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2019 AAFP NATIONAL CONFERENCE STORY & PHOTOS!
INTERVIEW: DEREK BAUGHMAN, MD
Representing Individual Physicians & Physician Groups Charles I. Artz, Esq. Health Law
PAFP CAREER CENTER
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PENNSYLVANIA ACADEMY OF FAMILY PHYSICIANS
T N S E T A THE L INFORMATIO & Y L I NEWS A D ... KP MAGAZINE ARCHIVE VISIT THE BACK CATALOG OF KEYSTONE PHYSICIAN AND MAKE YOUR OWN HEALTH CARE NEWS AND INFORMATION REMIX
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PENNSYLVANIA ACADEMY OF FAMILY PHYSICIANS & FOUNDATION 2704 Commerce Drive, Suite A Harrisburg, PA 17110 717-564-5365 • TOLL FREE 1-800-648-562 • FAX 717-564-4235 www.pafp.com
EDITOR-IN-CHIEF Chief Communications Officer
Michael Zigmund - mzigmund@pafp.com
MANAGING EDITOR Director of Media and Public Relations
Bryan Peach - bpeach@pafp.com
Keystone Physician, member magazine of the PA Academy of Family Physicians, is digitally published four times a year. Editorial opinions and advertisements in this publication do not necessarily reflect the views of the PAFP and Foundation, unless so stated. © 2016. Unless stated otherwise, nothing may be reproduced either wholly or in part without permission from the Editor-in-Chief.
EXECUTIVE VICE PRESIDENT John S. Jordan, CAE - jjordan@pafp.com
SUPPORTING MEMBERS WITH
GOVERNMENT AND PRACTICE ADVOCACY CONTINUING MEDICAL EDUCATION (CME) PROFESSIONAL AND CAREER RESOURCES STUDENT AND RESIDENT PROGRAMS DEDICATED MOBILE APP
STAFF Deputy Executive Officer / Chief Operation Officer Chief Education Officer Chief Financial Officer Chief Government Affairs Officer Director of Resident and Student Initiatives Director of Education
Brent Ennis - bennis@pafp.com Janine Owen - jowen@pafp.com Karen Runyeon - krunyeon@pafp.com Jennifer Reis - jreis@pafp.com Molly Talley - mtalley@pafp.com Lindsey Killian - lkillian@pafp.com
2019-20 OFFICERS PAFP President Mary Stock Keister, MD - Fogelsville Tracey Conti, MD - Monroeville Tiffany Leonard, MD - Willow Grove Chris Lupold, MD - Lancaster David O'Gurek, MD - Philadelphia
PAFP President-Elect Foundation President PAFP and Foundation Treasurer PAFP Board Chair and Immediate Past President
THE LATEST NEWS AND INFORMATION MEMBER DISCOUNTS AND SERVICES RECOGNITION AND LEADERSHIP OPPORTUNITIES
i Remember, your membership with the PAFP means you’re also a member of the American Academy of Family Physicians.
DOWNLOAD THE ‘PAFP CONNECT’ MOBILE APP TODAY!
DELEGATES TO THE AAFP CONGRESS Delegate Delegate Alternative Delegate Alternative Delegate
Bradley Fox, MD - Fairview Madalyn Schaefgen, MD - Allentown Nicole Davis, MD - Wyncote Kevin Wong, MD - Jeannette
BOARD OF DIRECTORS Board Member Board Member Board Member Foundation President Foundation Vice President Student Chair Resident Chair
Margaret Baylson, MD - Philadelphia Susan Fidler, MD - Abington D. Scott McCracken, MD - York Tiffany Leonard, MD - Willow Grove Jason Woloski, MD - Wilkes Barre Chelsea Kolodziej - Erie Lily Payvandi, MD - Belle Mead, NJ
www.pafp.com
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CONTENTS
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PRESIDENT'S MESSAGE Summer musings
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MEMBER NEWS
Congrats to PAFP members in 'Top Physicians Under 40' PAFP member recognized as ‘Best in Medicine’
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FEATURES
PAFP heads to the great outdoors for CME conference AAFP National Conference inspires thousands of students, residents
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INTERVIEW
COVER STORY PAFP members got a double-dose of CME at the Lake Raystown Resort, with dual tracks covering the topics of dermatology and outdoor medicine.
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Derek Baughman, MD - Newly elected AAFP Resident Alternate Delegate on AAFPNC, family medicine, and health care policy
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FALL 2019 VOLUME 79 | NUMBER 3
GOVERNMENT AFFAIRS
PAFP 2019-20 State Legislative Agenda
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LEGAL AND COMPLIANCE UPDATE
PA Supreme Court allows evidence of risks and complications as a defense in medical malpractice litigation Amendments to medical/ osteopathic practice acts physician assistant supervision agreements
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EDUCATION Online CME Catalog
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PRESIDENT'S MESSAGE MARY STOCK KEISTER, MD, President president@pafp.com
Summer musings ust like there are seasons to the natural world, I notice there are seasons in my personal and professional year. Some of this is because I have children in the house. My year revolves around their school year, which means that summer has a very different rhythm. Professionally, I tend to back off on CME during the summer, as I work in a residency clinic and there are a lot of transitions. I look forward to this change of pace. It offers different activities – some new, some familiar. This year I had several “bucket list” experiences: I went to see Hamilton on Broadway, and I went to France to attend the semifinal and final games of the FIFA Women’s World Cup. The former was a Christmas gift for my elder daughter. It was everything I expect in a Broadway show: excellent in execution, seamless in stagecraft. The ending had me in tears. I missed a PAFP event for it but wouldn’t change the time with my husband and daughter for the world. 6
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And then there was the 2019 Women’s World Cup. I’ve watched women’s soccer for 20 years. I enjoy watching men’s soccer as well, but I am drawn to the women’s game: similarly to watching the NCAA women's basketball tournament, or the WNBA, I can revel in what a body similar to mine can do. (Same reason I nearly cried during that scene in Wonder Woman when the titular character storms No Man’s Land: I’d never seen a woman do that! Representation matters, but I digress.) I attended several games of both the 2003 and 2015 Women’s World Cups, but this time, we made a family trip of it. Between DuoLingo, my daughters’ beginner French and the forbearance of the tourist-oriented people of Lyon, we explored a few parts of the city in addition to going to the games. But we were really there for the soccer. And we were very happy when the U.S. Women’s Team advanced to the semifinals, because it was far from a guarantee as the women’s game has developed internationally.
So we got to see “our team,” who we’ve watched through many changes in personnel over 20 years, play excellent soccer and win the Women’s World Cup! Christen Press’s header and Alyssa Naeher’s PK stop in the semifinal against England! What moments! Rose Lavelle’s individual effort for her goal in the Final! What amazing skills! But what was really fun for me was watching the team play – how they moved with both individual determination and with connection to their teammates, watching plays build up, watching the ball movement in testing the defenses of the opponent. Just “The Beautiful Game.”
SUMMER MUSINGS
I can look at it now and see some medical analogies to a well-run family medicine office or surgical team or ED performing well during a mass casualty incident they have been welltrained for. But in all honesty, in the moment, I was just enjoying watching the game! And then there were some regular summer things: Residency graduation and a trip to the beach. Celebrating family, transitions, the warmth of the sun and the rhythm of the waves. Taking time away from the hustle of clinical life in order to rest, to catch up on other things, to spend time with family. Which is why I am writing this article while overlooking the beach. The PAFP is like that too. There is the regular flow of the year, CME events, Board meetings, staff following the workings of the state legislature and the medical school and residency programs within Pa. And then there are the sin-
gular events, which this year will include AAFP COD and FMX to be held in Philadelphia in September, and then the retirement of the PAFP’s EVP, John Jordan at the end of 2019. I hope you have the opportunity to join us either for FMX or for our November CME event in Bedford Springs. We are a welcoming group always enjoying our time together and interested in new faces! And look out in your email for announcements on the happenings in Harrisburg. It could be a very interesting legislative season and we need feedback from you, our members, as we interact with legislators in the interests of family physicians and the patients they serve. WWW.PAFP.COM
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MEMBER NEWS THE LATEST NEWS AND INFORMATION FOR PAFP MEMBERS For more, visit: www.pafp.com
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PAFP on twitter
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PAFP Connect
Congrats to PAFP members in 'Top Physicians Under 40' The PAFP congratulates several of its members for their inclusion on the Pennsylvania Medical Society's (PAMED) 'Top Physicians Under 40' list: Leah Campbell, DO; Peter Din, DO; Andrea Heller, DO; Scott Heyl, MD; Tiffany Leonard, MD; Amy Maley, DO; Jyothi Patri, MD; Mylaina Sherwood, MD; Kristin Simmons, MD; Jillian Ventuzelo, DO; and Jason Woloski, MD. Photos of these members can be found on PAMED’s Top Physicians Under 40 webpage. Way to go!
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Leah Campbell, DO
Peter Din, DO
Andrea Heller, DO
Scott Heyl, MD
Tiffany Leonard, MD
Amy Maley, DO
Jyothi Patri, MD
Mylaina Sherwood, MD
Kristin Simmons, MD
Jason Woloski, MD
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PAFP member recognized as ‘Best in Medicine’ PAFP member John Surry MD, FAAFP has been recognized as one of the American Health Council’s “Best in Medicine” 2019 award winners. According to the American Health Council, “Only those who master the key roles that drive patient care – advocate, collaborator, communicator, decision maker, expert, manager, scholar – are deserving to be named the best doctors in America. The American Health Council’s ‘Best in Medicine’ honors the individuals and institutions that have contributed significantly to medicine, as well as the training and education of physicians.” Congratulations, Dr. Surry, for this honor!
John Surry MD, FAAFP
THE AAFP’S LARGEST ANNUAL FAMILY MEDICINE EVENT
THERE’S STILL TIME TO REGISTER! FULL EVENT DETAILS AVAILABLE AT
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Tiffany Leonard, MD goes “hands on” discussing outdoor patient and scene evaluation. 10
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PAFP TO THE OUT F CONF
P HEADS E GREAT TDOORS FOR CME FERENCE
FEATURE
ver the river and through the woods, the PAFP traveled to Lake Raystown Resort and Conference Center for its 3rd Annual Dermatology and Outdoor Medicine CME Conference. During the two-and-a-half day event, learning options included a dermatology CME track, an outdoor and wilderness medicine CME track, or a combination of both, with social events for family members and guests intermixed throughout. CME line-up included “What’s New in Dermatology for 2019,” “Melanoma and Look-Alikes,” and “Name That Rash,” along with cryosurgery, biopsy and dermoscopy workshops. With equipment provided by Brymil Cryogenic Systems and 3Gen, attendees were able to have the tools available to them during the conference to complete the workshops. The great outdoors became the classroom for such things as removing foreign objects, making a splint and litter out of only that which you’d find outside or have on you, and how to function effectively in a mass casualty situation such as a lightning strike. And of course, no event of this type would be complete withWWW.PAFP.COM
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FEATURE
out special appearances by a few scorpions and snakes, courtesy of Shaver’s Creek Environmental Center, for use during our “Envenomations – Spiders, Venomous Bites & Stings” segment. Attendees were pushed outside their comfort zone and forced to look at everyday items in a new light. Special thanks to Raystown’s Farmer Harold who provided transportation for attendees with his prized Farmall tractor between the conference center and the outdoor classroom where “fireside chats” brought people out to discuss various elements of medical kits for both indoor and outdoor environments, as well as the effects of climate change on human health.
All enjoyed the fresh mountain air, serene environment and peaceful setting on the lake for this unique program. So many attendees complimented on the sessions and were surprised by the fact they learned more than they expected! The conference concluded with a group picnic served by PAFP’s very own Janine Owen and Lindsey Killian with great food, s’mores and a movie by fireside. And there was plenty of sunscreen to go around thanks to Deer View Family Medicine. Be sure you don’t miss the PAFP’s next live CME event in November. You can click here to register today for the Bedford CME Conference at the Omni Bedford Springs in Bedford. The event runs Friday, Nov. 8 through Sunday, Nov. 10.
Some sessions combined dermatology and outdoor medicine, like this session on outdoor foreign body removal.
A bit of role play helped doctors learn about improvised splinting, litters, carries, and moving injured patients.
Indoors at the Lake Raystown Resort’s Conference Center, doctors enjoyed workshops on cryosurgery, biopsy, and dermoscopy.
SFishing injuries are common in the great outdoors: here, participants practiced by removing fishhooks from oranges.
Scott McCracken, MD helped physicians find their way during a session on orienteering, complete with maps and compasses.
The Pennsylvania Academy of Family Physicians Foundation presents
THE
BEDFORD CME CONFERENCE November 8-10, 2019 • Omni Bedford Springs Bedford, PA REGISTER NOW FOR EARLY BIRD PRICING! WWW.PAFP.COM
• More than 19 CME Hours (over 12 are Patient Safety!) • KSA -- Women’s Health • Discounted Hotel Rooms Rates & Resort Activities • Free Parking! REGISTER TODAY AT WWW.PAFP.COM
Online Store Information The first opportunity for members to use their points will be to redeem 10 points for a 10% discount code off PAFP merchandise from our new online storefront. The new online storefront will be available for a limited time twice a year. When new seasonal merchandise becomes available, PAFP will update the storefront and notify members of sales. You can click the link below to check out the storefront and view merchandise. You will need to create an account to make an online purchase.
Changes Coming to Reward Points and the Online Store
Instructions on accessing the online store:
The Pennsylvania Academy of Family Physicians is making some changes to its Reward Points system and its online apparel store. Below, we highlight what those changes are and how you can benefit from your existing Reward Points.
1. Visit the link below (or click here). 2. In the upper right-hand corner, select "Login." 3. At the bottom of the box that appears, click "Register." 4. Enter your user information, select "Graphtech" under "Choose Facility," and click "Submit."
Rewards Points Expiring - Last Opportunity to Use Them!
How to order items:
The PAFP currently offers members the opportunity to earn Reward Points* by attending or participating in various PAFP and PAFP Foundation sponsored programs and activities such as CME conferences, online CME or the PAFP Annual Meeting. Through this August, members who accrue 10 points can redeem the points for a $25 credit on the registration fee for a future CME conference or other PAFP Foundation education program or an item of PAFP apparel. As of Aug. 30, 2019, PAFP members will no longer be able to accumulate any additional points, as the program is being phased out. Members will have until March 30, 2020 to redeem their current point balance. To help members utilize their current Reward Points* balance, PAFP will be offering various discounts and opportunities to members to for redemption. Additional reward point announcements will be made shortly for members to use points for a discount on their November CME registration at the Omni Bedford Springs Resort in Bedford, Pa. or at the PAFP’s Annual Business Meeting, CME, and Research Day registration in March 2020.
1. 2. 3. 4. 5.
Select a product. Select your size. Select the quantity of the item you would like. Click the "Buy Now" button to add the item to your cart. Repeat the process to add other items to your cart.
How to check out: 1. Click the cart icon at the top right of your screen. 2. If your order looks correct, click "Proceed to Checkout." 3. Your address information will auto-populate but may be edited if needed. 4. Select "Save." 5. Click "Proceed to Payment." 6. Add a promo code if applicable. 7. Click "Place My Order." 8. You will be directed to a secure site for credit or debit card payment. View these instructions as a PDF with images
If you are unsure of your current reward point balance, please email Lindsey Killian to confirm your balance or to redeem your points for the 10% discount code. *NOTE: PAFP reward points are not transferable for cash and may only be used for PAFP Foundation CME programs or PAFP apparel. WWW.PAFP.COM
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Some attendees volunteered for slings and splints so others could practice their technique.
As always at PAFP CME conferences, doctors enjoyed good food and conversation during ample refreshment breaks.
Transportation to and from the outdoor sessions was provided by a pleasant, short hayride from the Conference Center to the pavilions.
There was plenty of family fun at Lake Raystown, including a water park and a movie night. Many attendees brought their entire crew.
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Why did it have to be snakes? Shaver’s Creek Environmental Center brought a few slithering specimens.
The Envenomations – Spiders, Venomous Bites & Stings session allowed doctors to hold and touch crawly critters – but the poisonous ones stayed safely in their cages!
Down time at Lake Raystown meant sitting around a campfire, roasting s’mores, and catching up with old friends and colleagues.
Doctors learned how to chart their course through the wilderness using simple tools that can be carried in a hiking backpack.
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Members of the Altoona UPMC Family Physicians Residency showed up in full force! (left to right) Ryan Lani, MD; Omar Bukhari, DO; James Kachmar, MD; Kathleen Sweeney, DO; Caitlin Szczupak, MD; Brandon Shute, DO; Donald Beckstead, MD
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WWW.PAFP.COM
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The Latest Health Care News...
The Pennsylvania Academy of Family Physicians’ PAFP Connect app is available no (iPhone, iPad) and Android (Samsung Galaxy, Google Nexus, Motorola Moto X, Ama
Scouring the latest headlines from reputable media sources across the globe, PAFP Connect brings you the most relevant, up-to-date news and information that affects your practice and your patients. At 1 p.m. daily, PAFP Connect posts the Afternoon Family Medicine news digest – headlines that take a deeper look at family medicine in the U.S., covering all the angles so that you can head into the rest of the day with a deeper understanding of the forces that impact you.
Available Now! Downloading the app is easy! Just search for PAFP Connect on your iPhone’s app store to get started. Alternatively, click on the icon for the app store that matches your device.
Afternoon Family Medicine puts the news into context, telling you what it means and why you should care. In addition to collaborative groups, information, a schedule of events, and links to other PAFP resources like Keystone Physician, Afternoon Family Medicine is one more reason to log on to PAFP Connect daily.
PAFP Connect was built in-house exclusively for PAFP members. To access the mobile app you will need to know your AAFP member ID number. For login assistance, email Michael Zigmund, PAFP’s Chief Communication Offic 20
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. Everyday.
ow for download on iOS azon Kindle Fire) devices!
cer WWW.PAFP.COM
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GOVERNMENT AFFAIRS BRENT ENNIS, Deputy Executive Officer / Chief Operation Officer bennis@pafp.com
PAFP 2019-20 State Legislative Agenda As of 8/7/19 PRIOR AUTHORIZATION REFORM Prior authorizations have become significantly burdensome to family physicians, and more importantly result in delays and jeopardized quality care to patients. The PAFP supports reforms that would maximize electronic communications for authorizations as well as adverse determinations, and define consistent response times for authorizations, rejections, appeals, and external utilization review. PAFP is working with Pennsylvania Medical Society and many stakeholders preparing for introduction of legislation, which will be carrying the designation of House Bill 1194 and sponsored by Rep. Mentzer. A cosponsorship memo (HCO 1917) is being circulated. NURSE PRACTITIONER INDEPENDENCE Nurse practitioners (NPs) are integral, valuable members of the health care team, held in the highest regard by family physicians. However, patients are best served when a physician-led, highly coordinated health care team provides care. Therefore, the PAFP opposes legislation that would expand their scope of practice and 22
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eliminate collaborative agreements. The Senate passed Sen. Bartolotta’s Senate Bill 25 on June 12. Rep. Topper has introduced House Bill 100. Both bills now rest in the House Professional Licensure Committee. HEALTH INSURER CREDENTIALING REFORM Delays in credentialing of new physicians or existing physicians changing practices create undo hardships most notably on the communities they serve. The PAFP supports legislation that would standardize the credentialing form and set processing standards. Rep. Owlett has introduced House Bill 533 seeking to codify significant reforms. The bill is in the House Health Committee. BUPRENORPHINE MEDICALLY ASSISTED TREATMENT ACT Access to care for patients suffering from substance abuse disorder is critical, and state regulation could significantly jeopardize access to office based opioid treatment (OBOT). The PAFP opposes legislation that would require prescribers of Buprenorphine to be licensed
by the state and pay any state licensing fee. Sen. Brooks has introduced Senate Bill 675 which passed the Senate on June 17. The bill is in the House Human Services Committee and the PAFP is working with the Committee and stakeholders in trying to find a compromise. DIRECT PRIMARY CARE (DPC) AUTHORIZING LEGISLATION
RESTRICTIVE COVENANTS In this age of health system consolidations, PAFP supports legislation limiting restrictive covenants in health care practitioner employment agreements. Rep. Deluca has introduced House Bill 601 that rests in the House Health Committee. POLST LEGISLATION
DPC is a model of care outside the bounds of health insurance and an emerging option for patients and physicians. The PAFP supports legislation that specifies direct primary care agreements are not insurance and therefore not subject to insurance laws or regulations. Sen. Browne is circulating SCO 877 seeking cosponsors for the impending bill.
Working with the Pennsylvania Medical Society, the PAFP supports updating and revising Pennsylvania law to include codification of Pennsylvania Orders for Life Sustaining Treatment (POLST) to be used by medical professionals across all health care settings for patients who voluntarily wish to execute a POLST order.
T h e Pe n n sylva n ia Ac a d e m y o f F a m ily P hy s i ci ans
Political Action Committee
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GOVERNMENT AFFAIRS Sen. Yaw has introduced SB 142 that has been assigned to the Senate Health and Human Services Committee. WORKPLACE ACCOMMODATIONS FOR NURSING MOTHERS The PAFP supports legislation that requires employers to provide employees time to express breast milk in a sanitary environment for her nursing child. Rep. Mary Jo Daley has introduced House Bill 1177 that rests in the House Labor and Industry Committee. EXPANDED PHARMACY VACCINATIONS TO MINORS The PAFP opposes legislation that would amend the Pharmacy Practice Act and allow pharma-
cists to administer all CDC recommended vaccinations to patients 9 years of age or older. As part of a compromise several years ago, pharmacist obtained the ability to provide influenza vaccine to those 9 and older. Sen. Judy Ward has introduced SB 274 that rests in the Senate Consumer Protection and Professional Licensure Committee, while Rep. Grove has introduced House Bill 91 that rests in the House Health Committee.
The PAFP’s State Legislative Agenda is developed through the Government and Practice Advocacy Committee with position decisions made by the Board of Directors. Questions or comments? Please contact Brent Ennis, PAFP Deputy EVP/COO and State-Registered Lobbyist at bennis@pafp.com.
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FEATURE
AAFP NATIONAL CONFERENCE INSPIRES THOUSANDS OF STUDENTS, RESIDENTS KANSAS CITY (Left to Right) Geisinger students Katya Malykhina and Cindy Ciccotelli chat with RSAC Chair Thiri Bickel, MD, at the PAFP Reception.
he AAFP National Conference, July 25-27 in Kansas City, Mo., brought together nearly 2,000 medical students, 1,300 residents, plus faculty and physician leaders from all over the country to the annual event. Of this group, the Pennsylvania contingent was high-profile. It numbered over 70 students, many attending thanks to the generous supporters of AAFP and PAFP Foundation student scholarships. Pennsylvania student and resident leaders represented the voices of their peers in the 26
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National Congress of Family Medicine Residents and Medical Students. One particular resolution, which was adopted by the Resident Congress, was brought by PAFP resident leader Adib Rushdan, MD, Drexel Family Medicine Residency. The resolution calls on the AAFP to work with the ACGME and other stakeholders to establish policy that, in the event of a program closure, would relieve residents and fellows of the financial burden of record retention and place all responsibility – including any financial burden – of retaining
training records on the sponsoring institution. Rushdan’s testimony was particularly compelling considering his experience as a Drexel resident living through the uncertainty surrounding Hahnemann Hospital’s closure. More on this at AAFPNews. Pennsylvania resident Derek Baughman, MD, Wellspan Health Family Medicine in Lebanon, was elected Resident Alternate Delegate to AAFP Congress of Delegates. He’ll serve as one of two alternate delegates at the upcom-
ing Congress of Delegates in Philadelphia, and as one of two resident delegates in 2020 at the Congress of Delegates in Chicago. More on resident and student elected leaders at AAFPNews. Policy development and elected leadership positions are only possible thanks to our passionate resident and student volunteer leaders. The groups were inclusive of all who wished to participate and met to collaborate during the weeks preceding the conference. WWW.PAFP.COM
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Pennsylvania students came together to support one another leading up to and during the conference. Friends and colleagues shared hotel rooms, Ubers and Airbnb rentals, soaked up inspiration, knowledge and new skills, tasted Kansas City barbeque and other treats, and made connections with residency teams and leaders that will serve them well through the next phase of their training in family medicine. Popular sessions included the Main Stage opening storytelling event and the always standing-room-only “Preparing for Residency” session. Former PAFP student leaders, now residents, Jacki Gallo, MD and Clay Cooper, MD, collaborated to deliver “Five Business School Lessons to Transform You into a Family Medicine Leader” to a lively crowd.
Foundation, and a former PAFP President, who gave a thorough report on the Foundation’s engagement around student leadership through scholarships and innovative new programs like the Family Medicine Leads Emerging Leader Institute. PAFP members participating in the ELI at the conference this year include Daniel Salahuddin, MD, MPH (Pittsburgh), Jillian Gansert, MD (Springfield), and Jason Spicher (PSU, State College). PAFP Board Chair and Temple faculty David O’Gurek, MD, served as a mentor.
The AAFP Foundation also supports FMIGs at each medical school though grant awards and the National FMIG Network, through which campus leaders can collaborate with and support leaders on other campuses in program Friday’s Family Medicine Interest Group development, community service, and leadawards breakfast featured a gracious welcome ership development. Penn State FMIG leaders by Douglas Spotts, MD, President of the AAFP Mary Connolly and Crystal Lovelace, faculty advisor Andrew Lutzkanin, MD, and mentor Dennis Gingrich, MD, from the Penn State Hershey campus were on hand to accept their recognition as a Program of Excellence, Overall Award, awarded to the top 10 proShow a student you care about their FM future: grams in the country. Support PAFP Foundation Student Scholarships
THE
PAFP FOUNDATION Your donation builds a home for future docs DONATE TODAY
VISIT WWW.PAFP.COM
Thank you for your support! 28
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Pennsylvania residency programs teamed up to form one of the largest state blocks within the Expo Hall. Framed with brightly
2019 AAFP NATIONAL CONFERENCE
Tracey Conti, David O’Gurek, Doug Spotts ( I call this “the three Prez”)
Ryan Fisher, Katie Shoemaker, Cindy Ciccotelli, Student Delegation
Mentor and AAFP Board Member Dennis Gingrich congratulates former student Jacki Gallo, MD, MBA, following her presentation at AAFPNC
colored “Pennsylvania” banners, it was hard to miss. More than 30 programs participated this year, more than any prior year. Program directors, faculty, program coordinators and residents teamed up to talk with the steady flow of interested students through the aisles. The Pennsylvania Reception at the Alamo Mainstreet Theater in the Power and Light District kicked off Friday evening activities with informal networking; more than 100 students attended.
Thiri Bickel, Chair, RSAC, PAFP Staff Lindsey Killian & Molly Talley at the FMIG Awards Breakfast
Wellspan Resident Derek Baughman, MD, gives his candidate speech at the Resident Congress. The Congress elected Derek Alternate Resident Delegate to AAFP COD.
Students are generous with their praise of the event and in their gratitude to those supporting student scholarships. Some student reflections: “I want to thank you from the bottom of my heart for the PAFP scholarship to attend AAFPNC. I had the best few days of my medical school journey at the conference and came away inspired about how amazing family medicine truly is … Receiving the financial assisWWW.PAFP.COM
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Congrats to AAFP National Conference poster presenters! ongratulations to Jillian Gansert, MD and Daniel Salahuddin, MD, MPH for being selected to present posters at the American Academy of Family Physicians (AAFP) National Conference! The year-long Family Medicine Leads (FML) Emerging Leader Institute focuses on ensuring the future of the Family Medicine specialty
by increasing the number of future Family Medicine leaders and provides training for this important role. The AAFP defines an emerging leader as “an individual who has shown historical aptitude for leadership and has exhibited to others a strong potential for future leadership. An emerging leader has little formal training or experience with leadership and is motivated to gain additional leadership skills and experience.”
Below are the details of the poster presentations: DANIEL SALAHUDDIN, MD, MPH Project Title: "Assessing Social Determinants of Health (SDoH) in a Residency Clinic in McKeesport, PA Through a Trauma-Informed Approach" Mentor: David O'Gurek, MD, FAAFP Year in Residency/School: PGY2 Program/School: UPMC Combined Family Medicine/Psychiatry Residency Program
JILLIAN GANSERT, MD Project Title: “Creating Tools for Success in Screening for and Treating Hepatitis C in the Primary Care Setting” Mentor: Anne Donnelly, MD Year in Residency/School: PGY2 Program/School: Crozer Keystone Family Medicine Residency
David O’Gurek, MD, and Dan Salahuddin, MD, MPH, flank Dr. Salahuddin’s winning poster on Social Determinants of Health.
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2019 AAFP NATIONAL CONFERENCE
tance means more than can be put into words and I am forever grateful for the opportunity you provided!” “Attending the conference proved to be as exciting as my mentors and previous graduates told me it would be … I quickly felt like I was among people who had very similar values and intentions as me. Thanks to the conversations I was able to have at the conference, I have figured out what kind of residency I’m looking for … Thank you very much for your contribution to my education and future.” “Attending this conference solidified my decision to go into family medicine and made me very excited for a future in family medicine … My favorite part of the conference was all of the compassionate and inspiring people I met there. It was great to be among this group who were so welcoming and such strong advocates for their communities. It was great to see these people doing the work I want to do in the future and gain so many role models.” “I’m so glad I was able to attend this conference! I attended many informative workshops, learned procedures, tips, and opportunities from leaders in the field … and left the conference with a reignited energy and passion for family medicine!” “AAFPNC was an amazing opportunity for me to learn about a variety of topics which greatly interest me, such as diet and exercise, caring for the underserved, and addiction … The main stage sessions were particularly moving and inspiring ... I am so grateful that I was able to participate in the conference and I look forward to a future in this field.”
PSU students Ben Carnahan, Ana Sanchez chat with PSU alumane and UPMC St Margaret residents Kayley Swope and Jacki Gallo at the PAFP Reception.
UPMC faculty Susan Skef, MD, and Victoria McCurry, MD visit with the best little recruiter on Pa Row, Dr. McCurry’s son. Family Medicine is about family!
Penn State Hershey’s Dan Schlegel, MD, and Dennis Gingrich, MD, PSU Hershey alumna and UPMC St Margaret resident Jacki Gallo, MD, MBA, and pre-medical student Hannah Spotts at the PAFP reception.
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AAFP NATIONAL CONFERENCE INSPIRES THOUSANDS OF STUDENTS, RESIDENTS KANSAS CITY
Residency teams interact with prospective applicants in the
Drexel FM Residency team, left to right: Adib Rushdan, MD, Program Director Leon McCrea, MD, Ansa Anderson, MD, PAFP Resident Board Rep Lily Payvandi, MD, Fotini Debonera, MD, relax after a long conference day at the PAFP reception.
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York FM Resident “Shu” Malhotra, DO, left, chats with Geisinger Commonwealth students Joshua Dearing, Cindy Ciccotelli and Erin Connolly at the PAFP Reception.
e Pa State Block at the AAFPNC Expo Hall, Kansas City, MO.
Penn State Hershey FMIG receives AAFP “Program of Excellence” Award; Faculty advisor Andrew Lutzkanin, MD, current FMIG President Mary Connolly, past FMIG President Crystal Lovelace, PSU faculty and AAFP Board Chair Dennis Gingrich, MD.
PAFP Resident Delegation at work in the Resident Congress: Alyssa D’Addezio, MD, Kayley Swope, MD, Lily Payvandi, MD, Derrek Baughman, MD.
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FEATURE
(clockwise from left) PUPPIES at conference registration! Here’s Molly Talley, PAFP Director of Resident & Student Initiatives, with one adoptable pup. They were in high demand; Penn State school of medicine alumni, Jacki Gallo, MD, MBA (UPMC St Margaret resident) and Clay Cooper, MD, MBA (Duke resident), share a podium for their presentation, “Five Business School Lessons to Transform You Into a Family Medicine Leader;" Wellspan Good Samaritan Residency Director Abdul Waheed, MD, and resident Derek Baughman, MD, celebrate Derek’s election win as Resident Alternate Delegate to AAFP COD. :Wellspan Good Samaritan residency team visit with Thiri Bickel, MD, PAFP RSAC Chair (second from left) at the PAFP Reception.
Temple students pose in the Expo Hall with FMIG Faculty Advisor (and PAFP Board Chair) David O’Gurek, MD, and Margot Savoy, MD, MPH, Chair, Family and Community Medicine (third from right). | KEYSTONE PHYSICIAN | FALL 2019
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THE
PAFP FOUNDATION Your donation builds a home for future docs
“ Having been a benefactor of the PAFP in so many ways, my service is a unique opportunity to continue to give back.” David O’Gurek, MD Assistant Professor, Family and Community Medicine Temple University
“ For continued growth of the PAFP Foundation and to help the organization support its members through advocacy and education it needs ongoing support for all its members so that we as family physicians continue to provide the best health care in our communities.” Munima Nasir, MD
“ As a person transitioning to PA for residency, my opportunities to be involved in the PAFP allowed me to develop meaningful and lasting connections with mentors and colleagues, making my decision to stay in PA to practice a no brainer.” Debra Bell, MD COE Medical Director/Hanover Site Lead Physician Family First Health - York, PA
“ I am so grateful for the foundation’s support when I was a medical student and resident, which allowed me to grow as a leader and advocate for family medicine.” Jason Woloski, MD Geisinger Wyoming Valley Wilkes-Barre, PA
Penn State Hershey Medical Group Middletown, PA
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Thank you for your support! FM InSpIRe (Family Medicine INfluencing SPecialty Interest REvolution) is a PAFP initiative to create awareness WWW.PAFP.COM | 35 of the PAFP Foundation and raise funds that directly support residents and students.
INTERVIEW CONVERSATIONS WITH INDIVIDUALS AT THE FOREFRONT OF FAMILY MEDICINE Interested in being featured in a future issue? Email Bryan Peach at bpeach@pafp.com
Newly elected AAFP Resident Alternate Delegate on AAFPNC, family medicine, and health care policy Derek Baughman, MD was born and raised in Lancaster, PA. He graduated with a BSc in Cell & Molecular Biology from West Chester University of Pennsylvania with minors in Chemistry and Studio Arts. During medical school at St. George’s University in Grenada, Derek served in several leadership positions that helped develop his interest health policy. During his clinical years, Derek cultivated his population health interests by participating in advocacy in Washington, D.C. and interning with a congressman’s office. Derek chose family medicine for the breadth of medical knowledge needed to prepare him for a career in health policy reform; he is passionate about leadership in medicine. At the AAFP National Conference over the summer, Baughman was elected Resident Alternate Delegate to AAFP Congress of Delegates. He’ll serve as one of two alternate delegates at the upcoming Congress of Delegates in Philadelphia, and as one of two resident delegates in 2020 at the Congress of Delegates in Chicago.
Keystone Physician: What led you into the family medicine specialty? Derek Baughman, MD: When I was a kid, I really wanted a four-wheeler. I got a job, saved up, and bought a brand-new ATV as a 12-yearold, with cash. For seemingly every childhood 36
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chore, I conceived some way to incorporate the four-wheeler into an efficiency model for accelerating the rate of said chore completion. My dad’s approach was “just do the work and get it done.” For some chores like wood stacking, he was right; I wasted my fair share of time in trying to rig pully systems with ropes and
Derek Baughman, MD
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INTERVIEW the four-wheeler all to avoid a flight of stairs. But for many chores, like taking the old mattresses out to the burn pile, the four-wheeler was faster, required less lifting, and was simply a superior approach to the blind manual labor model. Over the years I learned the balance of efficiency. Improvement begins with challenging the status quo and follows with assimilating expert viewpoints, utilizing better resources, and troubleshooting wiser alternatives to improve the process.
THAT DAY I WAS A PART OF A BIGGER MOVEMENT TO CHANGE THE RULES AND MAKE A PROCESS MORE EFFICIENT; IT PROVIDED INSIGHT FOR MY PLACE AS A PHYSICIAN LEADER AND OPTIMISM FOR MY NICHE WITHIN FAMILY MEDICINE
Somewhere between second and third year of medical school, I realized that the people who make the rules dictate how it’s practiced. Similar to starting a new job and getting inundated protocol at orientation, medical training is filled with thousands of things “you just do.” Guidelines, first-line treatments, proper algorithm navigation: we’re expected to have a nearly reflex response to management because that is standard of care and we learn to accept things because “that’s just the way it is.” But like the mattresses and the burn pile, I 38
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have always been the guy wondering why it’s done that way and how it could be better. As I started third-year clinical rotations, I began to read about paths for physicians with a desire change health care. My quest led me to Capitol Hill for my first advocacy summit. Before this experience, I never appreciated the value and potential policy holds for impacting change. My experience with advocacy revealed leaders on Capitol Hill who were unaware that important problems like residency training funding are even an issue. That day I was a part of a bigger movement to change the rules and make a process more efficient; it provided insight for my place as a physician leader and optimism for my niche within family medicine. Personal research, mentorship, and personalized fourth-year electives (including population health, administration, medical conferences, and a federal congressional internship) helped me realize my passion for pursuing policy. Fulfillment in tangibility of practicing family medicine combined with sheer breadth of exposure to health care made an easy choice for the decision to pursue the specialty. I don’t understand how one can expect to solve complex health care problems at a state or national level and develop the clarity necessary to make efficient logistical improvements without firsthand experience practicing clinical medicine. Moreover, the full spectrum of patient age, broad disease exposure, and a focus on the majority of need in a population gives family medicine physicians an unequivocal advantage in cultivating clinical clout for development of medical policy. That’s why I picked it.
I wrote in my personal statement for residency applications: “A few hundred million Americans and only one set of hands is my glass ceiling.” This is the value of policy. Most people will never need major surgery, but everyone should have a family doc. This is the value of primary care. I believe learning from the one-on-one encounters and the multifactorial issues affecting patients as a family physician enhances my ability to advocate for better health care solutions. Family medicine gives me a platform, and policy is my four-wheeler. Tell us about attending AAFP National Conference – what did you gain from your experience there? This was my first time attending an AAFP event, and it was well worth the flight. It was an invalu-
able experience that gave me a literal podium to jumpstart my family medicine residency training. Although I enjoyed some great lectures and stocking up on free pens, I gained more than expected. My journey to the conference and the alternate delegate position was hardly straightforward nor without setbacks. In short, I learned through the process that perseverance has its rewards but not necessarily in the way expected. Prior to residency, I was very involved with the American College of Preventive Medicine (ACPM) as a medical student (and met some great mentors who encouraged my interest in family medicine), but I had no direct involvement with AAFP until this past spring. After I matched into family medicine in Pennsylvania, I
A WellSpan Family Medicine Career: What's Your Goal? WellSpan Health is a not-for-profit, integrated health system that serves the communities of central Pennsylvania and northern Maryland. The organization is comprised of a multi-specialty medical group of more than 1,500 physicians and advanced practice clinicians, a home care organization, eight respected hospitals, more than 19,000 employees, and 170 patient care locations. Learn More About Our Outstanding Opportunity Near Gettysburg, PA: • Outpatient practice with 5 providers in Aspers, Pennsylvania • State of the art building with lab, imaging and rehab on site • Supported by nurse triage service when on call • Only 25 minutes from gated, lake-front communities • Abundant outdoor activities including horseback riding, fishing, hunting and hiking • Educational loan repayment program up to $100,000 • Sign-on bonus of $40,000 plus a monthly resident stipend • Emphasis on well-being and work-life balance - 5 weeks of time off + 6 holidays • Outstanding benefits package including malpractice and tail TO LEARN MORE about Family Medicine opportunities, visit JoinWellSpan.org or contact our recruiter: Cris Williams at (717) 812-4487 | cwilliams9@wellspan.org
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INTERVIEW
MY PRESENCE FELT VALUED, MY OPINIONS FELT APPRECIATED, AND I WAS GREATLY ENCOURAGED BY THE AUTHENTICITY OF MY PEERS AND LEADERS
quickly sought out ways to get involved during residency. I reached out to Molly Talley, PAFP Director of Resident and Student Initiatives, who was an excellent resource – getting me plugged in with the resident section of PAFP before I was even an official PGY1. I ambitiously applied for one of the resident state delegate positions for Pennsylvania but was not selected. I also applied for one of the Family Medicine Leads Emerging Leaders Institute scholarships but was denied. As a last-ditch effort to attend the conference, I applied for one of the AAFP Foundation scholarships to attend the national conference as a resident. Although this was a generous scholarship, between plane tickets and hotel, I basically drained my residency CME money for the year. I hoped it would be worth the investment and planned simply to take advantage of any opportunities. I figured at any rate, I’d have a good chance at securing my involvement with the AAFP as a PGY2. The best part of my experience at the conference was opportunities to participate in cor40
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porate AAFP. I did my research beforehand to discover that I could apply for one of the delegate positions as a participant in the resident congress. The more leaders I talked to, the more I discovered. I simply asked about getting involved with a reference committee and it happened that one of the committee positions was vacant. I “walked onto” ref-com 1 and got to see first hand the devotion of my peers to improving the practice of medicine. This gave me sincere hope for the future of medicine. I was honored to serve on a committee and get into the nuts and bolts of the AAFP policy making process. Through this involvement, I was introduced to other AAFP leaders and PAFP leaders who enlightened my understanding of other policy involvements during residency like elective and internship possibilities. My presence felt valued, my opinions felt appreciated, and I was greatly encouraged by the authenticity of my peers and leaders. The cherry on top was being elected to the alternate delegate position. The resident alternate delegate to the National Congress of Delegates is a two-year position (first year as alternate delegate, second year as voting delegate) where two residents represent the entire national AAFP resident body. These national delegates represent the voices of the state resident delegates to the national AAFP Congress of Delegates and have the same voting privileges as physician delegates. Delegates are sponsored by the AAFP to attend several conferences throughout the year to serve on committees, weigh in on academy initiatives, and vote on national policy. It’s a
Save the date MEDICATION-ASSISTED TREATMENT (MAT) REGIONAL SUMMITS These unique summits will include four hours of waiver training in the morning, lunch with plenary session, and afternoon sessions for practitioners and staff featuring sessions designed to address barriers and challenges. You may choose to attend in the morning, afternoon, or all day.
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INTERVIEW huge honor for anyone, especially a first-year resident. From my experience, I would challenge those who think that improving medicine is too far out of reach to be perseverant in exploring opportunities on how to contribute. You may apply for scholarships or stipends and not get them, you’ll have to spend some free time researching how and where to get involved, you’ll probably write a bunch of emails and not get responses, and you might even use up all your CME money for the year on a single conference. But if you’re passionate about making medicine better, there are ways to turn ideas into progress, the AAFP is an organization that is willing and capable of supporting efforts that can result in meaningful change. What do you hope to accomplish on the national stage as Resident Alternate Delegate? The AAFP is more than just a few doctors with opinions. Its one of the largest professional organizations in medicine. Applying for the alternate delegate position required a speech and answering a question panel in front of the resident congress. During the question panel, I referenced the movie “A Bug’s Life.” In the movie, the protagonist Flick was a guy who stood up for what was right and fought for a way to improve the lives of his population. I believe he would have used a four-wheeler to help build the bird if they came in ant-size, but nonetheless, the idea was a much more efficient approach than simply rolling over 42
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BY HARNESSING THE COLLECTIVE INFLUENCE OF STUDENTS, RESIDENTS, AND PHYSICIANS, THE CONGRESS OF DELEGATES HAS THE CLOUT TO GAIN THE ATTENTION OF POWERFUL PARTIES CONGRESS WHO CAN PROPAGATE LARGE SCALE CHANGE
and letting the grasshoppers continue to take their food each year. I mentioned in my question response that although Flick spoke up as a representative for everyone, it wasn’t until all the ants in the end of the movie collectively stood up to the grasshoppers that the grasshoppers finally left for good. Similarly, with the 130,000 plus members in the AAFP, we have the potential for great influence and change in medicine – but someone has to be Flick. On the national stage, I hope to use the platform to influence change. Like it or not, policy determines how we practice. By harnessing the collective influence of students, residents, and physicians, the Congress of Delegates has the clout to gain the attention of powerful parties congress who can propagate large scale change. I’m elated at the opportunity to learn the ropes of that process.
What is your favorite aspect of practicing family medicine? In short, the tangibility. Family medicine puts me front and center to a diverse yet personal experience with those whom the health care system directly affects. When I conduct nutritional counseling, colonoscopy scheduling, or review a patient’s health insurance limitations, I am making a tangible difference. When I promote HPV vaccination, I’m preventing cervical cancer; when I establish diet and exercise goals, I help alter the course of diabetes.
I’m thrilled to be part of such a diverse, passionate specialty that is constantly working to improve the lives of patients. Family medicine gives me a powerful platform to propagate influence and change the health of my community one patient at a time. I look forward to improving the lives of individuals as a family physician now, and I look forward to using policy to transform this generation’s health care problems into the next generation’s health system solutions.
Oversight like missed counseling for pre-diabetes or neglecting patient follow-up is sustaining fodder for preventable disease. I see the potential in explaining to the overweight, middle-aged mother that her lipid panel reflects an increased risk for heart disease because my recommendation could be the motivation she needs to start cooking healthier foods or commit to exercise goals. Moreover, lifestyle change is contagious. Healthier communities begin with leaders willing to be an example and guide others toward improvement. WWW.PAFP.COM
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LEGAL AND COMPLIANCE UPDATE CHARLES I. ARTZ, Esq., General Counsel cia@artzhealthlaw.com
PA Supreme Court allows evidence of risks and complications as a defense in medical malpractice litigation n a case closely watched by the Pennsylvania medical community, the Pennsylvania Supreme Court issued a landmark ruling on June 18, 2019 reversing a controversial and potentially devastating 2017 Superior Court decision involving the admissibility of risks and complications evidence in a medical malpractice ordinary negligence trial. In Mitchell v. Shikora, ___ A.3d ___ (Pa. 2019) (2019 WL 2504475), the legal issue was whether evidence regarding the risks and complications of a surgical procedure in a medical negligence case are admissible. The facts and procedural history will be briefly summarized initially. The Supreme Court’s rationale and legal conclusions follow. In May 2016, Dr. Shikora performed a laparoscopic hysterectomy on Ms. Mitchell. Dr. Shikora began the operation by making an incision into Mitchell’s abdomen; however, while the surgeon was opening the sheath of the peritoneum, fecal odor was detected. Dr. Shikora realized that Mitchell’s colon had been 44
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severely cut. The surgeon stopped the hysterectomy and consulted with a general surgeon who performed an emergency loop ileostomy, which ultimately was successful in repairing the bowel. Mitchell was required to wear an external ileostomy pouch for a short period. In December 2016, Mitchell sued Shikora, the practice and the health system. She alleged Dr. Shikora breached his duty of care by failing to take reasonable precautions to prevent her
from suffering complications, injuries and/or damages in connection with the surgery. Her theory was that Dr. Shikora’s failure to identify her colon before making an incision into her abdomen constituted a breach of the applicable medical standard of care. She did not sue Dr. Shikora for informed consent. Mitchell filed a motion before trial to exclude evidence of her informed consent regarding the risks of the procedure, which include perforation of the colon, as evidence of the risks themselves, as being irrelevant, unfairly prejudicial, or confusing. The trial court granted Mitchell’s motion regarding evidence of her informed consent document; however, with respect to whether a bowel injury was a known risk or complication of the surgery, that motion was denied. Expert testimony was allowed at trial. Dr. Shikora’s expert testified that injury to the bowel is a recognized complication of the surgery and that the riskiest part of the procedure is entry into the abdominal cavity “because it is blind” and the surgeon “can’t see beyond the skin and the layers below it.” Dr. Shikora’s expert testified the surgeon complied with the applicable standard of care; that in making the initial incision, a physician often cannot see through the tissue, and, thus, the surgeon does not know what is behind the peritoneum, and that this is when complications may occur, which can be unavoidable and can occur in the absence of surgical negligence. The jury returned a verdict in favor of
Dr. Shikora and the other defendants. Mitchell appealed, and the Superior Court reversed, holding that evidence of risks and complications are never admissible and granting a new trial. Dr. Shikora appealed to the Supreme Court. The Supreme Court’s holdings and rationale can be summarized as follows: 1. Evidence presented by an expert witness explaining a surgical procedure’s risks and complications may be admissible at trial in a medical negligence case. 2. Risks and complications evidence may help a jury determine the standard of care expected of a surgeon and whether the surgeon caused a patient’s injuries by breaching that standard. 3. Evidence of a patient’s informed consent (such as the signed informed consent document) is generally irrelevant and inadmissible in medical negligence cases, unless lack of consent is at issue. Thus, the informed consent document signed by the patient cannot be introduced unless the physician has also been sued for failing to provide informed consent. 4. Despite the inadmissibility of the patient’s informed consent document, evidence of the risks themselves may be relevant to establish the applicable standard of care, or to establish whether the physician breached the standard of care. WWW.PAFP.COM
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LEGAL AND COMPLIANCE UPDATE 5. Evidence of the risks and complications inherent to a surgical procedure is necessary to explain a physician’s decision making with respect to his or her actions, which in turn informs the standard of care. In this case, the first incision in the laparoscopic surgical procedure involves an increased risk of complications because the incision is undertaken “blind.” Thus, it follows that, if a bowel injury during abdominal surgery is a well-recognized risk or complication of laparoscopic surgery, it is less likely that the standard of care was breached.
written contract, a physician is “neither a warrantor of a cure nor a guarantor of the result of this treatment.” There is no presumption or inference of negligence merely because a medical procedure terminated in an unfortunate result which might have occurred despite the exercise of reasonable care. There is no requirement that a physician be infallible and making a mistake is not negligence as a matter of law. The idea that complications may arise through no negligence of the physician is ingrained in Pennsylvania jurisprudence.
6. With respect to causation, physician defendants in a negligence case are entitled to offer evidence as to alternative causes of injury. Here, it is permissible for a physician to introduce evidence suggesting another cause of the injury, such as routine medical complications.
9. The fact that a patient may have agreed to a procedure in light of the known risks (by signing the informed consent document) does not make it more or less probable that the physician was negligent in either considering the patient an appropriate candidate for the operation or in performing it in the post-consent time frame. There is no assumption-of-the-risk defense available to a physician that would eliminate his duty to provide treatment according to the ordinary standard of care.
7. Evidence of risks or complications address not only whether a physician’s conduct fell below the standard of care and caused injury, but is relevant to dispel a finding of negligence with respect to an injury which may have occurred despite the exercise of reasonable care. 8. Prohibiting risks and complications explanatory evidence would prevent a physician from presenting alternative causes, and, in effect, transform physicians into guarantors of a cure, contrary to longstanding precedent. In a 1968 case, the Supreme Court held that, in the absence of a specific 46
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10. It is axiomatic that complications may arise even in the absence of negligence. Risks and complications evidence may assist the jury in determining whether the harm suffered was more or less likely to be the result of negligence. 11. Without the admission of risks and complications testimony, a jury may be deprived of information that a certain injury can
occur absent negligence, and, thus, would be encouraged to infer that a physician is a guarantor of a particular outcome. 12. The expert testimony at the trial concerning risks and complications was both relevant and admissible regarding the proper standard of care and whether there was a breach of the standard. The dissent and Superior Court’s decision would prevent a jury from obtaining a complete understanding of the applicable standard of care and the possible breach of that standard. That approach undermines the foundational tenet that injuries may occur in the absence of negligence and would work a radical change in medical malpractice jurisprudence, making physicians virtual guarantors of a result or warrantors of a cure – neither of which, as a matter of fact or law, is supportable.
13. Evidence of risks and complications may be admissible, subject to traditional evidentiary concerns of relevancy, reliability and disqualifying considerations such as undue prejudice. The final point underscores the important balance established by the Supreme Court: as long as the expert witness’ testimony regarding risks and complications is relevant, reliable and not unduly prejudicial, it is admissible. The Supreme Court thoroughly rejected the Superior Court’s analysis and holding, which we all feared would have created a virtual type of strict liability. Accordingly, physicians can now breathe easier that their hands will not be tied behind their back in ordinary negligence medical malpractice cases and there is no strict liability in terms of risks and complications that occur without breaching the standard of care (of course, as long as a thorough informed consent was given).
Pain Management & Opioid Misuse Resource Center If you know of an additional resource that visitors to this page may find useful, please click here. WWW.PAFP.COM
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LEGAL AND COMPLIANCE UPDATE
Amendments to medical/osteopathic practice acts physician assistant supervision agreements n July 2, 2019, the governor signed two pieces of legislation into law amending the Medical Practice Act and the Osteopathic Medical Practice Act, changing the process by which physician-physician assistant (PA) agreements and scope of practice approvals are submitted to the State Board of Medicine and State Board of Osteopathic Medicine. Act 68 of 2019 amends the Medical Practice Act. Act 69 of 2019 amends the Osteopathic Medical Practice Act. Both Act 68 and Act 69 take effect August 1, 2019. Practically, both new statutes have the same legal effect, as follows: 1. A new definition of “primary supervising physician” has been added: A medical doctor who is registered with the Board and designated in a written agreement with a physician assistant as having primary responsibility for directing and personally supervising the physician assistant. 2. The requirement that the physician/PA written agreement be signed by the physician and the PA before submission to the licensing board has been repealed. 48
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3. Although two provisions in Act 68 and Act 69 either repealed or struck the requirement that the agreement be signed, we nevertheless recommend that the supervising physician and the PA continue to sign the written agreement. 4. The written agreement defining the PA’s scope of practice may be prepared and submitted by either the primary supervising physician, or the physician assistant, or a delegate of the primary supervising physician and the physician assistant. This delegation authority is important because the licensing boards’ new online PALS licensing system requires the supervising physicians personally to enter their own information into the PALS system which can be time consuming. The designee would no longer be allowed to do the background work or the filing. A change in the current law was required in order to allow designees to do this work under the new system. Therefore, Act 68 and Act 69 now allow a physician to designate another person to enter the written agreements and related documentation into the new PALS system.
5. Even though the physician or PA’s delegate can now perform the administrative filing tasks, Act 68 and Act 69 specifically state it is not a defense in any administrative or civil action (such as a medical malpractice case) that the physician assistant acted outside the scope of the description of services approved by the licensing board, or the supervising physician utilized the PA outside the scope of the description because they permitted a delegatee to file the documents that were approved. As a practical matter, that means the agreement must be carefully written to explain all of the services and scope of practice the PA will conduct under the physician’s supervision.
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1. Allow physician assistants to practice medicine independently. 2. Change the requirement regarding the frequency of patient record reviews conducted by the supervising physician. 3. The limitation that a physician cannot supervise any more than four physician assistants.
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Bedford CME Conference November 8-10, 2019 • Bedford, PA PAFP Annual Business Meeting & CME Conference March 5-8, 2020 • Hershey, PA
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Adult Immunization Update
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Top 10 Issues in Women Health
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DEPRESCRIBING AND POLYPHARMACY IN THE GERIATRIC POPULATION 0.75 CREDIT(S)
FECAL INCONTINENCE AND CONSTIPATION IN THE ELDERLY 0.25 CREDIT(S)
MEDICAL MALARKEY: MEDICAL MISINFORMATION IN THE DIGITAL AGE AND HOW TO CORRECT IT 0.75 CREDIT(S)
NARRATIVE MEDICINE 0.75 CREDIT(S)
ORAL HEALTH IN THE ELDERLY 0.75 CREDIT(S)
PAIN MANAGEMENT AND BEST PRACTICES 1.0 CREDIT(S) • MEETS MANDATED OPIOID EDUCATION CRITERIA
PRE-OPERATIVE EVALUATION 0.75 CREDIT(S)
WHEN TO STOP SCREENING AND TESTING – MAMMOGRAMS, PAPS, COLONOSCOPY 0.75 CREDIT(S)