Arizona Physician Summer 2022 - FREE

SUMMER 2022

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

Challenging Medicine’s Status Quo Sue Sisley, MD

33 Physicians across Arizona share their thoughts on medical cannabis.

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CONTENTS VOLUME 4 • ISSUE 2 Editor-In-Chief John McElligott, MPH, CPH

IN EVERY ISSUE 6 | From the MCMS Board President 8

| From the Editor-in-Chief

Edward Araujo

9

| MCMS Partner Program

Associate Editors

10 | Briefs

Managing Editor

Nayeli L. Guzman Mariana Nicolaides

Creative Design

26 | What Arizona Docs are Saying

Randi Karabin, KarabinCreative.com

30 | Legal Corner

Cover & Featured Articles Photography

34 | Physician Spotlight

32 | How To

Ben Scolaro, scolarodesign.com

14 The State of

Medical Marijuana How do people feel towards medical marijuana? Anna Hartman shares an update on medical marijuana across the country and Arizona.

22 In Depth:

Advertising ads@arizonaphysician.com

Maricopa County Medical Society Board Members

Virtuous Pain Centers

President

Dr. Wladislaw Fedoriw

Ricardo Correa, MD, EdD, FACP, FACE

and his team at Virtuous

Immediate Past President

Pain Centers, a multi-

John Prater, DO

location practice, shares

President-Elect

their views on medical

Zaid Fadul, MD, FS, FAAFP

marijuana and changes in

Treasurer

pain management.

Anne Maiden-Hope, DO, FAAP

18 C O V E R S T O R Y

Secretary

Dr. Sue Sisley shares her journey in getting the opportunity to research medical cannabis.

Jane Lyons, MD

Directors Karyne Vinales, MD Anchit Mehrotra, MD Rahul S. Rishi, DO, FAAAAI, FACAAI Ann Cheri Foxx Leach, MD, D.ABA Christopher DeNapoles, MD Ruchir Patel, MD, FACP

Resident & Fellow Director Emma Schnuckle, MD

Medical Student Director Anirudh Singh, OMS-III

Digital & Social Media arizonaphysician.com ArizonaPhysician

Check out our most recent episodes: •D avid Williams, JD, on Responding to Medical Board Complaints •T im Kavanaugh, MD, on Alcoholism and Recovery

@AZPhysician @AZ_Physician

A R I ZO N A P H Y S I C I A N . C O M

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FROM THE MCMS BOARD PRESIDENT

Medical Cannabis (Marijuana): a quick review of the literature

T

his edition of Arizona Magazine focuses on medical cannabis. However, the evidence regarding this topic is poor and controversial. This column focuses on the evidence found in a narrow literature search.

Medical cannabis uses the cannabis plant or chemicals to treat diseases or conditions. It is essential to mention that it’s the same product as recreational marijuana, but it’s taken for medical purposes.1 The marijuana plant contains more than 100 different chemicals called cannabinoids. Each one has a different effect on the body. Delta-9tetrahydrocannabinol (THC) and cannabidiol (CBD) are the main chemicals used in medicine. It is claimed that medical cannabis can be used to treat multiple diseases, including Alzheimer’s disease, appetite loss, cancer, diseases affecting the immune system like HIV/AIDS, eating disorders such as anorexia, mental health conditions like schizophrenia and PTSD, but the FDA has only approved it for treatment of two rare and severe forms of epilepsy, Dravet syndrome, and Lennox-Gastaut syndrome.2 To understand why it is claimed that medical marijuana can help in some of the above conditions, we need to understand the mechanism of action.

The endocannabinoid system regulates metabolism, appetite, blood pressure, glycemic control, immune response, and sense of reward. Although the receptors are located throughout the body, the central nervous system interactions arise from the most prominent effects. Since it has a high lipid-soluble profile, it circulates through the body efficiently and causes various products based on the receptors and dosage.3, 4 Marijuana can be administered in many ways — orally, sublingually, or topically. It can also be smoked, mixed into foods, and brewed as a tea. Medical marijuana is more focused on topical and orally. The recreational is consumed through food or smoked.

The most common emergency caused by marijuana ingestion is a panic attack.5 The most common adverse effects include dizziness, dry mouth, nausea, disorientation, euphoria, confusion, sedation, increased heart rate, and breathing problems.

There is minimal information available about contraindications with cannabis-derived pharmaceuticals and medical cannabis. Known contraindications 6

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to dronabinol, a synthetic THC and DEA schedule 3 drug, include hypersensitivity to the drug, allergy to cannabinoids/propylene glycol/peppermint oil, as well as concomitant use of ritonavir, which may lead to potential toxicity.6,7 Medical contraindications are cardiovascular disease, arrhythmias, poorly controlled hypertension, severe heart failure, history of psychotic disorder, patients under eight years old, pregnant women, or nursing women.8 One study showed that marijuana could worsen preexisting heart disease, resulting in a five-fold increase in heart attacks one hour after smoking marijuana.9,10 There is a vast amount of literature on marijuana and its health benefits. Unfortunately, the majority of these are anecdotal reports. Without clinical trials and a lack of a universal formula for marijuana, there appear to be significant controversies about the clinical benefits of marijuana.11 In conclusion, further research is needed to recommend marijuana for medical conditions. Much off-label use is out there in the market; however, following the evidence, it is essential to talk with the patient about this topic and address each patient with compassion and respect.

Respectfully,

Ricardo Correa, MD, EdD, FACP, FACE MCMS Board President Dr. Ricardo Correa is an endocrinologist at the Phoenix VA Medical Center. He is also the Endocrinology, Diabetes and Metabolism Fellowship Director, Director of Diversity GME, and Chair of the GME Diversity Subcommittee for the University of Arizona College of Medicine Phoenix. Dr. Correa is the Health Equity Fellowship Director for the Creighton School of Medicine and Medical Director of the Phoenix Allies for Community Health (PACH) Clinic. He is a Major in the U.S. Army Reserve.

Learn more and check the sources cited at arizonaphysician.com/cannabis-lit-review

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Medical Doctor | Physician Assistant | Nursing | Occupational Therapy Pharmacy | Physical Therapy Our interprofessional Phoenix campus is open now. Creighton University is the largest Catholic Health Professions educator in the U.S., and we’ve been helping passionate students become compassionate professionals for 140+ years.

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FROM THE EDITOR-IN-CHIEF “ O U R A M A D O E S N O T S U P P O R T L E G A L I Z AT I O N O F C A N N A B I S F O R A D U LT U S E U N T I L A D D I T I O N A L S C I E N T I F I C R E S E A R C H H A S B E E N C O M P L E T E D T O F U L LY D O C U M E N T T H E P U B L I C H E A LT H , M E D I C A L A N D E C O N O M I C C O N S E Q U E N C E S O F I T S U S E .”

—Susan R. Bailey, MD, Past President, AMA

C

BD oil and other cannabis products are hot items in Arizona. Billboards for all sorts of dispensaries line the highways and major thoroughfares. Are they snake oil or effective for a wide range of ailments?

Physicians are not sitting on the sidelines. Some are medical directors of dispensaries or investors in companies that sell CBD products. Others certify their patients for medical marijuana usage for qualifying conditions like HIV, Crohn’s disease, cancer, hepatitis C, or severe and chronic pain. Since the Arizona Medical Marijuana Program started in 2017, about 554,205 new patient applications have been submitted, 85% of which come from naturopathic physicians.

We thought it was important to examine what’s happening in the medical marijuana industry in Arizona and why it matters to physicians.

M E DIC A L M A R I J UA N A Sue Sisley, MD, speaks with Managing Editor Edward Araujo about using medical marijuana, cannabinoids, and synthetics to treat patients. They discuss the lack of data supporting many uses, questions researchers are examining, legal implications for physicians, and much more.

MPH candidate Anna Hartman provides an overview of the legality of marijuana in Arizona, statistics from the state certification process, findings for medical marijuana benefits, and cannabis derivatives approved by the FDA. In What Arizona Docs are Saying, we learn that seventy-six percent (76%) of survey respondents believe patients should have access to medical cannabis through a physician. Eighty-two percent (82%) want the state or local government to fund more research into the health effects of medical cannabis.

We go In Depth with Wladislaw Fedoriw, MD, of Virtuous Pain Centers. Dr. Fedoriw answers whether medical marijuana is part of the evolution of pain management or a passing interest. He also touches on the impact of legalization efforts, saying, “As marijuana becomes legal, the barriers to conducting research will fade away. New and thorough peer reviewed studies are the only way to safely bring medical marijuana to the forefront of patient care.”

Radiation oncologist Patrick Miller, MD, shares his thoughts on whether the oncology community supports medical marijuana. Dr. Miller says, “I think that the average medical or radiation oncologist favors the use of medical marijuana. In fact, I have not had experiences where colleagues told patients they should not use medical marijuana.”

VA LUA BL E A R T IC L E S In the How To section, Vickey Rinehart shared nine interview questions to ask that reveal you everything you need to know about company culture. Read this section before continuing your job search.

Legal risk management consultant Molly Adrian, JD, shares a helpful perspective on certifying patients for medical marijuana in our section Legal Corner.

She writes, “So far, Arizona courts have not reported a decision on negligent evaluation and/or certification for treatment with medical marijuana,” but there may be scenarios that could result in claims.

P R E F E R R E D PA R T N E R H IG H L IG H T In this issue, we feature MemberDeals, a benefit offered through Entertainment Benefits Group to members of MCMS. Practicing physicians, residents, medical students, and retired physicians can get access to exclusive discounts on hotels, concerts, attractions like Disney, and more.

Contact us at info@arizonaphysician.com with any comments or suggestions.

We are looking for article contributors, podcast guests, and virtual event presenters.

Contact us at info@arizonaphysician.com for these and many more opportunities.

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Enjoy the magazine.

By John E. McElligott, MPH, CPH

DISCOUNT PA RTNER

PARTNER PROGRAM What Is It?

Maricopa County Medical Society's Partner Program is designed to introduce select companies to our members. MCMS strives to facilitate physician growth in all areas of their life and practice. As we work to support our members, we think there are excellent opportunities to work closely with business partners that can facilitate that growth.

How Are Partners Selected?

The main criteria we look for are simple: companies that demonstrate value in their products/services and have staying power. The companies that have an honest approach and treat our members with an exclusive feel have historically had the best success.

What Are the Tiers?

ADVERTISING PARTNER | Organizations that advertise their products/services to members through our media platforms.

DISCOUNT PARTNER | Companies that offer blanket discounts to MCMS members.

Looking for great deals on travel and entertainment, hotels, rental cars, water parks, movie tickets, shopping, concerts, or sports events?

MCMS is offering its members discounts through MemberDeals, a site that curates exclusive offers to Disneyland, Las Vegas shows, and many attractions within Arizona. The company behind MemberDeals is Entertainment Benefits Group, which has been operating for 20 years.

WHY USE MEMBERDEALS?

PREFERRED PARTNER | Vetted companies that com-

mit to providing superior service, special discounts, and incredible value to physicians. These companies stand out from their peers. They demonstrate staying power and consistently deliver high-quality products and services to clients.

EXCLUSIVE PARTNER | Top partner company that MCMS will promote and endorse as the only company in its business category.

“I can explore the zoo and aquarium with my kids in Phoenix and enjoy discounts on activities when we travel to San Diego!”

Jane Lyons, MD Pediatrician

Extensive Listings: Sort through a growing list of special member discounts on big attractions, hotels in cities across the country, and Broadway shows.

EASILY TO NAVIGATE: Deals are

sorted by categories like Shows & Events, Hotels, or Theme Parks.

“The discounts are very helpful for working families and is an added benefit for being a part of MCMS.” Anne Maiden-Hope, DO, FAAP Pediatrician

Access the exclusive deals through your account on the MCMS website.

Not a member of MCMS? Call us at 602-252-2015 or visit mcmsonline.com/join.

LOCAL DEALS: Search by

city and select Phoenix, AZ, for some local options like Phoenix Zoo, LEGOLAND Discovery Center Arizona, hot air balloon rides, and more.

Submit your request to be part of the MCMS Partner Program @www.surveymonkey.com/r/MCMS_Partner_Program

BRIEFS

NEWS AND NOTES FROM THE FIELD

Improving your Sleep Hygiene

A

better night’s sleep can be supported through good habits, otherwise known as “sleep hygiene.” The Centers for Disease Control and Prevention (CDC) recommends the following five tips to improve your sleep: 1. HAVE A CONSISTENT SCHEDULE.

This includes weekends.

2. KEEP YOUR BEDROOM QUIET AND DARK . The room should feel relax-

ing and be at a temperature you find comfortable.

To learn more, visit www.cdc.gov/sleep

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3. YOUR BED SHOULD BE FOR SLEEP AND SLEEP ALONE. Remove electronic

devices such as TVs, computers, and phones from the area.

4. AVOID EATING MEALS before bed-

time. Caffeine and alcohol should also be avoided before bed.

5. BEING ACTIVE can help you fall

asleep easier at night, so exercising daily is recommended for better sleep. Make sure to do so at least two hours before bed.

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MISE EN PLACE | Mise en place, or “Putting in place”, is a French term and process that is commonly used today in professional kitchens, cooking shows, and restaurants.

This way of cooking saves time and allows you to cook or bake in a seamless manner, helping you to stay organized and cook with ease.

KEEP KNIVES SHARP | The most important tool in the kitchen is your knife. To care for your knife, make sure to cut only on wood or plastic surfaces, and never put it through the dishwasher. A good knife will not only make cooking easier and more efficient, but safer as well.

ACIDS | Adding a final splash of acid to your cooking (vinegar or citrus juice) will brighten up any dish and perk up the flavor. Do this at the end of cooking.

SWITCHING YOUR SALTS | Instead of ionized salt, switch to kosher or sea salt while cooking for an even better flavor.

READ THE RECIPE BEFORE COOKING | Being prepared before you begin is crucial. Make sure you have your ingredients, the time, and understand all the steps so you can avoid stress later in the process.

A R I ZO N A P H Y S I C I A N . C O M

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TRAPPER’S SUSHI | Phoenix | Trapper’s

Five Sushi Spots

You’ll Love in Phoenix Metro

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ating sushi is just as much about the chef’s knife skills as are presentation, fresh fish, the aesthetic of the restaurant, service, and most importantly taste.

Here are the top 5 sushi restaurants in Metro Phoenix.

HANA JAPANESE EATERY | Phoenix |

Hana has been a staple of the central Phoenix dining scene for over a

decade. From the house specialty Hana Pride to other delicious rolls, you will enjoy a delicious meal prepared using the most authentic and revered techniques.

HIRO SUSHI | Scottsdale | Try unique

items like deep-fried tofu rolls or the traditional California rolls. You will enjoy hearty lunch and dinner portions from the Hiro menu.

has a full bar with both indoor and outdoor seating in the heart of downtown Phoenix. It features allyou-can-eat sushi.

SUSHI NAKANO | Ahwatukee | From the

son of famed chef Hirofumi Nakano, owner of Hiro Sushi, comes Leo Nakano’s restaurant in the east valley.

The quaint and inviting restaurant features sushi and sashimi that will delight your palate.

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modern and fresh look alongside a new style sashimi is your thing, then Squid Ink is for you. Enjoy lobster with garlic chips or house rolls like the square shaped Zushi “Box Roll.”

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The State of

Medical Marijuana

BY ANNA HARTMAN

LEGA LIT Y Over the last few decades, attitudes, perceptions, and laws have become more supportive of marijuana use. Arizona laws permit the use of medical and recreational marijuana; however, the federal statutes deem it illegal.1 California legalized medical marijuana in 1996, and Colorado legalized recreational marijuana in 2012.2 The Grand Canyon State joins 34 other states which have legalized medical marijuana and 17 other states where recreational marijuana is legal.2 The Arizona Medical Marijuana Act (AMMA), passed in 2010 and legalized the use of medical marijuana without requiring testing from the U.S. Food and Drug Administration (FDA). The act became effective in 2011 and Arizona’s first dispensary opened in 2012.3

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The Arizona Department of Health Services (ADHS) is the designated state agency that oversees licensing and issuing authority of the Arizona Medical Marijuana Program (AMMP).4 About a decade later in 2020, Arizona passed the Smart and Safe Act, which legalized use of recreational marijuana.5 It is worth noting this legislation passed despite opposition from medical societies, due to the paucity of research into prolonged marijuana use.6

AT T I T U DE S A N D BE H AV IOR S According to a Medscape Medical News Poll in 2018, 67% of physicians nationwide support medical marijuana and 53% support recreational use only. A Pew Research poll in 2021 showed that 91% of Americans are in favor of either medical and recreational marijuana use, or for medical marijuana use only.

Learn more about the Arizona Medical Marijuana Program at azdhs.gov/licensing/medical-marijuana

DE MO G R A P H IC S ADHS reported in February 2022 there were over 244,000 qualifying patients with active medical marijuana cards.

The most qualifying patients reside in Maricopa (66.2%), Pima (13.8%), and Pinal (6%) counties. The most frequent qualifying health condition for this demographic is chronic pain, accounting for 94.23% of active patient card holders. Other qualifying health conditions are cancer (2.10%), PTSD (1.97%), nausea (1.58%), and muscle spasms (1.51%). The rest of the qualifying health conditions had under 1% of active patient card holders.

DI S P E NS A R Y L I M I TAT IONS Arizona differs from other state medical marijuana programs by limiting the number of dispensary licenses available.4 For instance, dispensaries can be limited by geographic location where a new medical marijuana dispensary certification may not be granted if it is within 25 miles of another registered certified dispensary. Also, ADHS may not issue more than one dispensary license for every ten registered pharmacies in the state. New recreational dispensaries must compete to acquire a license if not already affiliated with a licensed medical marijuana dispensary.

Dispensary licenses for rural or underserved communities are permitted through a separate application process.4 An additional 26 licenses were granted for recreational dispensaries in April 2022 due to the social equity ownership program introduced in the Smart and Safe Act.5

REVENUE Medical marijuana is subject to the state transaction privilege tax of 5.6%.4 Recreational marijuana sales must include another 16% Marijuana Excise Tax (MET) on top of the state and local sales tax. The Smart and Safe Fund holds this MET and is where the licensing and registration fees for recreational marijuana are also held. This fund contributes monies towards different departments and organizations including the state and local agencies that regulate marijuana, community colleges, and public health programs.5 Arizona Department of Revenue has reported around $239 million in tax revenue for the total combined medical and recreational marijuana since January 2021.

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DE F I N I T IONS Marijuana is scientifically known as Cannabis sativa and is not FDA approved. Marijuana is defined by the components of the plant from the genus cannabis including the leaves, stems, flowers, and seeds. This definition does not include the other parts of the plant like the stalks, fiber from the stalks, oil or cake made from the seeds of the plant, or any other compound of the plant which is incapable of germination.2 Hemp includes some Cannabis varieties that have low cannabinoid levels compared to marijuana. They are used for fibers and seeds instead of their CBD or THC properties.

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CANNABINOIDS are chemical substances that bind to cannabinoid receptors in the body. Marijuana has two primary cannabinoids, cannabidiol and tetrahydrocannabinol.

CANNABIDIOL (CBD) is processed Cannabis plant extract, oil, or resin that contains a high percentage of cannabidiol, but a low percentage of tetrahydrocannabinol (THC).

TETRAHYDROCANNABINOL is the primary psychoactive chemical in Cannabis, delta-9-tetrahydrocannabinol (THC), which is a partial agonist at cannabinoid receptors in the body.

MARIJUANA STRAINS. The ratio in CBD and THC plays a role in the strains used for medical and recreational purposes. ADHS reported in February 2022 that 94.23% of active card holders for medical marijuana are qualified because of chronic pain.

Since THC is responsible for the euphoric effects of marijuana, those who are using medical marijuana may opt for strains that have lower THC and higher CBD content.

C U R R E N T F I N DI NG S F OR M E DIC A L M A R I J UA N A BE N E F I T S In spite of overwhelming support for medical marijuana, there is still underwhelming consensus in research to prove its benefits. Efforts to establish credibility as a treatment for various medical conditions have not yet produced convincing enough results for instrumental agencies such as the FDA and Centers for Disease Control and Prevention (CDC).7 A recent review of the health effects of medical marijuana sponsored by authorities such as ADHS, CDC, and the FDA, found barriers in medical marijuana research include funding and access to medical grade marijuana. These barriers often produce low quality results which impact the already limited data. They also found a gap in this research for evidence on short and long term health effects of marijuana use. Concerning aspects of the research reviewed is the studies did not use medical dispensary products and mostly used CBD or THC instead of the marijuana plant itself. Another recent review highlights more deficits in medical marijuana research such as unknown biphasic effects, the influence of THC and CBD on addiction, and the lack of clinical testing for therapeutic treatments on humans.8

F DA A P P R O VA L The FDA has approved Cannabis derived and Cannabis related treatments and drugs.

Epidiolex is an FDA approved drug primarily for the treatment of seizures and contains CBD. Marinol and Syndros are approved treatments which contain a synthetic derivative of THC, dronabinol, to address anorexia associated with weight loss in AIDS patients. Lastly, Cesamet is an FDA approved drug that has a synthetic derivative of THC, primarily used to treat or prevent nausea and vomiting because of cancer medications.9

Learn more and check the sources cited at arizonaphysician.com/state-of-medical-marijuana

A R I Z ON A M E DIC A L M A R I J UA N A P R O G R A M The AMMP functions to facilitate AMMA within its specified rules and regulations. Arizona physicians can participate in varying degrees.

First, they may certify adult qualifying patients to become part of the medical marijuana registry.

Physicians would review the patient’s medical history and assess conditions which qualify for the AMMP. In providing certification to a patient for a debilitating qualifying condition, the physician assumes responsibility for providing management, routine care, and maintaining a medical record for the patient.3 In a more involved role, Arizona physicians may also be associated with a dispensary as a medical director, a position required by law of each medical dispensary. The medical director must be either on site or available by phone, and he or she must identify another physician designated to cover if the medical director is not available. The duties are to establish and provide training to the designated dispensary agents annually, put together educational resources for qualified patients and caregivers, and consult with qualified patients to assist them in tracking their symptoms, medical marijuana usage, and any side effects.3 There are some limitations. Any physician serving as a medical director for a dispensary may not provide a written certification for medical marijuana for qualifying patients.3 Additionally, Arizona physicians who submit Physician Certification Forms for qualifying patients will not be able to have the convenience of an in-house dispensary like some practices have in-house pharmacies. ■

By Anna Hartman, MPH Candidate 2022 University of Arizona, Mel & Enid Zuckerman College of Public Health hartmana@arizona.edu

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Challenging Medicine’s

STATUS QUO Sue Sisley, MD

S

uzanne (Sue) Sisley, MD, stands tall as an undaunted fighter for what she believes in. For over 15 years, she has fought for the opportunity to research medical cannabis and other medically active plants. Whether or not medical cannabis can make the cut into more FDA-approved medicines remains to be seen, yet she fights on.

Over decades of struggles with colleagues in the medical community, who are averse to change and federal agencies reluctant to fund Schedule 1 drug studies, Dr. Sue Sisley has maintained her staying power through a commitment to rigorous cannabis research.

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Dr. Sisley’s path to medicine started with her mother, Hanna T. Sisley, MD, a renowned Family Practice physician focused on indigent patients in the heart of innercity Phoenix for over 50 years. After earning her medical degree from the University of Arizona – College of Medicine, Dr. Sisley completed a combined residency in Internal Medicine & Psychiatry at Good Samaritan Regional Medical Center.

Sue then joined Hanna (and her devoted father Jack Sisley who served as their Office Manager) to supervise primary care patients for over 20 years in the only mother-daughter medical practice in Arizona.

THE JOURNEY TO MEDICAL CANNABIS A primary care physician, Dr. Sisley has devoted her career to treating military veterans, first responders, and American Indian tribal members. She’s built relationships in rural communities, championed underserved populations, and taken the path less travelled to find less addictive, more effective treatments for her patients.

Early on, she was anti-cannabis and anti-psychedelics.

Dr. Sisley’s medical training taught her to focus on FDAapproved medications and avoid the dangers surrounding marijuana and fungi. She then began seeing some of her veteran patients killing themselves. She was frustrated.

Many veterans she treated were continuously describing to her how cannabis was life changing for them. Slowly, her skepticism waned as she saw firsthand how natural interventions were improving their worldview, enabling those patients to be more functional and resilient.

Over time, other patients asked for treatment options that don’t contain the toxicity associated with typical pharmaceuticals. Dr. Sisley began to accept the natural medicine movement as a vital alternative. Even so, Dr. Sisley isn’t against Big Pharma, because as she states: “pharmaceuticals have an important place in our armamentarium to treat people.”

CANNABIS RESEARCH When the subject of medical cannabis comes up, most of her peers think of Dr. Sisley. She’s been a prominent spokesperson and is actively seeking to build evidence from randomized controlled trials. That will take some time, as most would-be researchers avoid the legal gray areas within and across state lines. Dr. Sisley seems to relish working in the gray areas.

Dr. Sisley’s home for conducting cannabis research is the Scottsdale Research Institute (SRI), LLC, a clinical trials site wholly owned by her. Also, Field to Healed Foundation, a 501(c)(3) non-profit arm of SRI. She runs SRI’s operations, research, and charitable donations and is where she works as principal investigator. Largely due to Dr. Sisley’s persistence and outside pro bono legal support, SRI received a DEA Schedule 1 manufacturing license in 2021 for growing Cannabis and Psilocybin mushrooms, and recently approved for LSD. Dr. Sisley calls the license their “golden ticket” to conduct research like the University of Mississippi has been doing exclusively for five decades.

“I’m not anti-pharma, I just wish pharma would stop blocking our research.”

– Sue Sisley, MD

OPPOSITION TO RESEARCH There are strong opponents to cannabis research, including pharmaceutical companies, law enforcement and the federal government.

Pharma may see cannabis as a financial threat. Dr. Sisley says, “Some of my young veteran patients pick up their pain meds at the VA, sell them, and then buy cannabis with the proceeds.” Having more legal options to purchase medical marijuana directly would undercut the sales of common pain/sleep/anxiety medications.

Under the Controlled Substances Act, the federal government argues marijuana is a Schedule 1 drug, listed alongside heroin, LSD, and ecstasy, and defined as having “no currently accepted medical use and a high potential for abuse.” Moving marijuana to Schedule 2 would make investigating medical effects much easier, allowing for more government grants and greater interest among researchers.

Dr. Sisley says, “That would probably lessen the load that private donors now carry and allow for more charitable donations as they’re afraid, as well. There are well-funded foundations eager to help in Arizona but refuse because funding research into a Schedule 1 drug could jeopardize their non-profit status with the IRS.”

OVERCOMING PHYSICIAN FEARS Dr. Sisley says her fellow physicians fear speaking with patients and their families about certifying use for qualifying conditions or being labelled a “pot” doctor. Despite marijuana being legal in Arizona, most physicians steer clear of jeopardizing their DEA registration to prescribe controlled substances.

Physicians were initially scared of retribution from state licensing boards, as they weren’t sure how the boards would react to state legalization. After the first Arizona dispensaries opened in 2012, a small number of naturopathic doctors started writing marijuana certifications at an alarmingly high frequency through the Arizona Medical Marijuana Program.

Reprimands of those bad actors helped to control the industry and lessen pressure on allopathic and osteopathic physicians.

Until the federal government legalizes medical marijuana use, some physicians will remain fearful and avoid certifying patients to use cannabis in its various forms.

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To assuage some fears, Dr. Sisley says of the state certification program, “It’s confidential.

They can’t be tracked by the public. ADHS is not disclosing which doctors are certifying.”

Another consideration is liability.

Fortunately, no suits have been filed by patients or families alleging misconduct by physicians who participate in the Arizona Medical Marijuana Program.

Although Dr. Sisley believes the state medical program is ethical, she fears that if more doctors don’t get involved, recreational marijuana will overrun the medical market. This could leave little room for truly sick patients to maintain their access to low-cost medical cannabis.

WHAT’S IN THE PL ANT? The whole cannabis plant is a complex symphony of hundreds of unique bioactive molecules interacting with each other. Dr. Sisley says, “That’s what’s amazing. We focus on the flowering tops of the plant because that’s where you find the biggest density of cannabinoids and terpenes. The whole plant, even those fan leaves, the sugar leaves are loaded with cannabinoids, flavonoids, and terpenes.”

If one further explores the plant, one will find other useful parts. “There is a lot of evidence our ancestors doctored themself with the roots of the plant, rich in interleukins that contribute to the well-documented anti-inflammatory action of cannabis,” according to Dr. Sisley.

The low-TCH version of cannabis, called hemp, is used for textiles, paper, animal bedding, insulation materials, food and feed, cosmetics, etc.

BUT DOES IT WORK? Few randomized controlled trails (RCTs) have shown medical cannabis to be effective.

Currently, there isn't enough RCTs have been conducted especially for psychiatric conditions, insomnia, autism etc. Observational trials have provided better data, because they’re easier and cheaper to conduct than RCTs and researchers can use real-world marijuana plants that are more robust than the less potent research cannabis currently available from University of Mississippi.

Observational trials are less rigorous than RCTs, so they have less credibility with the

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medical community. Dr. Sisley says, “You’re allowing people to take what they choose. They might be taking their normal daily dose of cannabis and you’re collecting their subjective, often biased reports. It doesn’t have a placebo control. No one is blinded. The researcher knows what everyone is getting, which introduces study bias.”

Dr. Sisley and SRI are committed to change the game. Leveraging their Schedule 1 manufacturing license from the DEA, they are seeking to grow higher quality and more diverse and robust plants with potency consistent with real-world flower for FDA-approved human research. Dr. Sisley and SRI design trials, grow the cannabis, receive funding from sponsors, and conduct the trials on volunteers. SRI can gift their plants to other researchers but only to scientists or organizations that also hold a Schedule 1 license.

What her research studies published in journals like The Journal of Pain, Journal of Cannabis Research, and National Library of Medicine. These have shown mixed results so far. In one study, “The Short-term impact of 3 smoked cannabis preparations versus placebo on PTSD symptoms: A randomized cross-over clinical trial”, the study did not find a significant difference in change in PTSD symptoms severity between the active cannabis concentrations and placebo by the end of Stage 1.1 Dr. Sisley attributes the low efficacy to poor quality of the government study drug. In “High-Frequency Medical Cannabis Use is Associated with Worse Pain Among Individuals with Chronic Pain,”2 greater daily frequency of cannabis use was linked with higher pain severity. In her study “Pills to Pot: Observational Analyses of Cannabis Substitution Among Medical Cannabis Users with Chronic Pain,”3 most users reported improved pain and health since substituting cannabis from pain medications.

WHAT THE FUTURE HOLDS Dr. Sisley doesn’t want to be characterized as a champion for medical cannabis. She says, “I’m a champion of objective data collection to hopefully uncover new medicines that are plant or even fungi-based that will serve as an alternative to toxic pharmaceuticals.” If there is any way to

On the Personal Side with Dr. Sue Sisley 1. If you could describe yourself in one word, what would that be?

A: Relentless, tenacious, persevering, and unforgettable

2. Do you have family? Pets?

A: I’ve had 6 chocolate labs over my lifetime and now blessed with a yellow Labrador named Dodger— emaciated dog rescued from Tucson desert who now serves as the beloved facility dog at our Laboratory.

3. Do you have a hidden talent most people wouldn’t know about you?

A: I am a member of Actors Equity - Union of Professional actors & stage managers and love to tap dance. I’ve played diverse lead roles in musical theater shows such as Miss Mona in Best Little Whorehouse in Texas, Miss Hannigan in Annie, Mrs. Lovett in Sweeney Todd, Mother Superior in Nunsense. veer away from opioids for chronic pain, then she believes that is a victory even if medical cannabis is never authorized as an FDA approved medicine.

She would like to persuade the FDA to reconsider its criteria for what is medicine. “Stop forcing physicians to the Big Pharma model of medicine that uses synthetic materials — a single molecule targeting one receptor in the body and that the drug must be clean and neat, and precision dosed,” she says. Dr. Sisley believes drugs approved by the FDA, including Epidiolex (cannabidiol), Marinol (dronabinol), Syndros (dronabinol), and Cesamet (nabilone) have not been successful.

That paradigm doesn’t always work well when it comes to complexity of natural plants and fungi.

Changing the current system is a big mountain to climb, however she believes the FDA needs a new paradigm when evaluating botanical medicine.

CONCLUSION For over 15 years, Dr. Sue Sisley has made it her mission to challenge the status quo in medicine, medical research, and how medicine works with government, simply so that her patients can have an opportunity to get better. Dr. Sisley's hard work and dedication have led her to the opportunity to conduct more research on medical cannabis.

The road ahead is long and arduous. We can all appreciate her resiliency. ■

Learn more information about Dr. Sisley and sources cited at arizonaphysician.com/sue-sisley-md

4. What books are you reading right now, or recently?

A: Good Chemistry: The Science of Connection, from Soul to Psychedelics by Julie Holland, MD, and Psychedelic Medicine: The Healing Powers of LSD, MDMA, Psilocybin, and Ayahuasca by Dr. Richard Louis Miller.

5. What’s your favorite movie?

A: The original Willy Wonka and the Chocolate Factory… so magical and I’m an unapologetic chocoholic.

6. What’s your favorite local restaurant?

A: Durant’s, partly because I have a plaque on their wall confirming I earned membership in the “Porterhouse Club” by eating 48 ounces of steak AND dessert all at once.

7. Do you have a favorite sports team?

A: PHOENIX SUNS! I’m a 14-year season ticket holder, front row courtside, instigated by my mom Hanna Sisley.

8. What’s your favorite activity outside of medicine?

A: Working with veterans and first responders in community gatherings, like Project Healing Waters & Heroes on the Water (HOW). I also enjoy going fishing/ kayaking with my dog up north.

By Edward Araujo Managing Editor Arizona Physician earaujo@mcmsonline.com

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IN DEPTH

A CONVERSATION WITH

Virtuous Pain Centers From left: Emily Tyler, Viola Sanderlin, Wladislaw Fedoriw, Jade Shields, John Tracey

M

edical marijuana and the scope of its use has been the subject of fevorous debate in the medical community. Among

the specialties most directly impacted by medical marijuana is pain management.

We had a chance to sit down with Wladislaw Fedoriw, MD, a practicing pain management specialist, to discuss his views on the changing landscape of his specialty and his growing medical practice, Virtuous Pain Center.

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“Treating patients with respect and viewing them as an essential part of the provider-patient relationship, will always be a valued commodity.”

MEDICAL MARIJUANA ARIZONA PHYSICIAN: Do you feel that

medical marijuana is part of the evolution of pain management, or a passing interest?

DR. FEDORIW: That depends on who you ask. Physicians believe that medical marijuana will be a permanent fixture in medicine; however, until the federal government legalizes its use our hands are tied. A standard of care must be created that outlines concrete guidelines as to the intended use. Marijuana is classified by the DEA as a Schedule 1 drug, defined as a substance with no currently accepted medical use and a high potential for abuse. Until that changes, medical marijuana will continue to face obstacles to its adoption.

AP: Are recent legalization efforts

helping or hindering the push for medical marijuana to be more widely accepted?

DR. FEDORIW: Helping. As marijuana becomes legal, the barriers to conducting research will fade away. New and thorough peer reviewed studies are the only way to safely bring medical marijuana to the forefront of patient care. One growing concern is that clinicians will shortcut medicinal studies and begin prescribing prior to clinical research. This timeline would not apply to a novel drug coming to market, and it should not apply in this case. Medicine has always approached new treatments carefully, and with as much information possible. The same should apply to medical marijuana.

AP: Do you feel that objections to medical

marijuana use are based in research or personal beliefs?

DR. FEDORIW: It’s a two-fold issue. Since the early 1960s, American culture has perpetuated a war on drugs that impacts the way in which people think about and discuss marijuana use. To change these sentiments, there needs to be scientific evidence as to the efficacy and target of its use.

AP: Why are physicians hesitant

to discuss medical marijuana openly and consider it as a treatment for their patients?

DR. FEDORIW: First, the continued Schedule 1 classification. Second, marijuana use as a medical treatment has evolved much more recently. Physicians practicing did not study the applications of medical marijuana in medical school. While continuing education is a cornerstone of medicine, there has not been enough research for physicians to have access to a wealth of peer reviewed studies that would normally accompany the introduction of a new drug or medical treatment.

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IN DEPTH

CHANGES IN PAIN MANAGEMENT AP: How long have you been a practicing pain

management specialist, and what changes have you seen in your specialty?

DR. FEDORIW: As a Physical Medicine and Rehabilitation specialist for over 15 years, there have been many changes in pain management. Often patients will not see a physician for initial visits. There is more regulation concerning what we can prescribe for patients, and there has been an increased rate of patient frustration due to the lack of access to adequate care.

AP: What are some ways that patients hear

about your practice?

DR. FEDORIW: Historically, word of mouth was essential. Today, online reviews have become the key to attracting new patients.

Specifically, Google reviews allow clinicians to respond to, but not delete, patient reviews about them and their practice.

REWARDS OF GROWTH AP: What have been some of the

most rewarding aspects about growing your practice?

DR. FEDORIW: Being able to travel across Arizona and share the quality of pain management for patients who have not previously had access. Also, training new clinicians as part of the expanding practice has been satisfying.

AP: How has your practice managed to stay competitive with larger hospital groups?

DR. FEDORIW: Simply put, patient loyalty.

Treating patients with respect and viewing them as an essential part of the providerpatient relationship will always be a valued commodity. Larger groups see patients as a number, and in healthcare empathy is fundamental.

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VIRTUOUS PAIN CENTERS By the Numbers

FOUNDED IN 2020 3 OFFICES Flagstaff

AP: What is the next area of

growth you envision for your practice?

DR. FEDORIW: Acquiring more practices and expanding into neighboring states. Our goal is to improve the patient and clinician experience across the field of pain management. ■

Show Low Chandler

2 OUTPATIENT SURGERY CENTERS 30 EMPLOYEES Learn more about Virtuous Pain Centers at virtuouspainceters.com

LIFE IS SHORT. WORK SOMEWHERE AWESOME.

Arizona’s Local Healthcare Recruiting Partner We Provide Recruitment and Placement Opportunities for Physicians, Nurse Practitioners

CALL TODAY 1.888.204.2139

jobs@insyncrecruiters.com

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(NP) and Physician Assistants (PA).

CELEBRATING 10 YEARS A R I ZO N A P H Y S I C I A N . C O M

25

What

Arizona

DOCS are Saying Have you ever prescribed medical cannabis to your patients?

Should patients have access to medical cannabis through a physician?

No 24%

Yes 76%

Yes 12%

No 88%

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Read more about medical cannabis at arizonaphysician.com/saying-medical-cannabis

Why or why not?

“For cancer treatment.” —Jeffrey Taffet, MD “It isn’t quality control tested, and the delivery system of smoking a burnt plant into one’s lungs is ludicrous.”

—Michael Denicole, DO “Only for legitimate medical purposes.” —Bryan Updegraff, MD “It causes heart attacks. Just like nicotine and cocaine. We see it regularly in our practice.” —John Adan, MD, FACC, FSCAI “Should be done though research studies. There is simply not enough known.” —Anita C. Murcko, MD “As an option to conventional care.” —Paul Benchwick, DO “There are some evidence-based indications for medical cannabis.” —Arthur Chou, MD “If something is medical, then it should be prescribed by doctors with dosage, indications, and monitored by us. Right now, it’s a free for all that is harming patients.”

—Christine Harter, MD “I am concerned about providing a product to a patient that is still considered illegal by the Federal government.”

—Joseph Torkildson, MD “In my opinion it is more harmful then beneficial and I do not want patients to harass me to give them a prescription.”

— Nadeem Shabbir, MD “MDs know how to take a history, do a P.E. and labs. Others, such as naturopaths, provide a one-page ‘evaluation’ from which a person qualifies for a medical marijuana card.” — Stephen P. Herman, MD

Should the state or local government fund more research into the health effects of medical cannabis?

No 18%

Yes 82%

“It helps reduce reliance on opioids and is safer than many of the substitutes.” —Klee Bethel, MD “It’s not without risk. It may not harm everyone but I’m aware of some with significant bad effects.”

— James R. Mouser, MD “Preparations are unstandardized. There is no or minimal basic research on what the many compounds in cannabis even do, let alone risks and benefits.” —Leo A. Martin, MD

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The DEA classifies marijuana (cannabis) as a Schedule I drug, which is defined as a drug “with no currently accepted medical use and a high potential for abuse.” Do you agree?

Why or why not?

“Cannabis is useful medically in certain instances.”

—Howard B. Wernick, MD “There are some studies showing benefits of marijuana for certain medical conditions. However, this area of research needs significantly more studies.”

—Rachel Giroux, DO “It has been shown to assist folks with chronic pain, cancer chemo symptoms, etc.” —Karen Chaney, MD

No 33%

Yes 67%

“It’s very useful for anxiety, pain, and sleep.”

—Lory Baraz, MD “Indicated for severe forms of PTSD and anxiety. Also, some indications in cancer patients. Some potential uses in some seizure disorder patients. Yes, it has a high risk of abuse and should not be a first line.”

—Traci Fitzhugh, MD, FACOG “The adoption of marijuana for medical uses is very recent. It’s simply too early to know what the longterm effects of its use will be.” —Rodney Jackson, MD “There is evidence of benefit in certain conditions via patient reports. Federal classification limits researchers’ ability to conduct randomized controlled trials.” —Elizabeth E. Smith, MD “Needs to be studied. Though I disagree it should be available now in its present form, I believe there are potential benefits from one or more of the active metabolites of the cannabis plant.”

—Michael Denicole, DO “Have to have controlled studies to prove value.” —James R. Siefer, DO, FACOS “The high potential for adverse effects and abuse outweigh any therapeutic benefit.” —Dennis Thrasher, MD, MA, MPH

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“Marijuana is not like heroin or cocaine. I believe it should be regulated as alcohol.”

—Jane Lyons, MD “Need more research, no adequate education to professionals, and there is a high degree of abuse potential.”

—Kathryn Sanderlin, MD “While there is potential for abuse, there are known benefits for pain control, nausea, and insomnia. It seems promising as an alternative to chronic opioid use, something that continues to be a problem.”

—Deva Boone, MD “Opiates are worse than cannabis.”

—Lindsey Bayer, DO “Data needed to ascertain proper classification. Currently very political.”

—Tim Bonatus, DO

We thank the following participating physicians Howard B. Wernick, MD (R) Jeffrey Taffet, MD Biltmore ENT Michael Denicole, DO The Meadows Rachel Giroux, DO Neighborhood Outreach Access to Health (NOAH) Karen Chaney, MD Arizona Complete Health (AZCH) Bryan Updegraff, MD Updegraff Clinic for Allergy & Dermatology Lory Baraz, MD Integrated Medical Services John Adan, MD, FACC, FSCAI Consulting Interventional Cardiology, LLC Traci Fitzhugh, MD, FACOG Southwest Contemporary Women’s Care Rodney Jackson, MD Good Night Pediatrics of Arizona

Have you heard of the ADHS Medical Marijuana program?

Anita C. Murcko, MD Arizona State University – College of Health Solutions Ann Cheri Foxx, MD Nocio Pain Management Paul Benchwick, DO Dr. Paul Benchwick, DO, PC

Yes 16%

Arthur Chou, MD Horizon Health and Wellness Elizabeth E. Smith, MD HonorHealth Christine Harter, MD Abrazo Medical Group

Joseph Torkildson, MD Banner Health James R. Siefer, DO, FACOS Arizona State Urological Institute (ASUI) Laura Hamant, MD Phoenix Children’s Hospital Dennis Thrasher, MD, MA, MPH Sunnyside MediCenter, PC Nadeem Shabbir, MD Banner Desert Neuroscience Jane Lyons, MD Dignity Health – St Joseph’s Kathryn Sanderlin, MD University of Arizona – College of Medicine, Tucson Deva Boone, MD Southwest Parathyroid Center Robert Autry Brooks, MD Banner Health Stephen P. Herman, MD University of Arizona – College of Medicine, Phoenix Klee Bethel, MD Arizona Spine and Joint Hospital James R. Mouser, MD Dignity Health Tim Bonatus, DO Northern Arizona Orthopaedics (NAO) Lindsey Bayer, DO Scottsdale Emergency Associates (SEA) Leo A. Martin, MD Leo A. Martin, MD, PC

No 84%

Learn more about physicians certification trends in Arizona by visiting arizonaphysician.com/saying-medical-cannabis

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LEGAL CORNER A M M A R E QU I R E M E N T S AND IMMUNITY

Know Your Risks Certifying Patients for Medical Marijuana

M

arijuana for medical use entered mainstream medicine in Arizona a decade ago. However, physicians new to Arizona, and those now considering adding certifications to their services, should be aware of the liability risks involved. The Arizona Medical Marijuana Act (“AMMA”) and corresponding Arizona Department of Health Services (“ADHS”) rules govern physicians certifying patients for application to the medical marijuana program. The form isn’t mere paperwork. Failure to comply with the AMMA, ADHS’ rules, and the legal standard of care could result in criminal charges, licensure actions, and/or medical professional liability (“MPL”) claims.

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The required Medical Marijuana Certification form is complicated given that it’s a checklist and an attestation. The Certification form is a list of key certifying physician responsibilities, which include the following:  Holding a valid license to practice medicine or osteopathic medicine;  Establishing a physician-patient relationship;  Creating a medical record and retaining it for at least six years after the adult patient’s last appointment or treatment;  Completing a full assessment of the patient’s medical history including reviewing other treating physicians’ records from the previous 12 months and the patient’s responses to conventional medications and therapies;  Conducting an in-person examination appropriate to the patient’s medical condition within the last 90 calendar days;  Diagnosing or confirming a “debilitating medical condition,” including cancer, glaucoma, acquired human immune deficiency syndrome, positive status for human immunodeficiency virus, hepatitis C, amyotrophic lateral sclerosis, Crohn’s disease, agitation of Alzheimer’s, and any other chronic or debilitating disease or medical condition that includes one or more of the signs, symptoms, or characteristics listed in the statute; i  Reviewing the patient’s profile on the Arizona Controlled Substances Prescription Monitoring Program (“CSPMP”) database;  Explaining the risks and benefits of the medical use of marijuana; and  Addressing the potential dangers of marijuana to fetuses and newborns, where applicable.

There are more responsibilities for patients under age 18.

By signing the Certification form, physicians attest to two things: 1) that, in their professional opinion, the qualifying patient is likely to receive therapeutic or palliative benefit from the medical use of marijuana, and 2) that the information contained in the form is true and correct. There are serious consequences for falsely attesting to these things.

The AMMA provides immunity from arrest, prosecution, disciplinary action by the certifying physician’s licensing board, and civil penalties for providing the certification. However, immunity does not apply to licensing board sanctions alleging failure to properly evaluate the patient or violating the standard of care for evaluating and treating the medical condition.

CR IMINA L CH A RGES The immunity provision of the AMMA was tested in a case involving a patient requesting certification for medical marijuana. The patient was part of a criminal investigation of the certification process and never provided previous medical records. The defendant physician signed the Certification form anyway.

The trial court dismissed the grand jury’s indictment for criminal charges, holding the AMMA immunized the physician against prosecution related to the form. The Arizona Supreme Court disagreed and decided immunity applied to the provision of written certification but did not extend to all conduct related to the certification process, thus making criminal charges appropriate under the AMMA.

L IC E NS U R E AC T IONS The ADHS reports noncompliance with the mandatory query of the CSPMP to certifying physicians’ licensing boards. Licensing boards generally view noncompliancebut-signing as “unprofessional conduct.” The Arizona Medical Board has specifically determined that completing and signing the Certification form without querying the CSPMP is a “false or fraudulent statement in connection with the practice of medicine” constituting unprofessional conduct.ii

MPL CL A IMS MPL plaintiffs must prove the defendant physician failed to meet the legal standard of care and the failure caused the plaintiff’s injury. The legal standard of care is

The signs, symptoms, and characteristics are cachexia or wasting syndrome; severe and chronic pain; severe nausea; seizures, including signs or symptoms characteristic of epilepsy; or severe and persistent muscle spasms, including signs or symptoms characteristic of multiple sclerosis.

See A.R.S. § 36-2801(3)(b). The Arizona Administrative Code, or ADHS Rules for marijuana for medical use, contains a more detailed list of “debilitating medical conditions.” i

what a reasonable prudent physician in the same specialty would have done in the same or similar circumstances. A jury ultimately decides the legal standard of care for each plaintiff and set of facts based on competing testimony from expert witnesses.

So far, Arizona courts have not reported a decision on negligent evaluation and/or certification for treatment with medical marijuana but here are two scenarios that could result in a MPL claim:  The physician reviewed the patient’s medical records from the past 12 months, overlooked a contraindication to medical marijuana, and signed the Certification form. The patient then suffered an injury believed to be caused by medical marijuana. The patient now claims the physician negligently reviewed the medical records resulting in a negligent treatment recommendation.  The physician reviewed the patient’s medical records from the past 12 months, including the patient’s responses to conventional treatments; explained the risks and benefits of medical marijuana to the patient; and signed the Certification form. The patient developed a subsequent medical problem, possibly caused by medical marijuana, and learned of alternative treatments for the original medical condition. The patient now claims that while the physician complied with the requirement to explain the risks and benefits of medical marijuana, the physician negligently obtained the patient’s informed consent by not discussing legitimate alternatives to medical marijuana.

Check your resources before adding certification for medical marijuana to your practice.  Your business or health care attorney can explain the expenses and consequences of criminal charges and prosecution.  The ADHS’ Medical Marijuana webpage offers frequently asked questions and physician-specific information.  Your MPL insurance carrier’s underwriting department or your broker can address coverages for licensure board actions and MPL claims. ■

See 9 A.A.C. 17-201 at p 21. See A.R.S. § 32-1401(27)(u), which states unprofessional conduct, whether occurring in Arizona or elsewhere, includes knowingly making any false or fraudulent statement, written or oral, in connection with the practice of medicine.

Learn more about medical cannabis risks at arizonaphysician.com/marijuana-risks

Molly B. Adrian, JD Legal Risk Management Consultant Risk Management Service Mutual Insurance Company of Arizona madrian@mica-insurance.com

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HOW TO

Company Culture 9 Interview Questions to Ask That Will Tell You Everything

F

or anyone considering a career change in healthcare right now, the landscape is your oyster. Candidates are exploring all kinds of opportunities with new hospitals, healthcare organizations, and private practices.

But it’s still critically important to remain diligent and thorough in your approach. Company culture matters, and you don’t want to trade one growthstifling environment for another.

For those physicians and healthcare professionals also in hiring and onboarding roles, it’s downright hard to find, attract, and hire top healthcare talent these days.

What today’s healthcare hiring managers can do is increase preparedness. Medical and healthcare professionals who are considering a career change will be expecting more from their employers. And while you might have your roster of interview questions ready to pose to interviewing candidates, you should also be prepared to field a new line of inquiries from them.

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One area that applicants are keen to ask about is company culture. As a physician looking for new healthcare job opportunities, be prepared to ask certain interview questions that can help you get a better perspective of the working environment and company culture. Here’s a checklist of questions to help you get ready for your next big interview. If you are the hiring manager for your organization, you should be prepared to field these questions about the workplace environment within your healthcare facility or office.

This line of questioning is positioned as advice to applicants to help them explore the company culture and workplace environment of the healthcare facility for which they’re interviewing. It describes what applicants should be asking, along with why they should ask, and what kind of responses they should look for from the hiring manager.

1. CAN YOU DESCRIBE YOUR COMPANY CULTURE IN FIVE WORDS OR LESS? Don’t be afraid to be direct or to come right out and ask. How the hiring manager responds will be telling in confirming either way. If there is hesitation or the response seems rehearsed, keep digging. However, if the response is favorable or even enthusiastic with examples, it’s a good sign the company culture and workplace environment are positive.

For more information, please visit arizonaphysician.com/company-culture

2. DOES THE ORGANIZATION RECOGNIZE INDIVIDUAL ACHIEVEMENTS? Asking an interview question like this, even if it doesn’t apply to the particular role you’re applying for, will tell you how the organization prioritizes individual growth.

If there aren’t initiatives in place that support great achievements or acknowledge performance, it might not be the supportive environment you have in mind.

3. DOES YOUR HEALTHCARE ORGANIZATION CONTRIBUTE TO ANY PHIL ANTHROPY EFFORTS? This is the question that should initiate a response about corporate responsibility. Any healthcare organization that engages in charitable good works, local community involvement, and philanthropy, does make an effort to preserve a positive brand image and company positioning. Smaller practices won’t have the big budgets for huge initiatives. But even the small healthcare organizations can support local efforts in small ways and will if it’s a priority.

4. ARE THERE OPPORTUNITIES FOR ADVANCED EDUCATION AND TRAINING? Even if you’re at the top of your game, with every required certification, distinction, and specialty training, this is a must-ask question. A healthy company culture will usually have ongoing training efforts and advanced education opportunities for staff across a variety of roles.

The company that promotes individual betterment will also be staff-focused.

5. WHAT WOULD OTHERS IN THIS ROLE SAY THEIR WORK-LIFE BAL ANCE IS LIKE? This is another interview question that seems fairly straightforward. But many healthcare professionals are hesitant to ask about it openly. Gauge the response, much like you did for the original question about company culture. Answers for a positive environment might include employee support efforts, like gym memberships, mental health days, or an on-site psychologist, depending on the field of expertise in the organization.

6. HOW FREQUENT ARE COMPANY WIDE MEETINGS HELD? Staff meetings are known to have a negative stigma, especially when they’re too frequent and unproductive.

But a sign of a well-connected corporate body to the healthcare professionals on the front lines are regular meetings. Companywide meetings are necessary for efficient communication. But they’re also great arenas to raise concerns and challenges that the front line might need help solving.

7. WHAT IS THE BEST PART OF WORKING HERE? This line of interview questions will prompt a more personal response, hopefully. Get the hiring manager to open up with you about what they enjoy most about working for the organization.

If the response is “great vending machines,” you know there’s likely a problem with the overall workplace environment.

8. ARE YOU PROUD TO BE AFFILIATED WITH THIS ORGANIZATION? Use that last question to pivot and transition into this one. It’s skewed, again, for a more personal response from the hiring manager or team. But it will help you distinguish between canned responses about culture from authentic sentiments. You can also use this topic to springboard into your requirement of working with a healthcare organization you can be proud to represent, solidifying your candidacy.

9. IF YOU COULD CHANGE SOMETHING, WHAT WOULD IT BE? Get specific when you ask this question regarding the role for which you’re applying, the department, and the healthcare organization as a whole. If the responses are about improving schedules, more time off, or restrictive policies, it might be a “red flag” that the company culture isn’t as conducive as you’d prefer it to be. Additionally, if the hiring manager doesn’t have anything to offer, it could also mean there’s hesitancy to be transparent about the topic.

Remember, during your interviewing process, keep the conversation flowing naturally and don’t feel obligated to force these or any answers. But do your best to incorporate responses that will help candidates better gauge the overall worklife balance and company culture within your organization.

And when you need help exploring your healthcare recruiting opportunities, let InSync Healthcare Recruiters be your guide to navigating this dynamic healthcare hiring landscape! ■

Vicky Rinehart President InSync Healthcare Recruiters vicky@insyncrecruiters.com

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PHYSICIAN SPOTLIGHT

Patrick Miller, MD, Radiation Oncologist at Ironwood Cancer & Research Centers in Glendale, AZ. Q: Why do you use medical marijuana

to treat your patients?

A: I use medical marijuana for symptom management. Most of our patients have received or are concurrently receiving chemotherapy, and are experiencing nausea/GI upset, fatigue, poor appetite, difficulty sleeping, and taste changes.

Medical marijuana can help to alleviate some of these symptoms.

Q: Are there cons to using medical marijuana

with patients?

A: Some people experience a dysphoric feeling, which I think is related to the THC concentrations of the product they are using. Concentrations in the 10-15% range usually do not cause that.

Financial costs can be difficult for many patients.

Q: What forms of medical marijuana do your

patients receive? For example, do patients use edibles, pills, liquids, smoke leaves, or other forms?

A: My patients almost exclusively use edibles, mostly gummies. I discuss various forms with them but feel that small edibles are the easiest.

Q: Would you say the oncology community

supports, opposes, or is on the fence about medical marijuana? Why? A: I think that the average medical or radiation oncologist favors the use of medical marijuana.

In fact, I have not had experiences where colleagues told patients they should not use medical marijuana. I think the major reluctance still lies in the fact that it is legal in Arizona, but not federally legal. Oncologists get DEA licenses from the federal government, and there is always a concern of new administrations turning back the clock and wanting to limit use of medical marijuana, or even prosecuting doctors who prescribe it. That makes many physicians somewhat wary to get involved beyond simply telling patients about it.

Q: Are there ongoing studies about medical

marijuana for cancer patients? If so, then what do you predict would be the outcomes about efficacy for relieving symptoms of pain, neuropathy, nausea, appetite, etc.?

A: There are starting to be some studies, but this area needs much more research.

Q: Are patients with certain types of cancer more

responsive to cannabis than others?

A: I do not have enough experience to say if particular cancer types respond better to the symptoms management. I do know that when the radiation field involves the GI tract, such as pancreatic cancer, or rectal cancer, and the patient is having concurrent chemotherapy, symptoms are hard to control.

PATRICK MILLER, MD Radiation Oncologist Ironwood Cancer & Research Centers pmiller@ironwoodcrc.com

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