2022 - Mar/Apr - SSV Medicine

Sierra Sacramento Valley Serving the counties of El Dorado, Sacramento and Yolo

March/April 2022

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Sierra Sacramento Valley

MEDICINE 4

12

Making Policy Means Hearing All Voices

Ryan Spielvogel, MD

PRESIDENT’S MESSAGE

Letting Go: A Physician’s Tale of Medical Aid in Dying

Paul Reynolds, MD

6

EXECUTIVE DIRECTOR’S MESSAGE

Leading the Way By Standing Behind You

Aileen Wetzel, Executive Director

8

16

The Beat of the Patient Polet Loynaz, MS I

19

2021 SSVMS Annual Report SSVMS Staff

24

Another Tough Year…

But Important Wins for Physicians

Elizabeth McNeil, CMA Vice President of Federal Government Relations

27

Board Briefs

We welcome articles from our readers by email, facsimile or mail to the Editorial Committee at the address below.

Authors will be able to review articles before publication.

Letters may be published in a future issue; send emails to SSVMedicine@ssvms. org.

All articles are copyrighted for publication in this magazine and on the Society’s website. Contact the Sierra Sacramento Valley Medical Society for permission to reprint.

28

New SSVMS Members

The Tragic, the Blissful and the Messy

Visit Our Medical History Museum 5380 Elvas Ave. Sacramento The museum is gradually reopening.

Visit our website at ssvms.org/museum for updates and virtual events.

Caroline Giroux, MD

VOLUME 73/NUMBER 2 Cover photo: A vineyard on a late spring afternoon near Clements in San Joaquin County.

Photo by Mark Finan

Official publication of the Sierra Sacramento Valley Medical Society

5380 Elvas Avenue Sacramento, CA 95819 916.452.2671 916.452.2690 fax info@ssvms.org

SSV Medicine is online at www.ssvms.org/Publications/SSVMedicine.aspx

March/April 2022

1

Sierra Sacramento Valley The Mission of the Sierra Sacramento Valley Medical Society is to bring together physicians from all modes of practice to promote the art and science of quality medical care and to enhance the physical and mental health of our entire community.

2022 Officers & Board of Directors

Paul Reynolds, MD, President J. Bianca Roberts, MD, President-Elect Carol Burch, MD, Immediate Past President District 1 Jonathan Breslau, MD District 2 Adam Dougherty, MD Judith Mikacich, MD Susan Murin, MD Vanessa Walker, DO District 3 Ravinder Khaira, MD

District 4 Shideh Chinichian, MD District 5 Christina Bilyeu, MD John Coburn, MD Farzam Gorouhi, MD Roderick Vitangcol, MD District 6 Marcia Gollober, MD

2022 CMA Delegation District 1 Reinhardt Hilzinger, MD District 2 Lydia Wytrzes, MD District 3 Katherine Gillogley, MD District 4 Anand Mehta, MD District 5 Sean Deane, MD District 6 Marcia Gollober, MD

District 1 Alternate Tanuja Raju, MD District 2 Alternate Janine Bera, MD District 3 Alternate Toussaint Mears-Clark, MD District 4 Alternate Shideh Chinichian, MD District 5 Alternate Joanna Finn, MD District 6 Alternate Natasha Bir, MD

At-Large Delegates R. Adams Jacobs, MD Barbara Arnold, MD Megan Babb, DO Jonathan Breslau, MD Carol Burch, MD Amber Chatwin, MD Angelina Crans Yoon, MD Mark Drabkin, MD Rachel Ekaireb, MD Gordon Garcia, MD Ann Gerhardt, MD Farzam Gorouhi, MD Richard Jones, MD Steven Kmucha, MD Sam Lam, MD

Charles McDonnell, MD Leena Mehta, MD Sandra Mendez, MD Taylor Nichols, MD Tom Ormiston, MD Sen. Richard Pan, MD Neil Parikh, MD Hunter Pattison, MD Paul Reynolds, MD Ernesto Rivera, MD J. Bianca Roberts, MD Ajay Singh, MD Lee Snook, MD Tom Valdez, MD John Wiesenfarth, MD

At-Large Alternates Brea Bondi-Boyd, MD Christine Braid, DO Lucy Douglass, MD Karen Hopp, MD Arthur Jey, MD Justin Kohl, MD Vong Lee, MD

CMA Trustees, District XI

Adam Dougherty, MD

AMA Delegation Barbara Arnold, MD

Editorial Committee

Scarlet Lu, MD Derek Marsee, MD Taylor Nichols, MD Ashley Rubin, DO Alex Schmalz, MD Ashley Sens, MD Rishi Sikka, MD Asmaneh Yamagata, MD Robert Oldham, MD Margaret Parsons, MD Sandra Mendez, MD

Megan Babb, DO Sean Deane, MD Caroline Giroux, MD Robert LaPerriere, MD Karen Poirier-Brode, MD

Gerald Rogan, MD Kayla Umemoto, MS II Michelle Ann Wan, MS III Lee Welter, MD Eric Williams, MD James Zhou, MS II

Executive Director Managing Editor Webmaster

Aileen Wetzel Ken Smith Melissa Darling

2

Sierra Sacramento Valley Medicine

HOSTED BY LOCAL PHYSICIANS

Listen and subscribe to Joy of Medicine - On Call on your favorite Podcast App or visit joyofmedicine.org

Sierra Sacramento Valley Medicine, the official journal of the Sierra Sacramento Valley Medical Society, is a forum for discussion and debate of news, official policy and diverse opinions about professional practice issues and ideas, as well as information about members’ personal interests.

Advertising rates and information sent upon request. Acceptance of advertising in Sierra Sacramento Valley Medicine in no way constitutes approval or endorsement by the Sierra Sacramento Valley Medical Society of products or services advertised. Sierra Sacramento Valley Medicine and the Sierra Sacramento Valley Medical Society reserve the right to reject any advertising.

Opinions expressed by authors are their own, and not necessarily those of Sierra Sacramento Valley Medicine or the Sierra Sacramento Valley Medical Society. Sierra Sacramento Valley Medicine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. Not responsible for unsolicited manuscripts. ©2022 Sierra Sacramento Valley Medical Society SIERRA SACRAMENTO VALLEY MEDICINE (ISSN 0886 2826) is published bimonthly by the Sierra Sacramento Valley Medical Society, 5380 Elvas Ave., Sacramento, CA 95819. Subscriptions are $26.00 per year. Periodicals postage paid at Sacramento, CA and additional mailing offices. Correspondence should be addressed to Sierra Sacramento Valley Medicine, 5380 Elvas Ave., Sacramento, CA 95819-2396. Telephone (916) 452-2671. Postmaster: Send address changes to Sierra Sacramento Valley Medicine, 5380 Elvas Ave., Sacramento, CA 95819-2396.

| FEATURED CONTRIBUTORS |

Paul Reynolds, MD

Caroline Giroux, MD

Developing policy, both at SSVMS and CMA, is a robust process that not only has opportunities for your input but encourages it, Dr. Reynolds writes. Here's how you can get involved in key issues.

Life can be, and often is, messy. Dr. Giroux is constantly awed at how victims of trauma use humor to heal. Getting through the absurdities of life can be easier, she says, if you don't take yourself too seriously.

paul.d.reynolds@kp.org

cgiroux@ucdavis.edu

Ryan Spielvogel, MD

spielrm@sutterhealth.org

Patients who choose medical aid in dying aren't choosing between life and death, Dr. Spielvogel says, because their time is up.

The End of Life Option Act enables them, and their families, to avoid suffering.

Serving More Than 6,500 Physicians

in the Sacramento Region

2021 Annual Report

Polet Loynaz, MS I

psloynaz@ucdavis.edu Just after her first SSV Medicine article appeared, Polet's life took an unexpected turn: a rare but benign brain tumor. Two surgeries later, she recounts the awesome and surreal days of treatment.

Elizabeth McNeil

2021 SSVMS Annual Report

Elizabeth McNeil is CMA's Vice President of Federal Government Relations. She provides a look back at what CMA fought for and accomplished in Washington, D.C. over the past year.

Vaccine clincs. Advocating for telehealth services and making PPP loan forgiveness tax-free in California. Thousands of dollars in scholarships and donated services. It was all part of another busy year at SSVMS.

emcneil@cmadocs.org

Prepared by SSVMS Staff

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to SSVMedicine@ssvms.org.

March/April 2022

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| PRESIDENT’S MESSAGE |

Making Policy Means Hearing All Voices

How the Process Works and How You Can Participate

W

e sometimes have members reach out to us about why CMA has taken a particular position for or against a bill in the Legislature. They also ask why SSVMS is deferring to the CMA, especially if they disagree with the position CMA takes, and question if our members were polled on the subject.

They’re good questions, and both answers involve the process that is used to build a unified stance on sometimes contentious issues before the Legislature.

It’s true that we don’t poll members on individual bills.

Instead, CMA develops policy through a robust statewide process that allows everyone, including SSVMS members, the opportunity to express their opinions to help shape cohesive political, legislative, regulatory, legal and economic policies reflective of views held by physicians across the state. Each policy is crafted and reviewed by physician members, then voted on by elected physician representatives and adopted by the House of Delegates and Board of Trustees.

Our primary goal as a local medical society is to serve you, the physicians in our area, by offering support for your practices and helping you face the daunting challenges in medicine today. But SSVMS is allocated 38 delegates and 38 alternates to the CMA who can convey our views and ask it to address policy issues specific to our region. Those delegates debate and communicate positions that have been vetted through the work of SSVMS committees that address subjects including public health, emergency care and health equity.

SSVMS also sends trustees to the CMA House of Delegates as a member of District XI, which encompasses eight Northern California medical societies and is the largest delegation in the CMA. The House of Delegates is where physicians from across the state meet to discuss positions on key issues, offer amendments to policy proposals, elect CMA officers, and — hopefully — reach a consensus that allows the medical community in California to speak with a united voice.

At its House of Delegates, much of the discussion 4

Sierra Sacramento Valley Medicine

By Paul Reynolds, MD paul.d.reynolds@kp.org

among delegates is on what CMA calls “Major Issues.”

Last year, the topics were the corporatization of health care and on how racism and other factors affect health equity. CMA says its policy is most effective when it is specific enough to stand alone and be understood and it is written in a way that enables the orgainization to use the values and intent for a wide range of advocacy purposes.

There is also another avenue you can take to help make policy. Any CMA member in good standing can author a resolution for consideration. For example, you could introduce a resolution in support of additional measures for patient safety. Last year, our delegates offered a resolution to support a change in California’s pharmacy laws to permit hospitals to supply medications to patients when they are discharged.

SSVMS is allocated 38 delegates and 38 alternates to the CMA who can convey our views and ask it to address policy issues specific to our region.

Once the resolution is written and in the proper format, you’ll need someone to introduce it. That person can be a delegate or alternate to the House of Delegates, a component medical society/delegation (such as SSVMS), a CMA section or mode of practice forum, the CMA Board of Trustees, or a CMA-recognized specialty society. Don’t know who to ask? Contact us at SSVMS and we’ll help you identify the most appropriate channel to get your resolution heard.

There are three submission deadlines throughout the year. The next deadline is April 20, 2022.

Approximately one month following the submission deadline, the resolution will be opened for thirty days to the House of Delegates and alternates to collect testimony and analyze it from as many angles as possible.

From there, the resolution is referred to the appropriate body — such as the CMA Council on Science and Public Health — for review and a recommendation

Once your proposal has had a recommendation attached to it, it’s ready for public comment. For approximately two weeks, your fellow CMA members will voice their support or express their concerns. The Board of Trustees will then meet to take everything that has been learned through the process and vote in support or in opposition to your resolution. This is when you discover whether your proposal was successful or not.

If your resolution passes, it becomes a policy that CMA fights for. Even if the Trustees vote it down, it still means the issue has been listened to, examined, and given consideration. In some cases, a proposal might be supported in concept but need more fleshing out or have problems that can be addressed in an improved version.

Whether it’s through the joint efforts of our Board of Directors and delegations to find a consensus on a resolution that goes through the process, the bottom line is that it allows the CMA advocacy team to speak with legislators and regulators knowing that it is representing what the majority of its members want. Not everyone

will agree, and that’s OK; the best ideas are developed through hearing different viewpoints, finding where we can agree, and standing together in ways that benefit physicians and their patients.

The bottom line is that it is important for everyone’s voice to be heard and for those voices to represent diverse backgrounds and experiences. You can volunteer to be part of an SSVMS committee, represent our delegation to the CMA House of Delegates, or take other leadership roles within SSVMS. We want you to speak up to help shape the future of medicine in California and across the nation. As the saying goes, “If you’re not at the table, you’re on the menu.” We have plenty of seats waiting for you.

The whole process of policy development is beautiful, frustrating, educational and emotional. It can be daunting, but it's how we make sure all persepctives are heard and that we can face issues that affect you and the future of medicine in California as one unified body.

To learn more about the process, read CMA's “Turning Policy Into Action” at https://tinyurl.com/5c9wys5j.

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March/April 2022

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| EXECUTIVE DIRECTOR’S MESSAGE |

Leading the Way By Standing Behind You

New Benefit Helps You Avoid ADA Lawsuits

S

SVMS has provided the resources necessary for medical professionals and practices to ensure their success for the past 153 years. That comes from listening to our members, identifying and working to solve the problems you face, and providing benefits that add value to your personal and professional lives.

Physician burnout has always been an issue in our profession, but those who faced it often had to do so silently and alone. Recognizing that physicians who had given so much to others had taken so much from themselves led us to create our landmark Joy of Medicine program, through which all local physicians can access wellness services. The program, which has been recognized as a national leader in addressing physician wellness, has grown with the addition of free sessions with psychologists and life coaches, by facilitating peer groups and Balint Groups for physicians to talk about the challenges they face, and through performing research on physician burnout. Visit www.

JoyofMedicine.org to learn more.

When vaccines became available to protect physicians and other providers from the deadly effects of COVID-19, SSVMS quickly made the shots available to you through a vaccine clinic for private practice physicians. We also helped practices get approval and funding to administer the vaccines and provided physicians the resources to address patient questions.

We're also looking ahead to the challenges to access to care. One of our favorite programs is The Future of Medicine, which encourages today’s youth to become the physicians of tomorrow. Now entering its second year, the program provides local high school students from underserved areas with the opportunity to shadow real medical professionals, participate in public health projects and get a taste of a medical career.

We were recently alerted to another issue and are seeking to prevent it from becoming a greater problem.

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Sierra Sacramento Valley Medicine

By Aileen Wetzel awetzel@ssvms.org

Last year, two longtime SSVMS members sharing a private practice were sued under a claim that their website was inaccessible to people with certain conditions covered by the American Disabilities Act (ADA).

The case is currently a legal quagmire and costing the practice time and money.

Over the past several years, a handful of unscrupulous attorneys and “advocates” have sued businesses with claims that their physical locations did not meet ADA requirements. These often minor infractions were used to try to get these businesses to settle for anywhere from a few thousand dollars to much more to avoid a potentially costly legal battle. The state ultimately stepped in to allow time for businesses to remedy these issues, putting some of the scammers out of business.

But now the issue has moved into cyberspace. Medical practices, clinics, and hospitals have been targeted by serial litigators claiming that a disabled patient has been unable to access information about treatment options on the provider's website in violation of the ADA. Any physician can be a target of this kind of litigation and it could potentially be devastating to a practice.

To make sure you have access to the expertise necessary to avoid similar lawsuits, SSVMS has negotiated a members-only discount on services designed to make your website ADA-compliant through an SSVMS partner. Fixes including tools that enable visitors to adjust text size and spacing, manage the contrast, highlight links, or even have text read out loud to accommodate visual disabilities can be made quickly and affordably.

To find out more and receive a 15% off discount code, send us a message at info@ssvms.org.

If you have an idea for a program or service that SSVMS could be offering our members, we’d like to hear about it. Our goal is to take care of you so that you can spend your time where it is needed most: taking care of your patients.

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MEDICINE

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Sponsor a medical student to attend the event!

| OPINION |

The Tragic, the Blissful and the Messy Patients Turn to Humor to Confront Tragedy

I

have had countless opportunities as a physician educator to witness the impact of the harsh culture in medicine on trainees. While supervising students a few years ago, I began to reflect on my own experiences in medical school and realized how overwhelming and shocking some of my rotations had been. At the time, I attributed my intense reactions to my notoriously hypersensitive nature. In other words, I thought it was part of the reality, that I should just push through. But my brain had found a shortcut: becoming numb to the messes of human condition.

Basically, I went through medical training not realizing there was an important, almost universal component of it that I couldn’t name at the time: trauma. A lot of medicine is about hardship, tragedies, despair, worries, life’s unpleasant surprises called accidents, and the diagnosis of crippling or fatal diseases. If it is tragic for a patient, it can directly impact the trainee (such as witnessing death) or act as a form of secondary trauma as we hear the dark stories of personal illness. Hard to comprehend until it hits, it is an indirect trauma experienced from hearing difficult patient narratives and reacting to them (including PTSD manifestations) as if it had directly happened to us.

Behind the scenes, there is also the trauma inflicted by the medical culture itself with its perennial hierarchy, gruesome hours and an epidemic of micro-aggressions.

I experienced my share of that as a female medical student who was also a neophyte about the field and a pioneer in my family as the first one to become a physician. I have kept in touch with recent graduates who tell me that they are currently trying to recover from the trauma endured in residency.

I have offered group therapies for survivors of trauma for about six years, and I have been a trauma psychiatrist for about a decade. You would think I have heard it all, or that by now I would be desensitized. But 8

Sierra Sacramento Valley Medicine

By Caroline Giroux, MD cgiroux@ucdavis.edu

I can still walk away from those sessions in shock at all the intense permutations of injustice, violence and victimization. In a recent group with a new crew, the participants disclosed stories that were challenging to absorb: one experienced trauma from domestic abuse and medical illnesses, another lost a child to murder, a third one grew up with alcoholic parents and a sibling with drug issues so she had to raise her sister’s children, another one is coping with metastatic cancer, a fifth one was sexually assaulted a few times, and another had been sexually abused by a parent who ended up dying by suicide. In the interim, she was repeatedly abused in foster care environments.

It is an understatement to say that my life is not pristine.

But the session, as heavy as it felt, was filled with laughter. I was moved to see all these incredible survivors bond immediately with each other, supporting and validating each other. Early on, they noted that humor — in the form of “trauma memes” — was part of their magic recipe.

“Even my ACE score is 10 because I am such an overachiever. I must always get 100%!” one of them said of her Adverse Childhood Experiences screen. It is all a matter of perspective, right?

I totally applauded that. Looking back, I could relate easily. I have been self-deprecating most of my life and it has become my signature in many of my writings.

Such a catharsis through reclaiming of my narrative has helped me go through frustration, embarrassment or despair, and I believe it helps readers process their own experiences vicariously. It’s just like our brave patients did when they listened to each other that day and knew they were not alone.

Those stories were unique and my trauma stories are not nearly as horrific. But I have had, and still have, my share of moments of tragedy that eventually, with the passage of time, could be made into a comedy if only to prove that life has not taken my sense of humor from me nor my ability to transcend the agonies of daily existence.

It is an understatement to say that my life is not pristine.

For years, as a beginner mother, I was often the target of dirty looks in airplanes or reprimanding phone calls from hotel staff because my very spirited kids were loud and rambunctious. I would easily get pre-fainting pale during a toddler tantrum at a restaurant.

I seem to always choose pasta (with red wine, just as a bonus) when I wear white. Food easily gets stuck in my front teeth. I drool when I sleep during flights.

I mispronounce stuff all the time to an embarrassing degree, like greeting someone I met named Damon by calling him something that sounded more like “demon.”

Just before announcing the prompt of a recent narrative therapy group by sharing (using self-deprecation) a previously embarrassing incident, I inadvertently pulled out what I thought was a tissue from the pocket of my denim vest to blow my nose. Instead, what I brought to my face was a pantyliner.

Although typically a good testtaker my whole life, I failed a driving test in Minnesota after carefully reading the booklet more than once — while my then-spouse passed it without studying. Always at the top of my class in grammar, composition and my native French, I got

something like 47% on a required essay writing test before going to university. The recommendation was to take a semester of French so I could succeed. I didn’t take the class and had a near-perfect score the second time. The initial poor score was seemingly due to polarized philosophical views about punctuation between the corrector and me.

My head is currently so saturated with the catastrophic chapters of my life trajectory that I have scratched my car three times this year by backing into obstacles. I have received so many threatening emails from the EMR police over the past months I am sure I just set a new world record.

My capacity to make fun of myself leads me to picture very vividly as a movie scene (because someday I will turn this into a comedy, or maybe a novel) my astonished stillness while listening to eight pages of rules, read by a captivating

person who seems to have been transported from Hogwarts. I am a soon-to-be professor of psychiatry and mother of 15 years in a custody battle, during which I apparently am not allowed to tell my own children I miss them “too often” because it could induce guilt. Nor can I spoil them too much with presents, I’m told, because it would look like I am trying to buy them. Oh, and the gifts must be in bags, not wrapped, so they can be inspected…

(This is where, in the movie with subtitles, we would read “music becomes ominous.”)

But when the red wine is too good, I can go from laughter to lament, and the thought arises that I could peacefully die in my sleep and leave this absurdity behind.

But darn it, too much wine gives me insomnia!

Life is a messy adventure. And when accompanied, with one’s hand held by another, a big enough one, life can become very blissful.

March/April 2022

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10

Sierra Sacramento Valley Medicine

Even days later, I usually can still feel the giant hand encompassing all love as it is tenderly deposited on my hip or my sacrum. It is holding me all together. Its warmth, light and love envelop my whole being.

The bliss is so strong I feel like a magnet towards this North Pole with five fingers. Or am I the North Pole and the hand is the magnet?

An impulse to go back to visual arts swept me recently after enough tears have been shed to qualify as amniotic waters that broke. Now the baby is ready to come out. There is an outpouring of my love through creativity and laughter therapy as as I fight for the dearest cause of my entire life.

Voilà, this is the mess of life: the tragic, then the blissful, interspersed with the funny and absurd. I am in awe of how patients who have lived through hell to tell their tales, who had so much in them that others filled with envy and driven by an evil ego tried (in vain!) to destroy them, eagerly share their experiences through a well-attuned language based in humor. The last word belongs to the joker, the creator, the narrator, because we are the heroes of our own life’s story, and we can choose to tell the story from an angle that is disturbingly messy or edifyingly funny. The latter illuminates the blissful instead of the tragic, putting the trauma overcomers back at the center of existence so they can thrive while leaving perpetrators on the outskirts of oblivion and unworthiness.

Patients have taught me that tragic messes can be transformed into parody, leading to laughter, a binding force between souls, a vehicle to bliss.

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| PERSPECTIVE |

Letting Go

A Physician’s Tale of Medical Aid in Dying

“G

osh, everyone looks so serious. Anybody know a good joke?” Rena said, looking around the somber room. With effort, a slow, wide smile spread across her face. The tension in the room snapped, and we all chuckled. Rena’s niece and nephew sat around her, and the hospice chaplain stood beside me.

Rena was lying on a couch that I could tell had become her makeshift bed. Her actual bed was down the hall of her double-wide trailer piled high with her life’s belongings. Rena was a hoarder. Newspapers, old vinyl records, pots, TV guides, boxes brimming with office supplies and other sundry items littered the floor.

In the center of it all was the couch that would be Rena’s deathbed. A small clearing around the couch served as our gathering place and gave the ominous feeling of the world closing in.

She had metastatic colon cancer and had steadily declined over the previous month. Everything hurt.

Morphine just made her vomit. It took her a good 15 minutes to get up and go to the bathroom — something she insisted on still doing as she considered the bedside commode “undignified.” However, this past week she began soiling herself. For her, that was the last straw.

Living had become unbearable, and she looked forward to the sweet release of death. After all, Rena had watched her own mother decline and knew that she herself might still linger this way for another month or two — all the while suffering more loss of function, autonomy, and dignity.

She looked at me and said, “I’m ready.” I went to the kitchen and reconstituted the medications with water.

It looked like thick, milky tea. Handing her the cocktail, I made sure with her one last time that this was what she wanted.

“Absolutely. See you on the other side.” Rena’s hands shook as she brought the bottle to her lips and drank it

12

Sierra Sacramento Valley Medicine

By Ryan Spielvogel, MD SpielRM@sutterhealth.org

all down in one go. She breathed a sigh of relief. Her niece and nephew took her hands and held them tightly, their eyes welling with tears. After two minutes, Rena’s eyes closed and she went into a deep sleep. Five minutes later, she stopped breathing. I watched silently from the dusty floor speaker I was using as a chair — anxious to pronounce her but not wanting to interrupt.

Finally, I slipped through to place my stethoscope on her chest, confirming death. A look of serenity and the faintest of smiles stayed on her face the whole time.

The family thanked me for allowing her this option of a quick and dignified death. I offered them my condolences and left.

Driving home through the rain, I kept coming back to that look of peace — haunting yet reaffirming.

Attending a death is a momentous occasion, and no two

Driving home through the rain, I kept coming back to that look of peace — haunting yet reaffirming. deaths are the same. It’s tempting to be analytical about it — to distance yourself emotionally, but that would be doing the deceased a disservice. Instead I try to focus on the sheer gravity of what I just witnessed: Rena’s final moments; the last laugh she ever uttered (in response to my best pirate joke told at her request); the beautiful symbolism of a hoarder finally ready to let go. And it is just that: beautiful.

But not all deaths are beautiful. For the record, I don’t like the term “death with dignity.” It implies that all non-aided deaths are undignified, which is just wrong.

But there are certainly undignified deaths out there that people try to avoid. The End of Life Option Act — the law that allows terminally ill, mentally competent patients in California to request lethal medications from their

Brittany Maynard was diagnosed with terminal brain cancer in 2014 at the age of 29. In October of that year, she made a six-minute video that transformed the discussion over allowing terminally ill patients to end their lives on their own terms with medical assistance. California's End of Life Option Act was adopted in 2016. doctors to end their suffering — has been in effect for over five years. It allows patients like Rena to bypass much of the suffering they know is ahead and skip to a more humane ending consistent with their values.

Patients choosing medical aid in dying are not choosing between life and death. Their time is up either way; it’s just a question of how much suffering they want to

in specialty care. Only 51% of primary care physicians nationally support patients having this option. Which begs the question: why the discrepancy between public support and support among physicians?

Could it be our training? In medical school, I was of course taught about palliative care, but the vast majority of my education centered on how to cure diseases and

Only 51% of primary care physicians nationally support patients having the option of assisted death.

Which begs the question: why the discrepancy between public support and support among physicians? endure. In five years and the dozens of cases in which I have participated, I have yet to meet a patient who wants to die. They would gladly relinquish the opportunity for more pain-free time with their loved ones, but that’s a choice they don’t have.

Despite the compassion present in this option, and the broad public support for it — 74% of people nationally in one survey — medical aid in dying remains somewhat controversial among physicians. While a majority of physicians in the most recent polling support terminally ill patients having this choice, the support is heaviest

prevent people from dying. Intellectually, all physicians know that everyone must die and that some kinds of terminal suffering cannot be sufficiently palliated. All physicians would also agree that it is our solemn duty to treat suffering. Yet the thought of a physician being party to the hastening of another’s death leaves many physicians feeling squeamish. Our education fails to address this gap.

At issue is that bedrock of medicine: do no harm.

But what constitutes harm? For the imminently dying patient who has no quality of life left and is ready to March/April 2022

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move on, continuing to live may constitute harm to them. Forcing our patients to endure suffering because it is the natural order of things is not new to our profession. James Young Simpson famously experienced a mighty backlash when he first used chloroform for effective labor analgesia in the 1800s because suffering was felt to be a necessary part of a woman’s delivery.

Quite clearly, it has since become common practice to ease labor pain with various medications. The insistence that all must suffer their lot when their end is near is similarly antiquated.

Ana was a patient of mine a few years ago who was also dying from metastatic colon cancer. Spinal mets made every movement agony and took away her last pleasurable activity: going out and tending her garden. She sought my assistance to help her end her suffering, but her family stonewalled us at every turn. Due to their deeply held religious beliefs, they felt strongly that going through with this act would damn her immortal soul. So under false pretenses, the family sent her to a religiously-affiliated skilled nursing facility that would not allow her to ingest the aid in dying drug on the premises. Then they quickly

sold her house so that she would have no where to go.

Once she and I figured out what was going on, it was too late. Ana was beyond distraught at the duplicity, but she was at their mercy.

I spent a whole month exploring options for her while she wasted away in bed suffering exactly the kind of agonizing existence she wanted to avoid. I did eventually find a skilled nursing facility that was willing to take her on a charitable basis and allow her to ingest once she got there, but Ana died before the transfer could happen. Ana had made her choice and her family had denied her that.

Every time I see a patient for medical aid in dying I think of Rena, Ana and others like them. Some make it out on their terms; some do not. I try to think about my own mortality, too. If I were facing a slow, steady decline and had intractable suffering resistant to other efforts to palliate, would I choose this option for myself?

I honestly don’t know, but the fact that I would have the choice makes all the difference. The sooner that our profession acknowledges this sentiment, the sooner we can all truly fulfill our oaths as physicians to aid our patients in their time of need.

Recollections Recollections of of How How Teaching Teaching and and Learning Learning Were Were Upended Upended in in 2020 2020

SSVMS Offers Free End-of-Life Planning Document

S

SVMS’s Honoring Wishes pays for Sacramento region community members to have free access to the Five Wishes Advance Care Plan. The Five Wishes document is a complete approach to discussing and documenting care and comfort choices.

The short form, legal in California, was chosen by the Honoring Wishes Advisory Committee because it succinct, easy for the patient to fill out and allows the health care team to appropriately adjust care to the individual patient.

The Five Wishes document can easily be attached to a patient’s medical record. Every downloaded Five Wishes document is paid for by SSVMS’s charitable fund. Download your copy at https://tinyurl.com/3uduyb8x or scan the QR code.

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Member Benefits & Resources

The Sierra Sacramento Valley Medical Society (SSVMS) offers many resources and services exclusively for our over 6,000 physician members. Members receive specialized one-on-one assistance designed to keep your independent practice healthy and viable. Join us today by contacting dbrooks@ssvms.org or by visiting www.ssvms.org.

COVID-19 Advocacy Access up-to-date members-only resources, including financial and practice management tools that will ensure your medical practice is prepared to survive and thrive during and after the pandemic.

Economic Advocacy Access to highly trained economic advocates with expertise in physician reimbursement are available to provide one-on-one help with payor issues and contracting at no cost.

Statewide, more than $30 million has been recouped over 12 years.

Legal Resources Over 5,400 pages of OnCall documents and valuable information for physicians and their staff at no cost.

Practice Resources For practices of all sizes, and including HIPAA compliance toolkits, practice management guides, patient forms, resources for starting, closing, or expanding your practice and more.

Joy of Medicine No-cost sessions with psychologists and life coaches, CME wellness education, physician interest groups and more. Visit www.JoyofMedicine.org to learn more.

Educational Programs Free CMEs, webinars and in-person seminars.

Discounts For insurance services, office supplies, magazines, security prescriptions and more.

Partners in Medicine Vetted vendors that provide SSVMS members with exclusive services and discounts. These partners have gone through an application process and provided multiple physician references. They are dedicated to offering special services or discounts to SSVMS members on various products and services designed to accommodate the business and personal needs of physicians.

News and Information Stay informed about public health, practice management, and other breaking healthcare news.

Leadership Opportunities Serve on the SSVMS Board of Directors, Delegation, or a Council or Committee.

Connect with Peers Meet colleagues through virtual networking opportunities.

www.ssvms.org March/April 2022

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| PROFILE |

The Beat of the Patient A Medical Student Experiences The Hospital From an Entirely Different View

A

s I laid down for my routine radiation appointment, I remember thinking how odd it was to stare up into alternating fluorescent lights — blue, red, yellow, white. Who ever thought an array of bright primary hues would be something relaxing to look up to? As a thirty-year-old, all I could think about was an outdated club scene or a retro nail salon; perhaps I was not its creator’s target audience. At least for the MRIs, the clouds on the roof made sense — that is something I could imagine to be relaxing for most people.

The lights were oddly matched with Christmas music and later with a pungent and strange smell of burning rusted metal. The latter was a rare side effect; a small number of people perceive this odd smell with brain radiation. I was told it was not an actual smell but the perception of one as the laser met the olfactory nerves.

The collage of random elements reminded me of differ-

So here I am, a thirty-year-old getting diagnosed with a rare tumor at a rare age, which just happened to be during my first year of medical school. I felt very special to say the least. ent genres of music overlapping in a busy city street, and I was the awkwardly placed, rare, and out-of-place street harmonica.

As I laid there, not only was I trying to piece together all these mismatched sensations, but I was also literally nailed down onto the treatment table by a plastic, tailored mask molded to keep my head still during the treatment. I remember thinking that if there was an emergency, such as a zombie apocalypse, that would be the end of me; I would be trapped forever, forced to make sense of the clashing tones and find my own meaning within their abstraction.

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By Polet Loynaz, MS I psloynaz@ucdavis.edu

How odd, all these stimuli, these thoughts. How did others feel and what did they think about in this exact situation? Most people I saw in the waiting room were much older than me. I doubt they thought about clubs, nail salons, zombies, or music in busy streets. So, how did they piece together all these sensations?

Regardless of the strangeness, the atmosphere at the UC Davis radiation center was always very pleasing, I think mostly due to the wonderful staff (truly the happiest techs I’ve ever met). And paradoxically, with time, the incongruous stimuli transformed into a unique harmonious rhythm that became what is now my radiation experience.

On October 28, 2021, I received my first brain surgery after almost losing vision in my left eye. I say first because I had to come back in for a second brain surgery on November 22 after many complications, which accumulated to a total of about three weeks in the ICU. Sometime before my first surgery I was diagnosed with a suprasellar adamantinomatous craniopharyngioma (yes, I know, quite the mouthful). According to The National Center for Biotechnology, the occurrence of these slow-growing benign tumors is 0.5 to 2 cases per million persons per year, in which most cases happen in childhood (under 14) or late adulthood (over 50). So here I am, a thirty-year-old getting diagnosed with a rare tumor at a rare age, which just happened to be during my first year of medical school. Here is the key word again: rare. I felt very special to say the least.

I like to think of myself as an observer of this life; I witness the events of my life unfold before me like I witness the ocean tide come and go on the beach shore.

I had a lot of feelings about my situation and my time at the hospital, however, those feelings did not serve a useful purpose at the time. Therefore, I just witnessed

as fear, depression, anxiety and frustration came and went — I did not hold on to them, just like it is pointless to try to hold on to the ocean’s changing tides.

Regardless of my stoic demeanor, and mindful perspective, there was much I felt and thought during my time at the hospital. One of the biggest things I experienced was the physical discomfort: muscle aches from laying in one position for days, bloating, nausea, fatigue, weakness, headaches, palpitations, light sensi-

few days, the infrequent visitation of the “others”: physical therapy, chaplains, music therapy, animal therapy and perhaps even other “others” I did not get the pleasure of meeting. Every element hummed in perfect synchrony only to be disrupted by the rising and setting of the sun, disrupted because there was a big disconnect with the outside world. In the hospital, the days and nights merged and had their own rhythm.

Each wing of the hospital had its own melody. The

Polet during one of her radiation treatments. “I was pinned down staring at the odd colors on the roof and listening to Christmas music. That is me making sense of all the abstract elements thrown together,” she said. tivity, hunger, thirst, dizziness, weight gain in unusual areas. And don’t even get me started with the pain of the IVs — I had a total of about 35 of them which resulted in many bruises, busted veins and superficial clots.

Another thing that stood out during my hospital stay was the hustle and bustle of the hospital. Lights on and off like clockwork, meds, meals, vitals, family visits, codes, doctor check-ins and if you stay for longer than a

ICU’s was serene, soft and deep, and the East Wing’s was fast, brassy, and accompanied by sharp breaks in silence coming from groans, moans, cries, laughs, screams and the not-so-pleasant gags and vomiting sounds. At this point, I was grateful my sense of smell had not yet come back after my endonasal surgery, where they go in through the nose to resect the brain tumor located around my pituitary.

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Most days, I sat and listened to the music of the day.

I stretched, prayed, and waited patiently, enduring the everyday needle sticks and body discomforts. I also connected deeply with my roommates who came and went. They were mostly older ladies who were too weak to walk, talk, eat, and who had very limited visitations from loved ones. It almost felt as though the world had forgotten about them and their existence faded into the background of the monotonous hospital tune. I cared for them deeply and realized a smile can go a long way.

Merely recognizing them and providing an ounce of warmth helped pull them out of their isolation.

In the end, what I mostly got out of this experience was gratefulness. Gratefulness to be given the chance to let go of expectations, to be humble and vulnerable.

I am grateful to have fully trusted the health care staff.

It is due to the incredible team at UC Davis Medical Center that I am not blind, that my hormones are still regulating my body and that I am alive and stable today.

(A special thanks goes to Dr. Kiarash Shahlaie, Dr. Ruben Fragoso and Dr. Edward Strong.) Not only am I well, but I am thriving and it is due to them that I can still pursue my dream of becoming a physician to help others as they have helped me.

And lastly, I am grateful that I got an opportunity to understand the experience of being an inpatient.

I hope that by sharing my story I can inspire you to observe, listen, and understand the perspective of the

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After finishing 30 radiation treatments, Polet rings the bell at the UCD Medical Center. It is only rung after all treatments are finished and was placed in the cancer center as something patients could look forward to. patient and the beat of the hospital, so that one day you can make its music more harmonious, and rather than accepting the patient as a forgotten background tune where they might feel like an awkward and rare out-of-tune harmonica, strive to make them the leading crescendo!

www.ssvms.org

5380 Elvas Ave. Suite 101, Sacramento, CA 95819

916.452.2671

Serving More Than 6,500 Physicians in the Sacramento Region

1 2 20 Annual Report @ssvms

@sierrasacmedsociety

@Sierra Sacramento Valley Medical Society

President’s Message The Sierra Sacramento Valley Medical Society (SSVMS) is dedicated to bringing physicians together from all modes of practice to promote the art and science of quality medical care and to enhance the physical and mental health of our entire community. In 2021, SSVMS hosted a COVID-19 vaccine clinic for medical professionals, allowing healthcare workers to safely continue providing care to patients. To address vaccine hesitancy in our community, SSVMS produced public service announcements and podcasts, launched a multilingual speakers’ bureau, and penned a letter to the community signed by more than 700 local physicians. SSVMS was a trusted source of information about the coronavirus with our daily-updated online resource center and provided answers to frequently asked questions in six different languages. Along with our COVID-19 resource efforts, SSVMS launched a program designed to increase the size of the healthcare workforce in our community. SSVMS worked with local medical professionals and high schools to create the “Future of Medicine” program. This program took place over the summer with virtual lectures and an in-person sheep heart anatomy lab. Future of Medicine connects local high school students to the vast variety of different careers in the healthcare industry and demonstrates that it isn’t as simple as “doctor or bust.” Finally, SSVMS convened an end-of-life planning committee, Honoring Wishes, to explore the cultural stigma in discussing death and how the local medical community can convince the public to think about how they want their care team to proceed. As part of the program, SSVMS provided dozens of free advance care directives to physicians who had not yet completed their own plans. As the 2022 SSVMS President, I look forward to working with our diverse physician community to advance high quality, timely medical care to those that call the Sacramento region home. I know that with your help we will accomplish great things. - Paul D. Reynolds, MD, 2022 President

2021 SSVMS/CMA Advocacy Highlights Established and administered CalVaxGrant program, providing $40 million to practices for the COVID-19 vaccines.

Sponsored SB 510 (Pan), requiring health insurers to cover the cost of COVID-19 tests and vaccines.

Sponsored AB 457 (Santiago), ensuring patients can access telehealth services from their selected providers.

Recouped more than $3.2 million from payors on behalf of physician members.

Worked with state administration to conform state policy to federal tax law for Payment Protection Program loans for physician practices.

Advocated to make permanent portions of Prop. 56 funding to pay for physician loan repayment, graduate medical education, and supplemental payments for Medi-Cal providers.

www.ssvms.org

It’s going to take a lot more than the pandemic to stop SSVMS members from advocating on behalf of physicians and the patients we serve.

2021 Medical Society Happeni ng s

Top left to right: (1) Richard Jones, MD and a SPIRIT patient who received donated care, (2) Public and Environmental Health Committee Members advocating at a Sacramento County Board of Supervisors Meeting (masking orders for fully vaccinated were relaxed when meeting occurred), (3) Andrew Hudnut, MD teaching heart anatomy to a Future of Medicine student, (4) Jose Cueto, MD participating in a vaccine video campaign, (5) Drs. Leena and Anand Mehta enjoying the virtual event, SSVMS Honors Medicine.

www.ssvms.org

COVID-19 VACCINE RESPONSE SSVMS coordinated a vaccine clinic in January 2021 at which more than 1,300 local physicians and medical staff were vaccinated, produced a series of frequently asked questions in six languages, established a speakers’ bureau representing ten languages, worked with member physicians to testify about the efficacy of vaccines at town hall meetings, distributed more than 2,000 “Got Vaccinated” buttons, produced a series of four public service announcements, and penned a community letter on the importance of vaccination signed by more than 700 local physicians.

2021 240 + accomplishments

185 $28,000 sponsored psychologist or life coach sessions for physicians

private practices received assistance

medical student scholarships granted

$603,501 147 200+

in-kind donated

SPIRIT

patient services

SPIRIT

surgeries donated

450+ SP I R I T pati ents treated

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future of medicine program graduates

ssvms.org

physician volunteers

1,355

physicians and medical staff vaccinated at SSVMS clinic

| 202 1 CMA FEDERAL WRAP-UP |

Another Tough Year… But Important Wins for Physicians CMA Makes Strides in D.C. on Behalf of Members

2021

proved to be another challenging year for physicians and a nation continuing to face a raging pandemic. It brought us tough confrontations over COVID-19 mask mandates and vaccination efforts, legal challenges that threatened to overturn the Affordable Care Act (ACA), a renewed fight for racial equity and an insurrection at the U.S. Capitol that challenged our democracy. But through it all, the California Medical Association was there, fighting for physicians and ensuring that our nation’s healers were able to continue providing care to patients as the pandemic raged on.

The nation inaugurated a new president, Joseph Biden, and the first woman vice president, California Senator Kamala Harris, who set out to heal a nation experiencing the worst public health crisis in history. As the Biden Administration settled in, key California leaders were placed in important positions in the federal government, giving CMA unprecedented access at the federal level. California Secretary of State Alex Padilla was appointed to the U.S. Senate to fill the vacancy left by Vice President Harris, while California Attorney General Xavier Becerra was named Secretary of the U.S. Department of Health and Human Services. Californians Nancy Pelosi and Kevin McCarthy were both reelected to their respective positions as Speaker of the House and Minority Leader.

The COVID-19 pandemic will be remembered as one of the most unprecedented and challenging times in our nation’s history. Physicians rose to their calling in heroic numbers to battle the virus, vaccinate the public, and fight for science and truth to protect public health.

Physicians demonstrated their compassion and courage — risking their lives and the lives of their families to care for the sickest of patients.

CMA successfully fought alongside the American

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By Elizabeth McNeil emcneil@cmadocs.org

Medical Association and others in organized medicine to ensure physicians were able to continue providing quality care to their patients during and beyond the public health emergency. Many physicians either implemented or expanded their use of telehealth as a treatment modality. CMA worked hard to ensure that Congress and the Biden Administration provided telehealth payment parity and waivers to allow physicians to provide a broad range of telehealth and audio-only services in a wide range of settings. CMA made sure policymakers understood how telehealth allowed physicians to meet their patients’ needs during the pandemic.

A Test of Stamina The second year of the pandemic truly tested physician stamina. Frontline physicians fought burnout and massive health staffing shortages; all physicians worked to sustain the viability of their practices; and physicians began to address the secondary impacts of the pandemic – worsening health conditions caused by delays in care, as well as a tsunami of mental health and substance abuse issues.

CMA warned Congress that the long-term fallout from the pandemic would be felt by patients for years to come and fundamentally alter the long-term stability of physician practices. Congress honored the sacrifices made by physicians and responded by dedicating substantial resources to help physicians fight the pandemic and sustain the viability of their practices for future patients.

In 2020-21, Congress enacted legislation to address all aspects of the COVID-19 battle, providing nearly $2 trillion in funding including hundreds of billions for physician practices: » $190 billion to the Provider Relief Fund

» $10 billion to reimburse physicians treating the uninsured

» $1 trillion to the Paycheck Protection Program and fair tax treatment for such grants

» 2% Medicare payment increase by waiving the sequestration cuts

» Billions in funding for personal protective equipment, mental health, substance abuse, public health, testing and vaccines

Medicare Payment Cuts Stopped As if the COVID-19 pandemic was not enough, physicians also faced 9.75% in Medicare payment cuts on January 1, 2022. It was a perfect storm of Medicare payment cuts resulting from an expiring 2% sequestration CMA advocates were busy on Capitol Hill in 2021. waiver, 3.75% budget neutrality cuts Fighting Back on Surprise Medical imposed by the fee schedule and an Billing unintended 4% cut due to a legislative “pay as you go” CMA continues to fight an ill-conceived federal regubudget neutrality rule. lation that disregards the balanced arbitration process In response to intense advocacy from CMA, AMA and in the No Surprises Act (NSA) law and threatens patient other medical societies, Congress recognized that physiaccess to in-network physicians. While CMA strongly cians could not continue to fight the pandemic, sustain supports the parts of the law that protect patients from their practices and care for patients under a 9.75% surprise medical bills, the arbitration regulation will Medicare payment cut. Led by California physician harm patients and drive up costs in the long term.

Congressman Ami Bera (D-CA), Congress enacted legislaIn the NSA’s statutory language, Congress established tion to stop most of the 9.75% payment cuts. The 2% a balanced process to fairly resolve payment disputes sequestration cuts will be phased back in by July 1, 2022. between physicians and insurers for certain unanticiCMA also successfully worked with AMA and orgapated out-of-network medical bills using several differnized medicine to rally Congress to: ent criteria. However, the implementing regulations are » Double the Medicare COVID-19 vaccine administrablatantly inconsistent with the clear language of the tion payment rates statute and Congressional intent. They effectively upend » Provide a Merit-Based Incentive Payment System the law, giving insurers an unfair advantage by relying quality reporting exemption almost exclusively on the insurers’ self-determined » Extend the telehealth waivers through the public median in-network billing rate, instead of considering the multitude of factors called for under the law. health emergency Nearly 200 members of Congress and the chairman » Delay mandatory e-prescribing for controlled subof the powerful Ways and Means Committee stood stances until 2023 with physicians, objecting to the regulations in multiple » Delay the Radiation Oncology Alternative Payment bipartisan letters. model and the Appropriate Use Criteria program CMA also submitted extensive comments to the reguuntil 2023 lators warning that the NSA regulations would produce March/April 2022

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the same unintended consequences that physicians and patients have experienced under California’s Assembly Bill 72. CMA provided detailed evidence from California that demonstrated how insurers cancelled long-standing contracts or imposed significant rate reductions that forced physicians out-of-network and reduced patient access to in-network physicians, particularly regarding on-call panels of physician specialists who treat patients in emergencies.

Several lawsuits have been filed against the federal government over its misguided implementation of the NSA. The suits argue that the regulations are a clear deviation from the law as written and all but ensure that hospitals, physicians and other providers will routinely be undercompensated by commercial insurers, and that patients will have fewer choices for access to in-network services. Through the Physicians Advocacy Institute, CMA, along with other state and national specialty societies, filed amicus briefs in support of a lawsuit brought by the Texas Medical Association and the AMA-American Hospital Association lawsuit. The American College of Emergency Physicians, American Society of Anesthesiologists and American College of Radiology also filed a joint legal action.

Public Service Loan Forgiveness In 2021, CMA continued to aggressively fight for a legislative or regulatory change to allow California and Texas physicians to participate in the Public Service Loan Forgiveness (PSLF) program like their colleagues in the other 48 states.

Congress established the PSLF program in 2007 to improve access to care by encouraging physicians to pursue careers working in nonprofit settings. When implementing regulations were issued, they were severely narrowed to require physicians to be “hired and paid by” hospitals in order to receive loan forgiveness. Because California and Texas law prohibit hospital employment of physicians, most physicians in California and Texas are precluded from participating in the program while their counterparts in all other 48 states receive loan forgiveness.

With an average $250,000 in student loan debt, the narrow regulation places California and Texas at a severe disadvantage in recruiting new physicians,

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thereby harming patient access to care in our underserved communities.

On behalf of CMA, California Congressman Josh Harder (D-Stanislaus) introduced HR 1133, the “Stopping Doctor Shortages Act,” and has led an intense advocacy effort in the House to fix this problem with the support of his co-authors, Congressmen Jay Obernolte (R-San Bernardino), Joaquin Castro (D-TX) and Van Taylor (R-TX). Identical legislation was introduced in the Senate (S 311) by Senators Dianne Feinstein (D-CA), John Cornyn (R-TX) and Alex Padilla (D-CA).

Throughout 2021, CMA urged Congress to pass a legislative fix but the high cost has made it extremely difficult.

Also in 2021, the U.S. Department of Education reopened its regulations to make changes to the Higher Education Act, which includes the PSLF. CMA testified before the education department and organized a joint bipartisan letter from the majority of the California and Texas Congressional delegations. Speaker Pelosi, Rep. Harder and Sen. Feinstein have also met with the Secretary of Education on CMA’s behalf.

This is a top priority for CMA; we will continue to urge regulators and Congress to resolve the problem as soon as possible.

Access to Affordable Health Care CMA has urged Congress to address two of our nation’s highest health care priorities in President Biden’s Build Back Better social programs infrastructure legislation: permanent access to more affordable health insurance through the Affordable Care Act and lowering prescription drug costs.

Although the 2021 American Rescue Plan Act (ARPA) expanded eligibility for ACA health insurance tax credits and assistance, these provisions were only authorized for two years. CMA is urging Congress to ensure the long-term affordability and effectiveness of the ACA by making the provisions of the ARPA permanent.

The Medicare drug pricing provision in the Build Back Better plan would allow Medicare to negotiate drug prices on many of the highest-priced drugs directly with pharmaceutical companies, including all insulin drugs. The legislation is estimated to save Medicare and privately insured patients 40-60% on drug costs.

| BOARD BRIEFS |

Pathways to Practice President Biden’s Build Back Better legislation would also authorize 4,000 new graduate medical education (GME) residency positions. The nation is currently facing a 15,000 residency position shortage. This CMA-supported provision would add residency slots to allow more medical students to match with a residency program and increase the overall supply of physicians.

The legislation also includes the new CMA-supported “Pathways to Practice” program, an innovative program that will allow more marginalized and minority students to go to medical school and choose a career in medicine. It provides tuition assistance, living stipends and expands the number of GME positions. It requires such students to serve in underserved areas for six years.

This program is a significant step forward in helping our nation address racial injustice and advance health equity. It will lead to real improvements in building a more equitable health care system for providers and patients.

Also this year, CMA supported multiple bills that addressed racial injustice and health care disparities and promoted adoption of AMA’s plan to “Embed Racial Justice and Advance Health Equity.”

CMA was honored to fight for physicians in the virtual halls of Congress this year and we will keep fighting so that you can focus on your patients and not be hindered by administrative burdens, declining reimbursements or a devastating virus.

While Congress did not finalize all of CMA’s priorities, important groundwork was laid for Congress to enact a more stable Medicare payment system that keeps pace with increasing practice costs, Medicare Advantage prior authorization reforms, public service student loan forgiveness for California physicians, the health care provisions in the Build Back Better plan, permanent telehealth waivers and bills that address physician workforce shortages. CMA will continue to stand with you and advocate on your behalf.

Elizabeth McNeil is CMA Vice President of Federal Government Relations.

Board Briefs January 10, 2022 THE BOARD: Installed Paul D. Reynolds, MD as the 2022 SSVMS President and thanked Carol Burch, MD, outgoing president, for her outstanding service as 2021 President.

Elected Adam Dougherty, MD 2022 Secretary and Vanessa Walker, DO 2022 Treasurer. Both will join Paul D. Reynolds, MD, President, J. Bianca Roberts, MD, President-Elect, and Carol Burch, MD, Immediate Past President, as SSVMS Executive Committee members.

Received COVID-19 updates from the following public health officers: Olivia Kasirye, MD, Sacramento County; Aimee Sisson, MD, Yolo County; Nancy Williams, MD, El Dorado County.

Approved the following Membership Report: January 10, 2022 For Change From Regular Active to Active 65/20 — Harry C. Wang, MD For Retired Membership — Helen M. Biren, MD; James H. Clingan, MD; Gerald J. Koh, MD; Alexander Locke, III, MD; Ronald T. Zielinsky, MD. For Resignation — Philip J. DeSouza, MD. For Transfer of Membership — Daniel M. Fentress, MD (to San Francisco), Joshua Levy, MD (to Sonoma).

Deceased — Faith T. Fitzgerald, MD 12/7/21; Merritt C. Warren, MD 7/23/21; Geoffrey E. Woo-Ming, MD 11/30/2021.

Approved the appointments to 2022 SSVMS committees.

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| NEW MEMBERS |

New SSVMS Members The following applications have been approved by the Sierra Sacramento Valley Medical Society. Information pertinent to consideration of any applicant for membership should be communicated to the Society.

— Adam Dougherty, MD, Secretary.

New Active Members *Physician specialty abbreviated following name.

Kyle J. Adams, DO, HOS, Sutter Medical Group Maryam Amir, MD, END, Sutter Medical Group Suchdeep S. Bains, MD, CD, Sutter Medical Group Satnaam S. Bassi, MD, IM, Sutter Medical Group Shiva Bhandaru, MD, IM, Sutter Medical Group Cedrick S. Bradley, MD, FP, Sutter Medical Group Valerie D. Curtis, MD, HOS, Sutter Medical Group Emmanuel S. De Jesus, MD, IM, Sutter Medical Group Brent A. Feldt, MD, OTO, Sutter Medical Group Amy W. Fong, MD, HOS, The Permanente Medical Group Jena K. Fujimoto, MD, DR, Sutter Medical Group Daniel Gondi, MD, FP, The Permanente Medical Group Shreya S. Gondi, MD, PD, The Permanente Medical Group Andrea M. Gonzalez-Falero, MD, END, Sutter Medical Group John T. Halloran, DO, IM, Mercy Medical Group Anthony L. Jackson, MD, UC, Sutter Medical Group Amanda L. Jamal, MD, FP, Sutter Medical Group Christopher Y. Jeu, DO, FP, The Permanente Medical Group

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Sierra Sacramento Valley Medicine

Jaison John, MD, HOS, Sutter Medical Group Lily E. Johnston, MD, VS, The Permanente Medical Group Raheel A. Khan, DO, P, Sutter Medical Group Arun R. Krishnan, MD, R, Sutter Medical Group Thong D. Le, MD, AN, The Permanente Medical Group Suegene K. Lee, MD, CD, Sutter Medical Group Allison C. Levitt, MD, HOS, The Permanente Medical Group Hailey R. Macnear, MD, OBG, Sacramento Women's Health Melanie J. Madriaga, DO, FP, The Permanente Medical Group Karyn S. Mallya, MD, IM, Sutter Medical Group Neeta Malviya, MD, D, Sutter Medical Group Jaspreet K. Mann, DO, CCM, Sutter Medical Group Rini S. Mathew, DO, OM, Mercy Medical Group Lynn M. Mcalister, DO, IM, Sutter Medical Group Scott B. Mccusker, MD, OTO, Sutter Medical Group Roberto A. Molera, Jr., MD, FP, The Permanente Medical Group Steven W. Nakano, MD, N, Sutter Medical Group Timothy P. Nguyen, DO, FP, The Permanente Medical Group

Saman Panahipour, MD, R, Sutter Medical Group Chirag V. Patel, MD, R, The Permanente Medical Group Tanvi Patel, MD, R, Sutter Medical Group David V. Pham, MD, NM, Sutter Medical Group Mukund Ramkumar, MD, IM, The Permanente Medical Group Sameera Rana, MD, IM, Sutter Medical Group Jessica K. Rouse, MD, IM, Sutter Medical Group Shivani S. Ruben, MD, IM, Sutter Medical Group Pooria Salari, MD, OSS, The Permanente Medical Group Sukhman S. Sandhu, MD, IM, Sutter Medical Group Sahar Sarkeshik, DO, HOS, The Permanente Medical Group Salma A. Shabaik, MD, FP, Sutter Medical Group Adrianna B. Sung, DO, FP, The Permanente Medical Group Jennifer R. Urban, MD, D, Sutter Medical Group Tony D. Veletto, MD, IM, Sutter Medical Group Jiao Xue, MD, FP, Sutter Medical Group

Closer to home + enhanced referrals = easier access to world-class care Chief of Pediatric General, Thoracic and Fetal Surgery Shinjiro Hirose, M.D., F.A.C.S., is a nationally recognized cancer surgeon and UC Fetal Therapy Consortium cofounder.

UC Davis Health offers nationally ranked expertise— now with added convenience for referring providers.

From the most delicate robotic and catheter procedures to the latest precision therapeutics, we’re proud to offer up-to-the-minute diagnostic and treatment options for both adult and pediatric referring providers across Northern California and the Central Valley.

Your referred patients benefit from shorter drives, less traffic gridlock, affordable lodging, and more support from local family and friends. We also offer robust telehealth and telemedicine options, for both initial consultations and follow up care.

Referring your patients to UC Davis Health specialty and subspecialty care is now easier than ever. Our physician referral liaison team is here to serve as direct lines of communication — helping to navigate and expedite referrals, obtain information, resolve process questions, and more.

Our liaisons can also help to: ■

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Facilitate access to our secure EMR system, PhysicianConnect Arrange meetings and/or webinars with our clinicians Assist with UC Davis Health clinical trials and telemedicine Keep you abreast of new services, providers and research programs Share information about CME and events such as tumor boards, grand rounds, lunch-and-learns and symposiums

We welcome you to reach out to your local UC Davis Health Physician Referral Liaison today: Tracy Bayne | 916-281-8734 | thbayne@ucdavis.edu

referrals.ucdavis.edu