San Antonio Medicine January 2018

SAN ANTONIO

THE OFFICIAL PUBLICATION OF BEXAR COUNTY MEDICAL SOCIETY

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JANUARY 2018

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VOLUME 71 NO. 1

DR. SHELDON GROSS 2018 BCMS PRESIDENT IN THIS ISSUE:

MEDICAL STUDENT PERSPECTIVES SAN ANTONIO, TX PERMIT 1001

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MEDICINE SAN ANTONIO

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VOLUME 71 NO. 1

San Antonio Medicine is the official publication of Bexar County Medical Society (BCMS). All expressions of opinions and statements of supposed facts are published on the authority of the writer, and cannot be regarded as expressing the views of BCMS. Advertisements do not imply sponsorship of or endorsement by BCMS.

Medical Student Perspectives Pages 14-32

EDITORIAL CORRESPONDENCE: Bexar County Medical Society 4334 N Loop 1604 W, Ste. 200 San Antonio, TX 78249 Editor: Mike W. Thomas Email: Mike.Thomas@bcms.org

Darren Donahue, Alejandra Morfin Rodriguez, Alexis Ramos, Jomari Guerero, Raul F. Membreno, Natalie Clericuzio, Prem Menon, Amanda Wedelich, Zach Coates, Matthew Milam, Manojna Kintada, Lauren Murphy, Anna Pritchard, Lorelle Knight, Meredith Furst, Giselle Castillo, Mouhamed Nashawi

MAGAZINE ADDRESS CHANGES: Call (210) 301-4391 or Email: membership@bcms.org

BCMS President’s Message ............................................................................................................8

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BCMS Legislative News ............................................................................................................................10 TMA Foundation Announces 2018 Gala Chairs .........................................................................................12 BCMS News .............................................................................................................................................33 Feature: Saying Goodbye By Rajam Ramamurthy, MD..............................................................................34 Medical Technology: New Image Technology has the Potential to Revolutionalize Medicine

By Mike W. Thomas ...............................................................................................................................36 BCMS Circle of Friends Directory ..............................................................................................................38 In the Driver’s Seat ....................................................................................................................................42 Auto Review: New Vehicle Rundown for 2018 By Steve Schutz, MD ........................................................44

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San Antonio Medicine • January 2018

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San Antonio Medicine is published by SmithPrint, Inc. (Publisher) on behalf of the Bexar County Medical Society (BCMS). Reproduction in any manner in whole or part is prohibited without the express written consent of Bexar County Medical Society. Material contained herein does not necessarily reflect the opinion of BCMS or its staff.

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BCMS BOARD OF DIRECTORS ELECTED OFFICERS Sheldon G. Gross, MD, President Gerald Q. Greenfield Jr., MD, PA, Vice President Adam V. Ratner, MD, President-elect Leah H. Jacobson, Immediate Past President Kristi G. Clark, Secretary John Robert Holcomb, MD, Treasurer

DIRECTORS Rajaram Bala, MD, Member Lori Boies, PhD, BCMS Alliance President Josie Ann Cigarroa, MD, Member Kristi G. Clark, MD, Member George F. "Rick" Evans Jr., General Counsel Vincent Paul Fonseca, MD, Member Michael Joseph Guirl, MD, Member John W. Hinchey, MD, Member Col. Bradley A. Lloyd, MD, Military Rep. Rodolfo Molina, MD, Board of Mediations Chair John Joseph Nava, MD, Member Gerardo Ortega, MD, Member Robyn Phillips-Madson, DO, MPH, Medical School Representative James E. Remkus, MD, Board of Censors Chair Ronald Rodriguez, MD, Medical School Representative Carlos Alberto Rosende, MD, Medical School Representative David M. Siegel, MD, JD, Member Bernard T. Swift, Jr., DO, MPH, Member

CEO/EXECUTIVE DIRECTOR Stephen C. Fitzer

CHIEF OPERATING OFFICER Melody Newsom Alice Sutton, Controller Mike W. Thomas, Director of Communications August Trevino, Development Director Brissa Vela, Membership Director

COMMUNICATIONS/ PUBLICATIONS COMMITTEE Rajam S. Ramamurthy, MD, Chair Kenneth C.Y. Yu, MD, Vice Chair Carmen Garza, MD, Community Member Kristi Kosub, MD, Member Lauren Michael, Medical Student Sara Noble, Medical Student Fred H. Olin, MD, Member Jaime Pankowsky, MD, Member Alan Preston, Community Member Adam Ratner, MD, Member David Schulz, Community Member J.J. Waller Jr., MD, Member Jane Yoon, Medical Student

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San Antonio Medicine • January 2018

PRESIDENT’S MESSAGE

President’s Message

By Sheldon Gross, MD, 2018 BCMS President Dear Colleagues, It is with a great sense of honor and a strong sense of challenge that I start my year as president of the Bexar County Medical Society. I have been active in organized medicine for over 30 years.

I have seen tremendous things accomplished at our county level, state level, and national level by organized medicine. I recall with pride how in 1988, we totally changed the nature of our state’s supreme court. We are all still benefitting from the tort reform package that was passed 12 years ago and the constitutional amendment which ensured that it would not be thrown out as unconstitutional. I have seen how effective our advocacy efforts can be in Austin as well as Washington, D.C. The basic building block of organized medicine all starts at the county level. It is the county medical society that introduces people to organized medicine. It is the county medical society that brings forth resolutions to be debated at our state and national meetings. It is the county medical society that identifies those individuals who we see as potential leaders for the future.

Through my involvement with the American Medical Association and its Political Action Committee, I have visited numerous state medical associations around the country. In my opinion, without doubt, the Texas Medical Association is the strongest and most effective state medical society in the country. I also feel that the Bexar County Medical Society is already a great institution and has the potential to become even greater. Throughout my year as president, I will focus on two main themes.

My first theme will be one of relevance. I started my practice in 1983 and I am a pediatric neurologist in solo private practice. My daughter Leah is a Cardiothoracic Anesthesiologist on the faculty of UT Health here in San Antonio. It was very obvious to me that the relevant issues that my daughter faced after her training were dramatically different than the issues I faced in 1983. I will spend the next 12 months trying to identify those issues of relevance to new physicians as well as physicians at different stages of their practice. We have already started seminars with regards to how to negotiate a contract for those just starting out. We hope to have a series of seminars that will enhance and increase our relevance to physicians at all stages of practice.

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San Antonio Medicine • January 2018

The second theme will be activism. We are already a society of activists. I was so proud of our response to Hurricane Harvey. We had so many hundreds of volunteers who were prepared to help with evacuees from various parts of Texas in any way possible. This was coordinated by Melody Newsom, our Chief Operating Officer. She did a superb job. This type of activist spirit is so crucial for our medical society to stay active, dynamic, and to continue to thrive in the 21st Century. I would encourage any member of our society with an idea involving physician activism to contact me or our medical society.

So many superb ideas and projects start with the imagination of a single member.

Lastly, I am going to do everything possible to identify future leaders and to give them leadership training for future years. I have learned from some of my friends in the military that leadership skills can be natural, but they can also be taught very effectively. I hope to begin a series of seminars on various aspects of leadership.

These will be geared towards younger physicians. Hopefully these will be individuals that will become actively involved in our society, in the Texas Medical Association, the American Medical Association, their hospital staff, as well as specialty societies and numerous other organizations. Physicians are constantly asked to lead. Most of us have received essentially no formal training in this area. I hope to change that.

I see the potential of this medical society as essentially without limit. I challenge every member to identify programs and other activities that our society can do to enhance our relevance and increase activism within San Antonio.

Thank you for this honor. I will do my best.

Sincerely, Sheldon Gross, MD

BCMS LEGISLATIVE NEWS

Leah Jacobson, MD, BCMS Past President, speaks during a press conference at City Hall on Dec. 6 in support of the Tobacco 21 ordinance.

TOBACCO 21 DISCUSSIONS CONTINUE

On Dec. 6, BCMS physician members and staff attended a news conference at City Hall promoting the importance of the Tobacco 21 ordinance presently under consideration. Many thanks to then-president, Dr. Leah Jacobson, who spoke both at the news conference and also testified before the City Council during the "Citizens to be Heard" portion of the public hearing in support of the ordinance. Thank you also to Daniel Deane, MD and Joel Reyes, DO for participating and also testifying before City Council on the issue. To learn more about the Tobacco 21 Coalition, of which BCMS is a member, visit www.tobacco21.org. City Council is expected to take up the issue on Thursday, Jan. 11.

For local discussion on this and other legislative and public health advocacy topics, consider joining the BCMS Legislative and Socioeconomics Committee by contacting Mary Nava, BCMS chief government affairs officer and lobbyist at mary.nava@bcms.org.

CALL FOR RESOLUTIONS

The deadline to submit resolutions for review by the BCMS Delegation to TMA is Jan. 31. If you have an issue you would like to address in the form of a resolution, the time to do this is now. At the local level, members of the BCMS Delegation to TMA will meet in early February to review all resolutions submitted for consideration. Resolutions will be reviewed and then voted on by the delegation members to determine which resolutions will be forwarded to TMA for consideration by the House of Delegates during TexMed 2018 scheduled for May 18-19, 2018.

For more information on the activities of the BCMS Delegation to TMA or to learn more about how you can get involved, contact Mary Nava, BCMS chief government affairs officer at mary.nava@bcms.org.

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San Antonio Medicine • January 2018

TMA FOUNDATION

TMA FOUNDATION ANNOUNCES 2018 GALA CHAIRS Red clown noses. Flappers. Spacesuits. Spies. Best Lawn Legs.

Cowboys. Heads. Tails. Masquerade.

What do all these things have in common? Twenty-five years of fun and funds raised through TMA Foundation’s annual gala to create a Healthy Now and a Healthier Future for all Texans.

TMA Foundation will welcome more than 500 physicians, and community and business leaders from across Texas to its 25th Anniversary Gala at the JW Marriott San Antonio Hill Country Resort and Spa. The gala will be held from 6:30 to 10:30 pm on Friday, May 18, and will feature a cocktail reception, seated dinner and auctions with unforgettable items. The event, which is part of TMA’s Annual Meeting (TexMed), also features dancing and live music by the Matchmaker Band of Austin. Dress is cocktail attire.

“We cordially invite one and all to join us in celebration at the TMAF 25th Anniversary Gala,” said Les H. Secrest, MD, TMAF president. “The success of the annual gala would not be possible without the help of host-city event chairs. We are pleased to announce Sheldon Gross, MD, and his wife Georgiana and Jayesh Shah, MD, and his wife Neha have committed to serve as our 2018 Gala Chairs. Many thanks for their service.”

Jayesh Shah, MD, practices hyperbaric medicine and wound care in San Antonio with his wife, Neha Shah, MPT, the physical therapist at South Texas Wound Associates, which they founded in 2000.

Dr. Shah is a current TMA delegate to the AMA and is a past president of Bexar County Medical Society.

Sheldon Gross, MD, is a pediatric neurologist in San Antonio and is affiliated with Methodist Children’s Hospital and University Hospital. Dr. Gross is the current Bexar CMS president and has served as vice-chair of TEXPAC and the AMA delegation. His wife, Georgiana Gross, RD, is a clinical instructor of nutrition at UT Health San Antonio School of Dentistry and has served as a vice-chair of TEXPAC. 12

San Antonio Medicine • January 2018

Top: Jayesh Shah, MD, and his wife Neha Shah, MPT, and below: Sheldon Gross, MD, and his wife Georgiana Gross, RD, will serve as TMA Foundation 25th Anniversary Gala CoChairs on May 18, 2018 in San Antonio as part of TMA’s Annual Meeting.

“Also as part of the festivities, TMAF will honor all past gala chairpersons who have given their time, talents and treasure to continue and expand TMA’s charitable programs through the annual fundraising gala. We thank each of them for their generosity.” Dr. Les Secrest added.

All gala chairs over the past 25 years have been named Honorary Chairs and will be recognized during the TMAF 25th Anniversary Gala. More information on sponsorships, tables, or individual tickets – as well as a list of all past gala chairs – can be found at www.texmed.org/gala, or by calling (800)-880-1300, ext. 1664.

MEDICAL STUDENT

PERSPECTIVES

Med Student Perspectives:

AN INTRODUCTION

By Darren Donahue

or many it seems that their years in medical school were over in a flash. But regardless of whether medical school is remembered fondly or otherwise, I’m sure you recall the sleepless nights, endless books, board exam studying, and the desperate attempt to provide your team with some value on your clinical rotations. In most cases, medical school is that transitionary period between undergraduate studies and finding one’s place as a professional in the community.

San Antonio Medicine last dedicated an issue to student writing in March 2014. But medical students make up an increasingly large proportion of the Bexar County medical community. UT Health San Antonio has four classes of approximately 200 students each and the University of the Incarnate Word’s first class in its School of Osteopathic Medicine has over 150. As UIW expands and fills out its four classes, Bexar County’s medical student population will undoubtedly grow in terms of numbers and in diversity, enabling it to serve more patients in more ways. Within a few years there will be almost 1,500 students in this county all doing their best to learn the ropes, give something back to the community, and form their professional identities. And just as medical school is a transitionary period, I believe San Antonio is also in such a period as it begins educating a larger percentage of our future doctors. Therefore, I think this is a great time to check the pulse of San Antonio’s medical student body and see what they have to say.

In this issue we have assembled thoughts from 15 students learning medicine here in San Antonio. Each took a different road to medical school and to that end, several students have described how they got here. From healthcare pipeline programs, to working in fast food, to growing up the Rio Grande Valley, these disparate paths surely influence how each will approach medicine and plan their future careers.

Much to the chagrin of second career medical students like my-

F

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San Antonio Medicine • January 2018

self, medical school presents the frustration of costly education coupled with unpaid labor. Admirably, despite the time and financial strain, medical students in Bexar County volunteer regularly, taking advantage of the unique opportunity to provide our time to those who cannot otherwise afford medical care. Since there is so much more to these four years than just lectures and clinical rotations, many students have written about how they are donating what little extra time they have. Based on their articles alone, the benefit Bexar County medical students provide to the community is clear.

Finally, the expression “drinking from a fire hose” gets thrown around a lot due to the sheer volume of information medical students are expected to learn during their time in medical school. But this time is about more than just memorizing the seemingly endless stream of facts that are thrown at us. Medical school teaches us how to think and use those facts to benefit those around us. It is a truly formative experience and as such it ought to profoundly influence our personal plans for the future and provide a lens through which we interpret current events and societal issues. The articles contributed by several students clearly demonstrate this influence as they think about their future careers in medicine as well as how issues such as obesity, vaccination attitudes, and gun violence affect our community.

Thank you for reading and if you would like contact information for any of our student authors, don’t hesitate to send me an email at Donahued@uthscsa.edu.

Darren Donahue is a former practicing attorney and MS2 at UT Health San Antonio. He is a member of the BCMS Publications Committee.

MEDICAL STUDENT

PERSPECTIVES

WHEN I CAME TO MEDICAL SCHOOL

By Alejandra Morfin Rodriguez When I came to medical school, I stared at my White Coat in disbelief. Like many other first-generation students, I felt the weight of my family’s sacrifices in every thread of the white coat.

When I came to medical school, I reflected on how my story began 1,500 miles and a world away in Jalisco, Mexico. My mother brought my sister and me to this country with the American dream in her heart, ready to undertake the challenge of raising two girls alone.

When I came to medical school, I thought about Pasadena, Texas — a place full of culture, family, and poverty. My first home in the United States. The city that gave me a firsthand view of the social determinants of health at work. I witnessed desperation in the eyes of my neighbors as they continued pursuing a normal life while their families, friends, and acquaintances fell ill due to the pollution of the hundreds of surrounding chemical plants and refineries.

When I came to medical school, with tears in my eyes I was sworn in as a naturalized citizen of the United States of America. Never forgetting the long 18 years of living in fear as an undocumented immigrant that led to that fateful day. Never forgetting the words of those that I represented when they told me “Mija, you are our voice now.”

When I came to medical school, I was told “that I was not like the other Mexicans,” a phrase I heard too often. A phrase that exposed the attitude that my accolades were seen as an anomaly rather than an accurate representation of the hardworking Latino community.

When I came to medical school, I felt like I was crossing another border. Not a geographical one that existed on maps but rather a border that was drawn with income, education levels, and connections to resources.

When I came to medical school, I quickly realized that the warnings I had received about not being the typical medical student were true. I noticed that it was common for my classmates to have private school educations, and physician parents along with all the other workings of a well-educated, elite family. I realized that I still did not have a firm conceptual understanding of what having a career really meant while my peers seemed to “have it all figured out”. I felt inadequate and alone.

When I came to medical school, I encountered implicit assumptions insinuating that medical students all come from a high socioeconomic background. These implicit assumptions reaffirmed my belief that medicine is inaccessible — not only to the patient but also to the underprivileged student who has to finance the astronomically expensive medical school application process from start to finish.

When I came to medical school, I chose to bridge the gap between the two worlds that I now live in. Determined to wear my roots on my sleeve in an effort to increase understanding of the plight of immigrants and to advocate for the poor.

When I came to medical school, according to the AAMC, “Hispanic or Latino only” females only made up 3 percent of all the matriculating medical students.

When I came to medical school, I felt like I was immigrating yet again to another land, one where I struggled to fit the “mold.” As time passed, I realized “fitting a mold” should have never been one of my concerns.

When I leave medical school, I will have two new letters at the end of my name. Each obstacle that I have faced along the way will serve as part of my training to become a physician advocate. A physician that can truly empathize with some of the most vulnerable of patients.

Alejandra Morfin Rodriguez is a second year medical student and a member of the Fightin' Texas Aggie Class of 2016.

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MEDICAL STUDENT

PERSPECTIVES

THE WEIGHT OF POVERTY

By Alexis Ramos The news and media continuously describe obesity epidemics and overeating trends in America, labeling the U.S. as a Fast Food Nation. The medical care costs of obesity in the United States were estimated by the Center for Disease Control to be roughly $147 billion dollars annually. During high school, I worked as a McDonald’s cashier to better position myself in the future financially. I did not imagine the impact it would have on me during my journey to become a medical student. I remember one encounter with a father carrying his small, blonde child around the age of five in his arms. He approached the cash register and ordered one ice cream cone. It is important to note that an ice cream cone was $1.08. The child muttered, “but Dad, I want chicken nuggets.” The small chicken nuggets were $2.37 alone.

The father replied, “The ice cream will make you fuller.” I could tell by his eyes that he meant they’ll crush any feelings of hunger quicker and cheaper than the chicken nuggets. My heart felt empty that this man had to choose the less nutritious option for his daughter. Being constrained to a limited income implies the options of eating become limited as well. A fast food burger costs as little as $1, while a salad holds a hefty price of $6. I empathize with families who feel the effects of poverty and obesity because their time, access to grocery stores, and money are limited. It becomes troubling when realizing medical professionals are the examples for the public, yet usually our knowledge and opportunity greatly outweighs most of the community’s — which may be why the public is outweighing us in Body Mass Index (BMI).

Many unaware adults see obesity as a sign of overeating and laziness. Most physicians even hold weight biases against patients, seeing them as lacking self-control and being non-compliant. Obesity strikes those with low-incomes the hardest, therefore scare tactics and shaming perpetuates the problem. If a patient who worked as a zookeeper came into the emergency room with leprosy, a resident would not state, “you chose your occupation” or “maybe your illness would have been avoided if you stayed away from the animals.”

Most doctors treat the disease and tailor future prevention options to the patient’s lifestyle and situation. Yet we do not do this for obese patients. The problem persists when medical professionals give patients meaningless advice on how to lose weight. Most patients understand the ratio of “caloric intake” needs to be less than “energy out” while trying to lose weight. An average obese patient will attempt to lose weight several times before even stepping foot in a doctor’s office. As physicians, we need to address this issue in full context rather than stating to eat more protein, less salt, and incorporate fiber. This is as if we were bankers giving advice to customers on how to be fiscally responsible, telling them to simply apply marginal utility theories and pay attention to sunk cost fallacies. Unless realistic implementations are explained to patients, we are setting them up for failure (which is fiscally irresponsible for any doctor).

Some realistic tips for a Hispanic family, the major demographic in San Antonio, would be to ask about their diet. If they say tortillas, tell them to switch instead from four flour tortillas at dinner to one corn tortilla. Limiting pan dulce and other sweets to a reward on the weekend sets a realistic, attainable goal for the patient. Parking farther away at work so they become less sedentary is a milestone for patients that should be celebrated. After all, health benefits can be seen when patients lose just 5 percent of their body weight. If doctors become more responsible for our patient’s living circumstances, we can chip away obese mindsets with an ice pick, not a spoon.

Fast food prices that are congruent with healthy choices could tackle a great deal of the obesity in America. Having worked in the fast food industry, most citizens do not make unhealthy choices purposefully. They make them because that is the convenient way to survive.

Changing the narrative from simply “eating better” to providing actual solutions lower-class Americans can put in place will help end an obesity crisis.

Alexis Ramos is a second year medical student at UT Health San Antonio.

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San Antonio Medicine • January 2018

MEDICAL STUDENT

PERSPECTIVES

FULFILLING A CHILDHOOD DREAM

By Jomari Guerero In fifth grade I dressed up as a health professional for halloween. I didn’t necessarily know the complex differences between the different types of health care workers at the time. I just knew that I wanted to wear scrubs and buy a giant toy syringe the size of my arm.

From that moment onwards, my interest in the field grew exponentially. I began to research what it meant to be a doctor and the differences they made in the community. This guided my early interest that led to my attendance in pipeline programs such as a medical related magnet high school and from there participating in an accelerated BS/MD program in partnership with UTSA and UT Health San Antonio.

My high school had a clinical rotations program that allowed students to shadow in all types of healthcare settings including the I.C.U., the operating room, local family clinics, etc. Being in the My brother (left) and I (right) posing as I pretend to take blood from him. valley (Deep South TX), this allowed me to understand how underserved the region was. We had interactions with a physician twice a week during our senior year. In college, we had intimately-sized classes on subjects based on psychiatry, geriatrics, cancer, and pediatrics. Classes like these allowed me to conduct my first real HPI on a patient and partake in standardized patient encounters.

Some critics consider being exposed to a singular field at a young age a disadvantage. Personally, these ambitions only allowed me to grow further as a person and as an aspiring future health care professional. Now that I’m a first-year medical student, it’s definitely surreal. I’ve worked nearly all of my life towards this goal that continues to expand and grow as I do. I’ve learned two important lessons that come from journeys like mine.

It’s okay to know what you want. I’ve been told several times to explore my options. In some ways, this is important to realize.

I’ve found a healthy balance in, for example, taking that intriguing art class in college, while at the same time not forgetting what’s important to me. A lot of the healthcare related experiences fostered self-exploration as I found myself lost in the possibilities of medicine. Every step is one step closer towards knowing what it means to make a difference in someone’s life. That has always been the number one goal.

There is always room for growth. Medical school is an entirely different beast. Even though I’ve had a surplus of healthcare related experiences since ninth grade, I never would’ve imagined my first semester to play out like it has. The level of in-depth learning and application of that knowledge is more intense than anything I’ve done before. Overall, this is just one of the many paths to medical school. Would I do it again? Most definitely. I will never underappreciate the amount of perspectives that I’ve been able to be a part of at such a young age and in the near future. With the first semester of medical school coming to a close, I am both ready and excited for whatever is to come next.

Jomari Guerero is a first year medical student and considers the AT&T center as his second home. Go Spurs Go!

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San Antonio Medicine • January 2018

MEDICAL STUDENT

PERSPECTIVES

SAN ANTONIO’S DISPARITIES: A NEW SOLUTION TO AN OLD PROBLEM

By Raul F. Membreno MD/MPH Candidate, UT Health San Antonio A house divided cannot stand. San Antonio is one of the nation’s fastest growing cities.

Growth often brings new economic opportunities, better schools and jobs, and greater access to parks and health services. However, not all growth leads to economic and social growth.

Studies show that the rich are getting richer and the poor are getting poorer in the Alamo City.

According to a study cited in the San Antonio Express News, ‘in 1980, 26% of lower-income households resided in majority lower-income tracts, but by 2010 that figure had risen to 38%.’ The polarization of the city has led to devastating consequences for low income communities including widespread hunger, low incomes and striking health disparities.

Hunger is still a problem today. CBS featured San Antonio in the documentary Hunger in America in 1968, which revealed that more than 400,000 Mexican Americans were living in hunger. Government programs and the SA food bank have aided in the fight against hunger but experts concur that hunger rates have not definitively decreased in the past 50 years. One theory for the lack of progress in reducing hunger rates is as follows: zip codes with higher income levels have greater access to reasonably priced, healthy food due to increased access to various supermarkets that must compete with each other; whereas areas with higher poverty rates may have to pay double for the same healthy food product due to lack of competition in these areas.

The San Antonio income disparity is among the nation’s worst. The Pew Research center labelled the Alamo City as the city with the greatest gap in income levels among zip codes in 2012. The average salary of San Antonio residents in the zip code 78207 is $21,903, whereas residents of 78258 earn on average $93,710. To elaborate on the reality of the poorest zip code in San Antonio, almost 50% of adults lack a high school diploma in zip code 78207. The unemployment rate is a devastating 60%, and 40% of people live in poverty.

On the other hand, the zip code of 78258 has approximately the same number of households and a 98% rate of high school graduates among adults, an unemployment rate less than 33%, and a mere 4% poverty rate.

Geography is the greatest determinant of health. Perhaps the most striking reason to address San Antonio’s notorious disparity in zip codes is the effect on life expectancy. The Texas Public Radio conducted a Community Health Needs Assessment in 2016 that identified a 20-year difference in life expectancy between different zip codes in the city. The affluent northwest and southeast residential communities had an average life expectancy of 90-94 years, whereas the west and east had an average life expectancy of 70-74 years.

If every human being deserves a long, healthy life regardless of the economic climate of his or her place of birth, then the need for initiatives to address this two decade gap is palpable.

An old problem requires a new solution. Proposed solutions to address the disparity between the north and south side of the city include adult education programs to increase the 17% literacy rate in Bexar County, improving the qualities of schools in decrepit areas, and investment in the economies of financially stagnant communities. All of these proposals require political and legislative action.

Unfortunately, this solution has been recommended in the past with limited change. Perhaps the way to breach the barrier between the affluent and the needy is to take a small step forward rather than a gallop to the finish line. The key issue that readers of the Bexar County Medical Society can directly affect is the enormous health disparity present in the Alamo City. San Antonio needs physicians committed to serving communities that cannot afford or access healthcare. Encouraging physicians to participate in community service via free health clinics and other public health efforts in low income areas is one step in the right direction to snap the trend of recordsetting health disparities in San Antonio.

Raul F. Membreno is a San Antonio native and an MS2 in the MD/MPH program at UT Health San Antonio.

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MEDICAL STUDENT

PERSPECTIVES

HOW TO FIND YOUR PLACE ON A PATIENT CARE TEAM: A NON-TRADITIONAL STUDENT’S APPROACH

By Natalie Clericuzio, MS3 During my second week on the inpatient pediatric hematology/oncology service, I realized that I hadn’t been lying to myself for the past two and a half years of medical school — I belong here. I’m what is referred to as a “nontraditional” medical student, an umbrella term describing students who strayed from the typical path to med school. My detours include an undergraduate degree in Classical Studies with a focus on ancient Latin and working for four years fundraising for my alma mater. Although I know my atypical path was the only way for me to achieve my goals, there were days during the preclinical years when I felt unconvinced that I deserved to be here among so many of my exceedingly bright and capable classmates.

Even on those days, I pushed forward. I coped with my feelings of inadequacy by reassuring myself that my previous life experiences would one day pay off. I told myself that practicing medicine involved more than just the ability to perform well on standardized tests (even though success on those tests undeniably stood as the gatekeeper between me and patient care). Thankfully, with the exception of a few spectacular moments of anxiety, my faith in delayed gratification, much encouragement from supportive friends and family, and discovering I wasn’t alone in my feelings of self-doubt helped me stay the course.

On the day I saw the real value of my nontraditional skills and experiences, my team in the pedi heme/onc ward was caring for a full load of patients all in different stages of acute illness, chemotherapy, admission and discharge. As only two medical students and two residents were on our team, there was more than enough work to go around. With a week on the service under my belt, I had a feel for the team’s workflow and jumped in wherever possible to help out, making follow-up appointments, checking in on patients, picking up imaging results — whatever I could to make the day go a little more smoothly. At some point in the middle of the afternoon, I realized that managing all the tasks to keep our patients as healthy as possible was in many ways not so different from the work I had done as a project manager in the fundraising office after college.

That realization surprised me. Before beginning medical school, I had looked forward to spending time with patients on the wards, caring for them and helping allay their fears during medical care. What I hadn’t expected is for my work experience to have prepared me to contribute to the everyday rhythm of patient care.

As I approach the halfway mark of my third year, I still have moments of self-doubt, and I still have to work hard to prepare for multiple-choice tests. One thing has changed: the moments of self-doubt come less often, and when they do, it’s getting a little easier for me to believe myself.

Natalie Clericuzio is a third year at UTHSA whose medical school class voted her the winner of the 'Best Laugh' superlative

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San Antonio Medicine • January 2018

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CARING FOR SAN ANTONIO’S REFUGEE POPULATION

By Prem Menon Hidden behind the hectic scene of the renowned Medical Center in San Antonio, a small Episcopal Church houses a well-equipped clinic for the city’s growing refugee population.

As everyone winds down on a Wednesday evening to power through the rest of the week, the refugee clinic opens its doors to deliver quality care. Every Wednesday from 5 p.m. to 7 p.m., refugees from varying countries arrive at St. Francis Episcopal Church seeking medical and dental care.

In September of last year, Texas pulled out of the refugee resettlement Above photo shows SARHC’s patient-centered care in paprogram, which has resulted in less access to care for refugees settling in tient room at St. Francis Episcopal Church with (from left) Texas. In the past couple years over 7,000 refugees have resettled in Texas, medical student leaders Mitchell Falkner and Emily Gallagher, dental hygiene student Guadalupe Morales, Arabic which is more than any other state in the country. interpreter Wisam Al Habeeb, and dental student Alex DolSan Antonio Refugee Health Clinic or SARHC forms the bridge be- bik evaluating a refugee patient. tween refugees and access to proper medical care. SARHC is one of the only refugee-centered student-run free clinics in the country, and aims to address the health and social needs of the 5,000+ refugees living in northwest San Antonio. The demographic of the refugee population in San Antonio is primarily of Bhutanese and Middle Eastern origin. However patients from all over the globe are seen. The clinic strives to serve as an initial safe and trustworthy location for refugees to overcome inhibitions/fears and to take charge of their own health. The clinic has translators that work to understand the needs of the patients as communication is the biggest barrier they face. The clinic not only stands to foster independence within the refugees and introduce treatments with preventative care, but it also brings a social component to allow a relationship to be formed.

The acute care clinic setup in the halls of St. Francis Episcopal Church is a cooperative effort between UT Health SA students of medicine, nursing, and dental schools to bring collaborative care. The clinic allows UTHSA students to sign-up for volunteering via an online portal. Clinic begins with a brief orientation to educate first-time volunteers about how the clinic runs. Clinic flow consists of a team (a medical student, a nursing student, and a dental student) taking vitals, full history and physical of a patient. After assessing the patient, the team reports back to one of the volunteer attending physicians. The team with the attending physician will see the patient together to conclude the case. SARHC does not stop at medical and dental care, but also offers a full pharmacy in-clinic to provide medications to patients free of charge including any lab work.

Through educational workshops and insurance seminars conducted with the help of social service volunteers from the Center for Refugee Services (CRS), refugee families learn about access of care, preventative measures, sanitation, benefits and available health care options. Through the successful management of the clinic, students learn the need to deliver treatment to underserved populations and the value of collaboration through an irreplaceable interdisciplinary approach to care.

Prem Menon is an MS2 at UTHSA and is a current medical student leader at the San Antonio Refugee Health Clinic.

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San Antonio Medicine • January 2018

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ACCESS TO HEALTHY FOODS IS KEY TO MANAGING OBESITY

By Amanda Wedelich The prevalence of obesity in our country is on the rise, leading to an increase in chronic diseases. In the United States, there have been cases of type 2 diabetes diagnosed in children as young as 9 due to obesity and bariatric surgery performed in children as young as 12. (4) In Bexar county, 71 percent of individuals are either overweight or obese. Of Bexar county adults, 14 percent have diabetes, which is higher than both the state and national average. (1) Prevention is imperative.

There are multiple reasons for these recent trends including an increase in families eating fast food meals, less access to produce and nutritious foods, increased consumption of prepackaged, high fat items, and a reduction in cooking sit-down meals. Some communities lack available healthy food choices, with no grocery store in the area. (4) These people are forced to either travel long distances to purchase food on a regular basis, buy fast food/restaurant items, or stock up on prepackaged meals with a later expiration date. Bexar County, is comprised of 70 ZIP codes, each with differing access to healthy food choices. Places to purchase groceries in the county range from convenience stores to high-end health food stores.

An analysis was performed to determine the availability of healthy food choices for Bexar County residents. Each of the s70 ZIP code areas were assessed for the presence of convenience stores, grocery stores, and high-end grocery stores. The category of grocery stores consisted of HEB, Wal-mart, Fiesta, Arlan’s, Fort Sam Houston Commissary, and Lackland Commissary. The following stores were considered high-end grocery stores: Whole Foods, Sprouts, Trader Joe’s, Central Market, and Natural Grocers. The ZIP codes were then grouped into a location (North, East, South, West, and Central) and designated as either inside or outside the 1604 loop.

Of the 70 areas in Bexar County, 28 had solely convenience stores as their options for purchasing groceries. Thirty-seven out of 70 had grocery stores and convenience stores present, and a total of five of the 70 areas had all three categories including high-end grocery stores. When arranged by location, all ZIP codes with high-end grocery stores were found in the north, ZIP codes with grocery stores were scattered throughout the city, and solely convenience stores were predominantly outside the 1604 loop.

Those living in areas without access to healthy food choices may end up having to purchase more prepackaged items, which are high in fat and sugar. They also have easier access to restaurants and fast food locations which provide high calorie, non-nutritious food choices. Even those with access to grocery stores, as opposed to high-end grocery stores, are offered fewer healthy food options. Solutions for this problem include teaching community members how to grow their own fruits and vegetables, showing families how to prepare healthy meals at home, and finding ways to bring healthy foods to the areas that lack through temporary, recurring markets or food trucks that sell produce.

REFERENCES:

1. Arias P. 71 percent of Bexar County residents are overweight or obese. KSAT. https://www.ksat.com/health/71-percent-of-bexarcounty-residents-are-overweight-or-obese. Published April 6, 2016. Accessed December 1, 2017.

2. Google Maps. https://www.google.com/maps. Accessed November 20, 2017.

3. P. Bexar County Zip Code Map. Zip Code Map. http://www.yourlincolnpark.com/bexar-county-zip-code-map.html. Published July 6, 2017. Accessed December 1, 2017.

4. Rome ES. Obesity Prevention and Treatment. Pediatrics in Review. http://pedsinreview.aappublications.org/content/32/9/363.

Published September 1, 2011. Accessed November 30, 2017.

5. U.S. ZIP Codes: Free ZIP code map and zip code lookup. UnitedStatesZipCodes. https://www.unitedstateszipcodes.org/. Accessed November 20, 2017.

Amanda Wedelich is a second year medical student at The University of Texas Health at San Antonio Long School of Medicine.

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INCREASING MASS VIOLENCE IN AMERICA WILL BE AN ONGOING CHALLENGE FOR NEW DOCTORS

By Zach Coates As a second-year medical student, the past year and a half has been full of learning, experiencing, and observing. I witnessed myself and my classmates grow as we began our futures in medicine at UT Health San Antonio. Unfortunately, in our short time in medical school, we also witnessed three of the five deadliest shootings in American history. Shootings in Las Vegas, Orlando, and Sutherland Springs in 2016 and 2017 have left over 130 dead and countless more with collateral damage. More importantly, we are witnessing a frightening trend in our society that shows no signs of slowing. The increasing incidence of mass violence in America is a problem that student doctors need to begin to address as our society recovers from these tragedies. Our involvement in our country’s future is twofold; we hold a responsibility to begin to understand why mass violence is increasing and we should take steps in order to prepare ourselves for inevitable mass casualty events in the future.

Increasing incidences of mass shootings is undoubtedly a multifactorial problem with no obvious cause or solution. As student doctors, we need to begin to think about why these tragedies continue to persist throughout our society and how we can solve this problem. One advantage that our students have over the last generation of doctors is that we are a product of the same generation as the perpetrators. Four out of the five deadliest shootings in American history involve gunmen under the age of 30. Similarly, 10 of the 17 (59%) deadliest shootings in America since the year 2000 have involved gunmen under 30. In contrast, before the year 2000, only 4 of 13 (31%) gunmen were under the age of 30. These statistics, along with the fact that the past three of five shootings happened in the past year and a half, show an increasing number of relatively young perpetrators involved in a rising number of more deadly shootings. As student doctors, we have a responsibility to think about why these events are occurring in our generation and, in collaboration with past generations, begin to understand why shootings are on the rise. What makes our generation different from those prior? In what ways were we raised differently that set us apart? In what ways has our society changed that could explain this phenomenon? Through holding discussions and asking ourselves these types of questions, we can begin to solve the problem of why there is an increasing rate of mass violence in America.

Unfortunately, future mass shooting events are inevitable. The shooting in Sutherland Springs was a wakeup call to me as a medical student in more ways than one. I heard firsthand accounts of students experiencing and witnessing the tragedy as victims were brought to UT Health affiliated hospitals. Through these accounts I realized that my classmates and I would one day be caring for these victims.

In the UT Health medical school graduating class of 2017 alone, one student is completing residency in Orlando, another in Las Vegas, and many in San Antonio. These students, along with students from each future graduating class, will care for future victims of mass casualty and we need to be prepared to handle these situations in regards to both trauma response and long-term effects on survivors and those in the community.

As student doctors we should take active steps to prepare ourselves for future events. This includes learning and understanding protocols for mass violence events in the hospitals and participating in mock drills to simulate mass violence. Preparing for such an event is difficult to learn from a textbook, and in this way we will prepare ourselves to care for victims that we will inevitably encounter in the future. Additionally, we should emphasize education focusing on long-term effects of mass violence. Examples include understanding psychological damage after a mass violence event, knowing normal responses to these events, and knowing how to care for patients who have experienced these tragedies.

In a short time, we will travel to all parts of the country and we will, in one way or another, become involved in more fields than just medicine. Our actions now will shape our ideas for the future when we will be in positions of power to influence change in our society.

The increasing number of mass shootings in the United States continues to be a worsening problem that medical students need to begin addressing. As we continue in our education, we need to put our minds together to understand these problems and better prepare ourselves for our careers in medicine.

Zach Coates is an MS2 at UTHSA 24

San Antonio Medicine • January 2018

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LEARNING SPANISH WILL GREATLY BENEFIT YOUNG DOCTORS

By Matthew Milam Cultural Competency: It’s a term drilled into us over our preclinical years. Rightfully so, understanding of the backgrounds of our patients is critical for establishing an adequate physician patient relationship. In our classes, we address several of the major national issues in American culture such as gender inequality, heath care concerns of the LGBTQ community, and the importance of health literacy. Yet, with a city as diverse as San Antonio are we really addressing the culture and needs of our own community?

San Antonio has long been known for its rich history and vibrant cultural diversity, showcased across the city from its old esteemed missions to the festive River Walk. But perhaps the place that showcases this diversity the most is none other than University Hospital. If you were to walk through the wards of University Hospital you would be able to notice a hodgepodge of culture present. Interestingly, you would likely be able to notice it even without seeing any patients, just simply by hearing the variety of languages ambient in the air.

Although even in my early career I have seen patients from across the globe, you would be quick to notice that one culture in particular is far more prevalent than the rest. It is a culture that is intimately associated with San Antonio, so intertwined in fact that the name of our city is derived from its language. It is the Hispanic culture, and it is a culture that for how prevalent it is in our community I think we may be neglecting its importance in our medical training.

It is no secret that knowing Spanish is a very valuable skill for a medical student to have. When asking advice for how to succeed during clinical rotations I have been told several times by older students that as long as you can show up on time, speak Spanish, and not be a jerk you are almost guaranteed fantastic evaluations. However, most importantly being fluent in Spanish allows you to communicate directly with so many patients in hospitals across San Antonio and within the community of South Texas. This is critical for establishing personal connections and trust.

Clearly it is important to learn Spanish, but is it even possible for a medical student to spend enough time to thoroughly learn a new language? It can seem like an impossible challenge when you are constantly bombarded with multiple weekly quizzes and monthly examinations, not to mention volunteering, research, shadowing, networking and trying to maintain at least some remnant of a social life. Quickly realizing the importance of learning Spanish myself, I have made several attempts at learning. I’ve tried a few online resources, nagged some of my fluent friends to teach me phrases, and volunteered at medical community service events across South Texas to try to speak to patients in Spanish. Yet, despite these efforts I am still far from fluent. It can be disheartening because whenever I feel like I am quickly making progress a major project or test will appear on the horizon and interrupt my efforts.

Now as my classmates and I creep nearer and nearer the end of the preclinical years we are starting to feel the pressure of upcoming national board examinations, most notably the USMLE STEP 1 exam that has become overwhelmingly important with regards to becoming a competitive residency applicant.

Learning Spanish as a medical student is certainly no easy task. Having more opportunities to learn Spanish such as elective classes or subscriptions to online classes would be helpful, but ultimately the responsibility of learning a new language is on the learner. In the end, I think that it is unreasonable to expect a medical student to completely learn a new language during medical school, especially during the preclinical years. However, I think it is completely reasonable, and I even think it should be expected, that medical students put in enough effort to learn at least a few basic greetings and some basic medical Spanish. Even if a translator is still required, making an effort to communicate directly with patients is important and will go a long way with regards to making a positive physician patient relationship.

Matthew Milam is a second year medical student at UTHSA.

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A NOVEL EXPERIENCE AT THE UIW SCHOOL OF OSTEOPATHIC MEDICINE

By Manojna Kintada For as long as I can remember, I wanted to become a physician. And to achieve that, I tried to map out every step of my life. I worked hard in my undergraduate studies taking challenging classes to prepare for my next step: medical school. However, when the day came to make my decision on which medical school to attend, I was in a dilemma. On one hand, I had the opportunity to attend the University of the Incarnate Word School of Osteopathic Medicine (“UIWSOM”) and be a part of the inaugural class of 2021. On the other hand, I had the option of attending medical schools with the traditional curriculum consisting of the multitude of tests and quizzes. For someone like me who had mapped out every step of my life, it was intimidating to attend a school as a member of the inaugural class. However, I realized that real growth came from stepping out of my comfort zone and venturing out something new. I realized that the UIWSOM was the perfect fit for me because it had unprecedented ideas that will only nurture my growth as a student and an aspiring physician. The reason I chose UIWSOM was because of its novel curriculum, dedicated faculty, and the chance I had at making history. I chose this school because I had the opportunity to be a pioneer in a transformative curriculum that emphasized not only success, but lifelong learning.

The innovative program at the UIWSOM strives to transform medical students to empathetic and compassionate physicians who are educated to address the needs of all populations including those that are undeserved.

In addition to the didactic classes that focus on the foundations of medicine, I also have the opportunity to participate in community engagement and early clinical experiences. As a first year medical student, I have the opportunity to serve my community by volunteering at notable nonprofit organizations around San Antonio such as Haven for Hope. In addition, I have the opportunity to adopt a family from an undeserved background in the Southside community. By serving in the community, I have come to realize the financial, psychological, and clinical concerns that grip my community. Through the community engagement and early clinical experiences that has been incorporated into the curriculum, I was able to step into the life of another individual, and visualize the disparities that have stalled their access to health care and other critical needs. I am grateful that I attend UIWSOM because it enables me to not only serve my community but also learn about the many disparities that affect the members of the community.

In addition, the novel curriculum at this school integrates a flipped classroom setting. Every week, we are assigned two case studies that we as student doctors take apart over the span of the next 5 days and report our findings to our peers. Most of the didactic learning takes place in small group activities which allows us students to collaborate our findings and put it together in a cohesive piece to present to other students as well as faculty. In addition, we are given ample resources to facilitate our learning such as the Anatomage and many board prep tools. The curriculum at this school allows me to self-guide my learning and discover new resources to extract significant information from multiple sources. The curriculum allows for a self-guided learning that has not only allowed me to be a more proficient learner, but also an adept critical thinker.

My experiences at UIWSOM far exceeded my expectations. I am grateful that I have the opportunity to study under a curriculum that addresses my needs as a student and allows me to learn using many resources and learning styles. The incorporation and integration of a curriculum that establishes the didactic knowledge, in addition to the implementation of the humanistic perspective through the utilization of early clinical experience and community engagement programs truly makes this medical school exceptional and extraordinary. I believe this school will help me become the ideal physician I envision myself becoming: a physician who is focused on lifelong learning, empathy, and patient-centered care.

Manojna Kintada is an OMS-1 medical student at the University of the Incarnate Word School of Osteopathic Medicine.

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San Antonio Medicine • January 2018

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COMBATTING AND CORRECTIING MISINFORMATION ON VACCINES

By Lauren Murphy and Anna Pritchard In recent years, vaccination safety has been under increasing scrutiny and with easy access to the internet, many people have fallen victim to circulating misinformation causing them to have negative attitudes towards vaccination. According to a 2015 NIS survey, Bexar County falls behind the other major Texas cities in vaccination rates. To assess whether this is due to the increasing circulation of negative press towards vaccinations, we held a flu vaccine drive in the Westlawn community where we spoke with members about their beliefs and knowledge of vaccinations.

Overall, most people we spoke with were in favor of vaccinations and believed that their benefits outweighed the risks. That being said, a significant portion of the community came with misguided information learned online or through friends. One of the biggest concerns expressed was vaccinations causing Guillain-Barre Syndrome. Because this tight knit community saw this rare side effect on their own, they believed it to be likely to occur again. In predominantly Hispanic communities, like Westlawn and much of Bexar County, there is a strong emphasis on family and community and there is much dialogue amongst members. This can lead to scenarios like the one above where large batches of a community receive some of their medical knowledge from people other than health care providers that may be extrapolated.

Another common concern was vaccination cost, particularly among parents. For these people, the financial hurdle prevented them for being able to have themselves and their children vaccinated. We provided these people with a list of local clinics that give free or discounted vaccinations or participated in programs like TVFC or the Adult Safety Net Program, which provide affordable vaccinations for qualified individuals. They were also advised on how to enroll in these programs as well as local programs like CareLink.

While nearly everyone we talked with told us they knew how vaccinations worked. However, when asked to explain much of the community had an incorrect idea of how vaccinations provided immunity. For instance, many people surveyed believed that when getting an influenza vaccine they were being injected with the live virus. They reported that they felt sick after getting the vaccine in the past because they were given the flu by it, not that feeling sick was a normal immune response to the vaccine. By teaching them how vaccinations work and showing them that the influenza vaccine is a dead virus and therefore cannot give you the flu, many people that were initially reluctant to get vaccinated decided to proceed.

The Westlawn community was receptive towards us and eager to learn about vaccinations. After speaking with them, it seemed that the overall attitude towards vaccinations was positive and only got better when we addressed any concerns they may have had. We were able to learn more about the area's culture and better understand how it played a role in their health care decisions. After working within the community and seeing their open communication, we hope that their new knowledge of vaccinations spreads throughout its members. This is turn may diminish some of the negative attitudes towards vaccination eventually leading to higher immunization rates in Bexar County.

Lauren Murphy is a MS2 at Anna Pritchard is a MS2 at UT Health San Antonio UT Health San Antonio

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BEST TO ADDRESS THE THREAT OF PHYSICIAN BURNOUT EARLY IN YOUR CAREER

By Lorelle Knight Most practicing physicians are familiar with the threat of physician burnout. Most know of a colleague who quit their career or have been required to attend lectures and discussions about avoiding compassion fatigue. Perhaps they’re even overly familiar with the thought: “would I do this all again, given the chance?” To a preclinical medical student trying to decide what specialty she might go into, however, the honest details of physicians’ satisfaction with their career choice can be difficult to figure out. And to some physicians, it can be difficult to admit to aspiring doctors what they wish they’d done differently.

Before beginning medical school, I had the opportunity to scribe in an emergency department in north Texas. For one year, I got to know these physicians, and at the end of my time there I asked a dozen of them individually: “Would you go into emergency medicine again if you could do it all over?” I received candid, heart-felt answers, and throughout my preclinical years I have made a point to keep in mind what they said.

To my surprise, about a third answered some version of “no” and let me write down their reasoning. Dr. “D,” for example, would choose medicine again but not her specialty. “My husband and I decided we were going to raise our kids ourselves and not get a nanny, and it’s been exhausting,” she told me. She explained that she was very career-oriented before having kids, but since having children she’s wished for much more time with them. She also mentioned that, in another life, she would have been a “dean of students or something” because she missed teaching. Since I myself am interested both in having children and in academic medicine, I highly valued her honesty.

Dr. “T” wasn’t sure if he’d even choose medicine again. “I feel like I would have liked to invent things. I miss being able to create and design stuff,” he told me. In his opinion, his field did not have enough creative opportunity, and while he was aware of that potential while in medical school, he didn’t appropriately consider how much it mattered to him before applying to residency. Because of him, I’ve thoroughly thought through how much I value room for innovation in my own future.

Others mentioned the emotional toll of certain aspects of medicine, the feeling that they were treating patients who were “just going to go home and not take care of themselves,” and the frustrations of trying to achieve a good patient satisfaction score from a patient whose first words were “I just need Dilaudid.” Their honest remarks have benefitted me more than these physicians likely ever predicted; rather than dissuade me, they’ve enabled me to address these issues now and have prepared me to face similar ones in my future.

Most of these doctors spoke very positively about their decisions. The aspects of their careers that made them happiest included feeling like they were well taken care of by their institution, feeling like their peers were satisfied, having enough time to take family vacations, appreciation from their patients, and the ability to maintain their hobbies outside of medicine. Dr. “P,” in particular, told me: “I think I get even more satisfaction out of it now than I did when I got out of residency,” just after suggesting that I never quit setting goals for myself.

Talking openly with these physicians about their personal experiences was one of the most important things I could have done to prepare myself for deciding on a specialty. I’ll be pursuing emergency medicine even after everything I learned, and because of our conversations, I feel my decision was wholly educated. I’d like to encourage all physicians, whether they interact with aspiring doctors regularly or only on occasion, to be as candid as possible with us. We look up to the generations ahead of us, but we also want to learn from any regrets and hear about any difficulties as well as thrills. I’ve been fortunate to have these doctors’ honest perspectives in mind during my preclinical years, and I charge all physicians to speak openly with my peers and myself when given the chance.

Lorelle Knight is an MS2 at UTHSA

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San Antonio Medicine • January 2018

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MEDICAL SCHOOLS HAVE CHANGED, MOSTLY FOR THE BETTER

By Meredith Furst Ah, medical school. Something that all physicians, regardless of generation, can relate to. Dreams of white coats and helping patients have driven us to work through those sleepless nights and endless hours in the library. As a 2nd year medical student at UT Health San Antonio (UTHSA), I’m currently experiencing the trials and milestones each physician has dealt with during some point in their career. Interestingly enough, both of my parents are physicians who attended Texas medical schools, so I have heard my fair share of stories about what it was like “back in the day.” Many physicians are aware of some obvious changes in medical education, such as hospital hour restrictions and over-head paging, but hearing my parents’ stories from medical school in the 1980s has shown me that there are several other differences between what it was like then and now.

Medical school has never been a bargain. At UTHSA for example, tuition and education fees alone can rack up to $79,970 for four years. Throw in the cost of living, travel expenses, and board exams among other things, and you are looking at a significant cost. In an AAMC report from 2017, the median cost of attendance for a four-year public medical school came in at $232,800, and the median education debt for these schools was $180,000.

In a similar analysis from 2011, the AAMC found that medical school graduates from 1978 on average owed $13,500 in education debt (or $46,500 in 2011 constant dollars). My mother recalls her father, who was also a physician, complaining about the “exorbitant” semester tuition fees of $385. Imagine what he would think of the semester tuition now! Of course, everything is bigger in Texas, but medical school education debt overall isn’t part of that. A recent report by USA Today College ranked 5 Texas medical schools in the top 10 most affordable, with UTHSA as #10 and with an average debt of $120,529.

With evolving technology and resources, teaching and testing the science and practice of medicine has also changed. As every young medical student knows, nothing can be more anxiety provoking than the USMLE STEP 1 board exam. This exam, the first board exam taken as a medical student, is used to evaluate our competencies in basic medical science and now is a major determinant in matching to residency programs. These medical board examinations have been continuously evolving. Back then, the NBME part examinations and FLEX like my parents took were a requirement but were not weighed as heavily during residency selection as the exams are now.

It seemed like just another hurdle each student needed to pass in order to be licensed. Today, the USMLE STEP exams function as a uniform educational process evaluation, allowing all residency programs to evaluate applicants on a level playing field regardless of medical school program. Some major changes have occurred in licensing exams such as the transition from paper to computer based exams, and the addition of the clinical skills standardized patient exam. Due to this, patient interaction and clinical skills is being introduced much earlier in medical training. Our first week of medical school, we start practicing physical exam skills on standardized patients and going to the hospital once a month to practice these skills on real patients. Most medical students in the 1980s didn’t see a real patient until the start of clinical rotations.

A change that I personally am very excited about is the increase in female medical school students over the years. When my mom was in school, there were only 17 girls in her approximately 100-person medical school class. In fact, the AAMC found that from 19821983, less than a third (31.4%) of medical school matriculants were female. That number has increased over the years and from 20112012, females made up 47% of all medical school matriculants. My class at UTHSA was approximately 48% female, so I get to see that progress on a day to day basis!

Of course, this is merely the opinion of one medical student with insight and stories from another medical student (who happens to have a 1980s perspective). I’m sure there are countless other things that have changed in medical school, similar to how the practice of medicine is changing constantly. I do know that changes and advancements in medical education have given us new challenges and new opportunities that others might not have had in the past. As a different generation of students, we are fortunate enough to be able to work through the unique experience of medical school with the advice and guidance of other physician preceptors and mentors. Despite the changes, they know how to survive medical school and are the best people to learn from. Even if it’s through a “back in the day” story.

Meredith Furst is a second-year UTHSA medical student from Austin, who has enjoyed learning about and exploring San Antonio.

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San Antonio Medicine • January 2018

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BRINGING HEALTHCARE BACK HOME TO “THE VALLEY”

By Giselle Castillo The place that I call home tops the nation’s charts for rates of residents who live in poverty or are uninsured, obese, or diabetic. My home lies along the TexasMexico border in a small town called Mission. This area known to many as the Rio Grande Valley or simply “the Valley,” has one of the lowest rates of physicians per capita. The health disparities in the region were evident to me throughout the time I was growing up and propelled me to want to be part of the solution. My goal has always been to return home to practice as a physician. The steps to achieving my goal are rooted in learning, growth, and opportunities for me to become the best physician I can be. UT Health San Antonio has provided all of this and more. As a current first-year medical student, I am constantly in awe of the resources and opportunities provided to help me achieve my dream.

One of the lines in the mission statement for UT Health San Antonio Long School of Medicine reads, “Attain health equity for the diverse patient population of South Texas.” This line aligns with my goal and reading it before starting medical school reaffirmed what I already knew, that I made the right choice in choosing where to receive my medical education. A couple of weeks into the school year an opportunity to take an elective titled “Homelessness and Addiction” arose. This year-long elective had several objectives. It was designed to increase awareness about homelessness and addiction, and how these relate to the provision of healthcare to underserved and vulnerable populations. This elective was also designed to prepare medical students to work at Student Faculty Collaborative Clinics, clinics that provide free health services to underserved and vulnerable populations in San Antonio. I was intrigued and immediately signed up for the course. I found myself looking forward to every class lead by Dr. Usatine, our course director. We have learned about health-related issues that are more prominent in vulnerable populations, and have had discussions about what our role as future physicians means in advocating for these populations. This elective has also opened the door for me to volunteer at the Student Faculty Collaborative Clinics. In these clinics, I have helped translate for Spanish speakers and helped provide health care for people of different ages and backgrounds. These experiences are especially important to me and hold a special place in my heart because they remind me of why I was drawn to medicine in the first place.

One of the student organizations at UT Health San Antonio is called “Frontera de Salud” which translates to “border health.” This is a health outreach and education program that brings together health profession students with the goal of improving the health of medically underserved people in San Antonio and South Texas. The organization visits several cities including Laredo, Eagle Pass, and cities in the Rio Grande Valley to provide health services. I am looking forward to volunteering with this organization and am especially looking forward to taking the trip back home and providing health services as a medical student.

My goal to return back to the Rio Grande Valley as a physician has been and will continue to be my guiding principle throughout my medical education. It is why I am thankful to be attending medical school at UT Health San Antonio. I am thankful because of its long presence in the Rio Grande Valley, its goal to serve the people of South Texas, and because of the opportunities it has already given me, and the ones that are to come, to serve the community that I call home.

Giselle Castillo is a Rio Grande Valley native and MS1 at UTHSA

visit us at www.bcms.org

31

MEDICAL STUDENT

PERSPECTIVES

IMPROVING MEDICINE WITH MATH AND TECHNOLOGY

By Mouhamed Nashawi One of the most beautiful qualities of investing a life into a career in medicine is joining a dynamic field that demands lifelong learning and commitment from its practitioners. Physicians change the medications they prescribe, the surgical methods they perform, and the guidelines that they use to diagnose patients based on the influx of new data we constantly receive as an ever-changing society. Upon careful consideration and scrutiny of the latter data, physicians have been afforded the opportunity to improve their practice of medicine and fulfill their commitments to their patients to the best of their ability. The emerging quantitative technologies of today offer the same proposal of an improved practice of medicine in ways that borrows from the innovation seen in seemingly exclusive industries such as information technology or multimedia. The value of these technologies is important to me, which is why I want to advocate for society’s attention to supporting the pipelines that will help these technologies find their way into clinics and hospitals.

Prior to starting medical school, I majored in mathematics at the University of Texas at Arlington. While at a glance, the decision to take courses such as “MATH 5321- Applied Partial Differential Equations” seemed antithetical to preparing myself for a lifetime of physical examinations, surgical procedures, or interacting with those struggling to make sense of their lives, I soon learned the opposite to be true. For me, studying mathematics helped me refine the skill of problem solving. As a medical student, I want to apply these same skills of problem solving to one day join my colleagues in helping the people of tomorrow take control of their livelihood and health. Mathematics also afforded me the opportunity to take a glimpse at the future of medicine.

Cancer is one of the most notorious problems affecting our world today with impacts felt in San Antonio. Physicians and healthcare providers feel the impact of cancer in their patients, irrespective of the specialty that they practice. The most recent Bexar County Community Health Needs Assessment Report (2016) estimates that the years of potential life lost due to cancer in Bexar County based on average life expectancy eclipses that of diabetes and coronary heart disease. The contemporary approach to treating cancer is multidisciplinary with innovations arising in nutrition, physics and chemistry, and even psychology as it pertains to educating patients. Considering the latter, one of the most robust ways of improving clinical outcomes with patients who have cancer is early detection and diagnosis, with an emphasis on elucidating specific characteristics of their cancers.

Early detection is now in the works through using mathematical concepts such as machine learning, that take large sets of data fed into a system, and compare patient values to see where they cluster. For example, tumor biopsies of patients can be analyzed based on cell dynamics and behavior in vivo to make educated conjectures on the specific cell type a cancer is, which has huge clinical manifestations in the fields of targeted therapies. Other screening techniques are interested in using statistical methods of sorting data to improve the efficiency and speed of genetic sequencing to make these technologies more accessible for those who do not have the socioeconomic luxury of affording innovative cancer therapy. Working on these projects as a college student had me excited for a career in medicine, and I was even more excited to hear speakers at UT Health San Antonio mirror the same optimism for the future of medicine.

I would like to end this perspectives paper by asking the readers of this magazine to contribute in society’s support for these technologies. By advocating support for and raising awareness for these technologies, physicians can contribute to persuading private industry, government, academia, and the healthcare industry to cooperate on efforts that make quantitative therapies not just in cancer, but in all facets of medicine, more ubiquitous in the future. Moreover, as a medical student, the advent of an improved clinical practice in the near future is something I am confident in saying that my classmates and I are eager to be able to utilize in our careers.

Mouhamed is an MS1 at UT Health San Antonio. In his free time, he enjoys watching and playing basketball.

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San Antonio Medicine • January 2018

BCMS NEWS

CORPORATE CHANGES TO THE BEXAR COUNTY MEDICAL SOCIETY

By Stephen Fitzer, BCMS Executive Director

The Bexar County Medical Society has historically had several types of corporations to comply with state and federal statutes, many organized according to the types of services each corporation provides and/or the federal taxability of those services. For example, the Bexar County Medical Society itself is a 501c6 corporation which is specifically designed for membership organizations. The Bexar County Medical Library Association is a 501c3 corporation, which is designed for charitable entities. BCMS has three for-profit corporations, being the BCMS Service Bureau, Bexar Credentials Verification, and the BCMS Management Holding Company. See the chart below.

BCMS recently merged several corporate entities together for a variety of reasons, but mostly for the reason that the audits and tax filing fees for so many companies were becoming prohibitive.

Therefore, the former Bexar County Medical Society Real Estate

Holding Company (501c2) and the BCMS Foundation (501c3) were merged into the Bexar County Medical Library Association. The final impact of these mergers is that the Library Association now owns the BCMS building instead of it being owned by the Real Estate Holding Company. Also, the philanthropy of the BCMS Foundation will now be carried out by the Library Association. The funds (bank account) of the BCMS Foundation that had been set aside for scholarships and other educational supports will be rolled over to the Library, kept separate, and will be used for the purposes for which they were originally intended.

The effect of these mergers will save BCMS several thousands of dollars per year without affecting the missions or purposes of the society or the absorbed entities. If you have any questions about the changes, please email me at steve.fitzer@BCMS.org.

visit us at www.bcms.org

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FEATURE

Saying Goodbye

By Rajam Ramamurthy, MD As I sat down to pen this message nostalgia flooded my thoughts. I would eagerly wait for the first Tuesday of the month when the Publications Committee met. Mike Thomas the communications director for BCMS would have readied everything for the meeting, the month’s San Antonio Medicine magazine (SAM), which we got to read first, agenda and other material for discussion all laid out. He was also kind enough to order the food for the meeting. I must get it off my chest, food choice was not Mike’s forte. Louise Doucette the publisher of SAM since — was one of the early arrivals. He has the aura of a magician, he brought the committee’s controversial discussions alive in the magazine pages. Often Dr. Fred Olin will be there early, narrating his latest encounter with another person from whom he managed to get an article. Fred still practices. How and when he manages to read and write as much as he does is a mystery. As far back as I can remember he has been on the editorial committee. Dr. Waller is another icon on the committee. His contributions in writing for the magazine far outweighed those of policy making. When Dr. Yu came on the committee in — I secretly chuckled, here is a young person, we won’t see him for the rest of the year. He proved me wrong. He was present, articulate and liked writing.

My love affair with writing began in school. In those days students were made to write elaborate essays, this is pre-multiple choice days.

When answering a question in anatomy to point the surface markings on the skull, I started, “His eyes seem unevenly placed as though one eye brow was constantly raised leaving a permanent impression on the skull. Was he wondering if she would ever respond?” Our professor otherwise a very strict man was more amused than annoyed and commented, keep writing. The first time I was on the editorial committee of SAM I was bewildered. Dr. Dale Wood was the chair, I want to say that Dr. Wood was chair for as long as I could remember. The meetings would start with comments about what the Spurs could and should have done, some trashing of the Medicare rules and some hushed whisperings between members. It took several meetings before I caught on to what the com34

San Antonio Medicine • January 2018

mittee’s task was. I began to speak up when we discussed art in medicine. At that time most pictures and covers for SAM were photographs taken by Dr. Dudley Harris an iconic photographer.

Reluctantly I went off the committee for a few years as demands on my time from BCMS, TMA and AMA, TIPS and AAPI increased exponentially. Throughout this period I would still write. I remember writing for an issue that address the great Tsunami of 2004. I loved writing the Presidential Columns in the year 2004. I saw the same eagerness in wanting to tell a story in Dr. Leah Jacobson the 2017 President’s column. Although she often minimizes her writing skills, I think the words are locked up in her waiting to burst out. I thoroughly enjoyed my second time on the Committee, around 2011 or 2012. In 2015 I was assuming chairmanship of committee. Almost an unspoken tradition, the chair was the one with the longest tenure, who loved to come to the meeting, was engaged and in love with writing. There is always one who is serving on the committee when every two years a new chair is named by consensus. This brings me to the past two years as Chair.

As the year begins the committee already has a template for the theme for the magazine for each month for the entire year. The themes got shifted around new pressing issues came up and above all the articles to address each theme was woefully lacking. A turnaround happened when the year started with new blood on the

FEATURE committee. The situation changed dramatically and we were with their valuable suggestions so also Dr. Carmen Garza. I believe flooded with articles to the extent we on more than one occasion the Magazine is poised to recognize those who have rendered had to print two issues with the same theme and some to spare that Yeomen services to this effort over the years. For the first time the we published in subsequent issues. The issues on Generation was ‘San Antonio Medicine Literary Award’ will be given in the name one such. Another major addition was brought by Dr. Adam Ratner. of Mrs. Merty and Dr. Dale Wood’. We thank Dr. Dale Wood for He has been a wonderful liaison with UT Medical School and now sponsoring this award. with UIW School of Osteopathic Medicine, he has involved the In 2015, I was asked to be chair. At the same time disaster struck medical students. It started with a project that senior medical stumy family in the form of an illness that affected my husband and dents at UTH had started called shook the earth beneath me. I sat 60-50 where the 3rd year students in front of the computer to send engage in a writing session. an email to the committee about Give me a cup of coffee, an issue of SAN ANTONIO Amazing writing from the heart, MEDICINE and a little time. If I could thus stretch my my inability to continue a task I it was published in SAM. We have tired legs in the doctor’s lounge. I should deem myself happier so much looked forward to doing student representation on the than having won the Pulitzer Prize. and a service to the society I chercommittee. Another transformaished. It was as though a lifeline — Rajam Ramamurthy tional suggestion by Dr. Ratner – Writing, was being severed. was to create a permanent posiThen I remembered something I tion for Medical students on the publications committee. The socidid when I spoke to parents of very tiny premature infants who had ety could be the common ground for both medical schools. Thanks to stay in the NICU for several months. Mothers would sit by the to Dr. Ratner for he has moved the bar forward by leaps. As is the baby for hours, day and night, just looking, for sometimes they case with many committees it takes a person to swing the needle could not even hold them. I would say to them; “this weekend I and Student participants like Sara Noble and Darren Donahue have want you to go away, go see a movie, eat in your favorite restaurant, pushed it beyond my imagination. go visit family or a friend” we will keep you posted. I felt care giver The committee reviews every article that is to be published. When wellness and strength came from being away, refreshing and coming I read the writing of physicians, the passion for writing is apparent, back with renewed energy to invest. I decided to continue my enthe craft of writing lacked. Having a writing workshop for physigagement with writing. The committee has been my family for nurcians was a bee in my bonnet for turing for the past two years. some time. We selected Gemini Writing in almost virtual time has Ink a literary organization in San been healing. I wish those of you Give me a flagon of red wine, a book of verses, a loaf of Antonio to do this. It was made who long to write to just write. bread, and a little idleness.

If with such store I might sit by possible through generous sponWords have the power of healing. sorship by DR. Dale Wood and thy dear side in some lonely place, I should deem myself hapBy providing a medium for pourpier than a king in his kingdom.

Merty Wood and Louise ing your words San Antonio — Omar Khayyam Douchett and wonderful support Medicine has been a wondrous from BCMS. Twenty three physireceptacle. For sharing your joy, cian’s participated. I know at least frustration and knowledge SAM one physician who tells me he writes for at least an hour every has been a reliable friend. The welcome presence of Leah Jacobson, morning. I hope the writing workshop is offered by BCMS for 2017 President of BCMS at our meetings, thoughtful support and physicians often. The magazine has soared to a different level, the guidance of Steve Fitzer, BCMS Executive Director and the Steady themes are refreshing. The one in January will be on the aftermath thoughtful navigating of the committees work by Mike Thomas, of disaster and the forgotten communities that take decades to reDirector publications have all made the past two years a gift for me. cover. A tercentennial issue is planned, and articles about evolution Now I say goodbye as chair and look forward to many more years of different specialties’ and pioneers in the field is welcome. The of writing. committee is enriched by the presence of non- physician members.

Mr. Alan Preston and Mr. David Schulz, both experienced in JourRajam Ramamurthy. MD, Professor Emeritus, Department nalism have weighed in on themes selected for SAM with their exof Pediatrics, Division of Neonatology. UTH 2016-2017, pertise and contributed greatly. Members of the committee Dr. Chair, Editorial Committee. BCMS, 2004 President of Kristi Kosub and Dr. Jaime Pankowsky have been a vocal presence BCMS. visit us at www.bcms.org

35

MEDICAL TECHNOLOGY

NEW IMAGING TECHNOLOGY HAS THE POTENTIAL TO REVOLUTIONIZE MEDICINE

By Mike W. Thomas aptist Health System in San Antonio has opened a new imaging center on the north side of town that promises to bring a new focus to orthopedic and neurologic medicine with top of the line technology. Besides subspecialized care, this imaging center is capable to serve all general radiology needs. It will be run by Baptist M&S Imaging, one of the first established radiology groups in San Antonio.

The new center will feature a 3 Tesla MRI (magnetic resonance imaging) machine which is twice as powerful as the previous highfield standard 1.5 Tesla machine. A Tesla is the unit of measurement quantifying the strength of a magnetic field. The increased image clarity that will be possible with a 3 Tesla MRI will be very beneficial for patients as it will allow for better diagnosis and better patient care, says Ankitkumar Patel, MD.

B

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San Antonio Medicine • January 2018

In addition, the center will have a 64-slice CT scanner (computed tomography) capable of capturing up to 64 simultaneous anatomical slices of 0.5 mm in a single rotation. This allows for precise imaging of even rapidly moving organs like the heart and lungs.

Dr. Patel will oversee the new Orthopedic and Neurologic Imaging Institute that will be located on the first floor of the Baptist Emergency center at the northwest corner of Loop 1604 W and NW Military Highway. He is board-certified in diagnostic radiology with training from University of Texas Health Science San Antonio, and University of California San Diego.

This is the tenth imaging center for Baptist M&S in San Antonio, but the first dedicated to orthopedic work. The other centers are located throughout San Antonio in the following areas: Downtown, Medical Center, Mission Trail, Northeast, North Central, Schertz,

MEDICAL TECHNOLOGY Westover Hills and the Baptist Breast Center is located in Stone Oak, Westover Hills and Downtown.

Dr. Patel says that the demand for high-quality imaging is growing and there is an increasing need for more sites dedicated to different sub-specializations. These high-tech scanning and imaging machines are helping to revolutionize medicine today, Patel says. With more information to look at and study, doctors today can be more accurate and precise in their diagnosis. When the doctor can see exactly where a tear has occurred before cutting a patient open, then the subsequent surgery to make repairs can be less invasive and recovery time is quicker.

“We can perform better scans today and get more information than ever before,” Patel says. “The Orthopedic and Neurologic Imaging Institute will take us to a different level.”

If a patient comes in with a shoulder problem, for example, the radiologist can inject a dye that can help them see by contrast where

any abnormalities are in the joint. Then they can aid in decision making whether the patient needs surgery, or just medication and therapy. Now special software on the MRI and CT scanner can help reduce metal artifacts to aid study of the surrounding soft tissues.

Fine detailed evaluation of the brain, spine, abdomen and pelvis can also be performed.

The imaging process is also painless and does not require any special preparation such as special diets or anesthesia. It is relatively risk free, Patel says.

The imaging technology has been getting better and better over the last 30 years and it is now to a point where it has become a very powerful tool in the hands of medical professionals, Patel says. It is having an impact in all fields of medicine as well. For instance, in treating cancer patients it allows doctors to pinpoint precisely where to deliver chemotherapy to have the most potent effect on a tumor without effecting the rest of the body.

“This technology has given us incredible power to be able to diagnose a patient and prescribe treatment without having to open them up,” Patel says. “It is a level of tailoring that was unheard of just a few years ago.”

visit us at www.bcms.org

37

BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY Please support our sponsors with your patronage; our sponsors support us.

ACCOUNTING FIRMS Sol Schwartz & Associates P.C. (HH Silver Sponsor) We specialize in areas that are most critical to a company’s fiscal well-being in today’s competitive markets.

Jim Rice, CPA 210-384-8000, ext. 112 jprice@ssacpa.com www.ssacpa.com “Dedicated to working with physicians and physician groups.”

ASSET MANAGEMENT

Avid Wealth Partners (HHHH 10K Platinum Sponsor) The only financial firm that works like physicians, for physicians, to bring clarity and confidence in an age of clutter and chaos. You deserve to be understood and well-served by a team that's committed to helping you avidly pursue the future you want, and that's our difference.

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The Mani Johnston Group at UBS (HHH Gold Sponsor) Advice Beyond Investing, Dedicated Client Service Team, 4 decades serving the Bexar County medical community. Specialization in customized asset management and lending services supported by the strength of the UBS Global Bank.

Senior Vice President – Wealth Management Senior Portfolio Manager Carol Mani Johnston 210-805-1075 Carol.manijohnston@ubs.com www.ubs.com/team/manijohn-

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San Antonio Medicine • January 2018

ston "UBS is honored to be named Best Bank for Wealth Management in North America for 2017 by Euromoney."

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From business transactions to physician contracts, our team can help you in making the right decision for your practice.

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BANKING

Amegy Bank of Texas (HHH Gold Sponsor) We believe that any great relationship starts with five core values: Attention, Accountability, Appreciation, Adaptability and Attainability. We work hard and together with our clients to accomplish great things.

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Broadway Bank (HHH Gold Sponsor) Healthcare banking experts with a private banking team committed to supporting the medical community.

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Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community.

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Synergy Federal Credit Union (HHH Gold Sponsor) BCMS members are eligible to join Synergy FCU, a full service financial institution. With high savings rates and low loans rates, Synergy can help you meet your financial goals.

Synergy FCU Member Service (210) 345-2222 or info@synergyfcu.org www.synergyfcu.org “Once a member, always a member. Join today!”

We believe that any great relationship starts with great core values: Attention, Accountability, Appreciation, Adaptability and Attainability Financial Consultant Doug Elley 210-961-9991 delley@ft.newyorklife.com www.newyorklife.com

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BUSINESS CONSULTING Alto Vista Enterprises, LLC (HH Silver Sponsor) We specialize in helping physicians grow their business according to the goals and timeline of the practice. Customized business development strategies are executed by an experienced and dedicated team of consultants.

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Avid Wealth Partners (HHHH 10K Platinum Sponsor) The only financial firm that works like physicians, for physicians, to bring clarity and confidence in an age of clutter and chaos. You deserve to be understood and wellserved by a team that's ommitted to helping you avidly pursue the future you want, and that's our difference.

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continued on page 40

visit us at www.bcms.org

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BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY continued from page 39

Elizabeth Olney with Edward Jones ( Gold Sponsor) We learn your individual needs so we can develop a strategy to help you achieve your financial goals.

Join the nearly 7 million investors who know. Contact me to develop an investment strategy that makes sense for you.

Elizabeth Olney Financial Advisor (210) 493-0753 Elizabeth.olney@edwardjones.com www.edwardjones.com/elizabeth-olney "Making Sense of Investing"

RBFCU (HHH Gold Sponsor) RBFCU Investments Group provides guidance and assistance to help you plan for the future and ensure your finances are ready for each stage of life, (college planning, general investing, retirement or estate planning).

Shelly H. Rolf Wealth Management 210-650-1759 srolf@rbfcu.org www.rbfcu.org

The Mani Johnston Group at UBS (HHH Gold Sponsor) Advice Beyond Investing, Dedicated Client Service Team, 4 decades serving the Bexar County medical community. Specialization in customized asset management and lending services supported by the strength of the UBS Global Bank.

Senior Vice President – Wealth Management Senior Portfolio Manager Carol Mani Johnston 210-805-1075 Carol.manijohnston@ubs.com www.ubs.com/team/manijohnston "UBS is honored to be named Best Bank for Wealth Management in North America for 2017 by Euromoney."

GRADUATE PROGRAMS Trinity University (HH Silver Sponsor) The Executive Master’s Program in Healthcare Administration is ranked in the Top 10 programs nationally. A part-time, hybrid-learning program designed for physicians and health-

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San Antonio Medicine • January 2018

care managers to pursue a graduate degree while continuing to work full-time.

Amer Kaissi, Ph.D. Professor and Executive Program Director 210-999-8132 amer.kaissi@trinity.edu https://new.trinity.edu/academics/departments/health-careadministration

HEALTHCARE REAL ESTATE SAN ANTONIO COMMERCIAL ADVISORS (HH Silver Sponsor) Jon Wiegand advises healthcare professionals on their real estate decisions. These include investment sales- acquisitions and dispositions, tenant representation, leasing, sale leasebacks, site selection and development projects Jon Wiegand 210-585-4911 jwiegand@sacadvisors.com www.sacadvisors.com “Call today for a free real estate analysis, valued at $5,000”

HEALTHCARE TECHNOLOGY RubiconMD (HH Silver Sponsor) RubiconMD enables primary care providers to quickly and easily discuss their e-Consults with top specialists so they can provide better care - improving the patient experience and reducing costs Shang Wang Business Development (845) 709-2719 shang@rubiconmd.com Cyprian Kibuka VP of Business Development (650) 454-9604 cyprian@rubiconmd.com www.rubiconmd.com “Expert Insights. Better Care."

HOSPITALS/ HEALTHCARE SERVICES

Warm Springs Medical Center Thousand Oaks Westover Hills (HHH Gold Sponsor) Our mission is to serve people with disabilities by providing compassionate, expert care during the rehabilitation process, and support recovery through education and research.

Central referral line 210-592-5350 “Joint Commission COE.”

Methodist Healthcare System (HH Silver Sponsor) Palmire Arellano 210-575-0172 palmira.arellano@mhshealth.com http://sahealth.com Select Rehabilitation of San Antonio (HH Silver Sponsor) We provide specialized rehabilitation programs and services for individuals with medical, physical and functional challenges.

Miranda Peck 210-482-3000 mipeck@selectmedical.com Jana Raschbaum 210-478-6633 JRaschbaum@selectmedical.com http://sanantonio-rehab.com “The highest degree of excellence in medical rehabilitation.”

INFORMATION AND TECHNOLOGIES Network Alliance (HHH Gold Sponsor) We are experts in managed IT services, business phone systems, network security, cloud services and telecom carrier offerings, located in the heart of the medical center at Fredericksburg & Medical Dr. Rod Tanner (210) 870-1951 rtanner@network-alliance.net Carl Lyles (210) 870-1952 clyles@network-alliance.net www.network-alliance.net “Delivering solutions through technology”

SWBC Mortgage www.swbc.com Mortgages, investments, personal and commercial insurance, benefits, PEO, ad valorem tax services

TMA Insurance Trust (HHHH 10K Platinum Sponsor) Created and endorsed by the Texas Medical Association (TMA), the TMA Insurance Trust helps physicians, their families and their employees get the insurance coverage they need.

Wendell England 512-370-1746 wengland@tmait.org James Prescott 512-370-1776 jprescott@tmait.org John Isgitt 512-370-1776 www.tmait.org “We offer BCMS members a free insurance portfolio review.”

Humana (HHH Gold Sponsor) Humana is a leading health and well-being company focused on making it easy for people to achieve their best health with clinical excellence through coordinated care.

Jon Buss: 512-338-6167 Jbuss1@humana.com Shamayne Kotfas: 512-338-6103 skotfas@humana.com www.humana.com

INSURANCE/MEDICAL MALPRACTICE

INSURANCE

SWBC (HHHH 10K Platinum Sponsor) SWBC is a financial services company offering a wide range of insurance, mortgage, PEO, Ad Valorem and investment services. We focus dedicated attention on our clients to ensure their lasting satisfaction and long-term relationships.

VP Community Relations Deborah Gray Marino 210-525-1241 DMarino@swbc.com Wealth Advisor Gil Castillo, CRPC® 210-321-7258 Gcastillo@swbc.com Mortgage Kristie Arocha 210-255-0013 karocha@swbc.com

Texas Medical Liability Trust (HHHH 10K Platinum Sponsor) Texas Medical Liability Trust is a not-for-profit health care liability claim trust providing malpractice insurance products to the physicians of Texas. Currently, we protect more than 18,000 physicians in all specialties who practice in all areas of the state. TMLT is a recommended partner of the Bexar County Medical Society and is endorsed by the Texas Medical Association, the Texas Academy of Family Physicians, and the Dallas, Harris, Tarrant and Travis county medical societies.

Patty Spann 512-425-5932 patty-spann@tmlt.org www.tmlt.org Recommended partner of the Bexar County Medical Society

BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY The Bank of San Antonio Insurance Group, Inc. (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians.

Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community.

Katy Brooks, CIC 210-807-5593 katy.brooks@bosainsurance.com www.thebankofsa.com “Serving the medical community.”

The Doctors Company (HH Silver Sponsor) The Doctors Company is fiercely committed to defending, protecting, and rewarding the practice of good medicine. With 78,000 members, we are the nation’s largest physician-owned medical malpractice insurer. Learn more at www.thedoctors.com.

Susan Speed Senior Account Executive (512) 275-1874 Susan.speed@thedoctors.com Marcy Nicholson Director, Business Development (512) 275-1845 mnicholson@thedoctors.com “With 78,000 members, we are the nation’s largest physician-owned medical malpractice insurer” MedPro Group (HH Silver Sponsor) Medical Protective is the nation's oldest and only AAA-rated provider of healthcare malpractice insurance.

Kirsten Baze 512-375-3972 Kirsten.Baze@medpro.com www.medpro.com ProAssurance (HH Silver Sponsor) Group (rated A+ (Superior) by A.M. Best) helps you protect your important identity and navigate today’s medical environment with greater ease—that’s only fair.

Keith Askew Market Manager kaskew@proassurance.com Mark Keeney Director, Sales mkeeney@proassurance.com 800.282.6242 www.proassurance.com

INTERNET TELECOMMUNICATIONS

Network Alliance (HHH Gold Sponsor)

We are experts in managed IT services, business phone systems, network security, cloud services and telecom carrier offerings, located in the heart of the medical center at Fredericksburg & Medical Dr. Rod Tanner (210) 870-1951 rtanner@network-alliance.net Carl Lyles (210) 870-1952 clyles@network-alliance.net www.network-alliance.net “Delivering solutions through technology”

MEDICAL BUSINESS CONSULTING

Progressive Billing (HHH Gold Sponsor) The medical billing professionals at Progressive Billing realize the importance of conducting business with integrity, honesty, and compassion while remaining in compliance with the laws and regulations that govern our operations.

Owner – Lettie Cantu 210-363-1735 Lettie@progressivebilling.com Administrator Richard Hernandez 210-733-1802 richard@progressivebilling.com www.progressivebilling.com "We provide quality, professionalism and results for your practice."

MEDICAL BILLING AND COLLECTIONS SERVICES

Progressive Billing (HHH Gold Sponsor) The medical billing professionals at Progressive Billing realize the importance of conducting business with integrity, honesty, and compassion while remaining in compliance with the laws and regulations that govern our operations.

Owner – Lettie Cantu 210-363-1735 Lettie@progressivebilling.com Administrator Richard Hernandez 210-733-1802 richard@progressivebilling.com www.progressivebilling.com "We provide quality, professionalism and results for your practice."

Commercial & Medical Credit Services (HH Silver Sponsor) A bonded and fully insured San Antonio-based collection agency.

Henry Miranda 210-340-9515 hcmiranda@sbcglobal.net www.cmcs-sa.com “Make us the solution for your account receivables.”

MEDICAL SUPPLIES AND EQUIPMENT

Henry Schein Medical (HHH Gold Sponsor) From alcohol pads and bandages to EKGs and ultrasounds, we are the largest worldwide distributor of medical supplies, equipment, vaccines and pharmaceuticals serving office-based practitioners in 20 countries. Recognized as one of the world’s most ethical companies by Ethisphere.

Tom Rosol 210-413-8079 tom.rosol@henryschein.com www.henryschein.com “BCMS members receive GPO discounts of 15 percent to 50 percent.”

PAYROLL SERVICES

SWBC (HHHH 10K Platinum Sponsor) Our clients gain a team of employment experts providing solutions in all areas of human capital – Payroll, HR, Compliance, Performance Management, Workers’ Compensation, Risk Management and Employee Benefits.

Kristine Edge Sales Manager 830-980-1207 Kedge@swbc.com Working together to help our clients achieve their business objectives.

PRACTICE CONSULTANTS

New York Life Insurance Company (HHH Gold Sponsor) Our Goal, increase patient & employee satisfaction, generate more free time for practitioners and mitigate both business and personal financial risk. (No Cost Financial and Business consulting including HIPAA audit evaluations, BCMS members only).

Doug Elley 210-961-9991 delley@ft.newyorklife.com www.newyorklife.com “20+ years helping Physicians to increase practice profits and efficiencies, reduce operations stress”

PROFESSIONAL ORGANIZATIONS The Health Cell (HH Silver Sponsor) “Our Focus is People” Our mission is to support the people who propel the healthcare and bioscience industry in San Antonio. Industry, academia, military, non-profit, R&D, healthcare delivery, professional services and more!

President Kevin Barber 210-308-7907 (Direct) kbarber@bdo.com Program Coordinator Valerie Rogler 210-904-5404 Valerie@thehealthcell.org www.thehealthcell.org “Where San Antonio’s Healthcare Leaders Meet”

SENIOR LIVING Legacy at Forest Ridge (HH Silver Sponsor) Legacy at Forest Ridge provides residents with top-tier care while maintaining their privacy and independence, in a luxurious resortquality environment.

Shane Brown, Executive Director 210-305-5713 hello@legacyatforestridge.com www.LegacyAtForestRidge.com “Assisted living like you’ve never seen before.”

STAFFING SERVICES

Favorite Healthcare Staffing (HHHH 10K Platinum Sponsor) Serving the Texas healthcare community since 1981, Favorite Healthcare Staffing is proud to be the exclusive provider of staffing services for the BCMS. In addition to traditional staffing solutions, Favorite offers a comprehensive range of staffing services to help members improve cost control, increase efficiency and protect their revenue cycle.

Brody Whitley, Branch Director 210-301-4362 bwhitley@favoritestaffing.com www.favoritestaffing.com “Favorite Healthcare Staffing offers preferred pricing for BCMS members.”

To join the Circle of Friends program or for more information, call 210-301-4366 or email August.Trevino@bcms.org Visit www.bcms.org

visit www.bcms.org 41 41 visit usus atatwww.bcms.org

RECOMMENDED AUTO DEALERS AUTO PROGRAM

• • • •

We will locate the vehicle at the best price, right down to the color and equipment.

We will put you in touch with exactly the right person at the dealership to handle your transaction.

We will arrange for a test drive at your home or office. We make the buying process easy!

When you go to the dealership, speak only with the representative indicated by BCMS. GUNN AUTO GROUP

Ancira Chrysler 10807 IH 10 West San Antonio, TX 78230 Cary Wright 210-558-1500

Ancira Buick, GMC San Antonio, TX Jude Fowler 210-681-4900

Ancira Chevrolet 6111 Bandera Road San Antonio, TX

Batchelor Cadillac 11001 IH 10 W at Huebner San Antonio, TX

GUNN Chevrolet GMC Buick 16550 IH 35 N Selma, TX 78154

Jude Fowler 210-681-4900

Esther Luna 210-690-0700

Bill Boyd 210-859-2719

GUNN AUTO GROUP

GUNN AUTO GROUP

GUNN AUTO GROUP

GUNN Honda 14610 IH 10 W San Antonio, TX

GUNN Acura 11911 IH 10 W San Antonio, TX

GUNN Nissan 750 NE Loop 410 San Antonio, TX 78209

Pete DeNeergard 210-680-3371

Coby Allen 210-625-4988

Abe Novy 210-496-0806

Alamo City Chevrolet 9400 San Pedro Ave. San Antonio, TX 78216

Cavender Audi 15447 IH 10 W San Antonio, TX 78249

David Espinoza 210-912-5087

Sean Fortier 210-681-3399 KAHLIG AUTO GROUP

Cavender Toyota 5730 NW Loop 410 San Antonio, TX

Northside Ford 12300 San Pedro San Antonio, TX

Mercedes Benz of San Antonio 9600 San Pedro San Antonio, TX

Mercedes Benz of Boerne 31445 IH 10 W Boerne, TX

North Park Subaru 9807 San Pedro San Antonio, TX 78216

Gary Holdgraf 210-862-9769

Wayne Alderman 210-525-9800

William Taylor 210-366-9600

James Godkin 830-981-6000

Mark Castello 210-308-0200

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

North Park Mazda 9333 San Pedro San Antonio, TX 78216

North Park Lexus 611 Lockhill Selma San Antonio, TX

North Park Lexus at Dominion 21531 IH 10 W San Antonio, TX

North Park Toyota 10703 SW Loop 410 San Antonio, TX 78211

Scott Brothers 210-253-3300

North Park Subaru at Dominion 21415 IH 10 W San Antonio, TX 78257

Jose Contreras 210-308-8900

Justin Blake 888-341-2182

Stephen Markham 877-356-0476

Justin Boone 210-635-5000

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

North Park Lincoln 9207 San Pedro San Antonio, TX

North Park VW at Dominion 21315 IH 10 W San Antonio, TX 78257

13660 IH-10 West (@UTSA Blvd.)

San Antonio, TX

Porsche Center 9455 IH-10 West San Antonio, TX

Barrett Jaguar 15423 IH-10 West San Antonio, TX

Sandy Small 210-341-8841

James Cole 800-611-0176

Ed Noriega 210-561-4900

Matt Hokenson 210-764-6945

Dale Haines 210-341-2800

15423 IH-10 West San Antonio, TX Dale Haines 210-341-2800

Land Rover of San Antonio

AUTO PROGRAM

Call Phil Hornbeak 210-301-4367 or email phil.hornbeak@bcms.org

visit us at www.bcms.org

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AUTO REVIEW

NEW VEHICLE RUNDOWN FOR 2018

By Steve Schutz, MD

For this issue I selected a handful of noteworthy new vehicles that have either just launched or will launch in the next few months. This is by no means an exhaustive list of such vehicles, but it it’s a rundown of the ones that are most interesting to me.

Audi A8

Audi’s technology leader, the upcoming full size A8 sedan comes with cool goodies like self-driving capability up to 37MPH, an advanced lighting system that uses GPS data to point the LED headlights where they need to go before you even turn the steering wheel, and Audi’s most intelligent and intuitive MMI system. Design-wise, the new A8 will incorporate Audi’s new styling language, which, OMG this is so not a surprise, looks a lot like their old styling language. The car looks good though, so I guess Audi’s elegant design consistency still works. Certainly their seven consecutive years of sales growth say it does.

Chevrolet Corvette ZR1

Around 30 years ago, the first ZR1, known as, “the King of the Hill” as it was being developed, blew people away with 375HP and a 060MPH time of 4.9 seconds. In an era of 700-plus HP Dodge Chargers those numbers seem quaint today, so Chevrolet made sure the newest ZR1 was legit with 755HP. Acceleration times have not been released, but expect a 0-60 time of less than 3 seconds and a top speed of over 200MPH when this beast surfaces in the Spring of 2018.

Lexus LS500/500h

As the luxury car market moves rapidly towards SUVs and crossovers, sedans like the new Lexus LS don’t matter like they used to. While the LX570 SUV may be Lexus’ true flagship now, the LS still matters, and the new one provides a more contemporary exterior design than it used to have — am I the only one who thinks it looks a little too much like the Nissan Maxima? — combined with a nice interior and two advanced powertrain options. The advanced powertrains no longer include a V8 though, and the cool 10-speed vanishes if you select AWD. It would seem that the new LS is poised to move one step closer to the class leading Mercedes S-class. Which has moved three steps forward.

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San Antonio Medicine • January 2018

AUTO REVIEW Lexus RX350L

Thanks to a more upright rear hatch and 4.4 inches of additional length between the axles, Lexus was able to add a third row of seats to their perennial best seller. On the one hand, these are small seats fit mostly for kids, on the other hand buyers of these longer RXs want seats and seatbelts for kids to use every once in a while (think runs for pizza with the soccer team and sleepovers). Other than extra space and seats, the longer RXs are the same as the standard versions: normally aspirated 3.5L V6 engines power most of these, while hybrids are available for customers who want to be more ecofriendly. Lexus expects the availability of a longer RX to boost sales by 20,000-30,000 annually, which seems about right to me.

Jeep Wrangler

When it’s time to update an icon like the Jeep Wrangler, is it OK to make it more fuel efficient, modernize the interior, clean up emissions, and change the design? If your answers are, yes, yes, yes, and absolutely not, then you’re on the same page as the FCA engineering team in charge of the 2019 Wrangler development. A new turbocharged four-cylinder engine is sure to be popular, and in 2019 a diesel engine — a Wrangler first in this country — is promised. Oh, Jeep changed the doors so that they’re easier to remove. Still, I’ll bet I won’t be able to tell the difference between a 2017 and 2018 model when the new one launches.

Range Rover Velar

This achingly beautiful mid-size Range Rover is based on the Jaguar F-Pace platform and was conceived as an on-road SUV that will get you through rainy and snowy conditions but won’t take you over the Rubicon trail. So what? Hardly any Range Rover owners ever go off road, and the Velar, situated between the Evoque and Range Rover Sport in the lineup, more than makes up for its lack of off-road chops with good looks.

Porsche Panamera Sport Turismo

Take the Porsche Panamera — redesigned to great effect earlier this year (yay!) — add a fifth seat (yay!) and a station wagon-esque rear end, and voila!, a Sport Turismo. Naturally there’s more headroom and luggage space, but my favorite thing about this very niche Porsche is how great it looks. I’d take it over the Panamera sedan every day of the week.

If you’re in the market for this kind of vehicle, call Phil Hornbeak at 210-301-4367.

Steve Schutz, MD, is a board-certified gastroenterologist who lived in San Antonio in the 1990s when he was stationed here in the U.S. Air Force. He has been writing auto reviews for San Antonio Medicine since 1995. visit www.bcms.org 45 45 visit us us at at www.bcms.org

THANK YOU

to the large group practices with 100% MEMBERSHIP in BCMS and TMA ABCD Pediatrics, PA Clinical Pathology Associates Dermatology Associates of San Antonio, PA Diabetes & Glandular Disease Clinic, PA ENT Clinics of San Antonio, PA Gastroenterology Consultants of San Antonio General Surgical Associates Greater San Antonio Emergency Physicians, PA Institute for Women's Health Lone Star OB-GYN Associates, PA M & S Radiology Associates, PA MacGregor Medical Center San Antonio MEDNAX Peripheral Vascular Associates, PA

Renal Associates of San Antonio, PA San Antonio Gastroenterology Associates, PA San Antonio Infectious Diseases Consultants San Antonio Kidney Disease Center San Antonio Pediatric Surgery Associates, PA Sound Physicians South Alamo Medical Group South Texas Radiology Group, PA Tejas Anesthesia, PA Texas Partners in Acute Care The San Antonio Orthopaedic Group Urology San Antonio, PA WellMed Medical Management Inc.

Contact BCMS today to join the 100% Membership Program! *100% member practice participation as of December 24, 2017.

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San Antonio Medicine • January 2018