is less painful Than admitting that we failed And lost our ‘most important’ virtue Now at night is hard to sleep And during the day is hard to trust Because we are safe in our secret space That we created away from all And we decided to call it stress Or to call it a bellyache Some days we justify it and take the blame And then submerge in a lake of pain And though everyone thinks we are different Because I wear a coat and you a hospital gown It was only your courage that sets us apart The day you decided it was enough

SAN ANTONIO MEDICINE • November 2021

– We are the same – I am here to learn

Ivelisse Velázquez Negrón, MD is a resident in the Department of Psychiatry at the UT Health Long School of Medicine. She is a resident member of the Bexar County Medical Society.

Note from the author: This is a poem I wrote on how patients are not different from us. It is about how patients can help us and teach us with their life experience and their courage of how to ask for help. Sometimes we think we should know, and we should be able to take care of our problems without difficulty. However, patients are more than just patients. They are human beings as we are, who suffer as we do and are able to help us grow in unimaginable ways. “We Are The Same” also touches on topics that are important for all women like consent, guilt and shame.

To see more art and literature, scan the QR code to discover more from Connective Tissue.

SAN ANTONIO MEDICINE

LETTER TO THE EDITOR I have just read your October issue through. It is excellent. I particularly like the consistent theme from start to finish of destigmatizing mental health issues/fluctuations/needs, empowering people (professionals and others) to make healthy adaptations/engage

was a beautifully humble example of what we call “use of self ” in social work parlance to heighten awareness and teach self-care. It is very true that the women physicians whom I know well enough to share stories with, shoulder that “second shift” of family care more than most male

their own healing processes, as well as how to discern when outside help is necessary. The article on helping refugees was excellent and nuanced. So timely as well! The post-COVID syndrome article was very interesting… if I may, I would like to share it with a friend in NYC who has suffered daily migraines since having a case of (“mild!”) COVID early on in the pandemic. I was particularly impressed by how your second-year student, Niva Shrestha, thoroughly researched statistics tracing seeds of burnout in later life to medical school “norms” and learned behaviors in the context of high stress and high expectations. Her graph was crystal clear and could be applied to many professions. Dharam Kaushik, MD’s story broke my heart. Tragic to learn from the fatal, suicidal burnout of a mentor. And Nora Vasquez, MD’s essay

physicians do. I love the concept of healing narrative and of course know the writing of Rachel Naomi Remen, MD, but still today got new gems from David Schulz’s review— especially the Talmudic teaching: “We do not see things as they are. We see them as we are.” Not only did I take this to heart personally… but… Bingo: Our national polarities explained! May I also forward this issue to my two women psychiatrist colleagues (one of who is a DO) in Westchester, NY? Thanks again for an illuminating read!

Susan V. Walton, LCSW-R, MFA

If you would like to send a letter to the editor of San Antonio Medicine magazine, please email editor@bcms.org.

Artistic Expression in Medicine By Sarah Cox

Stronger Together, Oil on Canvas

Sarah Cox is a medical student at the Long School of Medicine, UT Health San Antonio, Class of 2023. Visit us at www.bcms.org

PHYSICIANS PURCHASING DIRECTORY Support the BCMS by supporting the following sponsors. Please ask your practice manager to use the Physicians Purchasing Directory as a reference when services or products are needed. ACCOUNTING FIRMS

Sol Schwartz & Associates P.C. (HHH Gold Sponsor) Sol Schwartz & Associates is the premier accounting firm for San Antonio-area medical practices and specializes in helping physicians and their management teams maximize their financial effectiveness. Jim Rice, CPA 210-384-8000, ext. 112 jprice@ssacpa.com www.ssacpa.com “Dedicated to working with physicians and physician groups.”

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 “Leaders in Healthcare Software & Consulting”

ATTORNEYS

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

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”

ASSETT WEALTH MANAGEMENT

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

BANKING

BankMD (HHH Gold Sponsor) Our Mission is your Success. We are the ONLY Physician-Focused Bank in the Country Moses Luevano, President

SAN ANTONIO MEDICINE • November 2021

512.547.6065 mdl@bankmd.com Chris McCorkle Director of Healthcare Banking 210.253.0550 cm@bankmd.com www.BankMD.com “Specialized, Simple, Reliable”

Broadway Bank (HHH Gold Sponsor) Healthcare banking experts with a private banking team committed to supporting the medical community. Shawn P. Hughes, JD Senior Vice President, Private Banking (210) 283-5759 shughes@broadway.bank 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 BB&T (HH Silver 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" Synergy Federal Credit Union (HH Silver 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

Medical Financial Group (★★★ Gold Sponsor) Healthcare & Financial Professionals providing core solutions to Physicians from one proven source. CEO is Jesse Gonzales, CPA, MBA Controller & past CFO of (2) Fortune 500 companies, Past Board President of Communicare Health Systems. Jesse Gonzales, CEO CPA, MBA 210.846.9415 information@medicalfgtx.com Linda Noltemeier-Jones Director of Operations 210.557.9044 lindanj@medicalfgtx.com www.medicalfgtx.com “Let’s start with Free Evaluation and Consultation from our Team of Professionals”

CREDENTIALS VERIFICATION ORGANIZATION

Bexar Credentials Verification, Inc. (HHHH 10K Platinum Sponsor) Bexar Credentials Verification provides primary source verification of credentials data that meets The Joint Commission (TJC) and the National Committee for Quality Assurance (NCQA) standards for health care entities. Betty Fernandez Director of Operations 210-582-6355 Betty.Fernandez@bexarcv.com www.BexarCV.com “Proudly serving the medical community since 1998”

FINANCIAL ADVISOR

medical community. Brian T. Boswell, CFP®, QKA Senior Private Wealth Advisor 512-649-8113 SERVICE@OAKWELLPWM.COM www.oakwellpwm.com “More Than Just Your Advisor, We're Your Wealth Management Partner” Elizabeth Olney with Edward Jones (HH Silver 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 210-858-5880 Elizabeth.olney@edwardjones.com www.edwardjones.com/elizabeth-olney "Making Sense of Investing"

FINANCIAL SERVICES

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 & 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

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!”

SWBC (HHH Gold Sponsor) SWBC for Personal and Practice: Physician programs for wealth

management and homebuying. For You Practice: HR administration, payroll, employee benefits, insurance, and exit strategies. SWBC’s services supporting Physicians and the Medical Society. Michael Leos Community Relations Manager Cell: 201-279-2442 Office: 210-376-3318 mleos@swbc.com swbc.com

HEALTHCARE BANKING

BankMD (HHH Gold Sponsor) Our Mission is your Success. We are the ONLY Physician-Focused Bank in the Country Moses Luevano, President 512.547.6065 mdl@bankmd.com Chris McCorkle Director of Healthcare Banking 210.253.0550 cm@bankmd.com www.BankMD.com “Specialized, Simple, Reliable”

First Citizens Bank (HHH Gold Sponsor) We’re a family bank — led for three generations by the same family-but first and foremost a relationship bank. We get to know you. We want to understand you and help you with your banking. Stephanie Dick Commercial Banker 210-744-4396 stephanie.dick@firstcitizens.com Danette Castaneda Business Banking Specialist 512.797.5129 Danette.castaneda@firstcitizens.com https://commercial.firstcitizens.co m/tx/austin/stephanie-dick “People Bank with People” “Your Practice, Our Promise” Amegy Bank of Texas (HH Silver 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”

HEALTHCARE TECHNOLOGY SOLUTIONS SUPPLIER

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”

INSURANCE

Nitric Oxide innovations LLC, (★★★ Gold Sponsor) (NOi) develops nitric oxide-based therapeutics that prevent & treat human disease. Our patented nitric oxide delivery platform includes drug therapies for COVID 19, heart disease, Pulmonary hypertension & topical wound care. info@NitricOxideInnovations.com (512) 773-9097 www.NitricOxideInnovations.com

HOSPITALS/ HEALTHCARE FACILITIES

UT Health San Antonio MD Anderson Cancer Center, (HHH Gold Sponsor) UT Health San Antonio MD Anderson Cancer Center, is the only NCI-designated Cancer Center in South Texas. Our physicians and scientists are dedicated to finding better ways to prevent, diagnose and treat cancer through lifechanging discoveries that lead to more treatment options. Laura Kouba Manager, Physician Relations 210-265-7662 NorrisKouba@uthscsa.edu Lauren Smith, Manager, Marketing & Communications 210-450-0026 SmithL9@uthscsa.edu Cancer.uthscsa.edu Appointments: 210-450-1000 UT Health San Antonio MD Anderson Cancer Center 7979 Wurzbach Road San Antonio, TX 78229

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

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 www.tmait.org “We offer BCMS members a free insurance portfolio review.”

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

INSURANCE/MEDICAL MALPRACTICE

Texas Medical Liability Trust (HHHH 10K Platinum Sponsor) With more than 20,000 health care professionals in its care, Texas Medical Liability Trust (TMLT) provides malpractice insurance and related products to physicians. Our purpose is to make a positive impact on the quality of health care for patients by educating, protecting, and defending physicians. Patty Spann 512-425-5932 patty-spann@tmlt.org www.tmlt.org

continued on page 38 Visit us at www.bcms.org

PHYSICIANS PURCHASING DIRECTORY continued from page 37

Recommended partner of the Bexar County Medical Society

“UPN is very proud of our 98% customer retention rate”

INVESTMENT ADVISORY REAL ESTATE 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) Rated A++ by A.M. Best, MedPro Group has been offering customized insurance, claims and risk solutions to the healthcare community since 1899. Visit MedPro to learn more. Kirsten Baze 512-658-0262 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

INTERNET TELECOMMUNICATIONS

Unite Private Networks (HHH Gold Sponsor) Unite Private Networks (UPN) has offered fiber optic networks since 1998. Lit services or dark fiber – our expertise allows us to deliver customized solutions and a rewarding customer experience. Clayton Brown Regional Sales Director 210-693-8025 clayton.brown@upnfiber.com David Bones – Account Director 210 788-9515 david.bones@upnfiber.com Jim Dorman – Account Director 210 428-1206 jim.dorman@upnfiber.com www.uniteprivatenetworks.com

MEDICAL BILLING AND COLLECTIONS SERVICES

PCS Revenue Cycle Management (HHH Gold Sponsor) We are a HIPAA compliant fullservice medical billing company specializing in medical billing, credentialing, and consulting to physicians and mid-level providers in private practice. Deion Whorton Sr. CEO/Founder 210-937-4089 inquiries@pcsrcm.com www.pcsrcm.com “We help physician streamline and maximize their reimbursement by 30%.”

SAN ANTONIO MEDICINE • November 2021

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 PHYSICS

Medical & Radiation Physics, Inc. (HHH Gold Sponsor) Medical physics and radiation safety support covering all of South Texas for over 40 years. Diagnostic imaging, radiation therapy, nuclear medicine and shielding design. Licensed, Board Certified, Experienced and Friendly! Alicia Smith, Administrator 210-227-1460 asmith@marpinc.com David Lloyd Goff, President 210-227-1460 dgoff@marpinc.com www.marpinc.com Keeping our clients safe and informed since 1979.

MEDICAL PAYMENT SYSTEMS/CARD PROCESSING

tomized solutions to healthcare professionals, assisted-living facilities, and more. CSI was founded in 1978, it was one of the first companies to move medical testing information from self-service kiosks into the cloud. Brad Bowen, President, CEO 210-434-2713 brad@computerizedscreening.com Katherine Biggs McDonald Brand Development Manager 210-434-2713 katherine@computerizedscreening.com Bobby Langenbahn National Sales Manager 210-363-1513 bobby@computerizedscreening.com www.csihealth.net Extend the Reach of Healthcare. Elevate the Level of Remote Care. Enhance the Patient Experience. 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.”

MOLECULAR DIAGNOSTICS LABORATORY First Citizens Bank (★★★ Gold Sponsor) We’re a family bank — led for three generations by the same family-but first and foremost a relationship bank. We get to know you. We want to understand you and help you with your banking. Stephanie Dick Commercial Banker 210-744-4396 stephanie.dick@firstcitizens.com Danette Castaneda Business Banking Specialist 512.797.5129 Danette.castaneda@firstcitizens.com https://commercial.firstcitizens.co m/tx/austin/stephanie-dick “People Bank with People” “Your Practice, Our Promise”

iGenomeDx ( Gold Sponsor) Most trusted molecular testing laboratory in San Antonio providing FAST, ACCURATE and COMPREHENSIVE precision diagnostics for Genetics and Infectious Diseases. Dr. Niti Vanee Co-founder & CEO 210-257-6973 nvanee@iGenomeDx.com Dr. Pramod Mishra Co-founder, COO & CSO 210-381-3829 pmishra@iGenomeDx.com www.iGenomeDx.com “My DNA My Medicine, Pharmacogenomics”

MEDICAL SUPPLIES AND EQUIPMENT

MORTGAGES

CSI Health (HHH Gold Sponsor) CSI Health is a telehealth technology company providing cus-

SWBC MORTGAGE - THE TOBER TEAM (HHH Gold Sponsor) SWBC for Personal and Practice:

Physician programs for wealth management and homebuying. For You Practice: HR administration, payroll, employee benefits, insurance, and exit strategies. SWBC’s services supporting Physicians and the Medical Society. Jon Tober Sr. Loan Officer Office: 210-317-7431 NMLS# 212945 Jon.tober@swbc.com https://www.swbcmortgage.com /jon-tober

PRACTICE SUPPORT SERVICES

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

Alamo Capital Advisors LLC (★★★★ 10K Platinum Sponsor) Focused on sourcing, capitalizing, and executing investment and development opportunities for our investment partners and providing thoughtful solutions to our advisory clients. Current projects include new developments, acquisitions & sales, lease representation and financial restructuring (equity, debt, and partnership updates). Jon Wiegand Principal 210-241-2036 jw@alamocapitaladvisors.com www.alamocapitaladvisors.com CARR Healthcare (HH Silver Sponsor) CARR is a leading provider of commercial real estate for tenants and buyers. Our team of healthcare real estate experts assist with start-ups, renewals, , relocations, additional offices, purchases and practice transitions. Brad Wilson Agent 201-573-6146 Brad.Wilson@carr.us Jeremy Burroughs Agent 405.410.8923 Jeremy.Burroughs@carr.us www.carr.us “Maximize Your Profitability Through Real Estate” Foresite Real Estate, Inc. (HH Silver Sponsor) Foresite is a full-service commercial real estate firm that assists with site selection, acquisitions, lease negotiations, landlord representation, and property management. Bill Coats 210-816-2734 bcoats@foresitecre.com https://foresitecre.com “Contact us today for a free evaluation of your current lease” The Oaks Center (HH Silver Sponsor) Now available High visibility medical office space ample free parking. BCMS physician 2 months base rent-free corner of Fredericksburg Road and Wurzbach Road adjacent to the Medical Center. Gay Ryan Property Manager 210-559-3013 glarproperties@gmail.com www.loopnet.com/Listing/84348498-Fredericksburg-Rd-SanAntonio-TX/18152745/

RETIREMENT PLANNING

Oakwell Private Wealth Management (HHH Gold Sponsor) Oakwell Private Wealth Management is an independent financial advisory firm with a proven track record of providing tailored financial planning and wealth management services to those within the medical community. Brian T. Boswell, CFP®, QKA Senior Private Wealth Advisor 512-649-8113 SERVICE@OAKWELLPWM.COM www.oakwellpwm.com “More Than Just Your Advisor, We're Your Wealth Management Partner”

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. Cindy M. Vidrine Director of Operations- Texas 210-918-8737 cvidrine@favoritestaffing.com “Favorite Healthcare Staffing offers preferred pricing for BCMS members.”

TELEHEALTH TECHNOLOGY

CSI Health (HHH Gold Sponsor) CSI Health is a telehealth technology company providing customized solutions to healthcare professionals, assisted-living facilities, and more. CSI was founded in 1978, it was one of the first companies to move medical testing information from self-service kiosks into the cloud. Brad Bowen President, CEO 210-434-2713 brad@computerizedscreening.com Katherine Biggs McDonald Brand Development Manager 210-434-2713 katherine@computerizedscreening.com Bobby Langenbahn National Sales Manager 210-363-1513 bobby@computerizedscreening.com www.csihealth.net Extend the Reach of Healthcare. Elevate the Level of Remote Care. Enhance the Patient Experience.

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, please contact: Development Director, August Trevino august.trevino@bcms.org or 210-301-4366

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AUTO REVIEW

SAN ANTONIO MEDICINE • November 2021

AUTO REVIEW

2021 BMW 440i Convertible By Stephen Schutz, MD

The 2021 BMW 440i is all new, and it represents the latest generaalso do everything that iDrive does using your finger, because it’s a touchtion of the venerable 3-series BMW, which dates back to (can it have screen. And the gauges, which look mostly the same, are now virtual. been that long ago?) 1977. The original E21 320i, which was available The materials and surfaces look and feel lux, except for a few exceponly as a two-door coupe back then and is a favorite of mine, added tions here and there. And sitting in the 440i is a very pleasant experience significantly to BMW’s nascent popularity in the U.S. during its run, thanks to the excellent tech and careful attention to detail in the selecand it remains popular with enthusiasts today. tion of those materials. It used to be that only Audi seemed to care The following E30 generation of the 3-series moved the sales needle about making interiors that looked and felt like they were worth the even more, due in part to its prominent positioning in the 1986 cineextra money, but now every mainstream luxury automaker does too. matic phenomenon, “Pretty in Pink,” and the 3-series has been a mainDriving the 440i is equally pleasant. It’s seriously quick thanks to a stream vehicle here ever since. 382 hp turbocharged in-line six-cylinder engine In 2014, BMW decided to rebadge their twothat now has a 48-volt mild hybrid assist (its 0Sitting in the 440i is a very door 3-series models as 4-series, and now we live 60 time is 5.1 seconds). However, electrically asin a world where there are 3- and 4-series BMWs pleasant experience thanks to sisted steering (that’s too light for me), a built on the same platform. the excellent tech and careful suspension that’s set up to favor ride quality over Last year, the 4-series further distanced itself handling and, mostly, a curb weight of 4,171 lbs. attention to detail. from its 3-series sibling with a new and contromean that this BMW is more comfortable cruisversial grille. The automotive press is split on ing into town for dinner than attacking your fait—I’d say they’re 60% negative and 40% positive—but I like it. vorite back road. That grille was on the 440i convertible that I tested recently, and I Pricing starts at just under $65,000 for the 440i convertible, but think it works on the 4-series coupe and convertible, as well as the choosing the four-cylinder 430i convertible saves around $11,000 and ultra-sporty M3 sedan, where it also resides (I’m not a fan of the big doesn’t really lose you that much (mainly the rich in-line six sound grille on the 4-series Gran Coupe, by the way). But I can understand and some performance). the negativity. Do I think it looks like beaver teeth, a 1950s Edsel or As always in a German car, adding options or option packages, any number of other pejorative descriptors I’ve read? No. which are numerous, can result in a much more expensive car than The rest of the 440i’s exterior looks crisp and modern, as you’d exyou’re expecting. Fuel economy is 23 mpg city and 31 mpg highway pect. The car is around the size of a Ford Mustang, which is the right (the 430i version is 24/33; not that much better). size for its target customer: a 50-ish man or woman in their peak earnBMW’s 4- and 3-series cars are perennially popular, and they coning years who doesn’t need to do a lot of ferrying kids hither and yon. tinue the legacy of some wonderful predecessors, particularly the E21 The styling features a blend of curves and creases that just work, and and E30 models that many of us remember fondly from our youth. the squinting head and tail lights emphasize the sleekness of this deWhile the 440i convertible is heavier and less nimble than those classic sign. I’m not a BMW fanboy, but I think it would take a clear antiBMWs used to be, it’s still an excellent car that will appeal to successful BMW bias not to call the 440i convertible handsome. professionals who don’t need to haul kids around. Interestingly, luxury convertibles have moved full circle when it comes to their tops. In the 1960s, all convertible tops were cloth, and As always, call Phil Hornbeak, the Auto Program Manager at it stayed like that until retractable steel tops became popular in the BCMS (210-301-4367), for your best deal on any new car or truck late 1990s. It seemed like those tops might take over completely, and brand. Phil can also connect you to preferred financing and lease rates. then about 10 years ago cloth tops made a comeback, and now retractable hardtops are gone. Stephen Schutz, MD, is a board-certified gastroenterologist Inside the 440i, everything’s just where you left it the last time you who lived in San Antonio in the 1990s when he was stationed drove any modern BMW. An iDrive wheel sits on the center console and here in the US Air Force. He has been writing auto reviews controls all of the functions on the central screen, except now you can for San Antonio Medicine since 1995.

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San Antonio Medicine November 2021

Articles inside

By Taylor Sullivan, DO

Award Recipients

A Working Mom in Progress By Brittany Lenz, MD

By Lou Anne Wellford, MD

Award in Her Honor By Mary E. Nava, MBA, BCMS Chief Government Affairs Officer

2021 Women Leaders in Medicine Awards Event

in Medicine By Cara J. Schachter and Allison Foster

Pandemic By Monica Verduzco-Gutierrez, MD