Look Who’s Joined BayCare Medical Group Somphanh T. Khousakoun, DO Neurology
Lolita Ontiveros, MD Family Medicine
Education: Doctor of Osteopathic Medicine – University of New England; Biddeford, Maine
Education: Doctor of Medicine – University of Illinois-Chicago College of Medicine; Rockford, Illinois
Residency: Internal Medicine – University of Florida College of Medicine; Jacksonville, Florida, Neurology – University of Florida College of Medicine; Jacksonville, Florida 300 Pinellas St., Clearwater | (727) 442-8585
Residency: Family Medicine – University of Illinois-Chicago College of Medicine; Rockford, Illinois 8839 Bryan Dairy Road, Suite 200, Largo | (727) 391-6296
Francis Daniel LaBarbera, MD Hospitalist
Sai C. Oruganti, MD Hospitalist
Education: American University of Antigua, St. Johns, Antigua, West Indies
Education: Ross University School of Medicine; Portsmouth, Dominica
Residency: Internal Medicine – Pinnacle Health Harrisburg Hospital, Harrisburg, Pennsylvania
Residency: Internal Medicine – New York Hospital Medical Center of Queens; Flushing, New York
Board Certification: Internal Medicine
Board Certification: Internal Medicine
6901 Simmons Loop, Suite 3014, Riverview | (813) 302-8388
Barry L. Leber, MD Neurology Education: Doctor of Medicine – University of Florida; Gainesville, Florida Residency: Internal Medicine – University of Florida; Gainesville, Florida, Neurology – University of Florida; Gainesville, Florida
4211 Van Dyke Road, Suite 200, Lutz | (813) 321-6237
Not Pictured: Steven M. Jackson, DO, General Surgery Seventy physicians joined BayCare Medical Group in 2017. If you’re a primary care physician or a specialist, we have exciting opportunities for you. Whether you’re a new or experienced physician, if you’re looking for a new professional home, consider BayCare Medical Group.
Board Certification: Neurology 300 Pinellas St., Clearwater | (727) 442-8585
To learn about employment opportunities, visit BMGPhysicians.org or contact a recruiter at (813) 402-2320. 17-242955-1217
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Contents 6 8
8
Top 4 Nutrition Predictions in the New Year
12 14
Reasons Medical Practice Change Initiatives Fail
Impact in Our Own Way 4
From the Publisher Feature Top 4 Nutrition Predictions in the New Year
12
Feature Reasons Medical Practice Change Initiatives Fail
14
Impact Impact in Our Own Way
16
Feature Making Lemons from Lemonade: Squeezing the Joy Out of Medicine
20
Feature 7 Tips to Consider Before Travel - Dangers of Oversharing on Social Media
Advertisers Anise Restaurant 7 BayCare Medical Group 2 CATI Healthy Meal Delivery 9 Cena 5 The Florida Orchestra 3 JW Marriott 23 The Meridian Club 21 Opes Health 17 PNC Bank 24 Point Grace 19 Transplant & Hepatobiliary Specialists at Largo 11
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7 Tips to Consider Before Travel Doctor’s Life Tampa Bay
Issue 6, 2017
From the Publisher
www.doctorslifetampabay.com
H
appy New Year! For many of us, each New Year marks a chance for renewal, and 2018 is no exception. Every New Year brings us challenge, opportunity, and the transformative power of hope. What was yesterday is gone and tomorrow is full of possibilities. We choose our own destiny and the universe allows it to happen. Doctor’s Life Magazine is celebrating our 6th year in Tampa Bay and our 10th as a running publication. We are excited for all we aim to deliver in 2018. “Resolve to keep happy, and your joy and you shall form an invincible host against difficulties. Year's end is neither an end nor a beginning but a going on, with all the wisdom that experience can instill in us. Be at war with your vices, at peace with your neighbors, and let every New Year find you a better person.” – Helen Keller
TAMPA BAY
™
Published by
In this issue of DLM contributor Melanie Hicks, Ph.D. teaches us how to make an impact in our own way and Dr. Marilyn Singleton discusses why doctors are losing the joy in practicing medicine. On page 12 learn why medical practice change initiatives fail and the methods to keep change a success.
Tampa Headquarters 1208 East Kennedy Blvd. Tampa Fl, 33602 813-867-0916 Group Publisher Ed Suyak publisher@doctorslifetampabay.com
Nutrition is a key factor in health. On page 8 check out what the 2018 top four nutrition predictions are and on page 20 read about tips to consider before you travel and why oversharing on social media can be a danger.
Creative Director Rob Stainback Editorial Director Danielle Topper
I hope you had a great 2017 and wish you an even better 2018. As always, thank you for your readership.
Associate Publisher CJ Cooper
Be well,
-Ed
Advertising Account Executive Ryan O’Neil Contributing Writers Marilyn M. Singleton, M.D., J.D. Melanie Hicks, PhD Nick Hernandez
Ed Suyak Group Publisher publisher@doctorslifetampabay.com
Doctor’s Life Magazine’s mission is to provide physicians content and information that may assist in creating a better professional and leisure life. Our focus is to provide articles that can help to better your practice and your lifestyle outside of the white coat. We want to be your source for inspiration and content on living a good life. Doctor’s Life Magazine wants to know about extraordinary physicians and staff, upcoming events, and article ideas or contributors. Please email us if you have an event, idea or know of a doctor making a big difference. We want your suggestions and feedback. For all comments, ideas, advertising inquires or to request a media kit contact publisher@doctorslifetampabay.com. Doctor’s Life Magazine, Tampa Bay does not assume responsibility for advertisements or articles published, nor any representation made therein, nor the quality or deliverability of the products themselves. Reproduction of articles and photographs, in whole or in part, contained herein is prohibited without expressed written consent of the publisher, with the exception of reprinting for news media use. Doctor’s Life Magazine is considered a form of entertainment and should not be deemed as medical, legal or business advice without consulting the appropriate professional regarding the specific subject matter. Printed in the United States of America.
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Doctor’s Life Tampa Bay
Issue 6, 2017
TOP
4
Nutrition Predictions in the New Year
Several food and nutrition trends were in the spotlight this year, including the continued rise of plant-based diets, non-dairy ice creams and superfoods that are blasts from the past - legumes, apples and cabbage. It can be easy to experience nutrition whiplash in the New Year, but don't be a victim. Get a jumpstart on understanding the top nutrition trends that will impact quality of life and make it easier to add important vitamins and nutrients to the body.
"The start of a fresh year always ushers in new opportunities to make one's health better," said Elizabeth Somer, MA, RD and author of "Eat Your Way to Sexy." "Study after study consistently finds that most Americans don't meet even minimum standards of a balanced diet, so it's important to be aware of advances in nutrition, so you can optimize your health all year long." There are four key nutrition predictions that will top 2018:
1. Personalized Nutrition A one-size-fits-all approach that can be applied to vitamins, minerals, omega-3s and other essential nutrients doesn't align with what research reveals about individual nutrient needs. Many factors tweak the basic recommendations, including age, gender, health status, medication use, stress level, sleep habits, exercise routines and more. For example, when the body is exposed to ultra violet (UV) light, it manufactures vitamin D; however, as we age, the CONTINUED ON PAGE 10
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CONTINUED FROM PAGE 8
body becomes less and less efficient at making vitamin D. This is when dietary and supplement sources become increasingly more important while the needs for the vitamin increase. It is no wonder there will be a growing trend and demand for personalized nutrition recommendations in 2018. Nutrition innovators like www.vitaminpacks.com - are already responding by developing comprehensive nutritional assessments to curate unique combinations of vitamins and nutrients designed specifically to the individual consumer.
2. Awareness of drug nutrient interactions According to a recent paper published in the European Journal of Nutrition, vitamins and other nutrients play a crucial role in metabolism - the process in the body that supports overall health. How vitamins and phytonutrients interact with prescription medications can impact metabolism. In one example, antacid medications can interfere with vitamin B12 and calcium absorption, so requirements for
10
these and other nutrients may increase, yet people don't make the adjustment in their supplement plans. Therefore, it is important to consult a health care practitioner before adding a dietary supplement, so prescription medications and vitamin supplements can live in harmony.
3. Go with your gut Probiotics are live bacteria that are good for health, especially the digestive system. It may be easy to think of bacteria as something that causes diseases, but the body is full of bacteria, both good and bad. Probiotics are the "good" or "helpful" bacteria because they have been known for years to help keep the gut healthy. What's more, research has shown that the benefits of probiotics may span more than the gut, including the circulatory, hormonal and nervous systems. Probiotics are naturally found in the body to varying degrees, and there are high levels of probiotics in some foods and supplements. Encouraging the growth of probiotic bacteria is important in maintaining an effective intestinal barrier, enhancing
Doctor’s Life Tampa Bay
nutrient absorption and blocking toxins and pathogens. A focus on gut health and spotlighting food and dietary supplements that support a healthy belly will top 2018 nutrition trends.
4. Vitamin K2 Don't confuse this K2 with the mountain in the Himalayas. Vitamin K2 is an overlooked vitamin that helps control calcium movement in the body and supports healthy arteries and bone health. It is found at sub-optimal levels in the traditional diet, but can be found at high levels in fermented foods, like sauerkraut and the Korean dish kimchi. Vitamin K2 will no longer be overlooked in 2018. Ask a health care practitioner about adding this important vitamin to the diet, especially if fermented foods aren't served regularly for dinner. It doesn't take a crystal ball to predict what will be the hottest nutrition trends in 2018; it only requires a look at the latest nutrition research and connecting with a health care provider or registered dietitian.
Issue 6, 2017
Life-saving Care with Compassion Transplant & Hepatobiliary Surgical Specialists at Largo offers advanced, life-saving kidney and liver transplant and hepatobiliary pancreatic surgery for those with both benign and malignant disease of the kidney, liver and pancreas.
Dr. Hussein Mohamed is a board-
Dr. Basem Alkurdi is the Medical
Director of the Liver Transplant program at the Transplant Institute of Florida at Largo Medical Center. Dr. Alkurdi has extensive experience in managing viral hepatitis, alcoholic, metabolic and genetic liver disease. His special interest is management of Cirrhosis complications, liver transplant and viral hepatitis.
certified surgeon, specializing in transplant and hepatobiliary pancreatic surgery. He is the Medical Director of the Kidney and Liver Transplant Program and Hepatobiliary Pancreatic (HBP) Surgery Center at Largo Medical Center. Dr. Mohamed is also an Affiliate Assistant Professor of Surgery at the University of South Florida and Teaching Professor for DO Students, Residents and Fellows at Largo Medical Center, for Nova Southeastern University.
Dr. Layal Abdel Rahman is a board-certified nephrologist and the Medical Director of the kidney transplant program at the Transplant Institute of Florida. Dr. Rahman has advanced training in taking care of very high immunologic risk patients, managing a broad spectrum of post-transplant complications.
To Learn More or to meet with our team, call (727)-587-7120 or visit TransplantSurgeryLargo.com
Transplant & Hepatobiliary Surgical Specialists At Largo 1301 2nd Ave. S.W., Suite 315, Largo, FL 33770
FAIL REASONS MEDICAL PRACTICE
Change Initiatives By Nick Hernandez
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Doctor’s Life Tampa Bay
Issue 6, 2017
Good is rarely good enough, and opportunities for improvement are never lacking. Unfortunately, the success rate of major change initiatives in medical practices is often low due to poor management of the change.
P
hysician leaders and practice managers should expect and accept disruption and resistance to change, and never lose sight of the fact that costs are high when change efforts go wrong. The consequences of poorly executed change are not only financial costs, but also lost opportunity, wasted resources, confusion, and diminished morale.
enough to send out an e-mail addressing those points. Communication should be regular and should continue over an extended period of time.
Invite and acknowledge concerns Make change a part of your business and an expectation among staff and providers. Many members of your practice are innovative and eager to contribute their insights and suggestions for improvement. Treat them as a natural part of the process and address resistance by asking for input. Work with all staff to measure “real” vs. “perceived” disruption. The path of rolling out change is immeasurably smoother if these people are tapped early for input on issues that will affect their jobs. The goal is to quickly get employees through the denial and resistance stages and on to the commitment phase where you get the buy-in from staff.
Develop commitment Work on developing commitment from the staff and avoid demanding compliance. People respond to calls to
action that engage their hearts as well as their minds, making them feel as if they’re part of something consequential, so make the rational and emotional case for change together. Their full-hearted engagement can smooth the way for complex change initiatives, whereas their resistance will make implementation an ongoing challenge. Address any reservations and give some consideration to possibly rewarding initiative. You must either build commitment or prepare for the consequences. Medical practices must constantly change in order to survive in today’s competitive healthcare arena. Practices should never settle for something that is considered completed; all things can improve with change. Managing change in an already busy practice environment, however, can be challenging and you may want to consider bringing someone in to help structure the rollout of a project and guide you through key change initiative milestones. When employees who have endured real upheaval and put in significant extra hours for an initiative that was announced with great fanfare see it simply fizzle out, cynicism sets in.
Here are three major areas to focus on to help with your change management efforts.
Clarify direction As the saying goes, “culture is everything.” To effectively manage change, you must consider your practice culture, and thus clarify how the change relates to your practice culture, vision, and goals. Communication is paramount when trying to raise the level of understanding of why the change is taking place. Employees should be told why the change is taking place, what the change will mean for them, when the change will be happening, how the change will be carried out, what support will be available to help them adjust to the change, and what will be expected of employees as a result of the change. Over-communicate your goals, direction, and expectations. It's not Issue 6, 2017
Doctor’s Life Tampa Bay
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Impact
Impact
in Our Own Way I
By Melanie Hicks, PhD
f you are like most of us, you kick off the New Year reflecting on life - your past and your future. I traded in turkey and stuffing with my family for a trip to Nicaragua to work with Habitat for Humanity on a Global Build. For 9 days we began our days at from 6:30am and finished up dinner at 8pm. We moved and laid cinderblock, mixed concrete and mortar, cut, bent, and tied rebar, and tamped a floor all without the use of a single power tool or running water. To marvel at the impact that a 38 square meter home will have on, not just a family but a generation, is an understatement. And I am unalterably grateful for my time here. And yet, as I pushed through hour 5-6 of rebar bending, I began to be grateful for other small lessons. Lessons like the privilege we have to access technology and innovation. Innovation to solve societal challenges is not new, but there is a growing amount of discussion and pilot projects happening around the country on how to best connect wealth with entrepreneurial innovations solving these societal challenges. This is what we call Impact Investing. Similar to investments in any new business venture, Impact Investing has a level of risk higher than that of traditional financial models. However unlike traditional philanthropic giving, you have the chance to not only give to a cause you care about but also potentially make a return on your investment through a Business for Good. Let’s look at an example of the Business for Good Model (B4G). Just Grow is an early stage start up company that sells a fully sustainable
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Doctor’s Life Tampa Bay
Issue 6, 2017
indoor aquaponics ecosystem. The sleek modern design and compact size make it perfect for a home, office or customer waiting room. You have the visual appeal of a fish tank combined with the functionality of an indoor herb or vegetable garden all in a low maintenance, self-sustaining and resource efficient tabletop unit. This alone is impact on some level, but this is only the beginning of the story. Just Learn, a sister 501c3 organization, uses the proceeds from Just Grow to place these units into K-12 classrooms along with science and math curriculum equipping teachers with the tools they need to bring nature front and center in a child’s world. This is Business for Good. This is Impact. So let’s assume we all see the value in a company like Just Grow. The first few questions might be: How do I make an investment? How do I find out about other Businesses for Good that are looking for investors? And what about risk? The answers are not nearly as simple. If you circulate in the world of startups, you might stumble upon a great company looking for investors. And if serendipity works its magic and the stars align between your interests and their business model you might make an investment. But this is obviously a long shot and exactly what myself, and others around the country, want to see change. Cities from San Francisco and Oakland to Cincinnati and Pheonix, are examining ways to better link innovative entrepreneurs to forward thinking investors. Some communities are finding ways to fund a System Entrepreneur, a person who is employed just to architect these relationships. In Oakland and Seattle, Kaiser brought together a cohort of more than 13 hospital systems to fund this role in their communities to look for B4G companies focused on solving a wide range of community health issues. In Cincinnati, it was the faith-based communities that rallied to fund a similar position to accelerate linking B4G with Impact Investors looking to address issues directly relating to the poor. Issue 6, 2017
Other cities are piloting new financial tools, like Friends & Family certificates of deposit which pool money from a wide range of investors ranging from community foundations to high net worth individuals to millennials with inherited wealth. These funds typically have a loan loss reserve, which does not guarantee a return on their investment but does offer full protection against loss. Any of these or other new financial models have the potential to increase B4G entrepreneurs access to capital and thereby increase their potential impact on their communities and our world. Not everyone has the inclination to give up 9 days of his or her life to do tough work in even tougher conditions
Doctor’s Life Tampa Bay
but nearly everyone has a desire to make an impact in their own way. I will likely never have the money to be a great philanthropist or an angel impact investor so I give what is precious to me - my time, my mind and my physical strength – to projects like homes in Nicaragua and innovative start ups like Just Grow. If, like me, you are intrigued by the potential of moving beyond traditional philanthropic giving and supporting the future of innovative solutions to our community’s greatest needs, then I encourage you to join the impact investing movement. Let’s support great businesses solving today’s greatest challenges with tomorrow’s greatest innovations.
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MAKING LEMONS FROM LEMONADE: SQUEEZING THE JOY OUT OF MEDICINE
By Marilyn M. Singleton, M.D., J.D.
Scandal upon scandal has dominated the airwaves and the web. Other than those involved, we have no way of knowing the truth or misremembering of the allegations. But we do know it is beyond sad that our congressional representatives who have the privilege and honor to serve their country have used the public purse to whitewash their misdeeds. These critters certainly know how to drag a noble calling into the gutter.
I
n the case of medicine, it is not the few well-publicized bad apples, but government and corporations injecting themselves into clinical practice that is driving the down trajectory of patient care. The days of physician as independent member of the community are fast waning—thanks to those paragons who run our country. According to an American Medical Association survey, by 2016 only 47.1 percent of practicing physicians owned their own practice. Another report noted that hospitals acquired 31,000 physician practices, a 50 percent increase, from 2012 to 2015. Now UnitedHealth Group plans to purchase the physician group from DaVita, a chain of dialysis centers, adding to their urgent care and surgery centers. Insurers owning (enslaving?) physicians is hoped to contain costs. While innovation in improving delivery of medical care is laudable, it is not without risks. Patients likely will have fewer choices of physicians or be told whom to see. As far CONTINUED ON PAGE 18
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as insurance pricing, economists agree that more competition benefits consumers. We must be wary: as these behemoths consume and control medical care, sins are mounting. A few transgressions include Northern California’s Sutter Health that intentionally destroyed 192 boxes of documents that employers and labor unions were seeking in a lawsuit that accuses Sutter of abusing its market power and charging inflated prices. Anthem, the second largest health insurer in the U.S., was fined $5 million by California’s Department of Managed Health Care for “flouting the law” in dealing with consumer complaints. In 2016, insurance company denials were overturned in nearly 70 percent of medical review cases. California had already fined Anthem more than $6 million collectively for grievance-system violations since 2002. And the federal government has stacked the deck in its new Quality Payment Program that “adjusts” physicians’ government payments if they don’t comply with the complex metrics. First, electronic medical records are a must. On the clinical front, anesthesiologists are scored on the percentage of current smokers who abstain from cigarettes prior to anesthesia on the day of elective surgery or procedure. Is the anesthesiologist supposed to send a proctor home with the patient? How is patient compliance grafted on to a physician whom the patient just met—no matter how convincing the anti-smoking pitch? And then for internists there are “Additional improvements in access as a result of QIN/ QIO TA” [Quality Improvement Network/Quality Improvement Organization technical assistance]. Or participation in a QCDR that promotes use of patient engagement tools. And what is a QCDR? A qualified 18
clinical data registry. “A QCDR is a CMS-approved entity (such as a registry, certification board, collaborative, etc.) that collects medical and/or clinical data…” The new medicine is forcing the remaining independent physicians to devolve from trusted confidants to automatons in order to survive in medicine’s brave new world. And it is not so pleasant for the patients: the algorithms, electronic computer screens, and hospitalists taking over care often with no consultation with the primary care physician. Call me old-fashioned, but I come from a line of private practitioners who provided “population health” by being an integral part of the community. The Bradfield Community Association of Lima, Ohio, was formed in 1938 and named after my grandfather, Joseph C. Bradfield, M.D., a World War I veteran and beloved physician. The San Diego Board of Supervisors adjourned in memory of the death of my father, E.B. Singleton, M.D., a Tuskegee flight surgeon and primary care physician who charged people what they could afford and accepted tamales as payment. He didn’t need to take classes on dealing with denied insurance claims or filling our government forms. Dr. Benjamin Rush, a signatory of the Declaration of Independence said, “Without virtue there can be no liberty and liberty is the object and life of all republican governments.” Liberty is also the cornerstone of good medical care. Ask yourself do government bureaucrats and nameless faceless insurers have the moral authority to tell us what is just in delivering medical care to our populace? If the current happenings do not convince you that you and your private physician are your best advocates, then nothing will. I wish you love, peace, and joy in this blessed season. Doctor’s Life Tampa Bay
Issue 5, 2017
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www.heartbeatsaveslives.org
7 TIPS TO CONSIDER BEFORE TRAVEL DANGERS OF OVERSHARING ON SOCIAL MEDIA
Locking doors and windows and leaving a light on used to deter criminals from breaking into homes when you were away on vacation, but our obsession with sharing photos and experiences in real time on social media has created a whole new security risk for travelers. According to Mercury Insurance, burglaries involving social media have become all too common these days. CONTINUED ON PAGE 22
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Doctor’s Life Tampa Bay
Issue 6, 2017
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"Instead of looking for physical signs that a home is unoccupied, burglars can simply scan Instagram posts, monitor Twitter feeds and check Facebook for signs that someone isn't home. Posted photos can also show them exactly what to look for when they break in," says Mercury Insurance Vice President of Claims Kevin Quinn. "Oversharing on social media is commonplace and built-in smartphone features like geotagging, which share the user's exact location when they post, are only making things easier for thieves." One example is of a recent claimant who took his family on vacation to Cancun, Mexico. The family was very active on social media, publicizing their upcoming vacation and continuing to post updates throughout the trip. Thieves used this information to break into the claimant's home and steal nearly $200,000 worth of personal property, along with a Mercedes-Benz parked in the driveway. Many of the items stolen were pictured on the family's social media accounts, so the thieves knew exactly what to target. "It's important to make sure no one in your family is posting your travel plans. Facebook posts checking
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into restaurants or Instagram photos of your family's vacation blatantly advertise that you're away from home and put your property at risk," adds Quinn. Social media tips to consider before taking off on your vacation: 1. Never share photos of your belongings. Be careful about displaying any expensive belongings on social media that might entice thieves. Steer clear of posting pictures of expensive jewelry, cash, designer clothing and accessories, and electronics. 2. Don’t tag your location. Disable the geotagging feature on your smartphone and resist the urge to check in at locations while you're away. 3. Avoid uploading photos during your vacation. Wait until you're home to share your family's trip. 4. Be selective about what and with whom you share. Limit your following or friend base on your personal accounts and adjust your privacy settings so that others have a limited view of your profiles. You never know if a friend of a friend is looking at your photos or other posts.
Doctor’s Life Tampa Bay
5. Never announce your vacation plans on your social media channels. If you plan to go out of town, consider having a neighbor check on your home, or hiring a trusted friend or family member to housesit. 6. Verify friend requests. It's easy for people to pretend to be someone they're not online, so don't get "catfished." Be wary of connecting with people you don't know. 7. Power down your PC. Disable the internet connection to cut off access to any personal information stored on your computer, because unattended machines are easy marks for hackers.
Live in the moment and enjoy your time with your family. The purpose of vacation is to relax, recharge and experience things in person, not just on a screen. Save the photo sharing and status updates for when you return home - it could make the difference between whether you need to file an insurance claim after your well-deserved time away or not.
Issue 6, 2017
AFRICA
ASIA
EUROPE
LATIN AMERICA
MIDDLE EAST
NORTH AMERICA
&