Arizona Physician Winter 2023

WINTER 2023

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

An Entrepreneurial Spirit in Primary Care Vishal Verma, MD, discusses his journey in medicine and how physicians can continue to lead in primary care

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Arizona physicians share their thoughts on the future of primary care

Become an MCMS member

CONTENTS VOLUME 5 • ISSUE 4

IN EVERY ISSUE 4 | From the MCMS Board President

Editor-In-Chief

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| From the Editor-in-Chief

7

| MCMS Partner Program

8

| Briefs

Desire’e Hardge, MBA

Managing Editor Edward Araujo

Creative Design

10

Why Primary Care?

18 | What Arizona Docs are Saying

Phoenix Children’s Kristen

26 | Legal Corner

its important to discuss

Ben Scolaro, scolarodesign.com

28 | How To

primary care with young

Advertising

30 | Physician Spotlight

physicians during residency.

Randi Karabin, KarabinCreative.com

Cover & Featured Articles Photography

ads@arizonaphysician.com

Samaddar, MD, shares why

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Maricopa County Medical Society Board Members

In Depth: Neighborhood Outreach Access to Health

President Zaid Fadul, MD, FS, FAAFP

President-Elect Jane Lyons, MD

Treasurer Vishal Verma, MD, MBA

Secretary Ann Cheri Foxx-Leach, MD, D.ABA

Past President Ricardo Correa, MD, EdD, FACP, FACE

Suganya Karuppana, MD,

Directors Kishlay Anand, MD, MS Jay Arora, MD, MBA Rahul S. Rishi, DO, FAAAAI, FACAAI Karyne Vinales, MD

Resident & Fellow Director Deepika Razia, MD

14 C O V E R S T O R Y

Vishal Verma, MD, MBA, is a primary care success story. He shares his thoughts on the current state and future of primary care.

Chief Medical Officer at NOAH discusses their primary care programs and services.

Medical Student Director Sarah Carpinelli, OMS-IV

Digital & Social Media arizonaphysician.com ArizonaPhysician @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

Physicians Should Continue Being Leaders in Primary Care

P

rimary Care is the most undervalued specialty in our healthcare system today. That role is an incredible responsibility and a privilege to serve but requires more effort and thoughtfulness than might seem obvious. A good PCP is the best manager of limited

healthcare resources, akin to a quarterback that runs an offense, calling the right plays to keep the offense moving forward. Everyone wins when the PCP role is fully supported. Conversely everyone loses with fragmented care, poor system design, and undertrained clinicians at the helm.

MCMS is and has always been committed to supporting and developing a vibrant community of PCPs as they are the best indicator of a healthy medical ecosystem. We will continue to support the medical community by working with legislators, advocacy groups and physicians to keep the focus on these issues that inevitably permeate the entire health care system.

On that note, this is my final month serving as Board President of Maricopa County Medical Society (MCMS) and I couldn’t be more grateful for the opportunity and privilege to serve. I am also very excited for the future with Dr Jane Lyons taking the helm as next year’s President coupled with the arrival of our new CEO & Executive Director, Desire’e Hardge, MBA. MCMS is in great hands and positioned to do wonderful things for our community of physicians in the coming years!

Zaid Fadul, MD, FS, FAAFP MCMS Board President Dr. Zaid Fadul's focus in medicine has been on improving patient outcomes and building better care delivery systems. He is Board Certified in Family Medicine and Addiction Medicine.

He also has the privilege of serving in the US Air Force Reserve as a Flight Surgeon, where his training is focused on Occupation and Aerospace Medicine. He currently serves as the Chief Medical Officer for Steady Hand Medical and the President of the Maricopa County Medical Society. Dr. Fadul has traveled extensively as a photographer and is proficient in Spanish and conversational Arabic. His proudest moments come as a father of three with a loving and supportive wife.

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Interested in getting involved with MCMS? Reach me at mcms@mcmsonline.com

Advocacy Pushing policies that matter

Patient Referrals Online directory and referral line

Professional Referrals Legal, financial, staffing, real estate, etc.

Scan to learn more about the benefits of being an MCMS member

CME In person and virtual

Physician Stories Print and digital magazine, podcast

Networking Happy hours and fun events

Focused on Physicians Like You! Become a Member Today.

FROM THE EDITOR-IN-CHIEF

“ I N A M E R I C A N L I F E T H E FA M I LY D O C T O R , T H E G E N E R A L P R A C T I T I O N E R , P E R F O R M S A S E R V I C E W H I C H W E R E LY U P O N A N D W H I C H W E T R U S T A S A N AT I O N .

A

— President Franklin D. Roosevelt

s the greatest country in the world,

Dr. Kristen Samaddar, as she discusses how to get

aligned with the best physician

more residents interested in primary care.

association in Arizona, Maricopa

In our legal corner, attorney Roger Stahl dis-

County Medical Society (MCMS) is

cusses the new Federal Corporate Transparency Act

grappling with the deficit of primary

and how it will affect physicians and their practices.

healthcare physicians and healthcare

Mutual Insurance Company of Arizona (MICA)’s

maintenance that helps support the increase of quality

Juliana Stanley, MBA, discusses the importance of

health and patient care. Primary care physicians (PCPs)

physicians putting together business continuity

serve as the first point of contact for patients and

plans. The issue finishes with Dr. Greg Aran, an

are responsible for managing a wide range of health

internal medicine physician sharing his thoughts on

concerns. From comprehensive care, coordination of

primary care.

care, diagnostic and treatment services, to; community

Finally, I want to introduce myself to you, our

health, and team-based care. Effective primary care is

physician reader, as Arizona Physician’s Editor-

essential for building a strong foundation for Arizona’s

In-Chief and Maricopa County Medical Society

healthcare system, promoting early intervention, and

(MCMS)’s CEO & Executive Director. I hope you con-

improving overall health outcomes for individuals and

tinue enjoying our magazine and that you will allow

communities. It plays a vital role in addressing both

us to serve you as an MCMS member in 2024. Since

acute chronic health conditions while emphasizing

1892, MCMS has been a beacon of stability within

preventive measures and patient education.

the healthcare community and for physicians like

In this issue our featured articles come from MCMS community partners like the Neighborhood Outreach

you of all specialties.

As we move into 2024, we thank you our readers,

Access to Health (NOAH) through their CMO, Suganya

our members, our partners, and community allies

Karuppana, MD, MHCD, CPE, CHC, CPHQ, and we

for making us the number one medical association

profile physician entrepreneur and MCMS Board

in Arizona.

member, Vishal Verma, MD, MBA. We also get great feedback from physicians on the future of primary care in our continuing series, What Arizona Docs are

We hope you continue to enjoy the magazine!

Saying. Together, they share how making a difference in removing barriers to quality primary care increases health equity.

You will also get an opportunity to read first-person articles from Dr. Michael Konopacki on how primary care can transition into a value-based model and from Not an MCMS member? Visit mcmsonline.com/join or call us at (602) 252-2015.

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By Desire’e Hardge, MBA

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How Are Partners Selected?

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

7

BRIEFS

NEWS AND NOTES FROM THE FIELD

5 Wellness Tips That Will Keep You Healthy this Winter

GET GOOD REST | Not getting good sleep can lower your immune system. Try maintaining a consistent sleep schedule for yourself. Getting 7 to 9 hours of sleep will allow your body to recover and protect itself against sickness.

DO YOUR BEST TO REMAIN HYDRATED | Keep drinking water. Drinking water will boost your immune system and help you fight viruses. From regulating internal body temperature, lubricating joints, to better metabolizing food, consistent water intake is very beneficial.

MANAGE DRY SKIN | Protect yourself during cold days of low humidity. These conditions can cause dry, itchy skin. Try to keep your skin healthy by limiting your shower time, quickly applying lotion, and wearing lip balm.

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GET VACCINATED | From COVID to flu, immunizations are very important in keeping you healthy this winter. Find resources across your community providing flu shots or boosters against airborne or droplet viruses.

LIMIT THE SPREAD OF GERMS | While getting sick is almost quite inevitable during the winter season, doing your part to minimize the spreading of germs is important. Cover your mouth and nose when you sneeze or cough. Try washing your hands regularly with soap and warm water for at least 20 seconds every time.

4 Great Tea Types that Keep You Healthy Studies share how drinking tea can bring you great benefits. Yet, which tea is best? There are many options awaiting you down one of the many aisles of your local supermarket. Here are 4 great types of tea.

CHAMOMILE TEA | This tea comes from the daisy-like plant that contains apigenin. Apigenin attaches itself to receptors in your brain and works to reduce anxiety, which can lead to a peaceful calm and drowsiness.

This tea will help you sleep.

HERBAL TEA | This tea has anti-inflammatory properties that can help you loosen your airways should they feel tightened by such conditions as asthma. Another added benefit of drinking herbal teas that have turmeric, cinnamon or ginger is that they can help clear congestion by loosening mucus.

GREEN TEA | This tea has great healing powers because of the antioxidant compound, catechin which is found on these tea leaves. Green tea helps prevent cancer, fight heart disease, lower blood pressure, lower cholesterol, and even weight loss.

GINGER TEA | Calming your stomach since ancient times, ginger tea helps combat nausea.

It also helps during pregnancy when dealing with morning sickness. It has been shown to be digestively beneficial by helping your body move food through your digestive tract and through your stomach.

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Why

I

Primary

meet with first-year medical students every fall and am inspired by their enthusiasm and limitless career possibilities. I am often asked, “Why did you choose pediatric primary care?” After practicing medicine for twenty-two years, I appreciate subtleties in many of the decisions I make. Yet, I am certain with this one that I made the right choice. In the last two decades, the climate of healthcare has changed considerably, and the branches of expertise have divided even further.

Nonetheless, the need for doctors who truly see you and have an invested interest in your wellness, support systems, and each of your ICD 10 codes, is more valuable than ever.

In primary care, there are times to move quickly to stabilize and transfer a child with respiratory distress to the emergency department. There are occasions to slow down and recognize someone’s pain and understand that the only medicine for this particular moment is listening, stillness, and genuine compassion. There are moments to celebrate because after many semesters of struggling, the student made the honor roll. In pediatric primary care, all these meaningful visits happen in a single afternoon.

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A colleague told me that primary care is like being a quarterback for a team. You must communicate well and understand what makes the most sense for each stage of the game. A primary care provider (PCP) has a unique role to gather the medical team and family in a huddle and help make joint decisions about treatment plans, re-center on goals, or determine how to proceed amid perplexing findings. During these care conferences, I feel honored to help our team operate in a more coordinated way.

To be a PCP, you need to have sophisticated clinical decision making and emotional intelligence. Primary care is about relationships. There are times when each of us needs a little motivation to move forward. The art of a successful nudge is taking the time to understand how to help people

remove barriers that are holding them back. This could be discovering that a basic need isn’t being met, like food or transportation, or sensing that the root of the problem is something that hasn’t yet been spoken. It could be providing more information and/or recognizing the progress they have already made. Only through trusting relationships can these nuances be uncovered.

Somewhere in my training, I remember absorbing the message that primary care is less intellectually stimulating than other fields. I have never felt this way. In fact, working as an educator and primary and complex care pediatrician has taught me that I can learn something new every day. As a teacher, I hope to inspire trainees to stay curious by asking them to share at least one new thing they discovered that day. It could be about the features of a genetic syndrome, how to teach a teen to find calm, or the most recent update to a guideline. There is never a shortage of material.

I believe that the medical community and education systems could better support trainees as they consider careers in primary care. One of the current barriers is lack of exposure. In most training programs, residents spend the majority of their time in inpatient settings. We need to allow for more consistent experiences in primary care. When students and residents do come to clinic, they rarely see the same patient twice. Therefore, it is harder to develop long-term relationships with patients and families. We need to develop systems that promote continuity.

Historically trainees have not had formal mentorship for careers in primary care. Programs have been created for understanding the day-to-day life as a specialist and supporting trainees pursing these careers, but less emphasis has been placed on primary care.

As a medical community, we need to resolve some of the challenges that primary care doctors face. We need to advocate for better systems of support for both patients and providers such as care coordinators and imbedded mental health services. We need to implement technological solutions so doctors can spend more time at the bedside and less doing clerical tasks. We need reimbursement models that prioritize prevention and value the scope of care provided.

However, despite all these challenges, primary care is a calling. It’s about being present and helping at key times in people’s lives. When I open the exam room door and see smile and a sigh of relief because a family recognizes that I have come to help, I am certain I am in the right place. ■

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By Kristen Samaddar, MD, FAAP Associate Program Director, Pediatric Residency Program Phoenix Children's Hospital ksamaddar@phoenixchildrens.com

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

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The

Future of Primary Care from the Lens of a Family Medicine Physician

P

rimary care is arguably the most difficult specialty in medicine.

We are expected to solve all the problems or instantly know who can. We do this under a perpetual time crunch as stagnant changes in payments though the fee-for-service payment models lags. Our capabilities to save the system money and heartache is grossly underutilized.

Healthcare is becoming increasingly expensive due to several complex issues including decreasing reimbursement, increased costs of running a practice, more medications being used for preventive purposes, increasing retirement, and decreased desire to enter primary care, and our rapidly aging population. Transitioning into value-based medicine should be a priority in how primary care is delivered.

Everyone who has been practicing primary care over the past several years has seen an increase in the responsibilities and requirements of practicing primary care. All the “extra clicks” we have been adding each year has stacked like a Jenga tower all while we’ve had

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idled increases in Medicare reimbursements. This, combined with the increasing costs of running a practice are leading to more and more private practices selling into large hospital owned organizations. The hope of being able to return to a focus on patients instead of running a business is short lived and now is a focus on maintaining an impossible growth model. Over the past year inflation has become an added variable.

In the past, fee-for-service (FFS) has incentivized an over reliance on ancillary services to boost revenue.

We do more to get paid more. Now, patients feel that the more we do the better the care they’re getting.

Decades of doing this have now translated to patients demanding everything that can be done; be done and be done quickly. Now, when I discourage my healthy 50-year-olds from getting a prophylactic stress test, an exorbitant amount of time is spent explaining why.

Entering a value-based model can help swing the pendulum back towards a healthy reliance on primary care to provide the best care possible. We are not a glorified referral service, and we can manage and

monitor diseases that are normally done by several different specialists. When maximizing our capabilities in a value-based model, primary care docs can increase their clinics revenue, save patients money, save patients from unnecessary procedures, keep patients out of the hospital and urgent care clinics and reduce the burden on our healthcare system. We truly can do it all.

In order to do this, we must become better advocates for our patients’ well-being. I understand that in the FFS model this will lower revenue, and this is the exact reason we need to do it. Healthcare is a business and as payments go down or don’t increase, we have to find ways of increasing business to cover the cost. We are limited to how many patients we can see per day so we “do more.” Soon, through the bundling of services, insurances decreasing or refusing to pay for services, or the time required to provide the services themselves will hamper our abilities to utilize those ancillary procedures to bolster revenue. Transitioning to value-based models allows us to decrease the number of patients we must see per day while increasing revenue. You

become incentivized to find ways to save your patient from unnecessary healthcare utilization. You profit more by keeping your patients healthy, not by creating an efficient way of doing more things.

The value-based model doesn’t solve all the problems facing primary care. The newer model can be abused just as the FFS is. The difference between the two is that if we focus on the long-term outcomes, a short-term loss will translate to a long-term gain. The FFS model focuses on short term gains in sacrifice of the long term. ■

By Michael Konopacki, MD Family Medicine Physician, Health Texas Primary Care Doctors htmg.marketing@healthtexas.org

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

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An

Entrepreneurial

Spirit

in Primary Care

Vishal Verma, MD, MBA

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“Primary Care today lacks resources, is

A

s he ponders his career path, Vishal Verma, MD can reflect on a journey in primary care that has brought him many highs. He is a breath of fresh air as a caring physician & leader, an entrepreneur, and most importantly a person striving to continue learning and applying that learning to his profession. Being a physician isn’t easy; neither is being an entrepreneur. Dr. Verma is that rare person who has worn both hats and built one of the largest primary care physician (PCP) focused medical groups in Arizona. Along the way, he managed to earn an advanced business degree (EMBA) focused on healthcare.

Vishal Verma, MD, began his medical career in Kasturba Medical College in Karnataka, India in the mid 1990’s. After graduating from medical school, he completed both his residency and fellowship in Brooklyn, New York. Post fellowship, Dr. Verma began practicing in internal medicine in 2011 and has continued in Primary care, and Hospital Medicine to this day.

A CAREER IN MEDICINE AND BUSINESS Vishal Verma, MD’s passion for medicine is grounded in a lifelong commitment to serving humanity. He saw in his parents two purpose driven adults dedicated to helping those less fortunate and their example to this day remains the inspiration for his career in medicine. His journey with 4C Medical Group began in 2013. Within a short time, his leadership strength began steering the group from one success to the next. The 4C Medical Group became a collective-effort led by passionate physicians who wanted to create an elite organization capable of delivering exceptional quality, cost-effective, timely, compassionate, datadriven, and goal-driven care to its patients across Arizona. 4C physicians strove to develop a system of medical care that not only enhanced the patient’s experience but also enhanced the physician’s experience within the healthcare delivery model.

underpaid, fragmented, overburdened, exhausting, and in need of a complete overhaul.”

“We demonstrated to the world that the hard-earned TRUST of physicians and patients is not a commodity that can be traded in the free market but a precious asset that should be nurtured and treasured. This trust was the catalyst of the massive transformation 4C went through… and as they say, rest is history.” Vishal Verma, MD 4C Medical was unique as it was both physician-led and patient-centric. Dr. Verma and his partner physicians were able to demonstrate in the primary care market that physicians can come together to build both a reputable and well-run organization that one day would become a part of a Fortune 500 company. “I am so deeply honored to have led an organization such as 4C Medical through some challenging times; especially during the global pandemic, to its pinnacle when it became a part of Optum.

After 4C Medical became Optum, due to a conversation with an Optum executive, Dr. Verma was inspired to continue his business education. He enrolled at Arizona State University’s W.P. Carey School of Business to earn an Executive MBA. That academic exercise only further augmented the work he and his partners had done at 4C Medical. Additionally, the Executive MBA opened a new world of healthcare entrepreneurship opportunities for him.

Currently Dr. Verma serves as a physician executive cum advisor at Abrazo Health. Though being at a larger hospital system is a new challenge, Dr. Verma enjoys his role. His position has enabled deeper insights into understanding how payors are driving acute care medicine and the many challenges hospitals face in delivering quality acute care. Also, his current position has familiarized him with payor barriers and how

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

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such barriers impact healthcare outcomes. The position has also provided him a bird’s eye view of how difficult it is for patients to navigate through a very complex healthcare system. He has observed firsthand how disparities, lack of equity, and social determinants of health are the real challenges facing patients in their journey to accessing good quality affordable care.

THE CURRENT STATE OF PRIMARY CARE “Primary Care today lacks resources, is underpaid, fragmented, overburdened, exhausting, and in need of a complete overhaul,” notes Dr. Verma.

Dr. Verma shares that primary care matters to patients because they feel it’s their most cost-effective way to access quality care. Yet, it’s fragmented and at times isolated from mainstream medicine. Patients want more time with their doctors, but the opposite is happening. “Health care must be personal and has to be customized to fit the needs of the population that a clinician is serving,” states Dr. Verma.

Dr. Verma identifies several problems in primary care. First, there is the burden of administrative tasks which constrain the doctor-patient experience and relationship.

Second, shrinking reimbursements, which lead younger physicians to choose other specialties.

Third, he notes physicians are “getting tired of the cookie-cutter, one-size-fits-all approach in the current primary care model used at many practices.” Consequent burnout is a real problem in primary care.

But does such a dire assessment warrant hopelessness? “Absolutely not!” states Dr. Verma. He believes the administrative tasks burden placed on physicians can be reduced.

Further, appropriately staffing of primary care clinics can lower support-staff attrition.

Third, improving the efficiency and performance of the payment models and increasing reimbursements can turn the tide. Fourth, make a push for more primary care-focused residency programs. Fifth, subsidize medical education so physicians aren’t starting their careers with hundreds of thousands of dollars in debt. Finally, build true physician-led and patient-centric care delivery models that focus

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on delivering high quality, low-cost care, while bringing joy and pride to the physicians toiling in the clinic. By making such material changes to our healthcare, Dr. Verma believes that primary care physicians can once again truly enjoy being in medicine.

Primary care has seen continued consolidation in the market. Many practices are merging into larger groups with payors, hospitals, and even national pharmacy drug stores are buying primary care practices. Dr. Verma remains unconvinced that such trends will actually improve primary care. He shares that in some of those types of practices it can lead to an exhausted primary care workforce that has lost professional joy and pride. Further most physicians and clinicians are frustrated by the rampant greed that exists in such corporate healthcare models.

WHAT THE FUTURE HOLDS In primary care, the goal should always be to deliver quality, cost-effective, timely, and passionate care to patients. Care that not only enhances the patient’s experience but also the experience of those that are providing it like physicians and other clinicians. This can only

Get to know Dr. Verma and his journey in primary care by visiting arizonaphysician.com/vishal-verma-md

On the Personal Side with Dr. Vishal Verma Q: If you could describe yourself in one word, what would that be?

A: Courageous Q: Do you have family?

A: Yes, my wife Menakshi and son Shivam Q: Pets?

A: A fish named Hope Q: Do you have a hidden talent most people would not know about you?

A: Writing poetry Q: What career would you have had if you were not a physician?

A: Policy maker and organizer happen through an exceptional care delivery model that should be physician-led, patient-centric and data-driven.

These primary care practices should serve as the hub of the healthcare delivery model of the future.

Advances in AI and other technology driven solutions need to be deployed to diminish the burdens of the front office, back office and clinical support teams, leaving ample amount of time for clinicians to listen to their patients and assist the patients’ desire to live longer and healthier lives. ■

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

Q: What book are you reading now, or recently?

A: Bhagvat Gita Q: What is your favorite sports team?

A: Phoenix Suns Q: What is your favorite movie?

A: The God Father Q: What is your favorite food?

A: Red beans and rice (Rajma-Chawal) Q: What is your favorite restaurant?

A: PF Chángs Q: What is your favorite activity outside of medicine?

A: Listening to spiritual music/Ghazals while gardening

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

17

What

Arizona

DOCS are Saying

The lowering reimbursements for primary care.

—Sheena Banjeree, MD The lack of providers and lack of payment for primary care services. —Joseph Piacentine, MD Decreasing insurance payments and games to not pay PCPs, too many inferiorly educated mid-levels providing poor medical care.

—Elissa Gartenberg, DO Insurance Reimbursement. —Pamela Davis, MD The continued increases in government regulation & decreased reimbursements. —Jeffrey Taffet, MD

What changes in healthcare could disrupt primary care?

The continuing administrative burden from commercial and governmental payers.

—Paul Barnard, MD Methods of reimbursement, Prior Auths process optimized, physician autonomy regarding scheduling.

—Kelly Isbell, DO Decrease documentation burden and insurance busywork. —Atul Jain, MD Supply chain shortages. —Marie Gronley, MD Artificial intelligence is a threat to primary care.

—Ronald Borg, MD An increase in fragmentation of care. There is a disconnect between the time cost of providing care and reimbursement. There is also a disconnect between the perception of work-life balance and costs of providing appropriate care. —Louis Vu, MD Primary care practices are being purchased by corporate groupsThe days of a small private owned practice are dwindling.

Also, corporate owned clinics are now staffed by NPs & PAs. —Wendy Kaye, MD

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Read more about what physicians in Arizona are saying about primary care by visiting arizonaphysician.com/primary-care

Why are there fewer physicians entering primary care?

Because primary care physicians are exploited by administrators. The consequences of the healthcare industry inefficiencies and the healthcare organizations ultimately all roll downhill into the physicians because we are ultimately liable, and we work on our own time to resolve issues since no one else can do them during their paid hours. We do it because our license is on the line and the administrators know this. —Kelly Isbell, DO

Should mid-level practitioners provide primary care without physician supervision?

27% YES

73% N O

Low pay for high effort, high non-clinical burden.

—Atul Jain, MD Lower pay compared to other specialties.

Debt burden after Medical School graduation.

—Richard Howe, MD The perception of “It’s not worth it.”

—Louis Vu, MD It is such a rewarding field; however, the compensation is inadequate for those in medicine with large student loans to pay. —Wendy Kaye, MD Poor payment, difficult to work with insurance payers, lots of burdensome paperwork and increased admin duties. —Christine Holmes, MD Loss of autonomy in caring for patients.

—Pamela Davis, MD A large factor is lack of appropriate reimbursement for primary care. It also is not helpful that residencies focus so much on specialty rotations, residents do not have as much exposure to primary care and different practice options in primary care (including solo practice and small group, not just large academic groups).

—Jane Lyons, MD Less “glamour” and often money than other specialties; residents being more comfortable with hospital than outpatient work due to residency bias toward this.

—Melanie Cloonan-Schulte, MD

Why or why not?

No, primary care needs to be co-signed by an MD. —Michelle Prestoza, MD No, they should function as assistants only, not as independent practitioners. They don’t have the same education, knowledge, and clinical expertise as a physician.

—Ronald Borg, MD No, they don’t have the education to provide expertise or the experience in various specialty fields to properly work up patients. They have loose governing boards that literally allow them to get away with murder. —Elissa Gartenberg, DO Yes, for basic routine medical issues but a physician should be consulted and available when needed for more complex patients. —Pamela Davis, MD No, mid-level practitioners have nowhere near the rigor of training, or the hours invested in training, to be equivalent to physicians. Many studies show that physicians have improved outcomes as well as lower costs of healthcare.

— Jane Lyons, MD Diagnosis/definitive treatments. —Jeff Edelstein, MD No, In Arizona, an NP degree can be earned without clinical experience. The depth of clinical experience and hours seeing patients in medical school and residency are far more important. The NP and PA programs should have the same number of hours of clinical experience as med schools.

—Sheena Banerjee, MD Continued on next page

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

19

On a scale of 0 to 10, as a practicing physician how important is it for patients to see a primary care physician instead of other mid-level practitioners for primary care.

Zero equals not important and ten equals very important.

What changes to medicine are needed to encourage more physicians to choose primary care?

Better reimbursement. —Paul Barnard, MD

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2

2

0

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0

0

10

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Significantly increase reimbursements and decrease non-clinical burden. —Atul Jain, MD Higher reimbursements, reasonable workload.

—Richard Rowe, MD Need to address payment discrepancies. Pay your primary care physicians on the same level as subspecialists. That is the only way to encourage medical students to pursue primary care as a medical profession. —Ronald Borg, MD

Why do you think patients are getting care from mid-level practitioners for primary care?

Make more emphasis on primary care in medical schools & adequate compensation. —Wendy Kaye, MD Payment increases by payers. —Christine Holmes, MD Loan forgiveness. —Joseph Piacentine, MD Insurance accountability for their interference which often restricts work ups and make it a hassle prescribing certain medications which lead to frustration. —Elissa Gartenberg, DO

10

ien c Conven

5

e

C os t

Other

ies, ompan c e c n a a Insur cess to e c a f o k lac y ar d ian, the physic uncomplicate r o f there issues.

20 n A R I ZO N A P H Y S I C I A N M A G A Z I N E

More training in residency, and not just for those choosing an outpatient primary care “track.” Less loan burden so that residents can chose based on factors other than just salary when deciding what to pursue post-residency. Great PCP role models for residents would also be helpful. —Melanie Cloonan Schulte, MD Probably too late, that ship has already sailed as insurers, private equity, and federal mandates for “quality/cost controls” force changes. The new physicians’ role is to clean up the messes created by the new order. —Jeff Edelstein, MD System too entrenched. Too late. —Jeffrey Taffet, MD

Read more about what physicians in Arizona are saying about primary care by visiting arizonaphysician.com/primary-care

How do primary care physicians regain trust with patients?

Easier accessibility —Michelle Prestoza, MD I think patients trust PCPs, there just isn’t enough of them.

—Marie Gronley, MD Allow them for time to care for patients. Provide more ancillary support (staff and equipment) to allow them to focus on patients instead of externals.

Provide better linkage to specialist care/ info/advice. Ai’s in that role would be extremely helpful. —Louis Vu, MD The ability to spend more time with each patient will improve trust. Often primary care docs are pressured to see 5-6 or more an hour! —Wendy Kaye, MD They haven’t lost trust????

This question is very biased and not true. My patients trust me.

—Elissa Gartenberg, DO

Clarity, compassion, patience, and a listening ear. —Pamela Davis, MD Build long term relationships with patients. Have real people answer phones in the office and quickly. Be able to make same day appointments for urgent situations. Availability and then listening to patients.

—Gary Muncy, MD See your own patients, engage them to be proactive, offer options, likely outcomes when cost is an issue, get politically active to support healthcare issues. —Jeff Edelstein, MD I don’t think trust is the main issue, but recent insurance related ads are making this worse. —Steven Schild, MD Availability. —David Suber, MD Physician PCPs should be acknowledged for their unique skills that go beyond other providers.

Their hard-earned medical degrees, training, and experiences should mean something to the patients they treat.

—Ann Cheri Foxx, MD

Participating Physicians Sheena Banerjee, MD All Kids Urgent Care Paul Barnard, MD Retired Ronald Borg, MD Retired Pamela Davis, MD Intercept Pharmaceuticals Jeff Edelstein, MD Jeffrey Paul Edelstein MD Ltd Ann Cheri Foxx, MD Nocio Pain Elissa Gartenberg, DO Modern Family Medicine Marie Gronley, MD Scottsdale Mental Healthcare PC Christine Holmes, MD Desert Shore Pediatrics Richard Howe, MD Retired Kelly Isbell, DO HonorHealth Atul Jain, MD, MS Mayo Clinic Wendy Kaye, MD Scottsdale Pediatric Center Jane Lyons, MD Banner Health Gary Muncy, MD Optum Joseph Piacentine, MD Phoenix Children’s Hospital Michelle Prestoza, MD Banner Health Steven Schild, MD Retired Melanie Cloonan-Schulte, MD Melanie Cloonan-Schulte MD PC David Suber, MD Desert Neurology Jeffrey Taffet, MD Biltmore ENT Surgeons Louis Vu, MD Banner Health

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

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IN DEPTH

ARIZONA PHYSICIAN: Please tell us

about NOAH. How did Neighborhood Outreach Access to Health begin?

What services does it provide for patients?

A CONVERSATION WITH

Neighborhood Outreach Access to Health

M

eet Suganya Karuppana, MD, MSHD, CPE, CHC, CPHQ, Chief Medical Officer at NOAH. We discuss NOAH’s programs and services plus her

take on what she feels the future of primary care will be.

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DR. KARUPPANA: Neighborhood Outreach Access to Health (NOAH) has provided affordable, high-quality healthcare services throughout Maricopa County for over 25 years.

As a Federally Qualified Health Center (FQHC), NOAH is focused on reducing barriers to healthcare including cost, lack of insurance, language, culture, and other Social Determinants of Health (SDoH).

Serving a diverse population of 50,000 neighbors at every stage of life, NOAH’s model of care places patients’ needs at the center of attention while delivering comprehensive health services including medical, dental, behavioral health, psychiatry, nutrition, pharmacy, preventive health, enrollment assistance, and health education programs.

NOAH was established in 1997 in response to local school districts’ concerns that not all students were able to access quality healthcare. Volunteers and a nurse practitioner visited schools across the Scottsdale and Paradise Valley Unified School Districts to provide on-the-spot care for children, especially those from Title I schools and low-income families.

By 2001 NOAH had deployed a mobile clinic and established a brick-and-mortar health center at the Palomino Primary School in the

Paradise Valley School District. Recognizing the community need was larger than school-aged children, NOAH became as a 501(c)(3) organization, achieved FQHC status in 2013 and began supporting children, youth, adults, and seniors. The Palomino Health Center grew to serve adults and children and added dental care while NOAH opened the Heuser and Paiute Clinics in central Scottsdale.

NOAH continued to grow and expand its footprint to areas throughout the Valley. Today, NOAH employs a team of nearly 500 health care providers, support staff, and administrative positions and operates seven health centers across the valley including Cholla Health Center in Scottsdale, Desert Mission, Midtown, Palomino, and Venado Valley in Phoenix, and Copperwood I and II in Glendale.

foot in each world, it will not be sustainable or achievable.

AZP: Dr. Karuppana please share with us how you

came to NOAH? DR. KARUPPANA: Community Health Centers (aka Federally Qualified Health Centers - FQHCs) in Arizona are all part of the Arizona Alliance of Community Health Centers (AACHC). This is our state Primary Care Association (PCA) which provides technical assistance, training, and support to the FQHCs in the state. As a member of AACHC for the past 12 years through my work at 2 prior health centers, I had come to learn about the great work done

by NOAH and met several members of their team.

AZP: You previously worked at Valle Del Sol and

AZP: What is NOAH’s focus? What does it do

better than other primary care providers?

Adelante Healthcare. What did those experiences teach you about community based primary care?

DR. KARUPPANA: Addressing patients’ needs from a whole-person perspective allows NOAH providers to work as a team to develop the best plan of care for every patient. When patients are seen by a team of NOAH providers, they can share any questions or concerns about their overall health and participate in creating the plan for their healthcare going forward. This unique approach is the foundation of NOAH’s mission to provide compassionate, quality healthcare for all.

DR. KARUPPANA: My experiences at these Community Health Centers (CHCs) taught me a few things. First was that I felt most fulfilled in my work when providing care to an entire community, regardless of insurance or ability to pay. Having the sliding-fee-scale and discount services for uninsured/ under-insured patients was a core value to me as a physician. Second, I learned that I was not alone, that many others shared

AZP: You’re currently the Chief Medical Officer at

NOAH, what are some of the challenges you see facing your organization?

DR. KARUPPANA: There are quite a few challenges facing community health centers in general. There is a national shortage of primary care providers, making it difficult to meet the health needs of our community. The cost of doing business has increased dramatically over the past few years (supplies and wages) but the reimbursement rates for our services have not increased. Finally, funding for health center programs is always at risk for renewal with each election.

AZP: Do you see the current reimbursement models

sustainable for primary care groups such as yours?

DR. KARUPPANA: There is a disconnect between how community health centers have historically been reimbursed, (through a prospective payment model from Medicaid and Medicare), and the full risk capitated value-based care arrangements that most commercial payers and advantage plans would like to move toward. Each reimbursement model requires a different care team structure, and while we have one

Learn more about NOAH by visiting arizonaphysician.com/NOAH

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

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IN DEPTH

these values. Not only the hundreds of people who worked at my community health centers, but there was the statewide organization (AACHC) with 24 other community health centers as well. Then I learned there is a National Association of Community Health Centers (NACHC) with 1400 CHCs across the country with over 9000 clinics serving more than 22 million people. That tells me this community health center movement is creating a huge impact on our health care system and the lives our communities coast to coast.

AZP: What insights do you have into the next

generation of physicians? What do they think about when it comes to primary care?

DR. KARUPPANA: I think there are likely a wide spread of interests and priorities that lead physicians to choose different specialties. Some prioritize shift work, so they don’t need to be on call or bring work home. Others love the immediate gratification of fixing something with their hands and then moving on to the next challenge. And others love building relationships,

“Addressing patients’ needs from a wholeperson perspective allows NOAH providers to work as a team to develop the best plan of care for every patient.”

—Dr. Karuppana being a part of families, educating, and working toward prevention. If they read this and feel like the third description best described them, then primary care is their niche.

AZP: How would you describe the current

state of primary care for patients?

Copperwood Health Center 11851 N. 51st Avenue, Suite B110, Glendale, AZ 85304

DR. KARUPPANA: There are still significant challenges accessing primary care providers for patients. Because of this shortage, most primary care providers are booked out weeks in advance and it is difficult for patients to get same day access to their primary care provider when they have an urgent issue. This has led to patients turning to urgent care/ emergency room more and more for same day needs. Our patients often don’t understand the importance of continuity of care and the complexity of care when information is disjointed across health records, they of course are looking for the simplest way to get today’s issue addressed. It will take a system overhaul to re-instate the role of a primary care provider as the first point of contact for a person’s health care needs.

Copperwood II Health Center 11851 N. 51st Avenue, Suite F140, Glendale, AZ 85304

AZP: How did we get to the current situation

HOW DO PATIENTS FIND NOAH? NOAH accepts Medicaid, Medicare, and most insurance plans and is always accepting new patients.

Everyone is welcome at NOAH regardless of insurance or financial status — there is even a sliding fee scale program offering reduced rates for those who qualify based on household income and family size.

To learn more or schedule an appointment, visit noahhelps.org or call 480-882-4545.

Cholla Health Center 8705 E. McDowell Road, Scottsdale, AZ 85257

Desert Mission Health Center 9015 N. Third Street, Phoenix, AZ 85020 Midtown Health Center 4131 N. 24th Street, Suite B102, Phoenix, AZ 85016 Palomino Health Center 16251 N. Cave Creek Road, Phoenix, AZ 85032 Venado Valley Health Center 20440 N 27th Avenue, Phoenix, AZ 85027

24 n A R I ZO N A P H Y S I C I A N M A G A Z I N E

with a shortage of primary care physicians?

DR. KARUPPANA: There are quite a few reasons for what created the shortage of primary care physicians. First, medical school training is extremely expensive, and most students finish medical school with several hundred thousand dollars of debt. Primary Care is the lowest paying specialty with the lowest reimbursement rates. Students coming out of school with high debt are often

Interested in having your medical practice/hospital showcased in Arizona Physician? Let us know at info@arizonaphysician.com

NOAH By the Numbers FOUNDED IN 1997 21 PHYSICIANS 29 ADVANCE PRACTICE PROVIDERS 21 PSYCHIATRIC PROVIDERS 47 BEHAVIORAL HEALTH COUNSELORS 6 NUTRITIONISTS swayed by the weight of their debt into higher paying specialties for residency. Specifically in Arizona, we have very few primary care residency spots compared to other states and based on our population. Studies show that most physicians end up practicing close to where they complete their residency training. Given our lack of primary care residency in Arizona, it is no surprise that we have an extreme shortage of primary care physicians in Arizona.

AZP: We see continued consolidation in the

6 DENTISTS 473 TOTAL EMPLOYEES 7 LOCATIONS Phoenix, Glendale, and Scottsdale

SERVICES PROVIDED Family medicine, internal medicine, pediatrics, psychiatry, telehealth, nutrition, pharmacy, counseling, dental, and community resources.

CONNECT WITH NOAH noahhelps.org | (480) 882-4545

market of practices merging into larger groups and hospitals buying out practices. Does that trend help or hurt primary care?

DR. KARUPPANA: With anything, I believe there are some positives and some opportunities with this trend. The larger groups/ hospitals likely provide some needed infrastructure and standardization which improves quality of care regarding staff training, protocols, drills. But often the larger groups can feel more impersonal, patients can struggle to see their primary care provider regularly because there is always someone else with a sooner appointment the call center provides as an alternative. The shortage of providers is the primary driver of the shift to urgent cares and alternative providers, but also the large groups who offer alternative providers rather than an appointment with the primary care provider also normalizes that experience for patients, making it harder for them to see the value in the longitudinal doctor patient relationship.

AZP: What future would you like to see for primary care?

DR. KARUPPANA: I would like to see a sufficient amount of Primary Care Physicians to meet the health needs of our community. I would like to see more primary care residency programs in Arizona, particularly in CHCs so we can grow our future workforce. I would like the payment structure to change so we are paid for the value we bring rather than our volume of visits. I would like patients to be able to come in to see their primary care provider for the same day/ urgent issues and have a panel size and schedule to accommodate the day-to-day variation that would occur. I would like to see more primary care physicians in leadership positions, public health positions, health care advocacy/ legislative positions, because of the unique perspective we have on health, health care, social determinants of health, and the wellbeing of our communities. ■

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

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LEGAL CORNER

“You’ll Just Feel a Little Pinch…”

This article is for your general education, does not constitute legal advice, and cannot replace the relationship that you have with your attorney. For legal advice on a specific matter, please consult with an attorney who is knowledgeable and experienced in that area. No attorney-client relationship is created by your use of the information in this article. Before relying upon this article, care should be taken to verify that the law described has not changed since the article’s publication.

HOW THE NEW FEDERAL CORPORATE TRANSPARENCY ACT WILL AFFECT YOUR PRACTICE

F

rom the patient side of the treatment table, “a little pinch” generally means brace for a bit of discomfort and pain. If you hold an ownership interest in your practice or in

the building where your practice is located (or in any other corporation, limited liability company for that matter), the exact same thing can be said for how the new Corporate Transparency Act may affect you. In short, the examination is about to get . . . personal.

26 n A R I ZO N A P H Y S I C I A N M A G A Z I N E

The Corporate Transparency Act (CTA) was passed in 2020, as part of the Anti-Money Laundering Act, to combat financial crimes by establishing a federal database of companies and information about the individuals involved in each company’s formation, control, and ownership.

Where does the information that will populate this database come from? That is where the “little pinch” comes in. The information will come from self-reporting by owners or “company applicants” (more on this later) who will have a limited time to provide detailed personal information to FinCEN or risk very significant potential penalties.

Here is a very brief summary of what you should know and ask your legal professional about concerning the CTA reporting and compliance requirements:

W H E N D OE S T H E R E P OR T I NG RU L E TA K E E F F E C T ?

The effective date for the reporting rule is January 1, 2024. Entities that are subject to the new law, so-called “Reporting Companies,” which were formed prior to January 1, 2024, will have one year to file their initial report with FinCEN. Reporting Companies formed between January 1, 2024, and December 31, 2024, must file their initial report within 90 days after formation. Reporting Companies formed on or after January 1, 2025, must file their initial report within 30 days after formation.

W HO W I L L N E E D T O F I L E ?

The reach of the CTA is expansive, requiring reports from any entity created in the U.S. through the filing of a document with the Secretary of State or a similar office. These are the Reporting Companies noted above and include (i) domestic corporations, limited liability companies (LLCs), or other entities created by the filing of a document with any government authority of a state, Indian tribe, or U.S. territory, and (ii) foreign corporations, LLCs, or such other similar entities that are registered to do business in a state, tribe, or U.S. territory.

In most states, that means virtually every limited partnership, limited liability company, corporation, statutory trust, and more. The CTA exempts certain entities from the reporting requirements, including large operating companies, public companies, and certain tax-exempt entities.

W H AT N E E D S T O BE R E P OR T E D ?

Reporting Companies will need to file reports which include the following information about the reporting company, its owners, and its “company applicants” (see below):  For the company: name, trade

name or d/b/a name (if any), address, jurisdiction where it was formed or registered, and tax identification number (TlN)  For beneficial owners (that is, individuals who either (i)

exercise substantial control over a reporting company, or (ii) own or control at least 25% of the company): name, date of birth, residential address, ID number, and photo of ID.  For company applicants (that is, the person responsible

for filing the entity with the Secretary of State, such as an attorney): name, date of birth, residential or business address, ID number, and photo of ID. This reporting element only applies to entities created after January 1, 2024.

The CTA also requires companies to file updated reports whenever there is a change in any reported information.

HO W I S T H E R E P OR T E D I N F OR M AT ION U S E D ?

FinCEN stores reported information on a secure, nonpublic database. Disclosure of the information is intended to be restricted, limited to various federal and state law enforcement agencies, and financial institutions.

W H AT A R E T H E R I S K S OF NO T F I L I NG? Failure to comply with the requirements could result in harsh penalties, including fines up to $10,000 and imprisonment for up to two years, for any person who willfully fails to file required reports or provides false information in a report. Penalties may be imposed on the Reporting Company and certain individuals who cause the Reporting Company to violate the law. A 30-day cure period after discovery is provided to file corrective reports.

HO W D OE S T H E C TA A F F E C T M E ?

As you can see, this new law will impact many who are not the target of law enforcement agencies for any reason (e.g., money laundering, foreign investment, or organized crime).

It is important therefore to consult with your legal advisor to determine whether you are required to report information and, if so, to formulate a plan for compliance. ■

By Roger Stahl, JD Partner & Estate Planning Attorney Frazer Ryan Goldberg & Arnold LLP rstahl@frgalaw.com A R I ZO N A P H Y S I C I A N . C O M

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HOW TO

Business Continuity Plans Aren’t Just for Natural Disasters

M

ost physicians don’t have a business continuity plan (BCP) but have experienced disruptions in their capacity to see patients and run their practices. While earthquakes, tornados, and hurricanes are unlikely in Arizona, physicians occasionally experience power outages, phone service interruptions, multiple unexpected staff absences, or the inability to use their computers and electronic health record (EHR) for other reasons.

IT’S NOT JUST ABOUT THE WEATHER

The sky was sunny and clear A medical practice lost their power and phones, there was no back up power for their server, and they could not remotely access their EHR or website. There wasn’t a cloud in the sky.

The practice couldn’t see the appointment schedule for the day and didn’t store patient contact information outside of the EHR, so patients would be coming in for appointments. The practice manager waited in the dark without air conditioning to let each patient know as they arrived.

28 n A R I ZO N A P H Y S I C I A N M A G A Z I N E

Everyone called in sick During flu season, most of the practice staff had called in sick the morning of a particularly busy day, and likely couldn’t come in for a few days. There was more work than the physicians and remaining staff could manage in a business day.

The remaining staff rescheduled as many patients as they could but needed to see many of the patients that day. They postponed scheduling follow up appointments and some of the coding and billing work until the rest of the team could return. They saw patients throughout the day and into the evening.

Government investigators want to see it A business continuity plan (BCP) should help physicians and their practices contact patients, carry on at least minimal business operations, and continue or coordinate patient care. A BCP is more than just a good idea; it’s a federal requirement. The HIPAA Security Rule requires physicians and practices to create a disaster plan with a data backup process.

INTENTIONS ARE NICE BUT PLANNING IS BETTER Business continuity planning is like disaster planning and many practice address both situations in one plan.

Before the actual planning begins, physicians and practice leaders should identify the most knowledgeable and experienced people to create a plan to prevent poor patient outcomes and keep the business running.

The practice can also contribute to the BCP by including some newer or less experienced team members who may one day take the places of the long-time and experienced team members.

Identifying key planning staff The physicians or other medical practice leaders should form a BCP team with members who know and understand all the processes and functions for business operations, safety, and patient care. A large practice with service areas or departments may choose a team of managers and leaders of the overall medical practice, billing, clinical or patient care, human resources, the laboratory, safety, and scheduling. A small practice may put together team of individuals with responsibilities for these areas but who may not have related job titles.

Assessing vulnerable processes and equipment BCP teams often start by making a list of the unexpected or unplanned events that could interrupt patient care and practice operations. Next, the team assigns a score to the likelihood of the event occurring and potential impact of the event if it occurs. Based on both likelihood and severity scores, the team then prioritizes processes for further review, new or revised policies and procedures, and training.

Scoring the likelihood and impact of vulnerabilities A typical BCP analysis of medical practice processes might appear simple, but requires time, thought, research, and discussion (see below).

PROCESSES AND EQUIPMENT Potential Vulnerability No electrical power No EHR No Wi-Fi/internet service down No landline phone service No water No cell phone service No working fire extinguishers Situations that block entrances, exits, hallways, exam or treatment rooms, or work areas

Likelihood Score 1-5 (5 = greatest)

Severity Score 1-5 (5 = greatest)

A PLAN IS ONLY AS GOOD AS ITS USERS

Give the team something to go by The recommendation to develop or revise policies and procedures leads many physicians and practice staff members to roll their eyes but when the unexpected happens they are often desperately looking for a guide, flowchart, or list of instructions when it does. Before physicians and their practices use policies and procedures to move patient care and business operations along under the stress of interruptions, they can use them to train each other to reasonably respond.

Preparing for that dreaded day Training physicians and practice staff to effectively respond to unexpected events begins during new employee orientation when the potential users of the policies and procedures first read them. Using policies and procedures during a drill is perhaps the most valuable form of training. Training continues when the users re-read the policies and procedures every year and any time the BCP team changes them.

DON’T PUT OFF BUSINESS CONTINUITY PLANNING Business continuity planning may sound like an overwhelming project, but it will seem like a minor task compared to the overwhelming feeling of reacting to an unexpected event without a plan. Physicians and their practices should work with their business lawyers and accountants on the business aspects of the plan and contact their medical professional liability insurance company for patient care ideas. A plan promotes optimal patient outcomes, financial stability, business longevity, and staff and patient loyalty when the expected happens. ■

Something blocking streets or parking Minimum number of clinical or administrative staff for regular services/operations cannot come into the practice or work remotely

Juliana Stanley, MBA, FACMPE Risk Management Consultant Mutual Insurance Company of Arizona (MICA) jstanley@mica-insurance.com

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

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PHYSICIAN SPOTLIGHT Greg Aran, DO, shares his thoughts on the future of primary care.

Q: How would you describe the current state of

primary care for patients? Do you think patients care being seen by mid-level practitioners instead of physicians?

A: The current state of primary care in Arizona and frankly all of across the country in one word is understaffed. Primary Care Providers (PCPs) are working more hours, having to see more patients than ever before and are under more scrutiny than ever before. On top of this, the PCP shortage has not been adequately addressed and future models show it is only going to get worse, possibly much worse without incentives to attract future PCPs. I do think patients care and notice the difference between a MD/DO primary care doctor vs a nurse practitioner or other mid-level providers. They simply do not undergo the same rigorous training that fosters a way of clinical thinking and judgment that a traditional four year medical school and three or four year residency provides. The continued rise of mid-level providers and in many instances replacing MD or DO PCPs will be an ongoing concern moving forward. With the rise of mid-level providers replacing MD/DO PCPs, this will continue to be an ongoing concern going forward.

Q: You went to an osteopathic school instead of

an allopathic school for medicine, do you see any advantages that have helped you as an internal medicine physician?

A: I would recommend careful, thoughtful consideration of the type of lifestyle they would like to live and knowledge of the difficulties that are ever increasing in the primary care field.

Quality primary care physicians are crucial for overall patient health and preventing progression of disease or the start of diseases all together.

These quality physicians must know the rules of the game they play in and the challenges the field brings in order to best serve their patients.

Q: What changes are needed to encourage

more medical students and residents to go into primary care?

A: Unfortunately, health systems are lagging in recognizing that PCPs are an essential component of in-patient health. Understaffed and underpaid, the average age of a PCP in America is rising, and we have a whole generation of older physicians who are nearing retirement without adequate replacements in line.

Wages need to be increased, the number of physicians per clinic needs to be increased for the PCP role to be appealing going forward, it is as simple as that. Until that happens, we can’t expect new physicians to be attracted to the field. ■

A: Absolutely. I consider ‘form and function’ with nearly every disease process and how it relates to my patient’s current problems. Not to say allopathic schools don’t, it is just not as stressed or taught the same as osteopathic schools are. However, both degrees undergo the same rigorous credentialling and licensing in many cases so there are more similarities than differences nowadays.

Q: You recently began your medical career in internal

medicine. What have you seen so far that you would recommend younger physicians like residents/medical students learn before getting into primary care?

30 n A R I ZO N A P H Y S I C I A N M A G A Z I N E

GREG ARAN, DO

Internal Medicine Dignity Health Medical Group – St Joseph’s

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