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ON CALL magazine

The Official Publication of the Palm Beach County Medical Society

Quarter Three 2012


Palm Beach County Medical Society Services presents The Future of Medicine Summit IV

Jointly Sponsored by the West Palm Beach VA Medical Center and MAGEC

September 27-28, 2012 “Striving for Medicine’s Better Future” Palm Beach County Convention Center, West Palm Beach, Florida Featuring Nationally Recognized Health Care Leaders and Local Experts

Summit Schedule September 27, 2012 (Thursday)

Michael Dennis, MD Summit Chair

8:00-8:45 am

Registration & Exhibit Hall

12:00-12:45 pm

8:45-9:00 am

Welcome & Opening Remarks Brent M. Schillinger, MD, President, PBCMS Services Jose F. Arrascue, MD, Chair, Future of Medicine Michael Dennis, MD, Summit Chair

Science, Medicine & Community

Carol Beasley, Director of Strategic Projects, Institute of Healthcare Improvement “Improving Population Results Using the Triple Aim” Jim Kupel, Managing Principal, Crescendo Consulting Group

Summit VI Panelists: Alina Marie Alonso, MD, Palm Beach County Health Department John H. Armstrong, MD, Florida Department of Health Jose F. Arrascue, MD, South Palm Beach Nephrology Stephen Babic, MD, Boca Raton Cardiology Associates James J. Byrnes, MD Jeff Cohen, Esq., Florida Healthcare Law Firm Kelly Conroy, Palm Beach Accountable Care Organization John D. Couris, Jupiter Medical Center J. Michael Cowling, Palm Beach Gardens Medical Center Ronald L. Davis, PhD, Scripps Florida Linda De Piano, PhD, Jerome Golden Center for Behavioral Health Amy Dean, Palm Healthcare Foundation Malcolm Dorman, MD Phil Galewitz, Kaiser Health News Pamela Gionfriddo of Mental Health Association of Palm Beach County Pascal J. Goldschmidt, MD, University of Miami Miller School of Medicine Donald S. Grossman, MD, Florida True Health W. Alan Harmon, MD, Florida Medical Association Janet Hibel, PhD Daniel R. Higgins, MD James T. Howell, MD, Nova Southeastern University Jerel Humphrey, Wellington Regional Medical Center Bruce Inverso, American Heart Association Roger Kirk, Bethesda Memorial Hospital Kirill A. Martemyanov, PhD, Scripps Florida Patricia McDonald, PhD, Scripps Florida Gina Melby, JFK Medical Center Eugenia Millender, PhD, FAU Diabetes Education and Research Center Juan Nogueras, MD, Cleveland Clinic Florida Kathryn Reynolds, MD, Palm Beach Diabetes & Endocrine Specialists, P.A. Dan Sacco, Boca Raton Regional Hospital Bruce L. Saltz, MD, Mental Health Advocates, Inc. Parag Shah, HealthPrime International Kelly Skidmore, UnitedHealthcare Abbey Strauss, MD John Vara, MD, VA Medical Center Ronald J. Wiewora, MD, Health Care District of Palm Beach County Jack Zeltzer, MD, Palm Beach Surgical Associates, LLC

Register Online at www.pbcms.org

9:00-11:00 am

11:00 am-12:00 pm

Lunch & Exhibit Hall

12:45-2:00 pm

Current Perspectives in Bipolar Disorder

2:00-3:15 pm

Diabetes: A National and Global Crisis

3:15-3:30 pm

Break & Exhibit Hall

3:30-5:00 pm

Latest Advancements in Cardiovascular Disease Research, Treatment and Care

5:00-6:00 pm

VIP Reception, Exhibit Hall & Poster Symposium

Pete Martinez, Chairman, Palm 6:00-8:00 pm Beach Medical Education Corp. “How Technology is Advancing Health Care” Lisa Rawlins, Executive Director, South Florida Regional Extension Center “The Future of Medicine: Resources Available, Tools Needed, Impact on the Practice”

VIP Dinner* and Program Jeremy Lazarus, MD, President, American Medical Association Donna E. Shalala, PhD, President, University of Miami, “The Future of Universal Health Care” Poster Symposium Awards Jack Zeltzer, MD, President, Palm Beach County Medical Society

* VIP dinner tickets sold separately September 28, 2012 (Friday) 11:00 am-12:00 pm Joe Mott, Vice President, Healthcare Transformation, Intermountain Healthcare “Fixing Health Care: What Has to Change”

8:00-8:30 am

Registration, Continental Breakfast & Exhibit Hall

8:30-8:45 am

Welcome and Opening Comments Jack Zeltzer, MD, President, PBCMS 12:00-1:00 pm Michael Dennis, MD, Summit Chair Jose F. Arrascue, MD, Chair, Future of Medicine

Transformational Change: A New Reality for Health Care 8:45-9:15 am

9:15-10:00 am

10:00-10:45 pm

10:45-11:00 am

Cecil B. Wilson, MD, MACP, President-Elect, World Medical Association “Transformational Change: A New Reality for Health Care” Chris Dawe, Director, Delivery System Reform, US Department of Health & Human Services “Perspectives of Delivery & Innovation from the Public and Private Sectors” V. Anthony Marino, Vice President, Network Development, Florida Blue Jeff Goldsmith, PhD, President, Health Futures “The Future of Medical Practice” Break & Exhibit Hall

Lunch & Keynote Speakers Mike Segal, Esq., Partner, Broad and Cassel Chris Schlanger, MD, MBA, Managing Director, The Advisory Board Company “State of the Union”

Practice Solutions: Practice Solutions will be moderated by Rick Cameron, Managing Director, Navigant 1:00-2:15 pm

A New Era for Physician Organizations

2:15-3:15 pm

Physician & Hospital Integration

3:15-3:30 pm

Break & Exhibit Hall

Health Policy 3:30-5:00 pm

Medicine, Policy and Politics

5:00 pm

Closing Remarks 16 CMEs and CEUs Visit www.pbcms.org/FOMSummit for more information

16 CMEs and CEUs offered. Visit www.pbcms.org/FOMSummit for more information


On CALL Magazine Quarter THREE 2012 / PRESIDENT’S REPORT

3 2

President’s REPORT Jack Zeltzer, MD

Quarter Three 2012

President, Palm Beach County Medical Society

Physicians: We Are the Future of Medicine The past few months have seen an interesting intersection of what I’ll generically call the Future of Medicine. As of writing time, the Supreme Court controversially and historically voted to uphold the Patient Protection and Affordable Care Act (PPACA), or Obamacare, depending on which side of aisle one sits. PBCMS took an official position that we “must work within the framework to continue doing what we deem to be right. Palm Beach County’s physicians will continue our efforts to ensure that our patients have access to quality, affordable health care delivered by the physician of their choice. PBCMS is also committed to the preservation of physician autonomy as a main pillar in support of patient care. Additionally, we will continue our work to eliminate fraud and waste in the health care system. It is critical to address these issues now so that patients can receive the first-class care they deserve and so that physicians can provide that care in a patientfocused, cost-effective way.” While some may believe this to be a “NEUTRAL” position because it is neither Left or Right nor Blue or Red, in fact it is not. It is “Patient Centric” which is the only appropriate focal point when considering health care issues. We must not allow ourselves or others to be distracted from this fundamental principle. Regardless of PBCMS’ official position, that of each of our members, or what the federal or state governments decide, the future of health care will be fundamentally different tomorrow than it was yesterday.

PBCMS will host the Future of Medicine Summit VI on September 27 and 28 at the Palm Beach County Convention Center, bringing nationally recognized leaders to speak alongside our local experts and visionaries. This is an educational forum not to be missed, and for us practicing physicians, yes, it’s worth rescheduling your patients for these two days. In fact, why don’t you invite them to attend? Patients will find particular interest the afternoon of Thursday, September 27 during the Science, Medicine & Community panels. Each year we partner with Scripps Florida to discuss 3 topics of interest not only to physicians and health care providers, but also to the general public. This year, Scripps researchers, local physicians, and community advocates will speak about diabetes, heart disease and mental health with a focus on bipolar disorder. Other topics of interest will be Innovations in Health Care Technology; Transformational Change: A New Reality for Health Care; and Health Care Economics. We’ll learn from industry leader Intermountain Healthcare about the unique model of care delivery. And for the practicing physicians who may be struggling with or have questions about the various new options available to us and our practices, join us on Friday afternoon for Practice Solutions, where we’ll learn about MSOs and ACOs, and the future of physician and hospital integration.

Despite the unknowns, PBCMS must continue to advocate on behalf of our members – some of Palm Beach County’s most passionate physicians – and their patients. And now our voice is even stronger. Thanks to the resounding success of the recent membership recruitment campaign, we are thrilled to welcome PBCMS’ 130 new members. These physicians, they are the future of medicine. They and our current members know that PBCMS and its 1300 members will address the current professional and economic challenges head-on, and one way to accomplish this is to educate our membership with some of the most prolific health care industry thought leaders from our area and around the country.

by physicians. The best way to address the challenging

PBCMS believes the future of medicine should be decided issues facing medicine today is by becoming engaged at the local level, and the best means to protect physicians and patients rests in our collective strength. PBCMS offers that common ground, and we are the future of medicine.

No doubt exists that uncertainty in the medical profession will only escalate, but in the end I challenge us all to navigate our thoughts and actions by keeping in mind the fundamental question to be resolved: “Is this the right thing to do to ensure quality health care is readily available and actually affordable?”


We’ve made it a practice. to deal with solutions.

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On CALL Magazine Quarter THREE 2012 / THIS ISSUE

This Issue FEATURES

8 c ASE FOR TRIPLE AIM

14

10 p OTENTIAL TAX SAVINGS: TAKE ACTION NOW

12 M  EDICAL EDUCATION: MENTORING

14 MENTAL HEALTH: INTEGRATING

17

PRIMARY AND BEHAVIORAL HEALTH CARE

16 fma  : MEDICAL LEADERS IN ACTION

17 B ACK FROM THE EDGE:

coping WITH PHYSICIAN STRESS

20

20 TECHNOLOGY: how MOBILE COMPUTING IS CHANGING HEALTH CARE

This Issue

22 w  EIGHT, dONT wAIT: the FIGHT AGAINST OBESITY

ARTICLES

2 President’s Report

23 Med Memo

24 PBCMS Feature Member: Shawn BACA, MD

22

12

24

16

25 M  ed Society News: New Members

26 Classifieds

54


Find out why we are the only agency endorsed by the Palm Beach County Medical Society. We make it our practice to genuinely care about yours. As a long-time supporter of the Palm Beach County Medical Society, we do much more than just negotiate the best med mal rates available. We are financially and actively involved, both locally and statewide, in seeking solutions to some of healthcare’s most pressing issues. Call us today to see what we can do for you.

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Delray Beach • Orlando • Miami • Jacksonville 800.966.2120 • info@dannagracey.com • www.dannagracey.com

Did you receive money back on your premium last year? Many doctors have through the Palm Beach County Medical Society Workers’ Compensation Program. The rates for all physicians throughout the state are set by the State of Florida. Your practice will pay the same price no matter where you choose to secure coverage. However, under the OptaComp program, you may be eligible for a potential dividend of up to 24.8%. Your membership with the PBCMS can provide savings that can be paid back in dividends. OptaComp has returned a dividend for 12 straight years, with over $4 million over the past six years to Florida medical societies’ members: $600,000 of that went to PBCMS members. The OptaComp (rated “A” by A.M. Best) program is endorsed by the PBCMS and is offered by Danna-Gracey, Inc. For more information, please call Tom Murphy at 800.966.2120.

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On CALL Magazine Quarter THREE 2012 / Director’s Desk

Director’s

Desk

Tenna Wiles, CEO

Palm Beach County Medical Society

P hysicians

Shaping the Future of Medicine

Several years ago, the Palm Beach County Medical Society launched the Future of Medicine Initiative, under the leadership of Jose Arrascue, MD. Our vision was that local physicians working together with the community can play an important role in shaping the future of medicine. Our initial goals were to increase the access to health, enhance prevention and wellness efforts and improve patient safety and quality, and ensure the viability of the physician practice. As a result, numerous successful programs and initiatives have been launched. Today, while our goals are the same we have learned that it is essential that we must integrate these efforts to improve the care of the individual, the health of the community while controlling the costs. Our physician leaders who have guided the process have dedicated an enormous amount of time and personal sacrifice. By empowering others, asking the right questions, welcoming new ideas and diverse points of view, and building partnerships they have established a foundation for thoughtful work and opportunity. Now, more than ever, physician leadership is of vital importance. With an increasing focus to improve the quality of care and lower health care costs, it is essential that physicians and members of the health care team understand the changes taking place and those being proposed. Continued learning is essential. The Future of Medicine Initiative has established PBCMS as a learning organization. On September 27 -28, the Sixth Annual Future of Medicine Summit will be held at the Palm Beach Convention Center. For the third year Michael Dennis, MD, will serve as Chairman and Grand Benefactor of a two day program featuring nationally recognized speakers. The Future of Medicine Leadership Committee and Host Committee have worked tirelessly to make this year’s Summit the best ever. I am honored to work with physicians and community partners who care deeply about the future of medicine. I hope you will join us on this journey.

Tenna Thank you to the Future of Medicine Leadership Team Jose F. Arrascue, MD Stephen Babic, MD Ronald L. Davis, PhD Michael Dennis, MD Malcolm Dorman, MD Claude Earl Fox, MD Daniel R. Higgins, MD

James T. Howell, MD Brent M. Schillinger, MD Joan E. St. Onge, MD Ben Starling Abbey Strauss, MD Frederick Kent Williams II, MD Jack Zeltzer, MD

6 7

Palm Beach County Medical Society

2012 Board of Directors Jack Zeltzer, MD President K. Andrew Larson, MD President Elect, Chair, Leadership Development Council Ronald Zelnick, MD First Vice President, Chair, Council on Membership & Member Services Stephen Babic, MD Second Vice-President, Chair, Council on Legislation & Physician Advocacy Malcolm Dorman, MD Secretary, Co-Chair, Council on Finance & Governance James T. Howell, MD Treasurer, Chair, Council on Finance & Governance James J. Byrnes, MD Past President, Leadership Development Hatem Abou-Sayed, MD William R. Adkins, MD Jose F. Arrascue, MD Shawn Baca, MD Jeffrey Bishop, DO Mark Brody, MD Jeff Davis, DO Michael Dennis, MD Roger Duncan, MD Karen Flannery, MD Randy Gershwin, MD James Goldenberg, MD Lawrence Gorfine, MD Richard Greenwald, MD

Daniel Higgins, MD Beth Lesnikowski, MD Brandon Luskin, MD Harish Madhav, MD Alan B. Pillersdorf, MD Mark Rubenstein, MD Brent Schillinger, MD Richard Shugarman, MD Andrew Shapiro, MD David Soria, MD Joan St Onge, MD Maureen Whelihan, MD Jeffrey Wisnicki, MD Kenneth Woliner, MD

Palm Beach County Medical Society

2012 Board of TRUSTEES Jose F. Arrascue, MD Stephen Babic, MD James J. Byrnes, MD Malcolm Dorman, MD Lawrence Gorfine, MD K. Andrew Larson, MD

Alan B. Pillersdorf, MD Richard Raborn, MD Brent M. Schillinger, MD Maureen Whelihan, MD Ronald Zelnick, MD Jack Zeltzer, MD

ON CALL magazine

Staff Tenna Wiles, CEO Tara Auclair Ryan, Director of Marketing & Community Relations John James, Director of Public Health & Disaster Services Deanna Lessard, Director of Member Services & Education Nicola Chung, Project Access Program Director Maria Turkki, Project Access Program Coordinator Sadia Peck, Project Access Program Coordinator Mindi Tingler, Administrative Assistant Natalie Gonzalez, Administrative Assistant, PBCMS Services Lauren Tome, Receptionist Patricia Beeler, Receptionist Managing Editor: Tara Auclair Ryan Subscriptions to On Call are available for an annual rate of $50. For more information contact Tara Auclair Ryan at 561-433-3940 x15. The opinions expressed in On Call are those of the individual authors and do not necessarily reflect official policies of Palm Beach County Medical Society or its committees. On Call is owned and published four (4) times per year by Palm Beach County Medical Society, Inc., 3540 Forest Hill Blvd., #101, West Palm Beach, FL 33406. (561) 433-3940 & (561) 276-3636. ©Copyright 2012 Palm Beach County Medical Society, Inc.


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On CALL Magazine Quarter THREE 2012 / FEATURE - THE TRIPLE AIM

The

Triple

8

Aim

By:

Jose F. Arrascue, MD The American health care system which is the best in the world in innovation, technology, surgical procedures, pharmaceuticals, diagnosis and management of complex medical conditions is also highly disjointed, overly costly and underperforming. The current conventional wisdom is that the fee-for-service payment model used by Medicare and private-payers provides no incentive to provide high quality and cost-effective care. Medicare, the biggest purchaser of health care, spent $810 billion in 2010 and the bill is expected to rise to $1.8 trillion by 2021 at the current growth rate. This may cripple the U.S. economy and curtail investment in our country’s infrastructure and our future economic prosperity. Unless we improve efficiency and quality, reduce variation in care and cost and improve the appropriateness of care, we as a profession are at risk of relinquishing control in health care delivery and losing our professional autonomy.

This spring a delegation from PBCMS Services attended an Institute of Health Improvement (IHI) Training Seminar on implementing a Triple Aim Initiative. As a result a leadership team was formed, diabetes was selected as a pilot population health management program and the following purpose statement was drafted: “Our long term vision is to partner with local patients and communities to collaboratively develop methods to improve overall health as well as health care access and delivery in Palm Beach County while being responsible stewards of our limited resources.

We will work to improve the experience of care, improve the health of We are already witnessing cost-saving mechanisms such as populations, and reduce per capita cost of health care by focusing on bundling of procedure codes, refusal to pay for medical “errors,” low income and/or uninsured persons with diabetes in our county.” refusal of reimbursement for avoidable readmissions and others. Reducing the cost of care is critical, not only to ensure the viability of our respective practices, but also to ensure that our patients will not The following Leadership Organizations are partners with us in this lose benefits for necessary care. The question is: endeavor: Allegany Franciscan Ministries Inc., Bethesda Memorial Hospital, Charles E. Schmidt College of Medicine, Crescendo Consulting Group, Florida Public Health Institute, Health Care District of Palm Health care delivery is centered on the doctor-patient relationship. Beach County, Health Council of Southeast Florida, JFK Internal We must provide coordinated, patient-centered care within Physicianled systems that support innovation, promote quality and create value. Medicine Faculty & Resident Practice, JFK Medical Center, MDVIP, Medical Specialists of the Palm Beaches, Palm Healthcare Foundation, and the Quantum Foundation. Value is defined as quality of service, outcome, satisfaction and safety

How do we get there?

divided by cost over time. In other words we must devise a strategy

Recently our efforts have been recognized by the IHI and we have been invited as partners in their Triple Aim Learning Community. per We hope for your collaboration and invite your involvement in this Triple Aim Learning Community. The Future of Medicine Summit VI from September 27-28, 2012 will provide extensive educational programs on the Triple Aim Initiative, in addition to other relevant topics. The West Palm Beach VA Medical Center designates this educational activity for a maximum of 16 AMA PRA Category 1 Credit(s)TM.

that achieves these three aims of improving the individual experience of care, improving the health of populations and reducing the capita costs of care for populations (The Triple Aim)

These systems should also work to eliminate disparities in access and outcome, promote medical professionalism and increase physician practice satisfaction. The challenges to accomplishing these goals are formidable. The New England Journal of Medicine (Online First Articles) issue 8/1/12 contains two scholarly articles which provide excellent summaries of two perspectives addressing these issues: “Bending the Cost Curve through Market Based Incentives” by Joseph R. Antos, PhD and others and “A Systematic Approach to Containing Health Care Spending” by Ezekial Emmanuel, M.D., PhD and others. An important point to remember is that whatever the outcome in November, whether PPACA or the Ryan/Romney plan prevails, both plans promote high value health care and new payment models as part of the strategies to control cost

In my 2007 Presidential Inaugural Address I challenged Physicians to be leaders in the quality movement in response to the following Institute of Medicine reports: To Err is Human, Crossing the Quality Chasm, Pay-for-Performance. In November 2007 PBCMS launched the first annual Future of Medicine Initiative that devised four working groups to address the following health issues in Palm Beach County: improving access to care, prevention and wellness, quality of care, patient safety, and the viability of physician practices and other health care providers. Although improvements have been made over the last 5 years there is much work to be done.The Triple Aim Initiative may be the most powerful strategy today to achieve these objectives.


9


On CALL Magazine Quarter THREE 2012 / Feature - Potential tax savings, comerica wealth planning

10

Potential Tax Savings-

Take Action Now By:

Bart Burns, CF P,

Vice President, Comerica Wealth Planning

While taxes should never be the primary reason for a financial action, they can certainly influence a financial decision. That being said, a short window of opportunity may exist for clients to transfer wealth to the next generation now, in a tax-advantaged manner. Under current law, the Federal gift tax exemption of $5,210,000 (or $10,240,000 for married couples who elect to split gifts) is scheduled to revert to $1 million (or $2 million for married couples who elect to split gifts) on January 1, 2013. Consequently, you may wish to consider making immediate gifts to use part or all your Federal gift tax exemption; which will allow you to shelter any appreciation on gifted assets from future estate or gift tax.

Here are some additional tips regarding gifting and other estate reduction techniques: • Make your allowed annual exclusion gifts each year. You can gift $13,000 tax-free to any individual ($26,000 if both you and your spouse make gifts). • Make annual exclusion gifts early in the year. • Make healthcare and educational exclusion gifts. When paid directly to the healthcare or educational institution, you can make unlimited tax-free gifts. Lock-in these gifts before any law changes that could adversely affect wealthy families. • Gift away your $5,120,000 exemption to a dynasty trust. • Gift or sell property eligible for a marketability or minority interest to family members.

For more information, please contact:

Kerri L. Burke,

Vice President, Private Banking

at 561-804-1420 or

klburke@comerica.com.

• F  und dynasty trust before implementation of a federal rule against perpetuities. Generation Skipping Trusts (GSTs) are essential for preserving wealth on a long-term basis. • Make intra-family loans now while the interest rates are low. •C  onsider installment sales to intentionally defective grantor trusts. • Create Family Partnerships or Family LLCs. • Create GRATs (Grantor Retained Annuity Trusts) before the federal government changes the current law. • Create CLATs (Charitable Lead Annuity Trusts) for income and gift tax planning. Similar to GRATs, CLATs shift appreciation to younger generations and provide substantial income tax benefits. • Incur gift taxes before we have a higher tax rate. The current gift tax rate is 35% which could be higher in the future.


Planning for a financially secure retirement is now more challenging than ever. The rules of retirement are in need of a rewrite for physicians who are in private practice. The reduction of professional fees, concerns over malpractice claims and a volatile investing world are among the forces that make planning for a financially secure retirement so challenging. You don’t have to go it alone, there is specialized planning services available for physicians in private practice.

Building Stronger Communities Together Patricia C. Corbett and Morgan Stanley Smith Barney is proud to support the Palm Beach County Medical Society Patricia Corbett, CFP® Vice President Financial Advisor 595 S. Federal Highway, 4th Floor Boca Raton, FL 33432 561-393-1535 patricia.c.corbett@mssb.com www.fa.smithbarney.com/pattycorbett

Call us today, we can help. PROFESSIONAL PLANNING TEAM

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Celebrating 28 Years of Innovation and Leadership in 2012

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NY CS 6693029 04/11

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On CALL Magazine Quarter THREE 2012 / feature - announcing New PBCMS mentoring program

12

PBCMS Announces: New Mentoring Program Richard Greenwald, MD By:

PBCMS is pleased to announce the start of a new Medical Society facilitated mentoring/shadowing program for premed college students. The Mentoring Program has been developed for several reasons:

1. A need expressed by undergraduate and graduate premed students to have defined clinical shadowing experiences available in a variety of disciplines. 2.  A desire expressed by many members of the Medical Society to become involved in the educational, experiential processes for future members of the profession. 3. Testimonies of current medical students as well as members of local medical school admission committees and pre professional programs at area universities to the importance of mentoring/ shadowing in making students aware of what is involved in the practice of medicine and equipping them for the rigorous application process. The Council for Medical Education and the Board of Directors of your Medical Society also recognized this need---hence the introduction of the program as outlined below: If you are interested in participating as a voluntary mentor you will be asked to complete a short registration form online at www.pbcms.org. Your name will be made available to students who are looking for a mentor through the Physician Locator on the PBCMS website. If you currently have an entry on the Physician Locator to enable prospective patients to find you, a second entry will be created indicating you as a Mentor. This is to help alleviate confusion for patients looking for a physician. The program will be promoted to the students through the local universities’ pre professional advisors. Students are expected to be enrolled in an accredited program and have an interest in pursuing a premed track.

The students will contact the physician mentor directly to customize the

shadowing experience based on interests, needs, schedules, etc. Volunteer physicians are not expected to be available at all times or for all purposes. However, we do ask that physicians respond in a timely and responsible manner to student inquiries. Students and mentors will be asked to complete an online survey evaluating their mentoring experiences. We will use the survey results to better meet the needs of future mentors and students. Medical education in Palm Beach County has changed dramatically in the last 10 years. The scope of undergraduate medical education was featured in the July/August 2011 issue of On Call. The mentoring program places your Medical Society at the forefront of another important aspect of the medical education process---preparing interested students for the long journey before them. We are excited about this new program. It should prove gratifying and satisfying for students and physician mentors alike, and we hope that you will consider participating. To register or learn more please visit the PBCMS website at www. pbcms.org or call PBCMS at 561-433-3940.

“No bubble is so iridescent or floats longer than that blown by the successful teacher� - William Osler


13

The ACA: An important first step.

0

Number of patients in 2014 and beyond who can be denied coverage due to a pre-existing condition

MILLION

3.1

Number of young adults up to the age of 26 who have already gained coverage now that they can stay on their parents’ insurance

FIFTY-FOUR MILLION Number of Americans who have already benefitted from expanded coverage for prevention and wellness care

2014

The year in which an estimated 30 million more Americans will begin obtaining health insurance coverage

5.1MILLION

Number of Medicare patients who saved significantly on prescription drugs in 2010 and 2011

$1,000

Amount the average insured family stands to save in yearly insurance premiums now that more uninsured patients will have access to health care

But there is more work to be done. The AMA will continue to work with Congress and the Administration to ensure the best outcomes for patients and physicians. Three of our top goals include:

Eliminate IPAB. 

Replace SGR.

Enact MLR.

The AMA is fighting to eliminate the Independent Payment Advisory Board, which will impose arbitrary across-the-board cuts to physicians and other providers.

The AMA is fighting to replace the fatally flawed SGR formula with new payment systems that reward physicians for the value of care they provide.

The AMA is fighting to fix the broken medical liability system for patients and physicians by pushing Congress and states to enact reform.

Learn more about these efforts at ama-assn.org/go/improvinghealthcare Š 2012 American Medical Association. All rights reserved. FA25:12-0334:PDF:7/12


On CALL Magazine Quarter THREE 2012 / Feature - Mental Health

14

Integrating Primary & Behavioral Health Care By: Fran Hathaway

“The inseparability of mental health from physical health is no longer in question. What remains in question is how to change healthcare systems to accommodate the indisputable fact that more mental health is treated in the primary care setting than any other healthcare setting.” The speaker is Dr. Benjamin Miller, a leading voice in the discussion on integrating behavioral and primary health care. Dr. Miller, assistant professor of family medicine at the University of Colorado Denver School of Medicine, is responsible for integrating mental health across that department’s core mission areas. He’s also a co-principal investigator and co-creator of the National Research Network’s Collaborative Care Research Network. That’s a mouthful, but boiled down, “collaborative care” is a simple concept, described by the American Academy of Family Physicians as the integration of behavioral health and primary care services. The Mental Health Association of Palm Beach County, with a grant from Palm Healthcare Foundation, has responded to this trend by creating Be Merge, an on-line training program for primary care providers who want to strengthen the system of care locally. It includes an evidence-based toolkit, webinar training and an online Provider Directory to help with diagnosis, medication and referrals to mental health professionals. Florida ranks at or near the bottom in per-capita funding for behavioral health services, yet one person in every four families needs them. Funds for community-based services are often fragmented and uncoordinated.

An example of a chronic physical health condition elevating the risk of developing a related behavioral health condition involves diabetes. Diabetics and overweight prediabetics may not lose weight until the emotional issues leading to overeating are dealt with. Providing behavioral health care in a primary medical care setting can reduce stigma and discrimination, leading to better compliance and improved outcomes and to a decrease in medical use and overall health costs. Much research is presently being done on the power of negative and positive emotions to affect a person’s well-being and longevity, but it’s hardly a new idea. When Dr. Herbert Benson began medical practice as a Harvardtrained cardiologist 35 years ago, the term “mind/body medicine” was unknown. In the late 1960s, his work linking stress to physical health was contrary to existing medical thought. Today the founder of the BensonHenry Institute for Mind Body Medicine at Massachusetts General Hospital can take credit for the fact that the concept has been scientifically-validated and is commonly accepted.

for their patients. Barriers include shortages of mental health providers and lack of, or inadequate, insurance. The Affordable Care Act will expand access to prevention services and create additional incentives to coordinate care. The integration of primary and behavioral health care, which can be bidirectional, is already happening nationwide, according to Cheryl Holt, director of training and technical assistance for the SAMSA-HRSA Center for Integrated Health Solutions. CIHS offers assistance for all aspects of integration, from ways to do it – there are several models – to how to bill for it. The historic silos of care have begun to crack, she says, allowing health care professionals in both systems to engage in partnerships that serve those with behavioral health problems. Such collaborative care not only can be good for patients, but for physicians who are increasingly being asked, and paid, for improved outcomes.

For more information, see Cheryl Holt at www.integration.samhsa.gov; Pam Gionfriddo at www.mhapbc.org/Programs; and Dr. Benjamin Miller at www.ucdenver. edu/academics/colleges/medicalschool.

Many primary docs report challenges in accessing outpatient behavioral health care

Studies illustrate the importance of primary care in this picture: • 80 percent of people with a behavioral health disorder visit a primary care site at least once a year. • 48 percent of prescriptions for psychotropic agents are written by a non-psychiatric primary care provider. • 67 percent of people with a behavioral health disorder do not get proper treatment, despite the fact that chronic health conditions and behavioral health conditions are often comorbid, impacting overall treatment. • People with serious mental illness die 25 years earlier than the general population, mainly from preventable diseases. • The economic cost of mental health and addiction issues exceeds $200 billion nationwide – $1 trillion when lost productivity is considered. • Cost-shifting that affects us all occurs when emergency rooms, the criminal justice system and people with health insurance bear the burden of untreated or improperly treated disorders. • About half of all people with serious mental illnesses first experience them by age 14 but are not treated until they are 24, according to Mental Health America, yet early intervention helps reduce later disability and costs.


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On CALL Magazine Quarter THREE 2012 / Feature - fma: medical LEADERS IN ACTION

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Physician Leaders

in Action!

Under the leadership of President Jack Zeltzer, MD, the 2012 PBCMS Delegates to the Florida Medical Association (FMA) represented Palm Beach County physicians at the FMA Annual Meeting held at the Boca Raton Resort & Club from July 27-29.

The South Florida Caucus, which includes PBCMS as well as the Broward County Medical Association and the Dade County Medical Association, submitted 7 resolutions. For a complete report on the Actions of the House of Delegates visit www.pbcms.org.

Alan B. Pillersdorf, MD, was elected Secretary and Delegate to the American Medical Association (AMA). Dr. Pillersdorf announced his candidacy for President – elect in 2013. Jose F. Arrascue, MD, was elected as AMA Alternate Delegate and will continue to serve as District Representative. Special thanks to our PBCMS physician leaders for dedicating their time, and sacrificing their personal interests, to represent the physicians of Palm Beach County. PBCMS members Stuart Himmelstein, MD, Maureen Whelihan, MD, Jeffrey Berman, MD, and Jeffrey Liner, MD, served as Specialty Society Delegates. A salute to James T. Howell, MD, for his participation on the Scope of Practice. Vincent DeGennaro, MD, of Miami VA Healthcare System, and Past President of the Broward County Medical Association, was installed as the 136th FMA President. PBMCS thanks outgoing president Miguel A. Machado, MD, for his service and leadership.

L to R: James Byrnes, MD; Andrew Larson, MD; Emanuel Newmark, MD; Alan Bauman, MD; Mark A. Rubenstein, MD; Vincent DeGennaro, MD; Ken Woliner, MD; Ronald S. Zelnick, MD; Shawn Baca, MD; and Jose F. Arrascue, MD.

L to R: Ronald S. Zelnick, MD and Alan B. Pillersdorf, MD

PBCMS Delegation Stephen Babic, MD; Shawn Baca, MD; Alan Bauman, MD; James Byrnes, MD; Cynthia Clayton, MD; James Goldenberg, MD; Donald Grossman, MD; Marc Hirsh, MD; James Howell, MD; Andrew Larson, MD; Beth Lesnikoski, MD; Harish Madhav, MD; Emanuel Newmark, MD; Henry Pevsner, MD; Mark A. Rubenstein, MD; Ken Woliner, MD; Ronald S. Zelnick, MD; and Jack Zeltzer, MD.


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Feature - Back from the edge: Coping with physician stress / On CALL Magazine Quarter THREE 2012

Back from the Edge: Coping with Physician Stress By: David

Hanscom, MD

Our culture expects doctors to be strong and stoic.... Physicians do nothing to belie that impression—they rarely discuss their personal issues. It’s an unspoken rule that if you’re ever feeling stressed, you put your head down and persevere. That’s why I didn’t know that my close friend and fellow surgeon was on the edge. One afternoon last year, he left after assisting me in a complicated spine surgery. We shook hands and he said, “Nice case.” It came as an incredible shock when I heard that three hours later, he was dead from a self-inflicted gunshot to his head. I later found out that my colleague was under enormous personal stress. His problems were complicated, but I know that much of his stress stemmed from his habit of constantly beating himself up. This led to uncontrollable anxiety, which had been building for several years. The tragedy is that he didn’t seek help earlier. He didn’t feel that he could. My colleague’s story is not an isolated case. In fact, one in 16 physicians reported having contemplated suicide, according to a study published in the Archives of Surgery. This rate is higher than the general public (6.3 percent vs. 3.3 percent). Only 26 percent sought out help.1 Out of my 80 medical school classmates, four killed themselves within three years of completing their training. Another dozen colleagues have committed suicide. I can imagine how those doctors felt before deciding to end their lives. About 10 years ago, I was driving home one evening after a busy day at the clinic.

I was agitated. I was in my mid-40s and was experiencing crippling anxiety on a daily basis. My anxiety had begun to rear its head 12 years earlier, and for the past year, I had struggled. I saw no way out. I was done.

a business, angry patients, surgical complications, threat of litigation, partner problems, etc. As a surgeon, it’s not uncommon to operate for 10 or 12 hours and then go to the office for another four hours to catch up on paperwork.

That night, I weighed all of my options and decided that was it—once I pulled into the garage, I would close the door behind me and leave the car running. But at the final moment, I turned off the car. I thought of two classmates whose physician fathers had taken their own lives during my classmates’ teenage years. I knew how devastating it was, how hard it had been on them. I had a young son. I felt that I couldn’t abandon him and leave a legacy of death. If it weren’t for my family, I have no doubt that I would have left the motor running.

Stress management skills are not part of the medical training process. No one provides physicians with the tools to assess their mental health. There are no preventative mental health resources, such as mental health professionals on staff; there’s no one to easily talk to about the stress. Any hint of mental distress causes the hospital to examine under a microscope the physician’s ability to practice.

Burnout Burnout contributes to the stress that can drive physicians to thoughts of suicide. About 40 percent of physicians experience burnout, according to the California Medical Board.2 Doctors live with a combination of pressures that can result in burnout: suppressed anxiety, perfectionism, and massive amounts of stress. Medical authorities have made some effort to limit stress on doctors. For example, there are now laws limiting residents’ work to 80 hours per week. Enforcement of these rules is spotty, though, and the older hierarchy feels that these guidelines are too lenient. Physicians face many stresses: running

Litigation Stress Physicians face intense stress when they are named as a defendant in a medical malpractice lawsuit. Most physicians will face a suit at some point in their career, but few are prepared to cope with litigation. Malpractice suits are a frontal assault on physicians’ professional integrity, thrusting them into an alien environment where they are not in control. Litigation can have the same emotional impact as the death of a loved one.

Suppressed Anxiety Physicians are conditioned to be really tough. From the first day we walk into the anatomy lab of medical school, it’s understood that we are essentially in boot camp. The intention is to quickly weed out those who cannot cut it. The ones who can suppress their anxiety are the ones who survive.


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On CALL Magazine Quarter THREE 2012 / Back from the edge: Coping with physician stress

Early in my practice, I always thought I was in control. It didn’t matter what I encountered—angry patients, billing problems, even a malpractice suit—I remember thinking, “I can take it. Bring it on.” All physicians are used to being in control, especially when it comes to anxiety. Anxiety cannot be suppressed forever. Research has shown that the more one tries not to think about something, the higher the chance it is thought about.3 Many physicians find themselves in a state of chronic anxiety. When this happens, surgeons may quit doing the bigger cases or stop doing surgery altogether. Addictions begin to surface. Other dysfunctional coping mechanisms, such as aggressive behavior toward staff and residents, are common. And then there is suicide.

Perfectionism Doctors hold up perfectionism as one of the highest virtues of their profession. Most physicians would agree that “perfect” is the standard for our medical culture. It’s both implicitly and explicitly taught from the time they enter medical school. Unfortunately, many mentors react severely to their underlings when a given task is performed in a less-thanperfect manner. But what does perfectionism really accomplish? Nothing. It’s a destructive trait. As doctors, our goal is 100 percent success for every patient. But that’s not

humanly possible. If you torture yourself over every case that doesn’t turn out perfectly, you can’t do your job well. The energy burned up by judging yourself negatively is the energy you need to perform at the highest level. Since there’s no such thing as perfection in the human experience, the difference between reality and expectation will determine the degree of your unhappiness. For many physicians, failure to meet the standard of perfection engenders growing anxiety, anger, and guilt that facilitate suicide.

Reprogramming I was able to escape the perfectionist trap by using a technique known as neuro-cognitive reprogramming, which involves writing down your thoughts to create new, alternate neurological pathways. These pathways connect the thoughts with sight and feel. In David Burns’s book, Feeling Good,4 one of his tools is to write down negative thoughts and then categorize them. By using Burns’s writing methods and facing my anger, I was able to work myself out of the abyss. For me, it has been life altering. There are other reprogramming methods. They include mindfulness/ meditation, awareness, group dialogue, auditory methods, art, role playing, music, and many other techniques.

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Broken down, each follows a pattern of three parts: (1) awareness, (2) detachment, (3) reprogramming. Each person’s journey will be unique.

Going Forward As a medical community, we must recognize that anxiety is not a dirty word and that it’s not a sign of weakness to admit that you have anxiety. Members of the medical community must engage in a dialogue about allowing doctors to speak openly about their stresses. Each of us is so good with our façade that we couldn’t imagine that the other physician is anything less than completely together. We are human, too, however, and we are suffering—badly. With an open dialogue, the medical community can start to heal its own members. Dr. David Hanscom is an orthopedic spine surgeon at the Swedish Neuroscience Institute in Seattle, Washington, and is a member of The Doctors Company. References 1.  McCoy KL, Carty SE. Failure is not a fate worse than death. Arch Surg. 2011;146(1):62-63. 2.  Duruisseau S, Schunke K. Physician wellness as constrained by burnout. Medical Board of California Newsletter. November 2007;104:1. 3. Wegner DM, Schneider DJ, Carter SR 3rd, White TL. Paradoxical effects of thought suppression. J Pers Soc Psychol. 1987;53:513. 4.  Burns D. Feeling Good. New York, NY: HarperCollins; 2000.

Alleviating the Stress of a Malpractice Claim The Doctors Company, the nation’s largest insurer of physician and surgeon medical liability, goes beyond a superior legal defense for members facing a claim. We created regional Litigation Education Retreats to help members who are involved in a malpractice claim. Each retreat provides a safe and supportive environment for physicians and their spouses to become familiar with the litigation process and to learn constructive methods for alleviating stress and anxiety. It’s also a valuable opportunity for them to meet others experiencing a claim. To learn more about our unique program and how attending a Litigation Education Retreat helped one physician, visit www.thedoctors.com/ler watch our six-minute video, or visit www.thedoctors.com. Participating physicians may also be eligible for up to 6.5 CME credits.


On CALL Magazine Quarter THREE 2012 / FEATURE - how Mobile computing is changing health care 20 21

How Mobile Computing

is Changing Health Care By

Tammy Clarke

A running joke still circulates around our office about a comment one of our partners made years ago, calling the internet “a fad.”

Physicians

Many people thought the same thing when mobile telephones started adding nonphone related features. Those people might be laughing at themselves now but the truth is, back then most people couldn’t conceive of our mobile world today.The health care industry has certainly accepted the mobile computing revolution and the amazing opportunities few even dreamed of just five years ago. In 2011, QuantiaMD surveyed almost 4,000 physicians and the results were quite surprising.

80% 30% 84% 30 

 umber of physicians who N responded that they owned a mobile device capable of downloading applications  Number of doctors who use a tablet (compared to 5% of US consumers) Number of the remainder who said they were at least somewhat likely to purchase one soon. Years in practice of Physicians who are are almost as likely to purchase a tablet as someone right out of school.

As expected, physicians are not the only users of this technology in the healthcare industry. Over the last few years, use by hospitals, medical schools, students, and patients has skyrocketed. So how exactly is this mobility making our world a healthier place?

69% 42% 39% 26% 20%

Look up drug treatments/ reference materials Research Diagnose – image / video Make decisions about ordering labs or tests Access patient information

Doctors are a unique group of mobile users and according to the QuantiaMD survey, they have embraced these new tools, saving time and creating efficiencies. With the rate of advancement in technology these days, expect their usage in these common tasks to increase drastically over the coming years. Physicians also use their mobile device for dictation, CME, monitoring vitals, reviewing x-rays, educating patients, and calculating dosages. Of course, they also browse online, use email, and possibly play Angry Birds.

Hospitals Hundreds of hospitals have developed their own apps, and most have been pretty basic, including directions to the campus, physician finders, and educational information. Some hospitals, such as the Mayo Clinic, have created apps to sell as a revenue source. Cleveland Clinic has an app that plays on its history in the community, featuring its medical advances, interviews, and community services. Other hospitals have taken advantage of a growing number of apps that help hospitals better care for - and communicate with - their patients. For example, if you’re a patient at Brockton Hospital in Massachusetts, before being released you’ll be handed an iPad to take a survey using an app called Survey on the Spot. This tool will educate staff on how the hospital can improve operations in an extremely timely manner by giving supervisors and staff real-time feedback.

Medical Schools Many schools are switching to iPads as their main platform for delivering their curriculum. In 2011, Yale School of Medicine invested $600,000 in iPads to give to its 520 medical students. The main goal of this initiative was

eliminating all paper-based course material while delivering more versatile information to students. When given to first and second year students, the iPads were preloaded with a two year curriculum and third and fourth year students received information on specialties. Students reported that they completed tasks quicker, freeing them up to spend more time on patient care and educational activities.

Patients I consider myself a fairly intelligent person, yet when I needed shoulder surgery last year I know I had a blank stare when the doctor was explaining the injury to me. Within minutes after leaving, I was researching rotator cuff injuries on my iPad. In the following months, I read many articles and message boards, trying to learn everything about the injury. Post-surgery I looked up medications in my iPharmacy app and documented my rehab progress. My example is a simple one that expresses how a typical patient is using mobile technology. Sadly, many situations are far from typical, and tablets, such as the iPad, have been life changers. •

Autistic children are using applications to learn basic skills, like brushing teeth and communicating better

Those with muscular and skeletal diseases are able to interact with the touch screen in a way that conventional computers have not

The iPad’s built-in VoiceOver feature converts text and images on the iPad into audio, allowing blind people the ability to navigate the iPad

While many challenges face this new technology, we know two things: its potential in health care is limitless, and mobile computing isn’t a fad.


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On CALL Magazine Quarter THREE 2012 / Feature - Weight, Don’t Wait 22

Weight, By:

Cynthia C. Clayton, MD

Don’t Wait

It’s insidious. It just appears and seems impossible to discard---EXCESSIVE WEIGHT. As we aged, we found an extra pound around the middle and other places. Perhaps we exercised less frequently, or a change in hormones affected our metabolism. Suddenly, weight overtook our body and refused to leave! Tired after work, we stopped cooking as often at home, and relied on take-out or drive through. We traded fresh vegetables and proteins for highly salted processed foods, while drinking sugared beverages in front of the TV or iPad. Community demographics changed with a larger percentage of the population living alone, without a social network for daily dining. Work schedules did not always allow friends and family to eat together, and partners could be absent for considerable periods.

CALL TO ACTION PLANNING FORUM on February 16, 2012. Forty professionals from over 30 organizations with an interest in obesity met to consider strategies to attack this issue on all levels of need— government, health care, early childhood and schools, community, media, and business. Physicians networked with community leaders to discuss strategies to educate the public on the serious consequences of poor health habits. Many organizations already have programs in place to combat excessive weight, diabetes, and inactivity. We are committed to continuing the dialogue and supporting all existing efforts, while expanding the effort to reach more of the community. The CALL TO ACTION ON OBESITY hopes to become a major participant in the prevention of serious chronic diseases for which treatment is difficult. The door is open to all ideas and assistance. Let’s energize ourselves and the community for change.

Then, we noticed that our children and grandchildren preferred to eat snacks, not meals, in front of an array of electronics, after school, at sports practice, or at their friends’ homes. There were fewer opportunities to gather the family at the kitchen table for a ers regular fresh cooked meal. When the pediatrician or health clinic Memb nd health S M C a B showed us the increasing Body Mass Index (BMI) curve of our as for P ur own eating ffice staff, e d I e children, we shouted, “Go outside and play.” However many Som ving o r our o y impro the same fo b t neighborhoods did not have safe spaces, and there may not r a t s g We can d encouragin always be sidewalks, playgrounds, or public space to kick ome, n a s t from h -20 habit h . g le u a ball. Most playgrounds on school property are closed o ib r s 15 sb os lunche , and allow a when p e r to public use, and physical education is not a daily or even o t s ce to ating e a pla re for e weekly requirement at school. Finally, although we have ak. ters • Provid nt atmosphe he lunch bre ure cen t a t a n s beautiful parks and wildlife refuges in Palm Beach County, f a d o n art sa a ple alk as p ur local park tion. transportation to their facilities by car is a requirement. o inute w a s to

m ue orm s of picture d provide inf avior techniq ealth g n a H h n h •  Physicians noticed the widening girth of our citizens. The BMI of the office a tivational be r t r u a o p y s in o a (weight in kilograms divided by the height in meters squared) -up. rate m uction ncorpo e weight red es and follow I   • of all ages increased rapidly and out of control. Children began ag hur r our encour provide broc to develop disease profiles formerly only seen in adults: lipid start fo ians. d y ic n t h a lt ie , a it D e vis disorders, cardiac problems, diabetes of adult types with insulin lp from s the h k for he astfeeding a and s A  • resistance, hypertension, pulmonary complications and mental utrition bre n t r d o o p o • Sup . vide g health disorders especially related to bullying. New surgical citizens hools to pro ily. w e n a sc procedures were developed to staple the stomach and stop the rams d urage • Enco l activity prog intake of excess calories. New businesses opened-- diet shops, physica diet drugs, diet supplements, diet coaching.

The early 2012 statistics from the CDC have shown a slowing of general population weight gain. Local produce is in favor. School districts are improving the choices for breakfasts and lunches. Community gardens are planted, tended, and harvested. However, the entire community has to come together to make a sustained and consistent change in our eating habits and health. In the end we cannot rely on grants and outside influences. Palm Beach County Medical Society (PBCMS) in partnership with the Palm Beach County Health Department held the first COMMUNITY

Community Call to Action Steering Committee Cynthia C. Clayton MD, FAAP, PBCMS &Volunteer, Palm Beach County Health Department Alina Alonso, MD, Director, Palm Beach County Health Department Marsha Fishbane, MD, Director School Health, Palm Beach County Health Department, Florenzia Davis, PHD, Senior Public Health Nutritionist, Palm Beach County Health Department Tenna Wiles, Chief Executive Officer, Palm Beach County Medical Society Quinn Hayes, Palm Beach County Coalition to ACHIEVE Wellness, CB Wohl, Healthy Communities Coordinator, Palm Beach County Health Department

For more information, contact Cynthia C. Clayton, MD, FAAP, at drcclayton@gmail.com.


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Med memo / On CALL Magazine Quarter THREE 2012

Med memo

Quarter Three 2012

SAVE THE DATES September 27-28, 2012. Future of Medicine Summit VI, Palm Beach County Convention Center December 1, 2012. Annual Gala, Kravis Center Cohen Pavilion Congratulations to Emanuel Newmark, MD on Receiving John R. Brayton, Jr., MD Leadership Award Please extend your generous congratulations to Emanuel Newmark, MD, PBCMS Life Member, who on June 23 received the John R. Brayton, Jr., MD Leadership Award from the Florida Society of Ophthalmology, the preeminent professional Florida State association for medical and osteopathic doctors. This annual award recognizes a Florida-based ophthalmologist who exemplifies leadership and dedication to the profession. Richard G. Shugarman, MD, Receives the Shaler Richardson, MD, Service to Medicine Award The Florida Society of Ophthalmology (FSO) announced that Richard G. Shugarman, MD, received the Shaler Richardson, MD, Service to Medicine Award at its Annual Meeting, Masters in Ophthalmology 2012, held June 22-24 in Orlando, FL. Established in honor of Shaler Richardson, MD, this annual award is presented to a Florida ophthalmologist who has made the greatest personal contribution to quality patient care by coordinating, participating, collaborating, and integrating ophthalmology into the great body of the medical profession on a local, state or national level.

PBCMS and Palm Beach Medical Group Management Association Announce Health Care Connection What you once knew as the Office Manager Institute is now the new educational program, Health Care Connection. Monthly luncheons will be held the 1st Wednesday of every month (except January) from 11:30am to 1:00pm at various locations throughout Palm Beach County. Location, speaker and registration information can be found at www. pbcms.org. Register for the entire series by October 1 and save $25.00. Programs are $25 for PBCMS and PBMGMA members and staff and $35 for non-members and staff. TEST PALM BEACH COUNTY On Friday, July 20, PBCMS hosted a press conference organized by the Palm Beach County Health Department promoting TEST PALM BEACH COUNTY. This new and important opportunity is for all health care professionals to get personally involved in the fight against HIV and AIDS, even if they are not currently involved in HIV/AIDS patient care. TEST PALM BEACH COUNTY is a partnership encouraging routine HIV Testing for everyone age 13 and up. By encouraging routine testing, early diagnosis can save lives. Speakers included (L to R) Rob Scott, Early Intervention Consultant; Maureen Whelihan, MD, PBCMS Board member and past president; Palm Beach County Health Department Director Alina Alonso, MD; Jose Menajovsky, MD, an infectious disease specialist with emphasis on HIV Management; and Metris Batts, Minority HIV/AIDS Coordinator.

EDUCATIONAL OPPORTUNITIES Sept. 27-28. Future of Medicine Summit VI. Physician attendees at the Future of Medicine Summit can earn a maximum of 16 AMA PRA Category 1 Credit(s)TM. Palm Beach County Convention Center, West Palm Beach. Register at www.pbcms.org. MEDICAL FRATERNITY OPEN TO NEW MEMBERS Individuals that are pre-med students through retired physicians are invited to join Phi Delta Epsilon International Medical Fraternity. Interested? Please contact Lewis Green, MD, at lewgreen10@gmail.com or 561-637-1802.

ON CALL ADVERTISING RATES- OnCall is published quarterly, and advertising rates and deadlines can be found at http://www.pbcms.org/advertise.


On CALL Magazine Quarter THREE 2012 / FEATURE - NEW MEMBER profile

24 25

PBCMS Feature Member: Shawn Baca, MD

PBCMS would like to thank Board member Shawn B. Baca, MD for his recruiting efforts during the recent membership drive. All members who recruited a new member were entered for a chance to win a Member Profile, and Dr. Baca was the winner! Dr. Baca joined PBCMS in 2003. He currently is a member of the Board of Directors and sits on the Legislation & Physician Advocacy Council. In this role he represents and supports the rights of physicians in both Tallahassee and Washington, DC. Dr. Baca is a physician at Rheumatology Associates of South Florida in Boca Raton, and past Treasurer of the Boca Raton Regional Hospital Medical Executive Committee. Besides his impressive professional credentials, here is some information to get to know Dr. Baca.

Q: Why did you join PBCMS? A: I am very concerned with current state of the medical system.

I have been impressed with the advocacy efforts made by the PBCMS on behalf of the practicing physicians in Florida. I think it very important for all doctors in the county to belong to the PBCMS.

Q: What is your favorite aspect of PBCMS membership? A: I feel privileged to serve on the board of directors. I have seen how effective the PBCMS has been at influencing political opinion at the county and state level.

Q: Where did you grow up? A: Albuquerque, NM. Q: What is your favorite restaurant? A: Any restaurant that shows the Miami Heat on their TV! Q: What do you enjoy doing when you’re not working? A: Spending time with my family, traveling, cooking and exercising.

Q: Any other information that you want our readers to know?

A:

I think with our busy lives we sometimes forget the amazing things that we get to do and see every day. We truly live in an era of medical miracles.

Thank you Dr. Baca! Note: If any new members would like to be featured in future issues of On Call, please contact Tara Auclair Ryan at tarar@pbcms.org or call 561-433-3940.


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NEWS & Classifieds / On CALL Magazine Quarter THREE 2012

Med SocietyNews

130 new members welcomed during the spring membership campaign!

PALM BEACH COUNTY MEDICAL SOCIETY welcomes New Members In May, June & July 2012 Daniel Nadar Adam, MD (Resident) Referred by Sumathi Raja, MD

Lee Epstein, DO (Resident) Referred by Jeffrey Bishop, DO

Adetola Ajibade, MD (Resident) Referred by Sumathi Raja, MD

Rahat Faderani, DO (Resident) Referred by Jeffrey Bishop, DO

Oluwadamilola Akinnifesi, MD (Resident) Referred by Sumathi Raja, MD

Cristina Figueira, MD Delray Beach, FL Specialty: Internal Medicine

Ali Alagely (Medical Student)

Mirta Galante, MD West Palm Beach, FL Specialty: Internal Medicine

Ilan D. Avin, MD Boca Raton, FL Specialty: Oncology/Hematology Sasha Baker (Medical Student)

Danon Garrido, MD (Resident) Specialty: General Surgery Referred by Andrew Shapiro, MD

Rajendra Bansal, MD Jupiter, FL Specialty: Geriatrics Referred by Ronald Zelnick, MD

Nadine George, DO (Resident) Referred by Jeffrey Bishop, DO

Wayne Barish, MD Atlantis, FL Specialty: Ophthalmology Patrick James Barrett (Medical Student) Marcelle A. Bertrand, MD Jupiter, FL Specialty: Oncology Referred by Ronald Zelnick, MD David Bloom, MD Delray Beach, FL Specialty: Internal Medicine David Bohorquez, DO Specialty: Emergency Medicine Todd Harold Bradford, DO Jupiter, FL Specialty: Referred by Ronald Zelnick, MD

Mark Gigliobianco, DO (Resident) Referred by Jeffrey Bishop, DO Brad Glick, DO Wellington, FL Specialty: Dermatology Alan M. Gomer, MD Delray Beach, FL Specialty: Internal Medicine Donald Grossman, MD West Palm Beach, FL Specialty: Internal Medicine Ranya Habash, MD Specialty: Ophthalmology Medical Kristin Herbert, DO (Resident) Specialty: Pediatrics Referred by Bradley Feuer, DO

Maria V. Bravo, MD (Resident) Referred by Bradley Feuer, DO

Elizabeth Anne Hevert, MD (Resident) Referred by Sumathi Raja, MD

Isabel Bueno, MD (Resident) Referred by Sumathi Raja, MD

Mel S. Jacoby, MD (Retired) Specialty: Radiology

Scott Cameron, DO (Resident) Referred by Jeffrey Bishop, DO

Michael Z. Kalter, MD Jupiter, FL Specialty: Internal Medicine Referred by Ronald Zelnick, MD

Beth Card, DO (Resident) Referred by Bradley Feuer, DO Alvaro Castillo, MD (Resident) Specialty: General Surgery Referred by Andrew Shapiro, MD Vishala Sharma Chang, DO (Resident) Referred by Sumathi Raja, MD

Hitesh Kapupara, MD Atlantis, FL Specialty: Nephrology Referred by Jose Arrascue, MD Aviv Katz, MD Atlantis, FL Specialty: Gastroenterology Referred by K. Andrew Larson, MD

Cornelia Charles, MD (Resident) Referred by Sumathi Raja, MD

Lawrence Katzen, Ophthalmology

Michelle Cohen, MD Delray Beach, FL Specialty: Internal Medicine

Geetanjali Kelkar, MD (Resident) Specialty: Internal Medicine Referred by Sumathi, Raja, MD

Jose Conde, MD Delray Beach, FL Specialty: Internal Medicine Jeanmarie Burigo Connor, MD Palm Beach Gardens, FL Specialty: Pediatrics Referred by Alan Pillersdorf, MD Michael Connor, MD West Palm Beach, FL Specialty: Oculoplastic Surgery Referred by Alan Pillersdorf, MD Linda S. Cox, MD Specialty: Allergy & Immunology Helena De Carvalho, MD (HCD) Lantana, FL Specialty: Obstetrics and Gynecology Referred by Harish Madhav, MD & James Howell, MD Lucy DeLaCruz, MD (Resident) Specialty: General Surgery Referred by Andrew Shapiro, MD

MD

Boynton

Beach,

FL

Specialty:

Kandace Kichler, MD (Resident) Referred by Beth Lesnikoski, MD Sima Kurland, DO (Resident) Referred by Bradley Feuer, DO K. Adam Lee, MD Jupiter, FL Specialty: Thoracic Surgery Referred by Ronald Zelnick, MD Woongchae Lee, MD Boca Raton, FL Specialty: Vascular Surgery Marvin Lopez, MD (Resident) Specialty: Internal Medicine Referred by Sumathi Raja, MD Vibert Mahanger, MD (Retired) Specialty: Family Medicine Alice Major, DO (Resident) Referred by Bradley Feuer, DO


On CALL Magazine Quarter THREE 2012 / NEWS & Classifieds

26 27

David Makover, MD Boca Raton, FL Specialty: Rheumatology

Diego Sadler, MD West Palm Beach, FL Specialty: Cardiovascular Disease

Sampath Manickom, MD (Resident) Referred by Sumathi Raja, MD

Wassim Samra, MD (Resident) Referred by Sumathi Raja, MD

Rosa Marin, MD Boynton Beach, FL Specialty: Internal Medicine

Richard Sarner, MD Jupiter, FL Specialty: Radiology

Vicky Marsh, DO (Resident) Referred by Jeffrey Bishop, DO

Robin Schecter, DO Lake Worth, FL Specialty: Dermatology

Casandra Mateo, MD Atlantis, FL Specialty: Neurology Referred by James Goldenberg, MD

Amy Schiffman, MD (Resident) Referred by Sumathi Raja, MD

Charles Metzger, MD Boca Raton, FL Specialty: Internal Medicine

Julie Servoss, MD Boca Raton, FL Specialty: Administrative Medicine

Seetal Mewar, MD Lake Worth, FL Specialty: Hematology/ Oncology

Eric Shapiro, MD Boynton Beach, FL Specialty: Orthopaedic Sugary

Jeffrey I. Miller, MD Boca Raton, FL Specialty: Urology

Abeer Siddequi, MD (Resident) Referred by Bradley Feuer, DO

Mistyann-Blue Miller, MD (Resident) Specialty: Internal Medicine Referred by Sumathi Raja, MD

Anthony Stampalia, MD Boca Raton, FL Specialty: Internal Medicine

Sean Miller, MD Jupiter, FL Specialty: Family Medicine Referred by Ronald Zelnick, MD

Stephen Steinberg, MD Boca Raton, FL Specialty: Gastroenterology

David C. Mishkel, MD Boca Raton, FL Specialty: Interventional Cardiology Barry M. Miskin, MD Jupiter, FL Specialty: General Surgery Referred by Ronald Zelnick, MD

Christina Steinmetsz-Rodriguez, DO (Resident) Referred by Bradley Feuer, DO Noelle Stewart, DO (Resident) Referred by Bradley Feuer, DO Nicole Swenson, DO (Resident) Referred by Bradley Feuer, DO

Michael Monzel, MD Loxahatchee, FL Specialty: Gastroenterology Referred by K. Andrew Larson, MD

Rotana Steven Tek, DO (Resident) Referred by Jeffrey Bishop, DO

Amanda J. Nederveit, MD (Resident) Referred by Jeffrey Bishop, DO

Benjamin Tripp, MD Specialty: Urology

Erin C. Toller-Artis, DO (Resident) Referred by Bradley Feuer, DO

El Noh, DO (Resident) Referred by Bradley Feuer, DO

Robert Ullman, MD Boca Raton, FL Specialty: Cardiology

Anthony Pannozzo, MD Delray Beach, FL Specialty: Physical Medicine and Rehabilitation

Vanitha Vasudevan, MD (Resident) Specialty: General Surgery Referred by Andrew Shapiro, MD

Ira Pardo, MD Boca Raton, FL Specialty: Rheumatology Referred by Shawn Baca, MD

Jefferson R. Vaughan, MD Jupiter, FL Specialty: Surgery Referred by Ronald Zelnick, MD

Chetan Patel, MD (Resident) Specialty: General Surgery Referred by Beth Lesnikoski, MD

Sol Velez-Cortes, MD Boynton Beach, FL Specialty: Geriatric Medicine

Monal Patel, DO (Resident) Referred by Bradley Feuer, DO

Carol Vicinanaza-Adami, MD Boynton Beach, FL Specialty: Radiology

Dov Pickholtz, DO (Resident) Referred by Jeffrey Bishop, DO Allison Price, MD (Resident) Referred by Sumathi Raja, MD

Benjamin Weinstein, MD (retired) Specialty: Internal Medicine

Eva Raj, DO (Resident) Referred by Jeffrey Bishop, DO

Debra Weinstein, MD Boynton Beach, FL Specialty: Internal Medicine

Chadwick Rastatter, MD (Resident) Specialty: General Surgery Referred by Andrew Shapiro, MD

Noah Weisberg, MD Jupiter, FL Specialty: Dermatology

Elie Razzouk, MD (Resident) Referred by Sumathi Raja, MD

Jason Yarsley, DO (Resident) Referred by Sumathi Raja, MD

Garrel Renick, DO (Resident) Referred by Jeffrey Bishop, DO

Hedayatollah Zaghi, MD Atlantis, FL Specialty: Cardiovascular Disease

Bradford Ress, MD Boca Raton, FL Specialty: Otolaryngology

Alberto Zarak, MD (Resident) Specialty: General Surgery Referred by Andrew Shapiro, MD

Susan Rodell, MD Boca Raton, FL Specialty: Geriatric Medicine Mark D. Rothenberg, MD Atlantis, FL Specialty: Cardiovascular Disease

Bruce Zuckerberg, MD Delray Beach, FL Specialty: Internal Medicine

Classifieds Primary Care Physician Wanted Three physicians in an established primary care practice are looking for an Internal Medicine or Family Practice physician. Excellent Opportunity for an ambitious physician. Competitive salary and benefits. Call 561-622-7699, fax 561-622-4651, or email to jgatyas@comcast.net.


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We created the Tribute Plan to provide doctors with more than just a little gratitude for a career spent practicing www.thedoctors.com/tribute.

good medicine. Now, the Tribute Plan has reached its five-year anniversary, and over 22,700 member physicians We created the Tribute Plan to provide doctors with more than just a little gratitude for a career spent practicing

have qualified for a monetary award when they retire from the practice of medicine. More than 1,300 Tribute

good medicine. Now, the Tribute Plan has reached its five-year anniversary, and over 22,700 member physicians

awards have already been distributed. So if you want an insurer that’s just as committed to honoring your career have qualified for a monetary award when they retire from the practice of medicine. More than 1,300 Tribute

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On Call - The Journal of Palm Beach County Medical Society (Quarter Three 2012)