FALL 2021
G U IDIN G T H E FU T U RE OF
ART IFICIAL IN T ELLIGENC E Real Intelligence and Early Action Needed by Physicians
Psychiatric Illness
Manifesting as Stroke-like Symptoms Confidentiality, Compassion and Competent Care
CONTENTS FALL 2021 MCMS BOARD
Jennifer Lorine, DO – President Joseph L. Grisafi, MD – Vice-President Jay E. Rothkopf, MD – Board Chair Walter M. Klein, MD – Immediate Past President Stanley R. Askin, MD – Treasurer Michele Boylstein – Executive Director
COUNTY BOARD OF DIRECTORS Kathleen M. Allen, Administrator Stanley R. Askin, MD Frederic S. Becker, MD Sherry L. Blumenthal, MD Charles Cutler, MD, MACP James A. Goodyear, MD, FACS Jennifer Lorine, DO George R. Green, MD Joseph L. Grisafi, MD Walter M. Klein, MD Mark A. Lopatin, MD Cheri L. Matthews, Administrator Robert M. McNamara, MD Mark F. Pyfer, MD, FACS Jay Evan Rothkopf, MD Scott E. Shapiro, MD, FACC Steven A. Shapiro, DO Jim Thomas, MD, MBA Martin D. Trichtinger, MD
BCMS BOARD
Richard Leshner, DO – President Daniel Latta, MD – President-Elect Marilyn Heine, MD, FACP, FACEP – Secretary John T. Gallagher, MD – Treasurer Jennifer Redmond – Executive Director
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FEATURES 1 Legislative Updates 2 Letter from the President 4 Guiding the Future of Artificial Intelligence 6 Psychiatric Illness Manifesting as Stroke-like Symptoms 8 Confidentiality, Compassion and Competent Care G U ID IN 12 Member Spotlight: A R T IG FTHIE CFU TU R E O F Pediatric Practice Invests in INTELLI I G E N CAEL New Technologies
FALL 202
Real Intel ligence an Ac tion Ne d Early eded by Physician s
DIRECTORS
Robert Mirsky, MD – Immediate Past President Jerome Burke, MD, FACG Karl Helmold, MD, FACS Bindukumar Kansupada, MD
HOSPITAL STAFF REPRESENTATIVES Frank Clark, MD Chris Frankel, MD Daniel Latta, MD Joseph O’Neill, DO David Pao Gerald C. Wydro, MD
BUCKS COUNTY FOUNDATION BOARD REPRESENTATIVE Joseph O’Neill, MD
LIAISONS
David Damsker, MD Marilyn Heine, MD, FACP, FACEP Marion Mass, MD 400 Winding Creek Blvd Mechanicsburg, PA 17050
CREATIVE CORNER 3 Meniscus IN EVERY ISSUE 13 Medical Society Member News
Psychiat ric Illness
Manifest ing as Stroke-l ike Symp toms
Confi den tiality, Comp ass ion and Comp etent Care
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ON THE COVER
CONTACT INFORMATION 2669 Shillington Road, #438, Sinking Spring, PA 19608 HoffmannPublishing.com 610.685.0914 ADVERTISING Tracy Hoffmann 610-685-0914 x 201 tracy@hoffpubs.com Any opinions expressed in this material are for general information only and are not intended to provide specific advice or recommendations for any individual. All rights reserved. No portion of this publication may be reproduced electronically or in print without the express written permission of the publisher. Bucks/Montgomery Physician is published quarterly {Spring, Summer, Fall, Winter}.
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QUARTERLY LEGISLATIVE UPDATE
Legislative Updates October 1, 2021
Stay up to date on PAMED’s legislative priorities at www.pamedsoc.org/Advocacy. RETURN TO HARRISBURG The 3rd quarter is typically the ‘quietest’” time of the legislative year as there is a long break in session during the months of July and August, followed by a shortened September session scheduled post the Labor Day Holiday. Both chambers of the Pennsylvania General Assembly returned to Harrisburg to continue work in the 2021 Regular Session. The legislature is currently in year one of the two-year legislative session and will now have another condensed schedule as they have a short window before the upcoming election cycle taking place on Tuesday, November 2, 2021. Despite the limited number of session days, the Pennsylvania Medical Society (PAMED) still saw a few priority issues get some attention and advance in the legislative process. Most notably, legislation to streamline the process through which physicians must navigate on behalf of their physician assistants (PAs) received final passage and was signed into law by the Governor. These were SB397-398 (Pittman – 41st Senate District) and were signed into law as Act 78 of 2021. The stakeholder process leading to the final passage of this legislation included the broader provider community across the Commonwealth and Hospital and Health System Association of Pennsylvania. Specifically, these bills significantly decrease the “start-up” time required to employ a PA by no longer requiring Medical or Osteopathic Board approval of PA agreements. However, the boards will be required each year to review 10% of agreements filed after the bill’s passage. The measure will also allow physicians to determine the degree of oversight they wish to employ over their PAs as it relates to medical chart reviews, though the legislation continues to require a 12-month 100% chart review for new PAs entering the workforce and for those who may be changing medical specialties. Neither bill expands a PA’s scope of practice, nor do they diminish a physician’s responsibility to appropriately supervise the care PAs are providing to patients. While we often report on the legislation that is front and center and “moving” through the legislative process, PAMED’s advocacy goes beyond the bills that get voted. During much of the time leading up to the legislature’s return, PAMED’s advocacy team focused intensely on a proposed bill to allow expanded access to the Prescription Drug Monitoring Program (PDMP). Having conducted multiple district visits to meet legislators and having PAMED physician leaders directly engage, among other efforts, at this time we have yet to see this legislation advance through the legislative process. Other bills that PAMED is following through the lawmaking process included: House Bill 245 (PAMED supports) – Legislation to modernize the process by which International Medical Graduates (IMGs) become
licensed. (Passed out of Senate Consumer Protection & Prof. Licensure) House Bill 1082 (PAMED supports) – An effort to establish an education program for providers on early diagnosis of dementia and incorporates information about the disease into existing public health outreach programs. (Passed out of Senate Aging and Youth; awaiting final consideration) House Bill 1774 (PAMED supports) – This was necessary legislation to extend the sunset date for the Achieving Better Care by Monitoring All Prescriptions Program. (Signed into law by the Governor as Act 72 of 2021) While the legislation listed above reflects PAMED’s legislative efforts and the efforts of engaged physicians, there are several bills that we continue to oppose and actively monitor. It is important for legislators to hear from their physician constituents on all these pieces of legislation to either thank them or explain why specific legislation is not in the best interest of patient care. PAMED is closely monitoring and engaging in the following: Senate Bill 225 (PAMED supports) – This bill is a multi-session effort to reform prior authorization. Simply, this bill streamlines and standardizes the process of prior authorization of medical services in the Commonwealth. PAMED continues to engage with a broad provider coalition to advocate for the advancement of this legislation, after being introduced for the fourth consecutive legislative session. This bill has been voted favorably out of the Senate Banking and Insurance Committee and is awaiting further action by the full Senate. House Bill 681 (PAMED supports) – Another long-discussed issue, restrictive covenants in physician employment contracts, this legislation aims to set parameters for when restrictive covenants are utilized and seeks to limit them in situations where they are deemed not appropriate. Having advanced overwhelming out the House Health Committee with bi-partisan agreement on pursing a “middle ground approach” this legislation is awaiting final approval from the full House. PAMED encourages physicians to set aside time to reach out to their local legislators and begin to develop a personal relationship. For those who already know their representative or senator, it is a good time to simply touch base. The first lesson in effective advocacy is to avoid your first meeting with lawmakers to be the one where you are asking for help. Physicians interested in engaging in the issues above, or on any legislative proposal, are encouraged to reach out to PAMED’s Government Relations staff for assistance at 800-228-7823.
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LETTER FROM THE PRESIDENT
A Message From MCMS President by Jennifer Lorine, DO
R
ecent events have me thinking about the big picture. There’s often so much more than one side to an issue, and it is difficult to gauge long-term consequences without approaching issues with an open mind. Let’s start with mandates. Many have expressed concern over the repercussions of a COVID vaccine mandate. We are beginning to see increased shortages of healthcare and emergency workers. In addition, conflicting guidance from Washington – and indeed, mixed messaging over the scope and even existence of exemptions from the federal mandate, as well as a lack of guidance on testing – have increased the burden on already-overstretched and burned-out physicians. A conversation over the value of natural immunity has also been sorely lacking, adding to polarization surrounding this issue. Even free speech has come under attack from COVID as licensing boards and credentialing organizations have issued threats against physicians for saying anything that may be perceived as ‘misinformation’, without any attempt to separate valid debate from outlandish conspiracy theories. At this juncture, we are unlikely to change many minds, and may indeed harden positions if we come across as judgmental or attempting to pursue a political agenda. It may also lead patients to question our motives, and certainly won’t inspire confidence. Instead, it’s important
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to provide our patients with options, then engage with them on a solution that best suits their needs. And that leads me to my next point: the underlying cause of many poor outcomes due to COVID. Obviously, this is a contagious disease, but it’s one which is correlated with many of the chronic lifestyle-related illnesses that plague Americans today. Obesity, diabetes, heart disease – all lead to poor outcomes and death, both from the virus and on their own. Yet we locked down, closed the gyms, and told people to stay at home. The result was an increase in sedentary behavior, poor dietary choices, and the gaining of weight. Logic dictates that we should be at the very least talking about this, if not taking active steps to promote better management of our patients’ overall health. Encouraging exercise, eating a healthy diet, getting adequate sleep, and engaging in stress management would pay dividends, even with only small changes over time. So where am I going with all this? Once COVID has calmed down, will we be left with the respect of our patients, or further ‘muddied the waters’? Will we have engendered trust, or simply more suspicion towards physicians and medical science in general? Some of you may recall that I’ve pressed to make our organization as apolitical as possible, but that seems a bit of a stretch of late. Hopefully, we can again work towards that goal as we move forward to strengthen the patientphysician relationship that is the foundation of our oath.
CREATIVE CORNER
Meniscus by Christopher Drumm, MD Norristown Family Physicians, Einstein Medical Center Montgomery
I
spend my days running from room to room seeing patients. My weekends chasing my children. While trying to sneak in time to exercise and improve my health. And also time for punishing my body with chips and occasional IPAs. But you never see the change in your joints coming – and then it is there. I took a step and felt a shearing force in my knee. I was not jumping or hurdling, but something funny happened. I continue my day and pretend that I am fine. Then the next day walking to a patient room I feel my knee give out. Luckily my peripheral nerves, cerebellum, and my vestibular center are still intact. I do not fall. Immediately I feel a click and realize that this joint is now swollen. Fluid pushing posteriorly. There is no Baker’s cyst, but I am sure that I have an effusion. There is not pain but I realize that my knee has failed me. I do not have my partner prescribe me Percocet. I do not stop working. I push through because that is what we are taught to do. I ice my knee and use the occasional ibuprofen. It is now 2 weeks later, and I have still not had it examined. I have been ignoring and hoping it will go away. I often am surprised when patients are not able to explain their pain. I give them descriptive options if they cannot come up with a description on their own – sharp,
achy, lancinating, burning, throbbing, crushing, gnawing, tingling, dull and more. Yet I cannot even describe how my own knee feels. It is not pain but discomfort. Yet discomfort is a type of pain. It feels tight. I cannot feel tearing along my tibial plateau. I cannot tell if it is patella vs medial. I worry that I have torn my meniscus. I am a trained physician, yet all I can think about is how my body has failed me. Will it heal on its own? When do I get an MRI? Will I ever play basketball again? Should my weekend runs come to an end? Was this an acute tear or degenerative? Could I be that old that I have a degenerative meniscal tear? I have started some PT and hope every day that the effusion will have disappeared, but it has not. But if a patient came in with this complaint it would be a simple visit. I could get a history, examine, and create a plan in a few minutes. I would ask the patient if they had any questions, while hoping the answer was no. But I am the patient. And it feels so different and yet it is not even a scary medical issue that I am dealing with. If I feel this way, I cannot imagine how patients feel. I realize I need patients to ask me more questions because they have them. They have concerns and fears. As do I. Now that I have finished writing about my fears, maybe it is time for me to see a doctor.
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FEATURE
GUIDING THE FUTURE OF ARTIFICIAL INTELLIGENCE Real Intelligence and Early Action Needed by Physicians
A
Colin G. DeLong, MD, Penn State Hershey Department of Surgery
s a general surgery resident, I had not put much thought into the prospect of artificial intelligence (AI) and its potential impact on my training and career until one particular patient phone call. “Hello, this is Dr. DeLong. How can I help you?” An exasperated voice answered back. “I’m calling to cancel my hernia surgery. The reminder I received mentioned robotic surgery. I will NOT allow a robot to do my surgery. I’ll find a real surgeon!” He hung up the phone, leaving me stunned. If this innovative—yet entirely human-driven—surgical technology could cause such distrust, I shuddered to imagine what additional challenges patients and physicians alike will face with the increasing role of AI in modern healthcare. The concept of AI, admittedly, can be difficult to grasp. How we define AI and what does—and does not—constitute AI technology can be conceptually nebulous questions to answer. Historical perspective can help to bring clarity by framing the current state of AI development within a broader timeline of computerized healthcare innovations. The early 1970s brought about the first attempts to develop and implement electronic health records (EHR) and it is interesting to note that while the term “artificial intelligence” was yet to be popularized, these actions set in motion substantial, lasting changes in healthcare delivery—the incorporation of computerized systems into physicians’ daily practice. An early paper describing EHRs by McDonald et al, published in the American Journal of Public Health in 1977, described an “automatic 4
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physician guidance” system1. Designed to warn against drug interactions and prompt physicians to schedule proper followup tests, the authors optimistically touted that “a computer system such as ours will significantly reduce the physician’s error rate and his time investment in clinical bookkeeping.” Fast-forward forty years and enthusiasm for EHRs has withered into frustration and cynicism. In the now-famous 2019 article, “Death by 1,000 Clicks: Where Electronic Health Records Went Wrong”, authors Fred Schulte and Erika Fry lament how “electronic health records were supposed to […] make medicine safer, bring higher-quality care, empower patients, and […] save money” yet have become a “tragic missed opportunity”2. With over $36 billion invested by the U.S. government alone in the last decade, the system has become an “unholy mess”—despised by providers and dangerous for patients. And worst of all, the system is—in all practicality—unfixable. In four decades, the most publicized and promising advancement in modern healthcare delivery has failed so disastrously as to be considered unsalvageable. But how did we get here? The answer to this question reveals insight into how similar mistakes can be avoided in the development of AI. Novel technology—like a snowball rolling downhill—can start so innocently small yet gather size and momentum so swiftly that it overpowers any attempt to modify its course. Driven by healthcare administrators, private industry, and other nonphysicians, the EHR haphazardly consumed everything in its path (billing, legal documentation, scheduling, prescription services) before most physicians
could even understand the evolving system, much less act meaningfully to alter its development. Regardless of how we define AI, I believe we are now standing at the precipice on which a new snowball is forming: while computers to this point have largely only assisted the function of physicians, AI is currently being developed to replace these functions. The performance of physician-tasks by computers, no matter how unrealistic or distant seeming now, is a quietly forming snowball with the potential to careen downhill with unprecedented force and seismically change healthcare as we know it. And so, the great challenge for our generation will be to shape and steer this new advent in AI before, in an unchecked course, it has irrepressibly burdened future generations. The potential advantages of AI in medicine are unmistakable, including developments in the realms of machine learning, imaging analysis, and large-data analytics. However, the implementation of these technologies must be thoughtful, deliberate, and physician led. I believe that groups of physicians—from local medical groups to national societies—must be the global leaders in the implementation of AI into medical practice. Committees and taskforces formed by these organizations should work with administrators, researchers, industry, and politicians to ensure that AI is developed in a manner endorsed by physicians,
with the needs of their patients prioritized above all else. While most physicians may not yet be noticing the effects of AI in their current practices, it is imperative to understand the foresight and preemptive action necessary to guide a new technology before its momentum has propelled it beyond our capacity for redirection. The lessons of the EHR are clear: nonphysician stakeholders with vested interest will drive the development of AI if not restrained by the proactive voice of physicians. As a resident, this investment in the future could not feel more vital. Yet I am confident that artificial intelligence, guided by the very real intelligence of committed physicians, will lead to a brighter future of healthcare delivery. REFERENCES 1. McDonald CJ, Murray R, Jeris D, Bhargava B, Seeger J, Blevins L. A computer based record and clinical monitoring system for ambulatory care. Am J Public Health. 1977;67(3):240-245. doi:10.2105/AJPH.67.3.240 2. Schulte F, and Fry E,. Death By 1,000 Clicks: Where Electronic Health Records Went Wrong. Kaiser Health News. March 18, 2019. https:// khn.org/news/death-by-a-thousand-clicks/
Oncall provides a better way to practice medicine.
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FEATURE
Psychiatric Illness Manifesting as Stroke-like Symptoms TREADING THE UNKNOWN WATERS
by Yang Song, DO, Kendall Cliatt, DO, Tia Nelson, DO, and Hemanth Neeli, MD, Suburban Community Hospital, Department of Internal Medicine, East Norristown, PA
CASE PRESENTATION A 68-year-old male navy veteran with past medical history of bipolar I disorder, depression, post-traumatic stress disorder (PTSD), hypertension, and hyperlipidemia presented to the ED with a two-hour history of right facial droop, right-sided weakness, and aphasia. NIH stroke scale at the time was 7. Stroke alert was called. CT head without contrast and CT angiogram of head and neck with and without contrast were performed in the ED and showed no acute abnormalities. His wife was informed of a possible cerebrovascular accident (CVA) event to obtain consent for tissue plasminogen activator (TPA) infusion. Patient’s wife denied TPA and informed us the patient has had similar episodes at least twice a year in the past, related to his psychiatric diagnoses. Psychiatry, neurology, and speech/swallow evaluation specialists were consulted. Psychiatry diagnosed the patient with delirium secondary to bipolar I disorder and PTSD and recommended in-patient psychiatry admission, adjusting 6
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the dosing of his regimen of Depakote, Zoloft, Seroquel, and PRN Ativan. Neurology ruled out a vascular event and deemed the patient to have retarded catatonia, while recommending continuing his home medications atorvastatin and aspirin. Initially the patient had increased tone in all extremities and was not able to swallow. Gradually the patient improved symptomatically. Two weeks later, the patient was back to baseline functions with an NIH score of 0. He was stable enough to be discharged to an outpatient facility. DISCUSSION Neuropsychiatry remained a largely unexplored realm until the past few decades1. In this case, stroke-like symptoms in the setting of bipolar I disorder and PTSD alluded to retarded catatonia. However, unlike the majority of catatonic patients that show immediate improvement via benzodiazepine therapy, our patient did not respond to Ativan. His symptoms were resolved gradually with elapsed time and titrating his psychiatric medications.
Catatonia, although with unknown pathophysiology, is hypothesized to implicate the basal ganglia-cortex and basal ganglia-thalamus pathways, as well as in downregulation of GABA and dopamine receptors with concomitant upregulation of NMDA receptors. Genetic predispositions have preliminarily mapped to chromosomes 15 and 222. Environmental influences also result in significant variations in risks and predispositions of neuropsychiatric conditions. These contributing factors include diet and nutritional status, psychosocial elements, current/previous medical treatments and conditions, infectious agents, environmental exposures, drug and alcohol use, early life adversities (such as history of preterm birth), and current life stressors1.
stroke-mimetics, more efficient usage of diagnostic tests, and optimization of treatment approaches in psychiatric patients, supplying necessary answers to psychiatric patients and lessening the burden on caregivers.
CONCLUSIONS The utmost importance of patient history in guiding management is highlighted in this case. It can be postulated that the brain areas regulating mood, emotion, cognition, and perception can suffer from neurochemical imbalances and metabolic hyperactivity, which can lead to damages to specific brain regions, resulting in neurological manifestations. Improved characterization of this overlap will shed light on clarification of risk factors, better recognition of
REFERENCES 1. Hollander, J. A., Cory-Slechta, D. A., Jacka, F. N., Szabo, S. T., Guilarte, T. R., Bilbo, S. D., Mattingly, C. J., Moy, S. S., Haroon, E., Hornig, M., Levin, E. D., Pletnikov, M. V., Zehr, J. L., McAllister, K. A., Dzierlenga, A. L., Garton, A. E., Lawler, C. P., & Ladd-Acosta, C. (2020). Beyond the looking glass: Recent advances in understanding the impact of environmental exposures on neuropsychiatric disease. Neuropsychopharmacology, 45(7), 1086–1096. https://doi.org/10.1038/s41386-020-0648-5 2. Stöber, G., Saar, K., Rüschendorf, F., Meyer, J., Nürnberg, G., Jatzke, S., Franzek, E., Reis, A., Lesch, K.-P., Wienker, T. F., & Beckmann, H. (2000). Splitting schizophrenia: Periodic catatonia–susceptibility locus on chromosome 15q15 The American Journal of Human Genetics, 67(5), 1201–1207. https://doi.org/10.1016/s0002-9297(07)62950-4
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FEATURE This piece was originally published in the Spring/Summer 2021 issue of Physician Family Magazine.
Confidentiality, Compassion and Competent Care HIGHLIGHTING PHYSICIAN HEALTH PROGRAMS By Angelic Rodgers, PhD
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n April of 2020, Pennsylvania physician and chair of the Pennsylvania Medical Society Foundation Dr. Virginia Hall put out a call for greater support of Physician Health Programs (PHPs) in an essay on KevinMD.org:1 “Some physicians have opined their belief that physician health plans (PHP) are contributing to the increasing physician suicidality. These beliefs have been used to attack PHPs and unfortunately, steer those in need to other resources or even have those in need not getting help.” That fear of stigma is mentioned in the Spring/Summer 2021 issue of Physician Family Magazine by Julie Petrera, who
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points out that: “Currently, only 14-15% of the physicians admitting to stress and burnout seek treatment, despite 81% of them knowing how or where to get help. When asked why they don’t seek assistance, physicians reference stigma and potential career risk as reasons for not seeking support.2” Physician Family Magazine always strives to support the family members of physicians, but at the same time, we constantly ask ourselves the question posed by Erika Beck in the Winter 2021 issue of Physician Family Magazine: Who will heal the healers?3 In addition to resources like the Physician Support Line4 and the Surgeon Masters Physician Peer Support Line,5 we wanted to highlight some exemplary PHPs, as
well as motivate you to find out more about your state’s PHP and hopefully reach out to support their work. The Professionals Resource Network, Inc., (PRN) is a private non-profit 501(c)3 organization that provides assistance and monitoring to a wide range of healthcare professionals with potentially impairing conditions in the state of Florida. While it was originally created to serve primarily physicians, it has grown to serve a wide range of healthcare and other professionals as diverse as harbor pilots, physical therapists, and mental healthcare practitioners. It has, from the beginning through today, benefited from the support and influence of the Florida Medical Association (FMA), the FMA Alliance, and the Florida Osteopathic Medical Association. The idea for a physician health program in Florida was, in large measure, initiated and fortified by the pivotal work of FMA Alliance member Nancy Hogshead. An FMA Alliance member has continuously served on our Board of Directors since its formation. The program admitted its first participants in 1981. By 2019, PRN had touched the lives of 11,333 referrals and participants from 33 state professional boards and councils. While PRN has grown and changed in the implementation of its mission, the mission has remained the same: to protect the citizens of Florida and to provide a confidential avenue of assistance to professionals who are impaired or are at elevated risk of an impairing condition that could affect their ability to practice safely. The program’s growth reflects both the population growth of Florida and the way society regards potentially impairing health conditions, regarding substance use disorders and mental health conditions as illnesses rather than character flaws or personal weaknesses, thus encouraging healthcare professionals to seek help. The resultant outcomes of thorough evaluations, adequate treatment, and longitudinal monitoring for safety and stability, where indicated, far surpass those who suffer from these conditions in the general public. The desire and ability to help others and to make a difference in their lives that attracts physicians and others to healthcare specialties are extinguished in slow increments as the person’s own illness progresses. Rebuilding self-worth and self-compassion, accepting one’s humanity, and realizing that perfection is not achievable, all take time to internalize. This occurs, in our program, through attendance at various therapies and support meetings, including one of our unique program offerings, professionally facilitated weekly group meetings. There, people can share information regarding work stresses and challenges that they cannot in open community settings. There are specialized groups for mental health concerns, substance use disorders, professional boundary issues, and professionalism. Two other areas that we are fortunate to have developed include an active research program (recent publications can be accessed on our website www.flprn.org) and our professional student program, which has served 141 students from 10 medical schools
since its inception in 2006. From being the first state, in 1969, to acknowledge and enact what was dubbed a “sick doctor” statute, to today with resources for those dealing with the acute and chronic effects of the COVID-19 pandemic, Florida has been on the forefront of advocating for physicians who need assistance with their own medical conditions, and PRN has been a grateful and proud advocate for professional health and wellness in our state. ALEXIS POLLES, MD, FAPA Southeast Region Director, 2019-2021 Federation of State Physician Health Programs https://flprn.org/ The Missouri Physicians Health Program (MPHP) is a valuable resource to all Missouri physicians, residents, fellows, and medical students. It is a program of support and advocacy to assist physicians in a time of need. What we know is that everyone needs help at some point in time and the MPHP is here for physicians when they reach that point. Our role is not to punish or shame physicians. Rather, it is to offer compassionate support in a safe confidential setting. MPHP does not diagnose or treat. It is our goal to find solutions for physicians as they face personal and professional challenges. These could include substance use disorder, behavioral problems, mental health issues, or boundary violations. We work with remarkable treatment providers that offer services to address these challenges. Once a physician seeks the treatment they need, recommendations are given to assist them with maintaining the skills and tools they have acquired during the treatment process. This is where MPHP comes in and monitors the recommendations that offer a physician a comfortable and healthy life. Our purpose is to create a record that verifies the physician’s compliance with their recommendations and assures employers, hospitals, and regulatory agencies that physicians are safe to practice medicine. We do not work for regulatory agencies, but we work cooperatively with them by advocating for our physicians. These agencies have a healthy respect for the MPHP and look to us to confirm that a physician is able to practice with safety and skill. It is the mission of the MPHP to restore physicians to healthy functioning so they can have success in all aspects of their lives. It is truly an honor to offer our services. We work with really good physicians who are called to ask for help. MPHP is fully committed to our mission of helping physicians. Our biggest challenge is reaching all of the physicians that need our help. We do outreach and presentations to get the word out, but there are many physicians that could benefit from our support. Please contact continued on next page
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FEATURE
Mary Fahey at 314-578-9574 if you or someone you know is struggling. There is a solution. MARY FAHEY, LCSW Central Region Director, 2019-2021 Federation of State Physician Health Programs https://www.themphp.org/ The Pennsylvania Physicians’ Health Program (PA PHP) is a physician-led, non-profit program of the Foundation of the Pennsylvania Medical Society that provides support and advocacy to physicians and other eligible health care professionals struggling with a substance use disorder, mental illness or behavioral concerns. The program also offers information and support to the families of impaired physicians and encourages their involvement in the recovery process. The PA PHP has a rich history with roots in a volunteerbased, impaired-physician program that began in 1970. The Pennsylvania Medical Society (PAMED) responded to a growing need for services by hiring a medical director and case managers and officially started the PA PHP in 1986 under the umbrella of the Foundation. It is now one of the largest, most fully developed physicians’ health programs in the country. The PA PHP has a cooperative working relationship with PAMED, the State Board of Medicine, and the State Board of Osteopathic Medicine, as well as the Pennsylvania Dental Association. The PA PHP assists physicians, physician assistants, medical students, dentists, dental hygienists, expanded function dental assistants, and veterinarians. Many hospitals, medical staffs, and managed care organizations in Pennsylvania use the services offered by the PHP. The PA PHP’s goal is to provide each person with the confidential care they need to recover and return to the practice of their chosen profession. In a 2020 participant impact survey, 91.18 percent of respondents said they “have an active license to practice their profession” and 85.71 percent “are working in their chosen profession.” The PHP serves individuals who self-refer or who are directed by their licensing board to seek assistance. Master’s level, experienced case management staff are available to help participants find the most appropriate resources and develop an individualized approach to each case. The PA PHP utilizes assessment and treatment providers who specialize in the unique needs of the health care professional and their family. To keep a clear line of separation, the PA PHP does not accept philanthropic gifts from assessors or treatment providers. The COVID-19 pandemic forced the provision of some services through secure video communication; however, the provision of services never ceased. Additional resources were added for physicians and their workplaces to address the physical and
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psychosocial needs of health care professionals during this challenging time. COVID-19 left many health professionals seeking help for stress and trauma. The PA PHP case management staff are trained to assist in screening and resource coordination for individuals seeking mental health support. The PA PHP recognizes the critical role engaged workplace and family systems play in the recovery process. Outreach, peer monitoring, and advocacy are essential components which support participants within the workplace. CME and nonCME education is offered to educational institutions, health systems, and other groups. As the PA PHP plans for the future, it will continue to identify and develop services relevant to the unique needs of the safety-sensitive participants it serves. TIFFANY BOOHER, MA, LPC, CAADC, CIP, CCSM Director, Physicians’ Health Program, The Foundation of the Pennsylvania Medical Society http://www.paphp.org WPHP is a non-profit, physician-led, confidential program that supports physicians and their families to have lives and careers they never thought possible. WPHP began as a committee in our state medical society in 1972 and evolved over 40 years into the program we are today. 70% of WPHP’s operating budget comes from a surcharge that the license holders we serve impose on themselves to support their colleagues and peers in distress. This stable source of funding contributes to the strength of our program and reflects the deep commitment the Washington medical community has placed in WPHP. There are several things that make WPHP special and have contributed to the gratitude WPHP receives from participants, family members, and professional stakeholders. First and foremost is the community we create for our participants and their families. Many physicians and family members experience illness-driven shame, isolation, and relationship erosion. Through WPHP’s weekly group monitoring, online support for significant others, and our annual reunion, participants and their families can connect with each other and develop lifelong relationships. WPHP’s alumni community can choose to stay in touch through our Graduate Support Program after they have completed their monitoring agreement. WPHP participants also experience excellent outcomes. Less than half of physicians who are referred to WPHP require monitoring. This means that in most cases we can offer support and referral to appropriate services without the need for a more involved monitoring agreement. For those who do need monitoring, 90% are unknown to their licensing board, successfully complete the program, and are
practicing in their field at program completion. Return to use is uncommon among substance use disorder participants with 12- and 60-month abstinence rates greater than 90%. Half of program participants describe it as “lifesaving” at program completion with another 35% describing it as “extremely useful.” Accountability, a chronic illness management model, our highly trained and experienced staff, and the exceptional motivation of our participants make these outcomes possible. Finally, WPHP stands out as a “high-touch” program. Our staff considers their relationships with participants and their families to be the most gratifying part of their work. Caseloads are low which means each participant receives the time and attention they need from their coordinator. Our staff is consistently praised by participants and their families for their kindness and empathy during times of extreme difficulty. We are a soft place to land for physicians who need to know they are not alone and that things will be okay. Recovering from COVID-19 will require that we attend to the hidden wounds of our healthcare heroes. WPHP wants their families to know that there is help and support and that PHPs around the country stand ready to assist them. Asking for help is a courageous act of compassion that may save the life and career of the health professional you love. CHRIS BUNDY, MD, MPH, FASAM Executive Medical Director, Washington Physicians Health Program, & President, Federation of State Physician Health Programs https://wphp.org/ We want to thank each PHP which contributed to this article, as well as to emphasize Dr. Hall’s call to action: “Let your state’s PHP help you. Work with your state medical association to help your PHP be the best it can be. Let’s not blame PHPs for the physician who arrives late and far advanced in their downward spiral. Let us help and care for one another by assuring that our PHPs can do their work of life and career-saving by supporting PHPs rather than castigating by anecdotes. Be in communication with your PHP and understand confidentiality, compassion and competent care are the pillars.1”
REFERENCES 1. https://www.kevinmd.com/blog/2020/04/whyyou-should-support-physician-health-plans.html 2. https://bluetoad.com/ publication/?m=62681&i=702934&p=24&pp=1 3. https://bluetoad.com publication/?m=62681&i=690093&p=18 4. https://www.physiciansupportline.com/ 5. https://surgeonmasters.com/peersupport 6. https://www.fsphp.org/ 7. https://www.fsphp.org/state-programs WRITER BIO: In addition to serving as Physician Family Magazine’s Associate Editor, Angelic Rodgers, PhD, is a writer and freelance consultant. She and wife, Dr. Dani Cothern, live in Camden, Arkansas, where Dani is an OB/GYN with Ouachita Regional Medical Center. Angelic can be reached through her website at www.angelicrodgers.com.
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BUCKS AND MONTGOMERY COUNTY MEDICAL SOCIETIES
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FEATURE
MEMBER S P OTL I G H T:
PEDIATRIC PRACTICE INVESTS IN NEW TECHNOLOGIES
with PAMED’s Community Care Grant By Dr. Steven Shapiro, PAMED member
T
he Pennsylvania Medical Society (PAMED) awarded our practice – Pediatric Medical Associates – a Community Health Reinvestment Grant sponsored by Highmark, Inc. for the purposes of advancing the level of preventative health care that we could offer to our community. When the opportunity arose for us to be applicants, we immediately recognized a chance to improve the existing services that the practice already offered. The grant will allow us to invest in technology; something an average independent primary care pediatric practice may never approach given the nature of how limited funds exist in primary care for growth and development. Funding will allow us to optimize practice workflows and adopt best practices that otherwise may never have been attainable. We will have an opportunity to investigate more time efficient methodologies to deal with many of the children and young adults who present with emotional, social, and behavioral disorders. The practice participates in a wide-range of surveillance activities, none of which are more important than screening new mothers for post-partum depression. We regularly employ the use of the Edinburgh Screening Tool for mothers at our well visits beginning at one month of age. We have done an exceptional job as physicians in providing proper screening and proper referrals to our new mothers when necessary. Ideally, and to make the process seamless with our obstetrical colleagues, this grant will allow us to explore other tools that might 12 BUCKS/MONTGOMERY PHYSICIAN
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make our process much more efficient and complete. We will use the Community Care Grant funds to optimize well child preventative care workflows to increase the reliability of evidence based and nationally recommended preventative screening. It is our hope that we can update our audiology and eye vision testing capability, add infant strabismus evaluations, and eventually explore connecting our Electronic Medical Record to various health care inventories for such diagnoses as ADHD, drug and alcohol screening, and other developmental tools. Participating in PAMED’s Care Centered Collaborative as well as our own pediatric-focused Women and Children’s Healthcare Alliance (WCHHA) also provides for additional opportunities for health care improvement within a larger network of patients with seamless referral channels. This will enable our practice to learn about and adopt best practices from other participating providers and to coordinate care for maximum impact on our patients’ well-being. We’ve begun our research. Our hope as a practice is to be as efficient as possible in determining best practices, but research in many of the areas previously mentioned requires significant due diligence to find best products to aid the effort. This process may indirectly provide a greater challenge to improve our level of understanding of how to make an independent primary care pediatric practice in the ex-urban setting an even better resource for the patients that it serves.
BUCKS COUNTY MEDICAL SOCIETY MEMBER NEWS
BUCKS COUNTY Frontline Groups
Abington Rehabilitation Associates LLC Bensalem Medical Practice PC Bruce A Goodman MD PC Bucks County Gastroenterology Associates Bucks County Medical Associates Bucks County Orthopedic Specialists Bucks ENT Associates PC Bucks-Mont Eye Associates PC Cardiology Consultants of Philadelphia-Yardley Central Bucks Family Practice PC-Jamison Central Bucks Rheumatology Chalfont Family Practice Charles Campbell MD CHOP Care Network-Central Bucks Comprehensive Care Medical Associates Cosmetic Surgery Specialists Coverdales-Hermann Ltd Crit Acuity Medical Group Daniel Haimowitz MD Dermatology Specialists of Warrington Diabetes & Endocrinology Consultants of Pennsylvania LLC Diabetes Endocrinology Consultants of PA LLC Doylestown Cardiothoracic Surgery-CVT Doylestown Dermatology LLC Doylestown Health Breast Surgery Doylestown Health Cardiology CBC Doylestown Health Cardiology DCA Doylestown Health Colorectal Specialists Doylestown Health Ctr for Wound Healing & Hyperbaric Medicine Doylestown Health Gastroenterology Doylestown Health General Surgery Doylestown Health Hospitalists Doylestown Health Infectious Disease Doylestown Health Internal Medicine Doylestown Health Neurology Doylestown Health Physicians Doylestown Health Primary Care-Buckingham Doylestown Health Primary Care-Chalfont Doylestown Health Primary Care-Richboro Doylestown Health Primary CareShady Retreat Doylestown Health Primary Care- Spruce Doylestown Health Rehabilitation Medicine Doylestown Health Subacute Doylestown Health Urgent Care Doylestown Health Urology Doylestown Health Vascular Surgery Doylestown Medical Associates PC Doylestown Pediatric Hospitalists Dr William F Bonner Drs Schelkun & Kienle Associates Elizabeth M Spiers MD LLC ENT & Facial Plastic Surgical Associates dba Premier ENT Family Practice Center-Newtown Fountain Health Inc Grand View Anesthesia Associates
MONTGOMERY COUNTY Grand View Health Primary CareSouderton Grand View Pathology Associates Kim Kuhar DO PC Kressly Pediatrics PC Langhorne Physician ServicesMedical Arts Margiotti & Kroll Pediatrics PC Mary B Toporcer MD PC Nephrology & Hypertension Associates PC Nephrology-Hypertension Specialists New Jersey Urology LLC-Langhorne Newtown Cardiology Associates Northeast Family Health Care LLC Otolaryngology Plastic Surgery Associates Oxford Valley Medical Practice Patient First-Feasterville-Trevose Paul L Zazow MD Peace Valley Internal Medicine PC Penn Neurology Pennridge Pediatric Associates Pennsbury Medical Practice Personalized Internal Medicine PC Philadelphia Hand to Shoulder Center Pinnacle ENT Associates LLC-Doylestown Division Plumsteadville Family Practice Premiere Urology Associates LLC Red Lion Pediatrics Rehabilitation & Occupational Specialist Robert A Davis MD Family Practice Rosenman & Leventhal PC Signature Medicine Stoneridge OB/Gyn Street Road Medical Associates The Gastroenterology Group PA Tri County Pediatrics Inc TriValley Primary Care/Pennridge Office TriValley Primary Care/Western Bucks United Therapy Centers Upper Bucks Orthopaedic Associates Urological Associates PC Valley Pediatrics PC
NEw Members Ganiyu T. Amusa, MD Karen Beer Mike Desai Samantha D’souza, MD Amanda Herbert Kim Horgan Scott Kenneth Kindsfather, MD Susan Lamberti Vishnu Vandhana Oruganti, MD Claire Rossi Abigail Stever Katelin Stuart
RENEWING MEMBERS
Andrea Candia, MD Kanchan Cavale Rakesh R. Shah, MD
Frontline Groups
Abington Neurological Associates Ltd Abington Perinatal Associates PC Abington Primary Care Medicine Advocare Main Line Pediatrics Amy M MacIntyre MD PC Annesley Flanagan Stefanyszyn & Penne Bala Eye Care Berger/Henry ENT Specialty Group Bryn Mawr Psychiatry LLC Cardiology Consultants of Philadelphia-Blue Bell Cardiology Consultants of Philadelphia-Einstein Cardiology Consultants of Philadelphia-Lansdale Carty Eye Associates Ltd Central Montgomery Orthopaedics Chestnut Hill Allergy and Asthma Association LLC CHOP Care Network-Norristown Comprehensive Arthritis Care Consultants Concierge Medical Services - FPUD Cowpath Pediatrics LLC Deer View Physicians LLC Delphi Family Health Center Dermatology Partners-Bryn Mawr Dermatology Partners-KOP Doylestown Health Cardiology at Huntingdon Valley East Norriton Womens Health Care PC Einstein Montgomery Home Health Hospice and Palliative Care Endocrinology Associates Gastrointestinal Specialists Inc George L Martin MD PC George P Zavitsanos MD Green & Seidner Family Practice Holy Redeemer Pediatric UrgiCare Huntingdon Valley Pediatrics PC Independence Pain Associates Injury Rehabilitation Center of Pennsylvania Jeffrey L Pollock MD Jill Schneider MD PC John M Andersen MD Joseph C D’Antonio MD PC King Of Prussia Medicine Knobler Institute of Neurologic Disease PC Lawrence S Borow MD PC Lemole & Spagna PC Lifestyle Changes LLC LMG Family Practice PC Lockman & Lubell Pediatric Associates Louis X Santore MD PC Lowell D Meyerson DO PC Lower Merion Rehabilitation Associates Main Line Ear Nose Throat-Head & Neck Surgery Main Line Fertility Center Main Line Hand Surgery PC Main Line Oncology Hematology Associates Main Line Radiation Oncology-Bryn Mawr Manstein Plastic Surgical Association Marc Kress MD & Associates Marks Colorectal Surgical Associates Marlene J Mash Md Michael D Overbeck MD Mid Atlantic Retina Millgrove Medical Center MLHC Endocrinology in Media MLHC OB/Gyn at Lankenau Newborn Special Care Associates PC North Orchard Medicine PC North Penn Pediatrics On Call Hospitalist Staffing Ophthalmic Associates of Ft Washington Otolaryngology Associates
PA Allergy & Asthma Consultants Panda Bear Pediatrics Patient First-East Norriton Patient First-Pottstown Paul Berenbaum MD Associates Pediatric Care Group PC Pediatric Medical Associates Phila Hypertension & Nephrology Consultants-Huntingdon Valley Plaza Surgical Center PMA Rheumatology & Infusion Center Precision Pain Management Premier Orthopaedic and Sports Medicine Associates LTD Premier Orthopaedics & Sports Medicine-Brandywine Division Regional Womens Health Group Respiratory Associates Ltd Rheumatology Associates Ltd Richard L Bove Md Robert Fox MD Roberto P Panis MD PC Rothman Orthopaedics-Abington Scott A Fleischer MD PC Siepser Laser Eyecare Sincera Reproductive Medicine Stanley R Askin MD Stephen E Sacks MD Stephen J Renzi Medical PC-Conshohocken Stephen M Gollomp MD PC Suburban Plastic Surgeons PC Surgical Care Specialists Inc The Center for GI Health The Headache & Neurologic Center of Philadelphia Tri-County Rheumatology TriValley Primary Care/Franconia Office TriValley Primary Care/Lower Salford Office TriValley Primary Care/Upper Perkiomen TriValley Primary Care-North Willow Grove True North Pediatrics Turner Dermatology US Digestive Health Valentino Spine & Orthopedics William A Horn Md & Associates Wills Eye Physicians-Bailey Weber Wisner Wyncote Physical Medicine & Diagnostic Zager ENT Specialists
NEw Members Amir A. Amanullah Jan Anderson Thomas McIvor Freitag Mohammed Mominul Islam, DO Shannin Dion Lewis, DO Joel Lopez Bradley Martin Christine Patricia Newman, DO Hannah Park, MD Codee Ali Ross Adam Boyd Scanlan, MD
RENEWING MEMBERS
Mohsin Hamid, MD Alexander Kutikov, MD, FACS Cassandra J. Liu, MD Bethany L. Perry, MD Anthony R. Rodriguez, MD
BUCKS AND MONTGOMERY COUNTY MEDICAL SOCIETIES
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