San Antonio Medicine January 2022 by Traveling Blender

S A N A N TO N I O

Rajeev Suri, MD, MBA, FACR, FSIR, FCIRSE

2022 BCMS President

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HEALTHY LIVING The Need for a Biopsychosocial Model of Health By Venkat Srinivasan, MD....................................................12 Managing Your Mind Is the Key to Empowered Living By Nora Vasquez, MD .........................................................14 The Treatment of Obesity By Jennifer Seger, MD.........................................................15 Fostering a Culture of Well-being in Residency Programs By Faraz Yousefian, DO, Sujitha Yadlapati, MD and Eduardo Rodriguez, MD ......................................................16 The Running & Wellness Club By Andrew Meigs and Victor Martinez ..................................18 Mobile Mercado, a Food Retail Enterprise of the San Antonio Food Bank to Address Diet-Related Conditions and Food Insecurity By Luz-Myriam Neira, PhD ...................................................20 Metro Health’s ¡Por Vida! Program Expands to Promote San Antonio’s Healthiest Food Service Establishments By Haley Amick MPH, CHES ...............................................22

Cover photo by Oliver Johnson, MD BCMS President’s Message .................................................................................................................................................8 BCMS Alliance President’s Message ..................................................................................................................................10 A Team-Centered Approach in Detecting Breast Cancer By Ramon S. Cancino, MD, MBA, MS, FAAFP ...........................24 100% Large Practice Groups Membership Highlight By HealthTexas Medical Group.........................................................26 Charting Paths Through the Fog – Reviewing “High Conflict” By Amanda Ripley, Reviewed By David Alex Schulz, CHP ....28 Artistic Expression in Medicine By Caroline Zhu, Cynthia Jiang, Sijil Patel and Richard Marlow Taylor, MD ..........................30 2022 BCMS Installation of Officers .....................................................................................................................................32 2022 BCMS Alliance Installation of Officers ........................................................................................................................35 Physicians Purchasing Directory.........................................................................................................................................36 Auto Review: 2022 Mercedes AMG GT 53 By Stephen Schutz, MD...................................................................................40 Recommended Auto Dealers .............................................................................................................................................42

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SAN ANTONIO MEDICINE • January 2022

JANUARY 2022

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VOLUME 75 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. EDITORIAL CORRESPONDENCE: Bexar County Medical Society 4334 N Loop 1604 W, Ste. 200 San Antonio, TX 78249 Email: editor@bcms.org MAGAZINE ADDRESS CHANGES: Call (210) 301-4391 or Email: membership@bcms.org SUBSCRIPTION RATES: $30 per year or $4 per individual issue ADVERTISING CORRESPONDENCE: Louis Doucette, President Traveling Blender, LLC. A Publication Management Firm 10036 Saxet, Boerne, TX 78006 www.travelingblender.com

For advertising rates and information Call (210) 410-0014 Email: louis@travelingblender.com 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, its members, or its staff. SAN ANTONIO MEDICINE the Publisher and BCMS reserves the right to edit all material for clarity and space and assumes no responsibility for accuracy, errors or omissions. San Antonio Medicine does not knowingly accept false or misleading advertisements or editorial nor does the Publisher or BCMS assume responsibility should such advertising or editorial appear. Articles and photos are welcome and may be submitted to our office to be used subject to the discretion and review of the Publisher and BCMS. All real estate advertising is subject to the Federal Fair Housing Act of 1968, which makes it illegal to advertise “any preference limitation or discrimination based on race, color, religion, sex, handicap, familial status or national orgin, or an intention to make such preference limitation or discrimination.

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BCMS BOARD OF DIRECTORS

ELECTED OFFICERS

Rajeev Suri, MD, President Brent W. Sanderlin, DO, Vice President Ezequiel “Zeke” Silva III, MD, Treasurer Alice Gong, MD, Secretary John J. Nava, MD, President-elect Rodolfo “Rudy’ Molina, MD, Immediate Past President

DIRECTORS

Vincent Fonseca, MD, MPH, Member Woodson "Scott" Jones, MD, Member Lubna Naeem, MD, Member Lyssa N. Ochoa, MD, Member Jennifer R. Rushton, MD, Member Raul Santoscoy, DO, Member John Shepherd, MD, Member Amar Sunkari, MD, Member Lauren Tarbox, Member Col. Tim Switaj, MD, Military Representative Manuel M. Quinones Jr., MD, Board of Ethics Chair George F. “Rick” Evans, General Counsel Jayesh B. Shah, MD, TMA Board of Trustees Melody Newsom, CEO/Executive Director Taylor Frantz, Alliance Representative Ramon S. Cancino, MD, Medical School Representative Lori Kels, MD, Medical School Representative Ronald Rodriguez, MD, PhD, Medical School Representative Carlos Alberto Rosende, MD, Medical School Representative

BCMS SENIOR STAFF

Melody Newsom, CEO/Executive Director Monica Jones, Chief Operating Officer Yvonne Nino, Controller Mary Nava, Chief Government Affairs Officer Brissa Vela, Membership Director Phil Hornbeak, Auto Program Director August Trevino, Development Director Betty Fernandez, BCVI Director Al Ortiz, Chief Information Officer

PUBLICATIONS COMMITTEE John Joseph Seidenfeld, MD, Chair Kristy Yvonne Kosub, MD, Member Louis Doucette, Consultant Fred H. Olin, MD, Member Alan Preston, Community Member Rajam S. Ramamurthy, MD, Member Adam V. Ratner, MD, Member David Schulz, Community Member Taylor Sullivan, DO, Member Faraz Yousefian, DO, Member Neal Meritz, MD, Member Jaime Pankowsky, MD, Member Winona Gbedey, Student Member Cara J. Schachter, Student Member Niva Shrestha, Student Member Danielle Moody, Editor

SAN ANTONIO MEDICINE • January 2022

PRESIDENT’S MESSAGE

Empowering Our Physicians to Make Bexar County a Healthier Community By Rajeev Suri, MD, MBA, FACR, FSIR, FCIRSE, 2022 BCMS President

‘The old order changeth yielding place to new.’ Though we have another transition in the physician leadership at BCMS, the ideals and the mission of Bexar County Medical Society (BCMS) remain steadfast to ‘serve and represent the member physicians of Bexar County in providing quality health care for their patients and the public.’ The past two years of the pandemic did challenge our resolve, but strengthened our goal to better represent our physicians and take care of our patients. A lot has been happening to achieve those goals, but I wanted to highlight three especially important initiatives as we head into the new year. I am certain these initiatives will benefit BCMS for years to come. BCMS has and always will be a voice for physicians, but to be equipped to do that, BCMS has to be a viable organization today and in the future. It can only do so by culturing and promoting leaders of tomorrow. In line with that goal, the BCMS Leadership Development Committee will begin coordinating with local academic institutions and BCMS/TMA leaders to rekindle the leadership training pathways that many of our members benefited from in the past. Structured outcomes-based mentorship programs are key to training our physicians to lead successful practices locally, and to be leaders in organized medicine at the county, state and national level. We know that BCMS physicians have the immense potential to be national leaders, and we need to pave the path for these physician leaders. To be successful as physicians and leaders, we as health care providers need to be more diverse to benefit and connect with the patient populations we serve. BCMS and its physician community is amongst the most diverse in the nation, and closely represents our communities. We cannot, however, sit on our laurels, and need to be part of a conscious effort for creating the pipeline for improving

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diversity in health care delivery. BCMS is partnering with local health career-focused schools and colleges, and over this coming year, we will work together to create more robust pathways for student mentoring/shadowing with the aim to improve recruitment amongst diverse populations to future health careers. No strategic plan can be complete without discussing the impact of COVID-19 on health care. Many challenges to our health care delivery system were uncovered by the COVID-19 pandemic— chronic challenges we knew existed but were really brought to the forefront as of late. Physician burnout was one such problem worsened by the pandemic. We as physicians are devoted to the care of our patients, but in doing so, day after day in a never-ending pandemic, many of us end up hurting ourselves as we carry all their emotional burdens. We need to provide easily available resources to our physicians and health care providers, and LifeBridge from BCMS is one such option. We need to invest in LifeBridge and other similar options and make sure these resources are easily accessible to all who need them. Quoting Robert Frost, ‘The woods are lovely dark and deep, But I have promises to keep, And miles to go before I sleep.’ There is a lot we can do for our physician community, and I look forward to serving you all as President of BCMS. For our physicians, I promise that BCMS will always work for you, and we also look forward to your more active participation in BCMS. Let’s work together to make Bexar County a healthier community. Rajeev Suri, MD, MBA, FACR, FSIR, FCIRSE is the 2022 President of the Bexar County Medical Society, Tenured Professor and Vice Chair of the Department Radiology at UT Health San Antonio, and Chief of Staff at University Hospital San Antonio.

BCMS ALLIANCE

Creating New Habits in the New Year By Taylor Frantz, RDN, LD, 2022 BCMS Alliance President

Walk into any gym in January, and you can see that every machine is in use and the room is bustling with people. If you check back in March, you will see it’s back to its normal number of patrons. The New Year always brings resolutions for healthier living, weight loss or dietary changes. Unfortunately, most of these well-intended resolutions quickly fade as life gets in the way and motivation dwindles. Even for those who achieve weight loss through dieting, data has shown that long-term weight management and weight maintenance can be incredibly challenging. As a dietitian, I strive to help my patients make sustainable lifestyle changes that will impart lasting improvements in their lives, and not chase quick weight loss and its fleeting results. So, what can you do to create a healthier, happier you? First, it’s important to understand why it can be so difficult to lose weight and keep it off. Your weight is not as simple as a ‘calories in, calories out’ math problem, and it is sadly much more complicated than the antiquated notion that 3,500 calories is a pound of fat. Factors like diet composition (carbohydrates, fats and proteins), appetite, genetics, metabolism, energy needs, underlying health conditions, one’s emotional relationship with food and socioeconomic status all play a role in weight. Shift your mindset. Set a realistic goal that is not based on the number on the scale or the size of your pants. Being able to keep up with your kids on family bike rides, decreasing the dose of your blood pressure medication or accomplishing a difficult hike is a much more rewarding goal than just losing pounds. Small changes create big results. Drastically changing your diet overnight will leave you feeling deprived and unhappy. One of my favorite ways to help patients improve their diet is not by removing foods but rather adding one additional serving of vegetables. Amending your regular diet by slowly adding vegetables to your plate will provide nutrients and satiating fiber without having to feel like dieting. The longterm goal is to ‘create a plate’ that is one half fruits and vegetables, one fourth lean protein and one fourth whole grains. Add in joyful movement. So often we think of exercise as being miles on the treadmill or countless reps on the rowing machine, but if those activities don’t interest you, then exercise becomes a dreaded chore. There is no reason to suffer through an exercise that you dislike. Exercise can simply be any movement that you enjoy doing − walking the dog, taking a dance class, playing tag with your grandkids or practicing yoga in your living room all count towards movement. Taylor Frantz, RDN, LD is the 2022 President of the BCMS Alliance.

SAN ANTONIO MEDICINE • January 2022

HEALTHY LIVING

The Need for a Biopsychosocial Model of Health By Venkat Srinivasan, MD

Introduction The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”1 This definition, which was adopted in 1948, created a seat for social and psychological well-being at the table of health care. One could state that being happy, having a family and having a comfortable job were conceived to be as relevant to health as having healthy cholesterol levels. Translating this definition into an actionable plan has, however, proven elusive. Limitations of the Biomedical Model Health care is dominated by a biomedical model, where diseases are primarily defined by underlying biochemical abnormalities; interventions are directed at reversing them. One of the critics of this biomedical model was George L. Engel (1913-1999), who was a major figure in the field of psychosomatic medicine in the United States. He felt that medicine was bound by a seventeenth-century worldview of a body-mind divide that was erroneous.2 This artificial dichotomy had resulted in a hierarchical organization in the treating physician’s estimate that continues to this day. Physical processes that can be measured and easily manipulated alone are “real” and considered as worth treating, while the more subtle psychological processes are relegated as much less relevant.

SAN ANTONIO MEDICINE • January 2022

He stated that: 1. A biochemical alteration does not translate directly into an illness. The appearance of illness results from the interaction of diverse causal factors, including those at the molecular, individual and social levels. And the converse, psychological alterations may, under certain circumstances, manifest as illnesses or forms of suffering that constitute health problems, including, at times, biochemical correlates. 2. The presence of a biological derangement does not shed light on the meaning of the symptoms to the patient, nor does it necessarily infer the attitudes and skills that the clinician must have to gather information and process it well. 3. Psychosocial variables are more important determinants of susceptibility, severity and course of illness than had been previously appreciated by those who maintain a biomedical view of illness. 4. Adopting a sick role is not necessarily associated with the presence of a biological derangement. 5. The success of the most biological of treatments is influenced by psychosocial factors, for example, the so-called placebo effect. 6. The patient-clinician relationship influences medical outcomes, even if only because of its influence on adherence to a chosen treatment. 7. Unlike inanimate subjects of scientific scrutiny, patients are profoundly influenced by the way in which they are studied, and the scientists engaged in the study are influenced by their subjects.2

HEALTHY LIVING

Biopsychosocial Model of Engel In 1977, George Engel proposed his biopsychosocial model of health as an alternative to the generally accepted biomedical model of health.3 His model takes into consideration a hierarchy of systems ranging from the molecular and biochemical processes all the way to societal, geopolitical and environmental forces that collide to contribute to health or disease. The biopsychosocial model is both a theoretical framework to understand health and illness and also a treatment guide. The construct recognizes that different clinical scenarios necessitate the understanding of illness at more than one level of the natural systems continuum. It also restores primacy to the unique subjective experience of the patient, thus redirecting the treatment plan to address the elements affecting it. Mr. T. is a 70-year-old widower with coronary heart disease. His dyspnea limits his ability to get out of the house resulting in social isolation, which in turn makes him feel depressed. His depression affects his motivation to exercise or get out of his house. He, therefore, does not want to participate in any rehabilitation program, whereby his dyspnea does not improve. He feels lonely at home and this perpetuates his depression. All three dimensions of his personality — the physical, emotional and social — have been affected by his illness and contribute to his experience of illness and suffering. The risk factors for his illness can also be viewed through the biopsychosocial model. The universally accepted risk factors include age, smoking status, family history, physical activity, diabetes, hypertension and hyperlipidemia. If, however, we lift our gaze and look beyond the obvious, we can recognize multiple elements in the biopsychosocial spheres contributing to and affected by the patient’s illness — food preferences of parents during development, financial status, work hours, the extent of social support available, quality of marriage, perception of self-esteem, sense of optimism, stress at work and at home, availability of healthy food choices at work, the sociocultural norms for activity, sleep, religious inclination, etc. Medicine is more easily understood through linear causations; however, and in our eagerness to simplify, we should not run the risk of oversimplification.4 Biopsychosocial Model in Clinical Practice The astute clinician, using the biopsychosocial perspective, can tailor the treatment plan to fit the unique needs of the individual patient. According to Engel, to apply the biopsychosocial approach in clinical practice, the clinician should: • Recognize that relationships are central to providing health care, • Use self-awareness as a diagnostic and therapeutic tool, • Elicit the patient’s history in the context of life circumstances,

• Decide which aspects of biological, psychological and social domains are most important to understanding and promoting the patient’s health, • Provide multidimensional treatment. Thus, the biopsychosocial model enables the treating physician to develop a construct to understand the various factors contributing to the health/illness of the patient and also an insight into their belief and value systems. It also offers multiple targets to intervene in, which could potentially help improve the health of the patient. Conclusion The past two years have acutely brought into focus the psychosocial factors and belief systems that influence choices made by patients in matters of life and death. These elements are even more important in the management of noncommunicable diseases. We, as health care providers, are only too aware that stemming the relentless tide of diabetes, obesity and metabolic disorders is not going to be from better diagnostic tools or a magic pill. The need for a biopsychosocial approach to health has never been more imperative than today. References 1. "WHO Definition of Health." WHO Definition of Health. World Health Organization, 2003. Web. 31 July 2016. 2. Engel, George L. "How Much Longer Must Medicine's Science Be Bound by a Seventeenth Century World View?" Family Systems Medicine 10.3 (1992): 333-46. Web. 31 July 2016. 3. Borrell-Carrio, F. "The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry." The Annals of Family Medicine 2.6 (2004): 576-82. Web. 31 July 2016. 4. Engel, G. "The Need for a New Medical Model: A Challenge for Biomedicine. “Science 196.4286 (1977): 129-36. Web. 31 July 2016. 5. Srinivasan, Venkat. Principles of Mind Body Medicine. Norton Publishing, 2017. 6. Engel, G. "biopsychosocial model approach definition - University of Rochester ..." 2014. <https://www.urmc.rochester.edu/education/md/documents/biopsychosocial-model-approach.pdf> Venkat Srinivasan, MD is a member of the Bexar County Medical Society.

Visit us at www.bcms.org

HEALTHY LIVING

Managing Your Mind Is the Key to Empowered Living By Nora Vasquez, MD

id you know that your thoughts create feelings which drive all your actions? I didn’t. When I first learned this simple, yet profound concept, it transformed the way I experienced my life for the better. This awareness created opportunities for me to purposefully choose who I wanted to be in the world, even when the frustrations of career burnout or personal challenges arose. I began to realize that I had more agency and options in my life than I previously thought possible. I recognized that although there are some circumstances I cannot control, I always have the power to choose how I want to think about those circumstances and ultimately, how I want to respond. I stopped feeling like life was happening to me. I started to pause, reflect and then respond instead of just reacting. That is the key to living life on your own terms. There were times in my career as an outpatient Internist when I felt the symptoms of burnout but didn’t even know it. I assumed that if I just kept working and going through the motions, the burnout would resolve on its own. Of course, the burnout didn’t subside because I kept thinking negatively about my circumstances and expecting myself to feel better. Now I understand that burnout is a temporary state of emotional exhaustion, feelings of cynicism and a sense of ineffectiveness due to prolonged exposure to occupational stressors. I share this with you to help you realize that by understanding the power of your thinking and managing your mindset, that is the way to living an empowered life personally and professionally. Now I understand that to mitigate burnout, we need to think differently to find a new solution. As a Certified Physician Coach, I’ve had the honor of coaching hundreds of physicians across the United States and Canada. What is resoundingly clear is that many are struggling to balance all the responsibilities of life and their medical practice. Often, they are just trying to survive the next shift. The truth is, if you have a human brain, you’ve probably had similar negative thoughts. If you find yourself spinning in negative thoughts and feel the symptoms of burnout: 1. You are not alone, and 2. It doesn’t have to be this way. 14

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Here are a few tips to create an empowered mindset: 1. Create Awareness − Start to notice your self-talk and explore your negative thoughts. Then, choose to challenge your negative thoughts and the story you have created of your lived experience. You can ask yourself, “Is this thought true?” and then look for counter evidence. Then, if it is true, you can ask yourself, “Is this thought serving me and creating the results I want in my life?” 2. Change Your Narrative − With increased awareness, you get to decide to rewrite your story if it isn’t serving you. You can explore all your options and see if you want to change your circumstances, or simply change the way you think about them. 3. Get Support − Your well-being matters. I realize not all circumstances are easy to manage alone. That is why I always encourage help-seeking behavior. Everyone deserves to get the support they need, whether that is from a trusted peer, family member, pastor, counselor, physician, coach or psychiatrist. Reach out and utilize the support and community you need so that you can thrive. 4. Resources − BCMS is committed to supporting physicians through the Physician Coaching and Wellness Program. You can participate in the free monthly Physician Coaching webinars where you can learn effective tips to create an empowered mindset. You can register and learn more by visiting the BCMS Calendar of Events at www.bcms.org. Nora Vasquez, MD is a Certified Physician Coach and a Board-Certified Internal Medicine Physician with over a decade of experience. She developed the Physician Wellness Webinar Series for BCMS physician members to empower physicians with evidenced-based coaching strategies to mitigate burnout and enhance physician well-being. You can learn more about Dr. Nora Vasquez at www.renewyourmindmd.com. Dr. Vasquez is a member of the Bexar County Medical Society.

HEALTHY LIVING

The Treatment of Obesity By Jennifer Seger, MD

hen I went through medical training a little over 20 years ago, we were taught very little about obesity. In fact, obesity was not even considered a disease until 2013 when the American Medical Association issued its declaration. Despite this milestone, obesity continues to be the most undertreated chronic disease of modern time. Currently, two out of three Americans are considered overweight (BMI >25 kg/m2) or have obesity (BMI >30 kg/m2) (NIDDK). The prevalence of obesity is expected to reach 50% in the U.S. by 2030, with 29 states having a prevalence above 50%. Zero states are predicted to have a prevalence below 35% (Harvard T.H. Chan School of Public Health). Obesity affects every organ system in the human body and is a significant contributing factor in hundreds of chronic diseases, therefore, no medical specialty is immune from its impact on patients. Even if a provider isn’t equipped to address obesity, he or she must still take it seriously and provide the patient with information related to effective treatment options. The good news is that there are many options (more on that later). It often seems as though there is an unspoken policy of “don’t ask, don’t tell” in doctors’ offices when it comes to weight. We readily address the patient’s diabetes, high blood pressure and high cholesterol, but often make little to no mention of the patient’s abnormal BMI. Prescriptions are written and costly interventions are performed, without a word about the importance of losing weight. If advice is given, it often amounts to “eat less and exercise more.” Doctors frequently report feeling uncomfortable discussing weight with their patients. This could be due to a lack of knowledge or inexperience in treating obesity or perhaps he or she is struggling with their own weight. After all, we know obesity affects all ethnicities and all socioeconomic groups, including many of us in health care. Nowadays, you cannot pick up a medical journal without reading at least one article on obesity. If you haven’t had the time, or perhaps the interest, in keeping up with the rapidly evolving research around obesity, you may be surprised to learn just how complex of a disease it is. The old belief of calories-in versus calories-out has been shown to be a gross oversimplification and does injustice to the metabolic mayhem that obesity can inflict. Underlying contributing factors such as unhealthy nutrition, sedentary lifestyle, hormones, medications, sleep

disturbances, stress and even the gut microbiome all play a role in obesity. Genetics also plays a role in sending one down the path of obesity; however, our genetics as a species have not changed in the past 40-50 years, but rather our environment has and that is where we must turn our attention. It can be uncomfortable, but we need to find a way to start the conversation with our patients about their weight. Perhaps next time you have a patient sitting across from you in the office, consider asking the patient for permission to discuss his or her weight and how it may be related to the other problems you are addressing for the patient. Simply letting the patient know that you are concerned can go a long way to motivate the patient and move him/her along the levels of readiness. If doctors continue to ignore their patients’ weight and its relationship to other chronic diseases, we will only perpetuate the viscous cycle of disease, promoting further pain and suffering and exposing the patient to future health risks. If you are interested in learning more about obesity, please check out both The Obesity Medicine Association (www.obesitymedicine.org) and The Obesity Society (www.obesity.org) — both excellent organizations dedicated to educating providers about obesity. There is also a more formal pathway in which physicians can obtain certification in Obesity Medicine through the American Board of Obesity Medicine (www.abom.org), which as of today, has certified over 5,000 physicians in the U.S. and Canada. For those interested in an even more extensive education and formal fellowship, please check out the Obesity Medicine Fellowship Council at http://www.omfellowship.org. There are currently 22 active fellowships in the U.S. Finally, for whatever reason, even if directly treating obesity is not comfortable for you, please don’t ignore the patient’s obesity. Consider a referral to a physician who is certified by the ABOM and one who is experienced, knowledgeable and able to provide all available safe and effective treatment modalities in a comprehensive and compassionate center of care. To find one near you, you can visit https://abom.learningbuilder.com/public/membersearch. Jennifer Seger, MD is a member of the Bexar County Medical Society. Visit us at www.bcms.org

HEALTHY LIVING

Fostering a Culture of Well-being in Residency Programs By Faraz Yousefian, DO, Sujitha Yadlapati, MD and Eduardo Rodriguez, MD

urnout is defined as a combination of emotional exhaustion, low sense of accomplishment and depersonalization. This remains an ongoing concern in residency programs.1 Residency requires long work hours filled with intense scrutiny of one's clinical performance, which is coupled at times with reduced exposure to experiences outside the workplace. Continuous exposure to workplace stressors places trainees at risk of emotional exhaustion, depression and suicidal ideation. While the percentage of physicians reporting burnout differs among different specialties, nearly half of all physicians report burnout with higher rates seen in residents than medical students or early-career physicians.2 ACGME (Accreditation Council for Graduate Medical Education), in response to this, has revised program requirements for residencies to include initiatives for resident wellness. In 2018, ACGME began measuring resident well-being with a national well-being survey. The first step to establishing steps for intervention is to assess burnout. This can serve as a starting point for residencies to identify specific circumstances and establish a framework of interventions. Many standardized assessment tools and surveys ranging from freely available resources to those available at cost have been established. ACGME has endorsed Maslach Burnout Inventory (MBI-HSS), Mayo Clinic Well-Being Index, Patient Health Questionnaire-9 and professional quality of life scale as assessments at the program-level and individual resident level.1 Assessment of burnout should be conducted periodically for each resident or the program as a whole. While each of these tools can be used, extra caution should be taken while assessing residents who are at risk. Trainees at risk of suicidal ideation are challenging to identify, and reliance on assessment tools alone should be avoided.1 In terms of interventions, a residency learning environment can be a tool for reducing burnout if systematic interventions focused on promoting well-being, specifically self-care, mindfulness and meditation, are established. Reduced work hours have also been shown to improve well-being.3 Practical strategies for strengthening resident well-being require organizational change. Systems can be implemented at individual resident, program and institutional levels to create a cultural shift. Although no standardized plan is established across residency programs, institutional (top-down) and resident (bottom-up) are critical. On reviewing plans published in literature by various residency programs, resident-proposed wellness activities can include policy changes for adequate time off or breaks between rotations such as ICU

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and CCU, or other equally intensive rotations in surgical fields. Initiating incentives to encourage resident physical fitness, such as offering yoga sessions, allowing residents access to hospital gyms or discounts to fitness classes, can promote physical fitness. Establishing an annual wellness retreat or events for all residents can encourage team building and camaraderie.4 Addressing sleep disorders and sleep deprivation by structuring days off can be helpful. In addition, psychological health also plays an important role. Alcohol dependence, abuse of sedative medications and overeating are related to higher rates of depression among residents.1 Residents often delay seeking mental health or medical treatment due to lack of time, concern for confidentiality and cost. Encouraging and allotting time off for doctor’s visits is crucial to address this. Building a solid support system of colleagues and friends has also been shown to lower burnout.1 Mentoring from peers and faculty may also help provide support and lower burnout. The path to wellness begins with an empathetic, judgment-free discussion of a resident’s health and well-being with a faculty member, program director or advisor. Trust and confidentiality are crucial elements offered by faculty to ensure residents feel supported in their effort to seek help when experiencing burnout. Interventions such as speaking with a professional therapist, examining the basis of burnout, developing better relationships with colleagues and reshaping one’s mindset can all be effective strategies.1 While individual interventions can benefit, studies show that institutional and organizational changes are necessary to shift significantly. Organizational interventions can include forming committees composed of residents and faculty who meet regularly to develop strategies to improve the clinical environment and ensure adequate time off.4 Workplace interventions such as EHR (electronic health record) optimization and delegating administrative tasks to nonclinical staff can improve overall wellness. Resident schedules are a vital component of this discussion as well. ACGME duty hour changes over the last decade came into place to combat burnout.1 Protected time off and openness of a program to work with a resident to ensure they can have days off to attend health care appointments and personal commitments outside the workplace can be beneficial. Residency programs should recognize that allowing residents to have more control over their schedules leads to overall improving wellness. In conclusion, wellness should become a culture rather than a benchmark in residency training. Continual efforts to work on this

HEALTHY LIVING

throughout resident training can have lasting consequences for residents and affect patient care. A holistic approach that focuses on a resident’s physical, psychosocial and mental vitality is essential. For a resident, it is vital to be part of a program that provides a supportive, judgment-free environment to exercise vulnerability while overcoming challenges and ultimately cultivate professional success.

Faraz Yousefian, DO is an intern at the Texas Institute for Graduate Medical Education and Research (TIGMER) in San Antonio, Texas. He is very passionate about mentoring nascent physicians and educating the general populous about skin diseases and the steps they can take to prevent them. Dr. Yousefian is a member of Bexar County Medical Society.

References 1. Parsons M, Bailitz J, Chung AS, Al. E. Evidence-Based Interventions that Promote Resident Wellness from the Council of Emergency Residency Directors. West J Emerg Med Integr Emerg Care with Popul Heal 21(2). Published online 2020. 2. hanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377-85. 3. Busireddy KR, Miller JA, Ellison K, Ren V, Qayyum R, Panda M. Efficacy of Interventions to Reduce Resident Physician Burnout: A Systematic Review. J Grad Med Educ. 2017;9(3):294-301. doi:10.4300/JGME-D-16-00372.1 4. Stansfield RB, Kenaga H, Markova T. Building a culture of wellbeing in primary care resident training programs. Ochsner J. 2021;21(1):68-75. doi:10.31486/toj.19.0111

Sujitha Yadlapati, MD, is a PGY-2 dermatology resident at HCA Corpus Christi Medical Center- Bay Area Program. Her professional interests include skin cancer prevention, cutaneous oncology, procedural dermatology and complex medical dermatology. She is interested in resident education and leadership. Dr. Yadlapati is a member of the Texas Dermatological Society. Eduardo Rodriguez, MD is a resident at the UT Health Science Center at San Antonio. He is passionate about general dermatology with a special interest in dermatopathology. Dr. Rodriguez is a member of Bexar County Medical Society.

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The Running & Wellness Club By Andrew Meigs and Victor Martinez

he Running & Wellness Club at the University of the Incarnate Word School of Osteopathic Medicine (UIWSOM) is not your average organization. Originally called “Run Club,” this group was created by a handful of students who shared a passion for staying active and waking up at 5 a.m. Despite the early morning start time, this small group had one infectious quality that they nourished together every time they met: joy. Of course, with joy comes growth, and the small group grew so big they included more days and (thankfully) later meeting times to accommodate the number of people who wanted to join. Eventually, the group expanded the “Run Club” to an official UIWSOM organization, the “Running & Wellness Club,” and included people who wanted to come but perhaps just felt like walking or jogging. As we grew, our emphasis on the organization also grew, and we started to address disparities within our own San Antonio community. For example, as of 2020, San Antonio stayed home to around 3,000 homeless persons that we know of, and houses District 3, the largest area in the city still classified as a “food

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desert.” Here, the Running & Wellness Club truly began to adopt the UIWSOM mission of improving health and wellness in the San Antonio communities. We began doing this through one of our yearly events of raising pledge donations for miles walked or ran for the San Antonio Food Bank. Throughout quarantine, while adhering to COVID-19 restrictions, we raised $1,062 our first year of fundraising in 2020 and $788 the next year for a total of $1,850! This year, we’ve doubled the number of organizations we are supporting and raised $661 for the Special Olympics. Aside from using our shared exercising experiences as a platform to help improve our San Antonio community, we understand that the environment cultivated at our Running & Wellness Club is healing in of itself. Over the last five years, research has shown that 50% of medical students experience burnout and 10% of medical students have suicidal ideations. So, we spend extra effort building a welcoming environment for our members − every member of the Running & Wellness Club is a part of our family. Plus, while staying active, we are also grow-

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ranean-style potluck dinner. Our organizations chose this theme for the potluck because a Mediterranean diet has been shown to provide many health benefits including improvements in cardiovascular and neurologic health. While adhering to COVID-19 restrictions, we shared our Mediterranean meals together along with their recipes so everyone in attendance could recreate these meals at home.

Currently, the Running & Wellness Club hosts biweekly walks and runs every Wednesday and Saturday of the month either on a trail in Brooks City Base or at Phil Hardberger Park.

ing relationships and friendships within our school community. We believe this mindset and the coordinated events impact the wellness of medical students by improving our work-life balance and ensuring that we keep ourselves healthy and equipped to treat others. At the end of the day, medical school can be very demanding and overwhelming, so a healthy outlet is a fantastic way to support our physical and mental health. Moreover, the Running & Wellness Club fosters inclusivity and shared goals by partnering with multiple organizations on campus. For example, our organization co-hosted a “Mental Health Walk” with the Psychiatry Interest Group to further address mental health issues. This 2-mile walk opened a brave and safe space for students, especially struggling first-year medical students, to have an opportunity to voice their honest thoughts and feelings about medical school or life struggles with their peers and upperclassmen. Additionally, at our last co-hosted event, the Running & Wellness Club partnered with our Food and Medicine Club to form a Mediter-

Those who enjoy walking follow one of our several 1.5-mile routes and our runners follow one of our 3-mile loops. Our organization is unique in that we have an Adventure Advocate that finds and hosts different adventures once a month for those interested in doing hikes, rock climbing, spelunking, half marathons and fun runs. Our last adventure was at Enchanted Rock where we spent the entire day hiking with students who knew the location. We then concluded the day with dinner in Fredericksburg. As of now, quite a few of us just started training for the 2022 Run the Alamo Half-Marathon. If you read this entry and end up seeing us in our matching “C. Diff and the Runners” t-shirts at our March 6 race, come spend some time with us! You can find us leading in the front or trailing in the back, because we are diverse and numerous with every member setting their own unique pace. Yet, regardless of speed, we’ll always cheer each other on and celebrate together at the finish line; at the end of the day, we are more than just a “Run Club” − we are a family. Andrew Meigs is a second-year medical student at the University of the Incarnate Word School of Osteopathic Medicine. Outside of his studies, he holds the presidency position for “Pride in Practice,” his school’s LGBTQI+ organization, the presidency position for his school’s “Running & Wellness Club” and a membership in his school’s “Learner Ambassador Program.” Victor Martinez is a second-year medical student at the University of the Incarnate Word School of Osteopathic Medicine. While pursuing his medical degree, Victor is also pursuing a Master of Public Health and holds executive positions for the UIW “Running & Wellness Club” and “Student Osteopathic Orthopedics Club.”

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Mobile Mercado, a Food Retail Enterprise of the San Antonio Food Bank to Address Diet-Related Conditions and Food Insecurity By Luz-Myriam Neira, PhD

he San Antonio Food Bank (SAFB) was established in 1980 and serves one of the largest areas in Southwest Texas, offering programs and services in 29 counties focusing on client food security. The SAFB has run a food retail enterprise since 2016 utilizing the Mobile Mercado (MM) to increase access to seasonal produce and other healthy foods for low-income/food desert area residents in Bexar County. The MM is a 35-foot specialized truck consisting of a mini-grocery store which carries seasonal fresh produce as well as other healthy food items and a demonstration kitchen that has been utilized to prepare/sell heart-healthy/diabetic-friendly meals at convenient prices. Since 2017, the Mobile Mercado has been a Supplemental Nutrition Assistance Program (SNAP) retailer, facilitating the access of fresh produce by SNAP participants. As of July 2021, the Mercado began offering the Double-Up Food program which further incentivizes SNAP participants to double the amount of produce they access with their SNAP card. For every one dollar spent, participants receive an 20

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additional dollar incentive to spend on produce, up to $30 dollars. The Double-Up Food program helps SNAP participants increase their food security while supporting local farmers. The Mobile Mercado began operating the Prescription for Produce program in 2018, gaining recognition from health care organizations. Currently, the Food Bank partners with eight health care organizations sponsoring patient prescriptions, each of whom obtain up to 15 pounds of fresh produce per prescription. Presently, the Mobile Mercado serves 17 sites each month (12 clinics/5 community sites). MM strengths include being a custom truck that is well equipped, visually appealing, recognizable and a popular stop to purchase hot, healthy meals. The Mobile Mercado is expertly run, and is comprised of 100% minority and 75% female staff. Opportunities for the upcoming future of the Mobile Mercado include adding additional lowincome sites in East Side San Antonio, where there is a significant representation of African Americans. The Mobile Mercado operates in four of the 11 high-risk zip codes of San Antonio, and by expand-

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ing to the East Side, five more sites will be added so the Mercado will then be operating in nine of the 11 high-risk zip codes. The Mobile Mercado also has the potential to expand the Prescriptions for Produce sponsorships, increasing the popularity of health and wellness enterprises generating profits. Lastly, the strong culture of giving in San Antonio and South Texas could contribute to the program’s sustainability. Threats such as the uncertainty around food costs and clients’ financial capacity to purchase food given the COVID-19 pandemic cannot be ignored, and are addressed through Prescription for Produce sponsorships. The Mobile Mercado business model for the new year (2022) will consist of: adding five more sites specifically benefiting minorities (Black and Hispanic) residing in East Side high-risk areas for a total of 22 sites; reviving the Mercado’s heart-healthy/diabetic-friendly meals sales and adding a new enterprise approach to the mini-grocery store; selling medically-tailored food packages; being a unique San Antonio food retailer in this category; and increasing convenience for

clients wanting to prepare their meals at home. This social enterprise business of the Food Bank offers at least 80% of food items that follow the U.S. Department of Agriculture recommendations to decrease saturated fat, sodium and added sugars, according to the Dietary Guidelines for Americans, 2020-2025. Being able to provide these items will help low-income minorities follow and maintain healthy lifestyles and contribute to the local sustainability food system. For the last four years, the experience of running this retail food enterprise and the Prescription for Produce sponsorships provided by the health care system has demonstrated to the SAFB that this partnership is essential. The Mobile Mercado catalyzes the vital role of food and nutrition in improving health and wellness for patients affected with diet-related health risks or conditions, food insecurity or other documented challenges to accessing nutritious foods. Luz-Myriam Neira, PhD is the Director of Nutrition, Health and Wellness for the San Antonio Food Bank. Visit us at www.bcms.org

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Metro Health’s ¡Por Vida! Program Expands to Promote San Antonio’s Healthiest Food Service Establishments By Haley Amick, MPH, CHES

How it Started In 2009, the ¡Por Vida! program was established when the San Antonio Metropolitan Health District (Metro Health) and the San Antonio Restaurant Association partnered and explored ways to work together to improve the health of the community. The collaboration quickly grew into what was called the Healthy Restaurants Coalition and included public health professionals, local restaurateurs, registered dietitians, local chefs, marketing professionals, educators and many others working to improve the health of our community. ¡Por Vida! meals follow strict nutrition criteria defined by registered dietitians, which include limiting calories, saturated fat, sodium and added sugars but are still loaded with great taste. If a customer or resident sees the ¡Por Vida! logo, then they know the meal is healthy. ¡Por Vida! is now housed within Metro Health and currently has 22 participating businesses that include restaurants, caterers, food trucks, worksites and school cafeterias. Expansion in 2022 Metro Health recognizes there are more ways the food and culinary industry promotes health than just offering healthy menu items. Community feedback collected from some of San Antonio’s highest needs zip codes has shown there is a need for healthy food options when dining outside the home. When local restaurants and stakeholders were surveyed about the ¡Por Vida! program, the feedback pointed to the importance of shifting our focus from what is “healthy” by simply offering nutritious menu options to a “whole health” or holistic approach. Metro Health’s Community Nutrition Program used this feedback to develop an expanded version of the ¡Por Vida! program, internally dubbed “Por Vida 2.0.” In 2022, Metro Health will launch this expanded ¡Por Vida! program as a tiered system that recognizes food service establishments not only for providing healthy menu items, but also for receiving high sanitarian scores, being tobacco-free, practicing environmentally friendly practices and giving back to the community. The expanded ¡Por Vida! criteria incorporate sustainability, community investment, local food systems, managing food waste, building up local businesses, providing resources to restaurant workers, donating food to food banks and promoting culinary mentorships. The new nutrition criteria support local food policies, such as menu labeling and ensuring kids’ menus do not offer sodas as default beverages. 22

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Metro Health will also hire three new Community Health Workers dedicated to nutrition programs, who will work to ensure food service establishments in the South, East and West regions of San Antonio have the resources and technical assistance needed to join and thrive in the ¡Por Vida! program. The ¡Por Vida! expansion addresses several social determinants of health, including access to healthy food and drink, clean air, education/mentorships/job opportunities and better work benefits. This program helps to increase access to healthy meal options in the community, drives the community to food establishments that promote a healthy environment and supports businesses as they work to create an even healthier San Antonio. Partners in the Culinary Industry Metro Health has partnered with key organizations and initiatives in San Antonio to further promote ¡Por Vida! restaurants that go above and beyond to obtain gold certification. ¡Por Vida! goldtiered restaurants will also receive special recognition as being affiliated with the San Antonio UNESCO Creative City of Gastronomy designation. In 2020, ¡Por Vida! and Culinaria partnered to create the “¡Por Vida! Healthy Trail” which highlighted 10 local restaurants that promote tasty and healthy menu options while also giving back to the community and environment. Unfortunately, many of the partners on this trail have closed temporarily or permanently due to the COVID-19 pandemic. However, the ¡Por Vida! Healthy Trail will be re-established and feature 10 of the new ¡Por Vida! gold-tiered partners. The goal of this program is to embrace and sustain the local community and culture by fostering a healthy environment through the rich, unique food and culinary industry in San Antonio. What to Look for in Early 2022 Metro Health’s expanded ¡Por Vida! Program will recognize local restaurants for creating healthy environments through good nutrition, sanitation, sustainability and community development. Restaurants, food trucks and caterers can score bronze, silver or gold medals for the work they do in these categories, which ultimately will provide residents healthy food options and healthy environments to dine in across the city. (The accompanying infographic outlines the criteria for restaurants earning bronze, silver and gold recognition).

HEALTHY LIVING Bronze Level ¡Por Vida! partners meet the original ¡Por Vida! criteria. They offer at least one healthy menu item (as outlined by the original Por Vida standards) and maintain high sanitarian scores. Silver Level ¡Por Vida! partners meet the original ¡Por Vida! criteria by offering at least one healthy menu item and maintaining high sanitarian scores, and also do advanced work in nutrition in addition to either sustainability or community giveback. Gold Level ¡Por Vida! partners meet the original ¡Por Vida! criteria by offering at least one healthy menu item and maintaining the highest sanitarian score possible, and also do advanced work in nutrition in addition to both sustainability and community giveback. Keep your eye out for the new ¡Por Vida! program, which is set to launch in early 2022! This program will offer full flavor and the convenience of dining out without sacrificing good nutrition and health. Our motto is: “When you choose ¡Por Vida!, you make a better choice ‘For Life’!”

Haley Amick, MPH, CHES is the Community Nutrition Program Coordinator for Metro Health’s ¡Por Vida! program. To learn more about ¡Por Vida! and to see a list of participating restaurants, visit www.porvidasa.com or contact porvida @sanantonio.gov.

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A Team-Centered Approach in Detecting Breast Cancer By Ramon S. Cancino, MD, MBA, MS, FAAFP

In 2021, breast cancer became the most common global cancer, accounting for 12% of all new cancer cases worldwide.1 In the United States, breast cancer is the second leading cause of cancer death in women. The chance a woman will die from breast cancer is about 1 in 39 (about 2.6%). Breast cancer can often be caught early through regular mammograms. In fact, timely breast cancer screening and increased awareness are among the factors contributing to decreasing cancer death rates nationally.2 As part of UT Health San Antonio Regional Physician Network (RPN) accountable care organization’s focus on wellness care, the RPN team partnered 24

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with San Antonio primary care physicians to develop patient-centered strategies to improve breast cancer screening rates. The physician-led effort started with discussions with primary care physicians in the RPN network. Members discussed current cancer screening workflows, successes and challenges. One common challenge was knowing which patients were still due for mammograms in the first place. For example, while many female patients reported having completed their mammograms, the PCP was not always aware that it was completed. RPN has developed sophisticated analytics capabilities, including aggregating and ana-

lyzing real-time, practice-level and claimsbased data. To provide a comprehensive analysis, the RPN platform is also able to combine automated data feeds with manually abstracted data. Using CMS data on paid Medicare claims of RPN-attributed patients, the RPN team was able to develop a report to identify patients whose mammograms were completed. The data allowed individual PCPs to get a clearer picture of which patients still needed to have breast cancer screenings completed. Another challenge was the lack of time and, in some cases, staff to call patients and help schedule mammograms. Even though

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the RPN team was able to provide the data necessary to help practices identify and close breast cancer screening gaps, it was difficult for physicians or their staff to carve out time to outreach to patients and imaging centers in scheduling mammograms and retrieving records. In partnership with more than 30 primary care practices in the San Antonio region, the RPN team reviewed and analyzed patient-level and claims data. Using this data, for those practices who requested the support, the RPN team provided targeted patient outreach to those patients still needing mammograms. This outreach was done using scripts and workflows that each individual practice helped develop. By developing these partnerships with RPN physicians and our community’s patients, many more patients received evidencebased breast cancer screening. An example of how our team members support patients involved a hesitant patient. An RPN team member identified a female patient was due for a mammogram and hesitant to get one. In response, the RPN team member stayed in touch with the patient, developed a rapport and worked with the patient’s PCP to help that patient learn the importance of regular breast cancer screening. With permission from the patient and the patient’s PCP, the RPN team member traveled to meet the patient at her breast cancer screening appointment to support her before and after the mammogram. The mammogram detected an early breast cancer; and, in the end, the woman was successfully treated for cancer. The team member’s ability to provide wraparound care helped the patient receive the screening that caught cancer sooner. In addition to providing accurate data, outreaching to patients and helping provide shared-decision making support, the RPN team also supports practices by adding the exact date of the last mammogram to the records of many RPN physicians. By adding this data to the records, RPN PCPs feel con-

fident that the breast cancer screening records they have are accurate. Therefore, RPN physicians can order necessary preventive care screenings without being concerned that they are ordering redundant testing. This simple intervention contributed to increasing breast cancer screening rate of four RPN practices by 100%. Taken as a whole, these breast cancer screening interventions helped raise the RPN’s breast cancer screening rate in 2020 by 17% compared to 2019 and increased the screening rate of 80% of RPN practices. While merely numbers on a page, these improvements reflect real women who received timely breast cancer screening! The COVID-19 pandemic has resulted in many elective procedures being put on hold, and this has led to a substantial decline in cancer screening.3 Locally, health care facilities are providing cancer screening during the pandemic with many safety precautions in place. Please continue to encourage patients to receive regular breast cancer screening. Prevention and early detection are essential to reducing cancer-related deaths.

References 1. Breast cancer overtakes lung as most common cancer-WHO. Reuters. https://www.reuters.com/article/healthcancer-int-idUSKBN2A219B. Published February 2, 2021. Accessed November 6, 2021. 2. How Common Is Breast Cancer? | Breast Cancer Statistics. Accessed November 6, 2021. https://www.cancer.org/cancer/ breast-cancer/about/how-common-isbreast-cancer.html 3. Cancino RS, Su Z, Mesa R, Tomlinson GE, Wang J. The Impact of COVID-19 on Cancer Screening: Challenges and Opportunities. JMIR Cancer. 2020;6(2): e21697. doi:10.2196/21697 Ramon S. Cancino, MD, MBA, MS, FAAFP is Senior Medical Director and Medical Management Director of the Primary Care Center of UT Health Physicians. He is a member of the Bexar County Medical Society.

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100% Large Practice Groups Membership Highlight By HealthTexas Medical Group

HealthTexas Medical Group is a group of local primary care physicians who care about the health and well-being of the communities of the San Antonio region. HealthTexas was founded in 1994 by four local physicians. These physicians recognized the need for primary care doctors to play a more significant role in a patient’s overall health and wellness. Founder, Dr. Richard Reyna retired as President & CEO of the medical group in 2018. Founder, Dr. Rowland Reyna is still a practicing physician within the medical group. HealthTexas believes a strong primary care provider is essential in helping patients navigate their medical care most successfully. Actively connecting a patient’s primary care visit, specialist, hospitalizations and ER care ensures a patient’s global care is focused upon rather than spread piecemeal throughout the health care system. The HealthTexas doctors’ recipe for success lies in the fact that each physician takes a hands-on approach to caring for patients. HealthTexas coordinates all aspects of care for their patients. They partner with a select group of quality specialists. This coordination of care occurs not only when the patients are ill, but also throughout all phases of their lives and all aspects of their health care, with a focus on preventative care as a priority for patients. This personal approach is what differentiates HealthTexas doctors from others and why patients choose HealthTexas for their primary care. The group focuses on primary care, preventive needs and chronic conditions. When outside care is required, they assist patients in navigating increasingly complex health care choices. They also partner with specialists who pay attention to needs that matter to their patients like character, on-call services, personal touch, quality and outcomes. All HealthTexas physicians are board-certified in their specialty of internal or family medicine. The group has been recognized for the following awards: • Best Doctors in America® • Texas Super Doctors® (as listed by Texas Monthly Magazine) • Top Doctors in San Antonio® (as listed in SA Scene Magazine) • Top Doctors in America® (as listed by Castle Connolly in U.S. News & World Report) • Patient’s Choice Award • Accredited Diabetes Education Program • National Committee for Quality Assurance (NCQA) 26

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• Best Places to Work® (San Antonio Business Journal) - 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2018 2019, 2020 • Top Work Places® (Express News) - 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017, 2018, 2019, 2020, 2021 • Top Work Places® (Express News) Training Award – 2009 • Top Work Places® (Express News) Manager Award – 2010 • Bexar County Medical Society (BCMS) o Previous President - Dr. Gabriel Ortiz (Blanco Clinic) o Previous President - Dr. Manuel M. Quinones, Jr (Helotes Clinic) • Texas Medical Board, Appointee by Governor Greg Abbott, Dr. Manuel Quiñones HealthTexas is a patient-centered, physician-owned and physicianled organization. The President and CEO of HealthTexas Medical Group is Dr. Kristi Clark. The HealthTexas Physician Board governs the providers and clinical operations of the Medical Group and is chaired by Dr. Manuel Quiñones. The HealthTexas Corporate Board governs the operations of the Management Company of HealthTexas and is chaired by Dr. Rowland Reyna.

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To learn more, please visit HealthTexas Medical Group’s social media: Website: HealthTexas.org Facebook:HealthTexas Medical Group LinkedIn:HealthTexas Medical Group Twitter: @HealthTX Instagram:healthtexas YouTube:HealthTexas Medical Group

Quality of care is their cornerstone, and because of that, they have many processes in place to ensure quality stays at the helm of patient care. They have established several committees that convene regularly to discuss priority matters: • Patient Care Committee (PCC) – ensures providers receive operational updates, current EMR training, review of policies and procedures as well as review of quality dashboards on a weekly basis. • Quality/Peer Review Committee – ensures each provider is achieving high quality and managing the needs of patients at the local clinic level. • Complex Care Committee – manages the outpatient needs of the most complex and vulnerable patients.

• Business Development Committee – reviews potential new business opportunities for the organization. • HTP/HTC Compliance Committee – ensures that HealthTexas is compliant with regulatory requirements. • Recruitment Committee – recruits providers to HealthTexas Medical Group. • The HealthTexas Experience Committee – focuses on improving the HealthTexas Experience for patients by standardizing customer service from clinic to clinic. • Electronic Medical Record (EMR) Committee – focuses on maximizing the strengths of EMR systems to improve quality of care and streamline provider workflow. Visit us at www.bcms.org

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Charting Paths Through the Fog Reviewing “High Conflict” by Amanda Ripley By David Alex Schulz, CHP

Bellicose argument has become a hallmark of the pandemic, and it can’t help but influence the physician-patient relationship. Journalist Amanda Ripley explores causes and solutions to our social belligerence in “High Conflict - Why We Get Trapped and How We Get Out” (August 2021; Simon & Schuster). Beginning with the legal arena’s progress from a solely antagonistic model to include mediation, Ripley traces paths to peace in case studies from the Hatfield-McCoy feud and the gang wars of South Chicago to Colombia’s civil war. The reader finds parallel pitfalls and opportunities for harmony, regardless of location or cause. “You might be reading this and thinking, I’m not part of a gang or a blood feud. Not yet anyway. What does this have to do with political polarization? Or the fight I had with my brother last year at Christmas?” Patient noncompliance has always been a concern, but mistaken beliefs in possibly dangerous and inappropriate therapies have scaledup with COVID-19. “High Conflict” isn’t a toolkit of persuasion techniques. It is an invitation to join the author on a journey that illuminates the reader’s own social interactions and helps them develop their own strategy to cool roiling waters. Ripley’s specialized vocabulary, defined in the introduction, hints at the common keys she found in conflict resolution. It’s a lexicon built on distinguishing the good, productive friction “that can be serious and intense but leads somewhere useful and does not collapse into dehumanization” from bad, high conflict “that becomes self-perpetuating and all-consuming, in which almost everyone ends up worse off. Typically an us-versus-them conflict.” One essential listening technique for conflict-resolution discussed at length is called “looping for understanding.” A non-passive technique “in which the person listening reflects back what the person talking seems to have said—and checks to see if the summary was right.” Purposeful listening is both a silver bullet and a vastly neglected skill. “Most people don’t know how to listen,” Ripley continues.

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“We jump to conclusions. We think we understand when we don’t. We tee up our next point, before the other person has finished talking. Basically, it means to listen in ways people can see. Show them you’re listening ; don’t tell them you are. Most of us do not feel heard much of the time.” Ripley’s case-in-point is peculiarly relevant to our readership (and earns our only footnote): “On average, doctors interrupt patients after only eleven seconds of listening to them explain what ails them. When doctors don’t interrupt, patients stop talking on their own just six seconds later. That’s all the time they needed to explain themselves: just seventeen seconds. But almost none of them got it. But patients, if they feel understood, leave the hospital more satisfied and more likely to follow their doctor’s orders.” * Ripley doesn’t simply observe: her analyses are based on first-hand experience, save the Hatfield-McCoy feud. Taking professional mediation workshops from the field’s leading pioneer; touring South Chicago with a reformed gangbanger and his lifelong lethal adversary; visiting with members of FARC in Colombia, “a place with decades of experience in trying to get people out of conflict at scale.” She finds, “to help people out of conflict at scale, you must clear a path,” which in Colombia’s case, runs through a soccer field. The book’s most relatable and compelling narrative is reserved for its final third, and it’s a doozy: building a path between members of a liberal New York Jewish congregation, and a Michigan community of conservative Christian correction officers. The discoveries each com-

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munity makes during reciprocal field trips, hosted in the homes of new-found friends, begin with erasing the anxiety of leaving a comfort zone, becoming strangers in a strange land. Once paranoia is cleansed, the atmosphere becomes one of delightful exploration, intellectual and experiential, of lifestyles found to be both exotic and familiar. Where Michiganders find the Upper West Side much friendlier and less threatening than expected, the Manhattanites’ visit to a Michigan gun range proves uncomfortably more fun and satisfying than expected. This achievement of mutual understanding breathes vitality and dimension into another glossary term: the Fourth Way. “The Fourth way,” explains Ripley “is a way to go through conflict that’s more satisfying than running away, fighting, or staying silent, the three usual paths. It involves leaning into the conflict.” The rabbi had previously found the “Fourth Way” to lead his congregation through contentious issues such as intermarriage and the Israeli-Palestinian conflict. Then he decided to tackle an even more challenging breach: politically polarized Americans. The congregation accomplished their goal, finding common ground and agreement in the meetings; neither side will look at each other in stereotype again.

But closing the schism took journeys to each other’s “world.” Hopefully, the paths we chart out of the current pandemic tribalism, with its allegiance to possible medical fallacies, won’t necessitate field trips. * eleven seconds: Singh Ospina, N., Phillips, K.A., Rodriguez-Gutierrez, R., et al. “Eliciting the Patient’s Agenda—Secondary Analysis of Recorded Clinical Encounters.” Journal of General Internal Medicine 34 (2019). more likely to follow their doctor’s orders: Kim, Sung Soo, Stan Kaplowitz, and Mark V. Johnston. “The Effects of Physician Empathy on Patient Satisfaction and Compliance.” Evaluation & the Health Professions 27, no. 3 (September 2004). All quotes and images from “High Conflict - Why We Get Trapped and How We Get Out” by Amanda Ripley, Simon & Schuster © 2021. David Alex Schulz, CHP is a community member of the BCMS Publications Committee.

Visit us at www.bcms.org

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Artistic Expression in Medicine By Caroline Zhu, Cynthia Jiang, Sijil Patel and Richard Marlow Taylor, MD

Flight, Colored pencil drawing

Wings of Hope, Watercolor painting

By Caroline Zhu

By Cynthia Jiang

As Emily Dickinson once personified hope as a bird, this portrait done in the Arcimboldo style brings together birds of the Greek Olympian Gods.

This is a watercolor painting of a bird that was always outside my window. I started painting while studying for Step 1 as a form of stress relief this past April during COVID-19.

Caroline Zhu is a medical student at the Long School of Medicine, UT Health San Antonio, Class of 2022.

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Cynthia Jiang is a medical student at the Long School of Medicine, UT Health San Antonio, Class of 2022.

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Stardust, Mixed media on drawing board By Sijil Patel

This piece is gesso, color pencil and assorted mixed media on drawing board. It was inspired by the song “Fix You” by Coldplay, which has helped me during difficult times. It serves as a reminder that even when we're faced with what may seem to be insurmountable challenges (such as those that come with being a female student-doctor pursuing medicine during a pandemic), we can continue to compassionately pursue our goals through grit and perseverance! Sijil Patel is a medical student at the Long School of Medicine, UT Health San Antonio, Class of 2022.

The Psychiatric Evaluation of Dog, Acrylic on canvas By Richard Marlow Taylor, MD

A: Pico appears well-groomed but upon closer inspection, malodorous from rolling around in the mud and certainly has not bathed in several days. His nails certainly need clipping. There is increased kinetic activity observed in frequent tail wags. Appears puppy-like despite documented geriatric age. Frequently observed to interact with internal stimuli – or merely snapping at flies. Speech is indiscernible but delivered at increased volume with punctuated emphasis on “woof ” when another dog walks by. M: Stated mood “woof ” is congruent with attentive affect with unconstricted range at times appearing perplexed, at other times inquisitive. S: Ready to move at a moment’s notice, able to sit, shake, fetch and roll over upon command. I: Clearly well above average based on ability to successfully beg for scraps with varied tactics and covert forays into the trash. T: Consistently goal-directed but with obviously paranoid thought content, notable for overtly homicidal thoughts toward squirrels and opossums who may or may not invade his yard. Endorsing grandiose thoughts that he owns the couch. Judgment is quite poor as evidenced by his breakneck sprints toward bicycles and heavy machinery. Insight is questionable, as he almost certainly believes himself to not be a dog. Richard Marlow Taylor is a resident in the Department of Psychiatry at the UT Health Long School of Medicine. He is a resident member of the Bexar County Medical Society. Visit us at www.bcms.org

BCMS INSTALLATION OF OFFICERS

2022 BCMS Installation of Officers Rajeev Suri, MD 2022 BCMS President

Brent W. Sanderlin, DO Vice President

Vincent Paul Fonseca, MD Board of Directors Second Term 2020-2022

Ezequiel Silva, III, MD Treasurer

Lubna Naeem, MD Board of Directors First Term 2021-2023

Alice Gong, MD Secretary

Lyssa Ochoa, MD Board of Directors First Term 2020-2022

John Joseph Nava, MD President-Elect

Rodolfo “Rudy” Molina, MD Immediate Past President

SAN ANTONIO MEDICINE • January 2022

Jennifer R. Rushton, MD Board of Directors First Term 2022-2024

BCMS INSTALLATION OF OFFICERS

Raul Santoscoy, DO Board of Directors First Term 2022-2024

Col. Timothy Lawrence Switaj, MD Board of Directors Military Representative

John Shepherd, MD Board of Directors First Term 2020-2022

Jayesh B. Shah, MD Board of Directors TMA Board of Trustees, Representative

Amar Sunkari, MD Board of Directors First Term 2021-2023

Ramon S. Cancino, MD Board of Directors Medical School Representative

Lauren Tarbox Board of Directors First Term 2022-2024

Lori Kels, MD Board of Directors Medical School Representative

Woodson “Scott” Jones, MD Appointed to fill Board of Directors First Term 2021-2023

Ronald Rodriguez, MD Board of Directors Medical School Representative

Visit us at www.bcms.org

BCMS INSTALLATION OF OFFICERS

2022 BCMS Installation of Officers (continued) Carlos Alberto Rosende, MD Board of Directors Medical School Representative

Melody Newsom BCMS CEO/Executive Director Board of Directors Liaison

Taylor Frantz President BCMS Alliance Representative

George F. “Rick” Evans, Jr. General Counsel

Manuel M. Quinones, Jr., MD Board of Ethics, Chair

Save the Date

2022 Joint Installation of Officers Dr. Rajeev Suri, BCMS President Taylor Frantz, Alliance President Saturday, January 15, 2022 7:00 pm Virtual Event Meeting Details and Link Available on BCMS website on 1/07/2022 34

SAN ANTONIO MEDICINE • January 2022

BCMSA INSTALLATION OF OFFICERS

2022 BCMS Alliance Installation of Officers Taylor Frantz President

Ryan Ramos 2nd Vice President Newsletter/ Communication

Virginia Profenna Treasurer-Elect

Cheryl PierceSzender President-Elect/ Treasurer

Jazmin Gibbons 3rd Vice President Programs/ Social Team

Victoria Kohler-Webb Secretary

Jenny Case President-Elect

Stephanie Stewart 3rd Vice President Programs/ Social Team

Nichole Eckmann Immediate Past President

Michelle Richardson 1st Vice President Membership Team

Amy Mahadevan 4th Vice President Comminity Outreach Team

Danielle Henkes Presidential Advisor

Heather Davila 1st Vice President Membership Team

Celinda Guerra 4th Vice President Community Outreach Team

Lori Boies Presidential Advisor

Visit us at www.bcms.org

PHYSICIANS PURCHASING DIRECTORY Support the BCMS by supporting the following sponsors. Please ask your practice manager to use the Physicians Purchasing Directory as a reference when services or products are needed. ACCOUNTING FIRMS

Sol Schwartz & Associates P.C. (HHH Gold Sponsor) Sol Schwartz & Associates is the premier accounting firm for San Antonio-area medical practices and specializes in helping physicians and their management teams maximize their financial effectiveness. Jim Rice, CPA 210-384-8000, ext. 112 jprice@ssacpa.com www.ssacpa.com “Dedicated to working with physicians and physician groups.”

ACCOUNTING SOFTWARE

Express Information Systems (HHH Gold Sponsor) With over 29 years’ experience, we understand that real-time visibility into your financial data is critical. Our browser-based healthcare accounting solutions provide accurate, multi-dimensional reporting that helps you accommodate further growth and drive your practice forward. Rana Camargo Senior Account Manager 210-771-7903 ranac@expressinfo.com www.expressinfo.com “Leaders in Healthcare Software & Consulting”

ATTORNEYS

Kreager Mitchell (HHH Gold Sponsor) At Kreager Mitchell, our healthcare practice works with physicians to offer the best representation possible in providing industry specific solutions. From business transactions to physician contracts, our team can help you in making the right decision for your practice. Michael L. Kreager 210-283-6227 mkreager@kreagermitchell.com Bruce M. Mitchell 210-283-6228 bmitchell@kreagermitchell.com www.kreagermitchell.com “Client-centered legal counsel with integrity and inspired solutions”

ASSETT WEALTH MANAGEMENT

Bertuzzi-Torres Wealth Management Group (HHH Gold Sponsor) We specialize in simplifying your personal and professional life. We are dedicated wealth managers who offer diverse financial solutions for discerning healthcare professionals, including asset protection, lending and estate planning. Mike Bertuzzi First Vice President Senior Financial Advisor 210-278-3828 Michael_bertuzzi@ml.com Ruth Torres Financial Advisor 210-278-3828 Ruth.torres@ml.com http://fa.ml.com/bertuzzi-torres

BANKING

BankMD (HHH Gold Sponsor) Our Mission is your Success. We are the ONLY Physician-Focused Bank in the Country Moses Luevano, President 512-547-6065 mdl@bankmd.com Chris McCorkle Director of Healthcare Banking 210-253-0550 cm@bankmd.com www.BankMD.com “Specialized, Simple, Reliable”

Broadway Bank (HHH Gold Sponsor) Healthcare banking experts with a private banking team committed to supporting the medical community. Shawn P. Hughes, JD Senior Vice President, Private Banking 210-283-5759 shughes@broadway.bank www.broadwaybank.com “We’re here for good.”

The Bank of San Antonio (HHH Gold Sponsor) We specialize in insurance and banking products for physician

SAN ANTONIO MEDICINE • January 2022

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. Brandi Vitier, 210-807-5581 brandi.vitier@thebankofsa.com www.thebankofsa.com Synergy Federal Credit Union (HH Silver Sponsor) Looking for low loan rates for mortgages and vehicles? We've got them for you. We provide a full suite of digital and traditional financial products, designed to help Physicians get the banking services they need. Synergy FCU Member Services 210-750-8333 info@synergyfcu.org www.synergyfcu.org “Once a member, always a member. Join today!”

BUSINESS CONSULTING

Medical Financial Group (★★★ Gold Sponsor) Healthcare & Financial Professionals providing core solutions to Physicians from one proven source. CEO is Jesse Gonzales, CPA, MBA Controller & past CFO of (2) Fortune 500 companies, Past Board President of Communicare Health Systems. Jesse Gonzales, CEO CPA, MBA 210-846-9415 information@medicalfgtx.com Linda Noltemeier-Jones Director of Operations 210-557-9044 lindanj@medicalfgtx.com www.medicalfgtx.com “Let’s start with Free Evaluation and Consultation from our Team of Professionals”

CREDENTIALS VERIFICATION ORGANIZATION

Bexar Credentials Verification, Inc. (HHHH 10K Platinum Sponsor) Bexar Credentials Verification Inc. provides primary source verification of credentials data that meets The Joint Commission (TJC) and the National Committee for Quality Assurance (NCQA) standards for health care entities. Betty Fernandez

Director of Operations 210-582-6355 Betty.Fernandez@bexarcv.com www.BexarCV.com “Proudly serving the medical community since 1998”

FINANCIAL ADVISORS

Oakwell Private Wealth Management (HHH Gold Sponsor) Oakwell Private Wealth Management is an independent financial advisory firm with a proven track record of providing tailored financial planning and wealth management services to those within the medical community. Brian T. Boswell, CFP®, QKA Senior Private Wealth Advisor 512-649-8113 SERVICE@OAKWELLPWM.COM www.oakwellpwm.com “More Than Just Your Advisor, We're Your Wealth Management Partner” Elizabeth Olney with Edward Jones (HH Silver 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 210-858-5880 Elizabeth.olney@edwardjones.com www.edwardjones.com/elizabeth-olney "Making Sense of Investing"

FINANCIAL SERVICES

Bertuzzi-Torres Wealth Management Group ( Gold Sponsor) We specialize in simplifying your personal and professional life. We are dedicated wealth managers who offer diverse financial solutions for discerning healthcare professionals, including asset protection, lending & estate planning. Mike Bertuzzi First Vice President Senior Financial Advisor 210-278-3828 Michael_bertuzzi@ml.com Ruth Torres Financial Advisor 210-278-3828 Ruth.torres@ml.com http://fa.ml.com/bertuzzi-torres

Aspect Wealth Management (HHH Gold Sponsor) We believe wealth is more than money, which is why we improve and simplify the lives of our clients, granting them greater satisfaction, confidence and freedom to achieve more in life. Jeffrey Allison 210-268-1530 jallison@aspectwealth.com www.aspectwealth.com “Get what you deserve … maximize your Social Security benefit!”

SWBC (HHH Gold Sponsor) SWBC for Personal and Practice: Physician programs for wealth management and homebuying. For You Practice: HR administration, payroll, employee benefits, insurance, and exit strategies. SWBC’s services supporting Physicians and the Medical Society. Michael Leos Community Relations Manager Cell: 201-279-2442 Office: 210-376-3318 mleos@swbc.com swbc.com

HEALTHCARE BANKING

Danette.castaneda@firstcitizens.com https://commercial.firstcitizens.co m/tx/austin/stephanie-dick “People Bank with People” “Your Practice, Our Promise” Amegy Bank of Texas (HH Silver 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. Jeanne Bennett EVP | Private Banking Manager 210-343-4556 Jeanne.bennett@amegybank.com Karen Leckie Senior Vice President | Private Banking 210-343-4558 karen.leckie@amegybank.com Robert Lindley Senior Vice President | Private Banking 210-343-4526 robert.lindley@amegybank.com Denise C. Smith Vice President | Private Banking 210-343-4502 Denise.C.Smith@amegybank.com www.amegybank.com “Community banking partnership”

HEALTHCARE TECHNOLOGY SOLUTIONS SUPPLIER

Laura Kouba Manager, Physician Relations 210-265-7662 NorrisKouba@uthscsa.edu Lauren Smith, Manager, Marketing & Communications 210-450-0026 SmithL9@uthscsa.edu Cancer.uthscsa.edu Appointments: 210-450-1000 UT Health San Antonio MD Anderson Cancer Center 7979 Wurzbach Road San Antonio, TX 78229

INFORMATION AND TECHNOLOGIES

INSURANCE BankMD (HHH Gold Sponsor) Our Mission is your Success. We are the ONLY Physician-Focused Bank in the Country Moses Luevano, President 512-547-6065 mdl@bankmd.com Chris McCorkle Director of Healthcare Banking 210-253-0550 cm@bankmd.com www.BankMD.com “Specialized, Simple, Reliable”

Nitric Oxide innovations LLC, (★★★ Gold Sponsor) (NOi) develops nitric oxide-based therapeutics that prevent and treat human disease. Our patented nitric oxide delivery platform includes drug therapies for COVID 19, heart disease, Pulmonary hypertension and topical wound care. info@NitricOxideInnovations.com 512-773-9097 www.NitricOxideInnovations.com

HOSPITALS/ HEALTHCARE FACILITIES First Citizens Bank (HHH Gold Sponsor) We’re a family bank — led for three generations by the same family-but first and foremost a relationship bank. We get to know you. We want to understand you and help you with your banking. Stephanie Dick Commercial Banker 210-744-4396 stephanie.dick@firstcitizens.com Danette Castaneda Business Banking Specialist 512-797-5129

UT Health San Antonio MD Anderson Cancer Center, (HHH Gold Sponsor) UT Health San Antonio MD Anderson Cancer Center, is the only NCI-designated Cancer Center in South Texas. Our physicians and scientists are dedicated to finding better ways to prevent, diagnose and treat cancer through lifechanging discoveries that lead to more treatment options.

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 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

Texas Medical Liability Trust (HHHH 10K Platinum Sponsor) With more than 20,000 health care professionals in its care, Texas Medical Liability Trust (TMLT) provides malpractice insurance and related products to physicians. Our purpose is to make a positive impact on the quality of health care for patients by educating, protecting, and defending physicians. Patty Spann 512-425-5932 patty-spann@tmlt.org www.tmlt.org Recommended partner of the Bexar County Medical Society

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.” MedPro Group (HH Silver Sponsor) Rated A++ by A.M. Best, MedPro Group has been offering customized insurance, claims and risk solutions to the healthcare community since 1899. Visit MedPro to learn more. Kirsten Baze 512-658-0262 Kirsten.Baze@medpro.com www.medpro.com ProAssurance (HH Silver Sponsor) ProAssurance professional liability insurance defends healthcare providers facing malpractice claims and provides fair treatment for our insureds. ProAssurance Group’s rating is AM Best A (Excellent). Mike Rosenthal Senior Vice President, Business Development 800-282-6242 MikeRosenthal@ProAssurance.com www.ProAssurance.com

continued on page 38 Visit us at www.bcms.org

PHYSICIANS PURCHASING DIRECTORY continued from page 37

INTERNET TELECOMMUNICATIONS

Unite Private Networks (HHH Gold Sponsor) Unite Private Networks (UPN) has offered fiber optic networks since 1998. Lit services or dark fiber – our expertise allows us to deliver customized solutions and a rewarding customer experience. Clayton Brown Regional Vice President of Sales – San Antonio 210-693-8025 clayton.brown@upnfiber.com Aron Sweet – Account Director 210-788-9515 aron.sweet@upnfiber.com Jim Dorman – Account Director 210-428-1206 jim.dorman@upnfiber.com Tammy Carosello – Account Director 210-868-0420 tammy.carosello@upnfiber.com www.uniteprivatenetworks.com “UPN is very proud of our 98% customer retention rate”

INVESTMENT ADVISORY REAL ESTATE

MEDICAL BILLING AND COLLECTIONS SERVICES

Medical Financial Group (★★★ Gold Sponsor) Healthcare and Financial Professionals providing core solutions to Physicians from one proven source. CEO is Jesse Gonzales, CPA, MBA Controller and past CFO of (2) Fortune 500 companies, Past Board President of Communicare Health Systems. Jesse Gonzales, CEO CPA, MBA 210-846-9415

information@medicalfgtx.com Linda Noltemeier-Jones Director of Operations 210-557-9044 lindanj@medicalfgtx.com www.medicalfgtx.com “Let’s start with Free Evaluation and Consultation from our Team of Professionals”

PCS Revenue Cycle Management (HHH Gold Sponsor) We are a HIPAA compliant fullservice medical billing company specializing in medical billing, credentialing, and consulting to physicians and mid-level providers in private practice. Deion Whorton Sr. CEO/Founder 210-937-4089 inquiries@pcsrcm.com www.pcsrcm.com “We help physician streamline and maximize their reimbursement by 30%.” 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 PAYMENT SYSTEMS/CARD PROCESSING

MEDICAL SUPPLIES AND EQUIPMENT

PROFESSIONAL ORGANIZATIONS

Henry Schein Medical (HH Silver 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 to 50 percent.”

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, nonprofit, R&D, healthcare delivery, professional services and more! President, Kevin Barber 210-308-7907 (Direct) kbarber@bdo.com Valerie Rogler, Program Coordinator 210-904-5404 Valerie@thehealthcell.org www.thehealthcell.org “Where San Antonio’s Healthcare Leaders Meet”

MOLECULAR DIAGNOSTICS LABORATORY

iGenomeDx ( Gold Sponsor) Most trusted molecular testing laboratory in San Antonio providing FAST, ACCURATE and COMPREHENSIVE precision diagnostics for Genetics and Infectious Diseases. Dr. Niti Vanee Co-founder & CEO 210-257-6973 nvanee@iGenomeDx.com Dr. Pramod Mishra Co-founder, COO & CSO 210-381-3829 pmishra@iGenomeDx.com www.iGenomeDx.com “My DNA My Medicine, Pharmacogenomics”

MORTGAGES First Citizens Bank (★★★ Gold Sponsor) We’re a family bank — led for three generations by the same family-but first and foremost a relationship bank. We get to know you. We want to understand you and help you with your banking. Stephanie Dick Commercial Banker 210-744-4396 stephanie.dick@firstcitizens.com Danette Castaneda Business Banking Specialist 512-797-5129 Danette.castaneda@firstcitizens.com https://commercial.firstcitizens.co m/tx/austin/stephanie-dick “People Bank with People” “Your Practice, Our Promise”

SAN ANTONIO MEDICINE • January 2022

SWBC MORTGAGE - THE TOBER TEAM (HHH Gold Sponsor) SWBC for Personal and Practice: Physician programs for wealth management and homebuying. For You Practice: HR administration, payroll, employee benefits, insurance, and exit strategies. SWBC’s services supporting Physicians and the Medical Society. Jon Tober Sr. Loan Officer Office: 210-317-7431 NMLS# 212945 Jon.tober@swbc.com https://www.swbcmortgage.com /jon-tober

San Antonio Medical Group Management Association (SAMGMA) (HH Silver Sponsor) SAMGMA is a professional nonprofit association with a mission to provide educational programs and networking opportunities to medical practice managers and support charitable fundraising. Alan Winkler, President info4@samgma.org www.samgma.org

REAL ESTATE SERVICES COMMERCIAL

Alamo Capital Advisors LLC (★★★★ 10K Platinum Sponsor) Focused on sourcing, capitalizing, and executing investment and development opportunities for our investment partners and providing thoughtful solutions to our advisory clients. Current projects include new developments, acquisitions & sales, lease representation and financial restructuring (equity, debt, and partnership updates). Jon Wiegand Principal 210-241-2036 jw@alamocapitaladvisors.com www.alamocapitaladvisors.com CARR Realty (HH Silver Sponsor) CARR is a leading provider of commercial real estate for tenants and buyers. Our team of healthcare real estate experts assist with start-ups, renewals, , relocations, additional offices, purchases and practice transitions. Brad Wilson Agent 201-573-6146 Brad.Wilson@carr.us Jeremy Burroughs Agent 405-410-8923 Jeremy.Burroughs@carr.us www.carr.us “Maximize Your Profitability Through Real Estate”

Foresite Real Estate, Inc. (HH Silver Sponsor) Foresite is a full-service commercial real estate firm that assists with site selection, acquisitions, lease negotiations, landlord representation, and property management. Bill Coats 210-816-2734 bcoats@foresitecre.com https://foresitecre.com “Contact us today for a free evaluation of your current lease”

RETIREMENT PLANNING

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. Cindy M. Vidrine Director of Operations- Texas 210-918-8737 cvidrine@favoritestaffing.com “Favorite Healthcare Staffing offers preferred pricing for BCMS members.”

Join our Circle of Friends Program The sooner you start, the sooner you can engage with our 5700 plus membership in Bexar and all contiguous counties. For questions regarding Circle of Friends Sponsorship, please contact: Development Director, August Trevino august.trevino@bcms.org or 210-301-4366

Visit us at www.bcms.org

AUTO REVIEW

2022 Mercedes AMG GT53 By Stephen Schutz, MD

SAN ANTONIO MEDICINE • January 2022

AUTO REVIEW

The Mercedes AMG GT coupe is a serious Porsche 911 rival that’s 90% sports car and 10% luxury conveyance (I’ve reviewed it previously). The sedan version of the AMG GT, on the other hand, is a different animal. Based on the E-class sedan, the four-door AMG GT is definitely an automotive athlete, but a stretched AMG GT coupe it is not. It looks like that though. The aggressive AMG GT grille and angry headlights seem like they could be the same (they’re not), and the

a monster 4.0-liter V8, the max AMG GT sedans combine dry-sump oiling, direct injection and two turbochargers to crank out 577HP in the GT63 and 630HP in the GT63S. Sounds great, doesn’t it? Regrettably, due to supply chain snafus and other challenges, Mercedes will be importing very few if any V8-powered cars and SUVs for a lot of the 2022 model year. I’m a fan of Mercedes’ new inline six-cylinder engines, but there’s nothing like a V8. Driving the AMG GT53 is a treat and a reminder that, regardless

flowing profile and tapered rear end say “high performance” almost as much as the coupe’s styling does. Nevertheless, the AMG GT sedan is also seriously handsome with an elegant exterior that would merit a valet parking spot in front of any hot restaurant. Its competitors, the BMW 8-series Gran Coupe and Porsche Panamera, provide similar driving experiences, but neither is anywhere near as good-looking as this car. The good looks extend to the cabin, where everything looks and feels top shelf. Surprisingly, the objects that draw your eye the most inside the AMG GT sedan aren’t the seats, gauges or center console, although they’re all nice, but the HVAC vents. Round, aluminum and very visible, those vents add attractive jewelry-esque elements to Mercedes’ interiors. Good for Mercedes. In the 1980s, Bruno Sacco’s restrained but modern interiors were easily the class of the luxury automotive space. Since that high water mark, however, Mercedes seemingly lost their way when it came to automotive interior design. Who took over that leadership position? 30 years ago, Lexus had the best interiors, 20 years ago it was Audi, 10 years ago, still Audi, and now it’s Mercedes. Who will it be 10 years from now? Maybe Lucid.

of a modern luxury crossover or SUV’s utilitarian advantages, and there are many, in no way will any of those types of vehicles go down the road as well as a sports sedan. The AMG GT53 attacks high-speed sweeping corners with confidence and competence, and just gobbles up interstates. It’s so good when you’re in a hurry, in fact, that I’m amazed that it’s based on the relatively pedestrian E-class. Trudging around town in the AMG GT sedan is nothing special, but that’s true for almost any vehicle. As always with a Mercedes, options, which are many, can quickly inflate the price of an AMG GT53 from its base of $108,000 to close to $150,000 or even more if you get overly exuberant. It’s worth noting that Mercedes, like all automotive manufacturers, is directing almost all of its R&D capital towards electrification, which means that delicious ICE sedans like the AMG GT53 won’t be around forever. I suspect that the venerable S-class will be the last Mercedes to give up its engine for an electric motor, and it makes sense that niche gasoline-powered sedans such as the AMG GT and CLS will go away sooner. Too bad, these are peak times for luxury ICE sedans, especially those from Germany, and, sadly, they’re not long for this world.

Internal combustion engine (ICE) development is nearing an end as all automotive manufacturers pivot to battery electric vehicles, and the powerplants available in the Mercedes AMG GT sedans may be the ICE high water mark. The GT53 I tested features a 3-liter inline six-cylinder engine that integrates a turbocharger, electric supercharger and an electric motor to maximize power. The electric motor and supercharger provide instant oomph before the turbo kicks in, which is when the GT53’s 429HP gets real. My test car was seriously fast—zero to 60 mph in 4.1 seconds fast, actually—and it was amazing to experience how all of that powerplant tech combined with a nine-speed automatic transmission moves this relatively large sedan forward. A detuned GT43 is available in addition to the GT53, but the OTT GT63 and GT63S models are the ones you want. Powered by

The AMG GT sedan is a terrific driver’s car that can do it all, from taking four friends to dinner in comfort to ferrying you quickly and safely to the hospital at 2 a.m. It’s not cheap, but nothing this good ever is. Get it while you can. As always, call Phil Hornbeak, the Auto Program Manager at BCMS (210-301-4367), for your best deal on any new car or truck brand. Phil can also connect you to preferred financing and lease rates. Stephen Schutz, MD, is a board-certified gastroenterologist who lived in San Antonio in the 1990s when he was stationed here in the US Air Force. He has been writing auto reviews for San Antonio Medicine since 1995.

Visit us at www.bcms.org

11911 IH 10 West San Antonio, TX 78230

Audi Dominion 21105 West IH 10 San Antonio, TX 78257

Northside Chevrolet 9400 San Pedro Ave. San Antonio, TX 78216

Chuck Nash Chevrolet Buick GMC 3209 North Interstate 35 San Marcos, TX

Coby Allen 210-696-2232

Rick Cavender 210-681-3399

Charles Williams 210-912-5087

William Boyd 210-859-2719

Bluebonnet Chrysler Dodge Ram 547 S. Seguin Ave. New Braunfels, TX 78130

Northside Ford 12300 San Pedro San Antonio, TX

Northside Honda 9100 San Pedro Ave. San Antonio, TX 78216

14610 IH 10 West San Marcos, TX 78249

Matthew C. Fraser 830-606-3463

Marty Martinez 210-477-3472

Paul Hopkins 210-988-9644

Mark Hennigan 832-428-9507

Kahlig Auto Group

Land Rover San Antonio 13660 IH 10 West San Antonio, TX

North Park Lexus 611 Lockhill Selma San Antonio, TX

North Park Lexus at Dominion 25131 IH 10 W Dominion San Antonio, TX

North Park Lincoln 9207 San Pedro San Antonio, TX

Cameron Tang 210-561-4900

Tripp Bridges 210-308-8900

James Cole 210-816-6000

Sandy Small 210-341-8841

North Park Mazda 9333 San Pedro San Antonio, TX 78216

Mercedes Benz of Boerne 31445 IH 10 West Boerne, TX

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

9455 IH 10 West San Antonio, TX 78230

John Kahlig 210-253-3300

James Godkin 830-981-6000

Al Cavazos Jr. 210-366-9600

Douglas Cox 210-764-6945

Kahlig Auto Group

North Park Subaru 9807 San Pedro San Antonio, TX 78216

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

Cavender Toyota 5730 NW Loop 410 San Antonio, TX

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

Raymond Rangel 210-308-0200

Phil Larson 877-356-0476

Gary Holdgraf 210-862-9769

Justin Boone 210-635-5000

Kahlig Auto Group

San Antonio Medicine January 2022

Articles inside

By Haley Amick MPH, CHES

By Jennifer Seger, MD

By Nora Vasquez, MD

By Venkat Srinivasan, MD

By Faraz Yousefian, DO, Sujitha Yadlapati, MD and Eduardo Rodriguez, MD

By Luz-Myriam Neira, PhD

By Andrew Meigs and Victor Martinez