Lancaster Physician Summer 2022

Summer 2022

h a t n l a d e We H e ll e y PERSPECTIVES FROM LOCAL HEALTH CARE PROFESSIONALS

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lo

By Susan Shelly

plus summer insect health risks Symptoms, Prevention, & Treatment

By Amanda Bittner, MD Lancaster Family Allergy

Wellness has a way of finding you.

Check off your checkup.

— — — — — You’ve weeded the garden, mulched the beds and watered the plants.

But what about tending to yourself? Things like a physical, updated blood work and vaccinations are easy yet crucial steps to keeping you well.

So this year, get back to checking your checkup off the to-do list.

Make an appointment today.

WellSpan.org/Wellness

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contents

SUMMER 2022

2021/2022 BOARD OF DIRECTORS OFFICERS Laura H. Fisher, MD President

Lancaster Family Allergy

Stacey Denlinger, DO President Elect

UPMC Highlands Family Practice & UPMC Wound Healing Center

Sarah Eiser, MD Vice President Penn Medicine Lancaster General Health Physicians Lancaster Physicians for Women

COVER STORY

How Health Care Systems are Working to Boost Employee Health and Well-Being p. 24

Stephen T. Olin, MD Treasurer

Penn Medicine Lancaster General Health Walter L. Aument Family Health Center

Robin M. Hicks Secretary

UPMC Supportive Care & Palliative Medicine

Robert K. Aichele Jr., DO Immediate Past President

Penn State Medical Group - South Lancaster

DIRECTORS Marco A. Cunicelli, DO | Resident Lena Dumasia, MD

Best Practices 6 Lancaster General Hospital’s New Central Table Eatery Aims To Redefine “Hospital Food” 8 Penn State Health: Custom-Made Camp for Kids with Heart Conditions

David J. Gasperack, DO Lauren M. Hammell, DO | Resident James M. Kelly, MD Karen A. Rizzo, MD, FACS Christopher R. Scheid, DO Susanne Scott, MD, MPH Danielle Rubinstein, DO | Resident

EDITORS Dawn Mentzer

10 More Talking, Less Typing: WellSpan Health Uses New Technology to Transcribe Medical Visits 12 Practice Management Insights: A View From 30,000 Feet Down to Our Town

In Every Issue 5 President’s Message

28 Legislative Updates

14 Healthy Communities

30 Restaurant Review

23 Passion Outside of Practice

33 News & Announcements

24 Perspectives

Beth E. Gerber Lancaster City & County Medical Society Robert K. Aichele Jr., DO Immediate Past President

Penn State Medical Group - South Lancaster

Lancaster Physician is a publication of the Lancaster City & County Medical Society (LCCMS). The Lancaster City & County Medical Society’s mission statement: To promote and protect the practice of medicine for the physicians of Lancaster County so they may provide the highest quality of patient-centered care in an increasingly complex environment.

Content Submission The Lancaster Physician magazine welcomes recommendations for editorial content focusing on medical practice and management issues, and health and wellness topics that impact our community. However, we only accept articles from members of the Lancaster City & County Medical Society. For more information or submission suggestions, please email bgerber@lancastermedicalsociety.org.

Lancaster Physician is published by Hoffmann Publishing Group, Inc. Sinking Spring, PA HoffmannPublishing.com 610.685.0914 SEE PAST ISSUES AT LP.HoffmannPublishing.com FOR ADVERTISING INFO CONTACT: Sherry Bolinger, Sherry@hoffpubs.com, 717.979.2858

RECEIVE THE LATEST UPDATES BY FOLLOWING US ON SOCIAL MEDIA

SUMMER 2022

President’s Message

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ummer is usually a good time to rest and regroup. I encourage our membership to do that with vacations, staycations, or just a slow-down from the usual hectic pace. Physician burnout is still a big issue. Please look to our small group sessions to meet and mix with other physicians, relax, have a drink, and discuss topics of interest from fly fishing to gardening to wine.

Of course, we still must deal with coronavirus and a local population that is resistant to vaccination and public health measures. The scope of our response is changing, and, as the disease becomes endemic, there are new challenges. Many of our patients are at increased risk even now, and it is a struggle to stay connected with resources and information. Lancaster City & County Medical Society continues to participate in community endeavors. Please reach out to us about areas of need in your practice.

Laura H. Fisher, MD Lancaster Family Allergy Visit lancastermedicalsociety.org

As we move into fall, I would like our membership and organization to move toward advocacy. These are challenging times, but as professionals I ask that we step back from personal political creeds, step above the fray, and look to the health of our communities. Issues such as death from firearms and lack of access to health care for large segments of women in our population may not be popular but should be addressed.

PAMED is advocating for timely physician input on important issues and often asks for a reach-out to your representative. This is an easy process, involving just a click of a button. Introduce yourselves to your local representatives now — when you don’t have an “ask.” Establish yourself as a resource for information if they have a question.

I look forward to seeing you in September at our IN-PERSON annual meeting.

It will feature a speaker to address some of these topics. And more importantly, it provides an opportunity for our physician community to connect.

LHF

Wondering how to keep up with important LCCMS and PAMED news and updates?

Visit our website at www.lancastermedicalsociety.org

Follow us on Facebook at www.facebook.com/LCCMS

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best

pr ctices ALSO IN THIS SECTION

• Custom-Made Camp for Kids with Heart Conditions • More Talking, Less Typing, Faster Documentation – New Technology Transcribes Medical Visits • A View From 30,000 Feet Down to Our Town

LANCASTER GENERAL HOSPITAL’S

NEW CENTRAL TABLE EATERY AIMS TO REDEFINE “HOSPITAL FOOD” Focus is on Healthy, Local Ingredients

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he term “hospital food” isn’t generally seen as a compliment.

The Food Services team at Penn Medicine Lancaster General Hospital is out to change that perception. At the new Central Table Eatery, hospital staff and visitors can dine on everything from chimichurri strip steak to matcha macaroons.

The new eatery, currently in its first phase, opened in May and serves as the hospital’s communal hub, offering handcrafted food in a bright, comforting environment. The second phase will bring additional food stations and indoor and outdoor seating areas. Its expected opening is early 2023.

The menu at the eatery’s Harvest Grill station includes a salmon, avocado, lettuce, and tomato burger.

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Stacey Jinks, a veteran of area fine restaurants, includes indulgent choices, such as a petite peanut butter cheesecake, as well as gluten-free flourless chocolate cake and better-for-you Bundt cake made with kale, applesauce, and lemon and orange zest.

In addition to sourcing food from more than two dozen local vendors, the new Central Table Eatery at Penn Medicine Lancaster General Hospital aims to make healthy choices accessible to everyone.

“We offer a wide variety of delicious, healthy food options that fortify both the body and spirit,” said Nick Del Valle, LGH Director of Food Services. “We also provide a place of respite for our employees during breaks in the workday, as well as hospital visitors, who may be experiencing very challenging times in their lives.”

The Central Table Eatery marks the first update and expansion of the hospital’s dining services in 30 years. Ongoing construction of the Trauma & Emergency Department expansion required the relocation of the former ground-floor kitchen and cafeteria. In February 2022, an entirely new kitchen, which provides 3,400 meals daily for hospital patients and others, opened adjacent to the new eatery, located on the first floor.

In addition to sourcing food from more than two dozen local vendors, the eatery aims to make healthy choices accessible to everyone, serving an acai bowl for $7.50 and a shiitake beet burger for $6.50. Featured vendors — highlighted on “eat local” displays throughout the eatery — range from coffee by Square One Coffee, roasted just a mile from the hospital, to ice cream by Fox Meadows Creamery, made on a family dairy farm in Ephrata.

Executive Chef Stephen Gotthelf said the eatery’s local focus is about both the flavor of the food and the health of the community. As more people are interested in eating locally, LG Health hopes to partner with additional companies from Lancaster County and the surrounding region,

especially those that embrace sustainable business practices.

“As a chef, for me, flavor comes first,” he said.

“Foods that are grown or produced locally taste fresher, and they don’t lose flavor or nutritional value during long periods spent in transit. We also want to do our part to support local food vendors, which benefits the entire community.”

Gotthelf’s aspirations for the eatery include earning a reputation for making the best pizza in Lancaster County. The pizza, which starts with a made-from-scratch dough and finishes with 85 seconds in a special rotating oven, comes with healthful side options, including roasted vegetables and farro risotto.

The eatery’s Harvest Grill offers traditional hamburgers as well as a veggie burger and a salmon, avocado, lettuce, and tomato burger.

And since a satisfying diet requires the occasional treat, the grill station also serves chocolate, vanilla, and strawberry milkshakes.

The Create station’s salad bar offers dozens of hot and cold items, many sourced through Kegels Produce in Lancaster. It also features four soups that change daily. And you can’t get much more local than the “growing cabinet” above the salad bar, which provides fresh microgreens for garnish.

Across the hall from the main eatery, the upscale Craft coffee bar offers a full selection of coffee drinks, made with products from Philadelphia’s La Colombe Coffee Roasters.

The rotating menu designed by pastry chef

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Rachel Schaffer, Associate Director of Retail, said staff and visitor convenience was another key consideration in designing the new eatery.

The Market area offers grab-and-go grocery items and gifts, including Hammonds Pretzels, Evans Candy, and other local products. And at the end of their workday, staff can pick up whole rotisserie chickens or other dinner items to go.

“Our employees give so much of themselves to care for our patients and the community,” she said. “This has been especially true over the past two years. We want to do everything we can to support them and help make their day go a little more smoothly.”

Diners order their food using digital kiosks, with employees receiving a 20 percent discount and earning rewards points toward future purchases. Employees can pay for their meals through payroll deduction and by scanning their identification badges. Soon they will be able to place orders in advance by using a mobile phone app.

The eatery currently offers seating for about 120 people at tables, high-top tables, and booths. The second phase includes more indoor and new outdoor seating options as well as sushi, a deli, and bowls made with ancient grains, local produce and house-made bone broths. A new Foodworks station will showcase local restaurants and double as a demonstration kitchen for cooking classes.

“We want to change what people think of when they picture ‘hospital food,’” food services director Del Valle said. “Our goal is to exceed the expectations of our staff, visitors and the community by offering a dining experience that rivals the best restaurants in Lancaster.”

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Best Practices Camper Kaeden Rhoads makes his way down a zip line at Camp Lionheart, the annual summer camp for children with heart disease held at Camp Kirchenwald in Colebrook Township, Lebanon County.

Custom-Made Camp for Kids with Heart Conditions PE N N S TAT E H E A LT H CAM P LION HE ART OFFE RS A N OP PO R T U NI T Y F O R SUM M E R FUN AN D N ORM ALCY LANCASTER

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his summer, Kaeden Rhoads will spend a week hiking, biking, and having fun with a group of campers hailing mostly from central Pennsylvania. He can’t wait, but at the same time, he knows the stakes for kids at this camp run far beyond combating homesickness or scraped knees. He understands that for some campers, the summer of 2022 is their first shot at being a normal kid.

For others, more profoundly, it could be their last shot.

Rhoads knows all too well what the summer holds. This will be his first year as a counselor, but he’s no stranger to Camp LionHeart. The Millersville native was born with life-threatening heart defects and has had many open-heart surgeries since his first one at just four days old. Camp LionHeart was custom made for kids just like him.

Every summer since 2016, Camp LionHeart offers a chance at normalcy for children who have previously undergone open heart surgery for heart defects present at birth or who have chronic heart diseases such as cardiomyopathy. Nurses, physicians, and other medical personnel volunteers provide around-the-clock coverage over the course of the five-day camp. In addition, two Life Lion Emergency Medical Services and Critical Care Transport paramedics volunteer their time.

While offering many traditional activities like swimming, biking, canoeing, and — Rhoads’s favorite — ziplining, Camp LionHeart also provides participants opportunities to learn about their hearts in the company of other children with heart disease.

“As a person with a heart defect, I’ve struggled with people bullying me because I’m different,” Rhoades said. “At this camp, you don’t have to worry about that because you’re there with kids who are just like you.”

One of the most important things that the camp does is to teach kids how to take more responsibility for their own lives, says Dr. Thomas Chin, the camp’s founder and a pediatric cardiologist with Penn State Health

Children’s Hospital, Penn State Health Lime Spring Outpatient Center, and, starting in July, the new Penn State Health Children’s Lancaster Pediatric Center. “Scattered throughout the campers’ days are sessions to learn about their medications and why they’re taking them, and what is going on with their hearts,” Chin said.

T HE H EA RTTH EMED L E SSO NS A RE AN YTH I NG B U T B O RI NG , R H OADS SAYS. “When they wanted to show us models of the heart, they didn’t just show us pictures,” he said. “They actually had 3D printed models that we could take apart to see all the different areas. And they brought in pig hearts — so similar to human hearts — so we could touch them and get an understanding of what it really feels like.”

Campers also learn about heart-healthy lifestyles and nutrition as well as life-saving techniques that can help others — such as hands-on cardiopulmonary resuscitation and how to use an automated external defibrillator. And they learn how to deal with grief and loss. Each camp session includes a butterfly service honoring previous campers and family members who have since died from heart disease.

This summer’s camp is Sunday, July 24 through Thursday, July 28, at Camp Kirchenwald in Colebrook, Lebanon County. Each year, in addition to accepting applications from interested campers with the knowledge and support of their cardiologists, the camp also welcomes applications for volunteer medical personnel with cardiology expertise and a passion for helping children with heart disease.

The camp is provided free of charge to all campers through donations from Children’s

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Miracle Network, Ellie’s Heart Foundation, Penn State Health Children’s Hospital, Penn State Health Children’s Heart Group and individual private donors. The camp is made possible by the Lutheran Camping Corporation of Central Pennsylvania and numerous volunteers, including physicians and nurses from Penn State Health Children’s Hospital and staff from Penn State Health Life Lion Emergency Medical Services and Resuscitation Sciences Training Center.

While the majority of campers are from central Pennsylvania and Penn State Health Children’s Hospital, youth from Children’s Hospital of Philadelphia, Johns Hopkins Hospital, and Boston Children’s Hospital have also participated.

Physicians who want to learn more about the program for their patients or to volunteer can visit the web site camplionheart-elliesheartfoundation. org and contact Elizabeth Hulstine at ehulstine@pennstatehealth.psu.edu or Dr. Chin at tchin@pennstatehealth.psu.edu.

Now a student at Harrisburg Area Community College where he’s studying protective services, Rhoads is counting down the days till this year’s camp.

“As a camper, I remember the counselors being parent figures and being so helpful,” he said. “I’m excited to step up and be there for the younger kids and help them with whatever they’re going through. And at the same time, I really look forward to seeing them get the same sense of independence that I did as a camper. The camp is just awesome.”

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Best Practices

A WellSpan physician (left) talks to patient Harry Donahue, while DAX uses voice recognition to document their conversation, via the physician’s cell phone.

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SPRING 2022

MORE TALKING, LESS TYPING, FASTER DOCUMENTATION

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WellSpan Health Uses New Technology to Transcribe Medical Visits

nnovative, voice-activated technology is allowing WellSpan physicians to automatically transcribe patient visits, providing a better connection as well as a thorough documentation of the encounters.

Nicknamed DAX, short for Dragon Ambient eXperience, the artificial intelligence technology uses voice recognition to listen to and document the conversation between a physician and a patient, converting it into clinical notes.

WellSpan first piloted the secure, innovative technology with more than 75 providers and recently began expanding its use to an additional 200 physicians in its primary care network and specialty practices. WellSpan is the largest adopter of DAX in Pennsylvania and is a leader in using the technology in its primary care practices.

DAX is a high-tech solution that enables a high-touch experience both physicians and patients have noticed and enjoyed.

“My favorite part of using DAX is how it allows for better connection with my patients. I now feel like I attend to my patient’s story and not just medical details,” said Dr. Christopher McCarty, who practices at WellSpan Family Medicine – Terre Hill, in Lancaster County. “A visit now feels more like a conversation instead of an interview.”

Benefits for physicians In addition to improving the provider and patient interaction, DAX reduces physician documentation time by an average of 37 percent, saving over 30 minutes a day of documentation time for WellSpan physicians, said Dr. R. Hal Baker, WellSpan senior vice president and chief digital and information officer. Baker, a practicing physician, uses DAX with his patients at WellSpan Internal Medicine – Apple Hill, in York County.

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“We believe its use will help prevent burnout as we let our physicians focus on what they love: caring for patients,” Baker said.

The program increases accuracy, efficiency, and throughput for physicians, with 79 percent of WellSpan physicians reporting the program improves the quality of their documentation. Physicians still need to enter orders and billing codes, but they do not need to dictate the clinical notes.

“The dictation is more accurate and detailed than what I could document from memory,” said Dr. Teresa Joy, who practices at WellSpan Family Medicine – Chambersburg and WellSpan Urgent Care offices in Franklin County. “It allows me to concentrate on what the patient is saying so I have time to process what they are telling me and have time to formulate the best and most appropriate treatment plan.”

Developed by Nuance and Microsoft, DAX uses technology, similar to what is employed by Amazon’s Alexa or Apple’s digital assistant Siri, to understand conversational language. Patients are informed of the use of the software during their visit and must approve its use, which is done via a cell phone.

Benefits for patients Patients say the technology results in more talking and less typing by the physician.

“It’s a great idea,” says Harry Donahue, one of McCarty’s patients. “I know it’s important they get everything down so they can treat the patient. We can talk and everything is clear, and he isn’t busy typing. There is more eye contact. It’s nice.”

A survey showed that 80 percent of WellSpan patients felt the technology allowed their physicians to be personable and conversational during their visits.

L A N C A S T E R M E D I C A L S O C I E T Y.O R G

Best Practices

Practice Management Insights

ADDRESSING THE ISSUES, CHALLENGES, AND OPPORTUNITIES THAT IMPACT TODAY’S MEDICAL PRACTICES

R TOWN U O TO N AV OW IEW F D T ROM 30,000 FEE

ROBERT D. ORZECHOWSKI, MBA, SHRM-SCP

COO, Lancaster Cancer Center, Ltd.

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SUMMER 2022

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recently reviewed many of the past issues of Lancaster Physician and was struck by the sheer variety and quality of so many topics covered therein.

I’ve done such reviews of past meeting agendas from our medical practice as well as for volunteer organizations to which I belong. I find the exercise helpful and often re-centering.

As indicated by the aforementioned variety and quality of past articles, the Lancaster City & County Medical Society (LCCMS) publication is not just about medicine and the science driving its content. As a lay person, I can certainly appreciate the value such an approach provides us at the local level. LCCMS’s journal recognizes the value of offering articles not only focused on medicine, the organization itself, events, and other resources, but also on general and medical group practice management, leadership concepts, COVID-19’s impact, patient relations, HR management, cybersecurity, and much more.

The previous articles offer a valuable background and sound treatment of those substantive topics, offering personal and professional perspectives to better our understanding of the articles’ premise, message, and takeaways for our betterment.

I thought to take a somewhat different approach to those critical topics in this issue.

The past two years left an indelible mark on the world, and certainly on the health care industry, which now is in a real state of flux.

All medical and health care related organizations — indeed all organizations — have three “universals.” They have a mission, some kind of infrastructure (physical, financial, administrative), and they have people, including a paid staff, volunteers, or other stakeholders who are relied upon for mission success. There is an interrelationship between these three universals that is not easy to operationalize in a time of such significant change.

CONSIDER THE VELOCITY OF CHANGE.

SCIENTIFIC, TECHNOLOGICAL, AND SOCIETAL CHANGE —I.E., INNOVATION— IS ACCELERATING WHILE BECOMING MORE DECENTRALIZED ACROSS THE THREE UNIVERSALS. Even our laws, regulations, and their agencies, guidelines, and standards exist in response to earlier forces and norms. How then, in our own organization, can we plan, optimize, implement, and control so many variables given the pace of change that impacts the three universals? This diffusion of forces across structural and human boundaries can result in no single regulatory agency or organizational structure having a full picture of the technologies, nor of its ultimate impact. These are but a few of our challenges as stewards of the health care delivery model, which itself continues to see its own consolidation. Health plans not only are consolidating; they are also diversifying. Health care professionals at all levels are in a workforce sustainability threat state of being.

As employers, we have become more focused on diversity, employee equity (including health equity) and inclusion (“D/E/I”), workplace safety, workforce health and wellness, a hybrid work force, cybersecurity, privacy, engagement, and certainly, retention.

Pandemic-inspired reviews and adjustments to total rewards systems, and especially in the non-wage areas like benefits, all require new approaches to managing our human assets to assure mission success.

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We in health care live at the nexus of science, technology, and human service. Thus, with the acceleration and diffusion of so many forces, we now accept a growing awareness of the impact of these new advancements and their effect on us in uneven ways. It has been said that in health care there are three issues: cost, access, and quality — and that at any time we can only achieve two. These advancements in technology and medicine raise certain fundamental moral and ethical issues that are indeed challenging for leaders to address. Developing and communicating policies for D/E/I, cultural sensitivity, and ethical behavior can expand and affirm our organizations as aligning our culture with our mission.

With all the aforementioned challenges and unknowns facing health care professionals, organization leaders and managers, and stakeholders, it is understandable that we may begin to think more tactically than strategically. I recently heard a business executive decry the five-year strategic plan. He stated he is now developing one-year plans with options depending on certain assumptions about laws, regulations, court decisions, or relevant business forces not yet fully recognized or quantifiable. This executive was not in the health care delivery space.

With no clear path forward, it is prudent to recognize the strength and power of the human spirit, the intellect, competence, and emotional IQ we should and must possess.

The velocity of change across so many organizational fundamentals is expected to be a new normal. We must recognize the need to change in ways that render us a better fit to remain those stewards of the tools, technology, and science in ethical and empathetic ways. We must remain vigilant for the post-pandemic world and the potential therein to challenge us in ways we cannot yet comprehend. We continue to see variants and news makers, guidelines, or agencies trying to use their powers or court actions to dictate activities on their terms. Only by openly and effectively communicating with all stakeholders, by keeping the patient at the center of our delivery models and our mission, and by holding ourselves accountable can we hope to realize mission success.

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Healthy Communities

WHAT IS

APHASIA?

JUSTIN FISHER, MD WellSpan Neurology

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n March of this year, Bruce Willis’s family announced that the 67-year-old was stepping away from his acting career after being diagnosed with aphasia.

For many Americans, this was the first time they had ever heard the term “aphasia.” For some physicians, hearing it likely brought back unpleasant repressed memories from their neurology rotations as medical students.

But aphasia is actually a common affliction that we as neurologists encounter frequently in our practice, both in the inpatient and ambulatory settings. Put simply, aphasia is a disorder of expression and/or comprehension of language that cannot be attributed to peripheral causes like hearing loss or bulbar muscle weakness. Aphasia is not a single disease entity but rather a symptom of a wide variety of central nervous system (CNS) disorders. In this article, we will briefly review the types, causes, features, and management of aphasia.

LANGUAGE AND T HE BRAIN Our understanding of the brain’s control of language function began to take form in the mid-19th century when the legendary neurologist Paul Broca described a patient whose ability to communicate suddenly became restricted to just a single phrase.

Autopsy ultimately revealed that this condition was caused by a stroke the patient had suffered, affecting the left frontal lobe.

This was the first time a cognitive function was definitively localized to a specific region of the brain and was the beginning of a long — and ongoing — exploration of the complex networks that underlie our ability to communicate through language.

ST ROKE AND APHASIA Different aspects of language function are distributed widely throughout the brain, so many different neurologic processes can potentially affect language. But by far, the most common cause of aphasia is stroke.

In most right-hand dominant individuals (and even many lefties), a vast majority of the territory involved in language function is located in the brain’s left hemisphere, in the distribution perfused by the left middle cerebral artery (MCA). A stroke involving the left MCA (either the main trunk or one of its branches) often leads to ischemic

injury to the regions of the brain that either comprehend or produce language, or to the connections between those regions. As with Broca’s famous first patient, the exact areas involved determine the type of language dysfunction that results.

In broad terms, the inferior left frontal lobe (Broca’s area) is responsible for production or expression of language. Damage to that region leads to an expressive or non-fluent aphasia, characterized by slowed and effortful speech and reduction of average words spoken per minute and per utterance. Speech is typically restricted to short, simple phrases with a paucity of grammatical elements.

In contrast, the region of the junction between the left parietal and temporal lobes (Wernicke’s area) is responsible for comprehension of language. Damage to that region leads to a receptive or fluent aphasia, characterized by normal-sounding fluent speech that is nonsensical and often includes paraphasic errors, made-up words, etc., as well as impaired comprehension of spoken and written language. Mixed forms of aphasia also exist, when both the receptive and expressive regions are affected, or if the white matter connections between those areas are disrupted.

OT HER CAUSES Conditions other than stroke that may lead to aphasia are as diverse as traumatic brain injury, neoplasm, CNS infections, intracerebral hemorrhage, and degenerative processes. Even transient conditions such as seizures and migraine may result in temporary language dysfunction. Although Bruce Willis’s family has not disclosed the exact cause of his aphasia, it seems likely that it represents one of the degenerative forms of this condition.

Colleagues of Willis have commented that he began showing signs of a problem as early as two years before his family disclosed his diagnosis. This suggests he is experiencing a slow progression and deterioration characteristic of degenerative disorders.

Forms of aphasia can be seen with the more common neurodegenerative processes such as Alzheimer’s disease, but the prototypical degenerative language disorder is primary progressive aphasia (PPA). In

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this condition, language dysfunction is the dominant clinical feature, although other aspects of cognitive dysfunction can be present to a lesser degree. PPA is actually a collection of several different disorders; most share pathologic features with frontotemporal dementia but some are more similar to Alzheimer’s pathologically. PPA is further subcategorized by the type of language dysfunction present. Nonfluent/ agrammatic PPA is characterized by slow, effortful speech similar to that seen after a stroke affecting Broca’s area. Semantic variant PPA is characterized by progressive difficulty with language comprehension and naming, in some ways analogous to the fluent aphasia seen after a stroke affecting Wernicke’s area.

Logopenic PPA is more akin to mixed forms of aphasia seen after stroke, with both fluent and nonfluent features. The main distinction between stroke-related aphasia and PPA is the insidious onset and slow progression of deficits seen in PPA. T REATMENT OPT IONS Unfortunately, despite our rapidly increasing understanding of the underlying causes, treatment options for aphasia remain limited.

Speech therapy (ST) is the mainstay of treatment in all forms of aphasia. After a stroke, ST can provide patients with invaluable compensatory strategies to aid them as their brain recovers. Many patients will experience gradual spontaneous improvement in their speech. Some recover fully. Degenerative conditions like PPA relentlessly worsen, but ST can still help patients and their families cope with these devastating illnesses. Alternative forms of communication such as picture dictionaries and gestures can sometimes be useful. Research suggests that transcranial direct current stimulation and transcranial magnetic stimulation may augment speech therapy. Trials of medications such as bromocriptine, amphetamine, donepezil, and memantine have yielded small but possibly meaningful benefit.

And so, when you re-watch Bruce Willis classics like Die Hard, spare a moment to ponder aphasia and the complex and fascinating features of the brain that allow us to utter classic lines like “Yippee Ki-Yay!”

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Healthy Communities

summer insect health risks S Y M P T O M S , P R E V E N T I O N , T R E AT M E N T S

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AMANDA BITTNER, MD Lancaster Family Allergy

t is the season of sun, fun, picnics, pools, BBQs and…insects. Here’s a quick review of bug-related risks — from mosquitos to ticks to the stinging insects — from an allergist’s perspective.

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Mosquitos One of the most common issues is large, localized reactions to mosquito bites. Unfortunately, there is no testing or desensitization for sensitivity to mosquitos.

First line treatment is primary prevention.

Patients should be encouraged to use an insect repellent with at least 25% DEET and reapply regularly. For any problematic bites, patients may use symptomatic treatments, such as topical steroid creams and antihistamines to help reduce pruritus (itchy skin). There are case reports of people having anaphylaxis (a potentially deadly immune response) to mosquito bites, deer flies, lady bugs, etc., but there is no testing for sensitivity to these insects. Treatment consists of primary prevention and epinephrine for any subsequent bites which may cause anaphylactic symptoms.

Ticks A more recent discovery is the association of tick bites and the development of mammalian meat allergy. This is called alpha-gal syndrome, and in the USA it is usually associated with bite of a lone star tick. In affected patients, the tick bite causes development of IgE antibodies against galactose-alpha-1,3-galactose (alpha-gal), which is found in mammalian meat. Unlike typical food allergies that cause immediate reactions, alpha-gal syndrome causes anaphylaxis hours after the ingestion of mammalian meat. Patients with alpha-gal syndrome frequently wake in the middle of the night with anaphylaxis. In addition to the delayed food reaction, patients can have immediate anaphylactic reactions to subsequent tick bites and to cetuximab, a cancer medication. Besides the history, this condition can be diagnosed by measuring serum IgE to alpha gal. Treatment is avoidance of beef, pork, lamb, rabbit, goat, etc., and their internal organs. Patients should avoid cetuximab and gelatin-based colloidal plasma. Eighty percent of patients can control the condition by avoidance of these products. Approximately five to 20 percent of patients will need to avoid some derivatives of mammalian meat such as dairy and gelatin. Less than one percent of patients need to avoid most derivatives or related products. All patients with this condition

should always have an epinephrine injector available. Interestingly, it appears that some patients lose their allergy to alpha gal over time if there are no subsequent tick bites.

Hymenoptera Hymenoptera are the insects most likely to cause an allergic reaction. In our geographic area, this includes bees, wasps, and mixed vespids. Fire ants are also problematic in the southern states. There is a wide range of reactions, but the mildest and the most common is a localized reaction.

This just requires symptomatic treatment including ice, NSAIDs (e.g., ibuprofen), topical steroids, antihistamines, etc. Some patients develop large, localized reactions characterized by indurated (hardened) sites greater than 10 cm that may last for days.

Patients with large, localized reactions are at a slightly increased risk of anaphylaxis (five to 10 percent versus the general population’s risk of four to five percent) with a subsequent sting. Those patients should be prescribed an epinephrine injector to use in the case of anaphylaxis. However, for large, localized reactions, treatment includes prednisone and other symptomatic measures.

Situational awareness — such as minimizing exposure to the stinging insects, removing of bees’ nests in the yard by someone not sensitive, and avoiding drinking from open containers when outdoors — should be stressed to patients. Patients with large, localized reactions do not need to undergo venom testing as venom immunotherapy is not going to significantly reduce the risk of anaphylaxis. There are some exceptions when venom immunotherapy is a comfort measure or minimizes missed work for those who have frequent unavoidable exposure and their large reactions would significantly interfere with their daily lives.

The more serious reactions people experience include systemic reactions. There are two categories: cutaneous only (skin reactions including urticaria and angioedema) and anaphylaxis. For cutaneous reactions, children have a 10 percent chance of repeat urticaria/angioedema (hives and swelling) with a subsequent sting but less than a three percent chance of anaphylaxis. Adults with isolated cutaneous manifestations have up

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to a 20 percent chance of repeat cutaneous symptoms, and less than a 5 percent chance of anaphylaxis. Again, this group does not require venom testing/venom immunotherapy as the risk of anaphylaxis is low. However, testing for possible venom immunotherapy could be considered under the same conditions mentioned above.

Patients who have had anaphylaxis to a sting must always carry epinephrine and undergo venom testing in order to start venom immunotherapy. A patient who has had anaphylaxis is at high risk, approximately 60 percent, of another episode with a subsequent sting. Venom immunotherapy can decrease this risk to as low as five percent for patients allergic to mixed vespids and wasps. It also reduces the risk in patients with honeybee allergies. For most patients, venom immunotherapy is usually a five-year commitment, but some patients will require lifelong therapy.

A few tidbits related to venom patients Mastocytosis, a rare but serious condition, should be considered in patients with severe reactions. Beta blockers and ACE inhibitors should be used cautiously in patients with a history of anaphylaxis to stinging insects.

There is no need for venom testing for patients that have a family history of bee sting allergies as there does not appear to be a statistical correlation.

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The Dilemma of Whether to Get a Second Booster of the COVID-19 Vaccine

NITIN PATEL, MD, MBBS

Penn Medicine Lancaster General Health

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hould I get a second booster (fourth dose of the vaccine) now or wait for better options? How many boosters are we to keep getting?

In this pandemic era, these are the common questions physicians hear from our patients and our community. While we discuss the fourth dose, I want to emphasize there is no doubt about the efficacy of the third dose/first booster of the Moderna Spikevax and Pfizer-BioNTech vaccines. The data shows they are very good at preventing severe infections, hospitalizations, and deaths in all adult age groups.

On January 3, 2022, the FDA authorized a single booster of the Pfizer-BioNTech COVID19 vaccine based on real-world data from Israel, including safety data from more than 6,300 individuals 12 through 15 years of age who received a booster dose of the vaccine at least 5 months following completion of the primary two-dose vaccination series. Also, there was no new safety concern of myocarditis or

pericarditis after the booster. On May 17, 2022, the FDA expanded and authorized a single booster dose for administration to individuals 5 through 11 years of age at least five months after completion of a primary series with the Pfizer-BioNTech COVID-19 vaccine.

On March 29, 2022, the FDA authorized a second booster for the Moderna Spikevax or Pfizer-BioNTech COVID-19 vaccine for people over the age of 50 and people over the age of 12 who are immunocompromised.

These recommendations came from a study done in Israel on people 60 years and older.

The large amount of data collected from Israeli Ministry of Health showed rates of confirmed SARS-CoV-2 infection and severe COVID-19 were lower after a fourth dose of the Pfizer-BioNTech vaccine than after only three doses. It also showed a significant improvement in the number of deaths among patients older than 60. It also showed, as age increases beyond 69 years, there was more benefit, lowering the risk of severe infection and death. After statistical

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analysis, it showed protection against getting the infection was short-lived, but protection against severe illness did not wane during the study period.1 A smaller study on the immunogenicity and safety of the fourth dose was done at a large medical center in Israel, with a group of 1,050 healthy health care workers. It showed a marginal difference of infection rate between groups who received only three doses compared to those who received four doses of the vaccine.

Both groups had mild symptoms but a high viral load, and so remained infectious.2 Currently, multiple trials are in progress by different manufacturers to develop a vaccine more effective against omicron and active against prior variants. Recently, Pfizer announced by fall it could develop a new vaccine that protects against the Omicron variant as well as older forms of COVID-19.

On April 19, 2022, Moderna announced it is currently doing a phase II trial, combining

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Moderna’s booster candidates called mRNA1273.214 with the approved COVID-19 vaccine known as Spikevax.

As we know, protective effects of the vaccine wane after four to six months. This is also true for natural infections. Omicron variants became predominant since January of this year, and Omicron remains the main infecting strain with change in sub-variants.

It started with BA.1, followed by BA.2, and now BA.2.12.1. So far, there are no significant numbers of reinfections between Omicron variants. Internationally, in South Africa, Omicron BA.4 and BA.5 are becoming predominant, and there are reports of reinfection in patients who were previously infected with BA.1 or BA.2.

Currently, community transmission remains high, but luckily hospitalization and deaths remain low for younger age groups and otherwise healthy people. Based on the current data, I would suggest patients older than 60 years old who have not been infected with

COVID-19 in the last four months and who had their first booster more than six months ago should get the second booster now. Patients between 50-60 years of age, especially those without any significant health issues, fall into a gray zone. Their benefit of the second booster’s protection against COVID-19 has been less compared to the advantage people in the age group more than 60 and higher have experienced. So, healthy people between 50-60 years may do well with just one booster. There is clear evidence that immunocompromised individuals are at higher risk for getting severe COVID-19 infection and dying from it. Therefore, immunocompromised individuals should get their second booster now and not wait.

Over the course of the COVID-19 pandemic, we now have a better understanding of the virus’s pathogenicity and genomics. And we have more selective therapeutic agents — such as monoclonal antibodies; antivirals such as Remdesivir, Paxlovid and Molnupirivir; and immune-modulators such as Tocilizumab and Baricitinib — working against COVID-19

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infections. Even after all these advances, vaccines remain the most effective measure to control and hopefully eventually eradicate COVID-19. We have good vaccines but will need to continually evolve and develop more effective and longer-lasting vaccines.

REFERENCES 1. https://www.nejm.org/doi/pdf/10.1056/NEJMoa2115926?articleTools=true. Protection against Covid-19 by BNT162b2 Booster across Age Groups : Yinon M. Bar-On, M.Sc., Yair Goldberg, Ph.D., Micha Mandel, Ph.D.,Omri Bodenheimer, M.Sc., Laurence Freedman, Ph.D., Sharon Alroy-Preis, M.D., Nachman Ash, M.D., Amit Huppert, Ph.D., and Ron Milo, Ph.D. 2. https://www.nejm.org/doi/full/10.1056/NEJMoa2109072, Covid-19 Breakthrough Infections in Vaccinated Health Care Workers,.Moriah Bergwerk, M.B., B.S., Tal Gonen, B.A., Yaniv Lustig, Ph.D., Sharon Amit, M.D., Marc Lipsitch, Ph.D., Carmit Cohen, Ph.D.,Michal Mandelboim, Ph.D., Einav Gal Levin, M.D., Carmit Rubin, N.D., Victoria Indenbaum, Ph.D., Ilana Tal, R.N., Ph.D., Malka Zavitan, R.N., M.A., Neta Zuckerman, Ph.D., Adina Bar-Chaim, Ph.D., Yitshak Kreiss, M.D., and Gili Regev-Yochay, M.D.

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Melanoma Risk Factors & Prevention Tips DON’T LET FUN IN THE SUN PUT YOUR SKIN IN DANGER

JEANETTE HEBEL, MD

Dermatology Associates of Lancaster

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ummer is here and, if you are like most people, you like to spend time outside in the sun. Before enjoying the beautiful weather, make sure to protect your skin from the sun. More people are diagnosed with skin cancer than all other cancers combined — and more than 90 percent of skin cancer cases are caused by sun exposure.1 The most dangerous form of skin cancer is melanoma. Having more than five sunburns over your lifetime doubles your risk of developing melanoma.2 While melanoma accounts for only a small subset of skin cancers, it is the leading cause of deaths related to skin cancers.3 In 2022, close to 200,000 people will be diagnosed with melanoma, and approximately 7600 will die from their disease.3

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WHAT CAUSES MELANOMA? The skin is divided into three layers: the epidermis, dermis, and subcutaneous tissue.

Melanocytes are found within the epidermal layer of the skin. These cells produce the tan and brown colors of the skin. When exposed to the sun’s ultraviolet (UV) rays, the melanocytes produce extra melanin to protect the layers underneath from damage. Suntans are your body’s natural reaction to trauma. With time and continued exposure, mutations in the DNA of the skin can cause cancers to form.

Intense but intermittent blistering sunburns are the greatest risk factor for the development of melanoma.4 This sun-associated risk factor is different than that for non-melanoma skin cancers (basal cell and squamous cell carcinoma), which are associated with prolonged and long-term sun exposure.5 RISK FACTORS While unprotected exposure to the sun is the culprit in most cases of melanoma, other causes play a role as well.3 Genetics can play a role in cancer development with about 10 percent of people diagnosed with melanoma having a family history of the disease.6 Greatly elevated risk factors for the development of melanoma include: Having fair skin, especially if you freckle or burn easily or have red or blonde hair and green or blue eyes Having more than 50 moles Having a changing mole Having a personal history of skin cancer Being immunosuppressed3 Internationally, the incidence of malignant melanoma has dramatically increased over the past 50 years. The highest incidence of melanoma is in fair-skinned populations and those closest to the equator. Australia and New Zealand have the highest incidence of melanoma in the world.7 While melanoma is more common in Whites, late-stage melanomas are more prevalent in Blacks and Asians.3,8 Melanoma in people of color most often occurs on nonexposed skin with less pigment, such as the palms, soles, mucous membranes, and nailbeds.9

WHAT DOES MELANOMA LOOK LIKE? Since melanocytes produce the pigment melanin, most melanomas are often brown or black in color. However, they can also present as pink, tan, or white. The areas most affected in men are on the chest and back while women more commonly develop melanoma on their legs.3 Any new growth or spots on your body should be brought to your healthcare provider’s attention. The ABCDE guidelines are used to detect the usual signs of melanoma.

A IS FOR ASYMMETRY: Does one side of the lesion not match the other side?

B IS FOR BORDER: Are the edges smooth or irregular and ragged?

C IS FOR COLOR: Does the color vary and include multiple colors of brown, black, pink, red, white, or blue?

19 states now ban indoor tanning for people younger than the age of 18.15,16 Women who tan indoors are six times more likely to be diagnosed with melanoma in their twenties than those who have never tanned indoors. 17 PROGNOSIS AND PREVENTION The prognosis of melanoma is determined by the depth within the skin at the time of presentation. Small skin lesions that are superficial are easily curable with surgical resection while larger tumors that invade more deeply into the skin can extend beyond the skin and metastasize to the lymph nodes, lung, gastrointestinal tract, or brain.

How do we reduce our risk for developing melanoma? The most effective strategies for protecting our skin include these recommendations from the American Academy of Dermatology: • Avoid tanning beds at all costs.

D IS FOR DIAMETER: Is the lesion greater than 6 mm or the size of a pencil eraser?

• Wear a broad spectrum (both UVB and UVA) sunscreen daily even if you will be mostly indoors as UV rays still penetrate though window glass.

E IS FOR EVOLVING: Is the spot changing in size, color, or shape?10

• Reapply sunscreen every two hours while outdoors and more often if sweating or swimming.

Not all melanomas begin with an existing mole. Seventy to 80 percent of diagnosed melanomas arise as a “new” mole while 20-30 percent arise from an existing mole.11 Changes in a mole’s size, shape, color, or texture should prompt an evaluation by your healthcare provider. When looking at the overall appearance of your moles, look for the “ugly duckling” mole that appears different from your other moles or spots.12 Other warning signs include a sore that will not heal or goes away but comes back again, redness or swelling in the skin around a mole, changes in sensation (including itching or pain), and finally, changes in the surface of a mole, such as scaling or bleeding.

Indoor tanning can emit UV radiation in amounts 10-15 percent higher than the sun at its peak intensity. 13 UV tanning devices have been classified by the FDA as a moderate to high risk (Class II) device since 2014, and

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• Avoid the strongest UV rays of the day between the hours of 10:00 am and 4:00 pm.

• Wear protective clothing, such as long-sleeved shirts and pants.

• Wear a broad-brimmed hat that covers the face, ears, and neck.

• Wear UV-blocking sunglasses.

• Seek shade when it is possible.

• Examine your skin monthly and schedule a complete skin examination if you have substantial risk factors for developing skin cancer.

Continued on page 22

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Healthy Communities

9. Gloster HM, Neal K. Skin cancer in skin of color. J Am Acad Dermatol 2006; 55:741-60.

Early detection is the key to curing melanoma. Pay attention to your skin. Encourage sun protection from an early age to prevent damage to your skin. Enjoy the summer sun safely!

10. Abbasi NR, Shaw HM, Rigel DS, et al. Early diagnosis of cutaneous melanoma: revisiting the ABCD criteria. JAMA. 2004;292:2771–2776.

11. Cymerman RM, Shao Y, Wang K, et al. De novo versus nevus-associated melanomas: Differences in associations with prognostic indicators and survival. J Natl Cancer Inst 2016 May 27; 108(10). doi:10.1093/jnci/djw121.

REFERENCES

1. Guy GP, Thomas CC, Thompson T, Watson M, Massetti GM, Richardson LC. Vital signs: Melanoma incidence and mortality trends and projections—United States, 1982–2030. MMWR Morb Mortal Wkly Rep. 2015;64(21):591-596.

12. Grob JJ, Bonerandi JJ. The “ugly duckling” sign: identification of the common characteristics of nevi in an individual as a basis for melanoma screening. Arch Dermatol.

1998;134(1):103–104.

2. Wu S, Han J, Laden F, Qureshi AA. Long-term ultraviolet flux, other potential risk factors, and skin cancer risk: a cohort study. Cancer Epidemiol Biomar Prev; 2014. 23(6); 1080-1089.

13. Le Clair MZ, Cockburn MG. Tanning bed use and melanoma: Establishing risk and improving prevention interventions. Prev Med Rep. 2016; 3:139–144. Published 2016 Jan 14. doi:10.1016/j.pmedr.2015.11.016.

3. American Cancer Society. Cancer Facts & Figures 2022. Atlanta: American Cancer Society; 2022.

4. Gandini S, Sera F, Cattaruzza MS et al.. Meta-analysis of risk factors for cutaneous melanoma: II. Sun exposure. Eur J Cancer. 2005;411:45–60.

14. National Cancer Institute. U.S. indoor tanning rates are dropping, but still high. https://www.cancer.gov/news-events/cancer-currents-blog/2015/indoor-tanning. Accessed January 31, 2018.

5. Iannacone MR, Wang W, Stockwell HG et al.. Patterns and timing of sunlight exposure and risk of basal cell and squamous cell carcinomas of the skin—a case-control study.

BMC Cancer. 2012;12:417.

15. Indoor tanning restrictions for minors — a state-by-state comparison. NCSL, National Conference of State Legislatures. http://www.ncsl.org/research/health/indoor-tanning-restrictions.aspx. Accessed January 29, 2018.

6. Florell SR, Boucher KM, Garibotti G, et al. Population-based analysis of prognostic factors and survival in familial melanoma. J Clin Oncol 2005;23:7168-77.

16. Lazovich D, Vogel RI, Weinstock MA, et al. Association between indoor tanning and melanoma in younger men and women. JAMA Dermatol 2016; 152(3): 268–275. doi:10.1001/jamadermatol.2015.2938.

7. Ward WH, Farma JM. Cutaneous Melanoma: Etiology and Therapy. 2017 Dec 21.

8. Agbai ON, Buster K, Sanchez M, Hernandez C, Kundu RV, Chiu M, Roberts WE, Draelos ZD, Bhushan R, Taylor SC, Lim HW. Skin cancer and photoprotection in people of color: a review and recommendations for physicians and the public. J Am Acad Dermatol. 2014;70(4):748-62.

Confidence for Tomorrow.

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Domani Wealth, LLC (“Domani”) is an SEC registered investment adviser with its principal place of business in Lancaster, Pennsylvania. Domani and its representatives may only transact business in states where they are appropriately notice-filed and registered, respectively, or exempt from such requirements. For information pertaining to the registration status of Domani, please contact the SEC or the state securities regulators for those states in which Domani maintains a notice-filing.

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SUMMER 2022

Passion Outside of Practice

Hayley Ryan, DO WellSpan Family Medicine – Trout Run

It’s our pleasure to highlight a Lancaster City & County Medical Society member’s “passion outside of practice” in each issue of Lancaster Physician. Beyond their commitment to health care, LCCMS members have many other talents, skills, and interests that might surprise you. In this issue, we’re thrilled to feature Hayley Ryan, DO, and her passion outside of practice.

How did you develop an interest in your passion outside of practice?

I have a long history with theater, performing in musicals and plays since childhood. I am the child of a professional actor and a jazz musician. Through college and med school, I found ways to continue to perform, but once residency started I found it too difficult to commit to the rehearsal schedule of a typical play. I was looking for something I could do once a week as a creative outlet. I signed up for a 6-week training workshop in playback theatre with the River Crossing troupe in 2013 and fell in love with the art form. I continued training and joined the performing group shortly thereafter. We did a few performances and workshops for my residency in those early years (helping to process the resident experiences) and have performed for a variety of community groups. During the pandemic, we moved to zoom rehearsals and performances, and we have recently started performing live again.

Dr. Hayley Ryan, center in red, and members of River Crossing Playback Theatre perform a fluid sculpture to depict an emotion and story shared by an audience member.

Improvisational Theatre Would you briefly describe your passion outside of practice for those who might be unfamiliar with it?

Playback theatre, developed by Johnathan Fox in 1975, is an original form of improvisational theatre in which audience members tell stories from their lives and watch them enacted on the spot.

The structure of a playback theatre performance involves a “conductor” who guides and interacts with the audience, asking open-ended questions to draw out spontaneous personal feelings or stories, often around pre-determined topics. A group of three to five actors listens carefully to the feelings and experiences of the audience members, then creates an artistic offering on the spot, using sound

and motion to capture the essence of what has been shared. As a performance evolves, we get into deeper and more complex stories and use longer improvisational forms to “play them back.” The conductor prompts a storyteller to choose an actor to portray themselves and any other significant character in their story. A musician also performs improvisational music using a variety of instruments to complement and guide the performance. This can be a powerful collective experience for the “teller” of the story, the audience, and the performers. I am an actor in River Crossing Playback Theatre, a local chapter based in Marietta, PA. There are playback theatre troupes all over the world, often using their gifts of performance as a vehicle for social change and community processing.

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How long have you been participating in this activity?

Nine years!

Why is this pursuit special to you?

Playback acting requires listening with your entire body, and the “playing back” of a person’s emotions is often therapeutic. They often feel heard and cared for in ways they have not felt before. This is the type of listening every patient deserves, but the confines of the medical system and culture of patient care does not make this easy for physicians. Training in this art form has definitely improved my empathy and listening skills. Telling stories in rehearsals and seeing them played back by my team has also been extremely therapeutic for me as I have moved through my career in medicine.

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Perspectives

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BY SUSAN SHELLY Writer

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H O W H EA LTH C A RE SYSTEM S ARE WORKING TO BOOST

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W

hile many industries have been affected by workforce shortages, supply chain issues, inflation, consumer confidence, declining employee morale, and other issues, few have been hit harder than health care. One result, according to experts, is an unprecedented level of burnout among health care workers.

Burnout in the health care industry was a problem even before the pandemic. In 2019, the National Academies of Medicine (NAM) reported that burnout had reached crisis levels, with up to 54 percent of nurses and physicians and up to 60 percent of medical students and residents affected. The situation was exacerbated by effects of the pandemic, prompting nearly one in five health care workers to leave their jobs. In addition, surveys show that many more health care workers are considering leaving their jobs within the next two years.

The increasing seriousness of the situation led United States Surgeon General Dr. Vivek Murthy to issue an advisory addressing the issue.

He urged action and made recommendations in the Surgeon General’s Advisory Addressing Health Worker Burnout, released May 23.

If steps are not taken to address the issues of burnout and employee well-being, the health care system — and patients — will suffer, Murthy warned.

The health care systems serving Lancaster County are not immune to problems facing the industry, including threats to employee well-being and morale. Lancaster Physician reached out to learn more about how our health care systems are supporting the health and well-being of their employees. Penn State Health, WellSpan Health, and Penn Medicine Lancaster General Health responded.

Penn State Health Recognizing that the needs of employees vary tremendously, Penn State Health has been aggressively working to expand programs to provide Jennifer Sarff a range of services addressing areas including financial, emotional, physical, occupational, and environmental well-being.

“We are looking at wellness and well-being holistically, understanding that everyone has different needs,” said Jennifer Sarff, vice president of human resources.

employees trying to learn whether they qualify for the federal Public Service Loan Forgiveness program. Employees also can get tuition discounts for continuing education and other perks.

With between 18,000 and 19,000 employees working at a number of locations in a wide range of jobs, it can be difficult to assure everyone is aware of the various resources available to them, Sarff explained. To increase awareness, the health care system established a wellness website on which all resources are listed and explained.

When Penn State Health CEO Stephen Massini announced the site about four months ago, employees responded with enthusiasm.

“We feel that all these things are tied to overall wellness,” Sarff said.

“Steve shared the news and we had 2,500 hits in just a couple of hours,” Sarff said.

“Employees are looking to learn about what is available to them.”

The website details services available under each area of wellness, such as retirement consultations and budgeting programs under financial well-being, or gym memberships, nutrition counseling, and discounts for tobacco cessation programs under physical well-being.

Penn State Health also recently established an Office of Professional Health and Well-Being that offers counseling and other services on site to accommodate the needs of busy providers, medical students, and residents.

The system recognizes “wellness champions” at various locations throughout the system and provides grants to encourage individuals across the system to come up with creative ways of enhancing wellness in their practice or office.

One champion established a meditation room at a practice, while another created a hydration, sleep, and walk challenge.

A new Employee Assistance Program (EAP) has been put into place, addressing a wide variety of issues and needs, and increased attention has been given to the spiritual needs of employees.

“We have so many wellness initiatives across the system. This just gives us a way to pool them all at one site,” Sarff said.

“We’ve been able to pull together our chaplaincy resources so they can service not only our patients, but also our employees,” said Sarff.

Penn State Health also focuses on social and intellectual wellness, offering “affinity groups” for employees throughout the system. Groups include military veterans, women, interfaith, LGBTQ and allies, multi-cultural, and NextGen, made up of employees of varying ages.

The groups are well attended, according to Sarff, and members are engaged in making sure their interests are recognized and represented.

A recent employee engagement survey showed that, while there are areas in which there is room for improvement, employees generally appreciate the efforts of leadership to give them the services and programs they desire and need.

While working in health care was never easy and has become even more challenging since the start of the pandemic, Sarff believes that the majority of Penn State Health employees have found ways to cope with support from leadership and one another.

For instance, she shared, members of the LGBTQ affinity group asked for a review of employee benefits to make sure they were equal for everyone regardless of sexual orientation.

Management was happy to heed the request.

“We want to support our employees in every way we’re able to, and these groups can identify needs that help us do that,” Sarff said.

As part of its focus on intellectual wellness, Penn State Health provides support for

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“I think our employees have maintained focus and are doing quite well, despite the challenges,” she said.

WellSpan Health WellSpan Health has been taking measures to assure the well-being of its health care workers for years but ramped up its efforts to address Dr. Ridgley Salter

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challenges brought on by the pandemic, according to Dr. Ridgley Salter, a family physician and medical director within WellSpan’s primary care service line who serves as chair of the WellSpan Medical Group Well-Being Council.

WellSpan regularly addresses self-care with its employees through conferences, events, and educational seminars, and encourages practices such as exercise, proper rest, yoga, and meditation.

“If you’re going to be a great physician or APP (advanced practice provider) you’ve got to take care of yourself first,” Salter said. “We recognize that at WellSpan.”

But while self-care is important in combatting worker stress and burnout, Salter believes it is not enough.

“We know that self-care is important, but it can’t be the only thing we talk about,” he said.

The answer to combatting employee burnout, he believes, is to create a culture of care within all WellSpan workplaces that enables staff members to work more effectively in less stressful environments.

Studies have revealed that health care workers — particularly physicians — tend to possess high levels of resiliency. And it’s known that resilient people are less likely to experience burnout than those who are less so. But while it’s important to encourage resiliency in employees, that trait alone cannot prevent burnout in very difficult work environments.

“We can’t just work on making tougher canaries,” Salter said. “At some point we need to address the condition of the coal mine.”

WellSpan, which employs 20,000 system-wide, is working to enhance its culture of care in various ways, including making myStrength, a free behavioral health app, available to employees; enabling easy access to its Employee Assistance Program (EAP); and elevating online resources for employees. During the peak of the pandemic, leaders distributed “hope kits” to caregivers working in high-risk areas. In turn, leaders were offered care communities that provided safe places for them to vent

and recharge. Many meetings include “gratitude moments,” and every employee received an “end of the day checklist” designed to aid in self-awareness and well-being.

said. “They got into the profession for a reason and want to fulfill that mission. There are fewer things that are of a higher calling than taking care of your fellow human being.”

“It’s always a work in progress, but I’m excited because from the top our leaders are really concerned about our well-being and are working on improving it,” Salter said. “It’s a stressful time right now, but I’m hopeful for continuing systemwide improvement.”

Penn Medicine Lancaster General Health Jennifer Collins, PsyD, MSCP, was named Chief Well-Being Officer at Penn Medicine Lancaster General Health in October 2019, a role that turned out to be very different from what she Jennifer Collins was expecting.

Many health care systems were already addressing staffing shortages prior to the outbreak of COVID-19, and according to some reports, the field lost about 20 percent of its workforce during the pandemic in what is often referred to as the “Great Resignation.”

Equally concerning, noted Salter, is that studies have shown many other employees, including one out of five physicians and two out of five nurses, plan to leave their jobs within the next two years. Additionally, many plan to reduce their hours within the next 12 months.

“This is quite the threat,” Salter said. “We don’t need fewer health care providers, we need more.”

To address the issue, WellSpan is looking at steps it can take to set itself apart from other systems in order to attract employees. That includes generous benefits packages offering sign-on bonuses, flexible schedules, educational assistance, flexible spending programs, and other perks.

“We’re really looking at how we can be the health care system of choice for people who are looking for a great place to work,” Salter said.

“We think the best way to do that beyond promoting personal well-being is to employ strategies that improve efficiency of practice and continue to develop our leaders for a culture of wellness.”

He noted that people who choose to work in health care do so out of a desire to help and serve others. When it becomes challenging to do so because of difficult work circumstances, employees become frustrated, and burnout sets in.

“It grieves me to see health care workers who are discouraged or even unable to work,” Salter

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“I got the position four months before the pandemic started, so it was challenging to be in a new role with all that was going on,” she said. “My challenge was to identify others within the system who were already doing the work I knew would be necessary. It was more important than ever that we make the well-being of our employees an immediate priority.”

Looking to chaplains, behavioral health specialists, holistic therapists, corporate wellness employees, and others, Collins quickly put together a team to address the needs of clinicians and other staff members who were struggling with ever-increasing challenges in the areas of patient care, increasing work hours, shortages of personal protective equipment, general uncertainty about the progression of the pandemic, and others.

They established a “Wellness for You” care for the caregiver initiative that provided self-care stations at COVID testing sites and hospital locations. These stations included stretching classes, snacks and drinks, and stress management resources for employees.

Behavioral health specialists and chaplains were dispatched to talk with staff members during their breaks, monitoring their well-being and addressing any needs.

“We continue to find ways to collaborate with groups across the health system that support employee well-being even beyond the crisis of the pandemic,” Collins said.

SUMMER 2022

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While some aspects of addressing employee health and well-being became easier as the worst of the pandemic subsided, many challenges remain. Ongoing staffing shortages continue to cause stress, resulting in discouragement and burnout among physicians and staff members across the board, Collins said.

Newer physicians — those who have been out of medical school for five years or less — are showing the highest burnout rates among doctors, according to Penn Medicine’s most recent survey of clinicians with the Well-Being Inventory (WBI). Newer nurses also are suffering, affected by the demands of longer hours, fewer nurses to care for patients, and other factors.

“Unfortunately, these newer employees may think about leaving the profession because they only know healthcare during a pandemic. We are hoping they hang on as we establish a ‘new normal,’” Collins said.

LG Health, which continues to look at ways to offer flexible scheduling options and increase compensation, has established a task force to address the issue of burnout among employees. Task force members conduct well-being rounds, asking employees how they are feeling and inquiring about their needs. The health system also increased the number of free counseling sessions available to staff through the Employee Assistance Program (EAP) from three per year to eight.

Contact: Anne M. Lusk, REALTOR® 717.291.9101 | aluskhomes@gmail.com | AnneLusk.com Each Office Is Independently Owned And Operated.

“That’s a fantastic move on the part of the health system,” Collins said. “And it’s not only for staff — it’s for their families, too.”

Lancaster County

Plans of Safe Care

Ultimately, Collins said, the goal is to help employees rediscover the reasons they chose health care as a career.

for substance affected infants and caregivers.

“People go into medicine for a reason,” she said. “I see our role as helping people get back to finding fulfillment in their work.”

LG Health participates in the American Medical Association’s Joy in Medicine™ health system recognition program, which is designed to guide organizations in improving employee satisfaction and reducing burnout. Completion of certain criteria earns an organization the designation of bronze, silver, or gold. While the health system applied for bronze designation earlier this year, Collins said it is ultimately working toward gold.

“The organization is striving for that goal,” she said.

There is much work still to be done, but Collins is optimistic that the efforts in place will help employees who are feeling stressed, anxious, and overworked to find increasing satisfaction in their jobs and feel supported.

“The pandemic has been really tough on the entire health-care profession, and I think we need to bring people back to finding a sense of joy in their work,” she said. “I’m hopeful we’ll do that, and people will rediscover why they went into health care in the first place.”

LANCASTER

Visit LancasterJoiningForces.org/LancMD or call 2-1-1

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L A N C A S T E R M E D I C A L S O C I E T Y.O R G

Legislative Updates

PENNSYLVANIA MEDICAL SOCIETY QUARTERLY LEGISLATIVE UPDATE

A

lot of legislation has been going on in Harrisburg in the last couple of months. There was a big win for international medical graduates in April when Governor Tom Wolf signed House Bill 245 into law, which establishes a licensing parity for graduates of international medical schools. This reduces the clinical residency requirement from three years to two years from IMGs to apply for a medical license.

PAMED championed this legislation and celebrated this win.

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SUMMER 2022

On May 17th, Pennsylvania held is primary election day and there were a lot of interesting results. One loss we saw was for House Appropriations Committee Chair Stan Saylor (R-York) by over 10 percent to his challenger. Another highlight to note, the race for the 86th PA State House District pitted incumbent Rep. John Hershey (R- Mifflin/ Juniata/Franklin) against incumbent Rep. Perry Stambaugh (R-Perry/Cumberland); Stambaugh won re-election in the new district by 10 percent.

As the legislative session neared its end in June, there was a lot of movement on bills we are keeping an eye on: Venue Rule (House Bill 2660) – Introduced by State Representative Rob Kauffman, institutes Constitutional amendment that will strip the Supreme Court’s ability to establish venue and place the matter in the hands of the legislature. While the Supreme Court has not acted on the proposed venue rule change, it continues to be a threat. PAMED supports the proposed amendment to keep the current venue rule in place.

Prior Authorization (Senate Bill 225) – The prior authorization bill, which reforms processes for prior authorization and step-therapy protocol, was unanimously passed in the PA State Senate. While this bill does not end the practice of prior authorization; it standardizes and streamlines the practices of prior authorization to allow physicians to return to treating patients, rather than spending time processing insurance requests. The bill now moves to the State House for consideration and PAMED will continue to advocate for its passage.

Pharmacists Performing Immunizations (House Bill 2679 & Senate Bill 511) – The temporary waiver issuing Pharmacists to perform vaccinations expired on June 30th. The Pennsylvania Pharmacists Association has been

advocating for a permanent position for pharmacists to perform all vaccines for children.

Working in coordination with the PA Chapter of the American Academy of Pediatrics, the PA Academy of Family Physicians, POMA, and the PA Chapter of the American College of Physicians, an agreement has been reached to allow pharmacists to administer seasonal flu and COVID vaccines to their customers aged 5 and above. The legislation, House Bill 2679, along with Senate Bill 511, contains the compromise language. At this time, it is uncertain as to what vehicle will be approved and sent to the Governor.

Mental Health Services (House Bill 2686) – Introduced by Rep. Wendi Thomas, this legislation aims to improve access to mental health care in Pennsylvania through the Collaborative Care Model, an integrated care model that can deliver timely psychiatric care in the primary care setting. This grant would create a program for small and solo practices to cover their Collaborative Care Model start-up costs, prioritizing those practices in rural and underserved areas of Pennsylvania. PAMED is in support of these services; the bill has been referred to the Health and Human Services Committee.

Fentanyl Strips (House Bill 1393) – This bill amends The Controlled Substance, Drug, Device and Cosmetic Act of 1972, which includes the definition of drug paraphernalia.

The Pennsylvania House of Representatives unanimously approved the bill which would legalize fentanyl test strips. PAMED supports this legislation; the bill has been referred to the Judiciary Committee in the Senate.

results will be sent to the ordering health care practitioner, at the time of any imaging service. PAMED supports this legislation and is awaiting approval from the Health and Human Services Committee. We remain hopeful that the bill will win final approval before the end of the legislative session in late November.

In addition, PAMED has written letters in support of the following: Primary Care Loan Repayment PAMED sent a letter to representatives in support of an increase in funding for the Pennsylvania Primary Care Loan Repayment Program in the 2022-2023 state budget.

Access to Vision Medications PAMED wrote a letter to the PA Senate Banking and Insurance Committee in support of Senate Bill 1201, expanding access to important sight-saving medicine by authorizing refills for prescriptions at 70% of the original length.

At the beginning of this year, PAMED launched a new legislative community platform. The platform is a way to get physicians more engaged with legislation and to provide an opportunity to keep up to date on regulation and calls to action.

Patient Test Result Information Act Amendment (House Bill 1280) – The proposed legislation amends the current Patient Test Result Information Act to remove the definition of “significant abnormality” and require diagnostic imaging entities to provide patients with written notice that their

For more information about any of the items mentioned above, please visit the Advocacy Section of PAMED’s web site at

www.pamedsoc.org/advocacy LANCASTER

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L A N C A S T E R M E D I C A L S O C I E T Y.O R G

Restaurant Review

IMAGE PROVIDED BY AND USED WITH PERMISSION OF RACHEL’S CAFE & CREPERIE

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SUMMER 2022

Rachel’s Cafe & Creperie reviewed by

MARCO CUNICELLI, DO

Penn Medicine Lancaster General Hospital Family Medicine Resident

I

first heard about Rachel’s Cafe & Creperie from the resident physicians at Penn Medicine Lancaster General Health. Everyone raved that it was Lancaster’s go-to place for brunch, and now I see why.

With its quaint location on W. Walnut Street, this full-service cafe gives off “local business” vibes with its eclectic décor. Not only that, but it proudly broadcasts an inclusive and welcoming environment for all individuals (pride flags in the windows, etc.). With both indoor and outdoor patio seating, there are options for whatever mood you are in or the weather conditions.

but not to be overlooked. The Nutella crepe is creamy and rich and sure to satisfy your sweet tooth —the perfect way to end your meal.

If none of these options pique your interest, there is a “build your own” crepe option. Add whatever you want! Another great thing about Rachel’s — it’s affordable. Dessert crepes will run you between $4-7 and savory between $8-11.

Now onto the food. I look forward to every trip to Rachel’s. The menu item that keeps bringing me back: the Oyler. Clearly the star of their menu, it is composed of a garlic-infused crepe stuffed with eggs, cheddar cheese, rib-eye steak, scallions, hot sauce, and hash browns.

What’s not to like? The savory flavors perfectly complement each other, providing protein, carbs, dairy, and fat to keep you energized all day. During my recent visit, I paired it with hash browns, which come as four to five quarter-sized circles. They were perfectly crispy, with just the right amount of “greasy.”

Some of the downsides: As you may expect, it can’t all be sunshine and rainbows. They do not take reservations or have call-ahead seating. This can make it difficult to get a table at times (especially during the brunch rush). To avoid this, I recommend placing to-go orders. Additionally, since the crepes are made fresh, it does take a little while to get your food. But don’t let the wait dissuade you from enjoying these delectable sweet and savory treats. Another minor inconvenience is their limited parking. Rachel’s has its own lot, but only a few cars can fit. The business also has shared parking at the lot across Water Street. Some of the signs say, “We share with Rachel’s,” which makes those spots fair game. Keep an eye on their hours as well. In true brunch-establishment fashion, they are only open from 8am-3pm. They are closed on Mondays.

I do not drink coffee, but my father paired his Oyler with a fresh cup of their coffee and raved about how strong and rich it tasted.

If you are a fan of black coffee, Rachel’s has you covered. Other options include chai tea lattes (a personal favorite of mine), juice, and sparkling water.

In summary, if you are looking to try a great breakfast restaurant with a welcoming atmosphere and delicious food made with high quality ingredients, look no further than Rachel’s. It is the perfect place for brunch with friends and the spot to bring friends and family visiting from out of town. You will not be disappointed.

Although the Oyler is by far my favorite crepe Rachel’s has to offer, I also tried the Thai Chicken crepe and was not disappointed. The hint of peanut butter takes your taste buds on an exotic journey. The Philly Cheese crepe is another one of my favorites, albeit a bit more basic. The dessert crepes are a little smaller than the savory crepes

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RACHEL'S CAFE & CREPERIE 201 W. Walnut Street, Lancaster, PA 17603 rachelscreperie.com | 717-399-3515

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Lancaster Physicians magazine.qxp_Layout 1 5/9/22 9:26 AM Page 1

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SUMMER 2022

Member Spotlight

News & Announcements

Where do you practice and why did you settle in your present location or community?

I practice at The Heart Group of Lancaster General Health. I have been with this practice since 2007.

We moved from New Jersey. My wife is a hematologist/oncologist, and both of us found excellent practice opportunities in Lancaster.

When we came to visit, we loved the area. We found this would be a wonderful community in which to raise our family and to practice medicine. Overall, our decision to move to Lancaster was driven by the practice opportunities and the community.

What do you like best about practicing medicine?

Medicine lies at the intersection of science and human interaction. The joy of practicing medicine lies in the ability to use science and technology to directly impact the quality of life of our patients. In interventional cardiology, we often see the results of our efforts relatively quickly (often immediately). I would say that my favorite aspect of practicing medicine is to help to improve symptoms and prognosis quickly.

Are you involved in any community, non-profit, or professional organizations? If so, please list the groups: I am a Fellow of the American College of Cardiology and a Fellow of the Society for Cardiac Angiography and Interventions.

What are your hobbies and interests when you’re not working?

Rupal Dumasia, MD

When I’m not working, I love to read and travel. In addition, I try to spend as much time as possible with our two children. We often do road trips as a family.

Section Chief, Interventional Cardiology, Lancaster General Hospital Penn Medicine Lancaster General Health

For what reason(s) did you become a member of the Lancaster City & County Medical Society and what do you value most about your membership?

Membership in the Society allows us to get to know other physicians in the community and share professional experiences. The social events of the Society allow physicians to get to know one another on a personal level outside of the hospital.

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L A N C A S T E R M E D I C A L S O C I E T Y.O R G

News & Announcements

Frontline Group Spotlight

Pennsylvania Specialty Pathology

TOP - Histology and office staff members (Top left – Melanie Gavlick, Office Manager; Standing 2nd from right – Chiemela Nwaobasi, Anatomic Pathology manager) BOTTOM – Technical lab staff, office staff and couriers.

Dr. Shashi Ariyanayagam-Baksh and Dr. Fabien Baksh, co-founders of the laboratory.

P

Pennsylvania Association of Pathologists, the Credentialing Committee of the PA Clinical Network of the Pennsylvania Medical Society and is the Pennsylvania State Laboratory Representative to the Novitas Contractor Advisory Committee. Dr. Shashi Ariyanayagam-Baksh is subspecialty Board certified in Dermatopathology and is President of the laboratory and the Director of Dermatopathology.

ennsylvania Specialty Pathology is an independent medical laboratory established in Lancaster on January 1st, 2008. It was founded by Dr. Fabien Baksh and Dr. Shashi Ariyanayagam-Baksh with the goal of filling a need for a physician-owned and managed local diagnostic pathology service. The laboratory provides diagnostic and technical-only anatomic pathology services to a wide range of practices in South-Central PA and beyond, including primary care and specialist physician offices, ambulatory surgery centers, small hospitals, and coroners. Services include biopsies, Pap smears, fine needle aspirations, non-gynecological cytology, and frozen sections, as well as molecular testing for infectious agents such as HPV and SARS-CoV2.

Physician-owned independent medical laboratories are a rare entity in a world of acquisitions and mergers. We enjoy the advantage of easily connecting with clients and patients and providing lower fixed prices for the uninsured, features unique to independent practices. We also pride ourselves on our ability to incorporate the best of different worlds: sub-specialization, detailed reporting, and access to advanced testing typical of academic centers and low costs (similar to prices at large national labs) to patients.

“The cornerstones of our practice are high quality, next-day results, low cost, and a personalized physician and patient-focused service,” states Dr. Fabien Baksh. Dr. Shashi Baksh adds, “We recognize that communication with our clinical colleagues is essential for collaborative optimal patient care, and to this end, we are easily accessible. Our twenty-five-member technical and office staff share our commitment to providing the best patient outcomes.” Dr. Fabien Baksh is fellowship-trained in Gastrointestinal Pathology and Surgical Pathology and is the Laboratory Director. He is on the Executive Committee of the

LANCASTER

Pennsylvania Specialty Pathology is proud to be a Frontline Group and an active member of the Lancaster City & County Medical Society and Pennsylvania Medical Society.

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You care for them like they’re your own.

We will, too.

Physicians whose pediatric patients need a higher level of care can take comfort knowing that the nationally recognized, specialty care of Penn State Health Children’s Hospital is now conveniently available right here in Lancaster County. The new Penn State Health Children’s Lancaster Pediatric Center offers a full spectrum of medical and surgical consultative care for children from infancy through age 18. It significantly expands access to the most advanced care in nearly every pediatric specialty and subspecialty.

Call 717-606-1170 to make a referral.

Learn more: pennstatehealth.org/lancasterpediatrics Penn State Health Children’s Lancaster Pediatric Center 1430 Harrisburg Pike Lancaster, PA 17601

CHI-18239-22 178787 052422

L A N C A S T E R M E D I C A L S O C I E T Y.O R G

News & Announcements

PA M E D AWA R D S

Top Physicians

under 40 P

ennsylvania Medical Society recently announced recipients of its annual Top Physicians Under 40 Awards. These annual awards are given to the best of the best early career physicians, nominated by their peers, and selected by a committee of PAMED members.

“With their ambition and innovative ideas, these candidates are more than qualified to be recognized with the top physicians’ award,” said F. Wilson Jackson, M.D., PAMED President-Elect and Chair of the award committee. “They will shape and shine bright in the future of medicine.”

This year’s list of honorees included five from Lancaster County: Ashley Kempsell, M.D., Family Medicine; Adam Lake, M.D., Family Medicine; James Lamberg, D.O., Critical Care Medicine (Anesthesiology); Laura Poskitt, D.O., Pediatrics; and Matthew Torres, M.D., Family Medicine.

DR. KEMPSELL is a family medicine specialist with Penn Medicine Lancaster General Health, where she also completed her residency. She is the managing physician of a nine provider and 10,000 patient practice in Ephrata. She actively works in significant leadership roles, namely as the chairperson of the patient experience committee at Lancaster General Health.

“Dr. Kempsell is dedicated to her patients both through work within the practice and in the Ephrata community. Along with other members of the practice, Dr. Kempsell serves as a school and team physician for Ephrata High School,” her nominator said.

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SUMMER 2022

DR. LAKE is a family medicine physician with Lancaster General Health, focusing on care for those who identify as LGBTQ+, those who are living with HIV/ AIDs, and those living with addiction and/or are in recovery.

During his tenure, he has been integral in developing a systemwide response to opioid use disorder and launching the Treatment Center of Excellence. Dr. Lake is an advocate for LGBTQ+ health and equity by partnering with Lancaster General Health and the LGBTQ+ Coalition of Lancaster and is the managing physician at Lancaster’s Ryan White HIV/AIDS clinic.

His nominator said, “Dr. Lake has been a tireless advocate of the underserved and unserved populations at both the system and community level.”

DR. LAMBERG is an anesthesiologist with Lancaster General Health and is a certified professional in Patient Safety to ensure his hospital, physicians, and colleagues excel and provide optimal patient care by instilling a just culture. He was a resident at Penn State Milton S. Hershey Medical Center and a board member of an education question bank striving to enhance learning in residents and fellows in Anesthesia. He also serves as the chair of the multidisciplinary peer review committee.

His nominator said, “Dr. Lamberg has always put patients first. Every step of the way he has gone above and beyond to ensure he is a model physician but also to encourage and teach others around him.”

DR. POSKITT is a pediatrician at the Clinic for Special Children in Lancaster County. She is passionate about advancing the treatment and care of rare genetic disorders and complex medical conditions. Dr. Poskitt works in providing affordable and compassionate care to largely uninsured members of the Amish and Mennonite communities.

Her nominator said, “Not only does she make affordable care more accessible for families, she also shares her knowledge with other physicians and scientists through her research.”

DR. TORRES is a family medicine physician with Penn Medicine Lancaster General Health, where he also completed his residency and opened a new family medicine site in an underserved area of Lebanon, PA. The practice filled a need in the area, caring for medical assistance patients and a large Spanish-speaking patient population. He has since transitioned into a much-needed role in the IT department at the practice in the medical innovation lab.

His nominator said, “I truly believe Dr. Torres will excel in the innovation IT role with the goal of advancement/promotion of health insurance in our community.”

To be eligible for the award, physicians must be PAMED members under the age of 40.

Learn more about all this year’s recipients, visit www.pamedsoc.org/top40.

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L A N C A S T E R M E D I C A L S O C I E T Y.O R G

News & Announcements

New Members Novisi Arthur, MD Neonatal Intensive Care, Women & Babies Hospital Paulina Bauer, DO Vittoria Boni, MD resident, Penn Medicine Lancaster General Hospital Alexander Cantu, MD resident, Penn Medicine Lancaster General Hospital Shiu Ho Chan, MD resident, UPMC Lititz

SUMMER TOURS AVAILABLE

Lei Alena Dagat resident, UPMC Lititz

AT LANCASTER COUNTRY DAY SCHOOL challenging academics are only the start of each student’s opportunities for personal discovery and growth. From preschool to 12th grade, LCDS students are able to develop established passions or try new activities in a supportive independent school environment.

Tyler Gillmen, DO Penn Medicine Lancaster General Health Physicians Anesthesiology

Schedule a tour today!

Lisa Golden, MD resident, Penn Medicine Lancaster General Hospital

www.Lancastercountryday.org | 717-392-2916

YOUR CANCER FIGHT IS OUR CANCER FIGHT

Nicholas Lefevre resident, UPMC Lititz Dorothy May, MD Drs. Eichenlaub & May Veronica Merelo, MD Dermatology Physicians, Inc. Ruhani Nanavati, MD resident Conor O’Day practice administrator, Penn Medicine Lancaster General Health Physicians Family Medicine Lititz Ben Roitberg, MD Devin Shanker, DO resident Christine Shind, DO resident, UPMC Lititz Christine Skiadas, MD JonathanTriantafyllou, MD

Dale Gozum, DO resident, UPMC Lititz

Adam Tuchinsky, DO resident, UPMC Lititz

Patrick Helm practice administrator, Manning Rommel & Thode

Michael Viray, MD The Heart Group of Lancaster General Health

Reinstated Members Lindsi DeArment, DO Highlands Family Practice Hiep Phan, MD General Surgery of Lancaster

H. Peter (Tracy) DeGreen III, DO and Lena Dumasia, MD

Cancer is an unexpected and unwanted illness. It will change your life forever in a way that no other illness can. Together, we found that treating the cancer as well as supporting the patient and their well-being, provides the ultimate outcome in winning the fight.

Varia Vasilliadis, DO Penn Medicine Lancaster General Health Physicians Geriatrics Ashima Vaswani, MD UPMC Pinnacle Anesthesia Services

New patients and second opinions will be seen within 24 hours, call 717.291.1313.

703 Lampeter Rd. • Lancaster, PA 17602 LancasterCancerCenter.com • (717) 291-1313 On-site Laboratory | Physician Directed Dispensary | Support

LANCASTER

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SUMMER 2022

FRONTLINE GROUPS SUMMER 2022 Frontline Practice Groups have made a 100% membership commitment to LCCMS and PAMED. We thank them for their unified support of our efforts in advocating on your behalf and facilitating an environment for physicians to work collaboratively for the benefit of the profession and patients.  A lere Family Health LLC  Allergy & Asthma Center  Argires Marotti Neurosurgical Associates of Lancaster  Avalon Primary Care  Campus Eye Center  Community Anesthesia Associates  Community Services Group  Conestoga Eye  Dermasurgery Center PC  Dermatology Associates of Lancaster Ltd  Dermatology Physicians Inc  Drs Eichenlaub & May  The ENT Center  Eye Associates of Lancaster Ltd  Eye Health Physicians of Lancaster  Family Eye Group  Family Practice Center PC - Elizabethtown  General Surgery of Lancaster  Glah Medical Group  Hospice & Community Care  Hypertension & Kidney Specialists  Lancaster Cancer Center Ltd

                

ancaster Cardiology Group LLC L Lancaster Ear Nose and Throat

Lancaster Family Allergy

Lancaster Plastic Surgery

Lancaster Radiology Associates Ltd

Lancaster Skin Center PC

Manning Rommel & Thode Associates

Medical Cosmetics LLC

Neurology & Stroke Associates PC

Ouilikon Medical Associates PC

Patient First - Lancaster

Penn Medicine Lancaster General Health

Care Connections Penn Medicine Lancaster General Health

Physicians Diabetes & Endocrinology Penn Medicine Lancaster General Health

Physicians Family Medicine Lincoln Penn Medicine Lancaster General Health

Physicians Family Medicine Manheim Penn Medicine Lancaster General Health

Physicians Family Medicine New Holland Penn Medicine Lancaster General Health

Physicians Family Medicine Norlanco

 P enn Medicine Lancaster General Health Physicians Family Medicine Susquehanna  Penn Medicine Lancaster General Health Physicians Lancaster Physicians for Women  Pennsylvania Specialty Pathology  Randali Centre for Aesthetics & Wellbeing  Retreat Behavioral Health  Stephanie A Mackey MD  Union Community Care - Duke St  Union Community Care - Hershey Ave  Union Community Care – Kinzer - Church St  Union Community Care - New Holland Ave  Union Community Care - Water St  UPMC Express Care  UPMC Lancaster Arthritis & Rheumatology Care  UPMC Pinnacle Breast Health Associates  UPMC Pinnacle Manheim Pike Primary Care  UPMC Pinnacle Plastic & Aesthetic Surgical Associates

LCCMS EVENTS 2 0 2 2 Wednesday, August 17

Docs, Drinks & Dialogue: Hot Topics for Women Physicians 6:30 p.m.

Tuesday, August 30

Thursday, September 15

Annual Dinner & Awards Celebration 6 p.m. | The Inn at Leola Village

Wednesday, September 28

Legislative Breakfast

Docs, Drinks & Dialogue: Walk & W(h)ine

7 a.m. | Lancaster Country Club

7 p.m.

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Friday, October 21 & Saturday, October 22 PAMED House of Delegates

Saturday, December 3

Holiday Social & Foundation Benefit 6:30 p.m. | Lancaster Country Cllub

WHY MAGEEWOMENS? Because we’ve been caring for women and their families for more than 110 years.

With the region’s largest network of ob-gyn experts, UPMC Magee-Womens provides comprehensive care for women of all ages. And with many locations close to home in central Pa., women can easily find the routine or specialized care they need when they need it. To learn more, visit UPMC.com/WhyMageeCPA.