by Attending an Alcoholics Anonymous Meeting By Lori Kels, MD, MPH and Madeline Kundler

Undergraduate Medical Education:

Developing Empathy for Patients with Substance Use Disorders by Attending an Alcoholics Anonymous Meeting

By Lori Kels, MD, MPH and Madeline Kundler

The integrated curriculum at University of the Incarnate Word School of Osteopathic Medicine (UIWSOM) introduces learners to the topic of substance use disorders during their first year. The UIWSOM curriculum utilizes a spiral approach to the curriculum to reinforce key concepts. Formal substance use disorder teaching occurs during large group didactics, small group case-based discussions and a recovering physician patient panel during the preclerkship phase.

During the psychiatry clerkship in the third year, learners are required to attend an Alcoholics Anonymous meeting. Many medical schools across the country have a similar requirement, in part based on evidence that increased exposure to treatment of patients with substance use disorders during medical education is correlated with increased empathy towards their patients.1 At UIWSOM, learners write a reflection on their experience after attending the meeting. They often report having a more meaningful and positive experience than expected. Excerpts from some reflections are shared below, with permission from each learner.

“As most medical students, I learned the basic sciences through reading textbooks. For psychiatry, most of my time was spent trying to differentiate the dozens of antipsychotic medications or wondering why a psychiatrist would prescribe one SSRI over the other.

For Alcohol Use Disorder, I concentrated on the timeline of symptoms and knew there were many nonpharmacologic treatment strategies. I read about cognitive behavioral therapy, patients can greatly

improve with the use of support groups or maintaining current relationships. I could tell you to include those management options in the plan for my clinical notes, but I never knew how these groups and therapies truly helped and impacted patients.

During my psychiatry clinical rotation, I observed an Alcoholics Anonymous Meeting, I walked into a small house filled with around 20 people. Each person shared their history of addiction and each story vastly differed.

At the meeting, I introduced myself as a medical student and I came to learn about Alcoholics Anonymous (AA). Each member shared their stories without hesitating. They trusted me with their vulnerability. After the meeting, I was individually greeted by most members that wanted to share more with me and even thanked me for my openness. My overall experience while attending these meetings as a medical student changed my view of Alcoholics Anonymous. It deepened my understanding of the chronic disease of alcoholism and it encouraged me to continue learning and observing all the possible treatments for addiction, and now that I’ve not only read but seen the benefits of Alcoholics Anonymous, I can confidently recommend it for my future patients.”

“It was nothing like I was expecting… It was empowering for me to see how these people wanted to give back to the community that did so much for them. Overall, I was blown away of the stereotypes that were broken by me going to this AA meeting and how many people need to experience these meetings to understand the hardships people are going through.”

“I had a lot of respect and developed more empathy for my group… I learned to challenge my bias I had for individuals who are suffering from substance abuse, I learned it was not a moral dilemma but one that included environmental trauma and hardships which are not always apparent at first glance. I am more humbled and grateful for all the opportunities I was given and the family support I am given. I become more understanding and I know I will be a more compassionate physician from this experience.”

“Being a family member of someone with alcohol use disorder is exhausting and heartbreaking, but attending this AA meeting reminded me just how heartbreaking and exhausting it is to be a person with alcohol use disorder.”

“I learned that many of the members had a daily struggle to fight the urge to use, especially when life got tough.”

“I was reminded of the importance of always extending grace to people, because you never know what someone may be going through. The stories that these men and women shared were sobering and they opened my eyes to not be so quick to judge.”

“The thing I learned that was the most compelling for me was the way each woman described their compulsion to drink. They each took turns explaining their experience, but they all had a similar theme. Even when they knew that their lives were going awry and faced with serious consequences, they could not stop the craving and compulsion to drink. This made me realize how debilitating this disorder is, and how sad it is that there are still people who think it’s simply a will-power issue.”

We thank the learners for their willingness to share their experiences and reflections with San Antonio Medicine Magazine readers.

References 1 Kastenholz, K.J., Agarwal, G. A Qualitative Analysis of Medical Students’ Reflection on Attending an Alcoholics Anonymous Meeting: Insights for Future Addiction Curricula. Acad Psychiatry 40, 468–474 (2016). https://doi.org/10.1007/s40596-015-0380-3

Lori Kels, MD, MPH is a board-certified psychiatrist and an Associate Professor at the University of the Incarnate Word School of Osteopathic Medicine, where she serves as the Psychiatry Clerkship Director. She is also a member of Bexar County Medical Society (BCMS) and serves as the UIWSOM representative on the BCMS Board of Directors.

Madeline Kundler is a medical student interested in Psychiatry at University of the Incarnate Word School of Osteopathic Medicine, Class of 2024.

36th Annual BCMS Auto Show

BCMS held our 36th Annual Auto Show on Thursday, October 20th. Over 300 BCMS physicians and family members attended. It was a lovely evening filled with food, drinks and music by "The Elvis Impersonator”, Travis Hudson. Thank you to our Sponsors: Genesis Care, San Antonio MGMA, Nolan, Fogo De Chao, Hard Rock, Enrique Thomas Experience, Sustenio, and Teppan Tx. Big Thanks to the following Dealerships: GUNN Acura, Audi, Blue Bonnett Dodge, Northside Ford, Northside Honda, North Park Lexus, North Park Lincoln, Northside Mercedes-Benz and North Park Subaru for displaying your alluring vehicles, making the night so special. Save the date for next years’ Annual Auto Show, October 26, 2023.

Tax Strategies For Physicians

By Jeffrey W. Bryson, Attorney

With calendar year 2022 quickly coming to an end, now is the optimal time to develop a strategy for maximizing permissible year-end deductions in order to minimize tax exposure and ensure a tax-efficient outcome. Too often physicians either overlook some of their personal and business tax deductions or misunderstand how best to take full advantage of the deductions available to them. This article describes some year-end tax planning strategies for 2022 and later years.

Background

The Tax Cuts and Jobs Act of 2017 (TCJA) made several significant changes to the individual income tax, including reforms to itemized deductions, an expanded standard deduction and lower marginal tax rates across brackets.

One significant change made by the TCJA was an increase in the standard deduction to $25,900 for 2022 and $27,700 for 2023 for married taxpayers filing jointly. Itemized deductions can only be claimed if all itemized deductions add up to more than the standard deduction. The most common expenses that qualify as itemized deductions include mortgage interest and charitable giving (discussed below).

Maximizing Charitable Donations

In order to claim a tax deduction for a charitable contribution, generally it is necessary to forgo the standard deduction in favor of itemized deductions. Physicians who previously utilized charitable donations as part of their overall itemized deduction planning, may not be able to benefit from making smaller charitable donations in 2022 as a result of changes made by the TCJA.

One possible workaround is to “stack” charitable donations in a single tax year. For example, assuming married physicians wish to donate $15,000 annually to a favorite charity and wish to maximize the benefit of these deductions. Instead of giving $15,000 in 2022, the couple may consider giving $15,000 of the cash bequest on January 1, 2023 and

another $15,000 on December 31, 2023. This stacking strategy will allow the full gift to be claimed as an itemized deduction in 2023 which may reduce their taxable income.

As the 2022 calendar year end approaches, another tax planning strategy for physicians who do not want to donate cash is to consider donating appreciated securities instead. Donating appreciated securities has two major benefits. First, the amount of the charitable donation will be the fair market value (FMV) of the security on the date of contribution. For example, stock purchased in 2017 for $100 may today be worth $400 which is the FMV of the stock. A donation of the stock to a favorite charity will be eligible for a deduction of $400.

Another benefit to donating appreciated securities is the avoidance of taxable gain on its sale. Normally when a security is held over a year and sold for a gain, capital gains taxes are owed on the gain at a rate as high as 20%. If the charity subsequently sells the security, even for a substantial gain, no capital gains taxes are owed.

Mortgage Interest Deduction

As mentioned above, the home mortgage interest deduction is one of the most common expenses that allows high-income taxpayers to itemize their deductions. Unfortunately, the TCJA decreased the available interest deduction to the first $750,000 of mortgage debt for a primary home, down from $1,000,000 before the passage of the TCJA. The limitation on home mortgage interest applies to loans taken out or refinanced after December 15, 2017.

For example, a physician who takes out a mortgage loan for $900,000 in 2017 can probably deduct all of the interest on the loan on his tax return. On the other hand, interest on the same mortgage taken out in 2022 may be restricted by the TCJA and limited to interest on the first $750,000 of principal value.

Refinanced mortgage loans are also subject to the limited interest deduction. With mortgage interest rates rising, the demand for refinancing loans may be less common but it is still a good strategy to check with a CPA prior to refinancing a home loan to avoid inadvertently losing a portion of the interest deduction.

In addition to the itemized deductions for charitable contributions and mortgage interest, physicians may further reduce their taxable income by claiming the following personal deductions which are often overlooked or underutilized:

Retirement Plan Contributions

Pre-tax salary deferral contributions are a deduction that can often be overlooked by physicians. Retirement plans for physicians employed by a hospital or medical group can include a 401(k), 403(b) or 457 plan and allow a physician avoid taxes on the compensation deferred under the plan. For example, if a physician who earns $300,000 per year defers the maximum amount to an employer sponsored 403(b) Plan ($20,500 for 2022 and $22,500 for 2023) for the 2022 calendar year, the physician will only be taxed on $279,500 for 2022. Deferrals and earnings on the deferrals are generally not taxable until withdrawn from the plan.

Small physician groups can benefit by implementing a 401(k) plan. A 401(k) plan works much like a 403(b) plan and permits pre-tax salary deferral contributions to the plan, subject to certain annual limitations.

For self-employed physicians, a SEP-IRA allows for a pre-tax deferral of up to 25% of earnings not in excess of $61,000 for 2022. The catch with a SEP-IRA is contributions must be made to the plan at the same rate for all eligible employees.

The benefit of implementing these types of retirement plans is a current deduction for plan contributions and tax-deferred growth on plan investments.

Tax Loss Harvesting

Tax loss harvesting is the practice of selling some underperforming investments at a loss in order to offset gains realized on the sale of other investments. Under IRS rules, taxes are only owed on the net gain realized, so offsetting investment gains with investment losses can reduce taxable income and create a tax savings for the physician.

Tax loss harvesting must be completed by the end of the calendar year. Accordingly, in order to utilize this tax planning strategy for 2022, the transactions must be completed by December 31, 2022.

Something to keep in mind when utilizing this strategy is the rules for tax loss harvesting preclude recognizing a loss on the disposition of stock or securities when a substantially similar stock is purchased within the 61-day period commencing 30 days before and ending 30 days after the date of sale. In other words, a taxpayer cannot sell a stock at a loss to claim the tax benefit and repurchase the stock the next day at the lower price. Known as a “wash sale,” the IRS may disallow realization of the artificial tax loss and the taxpayer will be unable to utilize the resulting tax break.

These are just a few year-end tax planning steps that can be taken to save on taxes. We encourage physicians and other high-income taxpayers to discuss these year-end tax planning strategies with their personal tax advisors to determine what works best for them.

Jeffrey W. Bryson is an Attorney at Kreager Mitchell, PLLC a BCMS Circle of Friends sponsor.

Many Hands, Many Masks, One Mission

By Christopher Ruano

It was January 21, 2020, and I vividly recall reading an online article about our Nation’s first case of SARS-CoV-2 (COVID-19). It was a day unlike any other – this one felt strangely ominous, somewhat distant, but quite real. I began to think about how we as a people would respond to this invisible, rapidly spreading pathogen that was spiraling into what would soon become a global pandemic. I began to rationalize these rapidly unfolding events through the lens of our shared American experience: I knew that we would rise to this occasion and help one another, because we have done it so many times before throughout history. After all, we are the people who reached the Moon, who liberated the oppressed in World War II, and who, despite our many growing pains and stumbles along the way, are at our core, decent and honorable people. Once again, Americans from all walks of life stood up and answered the call, but this time it would be different. Much different. This time we would face down an invisible enemy that knew neither boundaries nor limitations. To borrow the famous words of Apollo 13 Commander, James "Jim" Lovell, “Houston, we’ve had a problem”.

My name is Christopher Ruano – I am a US Army veteran and present-day Threat Intelligence Advisor with over 20 years of global operational experience. Although, I have been with the BCMS PPE Donation Program since its inception in early April 2020 and have since directed and worked in every facet of the program as a contractor, this short story is not about me. Rather, it is about how public and private community stakeholders banded together to respond to what would soon become a national emergency and felt more locally as a critical shortage of PPE supplies for underserved medical clinics, and the public at large. Further, it is a first-hand account that seeks to properly recognize the countless people who have helped to make this program a model in public-private emergency response cooperation in a time of great need.

The BCMS PPE Program was started in April 2020 by a small group of bright, ambitious and publicly focused medical students, who saw the immediate need to get involved in the COVID-19 response. Of noteworthy mention: Gwendolyn Quintana (now MD), Yvette Lopez and Kayla Pineda, who went on to form the Student Alliance for Emergency Response (SAFER Texas). Working directly with private sector donors, the team quickly gathered significant personal protective equipment (PPE) contributions from the home improvement and construction industries, thus setting the stage for what was to become a large donation influx from various private sources in the coming weeks and months ahead.

The SAFER team also spent a great deal of time coordinating large pallets of PPE from the Texas Division of Emergency Management (TDEM), by way of the Southwest Texas Regional Advisory Council (STRAC). The first few weeks of the program also saw a steady stream of medical student volunteers, who donated their free time away from classes and exams, to deliver hundreds of boxes of PPE to medical clinics across the greater San Antonio area. It is fair to say that this critically timed coordination saved countless lives and protected hundreds of frontline medical personnel, who individually on many occasions, warmly thanked the students in person, by phone and by email for their strenuous efforts.

The first several months of the program were incredibly busy, and this meant that the BCMS conference room would soon be repurposed as a storage facility for N-95 masks, surgical masks, Level IV gowns, coveralls, eye protection and other protective equipment. Thanks to Melody Newsom, present-day CEO (then Chief Operating Officer) of BCMS, the timely decision to take in one million PPE articles into storage was made, and as a result, the program’s sustainability was etched into stone – this time at scale. We were now truly ready, willing,

and able to meet the many challenges that lay ahead, but how would we manage it all? What systems would we use? How would we account for the donations and accurately report them to state and local agencies? How would we stay in constant contact with stakeholders, donation sources and clinics? These important questions led us to the creation, design and implementation of a proprietary emergency management PPE database that would serve as the center point for the program’s entire operations from end to end.

The PPE database took two weeks of around-the-clock efforts to first conceptualize, correctly build and then test under pressure (and did I mention test it some more?) Like any database technology project, there was a continuous need for the refinement and optimization of the records, the formatting and the reporting processes. Ours was no exception to this rule. After one month of real-world application (also known as bumps in the road), the system kinks were finally ironed out, the critical processes were clearly identified, and what emerged soon after grew to become a repeatable, scalable, and ultra-effective emergency management database that has successfully accounted for 100% of all PPE articles and their destinations across South Texas and beyond.

Fast forward to today, the program has successfully donated and delivered over 650,000 items of PPE, effectively meeting the PPE needs of BCMS members and thousands of medical practitioners alike. Additionally, BCMS donated almost 6 million PPE articles to the San Antonio Food Bank, over 300,000 to the Texas Med Clinic, Haven for Hope, Catholic Charities and dozens of community sources such as Sunshine Cottage School for the Deaf, San Antonio Independent School District, UTHSCSA Nixon Library, IDEA Schools, Corazon de San Antonio and the BCMS Alliance. BCMS’s final donation of PPE went to the government of Namibia, Africa. The PPE donation consisted of 5 pallets of KN95s, cloth masks, disposable surgical masks and liquid hand sanitizer. It was an honor to help the citizens of Namibia with our donation of PPE to help fight the COVID-19 pandemic which is still going on.

In closing, I would like to recognize the staff of BCMS and medical students who helped with the difficult work of delivery, pick-up, sorting and shipping out PPE. No easy feat by any measure, so my thanks go out to this dedicated group of people. A special acknowledgment for the heroism of our frontline medical personnel, who truly deserve our deepest gratitude and appreciation for their continued contributions to the health and well-being of our communities. As for me, I will be with the program until the last request for PPE is received and its last mask is dispatched. And so, the work continues . . .

Christopher Ruano is a U.S. Army veteran, and a 20+ year intelligence practitioner who specializes in Continuity of Operations (COOP), Critical Infrastructure Protection (CIP), Joint Targeting, C4ISR, Human Terrain System (HTS), Foreign Internal Defense (FID) and Security Force Assistance (SFA).

We encourage you to use our supporting vendors whenever you or your practice needs supplies or services.

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” ASSETT WEALTH MANAGEMENT

Bertuzzi-Torres-Fernandez 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 Will C. Fernandez, CEPA Senior Portfolio Advisor Financial Advisor 210-278-3812 wfernandez@ml.com https://fa.ml.com/texas/san-antonio/bertuzzi-torres-fernandez

BANKING

Broadway Bank (HHH Gold Sponsor) Healthcare banking experts with a private banking team committed to supporting the medical community. Thomas M. Duran SVP, Private Banking Team Lead 210-283-6640 TDuran@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 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!”

CLINICAL DIAGNOSTICS

Livingston Med Lab (HHHH 10K Platinum Sponsor) High Complexity Clia/Cola accredited Laboratory providing White Glove Customer Service. We offer a Full Diagnostic Test Menu in the fields of Hematology, Chemistry, Endocrinology, Toxicology, Infectious Disease, & Genetics. Robert Castaneda (CEO) 210-316-1792 Robert@livingstonmedlab.com Joey Martinez (Director of Operations) 210-204-7072 Joey@livingstonmedlab.com Dwight Chapman (Account Manager) 210-591-2649 Dwight@livingstonmedlab.com www.livingstonmedlab.com/home “Trusted Innovative, Accurate, and STAT Medical Diagnostics”

Genics Laboratories (HHH Gold Sponsor) Genics Laboratories offers accurate, comprehensive and reliable results to our partners and patients. Genics Laboratories is committed to continuous research, ensuring our protocols are always at the peak of current technology. Yulia Leontieva Managing Partner, Physician Liaison (210) 503-0003 (Phone) yulia@genicslabs.com (Email) Kevin Setanyan Managing Partner (210) 503-0003 kevin@genicslabs.com Artyom Vardapetyan Managing Partner (210) 503-0003 www.genicslabs.com “Accurate results in record time.”

CREDENTIALS VERIFICATION ORGANIZATION

Bexar Credentials Verification, Inc. (HHHH 10K Platinum Sponsor) Bexar Credentials Verification Inc. 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 ADVISORS

Oakwell Private Wealth Management (HHHH 10K Platinum 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”

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"

Bertuzzi-Torres-Fernandez 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 Will C. Fernandez, CEPA Senior Portfolio Advisor Financial Advisor 210-278-3812 wfernandez@ml.com https://fa.ml.com/texas/san-antonio/bertuzzi-torres-fernandez

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. Michael Clark, President 210-268-1520 mclark@aspectwealth.com www.aspectwealth.com “Get what you deserve … maximize your Social Security benefit!”

HEALTHCARE BANKING

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”

HOSPITALS/ HEALTHCARE FACILITIES

Nexus Neurorecovery Center (HHH Gold Sponsor) A post-acute rehabilitation facility focusing on brain injuries. Programming provides individual and group physical, occupational, cognitive, and speech therapy. We help residents return to lives of productivity and meaning. Sydney Kerr Liaison 346-339-2654 skerr@nhsltd.com Caitlyn Tewksbury ctewksbury@nhsltd.com Justin Sanderson CEO 210-854-4732 jsanderson@nhsltd.com Nexus Neurorecovery Center 227 Lewis St, San Antonio, TX 78212 https://nexushealthsystems.com “To return patients to lives of productivity and meaning”

UT Health San Antonio MD Anderson Cancer Center, (HHH Gold Sponsor) UT Health Physicians, the faculty practice of UT Health San Antonio, provides our region with the most comprehensive care through expert, compassionate providers treating patients in more than 140 medical specialties at locations throughout San Antonio and the Hill Country. UT Health San Antonio Physicians Regina Delgado Business Development Manager (210) 450-3713 delgador4@uthscsa.edu UT Health San Antonio MD Anderson Mays Cancer Center Laura Kouba Business Development Manager (210) 265-7662 norriskouba@uthscsa.edu Cancer.uthscsa.edu Appointments: 210-450-1000 UT Health San Antonio MD Anderson Cancer Center 7979 Wurzbach Road San Antonio, TX 78229 Conviva Care Center (HHH Gold Sponsor) Conviva’s value-based care model allows physicians to deliver high quality, personalized care and achieve better outcomes, while feeling free to focus on health equity and patient outcomes. Kim Gary Senior Physician Recruiter (812) 272-9838 KGary4@humana.com www.ConvivaCareers.com “Fuel Your Passion & Find Your Purpose”

INFORMATION AND TECHNOLOGIES

Express Information Systems (HHH Gold Sponsor) With over 29 years’ experience, we understand that real-time visibility into your financial data is critical. Our browser-based healthcare accounting solutions provide accurate, multi-dimensional reporting that helps you accommodate further growth and drive your practice forward. Rana Camargo Senior Account Manager 210-771-7903 ranac@expressinfo.com www.expressinfo.com “Leaders in Healthcare Software & Consulting”

INSURANCE

TMA Insurance Trust (HHHH 10K Platinum Sponsor) TMA Insurance Trust is a full-service insurance agency offering a full line of products – some with exclusive member discounts and staffed by professional advisors with years of experience. Call today for a complimentary insurance review. It will be our privilege to serve you. Wendell England Director of Member Benefits 512-370-1776 wendell.england@tmait.org 800-880-8181 www.tmait.org “We offer BCMS members a free insurance portfolio review.”

Guardian (★★★ Gold Sponsor) Live Confidently. Every financial dream deserves a well-crafted plan. Ned Hodge 210-332-3757 ned@nedhodge.com www.nedhodge.com | www.Opesone.com “Take care of today then plan for tomorrow”

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 Recommended partner of the Bexar County Medical Society

The Bank of San Antonio Insurance Group, Inc. (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians. Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community. Katy Brooks, CIC 210-807-5593 katy.brooks@bosainsurance.com www.thebankofsa.com “Serving the medical community.”

MedPro Group (HH Silver Sponsor) Rated A++ by A.M. Best, MedPro Group has been offering customized continued on page 42 Visit us at www.bcms.org 41

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’s rating is AM Best A (Excellent). Mike Rosenthal Senior Vice President, Business Development 800-282-6242 MikeRosenthal@ProAssurance.com www.ProAssurance.com

INVESTMENT ADVISORY REAL ESTATE

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

MEDICAL BILLING AND COLLECTIONS SERVICES

Wave Online (★★★ Gold Sponsor) Our team of professionals will act as your extended AR office enhancing your revenue through our proprietary metrics and claim management systems. In addition, you keep 100% control of your RCM. Contact us today for a no cost evaluation. Saranraj (Raj) Venkatesh Vice President – RCM | Sales and Client Relations 726-228-1097 saranraj@wavemt.com https://rcmwave.com/ “Innovation towards Solutions”

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 SUPPLIES AND EQUIPMENT

Henry Schein Medical (HH Silver Sponsor) From alcohol pads and bandages to EKGs and ultrasounds, we are the largest worldwide distributor of medical supplies, equipment, vaccines and pharmaceuticals serving office-based practitioners in 20 countries. Recognized as one of the world’s most ethical companies by Ethisphere. Tom Rosol 210-413-8079 tom.rosol@henryschein.com www.henryschein.com “BCMS members receive GPO discounts of 15 to 50 percent.”

MILITARY

San Antonio Army Medical Recruiting office (★★Silver Sponsor) Mission: Recruit highly qualified and motivated healthcare professionals for service in the Army Reserves or Active Duty Army, in support of Soldiers and their families. 1LT Thomas Alexandria 210-328-9022 Alexandria.n.thomas12.mil@army. mil https://recruiting.army.mil/mrb/ “Service to Country, Army Medicine, Experientia et Progressus”

MOLECULAR DIAGNOSTICS LABORATORY

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” Wave Online (★★★ Gold Sponsor) Our team of professionals will act as your extended AR office enhancing your revenue through our proprietary metrics and claim management systems. In addition, you keep 100% control of your RCM. Contact us today for a no cost evaluation. Saranraj (Raj) Venkatesh Vice President – RCM | Sales and Client Relations 726-228-1097 saranraj@wavemt.com https://rcmwave.com/ “Innovation towards Solutions”

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! Kevin Barber, President 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 Medical Group Management Association (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. Lindsey Herman Nolan, MHR, CMPE, 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 Realty (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 210-573-6146 Brad.Wilson@carr.us www.carr.us “Maximize Your Profitability Through Real Estate”

RETIREMENT PLANNING

Oakwell Private Wealth Management (HHHH 10K Platinum 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.”

2023 New Cars

By Stephen Schutz, MD

Autumn is traditionally the time when automotive manufacturers introduce new cars, trucks, and crossovers so I’m going to use this space to discuss some new 2023 vehicles that I think may be of interest to BCMS members. In no particular order, here they are.

Cadillac Escalade V - Escalades are popular with Texans in general and BCMS members in particular, and that’s certainly true for the latest generation, which launched two years ago with more interior space and a game changing independent rear suspension. The 2023 V version provides suspension upgrades and a supercharged V8 good for 682HP in an effort to “make an elephant dance”, as they say. Given its $155,000 starting price, I’d say, “pass”.

Alfa Romeo Tonale - Joining the Guilia sedan and Stelvio SUV, the Tonale aims to democratize Alfa with a smaller and cheaper crossover (think BMW X1 and Lexus UX competitor). Alfa sells around as many vehicles in a year as Ford sells F150s in a week, so I hope the Tonale succeeds (in case you’re wondering, it’s pronounced “toe-nah-lay” not “toe nail”).

Audi RS3 - The late-great Ferdinand Piech’s beloved 5-cylinder engine soldiers on in its 5th decade to power this joyously raucous sports sedan, which is surely on its last legs as Audi moves resolutely into the BEV (Battery Electric Vehicle) future. Get ‘em while you can.

Audi e-tron GT RS - Audi’s version of the BEV Porsche Taycan manages to both look better and have a nicer interior than its Porsche cousin. I’m not ready to trade my 911 for an electric car yet, but if I were, this is the one I’d buy.

BMW XM - Like the Escalade V, the XM is BMW’s attempt to sell a big and heavy SUV that’s also “athletic”. And like the 50-year-old obese man who shows up at your gym in early January, the XM seems likely to fail. It features a brawny twin-turbo V8 augmented by plugin hybrid technology. Its 0 - 60MPH time is around 3.5 seconds, so it has some undeniable pluses. But many will find its styling and $160,000 price tag to be challenging.

BMW M2 - while the new M2’s styling has also been described as challenging, I’m going to embrace this four-seat sports car because of its wonderful 453HP turbocharged in-line six-cylinder engine and standard six-speed manual transmission. As with the aforementioned RS3, get ‘em while you can.

Ford F150 Raptor R - Tired of getting sand kicked in its face by the completely OTT 700HP Ram TRX pickup, the badass Raptor R now offers a competitive V8 engine (borrowed from the Shelby GT500). I think the standard Raptor has plenty of power, but if you don’t, Ford now has you covered.

Jeep Wagoneer/Grand Wagoneer - longer wheelbase L versions of these popular Suburban/Escalade competitors are now offered. These full-size family haulers are proving to be popular in part, because they have best-in-class interiors.

Lexus RZ - A BEV counterpart to the perennially best-selling RX attempts to do for electric luxury crossovers what the original RX did for internal combustion engine (ICE) luxury crossovers—make Lexus the default choice. BEVs are so different from ICE vehicles that I have doubts this approach is best, but with Lexus’ impressive track record they very well may be right.

Mercedes EQS/EQE - BEV equivalents of the standard Mercedes models we know and (mostly) love, the EQ line looks quite different visually, with exterior designs that are all teardrops and jelly beans. This is BEV.1 time, so expect rapid evolution as engineers learn and innovate. To avoid getting stuck with obsolete technology (or styling) when it’s time to trade in your BEV, I’d recommend leasing over buying for now.

Nissan Ariya - The successor to the affordable Leaf BEV looks a lot like its predecessor, but delivers much more range (250mi vs around 100). If you want a BEV and are on a budget, this and the Chevy Bolt are pretty much your only choices.

Nissan Z - The legendary Nissan sports car lives! Essentially a rebodied 370Z, the 2023 model is full of retro styling elements that remind you of the original 240Z from the early 1970s. It’s an excellent choice for enthusiasts, but expect to wait a bit if you want one—it’s sold out for now.

Range Rover Sport - The go-to vehicle for 40-ish moms in upscale zip codes gets many enhancements for its third generation. It’s hard to tell it apart from the last one just by looking, but it’s all new, and, like the “big” Range Rover, the Sport has a nicer interior. In case you’re wondering. . . yes, the new one’s significantly more expensive.

As always, call Phil Hornbeak, the Auto Program Manager at BCMS (210-301-4367), for your best deal on any new car or truck brand. Phil can also connect you to preferred financing and lease rates.

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

11911 IH 10 West San Antonio, TX 78230 Coby Allen 210-696-2232

Kahlig Auto Group

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

Land Rover San Antonio 13660 IH 10 West San Antonio, TX Cameron Tang 210-561-4900

Kahlig Auto Group

North Park Mazda 9333 San Pedro San Antonio, TX 78216 John Kahlig 210-253-3300

Kahlig Auto Group

North Park Subaru 9807 San Pedro San Antonio, TX 78216 Raymond Rangel 210-308-0200

Audi Dominion 21105 West IH 10 San Antonio, TX 78257 Rick Cavender 210-681-3399

Northside Ford 12300 San Pedro San Antonio, TX Marty Martinez 210-477-3472

Kahlig Auto Group

North Park Lexus 611 Lockhill Selma San Antonio, TX Tripp Bridges 210-308-8900

Mercedes Benz of Boerne 31445 IH 10 West Boerne, TX James Godkin 830-981-6000

Kahlig Auto Group

North Park Subaru at Dominion 21415 IH 10 West San Antonio, TX 78257 Phil Larson 877-356-0476

Northside Chevrolet 9400 San Pedro Ave. San Antonio, TX 78216 Charles Williams 210-912-5087 Chuck Nash Chevrolet Buick GMC 3209 North Interstate 35 San Marcos, TX William Boyd 210-859-2719

Northside Honda 9100 San Pedro Ave. San Antonio, TX 78216 Paul Hopkins 210-988-9644

Kahlig Auto Group

North Park Lexus at Dominion 25131 IH 10 W Dominion San Antonio, TX James Cole 210-816-6000

14610 IH 10 West San Marcos, TX 78249 Mark Hennigan 832-428-9507

Kahlig Auto Group

North Park Lincoln 9207 San Pedro San Antonio, TX Sandy Small 210-341-8841

Mercedes Benz of San Antonio 9600 San Pedro San Antonio, TX Al Cavazos Jr. 210-366-9600

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

9455 IH 10 West San Antonio, TX 78230 Douglas Cox 210-764-6945

Kahlig Auto Group

North Park Toyota 10703 Southwest Loop 410 San Antonio, TX 78211 Justin Boone 210-635-5000