SCMS BULLETIN - Summer 2020

The

Bulletin Saginaw County Medical Society

Summer 2020 | Volume 78 | No 9

Virtual Walk for Hope August 7-9 p. 8

2020 GLBR CMU CoM Grads p. 11

Juliette’s Story p. 16-17

LARA Licensing & Certification Requirements During State of Emergency p. 27 Cover Photo:

Jan Masica Golden Moments Photography

www.SaginawCountyMS.com

There’s nothing more

extraordinary than a caring community.

Thank you from everyone at Covenant HealthCare.

Covenant HealthCare prides itself on delivering extraordinary care. But lately, we’ve been on the receiving end. Our community has given us: • 20,000 N95 masks • 11,000+ handmade masks • 10,750 face shields • 10,000 ear loop/tie masks • 50,000 gloves • 2,000 pairs of goggles • 312 gallons of sanitizer

• 5,000 caps and hair nets • 4,100 shoe/boot covers • Thousands of donated meals • Thousands of dollars in gift cards and monetary donations • Countless prayers and messages of encouragement

Our heartfelt thanks go to everyone who has supported us. You are all extraordinary.

The

Bulletin Saginaw County Medical Society

2019-2020 OFFICERS AND DIRECTORS President Mildred J. Willy MD President-Elect Anthony M. Zacharek MD

contents 8

11

Past President Julia M. Walter MD Secretary Caroline G.M. Scott MD Treasurer Miriam T. Schteingart MD

14

Board of Directors Jorge M. Plasencia MD Tiffany K. Kim MD Mark G. Greenwell MD

4 5

Harvey K. Yee MD Elizabeth A. Paulus MD Furhut R. Janssen DO Bulletin Editor Louis L. Constan, MD Retiree Representative Rustico B. Ortiz, MD Resident Representatives Mary J. McKuen, MD Anushka N. Magal MD MSMS Delegates

5 5

Mildred J. Willy MD Anthony M. Zacharek MD

18 20 22

Christopher J. Allen MD Miriam T. Schteingart MD MSMS Alternate Delegates Caroline G.M. Scott MD

MSMS Legislative Update

Physician Support Line SCMS Members Featured in Michigan Medicine

25

Health Professional Recovery Program

FCC Designates 988 as National Suicide Prevention Hotline

Joseph P. Contino MD Kristine K. Spence DO Karensa L. Franklin MD Scott E. Cheney MD Michael W. Warren MD Peer Review Ethics Committee Waheed Akbar, MD, Chair Caroline G.M. Scott, MD James R. Hines, MD MSMS Region 7 Director Thomas J. Veverka, MD Executive Director Joan M. Cramer Administrative Assistant Keri Benkert

MSMS Reimbursement Advocate Alert

26 Caduceus Meeting 28 THRIVE 29 AMA - Six Ways to Address Physician Stress During COVID-19 Pandemic

Key Provider of the Month Ascension St. Mary’s

30 32 32

Covenant HealthCare Ascension St. Mary’s

Advertiser Index Key Providers Calendar of Events

Fulfill Your Board of Medicine Requirements on Your Time The Bulletin can be viewed online at www.SaginawCountyMS.com under the Bulletin tab.

COVER PHOTO COURTESY OF JAN MASICA

Mohammad Yahya Khan MD Steven J. Vance MD

Benefits of SCMS/MSMS Membership

24 25

Cancellation of SCMS Meetings and Events

Waheed Akbar MD Virginia R. Dedicatoria MD

31

July, August and September Birthdays

CMU College of Medicine CMU Health

MDHHS Childhood Lead Poisoning Prevention Program

23

President’s Letter

10 12

Juliette’s Story

LARA Licensing & Certification

Requirements During State of Emergency

Importance of 15-Minute Breaks

From the Editor

Julia M. Walter MD

16-17 26 27

Congratulations 2020 GLBR CMU College of Medicine Grads

6 9

Elvira M. Dawis MD

Jorge M. Plasencia MD

VIRTUAL WALK FOR HOPE August 7-9, 2020 Your Financial Support Is Needed!

EDITOR Louis L. Constan, MD EXECUTIVE DIRECTOR Joan M. Cramer DESIGNER Lori Krygier

PUBLISHER Saginaw County Medical Society 350 St. Andrews Rd., Suite 242, Saginaw, Michigan 48638-5988. Hours: Tuesday, Wednesday, Thursday 8:30 AM - 3:30 PM. Web: SaginawCountyMS.com Telephone: (989) 790-3590. Fax: (989) 790-3640 E-Mail: jmcramer@sbcglobal.net

All statements or comments in the Bulletin are those of the writers, and not necessarily the opinion of the Saginaw County Medical Society. Contributions are welcome. We publish committee reports, letters to the editor, Alliance reports, public health activities of the members, and some personal items (birthdays, weddings, graduations and like events).

The Editor determines which are accepted. Advertisements are accepted as space is available at our going rates. Members may advertise office information, professional services, skills, and procedures, also at our going rates. We do not accept advertisements from nonmembers, or non-Saginaw hospitals.

The Bulletin is mailed free of charge to SCMS members as part of their membership.

Complimentary copies are sent to various other parties. Others may subscribe at the rate of $50 per year.

The Bulletin | August 2020 3

PRESIDENT’S LETTER

SCMS Leaders Address COVID-19 Issues with Congressman Dan Kildee Congressman Kildee Agrees to Co-Sponsor HR 7255, the Coronavirus Health Care Worker Wellness Act

By Mildred J. Willy, MD

O

n June 25, 2020, Dr. Mary Jo Wagner and I participated in a phone conference with Congressman Dan Kildee. The conference was coordinated by the American College of Emergency Physicians (ACEP). Additionally, anesthesiologists, cardiologists and ophthalmologists, among others, advocated on behalf of their specialty societies. The following were concerns raised by ACEP that Dr. Wagner and I addressed.

• Ensure emergency physicians have the equipment we need, including adequate PPE. Congress and the Administration must continue to ensure emergency physicians and frontline health care providers have adequate PPE as we continue responding to the coronavirus pandemic. While some areas are doing better, others are seeing significant increases in cases.

We need to ensure the frontline health care workers are equipped with the PPE we need to stay safe and healthy.

• Provide temporary liability protections.

Congressman Kildee was asked to co-sponsor HR 7059, the Coronavirus Provider Protection Act introduced in late May 2020, and sponsored by Reps. Phil Roe (R-TN) and Lou Correa (D-CA). Emergency physicians are putting themselves at risk each day while facing unprecedented challenges during the COVID-19 pandemic – inadequate safety supplies, scarce or changing information on treatment protocols, insufficient testing and a lack of other essential resources. Despite these challenges, we continue to provide the lifesaving care our patients need and deserve – yet still we face the threat of medical liability lawsuits due to circumstances that have frequently been beyond our control. HR 7059 would provide limited, temporary liability protections (with appropriate exceptions for gross negligence or willful misconduct) for the duration of the pandemic for health care professionals who are screening and treating COVID-19.

• Ensure emergency physicians have access to mental health resources.

Congressman Kildee was asked, and agreed, to co- sponsor HR 7255, the Coronavirus Health Care Worker Wellness Act introduced in mid-June

by Reps. Raja Krishnamoorthi (D-IL), John Katko (R-NY), and Frederica Wilson (D-FL).

The pandemic is taking a toll on the mental health of many emergency physicians as well. The job of an emergency physician is already challenging, but this is far from business as usual. While some hospitals are stretched beyond capacity forcing emergency physicians to make excruciating decisions given their sparse resources, others are grappling with devastating drops in patient volume resulting in pay cuts, furloughs and even layoffs.

We manage these challenges while we maintain social distance. For some of us that means isolation without our friends or families. We are in the fight of our lives and when our day ends, continued on page 5

We need to ensure the frontline health care workers are equipped with the PPE we need to stay safe and healthy.

4

The Bulletin | Summer 2020

continued from page 4

many of us retreat to solitude in hotels away from our homes, in our own garages, or even a tent in our backyards for weeks at a time.

HR 7255 will provide grants to hospitals and facilities to establish or improve mental health resources and access for health care providers providing care in response to the pandemic, and also commissions a study to look at the factors contributing to poor mental health and burnout.

• Ensure Provider Relief Funds reach emergency physicians.

The Provider Relief Fund established under the CARES Act was intended to support physicians and health care providers during these challenging times. Unfortunately, while HHS has so far attempted to distribute the funds proportionally to help providers, the funds distributed so far have not sufficiently covered the increased expenses and decreased revenues that many emergency physician groups in particular have faced.

Many of the funds distributed to date have gone to hospitals, but most emergency physicians are part of independent groups and are not employed by a hospital.

Lost ED visits cannot be rescheduled. Many EDs across the country have experienced significant reductions in volume as patients delay or avoid seeking necessary care due to fear of being exposed to COVID-19. Patients who do come to the ED are now often sicker than usual, increasing the time and average expense for care significantly. It is critical to ensure that a portion of these funds go directly to help emergency medicine groups and the physicians who practice within them to assist with lost revenues and increased expenses due to COVID-19.

The Saginaw County Medical Society would like to thank Congressman Dan Kildee for co-sponsoring HR 7255, the Coronavirus Health Care Worker Wellness Act which, if passed, will afford access to mental health resources for all physicians involved in treating COVID-19 patients.

CANCELLATION OF SCMS MEETINGS AND EVENTS Due to COVID-19, the SCMS has cancelled the September and October Membership Meetings. The Board will evaluate the state of the pandemic later this fall, and hopefully decide when we will start meeting again.

The April Membership Meeting program, "Physician Compassion Fatigue” to be presented by Molly E. GabrielChampine, PhD, LP, Director of Behavioral Science, Family Medicine Residency at McLaren Bay, will be rescheduled in 2021.

The 16th Annual Health Fair postponed in March will not be rescheduled in 2020. We do not feel it is in the best interests of the public who attend (many of whom have multiple medical conditions), our vendors, members and staff to bring together a large group of people since it is believed there will be waves of COVID later this year.

Board meetings for the immediate future will be held virtually.

SCMS Members Featured in the July/August 2020 Issue of Michigan Medicine “On the Front Lines Against COVID-19” Michigan Physicians Share Their Stories Stephanie J. Duggan, MD Juliette M. Perzhinsky, MD Delicia J. Pruitt, MD Thank you, Drs. Duggan, Perzhinsky and Pruitt for sharing your stories and representing the SCMS! Click HERE to read the July/August 2020 issue of Michigan Medicine!

The Bulletin | Summer 2020 5

FROM THE EDITOR

Us

By Louis L. Constan, MD

I

magine, if you will (I know you can do this) walking into your exam room and seeing there a tall, familiarlooking man with a stern look, a beard and an American flag. Hello, he says, I’m Uncle Sam, but you can call me Sam. You, always up to a challenge, reply with your usual: What seems to be the trouble, Mr. Sam? Sam, in a very loud voice, as if 320 million people were talking at once, said that he was feeling a bit under the weather.

No kidding. Well then, let’s have a look.

Undress and hop up on the table. Now inhale for me. Exhale. Cough. Does this hurt? Does this? Stand on one foot. On the other. Look to the right. Now to the left…

Thirty minutes later, and after you suppress the urge to tell Sam ‘I told you so,’ for ignoring medical advice all these years, you maintain your professionalism as you give him the bad news.

Sam, I’ve found the problem, and I can tell you that it is very serious. You’re a mess, and you’ve brought it all on yourself. First off, your immune system is basically shot.

“Immune system, what’s that?”

The immune system is your body’s mechanism to surveil and suppress invasions by pathogenic microorganisms.

Without it, you’re blind and helpless

in the face of external threats to your health. Your immunity is the men and women of the public health departments across the country, the ones you’ve been underfunding for decades. And it’s the people from Center for Disease Control.

They identify new outbreaks early when they can be contained, before they can spread, which we’re seeing now. Your entire CDC budget is only $6 billion dollars. I know wealthy people who spend more than that on their yearly entertainment! Don’t you understand that microbes are the dominant form of life on the planet, and that they’ve been causing epidemics throughout human history? And you think you can throw some chump change at them and protect yourself?

Alright, alright, I can handle this. A little more money to the epidemic guys.

Crisis solved!

It’ll have to be a LOT of money… and not just this year and next year, but forever. Can you handle that? I have my doubts. And even if you could, you’ve got bigger problems, what we call structural problems. That beautiful red, white and blue designer outfit you’re wearing… it’s not so pretty underneath. Some infections are inevitable; they’ve been occurring throughout human history.

Societies that handle them best are those with the most underlying strength, the most resilience. And THAT, my dear Sam,

you do not have. Simply put, you’re in poor health, out of shape and too fat; your people are too often without health insurance, without a doctor they can call, without adequate education, without a steady job paying a living wage and without decent housing. You can beef up your immune system, but you need a strong base if you’re going to weather storms like this.

You see, Sam, infections commonly first target the weak, the sick and those living in poor conditions. Those folks become the reservoir where the infection can persist while it spreads throughout the rest of your body. No part of you can be immune unless all of you is immune. When you say ‘we’re all in this together,’ you’re really saying that we all absolutely MUST have basic standards in health care, housing, employment and educational opportunity. The health of the whole is, in a very real way, dependent on the health of the parts. If we learn one thing from this current mess, this should be it.

Listen Doc, I’m not sure I’m willing to change my lifestyle so drastically. Can’t you give me a shot of something and dispense with the sermon? I’d just like to get back to normal.

Sigh. Aren’t you listening? We’ll never get back to the way we were.

Well then, Doc, I think I’ll just get another opinion…

The health of the whole is, in a very real way, dependent on the health of the parts. If we learn one thing from this current mess, this should be it.

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The Bulletin | Summer 2020

HIRE ME. All statements or comments in The Bulletin are those of the writer, and not necessarily the opinion of the Saginaw County Medical Society.

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The Bulletin | Summer 2020 7

Walk for Hope Has Gone VIRTUAL!

Annual Walk is the organization's only campaign to raise funds to support programs for suicide awareness, training and aftercare (support and counseling) for those left behind after suicide.

The Walk for Hope is now a virtual Walk/ Run raising money and awareness for depression and suicide. Now more than ever, we (and our communities) need support as the recent crisis in our country and our region have experts guesstimating a 32% increase in the rates of suicide. Join us in our Walk raising awareness and funds to help equip as many people as possible with tools in suicide prevention.

The Walk will be hosted over a three-day period, August 7-9, 2020. During those three days, pick the time, location and activity that best suits you to participate. Don't forget to snap a selfie, or take a group photo to commemorate bringing HOPE home and post it on our Facebook page.

Opening Ceremonies will take place over Facebook on the first day of the Walk on August 7, but will be available for your viewing at any time over the three day period.

We also ask that in preparation for your Walk, you prepare a stone with a hopeful word or message. Take the stone with the hopeful message along with you on the Walk and leave in memory of the event, and to help bring HOPE to someone else who may find it later on!

Additionally, you can expect some of the things you've come to know and love over the last 18 years of Walking for HOPE, but with a virtual twist. Please join us for music, photos, resources and opportunities to win prizes.

DID YOU SAY WIN PRIZES? YES! There are opportunities to win prizes! Individuals that raise more than $1,000 will be entered to win a two-day Grand Hotel getaway on Mackinaw Island (valued at over $1,200)! The team that raises the most funds will have their top contributors entered in a drawing for the chance to win two Michigan-

shaped Adirondack chairs built right here in Michigan! Other prizes include: • First team to complete the Walk and post a photo on Facebook wins a swag bag for each member.

• First individual to complete the Walk and post a photo on Facebook wins a gift card.

• First team that raises $2,500 or more wins a free catered party in a park of their choice (following CDC guidelines for COVID-19), and will be honored to serve as the models for all 2021 marketing materials.

• The team with the most members wins a free Awareness training, and their names entered to win a handmade wooden doll house.

REGISTER When you register, you will have the option to join an existing fundraising/walking team or to start your own. Be sure to get your t-shirt so you can walk in style, letting everyone know that you are bringing HOPE HOME in your community!

CLICK HERE TO REGISTER.

PLEASE DONATE! The annual Walk for Hope is the organization’s only campaign to raise funds to support programs for suicide awareness, training and aftercare (support and counseling) for those left behind after suicide. All donations stay in the Great Lakes Bay Region and help to remove financial barriers to those seeking suicide prevention training and care/resources after the impact of a suicide. CLICK HERE TO MAKE A DONATION.

Online Suicide Awareness Training Now Available A limited supply of FREE online trainings is available courtesy of the Barb Smith SR&RN. Contact Barb Smith at barb.smith@suicideresourceandresponse.net to request the free link while supplies last.

In times of heightened isolation and anxiety, people’s thoughts of suicide can increase. Now more than ever, it’s essential that we have effective skills to keep each other safe, even if it’s from afar.

A Way To Learn Life-Saving Skills Anywhere While face-to-face training isn’t possible right now, there is an alternative. LivingWorks Start is a 90-minute online continued on page 9

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The Bulletin | Summer 2020

continued from page 8

program that lets trainees learn suicide prevention skills even while working from home or practicing social distancing. It works on any computer, smartphone or tablet, and it includes simulations, practice and other skills-building activities. There are also ways to apply these skills via phone, text and other remote methods.

LivingWorks is working hard to support suicide prevention efforts during this difficult time. In sensitivity to the current financial situation, they’ve made LivingWorks Start available at a reduced cost of $20 of per license. In addition, 25 percent of the proceeds will go to help support suicide prevention organizations and trainers impacted by these conditions.

over one another, and LivingWorks Start gives people the skills to make it possible.

The Benefits of LivingWorks Start

Please let me know if you have any questions. It’s important for all of us to remember that together, even in the face of adversity, we can build a safer and more hopeful world.

LivingWorks Start enables people to recognize when friends, family members, co-workers and neighbors are struggling and take meaningful actions to keep them safe.

Trainees report feeling more confident and prepared to help someone, even during work-from-home and social distancing.

In today’s climate of uncertainty, it’s essential that we watch

How To Get Involved You can experience LivingWorks Start or bring it to your team by following this link: https://shopusa.livingworks.net/ products/livingworks-start.

A limited supply of FREE online trainings is available courtesy of the Barb Smith SR&RN. Contact Barb Smith at barb.smith@suicideresourceandresponse.net to request the free link while supplies last.

Barb Smith, Executive Director | 989-781-5260 | barb.smith@ suicideresourceandresponse.net

FCC DESIGNATES ‘988’ AS 3-DIGIT NUMBER FOR NATIONAL SUICIDE PREVENTION HOTLINE EFFECTIVE IN JULY 2022 Action Will Help Combat Rising Suicide Rates by Making It Easier for Americans in Crisis to Obtain Assistance from Trained Counselors On July 16, 2020, the Federal Communications Commission adopted rules to establish 988 as the new, nationwide 3-digit phone number for Americans in crisis to connect with suicide prevention and mental health crisis counselors effective July 16, 2022. The rules require all phone service providers to direct all 988 calls to the existing National Suicide Prevention Lifeline by July 16, 2022. During the transition to 988, Americans who need help should continue to contact the National Suicide Prevention Lifeline by calling 1-800-2738255 (1-800-273-TALK) and through online chats. Veterans and Service members may reach the Veterans Crisis Line by pressing 1 after dialing 1-800-273-8255, chatting online at www.veteranscrisisline.net, or texting 838255.

The new rules will apply to all telecommunications carriers, as well as, all interconnected and one-way Voice over Internet Protocol (VoIP) service providers. They provide for a two-year transition, reflecting the real challenges of this nationwide effort, including the need for widespread network changes and providing time for the National Suicide Prevention Lifeline to prepare for the expected increase in the volume of calls.

Under these rules, calls to 988 will be directed to 1-800-273TALK, which will remain operational during the 988 transition and after it is completed. To ensure that calls to 988 reach the National Suicide Prevention Lifeline, all covered providers will be required to implement 10-digit dialing in areas that both use seven-digit dialing and use 988 as the first three numbers in seven-digit phone numbers.

Since 2008, suicide has ranked as the tenth leading cause of death in the United States. Suicide claimed the lives of more than 48,000 Americans in 2018, resulting in about one death every 11 minutes. An FCC staff report to Congress in 2019 proposed establishing 988 as an easy-to-remember three-digit code for the National Suicide Prevention Lifeline.

Staff analyzed various options and determined 988 was the best option for increasing access to crisis resources and ensuring the fastest possible transition. Establishing the easy-to-remember 988 as the “911” for suicide prevention and mental health services will make it easier for Americans in crisis to access the help they need and decrease the stigma surrounding suicide and mental health issues.

The Bulletin | Summer 2020 9

College of

Medicine Dr. Mary Jo Wagner Receives Lifetime Achievement Award

Mary Jo Wagner, MD, Chief Academic Officer/Designated Institutional Official for the CMU Medical Education Partners residency programs, was recently selected by the Michigan College of Emergency Physicians (MCEP) as the 2020 John A. Rupke, MD Lifetime Achievement Award recipient.

The Award recognizes a member who has demonstrated a lifetime of contributions to the practice of emergency medicine by an unparalleled commitment to professionalism, leadership and service. We congratulate Dr. Wagner on being an exemplary role model and inspiration to our organization and the community.

Congratulations, Dr. Wagner!

Dr. Therese Mead Receives National ACEP Award The American College of Emergency Physicians (ACEP) has awarded Therese G. Mead, DO the 2020 ACEP National Emergency Medicine Junior Faculty Teaching Award.

This Award honors Dr. Mead as an outstanding educator in emergency medicine and recognizes tremendous efforts in advancing the specialty. It recognizes excellence in teaching, including development of innovative educational programs.

Congratulations, Dr. Mead!

10 The Bulletin | Summer 2020

CMU Health Pediatrics Welcomes Katie Londos, NP Katie Londos, a nurse practitioner, has joined our team of pediatricians at CMU Health’s Houghton Avenue clinic in Saginaw.

She obtained her Bachelor of Science in Nursing from Michigan State University, and completed her Master of Science in Nursing at the University of Michigan. While advancing her degree, she worked in general pediatrics and the Pediatric Intensive Care Unit at Covenant HealthCare.

Katie brings a wealth of knowledge to our practice, and will help expand patient access for our Pediatric Department.

Physicians on the Front Lines Discuss COVID-19 CMU Health’s very own Nicholas Haddad, MD, Infectious Disease Specialist, and Derek J. Schaller, MD, Emergency Medicine Physician, recently discussed a range of COVID-19 topics in a short video series.

They used research and medical expertise to offer guidance on subjects such as preventing the spread of the disease, the importance of maintaining routine health care and discussing our “new normal.”

Watch the full playlist on our YouTube channel!

Dr. Steve Vance Featured in Faith Saginaw Magazine

Steven J. Vance, MD, Emergency Physician and Associate Dean of Clinical Education at CMU College of Medicine, was featured in the May/June 2020 issue of Faith Saginaw, a publication of the Diocese of Saginaw. Dr. Vance was interviewed about his faith while serving on the front lines of the COVID-19 pandemic response in Saginaw. You can read about Dr. Vance in Faith Saginaw by clicking HERE.

College of

Medicine

Congratulations to the 2020 CMU College of Medicine Graduates from the Great Lakes Bay Region!

Note: Not all Great Lakes Bay Region graduates submitted photos.

The SCMS would like to congratulate all new physicians from our area!

The Bulletin | Summer 2020 11

Michigan’s leader in stroke care A Comprehensive Stroke Center close to home Ascension hospitals treat more people with strokes than any other hospital in Michigan.* Our stroke specialists work quickly to understand your situation and deliver the care you need, including follow-up care, when you need it. You have access to a Comprehensive Stroke Center with advanced training, technology and capabilities, right here in Saginaw, Michigan.

844-960-1435 If you are experiencing a life-threatening emergency, go directly to the ER or dial 911.

*Based on 2018 market share data/hospital discharges, July 2017-June 2018.

Š Ascension 2020. All rights reserved.

12 The Bulletin | Summer 2020

KEY PROVIDER OF THE MONTH!

Acting quickly and efficiently, we leaned on 50 years of operations experience to enhance safety protocols in response to COVID-19. Although the challenge of this virus was unprecedented, our prevention and response measures were rapidly developed and implemented. An equally deep commitment to resident well-being led to new and creative ways to keep our residents engaged, informed, and connected.

Fulfilling Our Mission While Protecting Residents, Employees & Community

PROTECTIVE EQUIPMENT

HEALTH AND SAFETY

CLEANING AND SANITIZING

RESIDENT EXPERIENCE

Every resident provided with a mask. Every employee outfitted with mask, gown, and gloves.

Completed over 5,000 health screenings every day. Over 10,000 employee temperatures taken twice daily.

18+ hours per day, every day exclusively dedicated to cleaning and sanitizing.

New and creative socially distanced activities and engagements made available to every resident.

PROTOCOLS

COMMUNICATIONS

DINING

TECHNOLOGY

Enhanced protocols have resulted in a 44% lower infection rates* in our communities.

Engaged and informed residents and family members through innovative electronic platforms.

Not a single meal missed; 3 meals and 2 snacks delivered daily through room service.

Developed weekly learning series to connect residents to family and loved ones through use of technology.

To Schedule a Tour: Wescourt 4141 McCarty Rd, Saginaw, MI 48603 989.797.3600

Learn More About Our Response holidaytouch.com/corona-virus-info

2020 Holiday AL Management Sub LLC, | * Compared to the national average among 75+ U.S. population since June 2020.

The Bulletin | Summer 2020 13

Importance of 15-Minute Breaks

By Rebecca “Becca” Bogin CMU College of Medicine Office of Student Affairs

Consider your average day at work. You start the day, work until lunch, then after lunch you return to work before heading home for the day. This is a pretty standard workday for most people. Do you know what your day is probably missing? It is so small most people would not even think twice about it, but it is an important piece of everyone’s day that they should be utilizing: 15-minute breaks. I know I am guilty of not using them and so are many of my co-workers. Do you really know what you are missing? Do you know the benefits of these breaks? Do you know there are some detrimental health risks associated with sitting for long periods? I did not know any of that. I decided on this research project for one of my Masters’ classes because I knew I could not be the only one not using them.

If you were to ask people why they don’t use their breaks, responses would include, “I’m too busy with my work,” “I don’t need them,” or “I just forget about them.” All three of these are examples of how stress in the workplace prevents us from taking our breaks. A study by Robertson in 2016 found each year companies lose an average of 27 working days per employee due to stress related illnesses, which is approximately 10.8 million working days around the world. A separate study

by Silcox in 2016 found that employees who work long hours can cause damage to their well-being and their health. While both studies show that stress and long hours can affect an employee’s well-being, it was also found that most employees follow what their managers do; this follows the belief of leading by example. If employees see their managers taking regular breaks throughout the day, they are more likely to mimic that behavior. However, the same is said if they see managers working long hours and not taking breaks, then the employees will most likely mimic that behavior. Therefore, it is important that managers practice the behaviors they want to see in their employees.

While we understand some of the reasons behind not taking breaks, some people may not realize how important breaks are in helping prevent health problems. If we knew those risks, would that change anything for us? Two separate studies in 2015, one by Reddy and one by Paddock, have revealed that sitting for long durations can lead to increased risk of cardiovascular disease and diabetes. Additionally, it can lead to a greater risk of several types of cancer including: • 24% higher risk of colon cancer • 32% higher risk of endometrial cancer • 21% higher risk of lung cancer These studies have also found these risks are still increased in people who participate in regular workouts. So we know the risks, how can we move forward?

We move forward by leading through example and setting an intention to do so. Managers who take regular breaks were found to do so because of a mentor in their past who advised them to do so! Do you see the trend here? Additionally, managers who do take breaks noted the following benefits in a study by Berman and West in 2007 – breaks helped to clear their minds, increased creativity, productivity and decreased stress. A key point for managers and companies to keep in mind is not to push employees past their limits. In a 2018 study, Payne found that pushing employees past their limits may lead to mistakes, and the same can be said for managers who push themselves too hard. When you have the intention of doing something, you are more likely to follow through than if there was no intention. Additionally, a study in 2017

by Kühnel and their colleagues found that when employees have the intention of taking a break, in most cases they will take the break and sometimes take them more often (Kühnel et al., 2017). Self-initiated breaks help lead to increased work productivity. continued on page 15

An office remodel could prepare your practice for modern challenges for patient flow changes, documentation storage, HIPAA compliance, and succession

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continued from page 14

So, you have your manager’s support, the intention and plan to take breaks, now what? How should you use your breaks? Any activity you do on your breaks, including lunch, should not be work related or use the same resources you need for work (Hunter and Wu, 2016). They should be something that you enjoy doing to help increase your energy recovery. This means avoiding activities like chores, running errands, grocery shopping or homework are important because they use the same cognitive resources needed for work. Need some ideas? I have you covered: • Take a walk • Do a 10-minute yoga routine • Read a book • Spend some time with co-workers in a social activity • Do a “Booster Break” where you get active with jumping jacks or a quick jog • Play a game on your phone - I recommend Toon Blast, as long as you are not connected to work.

Interestingly, studies have also been conducted on where employees take their breaks. These studies have shown that people who take breaks outdoors or in a wooded area especially in a wooded area - that the benefits include decreased fatigue and lower anxiety. In a study conducted by Bum-Jin Park and his colleagues (2011) on the relationship of a break in a forest setting on a person, it was found that being outdoors in a forest setting led to higher positive emotions, and a decrease in tension, anxiety, fatigue and confusion in participants.

As you can see, breaks have many benefits including increased productivity, increased creativity, decreased stress and increased performance to name a few. I know once I started this research, I found myself working harder to take my breaks and have even put them on my calendar to help remind me to take my breaks.

Breaks are good for your wellness, health and productivity, so what’s stopping you?

References available upon request.

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Juliette's Story

By Juliette M. Perzhinsky, MD MSc

A

lthough the following reflection piece I wrote a few months after my brother passed away does not directly speak about the opioid epidemic, the narrative is relevant. It intertwines a lot of topics pertaining to mental health, suicide and grief. I believe it may be helpful to share with SCMS members to help provide a very real perspective, and how it is important to connect with others during their time of need.

Note: The article was originally published on Closler.org on May 16, 2019 https://closler.org/lifelong-learning-in-clinicalexcellence/starry-starry-night Miller Coulson Academy of Clinical Excellence, Johns Hopkins Medicine. All Rights Reserved.

"The Starry Night," Vincent Van Gogh, 1889, Museum of Modern Art

TAKEAWAY There are times that as clinicians, we become patients ourselves, needing compassionate care for injuries entirely unrelated to our chief complaint.

With a hoarse voice, I called my brother pleading with him to tell me that Thomas was still alive. A defining pause followed, “No, our brother is no longer with us, he did not survive.” The sudden silence was transient, followed by an acute gasp for air and difficulty in breathing. I think I tried to yell out multiple times but I was disoriented and ill. One of my younger brothers had just taken his own life. He was 39 years old.

For the past few years, he struggled with severe depression, chronic pain further complicated by substance use disorder but I’m not writing this to share his life story.

My subsequent calls thereafter were to my sisters who were not yet aware of Thomas’ death. I could barely speak from the loss of voice and onset of emotional trauma, but somehow 1 the quasi-audible sounds emanating from my raspy throat conveyed the isolating sadness of my message. Our younger brother had just died. My sister kept repeating in a solemn 16

The Bulletin | Summer 2020

tone, “Do not do this to yourself, you did what you could to help him, please do not do this to yourself.”

I could not speak any longer with my eyeglasses blurred from the constant cadence of my tears. The calls ended and I was alone. I gathered my reserve after bawling through prayers of repose, finding a chair while playing poetic music in my intense search for peace, albeit only peripheral. Relentless episodes of melancholy that I had never experienced equated to the sense of dredging through mud on a long hike in the aftermath of a heavy spring rainfall.

Within a matter of a couple of hours, I was too weak to move and my fever spiked to 104.5 when my husband arrived home.

I could feel the tympanic pulsations of my tachy heartbeat.

Feeling my senses decline, I laid in the bed insisting that no one enter for fear of contagiousness.

My husband called 911. Firefighters arrived first followed by the paramedics. With assistance, I was moved from the bed onto the gurney, lifting my neck to see my family’s worried expressions as they waved at the door during this cold and empty period in time. A breath of crisp, frozen air was calming as I was rolled towards the ambulance. Lying supine, there was an eerie swiftness posed with viewing the night sky as I stared upward while the gurney rolled over gravel. I could see the mix of scattered glitter stars positioned in the backdrop of a blackened canvas of sky reminiscent of Van Gogh’s depiction of his own “Starry Night.”

Upon arrival to the hospital after the long drive in the ambulance on ice-covered country roads, I was rapidly triaged by the team with my temp trending down to 102.8. It was a Friday night and the emergency room was overwhelmed.

Holding my blood pressure with a pulse rate of 125, I was promptly masked and immediately sent to the waiting area.

Hours lapsed while I was periodically brought back for blood work, then a chest x-ray.

The first person to show genuine interest in my symptoms was the medical student, who curiously posited my history of present illness by asking what brought me to the ER. “My husband called 911 because of my high fever and weakness,” followed by an even more subtle and somber tone of, “I just lost my brother today.” The student’s response revealed a type of compassion that was ineffable - what I describe as the initial act of mercy in this encounter with the healthcare system.

His approach with conveying his condolences demonstrated sincerity, “I am truly sorry for your loss,” as continued on page 17

continued from page 16

he naturally paused in silence out of respect before slowly venturing into my social history. “May I ask what your occupation is?” he quietly asked. “I’m a general internist,” I responded groggily with a muffled and barely audible voice.

“Oh, you are a physician,” he stated cautiously, pausing again.

The medical student asked additional questions, then listened earnestly until he finally excused himself to review my history with his attending. As more time lapsed, I was later admitted to the hospital with influenza A. Despite interactions with dozens of clinical staff during my intake, I was met with a second act of mercy on a busy medical ward by the floor nurse. It was 4:30 a.m. and I could not hold my composure. Hours before, I tragically lost one of my younger brothers to suicide. The nurse came in to comfort me in-between overhead announcements and various alarms sounding. The registered nurse, who was required to wear a mask in my room, sat down holding my hand. Before being asked to tend to another patient, she agreed that I would benefit from a visit with the chaplain, but it would be hours before the chaplain arrived.

Placed in respiratory isolation without any family or the comfort found in close friends during my time of immense sorrow, I decided to use social media as my outlet to the world.

I felt an intense need to share what happened knowing that some of my colleagues and others may empathize with the indescribable pain experienced with the sudden death of a loved one - from cancer, Alzheimer’s, a sudden accident or suicide - no matter the etiology, death is death.

It was also through social media that the outpouring of support, encouragement and prayers surrounded me with a loving grace. It provided a seed of hope that this pain would not last forever, especially during an era when the stigmatization of mental illness is still so prevalent in our society. There was tremendous guilt that followed as the funeral arrangements became a bold reality that as a physician sister, I could not save my own brother’s life. Through social media, I was at least able to do something in the wake of my personal illness - I was able to grieve during a mournfully piercing starry, starry night.

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The Bulletin | Summer 2020 17

Covenant Welcomes New Physicians Drs. Kaul, Mills and Rajpurkar Join Covenant Urology Covenant HealthCare welcomes Sanjeev Kaul, MD, as a member of the Covenant Medical Group. Dr. Kaul joins the Covenant Urology team as a urologist. Dr. Kaul was an Associate Professor of Urology and Director of Robotic Surgery at William Beaumont Hospital. He has trained over 30 residents and fellows from Oakland University, DMC and Michigan State University, published over 100 peer-reviewed papers and book chapters, and lectured extensively in robotic surgery, genomics for prostate cancer, hereditary prostate cancer and bladder cancer.

Dr. Kaul offers the following services: • Advanced management of urologic cancers including contemporary diagnosis methods, robotic and open surgery, post-operative treatment and survivorship management.

• Medical and minimally invasive treatment of benign prostatic hyperplasia (UroLift, laser and Rezum).

• Advanced stone disease surgery (ureteroscopy, percutaneous nephrolithotomy (PCNL), extracorporeal shockwave lithotripsy (ESWL)) and medical evaluation of recurrent stone disease.

• Medical and surgical management of male and female incontinence.

• Medical and surgical treatment of erectile dysfunction.

• He has a special interest in: o Use of genomics to create personalized treatment of localized and advanced prostate and bladder cancer. o Advanced techniques in robotic surgery for prostate, bladder, kidney and testicular cancer.

Covenant HealthCare welcomes Richard A. Mills, MD, as a member of the Covenant Medical Group. Dr. Mills joins the Covenant Urology team as a urologist. Dr. Mills brings his knowledge of Urology to the Great Lakes Bay Region. He is fellowship trained and his services include: • Diagnosis and treatment of urologic malignancies.

• Extensive experience with cancer removal surgery.

• Expertise in infertility and impotence.

• Advanced skills in urinary stone disease.

• Treatment of benign prostatic hyperplasia, lower urinary tract symptoms and incontinence.

In addition, Covenant HealthCare welcomes Atul D. Rajpurkar, MD, as a member of the Covenant Medical Group.

18

The Bulletin | Summer 2020

Dr. Rajpurkar joins the Covenant Urology team as a urologist. He is board certified in Urology by the American Board of Urology, and has a vast experience in adult general urology. In the past, he has served as the Chief of Urology at Ascension Providence Rochester Hospital, and has been actively involved in training Urology residents from Michigan State University. He has lectured and published on diverse topics in the field. Dr. Rajpurkar offers the following services: • Robotic surgery in the management of prostate, kidney and bladder cancers, robotic management of benign urology for benign prostatic hyperplasia (BPH), reconstructive urology for ureteral strictures and for genitourinary prolapse in females.

• Minimally invasive management of BPH with laser, UroLift and Rezum.

• Management and prevention of complex kidney stone disease with laser and percutaneous nephrolithotomy.

• Medical and surgical management of erectile dysfunction and Xiaflex injections for Peyronie’s disease.

• Evaluation and surgical management of female urinary incontinence with sling, sacral neuromodulation, botox, as well as, robotic colpopexy for genitourinary prolapse.

The Covenant Medical Group Urology Office is located at 3875 Bay Road, Suite 2S in Saginaw and can be reached at 989.583.5370. Drs. Kaul, Mills and Rajpurkar join Kirstan K. Meldrum, MD, Pediatric Urologist.

Dr. Franklin Joins Covenant Primary Care - Frankenmuth Covenant HealthCare welcomes Karensa L. Franklin, MD, as a member of the Covenant Medical Group. Dr. Franklin joins the Covenant Primary Care team. Her office is located at 600 North Main, Suite 220B, Frankenmuth and can be reached at 989.652.1422.

Dr. Kriem, Pediatric Gastroenterologist, Joins Covenant Surgery Covenant HealthCare welcomes Jamal Kriem, MD, as a member of the Covenant Medical Group. Dr. Kriem joins the Covenant Surgery team as a Pediatric Gastroenterologist and specializes in Celiac Disease, Failure to Thrive, Eosinophilic Esophagitis Gastroesophageal Reflux, Upper Endoscopy, Colonoscopy, Percutaneous endoscopic gastrostomy (PEG) Tube Placement, Capsule Endoscopy, Esophageal pH Monitoring, Rectal Suction Biopsy, Constipation and Hirschsprung’s Disease, Inflammatory Bowel continued on page 19

continued from page 18

Diseases, Irritable Bowel Syndrome, Liver and Gallbladder Diseases, Lactose Intolerance/Malabsorption Testing, Small Intestinal Bacterial, and Overgrowth Testing (SIBO). The office is located at 5415 Cardinal Square in Saginaw, and the team can be reached at 989.790.4855.

Dr. Zaitoun Joins Covenant Cardiology Covenant HealthCare welcomes Anwar Zaitoun, MD, FACC, RPVI, FSCAI, as a member of the Covenant Medical Group. Dr. Zaitoun joins the Covenant Cardiology team as an Interventional Cardiologist. He specializes in coronary angiography and intervention, peripheral angiography and interventions, cardiac testing including echocardiography and cardiac stress testing, peripheral vascular testing including ankle-brachial index (ABI), arterial Doppler and venous Doppler, and cardiovascular consultations. The office is located at 900 Cooper, Suite 4100 in Saginaw, and the team can be reached at 989.583.4700.

Always Here to Provide Safe Care Covenant continues to re-engage the community for medical care. Our top priority, is always and will continue to be, ensuring we take the appropriate steps to maintain the safety of our patients, staff, providers and community. In order to best accomplish this, we have determined a phased approach to be the safest way to ensure the resources needed

diabetes SELF MANAGEMENT PROGRAM

to care for our patients are available when needed. We will continue to care for those patients who require emergent care, as well as, those patients whose health and safety are impacted. As always, we will rely on the clinical judgement of our providers and transparent communications with our patients.

Following the guidelines from the Centers for Disease Control and Prevention and the World Health Organization, Covenant HealthCare has taken initiatives to help do our part in controlling the spread of COVID-19. Although the way we provide care may look a little different, we are always here to provide safe, quality care for patients.

In addition, Covenant leadership is in regular contact with local and state health officials and we will continue to respond as information becomes available. Our implementation plan and timelines will take into consideration our community needs including COVID-19. We will be continuously evaluating our current state and ensure our timeline is adjusted accordingly.

As always, the Covenant Emergency Care Center, a verified Level II Trauma Center for Adults and Children, is available 24/7, and our five MedExpress locations are ready to support patients for urgent needs.

The community support has been amazing, and we sincerely thank you.

Dr. Michael Sullivan, Chief Medical Officer

In the United States, 30.3 MILLION people are living with diabetes – 84 million are living with prediabetes.

Covenant HealthCare is the region’s most experienced diabetes management team. Our program is certified by the Association of Diabetes Care & Education Specialists (ADCES) through the Michigan Department Health and Human Service (MDHHS). We are certified to provide education for patients of all ages and diabetes diagnoses, including pregnant women.

Put your trust in the region’s most experienced diabetes management team – your Patient-Centered Medical Home partner.

We also have a Diabetes Prevention Program to help prevent or delay Type 2 diabetes.

To refer a patient or for more information call:

989.583.5193.

©2020 Covenant HealthCare. All rights reserved. PK 2/20 13001

The Bulletin | Summer 2020 19

Welcome Dr. Lemos - Orthopedic Surgeon Ascension St. Mary’s is pleased to welcome orthopedic surgeon, David W. Lemos, MD, FRCSC, to the medical staff.

He joined Ascension Medical Group (AMG) Orthopedics and will see patients at offices located in Saginaw and Birch Run. Dr. Lemos is board-certified in orthopedic surgery in the United States and Canada. He provides treatment of sports-related injuries including degenerative problems of the shoulders, knees, ankles, feet and elbows. He offers a continuum of non-operative and surgical services including complex reconstructive procedures (both arthroscopic and open) and joint replacement to patients with a wide range of diagnoses. His care goal is to serve patients with the highest degree of competence in currently recommended operative and non-operative techniques, providing the very best care to each person, every time.

A graduate of Boston University School of Medicine, Dr. Lemos completed his orthopedic surgery residency at McGill University in Montreal, Canada and a fellowship in foot and ankle reconstruction at Michigan International Foot and Ankle Center in Pontiac. With a special interest in sportsrelated injuries, Dr, Lemos also completed a Sports Medicine Fellowship at Detroit Medical Center. During that time, Dr. Lemos assisted in providing orthopedic care to the Detroit Tigers, Detroit Pistons and Detroit Red Wings, among others.

Dr. Lemos joins Angel Bermudez, MD and Toby Blosser in the growing AMG sports medicine and orthopedics program.

Referrals are being accepted, and Dr. Lemos is seeing patients in Saginaw at Ascension Medical Group Orthopedics, 5275 Colony Drive North and in Birch Run at 9900 E. Birch Run Road.

Appointments can be made by calling 989-799-1350.

Telehealth Therapy Now Available Ascension St. Mary’s is proud to announce they are now offering outpatient therapy virtually as a treatment option for our patients and community. Telehealth therapy is now available for physical and occupational therapy services.

With traditional therapy services, a patient must drive to a physical clinic site. With telehealth therapy, a therapist can interact with a patient remotely using a smartphone, tablet or computer. At the designated appointment time, a patient logs into the virtual treatment room and is joined by his or her therapist, who is able to remotely monitor them, educate, provide feedback, and modify the treatment as necessary

20 The Bulletin | Summer 2020

through video and audio chat. Telehealth therapy is a private, one-on-one experience. For more information about telehealth therapy and its benefits, or to refer a patient, call 989-498-5102.

In addition, Ascension St. Mary’s Rehabilitation services has five area locations: • Ascension St. Mary's Birch Run Physical Therapy 989-624-1518 • Ascension St. Mary's Chesaning Physical Therapy 989-845-1808 • Ascension St. Mary's Gratiot Physical Therapy 989-791-3771 • Ascension St. Mary's Vassar Physical Therapy 989-823-2219 • Ascension St. Mary's Spine & Rehabilitation 989-498-5102 Rehabilitation services, including telehealth therapy, are also available in Standish and Tawas City.

Ascension Michigan Implements Phased Approach to Return to Surgeries, Other Healthcare Services Plan focuses on health and safety of all patients and associates Ascension Michigan resumed elective surgical procedures and other vital healthcare services at its sites of care using a phased and thoughtful approach with a focus on health and safety on May 29. All efforts are in alignment with Governor Whitmer’s Executive Order 2020-96 and in accordance with the Centers for Disease Control guidelines.

Ascension Michigan hospitals and outpatient facilities began scheduled surgeries and procedures, prioritizing those that are most urgent, while simultaneously ensuring continued capability and safety to provide care for patients with COVID-19.

“Ascension Michigan looks forward to safely providing additional non-emergent surgical and medical procedures as appropriate across all of our facilities, while continuing our current safety practices and following all CDC guidelines,” said Ken Berkovitz, MD, SVP, Ascension and Ministry Market Executive, Ascension Michigan. “Our approach for returning to scheduled surgeries is clinically-led, working with our physicians, clinicians and facility experts on a strategy that will keep our patients, associates and physicians safe.”

Time-sensitive surgical and medical procedures needed to protect and preserve the health, safety and welfare of Ascension Michigan patients have been ongoing in continued on page 22

Ascension Online Care Anywhere, anytime

Ascension Online Care is here for you and your family 24/7.

From anywhere, at any time, talk with a doctor using your smartphone, tablet or laptop.

Get the care you need and start feeling better for only $49 per visit. No insurance required.

Get started at ascension.org/onlinecare or download the mobile app.

See us for a wide variety of symptoms and conditions, including: • Sinus or upper respiratory infections • Eye infections • Allergic reactions/ allergies • Cold/flu • Fever • Urinary tract infections

If you are experiencing a major emergency, go to the ER as soon as possible or call 911. © Ascension 2019. All rights reserved.

The “Android” name, the Android logo, the “Google Play” brand, and other Google trademarks, are property of Google LLC. All rights reserved.

Apple, the Apple logo, iPhone, and iPad are trademarks of Apple Inc. All rights reserved.

The Bulletin | Summer 2020

21

continued from page 20

compliance with the Governor's Executive Order 2020-17.

Starting May 29, Ascension Michigan began scheduling additional surgeries, and prioritizing urgent procedures that could not be further delayed due to adverse healthcare risks. Seven days prior to surgery, patients will be asked to quarantine, per CDC guidelines, and follow social distancing measures. All patients with a scheduled surgery will be COVID-19 lab tested 48 hours prior, in addition to being screened the day of surgery.

Additionally, Ascension Michigan will continue a number of safety measures already in place, including advanced telehealth capabilities for virtual care, universal masking, hospital visitor restrictions, social distancing, and screening of all persons entering our facilities, including temperature checks. Ascension Michigan will continue the ongoing extensive sanitization and cleaning of our facilities, including all surgical areas, and each hospital will have a designated space for surgical patients. Measures are also in place to ensure we maintain adequate personal protective equipment inventory levels across our health ministries.

“We remain focused on surge readiness and providing continued COVID-19 care while we safely return to serving the community’s broader medically necessary healthcare needs,” said Charles Husson DO, Chief Medical Officer,

Ascension Michigan. “We know this is a fluid situation, and we are prepared to be flexible and responsive to rapidly evolving conditions in our community and our sites of care.

Our collective efforts to prevent the spread of COVID-19 are working, but the pandemic is not yet over,” said Husson. “As we look ahead, we ask not only our staff, but our community to remain vigilant in masking, practicing social distancing and continuing to follow local orders to stop the spread of the virus.”

Fulfill Your Board of Medicine Requirements on Your Time MSMS offers numerous on-demand webinars that fulfill the Michigan Department of Licensing and Regulatory Affairs requirements for continuing medical education, including: • A series of 12 covering Pain and Symptom Management • Three on Medical Ethics • Human Trafficking Download and watch at your convenience 24/7.

For a complete list and to register click HERE

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The Bulletin | Summer 2020

BIRTHDAYS July Birthdays

David B. O'Donnell MD

Ruth M. Licht DO

Matthew D. Deibel MD

Mark S. Adams MD

Sunil D. Parashar MD

Miles P. Light MD

Parminder S. Jaswal MD

Macksood A. Aftab DO

Donald B. Passal MD

Robyn M. Lorenzo DO

Ian R. Keck DO

Rawan A. Amir MD

Paul C. Pastolero MD

Amita Kakarla Maganti MD

Daniel B. Kehres DC

Kai Anderson MD

Jamie L. Ross MD

Steve Min DO

Zaira Khalid MD

Joan M. Cramer

Galileo A. Sarmiento MD

Charles E. Mueller MD

Palaniandy K. Kogulan MD

Thomas E. Damuth MD

Derek J. Schaller MD

Gopi K. Nallani MD

John B. Llewelyn MD

Christopher R. DeVries MD

Gerald R. Schell MD

Sujal G. Patel MD

Sohaib M.H. Mandoorah MD

Sonia S. Dhaliwal MD

Frank P. Schinco MD

Mindy L. Prows DO

Mary Jean McKuen MD

Sakshi Dhir MD

Ryan S. Shelby MD

Brian D. Purchase DO

Peter C. Morden MD

Almohanad Abdulghani Eidah MD

Khine Mon Swe MD

Zakir H. Qureshi MD

Chet A. Morrison MD

Jerry J. Evans MD

Sue C. Tobin DO

Ramesh Penumetsa Raju MD

Jeffrey D. Osborne MD

Austin G. Friswold DPM

Christopher D. Trumph DO

Nikita Roy MD

Arvind R. Patel MD

Ramakrishnayya Gadam MD

David D. Udehn MD

Manoj Sharma MD

Brian F. Perry MD

Megan S. Graham MD

Steven J. Vance MD

Chander W. Srinivasan MD

Kaushik Raval MD

Samantha R. Grosteffon Mikita MD

August Birthdays

Kimiko D. Sugimoto MD

Jennifer M. Romeu MD

Ali H. Hachem MD

Michael J. Argyle MD Ronald C. Barry MD Sussan M. Bays MD Caleb S. Dean MD Michael J. Dense DC Michael L. Fiore MD Karensa L. Franklin MD David B. Hansen DO Clark J. Headrick DO Mark J. Heinzelmann MD Courtney M. Hollingsworth MD Perlita P. Ilem MD Abdur R. Jamil MD Kimberly S. Johnson MD Christopher M.T. Le DO

Michael W. Sullivan MD

Naman A. Salibi MD

Navya S. Vipparla MD

Rupinder K. Sekhon MD

Tiffany A. Weiss-Feldkamp DO

Stacey L. Sharp MD

Matthew Wolf MD

Joginder Singh MD

Claudia C. Zacharek MD

Tory K. Snyder DO

September Birthdays

Venkataramana Somisetty MD

Harold B. Lenhart MD

Kristin M. Constantino MD

Syed R. Hassan MD Victor L. Hill, Jr. MD Mirza J. Hussain MD Ronald L. Jenson MD Samuel L. Kalush MD Muhammad Z. Khan MD Colleen A. Linehan MD Wynee S. Lou DO Venkat Maganti MD Chandramouli Mandalaparty DO Jisselly McGregor MD Therese G. Mead DO Mohamed Ayman Mohamed MD Dermot D. O'Brien MD

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Hassan H. Beiz MD

Prabhundha Vanasupa MD

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LEGISLATIVE UPDATE Surprise, Out-of-Network Bills Move to the Senate On behalf of MSMS and your specialty, thank you for your help to seek appropriate amendments to the surprise, out-ofnetwork billing legislation. Because of your advocacy efforts, the physician community was able to see a form of arbitration included in the language, and the average contracted rate is now based on geographic region and specialty.

Unfortunately, the arbitration is very narrow, and the average contracted rate remains a mystery.

Among those who testified Wednesday, June 24, were MSMS President S. Bobby Mukkamala, MD (Genesee); MSMS Board member Thomas George, MD (Kalamazoo); and MSMS member and Michigan Council of Emergency Physicians President Warren Lanphear, MD (Kent).

Julie Novak, MSMS Chief Executive Officer, issued this statement after the vote was taken late that evening: “As frontline health care workers continue to battle the impact and ongoing threat of the COVID-19 pandemic, the State House returned to Lansing tonight [Wednesday, June 24] to pass a bill written by health insurance companies and their executives at the expense of local physicians and their patients. The physician community stands with Michigan patients against out-ofnetwork bills and has proposed a fair process that removes the patient from being caught in the middle, while providing for an equitable dispute resolution process. Instead, the one-sided legislation completely eliminates a physician’s ability to negotiate with the biggest insurance companies in the state. Make no mistake, physician practices will close, and patients will lose access to care as a result.”

The Votes Taken on Wednesday, June 24: HBs 4459, 4460, 4990 and 4991 moved out of House Ways and Means with nine yes votes and two pass votes (Representative Warren and Griffin passed).

The bills then were moved to the House Floor and were just voted out that night, nearly unanimously. Five Representatives voted no on HB 4459, the bill we fought hardest against which contains the fee schedule and arbitration.

With so many votes in favor of the bill, that tells us that if these bills get a vote, the bills will pass. It is a very popular issue for the general public. Practically, that means we need to work hard in the next few weeks to educate members about why these bills harm health care heroes and patients, and we will need your continued help.

Future Advocacy: The bills now move to the Senate and will either be referred to the Senate Insurance Committee or the Senate Health 24

The Bulletin | Summer 2020

Policy Committee. There is a lot of work to do in the Senate in the coming weeks to educate members and make sure the physician's voice is heard. Over the coming weeks, MSMS and our county medical society partners will build on all of your efforts and recruit more of you to join these efforts. Please, feel free to get the word out that we need more boots on the ground.

If the bills get a vote in the Senate Committee, they will then be sent to the full Senate for a vote by the 38 members of the Senate. If they pass the full Senate, they would be sent on to the Governor for signature. By no means is this fight over.

How To Have the Biggest Impact: As part of our advocacy efforts, we also need to build up MDPAC contributions. In addition to the time you have spent educating your elected officials, MDPAC is the greatest tool we have to make sure the physician voice is heard. If you haven’t already donated this year, a contribution of $250 today could be significant in making sure we get the attention of those who are voting to determine the future of medicine.

Please donate by visiting http://MDPAC.org/Donate.

Senate Concurs with SB 899 to Provide Immunity Protection to Physicians and Other Healthcare Professionals Due to COVID-19 In the third week of July, the Michigan House of Representatives passed a revised version of SB 899 which ensures physicians and other health care providers responding to the coronavirus pandemic are provided immunity regarding medical liability while working through these extremely challenging and nearly unprecedented times. The Michigan Senate recently concurred with the legislation, and Senate Bill 899 will be sent to the Governor. CLICK HERE to contact Governor Whitmer today and urge her to support SB 899.

MSMS Lends its Voice to Lawsuit Seeking to Declare Key Elements of Michigan’s New Auto Insurance Law Unconstitutional A broad collection of organizations representing patients and Michigan health care providers are speaking out about the dangers of Michigan’s new auto insurance law through legal channels. With a major hearing set shortly in a lawsuit seeking to declare key elements of Michigan’s new auto insurance law unconstitutional, six Michigan associations representing tens of thousands of members have filed friend-of-the-court briefs (amicus briefs) in support of an 18-count lawsuit entitled Andary et al v. USAA Casualty Insurance Company et al. CLICK HERE to read more.

REIMBURSEMENT ADVOCATE ALERT HHS Releases Additional Provider Relief Funding to Medicaid and CHIP Providers On June 9, 2020, the Department of Health and Human Services (HHS) released information on additional funds targeted to Medicaid and Children’s Health Insurance Program (CHIP) providers through the Provider Relief Fund. This funding is available as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The Michigan Department of Health and Human Services (MDHHS) is providing a summary of the program and encourages eligible Medicaid providers to apply for this additional funding opportunity. Medicaid providers are eligible to apply for the Medicaid funds if they meet ALL of the following criteria: • Must not have received payment from the $50 billion General Distribution.

• Must have directly billed Medicaid for healthcare-related services between January 1, 2018 - December 31, 2019.

• Must have provided patient care after January 31, 2020.

• Must not have permanently ceased providing patient care directly or indirectly through included subsidiaries.

• Must have either filed a federal income tax return for fiscal years 2017, 2018 or 2019 or be an entity exempt from the requirement to file a federal income tax return, and have

no beneficial owner that is required to file a federal income tax return (e.g. a state-owned hospital or healthcare clinic).

• If the applicant is an individual, have gross receipts or sales from providing patient care reported on Form 1040, Schedule C, Line 1, excluding income reported on a W-2 as a (statutory) employee.

Additional information including the application process can be found HERE. Please contact Stacie Saylor at ssaylor@msms.org or 517-336-5722 for questions or concerns.

Health care professionals are not immune to substance abuse or mental health disorders. Many otherwise highly qualified professionals may develop these problems due to stress, long hours, a genetic predisposition, or a tendency to self-medicate.

To assist health care professionals impaired by these disorders, consider the care monitoring services of the Health Professional Recovery Program (HPRP).

The Michigan HPRP was established by legislation in 1993 to assist impaired professionals before their actions harm a patient or damage their careers through disciplinary action.

Any licensed or registered health care professional in the State of Michigan is eligible to participate in the program.

To maintain participant confidentiality, the HPRP is operated by a private-sector contractor under the authority of the Health Professional Recovery Committee (HPRC), a committee comprised of a representative from each of the health professional licensing boards. The Michigan Department of Community Health, Bureau of Health Professions provides administrative services to the HPRC.

Participation in the HPRP is confidential. If a licensee/ registrant is referred to the program, has a qualifying diagnosis and complies with the HPRP requirements, his/her name will not be disclosed to state regulatory authorities or the public.

Provided there is no readmission, records of HPRP participants are destroyed five years after successful completion.

Referrals to the HPRP may come in the form of a self-referral from a licensee/registrant or from colleagues, partners, employers, patients, family members or the State. Any of the 20 health professional licensing boards may also refer licensees/registrants to the HPRP for monitoring as a condition to regain or retain their license to practice. The names of individuals reporting a licensee/registrant suspected of impairment are also kept confidential.

For more information on the HPRP, call 1-800-453-3784 or visit www.HPRP.org. Informational presentations on the HPRP are available to employers and health professional groups at no charge. Call the toll-free number to arrange a presentation at your facility.

COVID-19: Payer Policy and Telehealth Updates MSMS has been closely following payer policies as related to COVID-19 and telehealth. The information is current as of July 9, 2020, and is a comprehensive guide that provides COVID telehealth reimbursement policies, as well as any published expiration dates.

As always, MSMS recommends practices consult the individual health plan websites regularly for changes. Click HERE to review the complete guide.

Please contact Stacie Saylor at ssaylor@msms.org or 517-336-5722 for questions or concerns.

TO MAKE A REFERRAL OR SELF REPORT, CALL 1-800-453-3784 The Bulletin | Summer 2020 25

MDHHS and the Child Lead Poisoning Prevention Program (CLPPP) are looking for provider input to guide strategies for decreasing lead poisoning in children, especially in our most vulnerable communities. Many of us know that lead is a powerful neurotoxicant and elevated blood lead levels (EBLLs) can result in damage to the brain and nervous system, as well as, developmental delays in children. Eliminating EBLLs among children is one of the U.S. national health objectives.

The CDC Advisory Committee on Childhood Lead Poisoning Prevention is updating recommendations for improving blood lead screening and information for health-care providers, state officials and others interested in lead-related services. Because state and local officials are more familiar than federal agencies with local risk for EBLLs, CDC recommends that these officials have the flexibility to develop blood lead screening strategies that reflect local risk for EBLLs rather than provide universal screening to all children. State and local officials should target screening toward specific groups of children in their area at higher risk for EBLLs. MDHHS’s CLPPP is working to launch a statewide survey for Michigan’s medical providers. The goal of this survey is to establish a baseline of current blood lead risk screening procedures and to define the following: 1. What percentage of medical providers are currently universally screening for blood lead exposure?

2. What percentage of medical providers are using targeted screening for blood lead risk?

3. What criteria are being used to target high risk populations (ZIP code characteristics, proximity of

residence to factory where lead is used, age of residence, etc.)?

4. Are physicians familiar with and regularly using the Michigan recommendations for screening and testing at-risk children?

5. What barriers may be prohibiting medical providers from instituting more targeted screening efforts (technological, or otherwise)?

MDHHS’s CLPPP is interested in assessing the barriers to blood lead risk screening, blood lead level testing, and blood lead level test result submissions to the Child Lead Poisoning Program’s Surveillance System with the ultimate goal of increasing screening and testing state-wide for at risk populations. We are asking for wide spread participation through a multitude of methods. All information captured will be kept private and will not be shared outside our organization (Altarum) or MDHHS (Child Lead Poisoning Prevention Program) . Survey responses may be anonymously submitted, many questions are optional, and survey time is estimated between 1-2 minutes.

Survey responses will be captured electronically through a web form HERE. The results of this survey will provide insight and further strategies to 1) improve screening rates of children at risk for EBLLs; 2) develop surveillance strategies that are not solely dependent on BLL testing; and 3) assist the state with their evaluation of provider access to screening questionnaires.

Caduceus Meeting for Recovering Health Care Professionals Third Thursday of each month at 7 p.m. | Zion Lutheran Church | 454 7th Street, Freeland, Michigan (Behind Pat’s Grocery Store on Midland Road in Freeland)

Caduceus meetings are available to health care industry professionals, and have adopted many of the principles of 12-Step programs.

Caduceus meetings are “closed” meetings for recovering health care professionals including, but not limited to, nurses, doctors, dentists and pharmacists.

We engage in group discussions where members may want to speak up, ask questions or share thoughts with fellow members.

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The Bulletin | Summer 2020

Licensing and Certification Requirements During State of Emergency On Monday, July 13, 2020, the Governor signed Executive Order 2020-150 regarding licensing and certification requirements and rescinded Executive Order 2020-61 which was previously relied upon for guidance in this area. The new Executive Order remains in effect until any state of emergency or disaster related to the COVID-19 pandemic ends. Currently, the state of emergency is scheduled to end on August 11, 2020.

While some provisions of EO 2020-61 were continued in EO 2020-150, many provisions were not and are, therefore, no longer in effect. We would encourage you to read both the new and old Executive Orders and note the changes.

Here are some of the key points and changes: • Many scope of practice and supervision exemption provisions that were in EO 2020-61 have been removed in EO 2020-150 and are no longer in effect. Since these changes were immediate and understanding the problems this may cause for providers, the Department of Licensing and Regulatory Affairs (“Department”) will give providers through 11:59 p.m. on August 31, 2020, to return to normal order. If the Bureau of Professional Licensing (BPL) receives any complaints covering the timeframe under EO 2020-61 through August 31, 2020, related to scope, supervision and delegation concerns, the BPL will review each complaint on a case by case basis as it has throughout the pandemic.

• The provision under EO 2020-150 allowing those licensed and in good standing in other states or territories to practice in Michigan without a Michigan license has been removed. However, they still may fall under the exemption from licensure provision under MCL 333.16171: BPL Clarification: Exemption of Michigan Licensure Time of Disaster/State of Emergency. Generally, this provision of the Public Health Code allows for licensees in good standing from other states to practice in Michigan under this type of emergency situation.

• Executive Order 2020-150, continues to allow the Department to waive an exam as a condition of licensure for health professions “to the extent that the exam’s administration has been canceled while the emergency declaration is in effect.” o As noted on our web page (michigan.gov/bpl), individuals who applied after 12 a.m. on July 2, 2020, or thereafter, where the entity offering the exams is scheduling exams, those professions and applicants will not be eligible for an exam waiver. Those who

applied prior to that date where the exam was waived, will need to meet all the other requirements for licensure in order to be approved to receive a license. o More information can be found in this document: Examination Waiver Guidance.

• Executive Order 2020-150 continues to allow the Department to waive continuing education requirements as part of the renewal process for health professionals. This provision only applies to individuals whose license renewal period occurs while the emergency is in effect. To take advantage of this provision, individuals may want to renew as soon as their license renewal period occurs during the state of emergency.

Again, the state of emergency is currently scheduled to end on August 11, 2020.

• While not addressed in any current Executive Orders, Executive Order 2020-82 allowed the Department to recognize hours worked by health professionals responding to the COVID-19 pandemic as hours toward continuing education courses or programs required for licensure. Since EO 2020-82 was rescinded, the Department will recognize hours worked responding to COVID-19 between March 17, 2020, and June 9, 2020, as continuing education hours at your next renewal, even if that renewal is after the emergency ends. In other words, the hours need to be accumulated during the license cycle you are renewing.

• Please note all Michigan health professionals are still required to renew their license before the expiration date. No Executive Order waives the license requirement and as such, licensees will want to continue to renew on-time or during the 60-day late renewal grace period.

• Additionally, the provision allowing those licensed and in good standing in another country is not included in EO 2020-150. If an individual was granted a license under this provision, the license will be valid for the duration of the state of emergency.

Again, we encourage you to review both the old and new Executive Orders for a complete understanding of the changes and differences. Thank you for your partnership during this very challenging time for the State of Michigan.

Sincerely, Bureau of Professional Licensing The Bulletin | Summer 2020 27

Hope

By Louis L. Constan, MD

S

tressed as you are these days, you may, on occasion, scan the local media for signs that someone is actually doing something to alleviate the shortterm, or to prevent the long-term suffering that your hometown is undergoing. And, added to the burdens of dealing with an already sick medical care system, this current crisis may seem quite unbearable to you.

But, rest assured. The very same initiative, THRIVE, of which I have been writing for more than a year, offers a framework and a comprehensive plan for getting the economy and the medical community on a path to a brighter future, even thru the pandemic. It is the very same plan that was developed for “Transforming Health in a Thriving Economy,” though recently modified, to place greater priority and emphasis on items of greatest need in these challenging times.

So then, the next time you find yourself frustrated beyond reason over one of the following impediments to the care of a patient, or to your practice of Medicine in general, instead of throwing up your hands in despair and crying: “Why doesn’t somebody do something about this,” you may want to read on: • Information Black Holes. You know this one well. Your patient has recently been to the ER or had a test at another institution, but there’s no way you’ll ever get the reports quickly enough to help you make a clinical decision in the here-and-now. THRIVE, aligned with national initiatives and regional partners, aims to make sure information is more easily available in real time and that information technology is working for us all, including patients.

• Your patient in the hospital got the wrong medicine, wrong treatment, wrong test…take your pick. We know that about 360 hospital error-related deaths occur each year in our region. Any way you look at this, it must end.

The THRIVE Patient Safety Task Force composed of leaders of the regional health systems, aims to reduce the number to zero.

• Doctors are burning out. Maybe you. Maybe your colleague. Why isn’t anybody paying attention? Society should never accept a casualty rate amongst the heroes (that’s us) who work to heal the sick. THRIVE places a

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priority on provider burnout and resilience. With regional partners, THRIVE aims to use assessments, including surveys of doctors working within organizations, and then explore system changes with expert resources shared with practices so that they can improve the working conditions of their doctors. About time.

• What’s with all this competition between hospitals, healthcare systems, providers up and down the scale?

The endless advertisements everywhere? What a waste!

THRIVE will focus on reducing duplication of efforts, especially in hospitals and in medical education.

University and Health Systems should be working together to provide efficient health care!

• Why doesn’t anybody do preventive healthcare anymore?

THRIVE has plans for revived screening and treatment programs for depression, suicide, opiate addiction and anxiety.

• Whatever happened to Public Health? THRIVE aims to improve the basic health and welfare of our community starting with prenatal and parenting classes; then on to nurse home visits, moving to support for at-risk youth; on to job training; then financial literacy training; even to nutritional training and transportation improvements so that everyone has access to well-paying job opportunities!

A healthier community; medically, psychologically, economically…it’s what we all want. It’s what we all need.

Although this seems like a lot, it is actually just a part of THRIVE’s plans. There’s more, much more. Tune in next time.

The very same initiative, THRIVE, of which I have been writing for more than a year, offers a framework and a comprehensive plan for getting the economy and the medical community on a path to a brighter future, even thru the pandemic.

Six Ways to Address Physician Stress During COVID-19 Pandemic Physicians and other health professionals are desperately needed during the global response to the COVID-19 pandemic. These individuals also represent one of the most at-risk populations for acquiring COVID-19. However, they face another risk - added stress. During these trying times, it is important to keep well-being in mind and address stress.

The AMA and the Centers for Disease Control and Prevention (CDC) are closely monitoring the COVID-19 global pandemic. Learn more at the AMA COVID-19 resource center and consult the AMA’s physician guide to COVID-19.

“The impact of COVID-19 is overwhelming,” said AMA member Mark Linzer, MD, director of the Institute for Professional Work Life at Hennepin Healthcare and professor of medicine at the University of Minnesota in Minneapolis.

“Everybody's wrestling with what's happening and what we can best do to take care of it. I am so overwhelmingly grateful to be part of this medical community,” said Dr. Linzer. “I have so much admiration and just exceptional gratitude for what our community is doing in this crisis.”

While the COVID-19 pandemic is changing by the hour, Dr. Linzer took some time to explain how to address physician stress while responding to COVID-19.

Pay attention to basic needs In times of crisis and stress, sometimes basic needs go out the window, including food, water, safety and sleep. For example, when physicians work 14- or 16-hour days, they may not think about these basic needs. Instead, they might realize they haven’t performed any in the last eight hours, said Dr. Linzer.

“Nobody's regulating well-being at all. It's just everybody's job to figure out how to get it done, and a physician's natural tendency is not to think about that very much,” he said, adding that it is important to “start with basic needs, which is sleep, hygiene, food, water, healthy snacks, coffee. Pay attention to the basic needs of the people who are working harder than before,” said Dr. Linzer.

Watch number of hours worked Health systems should pay attention to the number of hours physicians are working and make sure they receive breaks.

“The workload is markedly escalating and it's escalating in a very unusual way,” said Dr. Linzer. While Dr. Linzer is seeing fewer patients in the clinic, he is still fielding calls and messages to review and reassure them. And with a week of attending on the wards coming up soon, providing breaks and paying attention to hours worked can help balance the workload and reduce risk of burning out.

Share mental health support During this time, it is also vital that health systems and physicians do not lose sight of mental health support. “People need to know about the effects of acute and chronic stress and

how to alleviate it, whether it's pushing resilience, meditation or counseling,” said Dr. Linzer. “People need lists of mental health resources because this is going to get harder before we stabilize it.”

Compassion and empathy from leadership There is a common fear of acquiring COVID-19 and giving it to family members, loved ones or colleagues. Additionally, there is also “overwhelming information overload. I now may get 50 emails a day related to this, all of which are high-profile must read,” said Dr. Linzer, adding that a lot of physicians are unsure about “what is required and doing things that are not easy to understand, and the consequences of not getting it right feel pretty severe.”

This is where leadership in clinics, hospitals and health systems can step up and help. Leadership should continue to show compassion and empathy about what it’s like to be on the front lines, and acknowledge these fears that can impact physician stress and well-being.

Distribute workweeks effectively There may be instances when physicians or other health care workers are sent home to watch well children because schools are closed. This might also occur if someone has been exposed to a patient with COVID-19 but is feeling fine and must work from home. When this happens, workload redistribution can help. This means “the clinicians at home can manage electronic in-basket work for the patients while the people in the hospital can manage the sick people,” said Dr. Linzer.

Maintain a culture of wellness Throughout the response to COVID-19, health systems and hospitals must look at how to maintain a culture of wellness.

This can be accomplished by including leaders in the wellbeing needs of physicians. They can help reduce stress in the clinicians, and the system must also watch out for the leaders’ needs to refresh and sustain.

For example, Dr. Linzer received an email from his CEO about the COVID-19 response, which was supportive of the work being done and how important it is right now. It was marvelous. “Leader burnout was very high before we got to this, but right now I can’t imagine what our leaders are going through,” said Dr. Linzer. “They need to talk about cross training, rotating leadership just like airline pilots and forced time away from the office.” “This is going to be fully consuming for months and it could be many months. This needs to be the long haul, not a short one,” he said.

New measures of stress will be forthcoming and will include one that is targeted at coping with the COVID-19 crisis.

Sara Berg, Senior News Writer, AMA The Bulletin | Summer 2020 29

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BENEFITS OF SCMS/MSMS

MEMBERSHIP T he Saginaw County Medical Society (SCMS) is the professional association of physicians in Saginaw County, and a component of the Michigan State Medical Society (MSMS). In order to be a member of one, you must be a member of both.

I have been asked many times by both members and nonmembers “Why should I belong to the SCMS and MSMS?” “What do you do for me?” Some have responded they “don’t use their membership because they don’t attend SCMS meetings.” SCMS and MSMS membership is so much more than membership meetings. We are not only support for you, but for your office staff as well. I’m hoping the information below will help members who are on the fence about paying their dues decide to remain members, and also convince nonmembers why they should belong. We represent physicians in all specialties and in all types of practices – solo, group, employed, etc. Active membership is open to MDs and DOs. • Active physician dues are $795 per year ($495/MSMS and $300/SCMS). One hundred percent of SCMS dues and 87 percent of MSMS dues are tax deductible as a business expense.

• The SCMS offers a discount for first year physicians, and MSMS offers discounts for first, second and third year physicians, as well as, physician spouses when both are members.

• Resident and medical student memberships are also available.

What We Offer SCMS Members and Their Staff: • Five Membership Meetings per year where our members have an opportunity to network and enjoy the camaraderie of fellow physicians who love the practice of medicine and want to see progress made in the Saginaw medical community. In addition, our meetings include interesting speakers and an opportunity to earn FREE CME credit. A few recent and future program topics include: - Surviving Acts of Violence - Physician Resiliency - Ethics - Suicide Awareness Training - Human Trafficking - Second Victim - Implicit Bias - What to do if a complaint - Opioids has been filed against you • Representation of physicians in all specialties and in all types of practices–solo, group, employed, etc.

• Communication and camaraderie with physicians of other specialties in a neutral setting.

• Liaison with MSMS for assistance on practice issues, billing and coding, health information technology, legal alerts, legislative issues, insurance and much more.

• An independent voice for physicians on issues they face at the hospitals.

• The Bulletin with articles and information pertinent to SCMS members and their staff.

118 Years of Caring for Saginaw County Residents Joan M. Cramer, SCMS Executive Director

• Pictorial Membership Directory is published annually and used by members and their staff on a regular basis.

Our Private Directory provides information on your practice to other member physicians outside your specialty. In addition, a Public Directory that includes office address and phone (but not fax numbers or email) is printed and distributed to 1,000+ households in Saginaw County. The response from the public on this listing of SCMS physicians has been extremely positive.

• Website which is full of useful information and resources www.SaginawCountyMS.com.

• Referrals to patients seeking a physician.

• Contact with local, state and federal legislators regarding issues of importance in Saginaw County.

The SCMS maintains contact with local legislators to provide issue education and help them understand the impact of healthcare legislation.

• A unified voice on medical issues to our legislators, our area hospitals, insurance companies, etc.

• Political activism in support of medicine-friendly candidates.

• Loans and scholarships to local medical students, residents and nursing students.

• Community service to actively and tangibly give back to the community where you live and work through SCMS sponsored projects, such as our annual Health Fair for the Saginaw community attended by 1,100+ offering free health screenings and information, plus the opportunity for residents to speak with our member physicians directly to answer questions and promote your practice.

• An active Peer Review Mediation Committee to provide a forum for patient complaints to be heard. Peer Review reduces the number of malpractice lawsuits.

• An active Peer Review Ethics Committee for physician to physician issues.

• Confidential assistance for members with substance abuse or personal issues affecting their practice of medicine.

• And more!

WHY PAY DUES? • Because all physicians need to “fund their voice.”

• National polls show physicians as one of the most respected professions. Sadly, they don’t use their clout often enough to preserve their profession and protect their patients.

• There is strength in numbers. Together we are stronger.

If you or your office staff need assistance on an issue of any kind, please feel free to contact me at jmcramer@sbcglobal. net, (989) 790-3590 (office) or (989) 284-8884 (cell) and I will work with you to come up with a resolution for your problem through a variety of resources available to you as a SCMS/ MSMS member.

SERVING ALL SPECIALTIES AND SOLO, GROUP AND HOSPITAL EMPLOYED PHYSICIANS SINCE 1902 Visit www.SaginawCountyMS.com for a Membership Application under the “Membership” tab

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CANCELLATION OF SCMS MEETINGS AND EVENTS Due to COVID-19, the SCMS has cancelled the September and October Membership Meetings. The Board will evaluate the state of the pandemic later this fall, and hopefully decide when we will start meeting again.

All statements or comments in The Bulletin are those of the writer, and not necessarily the opinion of the Saginaw County Medical Society.

The April Membership Meeting program, "Physician Compassion Fatigue� to be presented by Molly E. GabrielChampine, PhD, LP, Director of Behavioral Science, Family Medicine Residency at McLaren Bay, will be rescheduled in 2021.

The 16th Annual Health Fair postponed in March will not be rescheduled in 2020. We do not feel it is in the best interests of the public who attend (many of whom have multiple medical conditions), our vendors, members and staff to bring together a large group of people since it is believed there will be waves of COVID later this year.

Board meetings for the immediate future will be held virtually.

Joan Cramer/SCMS | Office 790-3590 | Fax 790-3640 | Cell 284-8884 | jmcramer@sbcglobal net | www.SaginawCountyMS.com