Today's Christian Doctor - Summer 2018

Volume 49 No. 2 • Summer 2018

Today’s

Christian Doctor The Journal of the Christian Medical & Dental Associations

Am I Too Old to Practice?

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CEO EDITORIAL

M

WHAT IS YOUR GIANT?

by David Stevens, MD, MA (Ethics)

any of my grandsons have biblical names of a prophet, priest or king. They are named Gideon, Ezekiel, Josiah and Elijah. I’m glad. Names like that carry a parental hope and even an expectation that the children will be faithful to the Lord and serve Him with courage and perseverance like their namesakes.

My parents had the same expectations when they named me David. My mom related in her later years that she had suggested to my dad before I was born that I be named after him, “Maurice William Stevens, II.” He quickly vetoed that, never really liking his first name that much. It came from the Latin word meaning “moorish.” There were no parental hopes or expectations in that name.

Instead they chose the name “David” meaning “beloved.”

David was one of my dad’s favorite Old Testament heroes, and he has been mine as well. He was not a perfect man, but he was a wise, skilled and brave leader. Most of all, he loved the Lord and was faithful to do what God asked him to do, no matter the odds. I’ve desired those same characteristics.

My favorite biblical story growing up is the one of David and Goliath. I admire how David was embarrassed that the army of Israel was fearful and quaking in their boots before the giant Goliath. He saw it as an affront to God that they didn’t have enough faith in God to step up to the fight. With courageous confidence in God’s faithfulness, David walked out unarmored and under armed to face the giant as thousands of soldiers looked on. He ignored Goliath’s threats, boldly declared his faith in God and, with one stone and some pieces of rawhide, changed the course of a nation and his life.

As a child I wanted to be like David, and I still do. Don’t you?

Well, there is no lack of huge, seemingly undefeatable giants to take on these days—bioethical issues, a growing prejudice against Christians, the barriers to practicing good healthcare, a culture that has gone amok and so much more.

These giants seem too big and so well armed that they can’t be defeated.

Frankly, some days I feel that way. I’m worn out from the fight. I just want to leave the battlefront and retreat. I want to hide from the conflict, thinking I have done my share and someone else should take the battle from here.

I bet you feel the same way some days. You think about retiring early, getting an easier job or even changing your profession.

It is only human to do so, but I have to remind myself that I shouldn’t do it if that is not God’s will for my life. My life is not about making me comfortable and content. God didn’t create me to pursue my own happiness. In fact, happiness is not found in saving my life, but in losing it.

What’s more, as David realized, the size of the giants I face is insignificant in comparison to the size of my God. He has proven Himself faithful to me again and again. He wants me to finish His purpose for my life and keep my faith firmly grounded in Him, no matter the odds.

Last evening, after an overly full day dealing with some difficult issues, I had one of those “pity party” moments. Yeah, admit it. You’ve had them too. As I walked down the stairwell of CMDA and headed home, the Lord reminded me of what I just reminded you about. In a few moments, without conscious thought, I found myself singing a children’s chorus that I haven’t heard in years. It goes like this: “My Lord knows the way through the wilderness.

All I have to do is follow.

Strength for today is mine all the way and all that I need for tomorrow.

My Lord knows the way through the wilderness.

All I have to do is follow.”

Watchman Nee said, “Spiritual advancement is measured by faithful obedience.” David’s obedience was taking on Goliath.

What’s yours?

Transformed Doctors ➤ Transforming the World www.cmda.org 3

TO DAY ’ S C H R I S T I A N D O C TO R

contents

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VO LU M E 4 9, N O. 2

I

SUMMER 2018

The Christian Medical & Dental Associations ®— Changing Hearts in Healthcare . . . since 1931.

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20 ransformed Doctors, 12 TTransforming 34 the World

by Al Weir, MD

When is the right time to retire from practicing?

20

Decreasing Isolation in Healthcare

by Autumn Dawn Galbreath, MD, MBA

How Christians in healthcare can find respite in community

24

by David A. Prentice, PhD

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by Jonathan Imbody

Gene Editing of Human Beings

Genetic engineering has the potential for great benefit and great harm

Counting the Cost of Discipleship

Classifieds

featuring Shelley Craft, RPh

14 Cover Story

Am I Too Old to Practice?

28

Examining how a nurse practitioner refused to compromise her beliefs

EDITOR Mandi Mooney EDITORIAL COMMITTEE Gregg Albers, MD; John Crouch, MD; Autumn Dawn Galbreath, MD; Curtis E. Harris, MD, JD; Van Haywood, DMD; Rebecca Klint-Townsend, MD; Robert D. Orr, MD; Debby Read, RN AD SALES Margie Shealy 423-8441000 DESIGN Ahaa! Design + Production PRINTING Pulp CMDA is a member of the Evangelical Council for Financial Accountability (ECFA).

Today’s Christian Doctor®, registered with the U.S. Patent and Trademark Office. ISSN 0009-546X, Summer 2018, Volume XLIX, No. 2. Printed in the United States of America. Published four times each year by the Christian Medical & Dental Associations® at 2604 Highway 421, Bristol, TN 37620. Copyright© 2018, Christian Medical & Dental Associations®. All Rights Reserved. Distributed free to CMDA members. Nondoctors (US) are welcome to subscribe at a rate of $35 per year ($40 per year, international). Standard presort postage paid at Bristol, Tennessee.

Undesignated Scripture references are taken from the Holy Bible, New In-

4 TODAY'S CHRISTIAN DOCTOR Summer 2018

ternational Version®, Copyright© 1973, 1978, 1984, Biblica. Used by permission of Zondervan. All rights reserved. Other versions are noted in the text.

Christian Medical & Dental Associations P.O. Box 7500, Bristol, TN 37621 888-230-2637 main@cmda.org • www.cmda.org If you are interested in submitting articles to be considered for publication, visit www.cmda.org/publications for submission guidelines and details. Articles and letters published represent the opinions of the authors and do not necessarily reflect the official policy of the Christian Medical & Dental Associations. Acceptance of paid advertising from any source does not necessarily imply the endorsement of a particular program, product or service by CMDA. Any technical information, advice or instruction provided in this publication is for the benefit of our readers, without any guarantee with respect to results they may experience with regard to the same. Implementation of the same is the decision of the reader and at his or her own risk. CMDA cannot be responsible for any untoward results experienced as a result of following or attempting to follow said information, advice or instruction.

TRANSFORMATIONS

Empower Campaign Update At the 2018 CMDA National Convention, CMDA CEO Dr. David Stevens gave an update on progress for the Empower Capital Campaign. With an overall goal of $28.2 million in current and planned gifts, just over $17.2 million has been given and/or committed to the effort.

EMPOWER CAMPAIGN CURRENT GIFTS

The campaign, which will impact every area of ministry across CMDA, was launched last year and is gaining momentum as we head into the summer months. Both the Board of Trustees and the CMDA staff are participating at 100 percent. As we go out to a broader network of members and friends, we expect the totals to increase substantially over the next 12 months.

Beginning this summer, Dr. Stevens will be touring around the country giving updates about the campaign and how gifts that have already been received are being used to expand the work and influence of CMDA. He will also be listening to members about the needs they have and challenges they face on a daily basis as Christian healthcare professionals.

CONTRIBUTE

EMPOWER CAMPAIGN PLANNED GIFTS

$8 million

$20 million

$7 million

$18 million

$6 million

$15 million

$5 million

$12 million

$4 million

$10 million

$3 million

$7 million

$2 million

$5 million

$1 million

$3 million

Giving to date: $15,057,627

Giving to date: $2,186,642

If you have questions about the Empower Campaign or would like to contribute, please contact our Stewardship Department at 888-230-2637.

You may also visit www.cmda.org/empower.

New Ethics Statements During the 2018 CMDA National Convention held in Ridgecrest, North Carolina earlier this spring, the Board of Trustees and House of Representatives unanimously approved two new ethics statement and one public policy statement. Those statements were: • Genetics Information and Manipulation Technologies • Parental Rights • Racism The full statement on racism is printed on page 8 of this edition of Today’s Christian Doctor, and the other two statements are available online. These statements are designed to provide you with biblical, ethical, social and scientific understanding of these issues through concise statements articulated in a compassionate and caring manner. They are needed for the religious freedom battles we are currently facing, so we encourage you to share them with your colleagues, pastors, church leaders and others.

LEARN MORE

Visit www.cmda.org/ethics for more information about CMDA’s Ethics Statements and to review these new statements.

Regional Ministries Connecting you with other Christ-followers to help better motivate, equip, disciple and serve within your community Western Region Michael J. McLaughlin, MDiv P.O. Box 2169 Clackamas, OR 97015-2169 Office: 503-522-1950 west@cmda.org

Northeast Region P.O. Box 7500 Bristol, TN 37621 888-230-2637 ccm@cmda.org

Midwest Region Allan J. Harmer, ThM, DMin 951 East 86th Street, Suite 200A Indianapolis, IN 46240 Office: 317-257-5885 cmdamw@cmda.org

Southern Region Grant Hewitt, MDiv P.O. Box 7500 Bristol, TN 37621 402-677-3252 south@cmda.org

Transformed Doctors ➤ Transforming the World www.cmda.org 5

TRANSFORMATIONS

JOIN US FOR THE ICMDA XVI WORLD CONGRESS CMDA is a founding member of the International Christian Medical and Dental Associations (ICMDA). Birthed at an international conference in Amsterdam in 1963, ICMDA now consists of approximately 80 member-nations. ICMDA holds a World Congress every four years, and the next of these quadrennial world gatherings will be in Hyderabad, India on August 21-26, 2018.

We invite you to be part of the U.S. contingent at the Hyderabad World Congress.

You will join leaders from CMDA, including CMDA’s CEO Dr. David Stevens who is one of the featured speakers. Located in Central India, Hyderabad is a blend of old and new worlds. It has become a technology center, boasting a modern convention center and fine accommodations.

The city is easily reached by international flights.

The conference is broken into three parts: August 21-23: A special program for students and residents August 22-23: A variety of pre-conference topical tracks August 23-26: Main conference

You can register for any or all parts of the program. Discounts are offered for those who attend the entire program. To register, visit www.icmda2018.org.

EVENTS

For more information, visit www.cmda.org/events.

Deer Valley Summer Family Conference June 16-23, 2018 • Nathrop, Colorado Emerging Leaders in Dentistry Symposium June 22-24, 2018 • Bristol, Tennessee White Sulphur Springs Summer Family Conference July 27 – August 3, 2018 • Manns Choice, Pennsylvania New Medical Missionary Training August 2-5, 2018 • Bristol, Tennessee ICMDA XVI World Congress August 21-26, 2018 • Hyderabad, India Women Physicians in Christ Annual Conference September 20-23, 2018 • Essex, Vermont Marriage Enrichment Weekend October 12-14, 2018 • Bristol, Tennessee 2019 CMDA National Convention May 2-5, 2019 • Ridgecrest, North Carolina

MEMORIAM & GIFTS

Gifts received January through March 2018

Honor Ms. Martha Bass in honor of Dr. Thomas C. Bohmfalk Dr. and Mrs. David H. Chestnut in honor of John and Maggie Tarpley

Memory Dorothy C. Greibrok in memory of Donald F. Westra, Sr. Willis & Joan Duininck in memory of Donald F. Westra, Sr. Dr. and Mrs. Eliss Calterreo in memory of Donald F. Westra, Sr. Nell Coonrod in memory of Donald F. Westra, Sr. David and Margaret Ann Frizzell in memory of Virgil “Wayne” Anderson Mr. William A. Macaulay, Jr. in memory of Rev. Sidney Macaulay Mr. and Mrs. Thomas Titkemeier in memory of David Todd Ellenberger For more information about honorarium and memoriam gifts, please contact stewardship@cmda.org.

6 TODAY'S CHRISTIAN DOCTOR Summer 2018

TRANSFORMATIONS

CMDA Welcomes New GHO Director Patricia “Trish” Burgess, MD, joined CMDA as the new Global Health Outreach Director in 2018. Trish went to the University of Georgia for her undergraduate degree where she met her husband.

She took two years off before attending medical school and worked as a firefighter in Athens, Georgia during this time. She attended the Medical College of Georgia and did her residency in emergency medicine at the University of Missouri in Kansas City.

Dr. Burgess felt the call to short-term missions early in her career. However, early on she felt the Lord telling her that her mission field was her home and family. Later, after her children were older and more independent, she felt the Lord telling her it was time for her to go. Her first mission trip was to Nicaragua. During this trip, she felt Him clearly telling her this was the reason He had created her, and His

plans for her included continuing with short-term medical missions and leading teams. She went back to Nicaragua with her engineer husband and three children the next year.

Each family member from her husband to her youngest child had a wonderful experience on the trip; from the testimonies, daily devotionals, working with the in-country translators and local church, developing relationships with other Christians scattered around the U.S. and taking care of patients. Her call to healthcare missions became her family’s mission field as well.

With Global Health Outreach, Trish has also traveled to Cambodia, El Salvador, Ethiopia, India, Kenya, Moldova and Peru. Each time she goes, she seeks to be the hands and feet of Jesus Christ and share the love of her Savior with the world.

The body of Christ she knows has grown across the globe as she travels to seek and serve the least, the last and the lost.

GET INVOLVED

Sign up to travel on one of GHO’s short-term trips this year and join us in our efforts to transform the world. To find a trip that fits your schedule, visit www.cmda.org/gho.

In 2017, CMDA member Dr. Russell E. White became the second person to receive the annual $500,000 Gerson L’Chaim Prize for Outstanding Christian Medical Missionary Service.

Dr. White is a cardiothoracic surgeon at Tenwek Hospital in Kenya.

As a result of this award, Dr. White and his team at Tenwek will be training some of the first African heart surgeons to address this dire need. Already at Tenwek Hospital there is a waiting list of 450 patients—and that’s just the tip of the iceberg. Surgeons and special nurses are also needed for other heart and chest diseases. For the ICU, they will be purchasing additional equipment including ventilators, ultrasound machines and more. The hospital’s community health team will also screen local children to identify those who already have heart damage.

For more information about this award, visit www.amhf.us/lchaim.

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Transformed Doctors ➤ Transforming the World www.cmda.org 7

TRANSFORMATIONS

CMDA Statement on Racism Edited and Approved by the Board of Trustees on April 25, 2018 INTRODUCTION With the inherent belief that the Bible is the Word of God— and therefore our final authority for faith and practice—the Christian Medical & Dental Associations are committed to living according to biblical principles. Therefore: CMDA condemns racism in any form, including discriminatory practices utilizing segregation or bias based on race, ethnicity or social status.

CMDA affirms that there is one creator, the God of the universe and all humanity. Through Christ, He has given us a mandate to love others as we love ourselves1 and to love all people regardless of ethnicity, status, gender, genetics, beliefs or practices.2

DEFINITION OF RACISM CMDA recognizes that the term “race” has many connotations, yet we believe that God created only one race—the human race.

Given that usage determines meaning, for the purposes of this statement racism has been defined as the following: From Merriam-Webster: The belief that race is the primary determinant of human traits and capacities and that racial differences produce an inherent superiority of a particular race.

From Oxford: Prejudice, discrimination or antagonism directed against someone of a different race based on the belief that one’s own race is superior.

Racism comes in many shapes and forms. It can be overt and intentional or unintended but still present. CMDA views racism as a single core with two parts: i. A ctive/aggressive racism uses propaganda with hubris and misinformation and/or intimidation to promote an emotionally charged environment with the goal of segregation, superiority and/or domination over another racial group. ii. P assive/non-aggressive racism is often bred via a conscious or unconscious sense of superiority and/or self-centeredness, not looking at the world beyond what affects one’s 8 TODAY'S CHRISTIAN DOCTOR Summer 2018

personal comfort and happiness. This can result in a personal conviction influenced by common themes such as cultural ignorance, social laziness, political partisanship and forgetting God’s charge to His people as defined in Scripture.3,4

SCRIPTURAL DENOUNCEMENT OF RACISM CMDA believes that there is no place for racism, in any form, in the world, in healthcare or in the lives of its leadership, members or staff. Racism is incompatible with the mission, vision and core values of CMDA which are based on the Bible, and the Christian conviction that all people are made in the image of God, and are therefore equal in value.5 Additionally, we believe that the Scriptures clearly communicate God’s will for mankind to treat people everywhere in all circumstances with love, humility, kindness, compassion and self control.3,6,7,8

COMMITMENT TO COMBAT RACISM Combating racism calls for truthful acknowledgements and reconciliation on an individual, organizational and societal level. Through self-examination, acknowledgment and confession of our sins, the cleansing blood of Christ heals us9 and through obedience to the Holy Spirit, we are being transformed into God’s image.10,11 Racism is not just the result of individual attitudes, and can be perpetuated by social structures and systems.

CMDA is committed to addressing and fighting racism wherever it exists, is committed to equality and affirms diversity.

CMDA will seek to oppose racism in healthcare and society and to pursue justice in access to healthcare and equitable outcomes. Individuals within CMDA are expected to take personal action against racism in obedience to the image of God in every person. CMDA will strive for racial diversity in its leadership nationally, regionally and locally, in its commissions, board, staff, membership and in all aspects of its many ministries.

BIBLIOGRAPHY 1 Matthew 22:39 2 Luke 10:30-37 3 Deuteronomy 10:17-19 4 Colossians. 3:11 5 Genesis 1:26-27 6 Acts 10:34-35 7 Revelation 7:9-10 8 Galatians 3:28-29 9 Hebrews 9:22 10 Romans 12:1-2 11 2 Corinthians 3:18

LEARN MORE

CMDA’s position statements are based on scientific, moral and biblical principles, and they are approved by the Board of Trustees and the House of Representatives. We encourage you to familiarize yourself with them in an effort to adopt the ethical tenets as defined by Hippocratic tradition within your work as a healthcare professional. To see all of the statements, visit www.cmda.org/ethics.

The latest release from dr. david stevens and bert jones

“Being a servant leader is the goal. And this book is the ‘how to’ manual for reaching that goal.”

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Order your copy today Servant leadership is the most effective type of leadership in today’s world. But what does it mean to be a servant leader? And how do you do it? You may not know how to practice this type of leadership, but you recognize it when you see it. Though many people are attracted to the concept of being a servant leader in their homes, workplace and community, they don’t know how to do it or even where to begin. Old habits and ways of leading are hard to break. In their second collaboration, Dr. David Stevens and Bert Jones use pithy and succinct proverbs to teach you how to become the servant leader you desire to be. And as you apply these principles, you will become the servant leader God designed you to be and influence generations of servant leaders to come.

P.O. Box 7500 Bristol, TN 37621 888-230-2637 www.cmda.org

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TRANSFORMATIONS

CMDA 2018 MEMBER AWARDS 2018 MISSIONARIES OF THE YEAR AWARD Drs. Dennis and Nancy Palmer

2018 SERVANT OF CHRIST AWARD Rick Donlon, MD

Nancy and Dennis first served as medical missionaries in Cameroon from 1979 to 1984 at Mbingo Baptist Hospital, and again from 1988 to 1991 at Banso Baptist Hospital.

During his missionary career, Dennis was always interested in working to improve the care of patients, trying to give the best care possible using the limited resources available.

During his first term, he introduced a blood banking program and a pharmacy unit dose system to the hospital. After receiving training in internal medicine from 1984 to 1987, Dennis began an ultrasound program and an endoscopy program at Banso. He developed clinical protocols that resulted in standardized treatment guidelines that were used throughout the Baptist health system in Cameroon. These protocols served as the basis for the Handbook of Medicine in Developing Countries, co-written by Dr. Palmer and Dr. Catherine Wolf, now in its fourth edition. From 1991 to 2004, Dennis taught at the University of Missouri-Kansas City School of Medicine and was involved in clinical research in the treatment of hypertension and HIV/AIDS. They returned to Cameroon in 2004, and he currently serves as Clinical Supervisor at Mbingo Baptist Hospital and also as the Program Director of the Christian Internal Medicine Specialization residency.

Rick received his bachelor’s degree from Texas Christian University in 1986 and then attended Louisiana State University School of Medicine and graduated with his medical degree in 1990. He then moved to Memphis, Tennessee, where he completed a combined internship and residency in internal medicine and pediatrics. In 1995, Rick’s service to God’s call on his life led him to join with three other doctors in Memphis to found Christ Community Health Services, a faith-based, federally qualified health center serving the medically underserved in Memphis. Christ Community grew from one clinic in 1995 to seven free standing medical centers, three dental centers and a mobile van for the homeless across 10 low-income neighborhoods in Memphis. Dr. Donlon held a variety of positions with Christ Community, including Medical Director for Operations, Chief Operating Officer and Chief Executive Officer. In addition, he established a health center-based family medicine residency program for residents training specifically to practice among low-income, underserved populations. In 2014, he launched Resurrection Health, a similar faith-based clinic system to serve low-income residents of Memphis communities who lack primary care access. As a member of CMDA for more than 30 years, he has been a CMDA student retreat speaker multiple times and has also spoken at dozens of medical and dental school campuses. Rick, his wife Laurie and their seven children live in Memphis.

The Missionaries of the Year Award was presented to Drs. Dennis (left) and Nancy Palmer by CMDA President Dr. Al Weir (right).

CMDA President Dr. Al Weir (left) presented the Servant of Christ Award to Dr. Rick Donlon (center) who was accompanied by his wife Laurie.

LEARN MORE

The awards were presented at this year’s National Convention. These articles are excerpted from the actual award citations which can be viewed at www.cmda.org/awards.

10 TODAY'S CHRISTIAN DOCTOR Summer 2018

TRANSFORMATIONS

2018 PRESIDENT’S HERITAGE AWARD Shepherd Smith Shepherd has spent more than 30 years working on the issues of HIV/AIDS, global health and youth development, and he has been a consistent champion of the role of faith organizations and leaders in all of these arenas. He has worked in the U.S. with policy makers at all levels and has testified on Capitol Hill. As the founder of both the Institute for Youth Development (IYD) and the Children’s AIDS Fund, Shepherd has dedicated his career to showing Christ’s love by limiting the total suffering from AIDS/HIV. Shepherd and his wife Anita first traveled to Africa in 1995 and have returned more than 60 times to work on AIDS prevention, treatment and care, as well as youth development and global health issues. In 2003, Shepherd brought unity to the faith community and organized its support of PEPFAR (the President’s Emergency Plan for AIDS Relief ), which is the largest global health initiative. In addition, he regularly collaborates with global health leaders at the World Health

Shepherd Smith (right), accompanied by his wife Anita, accepted the President’s Heritage Award from CMDA President Dr. Al Weir (left).

Organization and UNAIDS. In 2017, Shepherd effectively impacted UNAIDS to be more faith inclusive and focus on men and boys as targets in HIV/AIDS education and prevention. In addition, he is a consultant to the Bill & Melinda Gates Foundation and Georgetown University. Shepherd and Anita currently live in Northern Virginia, and they have three children.

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SHELLEY CRAFT, RPh

H

ow often have you followed a plan for your life?

And how often has following that plan defined you? This is one time when my plans were forever altered, when God changed my life with His plan and His purpose for me.

It was 2008, when my daughter Emily was finishing her third year of dental school, and I thought it would be wonderful to go on a healthcare mission trip with her. I had been practicing pharmacy for 27 years at that point, and neither of us had been on an international mission trip. So we joined CMDA’s Global Health Outreach (GHO) on a trip to Ecuador. It was the beginning, I thought, of the plan.

In 2016, I decided to participate in a GHO trip to House of Hope (HOH) in Nicaragua, which focused on victims of human trafficking. Emily had been on this trip the year prior, and I couldn’t get enough of the stories she told. I wanted to be a part of it. Emily suggested we take time for rest and relaxation at the end of the trip, so she booked a three-night stay on a private eco-island in the Isletas of Lake Nicaragua near Granada. I was full of questions like, “Will we be able to order meals on the island?” or “Will there be someone there with us at night?” or “Will we be able to see land?” Emily’s answer was always the same, “Don’t worry! It will all work out. Have faith!” So it was with faith that we went off to Nicaragua, believing it would all work out as we had planned.

On our first day in Nicaragua, we went to the brothels to pray with the prostitutes and invite them to the clinic for medical care. Again, I had a lot of questions about our safety, and I was told, as before, to have faith. I cannot adequately tell you how it feels to lay hands on one of these women while we prayed over her. What it is like to wipe the tears from her eyes when the prayer ends. How it feels to 12 TODAY'S CHRISTIAN DOCTOR Summer 2018

see in her eyes that you might be the only one to ever show her a little kindness.

Each day when we arrived at HOH, we were greeted with long lines of smiling faces of people who have so little and were so desperate for help. We saw suffering and pain intermingled with joy and happiness. We cared, smiled, hugged and loved for days! The least of what we did was provide medical care. I could fill page after page with stories of the women of HOH; after all, that is where I thought God’s plan for the trip ended. But God had other ideas for us when we traveled to the island.

It was late on our final night on the island when the manager asked, “Do you want to meet Juan?” My answer was easy, “Sure, who is Juan?” After passing the squealing hog and the chickens running around the yard, we saw a young man. Juan was 25 years old, and he had been suffering from the crippling effects of juvenile rheumatoid arthritis since he was five years old. He is a self-taught artist who paints and draws beautiful pictures.

When we had first arrived on the island, I had jokingly said, “I wish I could buy an island!” The manager overhead me, pointed to the neighboring island and said, “Well, that one is for sale.” About 40 people, consisting of generations of the same family, were cramped on the quarter-acre island, but they couldn’t afford to buy other land until they sold

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their island. The island was going for half-price, or $30,000.

Meeting Juan that evening opened my eyes to the predicament of the families living on this island. I did the math, kept the faith and decided that my husband and I could help 40 people live better lives for this relatively small sum.

And just like that, my plans changed. My plan was meant to end after the three days on the island, but His plan was different. We now own an island in Nicaragua that we are building out as an eco-island hotel with proceeds going to the native people. The build out of the island has required that I travel to Nicaragua often, allowing me to develop a relationship with Juan and come to love him and his family.

We chat on the internet regularly and have become like family. The first year after meeting Juan, my mission was to help him sell artwork and earn money to begin to escape poverty.

Many of my friends now have beautiful paintings hanging on their walls, and Juan has a bank account and a cow!

ing joint replacement surgeries at no cost for those in need in the U.S. and globally. In January, Operation Walk provided Juan with bilateral hip replacements, and then he had a right knee replacement in March. The plan is for his right shoulder to be replaced in January 2019, allowing him to paint again without pain. Juan is so grateful to these volunteers who are his angels, and he want to glorify God with his story.

My journey is not over, but the mission work I’ve done through CMDA has changed my mind and transformed my heart. I now have a greater desire to watch for Him, walk with Him and work with Him. To do so, I must know Christ and have a personal relationship with Him. I wish I could tell you about all the “God winks” there have been along the way. I still fail to read the Bible every day like I should, but my faith is strong and I am watching, walking and working more than I was before the journey began.

Where it will end, only God knows!

It was after my second mission trip to HOH that I realized the extent of Juan’s suffering. A couple from the mission team joined us for our second stay at the eco-island after the mission trip. I did not know it at the time, but Paul is a rheumatologist! God sent a rheumatologist! Dr. Paul explained that Juan would need both hips and both knees replaced. Juan has never had access to the low-cost medication so accessible in the U.S., and, as a result, he is losing the ability to walk and paint.

Through all of this, God has given me a new mission and a new plan. I first thought my mission was simply the mission trip to HOH, and then I thought it was to help people trapped on an island. Later, I felt that it was to help Juan escape poverty through his art, and now I believe it is to help him receive multiple joint replacements so he can live a life undefined by pain and suffering. And even in that, God had a plan beyond my imagination.

At the beginning of 2018, Juan was evaluated for hip surgery by Operation Walk, a volunteer medical humanitarian organization that provides life-chang-

Transformed Doctors ➤ Transforming the World www.cmda.org 13

Am I Too Old to Practice?

by Al Weir, MD

14 TODAY'S CHRISTIAN DOCTOR Summer 2018

L

ucette Lagnado penned an article in the Wall Street Journal on June 25, 2017 entitled “When Are Doctors Too Old to Practice?”1 The central character in that article was a 71-year-old pediatrician who was facing a new rule at his New Jersey Hospital that required mental and physical testing for all physicians at the age of 72 in order to maintain their hospital privileges. He chose to retire instead. Age is becoming our issue as physicians.

The master surgeon and educator, Sir William Osler, once wrote: “The [physician] teacher’s life should have three periods, study until age twenty-five, investigation until forty, profession until sixty, at which age I would have him retired on a double allowance.”

Well, I’m past there now and no one is offering me a double allowance to quit. That’s the way my father was as well.

He and I were playing tennis when he reached 90 after retiring at 81. He loved his practice of internal medicine and left it with a sharp mind and good health because he had no buddies left to share night call with him. He fell into a funk for six months before he discovered that life in retirement could be wonderful.

On the other hand, when a senior member of my practice group was only 73, I walked into his office and told him, “You asked me to tell you if I ever thought you were losing your ability to take care of patients safely. I am so sorry, but I think you are there.” He suffered from early onset dementia, and I had been watching an escalation of minor mistakes in his patient care for several months. He thanked me for being honest and left practice within a month.

Thinking about the right time to hang it up is a fascinating process. When I was younger, I thought I might retire at 55 and enter a second career for the Lord, in international missions preferably. The Lord did allow me to take a break from practice at about that age for three years and serve full-time with CMDA, but my passion for patient care overwhelmed me and I returned to the occupation for which God created me, expecting to work well into my 70s if the Lord chooses.

In ever increasing numbers, physicians are choosing to work in practice after the age of 65. In fact, 23 percent of all physicians are over the age of 65, and 40 percent of those are actively practicing. We have all thought about those Golden Years when we no longer must hop out of bed at 5 a.m. and deal with time pressured decision making throughout our 10 to 12 hour days. But fewer of us are taking advantage of such opportunity. Why are more and more doctors not leaving the profession at 65 and enjoying the life we have Transformed Doctors ➤ Transforming the World www.cmda.org 15

built our nest eggs for? And, for that matter, why should our society allow us to continue very complex decision making and high agility procedures when the skills for such clearly diminish with advanced age?

To address the latter first, there is fairly good evidence that, in general, our cognitive and physical functions as physicians decline as we age past 60. Declining knowledge, failure to acquire new knowledge, decreased dexterity, increased surgical morbidity, failure to incorporate new modalities of therapy, slower reaction time and fatigue have all been documented to increase as physicians age in general (though wisdom, resilience, compassion and tolerance of stress may increase with aging).2, 3 Because of this decline in function in some physicians, the American Medical Association has recommended and is spearheading efforts to develop competency guidelines for older physicians. Some hospitals and medical staffs are moving ahead on their own, as described in the Wall Street Journal article.

This means that the future for many of us will be required testing after the age of 65 or 70 in order to remain in practice.

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Wow. There will certainly be problems in developing such a system of testing for many reasons. Most physicians who choose to practice after the age of 65 are highly competent and produce excellent result for their patients. The data presently used to suggest the need for such testing is of poor quality and relies to some degree on those physicians referred for testing based on observed concerns, a selection bias. There is presently no functional target to shoot for in deciding who is incapable of good practice. There is also presently no validated testing to measure deviation from that unknown target.4 Choosing whom to treat is also problematic. Relying on self-reporting of competency has been shown to be ineffective. Reporting by colleagues is limited by conflicts of interest and a desire to avoid harm to those reported. Referral for testing based on incidents of patient harm are clearly too late in many circumstances. Mandated testing by age is egalitarian but has no proven outcomes benefit. Much like reducing work hours in house staff training, the testing of elderly physicians will make theoreticians happy but may provide no improvement in overall healthcare. Nevertheless, we are moving toward a future in which some testing based on age will be mandated; and we, as Christian physicians, must accept the need to place the wellbeing of

our patients over our own self-interests. Some doctors do become functionally inadequate before we choose to leave practice and our patients deserve better. We should leave practice if we cannot provide good care for our patients.

Primum non nocere. Competence issues must be addressed in our personal practice decisions for our patients’ sake.

My personal approach to this concern has been to empower three colleagues to inform me if I become functionally deficient, at which time I will undergo the necessary testing to decide my future practice plans based on best patient care. By empowering them in the front end, it removes from them much of the guilt that might inhibit an honest assessment otherwise. By choosing three, I assume at least one will be honest, regardless of my feelings.

Assuming we have a system in place to ensure our competence, what personal factors come into play when we make our retirement decisions? Certainly, many physicians, just like other folk, are happy to retire and move on to other interests when they have the desire and the circumstances that allow a change. But others of us might have one or numerous incentives to continue working when we reach 65 to 70.

Sometimes, the anxiety of the unknown, life without healthcare, causes us to hesitate when the fork in the road appears ahead.

A common thread in many analyses of physicians facing retirement is the concern over losing their identity, which has been so wrapped up in practicing. We are uncertain there will be value to our lives once we are no longer practicing.

In a review regarding academic physicians, Onyura, et al.5 divide this identity concern into six distinctive and important needs: 1. Self-esteem: Need to maintain a positive conception of one’s worth 2. Self-efficacy: Need to maintain and enhance feelings of competence at a desired task

Often, we just love our work so much that we don’t want to let go of what we love. We have been blessed by God to be part of a profession that helps others and also fills our hearts with satisfaction.

Sometimes, we are confident God has clearly called us to continue our medical work. We are on mission. His will, as we understand it, overcomes any emotional or physical concerns that might lead us to retire.

Sometimes we have financial reasons, usually based on dependent family members or possibly the result of poor planning prior to age 65. Our required expenditures remain greater than our expected income if practice were discontinued, so the work goes on.

Sometimes there is just no one to take our place. There are people we serve and we have established no adequate succession plan to continue their care. We may want to decrease our workload, but the need is greater than our fatigue. This is particularly true of solo practitioners and physicians in rural practices.

Transformed Doctors ➤ Transforming the World www.cmda.org 17

3. Continuity: Need to maintain a sense of consistency across time and situation 4. Distinctiveness: Need to establish and maintain a sense of differentiation from others 5. Belonging: Need to maintain feelings of closeness to and acceptance by other people 6. Meaning: Need to find significance and purpose in one’s existence Any of these identity issues might make it difficult for us to hang up our stethoscopes, even though we might otherwise choose to do so. Onyura quotes one physician interviewed, “It’s hard to stop being a doctor, ever…All of us have a concern about the fact that leaving what has been the main focus of our lives, may leave us somewhat rootless. We worked so hard to get here, and I think, in many ways that’s our identity, that’s who we are.”

So, how do we decide if we are too old to work?

We should support and help develop a just and effective system to ensure competency of physicians at all ages. If we are physically or mentally unable to provide good care for our patients, we should stop.

But then, if our physical and neurocognitive status has been cleared, age is not the issue. Moses did perfectly well as an older gentleman leading the people of Israel, and Absalom failed miserably with the same nation as a younger man. If our mental and physical faculties are intact, we must address the personal considerations listed above in our decision to continue or to leave practice.

For Christian healthcare professionals, the primary issue is God’s will. Our determination of His will for our medical practice is wrapped up in all that we have been discussing.

Wanting His will with all our hearts, and following His will when we can see it, become the first steps toward making the right decision. This determination requires prayer, community, a greater desire for His glory rather than for our own satisfaction, and it requires trust. We must realize that His mission for our lives overrules fatigue, finances, pride and all identity issues. Perhaps His mission requires us to continue practice, or perhaps His mission is taking us in a totally new direction of service—international or local healthcare for the underserved, comforting of the widows and homebound in our churches, teaching God’s Word, mentoring a young generation of Christian healthcare professionals to take the baton from our hands and run, spending time with a family that needs us badly, etc.

When making retirement decisions, we need to consider those around us, those who are dependent on us emotionally or financially. God has ordained that family takes care of family. Sometimes that requires more money. Sometimes that requires more time at home. Financial support for others always requires wisdom. We are capable of being caught up emotionally in ways that prevent our dependents from finding their own wings or finding the wings that God would provide to help them fly. Sometimes those we think most need our financial help would be much better served with the gift of time that might come from cutting back our occupational load.

Of course, we must consider our patients. If we are all they have, we should not desert them without providing alternative avenues for patient care. I remember the weight of this obligation when I left practice for the mission field.

God provided then, and He will provide for all of us as we leave practice, but we must plan and be deliberate and do our best to develop a succession plan.

Loving our work is certainly a reason to continue it. But we must not make our work our idol. Considerations of God’s plan and the needs of our families may outweigh the joy of self-fulfillment. If God leads us away from practice, we can trust Him to replace that joy with something better. In When Your Doctor Has Bad News, I told the story of Jennifer Hanks and her children.6 Jennifer, who gave me permission to share, had suffered many months under my chemotherapy for her lymphoma. Her children suffered as well without a healthy mom and with little time dedicated to childhood fun. Finally, the treatment was completed and Jennifer’s family had planned a week away at nearby Pickwick Lake. Her young son prayed daily that this outing would actually happen, after many disappointed promises. The week came for

18 TODAY'S CHRISTIAN DOCTOR Summer 2018

the vacation and they were rained out. Jennifer’s son came to her in tears, “I asked God to let us go. Why didn’t He answer?” Jennifer answered her son, “God did answer. His answer was ‘no,’ but God said ‘no’ to Pickwick so He could say ‘yes’ to something better.” Jennifer did not know at the time, but her friends had entered their names in the Makea-Wish Foundation and presented them soon after with a fully paid family trip to Disney World. Jennifer was able to go to her son and announce, “Don’t you see? God said ‘no’ to Pickwick so that He could say ‘yes’ to Disney World.” It will be the same for some of us with quitting our practices. We cannot imagine leaving that which has provided so much joy and meaning. But, if God wishes us to leave it behind, He will replace Pickwick with Disney World, both in joy and usefulness. It took six months for my father to discover Disney World when he retired, but his joy resurfaced and he was a dedicated and happy servant for the Lord until he left us for heaven.

Questions surrounding anxiety over the unknown are simply a matter of trust. We take the step He chooses and trust Him to catch us.

Questions of identity, as listed by Onyura above, have been clearly settled by the apostle Paul. “For you are dead, and your life is hid with Christ in God” (Colossians 3:3, King James 2000). “...You are not your own, for you were bought with a price...” (1 Corinthians 6:19-20, ESV).

Our self-esteem is based on the value the Creator has placed on us. He values us enough to die for us. And our belonging is assured forever. “Come to Me, all who are weak and heavy-laden, and I will give you rest” (Matthew 11:28, NASB). “...I go and prepare a place for you... that where I am you may be also” ( John 14:3, ESV).

Our self-efficacy requires competency in whatever venue the Lord places us, whether right where we are in practice or in the new mission to which He sends us. Our continuity is in Him and in our church and will last forever.

Our distinctiveness is guaranteed if we follow the most distinctive man who ever lived. Matthew 5 is our path. Very few others will follow. Our meaning is the meaning of the cross. “And I, if I be lifted up from the earth, will draw all men unto me” ( John 12:32, King James 2000).

So, what are the takeaways? How do I decide if I am too old to practice?

1. Remember that God has a mission for your life as long as you live, whatever your occupation.

2. God’s will wins. Seek it and follow the best you can. What do you want me to do with the rest of my life, Lord?

3. Remain competent and up to date in knowledge and skills. It takes more energy to do so as we age.

4. Develop a system around you that will inform you if you are falling short of good patient care.

5 If you have physical or cognitive deficiencies that limit your capabilities, and you wish to remain in healthcare, consider changing your job description. Many choose fewer hours, volunteer work or administrative positions.

6. Decide what is best for your family, best for your patients and best for your Christian service.

7. Trust God to provide the joy and meaning for your life, whatever your decision.

8. Remember that your identity is in Christ, not in your occupation.

I have just turned 67. Someday, not yet, it will be my turn to set aside the work that has so blessed me. I hope to do so in the same way I started this beautiful journey into healthcare, as an offering to my Lord.

BIBLIOGRAPHY 1 Lagnado, L. (2017, June 25). When Are Doctors Too Old to Practice? Retrieved February 13, 2018, from https://www.msn.com/en-us/money/healthcare/when-are-doctors-too-old-to-practice/ar-BBD9gIF?li=AA4Zjn 2 Hawkins R, et al. Ensuring competent care by senior physicians. JCEHP. 2016; 36(3):226-231.

3 Grace E, et al. Predictors of physical performance on competence assessment. Acad Med. 2014; 89:912-919.

4 Kupfer J. The graying of US physicians. JAMA. 2016; 315(4):341-342.

5 Onyura B, et al. Reimagining the self at later career transitions. Acad Med. 2015; 90:794-801.

6 Weir A. When your doctor has bad news. Zondervan. Grand Rapids. 2003.

AL WEIR, MD, served in private practice at the West Clinic in Memphis, Tennessee from 1991 to 2005 before joining CMDA as Vice President of Campus & Community Ministries where he served for three years from 2005 to 2008. He is presently Professor of Medicine at University of Tennessee Heath Science Center and Program Director for the Hematology/ Oncology fellowship program. He is also Past-President of Albanian Health Fund, an educational ministry to Albania where he has been serving for 20 years. He is the author of three books: When Your Doctor Has Bad News, Whispers and Practice by the Book. Dr. Weir’s work has also been published in many medical journals and other publications.

Al and his wife Becky live in Memphis, Tennessee, and they have three children and three grandchildren. Dr. Weir is currently serving as President of CMDA and Chair of CMDA’s Board of Trustees.

Transformed Doctors ➤ Transforming the World www.cmda.org 19

Decreasing Isolation in Healthcare

by Autumn Dawn Galbreath, MD, MBA 20 TODAY'S CHRISTIAN DOCTOR Summer 2018

A

s a physician, my day-to-day-to-day routine of caring for people sometimes feels overwhelming. At times, it is difficult to feel compassion for the needs of the patient sitting in front of me, particularly if the need for which they are seeking care seems smaller than a need I have at that particular time. For example, when I am sick, I find myself much less sympathetic to the sick person seeking my help. Sometimes I even catch myself thinking something like, “Well, I’m clearly a lot sicker than you and I’m here at work. What’s stopping you from doing the same thing?” I have to actively catch myself in these low-compassion moments and remind myself of the perspective I want to have toward my patient.

On a seemingly unrelated note, as a Christian, the day-today-to-day routine of loving others and supporting them in their needs sometimes feels overwhelming. At times, it is also difficult to feel compassion for the needs expressed by others, particularly if I am personally fighting a spiritual struggle.

For example, when a prayer request is expressed in a Christian group (or on Facebook or in an email or…), sometimes I catch myself thinking something like, “Do you really need to publicize all your issues to everyone around you? I’m just handling things—can’t you do that, too?” Again, I have to actively catch myself in these low-compassion moments and remind myself of Christ’s perspective toward the needs of others.

The reactions I sometimes have in these situations—different contexts in which I am confronted by a person with a need—are evidence of compassion fatigue and emotional exhaustion, both key components of what is often called burnout. In a seminal discussion of burnout in the early 1980s, the syndrome was defined as: A syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment that can occur among individuals who work with people in some capacity. Emotional exhaustion refers to feelings of being emotionally overextended and drained by one’s contact with other people.

Depersonalization refers to an unfeeling and callous

response toward these people, who are usually the recipients of one’s service or care. Reduced personal accomplishment refers to a decline in one’s feelings of competence and successful achievement in one’s work with people.

It’s clear how this syndrome manifests itself in healthcare, with burned out, emotionally exhausted healthcare professionals struggling to find compassion toward the patients who seek their care, while ultimately feeling less successful in the pursuit of healthcare.

But it seems to me that Christians can experience these same symptoms in their personal relationships as they feel overwhelmed by the needs and prayer requests of those around them and begin to feel calloused toward those needs. In fact, I think a Christian can even feel “unsuccessful” in the Christian life. Haven’t you had moments when you wondered how God could use someone like you when you couldn’t even do X, Y or Z for a fellow Christian? It seems eerily similar to the professional burnout syndrome, doesn’t it?

What happens when these two roles—healthcare professional and Christ-follower—are joined in one person who wishes to follow Christ in and through their profession as a healer? This person typically strives to care for others in a deeper and more meaningful way than someone who shares either the profession or the faith might do. I do not believe Christian healthcare professionals are necessarily more susceptible to burnout and emotional exhaustion than non-Christian healthcare professionals, but I do think the two roles can compound each other’s challenges at times.

For example, as a Christian healthcare professional, do you ever feel as though these two parts of your identity exponentially multiply one another’s demands on your emotional reserves? Alternatively, do you ever detect a contradiction between those two parts of your identity? Do you ever feel that your faith is not welcome in healthcare, or that your medical identity is not welcome or—even worse—is taken advantage of in the church? I know I have experienced all of these feelings at times.

From the conversations at work in which colleagues stridently disagree with my views on bioethical and moral issues, to those Sundays when someone essentially wants a consult on their sick child in the church hallway, to the days when my well of compassion has run too dry to find the reserves to minister to my patients’ spiritual needs, sometimes it’s difficult to integrate my faith and my practice of healthcare.

Transformed Doctors ➤ Transforming the World www.cmda.org 21

As Christians, the idea of gathering, sharing experiences, supporting one another and living in community is foundational. Isn’t that what Hebrews 10:24-25, among other passages, commands?

And let us consider how we may spur one another on toward love and good deeds. Let us not give up meeting together, as some are in the habit of doing, but let us encourage one another—and all the more as you see the Day approaching.

An article crossed both my inbox and my Facebook feed recently entitled “Here’s Why Women Doctors Need Time Together.” It certainly wasn’t an academic study, but, as a woman physician, I was intrigued by the title. One sentence summarizes the author’s major premise: “There is an amazing power in gathering, shared experiences and decreasing isolation.” And I agree. When I watch my kids play sports or perform, I gather with other parents who share that experience—and we cheer as loudly as we can. When my marriage needs refreshment, my husband and I gather with other couples that share the experiences, both joyful and difficult, of marriage—and the isolation of our challenges is decreased. When I read a great book, I gather with my fellow literature-loving book club members to discuss it. In so many aspects of our lives, we seek community over shared experiences, and we feel a little bit more connected and a little bit more known than we were before.

22 TODAY'S CHRISTIAN DOCTOR Summer 2018

Most of the Christ-followers I know take this to heart, gathering with fellow believers in some setting or another on a regular basis.

Corporate worship, corporate prayer, Scripture reading and meditation, communion and teaching all serve to deepen our faith and to strengthen our bond with one another.

In my own life, I have places in which I gather with colleagues, and I have places in which I gather with Christfollowers. But sometimes I want those two defining parts of me—my faith and my medical training—to be considered together as important parts of my whole self. Those rare places where I can bring both of those parts of me are places I treasure. Places that offer respite. Where I feel understood. Where my isolation decreases. For me, the vast majority of those places relate to CMDA. From TRANSFORM: CMDA’s National Convention to Marriage Enrichment Weekends to commission meetings to my local CMDA chapter’s annual fall banquet, CMDA offers oases where my soul rests in feeling known and understood. Even my informal Bible study, in which I meet regularly with two dear friends, came out of CMDA. Of course, these gather-

UPCOMING EVENTS Looking for an opportunity to decrease your isolation in healthcare? Join us at one of our upcoming events. We host more than 40 topical, local, regional and national conferences each year. These events are some of the best opportunities for you to fellowship with other Christian healthcare professionals from all across the world, meeting with others who understand the same struggles you experience as a Christian in healthcare. For more information, visit www.cmda.org/events.

TRANSFORM: CMDA’S NATIONAL CONVENTION

ings offer more than just rest. They offer education, information, support and accountability. They meet needs that cannot be fully met in medical meetings or in Christian gatherings, because I can bring both parts of myself. As I am refreshed, I become a more congruent person, with the separate “boxes” of my identity integrated in a healthier way, and that healthy, congruent physician has so much more to offer to the patients and colleagues to whom she returns.

I think Rekha Chandrabose’s article hits the nail on the head: We “don’t have identical experiences, but we don’t have to start the conversation by [explaining some fundamental aspect of our lives to one another]…We can just breathe a little easier and know that the assumption in the room is that we all want [to reach similar end goals].” We can support one another as we grow into stronger, more faith-filled healthcare professionals and as we offer our patients both physical and spiritual healing.

www.cmda.org/nationalconvention Held each spring, CMDA’s National Convention is the premier convention for Christian healthcare professionals. You can fellowship with Christians in healthcare, learn about current health issues, renew your faith and network with exhibiting organizations.

MARRIAGE ENRICHMENT WEEKENDS

www.cmda.org/marriage Each year, CMDA’s Marriage Enrichment Commission offers four to six conferences in locations around the country. These weekends address the unique needs of healthcare marriages, offering couples the opportunity to nurture and grow in their marital relationships.

SUMMER FAMILY CONFERENCES

www.cmda.org/events Each summer, CMDA hosts two summer family conferences that offer your family an amazing opportunity to briefly disconnect from your busy lives to reconnect with your faith. These conferences include a wide variety of relaxing activities—like hiking, horseback-riding, swimming, eating—and programs for the entire family.

Join other CMDA families for a week of relaxation, recreation and reconnecting with God and each other.

WINTER CONFERENCES

AUTUMN DAWN GALBREATH, MD, MBA, is an internist in San Antonio, Texas, where she lives with her husband David and their three children.

Though they met in medical school, David now owns a restaurant in the San Antonio area. Between the two of them, they have experienced multiple career transitions and weathered the resultant stresses on their marriage and family. Autumn Dawn speaks to the issues of Christian marriage, being a working mother in the church and being a woman in medicine with an engaging humor that brings perspective to these difficult issues. Autumn Dawn earned her medical degree from the University of Texas Medical School at San Antonio, where she also completed her internal medicine residency. She earned her MBA from Auburn University in Auburn, Alabama.

www.cmda.org/events If you’re looking for a break from the doldrums of winter, look no farther than CMDA’s regional winter conferences. Offered in the Western Region, the Midwest Region and at CMDA’s national headquarters, each of these conferences provide a chance for you to reconnect with God’s purpose for your life as you also fellowship with your fellow Christians in healthcare.

WOMEN PHYSICIANS IN CHRIST ANNUAL CONFERENCE

www.cmda.org/wpc Hosted in a different location each year, this annual four-day conference for Women Physicians in Christ provides fellowship, continuing education, networking and spiritual growth and refreshment.

Transformed Doctors ➤ Transforming the World www.cmda.org 23

Gene Editing of Human Beings

by David A. Prentice, PhD

“I mean, if we could make better human beings by knowing how to add genes, why shouldn’t we do it?”

—Nobel Laureate James Watson, 1998

G

ene editing (the current term of art for genetic engineering or genome manipulation) has potential for great benefit but also for great harm. Newer techniques for genetic engineering provide much better accuracy than was achievable in the past and bring targeted genetic changes within reach. The range of medically beneficial applications is broad, including treating individuals with genetic diseases, intractable cancers and various previously incurable diseases. There is also the potential for designing new drugs and truly personalized, geneticallytailored therapies. But this more refined genetic manipulation technology also could be used to design children, weaponize biological agents or even alter or dehumanize our concept of humanity. As with many cutting-edge biological technologies, much depends on the targets, attitudes and motivations of the innovators.

24 TODAY'S CHRISTIAN DOCTOR Summer 2018

Genetic engineering has become a hot research topic of late, due primarily to the recent development of more accurate enzyme systems to target and cut DNA at specific sequences. These targeted nuclease systems provide sequence-targeting precision that was previously unavailable.

Prior techniques for genetic engineering primarily utilized the addition of genes as DNA pieces that integrated randomly (in placement and in number of insertions) into the genome, or with insertion facilitated using various viruses as vehicles which gave partial targeting into some portions of the genome but still produced largely a shotgun effect of gene insertion. One of the earliest gene therapy clinical trials used this technique to successfully correct severe

forms of genetic engineering. While cloning does not manipulate parts of the genome, nor insert or delete various genes, cloning as genetic engineering is indeed an attempt to create an individual with a specific genome, in a sense recreating a genetic information bank already lived. Cloning also provides a mechanism to replicate a complete genome’s information, multiplying this effect many times over. Construction of three-parent embryos uses the same techniques but transfers the nucleus at the earliest stages of embryonic development. Further discussion of these cloning technologies requires its own article, but in brief we can note that these types of cloning techniques fall into the category of unethical; human beings are not treated therapeutically in these cases but instead new individuals are manufactured as experiments themselves.

“Soon it will be a sin for parents to have a child that carries the heavy burden of genetic disease. We are entering a world where we have to consider the quality of our children.”

— Embryologist Robert Edwards, 1999 combined immunodeficiency (SCID; so-called “bubble boy syndrome”) in children, adding a correct gene to autologous hematopoietic stem cells in these children.1 However, the technique’s random insertion of the functional gene resulted in some instances where the added gene (containing a strong genetic promoter) inserted close to normal, growth-promoting genes and stimulated overproduction of the growth-promoting gene, resulting in leukemogenesis.2 We should also be aware of other brute force genetic manipulation techniques, specifically cloning (somatic cell nuclear transfer) and construction of three-parent embryos (which is also a form of cloning.) These are actually extreme

For specific gene editing, the three current nuclease systems that are most promising are ZFNs (zinc finger nucleases), TALENs (transcription activator-like effector nucleases), and the CRISPR-Cas complexes (clustered regulatory interspaced short palindromic repeats-CRISPR associated system.)3 ZFNs are constructed from a class of transcription factors that bind to specific DNA sequences, normally acting to turn on specific genes in the cell. Upon binding to DNA, the enzyme makes a double-strand cut, which activates the cell’s normal DNA repair system to insert DNA at the cut site. TALENs are also constructed from transcription activator proteins. By constructing variations in the amino acid sequence, almost any DNA sequence can be targeted. Like a ZFN, once the TALEN binds to its specific DNA sequence the DNA is cut, activating the DNArepair system of the cell, which inserts the added DNA as part of the repair of the cut. The CRISPR-Cas system also has a targeting portion associated with a nuclease (Cas), but the targeting uses a short guide RNA that base pairs with specific DNA sequences. Once the guide RNA binds to its specific target DNA sequence, the nuclease cuts doublestranded DNA at the binding site. Constructing different guide RNA sequences (easier than constructing different protein sequences) means any DNA sequence can be targeted for cutting. Safety is still a concern, particularly because these gene editing systems are not 100 percent accurate, leading to “off-target” cutting of DNA at sites throughout the genome other than the one desired site. Simple human genetic variation may be a barrier to successful therapeutic gene editing until accuracy can improve.4 Clinical trials have already begun in attempts to modify specific genes of people affected with genetic diseases or to treat cancer patients using genetically-altered immune cells. These projects are worthwhile pursuits, not least because they target alleviating the conditions of existing Transformed Doctors ➤ Transforming the World www.cmda.org 25

stimulatory proteins on a T lymphocyte with an antibody portion that targets the specific cancer or leukemia in the patient; the combination makes the cell able to specifically target and attack the individual’s cancer.9 Additional genetic modifications can also be added to equip the immune cells with other useful features in the treatment of the cancer. A version of this system was used to successfully treat two young leukemia patients.10,11 individuals. In one example, genetic correction of autologous epidermal stem cells has been used successfully to replace the diseased skin of a young boy in Germany suffering from a genetic condition called junctional epidermolysis bullosa ( JEB).5 JEB is a severe and often lethal disease—more than 40 percent of patients die before adolescence—where a mutation in a laminin gene means skin cells cannot interconnect; instead, the skin blisters and falls off with the slightest touch, leaving wounds all over the body. There is no cure and little beyond palliative care for sufferers. An Italian team grew epidermal stem cells from biopsies of the boy’s skin, used a retroviral vector to add the full-length, normal laminin gene to the cells and then grew sheets of genetically-corrected skin which were transplanted onto the boy. The transplants replaced more than 80 percent of his skin, and within six months the boy was back in school sporting healthy, blister-free skin, and he has remained healthy and active.6 In a clinical trial recently begun, the first patient has received gene therapy for Hunter syndrome, a condition where an important sugar-metabolizing enzyme is mutated and non-functional. In this trial, the patient received an injection of the gene editing enzymes and new gene, which work to insert the new, functional gene into a specific site in the liver cells.7 The cells then function as a factory to create the needed enzyme.

Other trials are slated to begin soon in Europe and in the U.S. to use specific gene editing to treat patients with β-thalassemia and sickle cell anemia.8 The trials will target activating the gamma-globin gene to replace the mutated beta-globin.

Another promising gene editing technique is construction of chimeric antigen receptor-T cells (CAR-T). Genetic engineering combines antigen-detecting receptors and 26 TODAY'S CHRISTIAN DOCTOR Summer 2018

But despite the successes and promise of gene editing for treatment of patients, there have been ethically troubling attempts to alter the genomes of young human embryos. This “germline” gene editing is aimed at creating new individuals with altered DNA. And since the genetic modifications are incorporated into all of the cells so early in life, any genetic change will be passed on to future generations, with unknown consequences for the gene-manipulated individual as well as future generations.

Chinese researchers previously published three reports on genetic manipulation of human embryos. More recently, scientists from the United Kingdom published their first experiment using CRISPR to disable different genes in human embryos simply to see how that would affect their early development.12 And finally, U.S. researcher Shoukhrat Mitalipov, PhD, reported a gene editing experiment on normal human embryos, including statements on his desire to gestate and birth some of these gene-edited children.13 Perhaps unsurprisingly, this researcher is also the one who created cloned human embryos, created three-parent human embryos using cloning techniques and advocated for gestation and birth of three-parent embryos. In their experiments to correct a mutation in the embryos’ genome, the researchers created 142 human embryos for the experiment; all were subsequently destroyed. The results reported by the team (100 percent effective with no off-target cuts) have been characterized as almost too good to be true and certainly much less than safe and effective. Other researchers have since published a paper that calls into question the conclusions of the Mitalipov gene editing paper, but whether or not the gene editing results are invalid in this experiment, there is a continued push by some scientists to do human embryo experiments. Dr. Mitalipov himself encouraged others to do gene editing experiments on human embryos, and he has stated his hope that U.S. lawmakers would loosen restrictions currently in place that prohibit funding of such experiments as well as clinical trials placing gene-edited embryos in the womb.

Those U.S. restrictions on clinical trials and gene editing experiments with human embryos were put in place by Congress, led by Alabama Rep. Robert Aderholt in 2015, and were a direct response to the attitude of some scientists and the National Academy of Sciences that creation, manipulation and destruction of human embryos in gene editing experiments is ethically permissible.14 The language suspends genetic experiments only with human embryos, but fully allows development and trials of genetic therapies for born individuals.

This highlights the real ethical line regarding application of genetic technologies: who will be genetically modified?15 Will we focus on born individuals and on gene editing that is truly therapeutic for human beings but not in the germline, or will be allow genetic experiments with human embryos and the manufacturing of new, better, geneticallydesigned human beings? Some researchers have foresworn any genetic experiments on human embryos, but there is still no final policy resolution. In the movie Gattaca, the main character struggles to overcome the stigma of not being genetically designed and enhanced (a “valid” birth), as well as to overcome the genetic caste system that gene editing of human embryos would create. Our human future, as well as our attitudes on how we treat “the least of these” among our fellow human beings, deserves full discussion.

BIBLIOGRAPHY 1 Marina Cavazzana-Calvo et al., “Gene Therapy of Human Severe Combined Immunodeficiency (SCID)-X1 Disease,” Science 288.5466 (28 April 2000): 669-672, doi: 10.1126/science.288.5466.669 2 Salima Hacein-Bey-Abina et al., “A serious adverse event after successful gene therapy for X-linked severe combined immunodeficiency,” NEJM 348.3 (January 16, 2003): 255-256, doi: 10.1056/NEJM200301163480314 3F or an overview, see Gaj T et al., ZFN, TALEN, and CRISPR/Cas-based methods for genome engineering, Trends in Biotechnology 31, 397-405, July 2013 4S amuel Lessard et al., Human genetic variation alters CRISPR-Cas9 on- and off-targeting specificity at therapeutically implicated loci, Proc.

Natl. Acad. Sci. USA 114, E11257-E11266, Dec. 26, 2017, doi: 10.1073/ pnas.1714640114

5 Tobias Hirsch et al., “Regeneration of the entire human epidermis using transgenic stem cells,” Nature 551.7680 (16 November 2017): 327–332, doi:10.1038/nature24487 6 David Prentice, “Adult Stem Cells and Gene Therapy Save a Young Boy,” Nov 16, 2017, accessed at: https://lozierinstitute.org/adult-stem-cells-andgene-therapy-save-a-young-boy/ 7 Jocelyn Kaiser, “A human has been injected with gene-editing tools to cure his disabling disease. Here’s what you need to know,” Science News, Nov 15, 2017, doi: 10.1126/science.aar5098 8 Ryan Cross, CRISPR is coming to the clinic this year, Chemical & Engineering News 96.2, 18-19, January 8, 2018; access at: https://cen.acs.org/ articles/96/i2/CRISPR-coming-clinic-year.html 9 National Cancer Institute, “CAR T Cells: Engineering Patients’ Immune Cells to Treat Their Cancers,” Dec, 14, 2017; accessed at: https://www. cancer.gov/about-cancer/treatment/research/car-t-cells 10 Jennifer Couzin-Frankel, “Baby’s leukemia recedes after novel cell therapy,” Science 350, 731, November 15, 2015 11 Qasim W et al., “Molecular remission of infant B-ALL after infusion of universal TALEN gene-edited CAR T cells,” Science Translational Medicine 9.374 (25 January 2017): eaaj2013, doi: 10.1126/scitranslmed.aaj2013 12 Heidi Ledford, “CRISPR used to peer into human embryos’ first days,” Nature News 20 Sept. 2017, doi: 10.1038/nature.2017.22646 13 Pam Belluck, “In Breakthrough, Scientists Edit a Dangerous Mutation From Genes in Human Embryos,” New York Times Aug 2, 2017; accessed at: https://www.nytimes.com/2017/08/02/science/gene-editinghuman-embryos.html 14 David A. Prentice, “Modest but Meaningful Protection from Human Embryo Genetic Manipulation,” Townhall Dec 17, 2015; accessed at: https:// townhall.com/columnists/davidaprentice/2015/12/17/modest-but-meaningful-protection-from-human-embryo-genetic-manipulation-n2094746 15 Michael Burgess and David Prentice, “Let Congress know to take it slow on human gene editing,” Dallas News December 28, 2016; accessed at: http://www.dallasnews.com/opinion/commentary/2016/12/28/letcongress-know-gene-editing-humans-bad-business

DAVID A. PRENTICE, PhD, is Vice President and Research Director for the Charlotte Lozier Institute. He served over 10 years as Senior Fellow for Life Sciences at the Family Research Council, and prior to that he spent almost 20 years as Professor of Life Sciences at Indiana State University. Dr. Prentice is an internationally-recognized expert on stem cell research and bioethics, and he has provided scientific testimony before the U.S. Congress and numerous state legislatures, the U.S. National Academy of Sciences, the President’s Council on Bioethics, European Parliament, British Parliament, Canadian Parliament, Australian Parliament, German Bundestag, French Senate, Swedish Parliament, the United Nations and the Vatican. Dr. Prentice has published numerous scientific and bioethics articles, and he travels nationally and internationally to give frequent invited lectures regarding stem cell research, cloning, bioethics and public policy. He has been interviewed in virtually all major electronic and print media outlets, including CNN, ABC, NBC, CBS, Fox, CSPAN, Reuters, AP, NPR, BBC, USA Today, The Washington Post, The Los Angeles Times and The New York Times.

Transformed Doctors ➤ Transforming the World www.cmda.org 27

I am sending you out like sheep among wolves.

Therefore be as shrewd as snakes and as innocent as doves.”

—Matthew 10:16

Counting the Cost of Discipleship

by Jonathan Imbody

28 TODAY'S CHRISTIAN DOCTOR Summer 2018

E

culturally diverse population background. My husband and I contemplated working overseas, and we felt this would be a great position to begin preparing for that role.”

“I began sending applications with my peers’ recommendations to prospective practices, pending passing the comprehensive and board examinations,” she recounted. “I applied at Tampa Family Health Centers because I was seeking to work in an area whose patients primarily come from an underserved, low-income,

Due to the fact we are a Title X [federal family planning funds] organization and you are a member of [a pro-life organization], we would be unable to move forward in the interviewing process.1

agerly approaching the end of her Certified Nurse Midwife education, CMDA member Sara Hellwege decided to seek a position where she could minister to medically underserved patients without compromising her life-affirming convictions. So she launched out into her job search, a seemingly simple and safe journey that unfortunately would end in a shipwreck.

Sara never anticipated the national firestorm that her job search would launch. “After sending an initial inquiry to the practice and some routine dialogue, I received an unexpected email,” she said. “The wording stunned me.”

Sara never anticipated a zero-tolerance, no-diversity policy of outright discrimination: “Pro-life health professionals need not apply.”

“During my previous professional experiences, there had been colleagues who had differed with my view, but we always maintained a respectful dialogue and working relationship,” she said. “I was shocked to learn that having a professional membership listed on a resume could then be brazenly utilized as justification to confidently deny employment. It saddened me to be turned away due to ideological and religious differences.”

APPEALING TO CAESAR Sara could have taken the route of passive acceptance, by ignoring the discrimination and simply keeping her head down, searching for a more sympathetic employer. Instead, she followed the example of the apostle Paul, who appealed to Rome to uphold his legal protections when he was unjustly persecuted for his Christian faith, as recorded in Acts 25:11.

Alliance Defending Freedom (ADF), one of several prolife groups CMDA works with to provide pro bono legal help to members2 who experience discrimination, agreed to take up Sara’s cause. ADF attorneys filed suit in federal district court in Florida, in addition to filing administrative complaints with the U.S. Department of Health and Human Services (HHS) and the Equal Employment Opportunity Commission (EEOC).

“I wanted to set the tone and a precedent,” Sara explained, “that this type of discrimination is not acceptable. I wanted to help my peers and others in the medical field, hoping that standing firm in my faith would empower others to speak up regarding their experiences regarding discrimination for their faith and convictions. I took my cues from 1 Corinthians 16:13-14: ‘Be on your guard; stand firm in the faith; be men of courage; be strong. Do everything in love.’”

Transformed Doctors ➤ Transforming the World www.cmda.org 29

PROGRESS ON CONSCIENCE PROTECTIONS A series of recent landmark actions at the federal level are poised to protect, enforce and educate others about your rights to believe as you choose and to act according to conscience upon your beliefs.

On May 4, 2017, a “Presidential Executive Order Promoting Free Speech and Religious Liberty” set the groundwork for a series of administrative actions by declaring, “It shall be the policy of the executive branch to vigorously enforce Federal law’s robust protections for religious freedom.” The order asserted the vision of American founders to establish “a nation in which religious voices and views were integral to a vibrant public square, and in which religious people and institutions were free to practice their faith without fear of discrimination or retaliation by the Federal Government.”

The order directed federal agencies to “address conscience-based objections to the preventive-care mandate” and “issue guidance interpreting religious liberty protections in Federal law.”

On January 18, 2018, the U.S. Department of Health and Human Services (HHS) held a press event to announce a new Conscience and Religious Freedom Division within the Office for Civil Rights. The new unit will “specialize in enforcement of and compliance with laws that protect conscience and free exercise of religion, and that prohibit coercion and discrimination.” Speakers at that event included Senator James Lankford and Rep. Vicki Hartzler (two people CMDA meets with regularly), as well as CMDA member Sara Hellwege, who recounted her story of discrimination.

At the March for Life on the morning of January 19, 2018, CMDA Vice President for Government Relations Jonathan Imbody spoke with U.S. Department of Health and Human Services’ Acting Secretary Eric Hargan regarding the need for conscience protections in healthcare and education regarding federal conscience laws.

Sec. Hargan told him to keep an ear out for some very good imminent news and assured him he would be happier by the end of the day. That afternoon, HHS publicly announced a new proposed rule, “Protecting Statutory Conscience Rights in Healthcare.” The regulation, which builds upon a 2008 rule that was subsequently gutted, is designed to educate the healthcare community about federal conscience laws and to provide for robust enforcement of the laws.

For more information on this topic, visit www.freedom2care.org.

WOLVES HOWL AS SHEEP SEEK FREEDOM As Sara soon discovered, standing firm in the faith in today’s toxic cultural environment can exact what Nazi-resister and Christian martyr Dietrich Bonhoeffer called the “cost of discipleship.” Her simple plea for freedom of conscience triggered scathing condemnations and even threats 30 TODAY'S CHRISTIAN DOCTOR Summer 2018

of violence from anti-religious, pro-abortion commentators and activists: • In a commentary on Sara’s court case, “The religious war on contraception,” Amanda Marcotte from Slate.com asserted, “Is ‘religious freedom’ about being free to practice your faith, or just a generic cover story for any and all attempts to try to foist your beliefs on others?”3 • In a follow-up op-ed published in USA Today, Marcotte continued the attempt to tar the victim as the attacker, opining that “a growing crop of fundamentalists are demanding that the religious freedom of patients to make their own decisions about health care should be curtailed, allowing providers to push their own agenda on them.”4 • Americans United for Separation of Church and State pulled out all stops and labeled the case as an “increasingly aggressive war against access to birth control” borne of a “theology anchored in judgment, punishment and retribution.”5 • An editorial at Jezebel slung a term at Sara and the “anti-birth control crowd” that is too crude to reprint here.6 • A commentator at Wonkette attacked Sara in a profanity-laced diatribe as a “wingnut nurse,” concluding, “Sara needs to find a new calling because obviously women’s health care provider ain’t it, and also, she should punch herself in the face.”7 “During the tumultuous time of the legal proceedings,” Sara recalls, “I was quite fortunate to have support of my local CMDA chapter, prayer from those in the national office and encouragement from my church family. That support allowed me to stand firm in my convictions and hope of the gospel.”

Sara offers a gentle response to the harsh allegations against her: “My religious belief to not end the life of an unborn person and working within the Hippocratic Oath does not lead me to isolate a segment of the population from receiving care. I have and will continue to provide respectful, evidence-based, compassionate care to all of my patients, regardless of their religious beliefs, sexual identity or lifestyle choices.”

CONSCIENCE FREEDOMS PROTECT PATIENT ACCESS Sara’s case illustrates that faith-based healthcare professionals do not, and cannot, separate the faith principles motivating them to serve the needy from the faith principles upholding the sanctity of human life.

Polling conducted for CMDA’s Freedom2Care revealed that 92 percent of faith-based physicians said they would be

forced to leave medicine if coerced into violating the faith tenets and medical ethics principles that guide their practice of medicine. The poll also found that 39 percent have “experienced pressure from or discrimination by faculty or administrators based on [their] moral, ethical or religious beliefs.”8 Conscience rights impact healthcare professionals as well as the patients they serve. In Freedom2Care’s polling, 88 percent of American adults surveyed said it is important to them that they share a similar set of morals as their doctors, nurses and other healthcare professionals.

Sara explains, “Conscience freedom widely impacts healthcare availability. Currently our nation possesses vast geographic areas with no OB/Gyn coverage, including 38 out of 67 counties in my own state of Alabama. Mounting shortages are not limited to the field of obstetrics and are climbing within nursing and medicine.”

CASE HIGHLIGHTS NEED FOR STRENGTHENED FEDERAL LAW The federal court examining Sara’s case ruled that the federal conscience protection law applicable to the discrimination she experienced does not make clear the right of a victim of discrimination to sue in court (a “private cause of action”).

The U.S. District Court in Florida, Tampa Division found that “whether Hellwege has alleged a private cause of action under either statute presents a novel and complex issue of state law” and accordingly “decline[d] to exercise supplemental jurisdiction over Hellwege’s claims under these statutes.”9 To address this gap, prolife organizations, including CMDA, are pressuring the U.S. Congress to pass the Conscience Protection Act. The act would give victims of discrimination the right to sue in court.

It also would make permanent certain conscience protections that Congress currently needs to pass every year.

division to enforce conscience protections and a new rule to protect conscience freedom in healthcare (see sidebar).

HOW IS GOD LEADING YOU TO BECOME ENGAGED? Undaunted by losing a court case and weathering a tidal wave of vitriol, Sara is now focused on advancing conscience- and life-affirming principles in the public policy arena, even if that means a career shift to public policy to advance the cause. She summed up her experience and engagement with this issue: I commend the actions of CMDA on the strides that have been made to protect the healthcare professionals’ conscience freedom on both the state and federal levels. I applaud their actions and service related to educating the public and professionals regarding vital issues such as human trafficking, physician-assisted suicide, embryonic stem cell research and a myriad of other critical issues that have the ability to affect our daily life as clinicians. I encourage us all to prayerfully consider how God may be leading us to work alongside CMDA to defend and advocate on crucial issues for professionals. We can all be fully devoted to the work to which He has called us, whether it be providing exemplary patient care, supporting a colleague through a difficult situation or advocating on behalf of the marginalized. Exodus 1 describes the Hebrew midwives disobeying the commands of Pharaoh by not killing the male Hebrew children, but instead, fearing the Lord and holding fast to the sanctity of life. In turn, God was faithful to provide protection and establish their households. A lesson that I learned from the Hebrew midwives and my experience is that our God is true

Meanwhile, the ship of American civil rights is being turned back in the direction of religious and conscience freedom, with an executive order, a new Transformed Doctors ➤ Transforming the World www.cmda.org 31

CMDA member Sara Hellwege (right) joined other pro-life advocates at this year's March for Life in Washington, D.C.

http://cqrcengage.com/f2c/app/bill/868228. To voice your views to your legislators on this and other issues, visit www.freedom2care.org.

BIBLIOGRAPHY

yesterday, today and forever; He is the one in whom we should place our trust. It is by His grace that He orchestrates the situations which pass before us, and we should be seeking His approval—not that of others.

Sara’s experience exemplifies what pro-life healthcare professionals can expect to experience in the current era if they choose to remain faithful to their conscience, to lifeaffirming medical ethics and to their faith in Jesus Christ: Arm yourself with the wisdom of a serpent.

Clothe yourself with the gentleness of a dove.

Prepare for persecution from the wolves.

Seek protection from governing authorities.

Stand firm in your faith in Christ.

“All men will hate you because of me, but he who stands firm to the end will be saved...So do not be afraid of them. There is nothing concealed that will not be disclosed, or hidden that will not be made known.”

—Matthew 10:22,26 GET ENGAGED WITH PUBLIC POLICY To learn more and get involved with CMDA’s efforts in public policy on the federal level, visit www.cmda.org/ washington. To learn more about the Conscience Protection Act, visit CMDA’s Freedom2Care legislative action site at 32 TODAY'S CHRISTIAN DOCTOR Summer 2018

1 To read the full memo, visit www.adfmedia.org/News/PRDetail/9176.

2 For a full listing of legal help options, visit www.freedom2care. org/legal-help.

3 Marcotte, A. (2014, July 23). The religious war on contraception.

Retrieved March 12, 2018, from www.tampabay.com/opinion/columns/the-religious-war-on-contraception/2189731.

4 Marcotte, A. (2014, July 25). Freedom isn’t forcing religion on others: Column. Retrieved March 12, 2018, from www.usatoday. com/story/opinion/2014/07/25/religious-freedom-women-discrimination-hobby-lobby-exemption-obama-column/12987547/.

5 Boston, R. (2014, July 21). Access Denied: The Religious Right Opens Up A New Front On Its War Against Birth Control. Retrieved April 19, 2018, from www.au.org/blogs/wall-of-separation/access-denied-the-religious-right-opens-up-a-new-fronton-its-war-against 6 Ryan, E. G. (2014, July 21). Nurse Who Won’t Prescribe Birth Control Sues Clinic For Not Hiring Her. Retrieved March 12, 2018, from www.jezebel.com/nurse-who-wont-prescribe-birth-controlsues-clinic-for-1608437415.

7 Gray, K. J. (2014, July 27). Wingnut Nurse Sues Family Planning Center For Not Giving Her Job Just Because She Says She Won’t Do Job. Retrieved March 12, 2018, from www.wonkette.com/554560/wingnut-nurse-sues-family-planning-centerfor-not-giving-her-job-just-because-she-says-she-wont-dojob#M6sFL4PwivBS6kyB.99.

8 Polling details available at www.freedom2care.org/polling.

9 Hellwege v. Tampa Family Health Centers, Case No. 8:14-cv-1576-T33AEP. April 10, 2015 order by Virginia M. Hernandez Covington, District Judge. Accessed online March 12, 2018 at www.leagle.com/decision/infdco20150413717.

JONATHAN IMBODY serves as CMDA’s Vice President for Government Relations. As CMDA’s liaison with the federal government, he has participated in dozens of White House meetings, has testified before the U.S. Congress and makes more than 250 personal contacts with congressional leaders and government officials each year. Jonathan is the author of Faith Steps, a book designed to encourage and equip people of faith to engage in public policy issues. He has also published more than 100 commentaries in The Washington Post, USA Today, New York Times, Los Angeles Times, San Francisco Chronicle and other publications. He received a bachelor’s degree in journalism and speech communications from Pennsylvania State University, a master’s degree from Penn State in counseling and education and a certificate in biblical and theological studies from the Alliance Theological Seminary. Jonathan’s wife Amy is an author and educator. They have four grown children and four grandchildren.

CMDA MEMBER SERVICES Dedicated to serving you

“I’m proud of the work of CMDA. My Lifetime Membership allows me to voice my strong support of this ministry. Additionally, Lifetime Membership saves me the time and worry about annual membership renewal.”

- Lisle Whitman, MD CMDA Member since 1991 Lifetime Member since 2006

LIFETIME MEMBERSHIP A LIFETIME OF OPPORTUNITY A LIFETIME OF CHANGE

A Lifetime Membership to CMDA offers extensive benefits to you as well as helps to ensure that the important work being done for healthcare continues far into the future.

HE MADE THE COMMITMENT.

WILL YOU?

• • • •

Never worry about a dues increase again Save time spent on repetitive check writing Gain a significant tax deduction Experience the satisfaction of providing funding for long-term, life-changing ministries • Now offering 50% off Lifetime Membership dues for retirees

Contact Member Services www.cmda.org/lifetime membership@cmda.org 888-230-2637

Merge your faith and your profession today!

Visit www.joincmda.org for more information.

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CLASSIFIEDS To place a classified advertisement, contact communications@cmda.org.

GENERAL

Affiliate Needed — Protect life and bring joy into the lives of couples unable to carry a pregnancy to full term. The National Embryo Donation Center (NEDC) has reached maximum capacity and needs an affiliate who shares the same Christian worldview and can provide the full range of services currently offered at the NEDC. More than 700 children have been born through embryo adoption at the NEDC since it was founded in 2003, and the program has garnered an outstanding reputation with a success rate above the national norm. Affiliate physician must be a reproductive endocrinologist (REI) who is board certified/board eligible. Contact Dr. Jeff Keenan at 865777-0088 or email jkeenan@baby4me.net. Go to www. embryodonation.org.

Practice for Sale — Are you ready to feel good about how you practice medicine? To practice free from preset patient-load quotas or external monetary goals?

Would you like to manage your own work schedule, office hours, and time off ? Take over our 40 year-old family practice near Seattle! Whether you are a physician who is just finishing residency training, or one who is becoming disgruntled with the impersonal and over-controlling physician-as-employee system, this practice is proof that the private small-practice setting is still alive, well and in demand by patients. For more information, check out https://sellingapractice.com/ family-practice/.

Tropical Medicine Course — Clinical Tropical Medicine and Traveler’s Health Course ASTMH accredited. Modules 1, 2 and 4 online and Module 3 in person.

Online modules start June 11, 2018 and are self-paced.

Module 3 (Parasitology and Simulations) July 9-20, 2018. Sponsored by West Virginia University School of Medicine, Global Health Program and Office of Continuing Education. For more information about course or continuing education, contact Jacque Visyak at 304-293-5916, jvisyak@hsc.wvu.edu or http://medicine.hsc.wvu.edu/tropmed.

DENTAL

Dentist — Established pediatric practice located in Beavercreek, Ohio seeking a pediatric dentist to join our team. New graduates welcome! Benefit package negotiable! If you have strong values, genuinely care about your patients and are a team member, you are what we are looking for! Email Heather@beavercreekpediatricdentistry.com.

MEDICAL

Advanced Registered Nurse Practitioner — Seeking Christian ARNP for Florida Mental Health Facility — Honey Lake Clinic is a non-profit organization (501c3) created to glorify God, in the name of Jesus Christ and the Holy Spirit, through the psychological and spiritual renewal of each individual to achieve their God-given potential and live fully transformed lives of joy, peace, forgiveness, freedom, meaning, purpose and fulfillment through world-class Christian mental health and substance abuse treatment. We are licensed by the State of Florida to provide Detox, Residential Level 1, Partial, and Intensive Outpatient Services at a 600-acre converted five-star resort in Greenville, Florida. We are currently seeking an ARNP to support the Medical Director in providing the psychiatric treatment components of patient care and serve as liaison to clinical staff as related to ongoing patient care. As this position is so integral to our mission, free onsite housing at the facility will be provided (staff member only). Minimum requirements include a master of science in nursing from an accredited nursing school and a current, active and unencumbered Florida ARNP license and DEA number. Three years of experience working with mentally ill patients or residents requiring substance abuse services and the ability to meet criminal background check and drug screening per state requirements is also necessary. If interested, please email aduran@honeylake.clinic and dhoskins@honeylake.clinic with cover letter and resume.

Family Medicine or Internal Medicine Physician — Seeking Stellar Family Medicine or Internal Medicine Physician — Arcadia, California has an excellent opportunity for a full time BC/BE family medicine or in34 TODAY'S CHRISTIAN DOCTOR Summer 2018

ternal medicine physician. Join a spirit-filled and growing outpatient/ambulatory practice that sees a blend of patients. Our two-physician group enjoys an excellent reputation among the community. Our physicians each see between 16-20 patients per day with ample opportunity to perform procedures or tailor your practice to your clinical interests. In fact, our physicians also have interests in travel medicine and sports medicine. Our amazing manager and staff keep the office running smoothly. Hospital work is an option but not necessary.

Community Highlights: warm and sunny Southern California. Live in community with excellent local food, entertainment, shopping, golf course, hiking trails, ample opportunity for outdoor activities. Excellent school district. Known for the Santa Anita Race Track hosting live horse races throughout the year. Historic Rose Bowl is 15 minutes away. Easily travel to the beach, as well as drive up to the mountains to ski/snowboard. Contact Office Manager Ellie Kotsoglou at ekotsoglou@pathwayshealthcare.org with your CV. General Neurologist — Florence, South Carolina — BC/BE neurologist sought to join solo Christian neurologist in independent practice with accredited MRI, EEG, EMG, U/S, infusion suite, EHR. No hospital call. Consulting privileges and sleep lab available at nearby hospital. Salary with production bonus and benefits offered. Florence, South Carolina (population 140,000) boasts a low cost of living, mild winters and proximity to Carolina beaches and golf courses. Send CV to evanswj@aol.com.

OB/Gyn — OB/Gyn practice opportunity on the Crystal Coast of North Carolina. My practice is the only faith-based option in three counties and is a ministry. Fifteen years in practice plus four years in Navy medicine. Now I am being called to other forms of practice and other avenues. Looking for someone to take over the business. Contact Katrina Conrad at katconrad2556@gmail.com.

Oncologist/Hematologist — Wenatchee, Washington — About the position: Seeking board certified or eligible oncologist/hematologist for busy, well-established and successful, comprehensive and accredited cancer care program. Integrated system with five hematologists/oncologists, two radiation oncologists, three ARNPs, case managers, nurse navigators, certified oncology nurses, pharmacist, in-house infusion center and radiation treatment, dieticians, behavioral medicine practitioners and all specialty and primary care partners.

1:5 call. Strong 19-member hospitalist team provides in-patient support. Multi-disciplinary tumor board and cancer registry. Proudly affiliated with the Seattle Cancer Care Alliance. Research and teaching opportunities.

We offer competitive benefits: Confluence Health is a non-profit organization that contracts with the physicians of the Wenatchee Valley Medical Group to provide medical services. The Wenatchee Valley Medical Group was founded in 1940 and is a physician-owned and led organization with a long history of financial stability. In addition to competitive wages, generous insurance programs and retirement contributions, we offer a comprehensive benefits package including relocation, annual allowances for continuing education, professional liability insurance including tail coverage and 11 weeks of time off per year. We provide cutting edge comprehensive medical care: Confluence Health is an integrated, regional healthcare delivery system that includes more than 40 medical specialties, and provides comprehensive medical care in North Central Washington. With over 270 physicians and 150 advanced practice clinicians, Confluence Health is the major medical provider between Seattle and Spokane.

Our goal is to deliver high quality, safe, compassionate and cost effective care close to home. Staying on the leading edge of healthcare innovation is important, so we invest in technology to provide better care for our patients and allow our providers to operate at the highest level. The quality of life is unparalleled: Nestled between the foothills of the Cascade Mountains and the Columbia River, we enjoy over 200 days of sunshine annually, snow-capped mountains and the lakes and rivers of the high desert. Our region offers a diversity of recreational activities to choose from including skiing, cycling, hiking, mountain biking, rafting, rock climbing, fishing, golfing and kayaking. The region also offers

a family friendly environment with safe communities, good schools and opportunities for the entire family to be involved in culture and arts. To learn more about us, please visit our website at http://www.ConfluenceHealth. org/Recruiting. To apply, please submit your CV to Joinus@ConfluenceHealth.org.

Psychiatrist — Washington, D.C. suburbs. Multispecialty private practice -outpatient - fee for service.

Full-time or part-time. Partnership opportunities available. Email donhallmd@aol.com.

Psychiatrist — Christian Psychiatrist Needed in Florida — Honey Lake Clinic is a non-profit organization (501c3) created to glorify God, in the name of Jesus Christ and the Holy Spirit, through the psychological and spiritual renewal of each individual to achieve their God-given potential and live fully transformed lives of joy, peace, forgiveness, freedom, meaning, purpose and fulfillment through world-class Christian mental health and substance abuse treatment. We are licensed by the State of Florida to provide Detox, Residential Level 1, Partial, and Intensive Outpatient Services at a 600-acre converted five-star resort in Greenville, Florida. We are currently seeking a psychiatrist to serve as Medical Director and oversee all of the psychiatric treatment components of patient care as well as work with the interdisciplinary team to ensure provision of complete psychological service delivery. The right candidate will provide direct psychiatric services as well as guide and assist in program development and delivery. As this position is so integral to our mission, free onsite housing at the facility will be provided (staff member only). Minimum requirements include an MD from an accredited medical school and completion of an accredited psychiatric residency program. A current, active and unencumbered Florida license with five years of experience working with mentally ill patients or residents requiring substance abuse services as well as the ability to meet criminal background check and drug screening per state requirements is also necessary. If interested, please email aduran@honeylake.clinic and dhoskins@ honeylake.clinic with cover letter and resume.

Psychiatrists — Pine Rest is hiring psychiatrists!

Pine Rest, located in West Michigan, specializes in faith-based mental health care throughout our inpatient, outpatient, partial hospitalization and residential programs. As one of the largest behavioral health systems in the nation, the opportunities are endless.

Please reach out to Lyndsay.Renshaw@PineRest.org if you are interested in learning more. If you haven’t considered Pine Rest in your career, let us show you why you should!

Radiologist — Private imaging center in California Gold Country is looking for a Christian board certified radiologist to partner with option to purchase a successful small imaging center offering 3D mammography, ultrasound, bone density and plain film.

All digital. No nights, weekends or call. Ideal location in historic towns of Grass Valley and Nevada City. Recreation and cultural opportunities abound.

Great schools and weather. Employ to purchase and financing considered. Contact Melisa Agness, MD, at melisaagness@gmail.com.

Reproductive Endocrinologist — Southeastern Center for Fertility and Reproductive Surgery (SCFRS) in Knoxville, Tennessee has an opportunity for a reproductive endocrinologist to join our dynamic practice. We also share a building and coordinate some operations with the National Embryo Donation Center (NEDC). The NEDC is a non-profit organization whose mission is to protect the lives and dignity of human embryos by promoting, facilitating and educating about embryo donation and adoption. It is critical that the physician who joins the practice be philosophically aligned with the NEDC mission and values. We are offering a very competitive salary and benefits, which will be negotiable and commensurate with experience.

SCFRS is located at the foothills of the Great Smoky Mountains National Park. The area’s natural beauty, recreational opportunities, high-quality schools, low cost of living and low crime rate make Knoxville a very desirable place to live, raise a family and work. Interested?

Contact Dr. Jeff Keenan at 865-777-0088 or email jkeenan@baby4me.net.

CMDA PLACEMENT SERVICES

BRINGING TOGETHER HEALTHCARE PROFESSIONALS TO FURTHER GOD’S KINGDOM We exist to glorify God by placing healthcare professionals and assisting them in finding God’s will for their careers. Our goal is to place healthcare professionals in an environment that will encourage ministry and also be pleasing to God. We make connections across the U.S. for physicians, dentists, other providers and practices. We have an established network consisting of hundreds of opportunities in various specialties.

You will benefit from our experience and guidance.

Every placement carries its own set of challenges. We want to get to know you on a personal basis to help find the perfect fit for you and your practice.

P.O. Box 7500 •Bristol, TN 37621 888-690-9054 www.cmda.org/placement placement@cmda.org

EVERY STEP OF THE WAY “CMDA Placement Services was with me every step of the way—for prayer, communication, whatever the need may be. I am overwhelmingly impressed by CMDA and their commitment to the Lord, first, and their diligence in seeking the Lord’s will for each medical professional they meet. God led me to CMDA to ultimately direct me to the career that will develop me professionally, spiritually and use me to glorify His kingdom. For this, I am boundlessly grateful!”

—Alyssa Allwardt, PA-C Paid Advertisement

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In His Image encourages and provides great opportunities for international rotations during residency. I explored the option of long-term medical missions while spending a month overseas during my second year of residency at IHI. The faculty physicians and many of the program’s graduates have extensive experience in international medicine and were enthusiastic in helping to provide me with training and counsel for my future.

After graduating from IHI, my family and I moved to Malawi, Africa. My husband teaches at a village school and I work at a hospital in the capital, treating patients and training Malawian family medicine residents.

We are so incredibly thankful for the guidance and experiences God gave us through IHI as we prepared for service in Malawi!