The Berks County Medical Society Medical Record Spring 2013

Medical Record spring 2013

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B e r k s

C o u n t y

M e d i c a l

S o c i e t y

The Changing Face of Medicine-

IMGs in the United States IMGs in the United States....................................12 Legislative & Regulatory Updates.......................20

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Medical Record

of the Berks County Medical Society

A Quarterly Publication To provide news and opinion to support professional growth and personal connections within the Berks County Medical Society community.

The Berks County Medical Record

Lucy J. Cairns, MD, Editor Editorial Board

Margaret S. Atwell, MD Charles Barbera, MD Betsy Ostermiller Bruce Weidman

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Berks County Medical Society Officers

Pamela Q. Taffera, DO, MBA, President Kristen Sandel, MD , President-Elect D. Michael Baxter, MD, Chair, Executive Council Michael Haas, MD, Treasurer Andrew Waxler, MD, Secretary William C. Finneran III, MD, Immediate Past President Bruce R. Weidman, Executive Director Publisher: Hoffmann PUBLISHING Group, Inc. Reading, Pa | 610.685.0914 | hoffmannpublishing.com For advertising information contact MedAds@nhgi.net or visit hoffmannpublishing.com/media Berks County Medical Society, 1170 Berkshire Blvd., Ste. 100, Wyomissing, PA 19610 Phone: 610.375.6555 | Fax: 610.375.6535 | Email: info@berkscms.org

The opinions expressed in these pages are those of the individual authors and not necessarily those of the Berks County Medical Society. The ad material is for the information and consideration of the reader. It does not necessarily represent an endorsement or recommendation by the Berks County Medical Society.

Manuscripts offered for publication and other correspondence should be sent to 1170 Berkshire Blvd., Ste. 100, Wyomissing, PA 19610. The editorial board reserves the right to reject and/or alter submitted material before publication.

All manuscripts and letters should be typed double-spaced on standard 8 1/2"x11" stationery.

The Berks County Medical Record (ISSN #0736-7333) is published four times a year in March, June, September, and December by the Berks County Medical Society, 1170 Berkshire Blvd., Ste. 100, Wyomissing, PA 19610. Subscription $50.00 per year. Periodicals postage paid at Reading, PA, and at additional mailing offices. POSTMASTER: Please send address changes to the Berks County Medical Record, 1170 Berkshire Blvd., Ste. 100, Wyomissing, PA 19610.

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Cover Photo by Barton Smith, MD

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President’s Message A message from Pamela Q. Taffera, D.O., M.B.A.

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The Changing Face of Medicine: IMGs in the United States

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By Lucy Cairns, MD

A World of Birds

By Barton Smith, MD

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Installation Update New officers installed and 50 Year Members honored in January 2013

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Retired Surgeon’s Meaningful Hobby Surprises, Benefits Others A family tradition contributes to area charities

Departments: Editor’s Comments ............................................................................................................................................................... 6 Alliance Updates................................................................................................................................................................. 26 Calendar of Events.............................................................................................................................................................. 29 Legislative Updates............................................................................................................................................................. 20 Practice Administrator’s Update.......................................................................................................................................... 21 Department of Family Medicine........................................................................................................................................... 25 MEDICAL RECORD

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EDITOR’S COMMENTS

Lucy J. Cairns, MD, Editor

A

s winter begins to lose its grip on Berks County, I’m sure I am not the only one eagerly anticipating the more generous helping of light, warmth, and color that is just around the corner. It was just these qualities in the image adorning the cover of this issue that led me to select it from the photos submitted by members as possible cover art. This rooster, strutting its stuff in the sun, caught the eye of Dr. Barton Smith at a farm near Lake Ontelaunee.

An avid and accomplished birder, Dr. Smith also submitted an article which effectively coveys his enthusiasm for the subject.

It will be followed in future issues by descriptions of the best birding sites in Berks County and helpful internet sites for bird-watchers. We can look forward to more of his photos of bird life and invite other members to submit their own local bird photos.

For this issue’s feature article, I delved into the subject of the contributions physicians from outside the U.S. have made to American health care. For many decades the U.S. has not trained enough home-grown doctors to meet the needs of the population. Of physicians currently practicing here, approximately one out of four graduated from a nonU.S. medical school. The importance of these International Medical Graduates (IMGs) is highest in primary care specialties. According to a 2009 report by the AMA, 37%

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of internists and 28% of pediatricians were IMGs. Another key fact is that IMGs are more likely than U.S. graduates to settle in rural, inner city, and other medically-underserved areas, since for many this is a requirement for obtaining permanent residency in the U.S. Changes in the works both here and abroad are almost certain to diminish the opportunities for IMGs in the U.S., with implications for access to medical care for underserved populations. Six International Medical Graduates who now call Berks County home agreed to share their stories for this article. I thank them for their generosity and guarantee you will find this section of the article illuminating.

Pamela Q. Taffera, D.O., M.B.A., of the St. Joseph Regional Health Network, is the new leader of the Berks County Medical Society for 2013. Be sure to read her installation address to understand her commitment to re-energizing the Society’s activities promoting the interests of members and improving the health of Berks County. In his article in the Winter Medical Record, Dr. Michael Baxter succinctly highlighted the findings of the recent “Berks County Health Needs Assessment Report.”

As he pointed out, this report should be seen as a call to action to address unmet needs in our community. Now it is up to all of us to follow Dr. Taffera’s leadership and make 2013 a healthier year for Berks County. n

The Berks County Medical Society invites you to attend the fourth annual

Memorial Lecture In honor of physicians who dedicated their professional lives to serving the health care needs of our community.

This will be held in conjunction with Residents’ Day, Friday, April 12, 2013 in BVNA Auditorium.

Rachel Masch, MD, MPH will be our speaker for the fourth annual Memorial Lecture. Dr. Masch attended Brown University where she majored in International Relations. Following her work with the World Health Organization in Switzerland, Dr. Masch returned to Brown University School of Medicine.

Her internship and residency were completed at The Reading Hospital and Medical Center. Dr. Masch is now on the faculty at New York University School of Medicine. Dr. Masch continues to pursue her love of teaching, research and global health, as well as her private gynecology practice at The Concorde Medical Group. Dr. Masch’s talk will be “Screening and Prevention in LowResource Settings.” A Buffet lunch will be available prior to the presentation.

Please RSVP to BCMS at 610-375-6555 or email at info@berkscms.org

by April 8, 2013.

Schedule of Events for Resident’s Day and the Memorial Lecture 10am-11am Review of Residents’ Posters 11am-11:45am Presentation of Winning Abstracts 11:45am- 12:15pm Buffet Lunch

12:15pm -1:00pm Presentation by Rachel Masch MD, MPH Please RSVP to BCMS

by April 8 610-375-6555 or e-mail info@berkscms.org

president’s message

Pamela Q. Taffera, D.O., MBA

L

et’s take a moment to remember those who have gone before us in our amazing profession. This year, the life of Dr. John Mauger Kearney is to be celebrated. He was 86 years old when he passed on January 17, 2013. Dr. Kearney was born and raised in Reading, attended Albright College and the University of Pennsylvania, and was a beloved surgeon at Community General and Saint Joseph Medical Center. He served as President of the Berks County Medical Society in 1974 with passion and dedication to service. 39 years later I am honored to stand before you and serve our county medical society.

Many thanks to honored guests who were able to attend the installation: 50 year members of the medical society, Mr. John Morahan, President and CEO of Saint Joseph Medical Center, and his lovely wife, Ann; Dr. Howard Davis, CMO of Saint Joseph Medical Center, and his lovely wife Wendy; Mr. Mario Lanni, Executive Director of the Pennsylvania Osteopathic Medical Association; Mr. Bruce Weideman and Ms. Betsy Ostermiller, executive director and assistant to the medical society; past presidents of the Berks County Medical Society; current executive council members; and my amazing Dad, Sandy Taffera, tailor by trade and forever hero to his little girl.

It was an honor to be installed as the 165th president of the Berks County Medical Society. Our profession is a blessing; I couldn’t imagine a more exciting or terrifying time to be a part of it, as healthcare continues to dramatically transform. Each day I am given the opportunity to work with young, bright, inspiring, and motivated students and doctors of the millennial generation, who teach me about balancing life and medicine. As I looked around the room at the installation breakfast this past January, I saw it filled with multiple generations of physicians, all leaders in different ways. So many of them had mentored me and continue to guide my path and career. Thank you.

I never, ever intended to move to Berks County. And I certainly never envisioned myself settling here. As a medical student at the Philadelphia College of Osteopathic Medicine, I knew exactly what I was looking for in a residency program—unopposed family medicine with dedication to osteopathic philosophy, leadership that was inspiring, motivated and forward thinking, and all of this in

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a major US City. I remember the day I called Dr. Margaret Wilkins to tell her that her family medicine residency had everything a young doctor was looking for. And, that I was a city girl, so I was going to need her to go ahead and move Saint Joseph Medical Center to Philadelphia. A few short weeks later, I can also recall a conversation I had with my father. Dad and I always spent small quiet moments taking on the world’s greatest challenges. This most often happened on trips to the grocery store. Dad and I picked out fresh Italian Bread for Sunday dinner and he told me “You followed your heart to The University of Scranton, and to Philadelphia College of Osteopathic Medicine.

Maybe you should follow it to Saint Joe’s in Reading. Your heart hasn’t steered you wrong so far…”

Demille said: “No trumpets sound when the important decisions of our life are made. Destiny is made known silently.”

Over the last 7 years I have fallen in love with Berks County, I’ve grown to appreciate its culture and history. I’ve developed deep friendships, fallen in love, learned so much about myself. It is the people of Berks that have driven me to stay and start growing roots here. I’ve become dedicated to my population of patients who desperately need better access to care. I’ve been inspired by the leaders in medicine, many in this room, who have both witnessed and caused the transformations of healthcare. I’m blessed by amazing partners who share passion for teaching and supporting a younger generation of doctors through the rigorous educational process. I’m thankful for the talents physicians who provide specialty and subspecialty care to the patients of Berks County. Every day I get to be a part of the healthcare team that “raised me” in medicine. I’m continually inspired by the students, residents, nurses, therapists, specialists, case managers who advocate for patient care. My Jesuit education reminds me: “To whom much is given, much is expected.”

This county has two amazing hospital systems with multiple generations of physicians and healthcare teams working towards improving the health of Berks County.

The vision of the Berks County Medical Society speaks to these goals. The Berks County Medical Society will be the vessel by which the gaps are narrowed between these generations and they can learn from each other. Our county medical society has outstanding and vast vision!

January 20th 2013 felt like an amazing day for me, as I took the oath of the Berks County Medical Society President, but I do believe there was another president who took oath on that chilly January morning, filled with shining sun and hope for a better future. His challenges are far greater than mine, but I am hopeful that we both aggressively address our incredibly broken health care system. As President Obama took oath for his second term as president of the United States, may we all stand united together to face the challenges before us. The young doctors growing before us deserve to love their careers as much as I know the seasoned physicians of Berks County do.

Dramatic change and action is necessary! We must stop diagnosing metastatic cancer in our emergency rooms. Primary Care must move to the Patient Centered Medical Home, and value must be placed on our primary care physicians. Their reimbursement must reflect this.

We must have the most important conversations with our patients and their families so that we stop futile spending in the last days of life. Brilliant young minds should not be terrified to attend medical school or nursing school

because of the exorbitant debt load. Our legislators need not only to hear but to address our concerns and advocate for physicians and patients窶馬ot for big business and private insurance. Our medical society can provide the medium for these conversations. I look toward 2013 and years beyond with optimism and hope for healthcare and wellbeing in Berks County. While I never intended to move to Berks County, I am privileged to be here and thank you for the opportunity to serve. My roots continue to dig deeper into the soils, and I am honored to serve as the 2013 Berks County Medical Society President. n

In memory of

Dr. John Mauger Kearney 1927-2013

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A World of Birds

By Barton Smith, MD

Birds are all around us,

I

f you were to start from scratch and create “this wonderful world” (as Charles Darwin called it), you might inhabit it with a thousand varieties of colorful creatures possessing distinct “personalities”, the ability to sing and fly, and able to live anywhere on earth including habitats incompatible with human life. This is a seemingly impossible task but one already done by evolution, the astounding mechanism of natural invention.

Birds are all around us, and if we pay attention, our lives can be greatly enriched by knowing them. In cities such as Reading, besides English sparrows, starlings, and rock doves (to give “pigeons” their proper name), you could see from time to time peregrine falcons, 2 types of vulture, nighthawks, and monk parakeets among others. This past fall, the first sighting in Berks County of a rare inhabitant of the tundra, the Northern Wheatear, occurred on the railroad tracks beside the Reading Area Community College campus.

In the suburbs the variety of species is more numerous.

My yard in Wyomissing Hills, just a few blocks from Walmart, is visited regularly by the usual “feeder birds”

and if we pay attention, our lives can be greatly enriched by knowing them. such as cardinals and chickadees, but seasonally some remarkable visitors such as the rose breasted grosbeak, red breasted nuthatch, purple finch, sapsucker woodpecker, and red shouldered hawk (not the common red tailed hawk which is a permanent neighborhood resident) appear.

Occasionally the great horned owl comes to the yard, but regularly it can be heard at night. Overhead, bald eagles and osprey do the occasional “flyover”, as do the white crowned night herons which have bred in various areas of the western Reading suburbs for years. There are very few night heron rookeries in our state, but they seem to be content to return here regularly. My best “yard bird” ever was the rare red cockaded woodpecker that came to the long leaf pine tree in our yard in Fort Benning Georgia the first day we moved in 1969.

To make your yard bird friendly, use native flowers, shrubs, and trees in your landscaping. Like us, birds need food and lodging, and thrive best in the type of environment in which their species has evolved. Bird feeders with a variety of seeds should be nearly covered and away from windows. I find shelled sunflower seeds are liked by the birds and not having the shells keeps the feeder area clean.

A bird bath, kept clean, and heated in the winter is popular with all the species.

On your travels, the new birds you see can seem exotic, and may define a trip for you. In Antarctica the penguins steal the show; in Arizona the roadrunner will amuse; in Africa the secretary bird, in New Guinea the various birds of paradise, and on the plains of Hungary the great bustard, violet breasted roller, and European bee-eater will keep you looking—all at no extra charge! Start looking today. n (There will be follow up articles on good birding sites in Berks County, and on internet sites to help your birding.)

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The Changing Face of Medicine: IMGs in the United States

By Lucy Cairns, MD

T

he U.S. physician workforce is over 800,000 strong, thanks in no small part to graduates of medical schools outside the U.S. IMGs (International Medical Graduates) who are not U.S. citizens at the time of entry to medical school comprise almost 20% of all physicians practicing in our country.

The term ‘IMG’ also refers to U.S. citizens who attend medical schools outside the U.S. and Canada, but in this article I will be examining the issue of non-U.S.-born graduates who come to our country for their postgraduate medical training . I will discuss the special role played by IMGs in our health care system, the hurdles such individuals must overcome to qualify for training and working in the U.S, and coming changes that may constrict future opportunities for this group of physicians. This article is followed by brief profiles of a few of the many IMGs who currently call Berks County home and provide medical care to our community.

The organization at the center of the process enabling IMGs to train in the U.S. is the ECFMG (Educational Commission for Foreign Medical Graduates). It was formed in 1956 to certify those IMGs who meet qualification standards to enter U.S. training programs.

In the years following the end of WW II, demand for physician services in the U.S. rose, but in 1958 there were only 6,861 U.S. graduates for 12,325 internship positions.

In 1959 a report from the Surgeon General’s office (the Bane Report) projected a huge physician shortage. Thus, the demand for IMGs and the need for the ECFMG. Current members of the ECFMG are: the American Board of Medical Specialties, the AMA, the AAMC, the Association for Hospital Medical Education, the Federation of State Medical Boards of the U.S., Inc, and the National Medical Association. The ECFMG is headquartered in Philadelphia.

The Bane Report recommended federal subsidies for medical education to increase the supply of U.S. graduates, and legislators took note. With federal and state support, existing medical schools expanded class sizes and many new schools were opened. In 1980, 18,200 students started medical school and the number

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of graduates had doubled compared to 1965. In 1979 the GME National Advisory Committee warned of an impending doctor glut and government funding decline.

U.S. medical school enrollment has remained fairly flat ever since. The entering U.S. medical school class of 2011 numbered 18,655.

Despite the increase in U.S. graduates, the need for IMGs to fill ‘surplus’ residency positions and join the domestic physician workforce has persisted. Between 2001 and 2007, the number of IMGs coming to the U.S. actually increased each year. Recently, approximately 7,000 IMGs have entered the country annually and most remain here to practice.

ECFMG certification is a prerequisite for entry into ACGMEaccredited GME programs, as well as for taking Step 3 of the U.S. Medical Licensing Exam and obtaining a state medical license. In order to qualify for ECFMG certification, an individual must: 1. Attend a medical school (of at least 4 years duration) listed in IMED. The International Medical Education Directory lists schools around the world recognized by local governments as authorized to confer a

medical degree. The ECFMG verifies the applicant’s diploma and transcript.

2. Successfully take the USMLE Step 1 and Step 2 examinations. Spoken English Proficiency is a subcomponent of the Step 2 CS. Aspirants face rather long odds in this process.

Between 1986 and 2005, only 57.2% of those who applied to take the first exam with ECFMG achieved certification in the end. And only 40.6% of certified IMGs who applied to U.S. GME programs in 2012 matched to a position.

Graduates of U.S. schools match at a rate close to 100%, so the opportunities for IMGs tend to be in specialties less favored by U.S. graduates. About 40% of IMGs train for careers in primary care, compared with only about 20% of U.S. graduates. Roughly 75% attain board certification, and a similar percentage of IMGs currently practicing in the U.S. have become citizens.

Once an IMG has matched to a residency program, he or she must obtain a visa to enter the U.S. Historically, the J-1 Visa has been the key to entry. The J-1 is an Exchange

Visitor non-immigrant visa available to individuals approved for work—and study—based exchange visitor programs. Holders of such visas are eligible to remain in the U.S. for up to seven years to complete their training, but are then required to return to their country of origin for two years—unless they obtain a waiver from the U.S. Department of State.

One widely-used waiver program originated in 1994 as the “Conrad State 20” program. It was created to allow each state health department to request up to 20 J-1 waivers per year, for the purpose of placing physicians in underserved or shortage areas for a 3-year commitment.

In 2002 the number of waivers available to each state was increased to 30 per year. Every state utilizes this program, since few U.S. graduates are willing to work in these primarily rural or inner city locations. In the fall of 2012, a 3-year extension of this program as signed into law by President Obama.

An “interested government agency” may also request J-1 visa waivers. Agencies such as the USDA, HUD, HHS, the VA, and the Appalachian Regional Commission have made such requests in exchange for commitments to practice in underserved areas for a minimum of three years. However, after years of being the major sponsor of J-1 waivers, the USDA announced in 2002 that it was ending its involvement, primarily due to its inability to perform the extensive background checks needed in the wake of the 9/11 attacks. It was this development that prompted the expansion of the Conrad State program in 2002.

An alternative to the J-1 visa program is the H-1B Visa program, under which an employer may sponsor

Recently, approximately

7,000 IMGs

have entered the country annually and most remain here to practice.

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To receive the top-notch medical training available in the U.S. and then to make a life here as a citizen is the dream of many IMGs. It is a dream likely to become more difficult in the near future, however.

‘temporary specialty occupation’ workers for up to six years. Advantages of the H-1B program include lack of the return-home requirement and the ability to apply for permanent resident status while on the visa. However, compared to the J-1 program, the H-1B is much more expensive for the employer, has a shorter eligibility period, and no authorization to allow a spouse to work in the U.S. Once an IMG receives a J-1 waiver and a state medical license, he or she is eligible to apply for an H-1B visa. A person holding an H-1B visa may initiate the process of applying for permanent resident status (a green card) and, if successful, may eventually attain citizenship.

To receive the top-notch medical training available in the U.S. and then to make a life here as a citizen is the dream of many IMGs. It is a dream likely to become more difficult in the near future, however.

One major factor likely to reduce opportunities for IMGs in the U.S. is the current push to once again increase the number of graduates from U.S. medical schools. The doctor glut predicted in 1979 never materialized, and in 2006 the issue came full circle once again when the Association of American Medical Colleges called for increasing enrollment a full 30% above 2002 levels—in response to yet another predicted doctor shortage. A total class size of 21,434 would be required to meet this goal. Another round of class size expansion and the opening of new schools is underway. More and more U.S. students are going abroad for medical school as well.

What is not happening is a commensurate increase in

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post-graduate training positions. Unless funding is found to support thousands of new residency positions, non-U.S. IMGs will be squeezed out of the system as the number of U.S. citizens graduating from medical school approaches the number of available GME spots.

The benefits to an IMG of training and working in the U.S. include the high quality of the education in U.S. GME programs, the technological and other resources available to physicians in our healthcare system, the opportunity to earn a good living, and, for some, escaping a less desirable political climate. These advantages gained by individuals who emigrate come at a cost to the home country, however, in those cases where skilled professionals are in short supply back home.

One attempt to address this problem is embodied in the WHO Global Code of Practice on the International Recruitment of Health Personnel, which was adopted in May 2010 by 193 member states of the World Health Association. This Code sets forth voluntary guidelines for national policies, creates a framework for monitoring and sharing information on this issue, and calls for coordinated efforts to develop the local healthcare workforce in areas of critical shortage. One example of such an effort is the U.S.’s involvement in a collaborative initiative to transform medical education at selected schools in Africa. Ongoing implementation of this Code should help ensure that the U.S. can continue to benefit from the contributions of International Medical Graduates in a fashion that does not place a burden on the countries of origin. n

Dr. Sharma’s story Pat Sharma, MD, came to the U.S. 41 years ago from Bangalore, Karnataka State, which borders the Arabian Sea in southern India. He attended Government Medical College in the city of Bellary. Early in his life, even before entering medical school, he developed the desire to become a surgeon. His motivation in part was the result of being mentored by an American surgeon who was engaged in medical missionary work in India.

His introduction to the mentor was unique. When Dr. Sharma was a high school student, his brother was suffering from pulmonary tuberculosis and needed a lobectomy. The surgeon scheduled to perform this procedure was the above-mentioned American (a Texan). He appeared larger-than-life to the young Pat Sharma, who nevertheless found the courage to ask if he could watch the surgery.

Amazingly, the surgeon said yes! The surgical procedure was quite fantastic—like a well-run orchestra—and the young high school student was hooked. He made a straight run towards becoming a surgeon and never looked back. He continued to seek and get mentorship and advice from the surgeon throughout his college and medical school years. His motivation to come to the U.S. was due in part to the influence of the mentor and in part due to a lack of good post-graduate training programs in India at that time (the early 1970’s).

schedule while also meeting family expectations both in the U.S. and

Dr. Sharma’s training in the U.S. took place at Cook County Hospital

back home. The support that allowed him to persevere came mainly

in Chicago, Illinois and in New York City at hospitals affiliated with

from other physicians from India, who knew exactly what he was going

New York Medical College. He practiced vascular surgery in New

through and who made a point of looking out for each other. Over time,

York for 15 years, also teaching at New York Medical College during

his professional success exceeded his expectations and validated his

the last 5 years of his stay in New York. A job opportunity prompted

decision to make the difficult transition to a career in the U.S.

him to move from New York City to this area about 20 years ago, and

Dr. Sharma’s advice to young International Medical Graduates who

the people of Berks County have been benefiting from his skills as a

are currently making this transition is: “Consistent good performance,

vascular surgeon ever since.

citizenship, and tolerance will lead to your gaining acceptance and

During his early years in the U.S. Dr. Sharma dealt with homesickness,

respect from the public and from your professional colleagues more

and the challenges of adapting to a new diet, new culture, and surgical

readily in the U.S. than in any other place in the world. No other

training were compounded by the need to maintain his rigorous work

country will afford you better opportunity and fairer treatment.”

Dr. xu’s story Dr. Xu was born and raised in Shanghai, China. She entered the Shanghai Medical University at the age of 18, completing the

bio-medical research on cystic fibrosis in a lab at the Children’s Hospital of Philadelphia (CHOP).

5-year M.D. course and then a 3-year residency in Pediatrics.

Dr. Xu knew little English upon her arrival, but her colleagues in

For several years afterward she was on the faculty of the

the lab spoke only English, so she learned quickly. Her employer at

pediatric hospital affiliated with Shanghai Medical University.

CHOP sponsored Dr. Xu for permanent residency status (also referred

Her life changed when her husband left China for Philadelphia

to as a green card). Subsequently her husband, Lin Li, also obtained a

to pursue Ph.D. studies in Materials Science at the University

green card, and within a few years both became U.S. citizens. It was

of Pennsylvania. Six months later Dr. Xu was able to rejoin her

during the years Lin was a Ph.D. student that this young immigrant

husband, having been hired under a visiting scholar visa to do

family welcomed a native-born U.S. citizen to their home—their son

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Daniel. Help with child care from Daniel’s grandparents enabled Dr. Xu to continue her research.

Dr. Xu arrived in Berks County in 1995, as a result of Lin’s accepting a position with Carpenter Technology after his graduation. Commuting to Philadelphia, where so many bio-medical research jobs are, was not practical with a young child at home, so Dr. Xu looked for an opportunity in Berks County. She attended a Volunteer Fair at the Reading Hospital, and was attracted by a chance to spend time in the hospital’s Pediatric Clinic. Her duties were restricted to escorting patients from the waiting room to the exam rooms, but her time in the clinic and the friendships she formed with the staff led her to decide to return to clinical practice.

This meant she must pass the U.S. Medical Licensing Exam and complete a 3-year U.S. residency program, even though she had completed training and practiced for years in China. She fulfilled these requirements, successfully completing the Family Medicine residency program at the Reading Hospital and Medical Center.

In the years since Dr. Xu and her family moved to Berks County, her husband has built his own business designing and manufacturing electronic devices. Daniel enjoyed a good childhood in Berks County and, upon graduation from high school, was accepted into the Huntsman Program at the University of Pennsylvania. Students in this program earn a B.S. in Economics from the Wharton School and a B.A. in International Studies from the School of Arts and Sciences.

Daniel has now launched his career in Boston, Massachusetts. The

been warmly received by the community as an established medical

family travels to China regularly. When Dr. Xu is not working and not

professional. With a smile, she recounts how one of her patients

visiting China, she enjoys cooking, reading, shopping, and swimming.

remarked to her (also with a smile), “Whoever would have thought

Dr. Xu has been providing primary care in Berks County since 2001.

I would have a little Chinese lady as my doctor!” Doubtless all her

Her busy office, Berks Family Physicians PC, serves a large patient

patients are grateful that she decided to practice medicine in Berks

population in the Blandon area. As an independent private practitioner,

County, and that she successfully persevered through the long and

Dr. Xu works very hard managing her practice in addition to caring

arduous process necessary to achieve her goal of providing primary

for her patients, but the rewards make it all worthwhile. She has

care to people of all ages.

Dr. Mengnjo’s story I

was

and

high school, through succeeding in a stiff competitive examination. I

Meluf-

graduated 7 years later with an MD diploma. I then entered the Cameroon

Kumbo, a small locality

civil service to fulfill my legal obligation. For 3 years I worked as a general

of

200,000

practitioner in Yaounde Central Hospital, the largest community hospital in

in

the

the city of Yaounde. It was during my time in this hospital that my interest in

North West province of

nephrology deepened, as I watched many of my patients die because the

Cameroon. Cameroon

only nephrologist in the hospital had been handicapped by a stroke. Any

is a country of about

aspiring nephrologist in Cameroon had to be trained outside the country,

20

as that particular sub-specialty was not being offered locally.

raised

born in

about

inhabitants

million

nestled

gulf

I travelled with my wife, Therese, and daughter, Jill, to the US in

coast of Africa. I entered the Faculty of Medicine and Biomedical Sciences

2003 on the Diversity Lottery or DV program after being one of the lucky

of the University of Yaounde (a.k.a. Universite de Yaounde I) right after

winners. It was difficult for my parents to see me leave, as I was the pillar

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the

on which most of my extended family leaned for financial support after my

the U.S. live. We are still learning a lot about living and working in the

medical school training. I had no problems with English, except for the

Reading area. On my few days off, I take trips with my family, not only

need to become attuned to the American accent. English and French are

to visit friends back in the NY/NJ and Washington DC areas, but also to

considered the official languages of Cameroon (though the country has

discover what the surrounding communities have to offer. My family has

over 200 local languages). My first job in the US was in housekeeping

come to enjoy local foods immensely and we never miss an opportunity to

in one of the local hospitals. This position allowed me to observe how

savor the local dishes in the restaurants and food stores. We also attend

hospital medicine was practiced in the U.S. None of my co-workers in

church services whenever possible. My best moments are when I am at

housekeeping ever knew that I was a trained physician, as I operated

home lazing around with my three kids, Jill (10), Ryan (3) and Ron (2).

discretely. My wife worked as an aide in a nursing home. I worked and

Of all the challenges I have faced since arriving the US about 10 years

studied for the USMLE board exams at the same time. Life was so tough with our meager wages that we decided to send our daughter back home to Cameroon.

It was in the middle of studying for the USMLE boards that I nearly lost my wife to a

ago now, the most difficult was keeping a

My best moments are

cool head when my wife was involved in the

when I am at home lazing

preparing for the step 2 CS and CK USMLE

around with my three kids.

motor vehicle accident. She was run over by a

near-fatal motor vehicle accident while I was examinations. I had to create time to care for my wife (who was bed-bound and wheelchair dependent), work, study, and take care

teenager learning to drive, sustaining several serious skeletal fractures.

of my family back home. After overcoming this almost insurmountable

I had to dig deep into my mental strength—a quality passed to me by my

hurdle, the words ‘despair’ and ‘depression’ no longer exist in my life. Most

parents—to overcome this tragedy. I had to work, take care of my wife,

of my patients and colleagues have remarked that I never lose my smile,

my parents, and extended family back home in Cameroon and study

even under stressful situations.

for the boards at the same time. At the end of it all, I gained an internal

The advanced medical training I have received in the U.S. has met

medicine residency spot in Mt. Sinai School of Medicine/Jersey City

all my expectations. I feel I have acquired the knowledge necessary

Medical Center Residency program and my wife completed her training

to confidently take charge of all my patients. The only surprising thing

as a nurse. I graduated in 2009, but spent an additional year as a Chief

about medical practice in the U.S. is how some patients may consider

Resident before relocating to the Geisinger Medical Center in 2010 for

procedures such as open heart surgery, organ transplantation and

my fellowship in Nephrology.

dialysis as trivial issues, whereas these procedures are out of reach of

I arrived in Berks County in June 2012 as an employee of Reading

the common man in the part of the world I come from. There are limitless

Nephrology. I chose this area because of its prime location midway between

resources and tools available to physicians here to provide the best

NJ/NY and MD/Washington—where most of my family and friends here in

quality healthcare for their patients.

Dr. kim’s story Dr. Dosik Kim was born a Korean citizen and graduated from the Severence College of Medicine of Yonsei University in Seoul. By the time he attended medical school, however, he had already lived and studied in the U.S. for years and had permanent resident status.

Nevertheless, his intention upon finishing medical school was to remain in Korea, and he began his post-graduate training there. The end of the story will have to wait, however, until the earlier chapters are described.

Dr. Kim’s first experience living in the U.S. occurred when his father was posted to the Dallas, Texas office of the company he worked for.

Dr. Kim was then 11 years old, and his father’s career kept the family in Texas through Dr. Kim’s sophomore year in high school. He and his family then returned to Korea, where he completed his junior year.

Intent on attending a U.S. college, Dr. Kim then returned to the U.S.

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without his family, finished high school, and entered Lafayette College

offered in a very few centers around the world. For those who achieve

in Easton, PA.

certification and apply to U.S. training programs, preferential treatment

After two years at Lafayette, Dr. Kim’s mother persuaded him

given to graduates of U.S. medical schools all but closes the door to

to return home. His father had died, and he was the oldest of three

the most sought-after programs and specialties. Only the very strongest

children. He completed college at Yonsei University and continued on

candidates are successful.

to medical school, with no plans to leave Korea. At the time he started

However, Dr. Kim is also aware that some IMGs fall short of being

his internship he was married. His wife was studying for her master’s

able to function optimally as physicians in the U.S. Understanding

degree in the U.S., at Indiana University, and planned to return to

and becoming comfortable with cultural differences is very important

Korea upon graduation. Their lives abruptly changed course when Dr. Kim was called up for service in the Korean military. Due to his status as a permanent resident of the U.S., Dr. Kim could not complete his training in Korea. He reluctantly resigned his position and moved back to the U.S. Since he had graduated from a foreign medical school, Dr. Kim had to obtain ECFMG certification and match to a U.S. residency program in order to continue his career. This arduous process took two years.

He did an internal medicine residency at St. Vincent Hospital in Indianapolis, IN and then a fellowship in pulmonary/critical care/sleep medicine at Henry Ford Hospital in Detroit, MI. When asked to comment on the challenges IMGs face in gaining entrance to training programs in the U.S., Dr. Kim can think

in a field like medicine, where success

Understanding and becoming comfortable with cultural differences is very important in a field like medicine, where success is dependent on developing trusting relationships with patients and colleagues.

of a long list. The cost of taking the exams

is

dependent

on

developing

trusting

relationships with patients and colleagues.

Dr. Kim’s years living and studying in the U.S. gave him an immense advantage in this regard.

Dr. Kim and his family are now in their 7th year of living in Berks County. He enjoys the local climate, with its four distinct seasons, and the fact that, while enjoying the quality of life available in Berks County, it is easy to occasionally spend a weekend in any of several nearby cities. And now to give him the last words: “I have a lovely wife, SeungAh, and two sons, Louis and Ian. I like to swing my golf clubs once in a while, and when the weather turns cold my family is always searching for the next ski slope to speed down. My wife is a soprano by training and we enjoy classical music, but

required to gain ECFMG certification is a hardship for those whose

we have not been able to attend as many RSO concerts as we would

families are not well-to-do. Travel costs alone can be prohibitive when

like. I guess that’s what happens when you have two active boys who

it is time to take the Clinical Skills Assessment exam, since it is only

would rather do something else.”

Dr. sAAB’s story The capital of Syria is home to Damascus University—the largest and

Becoming proficient in English was not easy, but before long Dr.

oldest university in the country. The School of Medicine was the first

Abou Saab was able to volunteer at Pittsburgh Medical Center,

division to open, in 1903. Over the years, it has expanded to include

participating in clinical research. Within a few years he was hired as a

fifteen colleges and institutes covering a wide range of disciplines. Dr.

Research Associate and became a published academic. His wife, who

Bassel Abou Saab earned his M.D. from this venerable institution, but

had earned a Dental Technician bachelor’s degree in Syria, was able

had to look outside his home country to find training programs in his

to find work in her field. Employment enabled a change to the H-1 Visa

chosen specialty of Family Medicine. The United States was a logical

program and the eventual attainment of a green card.

choice due to the high quality of the training programs available and

The next challenge for Dr. Abou Saab in his quest to train in Family

because Dr. Abou Saab’s extended family included U.S. citizens already

Medicine was to pass the U.S. Medical Licensing Exam and become certified

living in the country. Dr. Abou Saab and his wife entered the U.S. nine

by the ECFMG. Once he successfully cleared these hurdles, he applied

years ago on Academic Student (F-1) visas to study in an English as a

to the National Residency Match and happily accepted a position with the

Second Language program.

Reading Hospital Family Medicine Program. In 2012 he finally achieved his

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hard-won goal and began his career as a family physician at the Kenhorst Family Medical Center.

When not busy with work or school, Dr. Abou Saab, his wife Baraah, and their three young daughters enjoy recreational sports, including ice skating, basketball, swimming, and just exploring the outdoors. In addition, the girls are members of the Wyomissing Soccer Club and take karate lessons. Baraah volunteers with the Wyomissing school district, takes classes at RACC, and cares for her active family. With years of sacrifice and uncertainty behind them, Dr. Abou Saab and his family are grateful for the warm welcome they have received from

Dr. Abou Saab and his family are grateful for the warm welcome they have received from Berks County – the community they have chosen as their home.

Berks County – the community they have chosen as their home.

Dr. Hanafi’s story The Quaid-i-Azam Medical College in the city of Bahawalpur, Pakistan is the alma mater of Dr. Sana Hanafi. She has lived in the United States for the last twelve years, moving to Berks County about five years ago when her husband accepted a job in the area. As she pursued her goal of obtaining a position in a U.S. Graduate Medical Education program, she found that obtaining certification from the ECFMG was only part of the battle. Having clinical experience in a U.S. healthcare facility turned out be very important in the application process, but was not easy to obtain. Over time, she gained experience and understanding of the U.S. system by volunteering in a variety of facilities. Just as important, she met U.S. physicians who offered her advice and assistance.

Dr. Hanafi and her husband have found Berks County to be an excellent environment for raising their family.

The willingness of Americans to

Years of hard work, study, and persistence paid off when Dr. Hanafi was

accept newcomers without hesitation came as a very pleasant surprise.

accepted to the Reading Hospital Family Medicine residency program. It

They find themselves surrounded by good friends willing to help and

was “like a dream” to complete her training in a good U.S. program and go

support them. In her own words, “It is a great honor to be an American

to work as a member of the Reading Hospital Medical Group. Dr. Hanafi is

citizen and serve this nation. God bless America.”

grateful that she is now able to give back to the community in her capacity as a primary care physician.

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LEGISLATIVE AND REGULATORY UPDATES From: J. Scot Chadwick, V i c e P r e s i d e n t, G o v e r n m e n t a l Aff a i r s ———————— Amy C. Green, Ass o c i a t e D i r e c t o r , G o v e r n m e n t a l Aff a i r s P e n n s y l va n i a M e d i c a l S o c i e t y

The new 2013-2014 session of the General Assembly is under way, and the balance of political power is basically unchanged from the prior session. Republican Tom Corbett remains governor, as his first term does not expire for two more years. As a result of the November, 2012 election, Republicans will retain their 111-92 majority in the House of Representatives, the same margin they held going into election day. The Senate also remains in Republican hands, albeit by a considerably smaller margin than in the previous session. Last session’s overwhelming 30-20 edge has been reduced to 27-23 in the new term. Financial challenges will again take center stage this year, as the governor and legislature struggle to deal with a huge state pension funding deficit and transportation infrastructure funding shortfall.

Following is a status report on key legislative and regulatory activities in Harrisburg.

LEGISLATIVE UPDATE

2013-2014 State Budget As this is being written, Governor Corbett is scheduled to give his annual budget address on Tuesday, February 5, just before the PAMED February board meeting.

Another lean state budget is likely in the works, as the state struggles to deal with a massive pension shortfall, increased Medicaid spending and the need to fund repairs to the state’s aging transportation infrastructure. Specifics regarding the governor’s proposed budget will be provided to the board as soon as they are available.

Tort Reform As in the past session, PAMED is part of a large tort reform coalition which is comprised of organizations involved in health care, business, local government, and others. The coalition is actively engaged in a coordinated

campaign to generate action on a number of important initiatives. Chief among them are venue reform (we already have it, the business community wants it) and PAMED’s apology bill. As this is being written the coalition is preparing ajoint letter to the House and Senate urging action on these initiatives.

Mcare Pursuant to Act 13 of 2002, this spring Insurance Commissioner Michael Consedine will examine the fmancial health of the state’s primary liability insurance carriers this spring to determine their capacity to begin selling physicians and hospitals $750,000 in coverage, rather than today’s coverage level of$500,000. Previously, on July 29,2011, Commissioner Consedine ruled that the primary insurance limits would NOT be increased for the next two years. Now it is time to repeat the exercise.

A positive finding will cause the primary limits to rise to $750,000 next January, with a corresponding reduction in Mcare coverage from its current $500,000 level to $250,000. A negative fmding will keep primary and Mcare insurance at current levels for another two years, when the process would again be repeated.

An increase in the primary limits would result in a significant rise in out-of-pocket liability insurance costs for physicians unless accompanied by transition relief.

PAMED supports the phase-out of the Mcare Fund, but only in a manner that does not impose the cost of retiring the Fund’s $1.3 billion unfunded liability on the state’s physicians, and has so notified state officials. Some in the Corbett administration have strongly suggested that Commissioner Consedine will order the primary limits raised. Others have suggested that may not happen.

HAP, which wants to eliminate the Fund at any cost, has advocated legislation to raise the primary limits by $100,000 to $600,000, using the current Mcare “surplus,” estimated at $130 million, to offset the increased out-ofpocket costs for providers. The HAP proposal would then freeze the limits at this new, higher level and use future surpluses to reduce the following year’s assessment. In the event that a single year surplus of$75 million or more is realized, the primary limits would be raised by another $100,000, with the large surplus again helping to offset increased out-of-pocket costs for physicians. PAMED has been studying this proposal. The Insurance Department retained Price Waterhouse to run numbers on what this proposal and other possible phase-out scenarios might look like, and Representative Glen Grell (R-Cumbedand) is drafting legislation to move the proposal forward if stakeholders approve. However, HAP has now apparently disavowed its own proposal because of the likelihood that Continuesonpage22

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Health Care Reform update Jessica Dean, E m p l o y e e B e n e f i t s C o n s u lta n t

March 1st Exchange Notice Requirement Delayed

The Fair Labor Standards Act ("FLSA"), as amended

by Health Care Reform, requires employers to provide each employee, at the time of hiring (or originally no later than March 1, 2013 for existing employees), a written notice informing the employee of the existence of the Exchange. The notice also requires a description of the services offered within the Exchange, contact information, as well as additional financial information for employees pertaining to the Exchange.

To date there have been no regulations issued regarding the format and content of the Exchange Notice. Thus, employers were unsure what specifically needed to be contained in such notices. The Department of Labor recognized the need for additional employer guidance and, thus, has stated that employers are not required to comply with this requirement until such implementing regulations are released.

DOL FAQs about Affordable Care Act Implementation Part XI

On January 24, 2013, the Departments of Labor, Health and Human Services and the Treasury issued FAQs regarding various Affordable Health Care Act (“ACA” or “Health Care Reform”) requirements. The FAQs contained guidance officially delaying the Exchange Notice Requirement originally slated for implementation on March 1, 2013.

The Department of Labor is evaluating several options for templates and distribution processes in regard to the Exchange Notices. According to The Department of Labor, timing for the distribution of notices will be the late summer or fall of 2013, which will coordinate with the open enrollment period for the Exchanges. n More information on the DOL FAQs Part XI can be found at: www.dol.gov/ebsa/faqs/faq-aca11.html For questions or assistance, please feel free to contact Power Kunkle Benefits Consulting at 610-685-1790 and reference this article.

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it would never result in the ultimate elimination of the Mcare Fund. Rather, HAP is now working with the Mcare Fund to get numbers from Price Waterhouse on different scenarios that would ultimately end the Fund. None of these scenarios provide for any state funding to offset the increased cost, and would result in providers paying off the entire unfunded liability. PAMED opposes any such arrangement, and continues to work toward a satisfactory solution.

PAMED is coordinating its examination of this issue with the Pennsylvania Orthopaedic Society and other stakeholders.

Prompt Credentialing In the last session, Representative Bryan Cutler (R-Lancaster) introduced House Bill 1551, PAMED’s prompt credentialing legislation. A similar bill, Senate Bill 1224, was introduced by Senator Gene Yaw (R-Lycoming) on October 18,2011. These bills were intended to eliminate the unnecessary delays that frequently occur when physicians apply to be credentialed by various health insurers.

Under the bills, insurers would have to notify applicants of the status of their application for credentialing within five business days after receipt, including their intention to continue the process and an itemization of any missing items. Insurers would have 60 days to act on a completed application, and physicians would be eligible for reimbursement within 15 calendar days from the postmarked date on the application.

From that point until the credentialing process is complete, health insurers would reimburse physicians based on their fee schedule rates applicable to nonparticipating physicians. If the physician applicant is a member of a medical group practice currently contracted with the health insurer he or she will be reimbursed at the group’s contracted rate. A health insurer would be required to accept the CAQH’s Provider Credentialing Application when submitted by a physician for participation in the health insurer’s provider panel.

On November 30,2011, the House Insurance Committee held a public hearing on the bill, at which PAMED testified.

Committee members and staff expressed considerable interest in the proposal, and PAMED spent much of the last year responding to members’ questions and objections raised by payers.

As a result of input received last year, we have redrafted the legislation to address outstanding issues, and will be reintroducing the House and Senate bills shortly.

Regulation of Tanning Salons Last session Senate Bill 349, which would regulate the state’s tanning facilities and set age limits for who can use them, was approved by the Senate by a vote of

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48-1. The bill subsequently cleared the House Health Committee on December 5, 2011, and was poised for final House passage.

However, SB 349 was a ‘middle of the road” proposal which ultimately died in the tug of war between those who wanted a stronger bill and smaller government advocates who opposed any bill at all. PAMED will attempt to reconcile the two sides and get the strongest possible bill that can actually pass to the governor’s desk.

Fair Contracting Once again PAMED is seeking enactment of legislation to level the playing field between physicians and payers.

Last session PAMED supported House Bill 1763, legislation intended to closely track expired court settlements known as the Love settlements. However, the bill received harsh treatment during a November 2011 House Insurance Committee public hearing, which, as expected, generated considerable opposition from the Blues. This session PAMED will draft new legislation focusing on our core concerns and addressing payer objections.

Deemed Status In an effort to jumpstart a long overdue update of Pennsylvania’s hospital regulations, the Hospital and Healthsystem Association of Pennsylvania (HAP) is attempting to bypass the lack of regulatory action via the legislative route.

Last session House Bill 1570, introduced by Representative Doug Reichley (R-Lehigh), provided that facilities or specialized health care services accredited by a national accrediting organization approved by the Centers for Medicare and Medicaid Services (CMS) would be deemed to meet state licensure requirements and would be be entitled to a license issued by the Department of Health (DOH). This would allow them to ignore inconsistent state licensing requirements.

PAMED was, and remains, sympathetic to HAP’s desire to modernize the state hospital regulations, and indeed, supports such an endeavor. However, the blanket erasure of some significant state patient and physician protections through deemed status, is a major concern. Importantly, the bill as introduced would have eliminated state regulations that ensure the protection of physician-led hospital medical staffs.

HAP and PAMED worked to address those concerns, and that process produced an agreement on all issues, an agreement that was endorsed by DOH and Rep. Matt Baker, who chairs the House Health Committee. However, a number of non-physician provider groups saw the bill as an opportunity to expand their role and scope of practice

in a hospital setting. This and other complications resulted in a scuttling of the bill at the end of the session.

In the new session PAMED is working with DOH and other stakeholders to craft language that reduces the likelihood of an assault on the bill by mid-level provider groups.

Controlled Substance Database (CSDB) Last session Representative Gene DiGirolomo (R-Bucks) introduced House Bill 1651, legislation intended to improve the Commonwealth’s ability to enable informed and responsible prescribing and dispensing of controlled substances and to reduce diversion and misuse of such drugs in an efficient and cost-effective manner that will not impede the appropriate medical utilization of licit controlled substances.

PAMED supports the creation of a CSDB, but had a number of concerns with the bill as drafted, including the lack of legal protection for physicians who opt not to use the database, and overly broad language permitting law enforcement personnel to surf the data looking for fraud.

PAMED worked with Rep. DiGirolomo and key stakeholders to address these concerns, and ultimately a vastly improved version of the bill was approved by the House Human Services Committee. Unfortunately the bill went no farther.

However, PAMED’s “Pills for Ills, Not Thrills” campaign has generated significant support for a CSDB in the governor’s office and legislature, and we are optimistic that a good bill can be enacted this year.

the development of regulations never transpired. With the presence of a new Board Counsel, this issue has been raised again and a draft regulation attempting to tackle this issue was developed and sent to involved stakeholders where the Society commented on the draft regulation indicating some concerns.

The State Board of Medicine has since developed a revised draft of the regulation that is more pertinent to lasers and medical devices involving skin treatinent and

REGULATORY UPDATE

Use of Medical Devices and Laser Products The Society is currently working collaboratively with the PA Academy of Dermatology and Dermatologic Surgery (PAD) to address the problem that is currently taking place with estheticians and even unlicensed individuals using medical and laser devices without any supervision. This issue has been brought up by several physicians citing many instances in which patients come to the office with complaints of burns, pigmentary changes, inadequate treatment, infections, along with an array of other symptoms. The devices themselves are regulated by the Federal Food and Drug Administration (FDA), but there is nothing that regulates the particular use of these devices.

This was presented to the State Board of Medicine back in 2008 by both groups, and while the Board understood the problem and indicated a willingness to address it,

HEIDI MASANO HMasano@MasanoBradley.com

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care. According to the Board Counsel, all stakeholders appear to be satisfied with the revised draft and the Board is looking to move forward with the regulation.

Due to Act 76 (HB 1349) that amends the Regulatory Review Act that was recently signed by the Governor, it requires state agencies to consider the impact of proposed regulations on small businesses and provide alternative accommodating requirements. One of the main concerns with the new law is that it will significantly delay the already onerous regulatory process even more as they will have to enclose the required information with the regulation package. The regulation is being held until that portion is completed. It has been indicated that the Medical Board will be requesting hearings within the legislature to allow for understanding of the regulation among legislators and the public.

The Society and PAD also plans to meet with Senator Boscola who is perceivably opposed to the regulation due to a recent complaint from one of her physician constituents. This physician is specialized in internal medicine, but operates a medical spa that provides laser services from estheticians.

Act 110 ID Badge Regulations Act 110 (House Bill 1482), which passed at the close of the 2009-2010 General Assembly Session, requires that health care practitioners in non-health care facilities wear photo identification badges clearly identifying their practice, i.e. “physician”, “nurse”, etc. PAMED supported passage of this legislation as a means for patients to avoid confusion in identifying the health care practitioner(s) providing them care.

The Department of Health (DOH) distributed the draft proposed regulation to involved stakeholders as the interim regulation needs to be replaced by a final form regulation. PAMED received a copy of the regulation and provided comments in July 2012 addressing one major concern regarding the title.

A recent Department of Health Policy Board meeting was held and it was indicated that the regulations are still currently being worked on due to the amendment to the Regulatory Review Act that now requires a small business impact analysis. Jim Steele from the Department indicated that he hopes to have the proposed regulation through IRRC and to the public by spring 2013. PAMED will continue to work with the Department through the regulatory process and provide input as necessary to ensure that this regulation is implemented appropriately.

State Board of Pharmacy and Compounding Companies The outbreak of meningitis at the New England Compounding Center has sparked a large initiative among

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many states and the FDA on the issue of compounding.

We have received information from the PA Academy of Ophthalmology that an Arizona supplier indicated that PA now requires individual patient prescriptions for every compounded medication order that is mailing from or mailing to this state due to a recent change in regulation.

We have since learned that there has been no change in regulation from the State Board of Pharmacy or the Department of Health, but all departments are working together to address current issues.

As an update, staff and members at the Pharmacy Board attended a meeting held by the FDA and discussed what states are seeking to do through regulation and ways in which the FDA can tighten its rules. Many individuals from other states requested for a consistent definition of compounding/compounding pharmacy. A separate meeting was called on behalf of Rep. Matt Baker that brought together staff from the Department of Health, Department of State and several compounding experts.

One initiative that the State and DOH will look into is registering out-of-state compounding pharmacies.

We expect to see several pieces of legislation that deal specifically with this issue as well.

PennDOT Medical Advisory Board The Pennsylvania Department of Transportation (PennDOT) reached out to the Society for assistance in finding an orthopedic physician that they will contract with to serve as a consultant to revise the orthopedic regulations. In October 2012, we recommended Dr. Angela Rowe, DO (PAMED’s orthopedic representative for the Specialty Leadership Cabinet) to serve as a consultant for PennDOT. PennDOT’s Medical Advisory Board met and put her name forth to be considered as recommended

by PAMED. Mario Lanni from the PA Osteopathic Medical Association (POMA) suggested that rather than just bring one person on to assist, to develop a workgroup to discuss and provide input on the regulations they intend to change. The Board agreed with that notion and will work to collect names for the workgroup.

State Board of Medicine Vacancies At its May 2011 meeting, the PAMED Board of Trustees approved a process to be used to identify PAMEDrecommended candidates to fill future vacancies on the State Board of Medicine (SBOM). That process directs the Executive Committee to utilize specified suggested criteria to identify and ultimately select qualified candidates that PAMED will recommend for consideration by the Governor. The State Board of Medicine will have a total of three physician vacancies in spring 2013 and the Society

Department of Family Medecine

Berks County Medical Society’s

The Reading Hospital and Medical Center

l e c t u r e s e r i e s SPRIN G 2 0 1 3

Department of Family Medicine Lecture Series SPRING 2013 April 5 – Friday’s Child Lecture Series Cough and Cold Medicines for Children:

What Should We Tell Parents? 2772

Ian M. Paul, MD, MSc Professor of Pediatrics and Public Health Sciences Associate Vice Chair for Research, Dept. of Pediatrics Penn State Children’s Hospital

HEALTH TALK Tune in to Health Talk Live on WEEU radio to hear live community conversations about health topics with members and guests of the Berks County Medical Society!

Join the discussion every Wednesday evening from 6 to 7pm when the Berks County Medical Society presents “Health Talk.” It’s your chance to call and chat with many of the region’s leading health care practitioners! Take a look at the Berks County Medical Society’s website, BerksCMS.org, for more information.

FOr Live call in: (610) 374-8800 or 1-800-323-8800 to participate.

April 12 – No Conference

BCMS Memorial Lecture and Resident Research Day

Hosts include: Dr. John Dethoff (pictured) Dr. Chuck Barbera Dr. Andy Waxler Dr. Bill Finneran Dr. Margaret Wilkins Dr. Pam Taffera

April 19 – Alzheimer’s Disease: Diagnostic Tools

and Therapeutic Options 3249 Paul Kettl, MD Philadelphia VA Medical Center April 26 – Bipolar Disorder and Medical Co-morbidity Paul Brettschneider, MD, FAPA Department of Psychiatry Holy Spirit Hospital

3250

Health Talk Schedule

May 3 – 6th Annual Conference on Primary Care and Child/

Adolescent Psychiatry 2914

The Mind and Body Connection Location:Thun/JanssenAuditorium-Time:7:30a.m.–12:45p.m.

May 10 – Limiting Risk for Both Patients and Doctors Kurt Gingrich, President Gateway Risk Service May 17 – No Conference

BCMS Legislative Breakfast

May 24 – Optimizing Use and Limiting Abuse

of Opiates for Chronic Pain 3252

Thomas Raff, MD, Faculty Associate,

Department of Family & Community Med.

Martin Cheatle, PhD, Department of Psychiatry Reading Hospital

3251

Wednesday, April 3 “Update on Autism” Host: Chuck Barbera, MD Wednesday, April 10 “Preventive Medicine: How to get the patient involved” Host: John Dethoff, MD Wednesday, April 17 “Smartphones, the Internet and Medicine” Host: Bill Finneran, MD Wednesday, April 24 “Open Forum” Host: Pam Taffera, DO

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Holiday Brunch

ALLIANCE UPDATE E m i ly B u n d y B CMSA P r e s i d e n t - E l e c t

A special thanks to Carole Lusch for hosting this delightful event. With close to 30 attendees, we had a great turnout. Gifts were collected for the Reading Hospital Pediatric Inpatient wing, to be distributed to children spending their holidays in the hospital.

Second New Member’s Coffee

Spring General Meeting

Thank you to our speaker, Tara Kennedy-Kline who shared her experience as a “mother entrepreneur” and dream coach. Tara’s philosophy on parenting is that, “It's about embracing life on the level you’re at. It’s about making mistakes and learning from them. It’s about Loving Unconditionally, Communicating Respectfully, Laughing Openly and Appreciating the Brilliance each of us brings to the World.” She offered practical advice to parents, including: • Being present in the moment when listening to others.

• Engage with your children; make time for them.

• Challenge your belief system when necessary.

Sometimes our beliefs are incorrect, and false beliefs can prevent us from reaching our goals.

• Ask for help when it is needed.

• Don’t try to be everything to everybody. It can’t be done...well.

Donations of gently used books were collected for the Reach Out and Read program.Thank you to DeeDee Burke for hosting and to Lisa Banco for organizing this event.

Thank you to Gretchen Platt for hosting our second New Member’s Coffee in February. This event allowed us to meet a few new faces as well as some current members that had not been out to a meeting in a while. In addition, we would like to welcome Dr. Aparna Mele as our sixth new member this year!

Facebook

We are working hard to increase our audience on Facebook. Please like our page at “Berks County Medical Society Alliance.” Currently we have 92 likes; our goal is to have 100 likes by May! Health Project

This year’s Annual Health in Balance Lecture Series entitled, “Practical Approaches to Managing Autism for the School Aged Child” was held at Glad Tidings on April 4, 2013. The cost of the daytime program was $35 which included a continental breakfast, lectures, handouts and resource tables. The evening program was free and open to the public. This program was created for school nurses, teachers, coaches, childcare staff, and interested parents.

Act 48 Credits and Nursing CEUs were available to eligible professionals. More details and photos will follow in the next Medical Record.

Panel of Speakers:

Raymond J. Hubbard, MD Reading Pediatrics Physician, Coordinator, Medical Home initiative

Mary Lynch Barbera, PhD, RN, BCBA-D Board Certified Behavior Analyst, Author, The Verbal Behavior Approach Listed Left to Right: (front row) Sara Noori, (middle row) Sara Tuanquin, Teresa Wexler, Jill Haas, Deb Cordes, Carole Lusch, Beverly Patillo, (back row) Emily Bundy, Kathy Rogers, Erin Dougherty, Kara DeJohn, Kalpa Solanki, Carol Perlmutter, Neha Majmudar, Lisa Geyer, Carrie Latman, DeeDee Burke, Diana Kliener and Luba Karchevsky, (not pictured) Meghan White and Gretchen Platt

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Tara Kennedy-Kline Certified Dream Coach,™ Author, Stop Raising Einstein

Extended list of Physician’s to be honored in Spring 2013

Doctor’s Grove

1. Ronald Emkey, MD of Emkey Arthritis and Osteoporosis Clinic, by his son Gregory Emkey, MD 2. George Neubert, MD of The Reading Hospital OB/GYN Department, by Dr. and Mrs. Alex Massengale 3. Jason Bundy, MD of Center for Pain Control, by his wife and family 4. Barry S. Shultz, MD, given in memory of her husband,

by Linda Shultz 5. Nirav Patel, MD given in memory, Please join us as we celebrate the addition of 16 trees to Doctor’s Grove. This short, informal ceremony will take place at Berks County Heritage Center which is located behind St. Joseph’s Hospital, on April 26, 2013 from 11:30am-12:30pm. A light luncheon will be provided and there will be various historical articles and photos of the Grove throughout time for your viewing. If you would like your photo taken in the Grove, our photographer, Gretchen Platt will be available during this time. You are welcome to invite your family and friends to the ceremony. Please indicate the number of people attending so we can assure adequate catering. Thank you and look forward to seeing you there!

by friends of Dr. Patel 6. Nirav Patel, MD, given in memory

by Respiratory Specialists, Ltd. 7. Physicians of Berks County,

by Berks County Medical Society Alliance 8. George Kershner, MD, of The Reading Hospital Emergency Department, by Dr. JoAnne Gordon 9. Michael Weaver, MD, given by his wife and family 10. Marcia Q. McCrae, MD, given in memory

by Nancy Alley

11. Charles R. McCrae, MD, given in memory by his family 12. Samie A. Alley, MD, given by his wife Nancy Alley 13. Saint Joseph’s Hospital

Date: Friday, April 26, 2013 Time: 11:30am-12:30pm Where: 1102 Red Bridge Rd,

Reading, PA 19605 RSVP:emilybundy1@gmail.com

given in honor of its medical staff

14. Saint Joseph’s Hospital

given in honor of its medical staff

15. Hyder M. Carim, MD, given

in memory of her husband, by Mahera Carim

16. Neil A. Hoffman, MD, pathologist, Reading

Hospital, on his retirement, by his wife Judith Kraines

Try us out!

Potential new members are welcome to any of our events! See our website for the 2012-2013 schedule of meetings or contact our Vice President of Membership, Amy Impellizzeri at aimpell@gmail.com . Our website address is www.berkscmsa.org. n

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installation brunch recap

O

n Sunday, January 20, 2013 the Berks County Medical Society held its installation of new officers and annual meeting at the Berkshire Country Club.

The 2013 officers that were installed at this time were Pamela Taffera, DO, MBA President; Michael Baxter, MD Chair of Executive Council; Andrew Waxler, MD Secretary; Michael Haas, MD Treasurer; and Kristen Sandel, MD President-Elect.

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Also recognized during this gathering were members celebrating 50 years of medical service. This included Gerald Malick, MD; Arthur Oplinger, MD; John Rightmyer, MD; Larry Rotenberg, MD; and Kent Weaver. MD. Absent for the Brunch, but also being honored for 50 years of service were Samie Alley, MD and J. David Pearah, MD.

Berks County Medical Society

spring CALENDAR Residents’ Day/Memorial Lecture Friday, April 12, 2013

Practice Management Seminar Friday, April 19, 2013

Legislative Breakfast Friday, May 17, 2013

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Retired Surgeon’s Meaningful Hobby Surprises, Benefits Others A Report of the Foundation of the Pennsylvania Medical Society

F

oundation of the Pennsylvania Medical Society Board Chair Dr. Raymond Truex, a Reading-based neurosurgeon has performed hundreds of surgeries.

One that stands out most is Dr. Ferdinand Soisson’s back surgery. Dr. Soisson, 83, of Mechanicsburg, Pa. is testament to staying active, physically and mentally.

“He was a patient of mine and I was so impressed by his strength and resilience. He recovered like a 25 year old and never once required pain medicine–unbelievable!” Dr. Truex said.

“Also, we are all so impressed by his civic insight. At the Foundation, he always provides ideas and ways of encouraging others to provide service,” said Dr. Truex.

“We are all grateful for Dr. Soisson’s generous support

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and leadership of our programs over the years. Everyone who meets him recognizes that he is strong in body and mind. He is a fascinating person and he even harbors a surprising talent,” Dr. Truex said.

Quilts decorate Dr. Soisson’s Mechanicsburg home on every bed. There are various quilted wall hangings and family quilts draped over a rack in the living room.

And there is a queen size quilt-in-progress stretched over a frame in the back bedroom waiting to be stitched every afternoon.

It makes sense that quilting is a perfect pastime for a retired obstetric gynecological surgeon familiar with intricate surgeries. But for Dr. Soisson, it is a tradition steeped in family history.

Dr. Soisson, 83, was born on a western Pennsylvania farm, the eldest of eight children. His mother believed that all of her children needed to be familiar with household work. When he originally resisted saying that sewing was for girls, she admonished him by saying, “All of my children will know how to quilt.”

All winter long, a quilt stretched in a frame and neighbors would gather in the evenings to stitch. Dr. Soisson credits his fine surgical skills to his mother’s training and inheriting his father’s eye/hand coordination. From age

My father always taught us that whatever you give away you

get back a hundredfold. nine to 12, he enjoyed perfecting this skill. At age 12, he left the farm to attend St.Vincent College Scholastica, in Latrobe, to study to become a priest. He immersed himself in the Catholic Benedictine tradition but decided that he would rather serve people by becoming a doctor.

He went on to graduate from Georgetown University Medical School, Washington, DC. During the final year of school, he married his hometown sweetheart, Dorothy.

They started their family soon after and Dr. Soisson joined the Air Force to complete his training and to help pay his medical school bills. They moved quite a bit around the country: Colorado, Hawaii, and Massachusetts. Dorothy was a quilter and her projects moved with them.

Dr. Soisson gave up quilting when he was working all the time delivering babies. He estimates that he delivered more than 15,000 babies during his career. Also during this time his family grew. Dr. Soisson and Dorothy had nine children, six daughters and three sons. They enjoyed 46 years of marriage together. Sadly, Dorothy passed away in 2011.

After the funeral, Dr. Soisson’s sons, daughters and grandchildren–19 of them–came back to his house. They commented that their mother did not finish making quilts for all of them. He remarked that there was an unfinished quilt upstairs. They retrieved it and stretched it on the quilting frame. As is tradition for the Soissons, their mother taught them all to quilt. So they gathered and worked on the unfinished project.

After five minutes, the kids inspected Dr. Soisson’s work.

They never knew that he was just as talented quilter as their mother. “Wow! You really can quilt!” they remarked.

“I was quilting before any of you were even a thought in my mind,” he retorted.

Now, Dr. Soisson spends his afternoons working on beautiful quilts for his family. He can complete a queen size quilt in about three months. He has also fashioned quilts that he donates to charitable auctions retrieving a whopping $6,000 contribution for his latest work. The money went toward a fundraiser at a Catholic school where his daughter is principal.

He enjoys being able to support his favorite causes in this most sentimental way. Giving back was a way of life in his family and in his religious studies. “My father always taught us that whatever you give away you get back a hundredfold,” he remembers.

Service is foremost on Dr. Soisson’s mind when he recounts all that he has experienced as a doctor, a husband, a father, a grandfather, a son, a veteran. He also gave of his time and expertise as a community leader, a county commissioner and a Medical Society board member. “The care you provide to others makes for a charmed life,” he said. n

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