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Letter to the Editor Page 10
Celebrating 60 Years
- 015 1955 2
round-up Volume 61
Providing news and information for the medical community since 1955.
MEMBER PROFILE: Protecting patient-centered care and ensuring tomorrow’s future through adaptive and innovative techniques,
Jacqueline Chadwick, MD Page 20
IN THIS ISSUE: Practice Guidelines and Standards of Care, Page 16 Setting a New Course of Medical Education in Arizona: Mayo Medical School, Page 26 The ACT Health Fair: Improving Health, Education, and Quality of Life for Children, Page 30 Why I Chose A.T. Still University, Page 32 Finding Value in a Medical Education, Page 33 Six Reasons I Chose UA COM, Page 34 A Unique Experience at Creighton University, Page 35
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Please consider volunteering and making a difference on: Saturday, September 26, 2015 7:30 am - 3:00 pm The Salvation Army Ray & Joan Kroc Community Center 1375 E. Broadway Rd., Phx, AZ 85040
All volunteers are welcome: actively practicing and retired physicians, medical students, residents and other healthcare providers, and non-medical volunteers. Especially needed are individuals who are bi-lingual in English/Spanish.
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Pa Off Pay Of Y Your Mortgage Mor Mortgag Early Early? By By Mike M McCann, McC McCan McCann M Mc CFP C ÂŽ, AIFÂŽ There is no right or wrong answer that applies to everyone when it comes to paying off a mortgage early. Doing so requires planning and discipline. ,WÂśVLPSRUWDQWWRFRQVLGHUWKHPDQ\ benefits and potential drawbacks before taking action. Keep in mind that paying off your mortgage early: Red Reduce Reduces Ov Over Overa Overall Inves Inve Invest Investme Investment R Risk Think of it as a competitive alternative to the bond side of your investment portfolio. By putting more dollars into your mortgage, you are making a more conservative move than in your investment portfolio and receiving a guaranteed rate of return (the interest rate on your mortgage). This guaranteed rate might be better than you're currently receiving with your CDs or bonds. You may also consider increasing your risk exposure to equities in your investment portfolio concurrent to paying off the mortgage.
Reduces Red Reduce S Sh -Term Short ShortTer Liquidity Liquidit Liq Liquid Liqui The money to pay down your mortgage has to come from somewhere. Be sure to take into consideration the need for funding short- and intermediate-term goals (such as vacations, college tuition or automobile purchases), as well as maintaining an emergency fund. It would be counter-productive to pay off your mortgage and then have to borrow money for these items. Red Reduce Reduces TTax Ta Deductions D Ded Deduction
also understanding yourself and the affects your decisions will have on your future mindset. Paying off debt can take away stress and allow you to address other issues more clearly. It can also help you to better weather the inevitable storms that life brings Âą whether they are related to your job, personal life, or portfolio ups and downs. Builds Build Momentum Mome M Having no mortgage payment means having increased savings power while you are working and lower draw-down of those savings while you are retired.
Deductible housing interest alone may not be attractive enough to keep your mortgage. However, if you take ,WÂˇVLPSRUWDQWWRFRQVLGHUWKH ,WÂˇVLPSRUWDQWWRFRQVLGHUWK ,WÂˇVLPSRUWDQWWRFRQVL ,WÂˇVLPSRUWDQWWRFR ,WÂˇVLPSRUWDQWWR ,WÂˇVLPSRUWDQWW ,WÂˇVLPSRUWDQW ,WÂˇVLPSRUWDQ ,WÂˇVLPSRUW ,WÂˇVLPSRU ,W advantage of other deductions such as m benef and potential benefi benefits pot poten potenti man many a ben po charitable gifts, you drawb draw dra dr drawbacks b t ac bef before taki taking acti action. will want to ask your financial planner to If you are in the position of being provide a projection of your income DEOHWRFRQVLGHULW\RXÂśYHDOUHDG\ taxes after removing the interest demonstrated the level of financial deduction from your Schedule A. discipline required to manage the Make sure you understand the total early payoff. And the extra cash cost of paying down your flow provided by the elimination of mortgage. your mortgage can be quite Increases Increas Peace Increa P Pe Pea of o Mind M empowering. . Good financial planning is more than calculators and tax laws. It is
Mike McCann Mike M McCan is an investment advisor and founder of Perspective Financial Services, LLC. He develops long-term relationships with physicians and other professionals to create and manage personalized financial plans and investment portfolios. He is a Certified Financial PlannerÂŽ and an Accredited Investment FiduciaryÂŽ. To learn more, visit his website at www.Mo www.MoneyAZ.com. www.MoneyAZ.com www.MoneyAZ.co www.MoneyA www.Mon You may call or email him at 602 602--281281-4357 or Mike@ Mike Mike@MoneyAZ.com Mike@MoneyAZ.c Mike@MoneyA Mike@Mon Mike@M anytime. All investments have the potential for profit or loss and that past performance does not guarantee future success.
What’s Inside? July 2015: Education By Jay Conyers, PhD
espite a lack of support from the Arizona Board of Regents (ABOR) and our state legislature for the education of tomorrow’s physicians, our state continues to produce high-quality graduates that match in some of the most prestigious programs in the nation. After the legislature cut $99 million in university funding this year, ABOR approved tuition hikes of 3-4%. Some argue this will make Arizona less attractive as an education destination for aspiring physicians, yet the high quality of the programs offered in our state should ensure the appeal of these programs, especially in the Southwest. But what will be the impact of the increased cost of medical school?
On the heels of yet another double down of tuition increases and budget cuts for our state universities, which includes two of the five programs that train physicians, Arizona now leads the nation in the percentage decrease in state funding per student. From 2008-2015, Arizona cut student support by 47.0%, far outdistancing neighboring states such as Utah (16.3%), Colorado (17.7%), New Mexico (32.2%), and California (11.1%). The recently approved tuition hikes hit Arizona medical students the hardest, with some estimating that it may require an additional $50,000 in student loans to make it through.
Despite the increases in tuition, Arizona medical school graduates – at least those from the state universities – are coming out with considerably less debt than many other medical schools. Students completing programs at USC and Georgetown come away with an average of $219,000 and $224,000 in debt, respectively. Graduates of medical school at the University of Arizona walk away with close to 4 • Round-up • July 2015 • A monthly publication of the MCMS
$150,000 in student loan debt. Creighton students average $211,000 in debt and those from Mayo Medical School can breathe a sigh of relief when they see their tab as low as $65,000. Whether or not these numbers will apply to Creighton and Mayo graduates here in Arizona remains to be seen. What about A.T. Still and Midwestern, our two osteopathic medical schools? While Round-up could not track down specific numbers, we did find that the average debt for students graduating from private osteopathic schools was at roughly $210,000 (Note: These figures are from a 2013 report.)
Around this time last summer, we brought you an issue of Round-up focused on education, and had articles from each of the programs in town, as well as one from ASU’s College of Health Solutions. This year, we let you hear from the students enrolled in these programs. We asked each to share with us why they chose the program they did, and what sets it apart. We also profile Dr. Jacqueline Chadwick, Vice Dean at the University of Arizona College of Medicine – Phoenix, and a well-respected family physician in tune with the education landscape here in our state. Also in this issue we bring you an article from Dr. Michelle Halyard, describing the planned Mayo Medical School set to open in Arizona in 2017. There is more to describe, but not enough space to tell you everything we’ve included this month, so you’ll have to find the time to make your way through it. Next month, we’re focused on the legal aspects of medicine, and have some great articles lined up. Until then, stay cool. ru
Jay Conyers, PhD is the Executive Director for MCMS. He can be reached by email to email@example.com or by calling direct to 602-251-2361.
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letter to the editor
guest column Setting a new course of medical education in Arizona: Mayo Medical School.
doc edu The ACT Health Fair: Improving health, education, and quality of life for children.
physician-in-training – atsu
physician-in-training – midwestern
physician-in-training – ua com
physician-in-training – creighton
Why I chose A.T. Still University.
announcement Finding value in a medical education.
member profile: jacqueline chadwick, md
The joy of education.
Practice guidelines and standards of care.
Protecting patient-centered care and ensuring tomorrow’s future through adaptive and innovative techniques.
On the cover: Dr. Jacqueline Chadwick with her medical students in the Simulation Lab at the University of Arizona College of Medicine – Phoenix.
6 • Round-up • July 2015 • A monthly publication of the MCMS
Six reasons I chose University of Arizona College of Medicine – Phoenix.
A unique experience at Creighton University.
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Cover photo by: Denny Collins Photography, www.dennycollins.com or 602-448-2437
MCMS 2015 Officers
Editor-in-Chief Ryan R. Stratford, MD, MBA
Editor Jay Conyers, PhD
Advertising, Design and Production Candice Scheibel
Contributing Writer Dominique Perkins
Ryan R. Stratford, MD, MBA Adam M. Brodsky, MD John L. Couvaras, MD Secretary
Mark R. Wallace, MD
To obtain information on advertising in Round-up, contact MCMS.
Immediate Past-President Miriam K. Anand, MD Board of Directors 2013-2015
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Volume 61, No. 7, July 2015.
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Connect with your Society. Letters and electronic correspondence will become the property of Round-up, which assumes permission to publish and edit as necessary. Please refer to our usage statement for more information.
Round-up is a publication of the Maricopa County Medical Society (MCMS). Submissions, including advertisements, are welcome for review and approval by our editorial staff at email@example.com. All solicited and unsolicited written materials and photos submitted to Roundup will be treated as unconditionally and irrevocably assigned to and the property of MCMS and may be used at MCMS’ sole discretion for publication and copyright purposes and use in any publication, website or brochure. MCMS accepts no responsibility for the loss of or damage to material submitted, including photographs or artwork. Submissions will not be returned. The opinions expressed in Round-up are those of the individual authors and not necessarily of MCMS. Round-up reserves the right to refuse certain submissions and advertising and is not liable for the authors’ or advertisers’ claims and/or errors. Round-up considers its sources reliable and verifies as much data as possible, but is not responsible for inaccuracies or content. Readers rely on this information at their own risk and are advised to seek independent legal, financial or other independent advice regarding the content of any submission. No part of this magazine may be reproduced or transmitted in any form or by any means without written permission by the publisher. All rights are reserved.
Editor: Ryan R. Stratford, MD, MBA firstname.lastname@example.org Managing Editor: Jay Conyers, PhD email@example.com
A monthly publication of the MCMS • July 2015 • Round-up • 7
Josef J. Gerster, MD
Josef Jakob Gerster, MD, 91, of Paradise Valley, Arizona loving husband and beloved father, passed away in the early morning hours of Sunday, June 21, 2015.
Dr. Gerster was born August 28 of 1923 in Saarbrücken, Germany, the oldest of four children born to Jakob and Maria Gerster. As a young man, he was initially interested in a career as a diplomat, so he enlisted in an officer training program in the German Army when he was 18, choosing to serve under the command staff of Field Marshall Erwin Rommel’s Afrika Korps. By the time he arrived in North Africa, he was needed instead on the front lines, and he served in Libya, Sardinia and Corsica before finally being captured in a small town in Italy in November of 1943. For the remainder of the war he was interred as a POW at a large camp in Atlanta, Nebraska, where his previously unknown ability to identify the Malaria virus under a microscope earned him a coveted job in the camp hospital under the guidance of U.S. Army medical staff. He left with a gifted copy of Gray’s Anatomy and aspirations for a new career in medicine.
After completing his university and medical school education in France and Germany after the war, he did his internship at the U.S. Army Hospital in Frankfurt, Germany. In August of 1957, during a brief trip back to Frankfurt to visit friends before starting his residency in the United States, he met Dr. Carolyn Taylor, Army captain and medical resident, and thus began a whirlwind, international courtship that culminated with an accepted proposal in Cleveland, Ohio, where he was scheduled to complete his residency in the field of cardiology
During his long medical career, he served as the head of cardiology for Scottsdale Memorial Hospital and was a Fellow of the American College of Cardiology. He and Dr. Taylor enjoyed travelling extensively throughout the world, especially to the exotic locales. Dr. Gerster is survived by Dr. Carolyn Taylor, his wife of 57 years, and sons John, Eric, Kurt, Mark, and Karl, ten grandchildren, and a host of relatives in Germany and abroad. ru
8 • Round-up • July 2015 • A monthly publication of the MCMS
Richard W. Goodell MD
Richard William Goodell, MD, 73, of Scottsdale, Arizona passed away on June 27, 2015.
Dr. Goodell was born on June 27, 1942 in Detroit, Michigan. He was one of four brothers born to MaryAnne and Benjamin Goodell. He was a graduate of Michigan State University and Wayne State University, leading to his distinguished career in medicine in the field of neurology. He completed his residency at Barrow Neurological Institute. Dr. Goodell then practiced Critical Care Neurology and General Neurology for 38 years at Scottsdale Healthcare Osborn, treating and helping thousands of people.
An avid sportsman, he enjoyed swimming and rowing in his younger days and later hiking, climbing, marathons, triathlons, skiing and, his final punishment, golf. Dr. Goodell truly enjoyed spending time with family and traveling to Cannon Beach, Oregon, Coronado Island, Lake Powell, as well as Vail and Solitude ski resorts in the winter. Dr. Goodell lived a long and fulfilling life. His dry sense of humor and wit, fondness for practical jokes, never ending energy, his kindness and loving support for his friends and family will be remembered by all who knew him. He was very fortunate to have been married twice and has two loving families with four beloved children. He leaves behind his wife, Gretchen; children: Chris, Colleen, Ricky and Madison; grandchildren: Tyler, Brandon, McKenna and Caroline; and brothers: Pete and Tony. ru
Christopher J. Roberts, MD
Christopher John Roberts, MD, 64, of Scottsdale, Arizona died on Monday, July 13, 2015 at his home unexpectedly.
Dr. Roberts was born December 14, 1950, the eldest of four boys. He grew up in Denver, Colorado and graduated from the University of Colorado in Boulder with a biology degree. He attended medical school at the University of Colorado in Denver and moved to Phoenix, Arizona where he completed an internship and residency in internal medicine at Maricopa County Hospital. He then completed a fellowship in pulmonary medicine and practiced in the Phoenix/Scottsdale area in private practice for the next twenty-five years. Dr. Roberts became board certified in critical care medicine and joined a group of physicians at Scottsdale Healthcare. The last ten years of his life he enjoyed treating and caring for patients in the intensive care unit. He was admired by his colleagues and his numerous patients. Dr. Roberts was an avid cyclist, skier, and enjoyed hiking in the mountains and desert. His wife Christina was a constant companion and they were training for a bicycle trip in the Italian Alps just prior to his death. He loved everything about nature and could recite the names of flowers, birds, and all aspects of nature. He loved gardening around his home, loved jazz music, and gourmet cooking. Dr. Roberts would make frequent skiing and biking trips with his wife, friends, and brothers. He helped build the family cabin approximately fifty years ago in the Rocky Mountain National Park area and would visit there frequently to enjoy the solitude and tranquility of the mountains. He cared deeply for his family and was always a source of strength to those around him. He was admired for his many achievements, and will be deeply missed by all who loved him. Dr. Roberts is survived by his wife, Christina, and her two children, Jake and Lori, and their families; his two sons Brian and Colin Roberts; his 92-year old father, Dalton; his two brothers, Kirk and Al, and their families. ru
Martin C. Sheehy
Martin C. Sheehy, MD, 71, of Phoenix, Arizona passed away peacefully on July 15, 2015.
Dr. Sheehy was born on December 12, 1943 to loving parents John (Jack) and Moria (nee Madden) Sheehy of Listowel County, Kerry, Ireland.
He had many personal and professional accomplishments. Dr. Sheehy was a graduate of St. Michael’s College in Listowel and the University College Dublin Medical School. He also attained his MBA at the University of Phoenix. He worked for many years at St. Joseph’s Hospital in Phoenix and later had a career at Liberty Mutual in Arizona.
Dr. Sheehy leaves his brothers, Patrick of Skerries, Dublin, Ireland, and Jerry of Listowel, Kerry, Ireland, loving sisters-in-law Mary and Geri, loving niece Kerry (Liam), nephews John (Linda), Patrick (Jessica), David and Brian (Vanessa), grandniece, Kaitlyn, grandnephews, Colin, Lucas and Michael Martin. He is preceded in death by his parents, and brothers Michael of Yonkers, NY and John of Rhinebeck, NY. ru
I give you this one thought to keep: I am with you still. I do not sleep. I am a thousand winds that blow. I am the diamond glints on the snow. I am the sunlight on ripened grain. I am the gentle autumn rain. When you awaken in the morning’s hush, I am the swift, uplifting rush of quie birds in circled flight. I am the soft stars that shine at night. Do not think of me as gone. I am with you still in each new dawn. Native American Poem
A monthly publication of the MCMS • July 2015 • Round-up • 9
letter to the editor
A Message from an Older Clinician to a Medical Student By Jane M. Orient, MD To the editor:
This is a message from an older clinician to a medical student. No, there are not three groups of people: those for vaccines, those against vaccines, and the undecided; any more than there are three groups of people: those who are for prescription medications, those who are against prescription medications, and those who are undecided.
Every medical intervention, including vaccines, has risks and benefits, which may vary according to the individual patient and the circumstances. It is our job to give patients and parents the best advice we can. Unfortunately, the public has plenty of reason for distrusting the pharmaceutical industry, and even the Centers for Disease Control and Prevention (CDC). One style of communication that is not likely to be effective is to disrespect our patients.
It is a fact that babies are at risk for getting measles, and a much higher proportion of measles is occurring in babies than before. This is one of the unfortunate tradeoffs of measles vaccination. Mothers have not had natural measles and do not have robust lifelong immunity that they can transmit to their babies to protect them passively until the time at which the babies can be immunized.
I am sorry that Dr. Jacks’ children screamed when they got measles immune globulin. Lots of babies scream when they got measles immune globulin. Lots of babies scream when they get immunizations too, and many have reportedly screamed inconsolably for weeks after hepatitis B vaccine that was give to them in the delivery room without informed consent. Some children have even died from vaccines – reportedly 108 from the measles vaccine. Human papilloma virus vaccine has been followed by a fairly large number of very serious complications, including permanent paralysis. Many people think that this risk is not worth a reduction in the incidence of a fairly rare cancer, es-
10 • Round-up • July 2015 • A monthly publication of the MCMS
pecially since that cancer can easily be treated if found early on Pap smears, and is virtually absent in women who save sex for marriage.
Most parents elect to have their children vaccinated because they perceive the benefits to their children are worth the very small risk. However, they are probably not willing to take a risk, even one in a million risk of death, to protect someone against losing a snow vacation. Is it fair for you to ask people to protect your child against the very low probability that their child will contract measles, which is now very rare, and then also transmit it to your daughter? Keep in mind that measles can also be transmitted by people who are fully vaccinated. We need better vaccines, better early diagnostic methods, and better ways of treating viral diseases. The enemy is the disease, not the mama bears who are protecting their own children as best they can.
There is no substitute for vigilant public health officials who track and contain disease outbreaks. There will never be an arsenal of perfect vaccines against every potentially infectious disease. Sincerely yours, Jane M. Orient, MD
[Editor’s note: Dr. Tim Jack’s article, A Parent’s Perspective let’s Talk Measles: An Open Letter to the Parent of an Unvaccinated Child, was the Public Health feature in the March 2015 issue of Round-up.] Round-up welcomes letters to the editor. To have a letter considered for publication you must include your: name, daytime phone number or email, headline of the story and issue to which you're responding. Send your comments to: firstname.lastname@example.org.
Are You Interested in Serving on the MCMS Board of Directors?
he Maricopa County Medical Society Board of Directors serves as an advisory group that oversees the activities of the Society. The Board’s primary role is to ensure that the Society’s mission is being upheld and to oversee implementation of our strategic plan through various committees. The time commitment is minimal, and does not interfere with your practice, typically meeting once per month for less than two hours in the evening.
We are looking for fresh ideas and welcome new additions to the Board. No experience is necessary as an interest
in protecting the practice of medicine is all you need! Please consider a position on our Board of Directors and complete the brief application by typing the link below into the address bar of your browser: http://survey.constantcontact.com/survey/a07eb7x ml4qibjmv0t2/start
If you have any questions or concerns prior to applying, please contact Jay Conyers, PhD, Executive Director, by email at email@example.com. We hope to see you on the Board next year! ru
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A monthly publication of the MCMS • July 2015 • Round-up • 11
The physicians highlighted on this page recently joined the Maricopa County Medical Society. Please reach out to one or more of them, welcome them aboard, and share your insight on how the Society can be of service. RANDAL CHRISTENSEN, MD Pediatrics Medical School: Tufts University School of Medicine, Boston, MA Internship & Residency: Good Samaritan Regional Medical Center, Phoenix, AZ Practice Information: Phoenix Children’s Medical Group - General Pediatrics, 1919 E Thomas Rd, Phoenix, AZ Phone: 602-933-0945 ANTHONY DUNNIGAN, MD, MBI Clinical Informatics Internal Medicine Medical School: Uniformed Services University of the Health Sciences, Bethesda, MD Graduate School: Oregon Health and Science University, Portland, OR Residency: Good Samaritan Regional Medical Center/Carl T. Hayden VA Medical Center Phoenix Practice Information: Maricopa Integrated Health System, 2619 East Pierce St., Phoenix, AZ Phone: 602-344-8569
ELIZABETH JAREM, MD OBGYN Medical School: Medical University of
Lodez, Poland Internship: Jamaica Hospital Medical Center, Jamaica, NY Residency: Louisiana State University Health Sciences Center, New Orleans Practice Name: East Valley Women’s Group Address: 10238 E. Hampton Avenue, Suite 212, Mesa, AZ Phone: 480-632-2004 ROYA KARBAKHSH, MD Psychiatry Medical School: Isfahan University of Medical Sciences & Health Services, Iran Residency: St. Vincent’s Hospital, New York, NY Fellowship: New York University School of Medicine, New York, NY; Mid Hudson Medical Group, Fishkill, NY Practice Information: 6424 East Springway Parkway, Scottsdale, AZ Phone: 845-594-7250 MARK DAVID LOCKETT, MD Emergency Medicine Medical School: Uniformed Services Univ. of Health Sciences, Bethesda, MD Internship: Malcolm Grow Medical Center, Andrews Air Force Base, MD Practice Information: Gerald Champion Regional Medical Center, Alamogordo, NM; Med International, PLLC, Scottsdale, AZ; American Medical Response EMS, Alamogordo, NM
12 • Round-up • July 2015 • A monthly publication of the MCMS
AJAY UMESH MHATRE, MD Cardiovascular Disease Medical School: Florida State University College of Medicine, Tallahassee, FL Residency: University of Florida College of Medicine, Gainseville, FL Fellowship: University of Florida College of Medicine, Jacksonville, FL; University of Arkansas for the Medical Sciences, Little Rock, AR; Phoenix Heart Center, Phoenix, AZ Practice Information: Phoenix Heart Center, 555 North 18th Street, Suite 300, Phoenix, AZ Phone: 602-234-0004
MAURICIO ANDRES VALDES, MD Orthopaedic Surgery Medical School: Javeriana University, Santa Fe de Bogota, Columbia Internship: Brown University / Rhode Island Hospital, Providence, RI Residency: Brown University/Rhode Island Hospital, Providence, RI; Evaristo Garcia University Hospital / Universidad del Valle, Cali, Columbia Fellowship: Brown University/Rhode Island Hospital, Providence, RI Practice Information: Hedley Orthopaedic Institute, 2122 East Highland Avenue, Suite 300, Phoenix, AZ Phone: 602-553-3113 DARREN WETHERS, MD Internal Medicine Medical School: Feinberg School of Medicine at Northwestern University, Chicago, IL Internship & Residency: Emory University, Atlanta, GA Facility Name: Blue Cross Blue Shield of Arizona Advantage, 8220 North 23rd Avenue, Phoenix, AZ Phone: 1-888-274-0026
new members Educational Members University of Arizona School of Medicine – Phoenix, Class of 2018
Midwestern University, Class of 2019 Tricia Ngo
University of Arizona School of Medicine – Phoenix, Class of 2019
A.T. Still University – School of Osteopathic Medicine in Arizona, Class of 2019 Brian Buckner
James du Pont
Cindy Megan Chiu
Victoria Calvelage Katie Cho
Elizabeth Cornell Tanvi Devi
Spencer Eberhard Rudolf Estess Ivy Godana
Cherise Hatch Stephen Ingle
Meagan Johnson Pragya Kalla
Sameeha Khalid Adrienne Marler Jennifer Moon Victor Mori
Taylor Samora-Dietz Jenna Wong
Robert Neiberger Mitchell Ornelas Kara Parker
A monthly publication of the MCMS • July 2015 • Round-up • 13
The Joy of Education By Ryan R. Stratford, MD, MBA
MCMS President 2015 Ryan R. Stratford, MD, MBA Dr. Stratford specializes in Urogynecology/Pelvic Reconstructive Surgery. He joined MCMS in 2005. Contact Information: The Woman's Center for Advanced Pelvic Surgery 4344 E. Presidio Street Mesa, Arizona 85215 www.TheWomansCenter.com P: 480-834-5111 E: firstname.lastname@example.org
s physicians, we are deeply embedded in education. Whether we like it or not, we are both consumers and producers of education every day.
As I left fellowship, I was worried that starting my own practice and not being affiliated with an academic institution would force me to lose opportunities to teach. I enjoyed teaching, and also knew that I learned most when having to teach someone else. I did not want to lose my intellectual edge. I believed the slogans of the academic institutions where I had trained, such as the University of Chicago that purported being at the “forefront of medicine.” I spoke with my fellowship advisor about my concerns and his response surprised me. “You do not have to teach residents or students to be a teacher,” he said. He explained that everyone I interact with, including my medical assistant, the operating room assistants, office staff, physician colleagues, and especially patients are seeking education. He encouraged me to be a teacher all of the time. His suggestion quelled my fear of not being an educator and opened my eyes to the broader world of medicine outside of academics.
14 • Round-up • July 2015 • A monthly publication of the MCMS
president’s page Since that time, 10 years ago, I have enjoyed teaching and learning. Like exercising, I find reading scientific journals and going to scientific meetings rejuvenating. I enjoy the brain exercise I gain through learning and critical analysis of data. I also enjoy the learning I gain through observation of other physicians. I usually feel invigorated when I read and stretch my brain. Education, both as a consumer and producer is a big part of my life.
The options for accessing and consuming information have grown exponentially in the last decade. There is access to information everywhere we go. Learning has become more interactive with computers and 3D images. So much is changing and growing in the medical education.
In the eight moves I made with my family through medical training, I carried every one of the text books I poured through in medical school with all of their highlighted pages and notes. As it turned out, my wife’s repetitive requests to get rid of the heavy books was the right thing to do. I never referenced text books because access to information became so readily available. Using search engines for my research, such as Google and similar companies, became more intelligent and quick, helping me sort through the maze of information on the internet. Because access to information is readily available, we can find answers quickly and explore ideas any time we like. I remember spending hours learning how to search effectively through medical indexes in my medical school library. Now I can search all indexed journals quickly through PubMed (www.ncbi.nlm.nih.gov/pubmed). We are very lucky to have quick access to medical information.
The challenge is finding time to thoroughly review all of the information and remain up to date. I still enjoy reading and highlighting hard copies of medical journals and distributing interesting ideas to my staff. I especially enjoy attending scientific meetings where high quality science is presented and I can interact with colleagues in my specialty from all over the world. All of this, however, is just part of the educational maintenance that I think is necessary to keep the excitement of education a part of my professional life.
Rather than hold a scientific journal club every week with medical students, my fellowship mentor required the students to present once a month on a topic of interest that had nothing to do with medicine or science. The presentations were fascinating. I learned about everything from skydiving
to the history of Louisiana State University (LSU) football. On one occasion, my fellowship director took a number of residents and students to a glass blowers kiln to see how glass is artfully blown and made. We had other similar field trips to other craftsmen shops. I thought it was odd at first, especially when he required attendance, but I realized then and can clearly see now what he was trying to do. He loved to learn and wanted us to expand our horizons outside of the narrow view of education we had in training to see the fun of always learning, and not just learning medicine. He kindled the flame in all of us to remember one of the main reasons we were drawn to medicine: we love to learn.
After eight years of private practice and working hard to achieve efficiencies and good surgical outcomes, I felt a need to expand the influence I could have in my field. I approached a residency program director and offered to begin teaching residents if he felt it would be helpful for resident training. I now have two full-time residents rotating with me along with occasional medical students. Having someone with me every day, including in the clinic, has been an adjustment and requires a lot of additional energy, but I feel rewarded in seeing residents grow and progress. I love watching them learn and seeing the light bulb turn on when something finally comes together in their minds. I feel very lucky to be put in a place where I can have an impact on physicians’ lives.
How important is education? To physicians, this must seem like a silly question because in order to be a physician we had to compete pretty heavily for the privilege of being educated. Among the top 10 undergraduate schools who received the most applications in 2012, the acceptance rate of applicants ranged from 5.9% to 7.5%. The average acceptance rate for applicants to medical schools was less than 10%. Although there is some variation among different schools, the likelihood that we could make it where we are today is less than 6%. That puts all of us in a very unique position. Presumptively, we are all voracious learners, or just intelligent masochists, and have been given the privilege of being educated as physicians. I hope that I can maintain the thrill of learning and teaching throughout my life, whether it is at work, at home, or in my spare time. Education is not defined in completing a body of school work, it is a way of life and one that I am grateful I was taught how to love. ru
A monthly publication of the MCMS • July 2015 • Round-up • 15
Practice Guidelines and Standards of Care By Judy Avery, BSN, RN
Judy Avery, BSN, RN Judy is a native Phoenician with a BSN Degree from Arizona State University. She was employed at a regional medical center for 12 years as a staff nurse, administrator and clinical instructor prior to becoming a Legal Nurse Consultant for 20 years. Ms. Avery has been the Education Coordinator in Risk Management Services at MICA for the last 15 years. Her responsibilities include administration and maintenance of CME accreditation for the education programs.
ccasionally physicians refer to practice guidelines or evidence-based guidelines as establishing the standard of care, or that failure to follow a guideline is synonymous with falling below the standard of care. Often plaintiff attorneys urge physicians in deposition to agree that a practice guideline is the same as the standard of care. A few physician organizations have even supported legislation that would define adherence to guidelines as practice within the standard of care. That is not to say practice guidelines, protocols, or evidence-based guidelines have no value. They do have value. In equating them to a standard of care, the disconnect is in the failure to consider the judgment and the circumstances involved in their application.
Throughout physician training they are encouraged to be the best they can be at what they have chosen to do. “Good enough” is not sufficient. Physician training teaches individuals to strive to meet exceptionally high standards for caring, compassion, knowledge, judgment and skill. Even knowing mistakes will be made, they strive to make none.
Medicine is complex, highly dependent on interpretation of sometimes incomplete, even misleading information, and subject to patient comprehension, cooperation and compliance. Because of this, physicians are not always correct in their interpretation, diagnosis, judgment, treatment, follow-up, and procedure performance.
Because humans are fallible, because medicine is complex, and because the response to medical care is dependent on many variables outside the control or even awareness of the physician, determination of liability for allegedly negligent care requires an evaluation of much more than adherence
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clinical edu to a guideline. That determination requires a framework, and the standard of care, which is a legal concept, defines that framework. Statutes define standard of care. In Arizona it is A.R.S. §12-563, Necessary Elements of Proof. Both of the following shall be necessary elements of proof that injury resulted from the failure of a healthcare provider to follow the accepted standard of care: 1. The healthcare provider failed to exercise that degree of care, skill and learning expected of a reasonable, prudent healthcare provider in the profession or class to which he belongs within the state acting in the same or similar circumstances.
2. Such failure was a proximate cause of the injury.
It is, at its heart, a reasonableness standard. It is not a best practices standard; it is not a perfection standard. It requires that a physician be as caring and as careful, skillful and knowledgeable as a “reasonable and prudent” physician in the same profession. More than that, measurement of a
physician’s performance must be considered under the same or similar circumstances as the performance in question.
Despite increasing specialization by physicians and the advent of other practitioners including nurse practitioners and physician assistants, the statutory language defining the elements involved in establishing the standard of care remained unchanged for decades. In Arizona, for example, prior to adoption of the “expert witness qualifications” statute, A.R.S. §12-2604, “skill and learning” were so loosely defined that a neurologist could testify regarding the failure of a family practitioner to meet the standard of care, or an anesthesiologist could testify regarding the standard of care of a surgeon.
The current statute more accurately defines the standards against which a physician’s performance is to be measured by ensuring that experts opining on a physician’s performance have similar training, experience and skills as the physician accused of malpractice. Moreover, because medicine is changing rapidly, these criteria must apply contemporaneously with the event(s) and/or performance in question.
A monthly publication of the MCMS • July 2015 • Round-up • 17
clinical edu A number of states adopted similar legislation. In some jurisdictions courts have overturned the tightened requirements for expert testimony as unconstitutional. In Arizona, following a number of challenges the Supreme Court categorically upheld the constitutionality of A.R.S. §12-2604 in 2013 in Baker vs. UPH.
Long before the publication of “never events” and the quality measures contained in the Patient Protection and Affordable Care Act (PPACA), various medical and hospital entities developed evidence-based guidelines, patient care protocols, and policies and procedures. All are intended to encourage increasing uniformity to the delivery of medical care, uniformity based on evidence-based information. All fall short of encompassing the complexity of medical care delivery. And to be relevant and helpful, all must be viewed in the context of a specific patient and evolve as new information regarding safety, effectiveness, techniques and dangers manifest. They must change over time. In the early 1990’s, Maine adopted legislation designed to insulate physicians (and other practitioners) from suits alleging malpractice if they could demonstrate they followed published care guidelines. Less than ten years after its adoption the legislature repealed the statute. According to attorneys in the state, during that period they never utilized a defense based on the physician’s “adherence to guidelines.”
It is easier for a plaintiff attorney to establish a failure to adhere to a guideline than it is to define a standard of care through expert testimony and to demonstrate the physician fell below that standard.
In 2002, the National Quality Forum published a list of Serious Reportable Events (SREs) to increase public accountability and consumer access to information about healthcare performance. That list has been expanded to 28 events and renamed by many as “never events.” In 2008 the Centers for Medicare and Medicaid Services (CMS) announced it would stop paying for a CMS-defined list of hospital-acquired conditions, some of which overlap with SREs. Since then, plaintiff attorneys have sought to equate any occurrence of an SRE and non-payment by CMS as per se evidence of malpractice.
Adding to the effort to equate adherence to guidelines with the standard of care, an evaluation of the PPACA by attorneys working with Texas Medical Liability Trust (TMLT) identified 14 medical guidelines and reimbursement requirements they believed could become potential causes of action
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in medical liability suits. Subsequently, following a review required by Congress, the General Accounting Office (GAO) stated that “the determination as to whether the development, recognition, or implementation of guidelines or standards promulgated under . . . PPACA . . . give rise to new causes of action or claims ultimately rests with the courts” (emphasis added).
The annals of medical negligence law are littered with examples of ultimately disproven guidelines. For that reason, as recently as the June 10, 2013 issue of American Medical News, the American Medical Association expressed concern that provisions in the PPACA might be inflated “into something they were not meant to be by arguing that they establish new federal standards of care when it comes to determining medical liability in court cases.”
The good news for physicians in most states is the requirement that competent testimony indicating that a guideline or protocol is equivalent to the standard of care must be provided. However, if guidelines come from the defendants themselves, as may occur with hospital policies and procedures, some courts may be inclined to treat them as an admission that they are the standard of care. And, of course, when a defendant physician agrees with a plaintiff attorney’s characterization that a guideline is the standard of care, the court will likely do so as well.
As long as the provision of medical care requires professional judgment and interpretation of sometimes misleading, incomplete, even false information, guidelines must remain exactly that; guides, adjuncts, context, and support for complex and ongoing decision-making processes. It is important to remember; guidelines used prospectively often are interpreted quite differently retrospectively.
It is equally important to remember that care, as in careful and prudent but also as in caring, attentive and concerned, precedes skill and learning in the statutory definition of the standard of care.
The expectation on which the statute is based is that, “The healthcare provider will exercise that degree of care, skill and learning expected of a reasonable, prudent healthcare provider in the profession or class to which he belongs within the state acting in the same or similar circumstances.” There is no mention of adherence to a guideline or protocol, but there is a reasonable expectation of caring, judgment and best effort. ru
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member profile Protecting patient-centered care and ensuring tomorrowâ€™s future through adaptive and innovative techniques:
Jacqueline Chadwick, MD
Article photos: Denny Collins Photography www.dennycollins.com 602-448-2437
e all know the business of medicine is a changing landscape. So it follows that an adaptive medical education curriculum is more necessary than ever. Round-up sat down with the University of Arizona College of Medicine – Phoenix Vice Dean of Academic Affairs, Jacqueline Chadwick, MD. Starting out in Family Medicine and with plenty of private practice experience, Chadwick discusses her journey in healthcare and her passion for shaping the physicians of tomorrow.
Not What She First Expected
Dr. Jacqueline Chadwick was born in Indiana, where she spent far too much of her early childhood in poor health. Her doctor told her parents that a dry climate would be much healthier for her, and they took the advice very seriously. Packing up Chadwick and her younger sister, they moved to Arizona in the mid-50’s.
No long after arriving, there was a brief shuffle when her father was transferred to another company and the family wound up in the colder climates of Connecticut, before receiving a transfer to Florida. But that did not suit the family, either. “My parents did not like the society-jet-set culture there at the time and longed for a return to Arizona, a state they had fallen in love with,” Chadwick said. “We moved back to Arizona in the late 50’s to stay. My other sister was born shortly after our return back.”
Believe it or not, Dr. Chadwick did not originally intend to become a physician. As a small child with a deep love for animals, she was determined to become a veterinarian. She applied herself diligently at school and did very well. She thought her dreams were coming true when she was accepted to her school of choice – Colorado State University – where they had a wonderful veterinary school. However, this was the 1960’s, and her dreams took a sudden and crushing hit.
“During my freshman year, I met with one of the faculty at the vet school and was told in no uncertain terms that they would not accept a woman into their program,” Chadwick said. With her hopes ruined and no will to fight back, she
moved back to Phoenix and began attending Arizona State University (ASU).
ASU is where she caught the medicine bug, and she switched her goal to pre-med after her sophomore year. After leaving ASU she was accepted to the University of Arizona College of Medicine in Tucson, where she graduated in 1975. Protecting Family Practice
Chadwick took her time in deciding a specialty, partly due to the nature of the curriculum of the day.
“Patient contact and exposure to various specialties came later in the curriculum then, unlike today,” she said.
During her clerkship years she began to be exposed to the various sides and specialties of medical practice, and found that staying general was exactly what suited her best.
“I found I enjoyed every rotation equally. I enjoyed the cognitive side of medicine as well as the technical side of surgery. Pediatrics, geriatrics, community medicine, psychiatry, all appealed to me. I also really liked getting to know the patients and their families,” she said.
“Family practice was the best choice – absolutely no regrets about that specialty for me.”
After graduating and determining her specialty, Chadwick returned home to complete her residency at a small family practice at Scottsdale Memorial Hospital. She stayed on as an assistant program director before entering her own solo practice.
“I enjoyed all areas and types of practice – solo, small single specialty and multi specialty group environments – but frankly there’s something very special about solo private practice.”
“I found I enjoyed every rotation equally. I enjoyed the cognitive side of medicine as well as the technical side of surgery. Peds, geriatrics, community medicine, psychiatry all appealed to me. I also really liked getting to know the patients and their families.”
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Throughout her career in medicine, Chadwick appreciated the importance of involvement and networking through organized medicine. She joined the Maricopa County Medical Society and the Arizona Medical Association (ArMA) as well as her specialty society during her residency. “I always valued the importance of protecting my profession and I saw these organizations as the best way to do that,” she said.
She served as president of the Arizona Academy of Family Physicians in 1990, and on the board for its Women in Family Medicine Commission. She also served on the board of directors for the Christian Medical and Dental Association.
Chadwick also served as the first female president of ArMA in 1992, and has remained an active member of its 22 • Round-up • July 2015 • A monthly publication of the MCMS
board of directors, and the executive, legislative, and government affairs committees. Giving Back to the Profession She Loved
After her experiences in private practice, Chadwick saw the opportunity to make a change, and found another way to contribute her time and talents.
“I always thoroughly enjoyed private practice, but the medical environment changed dramatically in the late 80’s/early 90’s with the influx of HMO’s, etc.” she said. “I felt my primary passion of caring for patients threatened, but I also began thinking about what I could give back to the profession I dearly loved.”
Chadwick was raised in a family that placed a high value on education, and both her sisters and her mother have been
member profile involved in education throughout her life. Chadwick had done some teaching during residency as well as a few other opportunities, so when she saw a position open up at her alma mater, she was quick to apply.
“I never dreamed I would be strongly considered since I had not been in academic medicine since serving as assistant program director,” she said. “Nonetheless, I applied, and was honored to be hired as the first administrative presence in Phoenix for the University of Arizona College of Medicine – Phoenix (UA COM), allowing me to build the campus virtually from scratch.”
has stayed fairly consistent in the past couple decades, Chadwick said.
“Regarding state residents, we do have a responsibility to offer a quality education to our own residents, given the fact that we are a state university,” she said of UA COM.
“We opened admissions to out-of-state applicants but are striving to increase the Arizona pool. Therefore we are trying to broaden our outreach programs to high school and grade school in order to encourage young people to consider careers in medicine and healthcare early on.”
Along with reaching out to Arizona’s youth, exciting Along with her work as the inaugural associate dean at things are happening on campus for the University of AriUA COM, Chadwick also continued her private practice zona. Dean Stuart Flynn, MD has spoken about his desire part-time until just a few years ago. She still works with the campus, currently serving as Vice Dean for Academic Affairs, which includes overseeing the curriculum, as On the Personal Side… well as student, admissions, and other curricular units. “I have an amazing team of administrators, faculty and staff, making my job both rewarding and easier,” Chadwick said. “The students are amazing. I’ve often told them that I didn’t think I’d have a chance of getting into medical school today, as I hear of their phenomenal stories and backgrounds.” Training the Physicians of Tomorrow
As Chadwick has experienced throughout her life and practice, the business of healthcare and medicine has changed, and is changing, drastically. This, combined with both an overall physician shortage and a specific lack of residency slots, has made training tomorrow’s physicians in Arizona an interesting and important challenge.
Despite the growing number of medical schools and ultimate healthcare positions, the overall number of Arizona medical school applicants
1. Describe yourself in one word Determined
2. What is your favorite food and favorite restaurant in the Valley? Mexican food – Los Olivos in downtown Scottsdale 3. What career would you be doing if you weren’t a physician? Veterinarian, or history teacher 4. What’s a hidden talent that you have that most wouldn’t know about you? Playing piano 5. Best movie you’ve seen in the last ten years? Secretariat 6. Favorite Arizona sports team? Diamondbacks 7. Favorite activity outside of medicine? Theater and symphony; learning about and teaching bioethics
A monthly publication of the MCMS • July 2015 • Round-up • 23
to build a world-class academic medical center, emulating those recognized in states like Michigan, Houston and Baltimore. Chadwick says she believes the environment is ripe for making this dream a reality.
“Because of the size of our community, the population diversity, the hospitals interested in medical education, amazing physicians ready and willing to teach and many healthcare organizations desiring a partnership with a medical school, we are indeed poised to become a first-class academic medical center,” she said. The realization of this dream requires certain ingredients, Chadwick said. These ingredients include both undergraduate and graduate medical education; extensive research opportunities (basic, clinical, translational, and applied); and overall excellence in clinical practice. And she believes all of these ingredients are in place. “Our recent partnership with Banner augments our mutual ability to put all these together, but as a college that has
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been built on a distributed model partnering with all those interested, we have the desire to maintain our collaborative approach in education and research with all our partners,” she said. “It is our desire to provide the leadership, vision and expertise to accomplish this goal, one that Phoenix deserves.”
Along with these partnerships and plans for progress in the form of a medical center, curriculum is also remaining adaptable to keep up with changing times. Chadwick feels that the UA COM has done an admirable job of keeping up their curriculum to best prepare their students to enter any residency.
The integrated approach involves clinical experiences early on and a revisiting of basic sciences later, with fouryear themes that include ethics, behavioral science, public health/prevention/population medicine, biomedical informatics and healthcare transformation. “The last two are indicative of major changes that have occurred in medicine,” Chadwick said. “The ability to navi-
member profile gate information is crucial to practicing evidence-based medicine in this day and age. Teaching critical thinking and lifelong learning is at the core of our curriculum, as indicated in our blocks, themes, clerkships, courses and required scholarly projects.”
Some new program features also address other aspects of medical practice, such as insurance, legal, malpractice, advocacy, quality and safety. These innovative new teaching techniques are providing additional perspective and knowledge for medical students in a changing medical business landscape. Chadwick described another new feature that combines different specialties for a cooperative learning experience.
“Our new Longitudinal Patient Care course in third and fourth years involve medical students working with other healthcare students (physical therapy, physician assistant, occupational therapy, pharmacy and social work) periodically visiting patients (community mentors) in their homes to learn from them about such things as barriers to healthcare (e.g., insurance, finance, transportation), medication compliance, home safety and chronic disease management. Additionally it provides the opportunity to learn how to function as a team.”
While Chadwick is certainly best informed on the changes to her own alma mater’s curriculum, she believes the healthcare education experience across all of Arizona is unique in the opportunity it offers.
“To live in such a large city with such a diverse population and robust set of independent healthcare organizations gives this city the chance to create the academic medical center for the future,” she said.
In some large cities with long-standing medical histories, change can be difficult to influence, especially in academia. But Chadwick believes this is not the case for Arizona.
“We do not have to deconstruct here in order to address the rapidly changing environment,” she said. “We are innovative, creative and nimble. We do not operate with the constraint of, ‘not being able to do something new because this is the way we’ve always done it.’” Combating the Arizona Physician Shortage
Though full of many interesting and exciting opportunities for academic change, there are still some barriers to future Arizona physicians. As many as half of all medical
students who complete medical school here in Arizona end up in residency programs outside of the state. And, because many physicians settle down to practice where they complete their residency, this means we are producing far more physicians than we get to keep, despite a growing need.
While there may be other influences in the shortage, Chadwick feels Arizona offers competitive salaries and is a wonderful place to live.
“The medical board has struggled lately and hopefully licensing issues will continue to be addressed,” she said. “I do believe that resident slot shortages are the number one reason for our shortage.”
“We do not have near enough PGY1 slots in Arizona. We need at least 1000 slots just to get us to the national average,” Chadwick said, referencing a recent comprehensive study done by Flinn Medical Innovation Visiting Scholar Michael E. Whitcomb, MD. Chadwick says the report is well worth reading.
“Solutions are proposed but as you might guess, the main constraint is money. There is room to grow in Phoenix but it will take the support of the medical community, hospital leaders, business leaders and politicians to pull it off,” she said.
While it can be sad to see so many Arizona medical students ultimately leave the state, Chadwick is proud of how competitive the graduates are, vying for positions at the most prestigious institutions in the country.
That being said, enticing Physicians back to Arizona is definitely a part of the plan.
“We’ve seen members of our inaugural class who recently finished their residency training out of state return to Phoenix, and that’s our hope even if our graduates go to residencies outside Arizona,” Chadwick said.
“Most fourth year students across the country apply to residencies in academic medical centers, so increasing our numbers and more closely aligning residencies with the medical school will help,” she said. And, of course, having a full medical center would also help recruit those physicians who are interested in teaching and research as a part of their professional careers. ru
A monthly publication of the MCMS • July 2015 • Round-up • 25
Setting a New Course of Medical Education in Arizona:
Mayo Medical School By Michele Y. Halyard, MD
Michele Y. Halyard, MD
A New Medical School Coming to Arizona
Interim Dean, Mayo Medical School Professor of Radiation Oncology
In 2017, Mayo Medical School will open in Scottsdale, Arizona. The new school, made possible through the generous support of benefactors and Mayo Clinic, is part of the national expansion of the renowned Mayo Medical School in Rochester, Minnesota. (Mayo is also expanding a full third- and fourth-year medical education program on its Jacksonville, Florida campus.)
Dr. Michele Y. Halyard is a graduate of Howard University where she completed her undergraduate studies, medical school, and three years of training in Radiation Oncology. She also completed a fellowship in Radiation Oncology at Mayo Clinic in Rochester, Minnesota where upon completion, she joined the staff of Mayo Clinic in Arizona in the Department of Radiation Oncology in 1989. Currently she holds the rank of Professor of Radiation Oncology. Her area of expertise is in the treatment of breast and head and neck cancers. Her primary research area of expertise is the use of quality of life data and patient reported outcomes in cancer clinical practice. Administratively, Dr. Halyard was appointed as the Suzanne Hanson Poole Vice Dean of Mayo Medical School – Arizona Campus in April 2013 and is currently serving as the interim Dean of Mayo Medical School. She is also a past Chair of the Department of Radiation Oncology and served eight years on the Board of Governors of Mayo Clinic in Arizona, including serving as Vice Chair. She also served eight years as a member of the Mayo Clinic Executive Committee and Board of Trustees.
Mayo Medical School – Arizona campus will draw the brightest and most accomplished medical students from across the country to its four-year program in Maricopa County. This new opportunity will be particularly exciting for students from the West Coast and the Southwest who are familiar with the world-class Mayo Clinic model of patient care. Although it won’t open until 2017, the reputation of Mayo Medical School is already drawing the interest of perspective students to the valley. Mayo’s is one of the most selective medical schools in the country with 54 students traditionally accepted per class out of more than 4,750 national and international applicants. The new school in Scottsdale will admit 50 students per year – doubling the size of the student body over four years in an effort to address the advancing shortage of healthcare providers – particularly in Arizona and the southwestern region of the U.S.
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guest column Mayo Medical School is also recognized by U.S. News and World Report as one of the top ten most affordable private medical schools in the country. A strong financial aid and needs-based scholarship program is made possible through generous benefactor endowments and gifts. Mayo Medical School – Arizona campus will operate under the same tuition and scholarship structure – offering medical students in this region one of the most outstanding, highly affordable medical educations available. Mayo Medical School students regularly exceed the national average for matching to residency programs. In the past three years, 100 percent of its students have matched into a PGY1 program, with around 98 percent of these students reportedly getting one of their
top three requested choices, and 72 percent receiving their number one choice. An Innovative National Standard for Medical Education through Collaboration with ASU
Today physicians practice in a complex and evolving healthcare environment strained by unsustainable high healthcare costs, increasing burden of chronic diseases, aging populations and ongoing healthcare disparities. Nationally, physician burnout is at an all-time high. At the same time, patients are becoming savvy consumers and reimbursement programs are demanding better quality, safety and high-value care. Unfortunately, as the healthcare landscape has drastically changed, the medical education that should prepare
future physicians to meet these challenges has remained static for over 100 years – until now.
Mayo Medical School has committed to transforming medical education. In 2013, the school was chosen as one of the 11 top medical schools in the nation to lead the national transformation of medical training through the American Medical Association’s (AMA) Accelerating Change in Medical Education initiative. With a grant of $1 million over five years, Mayo Medical School has taken on the challenge of creating a new model of medical education that will prepare future physicians to better care for their patients and themselves and lead the transformation of the American healthcare system. The beauty of the AMA consortium is that all the schools are working on innova-
A monthly publication of the MCMS • July 2015 • Round-up • 27
tive changes to medical education – but they’re sharing their knowledge and best practices across the consortium and will more broadly disseminate these best practices to other medical schools around the country.
It made perfect sense for Mayo Medical School to team with Arizona State University (ASU), one of the top ranked research universities in the nation that leads in innovation, online learning and, importantly, the Science of Health Care Delivery. Over the course of the last two years, Mayo Medical School has worked closely with ASU to develop an entirely new level of transformative medical education based on the Science of Health Care Delivery.
The collaboration with ASU has resulted in a first-in-the-nation curriculum that expands medical education far beyond the current model of basic sciences and clinical sciences. The Science of Health Care Delivery – a third science, integrates components such as, high value care: systems engineering, process improvement, evidence-based medicine and patient safety; population-centered care: health disparities, health determinants, wellness and health promotion, and culturally sensitive care; team-based care: learning from and leading interprofessional teams and team-based care transitions;
leadership: strategic decision-making, change management and motivation in teams; person-centered care: shared decision-making, individualized care, and patient advocacy; and health policy, economics, and technology: healthcare policy, clinical informatics and healthcare economics. These additional knowledge and skill sets will allow future physicians to not only expertly care for patients, but also improve and heal the ailing healthcare system.
Additionally, the unique delivery of these domains feature a “flipped classroom,” where students access and study online learning modules jointly developed with ASU, and then, during what would be a normal didactic lecture with faculty, are instead engaged with highly interactive case studies, group discussions and opportunities to delve much deeper into these course topics.
Mayo Medical School students will complete the Science of Health Care Delivery requirements as part of their integrated curriculum and will be the first in the nation to receive a certificate of completion for this coursework – jointly conferred by Mayo Medical School and Arizona State University. They will also have the personal option to continue their Science of Health Care Delivery coursework with ASU, either during or outside their four-year medical program, to secure the 12 ad-
28 • Round-up • July 2015 • A monthly publication of the MCMS
ditional credits needed for a master’s in the Science of Health Care Delivery degree through ASU.
Along with the Science of Health Care Delivery curriculum, which is being launched with the July 2015 incoming class in Minnesota, students on the Arizona campus will also be availed to a unique program in student/physician wellness called THRIVE, which entails aspects of coping and wellness coaching, mentoring, success coaching, enhanced resiliency skills and self-assessment of psycho-social distress during medical school to provide students with earlier interventions for burnout. The skills learned during this wellness program will provide life-long coping skills to deter physician burnout.
Mayo Medical School – Arizona campus exemplifies the commitment of Mayo Clinic to the expanding healthcare needs of Arizonans. While Mayo Clinic has and will remain a premiere academic medical center, the inclusion of an on-site medical school, which has already received preliminary accreditation from the Liaison Committee on Medical Education and licensure by the state of Arizona, will also attract residents, fellows and expert faculty to the region. ru
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The ACT Health Fair: Improving Health, Education and Quality of Life for Children By Luz Rubio
Luz Rubio Luz Rubio has been in nonprofit management since 1986. Her career in this field started as the program director for the Epilepsy Foundation of Arizona. In 1991 she took a position as the receptionist for two organizations that were sharing an office, Service Station Dealers of Arizona (SSDAZ) and the Arizona Society of Association Executives (AzSAE), quickly understanding the role of industry associations and the importance of volunteers. In 1994 she took on the executive director role for AzSAE. In 20012, SSDAZ was looking to merge several automotive organizations. Ms. Rubio took over as director to lead the merger and successfully blended the organizations, which is now known as the Automotive Service Association of Arizona. Along with that challenge in 2002, Luz began volunteering for ACT as a general volunteer and then quickly was recruited to do registration and help with entertainment and other tasks. Currently, she serves as the President of the Board of Directors.
t’s a classic “Catch 22” situation: poverty-level families are eligible for Head Start programs for their children, but are unable to afford the government-required health screenings and immunizations needed to enroll. Without Head Start, these children would not be as ready for public schools as their peers in more affluent neighborhoods. This was the situation the Arizona Coalition for Tomorrow Charitable Fund, Inc. (ACT) was determined to change. ACT set out to provide the missing link for children and their families eligible for the Phoenix Head Start program by holding an annual ACT Kids Health Fair. And they have been able to do just that.
ACT works closely in partnership with many individuals and organizations that recognize the importance of this health fair and provide very important contributions of time, money, and supplies to make this important health care event an annual reality. Since 1990, through the ACT Kids Health Fair held every September, ACT has been improving and enhancing the quality of life for children, their families, and the community in which they live. ACT is a 501(c)(3) non-profit organization composed of as many as 1,200 volunteers committed to improving the health, education, and well-being of children from our community’s low-income families. ACT partners with both public and private organizations to provide comprehensive healthcare screenings to low income, at-risk children and families. Hundreds of volunteers are the driving force behind this huge effort, and include physicians, nurses, dentists, hygienists, students, and parents.
30 • Round-up • July 2015 • A monthly publication of the MCMS
doc edu trition information, diabetes, blood pressure, and asthma screenings to parents/guardians of the children as well as a free flu shot.
ACT is designated by Arizona State as a Qualifying Charitable Organization and relies solely on grant money, donations, and in-kind contributions to provide all the costly healthcare services. Kimberly Weidenbach, medical student at the UA COM-Phx, and Jennifer Heim, MD, resident physician, Phoenix Children’s Hospital, at the 2014 ACT Health Fair.
A majority of the volunteers are students. Annually, large numbers of participants come from Arizona State University, University of Arizona, Phoenix College, Midwestern University, AT Still University, Glendale Community College, Grand Canyon University, and more.
Many volunteers also come from hospitals and government and professional organizations, such as Phoenix Children’s Hospital, Maricopa County Medical Center, Maricopa County Medical Society, Arizona Department of Health Services, Maricopa County Department of Public Health, and Maricopa Integrated Health Services.
Leland Fairbanks, MD, passing on his knowledge to Garrett Frantz, medical student at U of A College of Medicine – Phoenix, at the 2013 ACT Health Fair.
Donations make it possible to purchase the necessary supplies, plan this massive one-day event, and raise awareness of critical health needs within our community. The annual expense budget ranges from $75k to $100k with less than 25% administrative cost. The value of services delivered to our community each year is calculated to be around $300,000.
ACT is an outstanding model of how private and public sector partnerships can improve health, education, and overall quality of life of our low-income, at-risk children and their families. ACT focuses on the Phoenix metropolitan area and is open to all low income at-risk families in the greater Phoenix metropolitan area.
ACT has continued to provide much needed services to our community, in spite of an increasingly difficult economic landscape. Costs are higher, and tighter times can frequently mean smaller donations and involvement. However, ACT is determined to continue their mission of providing healthcare screenings in our community to Head Start and non-Head Start children, their siblings and parents/guardians. ACT also strives to provide better socio-economic opportunities for these children and their families.
The ACT Health Fair is held the last Saturday in September of each year. Please consider donating your time to this worthy cause. For more information, turn to the ad on page 2, visit www.actkidshealthfair.org or call 602-370-7049. ru
The fair is a one stop location for all families, and even provides a medical home with community clinics for free medical services including emergency care, prescriptions and more. ACT provides information on physicians and other social service programs to benefit children and families, focusing on children from infants through 12 years of age.
These services are federally required for Head Start children, but, non-funded. ACT also includes non-Head Start children from AHCCCS eligible homes. ACT provides nu-
Jennifer Hartmark-Hill, MD and Alona Sukhina, medical student at UA COM-Phx, at the 2014 ACT Health Fair. A monthly publication of the MCMS • July 2015 • Round-up • 31
physician-in-training – atsu
Why I Chose A.T. Still University By Leigh Anne Costanzo
s a non-traditional student, I had many questions when I considered going to medical school. Once I realized the diversity in programs available, I prioritized key factors and compared each school to my list. At the end of this process, I chose A.T. Still University’s School of Osteopathic Medicine in Arizona (ATSU-SOMA).
Whole-person healthcare is a cornerstone of the ATSUSOMA program. As a registered nurse, I believe that patient, family and community are integral parts of the healthcare continuum. During my interview, it was clear that ATSUSOMA’s faculty and students felt the same way about holistic care. This was reinforced by the curriculum, my lectures and study materials, and then by exposure to community health centers (CHC). Additionally, the unique second year program promotes self-directed learning, which is a skill useful both now during school and later during my practice. ATSU-SOMA is focused on creating primary care physicians through an innovative partnership with CHCs across the country. These relationships introduce primary care principles and other primary care issues.
Although an osteopathic program, that is where most similarities end. ATSU-SOMA has a different academic calendar than the allopathic or fellow osteopathic counterparts. The extensive first year on campus focuses on several systems as well as osteopathic manipulation and medical skills. Second year, students are divided into several, smaller campuses, each associated with a CHC and regional medical directors, where students have an opportunity to see patients in outpatient clinics while continuing focused studies as independent learners. The intimate class size encourages interpersonal relationships between classmates, upper classmen, and faculty. 32 • Round-up • July 2015 • A monthly publication of the MCMS
Personally, working at the CHC in my second and third years exposed me to instances when a primary care physician had to act as a good steward of both the patient’s limited financial resources and the community’s limited healthcare resources. Our designated CHC campuses are often the location for core outpatient third year clerkships. Being able to care for people from a variety of backgrounds and cultures has encouraged me to grow as a future physician and as a person. Once assigned to my CHC, Adelante Healthcare in Mesa, I realized I needed to learn the issues affecting the community. One thing that has helped me to stay in touch with the local concerns while in medical school is joining the Maricopa County Medical Society (MCMS). While I cannot attend all of the activities, I appreciate the information provided in the monthly Round-up Magazine. Joining MCMS and other local or national organizations has kept me informed on my journey.
It is my joy and privilege to be a part of medicine. Every day leaves me astonished and humbled. I hope to keep the love of learning which has been tended and encouraged by ATSU-SOMA. ru
Leigh Anne Costanzo, OMS IV, BSN, is a fourth-year osteopathic medical student at A. T. Still University's School of Osteopathic Medicine in Arizona. She has represented the school on the Arizona Osteopathic Association's board of directors and is currently the secretary for the inaugural chapter of the Gold Humanism Honor Society at ATSU-SOMA. A registered nurse since 1991 and originally from northern California, she plans to become a primary care physician specializing in family medicine in the Phoenix metro area.
physician-in-training – midwestern
Leading with Your Gut, and Choosing Unique Experiences: Finding Value
in a Medical Education By Daniel Mabardy
n selecting a medical school, there are many factors to consider: the quality of the education, the structure of the curriculum, the condition of the facilities, and the extracurricular activities, to name a few. There is no denying that it can be overwhelming to try to assess all of these variables, and at the same time, accurately compare differences between academic institutions. I know this because it is exactly what I tried to do. I quickly realized that the best way for me to choose a medical school was not with my brain but with my gut – that’s right, a “gut decision.” This approach is often counterintuitive for medical students, who tend to be analytical and scientific in everything they do. However, I made my decision using my intuition – and it worked.
At the end of the day, I chose to attend Midwestern University because it just felt right. During my interview day, the campus and facilities were pristine, the atmosphere was collegial, and the people were welcoming and accommodating. I envisioned myself studying and living there. I felt at home.
The osteopathic medical program at Midwestern University is unique because everything is designed with the student in mind. Every plan, every decision, and every action is made to prepare students for success: the peaceful and grounding campus landscape, the faculty’s open-door policy, and the friendly staff in the student services office. Everyone at Midwestern University is committed to the same goal: to enable students to achieve academic excellence.
In addition to offering a rigorous basic science program and challenging clinical clerkships, Midwestern University is preparing me to be a physician by providing me the opportunity to extend my medical training by one year as a pre-
doctoral teaching fellow in the department of Osteopathic Manipulative Medicine (OMM). This unique experience allows me to instruct first and second year medical students on how to use their most powerful tools – their hands – to accurately diagnose patients and safely and effectively treat a variety of common conditions. During the last three years, I have been privileged to teach over 1,000 medical students the nuances of hands-on treatment while encouraging them to fulfill the promise of osteopathic medicine.
As the cost of medical education continues to rise, medical students are being strapped with exponentially greater student loan debts. As a society, we must look for ways to enable these bright, hard working, and altruistic young people to become the humanitarians the world desperately needs. After all, these are the people who will be taking care of our most precious resource – our health – for decades to come. Maricopa County Medical Society (MCMS) can support medical students by creating scholarship awards to ease their financial burden. As part of the scholarship process, MCMS could sponsor a symposium for students to showcase their ideas on how to address current and future healthcare challenges, including designing innovative practice models, applying emerging medical science to clinical practice, and utilizing technology to overcome the healthcare obstacles of our time. ru Daniel Mabardy, MS-V, OMM Scholar, is an osteopathic medical student at the Arizona College of Osteopathic Medicine at Midwestern University in Glendale. Daniel was one of three members of his class of over 250 students selected for the prestigious Osteopathic Manipulative Medicine (OMM) Scholarship. Daniel is also the founder and president of the Lifestyle and Functional Medicine Alliance, a newly established on-campus club. His passion for preventive medicine, preserving the doctor-patient relationship, and providing comprehensive, patient-centered care has led him to pursue a career in family medicine. A monthly publication of the MCMS • July 2015 • Round-up • 33
physician-in-training – ua com
Six Reasons to Choose the UA COM By Yael Kusne, PhD
n preparing to apply to medical school, pursuing the University of Arizona College of Medicine — Phoenix quickly became a priority. First, the university is full of faculty and staff who are not only extremely qualified – but also kind, caring, and invested in our success. Second, the university is in the center of a growing biomedical research community. Not only are there excellent basic science and translational medicine laboratories at the college, but many other local institutions (such as Barrow Neurological Institute) allow us to participate in cutting edge research.
Third, we are also lucky enough to be in close proximity to the Translational Genomics Research Institute (T-Gen), Caris Life Sciences and other biomedical companies who are changing the face of medicine by truly spearheading personalized medicine, diagnostics and therapeutics. Fourth, The Scholarly Project program allows us to venture into the world of clinical and basic science research. It provides us with an opportunity to learn how to conduct research and gain practice in writing scientific and clinical manuscripts.
Fifth, I am not only learning the basics of medicine – basic science and clinical correlates – but also how to conduct research and how to communicate in the best possible manner in order to hear, understand and empathize with our patients. We have an excellent doctoring program which is aimed at improving our skills in this manner. This program is run by Maricella Moffitt, MD, MPH, and Susan Kaib, MD – two exemplary physicians who teach us how to critically examine symptoms, conduct a thorough physical exam, listen to our patients and communicate with them in an effective and empathetic manner. Doctors have received a bad reputation for not caring about their patients, not having time to listen and not hearing their patients’ concerns. Our doctoring program 34 • Round-up • July 2015 • A monthly publication of the MCMS
prepares us to challenge this reputation by becoming a different kind of doctor who is truly compassionate and caring. UA COM makes sure that when we enter that stressful time in our training, we are better prepared to perform at the highest level. It ensures that these lessons will stay with us for the rest of our lives, impacting our careers by equipping us with the tools to change how doctors treat their patients.
Finally, in addition to our doctoring program, we also have two other programs which aim at providing us with clinical experiences – our Capstone Program and our Community Clinical Experience program. These are two wonderful programs that send us out into the greater Maricopa County community. The support we receive from our clinical partners is immeasurable. These Maricopa County institutions allow us to learn and train with them during these early years, helping to shape us into excellent physicians. It’s important to note that in addition to the local institutions, we also receive support from area physicians who run their own practices. Through these programs, they allow us into their practices to catch a glimpse of what it’s like to be a physician, either in family practice or subspecialty medicine.
Overall, I couldn’t imagine a better medical school to help me achieve my goals of becoming a compassionate, professional and well-trained physician. The UA College of Medicine — Phoenix, together with the local institutions of Maricopa County, are truly shaping the future of medicine through producing the next generation of physicians. ru
After finishing her doctorate in neuroscience at Arizona State University, Yael Kusne enrolled at the University of Arizona College of Medicine – Phoenix where she is a second-year medical student. After medical school, she hopes to be a physician-scientist, bringing cutting edge translational medicine from the bench to the bedside.
physician-in-training – creighton
A Unique Experience at Creighton University By Devin Dunatov
am blessed to be a part of the Creighton family as a member of the Class of 2016. Creighton offers a unique experience and education that is unmatched compared to other programs. As physicians, we will be entrusted with the responsibility of caring for our patients. This includes not only their physical ailments, but the emotions that accompany their specific diagnoses. Creighton embodies the Jesuit ideal of ‘cura personalis,’ or care for the whole person – mind, body, and spirit. So often, medical professionals become consumed with the physiologic disease that they forget to address the deeper issues at hand.
One of the reasons that I chose Creighton is because this mindset is encouraged from the first day of our medical education, and the elements of ‘cura personalis’ are woven throughout our curriculum until the time of graduation. I was also very attracted to Creighton’s emphasis on service to those in need. As first year medical students, we have the opportunity to provide free healthcare to the homeless and underserved population in Omaha through the student-run Magis Clinic. This spirit of service unifies our students in a way that is rivaled by other programs around the country. In 2010, Creighton University School of Medicine and St. Joseph’s Hospital and Medical Center established a partnership that provides third and fourth year students the opportunity to complete their clinical rotations in Phoenix, AZ. This program has thrived over the past four years, with students matching into competitive fields and residency programs across the country. I feel that the Creighton Phoenix Regional Campus (PRC) offers unique opportunities that are not afforded elsewhere. First, St. Joseph’s Hospital and Medical Center is a nationally recognized center for care, educa-
tion, and research. As students, we have the opportunity to rotate with physicians at the internationally renowned Barrow Neurological Institute, the Norton Thoracic Institute, as well as orthopedics, oncology, and other respected medical services. Second, with only 42 medical students comprising each class, the PRC provides the opportunity to receive intimate, one-on-one training from physicians across each specialty. The favorable faculty to student ratio creates an educational environment that can be transformed and applied to the needs of each individual student. Finally, our administration and support staff value student input, which has allowed us to create a program that is constantly evolving and providing an unparalleled medical education. It is the vision of the Creighton University School of Medicine, “to transform students into exceptional physicians who are leaders in advancing medicine, health and wellbeing.” As I look back on my medical education and prepare to begin my fourth year, I am confident that we, as Creighton students, have been trained to enter the medical field as physicians who are set apart in our ability to provide a comprehensive and integrated approach to patient care. We take pride in our desire to treat the whole patient, and we are prepared to deliver healthcare in a new and personal way. ru
Devin Dunatov is a native Phoenician, and has welcomed his return to Arizona. Prior to his last two years in Omaha, NE, Devin completed his undergraduate education at the University of Arizona with a degree in Physiology and a minor in Religious Studies. When not studying hard, Devin enjoys playing intramural sports, sipping a good cup of coffee, reading, and most importantly, spending quality time with his beautiful wife, Kia. After graduation next year, Devin plans to continue his medical education in Psychiatry.
A monthly publication of the MCMS • July 2015 • Round-up • 35
board of directors meeting minutes
The Maricopa County Medical Society & Medical Society Business Services
Board of Directors Meeting Minutes May 19, 2015 • 6 pm
Drs. Ryan Stratford, John Couvaras, Adam Brodsky, Kelly Hsu, Mark Wallace, Miriam Anand, Shane Daley, Tanja Gunsberger, Lee Ann Kelley, Marc Lato, Anthony Lee, May Mohty, and Anita Murcko were present. STAFF
Jay Conyers was present.
Dr. Stratford called the meeting to order at 6:06 pm. Dr. Stratford reminded the Board about confidentiality and properly disclosing conflicts of interest. OLD BUSINESS
Jay provided a summary report of the May 7th Medical Philanthropy event. It was suggested that the next event be videotaped. Jay also updated the Board on the status of the Pension Plan suit. PUBLIC HEALTH COMMITTEE
Jay provided an update of committee activities, and presented the e-cigarette resolution to the Board for approval, for submission to the ArMA House of Delegates. The Board approved the resolution. It was suggested that the Public Health Committee consider inclusion of hookahs in any future discussions of tobacco product use by teenagers.
36 • Round-up • July 2015 • A monthly publication of the MCMS
The Board discussed the various membership categories, and considered modification of categories to reflect the Board’s mission. The Board recommended to revise the membership categories, and approve through bylaws changes. MEDICAL BOARD PROJECT
Jay updated the Board on the status of the look-back audit for the Arizona Medical Board. NEW BUSINESS
Jay presented a resolution to close the dormant Chase account for BME. A motion was made to approve the resolution. The motion carried. ADJOURNMENT
The meeting was adjourned at 7:33 pm. ru
board of directors meeting minutes
The Maricopa County Medical Society & Medical Society Business Services
Board of Directors Meeting Minutes June 16, 2015 • 6 pm
Drs. Ryan Stratford, John Couvaras, Adam Brodsky, Kelly Hsu, Mark Wallace, Tanja Gunsberger, Ross Goldberg, Lee Ann Kelley, Marc Lato, Anthony Lee, May Mohty, and Anita Murcko were present. STAFF
Jay Conyers was present.
Dr. Stratford called the meeting to order at 6:04 pm. Dr. Stratford reminded the Board about confidentiality and properly disclosing conflicts of interest.
The Board discussed the current process for how Directors and Officers are chosen for the Society each year. The Board considered a revised process whereby candidates submit a brief application with their intent to serve, and discussed the qualifications necessary for the Executive Committee. DUES & ASSESSMENTS
The Board discussed the current dues rates for various membership categories, and the need to charge appropriate amounts to support Society activities. STRATEGIC PLANNING MEETING
Jay provided a summary of the ArMA Hosue of Delegates meeting held in late May.
Dr. Stratford reminded the Board of the purpose of the strategic planning meeting scheduled for the fall. A tentative date of September 26th was recommended.
Dr. Wallace summarized the recent meeting of the Finance Committee, in which they considered the IT upgrade for the Bureau of Medical Economics (BME). The committee’s recommendation was to invest in upgrading the IBM server and CUBS software. A motion was made to approve the recommendation. The motion carried.
No new business was presented.
The meeting was adjourned at 7:44 pm. ru
A monthly publication of the MCMS • July 2015 • Round-up • 37
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38 • Round-up • July 2015 • A monthly publication of the MCMS
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A monthly publication of the MCMS • July 2015 • Round-up • 39
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40 • Round-up • July 2015 • A monthly publication of the MCMS
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