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May Edition 2021

Inside This Issue

Physician Shortages in Medical Specialties By Linda Beattie

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VA Research Reveals Link Between Financial Strains and Risk Of Homelessness See pg. 12

INDEX Legal Matters....................... pg.3 Mental Health...................... pg.6 Healthy Heart....................... pg.8 Hospital News.................... pg.10

hysician shortages have been affecting America’s healthcare workforce for decades, contributing to a range of problems, from limited patient access and poorer outcomes to physician burnout. Despite ongoing efforts by many healthcare leaders and academics to sound the alarm and find long-term solutions, “there doesn’t seem to be a solution in sight,” said Andy Olson, divisional vice president of recruiting for internal medicine subspecialties at Merritt Hawkins, the nation’s leader in physician recruitment. “The physician shortage has always been part of the conversation, unfortunately,” said Olson who has worked in physician search and recruitment at Merritt Hawkins for more than 15 years. “We see the challenges every year, but sadly nothing has changed. Multiple bills have been introduced, and Merritt Hawkins’ leaders have even testified before Congress.” W h i l e Congress recently voted to add graduate medical education funding to last year’s COVID-19 relief package and support 1,000 new residency slots, this increase will not come close to bridging the gap between physician supply and demand. The projected shortfalls in physician specialties The most recent projections from

the American Association of Medical Colleges (AAMC) in June of 2020 show that the United States could see a shortage of between 54,100 and 139,000 physicians by 2033. This would include shortfalls in both primary and specialty

growth between 2018 and 2033. The population under age 18 is projected to grow by only 3.9 percent, indicating low growth in demand for pediatric specialties. Yet the 65 and older population is projected to grow by 45.1 percent, indicating high demand for physician specialties that predominantly care for older Americans. Additional findings showed that if currently underserved populations are given equal access to healthcare during this time period—which is a national goal—it could create even deeper shortages, with demand rising by an additional 74,100 to 145,500 physicians. Demographics affecting shortages in medical specialties “The country’s demographics are definitely changing, and as we age as a nation, our physician population is impacted greatly,” Olson said. “We have made great advances in how we care for our elderly population,” he continued. “The average life span continues to increase, which is wonderful, but the number of babies being born each year also continues to rise, or at minimum remain steady. What that tells us is there are more patients to care for now than ever

The range of physician shortages projected by 2033 include... Primary care– between 21,400 and 55,200 physicians

Ascension Seton Williamson Announces New Certification as Primary Plus Stroke Center See pg. 13

care. The range of physician shortages projected by 2033 include the following: • Primary care -- between 21,400 and 55,200 physicians • Nonprimary care specialties – between 33,700 and 86,700 physicians ∆∆ Surgical specialties – between 17,100 and 28,700 physicians ∆∆ Medical specialties – between 9,300 and 17,800 ∆∆ Other specialties (i.e. pathology, radiology, psychiatry) – between 17,100 and 41,900 physicians The annual AAMC study found that physician demand will continue to grow faster than supply, largely driven by the aging population and an expected 10.4 percent population

see Physician Shortage...page 14

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Legal Matters Keeping Virtual Meetings and Electronically Distributed Documents Secure By Erin L. Muellenberg Polsinelli, PC

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OVID-19 has pushed the healthcare industry across the Rubicon on the legitimacy of virtual meetings and it appears there is no going back. The COVID-19 pandemic has created a rapid transition to a world of “new” technology where meeting virtually will be strongly favored over in-person meetings. Privacy and security are of the utmost importance for medical staff meetings because of the sensitive nature of the issues presented. There will be discussion of specific peer review issues and practitioner performance that require absolute confidentiality. When a case is identified for peer review as the result of an adverse event or near miss, the practitioner reviewing the case is charged with determining whether the event or near miss was avoidable. While the initial review usually occurs outside a

meeting, questions may arise requiring collaboration to determine whether the care was appropriate. This may result in the committee seeking to review the record during a meeting. With the electronic medical record comes the challenge of sharing records during a peer review committee meeting without violating patient privacy or leaving a footprint in the record that later becomes discoverable. The convenience of virtual meetings with screen sharing provides a secure way to share only certain portions of a record allowing for collaboration and full discussion. This requires the medical staff to think in advance and develop policies that will address information security issues. When crafting policies and protocols for virtual meetings, medical staff members should keep the following tips in mind: • Ensure that the conferencing platform the medical staff is using meets the enhanced requirements for telehealth conferencing. There are multiple platforms available with enhanced security features to protect sensitive healthcare information. • Password protect meetings to prevent uninvited attendees. When

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possible, create a new meeting login ID for each meeting and require each participant to have a unique participant ID. The host should ask each attendee to identify him or herself and not allow any unidentified attendee to participate. • The meeting host should utilize a “waiting room” for participants. For the greatest level of protection, the meeting host should also disable the “Join Before Host” function and admit each participant individually. Ensure that the meeting host “locks” the meeting once all participants have joined. The host should expel any individual from the meeting who is not an invited participant if the hosting platform allows the host that ability. • As a confidentiality requirement, a rule or policy can be established requiring individuals to keep their video on at all times and use earphones. They may also be asked to confirm they are in a secure private location and based on the type of meeting can be asked to show the

group a video of the area from where they are taking the meeting. The chair of the meeting should issue a confidentiality reminder at the start of all meetings. • Many video conferencing platforms have the ability to record the meeting. A medical staff may want to record its video conferences for record-keeping purposes in certain circumstances which should be clearly defined in a policy. One instance might be in the event of a hearing or appeal procedure from an adverse action. Medical staff legal counsel should be consulted to determine if this is appropriate under the circumstances. Otherwise, see Legal Matters...page 14

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Esophageal Cancer Rates on the Rise, More Advanced at Diagnosis Among Younger Adults

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ew findings showing that esophageal cancer rates have been steadily increasing among the under-50 crowd, and that people in this age group are more likely to be diagnosed with advanced stage cancer compared to older counterparts. The rising numbers have prompted digestive health experts to call for greater awareness about prevention and screening for this deadly disease. A recent study published by the American Association for Cancer Research followed more than 34,000 cases of esophageal adenocarcinoma tracked in a national database from 1975 to 2015. People diagnosed with esophageal cancer below the age of 50: • Experienced an increase in esophageal cancer rates by about 3 percent every year over the 40-year study period; • Were more likely to be diagnosed with advanced stage cancer compared to older counterparts, with about 85 percent versus 67 percent, respectively;

• Had a five-year cancer-free survival rate of only 23 percent, compared to about 30 percent for adults over 50. “A late-stage esophageal cancer diagnosis generally means poorer survival rates than when the cancer is identified in the earlier stages,” said Deepak Agrawal, M.D., MPH, medical director of Digestive Health, a clinical partnership between Ascension Seton and UT Health Austin, the clinical practice of Dell Medical School at The University of Texas at Austin. “But the good news is that with early screening and treatment, we can avoid esophagectomy and esophageal cancer-related death altogether,” said Agrawal, who is also chief of Gastroenterology and Hepatology and associate professor for Dell Med’s Department of Internal Medicine. Experts on the Digestive Health team point to GERD (gastrointestinal reflux disease), commonly known as heartburn or acid reflux, as a key factor that raises the chances of developing

of esophageal cancer. About 15% of patients with chronic GERD develop a condition known as Barrett’s esophagus. “ B a r r e t t ’s esophagus is considered a pre-m a lig n a nt condition that predisposes patients to esophageal adenocarcinoma,” says F. Paul “Tripp” Buckley, M.D., Digestive Health surgical director and associate professor of Surgery and Perioperative Care at Dell Med. “About 3.3 million people in the U.S. have Barrett’s esophagus, and while the risk of esophageal cancer is low in patients with Barrett’s esophagus, overall about 0.5% of people with the condition still go on to develop malignancies. And that’s still a

lot of people and actually oversimplifies the problem,” Buckley explains. Since GERD has been occurring in increasingly younger patients, esophageal cancer is also becoming more common in people under age 50, says Buckley. 

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Mental Health How to Practice Socialization After Thriving In Isolation

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s the vaccination rate rises and COVID-19 restrictions begin to decrease, everyday activities are slowly becoming normal. But for those who have thrived during isolation, the idea of participating in social activities again may be daunting. “Socialization is important because touching and talking to people is a natural cure for anxiety and depression,” said Dr. Asim Shah, professor and executive vice chair in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor. “But those who experience social anxiety and enjoy staying at home do not need to socialize immediately – they need to take baby steps.” Many have experienced a complete lack of socialization throughout the pandemic and may need to relearn how to interact effectively. According to Shah, the best way to practice safe social interaction is by following CDC guidelines, which state that vaccinated people can gather in small groups. If you are vaccinated, start with

for many organizations. Employees are gradually returning to the workplace in person, which may cause anxiety for those enjoying working from home. Some even started new jobs remotely in the middle of the pandemic without meeting their colleagues in person. If you are worried about how to interact with coworkers, old and new, start having interactions with them safely in person or via Zoom so you see their facial expressions to learn how to interact with them. Start working from the office a few days a week if possible, then increase your time in increments. Sit in a larger conference room with fewer people while appropriately distanced to practice interacting with colleagues, or to get to know your new colleagues. “If you’ve been working from home five days a week, don’t immediately go to work five days a week. Gradually work your way up. If you return right away, you may experience anxiety flipping the switch suddenly,” Shah said. Those who have a fear of leaving

small, controlled gatherings with other vaccinated people for a short period of time to practice the act of socializing. Once you overcome that step, increase the amount of time you spend with others while abiding by CDC guidelines. Those who are not vaccinated can meet in smaller groups outdoors for social interaction. If you thrive in a socially isolated setting and you fear being in public after spending so much time at home, visit places that are familiar and limit your time there. Gradually, you can increase the time you spend in that location. Shah suggests going out with a friend, spouse or family member that will make you feel more comfortable. If you plan to go to a store, restaurant or any public location, make sure the exits are in sight so you can easily leave if you become panicky or afraid. Throughout the pandemic, working remotely became the norm

their home due to social anxiety can join online groups with video capabilities to interact with others, which can reduce anxiety. You could also have a gathering outside with your colleagues to feel welcome when returning to the workplace to increase your comfort level. Seek help from mental health professionals to practice cognitive behavioral therapy techniques to challenge and overcome feelings of anxiety or depression. “If you are more introverted and don’t socialize, your anxiety will worsen. This year has proven that social isolation is the number one cause of depression in Americans,” Shah said. “If you suffer from depression, you can experience feelings of anxiety, PTSD or being suicidal. Start interacting with others slowly but surely to reduce those feelings.” 

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May is National Stroke Awareness Month

05

Key Facts About Stroke

FACT # 1 :

FACT # 2 :

stroke kills brain cells

types of stroke

Stroke happens when a clot or rupture interrupts blood

Ischemic caused by a clot, Hemorrhagic caused by a rupture and Transient Ischemic Attack (TIA) or "mini stroke" caused by a temporary blockage.

oxygen-rich blood, brain cells die.

FACT # 3 :

FACT # 4 :

about one in four stroke survivors is at risk for another

prevention is key

Stroke happens when a clot or rupture interrupts blood oxygen-rich blood, brain cells die.

Had a stroke? Create a plan with your doctor to prevent another, which may include managing high blood pressure and discussing aspirin or other medicine. Aspirin is not appropriate for everyone, so be sure to talk to your doctor before you begin an aspirin regimen.

FACT # 5 :

time lost is brain lost Now that you know prevention, here's how you spot one.

Stroke.org

Learn the FAST warning signs:

F Face Drooping

A Arm Weakness

S Speech

T Time to Call 911

American Stroke Association is a registered trademark of the AHA. Unauthorized use prohibited. DS15342 10/19

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May 2021


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Healthy Heart

MARINE MILITARY ACADEMY

Nearly One in Three Young Adults In The U.S. Does Not Know Common Stroke Symptoms

t a time when stroke is on the rise among young adults, nearly 30% of U.S. adults younger than age 45 do not know all five of the most common stroke symptoms, according to research published in Stroke, a journal of the American Stroke Association, a division of the American Heart Association. May is National Stroke Awareness Month and stroke is the No. 5 cause of death and a leading cause of disability in the United States. Each year, 10% to 15% of the nearly 795,000 people in the U.S. who have a stroke are young adults — between ages 18 and 45. Recent studies suggest stroke incidence is declining in the general population, yet stroke incidence and hospitalizations have increased by more than 40% in young adults in the

common stroke symptoms, which in this survey were noted as: • • Numbness of face/arm/leg; • Confusion/trouble speaking; • Difficulty walking/dizziness/loss of balance; • Trouble seeing in one/both eyes; and • Severe headache. The researchers found: • Almost one in three respondents were not aware of all five common stroke symptoms. • About 3% of respondents, representing nearly 3 million young adults, were not aware of any stroke symptom. The researchers also found that nearly 3% of young adults surveyed would not contact emergency medical services if they did see someone experiencing perceived stroke symptoms. “That finding could be a

past several decades. “While the medical community has made significant improvements to reduce the severity and complications of strokes with early interventions, these efforts are of limited value if patients do not recognize stroke symptoms,” said study author Khurram Nasir, M.D., M.P.H., M.Sc., chief of the division of cardiovascular prevention and wellness at Houston Methodist DeBakey Heart and Vascular Center in Houston, Texas. “Time is critical for treating stroke. The earlier people recognize symptoms, the better their chances are to reduce long-term disability from stroke.” To assess how well the U.S. population understands common stroke symptoms, Nasir and colleagues reviewed responses to the 2017 National Health Interview Survey. As part of the annual survey, adults are asked several questions about stroke including identifying five of the most

matter of life and death,” said Mitchell S. V. Elkind, M.D., M.S., FAHA, FAAN, president of the American Heart Association. “With proper, timely medical attention, stroke is largely treatable. The faster you are treated, the more likely you are to minimize the long-term effects of a stroke and even prevent death,” said Elkind. Elkind says the American Heart Association/American Stroke Association advocates the use of the letters in “F.A.S.T.” to spot stroke signs and to know when to call 9-1-1: • Face drooping • Arm weakness • Speech slurred • Time to call 9-1-1 Nasir said F.A.S.T. is among a number of creative and community-engaged initiatives that have aimed to increase public recognition of common stroke symptoms.

By American Heart Association

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Recent Nursing Graduate Joins U.S. Navy Nurse Corps Class of August 2020 College Of Nursing Graduate Earns National Defense Service Medal and Begins Nurse Residency Program at U.S. Naval Medical Center By Kala McCain

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acy Failla, BSN, RN, knew she wanted to challenge herself after graduating in August 2020 from the Texas A&M University College of Nursing. Applying to join the United States Navy Nurse Corps provided an opportunity to do just that. “I have lived in the College Station area my whole life close to family, and although I loved every bit of it and it will always be my home, I wanted to challenge myself and be more independent for a little while,” Failla said. “I looked into several ways to do that, and knew it would be a great honor to serve in the military, and provide quality health care to the men and women who serve our country as well as their families.”

The U.S. Navy Nurse Candidate Program offers graduates an avenue to serve on active duty for at least four years. In return, they receive a stipend that helps offset the investment made to earn a bachelor of science in nursing degree. After her acceptance into the competitive program, Failla completed five weeks of didactic classroom instruction, sexual assault prevention and response training, officer etiquette and a 50-yard swim qualification. She also underwent intense simulation training aboard the USS Buttercup where she worked alongside classmates conducting damage control procedures to prevent ship compartment flooding and fire suppression training wearing total encapsulated Level-A Hazmat

suits. Failla joined 78 fellow graduating naval officers at the U.S. Navy Officer Development School – Officer Training Command in Newport, Rhode Island, to receive the National Defense Service Medal. Failla has now started her six-month long nurse residency program at the U.S. Naval Medical Center in San Deigo, California, where she is preparing to become a nurse on the Perinatal Specialty Care Unit. She will complete a 12-week orientation and ultimately provide care to critical antepartum patients on this specialized mother/

baby unit. When asked by Lt. Col. (ret) LeRoy Marklund, DNP, MPH, RN, CNS, CCRN, CEN, CNRN, clinical assistant professor at Texas A&M College of Nursing, how her initial U.S. Navy Nurse Corps training went, Failla replied with a smile. “I was hesitant at first about leaving home and reporting for the U.S. Navy Officer Development School in Rhode Island, but I soon realized as I ventured through military training that serving with my fellow shipmates was the most honored moment in my life.”

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Hospital News St. David’s South Austin Medical Center Offers New Robotic Technology for Biopsies In Hard-To-Reach Areas of Lung

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t. David’s South Austin Medical Center recently became the first in Central Texas to use a new robotic system, along with advanced imaging technology, to enable physicians to obtain tissue samples from deep within the lung—an area that can be challenging to access with existing technology. Physicians often recommend a biopsy to confirm a diagnosis after a mass or nodule is discovered on the lung. Biopsies involve obtaining a tissue sample from the suspicious area, then examining the cells under a microscope to determine if cancer or another disease is present. There are a number of ways to obtain tissue for biopsy. The approach taken usually depends on the size of the nodule, the location within the lung and a person’s

overall health. “Because the lung is often a difficult place to get biopsies, this new, robotic-assisted approach represents an advancement in the existing approaches to lung biopsies,” William Bartek, M.D., medical Intuitive Ion Staff in room at Work. Image courtesy: ©2021 Intuitive Surgical, Inc. director of pulmonology at St. David’s South Austin Medical Center, said. “This system, allows navigation far into the also provides direct vision during along with advanced imaging peripheral lung. During a bronchoscopy navigation. Once the catheter reaches technology, provides us with better procedure, physicians use the controller the pulmonary nodule, it locks into access and increased precision, which to navigate to the target area. The place, and the flexible biopsy needle can produce quicker results and may catheter can move 180 degrees in any passes through the catheter. The direction to pass through small, diffi- needle is then deployed into the target help avoid additional biopsies.” The Ion Endoluminal cult-to-navigate airways and around location to get a sample of the lung System features an ultra-thin, tight bends to reach all portions of tissue for further analysis. ultra-maneuverable catheter that the lung. The peripheral vision probe

Dell Children’s, UT Health Austin Celebrate 6-Month-Old’s Heart Transplant After 74 Days on Berlin Heart Ventricular Assist Device, Zaria Heads Home with Donor Heart

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oin Dell Children’s Medical Center and UT Health Austin, the clinical practice of Dell Medical School at The University of Texas at Austin, as six-month-old Zaria Grace Jackson heads home after a donor heart transplant at Dell Children’s. Zaria received her heart transplant on March 25. Zaria first arrived at Dell Children’s emergency department on January 8, presenting symptoms

May 2021

and signs of heart failure, and was quickly admitted to the pediatric cardiac care unit. Her condition rapidly deteriorated, and the cardiac team determined Zaria’s best chance for survival was a heart transplant. The cause of her heart failure is uncertain. On January 11, a Berlin Heart Ventricular Assist Device was

implanted in Zaria while waiting for a donor heart. The device functioned in place of her own heart when it became too weak to pump sufficient amounts of blood to the lungs or the rest of her body. The Berlin Heart supports patients in heart failure and offers a bridge to life for a child awaiting a heart transplant.

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The Texas Center for Pediatric and Congenital Heart Disease at Dell Children’s Medical Center began the heart transplant program in July 2020. This is the fourth heart transplant to have taken place at Dell Children’s.


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VA Research Reveals Link Between Financial Strains and Risk of Homelessness

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esearch findings from a Department of Veterans Affairs (VA) study reveal that issues related to financial strain are significant risk factors for becoming homeless and highlight the need to focus on financial well-being to help prevent homelessness among Veterans. The study, led by VA’s National Center on Homelessness Among Veterans (the Center), was published in the March edition of Medical Care. “The study revealed that four types of financial strain — debt, unemployment, lower income and financial crises — increased the risk of future homelessness,” said the Center’s Lead Researcher Eric Elbogen, Ph.D. “Focusing on financial well-being as a whole as part of homeless prevention efforts at the individual and community level could be promising in reducing homelessness among Veterans.”

The study recommends integrating f i n a n c i a l education and management into VA services for Veterans facing housing crises. Research evidence shows that continuing to supplement housing assistance with job retraining, vocational rehabilitation, financial support services, financial education and debt management services are vital to diminishing the risk of future homelessness among Veterans. VA’s Homeless Programs Office (HPO) follows a continuous improvement model which involves regularly assessing lessons learned and research findings to achieve better results for Veterans. Staff from

HPO and the Center will use this data on financial strain during the routine process of refining specialized programs for homeless Veterans to improve outcomes. The Center is the leading national resource for research and solutions to address homelessness among Veterans, ranging from early prevention, reintegration and relapse prevention. Additionally, the Center assesses the effectiveness of programs, identifies and disseminates

best practices and integrates them into polices, programs and services to enhance the lives of Veterans experiencing or at risk of homelessness. The Center also serves as a resource center for all research and training activities pertaining to Veteran homelessness carried out by VA and other federal and nonfederal entities.

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Ascension Seton Williamson Announces New Certification as Primary Plus Stroke Center

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scension Seton Williamson has received certification from DNV GL Healthcare as a Primary Plus Stroke Center, affirming the hospital’s readiness to take care of a broad range of stroke-related medical conditions. The most advanced stroke center from Temple to Austin, the hospital now offers acute stroke care, including thrombectomies and endovascular services, close to home for patients in Williamson County and the surrounding communities 24/7, 365 days a year. The clinical care expansion at Ascension Seton Williamson is supported by stroke specialists across Ascension Seton’s network of care. The DNV GL Healthcare certification is based on standards set forth by the Brain Attack Coalition, American Heart Association, American Stroke Association, and World Stroke Association, and declares that Ascension Seton Williamson addresses the full spectrum of stroke care – diagnosis, treatment, rehabilitation and education – and establishes clear metrics to evaluate outcomes.

“This certification provides our community with additional reassurance of the resources and commitment to provide the best possible stroke care close to home,” said Dr. Steven Warach, director of the stroke program at Ascension Seton. “It’s a combination of the right equipment, personnel and training to quickly assess and treat strokes. This includes the ability to efficiently transfer patients in the rare instances they require treatment beyond our capabilities.” The advanced certification includes all the requirements of the Primary Stroke Center Certification with the addition of the thrombectomy, medical staff and metric requirements. In a growing number of states, stroke center certification determines to which facility a patient should be taken for the most appropriate care. As the fifth leading cause of death and a leading cause of adult disability in the United States, it is important to have local access to treatment at the first sign of a stroke. Rapid and effective treatment can save lives and provide the best chance of

limiting the extent of long-term damage. “Timing is critical in treating a stroke. With this advanced certification, we are prepared to respond quickly, helping to reduce the damage caused by a stroke,” explained Dr. Michael Koltz, neurosurgeon at Ascension Seton Williamson. “Delaying care, even by a few minutes, can be the difference between recovery and permanent disability. Ascension Seton Williamson stroke specialists are trained in the latest technology and best practices, which helps us diagnose a stroke within seconds to quickly deliver treatment and improve patient outcomes.” The hospital continues to make ongoing investments in technology and clinical program expansions. This includes the addition of an orthopedic robot program, featuring the MAKO robot which offers minimally invasive

hip and knee replacement. Ascension Seton Williamson will celebrate the grand opening of a hybrid catheterization lab with advanced equipment and capabilities later this year, and expansion of its 6th floor, complete with the addition of 30 beds for a flexible care space, later this year. Additionally, Ascension Texas has made a significant investment in North Austin plans to build a new children’s hospital and medical office building. The new hospital in North Austin, along with planned expansions at Dell Children’s Medical Center and the recently announced Dell Children’s Specialty Pavilion, are part of a comprehensive, ongoing plan to continue expanding pediatric care in Central Texas over the next five years and beyond.

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Austin Medical Times

Physician Shortage

Continued from page 1 before in our history.” “Most medical specialties also have roughly 50 percent or more of their physicians at the age of 55 or older,” Olson noted. “We are on the verge of a perfect storm.” He pointed out that older patients have more chronic conditions and issues that affect physician demand in a variety of specialties, including a greater number of neurologic conditions, endocrinology issues, gastrointestinal issues and even cancer diagnoses. Physician shortages are also expected to get worse as physician supply will be negatively impacted by a wave of retirements and older physicians who tend to cut back their hours. ”Without a plan to increase supply, it will get worse before it gets better,” Olson said. According to the 2020 American Medical Association Physician Specialty Report, (using data up through December 2019), 44.9 percent of all active physicians were 55 or older. The specialties with the largest number of physicians in the near-retirement group included: • Pulmonary disease physicians – 90.1 percent are age 55+ • Preventive medicine physicians – 69.6 percent are 55+ • Anatomic/clinical pathologists – 67.7 percent are 55+ • Cardiologists – 62.8 percent are 55+ • Psychiatrists – 61.3 percent are 55+ • Thoracic surgeons– 60.1 percent are 55+ • Orthopedic surgeons – 57.7 percent are 55+ “Although many of the physicians

in these specialties extend their careers to help cover the need, they reduce their total hours worked, and many hospitals have bylaws that no longer require them to take call,” said Mike Jowdry, vice president of recruiting for Merritt Hawkins, who has worked in various divisions of the company for the last 20 years. “We have yet to properly address increasing our residency and fellowship programs to make up for the perfect storm of physicians retiring or slowing down and the increase in overall demand for their services,” Jowdry added. The top physician specialties in “absolute demand” A June 2020 white paper by Merritt Hawkins outlined a number of factors that are affecting physician supply, demand and staffing during and post COVID-19. In the months leading up to the pandemic, the following specialties were found to be the top 10 in “absolute demand” – i.e., number of job openings vs. number of physicians in a given specialty: 1. Neurology 2. Psychiatry 3. Gastroenterology 4. Hematology/Oncology 5. Dermatology 6. Urology 7. Otolaryngology 8. Geriatrics 9. Rheumatology 10. Family Medicine While it’s hard for anyone to predict how these specialties experiencing shortages may change

in the new COVID environment, the paper’s authors note several emerging trends, including an increase in overall demand for physicians: “Most of the factors driving physician supply and demand, including an aging population, widespread chronic illness, and a static supply of physicians, will remain in place. It can be expected that general health, both physical and mental, will be negatively affected by the pandemic, accelerating demand for doctors. Added to these factors will be increased volatility in the physician workforce, as doctors react to what for many has been an extremely challenging time that has compromised their finances and their health.” “The ‘new normal’ therefore is likely to resemble the old normal in at least one regard -- shortages of both primary care and specialist physicians will prevail,” they concluded. Pressing on toward future solutions “What to do about physician shortages is long-term question; a lot of conversations still need to take place to overcome that expected shortage of more than 130,000 physicians by 2033,” said Jowdry. “There is a lot of work that needs to be done. Telehealth will certainly allow for some physicians to have greater reach in their coverage, which will help, but that’s just one piece of the puzzle.”

and documents before activating the screen sharing function to avoid unwanted sharing of information. If the nature of the meeting is particularly sensitive, video conferencing may not be appropriate. There are some circumstances in medicine where there is no getting around face-to face contact. The same rings true for medical staff meetings. There will be situations of a nature so sensitive, that face-to-face meetings are required. In those cases, consider small limited attendance or a hybrid between virtual and in-person. Full virtual and hybrid meetings are likely

here to stay and will set the standard for meetings in the future. Conclusion Although adversity pushed us into the virtual world, our natural resilience and creativity has led to a “now-normal” that includes remote meetings thru digital technology with the direct benefit of increased participation in meetings, renewed interest in peer review, and substantial cost savings compared to in-person meetings. With the resulting increased efficiency and economy in time and expenses, virtual meetings will likely remain for the foreseeable future.

Legal Matters

Continued from page 3 the bylaws or virtual meeting policy should state that recordings of the meetings are not kept and minutes of the meeting are kept in the usual course of business. • Security of documents disseminated to medical staff members before or during virtual meetings is paramount. The medical staff should distribute documents via secure or encrypted means whenever possible. In circumstances where participants need to share their screen to share documents, the individual should be mindful to close all other applications

May 2021

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