MD-Update Issue 146

THE BUSINESS MAGAZINE OF KENTUCKIANA PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #146 WWW.MD-UPDATE.COM

Above and Beyond Endocrinologist Kupper Wintergerst, MD, and his team go the extra mile for their patients with diabetes

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ALSO IN THIS ISSUE SPORTS MEDICINE AT UofL HEALTH & ATHLETICS TAKING THE PAIN OUT OF JOINT PAIN AT WELLWARD REGENERATIVE SPORTS MEDICINE AT CHI SAINT JOSEPH HEALTH NEW ORTHOPEDIC CENTER AT BAPTIST HEALTH LOUISVILLE

2023

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World Class Hand Care Legendary practice Kleinert Kutz continues the training and legacy of its founders

ALSO IN THIS ISSUE SPORTS MEDICINE AT UofL HEALTH & ATHLETICS TAKING THE PAIN OUT OF JOINT PAIN AT WELLWARD REGENERATIVE SPORTS MEDICINE AT CHI SAINT JOSEPH HEALTH NEW ORTHOPEDIC CENTER AT BAPTIST HEALTH LOUISVILLE

ISSUE #147 (September) MUSCULOSKELETAL HEALTH

World Class Hand Care Legendary practice Kleinert Kutz continues the training and legacy of its founders

Orthopedics, Sports Medicine, Physical Medicine & Rehabilitation, PT/OT

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Oncology, Plastic Surgery, Hematology, Radiation, Radiology ALSO IN THIS ISSUE SPORTS MEDICINE AT UofL HEALTH & ATHLETICS TAKING THE PAIN OUT OF JOINT PAIN AT WELLWARD REGENERATIVE SPORTS MEDICINE AT CHI SAINT JOSEPH HEALTH NEW ORTHOPEDIC CENTER AT BAPTIST HEALTH LOUISVILLE

ISSUE #149 (December) IT’S ALL IN YOUR HEAD

Neurology, Neuroscience, Ophthalmology, Pain Medicine, ENT, Psychiatry, Mental Health Editorial topicsWorld andClass dates are subject to change Hand Care

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Legendary practice Kleinert Kutz continues the training and legacy of its founders

ALSO IN THIS ISSUE SPORTS MEDICINE AT UofL HEALTH & ATHLETICS TAKING THE PAIN OUT OF JOINT PAIN AT WELLWARD REGENERATIVE SPORTS MEDICINE AT CHI SAINT JOSEPH HEALTH NEW ORTHOPEDIC CENTER AT BAPTIST HEALTH LOUISVILLE

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Gil Dunn, Publisher • GDUNN@MD-UPDATE.COM • 859.309.0720 (direct) • 859.608.8454 (cell) Send press releases to gdunn@md-update.com ALSO IN THIS ISSUE SPORTS MEDICINE AT UofL HEALTH & ATHLETICS TAKING THE PAIN OUT OF JOINT PAIN AT WELLWARD REGENERATIVE SPORTS MEDICINE AT CHI SAINT JOSEPH HEALTH NEW ORTHOPEDIC CENTER AT BAPTIST HEALTH LOUISVILLE

LETTER FROM THE EDITOR/PUBLISHER

Welcome to the Women and Children’s Health Issue of MD-Update LEXINGTON It is a challenging time for

OB-GYNs, adolescent behavioral health providers, and pediatricians as well as 54% of Kentucky physicians, according to a recent Kentucky Medical Association members survey.

In the most recent 2023 KY legislative session a bill, SB 12, sponsored by Senator Donald Douglas, MD, was passed. The legislation encourages physicians to seek care for mental health when needed and the bill ensures that a record of care is kept confidential with additional legal protections.

Read more about other topics of interest in the KY legislative session that affect physicians in our recap provided by Amber Laflin, KMA director of governance and policy analyst, on page 4. James Schack, MD, president of the Northern KY Medical Society, shares his personal experience with work-related stress and counseling on page 6.

A New Look at BMI In case you missed it, the AMA has a new policy on Body Mass Index based on a report which identified “a problematic history with BMI…as an imperfect way to measure body fat in multiple groups given that it does not account for differences across race, ethnic groups, sexes, genders, and age-span.”

I’m grateful that age is considered a factor because it’s harder than ever to get into the pants that I’ve kept in my closet for the last 15 years, thinking how one day I’ll be able to wear them again.

Kentucky Otolaryngologist Chosen as AMA President-Elect Congratulations to Bruce A. Scott, MD, who was voted president-elect of the AMA at the annual meeting of the AMA House of Delegates.

After a year as president-elect, Dr. Scott will

be installed as AMA president in June 2024.

Based in Louisville, Scott is board-certified in otolaryngology and president of Kentuckiana Ear, Nose & Throat. He is medical director of Premier Ambulatory Surgery Center and holds a clinical appointment at the UofL School of Medicine.

Dr. Scott has been president of and continues to serve on the board of the Greater Louisville Medical Society and the Kentucky Medical Association. As a leader of these associations, he has fought for access to care for vulnerable populations, improvement in public health and reduction of administrative burdens in health care.

Baseball and Father’s Day I had a great Father’s Day weekend. I heard from my son Chris in Maryland and spent Saturday in Detroit enjoying the USPBL, an independent league baseball team, watching my son Chandler play for the Eastside Diamond Hoppers. We split a double header, had barbecue and local Detroit craft beer. I love summer nights, watching baseball. I hope you had a good Father’s Day as well.

Fall Issues of MD-Update Please look at the fall line-up of MD-Update editorial topics on the preceding page. If you see your specialty, give me a call. I’m sure you have an interesting story to tell or an update on your medical practice to share. My door is open for your view on any topic that concerns healthcare in Kentucky, such as the one shared in this issue

by Wanda Gonsalves, MD, on the importance of oral health.

Until September, best regards,

Gil Dunn Editor/Publisher MD-Update

2 MD-UPDATE

SEND YOUR LETTERS TO THE EDITOR TO: Gil Dunn, Publisher gdunn@md-update.com, or 859.309.0720 phone and fax

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ISSUE #146

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CONTENTS 4 7 8 10 12

ISSUE #146

HEADLINES ACCOUNTING FINANCE OP/ED COVER STORY

bove and Beyond 12 AEndocrinologist Kupper Wintergerst, MD, and his team go the extra mile for their patients with diabetes

SPECIAL SECTIONS: 16 OB-GYN 19 UROGYNECOLOGY 22 PSYCHIATRY/BEHAVIORAL HEALTH 24 PEDIATRIC ORTHOPEDICS 26 COMPLEMENTARY CARE: PUBLIC HEALTH 28 MENTAL WELLNESS 30 NEWS 31 EVENTS

COVER PHOTOGRAPHY

BY JAMIE RHODES

FEATURED

10 OP/ED

16 OB-GYN

19 UROGYNECOLOGY

22 PSYCHIATRY/ BEHAVIORAL HEALTH

24 PEDIATRIC ORTHOPEDICS ISSUE #146 3

Headlines

KMA Wraps 2023 Session With Win for Physician Wellness Other Priorities Advance

BY AMBER LAFLIN, KMA DIRECTOR OF GOVERNANCE & POLICY ANALYST

to improve physician well-being and address workforce issues in the state.

The 2023 General Assembly wrapped up the 30-day “short session” on Thursday, March 30. Although House and Senate leadership initially hinted at the possibility of a scaledback session, legislators ultimately passed over 180 new laws and resolutions, including several bills that generated a great deal of controversy. However, thanks to the advocacy efforts of members, the Kentucky Medical Association (KMA) was able to successfully advance priority bills this session and lay the groundwork for future advocacy efforts on a number of issues.

Prior Authorization Exemption

KMA PRIORITY ISSUES Enhancing Physician Wellness Physicians and other healthcare workers have an increased risk of experiencing burnout due to the demanding nature of their work. However, they are less likely to request and receive help for mental health issues due to the stigma associated with seeking treatment for themselves within the medical field. Senate Bill 12, sponsored

by Sen. Donald Douglas, MD, encourages physicians to seek care when needed through a wellness program and ensures that a record of a physician’s participation in such a program is confidential and has additional legal protections. In testimony before House and Senate Committees, KMA Vice President Evelyn Montgomery Jones, MD, and KMA Past President Shawn Jones, MD, highlighted the importance of helping physicians deal with job-related burnout without fear of retaliation. The bill passed unanimously out of both chambers and was immediately signed by the governor. The passage of this legislation is an important step in KMA’s overall efforts 4 MD-UPDATE

House Bill 134, sponsored by Rep. Kim Moser, would have established a prior authorization exemption program designed to automatically waive prior authorization requirements if a physician has historically been approved for a specific procedure/service at least 90 percent of the time. A prior authorization exemption program would ensure patients have timely access to the care they need, reduce administrative burdens for physicians, and lower healthcare costs. The bill easily passed the House Health Services

Committee, thanks to the testimony of KMA President Monalisa Tailor, MD. Despite the nearly unanimous consensus among lawmakers that prior authorization reform is desperately needed, the bill was ultimately recommitted to the House Banking and Insurance Committee for further consideration due to concerns over the potential cost of such reforms, especially to the Medicaid program. Although the bill did not pass the General Assembly this session, streamlining and reforming prior authorization will continue to be a major focus of KMA’s advocacy efforts throughout 2023 and into the 2024 session.

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Headlines

Introducing Scope of Practice Each year during the legislative session, various non-physician groups introduce legislation to increase their scope of practice in the state. KMA has successfully defended against the multi-year effort by the Kentucky Association of Nurse Practitioners and NurseMidwives (KANPNM) to phase out the CAPACS (Collaborative Agreement for Advanced Practice Registered Nurse’s Prescriptive Authority for Controlled Substances).

Following five months of negotiations, an agreement was reached this year on Senate Bill 94, that, consistent with KMA policy, preserves the physician-led, team-based care model. KMA Legislative Chair Donald Swikert, MD, led the efforts to ensure that the legislation strengthened the CAPA-CS, increased meaningful collaboration between APRNs and collaborating physicians, and provided the appropriate safeguards for public health. While an agreement has been reached on this issue, many other scope of practice bills are anticipated in future legislative sessions.

KMA encourages members to remain engaged on such issues to ensure the practice of medicine and patients are protected. KMA’s

“KY Physicians Care” campaign continues to educate legislators and the public on the importance of the physician-led, team-based care model. More information on this effort is available at kyphysicianscare.com.

Advocacy in Action More than 90 physicians and medical students from across Kentucky gathered in Frankfort on February 22 to advocate for their practice and their patients as part of the 2023 KMA Physicians’ Day at the Capitol (PDAC). In addition to the advocacy efforts at PDAC, KMA members were highly active on the grassroots level this session through compelling testimony at committee hearings, legislative visits, and messages sent through the KMA Action Center. KMA greatly appreciates the collective efforts of members to advance the priorities of physicians and patients across the Commonwealth.

For a more in-depth look at other bills of interest during the legislative session, including legislation related to transgender care, medicinal cannabis, and more, please visit kyma.org/advocacy for the full 2023 KMA Advocacy in Action Achievement Report.

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Full-Service Pain Management & Addiction Medicine ISSUE #146 5

Headlines

Senate Bill 12 Will Help Physicians Care for Themselves A personal reflection and decision

BY JAMES SCHACK, MD FAMILY MEDICINE PHYSICIAN PRESIDENT, NORTHERN KENTUCKY MEDICAL SOCIETY I was very grateful to see the passage of Senate Bill 12 this year. The new law encourages physicians to seek care when needed through a wellness program and ensures that a record of a physician’s participation in such a program is confidential and has legal protections. I went to Frankfort during KMA’s Physicians’ Day at the Capitol to advocate for this bill, among others.

I was particularly interested in supporting SB12 because of a recent personal experience.

Last year I was called by a neighbor for urgent help for her family member who had attempted suicide. The family had already called 911, but due to living in a rural area, response time was likely to be 15-20 minutes. I quicky drove over to their home to provide aid.

As I entered the room, the scene was traumatic due to the manner of the suicide attempt. I did everything any of you would do at such a scene. I quickly felt for a pulse, which was faint. I assessed and stabilized injuries, then reassessed a few seconds later for a pulse, which was now difficult to feel. I began administering CPR while waiting for the EMS to arrive and transfer her to a local hospital. Due to the traumatic nature of the attempt, I called ahead to the hospital to give the ER physicians there an idea of what was on their way. I then tried to console the family and returned home. Unfortunately, shortly thereafter I was contacted by the family to tell me that the person had succumbed to their injuries.

When I returned home, I walked from my garage to the trash can to discard most of my clothes and shoes. My wife, who knew I was responding to the situation, met me in

6 MD-UPDATE

James Schack, MD

the garage. One of the first things she said to me was, “Are you ok?” It was a simple, straightforward response. I work in outpatient primary care but I had been part of hundreds of code blues and rapid response during residency just a few years ago. I told her it was a difficult situation but, “I think I’ll be fine.”

Over the next few days I went through my normal routine at work and debriefed the experience with a colleague. I just tried to make things feel as normal as possible. But my wife could tell things weren’t quite normal. A few days after the event, she suggested I do a session of counseling. My first thought and response to that idea was, “Well, I might have to disclose that on my medical licensing form next year if I do that.”

As soon as the words left my mouth, I saw the look on my wife’s face and I realized how ridiculous of an argument that was. My wife cared about making sure her

husband and father of our three kids was okay. I was worried about a box on a licensing form more than I was worried about taking care of myself. Later that night I scheduled a counseling session and went a few days later. I found the experience helpful. I talked through what made the situation different from all those residency codes and felt much better after emotionally debriefing beyond the “medical debrief ” I did with a colleague the day afterward.

A recent KMA member survey found more than half (54%) of physicians indicated that they feel more stress now than before the pandemic. However, mental health continues to carry a stigma. And unfortunately, healthcare providers are some of the least likely to seek care for mental health. This new law is an important part of helping remove that stigma.

Checking a box on a licensing form shouldn’t be a barrier for someone receiving the care they need. As physicians, we are blessed with the opportunity to walk with our patients during some of the best moments of their life, such as the birth of a child, but we are also holding their hand on some of the worst days of their lives, like a cancer diagnosis three weeks before Christmas. Sometimes we are called into action on the side of the road to help people in a car accident; sometimes there is an overhead page on a plane; sometimes there’s an announcement at a kid’s sporting event; sometimes it’s a phone call from a neighbor.

I am grateful for SB12 and its sponsor, Senator Donald Douglas, MD. We have to care for ourselves and care for each other. So if you or one of your colleagues is struggling with the mental weight of our profession or just life in general, seek out the help you need and deserve. It’s easier and more confidential in Kentucky than ever before.

Accounting

Assessing Opportunities within Your Open Positions

BY ADAM SHEWMAKER, FHFMA, HEALTHCARE CONSULTING DIRECTOR

Staffing, turnover, and employee retention continue to be a significant challenge throughout the healthcare industry. Clients continue to share with us their frustrations on the inability to hire, train, and retain some of their key talent. A recent online open position search revealed the following nationwide job postings: • Medical auditor: 900+ open positions • Credentialing: 3,000+ open positions • Certified coder: 3,000+ open positions • Managed care contracting: 2,400+ open positions These job postings represent only a fraction of the critical open positions across the healthcare landscape. To further complicate matters, organizations are now recruiting candidates from across the country and establishing completely remote workforces for some positions.

It may be time to review your recruiting and retention strategy to determine how best to fill open positions, identify the best talent, and maximize your return on investment.

Strategies to consider should include: 1. Potential co-sourcing or outsourcing of certain positions

In order to minimize your organization’s turnover, consider co-sourcing or fractional utilization of subject matter expertise. In some cases, it may be more cost effective to purchase professional services than it is to recruit, train, compensate, and retain in house talent.

For example, does your organization need a team of dedicated credentialing specialists to onboard your new providers and manage provider expirables? Might it also work to retain your best and brightest key players but supplement them with professional outsourced services when you need it?

2. Re-examine remote workforce efficacy As it relates to coding positions, including chart auditing, these roles have increasingly transitioned to remote tasks in the last couple of years. Does your organization still maintain a positive return on investment in those positions? Has the transition to managing a remote workforce positively or negatively impacted the coding audit results and/or coding productivity? Did you overpay for the best resource only to discover they don’t produce in a remote/ virtual environment?

Empowering physicians to focus solely on the demands of their clinical practice

3. Analyze the data and benchmarking At Dean Dorton, clients routinely ask us to review department staffing and costs, productivity output, cost to collect, and other benchmarks. An independent perspective rooted in data and past experiences can help your organization identify potential improvement opportunities related to staffing, recruiting, and maximizing value in every position. How do you stack up to your competition and other professional service firms?

These critical steps to review your recruiting and retention policies take time and effort, but should not be overlooked, especially during this time of high employee turnover.

Contact the author at 502.566.1054 or ashewmaker@ddafhealthcare.com

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Finance

Estate Planning: Getting to the Basics

BY SCOTT NEAL, CPA, CFP®

Some of the more difficult conversations for many clients involve creating an estate plan.

That is a plan that necessarily deals with what happens when you die. We recommend that it consider these three issues: • Liquidity: will your estate have enough cash to pay all your outstanding obligations and to provide for those who depend on you?

• Taxes: will your estate incur taxes and are there steps that can be taken to minimize those?

• Control: will your assets wind up being distributed to those people and/or causes in the way, and at the time, that you want them to be?

We have seen that while estate planning may provoke anxiety, putting such a plan on paper and creating legally binding documents ultimately provides peace of mind.

Some people prefer a do-it-yourself approach by downloading documents from a website and filling in the blanks, but this is not likely to be the best option. One reason is because each state has its own set of laws and requirements.

You can find various templates online, but some of the documents may fall short of their claim to meet your state’s requirements.

It is crucial that your estate plan meets your state’s legal requirements to ensure your final wishes are honored, so expert help is recommended. Consult with an estate planning attorney to ensure that documents are correctly prepared, avoiding costly and time-consuming missteps.

While we encourage you to sit down with a legal professional, we also want to provide some general guidelines you can think through independently. It is a good idea to have considered these things before you sit down with a professional. Our aim here is to simply provide an outline for your consideration.

1. What do you want to accomplish and 8 MD-UPDATE

“Some people prefer a do-it-yourself approach by downloading documents from a website and filling in the blanks. It is crucial that your estate plan meets your state’s legal requirements to ensure your final wishes are honored” — Scott Neal what will bring that about? Will you need to provide for children under 18? Or are your beneficiaries young adults, older adults, relatives, or charities? Exactly how might you want to provide for them?

Options you may want to consider include a will and/or a trust. If you have these documents already, you should review them at least annually.

A trust is a fiduciary arrangement that allows a trustee to hold assets on behalf of one or more beneficiaries. Trusts provide control over the distribution of assets, privacy, and potential tax advantages. They can be arranged in many ways, specifying exactly how and when the assets are used or passed to the heirs.

For example, are you concerned that a young adult might fritter away his or her inheritance? A spendthrift trust might be the answer. Instead of an account that allows immediate access to the assets, the trustee of a spendthrift trust dispenses the assets over time.

Additionally, a spendthrift trust typically protects assets from the beneficiary’s creditors, bankruptcy, divorce, and lawsuits.

Is there a need to minimize taxes? An irrevocable trust might fit into your plan.

By placing assets into an irrevocable trust, the estate’s value is reduced regarding estate taxes. Besides tax considerations, irrevocable trusts also can help protect assets in lawsuits.

You may also decide to create a living trust, which operates during your lifetime and then transfers your assets to your beneficiaries upon your death and in the manner you specify. It also avoids probate for those assets that are included.

Other trusts that you may find advantageous include charitable trusts, special needs trusts, generation-skipping trusts, and/or bypass trusts. The latter two offer ways to reduce the estate tax.

Even when you have a trust, you will likely also have a will. A will is a legal document that only takes effect upon your death. It outlines your wishes, including provisions for guardianship of your minor children. Trusts can be created inside your will but those will not be funded or become effective until your death. If you have a living trust, you might consider a pour-over will that transfers any assets that are not already distributed to be placed into the living trust.

2. Have you taken stock of your possessions? It’s important to create an inventory of your assets, such as bank accounts, insurance policies, investment accounts, and personal belongings. Our clients who use our online tool for financial planning have access to an up-to-date balance sheet that lists assets and liabilities.

3. Don’t avoid the difficult conversation. If you were to die suddenly, do your loved ones have access to important documents, financial statements, etc.? It is important to inform your loved ones about the loca-

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tion of your will and the legal professionals who will handle the process.

In other words, it’s important to ensure that your heirs won’t be forced to embark on an unexpected scavenger hunt in the event of your unexpected death.

4. Choose the right executor or trustee. Select a trustworthy individual or institution to act on your behalf. You need someone dependable, trustworthy, organized, fair, and financially savvy.

Identifying the best candidate can be made easier if you focus on these important attributes. The executor or trustee can be an individual or an institution such as a trust company. It is vitally important that your representative know where to find your documents.

5. Be sure to designate and regularly update your beneficiaries. It’s common to list a beneficiary or beneficiaries for an IRA and life insurance policy.

However, it’s crucial to ensure that your designated beneficiaries align with your

will. For instance, if the will you recently drafted has your favorite nephew John to be the recipient of your IRA at ABC brokerage firm, but the beneficiary listed on that IRA many years ago is Susie, Susie will be the recipient of the assets.

6. Prepare for medical decisions. We believe that estate planning isn’t complete unless you prepare legal documents such as a durable power of attorney for financial matters and a medical power of attorney for medical decisions. It is crucial in the event you are incapacitated.

These documents appoint trusted individuals to make decisions on your behalf when you can’t. Once again, state rules are different from state to state, so it’s vitally important that you have legal counsel to advise you on drafting and verifying that your power of attorney is valid. If you have existing powers of attorney, it is also important to make sure that your financial institutions (banks and brokerage firms) will recognize them when they are

needed. Remember that if the power of attorney is being used, it is likely because you are suffering some sort of incapacity and won’t be able to explain what you meant when you drafted the document.

7. Update your estate plan regularly. Life is full of unexpected turns. Milestone events such as marriage, divorce, births, and deaths can significantly impact your wishes and create gaps in your plan.

In addition, charities that used to hold significance may not have the same impact anymore. Therefore, it is crucial to periodically review and make necessary adjustments to your plan.

While estate planning is something that is very easy to postpone. Resolve to do it now. Let me know how we can help you.

Scott Neal is the president of D. Scott Neal, Inc., a feeonly financial planning and investment advisory firm with offices in Lexington and Louisville. You may submit questions via email to scott@dsneal.com or by calling 1-800-344-9098.

ISSUE #146 9

Op/Ed

The Importance of Oral Health

Why health care providers need to be advocates for good oral health

BY WANDA GONSALVES, MD LEXINGTON Why is it in life we take so much

for granted that so many people can’t take at all. For example, right now maybe you’re eating a sumptuous meal, just finished one or looking forward to that first bite. Savoring as you chew, tasting every herb and seasoning that went into its preparation, you have a mouthful of happiness.

And yet you would never stop to think over 50% of Kentuckians have permanent teeth extraction because of tooth decay or gum disease. Yes, half the state may have trouble taking the first bite, or any bite at all. Even worse, some may skip the meal altogether because they know one bite and the pain shoots through their mouth with a relentless surge that makes it better to go hungry than seek to resolve the problem.

But why? Health care is available, or is it? The answer is yes and no. It is available to those of us who have dental insurance, good jobs, family insurance plans, etc. But to those with permanent teeth extraction, not so much. And that is where my passion intersects with the crisis of our Kentucky, providing affordable, accessible health care for all residents in the Bluegrass.

Rural Kentuckians suffer from a lack of

dental access, but racial and ethnically diverse populations suffer even more. Why? Many factors have contributed to the problem, including poverty, poor oral health knowledge by patients, racism, and lack of providers that accept Medicaid.

From an Early Age Prior to becoming a physician, I launched my career in dentistry as a hygienist, but turned to medicine when I learned that I was a risky hire by a white dentist who worried his patients “may be prejudiced” and a black dentist who couldn’t afford my salary. As a family physician, I was able to witness the value of consistent health care, but heartbroken over the lack of it, which led to edentulism as a result of negligence and the lack of dental health care. Kentucky has one of the highest rates of edentulism—60% of adults are edentulous by the age of 60.

Every day in this country roughly 30 million Americans of all ages go without health insurance (2021), which is 9.2% of the population (The Number of Americans without Health Insurance. moneygeek.com).

Think about being at a fast-food drive through and almost one out of every ten cars would have a person without dental insurance.

Maybe by now you’ve put your fork down

and really started to dive into this article, and I welcome your undivided attention. Simply put, we have a problem. We have the tools to change, and I have the concept. As Kentucky’s Oral Health Champion, chosen by the Center for OH Integration in Primary Care, a grantsponsored position, my goal is to highlight the problems of oral health in Kentucky and curricula recognized through survey data given to Kentucky educators. University of Kentucky College of Medicine, University of Louisville School of Medicine, and Pikeville College of Osteopathic Medicine were chosen to take the survey. Each school was suggested to make changes in the curriculum based on their results and to make recommendations for those changes. If we all have the best interest of Kentuckians at the forefront, we can bring about change and reduce the embarrassment in rural Kentucky and the inner city by joining our dental colleagues to advocate for the importance of good oral health and access to dental care.

An Epidemic of Bad Oral Health In 2016, there were nearly 45,000 new cases of cancer of the oral cavity and pharynx diagnosed in the United States and more than 10,000 deaths (cdc.gov). The five-year survival rate for these cancers is about 61 percent. The

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10 MD-UPDATE

Op/Ed

“The mouth is part of the body. You’re not healthy unless your mouth is healthy.” mortality rate from oral cancer is nearly three times as high in males as it is in females (4 vs 1.4 for every 100,000 people) and nearly twice as high in white and black populations as it is in Hispanic populations (2.6 vs. 1.5 for every 100,000 people). Preventing highrisk behaviors, including cigarette, cigar, or pipe smoking, use of smokeless tobacco, and excessive use of alcohol, is critical to preventing oral cancers. Early detection is key to increasing the survival rate for these cancers.

Have you lost your appetite yet? Have you, like me, decided enough is enough? Do you feel like your fellow Kentuckians deserve better? Then my call to action is simple.

Physicians, learn more about oral health and spend time educating your patients about the importance of oral health. A good resource is Smiles for Life, a nationally recognized online oral health curriculum found at www.Smiles for Life.org, which I developed in 2003 along with several other colleagues. Additionally, refer to your dental colleagues. For infants, it may be after the eruption of their first tooth.

Health care providers should be the oral health champions for those who can’t open their mouth without pain and for those who have missing teeth due to either caries or gum disease.

What Can Doctors Do As physicians we can decide to accept that the mouth is part of the body. It is our responsibility to help patients understand that “you’re not healthy unless your mouth is healthy” as our then Surgeon General David Satcher said in the 2000 Surgeon General’s Report on Oral Heath, in which he suggested that physicians, primarily primary care providers, improve their knowledge of oral health. Nothing can be truer as we begin to continue learning from research about the associations of oral health and overall health

including diabetes, heart disease, and remote infections like the brain abscess responsible for killing twelve-year-old Demonte Driver from Maryland in 2007 when he couldn’t access a dentist because of the lack of dental insurance.

Access to affordable dental care should be granted to every member of our great state.

We are lagging far behind literally the entire country. We have to be like a determined Derby horse as they head down the stretch trying to find a way to get to the finish line despite the grim circumstances. We have to push hard to expand access to dental care.

For children this would be improved grades in school and a better sense of self. For adults this might be improved diabetes, heart disease, and self-esteem.

Can you imagine moving the needle in the right direction for five straight years and what that would do for Kentuckians? More smiles, more healthy gums, more oral health relief, and yes, more Kentuckians able to enjoy a meal like the one you had in your mind when you started reading this article, because physicians join with their dental colleagues advocating for the importance of good oral health.

In March we all gathered to root for our Kentucky Wildcats and any other Kentucky team that made it to the tournament. But there’s another game we can win, and that’s the one where we put a full court press on this oral health crisis. We don’t let another neighbor, family member, or loved one, whether they be rural or in the inner city, go without oral health care. We must win the battle against a crisis that has resulted in too many deaths and permanent teeth loss.

So, enjoy your meal, maybe even a glass of wine, and ponder not only how you’re going be part of the solution, but how you can influence your colleagues to do the same. If it takes a village to raise a child, and it’s going to take our medical and oral health care village to be their oral health advocates. It’s something we can all sink our teeth into, just like that meal you may be enjoying.

Wanda Gonsalves, MD, (ret), is founder and director of Kentucky State Undergraduate Pre-Medical Academy, KUMA.

WANDA GONSALVES, MD, retired from academic medicine after twenty-five years where she held multiple positions as clinical faculty at two universities including the Medical University of South Carolina (MUSC) as associate dean for resident inclusion and diversity education, and at the University of Kentucky College of Medicine as vice chair in the department of family and community medicine. While at both medical schools, she helped students to reorganize a student-run free clinic, the UK Salvation Army Student Run Free Clinic and begin another student-run free clinic, the MUSC CARES clinic.

From 2019 to 2020, Dr. Gonsalves held the position of professor and interim dean of the College of Natural, Applied, and Health Sciences at Kentucky State University (KSU). Since September 2020, she is founding director of the Kentucky State Undergraduate Pre-Medical Academy, aka KUMA, which aims to increase the numbers of minority students who pursue careers in medicine, dentistry, or the physician assistant programs. Her mission is to mitigate shortages of well-trained minority students applying to health professional schools in order to improve health care disparities. At present, at least five students are preparing to apply to medical school.

Twelve students are currently in the KUMA program.

Dr. Gonsalves’ scholarly interests include service learning, interprofessional education, health disparities, and oral health for primary care clinicians. She has lectured on oral health topics nationally and locally. She is one of the coauthors for the award-winning Smiles for Life: A National Oral Health Curriculum (www.smilesforlifeoralhealth. org). Dr. Gonsalves has served on numerous boards including the Nicholas Pisacano Foundation, the Journal of the Academy of Physician Assistants, and the National Commission of Certification of Physician Assistants and Foundation.

ISSUE #146 11

Cover Story

Above and Beyond

Endocrinologist Kupper Wintergerst, MD, and his team go the extra mile for their patients with diabetes

BY JIM KELSEY LOUISVILLE As the saying goes, an

Endocrinology at Norton Children’s and the University of Louisville. His sister, Katherine Rogers, APRN, DNP, also works at Norton Healthcare as a Vice President of Patient Care Services and Chief Nursing Officer for Norton Medical Group and Norton Cancer Institute.

ounce of prevention is worth a pound of cure. While there is no cure yet for type 1 diabetes, significant strides have been made recently in understanding how to prevent — or at least delay — the onset of the disease. Kupper Wintergerst, MD, says that has led to a Patients, Administration, different approach to treating patients Teaching and with diabetes.

Clinical Trials “Teplizumab, the first drug availCurrently, Wintergerst sees patients “The more you can do for a patient and family as a healthcare provider, able to delay the progression of the more excited you are.” — Kupper Wintergerst, MD on Mondays and Tuesdays in the type 1 diabetes, is on the market,” Novak Center for Children’s Health, says Wintergerst, who is chief of pediat- Wintergerst. “But what we can do is potentially while his primary work is in clinical research ric endocrinology with Norton Children’s create something that takes away the burden of through the Norton Children’s Research Endocrinology, affiliated with the University diabetes, such as with islet cell transplantation. Institute. Wintergerst’s administrative duties of Louisville School of Medicine, and direc- Islet cells are in the pancreas, and beta cells are include overseeing the activities of faculty and tor of the Wendy Novak Diabetes Institute. a type of islet cell that produces insulin. If we the physicians who also have appointments.

“This is used in individuals whose probability were to take cells that are healthy, put them in a As if that weren’t enough, he also continues is nearly 100 percent of developing type 1 human who has type 1 diabetes and either give to teach as a professor of pediatrics at the diabetes in the immediate future. They not them a drug that protects those cells or create a University of Louisville School of Medicine. only have antibodies that are positive — evi- way to encapsulate those cells to protect them “Part of our responsibility in academic dence that their immune system is destroying from the immune system, then we could effec- medicine is to educate the physicians of the their beta cells — but they also have impaired tively make it so that someone with diabetes future,” Wintergerst says. “We have mediglucose tolerance, meaning their blood sugars doesn’t need to monitor their blood sugar or cal students, medical residents, and fellows are abnormal, but not yet at the threshold that take insulin because they have cells that are in all areas, including endocrinology, that we use for diagnosing diabetes. What if we doing the job that their body is supposed to rotate through our practice for their endocrine identified people with positive antibodies but do. I think we will eventually get to the point training, which includes direct patient care normal blood sugars and we could intervene where we will be able to do that type of therapy experience, didactic teaching sessions, and even earlier? We could potentially delay dia- for someone who has been diagnosed with dia- formal lectures.” betes by a decade or more. What if we could betes. That is on the ever-present horizon that Wintergerst says the ongoing research and eventually use these drugs to prevent it? So we’re all chasing.” advances in diabetes prevention and treatment it’s not a cure, it’s a prevention therapy that is Wintergerst has been chasing that hori- has helped create more student interest in another step forward.” zon since he graduated from the University endocrinology.

Prevention, not a cure, in many ways is the of Louisville School of Medicine. A native “When students see how valuable each of preferred route and likely the most achievable. of Louisville, he graduated from St. Xavier the disciplines are to the care of a single child “A true biological cure for diabetes will con- High School and Bellarmine University. After and their family, it really does create that tinue to be a challenge because it is a complex medical school, he did his pediatric train- excitement and there’s more exposure to our condition that has no one single cause. It is ing at the University of Florida, followed specialty,” he says. “Diabetes care options have multifactorial; it is caused by triggers that influ- by a pediatric endocrinology fellowship at dramatically changed from a simple, and very ence your immune system and create a cascade Stanford University. He returned to Louisville limiting, insulin management plan that was that isn’t always down one pathway,” says in 2006 to join the Division of Pediatric complicated by an inability for the patient to 12 MD-UPDATE

Cover Story

Louisville native Kupper Wintergerst, MD, is chief of pediatric endocrinology with Norton Children’s Endocrinology, affiliated with the University of Louisville School of Medicine, and director of the Wendy Novak Diabetes Institute.

deviate from a set schedule if they wanted to achieve even reasonable blood sugar control.

Now, the technology and the different therapeutic options that are available allow us to tailor our diabetes management to the child’s life rather than the other way around. Medical students see that they can make a meaningful difference in a child’s life and the more they can do for a patient and family as a healthcare provider, the more excited they are.”

The Wendy Novak Diabetes Institute serves everyone with diabetes within Norton Healthcare and Norton Children’s, totaling more than 100,000 patients. Specifically, in

pediatrics, the team serves endocrinology patients up to 21 years of age, and the Institute serves diabetes patients up to age 26. Wintergerst says there are more than 10 different forms of diabetes, with the most common being type 1 diabetes and type 2 diabetes.

A Statewide Problem and Solution Wintergerst says that many factors are responsible for the high rate of diabetes in Kentucky.

“There are communities that do not have access to healthcare providers,” he says.

PHOTOS BY JAMIE RHODES

“People are driving one, two hours for care.

Endocrinology, unfortunately, is one of those areas of health care that is underserved. We have areas within cities and in rural areas where people do not have easy access to fruits and vegetables and healthy choices that are affordable. It’s easy for me to say to a patient, ‘You need to include more vegetables in your diet, just go and buy them.’ But if they can’t afford them, then that can be an insurmountable challenge. Even with immediate access to cheap vegetables, change does not happen quickly because our eating habits are often generational. If families have been eating a ISSUE #146 13

Cover Story

certain way because that is all they’ve had available for generations, then it will take more than a single grocery store offering cheaper, healthier food options to affect rapid change within a community, much less an individual. We have to keep thinking bigger.”

Wintergerst knows change takes participation and teamwork from all angles, but he is determined to play his part to make it happen.

“Somewhere within my job title, I think, is working to change the future in the world of diabetes,” he says. “We had about a few hundred patients when the diabetes center was first formed and then we built it and they came. And they came from further and further and further away because they knew that if they committed to driving two or three hours to come to Louisville, that their children and their families would live longer, healthier, active lives. All because of our amazing team and how much they care about our kids.”

Wintergerst says that being active is essential for patients with diabetes.

“When it comes to diabetes, we’re trying to get patients out there for the first time if they’ve been fearful of participating in exercise,” Wintergerst says. “So how do we make it so that every athlete, every child, and adult who just wants to walk at the mall or the park or play soccer, or whatever it might be, how do we empower them, build their confidence so that they know how to safely do all those things? That’s what our sports program, the Christensen Family Sports and Activity Program, does.”

Connection and Education Connecting patients to resources and educating them about their care and management is one of the reasons Wintergerst was interested in endocrinology.

“One of the things that drew me to endocrinology is that we often see patients for many, many years because when they come to us, a high percentage of them have chronic health conditions that we do not just diagnose and then send them on their way,” he says.

“We manage them over the years as they grow and develop into healthy adults. When we manage diabetes, we actually have to delve into the daily lives of our patients. So we go 14 MD-UPDATE

“I try to treat my patients, these young adults and their families, like they’re mine, like they are my child or this is my family.”

— Kupper Wintergerst, MD

beyond that relationship, that patient-provider, that patient-family relationship, to a point where we know what sports they play and how well they did in the tennis tournament last week, and whether they have a dog or do they horseback ride or do they like to travel?

It’s valuable because it helps to determine what we’re going to do to more appropriately manage their health condition.”

During this season of graduations, Wintergerst is particularly mindful of the relationships he and his team develop with their patients.

“Sometimes it’s amazing to realize that you have been part of, and one of the reasons why, that child has been able to graduate high school and get their first job, or graduate college or even complete graduate school, because you and your team were a part of their lives,” Wintergerst says. “That is often what drives us.

We’re taking on burdens from those families and we’re taking them into ourselves. But in the end, those relationships are the reason that we continue. We’re passionate about what we do.”

Research and Relationships Wintergerst is also passionate about research and finding better ways to prevent diabetes. He hopes that screening, and medications such as Teplizumab, will help identify and prevent diabetes and other diseases.

“What we aim to do is to figure out how can we create public health initiatives around antibody screening,” Wintergerst says. “In PHOTOS BY JAMIE RHODES

the future, if we identify someone with an auto-immune condition early through public health screening programs, we can actually intervene and change their future. That’s what public health screening is all about.”

These advances are not happening overnight, which means Wintergerst and his team must continue their daily work to treat the patients and their families dealing with diabetes. He endeavors to listen and learn and understand their needs, even if it takes a little extra time.

“I try to treat my patients, these young adults and their families, like they’re mine, like they are my child or this is my family,” he says. “And so, when I think about what I would want for my child, that is exactly my focus. Not just when I am considering treatment options, but also how much time I spend with them. If this is a family that is struggling, I know that if I were struggling or if my child was struggling, how much I would appreciate someone spending that extra minute. There are kids and families that are having to manage something that can be devastating. And so how do we make it so that they can live happier too, not just healthier?”

With his teaching, research, hospital calls, and patient care, how does Wintergerst justify taking that extra time with each family? The answer is quite simple.

“We love our patients, we want them to be successful, we want them to have healthy lives,” he says. “That’s why you go above and beyond.

Above and beyond doesn’t end at 5:00.”

A partner in lifelong heart care With six fetal echo sites and over 25 tele-echo locations across Kentucky and Southern Indiana, the Fetal Cardiology Program at Norton Children’s Heart Institute, affiliated with the UofL School of Medicine, is the region’s trusted partner for diagnosing congenital heart defects before birth. Our specialists also work in collaboration with you to provide care to patients throughout pregnancy and after delivery, including a full range of prenatal testing, diagnosis and counseling; a customized care plan; and one-on-one assistance from a dedicated nurse navigator.

Norton Children’s Heart Institute wants to be a lifelong partner to you and your patients as they continue to grow and thrive. To refer or coordinate care for a pediatric heart patient, call (502) 629-2929.

SPECIAL SECTION

OB-GYN

“We Filled a Need”

The first all-female-run OB-GYN practice in the area focuses on advanced, comprehensive, compassionate care for women. when you’re having Braxton Hicks contractions, or you’re just tired,” the patient said.

BY MENISA MARSHALL LOUISVILLE Rebecca Terry, MD, is

flooded with memories and mixed emotions as she reflects on what Four Decades of GameWomen First of Louisville has achieved Changing Care since its launch in 1988. When she Throughout her career Terry has and Sarah Cox, MD, co-founded this been front row and center during a unique OB-GYN practice, staffed revolution in women’s health care. entirely by women, their aims were One of the “biggest gamechangers” she twofold. They wanted to meet women’s has seen is the advent and progress of care needs through every stage of their minimally invasive surgery. lives and deliver excellent care built “It used to be if a woman needed a on a foundation of compassion and surgical procedure, it would involve a kindness. By all measures those aims large abdominal incision that left a big and more have been achieved. scar and involved significant healing Within ten months of Women time,” she says. “Now that’s just so First’s opening, Rebecca Booth, rare, thanks to advanced laparoscopic MD, and Mollie Cartwright, MD, technology and techniques.” joined the practice after completing Terry notes that Women First their residencies at the University is unusual in the number of the of Louisville. Today the practice’s team’s physicians who can perform dedicated team includes 11 physicians, minimally invasive surgery. Several 12 nurse practitioners and physician practice members have had specialized assistants, plus an excellent support training in a significant variety of Rebecca Terry, MD, OB-GYN, co-founder of Women First of Louisville staff. procedures. “Patients can come in The group’s newest physician is for a minimally invasive procedure Taylor Hodge Aiken, MD, who happens felt their concerns were sometimes “unheard done either laparoscopically or robotically to share a unique bond with Terry. Early in and unseen.” It was not uncommon for and be able to quickly return to their normal Terry’s career she delivered the future doctor patients to say one benefit of seeing a female activities instead of having a huge incision to who would one day join her practice.

OB-GYN specialist was knowing that you deal with,” she says.

Terry’s voice cracks a bit as she talks about and your doctor may have faced similar health Women First meets patient care needs the lasting connections she has built with her concerns. on a technical level by providing onsite patients and their families over her years of “I believe women share an important mammography, bone density testing, practice. “I’ve haven’t done OB for 22 years connection as caregivers. There are other roles ultrasound, and other advanced diagnostics. but continue to take care of many patients too, of course but as caregivers we can identify This provides patients with efficient, whose babies I delivered,” she says. “And, now with one another’s experiences,” says Terry. convenient care and makes it possible to refer I’m taking care of their daughters as patients For instance, she recalls a patient who them quickly for additional high-risk care or too.” recently reminded her that during each of her followup as needed.

Such long-term relationships are not own pregnancies there was always someone Another trend the practice embraced was unusual when you believe that the better in the practice who was also pregnant. “You providing patients with holistic care. They you know your patients, the better you can all always understood what it was like to focused on meeting their needs beyond meet their care needs. Terry has had patients be pregnant, to be working full-time when the limits of typical standard obstetrical or tell her before coming to her practice they your legs are swollen and uncomfortable, or gynecological medicine.

16 MD-UPDATE

PHOTO BY ALEXANDRA RODGERS

SPECIAL SECTION

An Ongoing Women’s Care “Revolution” One growing trend Terry has seen unfolding is an overall increase in the number of women in medical practice. When she graduated from medical school about one-fourth of her class was women. The ratio of men and women graduates is now equal, and for some specialties women graduates outnumber men, particularly OB-GYN. At the time she was finishing her residency training in-vitro fertilization was in its infancy. Fast forward to today, and fertility specialists have a wide range of tools and resources they can use to help their patients. “We now have the ability collect much greater and more specific data around in-vitro procedures,” says Terry. “Experts can look at the egg and the sperm and see what genetic material we have in order to make sure an egg does not carry a high-risk genetic component.”

Another emerging and growing subspecialized area of care is maternal fetal medicine and high-risk pregnancies. Women First works closely as needed with a high-risk specialist to develop care plans for patients who meet high risk criteria. Should it become necessary, patients can be readily transferred to the specialist for care.

One development she sees evolving is the growth of more subspecialties.

One example of this is gynecologic urology, which had just gotten started around the time she finished her training but has recently become more prevalent. Another emerging subspecialty is menopausal care and medicine based on women helping other women through this major life transition.

She notes there is currently no specific fellowship training for menopausal care but predicts it will be available in the near future. For now, providers can earn certification through the North American Menopausal Society.

Terry feels this development is driven in part by today’s “baby boomer” demographics. She cites a recent New York Times article that reported millions of dollars are lost a year because of hot flashes and the lack of quality sleep women experience, along with mood shifts that can impact work performance.

“Women are looking for care that meets their needs at each transition of their lives, and we need to meet those needs,” she says Another troubling development being seen is a significant increase in endometrial and uterine cancers. This may be associated with obesity and diabetes, which are both linked to insulin resistance. In response, Terry stresses to patients the importance of eating a healthy diet, watching their carbohydrate intake, and staying active with at least thirty minutes of exercise a day. These recommendations take on even more importance during menopause when hormonal changes can ramp up insulin resistance.

One unfortunate and sad trend Terry has seen is a growing need for specialized obstetrics and gynecology addiction care. She is aware of only one specialist in the Louisville area who is currently delivering this specific type of care in the region. “Dr. Jonathan Weeks is with the Norton Healthcare system. He is doing excellent and important work as medical director of their Maternal Opiate Substance Treatment (MOST) Program,” says Terry.

Change Can Spur Blessings and Banes A current trend that has affected her work has been a significant decrease in the number of primary care doctors in active practice. This

OB-GYN

Care as Individual as You Are Women First is an all-female medical practice specializing in obstetrics and gynecology and committed to comprehensive women’s care through every stage of life.

We love caring for women first … in all we do.

Scan to Schedule Your Annual Women’s Wellness Exam Now WomenFirstLouisville.com (502) 383-0335 ISSUE #146 17

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OB-GYN

Taylor Hodge Aiken A Louisville native, Taylor Hodge Aiken, MD, OB-GYN, joined Women First of Louisville in September 2022, where her practice is general obstetrics and comprehensive gynecologic care for women and adolescents. She attended Louisville Collegiate School and graduated summa cum laude with honors from the College of William & Mary in Williamsburg, Virginia, where she also played Division-1 field hockey.

She received her medical degree from the UofL School of Medicine in 2018, where she was inducted into Alpha Omega Alpha and Gold Humanism Honor Societies. Aiken completed her internship and residency training at the UofL Hospital in 2022. Upon graduating, she was awarded the program’s “Golden Hands” Award, which is awarded to the graduating resident with the best surgical technique.

During medical school, Aiken received the Greater Louisville Medical Society Foundation Scholarship Award as a promising physician-to-be.

Aiken was delivered by WFOL cofounder Dr. Rebecca Terry who mentored Aiken throughout high school, college, and medical school. Aiken’s father is ENT surgeon Tony Hodge, MD, and her grandfather, deceased, was Dr. Kenneth Hodge.

Lauren Lewis A native of Durham, North Carolina, Lauren Lewis, MD, OB-GYN, received her undergraduate degree at Duke University with a BS in biological anthropology and anatomy. She received her medical degree from Duke University School of Medicine in 2010 and completed her residency at Duke University Medical Center in 2014. Lewis was an OB-GYN physician and assistant professor at Duke Women’s Health Associates, Duke University Medical Center, Department of Obstetrics and Gynecology.

During her residency, Lewis received a Special Resident Award from the American Association of Gynecologic Laparoscopists. She participated in the Clinical Research Training Program at Duke University Medical Center and was recognized for her research, which was presented at the AOA Medical Research Day while she was a medical student.

Lewis practices general OB-GYN. development, driven by various factors, has spurred many OB-GYN practices to become de facto primary care providers.

It makes sense, explains Terry, because most patients routinely schedule an annual checkup with their OB-GYN care providers. This yearly office visit provides an opportunity to ask patients an important question: “How has your life changed since last year?”

She says, “The answers patients give us often set the stage for ways our doctors and staff can help address certain care needs that are going unmet.”

Many patients rely on Women First providers to renew their prescriptions for various medications. This is generally a “doable task,” but trying to take care of certain other care referral needs and insurance coverage 18 MD-UPDATE

questions can present bigger challenge and sometimes disheartening outcomes.

For example, Terry periodically sees patients whom she feels could benefit from psychological counseling or psychiatric care. Her training and experience lead her to conclude this type of care, paired with appropriate medications, is indicated for the patient’s optimal care. Yet, she knows there is often difficulty obtaining insurance approval to cover this type of care and medications. It is, as one might assume, a hard pill to swallow.

It is well known that women in our region face various health challenges. Some of these may reflect national trends, yet others — such as Kentucky’s high levels of obesity, heart disease and lung cancer — may be linked to lifestyle choices. Terry encourages patients to PHOTOS BY ALEXANDRA RODGERS

follow a healthy diet and stay active. She refers patients who smoke to the American Lung Association that has well-established “quit programs” and resources in place.

What’s Next for This Medical Pioneer?

As she prepares to retire in October, Terry looks forward to enjoying more time with her children, her grandchildren, and her husband, who continues to practice law. Both her son and daughter are getting married, so she is excited to celebrate two upcoming weddings.

She also has some much-needed knee surgery scheduled.

The closer retirement comes, the longer and later her days at the office seem to grow.

“I’m seeing so many patients who want to be sure to see me before I go,” she says with a smile.

As she talks about the close relationships she has built with her patients and partners, she says, “Medicine is so all-encompassing.

I’m sure I will miss this part of my life. I don’t have all the answers yet as to what comes next for me, but I know I will look at the resources available and get help as I need it.”

She has not ruled out the possibility of returning to practice on a part-time basis, perhaps with a focus on menopausal medicine.

“I have a lifetime of learning and information that maybe someone will let me use in some way to help others in the future,” she says with a laugh. “I call it my database that I keep in my head.”

Terry feels that in most ways she has done in her career exactly what she was meant to do. She says that she has been incredibly lucky to work with brilliant partners including most recently a physician’s assistant who is “not only a lovely person but a skilled specialist in menopause medicine.”

She has loved the work and is very proud of what she and her colleagues have been able to achieve together.

“I’m very proud of what we’ve done,” she said. “I feel like we have let women know ‘you are important.’ We’ve set the standard of care for women in our community. We have created a unique practice. We saw a need and we filled it.”

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Urogynecology

Sean Francis, MD, MBA, Donald E. Baxter endowed chair of the OB-GYN and Women’s Health department at UofL Health.

Cutting Edge and Growing

The UofL Health – Center for Women’s Health is on the move

BY GIL DUNN LOUISVILLE The UofL Health – Center for

Women’s Health is growing to meet the needs of underserved women in areas of Louisville’s west and south ends and surrounding counties. The center is led by a dynamic and forward-thinking physician who wears many hats throughout the week like many department heads: clinician, surgeon, administrator, teacher, recruiter, coach, and father.

It is a mission that is fueled by his passion for his work, and the people and patients he works with and serves.

Sean Francis, MD, MBA, OB-GYN, was raised in the small hamlet of Roosevelt on Long Island, New York. How he made it to Louisville and UofL Health is a journey that continues to unfold.

Francis is the Donald E. Baxter endowed chair of the OB-GYN and Women’s Health department at UofL Health. He is also an

associate professor in urology, a full professor in OB-GYN and fellowship director of Urogynecology and Pelvic Surgery at the University of Louisville School of Medicine.

Francis left Long Island to attend Morehouse College for Men, an HBCU in Atlanta, which he says is where “I got it together and first believed that I could be a doctor.” He received his medical degree from Case Western Reserve University School of Medicine in Cleveland in 1994 where he also did his internship, followed by residency at the Medical College of Georgia in OB-GYN. Then he took fellowship training in female pelvic medicine and reconstructive surgery at the Mayo Clinic in Scottsdale, Arizona. He was recruited to UofL Health in 2010 when they were looking for a department chief for OB-GYN. Like many department heads, Francis continues to see patients and perform surgery, primarily laparoscopic and robotic, for uriPHOTO BY JOHN LAIR

nary and fecal incontinence and pelvic prolapse. Remaining active in the OR keeps Francis in touch with the staff, faculty, and patients. “I think it’s not only appreciated, but very helpful to me,” he says.

The majority of his female patients are over 50 years old with pelvic floor issues, although some younger women who have just delivered babies can be his patients as well.

Teaching the Next Generation As a faculty member at UofL School of Medicine Francis has a front-line view of the next generation of OB-GYN physicians. “They are much smarter and better informed then when I was a medical student,” says Francis.

“Their access to information is instantaneous and we have learned so much more about the human body in the last 20 years.”

Francis recalls “the process” of getting coin change for the copier machine and going to the medical library to make photocopies of a few ISSUE #146 19

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Urogynecology

pages of a medical book. “Now medical students have all that information in the palm of their hands,” he says, but that comes with a price.

“Today’s medical students are very aware of the world’s expectations of them because there is so much more knowledge available to them.”

“It’s rare to find a male resident in OB-GYN. Almost all of the residents are female. OB-GYN has always been on the cutting-edge of diversity,” says Francis.

UofL offers a three-year subspecialty fellowship program in urogynecology. Francis estimates that there are only 50 to 60 such programs in the country. “As an academic and research facility we get the more difficult and complex cases with presentations such as latestage prolapse or other comorbidities,” he says.

A Journey Filled with Joy and Expectations Francis had planned on a career as a cardiothoracic surgeon, OB-GYN never crossed his mind because he thought it was all about obstetrics. During his OB-GYN rotation however, his mind was completely changed when he saw female surgeons performing delicate and life-altering surgeries on women who were “happy and grateful patients,” he says.

Now as department chair, he has additional responsibilities.

“When I became chair of the OB-GYN department I realized that I was charged with controlling a lot of money. I took the UofL MBA degree so that I would have the business background to do what I needed to do and use the resources entrusted to me wisely,” says Francis.

While Francis practices downtown and at the Springs Medical Center with Stacy Lenger, MD, growing the footprint of the department is Francis’ plan and goal, starting with offering OB-GYN services for more women in underserved areas in southern and western Louisville through the addition of the UofL Health – Center for Women’s Health at UofL Health – Mary & Elizabeth Hospital, and by including surgery in Bullitt County.

Across the street from the center, Mary & Elizabeth Hospital also plans to bring back labor and delivery services with a focus on midwifery.

20 MD-UPDATE

Ankita Gupta, MD, MPH, urogynecologist, female pelvic medicine specialist, and reconstructive surgeon at UofL Health – Center for Women’s Health, associate fellowship director for the Female Pelvic Medicine and Reconstructive Surgery program

“Because I am academically focused, I want to make certain that everything we do is cutting-edge,” says Francis. “I’d like to add a maternal-fetal medicine fellowship program.”

One example of cutting-edge technology that Francis and his team are using is minimally invasive neuro-modulation for over-active bladder (OAB) using a battery-powered, implantable stimulator. Francis notes that the batteries now last longer and there are none of the side effects such as dry mouth and constipation typical with OAB medications.

Employing telehealth is another example of using technology in creative situations.

Though the in-person, physical exam is the gold-standard for OB-GYN care, in some instances Francis says that a telehealth visit can be effective, whenever the patient, or doctor, cannot be present. He recalls an instance when he used telehealth to consult with patients while he was home taking care of his own sick children. “I was able to talk with my patients from home, instead of not seeing them at all,” he says. “It worked out.”

Meet Ankita Gupta, MD, MPH Growing up in Mumbai, India, Ankita Gupta, MD, MPH, knew early on that she wanted to work in women and children’s health. She also wanted to work in public health to improve access to healthcare for underserved communiPHOTO BY JOHN LAIR

ties. To advance her goals, she first received her medical degree from Topiwala National Medical College & B.Y.L. Nair Hospital in Mumbai in 2012. Then she received her master’s in public health (MPH) from the Harvard T.H. Chan School of Public Health in Boston in 2013.

During her OB-GYN residency at Crozer Chester Medical Center in Pennsylvania, she discovered her passion for urogynecology, which showed her a path to combining her goals: becoming a skilled surgeon to address debilitating gynecological issues and helping women deal with often neglected and under-represented health concerns. She followed this path to the University of Louisville for a clinical and research fellowship in female pelvic medicine and reconstructive surgery in 2017.

After a short stint in Chicago, she was happy to return to Louisville to start a gynecological center at Mary & Elizabeth Hospital, the UofL Health – Center for Women’s Health. “We treat women who have problems that they are uncomfortable talking about such as urinary and fecal incontinence, pelvic organ prolapse, pelvic pain, bladder pain, and painful intercourse,” says Gupta.

“My goal is to help my patient’s quality of life get better, whether it is through medication or surgery or even lifestyle changes that they don’t realize can have an impact on their symptoms,” she says.

Advances in Urogynecology Urogynecology is a relatively new field for addressing female health issues. Options for women’s urologic and gynecologic health are increasing, and urogynecologists are telling women that there are options for treating the conditions that cause them problems. “They don’t have to live with them. We have the ability and training to perform surgeries in multiple modalities such as vaginal surgery, laparoscopic or robotic surgeries. I aim to provide excellent surgical and nonsurgical treatments to optimize health and quality of life for women of all age groups,” says Gupta.

In the past five years Gupta has been practicing in different locations, downtown Louisville, east Louisville and now southside.

She states that she can see that access to healthcare is different. “Many of our patients

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at Mary & Elizabeth didn’t seek care because they couldn’t get downtown or to the eastside location.” Offering urogynecologic services in the satellite locations has made a difference in these women’s lives, says Gupta.

She even sees women traveling from Elizabethtown, Kentucky, and southern Indiana because it is easier than driving to downtown Louisville or the eastside location.

Gupta operates two days a week, see patients in clinic, conducts research, mentors fellows, and does outreach. She estimates that 40-50% of her patients are post-menopausal and treats them for incontinence. “We’ve been advocating for younger women who have incontinence to seek care, so they can be active.”

“The most common surgery that I perform is for stress urinary incontinence. It’s a 20 to 30-minute outpatient procedure that can make a dramatic change in a woman’s life. I hear so often from women who say ‘I wish I

had known about this option 10 or 20 years ago. It would have changed my life.’”

“The great thing about my training at UofL is that I was trained in all three different surgical modalities: vaginal surgery, laparoscopic, and robotic, so I can comfortably tailor my surgical practice to meet the goals of my patients,” says Gupta.

Before her first consultation with her patients and to establish a trusting and understanding relationship, patients are asked to complete a patient questionnaire. This asks about issues that patients may not be comfortable talking about, but they may be comfortable checking a box. Then she reviews the questionnaire and can ask them about their complaints.

“Sometimes allergy season will cause a woman to cough more and when she coughs, she has urinary incontinence. I had one patient who developed bronchitis from her allergies and whenever she coughed, she

Urogynecology

leaked. That was the trigger that made her seek help for her incontinence,” says Gupta.

Working with Underserved Communities Under Francis’s direction, the UofL Health – Center for Women’s Health brings together OB-GYN providers, midwives, urogynecologists, gynecologic oncologists, and nurse practitioners. Notes Gupta, “We work as a team within the Center for Women’s Health. We collaborate. Our goal is to improve women’s health in the community. I’m very passionate about my patients and tailor my practice to my patient’s goals.”

Speaking of goals, Gupta and her husband have the goal of visiting all 50 of the United States. Spending the night in the state is their definition of “visiting.” So far, they have visited 39 states, including Hawaii. They still need to visit the upper western plain states and some of the southwest.

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ISSUE #146 21

Psychological Climate Change A lens on the landscape of adolescent mental health

and low energy, some symptomatology for young males and females with depression is disparate, and typically revealed between ages twelve and fourteen. “Girls exhibit sadness, guilt, punishment, and worthlessness. While boys also have sadness, their sadness is frequently expressed through anger,” explains Goodin. Depression, suicidal thoughts, and difficulty experiencing positive emotions are also exhibited. Between the ages of thirteen and fifteen, symptoms will be twice as prevalent in girls than boys, and this differential will continue until the end of adolescence.

BY JULIET EHRLICH LEXINGTON There are shifts within our youth-

ful population, and the trends demonstrate that things are indeed heating up. While climate change in the world outside is yet debated, there is another, parallel landscape in flux — the world inside the adolescent mind.

Graph lines show perilous inclines and these rapidly shifting trends are incontrovertible. It appears both the doctor and statistics are in.

Nicole Goodin, MD, is board certified in adult and child and adolescent psychiatry. In the fall of 2022, she was welcomed at CHI Saint Joseph Health – Behavioral Health in Lexington where she was born and raised.

This magna cum laude graduate received her Bachelor of Science in neuroscience from Furman University and her medical degree from the University of Kentucky College of Medicine. It was Cincinnati where she landed next, serving as distinguished triple board chief resident of child psychiatry at Cincinnati Children’s Hospital Medical Center, while serving as on-duty psychiatrist at the Veterans Affairs Medical Center. Following a two-year stint at LifeStance Health in Frankfort, Goodin is again managing the seemingly unimaginable — the vast scope of mental health.

“The opportunity for me to discover underlying biological causes, manage medicines, and also practice as a patient’s therapist, was the driving inspiration of my medical career,” shares Goodin. “This approach permits me to 22 MD-UPDATE

Nicole Goodin, MD, is board certified in general and child and adolescent psychiatry.

treat the whole person – body, mind and spirit. I bring focus to the basics of enough sleep and exercise.” These things, central to her treatment plans, are medicinal in themselves.

The ever-changing realm of medications is one of her specialties, and the teen population, one niche. She also manages treatment for adults, however, in the current landscape, the challenges overwhelming our pained, youthful society are pervasive. “About 20-25% of the adolescents are presenting with struggles with anxiety and depression alone,” she states emphatically. “The numbers are epidemic.” While both genders may share levels of depressive severity and present with appetite changes, stress, irritability, and sleep disturbances, difficulties concentrating, PHOTO BY MARK MAHAN

COVID and Social Fragmentation Unseen in decades of psychiatric record, upticks in mental health issues are now being widely reported by Goodin and her contemporaries. Also reported is the consensus opinion that one major contributor to this mental health decline in our youth can be found in our shared experience of COVID-19.

“It turns out that the maintenance of interpersonal connection among adolescents requires constancy,” states Goodin. So, too, the varied complexity of social skills acquired through those important connections, as well as the sense of emotional connectedness and mental cohesiveness engendered by those early, deeply valued bonds. The friendships they formed, nurtured, and reveled in while young began to suffer with the onset of the pandemic, and with them the carefree joy which has for so long typified the adolescent

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population. The loss of loved ones, the sudden interruption of school, and the decline of almost all direct social interaction coincides with the rise of the young and older teen mental health deterioration being managed by Goodin currently. We are watching the very fabric of their stability loosening.

Early Intervention and Trust For those working within psychiatric circles, for increasing numbers of worried parents, and for these teens themselves, there is a clear and ever more present danger within the adolescent population. “Early intervention is crucial in avoiding further complications and future life-impacting events,” says Goodin. “I discovered early that I really enjoy working with kids, and I derive enormous satisfaction from implementing my treatment plans, and then having the opportunity to observe their shifts back towards healthful balance. The resilience demonstrated within this youthful population is just extraordinary.”

Goodin shares her process during initial

encounters with the teens. “When I sit down for a first meeting with a young patient, I begin by asking low-risk questions. I want to start on a light note. I want to know who they are, and by increments gain their trust. Music can be important to this youthful demographic, so I might begin by asking about their favorite musicians and bands.” Goodin shares the pervasive response to what top three fun activities they enjoy. “Videos, television shows, and music. That’s what it is all about.”

Social Media, Screens and Self-Worth The unceasing screen use involved with this reality concerns this doctor of psychiatry greatly.

Unmonitored 24-hour access is a stealthy thief, an accomplice ensuring a constancy of content that often contains the ignition for their mental health difficulties. Screen time exacerbates and promulgates their struggles, oftentimes involving night use. Goodin underscores the basics. “Their minds need the rest and regeneration resulting from uninterrupted sleep.” Social media is one

What financial concerns keep you awake at night?

Psychiatry/Behavioral Health

of the root causes for the widespread diminishment of self-esteem evident in both males and females today. Goodin becomes reflective here. “The posts shared by those both in and outside their social circle, create unintentionally false facades which are perceived as ‘perfect, fun lives being lived’ ... lives and fun which are not always felt and perceived as shared by every teen seeing those images. Self-worth can be harmed.

This is also the realm that spawns pernicious bullying.” It is wreaking havoc on the hearts and minds of the young. This doctor of psychiatry has seen the outcomes of those who have been victimized.

The Adult Population and the Forces That Drive Goodin is fascinated by the new options available that can help her adult patients.

“These medicines cannot be used for children; moreover, there is a complexity of care for those older patients that is very interesting to me. I was a neuroscience major because the workings of the human mind captivated me.

I have always wanted to know ... ‘Why do people do what they do?’” While a research assistant, she was involved in a significant project that involved analyzing the prevalence of ADHD in mild cognitive impairment and Alzheimer’s patients.

Yes, the doctor is certainly in, and her fingers are on every pulse while teaching and presenting at conferences. Whether it is the pediatric, adolescent, or adult population sitting before her, it appears they have discovered a very accomplished doctor.

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859.313.6333 ISSUE #146 23

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Pediatric Orthopedics

Mending Parts, Healing Lives Pediatric orthopedic surgeon finds joy in treating children

Editor’s note: Dylan G. Kluck, MD, is a pediatric orthopedic surgeon at Shriners Children’s Lexington and an assistant professor at the University of Kentucky School of Medicine. He joined the team in October 2022 and recently sat down for a Q&A to talk about why he went into medicine, how he came to Kentucky, what makes working at Shriners so rewarding, and much more.

MDU Tell us your education, medical

training, and work history.

I grew up in Boulder, Colorado. I completed my undergraduate education at UC Berkeley in California and then did my medical training in St. Louis at Washington University Medical Center where I met my wife. We were medical students together and then matched together at UC San Diego for residency. After orthopedic surgery residency, I did my pediatric orthopedic fellowship at Scottish Rite for Children in Dallas. I started at Shriners and UK in the fall of 2022 with my wife starting in the OB-GYN department at UK at the same time.

MDU Tell us how you became

interested in pediatric orthopedics.

My love for pediatric orthopedics began during my first rotation of third year medical school, working with Dr. J. Eric Gordon at Washington University in St. Louis. Dr. Gordon is a big name in the pediatric orthopedic field and also a truly caring and nice person. Seeing the positive difference he was able to make with his surgeries and his incredible rapport and calm confidence with his patients and families was inspiring. So, my initial interest in orthopedics was specifically because of my interest in pediatric orthopedics. My

“I enjoy working with kids because there is an incredible opportunity to impact them in a positive manner for the rest of their life.” - Dylan G. Kluck, MD

24 MD-UPDATE

PHOTO BY WHITNEY LEGGETT

interest in pediatric orthopedics was then furthered during my residency training in San Diego where I was fortunate to work at Rady Children’s Hospital with a number of renowned pediatric orthopedic surgeons.

I enjoy working with kids because there is an incredible opportunity to impact them in a positive manner for the rest of their lives. By addressing a significant lower extremity deformity or some of these bigger problems that we treat, a pediatric orthopedic surgeon can have a huge impact on a child’s quality of life. Even with something like a fracture, kids are motivated and want to get back to doing the things that they love to do and being able to participate in that process is rewarding. In addition, I really enjoy the interaction with families as pediatric orthopedics is a team effort.

MDU What brought you to Kentucky and

Shriners Children’s Lexington?

I came to Shriners Children’s Lexington through a fellowship connection with several of my partners having also trained at Scottish Rite in Dallas. My interest in Shriners specifically really goes back to being exposed to the Shriners system early in my medical career and the amazing care that I saw Dr. Gordon and Dr. Perry Schoenecker providing as part of this institution. The mission of Shriners has always resonated with me — taking care of the kids that may have no other resources and may have no other place to go. Being

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Pediatric Orthopedics

able to help the families that really need us is incredibly gratifying. Walking the halls at Shriners, you see people who have been here for 15 or 20 years or longer because they’re all committed to the same goal, which is trying to make sure that we’re doing the right thing for each patient.

spine surgeries across the street, and I will perform some of the bigger, lower extremity cases there as well. Having the level one trauma center and the expertise of all the personnel associated with the University of Kentucky helps us take care of the unique and challenging conditions that we see at Shriners.

MDU D escribe your patient population

MDU What are the most common

and presentations?

My practice is still growing, but in general it is focused on the lower extremity. For the most part that means things like clubfoot, hip dysplasia, and lower extremity deformities and deficiencies as well as neuromuscular conditions. A lot of these kids have something that’s either happened at the time of birth — or around the time of birth — and has created challenges that we can help with as they move forward. In addition, I also take care of a wide range of acute injuries. Presentations are varied, and that is one of the things I enjoy about pediatric orthopedics. Within one clinic you can see a foot, a hip, and an upper extremity issue, and that variety, as well as the ability to take care of the entire patient, is something that is unique to pediatric orthopedics.

MDU D escribe the challenges and

rewards of being a pediatric orthopedic surgeon at Shriners Children’s Lexington.

Over the last several months, I have become acutely aware of the limited health resources that a lot of our patients have. The challenge with surgery is often the perioperative care and ensuring that patients are going to be successful when they go back to their home environment. For instance, is a patient going to be able to rehabilitate from the surgery that you’re doing?

One of the advantages of Shriners is that we have many services on site to help patients as much as we can during visits. For instance, we have prosthetics and orthotics; we have the therapy groups and we have multiple different orthopedic and non-orthopedic subspecialties all under one roof. So, when we have patients that travel from several hours away because they don’t have access to resources closer to

misconceptions about your specialty among non-pediatric orthopedics and other specialties that you want to address?

Dylan G. Kluck, MD, is a pediatric orthopedic surgeon at Shriners Children’s Lexington, and an assistant professor at the University of Kentucky School of Medicine.

home, we try to provide as complete of an approach to care as we can.

The rewards of working at Shiners are that we see a lot of kids that come in that have had no healthcare and need a lot of help.

Often, families are not here for small problems — they’re here because they legitimately need care and often have nowhere else to go.

At the same time, my partners have worked hard to establish a sense of trust with the care at Shriners Children’s Lexington within the surrounding community and we also provide care for more common pediatric orthopedic conditions and acute injuries. As a surgeon, I enjoy being at an institution where we can provide care for a variety of conditions ranging from simple to complex with a focus on always prioritizing the patient first.

MDU Can you talk a little bit about what

the partnership with University of Kentucky means in the ability to provide great care?

Shriners has many resources that we can offer, but the physical Shriners Lexington building is an outpatient clinic and surgery center. It is really important to have that academic partnership with the University of Kentucky because it then allows us to take care of both the outpatient and the inpatient care for some of the more complex cases. For instance, my colleagues are routinely doing PHOTO BY HOLIFIELD PHOTOGRAPHY

I think sometimes primary care providers feel bad about referring something that’s not obviously a surgical problem, but in truth we see a lot of things that are not surgical and can often still help these families by educating them on the non-operative things that we can do as part of their care. In addition, we may have the expertise to pick up on something that’s more subtle, and that is ultimately our role as specialists!

MDU Describe your personal

philosophy of care.

Pediatric orthopedics is unique in that care very much does depend on the collaboration between the patient, the provider, and the family. To that end, one of the challenges in pediatric orthopedics is that just because you can do something doesn’t mean it’s the right thing for that particular patient and family.

I think to have a good outcome in pediatric orthopedics you need to have full buy-in from the family and make sure that they’re comfortable with the plan of care, you have to have the patient’s best interest in mind, and you have to work very closely as a team to achieve that outcome. I really try take this dynamic into consideration as I outline a treatment plan. I strive to make sure the family understands that they have options and that they understand the risks and benefits of the different things that we’re proposing so that we can make the best decision for their child and for their family as a whole. As such, I focus on spending as much time with each family as they need to make sure they get the care they deserve.

ISSUE #146 25

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Public Health

Help Your Young Patients Break Free from Vaping One in five Kentucky high school students report using e-cigarettes in the past 30 days.

BY ELLEN CARTMELL, MPA AND JACLYN HODGES, BS, CHES FRANKFORT E-cigarette use, also called vaping,

continues to be the leading form of nicotine use among youth across the United States despite the fact it is not a safe alternative to smoking.

Fortunately, there are many resources available for providers to screen, counsel, and support young people who are using e-cigarettes.

Youth vaping has spiked dramatically over the last decade, with the National Youth Tobacco Survey reporting a 1833% increase in youth vaping between 2011 and 2019. JUUL prod-

26 MD-UPDATE

ucts led to a further spike in youth use in 2016 by altering the way nicotine was delivered; nicotine salts, instead of free-base nicotine, made e-cigarette aerosols easier to inhale and delivered concentrations of nicotine levels five to eight times higher than other tobacco products. In addition to the high levels of nicotine, vaping products are frequently sold in youth-friendly fruit and candy flavors frequently combined with menthol to mask throat irritation.

Today, around one in five Kentucky tenth and twelfth grade students use e-cigarettes, a rate higher than the national average. Nearly half (49.7%) of the young people who use

these products report trying them when they were younger than 14 years old. According to the U.S. Surgeon General, “The younger people begin smoking cigarettes, the more likely they are to become addicted to nicotine.” Young people who have ever used e-cigarettes have higher odds of becoming cigarette smokers in the future. While stores are not supposed to sell tobacco products to anyone under the age of twenty-one, 23.6% of sixth to twelfth graders report buying them in a store, such as a convenience store, supermarket, discount store, gas station, or vape store.

In addition to the risk of addiction, there is

strong evidence that vaping damages the cardiovascular and respiratory system.

Furthermore, using nicotine in adolescence can harm the parts of the brain that control attention, learning, mood, and impulse control. Compound these damaging effects with preexisting conditions, and a young person could be on a path to disaster. The Truth Initiative calls this a “colliding crisis” – combining growing rates of youth depression and anxiety with high rates of e-cigarette use, which is proven to worsen mental health symptoms.

The most effective way providers can begin to address youth use is through non-judgmental, strength-based approaches that include motivational interviewing. The resources listed in the attached sidebar can help begin important conversations with young patients about vaping.

The Tobacco Prevention & Cessation Program at the Kentucky Department for Public Health has additional resources on talking to young patients about tobacco use at CHFS.ky.gov.

Ellen Cartmell, MPA, is the manager of the Tobacco Prevention & Cessation Program at the Kentucky Department for Public Health. A graduate of Centre College and Morehead State University, Ellen’s other experience includes working for a local health department and in international public health.

Jaclyn Hodges, BS, CHES, is a health policy specialist with the Kentucky Department for Public Health, where she specializes in preventing youth initiation of all tobacco products. Prior to joining the Department for Public Health, Jaclyn worked at a local health department district in tobacco control and health promotion for 19 years.

MY LIFE, MY QUIT offers young people free, confidential coaching by text, online chat or phone call. Like Quit Now Kentucky, this youth quitline is offered by the Commonwealth of Kentucky in partnership with the respiratory experts at National Jewish Health. Teens who enroll in the program receive free, one-on-one guidance from coaches trained in nicotine addiction and child psychology. Refer a patient at MyLifeMyQuit.org.

Vaping Information, Solutions & Interventions Toolkit (VISIT), by Stanford Medicine, is an online toolkit that provides skill-building information and tools providers need to address vaping- prevention and intervention in a clinical setting. Learn more at med.stanford.edu/visit.html.

The American Academy of Pediatrics’ Tobacco Control & Prevention page at aap.org/en/patient-care/tobacco-control-and-prevention provides numerous resources for talking to youth about tobacco use. This includes the Ask, Counsel, Treat (ACT) model for youth tobacco cessation described at tinyurl.com/ACTmodel.

ACT to Address Youth Cessation, a training from the American Lung Association, is a one-hour, on-demand online course for healthcare professionals who want to provide brief tobacco-related interventions for teens. Thee training teaches the ACT method referenced above and provides guidance, support, and best practices for effectively delivering brief interventions for adolescents who use tobacco. Learn more about the training at: lung.training/courses/act-to-address-youth-cessation.html.

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ISSUE #146 27 1/5/23 9:44 AM

Mental Wellness

Don’t Let Your Strengths Hold You Back

BY JAN ANDERSON, PSYD, LPCC

You’d think that it would be enough to be really smart, talented, hard-working, and determined.

By the time Client entered medical school, she’d been at the top of her class all her life.

But it wasn’t enough to land her a residency in her dream specialty. Her biggest strengths — outstanding academics, natural giftedness, and the drive to succeed — were exactly what she had in common with everyone else.

CLIENT It’s a competitive specialty, but I was shocked that I didn’t make it. Everyone around me thought I’d make it, too. When I asked what happened, I was told my interview was “lackluster.”

It was a tough spot to be in. Client’s quiet confidence and sheer competence had gotten her through medical school with flying colors, but her career was at a dead end without a residency.

Unfortunately, how to portray your best self in a 15-minute interview isn’t something that’s emphasized in medical school, according to my other medical student clients. “You’re supposed to just know how to do that.”

ME That’s total BS. How to promote yourself under pressure isn’t something that comes naturally to most people, maybe even less so for those in highly technical professions.

I should know. My corporate career involved working with technical professionals in finance, IT, engineering, and law. Along the way, I did a psychology internship working with executives and professionals who had been “downsized” or “out-placed” into a career transition they didn’t expect. I worked with plenty of deserving candidates who succeeded once they got a better handle on how to sell themselves in an interview.

It’s also what happens when medical students run smack into the business side of medicine: There aren’t enough residencies to go around.

Client didn’t match to her specialty, but she wasn’t ready to give up or settle for something else.

28 MD-UPDATE

CLIENT I know that I’m a good doctor. And I’m willing to do whatever it takes to get the residency I want.

Welcome To Your Discomfort Zone ME The residency interview is more ‘tell me about yourself.’ They already know you’re qualified, but will you be a good fit, someone who’s good to work with? The competition is intense for only a few spots and the decision-makers don’t want to waste a spot on someone who isn’t excited about coming to their program. The interview is your chance to show why they want you in their program.

You want to show them why they’d be making a mistake not to pick you.

CLIENT But I’m not good at bragging about myself.

ME Good communicators don’t brag. They don’t sell themselves short, either. This is about how to show them who you are in a way that dramatically increases your chances of a match in your chosen specialty. Interviewing skills are the last thing many technically or scientifically oriented people consider a high priority. That’s why a standout interview will be a huge competitive advantage for you.

Client looked less than enthusiastic and I can understand why. All this talk about interviewing, interpersonal communication skills, and influencing others was just enough to quickly escort her right out of her comfort zone. But I had research on my side.

ME The research suggests that interpersonal skills are highly correlated with success, including having a good job and good relationships.

CLIENT Okay, I like the idea of communication skills and influencing others better than “selling” myself. But how do I do it?

ME Actually, you already know how to influence others with your communication skills.

You do it very naturally when you persuade

your friend to go see a movie or your husband to marry you. So it’s a matter of transferring that already-in-place skill set to an interview situation.

You can think of interpersonal communication skills as just another kind of intelligence.

It’s one of many types of intelligence humans possess: logical-mathematical, creative, kinesthetic, spatial, and linguistic intelligence. It’s entirely possible to raise your interpersonal skills I.Q. at any age and stage of your career to increase your personal happiness and career success. It’s a natural part of lifelong learning.

Here’s the best part: You don’t even have to get very good at it. You don’t have to transform yourself into a talk show host or the life of the party. You just need to get good enough. So they pick you.

How to Get Smarter in a Different Way CLIENT If a med student talks often and forcefully, they’re a player. Those who don’t get marginalized. But when my voice sounds normal to others, I feel like I’m shouting.

ME Up to now, you’ve done very well in competitive environments. You’ve demonstrated your competence in your own quiet way.

But in an interview, you have to speak up about your competence. What if I could show you how to get better at interviewing in a way that doesn’t feel like bragging to you? It won’t feel like you’re forcing or willing yourself to be someone you’re not.

CLIENT Even though I’m an introvert?

ME That’s the best part. We won’t be trying to force or push your inner introvert into changing into someone gregarious and extroverted.

First, I must send a clear message to your inner introvert that I’m not trying to “fix” it or change it in any way.

CLIENT (looking very relieved).

ME Your inner introvert may be a primary

Mental Wellness

part of your personality, but it’s not the only committee member in your head. I’ve noticed how engaged and enthusiastic you can get in our sessions. What would it take to lean a little into the part of you who is naturally quite passionate about a residency in this specialty?

So that part of you also gets a chance to express herself during the interview?

CLIENT Are you sure? I don’t know how to just trot that part of me out on demand, especially into a room full of strangers.

ME I understand. We’ll have to consciously draw it out in a way that doesn’t freak you out. We’re in a safe, private environment here where you can afford to be a little awkward.

You can try things out and fumble around until you get your footing. I have some easy exercises that may help.

Exercise 1: Avoid the Trap of Thinking the Only Option Is to Go to the Other Extreme 1) How do you act naturally? Think of this as Door #1: This is me.

2) How do you think you need to act in the interview? Think of this as Door #2: This is not me.

DOOR #1: This is me.

DOOR #2: This is not me.

Introverted Quiet Cooperative Modest

Extroverted Loud Competitive Braggy

Exercise 2: A Sub-therapeutic Dose Is All You Need ME A sub-therapeutic dose of Door #2 is all you need.

CLIENT (looking puzzled): I’m not sure I understand what you mean.

ME Think of it this way: As a doctor, you might prescribe a super-small dose of a tricyclic antidepressant to a patient who isn’t

depressed but needs help with insomnia and chronic pain. That sub-therapeutic dose isn’t enough to relieve major depression, but that’s not what you’re after. You know that a low dose of a tricyclic antidepressant is effective in promoting sleep and alleviating pain.

Here’s how this applies to you: I’d say that a sub-therapeutic dose of a loud extrovert would look a lot like you when I hear you talk about your career in medicine — excited, enthusiastic, and very passionate. When I think of a super-small dose of someone arrogant and bragging, I see someone like you, who exudes confidence without saying a word.

CLIENT What about a sub-therapeutic dose of competitive? I can’t even imagine!

Here’s what Client came up with when we finished the exercise.

DOOR #1: This is me.

DOOR #2: This is not me.

DOOR #3: .05% of Door #2

Introverted Quiet Cooperative Modest

Extroverted Loud Competitive Braggy

Curious, Engaged Enthusiastic, Passionate A Contributor, Helpful Quiet Confidence

Exercise 3: Pick Door #3 Next, we did two rounds of practice interviews.

Round 1: Answer the question from your Door #1, your “comfort zone” committee member in your head.

Round 2: Answer the question from Door #3, the “engaged, enthusiastic, passionate” committee member in your head.

Here’s an example of how this played out for Client as we practiced: CLIENT I believe I have a lot to offer our profession, and I want to have a chance to be part of this specialty. I want to make a contribution.

ME Did that feel like bragging to you?

CLIENT No. Not at all.

This time it worked. The interview went well and Client got the residency of her choice.

CLIENT You showed me how to look at my strengths and weaknesses and phrase them all to my advantage in an interview!

You Did It Because It Worked.

But Now It’s Not Working…

Now what? Life is complex and challenging.

We need to be able to adapt in order to stay relevant, vibrant, and keep our edge. When we overuse and overdevelop certain parts of our personality, we can find ourselves stuck or sidetracked.

Many of the professionals I encounter are so smart and capable that it takes a while to hit a wall.

No big deal — it’s just life’s way of letting you know it’s time to “up your game” and become more of who you already are.

ISSUE #146 29

News

SEND YOUR NEWS ITEMS TO MD-UPDATE > news@md-update.com

UofL Hospital Designated as Kentucky’s First Verified Burn Center LOUISVILLE Joining a select group of special-

ized centers across the country, UofL Health – UofL Hospital – Burn Center has achieved verification by the American Burn Association (ABA). This new mark of distinction further validates the high-quality patient care provided to burn patients from their time of injury through rehabilitation. The Burn Center at UofL Hospital becomes Kentucky’s first verified burn center.

“Every Kentuckian deserves quality care during their moments of need, which is why I have made health care a top priority as Governor,” said Governor Andy Beshear.

“Thankfully, we have committed partners like UofL Health, which is taking yet another step forward today with the new state-of-the-art Burn Center. I know it will better serve our people and help them get the care they deserve.”

UofL Hospital’s commitment to burn patients and burn prevention dates back nearly 40 years. Since 1984, the hospital has been operating Kentucky’s only burn center. The multidisciplinary team’s expertise includes specialized care for chemical, electrical, flame/ thermal, and scald burns, as well as complex wounds and skin conditions.

Verification of the Burn Center follows a rigorous review that included an in-depth site visit by members of the ABA Verification

Committee and senior ABA members. A written report was then reviewed by the entire ABA Verification Committee and by the American College of Surgeons’ Michelle Broers, PT, DPT, CWS, FACCWS, manager of the Burn Center at UofL Hospital speaks at the verification event.

Committee on Trauma.

“Burns remain a leading cause of injury in the US and Kentucky,” said vices, psychiatry, and nutrition departments Matthew Bozeman, MD, medical director for and the hospital chaplaincy. the Burn Center.

“Verification of the Burn Center is signifi“No two burns are cant,” said Michelle Broers, PT, DPT, CWS, alike. They vary in FACCWS, manager of the Burn Center at degree, depth and UofL Hospital. “It validates the expertise and the area impacted. care we provide each patient. Our goal is to That’s why a team leverage all our technology, knowledge, and specialized in the compassion to help each patient return to complex care is so their prior level of function.”

Matthew Bozeman, MD, important.”

The Burn Center serves a regional area medical director for the The Burn with patients coming from across Kentucky, UofL Hospital Burn Center.

Center includes a Indiana, and Illinois. In 2022, the Burn state-of-the-art 16-bed unit equipped with Center treated more than 250 patients, had individual temperature and humidity controls 1,150 outpatient visits and hosted many comand heat lamps, essential for customizing munity prevention programs. the climate for burn patients. The specialIn addition to the verified clinical care, the ly-trained burn team includes nurses and phy- Burn Center facilitates a trauma peer support sicians, along with rehabilitation specialists group with educational programs to share in speech, physical and occupational therapy. burn expertise with first responders and burn The team also has support from the social ser- prevention programs for adolescents.

Governor Andy Beshear with UofL Health – UofL Hospital Burn center staff.

30 MD-UPDATE

PHOTOS BY CHRIS CHANDLER

Events

Lexington Medical Society Foundation’s Golf Tournament Proceeds benefit Central Kentucky nonprofit health organizations

LEXINGTON On Wednesday, May 24, the

Lexington Medical Society Foundation’s (LMSF) 33rd Annual Golf Tournament teed off. At 1pm, 22 teams lined up for the starter’s call at the University of Kentucky Club on Leestown Road in Lexington.

Physicians and other medical community stakeholders and financial partners answered the call. Under sunny skies and near perfect conditions, players “scrambled” their way to

the finish. Over $25,000 was raised through player’s fees and corporate sponsorships.

The winning team of David Smyth, Jay Bley, Hal Skinner, and Zach Doyle posted a handicapped scored of 35. The second place team was Kevin Lane, Adam Franklin, Jason Ayers, and Brandon Eason with a score of 39.

The third place team was Kaveh Sajadi, MD, Ryan Atkinson, Daniel Hackett, MD, and Seth Christian with a score of 41.

LMSF chair John Collins once again steered the Foundation’s major fundraiser to a successful outcome. LMSF donates funding grants to Central Kentucky healthcare-oriented charities such as Baby Health Services, Bluegrass Council for the Blind, Radio Eye, Camp Horsin’ Around, Kidney Alliance of KY, Ronald McDonald House, Surgery on Sunday, and more.

Presenting sponsor of the 20232 tournament was Stock Yards Bank & Trust.

UK Transplant team: Dave Merrell, Tom Waid, MD, Bob Busch, and Ron Evans.

Baptist Health Lexington team: Michael Kirk, MD, Shawn Peterson, MD, Lee Dossett, MD, and Arvinda Padmanabhan, MD.

CHI Saint Joseph Health: Jillian Edwards, Chris Wood, Chris Schmitt, Frank Taddeo, MD, Kevin Ochs, Graham Gandee, and Brady Saunders.

From Stock Yard Bank & Trust, the presenting sponsor volunteers were Selina Shepherd, Lucien Kinsolving, and Alicia Jordan.

PHOTOS BY GIL DUNN

ISSUE #146 31

Events

An Award-Winning Night Physical well-being is theme of Lexington Medical Society meeting. David Bensema, MD, receives lifetime community service achievement award LEXINGTON In a night filled with awards, the

highlight was the presentation of the Jack Trevey Award for Community Service, the Lexington Medical Society’s highest honor, to David Bensema, MD, by Lee Dossett, MD, LMS president, on May 16th at the Signature Club. Bensema is a past KMA and LMS president, AMA delegate, and a mentor to a generation of physicians and medical students.

The Jack Trevey Award for Community Service is named after Dr. Jack Trevey, who was a leader in the Lexington Medical Society and the community, as well as a member of the KY House of Representatives and Senate.

The Trevey Award is given to physicians who demonstrate outstanding service to the community through volunteerism and/or service in state or local government. This award is not given out every year; it is only given when an individual has served their community in an exceptional manner.

In his presentation, Dossett stated, “This award is presented to honor Dr. Bensema’s body of work in service to improve the practice of medicine for his state, community, colleagues, and patients. What strikes you when you encounter Dr. Bensema is his entire focus is on you. David Bensema establishes trust through his integrity, character, and competence. We, the physicians of the Lexington Medical Society, are proud of Dr. Bensema for his leadership, service, and mentorship to a generation of current and future physicians. It is an honor and a privilege to present the 2023 Jack Trevey Award for Community Service to Dr. David Bensema.”

Additional awards for LMS essays were given out to Danesh Mazloomdoost, MD, Asha Shenoi, MD, Andrew Williams, DO. Medical student awards were given to Sasha Sairajeev, Alicia Fields, and Hanna Cleary.

Awards were presented by Robert Granacher, MD, chair of the LMS editorial board.

32 MD-UPDATE

A presentation on physician wellness “Rx – Resilience” was given by Steven Smith, PhD, and Sandra Hough, PhD, of the Woodland Group, partners with LMS and its Physician Wellness Program, which was created in 2016, one of the first in the country and replicated over three dozen times throughout the country.

Pat Padgett, KMA executive vice president gave a brief legislative update.

The next LMS dinner meeting will be Tuesday, October 10, 2023, 6pm at the Signature Club. The Lexington Medical Society is a nonprofit organization that supports physician members to improve the practice of medicine and the health of the community. Established in 1799, it is one of the oldest medical societies in the country.

Learn more about the LMS and its programs at lexingtondoctors.org.

Lee Dossett, MD, presents the Jack Trevey award to David Bensema, MD.

Jonathon Craft, director of imaging at Baptist Health Lexington, Pete Townsend, and Sandra Shuffett, MD.

David Bensema, MD, and wife Marian Bensema, MD.

Representing the LMS dinner meeting sponsor Republic Bank were Emily Miller, Emily Chambers, and Patricia Morgeson.

Jitander Dudee, MD, Monica Dudee, Rowshaw and Farhid Karim, MD, Terry Clark, MD. PHOTOS BY JOE OMIELAN

CONGRATULATIONS and Thank You!

OVER $25,000 RAISED! University Club of Kentucky | 4850 Leestown Road, Lexington, KY CONTRIBUTING SPONSORS

Presented by

All proceeds to benefit medical nonprofits in the Lexington area

Kaveh Sajadi, MD • Sam Coy, MD • Andrew Ryan, MD • Daniel Hackett, MD • David Hamilton, MD

www.kyboneandjoint.com

VISIT LEXINGTONDOCTORS.ORG TO JOIN

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