SPRING 2021
A P U B L I C AT I O N O F T H E M A R I C O PA C O U N T Y M E D I C A L S O C I E T Y
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A Reflection on Diversity
Physicians across Arizona share their views on diversity in medicine and why it matters to patient care
Toni Stockton, MD, discusses how diversity will improve the state's physician workforce
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It’s energizing to be a part of Village Medical, an innovative, physician-led organization. As a Village Medical primary care physician, I’m supported to deliver high quality care to my patients, just like I’d want and expect for my own family. -Karen Wetherell, MD
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At Village Medical, we know the more you can connect with patients, the better care they receive. That’s why we empower providers with a patient-centered, tech-enabled model backed by a clinically integrated care team, to help you deliver better outcomes at a lower cost. If you’re looking for a change, we’re hiring primary care physicians and advanced practice providers right now, in: • Mesa • Gilbert
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Join the team that’s transforming primary care. To learn more, contact Vice President of Business Development Sam Martinez at smartinez@villagemd.com.
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CONTENTS IN EVERY ISSUE 4 | From the MCMS Board President VOLUME 3 • ISSUE 2
6 | From the Editor-in-Chief
Editor-In-Chief
8 | Briefs
John McElligott, MPH, CPH
Managing Editor
22 | What Arizona Docs are Saying
Edward Araujo
26 | Legal Corner
Creative Design
28 | How To
Randi Karabin, Karabincreative.com
30 | Physician Spotlight
Cover & Physician Profile Photography
ads@arizonaphysician.com
Maricopa County Medical Society Board Members President
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John Prater, DO
Immediate Past President
What Arizona Docs are Saying
Lee Ann Kelley, MD
Treasurer & President-Elect Ricardo Correa, MD, ESD, FACP
18 C O V E R S T O R Y
Secretary
A Reflection on Diversity: Toni Stockton, MD, shares insights from a career marked by biases and triumphs.
Ann Maiden, DO, FAAP Jane Lyons, MD Gerald Golner, MD, FAAP Shane Daley, MD, FACS Zaid Fadul, MD, FS, FAAFP
Learn why having a diverse physician workforce matters.
Medical schools in Maricopa County are leading the way in improving health outcomes through diversity within the physician workforce.
Advertising
Directors
Physician Diversity
Medical Schools Lead the Way
Ben Scolaro, scolarodesign.com
Karyne Vinales, MD
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14 physicians throughout the state share their thoughts on diversity in medicine.
Resident & Fellow Director Anchit Mehrotra, MD
Medical Student Director Kristen Bolte, OMS-III
Digital & Social Media arizonaphysician.com ArizonaPhysician @AZPhysician @AZ_Physician
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FROM THE MCMS BOARD PRESIDENT
“ O U R C I V I L WA R I S A B L O T O N O U R H I S T O R Y, B U T N O T A S G R E AT A B L O T A S O U R B U Y I N G A N D S E L L I N G O F N EG R O S O U L S .” — M A R K T WA I N
T
he United States government is a special
many of us better at our jobs as we cross paths
social experiment put to paper by very
professionally with people of different backgrounds
learned people, the tenants of which
and orientations.
were outlined over 200 years ago. While
Maricopa County Medical Society embraces
not without challenges, their framework spoke to
the changes embodied by the concept of a diverse
individual rights and freedoms, wherein all people,
workforce, supporting the distinct qualities of not
regardless of background, were unique individuals
only our patients but our fellow physicians.
and possessed the inherent rights of life, liberty, and the pursuit of happiness. Because this social experiment was remarkable
As we move through the social landscape and all the challenges this last year has presented to us, let us all try to focus every day in seeing each of our
in so many ways, at various points in our history
colleagues as unique individuals and as members of
(most notably the civil war), there has always been a
a health care team team that each bring their own
somewhat charged difference of opinion between those
perspective to the service of our patients.
comfortable with society as they knew it, and those more liberal thinkers who brought forward ideas to
Respectfully,
challenge the status quo. That dynamic has always been a part of our history and has been instrumental in a positive way in re-shaping our society. We have now come to experience that challenge
John Prater, DO
to the status quo in medicine, wherein segments of our society have made it known they would be more comfortable seeing a physician of the same race, or gender, or sexual orientation. This is a change challenged initially by organized medicine, but now wholly embraced as fitting and socially appropriate. It has also been instrumental in making
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Dr. Prater moved from Ft. Myers, FL to Phoenix in 2017 and shortly thereafter became a Director on the Board of Maricopa County Medical Society. He was active at the state and local levels of organized medicine in Florida for decades where he served in several physician leadership positions, including President of the Southwest Florida Psychiatric Society and President of District Eleven of the Southwest Florida Osteopathic Medical Society. He is a board-certified psychiatrist currently practicing at the Phoenix VA Medical Center.
FROM THE EDITOR-IN-CHIEF
FAC I NG DI S C R I M I N AT ION “Not everything that is faced can be changed, but nothing can be changed until it is faced.” —James Baldwin 2020 was a momentous year for the United States. During a global pandemic, scores of Americans from all walks of life protested racial injustice. Individuals and corporations alike faced the reality that discrimination against people of color continues in America today. The medical community is no different. Physicians spoke up and acted. Maricopa County Medical Society (MCMS) launched a Diversity Subcommittee in July of 2020 and will focus its efforts on education and advocacy for greater diversity of the physician workforce. The Subcommittee members believe such diversity will lead to improved patient care, inclusivity in medical care, and physician well-being. Anyone interested in joining the MCMS Diversity Subcommittee can sign up online at surveymonkey.com/r/MCMSdiversity.
DI V E R S E C ON T E N T Our theme for this issue is Diversity in Medicine. We highlight the journey of Toni C. Stockton, MD, FAAD, and owner of Stockton Dermatology. Dr. Stockton spoke with Managing Editor Edward Araujo about how, despite her success as a physician, she still experiences racial and gender bias as a Black woman. However, some progress is happening. Dr. Stockton believes minority physicians have greater access to capital today than they did one or two decades ago. We delve deeper into the topic of diversity of the physician workforce in our section “What Arizona Docs are Saying.” Although it was somewhat difficult to convince doctors to go on record about race and gender, we publish responses from over a dozen physicians about why a diverse workforce is important, whether greater diversity of physicians would lead to improved care for patients, and what policies or systemic changes are needed. I thank the physicians who shared their perspectives.
Brian Powell of the Flinn Foundation returns as a guest author and writes about what medical schools are doing to increase the diversity of their student bodies. Brian spoke with Clinton Normore, MBA, Vice President of Diversity and Inclusion at A.T. Still University (ATSU), who added the School of Osteopathic Medicine in Arizona looks beyond skin color and has a concerted effort to recruit student from other underrepresented populations like “the LGBT population, disabled population, people in the military, the poor.” Karyne Vinales, MD, chair of the MCMS Diversity Subcommittee, recommends physicians consider what is within their control. She urges doctors to answer voluntary questions about demographics when renewing their medical licenses with the Arizona Medical Board or Arizona Board of Osteopathic Examiners. Dr. Vinales also recommends that physicians in leadership positions create plans for recruiting and retaining a diverse workforce, analyzing pay gaps based on race or gender, and considering opportunities to prepare underrepresented youth for a potential career in medicine.
SPE A K U P Please consider Arizona Physician as a medium for sharing your views with fellow physicians. We offer a quarterly print magazine, a growing digital magazine, and two episodes each month of the Arizona Physician podcast. We welcome you to submit topics of articles or potential guests for the show. Contact us at information@arizonaphysician.com with any comments or suggestions.
We are looking for article contributors, podcast guests, and virtual event presenters. Contact us at information@arizonaphysician.com for these and many more opportunities. 6
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Enjoy the magazine.
By John E. McElligott, MPH, CPH
Creighton’s Creighton’s four-year four-year medical medical school school is is coming coming to to Phoenix. Phoenix.
New New health health sciences sciences campus campus to to open open in in fall fall 2021. 2021. Creighton is expanding in the Southwest with a Creighton is expanding in the Southwest with a 183,000-square-foot, state-of-the-art interprofessional 183,000-square-foot, state-of-the-art interprofessional campus. The expansion will make Creighton the largest campus. The expansion will educator make Creighton the largest Catholic health professions in the nation, and Catholic health professions educator in the nation, we’re proud to bring a full range of health sciences and we’re proud a full range of health sciences programs to to thebring region. programs to the region. This expansion was brought to life through the This expansion was brought life through the Alliance, Creighton University Arizonato Health Education Creighton University Arizona Health Education Alliance, a partnership between Creighton University, Dignity a partnership between Creighton University, Dignity Health St. Joseph’s Hospital and Medical Center, Health St. Joseph’s Hospital and Medical Center,
Learn more at creighton.edu/phoenix Learn more at creighton.edu/phoenix The Creighton Alliance includes: The Creighton Alliance includes:
Valleywise Health, and District Medical Group. The Valleywise Health, will andprovide District access MedicaltoGroup. The Creighton Alliance high-quality Creighton Alliance will provide accessstudents to high-quality teaching environments for Creighton and teaching for Creighton and residents,environments and it’s a natural extensionstudents of our mission. residents, and it’s a natural extension of our mission. As a Jesuit, Catholic university, Creighton has been As a Jesuit,changemakers Catholic university, Creighton has been educating for more than 140 years. educating changemakers for more than 140 years. We’re proud to continue that tradition in Phoenix We’re that tradition in Phoenix as we proud partnertotocontinue help passionate students become as we partner toprofessionals. help passionate students become compassionate compassionate professionals.
BRIEFS
NEWS AND NOTES FROM THE FIELD
6 Ways to Prevent a Stroke High blood pressure is the biggest contributor to the risk of stroke in both men and women. Making sure to monitor blood pressure is probably the biggest difference people can make to their vascular health.
independent stroke reducer. By taking at least one walk per day, going to the gym, taking stairs instead of the elevator, or just putting aside 30 minutes of exercise activity will go a long way to reducing your stroke risk.
is okay, as it may decrease your risk of stroke. Yet if you drink more than two drinks per day your risk of stroke goes up dramatically. Watch your portion size and have no more than one drink per day.
2. EAT A HEALTHY DIET | What you
4. AVOID SMOKING | Smoking
eat is very important as obesity increases your stroke risk. You can reduce your stroke risk by reducing salts in your diet, eating fruits, and reducing foods high in saturated fats.
accelerates clot formation plus it thickens your blood as well as increases the amount of plaque buildup within your arteries. Quitting smoking may be one of the most powerful lifestyle changes you can do to reduce stroke risk.
blood sugar can do irreparable damage to your blood vessels over time, making clots more likely to form inside them, increasing your stroke risk. Keep your blood sugars under control by monitoring and consulting with your physician.
1. LOWER YOUR BLOOD PRESSURE |
3. EXERCISE REGULARLY | Exercise
will help you lose weight as well as lower your blood pressure, yet on its own it stands as an
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5. AVOID DRINKING TOO MUCH ALCOHOL | Drinking alcohol
6. TREAT DIABETES | Having high
Sources: Harvard Health Publishing, health.harvard.edu and WebMD, webmd.com
5 BOOKS AND MOVIES ON MILITARY MEDICINE 6 WAYS TO PREVENT PHYSICIAN BURNOUT Physicians are not immune to what may seem like a crush of email in your inbox or nonstop phone or video conferences. Add a commitment to helping patients, sometimes at the expense of your self-care, and you can see why some physicians face burnout. Here are some strategies other hard-working professionals use to prevent burnout.
TAKE A VACATION AND UNPLUG | Hit the road with family, friends, or just yourself. Set an out-of-office message and do not respond to emails.
CHOOSE HARMONY OVER BALANCE | Physicians are passionate
about providing medical care. If you disagree with the idea of work-life balance, then make sure the care you provide feeds your soul.
LEAN ON YOUR TEAM | Each medical
team has a mix of skills and personalities. Not good at something? Ask for help. Then, ask someone else if they need help. Pay it forward and remember those magic words of please and thank you.
Scores of physicians in Arizona are active-duty service members or reservists caring for fellow members of the uniformed services. This list is a glimpse of the contributions and sacrifices physicians made for their brothers and sisters in arms and for medicine in general.
WAR SURGERY IN AFGHANISTAN AND IRAQ: A SERIES OF CASES, 2003-2007 | With vivid photos, review 100 cases of acute combat trauma care conducted in forward operating environments. Learn about the medical interventions constantly evolving to treat war wounds.
PARADISE GENERAL: RIDING THE SURGE AT A COMBAT HOSPITAL IN IRAQ | At the age of 48, Dave Hnida, MD, left his family practice in Colorado and became a battalion surgeon with a combat unit in Iraq. In 2007, he served as a trauma chief at one of the busiest Combat Support Hospitals during the Surge. The 399th CSH soon became a medevac destination of choice because of its high survival rate, an astounding 98 percent. MILITARY MEDICINE: BEYOND THE BATTLEFIELD | This one-hour documentary from ABC News correspondent Bob Woodruff covers military medical advances and technology from the battlefield to the return home. Woodruff highlights the personal stories of physicians, scientists, active-duty troops, veterans, and military families to show how medicine is saving and changing the lives of America’s service members.
SCHEDULE FREE TIME | Block off some
free time on your calendar and be sure to use it. Go for a walk. Read a few pages of a book or magazine. Consider it time to recharge your batteries for the rest of your day.
TRAUMA | The documentary portrays how a medevac unit worked to save thousands of lives on the battlefields of Afghanistan and what the combat medics had to endure.
WORK OUT | Physical fitness helps every-
one. Endorphins released during exercise help to relieve stress and pain. Think of the “runner’s high” people get after a lengthy workout. Try knocking out a few push-ups or squats between patients.
FIND A HOBBY | We all need to take
our minds off work, regardless of the profession. Find a hobby you can do for a few hours each week and dive into it. Forget about your patients, practice, clinic, or whatever normally occupies your thoughts.
FIGHTING FOR LIFE | Terry Sanders created this documentary to show American military doctors, nurses, and medics on the front lines of Iraq. Through their eyes and those of wounded troops determined to survive, the film also reveals the students of the Uniformed Services University, “the best medical school no one’s ever heard of,” and their journey to becoming military physicians.
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cheese. Solid veggie options include the calabacitas with Mexican squash, corn, onion, and queso asadero. TACOS TIJUANA | Multiple locations
(Glendale, Phoenix, Avondale, Mesa, Gilbert) | Some of the best guacamole in town. Choose from classic favorites like carne asada, al pastor, carnitas, and chicken.
Great Taco Spots in Maricopa County
I
n recognition of Cinco de Mayo, enjoy some great tacos across Maricopa County!
TACO CHELO | Downtown
Phoenix | Amazing al pastor, costra, and carnitas tacos with flavorful salsas in conjunction with a downtown Phoenix vibe. TAQUERIA MI CASITA | Chandler | Great
service and delicious carnitas, al pastor, and carne asada tacos.
TACOS CALAFIA | Multiple locations LOS TAQUITOS | Multiple locations
(Ahwatukee, Phoenix, Chandler, Sky Harbor Airport) | This seven sisters’ run eatery still sizzles after multiple accolades thrown its way. From traditional al pastor to fish, you will not be disappointed with how these tacos taste. TACOS CHIWAS | Multiple locations
(Phoenix, Mesa, Chandler) | The signature taco chiwas has beef, ham, jalapeño, Anaheim chiles, and asadero
FOR LEASE CLASS “A” +- 6,535 SF
(Peoria, Tolleson, Phoenix, Surprise) | The vampiro is scary good. It’s a combination of a taco, a tostada, and a quesadilla. Or try the mulita, often described as a quesadilla on steroids. EMILIO’S TACOS & HOTDOGS | Phoenix | From tasty
tacos to incredibly hearty sonoran hot dogs and wild summer drinks, this place may have a line but, trust us, it’s worth the wait.
GalleryPlazaAZ.com 1310 E. Southern Avenue Mesa, AZ 85204
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Free Rent & Tenant Improvement Allowance Available
Dr. Singh (602) 380-8080 david.singh@pruthiproperties.com Formerly Hanger Clinic Idea for Surgery Center/ Dental/Medical Office Prominent Signage Covered Parking Rent from $18/SF Free 2,200 SF of Storage One-Half Mile N. of 60
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Despite the heat, there are some excellent yearlong choices for hikes in Arizona. Here are some getaways within the Phoenix area. Beat the heat and protect yourself by always taking water, and using sunscreen and a hat. 1. CAMELBACK MOUNTAIN | via Echo Canyon and Cholla Trail – Length 4.8 miles | Located in Paradise Valley, this route pushes your physical boundaries in the beginning of the trail route and then eases when you reach the summit and go down Cholla.
Exciting Hiking Trails within the Phoenix Area
2. PIESTEWA PEAK AND FREEDOM LOOP TRAIL | Length 4.5 miles | Located in north central Phoenix. This trail includes a hike up the 1.8 mile summit and back down and around the circumference of the mountain. The hikes both up and down will test you. 3. DREAMY DRAW LOOP TRAIL | Length 3.7 miles | Located in north central Phoenix. This mix of scenery and trail length will give you a nice workout and the opportunity to see plenty of wildflowers.
4. DIXIE MOUNTAIN LOOP WITH TWO SUMMITS | Length 5.5 miles | Located in north Phoenix in the Phoenix Sonoran Desert Preserve. This trail’s attraction is the flora, especially in the spring and fall. 5. TRAIL 100 & TRAIL 306 SHORT LOOP | Length 3 miles | Located in north Phoenix within North Mountain Park. This trail will give you scenic views across multiple washes you’ll cross. Plus, it is easier on your feet, as most of the trail is on flat ground. Great for taking kids and dogs. 6. SHADOW MOUNTAIN TRAIL | Length 2.6 miles | Located in north Phoenix within the Phoenix Mountain Preserve. Yet another mountain circumference trail that allows for great city views, wildflowers, and trail running. 7. TELEGRAPH PASS TRAIL | Length 2.2 miles | Located in south Phoenix within the South Mountain Preserve. This year round accessible trail isn’t difficult yet allows great views of wild flowers during the spring plus access to the Desert Classic Trail which goes for 9 miles if you want to challenge yourself.
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Physician
Diversity L
ast year was replete with racial unrest in cities throughout the country. Organizations large and small released statements denouncing racism or recognizing racism as a public health threat. Many organizations held virtual discussions about ways to reduce racist policies and practices and increase diversity in their communities. Physicians were among those voices calling for action. Before acting, we need to consider diversity of the physician workforce. Here, I examine why it matters, how diverse the physician workforce is today, what it should be, and what to do about creating the future we want.
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WHY DOES A DIVERSE PHYSICIAN WORKFORCE MATTER? It matters because greater diversity of physicians can lead to more and better care delivered to our local population, especially the underserved and minority populations. According to the Institute of Medicine, researchers found sufficient evidence “to support continued efforts to increase the number of physicians from underrepresented minority groups.” Here are some examples.
By Karyne Vinales, MD Endocrinologist Phoenix VA Health Care System karyclima@hotmail.com
Researchers at Penn Medicine analyzed 117,589 Press Ganey Outpatient Medical Practice Surveys, which measure the patient experience, and found that higher scores “were associated with racial/ethnic concordance between patients and their physicians.” Junko Takeshita, MD, PhD, MSCE, the study’s corresponding author, noted “patients who see physicians of their own race or ethnicity are more likely to rate their physicians higher than patients who see physicians of a different race or ethnicity.” In a recent study of physician-patient racial concordance, researchers found Black babies had a 50% higher chance to survive the neonatal period if they were cared by a Black physician. It is also important to note that diversity exposure during medical school increases students’ attitudes about importance of culture and awareness regarding societal issues, making students who attended more diverse medical schools better equipped to care for patients in a diverse society. In the study by Dr. Somnath Saha, almost 50% of the underrepresented minority medical students were planning to serve the underserved population, almost three-fold higher rate than non-underrepresented students. If we invest in training more minority students, perhaps we can assist states like California, where physician supply was inversely proportional to the number of Blacks and Hispanics in both urban and rural areas in a study. Although it is not difficult to guess that other states suffer from same fate.
DIVERSIT Y AMONG PHYSICIANS TODAY There are several ways to examine workforce diversity, chief among them race/ethnicity and gender. According to the American Medical Association, there are approximately 64% of physicians in the United States who identify as male and 36% who identify as female. This gap is decreasing, as half of graduating medical students are female, at least over the last five years, according to data from the Association of American Medical Colleges (AAMC). However, decreasing the gap needs to be accompanied by pay equity. The average female physician earns about 75 cents to a male physician’s dollar. Regarding race, data from the AAMC shows that 56.2% (516,304) of active physicians throughout the United States identified as White. There were 17.1% who identified as Asian, 5.8% as Hispanic, 5.0% as Black or African American, 1.0% as Multiple Race – Non-Hispanic, 0.8% as
Other, and 0.3% as American Indian or Alaska Native. A sizable 13.7% of race/ethnicity is identified as Unknown. For comparison, 13.4% of the U.S. population identifies as Black, according to U.S. Census estimates in 2019.
GOALS FOR FUTURE DIVERSIT Y A service industry workforce should represent the population it is serving. As a work environment, a diverse physician workforce can increase employee morale, provide better care for diverse populations, increase employee retention, provide better recruitment, possibly enhance individual motivation and thus problem solving, and all those reasons combined, provide better results in patients care. However, we cannot work effectively to increase diversity if we do not have a real grasp of the problem. By having a better idea of the gaps we are facing, we will be able to tailor solutions and bring key collaborators together to drive changes. While we have decent data regarding physician diversity at the national level, there are not good numbers for Arizona. At least, not yet. The Arizona Medical Board is now requesting demographic data of physicians who submit requests for either a new or renewal license to practice. Although the questions are not required, we will have, over time, more data about physician diversity.
WHAT TO DO NEXT? Consider what is within your control. When you renew your license, please answer voluntary questions about demographic data. If you employ physicians in your hospital or practice, then create a plan for recruiting and retaining a more diverse physician workforce. Ensure that well-qualified physicians of all demographics are considered equally for leadership roles. Review the pay provided to physicians in your hospital or practice and determine whether there are disparities based on race or gender. Encourage youth in Black, Latinx, Asian, or American Indian communities to study in the science, technology, engineering, or math (STEM) fields, which are common disciplines for the pipeline to medical schools. ■
Make a Difference! Maricopa County Medical Society (MCMS)’s Diversity Sub-committee will address how to diversify the physician workforce. Join the committee at www.surveymonkey.com/r/ MCMSdiversity.
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Medical Schools D
LEAD the WAY IN DIVERSIFYING PHYSICIAN WORKFORCE TO IMPROVE HEALTH OUTCOMES
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r. Kenneth Poole of Mayo Clinic Arizona says ideally, the race or ethnicity of a physician should not impact patient care. But Poole, an internal-medicine physician who oversees patient experience at Mayo Clinic Arizona and serves on the admissions committee for Mayo Clinic Alix School of Medicine, says that available data shows people tend to prefer racially and culturally congruent care—and that such care can impact outcomes. For instance, Black men have poor health outcomes compared to white men and a lower life expectancy. Poole points to data showing that the only proven way to date to narrow that health gap is for Black male patients to see Black male physicians, as Black men are more likely to engage in preventative services recommended by Black physicians.
By Brian Powell Communications Manager Flinn Foundation bpowell@flinn.org
“What if for certain groups there is a better outcome if they do have their physician-request granted. If, knowing that, you deny that request, is that morally wrong?” Poole said. This is just one example of how the racial and ethnic makeup of the physician workforce, starting with who is accepted into medical school, can impact health outcomes in the community. But today, Black males are the most underrepresented group in medical school, with only 5% of practicing physicians nationally identifying as Black. “When you have similarities between patient and physician, you get better compliance, probably because there is more trust there,” said Francisco Lucio, associate dean of equity, diversity, and inclusion at University of Arizona College of Medicine-Phoenix. “People are more likely to take their medications and come back to their next appointment, which is important to health outcomes.”
THE MEDICAL SCHOOL COMMITMENT TO DIVERSIT Y The four medical schools in Maricopa County have all made efforts to incorporate diversity and cultural teachings into their admissions process and curriculum as they seek to improve patient care by all physicians for all people. University of Arizona College of Medicine-Phoenix, Mayo Clinic Alix School of Medicine in Scottsdale, A.T. Still University School of Osteopathic Medicine in Arizona, Arizona College of Osteopathic Medicine at Midwestern University in Glendale, and the Creighton University School of Medicine Phoenix campus—which will be the county’s fifth medical school when it opens in midtown Phoenix in fall 2021—have all stated their commitment to diversity. School representatives shared examples of the work being done to lead to a more diverse student body and ultimately workforce. For instance, admissions offices are taking a more holistic look at applications. Admissions committees have representation from underserved communities. New programs have been established to create paths into medical school for students who would not qualify with their
undergraduate grade point average and MCAT scores. Attention is being placed on diversifying the faculty at medical schools, including seeking a higher percentage of women. And marketing and recruitment efforts are targeting the LGBT community and establishing relationships with historically Black colleges and universities. “We start with a goal of trying to reflect the community we are serving in Arizona,” Lucio said. “We let folks know that we are here and a place that wants students from groups that are historically underrepresented.” The medical schools offer their own scholarships and pipeline programs, such as the Pathway Scholars Program at University of Arizona for individuals who are socioeconomically disadvantaged, first-generation college students, from rural Arizona, or members of federally recognized American Indian tribes. Clinton Normore, vice president for diversity and inclusion at ATSU, says his medical school seeks students from rural or underserved urban neighborhoods, for instance, with a desire to return to those settings to make a difference. “Having practitioners that look like the population matters,” Normore said. In parallel to medical schools’ internal efforts are programs by nonprofit groups such as Scottsdale-based ElevateMeD, which assists students from racial and ethnic backgrounds traditionally underrepresented in medicine. ElevateMeD is led by Dr. Alyx Porter, a Mayo Clinic neuro-oncologist in Scottsdale. The organization she founded in 2019 provides financial scholarships as well as mentorship and leadership training to African American, Hispanic, and Native American medical students. In its inaugural year, $100,000 in scholarships were distributed to 10 students across the nation, including one attending the Mayo Clinic Alix School of Medicine in Scottsdale and another the University of Arizona in Tucson. The vision of the schools and supporting organizations is a more diverse physician workforce taught by a more diverse faculty will be better trained and prepared to serve an increasingly diverse and growing population, leading to improved care and health for the roughly 4.5 million Maricopa County residents and beyond.
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The 25 students, who are required to meet a minimum GPA and MCAT score for acceptance into the Bridges Program, will automatically have a spot reserved for them in the medical school and will not be required to retake the MCAT or reapply, but they must prove to be a high-performing student and maintain a 3.2 GPA, AZCOM Dean Dr. Lori Kemper said. “We feel this is going to increase our diversity and give people a foot in the door who wouldn’t have had one because their numbers were too low to be considered,” Kemper said. “But we want to know you are going to be successful and we are going to give you the tools to be successful.”
DIVERSIT Y BEYOND RACE THE MIDWESTERN BRIDGES PROGRAM The Midwestern University campus in Glendale, or AZCOM, receives about 5,400 applicants a year for 250 slots, with undergraduate academic performance and MCAT scores playing a large role in the admissions process. The new Bridges Program is committed to recruiting students from underrepresented and disadvantaged backgrounds who otherwise would not be accepted into the medical school. Up to 25 students per year, or 10% of the AZCOM class, will be accepted into the program which begins with a one-year biomedical sciences master’s degree program at Midwestern.
Normore said ATSU’s “Diversity Means More than Hue” marker reflects the fact that only thinking about people of color overlooks many other underrepresented populations—the LGBT population, disabled population, people in the military, the poor—who need be included in the process and are important to the idea of diversity. In Maricopa County, according to July 2019 estimates, 7.5% of the population under 65 lives with a disability and 12 percent live in poverty—factors that could impact a commitment to preventive medicine if there is trouble relating to a physician. The LGBT community can face barriers to care or encounter challenges as patients of primary-care
By the Numbers
Racial/Ethnic Physician Breakdown by Sex (2019) White Physicians
Male 65.0%
Female 35.0%
Native Physicians
Male 60.0%
Female 40.0%
Association of American Medical Colleges Data United States Active Physician Breakdown (2019)
Medical Student Acceptances (2019)
Hispanic Physicians Male 59.5%
Female 40.5%
Asian Physicians
Male 55.7%
Female 44.3%
56% White
49.8% White
Black Physicians
Male 46.9%
Female 53.1%
22.0% Asian
17% Asian
6% Hispanic
6.2% Hispanic
5% Black
7.1% Black
Maricopa County (July 2019 estimates, U.S. Census Bureau)
Population: 4.5 million
14% Unknown
0.1% Native American
64% Male
51.0% Women
54.5% White
36% Female
49.0% Men
31.4% Hispanic 6.4% Black
45% Age 55 or older
4.6% Asian
Academic Faculty (2019)
64.0% White
2.8% American Indian .3% Native Hawaiian or Pacific Islander
19.0% Asian
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5.5% Hispanic
27.0% speak a language other than English at home
3.6% Black
0.2% Native American
7.5% under 65 with a disability 12.0% live in poverty
physicians without a lot of experience working with the population, Lucio said. “We want to make the school welcoming for LGBT, and one of the first things we have done is revise our mission statement to include folks from different sexual orientations,” Lucio said. AZCOM has established a required course for students to learn about health disparities and how they may impact people’s ability to get needed medical care, said Kemper, helping students have the ability to meet patients where they are.
THE FUTURE WORKFORCE The most recent Association of American Medical Colleges data reveals a physician workforce already changing, even before the past year brought greater attention to diversity and inclusion issues. As of 2019, the AAMC reports 64% of active physicians are male and 56% are white. The percentage of Asian physicians, at 17%, is greater than the combined number of identified Hispanic, African American, and Native American physicians with the race unknown for 14% of physicians. However, about 45% of U.S. physicians are age 55 or older, and this cohort has a greater percentage of white and male physicians than in younger groups. Women
“We feel this is going to increase our diversity and give people a foot in the door who wouldn’t have had one because their numbers were too low to be considered.” —Dean Lori Kemper, DO, on the AZCOM Bridges Program
outnumber men, in fact, among physicians 34 years of age and younger. In 2019, 51 percent of all medical-school acceptances were female and 50 percent where white, the latter a significantly lower percentage than among all practicing physicians. If these trends continue, non-white patients will be more likely to see a physician who is the same race or speaks the same language, while female patients will be more likely to see female doctors. And the hope is the changing medical school—and future workforce—will translate into improved care for all patients. ■
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A R I ZO N A P H Y S I C I A N . C O M 17 4/30/21 11:15 AM
A Reflection on Diversity Toni Stockton, MD, of Stockton Dermatology BY EDWARD ARAUJO
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s a Black female physician, Dr. Toni Stockton has dedicated her career to shedding light on why diversity, equity, and inclusion matter in medicine. With over 30 years of experience in dermatology, Dr. Stockton’s uplifting spirit and endless drive to succeed have led to a thriving practice — Stockton Dermatology in Phoenix, Arizona — where both she and her staff address all manner of skin conditions and cosmetic needs. Dr. Stockton believes that a diverse workforce can lead to better medicine. Recognizing and celebrating what makes a person unique — be it someone’s skin color, ethnicity, religious beliefs, or even political views — can enhance the patient experience by brokering more honest, open dialogue.
“When I decided to volunteer, the flight attendants involved with the ailing patient looked me up and down and asked me to prove my credentials to help.” REFLECTING ON L ACK OF DIVERSIT Y AND HOW WE IMPROVE “Having a diverse workforce leads to better patient care. It starts with respecting differences amongst staff and patients when it comes to religious, political, and ethnic views,” states Dr. Stockton. It continues with creating an environment in which staff feel comfortable in asking questions about race, gender, or age and getting answers without scrutiny. During the interview for Arizona Physician, one of her Caucasian physician assistants asked about an oil hair care product for a Black female patient without the worry of any type of scrutiny from from Dr. Stockton or colleagues. That type of open communication with her diverse team translates to ensuring patients receive medical care and dermatological products that more appropriately match their racial skin type. According to Paul Rothman, M.D., Dean of the Johns Hopkins School of Medicine, “while racial and ethnic minorities make up 26 percent of the total U.S. population, only about 6 percent of practicing physicians and 9 percent of nurses are Latinx, African-American or Native American.” With minority populations representing the fastest growing segments of the U.S. population, a more racially and culturally diverse healthcare workforce will ultimately translate into better patient care when health professionals are culturally competent, helping them better identify with the people they are serving. Dr. Stockton has experienced a lack of cultural competency from healthcare colleagues and other professionals throughout her journey as a physician. She shares multiple examples of cultural and gender insensitivity. Dr. Stockton shared how a seemingly simple encounter during a dermatology rotation provided a teachable moment on the importance of cultural sensitivity. During a routine patient visit, the attending physician (who was Caucasian) told a Black woman that she needed to wash her hair daily to treat her dandruff. “That’s just not possible for a person of color, I had to explain to the doctor,” said Dr. Stockton. Without the valuable cultural context to fully understand how Black people take care of their hair, the doctor in this scenario missed a critical opportunity to deliver quality care.
On the Personal Side with Toni Stockton, MD Q: If could describe yourself in one word, what would that be? A: Happy Q: Do you have family? Pets? A: Yes, my wonderful husband, no children, no pets currently . Q: Do you have a hidden talent most people wouldn’t know about you? A: I am a balloon artist and I play the piano. Q: What career would you be doing if you weren’t a physician? A: Business owner and Educator What book are you reading right now? Or recently? A: The Step-by-Step Instant Pot Cookbook by Jeffery Eisner. I am trying to start meal prepping with this machine.
Q: What’s your favorite food? A: Shabu Shabu and Ethiopian. Darn, now I have a taste for both. Q: What’s your favorite local restaurant? A: Picazzo’s Healthy Italian Kitchen Q: What’s your favorite activity outside of medicine? A: Reading, binge watching shows.
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Stockton Dermatology’s Toni Stockton, MD, and Christina Alexander, Practice Administrator and longest serving team member.
On a flight home with her husband, she shares, “over the PA system, the flight crew asked for a physician as someone on the flight needed attention. A male Caucasian nurse volunteered first. He was not asked for credentials of any form and they took his word that he was a nurse. When I decided to volunteer, the flight attendants involved with the ailing patient looked me up and down and asked me to prove my credentials to help.” The difference in the approach applied by the flight crew highlights why other physicians of color may not be willing to volunteer and help, as they may feel unjustly scrutinized. As a physician and leader in dermatology, Dr. Stockton attends many conferences and seminars, including some at which she speaks. In one such conference, she shares, “I go to registration and I am asked, ‘Are you in the wrong place?’” We can only wonder how many physicians of color are made to feel they do not belong with their colleagues at medical education events. Even though most professions focus on overcoming racial discrimination, Dr. Stockton also believes gender bias remains in medicine. “I have been singled out as the woman in the room,” she said. “You know, I’m the combo package. I’m Black and female.” Taking these experiences — and others like it — to heart, Dr. Stockton emphasizes how important it is for physicians and their staffs like hers to feel comfortable asking questions and to avoid passing
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judgment on others who may look or act differently. Personhood goes so much deeper than what someone may see on the surface. Age and experience have taught Dr. Stockton to look at biases differently than when she was younger, yet it is important to not ignore them and to turn a negative experience into a teachable moment. To Dr. Stockton, “we are in a better place today when it comes to diversity in the workplace,” but that “nirvana” moment will truly come when society and those in medicine can look past the labels that define a person by their gender, race, or age and instead recognize the great work they do to help others.
THE JOURNEY TOWARDS MEDICINE Dr. Stockton grew up in a little town on the outskirts of Pittsburgh. As a self-described nerd, her interests included public speaking, drama, arts and crafts, and reading. Dr. Stockton embraced her gift of the gab by joining a competitive speech and debate team, but she credits her parents, both of whom were health professionals, for drawing her into medicine. She recounted memories of following around her mother — a nurse at a teaching hospital — as she would make the rounds with her students. Perhaps the biggest impetus for Dr. Stockton to enter medicine was when she spent time with her mother as she conducted health outreach in disenfranchised neighborhoods. Watching and learning, she drew on this experience to shape how she would
care for patients from diverse backgrounds when she started her own practice. Dr. Stockton went on to attend Howard University, a historically Black university in the heart of Washington, D.C. There she earned both her undergraduate and graduate degrees and completed her internal medicine residency. She went on to complete her dermatology residency at the Martin Luther King Jr. / Drew Medical Center in Los Angeles. When it comes to imparting advice to young people of color aspiring to become physicians one day, “[meet] your challenges with grace, and be good at what you do,” said Dr. Stockton. “This is a hard job. You must really want to help people.” Determination, coupled with a passion for learning, will help future physicians overcome barriers and forge new paths for others. Medical associations representing different racial and ethnic identities hold considerable value for Dr. Stockton. They help to build community, offer camaraderie, and help expand networks for professional development. “It is refreshing to talk to people that have the same concerns and allow you to let down your guard,” said Dr. Stockton.
SERVING THE COMMUNIT Y Since 2000, Stockton Dermatology has built a thriving practice serving a highly diverse clientele. Dr. Stockton and her staff offer comprehensive care ranging from preventative checks and treating more severe skin conditions to providing cosmetic services like laser hair removal and Botox. Dr. Stockton’s approach to treating patients goes beyond what lurks on the surface. She works closely with patients and staff alike to change stereotypes and stigmas, including the importance for all people — regardless of their skin
“Having more people of color in visible positions of power in places like hospitals and private practice will also help younger physicians feel like it’s possible [to build a career in medicine].” color — to apply sunscreen and wear protective layers, especially in the nearly year-round Arizona sun. While skin cancers and moles are more prominent conditions among Caucasian patients, it is not uncommon for Black and Hispanic populations to also develop melanoma, one of the most serious types of skin cancer.
INSPIRING THE FUTURE Developing a more representative and diverse workforce will take time and resources, including the need for mentoring opportunities and scholarships to help overcome typical barriers to entry. “Having more people of color in visible positions of power in places like hospitals and private practice,” said Dr. Stockton, “will also help younger physicians feel like it’s possible [to build a career in medicine].” ■
By Edward Araujo Managing Editor, Arizona Physician earaujo@mcmsonline.com
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What
Arizona
DOCS are Saying
Would greater diversity of physicians lead to improved care for patients? Of course! We need to learn that some medications don’t work well for certain groups of people, or that certain treatment plans wouldn’t fly in particular cultures. Physicians of different races, genders, etc., are great knowledge sources! —Sara Kertz, DO Yes. Patients would feel like they could identify more with their doctor/feel understood. —Monica Faria, MD
What does diversity in medicine mean to you? Acknowledging physicians of different colors, beliefs, sexuality, backgrounds — and appreciating the differences. We can learn to practice better medicine by not having a one-size-fits-all approach. —Sara Kertz, DO Diversity in medicine means having representatives from all groups at the table including ethnic minorities, people with disabilities, and women. —Traci N. Fitzhugh, MD, FACOG It means hearing from a plurality of voices, including different ages, genders, races, ethnicities, and backgrounds in medical practice. —Melanie Cloonan-Schulte, MD
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Diversity among physicians may lead to improved care if more diverse patient populations feel comfortable accessing medical care because someone “like them” is providing it. —Melanie Cloonan-Schulte, MD Physicians can provide better care if they understand the backgrounds of patients. For example, physicians who know the typical foods of a population can help in decreasing obesity. —Ricardo Correa, MD If patients can recognize a kindred spirit, they may engage more in the medical system, have a higher utilization of preventative care services, and hopefully have better health outcomes. —Anne Maiden, DO
Why is a more diverse workforce important to the medical community? It provides better access, innovation, and outcomes in healthcare. —Robert Dixon, MD
Learn more about the participating physicians Traci Fitzhugh, MD, FACOG PRACTICE | Southwest Contemporary Women’s Care PHONE | (480) 820-6657 WEBSITE | swcwc.net
A more diverse medical workforce enhances our ability to provide the best care possible to our diverse population of patients. Although I truly believe that any healthcare worker can provide excellent care to any patient, observing diversity among those who take care of them inspires confidence in patients that their unique needs are being considered and met appropriately. —Neil Fernandes, MD
Veronica Jean Ruston, DO PRACTICE | Best Life Medicine PHONE | (623) 232-0082 WEBSITE | bestlifefamilymedicine.com
For patient comfort in receiving care and information. —Judith Barnes Clark, MD, FAAP
Melanie Cloonan-Schulte, MD, FACP PRACTICE | Melanie D CloonanSchulte, MD, FACP PHONE | (480) 821-0788 WEBSITE | melanie-d-cloonanschulte-md.business.site
Do you believe leadership positions in practices and hospitals are available to all physicians, regardless of race, ethnicity, gender, or sexual orientation? Nope. Women lose time for childbearing and parttime positions for caregiving. And there is clearly bias around color and perceived strength/education. —Jacqueline May Carter, MD No, they are available to whoever knows whoever else. It is a system more based upon prejudice and discrimination than many other professions. —Veronica Ruston, DO
Judith Barnes Clark, MD, FAAP PRACTICE | Hip Kids Pediatrics PHONE | (480) 477-9490 WEBSITE | hipkidspediatrics.com
Victoria Hortsman, MD, RN PRACTICE | Care Access PHONE | (480) 570-7843 WEBSITE | careaccess.com Jacqueline May Carter, MD PRACTICE | Crossover Health PHONE | (602) 451-1702 WEBSITE | crossoverhealth.com Monica Faria, MD PRACTICE | Arizona Professionals Health Program PHONE | (602) 429-8447 WEBSITE | arizonaphp.net Continued on next page
It depends on the person, although I have heard of large practices and surgical groups where women still feel underappreciated and passed over for advances. —Victoria Horstman, RN, BSN, MD
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What
Arizona Continued from previous page
DOCS
are Saying
Learn more about the participating physicians James Bertz, MD, FACS PRACTICE | Scottsdale Facial and Oral Surgery PHONE | (480) 941-5005 WEBSITE | scottsdaleoms.com Robert Dixon, MD PRACTICE | District Medical Group PHONE | (719) 337-7281 WEBSITE | dmgaz.org Anne Maiden, DO PRACTICE | Midwestern University, Arizona College of Osteopathic Medicine PHONE | (602) 618-0002 WEBSITE | midwestern.edu Ann Cheri Foxx Leach, MD PRACTICE | Nocio Interventional Pain Management PHONE | (480) 818-4314 WEBSITE | nociopain.com Ricardo Correa, MD EdD PRACTICE | Phoenix VA Health Care System PHONE | (602) 277-5551 WEBSITE | phoenix.va.gov Neil Fernandes, MD PRACTICE | Skin and Cancer Center of Arizona PHONE | (480) 899-7546 WEBSITE |
skinandcancercenterofarizona.com Sara Kertz, DO PRACTICE | Paradise Pediatrics PHONE | (602) 996-0190 WEBSITE | paradisepediatrics.net
Read more about what these Docs are saying regarding diversity in medicine at arizonaphysician.com.
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How can practicing physicians recruit and retain a more diverse workforce? Through better understanding and hiring workers who best match the practice profile. —James E. Bertz, MD, FACS Mentor physicians who are early in their career. Be an advocate for physicians who may be challenged to find support in an organization that lacks diversity. Decide to be the change — especially the physicians who are in their mid- to late careers and have the influence. —Ann Cheri Foxx, MD Word of mouth among patients and peers — professional and personal. —Judith Barnes Clark, MD, FAAP Analyze the patient population. Then, stimulate high school students to seek a career in medicine, offering them rewards for staying in hard-to-fill locations. Over time, those new physicians will attract more doctors like them. —Ricardo Correa, MD By perpetuating a culture of acceptance and tolerance while maintaining a high standard of excellence. By having a culture that puts wellness first and prioritizes work/life balance, any employee would thrive because morale would be high. —Anne Maiden, DO
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What policies or systemic changes are needed for greater diversity among physicians?
Access to education; starting with pre-school. We also need low-cost higher education and medical school. —Robert Dixon, MD For greater gender diversity, we need parental leave. For racial diversity, we need pre-med mentoring programs for underserved and to recruit at colleges. We also need mentoring and greater diversity in leadership roles so they can support the next generation. —Jacqueline May Carter, MD
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It needs to start from someone in the family, a mentor, or a teacher telling a child he or she is smart and could become a physician. —Victoria Horstman, RN, BSN, MD Community partnerships, so we can communicate to the public that diversity in medicine is something the medical community prioritizes and is willing to work hard to achieve. —Neil Fernandes, MD ■
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LEGAL CORNER
Unique Considerations FOR RESTRICTIVE COVENANTS IN PHYSICIAN EMPLOYMENT AGREEMENTS
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BY JOHN BALITIS AND DINA AOUAD n order to protect legitimate business interests and prevent unfair competition, many employers utilize what are known as “restrictive covenants.” A restrictive covenant is a provision, often included in an employment agreement, that limits a worker’s ability to compete with a former employer. Restrictive covenants may prohibit a departing worker from engaging in competitive activities such as soliciting a former employer’s customers, clients, and/or employees and from revealing information that is proprietary or confidential. Restrictive covenants also may limit the time frame and geographic area in which an employee may work after leaving a job. These restrictions are known as noncompete provisions.
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Although restrictive covenants are popular, an employer’s ability to enforce them is limited. In Arizona, restrictions on an employee’s post-employment activities must be reasonable and limited in geographic and temporal scope. Also, restrictive covenants imposed on physicians are scrutinized more aggressively than in other industries. Despite the freedom to contract, Arizona law does not favor restrictive covenants, and this bias is particularly strong for restrictive covenants governing health care professionals. The Arizona Supreme Court in Valley Medical Specialists v. Farber affirmed this concept and established rules for the use of restrictive covenants in medical practices.
In 1985, Valley Medical Specialists (VMS) hired Dr. Steven S. Farber, an internist and pulmonologist, and eventually entered into an employment agreement with him that included a number of restrictions. The covenants in the agreement prohibited Dr. Farber from engaging in a number of activities, including: A) Requesting any present or future VMS patients to terminate their affiliation with VMS; B) Working in competition with VMS in the practice of medicine; C) Disclosing the identity of any VMS patients to any other business engaged in a medical practice similar to or in general competition with VMS; D) Providing medical care for any person who was a patient of VMS during Dr. Farber’s employment with the practice. The covenants in Dr. Farber’s employment agreement restricted him for three years after his separation and within a five-mile radius of any office maintained or utilized by VMS. VMS filed suit against Dr. Farber for violating his restrictive covenants, and the case eventually progressed to the Arizona Supreme Court. The Court ultimately concluded that the restrictions in his employment agreement were invalid because VMS’s “interest in enforcing [them was] outweighed by the likely injury to patients and the public in general.” The Court reasoned that the temporal and geographic limitations were too broad because the covenants did not involve Dr. Farber practicing pulmonology, but rather precluded any type of practice, even in fields outside of the VMS practice. More importantly, the Court confirmed VMS had a protectable interest in its patient referral sources but held that the interest was not sufficient enough to outweigh a patient’s freedom to choose his or her particular doctor. Limitations imposed by a restrictive covenant are unreasonable, and thus unenforceable, if they are broader than necessary to protect the employer’s legitimate interest, or if that interest is outweighed by the
A restrictive covenant is a provision, often included in an employment agreement, that limits a worker’s ability to compete with a former employer. hardship to the employee and the likely injury to the public. In the context of medicine, a patient’s right to see a doctor of choice is entitled to substantial protection. Thus, VMS’s interest in preventing competition was not outweighed by the significant public policy issues at play. So, given the great protection afforded to patients in choosing their own health care providers, what can a practice do to increase the likelihood that its restrictive covenants will be enforceable in Arizona? In order to maximize the chances of enforceability, a practice should ensure that a restrictive covenant agreement is carefully drafted. On this point, Arizona courts are permitted to “blue pencil” restrictive covenants, “eliminating grammatically severable, unreasonable provisions,” leaving the reasonable limitations intact. These severable terms are referred to as “step-down” clauses that allow a court to choose from multiple options. For example, terms like “geographic area” and “time frame” may be defined as a set of alternatives ranging from more to less restrictive. This drafting technique permits a court to pick and choose what it concludes is reasonable without putting the entire agreement at risk. Although the Court in Farber stopped short of holding that restrictive covenants for physicians never will be enforced, it made clear that restrictions included in provider employment agreements always will be strictly construed for reasonableness. Since Farber, Arizona courts have continued to uphold the unique protections afforded to the doctor-patient relationship. ■
John Balitis, JD Labor & Employment Chair Jennings, Strouss, and Salmon, PLC jbalitis@jsslaw.com
Dina Aouad, JD Labor & Employment Associate Jennings, Strouss, and Salmon, PLC daouad@jsslaw.com
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HOW TO
Leasing vs Buying Medical Office Space THE UPSIDES & DOWNSIDES
A
s you might imagine, there are many factors to consider when deciding about whether your practice should buy or lease real estate. There is no one-size-fits-all. The first thing to consider is the cost of each alternative. Ensemble has developed economic models to assist our clients in these assessments so we can compare outcomes with lease versus buy options, thereby arming our clients to make the best decision. Of course, there are other variables to consider.
L E A S I NG FLEXIBILITY | Leasing offers greater flexibility than owning, so if you are unsure if your practice is going to expand or downsize in the coming years, this option may be your best bet. COSTS | There are not many hidden costs with leasing since your lease dictates what your costs will be and most high-ticket capital items fall to the Landlord. MARKET FLUCTUATIONS | When leasing you are always riding the market. Significant increases in market rents could expose you to rent increases at the time of renewal. Conversely, tenants can benefit when markets experience declining rents and increased vacancy as landlords tend to be far more generous with lower rents and incentives to keep tenants.
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O W N I NG ARE YOU LANDLORD MATERIAL? | Although leasing offers more flexibility in your short-term future, owning lets you control your own destiny while potentially building wealth. RISK | Owning involves risk. When looking at ownership options you need to make some assumptions (i.e., guesstimates). What is the total investment, now and throughout the ownership cycle? Those high-ticket capital costs that fall under the Landlord when leasing are your responsibility now. Should you take on excess space for future expansion? Can you afford to carry the vacancy cost or pay for the leasing costs in order to secure an interim tenant? What will you sell the building for later — what is the exit strategy? With “assumptions” comes risk so it is important to ask the right questions. MARKET FLUCTUATIONS | While market downturns provide an advantage when leasing, it can significantly decrease the value of real estate that you own. However, even if appreciation doesn’t meet your projections, ownership might be more financially advantageous because
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I WILL PAY YOU $300 low interest rates and/or the tax benefits ownership provides could offset some market blips. Since those are based on an individual’s overall situation we always advise our clients to talk with their CPA. Ideally with ownership, if you’re paying market rent to yourself and paying your expenses and mortgage out of that rent, you pocket the amount left over as your return. Then a few years down the road — market willing — the building appreciates in value and you sell it for a sizable profit.
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T O L E A S E OR T O BU Y ? That is the question, and there’s no general rule-ofthumb for the answer. Except this: make sure you work with the right healthcare real estate advisor who has the tools and experience to help you make a decision you are confident in. ■
Tracy Altemus, CCIM Executive Vice President Ensemble Real Estate Solutions taltemus@ensemble.net
Murray Gares, CCIM Senior Vice President Ensemble Real Estate Solutions mgares@ensemble.net
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PHYSICIAN SPOTLIGHT Maria Christina Ospina, MD, shares her background and thoughts on this issue’s theme, The Diversity of Medicine. Q: How and when did you decide to get
into medicine? A: I was always interested in the brain and behavior and that is what lead me to medicine. Once I started medical school, I really enjoyed the patient interaction. Throughout my career I have enjoyed taking care of patients and their families and accompanying them through their journey with Parkinson’s disease.
after the pandemic, the changes that have occurred with telemedicine will continue, as it gives patients in rural areas and underserved areas greater access to a specialist; not to mention that it is easier for patients with chronic disease and mobility issues to use telemedicine than to travel a far distance to seek medical care.
Q: Gender diversity is very important. How are Q: You have served as an investigator at the
Parkinson Study Group, can you tell us about your experience there? A: I encourage my patients to participate in clinical trials, as it is the only way we will get new therapies and treatments. For many years, neurology had very few treatments for chronic diseases such as migraine, multiple sclerosis (MS), and Parkinson’s disease (PD). Now through the diligent work of investigators and patients who participated in clinical trials, we have life changing therapies in all three of these diseases.
women in medicine impacted when it comes to wage disparities and leadership opportunities? A: I think the pandemic has highlighted gender disparity. Many more women have had to leave the work force to take care of kids who are no longer in school. In our practice we have accommodated our staff and allowed them to have more flexible hours as well as bring their kids to work. We have been holding a “zoom” 1st grade for several months now in the office. Q: How should physicians recruit and
retain a more diverse medical workforce? Q: As a neurologist you diagnose and treat
disorders of the brain, spinal cord, and nervous system. What are some advancements you see now that weren’t available when you started your career?
A: Recognizing that your staff is valuable and accommodating their needs is key to retaining talent. ■
A: As I said above, our treatments for stroke, MS, Parkinson’s, migraine are night and day from when I started practicing 20 years ago. Patients treated early with tissue plasminogen activator (tPA), calcitonin gene–related peptide receptor monoclonal antibodies (CGRPS), and the multiple new medical and surgical treatments for PD and MS can have a vastly improved quality of life. Q: You are licensed in four states: AZ, FL,
LA, and WI. Are there difficulties you face in practicing medicine outside of Arizona? A: With the pandemic it has been easier to practice across state lines. I would hope that 30 n
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MARIA CHRISTINA OSPINA, MD Movement Disorder Neurologist Regional Parkinson Center drospina.com
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