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THE OFFICIAL PUBLICATION OF THE PALM BEACH COUNTY MEDICAL SOCIETY

DOCTOR Are You Well? Introducing

PBCMS Physician Wellness Program

QUARTER TWO 2017


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President’s Report Shawn Baca, MD

How does one define physician wellness and why should we care? It is no wonder when physicians are under great stress that wellness becomes increasingly important. Stress has never been higher especially with rising paperwork, less time for patients, medical malpractice, large student loans, physicians are now marginalized as “providers” and the health care delivery system is more and more dysfunctional. Physicians are constantly placed under “moral stress.” We are now asked to make medical decisions based on pitting our own personal needs against the patient’s. Example, do I order the safer and more efficacious drug and give myself a lot of administrative headaches to get it approved or just do what the insurance company or my institution wants? We all fight this fight every day, but as it gets harder to even get simple things done, where do we draw the line. According to the latest Merritt Hawking’s Survey only 7 percent of physicians are happy with the currently health care delivery system. We hear topics related to physician wellness in terms of physician burnout, early retirement and even physician suicide. Each year in the United States, the equivalent of one medical school graduating class commits suicide. The sad thing is that statistics show that almost every doctor in America knows at least one physician that has committed suicide. Unfortunately, I know a few including a medical school classmate. This disturbing problem appears to

President, Palm Beach County Medical Society

begin early a recent study showed at as early as medical school major depressive symptoms are seen in over 20 percent of students and more disturbing suicidal ideation occurs in over 10 percent of our medical students. Society has placed a high burden on its healers without regard for their basic human and emotional needs. We encourage our patients to seek professional mental health when they have problems but physicians are frowned upon when they are not 100 percent. The reality however is that as physicians start to burnout they become less effective, less efficient, less empathetic and more prone to mistakes. Physician satisfaction is tied to many issues. Wellness can be defined in terms of financial, physical and emotional wellness. The PBCMS has developed many programs to help with personal financial wellness. Healthcare connect is available monthly to help your practice survive and thrive in these changing times. The society is highly engaged with both local state and national politics and uses its personal contracts with our public officials to lend our voice on important topics that affect your ability to practice. Personal finance includes investing wisely realistic expectations and avoiding being over extended. Physical wellness is something we are all aware but many

don’t practice ourselves. When was the last time you got a physical? Do you exercise, watch your weight, get enough sleep and take time for yourself? We as doctors need to walk the walk not just talk the talk with our patients. Emotional wellness is the most complicated piece of the puzzle. Its foundation relies partly to the first two elements but personal problems such as mental health, coping skills and substance abuse become difficult issues. The PBCMS with its partners will promote more activities that promote coping skills, financial literacy, and physical health. We will aim to work at levels starting with problem prevention with our medical students and residents and young physicians. We are in the process of identifying confidential meeting places for AA meetings for doctors in substance abuse recovery. At the end of the year we will begin to offer 6 confidential visits for physicians in distress with qualified mental health professionals. I have personally donated 5,000 dollars towards this effort and ask you to help support it through donations as well. It now time for our community to help the physician to heel thy self.

ON CALL MAGAZINE QUARTER TWO 2017

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There are many ways you could be wasting money on your malpractice insurance Did you know that most doctors unknowingly waste money on malpractice insurance, which is one of the largest expenses in a medical practice each year? Some of the most common ways doctors continually spend too much include:

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The PBCMS Workers’ Comp Insurance Program Has a New Name and an Enhanced Dividend! All current and new Palm Beach County Medical Society members are eligible for an enhanced dividend of up to 30%. PBCMS members have received over $1 million and counting! Since the rates for workers’ compensation insurance are set by the state, prices are the same no matter where you secure coverage. But now, you are eligible for this enhanced 30% dividend, which effectively reduces the true cost of coverage. Other programs may offer similar dividends on an individual basis, but our program is based on the group’s experience and not the individual’s experience. This provides a better chance to not only receive the dividend, but to receive a higher dividend. AmTrust North America (formerly Comp Options) has been a true partner to the Palm Beach County Medical Society for many years, and now, with the resources of AmTrust - rated “A” (Excellent) by A.M. Best - we are able to provide this exclusive enhanced dividend program that is like no other for Florida physicians and medical practices. To date, these programs have returned a dividend for 12 straight years, with over $8 million over the past five years to Florida medical associations’ members: $1 million of that went to PBCMS members. For more details and to enroll in this beneficial program, please contact Tom Murphy of Danna-Gracey at 800-966-2120, or tom@dannagracey.com.


Contents PBCMS Staff Tenna Wiles, CEO Tennaw@pbcms.org Deanna Lessard, Director of Member Services & Education

Board of Directors Shawn Baca, MD

Features 07 Heroes in Medicine

President

Brandon Luskin, MD

Deannal@pbcms.org

President-Elect

Mindi Tingler, Operations Director

Marc Hirsh, MD

Mindit@pbcms.org

First Vice-President

Lauren Stoops, Project Access Program Director

Larry Bush, MD

Laurens@pbcms.org

Secretary

Graciela Gordillo, Project Access System Coordinator

Robert Tome, MD

Gracielag@pbcms.org

Treasurer

Karen Harwood, MSW, CCM, Care Coordinator

James Goldenberg, MD

Karenh@pbcms.org

Immediate Past President

10 Stress in Medical Practice, Physician Burnout and Suicide 13 Helping Our Patients Through Mindfulness 14 PBCMS To Launch New Program To Promote Physician Wellness 17 Time Management

John James, Director of Disaster Services Johnj@pbcms.org Stuart Miro, MD, Care Coordination Training Stuartm@pbcms.org Jim Sugarman, Development Coordinator Jims@pbcms.org Gwendolyn Marrero, Care Coordinator Gwendolynm@pbcms.org Katherine Zuber, Administrative Director Katherinez@pbcms.org Pamela Richards, Services Administrative Assistant Pamelar@pbcms.org Jane Scaturro, Administrative Assistant Reception@pbcms.org

On Call Magazine is designed by Forming Brands info@formingbrands.com or www.formingbrands.com

Subscriptions to On Call are available for an annual rate of $50. For more information contact PBCMS at (561) 433-3940. 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., Forest Hill Blvd., #101, West Palm Beach FL33406. (561) 433-3940 & (561) 276-3636. ŠCopyright 2013 Palm Beach County Medical Society, Inc.

Stephen Babic, MD Andrew Berkman, MD Kleper De Almeida, MD Michael Dennis, MD Roger Duncan, MD Ekaterina Kostioukhina, MD Henry M. Haire, MD James Heron, MD Hitesh Kapupara, MD Krishna Kishor, MD Stefan Pasternack, MD Alan Pillersdorf, MD Ronald, Zelnick, MD Jack Zeltzer, MD Ben Childs, Medical Student Jinendra Satiya, MD Resident

21 Your Most Significant Asset 23 Prescribing Opioids Safely: How to Have Difficult Patient Conversations Articles 03 President's Report 25 Med Memo 26 Welcome New Members

Board of Trustees Jose Arrascue, MD Stephen Babic, MD Shawn Baca, MD Larry Bush, MD James Goldenberg, MD Marc Hirsh, MD Brandon Luskin, MD Alan Pillersdorf, MD Maureen Whelihan, MD Ronald Zelnick, MD Jack Zeltzer, MD

ON CALL MAGAZINE QUARTER TWO 2017

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With close to 500 people in attendance at the Kravis Center’s Cohen Pavilion, the PBC Medical Society Services honored extraordinary men, women and organizations at the 14th Annual Heroes in Medicine luncheon on Friday, April 21, 2017. Individuals and organizations in health care that provide outstanding service to meet needs of people in local, national and/or global communities were recognized.

Alina Alonso MD, Roger Duncan MD-Hero of the Year, Shawn Baca MD and Alan Pillersdorf MD

Dr. Steven Rosenberg and Amanda Rosenberg

State Attoreny Dave Aronberg with Jack Zeltzer MD

Rendina, Joey Bulfin, Linda DePiano, Owen O'Neill receiving award on behalf of Tina Phillips,

Hero of the Year Roger Duncan, MD received the Hero in Medicine of the Year award. Dr. Duncan is dedicated physician and Board Certified Anesthesiologist for nearly 26 years, serves as the Chief of Anesthesia at Palms West Hospital. Considered a trail-blazer in the community. He has mentored, directed and showcased thousands of young people and steered them into health care careers. While President of the T. L. J. Medical Society, the organization received an award as the Best Mid-sized Local County Medical Society affiliate from the National Medical Association for its work on mentoring, back to school community health fairs, scholarship promotions, and building the organization's membership. A member of the Palm Beach County Medical Society Board, Dr. Duncan is a motivator who

Rik Pavlescak, Richard Rendina

gives tirelessly of his time and talent to develop the next generation of great health care providers, researchers, academicians and leaders. Dr. Catherine Lowe stated in his nomination that “his drive and determination makes him a treasure in this community.” Medical Student Heroes Nadine Najjar, Dan O'Shea,

Greg Quattlebaum and Jibby Ciric served as Chairs for the 2017 Heroes in Medicine Awards Luncheon and Ceremony. Dr. Alan Pillersdorf was the honorary host and Rendina Healthcare Real Estate Rendina Health Care Real Estate served as the founding and presenting sponsor.

Miranda Rosenberg with Emanuel Newmark MD

Proceeds from Heroes in Medicine 2017 support Project Access of the Palm Beach

To read and view a video on the Heroes please go to PBCMS.org

(far left) Sharon Beckley (far right) who presented awards to them

County Medical Society which provides pro bono care to uninsured children and adults of Palm Beach County.


Jibby Ciric and Greg Quattlebaum HIM 2017

Dean Phillip Boiselle MD and James Godenberg MD

Co-Chairs Welcoming all to Heroes 2017

Dr. Alan Pillersdorf and Family recieved an award in Memory and Tribute to Rhona Pillersdorf

Miguel Benavente MD with High School Heroes Tyler Gray, Charlize Estela, Daniela Mejoa Lagos, Incredible Thanks Are Due to Members of Our Host Committee-not all present in photo

Michael Hamper

Thank You to Our Host Committee and Judges Greg Quattlebaum Chair Jibby Ciric, PSyD Co-chair Jose Arrascue MD Jean Acevedo Merrell Angstreich William Adkins MD Elaine Alvarez Ferial Andre Steven Babic MD Shawn Baca MD John Bartosek Sharon Beckley Christine Brooks ARNP Sally Chester RN Pat Ciavola Senlai Cochrane Gregory Cotes Patricia C. Corbett Margaret Donnelly Rodney Dunetz DAOM

Judy Dunn RN Becky Dymond Charlie Eagle Diane Esposito, PhD, ARNP Trish Ernst Marina Glavota James Goldenberg MD Marc Hirsh MD Susan Kaplan Rick King Gary Lesser PJ Lyang Angelica Ligas RN Libby Marshall Arlene Marcello Amy McGuire Huntley Miller Michael Miller Brandy Monteleone

Emanuel Newmark MD Tina Newmark Owen O'Neill RN Alan Pillersdorf MD Nancy Quinlan Kannia Rousseau Amity Schuyler Irv Seldin Marnique Sparago Ben Starling III Bill Stefansic Jeanne Stefansic Marge Sullivan Julie Swindler Rob Torrington Marisa Vinas Gregg Weiss Edward Willey Jack Zeltzer MD Ron Zelnick MD


2017 Heroes in Medicine Special Friend

In Memory and Honor of Rhona Pillersdorf

Leadership Award

Advocacy

FAU Charles E. Schmidt College of Medicine

State Attorney Dave Aronberg

Bruce Redina Professional

Mary Jo “Joey” Bulfin RN, MBA

Linda De Piano PhD

Rik Pavlescak PhD

Tina Phillips

Physician

Patricios Espinosa MD

Claudia Mason MD

Suresh Rajpara MD

Ronald Romear MD

Emanuel “Dupree” Jackson

Marge Sullivan

Steven Rosenberg MD

Community Outreach

Elizabeth Cayson (PhD Candidate)

Judy Dunn RN

Community Outreach Organization

Boca Hoops High 5 League

Debby Walters and the Diabetes n Coalitio

Health Care Inovator

Satish Chandran PhD-Somahlution

John Couris-Jupiter Medical Center

Project Access

21st Century Oncology: Kishore K. Dass MD, Ben H. Han MD and Eugene C. Shieh MD

The Breakers Hotel Community Outreach

James Abramowitz DDS

Sarah Bland MD

Ramin M. Abdolvahabi MD

Roger Duncan MD

Karen Gilbert RN

Richard Levene DO

Meg Reller

Health Care Prevention/Wellness

Pascal Gedeon PA

Medical Students

Nadine Najjar

Bethesda Health

Health Care Educator

Health Care Providers

Barbara Abernathy PhD

Esther Swann

Captain Houston Park

Jane Robinson LMHC, RPT-S

Keith Hurbs and Palm Glades Rural Health Associates

Lauren Zuchman LCSW and Healthier Delray Beach

Michael Hamper

Daniela Mejia Lagos

High School Students

Dan O’Shea

Miranda Rosenberg

Charlize Estella

Tyler Gray


Stress in Medical Practice, Physician Burnout and Suicide By Stefan A. Pasternack, MD, Bruce L. Saltz, MD and Abbey Strauss, MD

Recent changes in the practice of medicine and the national health care system have a severe impact on physicians. Stress in medical practices has increased dangerously. Excess stress may lead to the syndrome of “physician burnout.” The Mayo Clinic Proceedings (in 2014) found that 46.9% of physicians reported a high degree of emotional exhaustion, 34.6% reported high rates of depersonalization, and 16.3% reported a low sense of personal accomplishment. At least 54% had a minimum of one symptom of burnout. Only 40% felt that their work schedule left enough time for personal or family life. The rate of burnout among physicians is up since 2011 while physicians’ overall satisfaction with life is lower. The culture of medicine assigns a low priority to physician wellness and mental health, despite the solid evidence that untreated mental disorders may lead to physician suicide. Physicians feel strong pressure to deny their own emotional and physical needs. They fear being stigmatized if they seek help. Medical students and residents are also reporting increases in burnout. Medical training itself imposes numerous risk factors for mental illness, such as adjusting to role transitions (from student to physician), very demanding academic and clinical schedules, decreased sleep, and exposures to such intense emotional experiences as examining patients with severe illness, learning how to compassionately care for those dying and their distressed families, and confronting the harsh specter of death. A recent national study showed that 25% of graduating medical students had clinically significant depression and 10% reported active suicidal ideation. That is a significant difference from earlier times when graduating medical students felt a great sense of accomplishment and triumph over the complex adversity of demanding studies 10

and the grueling clinical clerkships. Only recently have national organizations such as the Accreditation Council for Graduate Medical Education (ACGME) and medical school faculties started to develop strategies to reduce the stigma associated with seeking help for mental problems and to reduce overly stressful and onerous schedules. While these efforts are noteworthy, there is still an alarming shame about emotional disorders that results in trainees and practicing physicians going without needed treatment just at the same time as they are under more stress and have greater needs for help. What is going wrong? And what can we do about it in Palm Beach County? Mechanisms of stress and how it can break us: Hans Selye identified three separate stages of a stress reaction. First is the “alarm,” which is defined as an arousal and attention to stimulation. The second is “resistance,” which is when the individual responds with one’s usual coping mechanisms, such as working faster, with longer hours, trying to “squeeze in” more patients, hiring more staff to handle administrative tasks, and trying to use information technology for more efficiency and easier coordination of care. The third is “exhaustion,” which is when the adaptive capacity is overwhelmed. Selye notes that stress is cumulative and that everyone has a limit to how much pressure and stress they can handle. Animal and human studies show that stress, ranging from the pinpricks, disappointments, and annoyances of daily life, up through serious personal events such as lawsuits or coping with a major disaster, will trigger complex psychological and physiological reactions leading to illness or self-injury. Major changes in one’s family, such as death or divorce, are also associated with risk of a medical illness; for example,

QUARTER TWO 2017 ON CALL MAGAZINE

bereaved widows showed dysfunction of lymphocyte T cells. The stress of divorce has been shown to depress immune function and can even trigger retinal detachment. Stress researchers Holmes and Rahe documented the impact of a series of stressful events on a person’s mental and physical health by assigning a number to indicate degree of stress with each event. They demonstrated that having a high stress score within a 6 to 12-month period increased the likelihood of physical or mental illness or suffering an accident. The Holmes-Rahe Life Stress Rating Scale provides a useful objective scale for tracking one’s stress exposure so one can try to prevent becoming ill. Another investigator (Mason) reports that insults to self- esteem are associated with unusual pituitary stimulation and cortisol secretions. Levels of norepinephrine and serotonin are effected in emotionally damaging situations. Buell and Eliot showed that emotional stress can trigger catastrophic adrenaline surges leading to sudden cardiac arrhythmias and death. Threats to the identity, towards one’s self esteem and sense of autonomy are corrosive over time and constitute “psycho-endocrine” events which affect the amygdala, hippocampus, and basic memory mechanisms. So, physicians, being only human, face harmful effects of stress on their immune, endocrine, and psychological systems. What is burnout: Burnout is the equivalent of Selyes’ exhaustion. It comprises these three characteristics: emotional exhaustion, cynicism and depersonalization with loss of idealism. Often there is also a sense of personal ineffectiveness or lack of accomplishment. Burned out physicians express these as frustration, anger anxiety, sadness, substance abuse, marital discord, with emotional disconnection from their spouses and children and loss of sympathy and empathy for others. It may also involve sensations of


helplessness, hopelessness, despair and frank deterioration of physical health, declining ability to work effectively and can lead to severe depression and suicide. Physicians developing burnout can succumb to maladaptive behaviors to reduce or escape from their misery, for example by self- medicating; abuse of alcohol or drugs; gambling or involvement in sexual affairs or sexually addictive behavior; extravagant spending; falsifying documents. Burned out physicians are more likely to become impaired and unable to provide quality care. There is a higher incidence of malpractice lawsuits among impaired physicians. The MD/DO degree does not confer special protection against cognitive, financial, regulatory, physical health or emotional dissonance. Little in our training focuses on how to manage the real stressors of life and work. Burnout is driven by unrealistic expectations. Often patients expect too much attention, too fast, and too often. Health care organizations also impose many unrealistic demands on physicians as they exert pressure on physicians to see more patients and do ever more “big data” paperwork. Physicians often expect too much of themselves as they try to provide quality care for a large number of patients and handle too many

administrative tasks of practice. This evolves into a painful dissonance and mismatch between what is expected and what can be provided. This can foster frustration and anger which the physician turns inward. This powerfully drives physician burnout. A recent paper from a group of health care CEO’s noted “a healthy energized engaged and resilient work force is essential to national healthcare goals and burnout among physician is a public health crisis.” It is time for changes in the stresses imposed on physicians. The role of personality and how we may be our own worst enemy: We are all vulnerable to a certain amount of “internal emotional stress” due to our personal emotional conflicts. Physicians, like others in our society, must grapple with feelings about our own expectations regarding matters such as acquisition of wealth, assertion of power, relationships and sexuality, control over others, fears of dependency, and denial of our emotional needs. Physicians are altruistic and want to do a “perfect job.” Nothing disturbs a doctor more than a bad or less than desired result in treatment of

a sick patient. Having to pay attention to every detail to avoid a mistake in diagnosis or treatment fosters obsessive compulsive traits and behavior. Gabbard has highlighted the “compulsive triad in physicians’ personalities: doubt, guilt and exaggerated sense of responsibility. Doubt leads a physician to over diagnose or do more procedures than is required. Fearing he might have forgotten or over looked something the doctor may second guess himself, worry excessively and suffer from conscious and unconscious guilt, especially if anything goes wrong. Physicians try to achieve the highest standards of care. Physicians experience stress when they have to balance their ideals of providing the best possible care with practical realities and the limitations imposed by treatment guidelines and insurance company denials. Constant battles to get someone else to approve a medication or test they have prescribed create frustration and exhaust a physician’s resources. Continued on page 22


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“Whenever the art of medicine is loved, there is a love of humanity.”

We salute our own Patricio Espinosa, MD, Director of Neurology at Boca Raton Regional Hospital’s Marcus Neuroscience Institute, and all the other extraordinary 2017 Heroes in Medicine winners for their commitment to providing exemplary healthcare services and support to those in need.

Heroes in Medicine - OnCall.indd 1

4/20/17 3:28 PM


Helping Our Patients Through Mindfulness By Mark Gocke, Md

Every year, millions of people see a physician or other health care professional for advice, counsel, evaluation, referral and perhaps relief from a condition where its symptoms have become distressing. The condition has raised their concern enough that they take action – seeking out assistance, picking up the phone to make an appointment, driving to our office, waiting to be seen, and often receiving care. If their condition is severe enough, they may even necessitate an emergency room visit or possibly hospitalization. People who are suffering will subject themselves to a process that is, at the least, inconvenient and at times downright unpleasant. They will perceive something is wrong, and are in need of help, sometimes desperately so. In all of these people who have now become patients, there is varying degrees and sources of stress. Patients become ill as a result of stress and patients are stressed when dealing with illness – they’re either sick because their stressed or stressed because their sick. In nearly all patients who are suffering, there is an underlying element of stress. Managing that stress is a significant part of any practitioners care of the patient and is an extremely important determinant of our performance as it relates to the benefits we can provide to them. In view of these challenges, I am excited to announce the opening of a new center that was created with the sole purpose of helping people heal through the integrative medicine techniques of mindfulness. The new Calcagnini Center

for Mindfulness at Jupiter Medical Center is a 2,600-square-foot beautiful, soothing space overlooking the Jacqueline Fiske Healing Garden designed to provide assistance and teach people to be more mindful, to cope with symptoms of stress, and to manage the tension of everyday life. Let me share with you a little history about the movement known as mindfulness. In 1979, one of the nation’s foremost mindfulness experts, Jon Kabat-Zinn founded the Stress Reduction Clinic at the University of Massachusetts Medical Center to bring a form of meditation practice known as Mindfulness-Based Stress Reduction (MBSR) into mainstream medicine and health care. The Center for Mindfulness at Massachusetts Medical Center is an innovative leader and pioneer in mindbody medicine and mindfulness-based treatment and research investigation. One of the cornerstones of the Calcagnini Center for Mindfulness is MBSR training offered by Jupiter Medical Center in collaboration with the UMass Medical School’s Center for Mindfulness. This training is ideal for cultivating greater awareness of the mind-body connection and developing tools to improve health and well-being. Nearly four decades of scientific research by a growing cadre of highly regarded international scientists indicates that individuals trained in mindfulness and MBSR have an enhanced ability to tap into their inner resources and improve their own health. For instance, imagine a patient who actively participates in his or her own care, whose sense of well-being is increased simply by learning to take the time to meditate, whose treatment or surgical outcomes may improve by learning to live more mindfully “in the moment,” or whose medications may be reduced or work more effectively because

they are experiencing less stress. These are just a few of the possible benefits of mindfulness training. A variety of chronic health conditions and concerns that afflict so many of our patients have been demonstrated by recent studies to improve with mindfulness, including, but not limited to: • Pain • High blood pressure • Fibromyalgia • Cancer • Heart disease • Asthma • Gastrointestinal (GI) distress • Skin disorders • Anxiety • Panic • Depression • Fatigue • Sleep disturbances The practice of mindfulness is an intervention that could actually help improve conditions such as these, by lowering stress levels that are often a contributing factor to “dis-ease.” In addition, those who practice this discipline can achieve an enhanced sense of balance in their lives and a greater interest in learning the “how” of taking good care of themselves. As physicians, I think we’d all applaud anything that enhances our patients’ ability to focus on prevention and overall wellness. Continued on page 26

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PBCMS To Launch New Program To Promote Physician Wellness By Leon Fooksman

The practice of medicine is a highly stressful occupation. Physician are known to carry a high degree of emotional tension, but they are also known to seek help to a lesser degree and at a much later stage than many other professional groups. As a result, Palm Beach County Medical Society (PBCMS) is launching a new physician wellness program to address the barriers that typically prevent physicians from getting the help they need. Expected to be launched in the fall of 2017, the initiative will focus on personal counseling tailored to physicians’ needs, including quickly accessible, confidential and free services. PBCMS has launched a task force to research and implement the development of the physician wellness program. The agency has been working with more than 40 other local medical societies in sharing best practices and polices related to the program. In all, PBCMS has received $12,500 in funding to cover the expenses of kicking off the initiative as early as October. The Medical Society has asked three experts to discuss the new program further. They are 1) PBCMS President Shawn Baca MD, FACR, 2) Benjamin A. Bensadon, Ed.M., Ph.D., associate director of Internal Medicine Residency— Geriatrics & Palliative Care Rotation at Charles E. Schmidt College of Medicine at Florida Atlantic University, and 3) Stefan A. Pasternack, MD, DLFAPA, affiliate professor of biomedical science at Charles E. Schmidt College of Medicine at Florida Atlantic University. Why is this initiative necessary in Palm Beach County?

14

Dr. Baca: Physician burnout is at an alltime high. It manifests itself with early retirement, disengagement, depression, substance abuse and suicide. Physician suicide is tragic. The equivalent size of one medical school class dies by suicide each year. It is impossible to measure the human and financial costs to physicians being pushed to the edge. Recent surveys show over 50 percent of physicians have at least 1 of 3 major signs of burnout. We recognize many of the causes are due to outside interference with the practice of medicine. Unfortunately, in this digital age, there are more demands, more scrutiny and a campaign to dehumanize the physician. Nationally physician wellness is being recognized as a growing health care crisis. Our Medical Society has been engaged in the uphill battle since day 1 to push back and when necessary to help physicians adapt to the ever-changing medical landscape. This initiative is very different in that it will focus on the individual. It recognizes that physicians through their many sacrifices to the profession have a special place in society and have the right to be human and to be treated respectfully. Dr. Bensadon: Physician wellness is vital to Palm Beach County and throughout the nation. Local physicians are being pressured to see more patients, with more problems, in less time, and with limited support. These demands are untenable, especially in South Florida, where healthcare is increasingly guided by corporate interests in productivity, and patients are disproportionately geriatric, thus requiring more time to address both their biomedical and psychosocial needs. National data suggests physicians, without support, suffer in silence. Related burnout is increasing, as is early retirement and maladaptive coping via

QUARTER TWO 2017 ON CALL MAGAZINE


illicit substance use and tragically, even suicide. With adequate psychological support, burnout can be buffered, and related risks, mitigated. Dr. Pasternack: With the success of the new medical school -- Charles E. Schmidt College of Medicine at FAU-- Palm Beach County is now a new center for medical education and the training of residents in different specialties. The Physician Wellness initiative heightens awareness among trainees at all levels of the importance of good self-care and monitoring of stress levels as they go through their medical education. We hope to offer information about fostering resilience and stress reduction. What do you hope will be the outcome of this program? Dr. Baca: The program will be designed to incorporate many of the functions that the Medical Society currently performs and will approach wellness through trying to balance 3 main needs: the need to be financially well, physically well and emotionally well. The second and third needs have been largely ignored by most until recently. Physical and emotional health are intertwined, and emphasis on taking care of our most precious possession ourselves will be promoted. The emotional part will be the most difficult but in the end most rewarding part of the initiative. We are in the process of rolling out free to members, programs to help one achieve a better life balance. We will start with encouraging our institutions to support physician wellness education. We will also hold our own programs that will teach tools one needs to deal with various forms of stress. We are currently exploring various formats to provide a confidential platform to assist physicians who are in recovery

from substance abuse. Lastly, at the end of this year, we will offer to any member 6 free totally confidential counseling sessions with a certified mental health professional to those in need. Dr. Bensadon: As medical school faculty and a licensed geriatric psychologist, I sincerely hope this program will provide physicians the access to the support and understanding they desperately need. Traditionally, the culture of medicine has not been forgiving of physicians who show signs of vulnerability. Palm Beach County, both affluent and litigious, makes local physicians especially vulnerable and, unfortunately, often feeling defensive. Local mental health providers are poorly integrated into this system, as managed care entities restrict related coverage. Cumulatively, these factors perpetuate stigma and avoidance of psychological needs, and create adversarial more than therapeutic relationships. Hopefully the wellness program can begin to address this via honest dialogue and clinical support, so that patients, families, and physicians, alike, can feel better served and less isolated. Dr. Pasternack: We hope to see a reduction in the number of physicians who feel they are burned out, a reduction in number of physicians who retire early due to burnout, and a reduction in number of physicians who develop substance abuse or mental disorders. We hope to reduce the incidence medical errors, as burnout often leads to mistakes in diagnosis or treatment. To learn more about the physician wellness initiative, contact PBCMS at 561433-3940. Leon Fooksman is a writer for On Call Journal. He can be reached at leon@digitalstoryline.com or on Twitter at @ compellingstory.

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The GEO Group Foundation IS PROUD TO SUPPORT THE

Palm Beach County Medical Society Services’

Heroes in Medicine The GEO Group would also like to congratulate

Joey Bulfin RN, MBA on receiving the Bruce Rendina Professional Heroes Award.

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Making a Difference in Health Care

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Time Management We may have regimented schedules, even documenting our time in hopelessly exacting intervals, and some of us may run our professional lives using our smartphone or Google Calendar to be efficient – yet somehow there seems to be never enough time to do what we have to do (never mind what we WANT to be doing). More often than not, this can become a problem in our personal and financial lives. What Else Can We Do About This? A physician client asked me once if I could offer some advice or guidance on time management and it got me thinking about my post call days as a senior resident. Do you remember those daily patient lists that we would scribble all sorts of notes and stuff into our white coats? Well it turns out, the simple act of making that list represents some key tips for time management. Make a List Those patient lists that we would carry around with scribbled notes and reminders worked because it was a forced method of making a list. It was the first step toward the effective management of your day as a resident. So start by making your “to do list” and keep it focused. You do it for others; try it for yourself.

As you scroll down to the lower priority or less time – intensive activities, ask yourself: is there anything I can delegate? You’ve been there to assist colleagues, and that should be a two way street. Maybe some of those tasks can get knocked off the list with minimal input (or time) from you. Priority: YOU time. Don’t forget to mark off time for yourself! Ten minutes of mental silence at the right time in your day (perhaps after you’ve knocked off that first big task) can rejuvenate you tremendously, and that could make the rest of the day run smoother. An evening spent with your spouse over dinner with no distractions can make all the difference in the world. "You" time should not be at the bottom of the list! Make Decisions with the “Employer/ Employee” Approach. Organize your calendar at the beginning of the day – or, for you night owls, perhaps the night before – as if you are the boss, then follow your own lead

as if you are the employee. Set up the calendar in a distraction-free environment (I know that’s asking a lot) to help the objectivity, and once it’s done, that schedule is now the boss and you are following it. We make important life altering decisions for our patients on a daily basis. Now it’s time for you to make decisions about the priorities in your life. What needs to happen today? What can you put off until tomorrow? A resolute mind that has taken time to prepare the day’s activities into proper priority can allow you to relax and just flow with your own game plan. Time that is passively or mindlessly spent is too easily discarded, and this habit will help you to regiment all of it; even when the regiment says the time is free. And as for that free time – make the decision to leave plenty of time to enjoy life. Your practice does not define your life, you do! Ali Chaudhry, MD is President and AskAliandAlex.com and can be reached at ali@mpsmd.com

Set Priorities You would evaluate a critically ill patient before you would evaluate your stable, low – risk patient. It’s intuitive and does not require much debate. Yet without realizing it, you have learned a key aspect of time management; prioritization. So sit down and prioritize your list. When it comes to time management, tackling the toughest (perhaps the most time intensive) tasks first can not only help to determine how much of your day will be left to the less crucial tasks, but alleviate that mental burden of knowing “the worst is yet to come” that day. ON CALL MAGAZINE QUARTER TWO 2017

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Examining Strategic Alliances: Which One is Best for Your Practice? By: Heather S. Miller, Esq. Broad and Cassel

With reimbursement practices continually tightening, and payors transforming their traditional reimbursement model from a “fee for service” payment system to one based on quality and risk, there is an acceleration of mergers and acquisitions with respect to physician group practices. Physicians and physician group practices are realizing that in order to be able to stay competitive in this new value based reimbursement world, they need economies of scale and financial resources. Physicians and physician group practices that independent of a hospital system need to be preparing their business plan for the next five to ten years. While there has been a trend over the last decade or so for solo and small practitioners to former practice groups, the latest trend with decent size existing group practices is in merging with other group practices, joint venturing with private equity, or affiliating with a hospital system. Regardless of which opportunity seems to be fit your practice best, if you do not start planning for adapting to this new environment, you will find it exceedingly difficult to maintain your compensation and keep your practices financially sound over the next decade. Do you want to grow your group practice or merge with another group

practice? Do you want to partner with a private equity group? Do you want to become part of a hospital system? The answers to these questions will vary widely depending on the size of your current practice, your specialty, and your practices’ market saturation. Regardless of which path you chose, there will be benefits, consequences, and risk because healthcare is a dynamic industry that is constantly changing. However, there are two things that are not changing- quality and risk based payments are here to stay and the terms of your payor agreements (just like with fee for service) will have a substantial impact on your practice and profitability. Which strategic partner will give you the greatest chance of success in transitioning to the new payment models and which one has business goals that most align with your business goals are two important questions to answer. A partner’s payor strategies and relationship with the payors are equally as important, as well as the likeability and trustworthiness of the hospital, group, or private equity group. The culture of your potential partner needs to be considered as well – will the partner put its interests ahead of the health of the practice/venture?

Who will be leading the practice in the future? Ultimately, which path to choose will depend on: (1) how much control you want to have over your practice, (2) how much risk you are willing to take, (3) what options are being offered to you, and (4) the financial incentives being offered. Growing or merging a group practice is a good option for physicians that want to maintain control over their practice, want to be actively involved in managing and growing their practice, and being a driving force behind adapting to the changing marketplace. Private equity, on the other hand, may prove to be a better strategic partner for groups that want to seize business opportunities that they may not otherwise be able to take advantage of without business people and financial resources behind them. Joining a hospital group may be an option for physicians that are somewhat reliant on a hospital for their practice and who do not mind giving up autonomy and control of their practice. Clearly, making a decision to align with a strategic partner is far from simple. Do not forget that the devil is always in the details and in the terms of the written agreements memorializing the relationship.


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Your Most Significant Asset You are your most significant financial asset. Think about that statement and what it means. As physicians, we have invested a great amount of time and money to achieve our dream. And we know from our clinical experience, unforeseen illnesses occur on a daily basis. Your most significant asset is your ability to earn a living. The question I didn’t even know to ask: how can you protect the asset that is yourself? Disability Insurance: Guaranteeing a Paycheck Disability insurance provides a level of protection by providing income if you become disabled for an extended period of time. All Physicians must have it; that’s a given. However, choosing the right type of disability insurance is crucial. Remember, not all disability insurance policies are created equal. Consider your youth and health as an asset that can be insured against unforeseen illness (or injury). The ability to purchase disability insurance is unfortunately not guaranteed. However, a general rule of thumb is that the younger and healthier you are, the better your likelihood of obtaining a favorable policy. We meet and treat patients every day that did not expect to need us; we can’t ignore the possibility that we could also face an unforeseen occurrence that could compromise our ability to work. Life Insurance Essentially, life insurance protects your family in the event you were to have an unexpected death. It also creates an estate for you; not the easiest conversation to have, but difficult conversations with patients are commonplace for us, and they must be done. Term life will provide protection for a specified period of time, for example 20 years. Term life insurance is also based on a few factors including your age and medical history. The younger and

healthier you are, the more favorable the terms of the policy. However, also keep in mind that increased age and poor health could also prevent you from purchasing insurance. Term life is a great option while in residency training as a means to ensure yourself while you have your youth and health. A wealth creation tool not often explored is to convert this term life insurance to a permanent life insurance. Permanent life insurance is a long term asset in your portfolio which allows you to build guaranteed cash value. Remember with term life, when your policy expires you do not receive any cash payments but with permanent life you can provide protection for your family while also building a unique type of asset class that can compliment other assets you will have (whether already or later on) in your long term portfolio. How much Protection Do I Need? That is a good question that many physicians have asked me. There is no one size fits all answer. There are many factors that come into play when making this decision including your annual income (and the sources), family considerations, personal needs and what your other portfolio assets look like. Any good plan is based on strategy, so carefully consider your goals and then have a comprehensive discussion with your advisors to build the right customized solution for you and your family. This about your priorities and be proactive. I promise you will feel more secure in your career and in the future. Ali Chaudhry, MD is President and AskAliandAlex.com and can be reached at ali@mpsmd.com

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Continued from page 11 Research also shows that certain personality traits, such as a good sense of humor, capacity to maintain perspective, avoidance of negative thinking, feeling part of a larger cause, high frustration tolerance, and good use of leisure time, do mitigate many of the harmful effects of stress in the short run. The physician’s identity as “healer of the sick,” based on the Hippocratic tradition, is a source of pride and emotional strength. The many years of study instill a sense of distinction and scientific achievement and they have pride in their commitment to life-long learning. But physicians so often feel they must give up their leisure time to stay late at the office, write reports, read journals. As a result, they shortchange themselves. Their many long years of study and grueling clinical training have instilled compulsive work habits that lead them to neglect themselves. The physician’s sense of responsibility is a strength but also a vulnerability. Recently, insurance companies, Medicare and others have labelled physicians as “vendors” or “providers,” not taking care of patients, but providing services to “consumers.” This, further assaults the physician’s sense of identity and their connection to the people they treat. They want to be creative, inventive and able to help their patients. Unfortunately, every physician has to battle every day to maintain his sense of identity and live up to the highest ideals of the profession in the face of external stresses. Many of the external stresses that adversely affect physician are beyond their control. Let’s look closer at stresses physicians face every day, stresses that go beyond what they expected to face and what they were trained to do. Major sources of stress: A Rand Corporation study in 2013 and our own studies identified factors associated with burnout and exhaustion, including these: 1. Excessive productivity quotas and limitations of time with each patient undermine the physician’s high ideals of practice by forcing them to rush. The Hippocratic Oath establishes our “medical ideals” and calls upon 22

us to do the best for our patients. Organizational pressures to see patients every 15 minutes deny us the chance to live up to our ideals. The “business model” undermines careful patient care and interferes with development of a positive doctor patient experience. Both doctor and patient are left frustrated when there is simply no time to foster a “doctor- patient relationship” in which they are both united in the pursuit of health.

2. Loss of autonomy means that without any change in responsibility for patients, physicians have reduced control over treatment decisions Managed care companies and pharmacy benefit companies often limit the types of medications a physician may prescribe or hassle physicians with seemingly endless demands for prior authorizations. Insurance companies may try to force discharge of a hospitalized patient before the physician believes the patient is ready. Similarly, requests for MRI’s or CA scans and other specialized tests may be denied as companies second guess the physician who has ordered the test. Physicians are caught in a double bind. If they do what they feel is best they may be penalized for not conforming to “guidelines” or corporate policy. If they conform to these guidelines instead of doing what they think is right, it can foster a loss of personal integrity and despair and lead them to feel that they have “sold out.” 3. Burdensome rules and regulations due to MIPS, MACRA, PQRS, HIPPA, and Medicaid all take time away from patient care or from leisure pursuits. An endless series of pre-authorizations for medications or procedures bogs down the doctor or his staff. There is a huge waste of time. Frequently, the medical office cannot charge for these extra services, which frustrates and angers many physicians. 4. The Electronic Health Record is a major source of trouble. Physicians must complete the EHR while talking with their patients, putting a computer between them and their patients. According to Healthcare Finance News April 2017, they devote even more

QUARTER TWO 2017 ON CALL MAGAZINE

of their time on the EHR, consumed by desktop medical tasks for which they are not reimbursed. This comes out to about 3.08 hours a day on office visits and 3.17 hours on desktop medicine tasks. Over 6 hours on the computer!! There is a resulting decrease in “face to face time with patients.” Physicians were pressured to use EHRs before they were perfected, resulting in loss of funds on systems that did not work or were incompatible with other systems. In theory, EHRs have the potential to contribute to patient safety, good record keeping and enhanced coordination of care. In practice, they do not seem to be developed enough to achieve these goals and so contribute to physician stress.

5. Maintenance of Certification has also added to physician stress. While the achievement of Board Certification is an honor to be sought, changes in maintenance of certification have led to ever more onerous demands from the American Boards of Medical Specialists. So far, these new regulations by the ABMS have burdened physicians with needless tasks that many feel are not proven to enhance quality of care. 6. Threats of Malpractice law suits are a constant source of stress. While the number of lawsuits has diminished, lawsuits remain a “Sword of Damocles” over every doctor’s head. In response, physicians feel forced to engage in a form of expensive and overly “defensive medicine.” Proposals for more changes in national healthcare legislation have not included proposals for tort reforms. Physicians who are sued report feeling betrayed and traumatized. Some feel intense shame and blame themselves even when the facts are not certain. Several physicians have committed suicide rather than feel humiliated in a court room procedure. It’s common, because of these stresses, for well-adjusted physicians to be pushed to the point of exhaustion and hopelessness. They may retire early, sell their practices to larger organizations or reduce the size of their practices. Continued on page 24


Prescribing Opioids Safely: How to Have Difficult Patient Conversations By Roneet Lev, MD, Chief of Scripps Mercy Emergency Department, Chair of Prescription Drug Abuse Medical Task Force, and President of Independent Emergency Physicians Consortium

Drug overdose is the leading cause of accidental death in the U.S., and opioids account for over 60 percent of those deaths.1 While opioids are effective pain medications when used in the proper setting, concerns arise when the patient’s condition lasts longer than three months, and prescribing more medication does not necessarily result in better pain control. Building a strong doctor-patient rapport can help facilitate tough conversations with patients about opioid prescriptions and reduce risks. Communication issues appear in 40 percent of malpractice claims, according to a study by The Doctors Company.2 These tips can help when dealing with opioid requests and prescriptions: • Don't make the mistake of jumping to conclusions that the patient is a drug seeker because the patient is there

repeatedly for the same pain complaint. It could instead be a situation of missed diagnosis. Treat this patient like any other patient. Take a good history, including a very detailed medication history. Do a thorough physical examination. • Your prescription drug monitoring program (PDMP) is a valuable tool, like checking allergies and old records. Use the PDMP to learn about your patient's prescription patterns, not just to check for doctor shopping. • Medication refills for chronic conditions should have a medication agreement. ONE doctor and ONE pharmacy should prescribe controlled medication given for three months or more. • When patients say that their medication is not working, ask the patient, “How are you taking the medication?” You’ll be surprised how many patients used 400mg of ibuprofen twice a day and it was not enough. Taking a detailed

medication history and providing patient education about the right dosage, right timing, and side effects to be aware of is essential to medication safety.

• When you hand a patient a prescription for a controlled medication, add a few words to let the patient know that these are serious medications: "I will give you a prescription for Norco. Please realize that this is a medication that can be abused. Keep it secure, take it only as prescribed, and do not drive if not fully alert." • Be aware of the level of health literacy of the individual patient, and adjust your language appropriately. Ask patients to repeat back the information you gave to ensure they properly understand. • Communicate the risk of medication theft to patients. Patients who are on a chronic treatment plan should know to watch their medication as closely as they would their money. Get more safe prescribing resources at www. SanDiegoSafePrescribing.org and learn more about effective doctor-patient communication at www.thedoctors.com/ askme3. References; 1. Increases in drug and opioid-involved overdose deaths—United States, 2010-2015. Centers for Disease Control and Prevention. December 30, 2016. https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1. htm. Accessed January 26, 2017. 2. Patient-centered communications: Building patient rapport. The Doctors Company. http://www.thedoctors.com/KnowledgeCenter/ PatientSafety/articles/Patient-Centered-CommunicationsBuilding-Patient-Rapport. Accessed January 9, 2017. Contributed by The Doctors Company (www.thedoctors.com)


Continued from page 22 Physician suicide: Rates of suicide among physicians are 250% - 400% higher than the general population. On average, one physician every day commits suicide and of those, about 15% have never communicated their distress or sought help. A book, “Why Physicians Die by Suicide: Lessons Learned from Their Families and Others Who Cared,” by Dr. Michael Meyers, points out that physician’s fear being stigmatized and are ashamed when they have emotional difficulties. This prevents them from seeking help. They also have easy access to medications and knowledge about what it takes to kill themselves. The idea that death is the only solution reflects a loss of reality testing, a sense of helplessness, hopelessness, and impaired judgment. A troubled physician can impulsively act in a self-destructive manner without giving warning. The critical role of hospitals, managed care, ACOs and other medical organizations: Physicians need much more organizational support. Healthcare is not primarily a business or industry to pay dividends to stock owners. In too many instances physicians have been subjected to “industrial efficiencies and pressures” which are not appropriate to providing quality health care to patients. Health care CEO’s are finally noticing the problems of physician burnout. Recently a group of CEOs’ called for new approaches to this problem. These included requirements for healthcare organizations to regularly measure the well-being of the physician work force at institutions; to evaluate and track physician turn over; to study if early retirement and reduced clinical output are signs of physician disaffection that require corrective measures; to understand and address more fully the clerical burden and inappropriate allocation of work to physicians that is contributing to physician burnout; and encourage reduction in government regulations. Every hospital, accountable care organization or managed care company must take measures to reduce institutional pressures on doctors so they can do what they are trained for, taking care of patients. Doctors must also speak 24

up forcefully to press for change in any onerous conditions in the medical work place. All healthcare organizations should include physicians in their decisionmaking committees to make sure that adverse conditions are not imposed in the first place.

unhealthy and driving ambitions which unbalance your life.

Personal strategies to avoid burnout... What can I do? 1. Doctors must become more “mindful” of the ebb and flow of their emotional reactions and learn to detect as soon as possible the development of anxiety, depression, or other emotional warning signs such as insomnia or overuse of alcohol or prescription medication. Watch out for shame, guilt, and self doubt. Do not fear or hesitate to seek counseling.

When to go for help: Seek psychiatric consultation if you are struggling with any of the symptoms listed in the section on burnout. Don’t wait until you become “officially impaired.” The sooner you get help with your problems the fewer secondary complications such as conflicts with office staff and patients and possible legal issues you will have. Physicians today must not only be talented clinicians they must be businessmen, personnel managers, and compassionate physicians. Physicians must also take time to monitor their stress levels and to take care of themselves.

2. Doctors must avoid denial of the risks of stress and burnout. Unless problems are identified and faced, they can’t be resolved. Denial can lead to disaster. Listen to worries expressed about you from family or colleagues.

9. Keep up to date in your field but especially pay attention to studies on stress, burnout, and new strategies for preserving physical and mental health.

A bibliography available upon request. Stefan A. Pasternack, MD DLFAPA, is Board Certified in General Psychiatry and is Affiliate Professor of Biomedical

3. Doctors must practice good self-care: You must protect your own health and wellbeing. Take a regular vacation, plan long weekends, develop a hobby, be a bit more selfish for your personal and family needs, put time into relaxing and rejuvenation. Doctors must also learn to delegate to others as many nonmedical tasks as possible.

Science at Charles E. Schmidt College of Medicine at FAU and Teaching Analyst at the Florida Psychoanalytic Institute. He previously ran a program at Georgetown University Medical Center for physicians coping with burnout. He is in private practice in Boca Raton FL Bruce L. Saltz, MD DFAPA is Board Certified in Adult and Geriatric Psychiatry (ABPN), Private Practitioner Boca Raton Florida, President/Principal Investigator, Mental Health Advocates Inc. Boca Raton FL, and Voluntary /Affiliate Associate Professor of Psychiatry and Biomedical Science at

4. Learn to say NO and set limits on number of patients you see so that you have time to do what you feel is right.

the Charles E Schmidt College of Medicine at FAU. Abbey Strauss, MD is the President of the Florida Psychiatric Society and is in the private practice of general psychiatry in Boca Raton, FL

5. Think positive - When leaving the office think about what you have done well – don’t brood over what you think you did wrong. Give yourself some credit for a job well done. 6. Take reasonable part in hospital committee and medical societies to make your opinions and voice heard. 7. Foster a healthy marriage. A good love relationship is the best refuge against stress. 8. Reassess yourself and identify life goals at each stage of your life. Reassess your expectations of yourself as well. Control

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Med Memo Quarter Two 2017

Calendar

2017 PBCMS Services Annual Dinner

June 14th, 2017 11:30am-1:00pm Healthcare Connection Getting Social - leveraging Social Medica and Health care Marriott, West Palm Beach Register www.pbcms.org August 4-6, 2017 FMA Annual Meeting Lowes Sapphire Falls Resort at Universal Orlando October 12-13, 2017 Future of Medicine Airport Hilton, West Palm Beach December 2nd, 2017 PBCMS Annual Gala Cohen Pavilion, Kravis Center

Nominations for Delegates to FMA House of Delegates Did you know that Palm Beach County Medical Society has one of the largest delegations to the Florida Medical Association and the American Medical Association? Our Society is respected for its strong leadership in representing physicians and addressing policies impacting our patients. What issues are affecting your practice at this time? In order to have your voice heard, we encourage you to serve as a delegate in the House of Delegates. Nominations are now open for physicians to serve as Delegate for the FMA Annual Meeting to be held August 4 - 6 at the Loews Sapphire Falls Resort at Universal Orlando. This is an excellent opportunity to join with your colleagues in shaping the future of medicine. For additional information contact Katherine by email katherinez@pbcms.org or by phone 561-433-3940 x106.

HERC The Healthcare Emergency Response Coalition (HERC) is a network of acute and sub-acute care hospitals, county emergency response agencies, long term care, public health, law enforcement and other community disaster partners. The Coalition collaborates on planning, training and exercising for an area-wide health and/or medical response to a disaster or incident.

(Pictured from left to right) Brent Schillinger, MD, Malcolm Dorman, MD, Joseph Ouslander, MD, Shawn Baca, MD, Michael T.B. Dennis, MD and Phillip Boiselle, MD.

Palm Beach County Medical Society Services Annual Dinner was held on Wednesday, March 15th at Benvenuto’s in Boynton Beach. Featured speaker was Dean Phillip Boiselle, MD of the Charles E Schmidt College of Medicine. Officers for 2107 include Michael Dennis, MD, Ivy Faske, MD, Matt Gracey and Don Chester. Board members for 2017 include, Jean Acevedo, William R. Adkins, MD, Elaine Alvarez, Jose F. Arrascue, MD, Brenda Atkins, Nancy Beard, Don Chester, Ljubica Ciric, Psy.D. Patricia C. Corbett, K. Andrew Larson, MD, Robbin Lee, Alan Barth Pillersdorf, MD, Nancy Proffitt, Greg Quattlebaum, Brent M. Schillinger, MD, Heather Siegel Miller, Esq., Ben Starling III, Brandyce Stephenson, Maureen Whelihan, MD, Paul Wieseneck, CPA, Jack Zeltzer, MD.

HERC has launched a “Stop the Bleed” program throughout the County where several trainers teach the American College of Surgeons approved course called “Save a life: What Everyone Should Know to Stop Bleeding After an Injury”. The Coalition purchased six bleeding control kits to aid in the facilitation of the training. The Coalition also purchased 417 tourniquets and they will be provided to EMS and Law Enforcement personnel throughout Palm Beach County. To date, 145 Pharmacy & Nursing students, and EMS personnel have been trained.

PBCMS Physicians Visit Tallahassee Thank You! Special Thanks to The Ernst & Gertrude Ticho Charitable Foundation for funding of Physician Wellness Initiative

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Welcome New Members! Alfredo R. Dosdos, MD Tracy Goeken, MD Kenneth L. Manchon, MD Nathan Tennyson, MD Residents Alexis da Silva, MD University of Miami Sean Bhatia, MD Florida Atlantic University Camilo Gonzalez, MD Florida Atlantic University

Continued from page 13 Services at the new center include: • Mindfulness-Based Stress Reduction (MBSR) classes – a comprehensive, eight-week course that explores the principles and practices of MBSR • Mindfulness Meditation sessions for the community • Health coaching Additionally, Jupiter Medical Center is working with the UMass Center for Mindfulness to offer additional Mindfulness-Based Programs over the next year, including: • Introduction to Mindfulness • Mindfulness for Parents

• Mindful Eating • Mindful Self-Compassion • Deepening Practice for MBSR graduates • Other integrative medicine practices scientifically proven to complement traditional medicine, such as Yoga, Tai Chi, massage and acupuncture Integrative medicine is a new discipline of medicine and continues to develop as its own specialty of care. That’s why the Calcagnini Center for Mindfulness is a powerful asset to treating the overall health and wellness of patients in our community. For more information about The Calcagnini Center for Mindfulness, visit jupitermed.com/mindfulness or call 561660-1828.


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Phone: 561.650.7360 McKinley & Associates recognizes that significant wealth brings Toll-free: 800.964.1339 responsibilities as well as privileges. Our mission is to helpfor youover navigate Our Office: On Palm Beach 80 years and here to stay. E-mail: Karen_L_McKinley@ml.com Our Office: On Palm Beach for over 80 years and here to stay. McKinley & Associates recognizes the challenges of managing your wealth so that you can enjoy it, put it that significant wealth brings www.fa.ml.com/McKinley_associates

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well asinprivileges. to work toward your personal goalsresponsibilities and make wiseaschoices creating Our mission is to help you navigate a legacy for future generations. the challenges of managing your wealth so that you can enjoy it, put it to work toward your personal goals and make wise choices in creating Our small, highly engaged team thefor personalized attention youPierce, Merrill Lynch makesprovides available products andfuture services offered by Merrill Lynch, a legacy generations. Merrill Lynch makes available products offered by Merrill Lynch, Pierce, Fenner & Smith Incorporated (MLPF&S) and other subsidiaries of and Bankservices of America Fenner & Smith Incorporated (MLPF&S)valuing and other subsidiaries of Bank of America deserve. We seek toCorporation. earn your trust by respecting your privacy, Corporation. Our small, highly engaged team provides the personalized attention you your aspirations andInvestment puttingproducts: your interests first. Investment products: tes recognizes that significant wealth brings deserve. We to earn your trust by respecting your privacy, valuing Are Not FDIC Insured Are Not Bankseek Guaranteed May Lose Value Are Not FDIC Insured Are Not Bank Guaranteed May Lose Value ell as privileges. Our mission is to help you navigate your aspirations and putting your interests first. Our Office: On Palm Beach for over 80 years and here to stay. © 2017 All rights reserved. naging your wealth so that you can enjoy it, Bank put ofitAmerica Corporation. © 2017 Bank of America Corporation. All rights reserved. AR4D75P4 03/2017 AR4D75P4 03/2017 personal goals and make wise choices in creating

Create a Wealth Management sed on You.

4/4/17 5:55 PM


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PAID WEST PALM BEACH, FL PERMIT NO.515

3540 Forest Hill Blvd. Suite 101 West Palm Beach, FL 33406

Advancing the practice of good medicine.

RETURN SERVICE REQUESTED

NOW AND FOREVER. Advancing the practice of good medicine. NOW AND FOREVER. Advancing the practice of good medicine. NOW AND FOREVER.

ANNOUNCING THE 2017 DIVIDEND FOR FLORIDA MEMBERS The Doctors Company has returned nearly $400 million to our members through our dividend program— and that includes 4% to qualified Florida members. We’ve always been guided by the belief that the practice of good medicine should be advanced, protected, and rewarded. So when our insured physicians ANNOUNCING THE 2017 DIVIDEND FOR FLORIDA MEMBERS keep patients safe and claims low, we all win. That’s malpractice without the mal. The Doctors Company has returned nearly $400 million to our members through our dividend program— and that includes 4% to qualified Florida members. We’ve always been guided by the belief that the practice of good medicine should be advanced, protected, and rewarded. So when our insured physicians ANNOUNCING THE 2017 DIVIDEND FOR FLORIDA MEMBERS keep patients safe and claims low, we all win. That’s malpractice without the mal. The Doctors Company has returned nearly $400 million to our members through our dividend program— and that includes 4% to qualified Florida members. We’ve always been guided by the belief that the practice of good medicine should be advanced, protected, and rewarded. So when our insured physicians keep patients safe and claims low, we all win. That’s malpractice without the mal. Join us at thedoctors.com

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4/12/17 Join us at thedoctors.com

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